Healthcare Financial Services IG Edition 1
0.3.0 - STU-Ballot Saudi Arabia flag

Healthcare Financial Services IG Edition 1 - Local Development build (v0.3.0) built by the FHIR (HL7® FHIR® Standard) Build Tools. See the Directory of published versions

Resource Profile: Nphies Authorization Pharmacy

Official URL: http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/pharmacy-priorauth Version: 0.3.0
Draft as of 2025-07-30 Computable Name: NphiesPharmacyAuthorization

Copyright/Legal: Used by permission of HL7 International, all rights reserved Creative Commons License

Nphies Pharmacy Authorization Profile

Usages:

Formal Views of Profile Content

Description of Profiles, Differentials, Snapshots and how the different presentations work.

NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
.. Claim C 0..* NphiesAuthorizationBase Claim, Pre-determination or Pre-authorization
Constraints: BV-00002, BV-00044, BV-00054, BV-00057, BV-00137, BV-00330, BV-00453, BV-00454, BV-00368
... id Σ 1..1 id Logical id of this artifact
Max Length:64
... meta Σ 1..1 Meta Metadata about the resource
.... profile Σ 1..* DP_canonical(StructureDefinition) Profiles this resource claims to conform to
... implicitRules ?!Σ 0..1 uri A set of rules under which this content was created
... Slices for extension Content/Rules for all slices
.... extension:eligibilityResponse S 0..1 DP_Reference_3a(Nphies CoverageEligibilityResponse) Eligibility Response
URL: http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-eligibility-response
.... extension:eligibilityOffLine S 0..1 DP_string Eligibility Offline Reference
URL: http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-eligibility-offline-reference
.... extension:eligibilityOffLineDate SC 0..1 DP_dateTime Eligibility Offline Date
URL: http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-eligibility-offline-date
Constraints: BV-00347
.... extension:newborn S 0..1 boolean Newborn
URL: http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-newborn
.... extension:transfer S 0..1 boolean Transfer
URL: http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-transfer
.... extension:transferAuthorizationProvider S 0..1 DP_Reference_1or4(Nphies Provider Organization | Nphies Practitioner) Transfer Authorization Provider
URL: http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-transferAuthorizationProvider
.... extension:transferAuthorizationPeriod S 0..1 DP_Period_2 Transfer Authorization Period
URL: http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-transferAuthorizationPeriod
.... extension:transferAuthorizationNumber S 0..1 DP_string Transfer Authorization Number
URL: http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-transferAuthorizationNumber
.... extension:encounter S 0..1 (Complex) Encounter
URL: http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-encounter
..... extension 0..0
..... url 1..1 uri "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-encounter"
..... value[x] 1..1 DP_Reference_1(Nphies Encounter AMB (Auth)) Value of extension
... modifierExtension ?! 0..* Extension Extensions that cannot be ignored
... identifier 1..1 DP_Identifier_A Business Identifier for claim
... status ?!Σ 1..1 DP_code active | cancelled | draft | entered-in-error
Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance.
Required Pattern: active
... type Σ 1..1 DP_CodeableConcept Category or discipline
Binding: Claim Type Codes (required)
Required Pattern: At least the following
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
.... coding 1..* Coding Code defined by a terminology system
Fixed Value: (complex)
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
..... system 1..1 uri Identity of the terminology system
Fixed Value: http://terminology.hl7.org/CodeSystem/claim-type
..... version 0..1 string Version of the system - if relevant
..... code 1..1 code Symbol in syntax defined by the system
Fixed Value: pharmacy
..... display 0..1 string Representation defined by the system
..... userSelected 0..1 boolean If this coding was chosen directly by the user
.... text 0..1 string Plain text representation of the concept
... subType 1..1 DP_CodeableConcept More granular claim type
Binding: Claim SubType (required)
Required Pattern: At least the following
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
.... coding 1..* Coding Code defined by a terminology system
Fixed Value: (complex)
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
..... system 1..1 uri Identity of the terminology system
Fixed Value: http://nphies.sa/terminology/CodeSystem/claim-subtype
..... version 0..1 string Version of the system - if relevant
..... code 1..1 code Symbol in syntax defined by the system
Fixed Value: op
..... display 0..1 string Representation defined by the system
..... userSelected 0..1 boolean If this coding was chosen directly by the user
.... text 0..1 string Plain text representation of the concept
... use Σ 1..1 DP_code claim | preauthorization | predetermination
Binding: Use (required): The purpose of the Claim: predetermination, preauthorization, claim.
Required Pattern: preauthorization
... patient Σ 1..1 DP_Reference_1or2a(Nphies Patient) The recipient of the products and services
.... reference SΣC 0..1 string Literal reference, Relative, internal or absolute URL
Max Length:250
.... identifier SΣ 0..1 Identifier Logical reference, when literal reference is not known
..... use ?!Σ 0..1 code usual | official | temp | secondary | old (If known)
Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .
..... type Σ 1..1 DP_CodeableConcept Description of identifier
Binding: Patient Identifier Type (required)
..... system Σ 1..1 DP_uri The namespace for the identifier value
Example General: http://www.acme.com/identifiers/patient
..... value Σ 1..1 string The value that is unique
Example General: 123456
Max Length:50
.... display Σ 0..1 string Text alternative for the resource
Max Length:200
... created Σ 1..1 DP_dateTime Resource creation date
... insurer Σ 1..1 DP_Reference_1or2a(Nphies Insurer Organization) Target
.... reference SΣC 0..1 string Literal reference, Relative, internal or absolute URL
Max Length:250
.... identifier SΣ 0..1 Identifier Logical reference, when literal reference is not known
..... use ?!Σ 0..1 code usual | official | temp | secondary | old (If known)
Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .
..... type Σ 1..1 DP_CodeableConcept Description of identifier
Binding: Identifier Type Codes (extensible): A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.
Required Pattern: At least the following
...... id 0..1 string Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
...... coding 1..* Coding Code defined by a terminology system
Fixed Value: (complex)
....... id 0..1 string Unique id for inter-element referencing
....... extension 0..* Extension Additional content defined by implementations
....... system 1..1 uri Identity of the terminology system
Fixed Value: http://terminology.hl7.org/CodeSystem/v2-0203
....... version 0..1 string Version of the system - if relevant
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: NII
....... display 0..1 string Representation defined by the system
....... userSelected 0..1 boolean If this coding was chosen directly by the user
...... text 0..1 string Plain text representation of the concept
..... system Σ 1..1 DP_uri The namespace for the identifier value
Example General: http://www.acme.com/identifiers/patient
..... value Σ 1..1 string The value that is unique
Example General: 123456
Max Length:50
.... display Σ 0..1 string Text alternative for the resource
Max Length:200
... provider Σ 1..1 DP_Reference_1or2a(Nphies Provider Organization) Party responsible for the claim
.... reference SΣC 0..1 string Literal reference, Relative, internal or absolute URL
Max Length:250
.... identifier SΣ 0..1 Identifier Logical reference, when literal reference is not known
..... use ?!Σ 0..1 code usual | official | temp | secondary | old (If known)
Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .
..... type Σ 1..1 DP_CodeableConcept Description of identifier
Binding: Identifier Type Codes (extensible): A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.
Required Pattern: At least the following
...... id 0..1 string Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
...... coding 1..* Coding Code defined by a terminology system
Fixed Value: (complex)
....... id 0..1 string Unique id for inter-element referencing
....... extension 0..* Extension Additional content defined by implementations
....... system 1..1 uri Identity of the terminology system
Fixed Value: http://terminology.hl7.org/CodeSystem/v2-0203
....... version 0..1 string Version of the system - if relevant
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: PRN
....... display 0..1 string Representation defined by the system
....... userSelected 0..1 boolean If this coding was chosen directly by the user
...... text 0..1 string Plain text representation of the concept
..... system Σ 1..1 DP_uri The namespace for the identifier value
Example General: http://www.acme.com/identifiers/patient
..... value Σ 1..1 string The value that is unique
Example General: 123456
Max Length:50
.... display Σ 0..1 string Text alternative for the resource
Max Length:200
... priority Σ 1..1 DP_CodeableConcept Desired processing ugency
Binding: ProcessPriorityCodes (required)
... fundsReserve S 0..1 DP_CodeableConcept For whom to reserve funds
Binding: Funds Reservation Codes (required)
... related S 0..* BackboneElement Prior or corollary claims
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... claim 1..1 DP_Reference_1or3a(Nphies Authorization Pharmacy) Reference to the related claim
.... relationship 1..1 DP_CodeableConcept How the reference claim is related
Binding: Related Claim Relationship (required)
... prescription S 0..1 DP_Reference_4(DeviceRequest | Nphies MedicationRequest) Prescription authorizing services and products
... originalPrescription S 0..1 DP_Reference_3a(DeviceRequest | Nphies MedicationRequest) Original prescription if superseded by fulfiller
... payee C 1..1 BackboneElement Recipient of benefits payable
Constraints: BV-00056, BV-00494
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... type 1..1 DP_CodeableConcept Category of recipient
Binding: Claim Payee Type Codes (required)
.... party S 0..1 DP_Reference_1or2b(Nphies Organization | Nphies Patient) Recipient reference
... referral S 0..1 DP_Reference_3a(ServiceRequest) Treatment referral
... facility S 0..1 DP_Reference_1(Nphies Location) Servicing facility
... Slices for supportingInfo SC 0..* BackboneElement Supporting information
Slice: Unordered, Closed by value:category
Constraints: BV-00316, BV-00530, BV-00782, BV-00783, BV-00784, BV-00785, BV-00531
.... supportingInfo:All Slices Content/Rules for all slices
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... sequence 1..1 DP_positiveInt Information instance identifier
..... category 1..1 DP_CodeableConcept Classification of the supplied information
Binding: Claim Information Category (required)
.... supportingInfo:attachment SC 0..* BackboneElement Attachment
Constraints: BV-00316, BV-00530, BV-00782, BV-00783, BV-00784, BV-00785, BV-00531, BV-00404
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... sequence 1..1 DP_positiveInt Information instance identifier
..... category 1..1 DP_CodeableConcept Classification of the supplied information
Binding: Claim Information Category (required)
Required Pattern: At least the following
...... id 0..1 string Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
...... coding 1..* Coding Code defined by a terminology system
Fixed Value: (complex)
....... id 0..1 string Unique id for inter-element referencing
....... extension 0..* Extension Additional content defined by implementations
....... system 1..1 uri Identity of the terminology system
Fixed Value: http://nphies.sa/terminology/CodeSystem/claim-information-category
....... version 0..1 string Version of the system - if relevant
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: attachment
....... display 0..1 string Representation defined by the system
....... userSelected 0..1 boolean If this coding was chosen directly by the user
...... text 0..1 string Plain text representation of the concept
..... value[x] 1..1 DP_Attachment Data to be provided
.... supportingInfo:daysSupply SC 0..* BackboneElement Days Supply
Constraints: BV-00316, BV-00530, BV-00782, BV-00783, BV-00784, BV-00785, BV-00531, BV-00413
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... sequence 1..1 DP_positiveInt Information instance identifier
..... category 1..1 DP_CodeableConcept Classification of the supplied information
Binding: Claim Information Category (required)
Required Pattern: At least the following
...... id 0..1 string Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
...... coding 1..* Coding Code defined by a terminology system
Fixed Value: (complex)
....... id 0..1 string Unique id for inter-element referencing
....... extension 0..* Extension Additional content defined by implementations
....... system 1..1 uri Identity of the terminology system
Fixed Value: http://nphies.sa/terminology/CodeSystem/claim-information-category
....... version 0..1 string Version of the system - if relevant
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: days-supply
....... display 0..1 string Representation defined by the system
....... userSelected 0..1 boolean If this coding was chosen directly by the user
...... text 0..1 string Plain text representation of the concept
..... Slices for value[x] 1..1 Data to be provided
Slice: Unordered, Open by type:$this
...... valueBoolean boolean
...... valueString string
...... valueQuantity Quantity
...... valueAttachment Attachment
...... valueReference Reference(Resource)
...... value[x]:valueQuantity 0..1 DP_Quantity_2 Data to be provided
Required Pattern: At least the following
....... id 0..1 string Unique id for inter-element referencing
....... extension 0..* Extension Additional content defined by implementations
....... value 0..1 decimal Numerical value (with implicit precision)
....... comparator 0..1 code < | <= | >= | > - how to understand the value
....... unit 0..1 string Unit representation
....... system 1..1 uri System that defines coded unit form
Fixed Value: http://unitsofmeasure.org
....... code 1..1 code Coded form of the unit
Fixed Value: d
....... value Σ 1..1 DP_decimal Numerical value (with implicit precision)
....... comparator ?!Σ 0..1 code < | <= | >= | > - how to understand the value
Binding: QuantityComparator (required): How the Quantity should be understood and represented.
....... unit Σ 0..1 string Unit representation
Max Length:40
....... system ΣC 1..1 DP_uri System that defines coded unit form
....... code Σ 1..1 DP_code Coded form of the unit
.... supportingInfo:info SC 0..1 BackboneElement Information
Constraints: BV-00316, BV-00530, BV-00782, BV-00783, BV-00784, BV-00785, BV-00531, BV-00402
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... sequence 1..1 DP_positiveInt Information instance identifier
..... category 1..1 DP_CodeableConcept Classification of the supplied information
Binding: Claim Information Category (required)
Required Pattern: At least the following
...... id 0..1 string Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
...... coding 1..* Coding Code defined by a terminology system
Fixed Value: (complex)
....... id 0..1 string Unique id for inter-element referencing
....... extension 0..* Extension Additional content defined by implementations
....... system 1..1 uri Identity of the terminology system
Fixed Value: http://nphies.sa/terminology/CodeSystem/claim-information-category
....... version 0..1 string Version of the system - if relevant
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: info
....... display 0..1 string Representation defined by the system
....... userSelected 0..1 boolean If this coding was chosen directly by the user
...... text 0..1 string Plain text representation of the concept
..... value[x] 1..1 DP_string Data to be provided
.... supportingInfo:labTest SC 0..* BackboneElement Lab Test
Constraints: BV-00316, BV-00530, BV-00782, BV-00783, BV-00784, BV-00785, BV-00531, BV-00410, BV-00411
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... sequence 1..1 DP_positiveInt Information instance identifier
..... category 1..1 DP_CodeableConcept Classification of the supplied information
Binding: Claim Information Category (required)
Required Pattern: At least the following
...... id 0..1 string Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
...... coding 1..* Coding Code defined by a terminology system
Fixed Value: (complex)
....... id 0..1 string Unique id for inter-element referencing
....... extension 0..* Extension Additional content defined by implementations
....... system 1..1 uri Identity of the terminology system
Fixed Value: http://nphies.sa/terminology/CodeSystem/claim-information-category
....... version 0..1 string Version of the system - if relevant
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: lab-test
....... display 0..1 string Representation defined by the system
....... userSelected 0..1 boolean If this coding was chosen directly by the user
...... text 0..1 string Plain text representation of the concept
..... code 1..1 DP_CodeableConcept Type of information
Binding: LOINCCodes (required)
..... Slices for timing[x] 1..1 Period When it occurred
Slice: Unordered, Closed by type:$this
...... timing[x]:timingPeriod 1..1 DP_Period_3 When it occurred
..... value[x] 1..1 DP_Quantity_2 Data to be provided
...... value Σ 1..1 DP_decimal Numerical value (with implicit precision)
...... comparator ?!Σ 0..1 code < | <= | >= | > - how to understand the value
Binding: QuantityComparator (required): How the Quantity should be understood and represented.
...... unit Σ 0..1 string Unit representation
Max Length:40
...... system ΣC 1..1 DP_uri System that defines coded unit form
Required Pattern: http://unitsofmeasure.org
...... code Σ 1..1 DP_code Coded form of the unit
... diagnosis 1..* BackboneElement Pertinent diagnosis information
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... sequence 1..1 DP_positiveInt Diagnosis instance identifier
.... Slices for diagnosis[x] 1..1 CodeableConcept Nature of illness or problem
Slice: Unordered, Closed by type:$this
Binding: ICD-10Codes (example): Example ICD10 Diagnostic codes.
..... diagnosis[x]:diagnosisCodeableConcept 1..1 DP_CodeableConcept Nature of illness or problem
Binding: ICD-10-AM (required)
.... type 1..1 DP_CodeableConcept Timing or nature of the diagnosis
Binding: Diagnosis Type (required)
... insurance Σ 1..* BackboneElement Patient insurance information
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... sequence Σ 1..1 DP_positiveInt Insurance instance identifier
.... focal Σ 1..1 boolean Coverage to be used for adjudication
.... coverage Σ 1..1 DP_Reference_1(Nphies Coverage) Insurance information
.... preAuthRef S 0..* string Prior authorization reference number
.... claimResponse S 0..1 DP_Reference_1or3a(Nphies Authorization Response) Adjudication results
... accident S 0..1 BackboneElement Details of the event
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... date 1..1 DP_date When the incident occurred
.... type 1..1 DP_CodeableConcept The nature of the accident
Binding: ActIncidentCode (required)
.... Slices for location[x] 0..1 Where the event occurred
Slice: Unordered, Open by type:$this
..... locationAddress Address
..... locationReference Reference(Location)
..... location[x]:locationAddress S 0..1 DP_Address Where the event occurred
... item C 1..* BackboneElement Product or service provided
Constraints: BV-00036, BV-00042, BV-00123, BV-00439, BV-00482, BV-00484, BV-00502
.... Slices for extension S 1..* Extension Extension
Slice: Unordered, Open by value:url
..... extension:package S 0..1 boolean Package Code
URL: http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-package
..... extension:tax S 0..1 DP_Money_SAR Tax
URL: http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-tax
..... extension:patientShare S 0..1 DP_Money_SAR Patient Share
URL: http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-patient-share
..... extension:payerShare S 0..1 DP_Money_SAR Payer Share
URL: http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-payer-share
..... extension:prescribedMedication S 0..1 DP_CodeableConcept Prescribed Medication
URL: http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-prescribed-Medication
Binding: Prescriber Billing (required)
..... extension:pharmacistSelectionReason S 0..1 DP_CodeableConcept Pharmacist Selection Reason
URL: http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-pharmacist-Selection-Reason
Binding: Pharmacist Selection Reason (required)
..... extension:pharmacistSubstitute S 0..1 DP_CodeableConcept Pharmacist Substitute
URL: http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-pharmacist-substitute
Binding: Pharmacist Substitute (required)
..... extension:maternity S 1..1 boolean Maternity
URL: http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-maternity
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... sequence 1..1 DP_positiveInt Item instance identifier
.... diagnosisSequence S 0..* DP_positiveInt Applicable diagnoses
.... informationSequence S 0..* DP_positiveInt Applicable exception and supporting information
.... productOrService 1..1 DP_CodeableConcept_2 Billing, service, product, or drug code
Binding: Pharmacy Billing (required)
.... Slices for serviced[x] 1..1 Date or dates of service or product delivery
Slice: Unordered, Closed by type:$this
..... servicedDate date
..... servicedPeriod Period
..... serviced[x]:servicedDate S 0..1 DP_date Date or dates of service or product delivery
..... serviced[x]:servicedPeriod S 0..1 DP_Period_2 Date or dates of service or product delivery
.... quantity 1..1 DP_SimpleQuantity_1 Count of products or services
.... unitPrice C 1..1 DP_Money_SAR Fee, charge or cost per item
Constraints: BV-00092
.... factor S 0..1 DP_decimal Price scaling factor
.... net C 1..1 DP_Money_SAR Total item cost
Constraints: BV-00093
.... udi S 0..* DP_Reference_1or3a(Device) Unique device identifier
.... bodySite S 0..1 DP_CodeableConcept Anatomical location
Binding: SNOMEDCTBodyStructures (required)
.... subSite S 0..1 DP_CodeableConcept Anatomical sub-location
Binding: Sub Site (required)
.... detail SC 0..* BackboneElement Product or service provided
Constraints: BV-00043
..... Slices for extension Content/Rules for all slices
...... extension:tax S 0..1 DP_Money_SAR Tax
URL: http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-tax
...... extension:prescribedMedication S 0..1 DP_CodeableConcept Prescribed Medication
URL: http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-prescribed-Medication
Binding: Prescriber Billing (required)
...... extension:pharmacistSelectionReason S 0..1 DP_CodeableConcept Pharmacist Selection Reason
URL: http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-pharmacist-Selection-Reason
Binding: Pharmacist Selection Reason (required)
...... extension:pharmacistSubstitute S 0..1 DP_CodeableConcept Pharmacist Substitute
URL: http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-pharmacist-substitute
Binding: Pharmacist Substitute (required)
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... sequence 1..1 DP_positiveInt Item instance identifier
..... productOrService 1..1 DP_CodeableConcept_2 Billing, service, product, or drug code
Binding: Pharmacy Billing (required)
..... quantity 1..1 DP_SimpleQuantity_1 Count of products or services
..... unitPrice C 1..1 DP_Money_SAR Fee, charge or cost per item
Constraints: BV-00094
..... factor S 0..1 DP_decimal Price scaling factor
..... net C 1..1 DP_Money_SAR Total item cost
Constraints: BV-00095
..... udi S 0..* DP_Reference_1or3a(Device) Unique device identifier
..... subDetail S 0..* BackboneElement Product or service provided
...... Slices for extension Content/Rules for all slices
....... extension:tax S 0..1 DP_Money_SAR Tax
URL: http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-tax
...... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
...... sequence 1..1 DP_positiveInt Item instance identifier
...... productOrService 1..1 DP_CodeableConcept_2 Billing, service, product, or drug code
Binding: Pharmacy Billing (required)
...... quantity 1..1 DP_SimpleQuantity_1 Count of products or services
...... unitPrice 1..1 DP_Money_SAR Fee, charge or cost per item
...... factor S 0..1 DP_decimal Price scaling factor
...... net 1..1 DP_Money_SAR Total item cost
...... udi S 0..* DP_Reference_1or3a(Device) Unique device identifier
... total C 1..1 DP_Money_SAR Total claim cost
Constraints: BV-00096

doco Documentation for this format

Terminology Bindings

PathConformanceValueSet / CodeURI
Claim.statusrequiredPattern Value: active
http://hl7.org/fhir/ValueSet/fm-status|4.0.1
From the FHIR Standard
Claim.typerequiredPattern Value: pharmacy
http://nphies.sa/terminology/ValueSet/claim-type
From this IG
Claim.subTyperequiredPattern Value: op
http://nphies.sa/terminology/ValueSet/claim-subtype
From this IG
Claim.userequiredPattern Value: preauthorization
http://hl7.org/fhir/ValueSet/claim-use|4.0.1
From the FHIR Standard
Claim.patient.identifier.userequiredIdentifierUse
http://hl7.org/fhir/ValueSet/identifier-use|4.0.1
From the FHIR Standard
Claim.patient.identifier.typerequiredPatientIdentifierType
http://nphies.sa/terminology/ValueSet/patient-identifier-type
From this IG
Claim.insurer.identifier.userequiredIdentifierUse
http://hl7.org/fhir/ValueSet/identifier-use|4.0.1
From the FHIR Standard
Claim.insurer.identifier.typeextensiblePattern Value: NII
http://hl7.org/fhir/ValueSet/identifier-type
From the FHIR Standard
Claim.provider.identifier.userequiredIdentifierUse
http://hl7.org/fhir/ValueSet/identifier-use|4.0.1
From the FHIR Standard
Claim.provider.identifier.typeextensiblePattern Value: PRN
http://hl7.org/fhir/ValueSet/identifier-type
From the FHIR Standard
Claim.priorityrequiredProcessPriorityCodes
http://hl7.org/fhir/ValueSet/process-priority
From the FHIR Standard
Claim.fundsReserverequiredFunds Reservation Codes
http://hl7.org/fhir/ValueSet/fundsreserve
From the FHIR Standard
Claim.related.relationshiprequiredRelatedClaimRelationship(a valid code from Related Claim Relationship)
http://nphies.sa/terminology/ValueSet/related-claim-relationship
From this IG
Claim.payee.typerequiredClaim Payee Type Codes
http://hl7.org/fhir/ValueSet/payeetype
From the FHIR Standard
Claim.supportingInfo.categoryrequiredClaimInformationCategory(a valid code from Claim Information Category)
http://nphies.sa/terminology/ValueSet/claim-information-category
From this IG
Claim.supportingInfo:attachment.categoryrequiredPattern Value: attachment
http://nphies.sa/terminology/ValueSet/claim-information-category
From this IG
Claim.supportingInfo:daysSupply.categoryrequiredPattern Value: days-supply
http://nphies.sa/terminology/ValueSet/claim-information-category
From this IG
Claim.supportingInfo:daysSupply.value[x]:valueQuantity.comparatorrequiredQuantityComparator
http://hl7.org/fhir/ValueSet/quantity-comparator|4.0.1
From the FHIR Standard
Claim.supportingInfo:info.categoryrequiredPattern Value: info
http://nphies.sa/terminology/ValueSet/claim-information-category
From this IG
Claim.supportingInfo:labTest.categoryrequiredPattern Value: lab-test
http://nphies.sa/terminology/ValueSet/claim-information-category
From this IG
Claim.supportingInfo:labTest.coderequiredLOINCCodes(a valid code from LOINC)
http://hl7.org/fhir/ValueSet/observation-codes
From the FHIR Standard
Claim.supportingInfo:labTest.value[x].comparatorrequiredQuantityComparator
http://hl7.org/fhir/ValueSet/quantity-comparator|4.0.1
From the FHIR Standard
Claim.diagnosis.diagnosis[x]exampleICD-10Codes
http://hl7.org/fhir/ValueSet/icd-10
From the FHIR Standard
Claim.diagnosis.diagnosis[x]:diagnosisCodeableConceptrequiredICD_10_AM(a valid code from http://hl7.org/fhir/sid/icd-10-am)
http://nphies.sa/terminology/ValueSet/diagnosis-icd-10-am
From this IG
Claim.diagnosis.typerequiredDiagnosisType(a valid code from Diagnosis Type)
http://nphies.sa/terminology/ValueSet/diagnosis-type
From this IG
Claim.accident.typerequiredActIncidentCode
http://terminology.hl7.org/ValueSet/v3-ActIncidentCode
Claim.item.productOrServicerequiredPharmacyBilling
http://nphies.sa/terminology/ValueSet/pharmacy-billing
From this IG
Claim.item.bodySiterequiredSNOMEDCTBodyStructures
http://hl7.org/fhir/ValueSet/body-site
From the FHIR Standard
Claim.item.subSiterequiredSubSite(a valid code from Sub Site)
http://nphies.sa/terminology/ValueSet/subsite
From this IG
Claim.item.detail.productOrServicerequiredPharmacyBilling
http://nphies.sa/terminology/ValueSet/pharmacy-billing
From this IG
Claim.item.detail.subDetail.productOrServicerequiredPharmacyBilling
http://nphies.sa/terminology/ValueSet/pharmacy-billing
From this IG

Constraints

IdGradePath(s)DetailsRequirements
BV-00002errorClaimClaim care team sequence is not unique within the submitted claim resource.
: careTeam.exists() implies careTeam.sequence.isDistinct()
BV-00036errorClaim.itemNo Claim item detail provided when Claim item package = true.
: extension('http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-package').exists() implies extension('http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-package').first().value = true implies detail.exists().not()
BV-00042errorClaim.itemClaim item detail sequence in not unique within the Claim item.
: detail.sequence.exists() implies detail.sequence.isDistinct()
BV-00043errorClaim.item.detailClaim item subDetail sequence in not unique within the Claim item detail.
: subDetail.sequence.exists() implies subDetail.sequence.isDistinct()
BV-00044errorClaimItem sequence value is not unique within the Claim resource.
: item.sequence.exists() implies item.sequence.isDistinct()
BV-00054errorClaimOne and only one principal diagnosis is required.
: diagnosis.type.coding.where(code='principal').count() = 1
BV-00056errorClaim.payeePayee party is not provided when payee type='other'.
: type.coding.where(code='other').count() > 0 implies party.exists()
BV-00057errorClaimDiagnosis is not unique in the submitted request.
: diagnosis.diagnosis.ofType(CodeableConcept).isDistinct()
BV-00092errorClaim.item.unitPriceClaim Item UnitPrice Currency is not SAR.
: currency = 'SAR'
BV-00093errorClaim.item.netClaim Item Net Currency is not SAR.
: currency = 'SAR'
BV-00094errorClaim.item.detail.unitPriceClaim Item Detail UnitPrice Currency is not SAR.
: currency = 'SAR'
BV-00095errorClaim.item.detail.netClaim Item Detail Net Currency is not SAR.
: currency = 'SAR'
BV-00096errorClaim.totalClaim Total Net Currency is not SAR.
: currency = 'SAR'
BV-00123errorClaim.itemClaim servicedate is not using a correct data type.
: serviced.ofType(date).exists() or serviced.ofType(Period).exists()
BV-00137errorClaimThe claim identifier does not exist.
: identifier.exists()
BV-00316errorClaim.supportingInfo, Claim.supportingInfo:attachment, Claim.supportingInfo:daysSupply, Claim.supportingInfo:info, Claim.supportingInfo:labTestClaim supportingInfo valueString value length is longer than the maximum specified length of 250 English characters and 125 Arabic characters.
: value.ofType(string).exists() implies value.ofType(string).length() <= 250
BV-00330errorClaimClaim status is not using the specified value 'active'.
: status.exists() implies status='active'
BV-00347errorClaim.extension:eligibilityOffLineDateClaim eligibility OfflineDate is greater than current date.
: value.ofType(dateTime) <= now()
BV-00368errorClaimClaim subtype is using an incorrect value when Claim type is 'Pharmacy'.
: subType.coding.first().code = 'op'
BV-00402errorClaim.supportingInfo:infoSupporting information 'info' requires textual information in valueString.
: value.ofType(string).exists()
BV-00404errorClaim.supportingInfo:attachmentSupporting information 'attachment' requires the content to be provided.
: value.ofType(Attachment).exists()
BV-00410errorClaim.supportingInfo:labTestSupporting information 'lab-test' requires a valid LOINC code.
: code.exists()
BV-00411errorClaim.supportingInfo:labTestIf supporting information is 'lab-test' then valueQuantity SHALL exist and SHALL use a value specified in the UCUM code-system.
: value.ofType(Quantity).exists()
BV-00413errorClaim.supportingInfo:daysSupplyIf Supporting information is 'days-supply' then valueQuantity SHALL exist and number of days SHALL use UCUM code 'd'.
: value.ofType(Quantity).exists() implies value.ofType(Quantity).code = 'd'
BV-00439errorClaim.itemIf period is provided then Claim.item.servicedDate must not be used.
: serviced.exists() implies (serviced.ofType(date).exists() xor serviced.ofType(Period).exists())
BV-00453errorClaimClaim supportingInfo sequence value is not unique within the claim request.
: supportingInfo.sequence.exists() implies supportingInfo.sequence.isDistinct()
BV-00454errorClaimClaim diagnosis sequence value is not unique within the claim request.
: diagnosis.sequence.isDistinct()
BV-00482errorClaim.itemItem factor must be a positive decimal value.
: factor.exists() implies factor >= 0
BV-00484errorClaim.itemThe subSite shall not be allowed if the bodySite is not provided.
: subSite.exists() implies bodySite.exists()
BV-00494errorClaim.payeeClaim payee party must not provided when Claim payee type value is not 'other'.
: type.coding.where(code!='other').count() > 0 implies party.exists().not()
BV-00502errorClaim.itemClaim item informationSequence is not unique within the Claim item.
: informationSequence.isDistinct()
BV-00530errorClaim.supportingInfo, Claim.supportingInfo:attachment, Claim.supportingInfo:daysSupply, Claim.supportingInfo:info, Claim.supportingInfo:labTestIf supportingInfo code element is provided and the category is not 'chief-complaint' then a code is required.
: (code.exists() and category.coding.first().code != 'chief-complaint') implies code.coding.code.exists()
BV-00531errorClaim.supportingInfo, Claim.supportingInfo:attachment, Claim.supportingInfo:daysSupply, Claim.supportingInfo:info, Claim.supportingInfo:labTestThe supportingInfo code element is required if supportingInfo category is 'chief-complaint'.
: category.exists() implies (category.coding.first().code = 'chief-complaint') implies code.exists()
BV-00782errorClaim.supportingInfo, Claim.supportingInfo:attachment, Claim.supportingInfo:daysSupply, Claim.supportingInfo:info, Claim.supportingInfo:labTestSupporting information 'treatment-plan' requires textual information.
: category.coding.where(code='treatment-plan').count() > 0 implies value.ofType(string).exists()
BV-00783errorClaim.supportingInfo, Claim.supportingInfo:attachment, Claim.supportingInfo:daysSupply, Claim.supportingInfo:info, Claim.supportingInfo:labTestSupporting information 'patient-history' requires textual information.
: category.coding.where(code='patient-history').count() > 0 implies value.ofType(string).exists()
BV-00784errorClaim.supportingInfo, Claim.supportingInfo:attachment, Claim.supportingInfo:daysSupply, Claim.supportingInfo:info, Claim.supportingInfo:labTestSupporting information 'physical-examination' requires textual information .
: category.coding.where(code='physical-examination').count() > 0 implies value.ofType(string).exists()
BV-00785errorClaim.supportingInfo, Claim.supportingInfo:attachment, Claim.supportingInfo:daysSupply, Claim.supportingInfo:info, Claim.supportingInfo:labTestSupporting information 'history-of-present-illness' requires textual information .
: category.coding.where(code='history-of-present-illness').count() > 0 implies value.ofType(string).exists()
dom-2errorClaimIf the resource is contained in another resource, it SHALL NOT contain nested Resources
: contained.contained.empty()
dom-3errorClaimIf the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource
: contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
dom-4errorClaimIf a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated
: contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
dom-5errorClaimIf a resource is contained in another resource, it SHALL NOT have a security label
: contained.meta.security.empty()
dom-6best practiceClaimA resource should have narrative for robust management
: text.`div`.exists()
ele-1error**ALL** elementsAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ext-1error**ALL** extensionsMust have either extensions or value[x], not both
: extension.exists() != value.exists()

This structure is derived from NphiesAuthorizationBase

NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
.. Claim C 0..* NphiesAuthorizationBase Claim, Pre-determination or Pre-authorization
Constraints: BV-00368
... Slices for extension Content/Rules for all slices
.... extension:encounter S 0..1 (Complex) Encounter
URL: http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-encounter
..... value[x] 1..1 DP_Reference_1(Nphies Encounter AMB (Auth)) Value of extension
... type 1..1 DP_CodeableConcept Category or discipline
Required Pattern: At least the following
.... coding 1..* Coding Code defined by a terminology system
Fixed Value: (complex)
..... system 1..1 uri Identity of the terminology system
Fixed Value: http://terminology.hl7.org/CodeSystem/claim-type
..... code 1..1 code Symbol in syntax defined by the system
Fixed Value: pharmacy
... subType 1..1 DP_CodeableConcept More granular claim type
Required Pattern: At least the following
.... coding 1..* Coding Code defined by a terminology system
Fixed Value: (complex)
..... system 1..1 uri Identity of the terminology system
Fixed Value: http://nphies.sa/terminology/CodeSystem/claim-subtype
..... code 1..1 code Symbol in syntax defined by the system
Fixed Value: op
.... claim 1..1 DP_Reference_1or3a(Nphies Authorization Pharmacy) Reference to the related claim
... prescription S 0..1 DP_Reference_4(DeviceRequest | Nphies MedicationRequest) Prescription authorizing services and products
... originalPrescription S 0..1 DP_Reference_3a(DeviceRequest | Nphies MedicationRequest) Original prescription if superseded by fulfiller
... Slices for supportingInfo 0..* BackboneElement Supporting information
Slice: Unordered, Closed by value:category
.... supportingInfo:attachment C 0..* BackboneElement Attachment
Constraints: BV-00404
..... category 1..1 DP_CodeableConcept Classification of the supplied information
Required Pattern: At least the following
...... coding 1..* Coding Code defined by a terminology system
Fixed Value: (complex)
....... system 1..1 uri Identity of the terminology system
Fixed Value: http://nphies.sa/terminology/CodeSystem/claim-information-category
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: attachment
..... value[x] 1..1 DP_Attachment Data to be provided
.... supportingInfo:daysSupply C 0..* BackboneElement Days Supply
Constraints: BV-00413
..... category 1..1 DP_CodeableConcept Classification of the supplied information
Required Pattern: At least the following
...... coding 1..* Coding Code defined by a terminology system
Fixed Value: (complex)
....... system 1..1 uri Identity of the terminology system
Fixed Value: http://nphies.sa/terminology/CodeSystem/claim-information-category
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: days-supply
..... Slices for value[x] 1..1 boolean, string, Quantity, Attachment, Reference(Resource) Data to be provided
Slice: Unordered, Open by type:$this
...... value[x]:valueQuantity 0..1 DP_Quantity_2 Data to be provided
Required Pattern: At least the following
....... system 1..1 uri System that defines coded unit form
Fixed Value: http://unitsofmeasure.org
....... code 1..1 code Coded form of the unit
Fixed Value: d
....... value 1..1 DP_decimal Numerical value (with implicit precision)
.... supportingInfo:info C 0..1 BackboneElement Information
Constraints: BV-00402
..... category 1..1 DP_CodeableConcept Classification of the supplied information
Required Pattern: At least the following
...... coding 1..* Coding Code defined by a terminology system
Fixed Value: (complex)
....... system 1..1 uri Identity of the terminology system
Fixed Value: http://nphies.sa/terminology/CodeSystem/claim-information-category
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: info
..... value[x] 1..1 DP_string Data to be provided
.... supportingInfo:labTest C 0..* BackboneElement Lab Test
Constraints: BV-00410, BV-00411
..... category 1..1 DP_CodeableConcept Classification of the supplied information
Required Pattern: At least the following
...... coding 1..* Coding Code defined by a terminology system
Fixed Value: (complex)
....... system 1..1 uri Identity of the terminology system
Fixed Value: http://nphies.sa/terminology/CodeSystem/claim-information-category
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: lab-test
..... code 1..1 DP_CodeableConcept Type of information
Binding: LOINCCodes (required)
..... Slices for timing[x] 1..1 Period When it occurred
Slice: Unordered, Open by type:$this
...... timing[x]:timingPeriod 1..1 DP_Period_3 When it occurred
..... value[x] 1..1 DP_Quantity_2 Data to be provided
...... system 1..1 DP_uri System that defines coded unit form
Required Pattern: http://unitsofmeasure.org
... item
.... extension 1..* Extension Extension
.... Slices for extension Content/Rules for all slices
..... extension:prescribedMedication S 0..1 DP_CodeableConcept Prescribed Medication
URL: http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-prescribed-Medication
Binding: Prescriber Billing (required)
..... extension:pharmacistSelectionReason S 0..1 DP_CodeableConcept Pharmacist Selection Reason
URL: http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-pharmacist-Selection-Reason
Binding: Pharmacist Selection Reason (required)
..... extension:pharmacistSubstitute S 0..1 DP_CodeableConcept Pharmacist Substitute
URL: http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-pharmacist-substitute
Binding: Pharmacist Substitute (required)
..... extension:maternity 1..1 boolean Maternity
URL: http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-maternity
.... productOrService 1..1 DP_CodeableConcept_2 Billing, service, product, or drug code
Binding: Pharmacy Billing (required)
.... bodySite 0..1 DP_CodeableConcept Anatomical location
Binding: SNOMEDCTBodyStructures (required)
.... subSite 0..1 DP_CodeableConcept Anatomical sub-location
Binding: Sub Site (required)
.... detail
..... Slices for extension Content/Rules for all slices
...... extension:prescribedMedication S 0..1 DP_CodeableConcept Prescribed Medication
URL: http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-prescribed-Medication
Binding: Prescriber Billing (required)
...... extension:pharmacistSelectionReason S 0..1 DP_CodeableConcept Pharmacist Selection Reason
URL: http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-pharmacist-Selection-Reason
Binding: Pharmacist Selection Reason (required)
...... extension:pharmacistSubstitute S 0..1 DP_CodeableConcept Pharmacist Substitute
URL: http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-pharmacist-substitute
Binding: Pharmacist Substitute (required)
..... productOrService 1..1 DP_CodeableConcept_2 Billing, service, product, or drug code
Binding: Pharmacy Billing (required)
..... subDetail
...... productOrService 1..1 DP_CodeableConcept_2 Billing, service, product, or drug code
Binding: Pharmacy Billing (required)

doco Documentation for this format

Terminology Bindings (Differential)

PathConformanceValueSetURI
Claim.supportingInfo:labTest.coderequiredLOINCCodes(a valid code from LOINC)
http://hl7.org/fhir/ValueSet/observation-codes
From the FHIR Standard
Claim.item.productOrServicerequiredPharmacyBilling
http://nphies.sa/terminology/ValueSet/pharmacy-billing
From this IG
Claim.item.bodySiterequiredSNOMEDCTBodyStructures
http://hl7.org/fhir/ValueSet/body-site
From the FHIR Standard
Claim.item.subSiterequiredSubSite(a valid code from Sub Site)
http://nphies.sa/terminology/ValueSet/subsite
From this IG
Claim.item.detail.productOrServicerequiredPharmacyBilling
http://nphies.sa/terminology/ValueSet/pharmacy-billing
From this IG
Claim.item.detail.subDetail.productOrServicerequiredPharmacyBilling
http://nphies.sa/terminology/ValueSet/pharmacy-billing
From this IG

Constraints

IdGradePath(s)DetailsRequirements
BV-00368errorClaimClaim subtype is using an incorrect value when Claim type is 'Pharmacy'.
: subType.coding.first().code = 'op'
BV-00402errorClaim.supportingInfo:infoSupporting information 'info' requires textual information in valueString.
: value.ofType(string).exists()
BV-00404errorClaim.supportingInfo:attachmentSupporting information 'attachment' requires the content to be provided.
: value.ofType(Attachment).exists()
BV-00410errorClaim.supportingInfo:labTestSupporting information 'lab-test' requires a valid LOINC code.
: code.exists()
BV-00411errorClaim.supportingInfo:labTestIf supporting information is 'lab-test' then valueQuantity SHALL exist and SHALL use a value specified in the UCUM code-system.
: value.ofType(Quantity).exists()
BV-00413errorClaim.supportingInfo:daysSupplyIf Supporting information is 'days-supply' then valueQuantity SHALL exist and number of days SHALL use UCUM code 'd'.
: value.ofType(Quantity).exists() implies value.ofType(Quantity).code = 'd'
NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
.. Claim C 0..* NphiesAuthorizationBase Claim, Pre-determination or Pre-authorization
Constraints: BV-00002, BV-00044, BV-00054, BV-00057, BV-00137, BV-00330, BV-00453, BV-00454, BV-00368
... id Σ 1..1 id Logical id of this artifact
Max Length:64
... meta Σ 1..1 Meta Metadata about the resource
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
.... versionId Σ 0..1 id Version specific identifier
.... lastUpdated Σ 0..1 instant When the resource version last changed
.... source Σ 0..1 uri Identifies where the resource comes from
.... profile Σ 1..* DP_canonical(StructureDefinition) Profiles this resource claims to conform to
.... security Σ 0..* Coding Security Labels applied to this resource
Binding: All Security Labels (extensible): Security Labels from the Healthcare Privacy and Security Classification System.
.... tag Σ 0..* Coding Tags applied to this resource
Binding: CommonTags (example): Codes that represent various types of tags, commonly workflow-related; e.g. "Needs review by Dr. Jones".
... implicitRules ?!Σ 0..1 uri A set of rules under which this content was created
... language 0..1 code Language of the resource content
Binding: CommonLanguages (preferred): A human language.
Additional BindingsPurpose
AllLanguages Max Binding
... text 0..1 Narrative Text summary of the resource, for human interpretation
This profile does not constrain the narrative in regard to content, language, or traceability to data elements
... contained 0..* Resource Contained, inline Resources
... Slices for extension 0..* Extension Extension
Slice: Unordered, Open by value:url
.... extension:eligibilityResponse S 0..1 DP_Reference_3a(Nphies CoverageEligibilityResponse) Eligibility Response
URL: http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-eligibility-response
.... extension:eligibilityOffLine S 0..1 DP_string Eligibility Offline Reference
URL: http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-eligibility-offline-reference
.... extension:eligibilityOffLineDate SC 0..1 DP_dateTime Eligibility Offline Date
URL: http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-eligibility-offline-date
Constraints: BV-00347
.... extension:newborn S 0..1 boolean Newborn
URL: http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-newborn
.... extension:transfer S 0..1 boolean Transfer
URL: http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-transfer
.... extension:transferAuthorizationProvider S 0..1 DP_Reference_1or4(Nphies Provider Organization | Nphies Practitioner) Transfer Authorization Provider
URL: http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-transferAuthorizationProvider
.... extension:transferAuthorizationPeriod S 0..1 DP_Period_2 Transfer Authorization Period
URL: http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-transferAuthorizationPeriod
.... extension:transferAuthorizationNumber S 0..1 DP_string Transfer Authorization Number
URL: http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-transferAuthorizationNumber
.... extension:encounter S 0..1 (Complex) Encounter
URL: http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-encounter
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..0
..... url 1..1 uri "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-encounter"
..... value[x] 1..1 DP_Reference_1(Nphies Encounter AMB (Auth)) Value of extension
... modifierExtension ?! 0..* Extension Extensions that cannot be ignored
... identifier 1..1 DP_Identifier_A Business Identifier for claim
... status ?!Σ 1..1 DP_code active | cancelled | draft | entered-in-error
Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance.
Required Pattern: active
... type Σ 1..1 DP_CodeableConcept Category or discipline
Binding: Claim Type Codes (required)
Required Pattern: At least the following
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
.... coding 1..* Coding Code defined by a terminology system
Fixed Value: (complex)
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
..... system 1..1 uri Identity of the terminology system
Fixed Value: http://terminology.hl7.org/CodeSystem/claim-type
..... version 0..1 string Version of the system - if relevant
..... code 1..1 code Symbol in syntax defined by the system
Fixed Value: pharmacy
..... display 0..1 string Representation defined by the system
..... userSelected 0..1 boolean If this coding was chosen directly by the user
.... text 0..1 string Plain text representation of the concept
... subType 1..1 DP_CodeableConcept More granular claim type
Binding: Claim SubType (required)
Required Pattern: At least the following
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
.... coding 1..* Coding Code defined by a terminology system
Fixed Value: (complex)
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
..... system 1..1 uri Identity of the terminology system
Fixed Value: http://nphies.sa/terminology/CodeSystem/claim-subtype
..... version 0..1 string Version of the system - if relevant
..... code 1..1 code Symbol in syntax defined by the system
Fixed Value: op
..... display 0..1 string Representation defined by the system
..... userSelected 0..1 boolean If this coding was chosen directly by the user
.... text 0..1 string Plain text representation of the concept
... use Σ 1..1 DP_code claim | preauthorization | predetermination
Binding: Use (required): The purpose of the Claim: predetermination, preauthorization, claim.
Required Pattern: preauthorization
... patient Σ 1..1 DP_Reference_1or2a(Nphies Patient) The recipient of the products and services
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
.... reference SΣC 0..1 string Literal reference, Relative, internal or absolute URL
Max Length:250
.... type Σ 0..1 uri Type the reference refers to (e.g. "Patient")
Binding: ResourceType (extensible): Aa resource (or, for logical models, the URI of the logical model).
.... identifier SΣ 0..1 Identifier Logical reference, when literal reference is not known
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
..... use ?!Σ 0..1 code usual | official | temp | secondary | old (If known)
Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .
..... type Σ 1..1 DP_CodeableConcept Description of identifier
Binding: Patient Identifier Type (required)
..... system Σ 1..1 DP_uri The namespace for the identifier value
Example General: http://www.acme.com/identifiers/patient
..... value Σ 1..1 string The value that is unique
Example General: 123456
Max Length:50
..... period Σ 0..1 Period Time period when id is/was valid for use
..... assigner Σ 0..1 Reference(Organization) Organization that issued id (may be just text)
.... display Σ 0..1 string Text alternative for the resource
Max Length:200
... billablePeriod Σ 0..1 Period Relevant time frame for the claim
... created Σ 1..1 DP_dateTime Resource creation date
... enterer 0..1 Reference(Practitioner | PractitionerRole) Author of the claim
... insurer Σ 1..1 DP_Reference_1or2a(Nphies Insurer Organization) Target
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
.... reference SΣC 0..1 string Literal reference, Relative, internal or absolute URL
Max Length:250
.... type Σ 0..1 uri Type the reference refers to (e.g. "Patient")
Binding: ResourceType (extensible): Aa resource (or, for logical models, the URI of the logical model).
.... identifier SΣ 0..1 Identifier Logical reference, when literal reference is not known
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
..... use ?!Σ 0..1 code usual | official | temp | secondary | old (If known)
Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .
..... type Σ 1..1 DP_CodeableConcept Description of identifier
Binding: Identifier Type Codes (extensible): A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.
Required Pattern: At least the following
...... id 0..1 string Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
...... coding 1..* Coding Code defined by a terminology system
Fixed Value: (complex)
....... id 0..1 string Unique id for inter-element referencing
....... extension 0..* Extension Additional content defined by implementations
....... system 1..1 uri Identity of the terminology system
Fixed Value: http://terminology.hl7.org/CodeSystem/v2-0203
....... version 0..1 string Version of the system - if relevant
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: NII
....... display 0..1 string Representation defined by the system
....... userSelected 0..1 boolean If this coding was chosen directly by the user
...... text 0..1 string Plain text representation of the concept
..... system Σ 1..1 DP_uri The namespace for the identifier value
Example General: http://www.acme.com/identifiers/patient
..... value Σ 1..1 string The value that is unique
Example General: 123456
Max Length:50
..... period Σ 0..1 Period Time period when id is/was valid for use
..... assigner Σ 0..1 Reference(Organization) Organization that issued id (may be just text)
.... display Σ 0..1 string Text alternative for the resource
Max Length:200
... provider Σ 1..1 DP_Reference_1or2a(Nphies Provider Organization) Party responsible for the claim
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
.... reference SΣC 0..1 string Literal reference, Relative, internal or absolute URL
Max Length:250
.... type Σ 0..1 uri Type the reference refers to (e.g. "Patient")
Binding: ResourceType (extensible): Aa resource (or, for logical models, the URI of the logical model).
.... identifier SΣ 0..1 Identifier Logical reference, when literal reference is not known
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
..... use ?!Σ 0..1 code usual | official | temp | secondary | old (If known)
Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .
..... type Σ 1..1 DP_CodeableConcept Description of identifier
Binding: Identifier Type Codes (extensible): A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.
Required Pattern: At least the following
...... id 0..1 string Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
...... coding 1..* Coding Code defined by a terminology system
Fixed Value: (complex)
....... id 0..1 string Unique id for inter-element referencing
....... extension 0..* Extension Additional content defined by implementations
....... system 1..1 uri Identity of the terminology system
Fixed Value: http://terminology.hl7.org/CodeSystem/v2-0203
....... version 0..1 string Version of the system - if relevant
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: PRN
....... display 0..1 string Representation defined by the system
....... userSelected 0..1 boolean If this coding was chosen directly by the user
...... text 0..1 string Plain text representation of the concept
..... system Σ 1..1 DP_uri The namespace for the identifier value
Example General: http://www.acme.com/identifiers/patient
..... value Σ 1..1 string The value that is unique
Example General: 123456
Max Length:50
..... period Σ 0..1 Period Time period when id is/was valid for use
..... assigner Σ 0..1 Reference(Organization) Organization that issued id (may be just text)
.... display Σ 0..1 string Text alternative for the resource
Max Length:200
... priority Σ 1..1 DP_CodeableConcept Desired processing ugency
Binding: ProcessPriorityCodes (required)
... fundsReserve S 0..1 DP_CodeableConcept For whom to reserve funds
Binding: Funds Reservation Codes (required)
... related S 0..* BackboneElement Prior or corollary claims
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... claim 1..1 DP_Reference_1or3a(Nphies Authorization Pharmacy) Reference to the related claim
.... relationship 1..1 DP_CodeableConcept How the reference claim is related
Binding: Related Claim Relationship (required)
.... reference 0..1 Identifier File or case reference
... prescription S 0..1 DP_Reference_4(DeviceRequest | Nphies MedicationRequest) Prescription authorizing services and products
... originalPrescription S 0..1 DP_Reference_3a(DeviceRequest | Nphies MedicationRequest) Original prescription if superseded by fulfiller
... payee C 1..1 BackboneElement Recipient of benefits payable
Constraints: BV-00056, BV-00494
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... type 1..1 DP_CodeableConcept Category of recipient
Binding: Claim Payee Type Codes (required)
.... party S 0..1 DP_Reference_1or2b(Nphies Organization | Nphies Patient) Recipient reference
... referral S 0..1 DP_Reference_3a(ServiceRequest) Treatment referral
... facility S 0..1 DP_Reference_1(Nphies Location) Servicing facility
... careTeam 0..* BackboneElement Members of the care team
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... sequence 1..1 DP_positiveInt Order of care team
.... provider 1..1 Reference(Nphies Practitioner) Practitioner or organization
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
..... reference ΣC 0..1 string Literal reference, Relative, internal or absolute URL
..... type Σ 0..1 uri Type the reference refers to (e.g. "Patient")
Binding: ResourceType (extensible): Aa resource (or, for logical models, the URI of the logical model).
..... identifier Σ 0..1 Identifier Logical reference, when literal reference is not known
...... id 0..1 string Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
...... use ?!Σ 0..1 code usual | official | temp | secondary | old (If known)
Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .
...... type Σ 0..1 CodeableConcept Description of identifier
Binding: Practitioner Identifier (required)
...... system Σ 0..1 uri The namespace for the identifier value
Example General: http://www.acme.com/identifiers/patient
...... value Σ 0..1 string The value that is unique
Example General: 123456
...... period Σ 0..1 Period Time period when id is/was valid for use
...... assigner Σ 0..1 Reference(Organization) Organization that issued id (may be just text)
..... display Σ 0..1 string Text alternative for the resource
.... responsible 0..1 boolean Indicator of the lead practitioner
.... role 1..1 DP_CodeableConcept Function within the team
Binding: ClaimCareTeamRoleCodes (required)
.... qualification 1..1 DP_CodeableConcept Practitioner credential or specialization
Binding: Practice Codes (required)
... Slices for supportingInfo SC 0..* BackboneElement Supporting information
Slice: Unordered, Closed by value:category
Constraints: BV-00316, BV-00530, BV-00782, BV-00783, BV-00784, BV-00785, BV-00531
.... supportingInfo:All Slices Content/Rules for all slices
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... sequence 1..1 DP_positiveInt Information instance identifier
..... category 1..1 DP_CodeableConcept Classification of the supplied information
Binding: Claim Information Category (required)
..... code 0..1 CodeableConcept Type of information
Binding: ExceptionCodes (example): The valuset used for additional information codes.
..... timing[x] 0..1 When it occurred
...... timingDate date
...... timingPeriod Period
..... value[x] 0..1 Data to be provided
...... valueBoolean boolean
...... valueString string
...... valueQuantity Quantity
...... valueAttachment Attachment
...... valueReference Reference(Resource)
..... reason 0..1 CodeableConcept Explanation for the information
Binding: MissingToothReasonCodes (example): Reason codes for the missing teeth.
.... supportingInfo:attachment SC 0..* BackboneElement Attachment
Constraints: BV-00316, BV-00530, BV-00782, BV-00783, BV-00784, BV-00785, BV-00531, BV-00404
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... sequence 1..1 DP_positiveInt Information instance identifier
..... category 1..1 DP_CodeableConcept Classification of the supplied information
Binding: Claim Information Category (required)
Required Pattern: At least the following
...... id 0..1 string Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
...... coding 1..* Coding Code defined by a terminology system
Fixed Value: (complex)
....... id 0..1 string Unique id for inter-element referencing
....... extension 0..* Extension Additional content defined by implementations
....... system 1..1 uri Identity of the terminology system
Fixed Value: http://nphies.sa/terminology/CodeSystem/claim-information-category
....... version 0..1 string Version of the system - if relevant
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: attachment
....... display 0..1 string Representation defined by the system
....... userSelected 0..1 boolean If this coding was chosen directly by the user
...... text 0..1 string Plain text representation of the concept
..... code 0..1 CodeableConcept Type of information
Binding: ExceptionCodes (example): The valuset used for additional information codes.
..... timing[x] 0..1 When it occurred
...... timingDate date
...... timingPeriod Period
..... value[x] 1..1 DP_Attachment Data to be provided
..... reason 0..1 CodeableConcept Explanation for the information
Binding: MissingToothReasonCodes (example): Reason codes for the missing teeth.
.... supportingInfo:daysSupply SC 0..* BackboneElement Days Supply
Constraints: BV-00316, BV-00530, BV-00782, BV-00783, BV-00784, BV-00785, BV-00531, BV-00413
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... sequence 1..1 DP_positiveInt Information instance identifier
..... category 1..1 DP_CodeableConcept Classification of the supplied information
Binding: Claim Information Category (required)
Required Pattern: At least the following
...... id 0..1 string Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
...... coding 1..* Coding Code defined by a terminology system
Fixed Value: (complex)
....... id 0..1 string Unique id for inter-element referencing
....... extension 0..* Extension Additional content defined by implementations
....... system 1..1 uri Identity of the terminology system
Fixed Value: http://nphies.sa/terminology/CodeSystem/claim-information-category
....... version 0..1 string Version of the system - if relevant
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: days-supply
....... display 0..1 string Representation defined by the system
....... userSelected 0..1 boolean If this coding was chosen directly by the user
...... text 0..1 string Plain text representation of the concept
..... code 0..1 CodeableConcept Type of information
Binding: ExceptionCodes (example): The valuset used for additional information codes.
..... timing[x] 0..1 When it occurred
...... timingDate date
...... timingPeriod Period
..... Slices for value[x] 1..1 Data to be provided
Slice: Unordered, Open by type:$this
...... valueBoolean boolean
...... valueString string
...... valueQuantity Quantity
...... valueAttachment Attachment
...... valueReference Reference(Resource)
...... value[x]:valueQuantity 0..1 DP_Quantity_2 Data to be provided
Required Pattern: At least the following
....... id 0..1 string Unique id for inter-element referencing
....... extension 0..* Extension Additional content defined by implementations
....... value 0..1 decimal Numerical value (with implicit precision)
....... comparator 0..1 code < | <= | >= | > - how to understand the value
....... unit 0..1 string Unit representation
....... system 1..1 uri System that defines coded unit form
Fixed Value: http://unitsofmeasure.org
....... code 1..1 code Coded form of the unit
Fixed Value: d
....... id 0..1 string Unique id for inter-element referencing
....... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
....... value Σ 1..1 DP_decimal Numerical value (with implicit precision)
....... comparator ?!Σ 0..1 code < | <= | >= | > - how to understand the value
Binding: QuantityComparator (required): How the Quantity should be understood and represented.
....... unit Σ 0..1 string Unit representation
Max Length:40
....... system ΣC 1..1 DP_uri System that defines coded unit form
....... code Σ 1..1 DP_code Coded form of the unit
..... reason 0..1 CodeableConcept Explanation for the information
Binding: MissingToothReasonCodes (example): Reason codes for the missing teeth.
.... supportingInfo:info SC 0..1 BackboneElement Information
Constraints: BV-00316, BV-00530, BV-00782, BV-00783, BV-00784, BV-00785, BV-00531, BV-00402
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... sequence 1..1 DP_positiveInt Information instance identifier
..... category 1..1 DP_CodeableConcept Classification of the supplied information
Binding: Claim Information Category (required)
Required Pattern: At least the following
...... id 0..1 string Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
...... coding 1..* Coding Code defined by a terminology system
Fixed Value: (complex)
....... id 0..1 string Unique id for inter-element referencing
....... extension 0..* Extension Additional content defined by implementations
....... system 1..1 uri Identity of the terminology system
Fixed Value: http://nphies.sa/terminology/CodeSystem/claim-information-category
....... version 0..1 string Version of the system - if relevant
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: info
....... display 0..1 string Representation defined by the system
....... userSelected 0..1 boolean If this coding was chosen directly by the user
...... text 0..1 string Plain text representation of the concept
..... code 0..1 CodeableConcept Type of information
Binding: ExceptionCodes (example): The valuset used for additional information codes.
..... timing[x] 0..1 When it occurred
...... timingDate date
...... timingPeriod Period
..... value[x] 1..1 DP_string Data to be provided
..... reason 0..1 CodeableConcept Explanation for the information
Binding: MissingToothReasonCodes (example): Reason codes for the missing teeth.
.... supportingInfo:labTest SC 0..* BackboneElement Lab Test
Constraints: BV-00316, BV-00530, BV-00782, BV-00783, BV-00784, BV-00785, BV-00531, BV-00410, BV-00411
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... sequence 1..1 DP_positiveInt Information instance identifier
..... category 1..1 DP_CodeableConcept Classification of the supplied information
Binding: Claim Information Category (required)
Required Pattern: At least the following
...... id 0..1 string Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
...... coding 1..* Coding Code defined by a terminology system
Fixed Value: (complex)
....... id 0..1 string Unique id for inter-element referencing
....... extension 0..* Extension Additional content defined by implementations
....... system 1..1 uri Identity of the terminology system
Fixed Value: http://nphies.sa/terminology/CodeSystem/claim-information-category
....... version 0..1 string Version of the system - if relevant
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: lab-test
....... display 0..1 string Representation defined by the system
....... userSelected 0..1 boolean If this coding was chosen directly by the user
...... text 0..1 string Plain text representation of the concept
..... code 1..1 DP_CodeableConcept Type of information
Binding: LOINCCodes (required)
..... Slices for timing[x] 1..1 Period When it occurred
Slice: Unordered, Closed by type:$this
...... timing[x]:timingPeriod 1..1 DP_Period_3 When it occurred
..... value[x] 1..1 DP_Quantity_2 Data to be provided
...... id 0..1 string Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
...... value Σ 1..1 DP_decimal Numerical value (with implicit precision)
...... comparator ?!Σ 0..1 code < | <= | >= | > - how to understand the value
Binding: QuantityComparator (required): How the Quantity should be understood and represented.
...... unit Σ 0..1 string Unit representation
Max Length:40
...... system ΣC 1..1 DP_uri System that defines coded unit form
Required Pattern: http://unitsofmeasure.org
...... code Σ 1..1 DP_code Coded form of the unit
..... reason 0..1 CodeableConcept Explanation for the information
Binding: MissingToothReasonCodes (example): Reason codes for the missing teeth.
... diagnosis 1..* BackboneElement Pertinent diagnosis information
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... sequence 1..1 DP_positiveInt Diagnosis instance identifier
.... Slices for diagnosis[x] 1..1 CodeableConcept Nature of illness or problem
Slice: Unordered, Closed by type:$this
Binding: ICD-10Codes (example): Example ICD10 Diagnostic codes.
..... diagnosis[x]:diagnosisCodeableConcept 1..1 DP_CodeableConcept Nature of illness or problem
Binding: ICD-10-AM (required)
.... type 1..1 DP_CodeableConcept Timing or nature of the diagnosis
Binding: Diagnosis Type (required)
.... onAdmission 0..1 CodeableConcept Present on admission
Binding: ExampleDiagnosisOnAdmissionCodes (example): Present on admission.
.... packageCode 0..1 CodeableConcept Package billing code
Binding: ExampleDiagnosisRelatedGroupCodes (example): The DRG codes associated with the diagnosis.
... procedure 0..* BackboneElement Clinical procedures performed
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... sequence 1..1 positiveInt Procedure instance identifier
.... type 0..* CodeableConcept Category of Procedure
Binding: ExampleProcedureTypeCodes (example): Example procedure type codes.
.... date 0..1 dateTime When the procedure was performed
.... procedure[x] 1..1 Specific clinical procedure
Binding: ICD-10ProcedureCodes (example): Example ICD10 Procedure codes.
..... procedureCodeableConcept CodeableConcept
..... procedureReference Reference(Procedure)
.... udi 0..* Reference(Device) Unique device identifier
... insurance Σ 1..* BackboneElement Patient insurance information
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... sequence Σ 1..1 DP_positiveInt Insurance instance identifier
.... focal Σ 1..1 boolean Coverage to be used for adjudication
.... identifier 0..1 Identifier Pre-assigned Claim number
.... coverage Σ 1..1 DP_Reference_1(Nphies Coverage) Insurance information
.... businessArrangement 0..1 string Additional provider contract number
.... preAuthRef S 0..* string Prior authorization reference number
.... claimResponse S 0..1 DP_Reference_1or3a(Nphies Authorization Response) Adjudication results
... accident S 0..1 BackboneElement Details of the event
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... date 1..1 DP_date When the incident occurred
.... type 1..1 DP_CodeableConcept The nature of the accident
Binding: ActIncidentCode (required)
.... Slices for location[x] 0..1 Where the event occurred
Slice: Unordered, Open by type:$this
..... locationAddress Address
..... locationReference Reference(Location)
..... location[x]:locationAddress S 0..1 DP_Address Where the event occurred
... item C 1..* BackboneElement Product or service provided
Constraints: BV-00036, BV-00042, BV-00123, BV-00439, BV-00482, BV-00484, BV-00502
.... id 0..1 string Unique id for inter-element referencing
.... Slices for extension S 1..* Extension Extension
Slice: Unordered, Open by value:url
..... extension:package S 0..1 boolean Package Code
URL: http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-package
..... extension:tax S 0..1 DP_Money_SAR Tax
URL: http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-tax
..... extension:patientShare S 0..1 DP_Money_SAR Patient Share
URL: http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-patient-share
..... extension:payerShare S 0..1 DP_Money_SAR Payer Share
URL: http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-payer-share
..... extension:prescribedMedication S 0..1 DP_CodeableConcept Prescribed Medication
URL: http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-prescribed-Medication
Binding: Prescriber Billing (required)
..... extension:pharmacistSelectionReason S 0..1 DP_CodeableConcept Pharmacist Selection Reason
URL: http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-pharmacist-Selection-Reason
Binding: Pharmacist Selection Reason (required)
..... extension:pharmacistSubstitute S 0..1 DP_CodeableConcept Pharmacist Substitute
URL: http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-pharmacist-substitute
Binding: Pharmacist Substitute (required)
..... extension:maternity S 1..1 boolean Maternity
URL: http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-maternity
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... sequence 1..1 DP_positiveInt Item instance identifier
.... careTeamSequence 0..* positiveInt Applicable careTeam members
.... diagnosisSequence S 0..* DP_positiveInt Applicable diagnoses
.... procedureSequence 0..* positiveInt Applicable procedures
.... informationSequence S 0..* DP_positiveInt Applicable exception and supporting information
.... revenue 0..1 CodeableConcept Revenue or cost center code
Binding: ExampleRevenueCenterCodes (example): Codes for the revenue or cost centers supplying the service and/or products.
.... category 0..1 CodeableConcept Benefit classification
Binding: BenefitCategoryCodes (example): Benefit categories such as: oral-basic, major, glasses.
.... productOrService 1..1 DP_CodeableConcept_2 Billing, service, product, or drug code
Binding: Pharmacy Billing (required)
.... modifier 0..* CodeableConcept Product or service billing modifiers
Binding: ModifierTypeCodes (example): Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen.
.... programCode 0..* CodeableConcept Program the product or service is provided under
Binding: ExampleProgramReasonCodes (example): Program specific reason codes.
.... Slices for serviced[x] 1..1 Date or dates of service or product delivery
Slice: Unordered, Closed by type:$this
..... servicedDate date
..... servicedPeriod Period
..... serviced[x]:servicedDate S 0..1 DP_date Date or dates of service or product delivery
..... serviced[x]:servicedPeriod S 0..1 DP_Period_2 Date or dates of service or product delivery
.... location[x] 0..1 Place of service or where product was supplied
Binding: ExampleServicePlaceCodes (example): Place of service: pharmacy, school, prison, etc.
..... locationCodeableConcept CodeableConcept
..... locationAddress Address
..... locationReference Reference(Location)
.... quantity 1..1 DP_SimpleQuantity_1 Count of products or services
.... unitPrice C 1..1 DP_Money_SAR Fee, charge or cost per item
Constraints: BV-00092
.... factor S 0..1 DP_decimal Price scaling factor
.... net C 1..1 DP_Money_SAR Total item cost
Constraints: BV-00093
.... udi S 0..* DP_Reference_1or3a(Device) Unique device identifier
.... bodySite S 0..1 DP_CodeableConcept Anatomical location
Binding: SNOMEDCTBodyStructures (required)
.... subSite S 0..1 DP_CodeableConcept Anatomical sub-location
Binding: Sub Site (required)
.... encounter 0..* Reference(Encounter) Encounters related to this billed item
.... detail SC 0..* BackboneElement Product or service provided
Constraints: BV-00043
..... id 0..1 string Unique id for inter-element referencing
..... Slices for extension 0..* Extension Extension
Slice: Unordered, Open by value:url
...... extension:tax S 0..1 DP_Money_SAR Tax
URL: http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-tax
...... extension:prescribedMedication S 0..1 DP_CodeableConcept Prescribed Medication
URL: http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-prescribed-Medication
Binding: Prescriber Billing (required)
...... extension:pharmacistSelectionReason S 0..1 DP_CodeableConcept Pharmacist Selection Reason
URL: http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-pharmacist-Selection-Reason
Binding: Pharmacist Selection Reason (required)
...... extension:pharmacistSubstitute S 0..1 DP_CodeableConcept Pharmacist Substitute
URL: http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-pharmacist-substitute
Binding: Pharmacist Substitute (required)
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... sequence 1..1 DP_positiveInt Item instance identifier
..... revenue 0..1 CodeableConcept Revenue or cost center code
Binding: ExampleRevenueCenterCodes (example): Codes for the revenue or cost centers supplying the service and/or products.
..... category 0..1 CodeableConcept Benefit classification
Binding: BenefitCategoryCodes (example): Benefit categories such as: oral-basic, major, glasses.
..... productOrService 1..1 DP_CodeableConcept_2 Billing, service, product, or drug code
Binding: Pharmacy Billing (required)
..... modifier 0..* CodeableConcept Service/Product billing modifiers
Binding: ModifierTypeCodes (example): Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen.
..... programCode 0..* CodeableConcept Program the product or service is provided under
Binding: ExampleProgramReasonCodes (example): Program specific reason codes.
..... quantity 1..1 DP_SimpleQuantity_1 Count of products or services
..... unitPrice C 1..1 DP_Money_SAR Fee, charge or cost per item
Constraints: BV-00094
..... factor S 0..1 DP_decimal Price scaling factor
..... net C 1..1 DP_Money_SAR Total item cost
Constraints: BV-00095
..... udi S 0..* DP_Reference_1or3a(Device) Unique device identifier
..... subDetail S 0..* BackboneElement Product or service provided
...... id 0..1 string Unique id for inter-element referencing
...... Slices for extension 0..* Extension Extension
Slice: Unordered, Open by value:url
....... extension:tax S 0..1 DP_Money_SAR Tax
URL: http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-tax
...... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
...... sequence 1..1 DP_positiveInt Item instance identifier
...... revenue 0..1 CodeableConcept Revenue or cost center code
Binding: ExampleRevenueCenterCodes (example): Codes for the revenue or cost centers supplying the service and/or products.
...... category 0..1 CodeableConcept Benefit classification
Binding: BenefitCategoryCodes (example): Benefit categories such as: oral-basic, major, glasses.
...... productOrService 1..1 DP_CodeableConcept_2 Billing, service, product, or drug code
Binding: Pharmacy Billing (required)
...... modifier 0..* CodeableConcept Service/Product billing modifiers
Binding: ModifierTypeCodes (example): Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen.
...... programCode 0..* CodeableConcept Program the product or service is provided under
Binding: ExampleProgramReasonCodes (example): Program specific reason codes.
...... quantity 1..1 DP_SimpleQuantity_1 Count of products or services
...... unitPrice 1..1 DP_Money_SAR Fee, charge or cost per item
...... factor S 0..1 DP_decimal Price scaling factor
...... net 1..1 DP_Money_SAR Total item cost
...... udi S 0..* DP_Reference_1or3a(Device) Unique device identifier
... total C 1..1 DP_Money_SAR Total claim cost
Constraints: BV-00096

doco Documentation for this format

Terminology Bindings

PathConformanceValueSet / CodeURI
Claim.meta.securityextensibleAll Security Labels
http://hl7.org/fhir/ValueSet/security-labels
From the FHIR Standard
Claim.meta.tagexampleCommonTags
http://hl7.org/fhir/ValueSet/common-tags
From the FHIR Standard
Claim.languagepreferredCommonLanguages
http://hl7.org/fhir/ValueSet/languages
From the FHIR Standard
Additional Bindings Purpose
AllLanguages Max Binding
Claim.statusrequiredPattern Value: active
http://hl7.org/fhir/ValueSet/fm-status|4.0.1
From the FHIR Standard
Claim.typerequiredPattern Value: pharmacy
http://nphies.sa/terminology/ValueSet/claim-type
From this IG
Claim.subTyperequiredPattern Value: op
http://nphies.sa/terminology/ValueSet/claim-subtype
From this IG
Claim.userequiredPattern Value: preauthorization
http://hl7.org/fhir/ValueSet/claim-use|4.0.1
From the FHIR Standard
Claim.patient.typeextensibleResourceType
http://hl7.org/fhir/ValueSet/resource-types
From the FHIR Standard
Claim.patient.identifier.userequiredIdentifierUse
http://hl7.org/fhir/ValueSet/identifier-use|4.0.1
From the FHIR Standard
Claim.patient.identifier.typerequiredPatientIdentifierType
http://nphies.sa/terminology/ValueSet/patient-identifier-type
From this IG
Claim.insurer.typeextensibleResourceType
http://hl7.org/fhir/ValueSet/resource-types
From the FHIR Standard
Claim.insurer.identifier.userequiredIdentifierUse
http://hl7.org/fhir/ValueSet/identifier-use|4.0.1
From the FHIR Standard
Claim.insurer.identifier.typeextensiblePattern Value: NII
http://hl7.org/fhir/ValueSet/identifier-type
From the FHIR Standard
Claim.provider.typeextensibleResourceType
http://hl7.org/fhir/ValueSet/resource-types
From the FHIR Standard
Claim.provider.identifier.userequiredIdentifierUse
http://hl7.org/fhir/ValueSet/identifier-use|4.0.1
From the FHIR Standard
Claim.provider.identifier.typeextensiblePattern Value: PRN
http://hl7.org/fhir/ValueSet/identifier-type
From the FHIR Standard
Claim.priorityrequiredProcessPriorityCodes
http://hl7.org/fhir/ValueSet/process-priority
From the FHIR Standard
Claim.fundsReserverequiredFunds Reservation Codes
http://hl7.org/fhir/ValueSet/fundsreserve
From the FHIR Standard
Claim.related.relationshiprequiredRelatedClaimRelationship(a valid code from Related Claim Relationship)
http://nphies.sa/terminology/ValueSet/related-claim-relationship
From this IG
Claim.payee.typerequiredClaim Payee Type Codes
http://hl7.org/fhir/ValueSet/payeetype
From the FHIR Standard
Claim.careTeam.provider.typeextensibleResourceType
http://hl7.org/fhir/ValueSet/resource-types
From the FHIR Standard
Claim.careTeam.provider.identifier.userequiredIdentifierUse
http://hl7.org/fhir/ValueSet/identifier-use|4.0.1
From the FHIR Standard
Claim.careTeam.provider.identifier.typerequiredPractitionerIdentifier
http://nphies.sa/terminology/ValueSet/practitioner-identifier-type
From this IG
Claim.careTeam.rolerequiredClaimCareTeamRoleCodes
http://hl7.org/fhir/ValueSet/claim-careteamrole
From the FHIR Standard
Claim.careTeam.qualificationrequiredPracticeCodes
http://nphies.sa/terminology/ValueSet/practice-codes
From this IG
Claim.supportingInfo.categoryrequiredClaimInformationCategory(a valid code from Claim Information Category)
http://nphies.sa/terminology/ValueSet/claim-information-category
From this IG
Claim.supportingInfo.codeexampleExceptionCodes
http://hl7.org/fhir/ValueSet/claim-exception
From the FHIR Standard
Claim.supportingInfo.reasonexampleMissingToothReasonCodes
http://hl7.org/fhir/ValueSet/missing-tooth-reason
From the FHIR Standard
Claim.supportingInfo:attachment.categoryrequiredPattern Value: attachment
http://nphies.sa/terminology/ValueSet/claim-information-category
From this IG
Claim.supportingInfo:attachment.codeexampleExceptionCodes
http://hl7.org/fhir/ValueSet/claim-exception
From the FHIR Standard
Claim.supportingInfo:attachment.reasonexampleMissingToothReasonCodes
http://hl7.org/fhir/ValueSet/missing-tooth-reason
From the FHIR Standard
Claim.supportingInfo:daysSupply.categoryrequiredPattern Value: days-supply
http://nphies.sa/terminology/ValueSet/claim-information-category
From this IG
Claim.supportingInfo:daysSupply.codeexampleExceptionCodes
http://hl7.org/fhir/ValueSet/claim-exception
From the FHIR Standard
Claim.supportingInfo:daysSupply.value[x]:valueQuantity.comparatorrequiredQuantityComparator
http://hl7.org/fhir/ValueSet/quantity-comparator|4.0.1
From the FHIR Standard
Claim.supportingInfo:daysSupply.reasonexampleMissingToothReasonCodes
http://hl7.org/fhir/ValueSet/missing-tooth-reason
From the FHIR Standard
Claim.supportingInfo:info.categoryrequiredPattern Value: info
http://nphies.sa/terminology/ValueSet/claim-information-category
From this IG
Claim.supportingInfo:info.codeexampleExceptionCodes
http://hl7.org/fhir/ValueSet/claim-exception
From the FHIR Standard
Claim.supportingInfo:info.reasonexampleMissingToothReasonCodes
http://hl7.org/fhir/ValueSet/missing-tooth-reason
From the FHIR Standard
Claim.supportingInfo:labTest.categoryrequiredPattern Value: lab-test
http://nphies.sa/terminology/ValueSet/claim-information-category
From this IG
Claim.supportingInfo:labTest.coderequiredLOINCCodes(a valid code from LOINC)
http://hl7.org/fhir/ValueSet/observation-codes
From the FHIR Standard
Claim.supportingInfo:labTest.value[x].comparatorrequiredQuantityComparator
http://hl7.org/fhir/ValueSet/quantity-comparator|4.0.1
From the FHIR Standard
Claim.supportingInfo:labTest.reasonexampleMissingToothReasonCodes
http://hl7.org/fhir/ValueSet/missing-tooth-reason
From the FHIR Standard
Claim.diagnosis.diagnosis[x]exampleICD-10Codes
http://hl7.org/fhir/ValueSet/icd-10
From the FHIR Standard
Claim.diagnosis.diagnosis[x]:diagnosisCodeableConceptrequiredICD_10_AM(a valid code from http://hl7.org/fhir/sid/icd-10-am)
http://nphies.sa/terminology/ValueSet/diagnosis-icd-10-am
From this IG
Claim.diagnosis.typerequiredDiagnosisType(a valid code from Diagnosis Type)
http://nphies.sa/terminology/ValueSet/diagnosis-type
From this IG
Claim.diagnosis.onAdmissionexampleExampleDiagnosisOnAdmissionCodes
http://hl7.org/fhir/ValueSet/ex-diagnosis-on-admission
From the FHIR Standard
Claim.diagnosis.packageCodeexampleExampleDiagnosisRelatedGroupCodes
http://hl7.org/fhir/ValueSet/ex-diagnosisrelatedgroup
From the FHIR Standard
Claim.procedure.typeexampleExampleProcedureTypeCodes
http://hl7.org/fhir/ValueSet/ex-procedure-type
From the FHIR Standard
Claim.procedure.procedure[x]exampleICD-10ProcedureCodes
http://hl7.org/fhir/ValueSet/icd-10-procedures
From the FHIR Standard
Claim.accident.typerequiredActIncidentCode
http://terminology.hl7.org/ValueSet/v3-ActIncidentCode
Claim.item.revenueexampleExampleRevenueCenterCodes
http://hl7.org/fhir/ValueSet/ex-revenue-center
From the FHIR Standard
Claim.item.categoryexampleBenefitCategoryCodes
http://hl7.org/fhir/ValueSet/ex-benefitcategory
From the FHIR Standard
Claim.item.productOrServicerequiredPharmacyBilling
http://nphies.sa/terminology/ValueSet/pharmacy-billing
From this IG
Claim.item.modifierexampleModifierTypeCodes
http://hl7.org/fhir/ValueSet/claim-modifiers
From the FHIR Standard
Claim.item.programCodeexampleExampleProgramReasonCodes
http://hl7.org/fhir/ValueSet/ex-program-code
From the FHIR Standard
Claim.item.location[x]exampleExampleServicePlaceCodes
http://hl7.org/fhir/ValueSet/service-place
From the FHIR Standard
Claim.item.bodySiterequiredSNOMEDCTBodyStructures
http://hl7.org/fhir/ValueSet/body-site
From the FHIR Standard
Claim.item.subSiterequiredSubSite(a valid code from Sub Site)
http://nphies.sa/terminology/ValueSet/subsite
From this IG
Claim.item.detail.revenueexampleExampleRevenueCenterCodes
http://hl7.org/fhir/ValueSet/ex-revenue-center
From the FHIR Standard
Claim.item.detail.categoryexampleBenefitCategoryCodes
http://hl7.org/fhir/ValueSet/ex-benefitcategory
From the FHIR Standard
Claim.item.detail.productOrServicerequiredPharmacyBilling
http://nphies.sa/terminology/ValueSet/pharmacy-billing
From this IG
Claim.item.detail.modifierexampleModifierTypeCodes
http://hl7.org/fhir/ValueSet/claim-modifiers
From the FHIR Standard
Claim.item.detail.programCodeexampleExampleProgramReasonCodes
http://hl7.org/fhir/ValueSet/ex-program-code
From the FHIR Standard
Claim.item.detail.subDetail.revenueexampleExampleRevenueCenterCodes
http://hl7.org/fhir/ValueSet/ex-revenue-center
From the FHIR Standard
Claim.item.detail.subDetail.categoryexampleBenefitCategoryCodes
http://hl7.org/fhir/ValueSet/ex-benefitcategory
From the FHIR Standard
Claim.item.detail.subDetail.productOrServicerequiredPharmacyBilling
http://nphies.sa/terminology/ValueSet/pharmacy-billing
From this IG
Claim.item.detail.subDetail.modifierexampleModifierTypeCodes
http://hl7.org/fhir/ValueSet/claim-modifiers
From the FHIR Standard
Claim.item.detail.subDetail.programCodeexampleExampleProgramReasonCodes
http://hl7.org/fhir/ValueSet/ex-program-code
From the FHIR Standard

Constraints

IdGradePath(s)DetailsRequirements
BV-00002errorClaimClaim care team sequence is not unique within the submitted claim resource.
: careTeam.exists() implies careTeam.sequence.isDistinct()
BV-00036errorClaim.itemNo Claim item detail provided when Claim item package = true.
: extension('http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-package').exists() implies extension('http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-package').first().value = true implies detail.exists().not()
BV-00042errorClaim.itemClaim item detail sequence in not unique within the Claim item.
: detail.sequence.exists() implies detail.sequence.isDistinct()
BV-00043errorClaim.item.detailClaim item subDetail sequence in not unique within the Claim item detail.
: subDetail.sequence.exists() implies subDetail.sequence.isDistinct()
BV-00044errorClaimItem sequence value is not unique within the Claim resource.
: item.sequence.exists() implies item.sequence.isDistinct()
BV-00054errorClaimOne and only one principal diagnosis is required.
: diagnosis.type.coding.where(code='principal').count() = 1
BV-00056errorClaim.payeePayee party is not provided when payee type='other'.
: type.coding.where(code='other').count() > 0 implies party.exists()
BV-00057errorClaimDiagnosis is not unique in the submitted request.
: diagnosis.diagnosis.ofType(CodeableConcept).isDistinct()
BV-00092errorClaim.item.unitPriceClaim Item UnitPrice Currency is not SAR.
: currency = 'SAR'
BV-00093errorClaim.item.netClaim Item Net Currency is not SAR.
: currency = 'SAR'
BV-00094errorClaim.item.detail.unitPriceClaim Item Detail UnitPrice Currency is not SAR.
: currency = 'SAR'
BV-00095errorClaim.item.detail.netClaim Item Detail Net Currency is not SAR.
: currency = 'SAR'
BV-00096errorClaim.totalClaim Total Net Currency is not SAR.
: currency = 'SAR'
BV-00123errorClaim.itemClaim servicedate is not using a correct data type.
: serviced.ofType(date).exists() or serviced.ofType(Period).exists()
BV-00137errorClaimThe claim identifier does not exist.
: identifier.exists()
BV-00316errorClaim.supportingInfo, Claim.supportingInfo:attachment, Claim.supportingInfo:daysSupply, Claim.supportingInfo:info, Claim.supportingInfo:labTestClaim supportingInfo valueString value length is longer than the maximum specified length of 250 English characters and 125 Arabic characters.
: value.ofType(string).exists() implies value.ofType(string).length() <= 250
BV-00330errorClaimClaim status is not using the specified value 'active'.
: status.exists() implies status='active'
BV-00347errorClaim.extension:eligibilityOffLineDateClaim eligibility OfflineDate is greater than current date.
: value.ofType(dateTime) <= now()
BV-00368errorClaimClaim subtype is using an incorrect value when Claim type is 'Pharmacy'.
: subType.coding.first().code = 'op'
BV-00402errorClaim.supportingInfo:infoSupporting information 'info' requires textual information in valueString.
: value.ofType(string).exists()
BV-00404errorClaim.supportingInfo:attachmentSupporting information 'attachment' requires the content to be provided.
: value.ofType(Attachment).exists()
BV-00410errorClaim.supportingInfo:labTestSupporting information 'lab-test' requires a valid LOINC code.
: code.exists()
BV-00411errorClaim.supportingInfo:labTestIf supporting information is 'lab-test' then valueQuantity SHALL exist and SHALL use a value specified in the UCUM code-system.
: value.ofType(Quantity).exists()
BV-00413errorClaim.supportingInfo:daysSupplyIf Supporting information is 'days-supply' then valueQuantity SHALL exist and number of days SHALL use UCUM code 'd'.
: value.ofType(Quantity).exists() implies value.ofType(Quantity).code = 'd'
BV-00439errorClaim.itemIf period is provided then Claim.item.servicedDate must not be used.
: serviced.exists() implies (serviced.ofType(date).exists() xor serviced.ofType(Period).exists())
BV-00453errorClaimClaim supportingInfo sequence value is not unique within the claim request.
: supportingInfo.sequence.exists() implies supportingInfo.sequence.isDistinct()
BV-00454errorClaimClaim diagnosis sequence value is not unique within the claim request.
: diagnosis.sequence.isDistinct()
BV-00482errorClaim.itemItem factor must be a positive decimal value.
: factor.exists() implies factor >= 0
BV-00484errorClaim.itemThe subSite shall not be allowed if the bodySite is not provided.
: subSite.exists() implies bodySite.exists()
BV-00494errorClaim.payeeClaim payee party must not provided when Claim payee type value is not 'other'.
: type.coding.where(code!='other').count() > 0 implies party.exists().not()
BV-00502errorClaim.itemClaim item informationSequence is not unique within the Claim item.
: informationSequence.isDistinct()
BV-00530errorClaim.supportingInfo, Claim.supportingInfo:attachment, Claim.supportingInfo:daysSupply, Claim.supportingInfo:info, Claim.supportingInfo:labTestIf supportingInfo code element is provided and the category is not 'chief-complaint' then a code is required.
: (code.exists() and category.coding.first().code != 'chief-complaint') implies code.coding.code.exists()
BV-00531errorClaim.supportingInfo, Claim.supportingInfo:attachment, Claim.supportingInfo:daysSupply, Claim.supportingInfo:info, Claim.supportingInfo:labTestThe supportingInfo code element is required if supportingInfo category is 'chief-complaint'.
: category.exists() implies (category.coding.first().code = 'chief-complaint') implies code.exists()
BV-00782errorClaim.supportingInfo, Claim.supportingInfo:attachment, Claim.supportingInfo:daysSupply, Claim.supportingInfo:info, Claim.supportingInfo:labTestSupporting information 'treatment-plan' requires textual information.
: category.coding.where(code='treatment-plan').count() > 0 implies value.ofType(string).exists()
BV-00783errorClaim.supportingInfo, Claim.supportingInfo:attachment, Claim.supportingInfo:daysSupply, Claim.supportingInfo:info, Claim.supportingInfo:labTestSupporting information 'patient-history' requires textual information.
: category.coding.where(code='patient-history').count() > 0 implies value.ofType(string).exists()
BV-00784errorClaim.supportingInfo, Claim.supportingInfo:attachment, Claim.supportingInfo:daysSupply, Claim.supportingInfo:info, Claim.supportingInfo:labTestSupporting information 'physical-examination' requires textual information .
: category.coding.where(code='physical-examination').count() > 0 implies value.ofType(string).exists()
BV-00785errorClaim.supportingInfo, Claim.supportingInfo:attachment, Claim.supportingInfo:daysSupply, Claim.supportingInfo:info, Claim.supportingInfo:labTestSupporting information 'history-of-present-illness' requires textual information .
: category.coding.where(code='history-of-present-illness').count() > 0 implies value.ofType(string).exists()
dom-2errorClaimIf the resource is contained in another resource, it SHALL NOT contain nested Resources
: contained.contained.empty()
dom-3errorClaimIf the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource
: contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
dom-4errorClaimIf a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated
: contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
dom-5errorClaimIf a resource is contained in another resource, it SHALL NOT have a security label
: contained.meta.security.empty()
dom-6best practiceClaimA resource should have narrative for robust management
: text.`div`.exists()
ele-1error**ALL** elementsAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ext-1error**ALL** extensionsMust have either extensions or value[x], not both
: extension.exists() != value.exists()

This structure is derived from NphiesAuthorizationBase

Summary

Mandatory: 2 elements(8 nested mandatory elements)
Must-Support: 9 elements

Structures

This structure refers to these other structures:

Extensions

This structure refers to these extensions:

Slices

This structure defines the following Slices:

  • The element 1 is sliced based on the value of Claim.supportingInfo (Closed)
  • The element 1 is sliced based on the value of Claim.supportingInfo.value[x]
  • The element 1 is sliced based on the value of Claim.supportingInfo.timing[x]

Key Elements View

NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
.. Claim C 0..* NphiesAuthorizationBase Claim, Pre-determination or Pre-authorization
Constraints: BV-00002, BV-00044, BV-00054, BV-00057, BV-00137, BV-00330, BV-00453, BV-00454, BV-00368
... id Σ 1..1 id Logical id of this artifact
Max Length:64
... meta Σ 1..1 Meta Metadata about the resource
.... profile Σ 1..* DP_canonical(StructureDefinition) Profiles this resource claims to conform to
... implicitRules ?!Σ 0..1 uri A set of rules under which this content was created
... Slices for extension Content/Rules for all slices
.... extension:eligibilityResponse S 0..1 DP_Reference_3a(Nphies CoverageEligibilityResponse) Eligibility Response
URL: http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-eligibility-response
.... extension:eligibilityOffLine S 0..1 DP_string Eligibility Offline Reference
URL: http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-eligibility-offline-reference
.... extension:eligibilityOffLineDate SC 0..1 DP_dateTime Eligibility Offline Date
URL: http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-eligibility-offline-date
Constraints: BV-00347
.... extension:newborn S 0..1 boolean Newborn
URL: http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-newborn
.... extension:transfer S 0..1 boolean Transfer
URL: http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-transfer
.... extension:transferAuthorizationProvider S 0..1 DP_Reference_1or4(Nphies Provider Organization | Nphies Practitioner) Transfer Authorization Provider
URL: http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-transferAuthorizationProvider
.... extension:transferAuthorizationPeriod S 0..1 DP_Period_2 Transfer Authorization Period
URL: http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-transferAuthorizationPeriod
.... extension:transferAuthorizationNumber S 0..1 DP_string Transfer Authorization Number
URL: http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-transferAuthorizationNumber
.... extension:encounter S 0..1 (Complex) Encounter
URL: http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-encounter
..... extension 0..0
..... url 1..1 uri "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-encounter"
..... value[x] 1..1 DP_Reference_1(Nphies Encounter AMB (Auth)) Value of extension
... modifierExtension ?! 0..* Extension Extensions that cannot be ignored
... identifier 1..1 DP_Identifier_A Business Identifier for claim
... status ?!Σ 1..1 DP_code active | cancelled | draft | entered-in-error
Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance.
Required Pattern: active
... type Σ 1..1 DP_CodeableConcept Category or discipline
Binding: Claim Type Codes (required)
Required Pattern: At least the following
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
.... coding 1..* Coding Code defined by a terminology system
Fixed Value: (complex)
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
..... system 1..1 uri Identity of the terminology system
Fixed Value: http://terminology.hl7.org/CodeSystem/claim-type
..... version 0..1 string Version of the system - if relevant
..... code 1..1 code Symbol in syntax defined by the system
Fixed Value: pharmacy
..... display 0..1 string Representation defined by the system
..... userSelected 0..1 boolean If this coding was chosen directly by the user
.... text 0..1 string Plain text representation of the concept
... subType 1..1 DP_CodeableConcept More granular claim type
Binding: Claim SubType (required)
Required Pattern: At least the following
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
.... coding 1..* Coding Code defined by a terminology system
Fixed Value: (complex)
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
..... system 1..1 uri Identity of the terminology system
Fixed Value: http://nphies.sa/terminology/CodeSystem/claim-subtype
..... version 0..1 string Version of the system - if relevant
..... code 1..1 code Symbol in syntax defined by the system
Fixed Value: op
..... display 0..1 string Representation defined by the system
..... userSelected 0..1 boolean If this coding was chosen directly by the user
.... text 0..1 string Plain text representation of the concept
... use Σ 1..1 DP_code claim | preauthorization | predetermination
Binding: Use (required): The purpose of the Claim: predetermination, preauthorization, claim.
Required Pattern: preauthorization
... patient Σ 1..1 DP_Reference_1or2a(Nphies Patient) The recipient of the products and services
.... reference SΣC 0..1 string Literal reference, Relative, internal or absolute URL
Max Length:250
.... identifier SΣ 0..1 Identifier Logical reference, when literal reference is not known
..... use ?!Σ 0..1 code usual | official | temp | secondary | old (If known)
Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .
..... type Σ 1..1 DP_CodeableConcept Description of identifier
Binding: Patient Identifier Type (required)
..... system Σ 1..1 DP_uri The namespace for the identifier value
Example General: http://www.acme.com/identifiers/patient
..... value Σ 1..1 string The value that is unique
Example General: 123456
Max Length:50
.... display Σ 0..1 string Text alternative for the resource
Max Length:200
... created Σ 1..1 DP_dateTime Resource creation date
... insurer Σ 1..1 DP_Reference_1or2a(Nphies Insurer Organization) Target
.... reference SΣC 0..1 string Literal reference, Relative, internal or absolute URL
Max Length:250
.... identifier SΣ 0..1 Identifier Logical reference, when literal reference is not known
..... use ?!Σ 0..1 code usual | official | temp | secondary | old (If known)
Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .
..... type Σ 1..1 DP_CodeableConcept Description of identifier
Binding: Identifier Type Codes (extensible): A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.
Required Pattern: At least the following
...... id 0..1 string Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
...... coding 1..* Coding Code defined by a terminology system
Fixed Value: (complex)
....... id 0..1 string Unique id for inter-element referencing
....... extension 0..* Extension Additional content defined by implementations
....... system 1..1 uri Identity of the terminology system
Fixed Value: http://terminology.hl7.org/CodeSystem/v2-0203
....... version 0..1 string Version of the system - if relevant
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: NII
....... display 0..1 string Representation defined by the system
....... userSelected 0..1 boolean If this coding was chosen directly by the user
...... text 0..1 string Plain text representation of the concept
..... system Σ 1..1 DP_uri The namespace for the identifier value
Example General: http://www.acme.com/identifiers/patient
..... value Σ 1..1 string The value that is unique
Example General: 123456
Max Length:50
.... display Σ 0..1 string Text alternative for the resource
Max Length:200
... provider Σ 1..1 DP_Reference_1or2a(Nphies Provider Organization) Party responsible for the claim
.... reference SΣC 0..1 string Literal reference, Relative, internal or absolute URL
Max Length:250
.... identifier SΣ 0..1 Identifier Logical reference, when literal reference is not known
..... use ?!Σ 0..1 code usual | official | temp | secondary | old (If known)
Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .
..... type Σ 1..1 DP_CodeableConcept Description of identifier
Binding: Identifier Type Codes (extensible): A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.
Required Pattern: At least the following
...... id 0..1 string Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
...... coding 1..* Coding Code defined by a terminology system
Fixed Value: (complex)
....... id 0..1 string Unique id for inter-element referencing
....... extension 0..* Extension Additional content defined by implementations
....... system 1..1 uri Identity of the terminology system
Fixed Value: http://terminology.hl7.org/CodeSystem/v2-0203
....... version 0..1 string Version of the system - if relevant
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: PRN
....... display 0..1 string Representation defined by the system
....... userSelected 0..1 boolean If this coding was chosen directly by the user
...... text 0..1 string Plain text representation of the concept
..... system Σ 1..1 DP_uri The namespace for the identifier value
Example General: http://www.acme.com/identifiers/patient
..... value Σ 1..1 string The value that is unique
Example General: 123456
Max Length:50
.... display Σ 0..1 string Text alternative for the resource
Max Length:200
... priority Σ 1..1 DP_CodeableConcept Desired processing ugency
Binding: ProcessPriorityCodes (required)
... fundsReserve S 0..1 DP_CodeableConcept For whom to reserve funds
Binding: Funds Reservation Codes (required)
... related S 0..* BackboneElement Prior or corollary claims
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... claim 1..1 DP_Reference_1or3a(Nphies Authorization Pharmacy) Reference to the related claim
.... relationship 1..1 DP_CodeableConcept How the reference claim is related
Binding: Related Claim Relationship (required)
... prescription S 0..1 DP_Reference_4(DeviceRequest | Nphies MedicationRequest) Prescription authorizing services and products
... originalPrescription S 0..1 DP_Reference_3a(DeviceRequest | Nphies MedicationRequest) Original prescription if superseded by fulfiller
... payee C 1..1 BackboneElement Recipient of benefits payable
Constraints: BV-00056, BV-00494
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... type 1..1 DP_CodeableConcept Category of recipient
Binding: Claim Payee Type Codes (required)
.... party S 0..1 DP_Reference_1or2b(Nphies Organization | Nphies Patient) Recipient reference
... referral S 0..1 DP_Reference_3a(ServiceRequest) Treatment referral
... facility S 0..1 DP_Reference_1(Nphies Location) Servicing facility
... Slices for supportingInfo SC 0..* BackboneElement Supporting information
Slice: Unordered, Closed by value:category
Constraints: BV-00316, BV-00530, BV-00782, BV-00783, BV-00784, BV-00785, BV-00531
.... supportingInfo:All Slices Content/Rules for all slices
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... sequence 1..1 DP_positiveInt Information instance identifier
..... category 1..1 DP_CodeableConcept Classification of the supplied information
Binding: Claim Information Category (required)
.... supportingInfo:attachment SC 0..* BackboneElement Attachment
Constraints: BV-00316, BV-00530, BV-00782, BV-00783, BV-00784, BV-00785, BV-00531, BV-00404
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... sequence 1..1 DP_positiveInt Information instance identifier
..... category 1..1 DP_CodeableConcept Classification of the supplied information
Binding: Claim Information Category (required)
Required Pattern: At least the following
...... id 0..1 string Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
...... coding 1..* Coding Code defined by a terminology system
Fixed Value: (complex)
....... id 0..1 string Unique id for inter-element referencing
....... extension 0..* Extension Additional content defined by implementations
....... system 1..1 uri Identity of the terminology system
Fixed Value: http://nphies.sa/terminology/CodeSystem/claim-information-category
....... version 0..1 string Version of the system - if relevant
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: attachment
....... display 0..1 string Representation defined by the system
....... userSelected 0..1 boolean If this coding was chosen directly by the user
...... text 0..1 string Plain text representation of the concept
..... value[x] 1..1 DP_Attachment Data to be provided
.... supportingInfo:daysSupply SC 0..* BackboneElement Days Supply
Constraints: BV-00316, BV-00530, BV-00782, BV-00783, BV-00784, BV-00785, BV-00531, BV-00413
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... sequence 1..1 DP_positiveInt Information instance identifier
..... category 1..1 DP_CodeableConcept Classification of the supplied information
Binding: Claim Information Category (required)
Required Pattern: At least the following
...... id 0..1 string Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
...... coding 1..* Coding Code defined by a terminology system
Fixed Value: (complex)
....... id 0..1 string Unique id for inter-element referencing
....... extension 0..* Extension Additional content defined by implementations
....... system 1..1 uri Identity of the terminology system
Fixed Value: http://nphies.sa/terminology/CodeSystem/claim-information-category
....... version 0..1 string Version of the system - if relevant
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: days-supply
....... display 0..1 string Representation defined by the system
....... userSelected 0..1 boolean If this coding was chosen directly by the user
...... text 0..1 string Plain text representation of the concept
..... Slices for value[x] 1..1 Data to be provided
Slice: Unordered, Open by type:$this
...... valueBoolean boolean
...... valueString string
...... valueQuantity Quantity
...... valueAttachment Attachment
...... valueReference Reference(Resource)
...... value[x]:valueQuantity 0..1 DP_Quantity_2 Data to be provided
Required Pattern: At least the following
....... id 0..1 string Unique id for inter-element referencing
....... extension 0..* Extension Additional content defined by implementations
....... value 0..1 decimal Numerical value (with implicit precision)
....... comparator 0..1 code < | <= | >= | > - how to understand the value
....... unit 0..1 string Unit representation
....... system 1..1 uri System that defines coded unit form
Fixed Value: http://unitsofmeasure.org
....... code 1..1 code Coded form of the unit
Fixed Value: d
....... value Σ 1..1 DP_decimal Numerical value (with implicit precision)
....... comparator ?!Σ 0..1 code < | <= | >= | > - how to understand the value
Binding: QuantityComparator (required): How the Quantity should be understood and represented.
....... unit Σ 0..1 string Unit representation
Max Length:40
....... system ΣC 1..1 DP_uri System that defines coded unit form
....... code Σ 1..1 DP_code Coded form of the unit
.... supportingInfo:info SC 0..1 BackboneElement Information
Constraints: BV-00316, BV-00530, BV-00782, BV-00783, BV-00784, BV-00785, BV-00531, BV-00402
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... sequence 1..1 DP_positiveInt Information instance identifier
..... category 1..1 DP_CodeableConcept Classification of the supplied information
Binding: Claim Information Category (required)
Required Pattern: At least the following
...... id 0..1 string Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
...... coding 1..* Coding Code defined by a terminology system
Fixed Value: (complex)
....... id 0..1 string Unique id for inter-element referencing
....... extension 0..* Extension Additional content defined by implementations
....... system 1..1 uri Identity of the terminology system
Fixed Value: http://nphies.sa/terminology/CodeSystem/claim-information-category
....... version 0..1 string Version of the system - if relevant
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: info
....... display 0..1 string Representation defined by the system
....... userSelected 0..1 boolean If this coding was chosen directly by the user
...... text 0..1 string Plain text representation of the concept
..... value[x] 1..1 DP_string Data to be provided
.... supportingInfo:labTest SC 0..* BackboneElement Lab Test
Constraints: BV-00316, BV-00530, BV-00782, BV-00783, BV-00784, BV-00785, BV-00531, BV-00410, BV-00411
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... sequence 1..1 DP_positiveInt Information instance identifier
..... category 1..1 DP_CodeableConcept Classification of the supplied information
Binding: Claim Information Category (required)
Required Pattern: At least the following
...... id 0..1 string Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
...... coding 1..* Coding Code defined by a terminology system
Fixed Value: (complex)
....... id 0..1 string Unique id for inter-element referencing
....... extension 0..* Extension Additional content defined by implementations
....... system 1..1 uri Identity of the terminology system
Fixed Value: http://nphies.sa/terminology/CodeSystem/claim-information-category
....... version 0..1 string Version of the system - if relevant
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: lab-test
....... display 0..1 string Representation defined by the system
....... userSelected 0..1 boolean If this coding was chosen directly by the user
...... text 0..1 string Plain text representation of the concept
..... code 1..1 DP_CodeableConcept Type of information
Binding: LOINCCodes (required)
..... Slices for timing[x] 1..1 Period When it occurred
Slice: Unordered, Closed by type:$this
...... timing[x]:timingPeriod 1..1 DP_Period_3 When it occurred
..... value[x] 1..1 DP_Quantity_2 Data to be provided
...... value Σ 1..1 DP_decimal Numerical value (with implicit precision)
...... comparator ?!Σ 0..1 code < | <= | >= | > - how to understand the value
Binding: QuantityComparator (required): How the Quantity should be understood and represented.
...... unit Σ 0..1 string Unit representation
Max Length:40
...... system ΣC 1..1 DP_uri System that defines coded unit form
Required Pattern: http://unitsofmeasure.org
...... code Σ 1..1 DP_code Coded form of the unit
... diagnosis 1..* BackboneElement Pertinent diagnosis information
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... sequence 1..1 DP_positiveInt Diagnosis instance identifier
.... Slices for diagnosis[x] 1..1 CodeableConcept Nature of illness or problem
Slice: Unordered, Closed by type:$this
Binding: ICD-10Codes (example): Example ICD10 Diagnostic codes.
..... diagnosis[x]:diagnosisCodeableConcept 1..1 DP_CodeableConcept Nature of illness or problem
Binding: ICD-10-AM (required)
.... type 1..1 DP_CodeableConcept Timing or nature of the diagnosis
Binding: Diagnosis Type (required)
... insurance Σ 1..* BackboneElement Patient insurance information
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... sequence Σ 1..1 DP_positiveInt Insurance instance identifier
.... focal Σ 1..1 boolean Coverage to be used for adjudication
.... coverage Σ 1..1 DP_Reference_1(Nphies Coverage) Insurance information
.... preAuthRef S 0..* string Prior authorization reference number
.... claimResponse S 0..1 DP_Reference_1or3a(Nphies Authorization Response) Adjudication results
... accident S 0..1 BackboneElement Details of the event
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... date 1..1 DP_date When the incident occurred
.... type 1..1 DP_CodeableConcept The nature of the accident
Binding: ActIncidentCode (required)
.... Slices for location[x] 0..1 Where the event occurred
Slice: Unordered, Open by type:$this
..... locationAddress Address
..... locationReference Reference(Location)
..... location[x]:locationAddress S 0..1 DP_Address Where the event occurred
... item C 1..* BackboneElement Product or service provided
Constraints: BV-00036, BV-00042, BV-00123, BV-00439, BV-00482, BV-00484, BV-00502
.... Slices for extension S 1..* Extension Extension
Slice: Unordered, Open by value:url
..... extension:package S 0..1 boolean Package Code
URL: http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-package
..... extension:tax S 0..1 DP_Money_SAR Tax
URL: http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-tax
..... extension:patientShare S 0..1 DP_Money_SAR Patient Share
URL: http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-patient-share
..... extension:payerShare S 0..1 DP_Money_SAR Payer Share
URL: http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-payer-share
..... extension:prescribedMedication S 0..1 DP_CodeableConcept Prescribed Medication
URL: http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-prescribed-Medication
Binding: Prescriber Billing (required)
..... extension:pharmacistSelectionReason S 0..1 DP_CodeableConcept Pharmacist Selection Reason
URL: http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-pharmacist-Selection-Reason
Binding: Pharmacist Selection Reason (required)
..... extension:pharmacistSubstitute S 0..1 DP_CodeableConcept Pharmacist Substitute
URL: http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-pharmacist-substitute
Binding: Pharmacist Substitute (required)
..... extension:maternity S 1..1 boolean Maternity
URL: http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-maternity
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... sequence 1..1 DP_positiveInt Item instance identifier
.... diagnosisSequence S 0..* DP_positiveInt Applicable diagnoses
.... informationSequence S 0..* DP_positiveInt Applicable exception and supporting information
.... productOrService 1..1 DP_CodeableConcept_2 Billing, service, product, or drug code
Binding: Pharmacy Billing (required)
.... Slices for serviced[x] 1..1 Date or dates of service or product delivery
Slice: Unordered, Closed by type:$this
..... servicedDate date
..... servicedPeriod Period
..... serviced[x]:servicedDate S 0..1 DP_date Date or dates of service or product delivery
..... serviced[x]:servicedPeriod S 0..1 DP_Period_2 Date or dates of service or product delivery
.... quantity 1..1 DP_SimpleQuantity_1 Count of products or services
.... unitPrice C 1..1 DP_Money_SAR Fee, charge or cost per item
Constraints: BV-00092
.... factor S 0..1 DP_decimal Price scaling factor
.... net C 1..1 DP_Money_SAR Total item cost
Constraints: BV-00093
.... udi S 0..* DP_Reference_1or3a(Device) Unique device identifier
.... bodySite S 0..1 DP_CodeableConcept Anatomical location
Binding: SNOMEDCTBodyStructures (required)
.... subSite S 0..1 DP_CodeableConcept Anatomical sub-location
Binding: Sub Site (required)
.... detail SC 0..* BackboneElement Product or service provided
Constraints: BV-00043
..... Slices for extension Content/Rules for all slices
...... extension:tax S 0..1 DP_Money_SAR Tax
URL: http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-tax
...... extension:prescribedMedication S 0..1 DP_CodeableConcept Prescribed Medication
URL: http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-prescribed-Medication
Binding: Prescriber Billing (required)
...... extension:pharmacistSelectionReason S 0..1 DP_CodeableConcept Pharmacist Selection Reason
URL: http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-pharmacist-Selection-Reason
Binding: Pharmacist Selection Reason (required)
...... extension:pharmacistSubstitute S 0..1 DP_CodeableConcept Pharmacist Substitute
URL: http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-pharmacist-substitute
Binding: Pharmacist Substitute (required)
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... sequence 1..1 DP_positiveInt Item instance identifier
..... productOrService 1..1 DP_CodeableConcept_2 Billing, service, product, or drug code
Binding: Pharmacy Billing (required)
..... quantity 1..1 DP_SimpleQuantity_1 Count of products or services
..... unitPrice C 1..1 DP_Money_SAR Fee, charge or cost per item
Constraints: BV-00094
..... factor S 0..1 DP_decimal Price scaling factor
..... net C 1..1 DP_Money_SAR Total item cost
Constraints: BV-00095
..... udi S 0..* DP_Reference_1or3a(Device) Unique device identifier
..... subDetail S 0..* BackboneElement Product or service provided
...... Slices for extension Content/Rules for all slices
....... extension:tax S 0..1 DP_Money_SAR Tax
URL: http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-tax
...... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
...... sequence 1..1 DP_positiveInt Item instance identifier
...... productOrService 1..1 DP_CodeableConcept_2 Billing, service, product, or drug code
Binding: Pharmacy Billing (required)
...... quantity 1..1 DP_SimpleQuantity_1 Count of products or services
...... unitPrice 1..1 DP_Money_SAR Fee, charge or cost per item
...... factor S 0..1 DP_decimal Price scaling factor
...... net 1..1 DP_Money_SAR Total item cost
...... udi S 0..* DP_Reference_1or3a(Device) Unique device identifier
... total C 1..1 DP_Money_SAR Total claim cost
Constraints: BV-00096

doco Documentation for this format

Terminology Bindings

PathConformanceValueSet / CodeURI
Claim.statusrequiredPattern Value: active
http://hl7.org/fhir/ValueSet/fm-status|4.0.1
From the FHIR Standard
Claim.typerequiredPattern Value: pharmacy
http://nphies.sa/terminology/ValueSet/claim-type
From this IG
Claim.subTyperequiredPattern Value: op
http://nphies.sa/terminology/ValueSet/claim-subtype
From this IG
Claim.userequiredPattern Value: preauthorization
http://hl7.org/fhir/ValueSet/claim-use|4.0.1
From the FHIR Standard
Claim.patient.identifier.userequiredIdentifierUse
http://hl7.org/fhir/ValueSet/identifier-use|4.0.1
From the FHIR Standard
Claim.patient.identifier.typerequiredPatientIdentifierType
http://nphies.sa/terminology/ValueSet/patient-identifier-type
From this IG
Claim.insurer.identifier.userequiredIdentifierUse
http://hl7.org/fhir/ValueSet/identifier-use|4.0.1
From the FHIR Standard
Claim.insurer.identifier.typeextensiblePattern Value: NII
http://hl7.org/fhir/ValueSet/identifier-type
From the FHIR Standard
Claim.provider.identifier.userequiredIdentifierUse
http://hl7.org/fhir/ValueSet/identifier-use|4.0.1
From the FHIR Standard
Claim.provider.identifier.typeextensiblePattern Value: PRN
http://hl7.org/fhir/ValueSet/identifier-type
From the FHIR Standard
Claim.priorityrequiredProcessPriorityCodes
http://hl7.org/fhir/ValueSet/process-priority
From the FHIR Standard
Claim.fundsReserverequiredFunds Reservation Codes
http://hl7.org/fhir/ValueSet/fundsreserve
From the FHIR Standard
Claim.related.relationshiprequiredRelatedClaimRelationship(a valid code from Related Claim Relationship)
http://nphies.sa/terminology/ValueSet/related-claim-relationship
From this IG
Claim.payee.typerequiredClaim Payee Type Codes
http://hl7.org/fhir/ValueSet/payeetype
From the FHIR Standard
Claim.supportingInfo.categoryrequiredClaimInformationCategory(a valid code from Claim Information Category)
http://nphies.sa/terminology/ValueSet/claim-information-category
From this IG
Claim.supportingInfo:attachment.categoryrequiredPattern Value: attachment
http://nphies.sa/terminology/ValueSet/claim-information-category
From this IG
Claim.supportingInfo:daysSupply.categoryrequiredPattern Value: days-supply
http://nphies.sa/terminology/ValueSet/claim-information-category
From this IG
Claim.supportingInfo:daysSupply.value[x]:valueQuantity.comparatorrequiredQuantityComparator
http://hl7.org/fhir/ValueSet/quantity-comparator|4.0.1
From the FHIR Standard
Claim.supportingInfo:info.categoryrequiredPattern Value: info
http://nphies.sa/terminology/ValueSet/claim-information-category
From this IG
Claim.supportingInfo:labTest.categoryrequiredPattern Value: lab-test
http://nphies.sa/terminology/ValueSet/claim-information-category
From this IG
Claim.supportingInfo:labTest.coderequiredLOINCCodes(a valid code from LOINC)
http://hl7.org/fhir/ValueSet/observation-codes
From the FHIR Standard
Claim.supportingInfo:labTest.value[x].comparatorrequiredQuantityComparator
http://hl7.org/fhir/ValueSet/quantity-comparator|4.0.1
From the FHIR Standard
Claim.diagnosis.diagnosis[x]exampleICD-10Codes
http://hl7.org/fhir/ValueSet/icd-10
From the FHIR Standard
Claim.diagnosis.diagnosis[x]:diagnosisCodeableConceptrequiredICD_10_AM(a valid code from http://hl7.org/fhir/sid/icd-10-am)
http://nphies.sa/terminology/ValueSet/diagnosis-icd-10-am
From this IG
Claim.diagnosis.typerequiredDiagnosisType(a valid code from Diagnosis Type)
http://nphies.sa/terminology/ValueSet/diagnosis-type
From this IG
Claim.accident.typerequiredActIncidentCode
http://terminology.hl7.org/ValueSet/v3-ActIncidentCode
Claim.item.productOrServicerequiredPharmacyBilling
http://nphies.sa/terminology/ValueSet/pharmacy-billing
From this IG
Claim.item.bodySiterequiredSNOMEDCTBodyStructures
http://hl7.org/fhir/ValueSet/body-site
From the FHIR Standard
Claim.item.subSiterequiredSubSite(a valid code from Sub Site)
http://nphies.sa/terminology/ValueSet/subsite
From this IG
Claim.item.detail.productOrServicerequiredPharmacyBilling
http://nphies.sa/terminology/ValueSet/pharmacy-billing
From this IG
Claim.item.detail.subDetail.productOrServicerequiredPharmacyBilling
http://nphies.sa/terminology/ValueSet/pharmacy-billing
From this IG

Constraints

IdGradePath(s)DetailsRequirements
BV-00002errorClaimClaim care team sequence is not unique within the submitted claim resource.
: careTeam.exists() implies careTeam.sequence.isDistinct()
BV-00036errorClaim.itemNo Claim item detail provided when Claim item package = true.
: extension('http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-package').exists() implies extension('http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-package').first().value = true implies detail.exists().not()
BV-00042errorClaim.itemClaim item detail sequence in not unique within the Claim item.
: detail.sequence.exists() implies detail.sequence.isDistinct()
BV-00043errorClaim.item.detailClaim item subDetail sequence in not unique within the Claim item detail.
: subDetail.sequence.exists() implies subDetail.sequence.isDistinct()
BV-00044errorClaimItem sequence value is not unique within the Claim resource.
: item.sequence.exists() implies item.sequence.isDistinct()
BV-00054errorClaimOne and only one principal diagnosis is required.
: diagnosis.type.coding.where(code='principal').count() = 1
BV-00056errorClaim.payeePayee party is not provided when payee type='other'.
: type.coding.where(code='other').count() > 0 implies party.exists()
BV-00057errorClaimDiagnosis is not unique in the submitted request.
: diagnosis.diagnosis.ofType(CodeableConcept).isDistinct()
BV-00092errorClaim.item.unitPriceClaim Item UnitPrice Currency is not SAR.
: currency = 'SAR'
BV-00093errorClaim.item.netClaim Item Net Currency is not SAR.
: currency = 'SAR'
BV-00094errorClaim.item.detail.unitPriceClaim Item Detail UnitPrice Currency is not SAR.
: currency = 'SAR'
BV-00095errorClaim.item.detail.netClaim Item Detail Net Currency is not SAR.
: currency = 'SAR'
BV-00096errorClaim.totalClaim Total Net Currency is not SAR.
: currency = 'SAR'
BV-00123errorClaim.itemClaim servicedate is not using a correct data type.
: serviced.ofType(date).exists() or serviced.ofType(Period).exists()
BV-00137errorClaimThe claim identifier does not exist.
: identifier.exists()
BV-00316errorClaim.supportingInfo, Claim.supportingInfo:attachment, Claim.supportingInfo:daysSupply, Claim.supportingInfo:info, Claim.supportingInfo:labTestClaim supportingInfo valueString value length is longer than the maximum specified length of 250 English characters and 125 Arabic characters.
: value.ofType(string).exists() implies value.ofType(string).length() <= 250
BV-00330errorClaimClaim status is not using the specified value 'active'.
: status.exists() implies status='active'
BV-00347errorClaim.extension:eligibilityOffLineDateClaim eligibility OfflineDate is greater than current date.
: value.ofType(dateTime) <= now()
BV-00368errorClaimClaim subtype is using an incorrect value when Claim type is 'Pharmacy'.
: subType.coding.first().code = 'op'
BV-00402errorClaim.supportingInfo:infoSupporting information 'info' requires textual information in valueString.
: value.ofType(string).exists()
BV-00404errorClaim.supportingInfo:attachmentSupporting information 'attachment' requires the content to be provided.
: value.ofType(Attachment).exists()
BV-00410errorClaim.supportingInfo:labTestSupporting information 'lab-test' requires a valid LOINC code.
: code.exists()
BV-00411errorClaim.supportingInfo:labTestIf supporting information is 'lab-test' then valueQuantity SHALL exist and SHALL use a value specified in the UCUM code-system.
: value.ofType(Quantity).exists()
BV-00413errorClaim.supportingInfo:daysSupplyIf Supporting information is 'days-supply' then valueQuantity SHALL exist and number of days SHALL use UCUM code 'd'.
: value.ofType(Quantity).exists() implies value.ofType(Quantity).code = 'd'
BV-00439errorClaim.itemIf period is provided then Claim.item.servicedDate must not be used.
: serviced.exists() implies (serviced.ofType(date).exists() xor serviced.ofType(Period).exists())
BV-00453errorClaimClaim supportingInfo sequence value is not unique within the claim request.
: supportingInfo.sequence.exists() implies supportingInfo.sequence.isDistinct()
BV-00454errorClaimClaim diagnosis sequence value is not unique within the claim request.
: diagnosis.sequence.isDistinct()
BV-00482errorClaim.itemItem factor must be a positive decimal value.
: factor.exists() implies factor >= 0
BV-00484errorClaim.itemThe subSite shall not be allowed if the bodySite is not provided.
: subSite.exists() implies bodySite.exists()
BV-00494errorClaim.payeeClaim payee party must not provided when Claim payee type value is not 'other'.
: type.coding.where(code!='other').count() > 0 implies party.exists().not()
BV-00502errorClaim.itemClaim item informationSequence is not unique within the Claim item.
: informationSequence.isDistinct()
BV-00530errorClaim.supportingInfo, Claim.supportingInfo:attachment, Claim.supportingInfo:daysSupply, Claim.supportingInfo:info, Claim.supportingInfo:labTestIf supportingInfo code element is provided and the category is not 'chief-complaint' then a code is required.
: (code.exists() and category.coding.first().code != 'chief-complaint') implies code.coding.code.exists()
BV-00531errorClaim.supportingInfo, Claim.supportingInfo:attachment, Claim.supportingInfo:daysSupply, Claim.supportingInfo:info, Claim.supportingInfo:labTestThe supportingInfo code element is required if supportingInfo category is 'chief-complaint'.
: category.exists() implies (category.coding.first().code = 'chief-complaint') implies code.exists()
BV-00782errorClaim.supportingInfo, Claim.supportingInfo:attachment, Claim.supportingInfo:daysSupply, Claim.supportingInfo:info, Claim.supportingInfo:labTestSupporting information 'treatment-plan' requires textual information.
: category.coding.where(code='treatment-plan').count() > 0 implies value.ofType(string).exists()
BV-00783errorClaim.supportingInfo, Claim.supportingInfo:attachment, Claim.supportingInfo:daysSupply, Claim.supportingInfo:info, Claim.supportingInfo:labTestSupporting information 'patient-history' requires textual information.
: category.coding.where(code='patient-history').count() > 0 implies value.ofType(string).exists()
BV-00784errorClaim.supportingInfo, Claim.supportingInfo:attachment, Claim.supportingInfo:daysSupply, Claim.supportingInfo:info, Claim.supportingInfo:labTestSupporting information 'physical-examination' requires textual information .
: category.coding.where(code='physical-examination').count() > 0 implies value.ofType(string).exists()
BV-00785errorClaim.supportingInfo, Claim.supportingInfo:attachment, Claim.supportingInfo:daysSupply, Claim.supportingInfo:info, Claim.supportingInfo:labTestSupporting information 'history-of-present-illness' requires textual information .
: category.coding.where(code='history-of-present-illness').count() > 0 implies value.ofType(string).exists()
dom-2errorClaimIf the resource is contained in another resource, it SHALL NOT contain nested Resources
: contained.contained.empty()
dom-3errorClaimIf the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource
: contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
dom-4errorClaimIf a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated
: contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
dom-5errorClaimIf a resource is contained in another resource, it SHALL NOT have a security label
: contained.meta.security.empty()
dom-6best practiceClaimA resource should have narrative for robust management
: text.`div`.exists()
ele-1error**ALL** elementsAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ext-1error**ALL** extensionsMust have either extensions or value[x], not both
: extension.exists() != value.exists()

Differential View

This structure is derived from NphiesAuthorizationBase

NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
.. Claim C 0..* NphiesAuthorizationBase Claim, Pre-determination or Pre-authorization
Constraints: BV-00368
... Slices for extension Content/Rules for all slices
.... extension:encounter S 0..1 (Complex) Encounter
URL: http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-encounter
..... value[x] 1..1 DP_Reference_1(Nphies Encounter AMB (Auth)) Value of extension
... type 1..1 DP_CodeableConcept Category or discipline
Required Pattern: At least the following
.... coding 1..* Coding Code defined by a terminology system
Fixed Value: (complex)
..... system 1..1 uri Identity of the terminology system
Fixed Value: http://terminology.hl7.org/CodeSystem/claim-type
..... code 1..1 code Symbol in syntax defined by the system
Fixed Value: pharmacy
... subType 1..1 DP_CodeableConcept More granular claim type
Required Pattern: At least the following
.... coding 1..* Coding Code defined by a terminology system
Fixed Value: (complex)
..... system 1..1 uri Identity of the terminology system
Fixed Value: http://nphies.sa/terminology/CodeSystem/claim-subtype
..... code 1..1 code Symbol in syntax defined by the system
Fixed Value: op
.... claim 1..1 DP_Reference_1or3a(Nphies Authorization Pharmacy) Reference to the related claim
... prescription S 0..1 DP_Reference_4(DeviceRequest | Nphies MedicationRequest) Prescription authorizing services and products
... originalPrescription S 0..1 DP_Reference_3a(DeviceRequest | Nphies MedicationRequest) Original prescription if superseded by fulfiller
... Slices for supportingInfo 0..* BackboneElement Supporting information
Slice: Unordered, Closed by value:category
.... supportingInfo:attachment C 0..* BackboneElement Attachment
Constraints: BV-00404
..... category 1..1 DP_CodeableConcept Classification of the supplied information
Required Pattern: At least the following
...... coding 1..* Coding Code defined by a terminology system
Fixed Value: (complex)
....... system 1..1 uri Identity of the terminology system
Fixed Value: http://nphies.sa/terminology/CodeSystem/claim-information-category
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: attachment
..... value[x] 1..1 DP_Attachment Data to be provided
.... supportingInfo:daysSupply C 0..* BackboneElement Days Supply
Constraints: BV-00413
..... category 1..1 DP_CodeableConcept Classification of the supplied information
Required Pattern: At least the following
...... coding 1..* Coding Code defined by a terminology system
Fixed Value: (complex)
....... system 1..1 uri Identity of the terminology system
Fixed Value: http://nphies.sa/terminology/CodeSystem/claim-information-category
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: days-supply
..... Slices for value[x] 1..1 boolean, string, Quantity, Attachment, Reference(Resource) Data to be provided
Slice: Unordered, Open by type:$this
...... value[x]:valueQuantity 0..1 DP_Quantity_2 Data to be provided
Required Pattern: At least the following
....... system 1..1 uri System that defines coded unit form
Fixed Value: http://unitsofmeasure.org
....... code 1..1 code Coded form of the unit
Fixed Value: d
....... value 1..1 DP_decimal Numerical value (with implicit precision)
.... supportingInfo:info C 0..1 BackboneElement Information
Constraints: BV-00402
..... category 1..1 DP_CodeableConcept Classification of the supplied information
Required Pattern: At least the following
...... coding 1..* Coding Code defined by a terminology system
Fixed Value: (complex)
....... system 1..1 uri Identity of the terminology system
Fixed Value: http://nphies.sa/terminology/CodeSystem/claim-information-category
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: info
..... value[x] 1..1 DP_string Data to be provided
.... supportingInfo:labTest C 0..* BackboneElement Lab Test
Constraints: BV-00410, BV-00411
..... category 1..1 DP_CodeableConcept Classification of the supplied information
Required Pattern: At least the following
...... coding 1..* Coding Code defined by a terminology system
Fixed Value: (complex)
....... system 1..1 uri Identity of the terminology system
Fixed Value: http://nphies.sa/terminology/CodeSystem/claim-information-category
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: lab-test
..... code 1..1 DP_CodeableConcept Type of information
Binding: LOINCCodes (required)
..... Slices for timing[x] 1..1 Period When it occurred
Slice: Unordered, Open by type:$this
...... timing[x]:timingPeriod 1..1 DP_Period_3 When it occurred
..... value[x] 1..1 DP_Quantity_2 Data to be provided
...... system 1..1 DP_uri System that defines coded unit form
Required Pattern: http://unitsofmeasure.org
... item
.... extension 1..* Extension Extension
.... Slices for extension Content/Rules for all slices
..... extension:prescribedMedication S 0..1 DP_CodeableConcept Prescribed Medication
URL: http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-prescribed-Medication
Binding: Prescriber Billing (required)
..... extension:pharmacistSelectionReason S 0..1 DP_CodeableConcept Pharmacist Selection Reason
URL: http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-pharmacist-Selection-Reason
Binding: Pharmacist Selection Reason (required)
..... extension:pharmacistSubstitute S 0..1 DP_CodeableConcept Pharmacist Substitute
URL: http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-pharmacist-substitute
Binding: Pharmacist Substitute (required)
..... extension:maternity 1..1 boolean Maternity
URL: http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-maternity
.... productOrService 1..1 DP_CodeableConcept_2 Billing, service, product, or drug code
Binding: Pharmacy Billing (required)
.... bodySite 0..1 DP_CodeableConcept Anatomical location
Binding: SNOMEDCTBodyStructures (required)
.... subSite 0..1 DP_CodeableConcept Anatomical sub-location
Binding: Sub Site (required)
.... detail
..... Slices for extension Content/Rules for all slices
...... extension:prescribedMedication S 0..1 DP_CodeableConcept Prescribed Medication
URL: http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-prescribed-Medication
Binding: Prescriber Billing (required)
...... extension:pharmacistSelectionReason S 0..1 DP_CodeableConcept Pharmacist Selection Reason
URL: http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-pharmacist-Selection-Reason
Binding: Pharmacist Selection Reason (required)
...... extension:pharmacistSubstitute S 0..1 DP_CodeableConcept Pharmacist Substitute
URL: http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-pharmacist-substitute
Binding: Pharmacist Substitute (required)
..... productOrService 1..1 DP_CodeableConcept_2 Billing, service, product, or drug code
Binding: Pharmacy Billing (required)
..... subDetail
...... productOrService 1..1 DP_CodeableConcept_2 Billing, service, product, or drug code
Binding: Pharmacy Billing (required)

doco Documentation for this format

Terminology Bindings (Differential)

PathConformanceValueSetURI
Claim.supportingInfo:labTest.coderequiredLOINCCodes(a valid code from LOINC)
http://hl7.org/fhir/ValueSet/observation-codes
From the FHIR Standard
Claim.item.productOrServicerequiredPharmacyBilling
http://nphies.sa/terminology/ValueSet/pharmacy-billing
From this IG
Claim.item.bodySiterequiredSNOMEDCTBodyStructures
http://hl7.org/fhir/ValueSet/body-site
From the FHIR Standard
Claim.item.subSiterequiredSubSite(a valid code from Sub Site)
http://nphies.sa/terminology/ValueSet/subsite
From this IG
Claim.item.detail.productOrServicerequiredPharmacyBilling
http://nphies.sa/terminology/ValueSet/pharmacy-billing
From this IG
Claim.item.detail.subDetail.productOrServicerequiredPharmacyBilling
http://nphies.sa/terminology/ValueSet/pharmacy-billing
From this IG

Constraints

IdGradePath(s)DetailsRequirements
BV-00368errorClaimClaim subtype is using an incorrect value when Claim type is 'Pharmacy'.
: subType.coding.first().code = 'op'
BV-00402errorClaim.supportingInfo:infoSupporting information 'info' requires textual information in valueString.
: value.ofType(string).exists()
BV-00404errorClaim.supportingInfo:attachmentSupporting information 'attachment' requires the content to be provided.
: value.ofType(Attachment).exists()
BV-00410errorClaim.supportingInfo:labTestSupporting information 'lab-test' requires a valid LOINC code.
: code.exists()
BV-00411errorClaim.supportingInfo:labTestIf supporting information is 'lab-test' then valueQuantity SHALL exist and SHALL use a value specified in the UCUM code-system.
: value.ofType(Quantity).exists()
BV-00413errorClaim.supportingInfo:daysSupplyIf Supporting information is 'days-supply' then valueQuantity SHALL exist and number of days SHALL use UCUM code 'd'.
: value.ofType(Quantity).exists() implies value.ofType(Quantity).code = 'd'

Snapshot View

NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
.. Claim C 0..* NphiesAuthorizationBase Claim, Pre-determination or Pre-authorization
Constraints: BV-00002, BV-00044, BV-00054, BV-00057, BV-00137, BV-00330, BV-00453, BV-00454, BV-00368
... id Σ 1..1 id Logical id of this artifact
Max Length:64
... meta Σ 1..1 Meta Metadata about the resource
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
.... versionId Σ 0..1 id Version specific identifier
.... lastUpdated Σ 0..1 instant When the resource version last changed
.... source Σ 0..1 uri Identifies where the resource comes from
.... profile Σ 1..* DP_canonical(StructureDefinition) Profiles this resource claims to conform to
.... security Σ 0..* Coding Security Labels applied to this resource
Binding: All Security Labels (extensible): Security Labels from the Healthcare Privacy and Security Classification System.
.... tag Σ 0..* Coding Tags applied to this resource
Binding: CommonTags (example): Codes that represent various types of tags, commonly workflow-related; e.g. "Needs review by Dr. Jones".
... implicitRules ?!Σ 0..1 uri A set of rules under which this content was created
... language 0..1 code Language of the resource content
Binding: CommonLanguages (preferred): A human language.
Additional BindingsPurpose
AllLanguages Max Binding
... text 0..1 Narrative Text summary of the resource, for human interpretation
This profile does not constrain the narrative in regard to content, language, or traceability to data elements
... contained 0..* Resource Contained, inline Resources
... Slices for extension 0..* Extension Extension
Slice: Unordered, Open by value:url
.... extension:eligibilityResponse S 0..1 DP_Reference_3a(Nphies CoverageEligibilityResponse) Eligibility Response
URL: http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-eligibility-response
.... extension:eligibilityOffLine S 0..1 DP_string Eligibility Offline Reference
URL: http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-eligibility-offline-reference
.... extension:eligibilityOffLineDate SC 0..1 DP_dateTime Eligibility Offline Date
URL: http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-eligibility-offline-date
Constraints: BV-00347
.... extension:newborn S 0..1 boolean Newborn
URL: http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-newborn
.... extension:transfer S 0..1 boolean Transfer
URL: http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-transfer
.... extension:transferAuthorizationProvider S 0..1 DP_Reference_1or4(Nphies Provider Organization | Nphies Practitioner) Transfer Authorization Provider
URL: http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-transferAuthorizationProvider
.... extension:transferAuthorizationPeriod S 0..1 DP_Period_2 Transfer Authorization Period
URL: http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-transferAuthorizationPeriod
.... extension:transferAuthorizationNumber S 0..1 DP_string Transfer Authorization Number
URL: http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-transferAuthorizationNumber
.... extension:encounter S 0..1 (Complex) Encounter
URL: http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-encounter
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..0
..... url 1..1 uri "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-encounter"
..... value[x] 1..1 DP_Reference_1(Nphies Encounter AMB (Auth)) Value of extension
... modifierExtension ?! 0..* Extension Extensions that cannot be ignored
... identifier 1..1 DP_Identifier_A Business Identifier for claim
... status ?!Σ 1..1 DP_code active | cancelled | draft | entered-in-error
Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance.
Required Pattern: active
... type Σ 1..1 DP_CodeableConcept Category or discipline
Binding: Claim Type Codes (required)
Required Pattern: At least the following
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
.... coding 1..* Coding Code defined by a terminology system
Fixed Value: (complex)
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
..... system 1..1 uri Identity of the terminology system
Fixed Value: http://terminology.hl7.org/CodeSystem/claim-type
..... version 0..1 string Version of the system - if relevant
..... code 1..1 code Symbol in syntax defined by the system
Fixed Value: pharmacy
..... display 0..1 string Representation defined by the system
..... userSelected 0..1 boolean If this coding was chosen directly by the user
.... text 0..1 string Plain text representation of the concept
... subType 1..1 DP_CodeableConcept More granular claim type
Binding: Claim SubType (required)
Required Pattern: At least the following
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
.... coding 1..* Coding Code defined by a terminology system
Fixed Value: (complex)
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
..... system 1..1 uri Identity of the terminology system
Fixed Value: http://nphies.sa/terminology/CodeSystem/claim-subtype
..... version 0..1 string Version of the system - if relevant
..... code 1..1 code Symbol in syntax defined by the system
Fixed Value: op
..... display 0..1 string Representation defined by the system
..... userSelected 0..1 boolean If this coding was chosen directly by the user
.... text 0..1 string Plain text representation of the concept
... use Σ 1..1 DP_code claim | preauthorization | predetermination
Binding: Use (required): The purpose of the Claim: predetermination, preauthorization, claim.
Required Pattern: preauthorization
... patient Σ 1..1 DP_Reference_1or2a(Nphies Patient) The recipient of the products and services
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
.... reference SΣC 0..1 string Literal reference, Relative, internal or absolute URL
Max Length:250
.... type Σ 0..1 uri Type the reference refers to (e.g. "Patient")
Binding: ResourceType (extensible): Aa resource (or, for logical models, the URI of the logical model).
.... identifier SΣ 0..1 Identifier Logical reference, when literal reference is not known
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
..... use ?!Σ 0..1 code usual | official | temp | secondary | old (If known)
Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .
..... type Σ 1..1 DP_CodeableConcept Description of identifier
Binding: Patient Identifier Type (required)
..... system Σ 1..1 DP_uri The namespace for the identifier value
Example General: http://www.acme.com/identifiers/patient
..... value Σ 1..1 string The value that is unique
Example General: 123456
Max Length:50
..... period Σ 0..1 Period Time period when id is/was valid for use
..... assigner Σ 0..1 Reference(Organization) Organization that issued id (may be just text)
.... display Σ 0..1 string Text alternative for the resource
Max Length:200
... billablePeriod Σ 0..1 Period Relevant time frame for the claim
... created Σ 1..1 DP_dateTime Resource creation date
... enterer 0..1 Reference(Practitioner | PractitionerRole) Author of the claim
... insurer Σ 1..1 DP_Reference_1or2a(Nphies Insurer Organization) Target
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
.... reference SΣC 0..1 string Literal reference, Relative, internal or absolute URL
Max Length:250
.... type Σ 0..1 uri Type the reference refers to (e.g. "Patient")
Binding: ResourceType (extensible): Aa resource (or, for logical models, the URI of the logical model).
.... identifier SΣ 0..1 Identifier Logical reference, when literal reference is not known
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
..... use ?!Σ 0..1 code usual | official | temp | secondary | old (If known)
Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .
..... type Σ 1..1 DP_CodeableConcept Description of identifier
Binding: Identifier Type Codes (extensible): A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.
Required Pattern: At least the following
...... id 0..1 string Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
...... coding 1..* Coding Code defined by a terminology system
Fixed Value: (complex)
....... id 0..1 string Unique id for inter-element referencing
....... extension 0..* Extension Additional content defined by implementations
....... system 1..1 uri Identity of the terminology system
Fixed Value: http://terminology.hl7.org/CodeSystem/v2-0203
....... version 0..1 string Version of the system - if relevant
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: NII
....... display 0..1 string Representation defined by the system
....... userSelected 0..1 boolean If this coding was chosen directly by the user
...... text 0..1 string Plain text representation of the concept
..... system Σ 1..1 DP_uri The namespace for the identifier value
Example General: http://www.acme.com/identifiers/patient
..... value Σ 1..1 string The value that is unique
Example General: 123456
Max Length:50
..... period Σ 0..1 Period Time period when id is/was valid for use
..... assigner Σ 0..1 Reference(Organization) Organization that issued id (may be just text)
.... display Σ 0..1 string Text alternative for the resource
Max Length:200
... provider Σ 1..1 DP_Reference_1or2a(Nphies Provider Organization) Party responsible for the claim
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
.... reference SΣC 0..1 string Literal reference, Relative, internal or absolute URL
Max Length:250
.... type Σ 0..1 uri Type the reference refers to (e.g. "Patient")
Binding: ResourceType (extensible): Aa resource (or, for logical models, the URI of the logical model).
.... identifier SΣ 0..1 Identifier Logical reference, when literal reference is not known
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
..... use ?!Σ 0..1 code usual | official | temp | secondary | old (If known)
Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .
..... type Σ 1..1 DP_CodeableConcept Description of identifier
Binding: Identifier Type Codes (extensible): A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.
Required Pattern: At least the following
...... id 0..1 string Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
...... coding 1..* Coding Code defined by a terminology system
Fixed Value: (complex)
....... id 0..1 string Unique id for inter-element referencing
....... extension 0..* Extension Additional content defined by implementations
....... system 1..1 uri Identity of the terminology system
Fixed Value: http://terminology.hl7.org/CodeSystem/v2-0203
....... version 0..1 string Version of the system - if relevant
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: PRN
....... display 0..1 string Representation defined by the system
....... userSelected 0..1 boolean If this coding was chosen directly by the user
...... text 0..1 string Plain text representation of the concept
..... system Σ 1..1 DP_uri The namespace for the identifier value
Example General: http://www.acme.com/identifiers/patient
..... value Σ 1..1 string The value that is unique
Example General: 123456
Max Length:50
..... period Σ 0..1 Period Time period when id is/was valid for use
..... assigner Σ 0..1 Reference(Organization) Organization that issued id (may be just text)
.... display Σ 0..1 string Text alternative for the resource
Max Length:200
... priority Σ 1..1 DP_CodeableConcept Desired processing ugency
Binding: ProcessPriorityCodes (required)
... fundsReserve S 0..1 DP_CodeableConcept For whom to reserve funds
Binding: Funds Reservation Codes (required)
... related S 0..* BackboneElement Prior or corollary claims
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... claim 1..1 DP_Reference_1or3a(Nphies Authorization Pharmacy) Reference to the related claim
.... relationship 1..1 DP_CodeableConcept How the reference claim is related
Binding: Related Claim Relationship (required)
.... reference 0..1 Identifier File or case reference
... prescription S 0..1 DP_Reference_4(DeviceRequest | Nphies MedicationRequest) Prescription authorizing services and products
... originalPrescription S 0..1 DP_Reference_3a(DeviceRequest | Nphies MedicationRequest) Original prescription if superseded by fulfiller
... payee C 1..1 BackboneElement Recipient of benefits payable
Constraints: BV-00056, BV-00494
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... type 1..1 DP_CodeableConcept Category of recipient
Binding: Claim Payee Type Codes (required)
.... party S 0..1 DP_Reference_1or2b(Nphies Organization | Nphies Patient) Recipient reference
... referral S 0..1 DP_Reference_3a(ServiceRequest) Treatment referral
... facility S 0..1 DP_Reference_1(Nphies Location) Servicing facility
... careTeam 0..* BackboneElement Members of the care team
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... sequence 1..1 DP_positiveInt Order of care team
.... provider 1..1 Reference(Nphies Practitioner) Practitioner or organization
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
..... reference ΣC 0..1 string Literal reference, Relative, internal or absolute URL
..... type Σ 0..1 uri Type the reference refers to (e.g. "Patient")
Binding: ResourceType (extensible): Aa resource (or, for logical models, the URI of the logical model).
..... identifier Σ 0..1 Identifier Logical reference, when literal reference is not known
...... id 0..1 string Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
...... use ?!Σ 0..1 code usual | official | temp | secondary | old (If known)
Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .
...... type Σ 0..1 CodeableConcept Description of identifier
Binding: Practitioner Identifier (required)
...... system Σ 0..1 uri The namespace for the identifier value
Example General: http://www.acme.com/identifiers/patient
...... value Σ 0..1 string The value that is unique
Example General: 123456
...... period Σ 0..1 Period Time period when id is/was valid for use
...... assigner Σ 0..1 Reference(Organization) Organization that issued id (may be just text)
..... display Σ 0..1 string Text alternative for the resource
.... responsible 0..1 boolean Indicator of the lead practitioner
.... role 1..1 DP_CodeableConcept Function within the team
Binding: ClaimCareTeamRoleCodes (required)
.... qualification 1..1 DP_CodeableConcept Practitioner credential or specialization
Binding: Practice Codes (required)
... Slices for supportingInfo SC 0..* BackboneElement Supporting information
Slice: Unordered, Closed by value:category
Constraints: BV-00316, BV-00530, BV-00782, BV-00783, BV-00784, BV-00785, BV-00531
.... supportingInfo:All Slices Content/Rules for all slices
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... sequence 1..1 DP_positiveInt Information instance identifier
..... category 1..1 DP_CodeableConcept Classification of the supplied information
Binding: Claim Information Category (required)
..... code 0..1 CodeableConcept Type of information
Binding: ExceptionCodes (example): The valuset used for additional information codes.
..... timing[x] 0..1 When it occurred
...... timingDate date
...... timingPeriod Period
..... value[x] 0..1 Data to be provided
...... valueBoolean boolean
...... valueString string
...... valueQuantity Quantity
...... valueAttachment Attachment
...... valueReference Reference(Resource)
..... reason 0..1 CodeableConcept Explanation for the information
Binding: MissingToothReasonCodes (example): Reason codes for the missing teeth.
.... supportingInfo:attachment SC 0..* BackboneElement Attachment
Constraints: BV-00316, BV-00530, BV-00782, BV-00783, BV-00784, BV-00785, BV-00531, BV-00404
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... sequence 1..1 DP_positiveInt Information instance identifier
..... category 1..1 DP_CodeableConcept Classification of the supplied information
Binding: Claim Information Category (required)
Required Pattern: At least the following
...... id 0..1 string Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
...... coding 1..* Coding Code defined by a terminology system
Fixed Value: (complex)
....... id 0..1 string Unique id for inter-element referencing
....... extension 0..* Extension Additional content defined by implementations
....... system 1..1 uri Identity of the terminology system
Fixed Value: http://nphies.sa/terminology/CodeSystem/claim-information-category
....... version 0..1 string Version of the system - if relevant
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: attachment
....... display 0..1 string Representation defined by the system
....... userSelected 0..1 boolean If this coding was chosen directly by the user
...... text 0..1 string Plain text representation of the concept
..... code 0..1 CodeableConcept Type of information
Binding: ExceptionCodes (example): The valuset used for additional information codes.
..... timing[x] 0..1 When it occurred
...... timingDate date
...... timingPeriod Period
..... value[x] 1..1 DP_Attachment Data to be provided
..... reason 0..1 CodeableConcept Explanation for the information
Binding: MissingToothReasonCodes (example): Reason codes for the missing teeth.
.... supportingInfo:daysSupply SC 0..* BackboneElement Days Supply
Constraints: BV-00316, BV-00530, BV-00782, BV-00783, BV-00784, BV-00785, BV-00531, BV-00413
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... sequence 1..1 DP_positiveInt Information instance identifier
..... category 1..1 DP_CodeableConcept Classification of the supplied information
Binding: Claim Information Category (required)
Required Pattern: At least the following
...... id 0..1 string Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
...... coding 1..* Coding Code defined by a terminology system
Fixed Value: (complex)
....... id 0..1 string Unique id for inter-element referencing
....... extension 0..* Extension Additional content defined by implementations
....... system 1..1 uri Identity of the terminology system
Fixed Value: http://nphies.sa/terminology/CodeSystem/claim-information-category
....... version 0..1 string Version of the system - if relevant
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: days-supply
....... display 0..1 string Representation defined by the system
....... userSelected 0..1 boolean If this coding was chosen directly by the user
...... text 0..1 string Plain text representation of the concept
..... code 0..1 CodeableConcept Type of information
Binding: ExceptionCodes (example): The valuset used for additional information codes.
..... timing[x] 0..1 When it occurred
...... timingDate date
...... timingPeriod Period
..... Slices for value[x] 1..1 Data to be provided
Slice: Unordered, Open by type:$this
...... valueBoolean boolean
...... valueString string
...... valueQuantity Quantity
...... valueAttachment Attachment
...... valueReference Reference(Resource)
...... value[x]:valueQuantity 0..1 DP_Quantity_2 Data to be provided
Required Pattern: At least the following
....... id 0..1 string Unique id for inter-element referencing
....... extension 0..* Extension Additional content defined by implementations
....... value 0..1 decimal Numerical value (with implicit precision)
....... comparator 0..1 code < | <= | >= | > - how to understand the value
....... unit 0..1 string Unit representation
....... system 1..1 uri System that defines coded unit form
Fixed Value: http://unitsofmeasure.org
....... code 1..1 code Coded form of the unit
Fixed Value: d
....... id 0..1 string Unique id for inter-element referencing
....... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
....... value Σ 1..1 DP_decimal Numerical value (with implicit precision)
....... comparator ?!Σ 0..1 code < | <= | >= | > - how to understand the value
Binding: QuantityComparator (required): How the Quantity should be understood and represented.
....... unit Σ 0..1 string Unit representation
Max Length:40
....... system ΣC 1..1 DP_uri System that defines coded unit form
....... code Σ 1..1 DP_code Coded form of the unit
..... reason 0..1 CodeableConcept Explanation for the information
Binding: MissingToothReasonCodes (example): Reason codes for the missing teeth.
.... supportingInfo:info SC 0..1 BackboneElement Information
Constraints: BV-00316, BV-00530, BV-00782, BV-00783, BV-00784, BV-00785, BV-00531, BV-00402
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... sequence 1..1 DP_positiveInt Information instance identifier
..... category 1..1 DP_CodeableConcept Classification of the supplied information
Binding: Claim Information Category (required)
Required Pattern: At least the following
...... id 0..1 string Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
...... coding 1..* Coding Code defined by a terminology system
Fixed Value: (complex)
....... id 0..1 string Unique id for inter-element referencing
....... extension 0..* Extension Additional content defined by implementations
....... system 1..1 uri Identity of the terminology system
Fixed Value: http://nphies.sa/terminology/CodeSystem/claim-information-category
....... version 0..1 string Version of the system - if relevant
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: info
....... display 0..1 string Representation defined by the system
....... userSelected 0..1 boolean If this coding was chosen directly by the user
...... text 0..1 string Plain text representation of the concept
..... code 0..1 CodeableConcept Type of information
Binding: ExceptionCodes (example): The valuset used for additional information codes.
..... timing[x] 0..1 When it occurred
...... timingDate date
...... timingPeriod Period
..... value[x] 1..1 DP_string Data to be provided
..... reason 0..1 CodeableConcept Explanation for the information
Binding: MissingToothReasonCodes (example): Reason codes for the missing teeth.
.... supportingInfo:labTest SC 0..* BackboneElement Lab Test
Constraints: BV-00316, BV-00530, BV-00782, BV-00783, BV-00784, BV-00785, BV-00531, BV-00410, BV-00411
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... sequence 1..1 DP_positiveInt Information instance identifier
..... category 1..1 DP_CodeableConcept Classification of the supplied information
Binding: Claim Information Category (required)
Required Pattern: At least the following
...... id 0..1 string Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
...... coding 1..* Coding Code defined by a terminology system
Fixed Value: (complex)
....... id 0..1 string Unique id for inter-element referencing
....... extension 0..* Extension Additional content defined by implementations
....... system 1..1 uri Identity of the terminology system
Fixed Value: http://nphies.sa/terminology/CodeSystem/claim-information-category
....... version 0..1 string Version of the system - if relevant
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: lab-test
....... display 0..1 string Representation defined by the system
....... userSelected 0..1 boolean If this coding was chosen directly by the user
...... text 0..1 string Plain text representation of the concept
..... code 1..1 DP_CodeableConcept Type of information
Binding: LOINCCodes (required)
..... Slices for timing[x] 1..1 Period When it occurred
Slice: Unordered, Closed by type:$this
...... timing[x]:timingPeriod 1..1 DP_Period_3 When it occurred
..... value[x] 1..1 DP_Quantity_2 Data to be provided
...... id 0..1 string Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
...... value Σ 1..1 DP_decimal Numerical value (with implicit precision)
...... comparator ?!Σ 0..1 code < | <= | >= | > - how to understand the value
Binding: QuantityComparator (required): How the Quantity should be understood and represented.
...... unit Σ 0..1 string Unit representation
Max Length:40
...... system ΣC 1..1 DP_uri System that defines coded unit form
Required Pattern: http://unitsofmeasure.org
...... code Σ 1..1 DP_code Coded form of the unit
..... reason 0..1 CodeableConcept Explanation for the information
Binding: MissingToothReasonCodes (example): Reason codes for the missing teeth.
... diagnosis 1..* BackboneElement Pertinent diagnosis information
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... sequence 1..1 DP_positiveInt Diagnosis instance identifier
.... Slices for diagnosis[x] 1..1 CodeableConcept Nature of illness or problem
Slice: Unordered, Closed by type:$this
Binding: ICD-10Codes (example): Example ICD10 Diagnostic codes.
..... diagnosis[x]:diagnosisCodeableConcept 1..1 DP_CodeableConcept Nature of illness or problem
Binding: ICD-10-AM (required)
.... type 1..1 DP_CodeableConcept Timing or nature of the diagnosis
Binding: Diagnosis Type (required)
.... onAdmission 0..1 CodeableConcept Present on admission
Binding: ExampleDiagnosisOnAdmissionCodes (example): Present on admission.
.... packageCode 0..1 CodeableConcept Package billing code
Binding: ExampleDiagnosisRelatedGroupCodes (example): The DRG codes associated with the diagnosis.
... procedure 0..* BackboneElement Clinical procedures performed
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... sequence 1..1 positiveInt Procedure instance identifier
.... type 0..* CodeableConcept Category of Procedure
Binding: ExampleProcedureTypeCodes (example): Example procedure type codes.
.... date 0..1 dateTime When the procedure was performed
.... procedure[x] 1..1 Specific clinical procedure
Binding: ICD-10ProcedureCodes (example): Example ICD10 Procedure codes.
..... procedureCodeableConcept CodeableConcept
..... procedureReference Reference(Procedure)
.... udi 0..* Reference(Device) Unique device identifier
... insurance Σ 1..* BackboneElement Patient insurance information
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... sequence Σ 1..1 DP_positiveInt Insurance instance identifier
.... focal Σ 1..1 boolean Coverage to be used for adjudication
.... identifier 0..1 Identifier Pre-assigned Claim number
.... coverage Σ 1..1 DP_Reference_1(Nphies Coverage) Insurance information
.... businessArrangement 0..1 string Additional provider contract number
.... preAuthRef S 0..* string Prior authorization reference number
.... claimResponse S 0..1 DP_Reference_1or3a(Nphies Authorization Response) Adjudication results
... accident S 0..1 BackboneElement Details of the event
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... date 1..1 DP_date When the incident occurred
.... type 1..1 DP_CodeableConcept The nature of the accident
Binding: ActIncidentCode (required)
.... Slices for location[x] 0..1 Where the event occurred
Slice: Unordered, Open by type:$this
..... locationAddress Address
..... locationReference Reference(Location)
..... location[x]:locationAddress S 0..1 DP_Address Where the event occurred
... item C 1..* BackboneElement Product or service provided
Constraints: BV-00036, BV-00042, BV-00123, BV-00439, BV-00482, BV-00484, BV-00502
.... id 0..1 string Unique id for inter-element referencing
.... Slices for extension S 1..* Extension Extension
Slice: Unordered, Open by value:url
..... extension:package S 0..1 boolean Package Code
URL: http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-package
..... extension:tax S 0..1 DP_Money_SAR Tax
URL: http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-tax
..... extension:patientShare S 0..1 DP_Money_SAR Patient Share
URL: http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-patient-share
..... extension:payerShare S 0..1 DP_Money_SAR Payer Share
URL: http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-payer-share
..... extension:prescribedMedication S 0..1 DP_CodeableConcept Prescribed Medication
URL: http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-prescribed-Medication
Binding: Prescriber Billing (required)
..... extension:pharmacistSelectionReason S 0..1 DP_CodeableConcept Pharmacist Selection Reason
URL: http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-pharmacist-Selection-Reason
Binding: Pharmacist Selection Reason (required)
..... extension:pharmacistSubstitute S 0..1 DP_CodeableConcept Pharmacist Substitute
URL: http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-pharmacist-substitute
Binding: Pharmacist Substitute (required)
..... extension:maternity S 1..1 boolean Maternity
URL: http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-maternity
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... sequence 1..1 DP_positiveInt Item instance identifier
.... careTeamSequence 0..* positiveInt Applicable careTeam members
.... diagnosisSequence S 0..* DP_positiveInt Applicable diagnoses
.... procedureSequence 0..* positiveInt Applicable procedures
.... informationSequence S 0..* DP_positiveInt Applicable exception and supporting information
.... revenue 0..1 CodeableConcept Revenue or cost center code
Binding: ExampleRevenueCenterCodes (example): Codes for the revenue or cost centers supplying the service and/or products.
.... category 0..1 CodeableConcept Benefit classification
Binding: BenefitCategoryCodes (example): Benefit categories such as: oral-basic, major, glasses.
.... productOrService 1..1 DP_CodeableConcept_2 Billing, service, product, or drug code
Binding: Pharmacy Billing (required)
.... modifier 0..* CodeableConcept Product or service billing modifiers
Binding: ModifierTypeCodes (example): Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen.
.... programCode 0..* CodeableConcept Program the product or service is provided under
Binding: ExampleProgramReasonCodes (example): Program specific reason codes.
.... Slices for serviced[x] 1..1 Date or dates of service or product delivery
Slice: Unordered, Closed by type:$this
..... servicedDate date
..... servicedPeriod Period
..... serviced[x]:servicedDate S 0..1 DP_date Date or dates of service or product delivery
..... serviced[x]:servicedPeriod S 0..1 DP_Period_2 Date or dates of service or product delivery
.... location[x] 0..1 Place of service or where product was supplied
Binding: ExampleServicePlaceCodes (example): Place of service: pharmacy, school, prison, etc.
..... locationCodeableConcept CodeableConcept
..... locationAddress Address
..... locationReference Reference(Location)
.... quantity 1..1 DP_SimpleQuantity_1 Count of products or services
.... unitPrice C 1..1 DP_Money_SAR Fee, charge or cost per item
Constraints: BV-00092
.... factor S 0..1 DP_decimal Price scaling factor
.... net C 1..1 DP_Money_SAR Total item cost
Constraints: BV-00093
.... udi S 0..* DP_Reference_1or3a(Device) Unique device identifier
.... bodySite S 0..1 DP_CodeableConcept Anatomical location
Binding: SNOMEDCTBodyStructures (required)
.... subSite S 0..1 DP_CodeableConcept Anatomical sub-location
Binding: Sub Site (required)
.... encounter 0..* Reference(Encounter) Encounters related to this billed item
.... detail SC 0..* BackboneElement Product or service provided
Constraints: BV-00043
..... id 0..1 string Unique id for inter-element referencing
..... Slices for extension 0..* Extension Extension
Slice: Unordered, Open by value:url
...... extension:tax S 0..1 DP_Money_SAR Tax
URL: http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-tax
...... extension:prescribedMedication S 0..1 DP_CodeableConcept Prescribed Medication
URL: http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-prescribed-Medication
Binding: Prescriber Billing (required)
...... extension:pharmacistSelectionReason S 0..1 DP_CodeableConcept Pharmacist Selection Reason
URL: http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-pharmacist-Selection-Reason
Binding: Pharmacist Selection Reason (required)
...... extension:pharmacistSubstitute S 0..1 DP_CodeableConcept Pharmacist Substitute
URL: http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-pharmacist-substitute
Binding: Pharmacist Substitute (required)
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... sequence 1..1 DP_positiveInt Item instance identifier
..... revenue 0..1 CodeableConcept Revenue or cost center code
Binding: ExampleRevenueCenterCodes (example): Codes for the revenue or cost centers supplying the service and/or products.
..... category 0..1 CodeableConcept Benefit classification
Binding: BenefitCategoryCodes (example): Benefit categories such as: oral-basic, major, glasses.
..... productOrService 1..1 DP_CodeableConcept_2 Billing, service, product, or drug code
Binding: Pharmacy Billing (required)
..... modifier 0..* CodeableConcept Service/Product billing modifiers
Binding: ModifierTypeCodes (example): Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen.
..... programCode 0..* CodeableConcept Program the product or service is provided under
Binding: ExampleProgramReasonCodes (example): Program specific reason codes.
..... quantity 1..1 DP_SimpleQuantity_1 Count of products or services
..... unitPrice C 1..1 DP_Money_SAR Fee, charge or cost per item
Constraints: BV-00094
..... factor S 0..1 DP_decimal Price scaling factor
..... net C 1..1 DP_Money_SAR Total item cost
Constraints: BV-00095
..... udi S 0..* DP_Reference_1or3a(Device) Unique device identifier
..... subDetail S 0..* BackboneElement Product or service provided
...... id 0..1 string Unique id for inter-element referencing
...... Slices for extension 0..* Extension Extension
Slice: Unordered, Open by value:url
....... extension:tax S 0..1 DP_Money_SAR Tax
URL: http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-tax
...... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
...... sequence 1..1 DP_positiveInt Item instance identifier
...... revenue 0..1 CodeableConcept Revenue or cost center code
Binding: ExampleRevenueCenterCodes (example): Codes for the revenue or cost centers supplying the service and/or products.
...... category 0..1 CodeableConcept Benefit classification
Binding: BenefitCategoryCodes (example): Benefit categories such as: oral-basic, major, glasses.
...... productOrService 1..1 DP_CodeableConcept_2 Billing, service, product, or drug code
Binding: Pharmacy Billing (required)
...... modifier 0..* CodeableConcept Service/Product billing modifiers
Binding: ModifierTypeCodes (example): Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen.
...... programCode 0..* CodeableConcept Program the product or service is provided under
Binding: ExampleProgramReasonCodes (example): Program specific reason codes.
...... quantity 1..1 DP_SimpleQuantity_1 Count of products or services
...... unitPrice 1..1 DP_Money_SAR Fee, charge or cost per item
...... factor S 0..1 DP_decimal Price scaling factor
...... net 1..1 DP_Money_SAR Total item cost
...... udi S 0..* DP_Reference_1or3a(Device) Unique device identifier
... total C 1..1 DP_Money_SAR Total claim cost
Constraints: BV-00096

doco Documentation for this format

Terminology Bindings

PathConformanceValueSet / CodeURI
Claim.meta.securityextensibleAll Security Labels
http://hl7.org/fhir/ValueSet/security-labels
From the FHIR Standard
Claim.meta.tagexampleCommonTags
http://hl7.org/fhir/ValueSet/common-tags
From the FHIR Standard
Claim.languagepreferredCommonLanguages
http://hl7.org/fhir/ValueSet/languages
From the FHIR Standard
Additional Bindings Purpose
AllLanguages Max Binding
Claim.statusrequiredPattern Value: active
http://hl7.org/fhir/ValueSet/fm-status|4.0.1
From the FHIR Standard
Claim.typerequiredPattern Value: pharmacy
http://nphies.sa/terminology/ValueSet/claim-type
From this IG
Claim.subTyperequiredPattern Value: op
http://nphies.sa/terminology/ValueSet/claim-subtype
From this IG
Claim.userequiredPattern Value: preauthorization
http://hl7.org/fhir/ValueSet/claim-use|4.0.1
From the FHIR Standard
Claim.patient.typeextensibleResourceType
http://hl7.org/fhir/ValueSet/resource-types
From the FHIR Standard
Claim.patient.identifier.userequiredIdentifierUse
http://hl7.org/fhir/ValueSet/identifier-use|4.0.1
From the FHIR Standard
Claim.patient.identifier.typerequiredPatientIdentifierType
http://nphies.sa/terminology/ValueSet/patient-identifier-type
From this IG
Claim.insurer.typeextensibleResourceType
http://hl7.org/fhir/ValueSet/resource-types
From the FHIR Standard
Claim.insurer.identifier.userequiredIdentifierUse
http://hl7.org/fhir/ValueSet/identifier-use|4.0.1
From the FHIR Standard
Claim.insurer.identifier.typeextensiblePattern Value: NII
http://hl7.org/fhir/ValueSet/identifier-type
From the FHIR Standard
Claim.provider.typeextensibleResourceType
http://hl7.org/fhir/ValueSet/resource-types
From the FHIR Standard
Claim.provider.identifier.userequiredIdentifierUse
http://hl7.org/fhir/ValueSet/identifier-use|4.0.1
From the FHIR Standard
Claim.provider.identifier.typeextensiblePattern Value: PRN
http://hl7.org/fhir/ValueSet/identifier-type
From the FHIR Standard
Claim.priorityrequiredProcessPriorityCodes
http://hl7.org/fhir/ValueSet/process-priority
From the FHIR Standard
Claim.fundsReserverequiredFunds Reservation Codes
http://hl7.org/fhir/ValueSet/fundsreserve
From the FHIR Standard
Claim.related.relationshiprequiredRelatedClaimRelationship(a valid code from Related Claim Relationship)
http://nphies.sa/terminology/ValueSet/related-claim-relationship
From this IG
Claim.payee.typerequiredClaim Payee Type Codes
http://hl7.org/fhir/ValueSet/payeetype
From the FHIR Standard
Claim.careTeam.provider.typeextensibleResourceType
http://hl7.org/fhir/ValueSet/resource-types
From the FHIR Standard
Claim.careTeam.provider.identifier.userequiredIdentifierUse
http://hl7.org/fhir/ValueSet/identifier-use|4.0.1
From the FHIR Standard
Claim.careTeam.provider.identifier.typerequiredPractitionerIdentifier
http://nphies.sa/terminology/ValueSet/practitioner-identifier-type
From this IG
Claim.careTeam.rolerequiredClaimCareTeamRoleCodes
http://hl7.org/fhir/ValueSet/claim-careteamrole
From the FHIR Standard
Claim.careTeam.qualificationrequiredPracticeCodes
http://nphies.sa/terminology/ValueSet/practice-codes
From this IG
Claim.supportingInfo.categoryrequiredClaimInformationCategory(a valid code from Claim Information Category)
http://nphies.sa/terminology/ValueSet/claim-information-category
From this IG
Claim.supportingInfo.codeexampleExceptionCodes
http://hl7.org/fhir/ValueSet/claim-exception
From the FHIR Standard
Claim.supportingInfo.reasonexampleMissingToothReasonCodes
http://hl7.org/fhir/ValueSet/missing-tooth-reason
From the FHIR Standard
Claim.supportingInfo:attachment.categoryrequiredPattern Value: attachment
http://nphies.sa/terminology/ValueSet/claim-information-category
From this IG
Claim.supportingInfo:attachment.codeexampleExceptionCodes
http://hl7.org/fhir/ValueSet/claim-exception
From the FHIR Standard
Claim.supportingInfo:attachment.reasonexampleMissingToothReasonCodes
http://hl7.org/fhir/ValueSet/missing-tooth-reason
From the FHIR Standard
Claim.supportingInfo:daysSupply.categoryrequiredPattern Value: days-supply
http://nphies.sa/terminology/ValueSet/claim-information-category
From this IG
Claim.supportingInfo:daysSupply.codeexampleExceptionCodes
http://hl7.org/fhir/ValueSet/claim-exception
From the FHIR Standard
Claim.supportingInfo:daysSupply.value[x]:valueQuantity.comparatorrequiredQuantityComparator
http://hl7.org/fhir/ValueSet/quantity-comparator|4.0.1
From the FHIR Standard
Claim.supportingInfo:daysSupply.reasonexampleMissingToothReasonCodes
http://hl7.org/fhir/ValueSet/missing-tooth-reason
From the FHIR Standard
Claim.supportingInfo:info.categoryrequiredPattern Value: info
http://nphies.sa/terminology/ValueSet/claim-information-category
From this IG
Claim.supportingInfo:info.codeexampleExceptionCodes
http://hl7.org/fhir/ValueSet/claim-exception
From the FHIR Standard
Claim.supportingInfo:info.reasonexampleMissingToothReasonCodes
http://hl7.org/fhir/ValueSet/missing-tooth-reason
From the FHIR Standard
Claim.supportingInfo:labTest.categoryrequiredPattern Value: lab-test
http://nphies.sa/terminology/ValueSet/claim-information-category
From this IG
Claim.supportingInfo:labTest.coderequiredLOINCCodes(a valid code from LOINC)
http://hl7.org/fhir/ValueSet/observation-codes
From the FHIR Standard
Claim.supportingInfo:labTest.value[x].comparatorrequiredQuantityComparator
http://hl7.org/fhir/ValueSet/quantity-comparator|4.0.1
From the FHIR Standard
Claim.supportingInfo:labTest.reasonexampleMissingToothReasonCodes
http://hl7.org/fhir/ValueSet/missing-tooth-reason
From the FHIR Standard
Claim.diagnosis.diagnosis[x]exampleICD-10Codes
http://hl7.org/fhir/ValueSet/icd-10
From the FHIR Standard
Claim.diagnosis.diagnosis[x]:diagnosisCodeableConceptrequiredICD_10_AM(a valid code from http://hl7.org/fhir/sid/icd-10-am)
http://nphies.sa/terminology/ValueSet/diagnosis-icd-10-am
From this IG
Claim.diagnosis.typerequiredDiagnosisType(a valid code from Diagnosis Type)
http://nphies.sa/terminology/ValueSet/diagnosis-type
From this IG
Claim.diagnosis.onAdmissionexampleExampleDiagnosisOnAdmissionCodes
http://hl7.org/fhir/ValueSet/ex-diagnosis-on-admission
From the FHIR Standard
Claim.diagnosis.packageCodeexampleExampleDiagnosisRelatedGroupCodes
http://hl7.org/fhir/ValueSet/ex-diagnosisrelatedgroup
From the FHIR Standard
Claim.procedure.typeexampleExampleProcedureTypeCodes
http://hl7.org/fhir/ValueSet/ex-procedure-type
From the FHIR Standard
Claim.procedure.procedure[x]exampleICD-10ProcedureCodes
http://hl7.org/fhir/ValueSet/icd-10-procedures
From the FHIR Standard
Claim.accident.typerequiredActIncidentCode
http://terminology.hl7.org/ValueSet/v3-ActIncidentCode
Claim.item.revenueexampleExampleRevenueCenterCodes
http://hl7.org/fhir/ValueSet/ex-revenue-center
From the FHIR Standard
Claim.item.categoryexampleBenefitCategoryCodes
http://hl7.org/fhir/ValueSet/ex-benefitcategory
From the FHIR Standard
Claim.item.productOrServicerequiredPharmacyBilling
http://nphies.sa/terminology/ValueSet/pharmacy-billing
From this IG
Claim.item.modifierexampleModifierTypeCodes
http://hl7.org/fhir/ValueSet/claim-modifiers
From the FHIR Standard
Claim.item.programCodeexampleExampleProgramReasonCodes
http://hl7.org/fhir/ValueSet/ex-program-code
From the FHIR Standard
Claim.item.location[x]exampleExampleServicePlaceCodes
http://hl7.org/fhir/ValueSet/service-place
From the FHIR Standard
Claim.item.bodySiterequiredSNOMEDCTBodyStructures
http://hl7.org/fhir/ValueSet/body-site
From the FHIR Standard
Claim.item.subSiterequiredSubSite(a valid code from Sub Site)
http://nphies.sa/terminology/ValueSet/subsite
From this IG
Claim.item.detail.revenueexampleExampleRevenueCenterCodes
http://hl7.org/fhir/ValueSet/ex-revenue-center
From the FHIR Standard
Claim.item.detail.categoryexampleBenefitCategoryCodes
http://hl7.org/fhir/ValueSet/ex-benefitcategory
From the FHIR Standard
Claim.item.detail.productOrServicerequiredPharmacyBilling
http://nphies.sa/terminology/ValueSet/pharmacy-billing
From this IG
Claim.item.detail.modifierexampleModifierTypeCodes
http://hl7.org/fhir/ValueSet/claim-modifiers
From the FHIR Standard
Claim.item.detail.programCodeexampleExampleProgramReasonCodes
http://hl7.org/fhir/ValueSet/ex-program-code
From the FHIR Standard
Claim.item.detail.subDetail.revenueexampleExampleRevenueCenterCodes
http://hl7.org/fhir/ValueSet/ex-revenue-center
From the FHIR Standard
Claim.item.detail.subDetail.categoryexampleBenefitCategoryCodes
http://hl7.org/fhir/ValueSet/ex-benefitcategory
From the FHIR Standard
Claim.item.detail.subDetail.productOrServicerequiredPharmacyBilling
http://nphies.sa/terminology/ValueSet/pharmacy-billing
From this IG
Claim.item.detail.subDetail.modifierexampleModifierTypeCodes
http://hl7.org/fhir/ValueSet/claim-modifiers
From the FHIR Standard
Claim.item.detail.subDetail.programCodeexampleExampleProgramReasonCodes
http://hl7.org/fhir/ValueSet/ex-program-code
From the FHIR Standard

Constraints

IdGradePath(s)DetailsRequirements
BV-00002errorClaimClaim care team sequence is not unique within the submitted claim resource.
: careTeam.exists() implies careTeam.sequence.isDistinct()
BV-00036errorClaim.itemNo Claim item detail provided when Claim item package = true.
: extension('http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-package').exists() implies extension('http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-package').first().value = true implies detail.exists().not()
BV-00042errorClaim.itemClaim item detail sequence in not unique within the Claim item.
: detail.sequence.exists() implies detail.sequence.isDistinct()
BV-00043errorClaim.item.detailClaim item subDetail sequence in not unique within the Claim item detail.
: subDetail.sequence.exists() implies subDetail.sequence.isDistinct()
BV-00044errorClaimItem sequence value is not unique within the Claim resource.
: item.sequence.exists() implies item.sequence.isDistinct()
BV-00054errorClaimOne and only one principal diagnosis is required.
: diagnosis.type.coding.where(code='principal').count() = 1
BV-00056errorClaim.payeePayee party is not provided when payee type='other'.
: type.coding.where(code='other').count() > 0 implies party.exists()
BV-00057errorClaimDiagnosis is not unique in the submitted request.
: diagnosis.diagnosis.ofType(CodeableConcept).isDistinct()
BV-00092errorClaim.item.unitPriceClaim Item UnitPrice Currency is not SAR.
: currency = 'SAR'
BV-00093errorClaim.item.netClaim Item Net Currency is not SAR.
: currency = 'SAR'
BV-00094errorClaim.item.detail.unitPriceClaim Item Detail UnitPrice Currency is not SAR.
: currency = 'SAR'
BV-00095errorClaim.item.detail.netClaim Item Detail Net Currency is not SAR.
: currency = 'SAR'
BV-00096errorClaim.totalClaim Total Net Currency is not SAR.
: currency = 'SAR'
BV-00123errorClaim.itemClaim servicedate is not using a correct data type.
: serviced.ofType(date).exists() or serviced.ofType(Period).exists()
BV-00137errorClaimThe claim identifier does not exist.
: identifier.exists()
BV-00316errorClaim.supportingInfo, Claim.supportingInfo:attachment, Claim.supportingInfo:daysSupply, Claim.supportingInfo:info, Claim.supportingInfo:labTestClaim supportingInfo valueString value length is longer than the maximum specified length of 250 English characters and 125 Arabic characters.
: value.ofType(string).exists() implies value.ofType(string).length() <= 250
BV-00330errorClaimClaim status is not using the specified value 'active'.
: status.exists() implies status='active'
BV-00347errorClaim.extension:eligibilityOffLineDateClaim eligibility OfflineDate is greater than current date.
: value.ofType(dateTime) <= now()
BV-00368errorClaimClaim subtype is using an incorrect value when Claim type is 'Pharmacy'.
: subType.coding.first().code = 'op'
BV-00402errorClaim.supportingInfo:infoSupporting information 'info' requires textual information in valueString.
: value.ofType(string).exists()
BV-00404errorClaim.supportingInfo:attachmentSupporting information 'attachment' requires the content to be provided.
: value.ofType(Attachment).exists()
BV-00410errorClaim.supportingInfo:labTestSupporting information 'lab-test' requires a valid LOINC code.
: code.exists()
BV-00411errorClaim.supportingInfo:labTestIf supporting information is 'lab-test' then valueQuantity SHALL exist and SHALL use a value specified in the UCUM code-system.
: value.ofType(Quantity).exists()
BV-00413errorClaim.supportingInfo:daysSupplyIf Supporting information is 'days-supply' then valueQuantity SHALL exist and number of days SHALL use UCUM code 'd'.
: value.ofType(Quantity).exists() implies value.ofType(Quantity).code = 'd'
BV-00439errorClaim.itemIf period is provided then Claim.item.servicedDate must not be used.
: serviced.exists() implies (serviced.ofType(date).exists() xor serviced.ofType(Period).exists())
BV-00453errorClaimClaim supportingInfo sequence value is not unique within the claim request.
: supportingInfo.sequence.exists() implies supportingInfo.sequence.isDistinct()
BV-00454errorClaimClaim diagnosis sequence value is not unique within the claim request.
: diagnosis.sequence.isDistinct()
BV-00482errorClaim.itemItem factor must be a positive decimal value.
: factor.exists() implies factor >= 0
BV-00484errorClaim.itemThe subSite shall not be allowed if the bodySite is not provided.
: subSite.exists() implies bodySite.exists()
BV-00494errorClaim.payeeClaim payee party must not provided when Claim payee type value is not 'other'.
: type.coding.where(code!='other').count() > 0 implies party.exists().not()
BV-00502errorClaim.itemClaim item informationSequence is not unique within the Claim item.
: informationSequence.isDistinct()
BV-00530errorClaim.supportingInfo, Claim.supportingInfo:attachment, Claim.supportingInfo:daysSupply, Claim.supportingInfo:info, Claim.supportingInfo:labTestIf supportingInfo code element is provided and the category is not 'chief-complaint' then a code is required.
: (code.exists() and category.coding.first().code != 'chief-complaint') implies code.coding.code.exists()
BV-00531errorClaim.supportingInfo, Claim.supportingInfo:attachment, Claim.supportingInfo:daysSupply, Claim.supportingInfo:info, Claim.supportingInfo:labTestThe supportingInfo code element is required if supportingInfo category is 'chief-complaint'.
: category.exists() implies (category.coding.first().code = 'chief-complaint') implies code.exists()
BV-00782errorClaim.supportingInfo, Claim.supportingInfo:attachment, Claim.supportingInfo:daysSupply, Claim.supportingInfo:info, Claim.supportingInfo:labTestSupporting information 'treatment-plan' requires textual information.
: category.coding.where(code='treatment-plan').count() > 0 implies value.ofType(string).exists()
BV-00783errorClaim.supportingInfo, Claim.supportingInfo:attachment, Claim.supportingInfo:daysSupply, Claim.supportingInfo:info, Claim.supportingInfo:labTestSupporting information 'patient-history' requires textual information.
: category.coding.where(code='patient-history').count() > 0 implies value.ofType(string).exists()
BV-00784errorClaim.supportingInfo, Claim.supportingInfo:attachment, Claim.supportingInfo:daysSupply, Claim.supportingInfo:info, Claim.supportingInfo:labTestSupporting information 'physical-examination' requires textual information .
: category.coding.where(code='physical-examination').count() > 0 implies value.ofType(string).exists()
BV-00785errorClaim.supportingInfo, Claim.supportingInfo:attachment, Claim.supportingInfo:daysSupply, Claim.supportingInfo:info, Claim.supportingInfo:labTestSupporting information 'history-of-present-illness' requires textual information .
: category.coding.where(code='history-of-present-illness').count() > 0 implies value.ofType(string).exists()
dom-2errorClaimIf the resource is contained in another resource, it SHALL NOT contain nested Resources
: contained.contained.empty()
dom-3errorClaimIf the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource
: contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
dom-4errorClaimIf a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated
: contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
dom-5errorClaimIf a resource is contained in another resource, it SHALL NOT have a security label
: contained.meta.security.empty()
dom-6best practiceClaimA resource should have narrative for robust management
: text.`div`.exists()
ele-1error**ALL** elementsAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ext-1error**ALL** extensionsMust have either extensions or value[x], not both
: extension.exists() != value.exists()

This structure is derived from NphiesAuthorizationBase

Summary

Mandatory: 2 elements(8 nested mandatory elements)
Must-Support: 9 elements

Structures

This structure refers to these other structures:

Extensions

This structure refers to these extensions:

Slices

This structure defines the following Slices:

  • The element 1 is sliced based on the value of Claim.supportingInfo (Closed)
  • The element 1 is sliced based on the value of Claim.supportingInfo.value[x]
  • The element 1 is sliced based on the value of Claim.supportingInfo.timing[x]

 

Other representations of profile: CSV, Excel, Schematron