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

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Resource Profile: Nphies Claim Vision

Nphies Vision Claim Profile

Usages:

• Refer to this Profile: Nphies Payment Reconciliation and Nphies Claim Vision
• Examples for this Profile: Claim/123773

Formal Views of Profile Content

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

• Key Elements Table
• Differential Table
• Snapshot Table
• Statistics/References
• All

Name	Flags	Card.	Type	Description & Constraints    Filter: Bindings Constraints Obligations
Claim	C	0..*	NphiesClaimBase	Claim, Pre-determination or Pre-authorization Constraints: BV-00002, BV-00027, BV-00044, BV-00054, BV-00057, BV-00137, BV-00330, BV-00453, BV-00454, BV-00492, BV-00508, BV-00367
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		1..*	Extension	Extension Slice: Unordered, Open by value:url
extension:batch-identifier	S	0..1	DP_Identifier_A	Claim Batch Identifier URL: http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-batch-identifier
extension:batch-number	S	0..1	DP_positiveInt	Claim Batch Number URL: http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-batch-number
extension:batch-period	S	0..1	DP_Period_2	Claim Batch Period URL: http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-batch-period
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:authorizationOffLineDate	SC	0..1	DP_dateTime	Authorization Offline Date URL: http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-authorization-offline-date Constraints: BV-00348
extension:priorauthResponse	S	0..1	DP_Reference_3a(Nphies Authorization Response | Nphies Advanced Authorization)	Prior Authorization Response URL: http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-priorauthresponse
extension:newborn	S	0..1	boolean	Newborn URL: http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-newborn
extension:episode	S	1..1	DP_Identifier_A	Episode URL: http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-episode
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 (Claim))	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: vision
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: claim
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)
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 Claim Vision)	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_1or4(Nphies VisionPrescription)	Prescription authorizing services and products
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
careTeam		1..*	BackboneElement	Members of the care team
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
sequence		1..1	DP_positiveInt	Order of care team
provider		1..1	DP_Reference_1or2a(Nphies Practitioner)	Practitioner or organization
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
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:info	SC	0..*	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
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:$this Binding: ICD-10Codes (example): Example ICD10 Diagnostic codes.
diagnosis[x]:diagnosisCodeableConcept		1..1	DP_CodeableConcept	Nature of illness or problem Binding: ICD-10-AM (required)
type		1..1	DP_CodeableConcept	Timing or nature of the diagnosis Binding: Diagnosis Type (required)
insurance	Σ	1..*	BackboneElement	Patient insurance information
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
sequence	Σ	1..1	DP_positiveInt	Insurance instance identifier
focal	Σ	1..1	boolean	Coverage to be used for adjudication
coverage	Σ	1..1	DP_Reference_1(Nphies Coverage)	Insurance information
preAuthRef	S	0..*	string	Prior authorization reference number
claimResponse	S	0..1	DP_Reference_1or3a(Nphies Claim Response)	Adjudication results
accident	S	0..1	BackboneElement	Details of the event
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
date		1..1	DP_date	When the incident occurred
type		1..1	DP_CodeableConcept	The nature of the accident Binding: ActIncidentCode (required)
Slices for location[x]		0..1		Where the event occurred Slice: Unordered, Open by type:$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-00066, BV-00122, BV-00439, BV-00482, BV-00484, BV-00502
Slices for extension	S	2..*	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		1..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:patientInvoice		1..1	DP_Identifier_A	Patient Invoice URL: http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-patientInvoice
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
sequence		1..1	DP_positiveInt	Item instance identifier
careTeamSequence		1..*	positiveInt	Applicable careTeam members
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: Vision 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
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: Vision 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: Vision 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
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet / Code	URI
Claim.status	required	Pattern Value: active http://hl7.org/fhir/ValueSet/fm-status|4.0.1 From the FHIR Standard
Claim.type	required	Pattern Value: vision http://nphies.sa/terminology/ValueSet/claim-type From this IG
Claim.subType	required	Pattern Value: op http://nphies.sa/terminology/ValueSet/claim-subtype From this IG
Claim.use	required	Pattern Value: claim http://hl7.org/fhir/ValueSet/claim-use|4.0.1 From the FHIR Standard
Claim.patient.identifier.use	required	IdentifierUse http://hl7.org/fhir/ValueSet/identifier-use|4.0.1 From the FHIR Standard
Claim.patient.identifier.type	required	PatientIdentifierType http://nphies.sa/terminology/ValueSet/patient-identifier-type From this IG
Claim.insurer.identifier.use	required	IdentifierUse http://hl7.org/fhir/ValueSet/identifier-use|4.0.1 From the FHIR Standard
Claim.insurer.identifier.type	extensible	Pattern Value: NII http://hl7.org/fhir/ValueSet/identifier-type From the FHIR Standard
Claim.provider.identifier.use	required	IdentifierUse http://hl7.org/fhir/ValueSet/identifier-use|4.0.1 From the FHIR Standard
Claim.provider.identifier.type	extensible	Pattern Value: PRN http://hl7.org/fhir/ValueSet/identifier-type From the FHIR Standard
Claim.priority	required	ProcessPriorityCodes http://hl7.org/fhir/ValueSet/process-priority From the FHIR Standard
Claim.related.relationship	required	RelatedClaimRelationship(a valid code from Related Claim Relationship) http://nphies.sa/terminology/ValueSet/related-claim-relationship From this IG
Claim.payee.type	required	Claim Payee Type Codes http://hl7.org/fhir/ValueSet/payeetype From the FHIR Standard
Claim.careTeam.role	required	ClaimCareTeamRoleCodes http://hl7.org/fhir/ValueSet/claim-careteamrole From the FHIR Standard
Claim.careTeam.qualification	required	PracticeCodes http://nphies.sa/terminology/ValueSet/practice-codes From this IG
Claim.supportingInfo.category	required	ClaimInformationCategory(a valid code from Claim Information Category) http://nphies.sa/terminology/ValueSet/claim-information-category From this IG
Claim.supportingInfo:attachment.category	required	Pattern Value: attachment http://nphies.sa/terminology/ValueSet/claim-information-category From this IG
Claim.supportingInfo:info.category	required	Pattern Value: info http://nphies.sa/terminology/ValueSet/claim-information-category From this IG
Claim.diagnosis.diagnosis[x]	example	ICD-10Codes http://hl7.org/fhir/ValueSet/icd-10 From the FHIR Standard
Claim.diagnosis.diagnosis[x]:diagnosisCodeableConcept	required	ICD_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.type	required	DiagnosisType(a valid code from Diagnosis Type) http://nphies.sa/terminology/ValueSet/diagnosis-type From this IG
Claim.accident.type	required	ActIncidentCode http://terminology.hl7.org/ValueSet/v3-ActIncidentCode
Claim.item.productOrService	required	VisionBilling http://nphies.sa/terminology/ValueSet/vision-billing From this IG
Claim.item.bodySite	required	SNOMEDCTBodyStructures http://hl7.org/fhir/ValueSet/body-site From the FHIR Standard
Claim.item.subSite	required	SubSite(a valid code from Sub Site) http://nphies.sa/terminology/ValueSet/subsite From this IG
Claim.item.detail.productOrService	required	VisionBilling http://nphies.sa/terminology/ValueSet/vision-billing From this IG
Claim.item.detail.subDetail.productOrService	required	VisionBilling http://nphies.sa/terminology/ValueSet/vision-billing From this IG

Constraints

Id	Grade	Path(s)	Details	Requirements
BV-00002	error	Claim	Claim care team sequence is not unique within the submitted claim resource. : careTeam.exists() implies careTeam.sequence.isDistinct()
BV-00027	error	Claim	Claim diagnosis onAdmission is required for institutional claim type but is not to be used for non-institutional claim type. : iif(type.coding.first().code = 'institutional', diagnosis.onAdmission.exists(), diagnosis.onAdmission.exists().not())
BV-00036	error	Claim.item	No 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-00042	error	Claim.item	Claim item detail sequence in not unique within the Claim item. : detail.sequence.exists() implies detail.sequence.isDistinct()
BV-00043	error	Claim.item.detail	Claim item subDetail sequence in not unique within the Claim item detail. : subDetail.sequence.exists() implies subDetail.sequence.isDistinct()
BV-00044	error	Claim	Item sequence value is not unique within the Claim resource. : item.sequence.exists() implies item.sequence.isDistinct()
BV-00054	error	Claim	One and only one principal diagnosis is required. : diagnosis.type.coding.where(code='principal').count() = 1
BV-00056	error	Claim.payee	Payee party is not provided when payee type='other'. : type.coding.where(code='other').count() > 0 implies party.exists()
BV-00057	error	Claim	Diagnosis is not unique in the submitted request. : diagnosis.diagnosis.ofType(CodeableConcept).isDistinct()
BV-00066	error	Claim.item	Either item serviced date or item serviced period must be provided. : serviced.exists()
BV-00092	error	Claim.item.unitPrice	Claim Item UnitPrice Currency is not SAR. : currency = 'SAR'
BV-00093	error	Claim.item.net	Claim Item Net Currency is not SAR. : currency = 'SAR'
BV-00094	error	Claim.item.detail.unitPrice	Claim Item Detail UnitPrice Currency is not SAR. : currency = 'SAR'
BV-00095	error	Claim.item.detail.net	Claim Item Detail Net Currency is not SAR. : currency = 'SAR'
BV-00096	error	Claim.total	Claim Total Net Currency is not SAR. : currency = 'SAR'
BV-00122	error	Claim.item	Claim servicedate is not using a correct data type. : serviced.ofType(date).exists() or serviced.ofType(Period).exists()
BV-00137	error	Claim	The claim identifier does not exist. : identifier.exists()
BV-00316	error	Claim.supportingInfo, Claim.supportingInfo:attachment, Claim.supportingInfo:info	Claim 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-00330	error	Claim	Claim status is not using the specified value 'active'. : status.exists() implies status='active'
BV-00347	error	Claim.extension:eligibilityOffLineDate	Claim eligibility OfflineDate is greater than current date. : value.ofType(dateTime) <= now()
BV-00348	error	Claim.extension:authorizationOffLineDate	Claim authorization OfflineDate is greater than current date. : value.ofType(dateTime) <= now()
BV-00367	error	Claim	Claim subtype is using an incorrect value when Claim type is 'Vision'. : subType.coding.first().code = 'op'
BV-00402	error	Claim.supportingInfo:info	Supporting information 'info' requires textual information in valueString. : value.ofType(string).exists()
BV-00404	error	Claim.supportingInfo:attachment	Supporting information 'attachment' requires the content to be provided. : value.ofType(Attachment).exists()
BV-00439	error	Claim.item	If period is provided then Claim.item.servicedDate must not be used. : serviced.exists() implies (serviced.ofType(date).exists() xor serviced.ofType(Period).exists())
BV-00453	error	Claim	Claim supportingInfo sequence value is not unique within the claim request. : supportingInfo.sequence.exists() implies supportingInfo.sequence.isDistinct()
BV-00454	error	Claim	Claim diagnosis sequence value is not unique within the claim request. : diagnosis.sequence.isDistinct()
BV-00482	error	Claim.item	Item factor must be a positive decimal value. : factor.exists() implies factor >= 0
BV-00484	error	Claim.item	The subSite shall not be allowed if the bodySite is not provided. : subSite.exists() implies bodySite.exists()
BV-00492	error	Claim	The payee type can only be one of ('provider', 'other') in a claim or claim response. : payee.exists() implies (payee.type.coding.first().code = 'provider' or payee.type.coding.first().code = 'other')
BV-00494	error	Claim.payee	Claim 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-00502	error	Claim.item	Claim item informationSequence is not unique within the Claim item. : informationSequence.isDistinct()
BV-00508	error	Claim	The transfer extension cannot be used in a claim or predetermination transaction. : extension('http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-transfer').exists().not()
BV-00530	error	Claim.supportingInfo, Claim.supportingInfo:attachment, Claim.supportingInfo:info	If 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-00531	error	Claim.supportingInfo, Claim.supportingInfo:attachment, Claim.supportingInfo:info	The supportingInfo code element is required if supportingInfo category is 'chief-complaint'. : category.exists() implies (category.coding.first().code = 'chief-complaint') implies code.exists()
BV-00782	error	Claim.supportingInfo, Claim.supportingInfo:attachment, Claim.supportingInfo:info	Supporting information 'treatment-plan' requires textual information. : category.coding.where(code='treatment-plan').count() > 0 implies value.ofType(string).exists()
BV-00783	error	Claim.supportingInfo, Claim.supportingInfo:attachment, Claim.supportingInfo:info	Supporting information 'patient-history' requires textual information. : category.coding.where(code='patient-history').count() > 0 implies value.ofType(string).exists()
BV-00784	error	Claim.supportingInfo, Claim.supportingInfo:attachment, Claim.supportingInfo:info	Supporting information 'physical-examination' requires textual information . : category.coding.where(code='physical-examination').count() > 0 implies value.ofType(string).exists()
BV-00785	error	Claim.supportingInfo, Claim.supportingInfo:attachment, Claim.supportingInfo:info	Supporting information 'history-of-present-illness' requires textual information . : category.coding.where(code='history-of-present-illness').count() > 0 implies value.ofType(string).exists()
dom-2	error	Claim	If the resource is contained in another resource, it SHALL NOT contain nested Resources : contained.contained.empty()
dom-3	error	Claim	If 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-4	error	Claim	If 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-5	error	Claim	If a resource is contained in another resource, it SHALL NOT have a security label : contained.meta.security.empty()
dom-6	best practice	Claim	A resource should have narrative for robust management : text.`div`.exists()
ele-1	error	**ALL** elements	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ext-1	error	**ALL** extensions	Must have either extensions or value[x], not both : extension.exists() != value.exists()

This structure is derived from NphiesClaimBase

Name	Flags	Card.	Type	Description & Constraints    Filter: Bindings Constraints Obligations
Claim	C	0..*	NphiesClaimBase	Claim, Pre-determination or Pre-authorization Constraints: BV-00367
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 (Claim))	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: vision
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
related
claim		1..1	DP_Reference_1or3a(Nphies Claim Vision)	Reference to the related claim
prescription	S	0..1	DP_Reference_1or4(Nphies VisionPrescription)	Prescription authorizing services and products
careTeam		1..*	BackboneElement	Members of the care team
provider		1..1	DP_Reference_1or2a(Nphies Practitioner)	Practitioner or organization
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:info	C	0..*	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
item
careTeamSequence		1..*	positiveInt	Applicable careTeam members
productOrService		1..1	DP_CodeableConcept_2	Billing, service, product, or drug code Binding: Vision 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
productOrService		1..1	DP_CodeableConcept_2	Billing, service, product, or drug code Binding: Vision Billing (required)
subDetail
productOrService		1..1	DP_CodeableConcept_2	Billing, service, product, or drug code Binding: Vision Billing (required)
Documentation for this format

Terminology Bindings (Differential)

Path	Conformance	ValueSet	URI
Claim.item.productOrService	required	VisionBilling http://nphies.sa/terminology/ValueSet/vision-billing From this IG
Claim.item.bodySite	required	SNOMEDCTBodyStructures http://hl7.org/fhir/ValueSet/body-site From the FHIR Standard
Claim.item.subSite	required	SubSite(a valid code from Sub Site) http://nphies.sa/terminology/ValueSet/subsite From this IG
Claim.item.detail.productOrService	required	VisionBilling http://nphies.sa/terminology/ValueSet/vision-billing From this IG
Claim.item.detail.subDetail.productOrService	required	VisionBilling http://nphies.sa/terminology/ValueSet/vision-billing From this IG

Constraints

Id	Grade	Path(s)	Details	Requirements
BV-00367	error	Claim	Claim subtype is using an incorrect value when Claim type is 'Vision'. : subType.coding.first().code = 'op'
BV-00402	error	Claim.supportingInfo:info	Supporting information 'info' requires textual information in valueString. : value.ofType(string).exists()
BV-00404	error	Claim.supportingInfo:attachment	Supporting information 'attachment' requires the content to be provided. : value.ofType(Attachment).exists()

Name	Flags	Card.	Type	Description & Constraints    Filter: Bindings Constraints Obligations
Claim	C	0..*	NphiesClaimBase	Claim, Pre-determination or Pre-authorization Constraints: BV-00002, BV-00027, BV-00044, BV-00054, BV-00057, BV-00137, BV-00330, BV-00453, BV-00454, BV-00492, BV-00508, BV-00367
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 Bindings Purpose 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		1..*	Extension	Extension Slice: Unordered, Open by value:url
extension:batch-identifier	S	0..1	DP_Identifier_A	Claim Batch Identifier URL: http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-batch-identifier
extension:batch-number	S	0..1	DP_positiveInt	Claim Batch Number URL: http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-batch-number
extension:batch-period	S	0..1	DP_Period_2	Claim Batch Period URL: http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-batch-period
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:authorizationOffLineDate	SC	0..1	DP_dateTime	Authorization Offline Date URL: http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-authorization-offline-date Constraints: BV-00348
extension:priorauthResponse	S	0..1	DP_Reference_3a(Nphies Authorization Response | Nphies Advanced Authorization)	Prior Authorization Response URL: http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-priorauthresponse
extension:newborn	S	0..1	boolean	Newborn URL: http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-newborn
extension:episode	S	1..1	DP_Identifier_A	Episode URL: http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-episode
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 (Claim))	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: vision
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: claim
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		0..1	CodeableConcept	For whom to reserve funds Binding: Funds Reservation Codes (example): For whom funds are to be reserved: (Patient, Provider, None).
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 Claim Vision)	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_1or4(Nphies VisionPrescription)	Prescription authorizing services and products
originalPrescription		0..1	Reference(DeviceRequest | MedicationRequest | VisionPrescription)	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		1..*	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	DP_Reference_1or2a(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:info	SC	0..*	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.
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 Claim 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-00066, BV-00122, BV-00439, BV-00482, BV-00484, BV-00502
id		0..1	string	Unique id for inter-element referencing
Slices for extension	S	2..*	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		1..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:patientInvoice		1..1	DP_Identifier_A	Patient Invoice URL: http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-patientInvoice
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
sequence		1..1	DP_positiveInt	Item instance identifier
careTeamSequence		1..*	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: Vision 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
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: Vision 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: Vision 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
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet / Code	URI
Claim.meta.security	extensible	All Security Labels http://hl7.org/fhir/ValueSet/security-labels From the FHIR Standard
Claim.meta.tag	example	CommonTags http://hl7.org/fhir/ValueSet/common-tags From the FHIR Standard
Claim.language	preferred	CommonLanguages http://hl7.org/fhir/ValueSet/languages From the FHIR Standard Additional Bindings Purpose AllLanguages Max Binding
Claim.status	required	Pattern Value: active http://hl7.org/fhir/ValueSet/fm-status|4.0.1 From the FHIR Standard
Claim.type	required	Pattern Value: vision http://nphies.sa/terminology/ValueSet/claim-type From this IG
Claim.subType	required	Pattern Value: op http://nphies.sa/terminology/ValueSet/claim-subtype From this IG
Claim.use	required	Pattern Value: claim http://hl7.org/fhir/ValueSet/claim-use|4.0.1 From the FHIR Standard
Claim.patient.type	extensible	ResourceType http://hl7.org/fhir/ValueSet/resource-types From the FHIR Standard
Claim.patient.identifier.use	required	IdentifierUse http://hl7.org/fhir/ValueSet/identifier-use|4.0.1 From the FHIR Standard
Claim.patient.identifier.type	required	PatientIdentifierType http://nphies.sa/terminology/ValueSet/patient-identifier-type From this IG
Claim.insurer.type	extensible	ResourceType http://hl7.org/fhir/ValueSet/resource-types From the FHIR Standard
Claim.insurer.identifier.use	required	IdentifierUse http://hl7.org/fhir/ValueSet/identifier-use|4.0.1 From the FHIR Standard
Claim.insurer.identifier.type	extensible	Pattern Value: NII http://hl7.org/fhir/ValueSet/identifier-type From the FHIR Standard
Claim.provider.type	extensible	ResourceType http://hl7.org/fhir/ValueSet/resource-types From the FHIR Standard
Claim.provider.identifier.use	required	IdentifierUse http://hl7.org/fhir/ValueSet/identifier-use|4.0.1 From the FHIR Standard
Claim.provider.identifier.type	extensible	Pattern Value: PRN http://hl7.org/fhir/ValueSet/identifier-type From the FHIR Standard
Claim.priority	required	ProcessPriorityCodes http://hl7.org/fhir/ValueSet/process-priority From the FHIR Standard
Claim.fundsReserve	example	Funds Reservation Codes http://hl7.org/fhir/ValueSet/fundsreserve From the FHIR Standard
Claim.related.relationship	required	RelatedClaimRelationship(a valid code from Related Claim Relationship) http://nphies.sa/terminology/ValueSet/related-claim-relationship From this IG
Claim.payee.type	required	Claim Payee Type Codes http://hl7.org/fhir/ValueSet/payeetype From the FHIR Standard
Claim.careTeam.provider.type	extensible	ResourceType http://hl7.org/fhir/ValueSet/resource-types From the FHIR Standard
Claim.careTeam.provider.identifier.use	required	IdentifierUse http://hl7.org/fhir/ValueSet/identifier-use|4.0.1 From the FHIR Standard
Claim.careTeam.provider.identifier.type	required	PractitionerIdentifier http://nphies.sa/terminology/ValueSet/practitioner-identifier-type From this IG
Claim.careTeam.role	required	ClaimCareTeamRoleCodes http://hl7.org/fhir/ValueSet/claim-careteamrole From the FHIR Standard
Claim.careTeam.qualification	required	PracticeCodes http://nphies.sa/terminology/ValueSet/practice-codes From this IG
Claim.supportingInfo.category	required	ClaimInformationCategory(a valid code from Claim Information Category) http://nphies.sa/terminology/ValueSet/claim-information-category From this IG
Claim.supportingInfo.code	example	ExceptionCodes http://hl7.org/fhir/ValueSet/claim-exception From the FHIR Standard
Claim.supportingInfo.reason	example	MissingToothReasonCodes http://hl7.org/fhir/ValueSet/missing-tooth-reason From the FHIR Standard
Claim.supportingInfo:attachment.category	required	Pattern Value: attachment http://nphies.sa/terminology/ValueSet/claim-information-category From this IG
Claim.supportingInfo:attachment.code	example	ExceptionCodes http://hl7.org/fhir/ValueSet/claim-exception From the FHIR Standard
Claim.supportingInfo:attachment.reason	example	MissingToothReasonCodes http://hl7.org/fhir/ValueSet/missing-tooth-reason From the FHIR Standard
Claim.supportingInfo:info.category	required	Pattern Value: info http://nphies.sa/terminology/ValueSet/claim-information-category From this IG
Claim.supportingInfo:info.code	example	ExceptionCodes http://hl7.org/fhir/ValueSet/claim-exception From the FHIR Standard
Claim.supportingInfo:info.reason	example	MissingToothReasonCodes http://hl7.org/fhir/ValueSet/missing-tooth-reason From the FHIR Standard
Claim.diagnosis.diagnosis[x]	example	ICD-10Codes http://hl7.org/fhir/ValueSet/icd-10 From the FHIR Standard
Claim.diagnosis.diagnosis[x]:diagnosisCodeableConcept	required	ICD_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.type	required	DiagnosisType(a valid code from Diagnosis Type) http://nphies.sa/terminology/ValueSet/diagnosis-type From this IG
Claim.diagnosis.onAdmission	example	ExampleDiagnosisOnAdmissionCodes http://hl7.org/fhir/ValueSet/ex-diagnosis-on-admission From the FHIR Standard
Claim.diagnosis.packageCode	example	ExampleDiagnosisRelatedGroupCodes http://hl7.org/fhir/ValueSet/ex-diagnosisrelatedgroup From the FHIR Standard
Claim.procedure.type	example	ExampleProcedureTypeCodes http://hl7.org/fhir/ValueSet/ex-procedure-type From the FHIR Standard
Claim.procedure.procedure[x]	example	ICD-10ProcedureCodes http://hl7.org/fhir/ValueSet/icd-10-procedures From the FHIR Standard
Claim.accident.type	required	ActIncidentCode http://terminology.hl7.org/ValueSet/v3-ActIncidentCode
Claim.item.revenue	example	ExampleRevenueCenterCodes http://hl7.org/fhir/ValueSet/ex-revenue-center From the FHIR Standard
Claim.item.category	example	BenefitCategoryCodes http://hl7.org/fhir/ValueSet/ex-benefitcategory From the FHIR Standard
Claim.item.productOrService	required	VisionBilling http://nphies.sa/terminology/ValueSet/vision-billing From this IG
Claim.item.modifier	example	ModifierTypeCodes http://hl7.org/fhir/ValueSet/claim-modifiers From the FHIR Standard
Claim.item.programCode	example	ExampleProgramReasonCodes http://hl7.org/fhir/ValueSet/ex-program-code From the FHIR Standard
Claim.item.location[x]	example	ExampleServicePlaceCodes http://hl7.org/fhir/ValueSet/service-place From the FHIR Standard
Claim.item.bodySite	required	SNOMEDCTBodyStructures http://hl7.org/fhir/ValueSet/body-site From the FHIR Standard
Claim.item.subSite	required	SubSite(a valid code from Sub Site) http://nphies.sa/terminology/ValueSet/subsite From this IG
Claim.item.detail.revenue	example	ExampleRevenueCenterCodes http://hl7.org/fhir/ValueSet/ex-revenue-center From the FHIR Standard
Claim.item.detail.category	example	BenefitCategoryCodes http://hl7.org/fhir/ValueSet/ex-benefitcategory From the FHIR Standard
Claim.item.detail.productOrService	required	VisionBilling http://nphies.sa/terminology/ValueSet/vision-billing From this IG
Claim.item.detail.modifier	example	ModifierTypeCodes http://hl7.org/fhir/ValueSet/claim-modifiers From the FHIR Standard
Claim.item.detail.programCode	example	ExampleProgramReasonCodes http://hl7.org/fhir/ValueSet/ex-program-code From the FHIR Standard
Claim.item.detail.subDetail.revenue	example	ExampleRevenueCenterCodes http://hl7.org/fhir/ValueSet/ex-revenue-center From the FHIR Standard
Claim.item.detail.subDetail.category	example	BenefitCategoryCodes http://hl7.org/fhir/ValueSet/ex-benefitcategory From the FHIR Standard
Claim.item.detail.subDetail.productOrService	required	VisionBilling http://nphies.sa/terminology/ValueSet/vision-billing From this IG
Claim.item.detail.subDetail.modifier	example	ModifierTypeCodes http://hl7.org/fhir/ValueSet/claim-modifiers From the FHIR Standard
Claim.item.detail.subDetail.programCode	example	ExampleProgramReasonCodes http://hl7.org/fhir/ValueSet/ex-program-code From the FHIR Standard

Constraints

Id	Grade	Path(s)	Details	Requirements
BV-00002	error	Claim	Claim care team sequence is not unique within the submitted claim resource. : careTeam.exists() implies careTeam.sequence.isDistinct()
BV-00027	error	Claim	Claim diagnosis onAdmission is required for institutional claim type but is not to be used for non-institutional claim type. : iif(type.coding.first().code = 'institutional', diagnosis.onAdmission.exists(), diagnosis.onAdmission.exists().not())
BV-00036	error	Claim.item	No 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-00042	error	Claim.item	Claim item detail sequence in not unique within the Claim item. : detail.sequence.exists() implies detail.sequence.isDistinct()
BV-00043	error	Claim.item.detail	Claim item subDetail sequence in not unique within the Claim item detail. : subDetail.sequence.exists() implies subDetail.sequence.isDistinct()
BV-00044	error	Claim	Item sequence value is not unique within the Claim resource. : item.sequence.exists() implies item.sequence.isDistinct()
BV-00054	error	Claim	One and only one principal diagnosis is required. : diagnosis.type.coding.where(code='principal').count() = 1
BV-00056	error	Claim.payee	Payee party is not provided when payee type='other'. : type.coding.where(code='other').count() > 0 implies party.exists()
BV-00057	error	Claim	Diagnosis is not unique in the submitted request. : diagnosis.diagnosis.ofType(CodeableConcept).isDistinct()
BV-00066	error	Claim.item	Either item serviced date or item serviced period must be provided. : serviced.exists()
BV-00092	error	Claim.item.unitPrice	Claim Item UnitPrice Currency is not SAR. : currency = 'SAR'
BV-00093	error	Claim.item.net	Claim Item Net Currency is not SAR. : currency = 'SAR'
BV-00094	error	Claim.item.detail.unitPrice	Claim Item Detail UnitPrice Currency is not SAR. : currency = 'SAR'
BV-00095	error	Claim.item.detail.net	Claim Item Detail Net Currency is not SAR. : currency = 'SAR'
BV-00096	error	Claim.total	Claim Total Net Currency is not SAR. : currency = 'SAR'
BV-00122	error	Claim.item	Claim servicedate is not using a correct data type. : serviced.ofType(date).exists() or serviced.ofType(Period).exists()
BV-00137	error	Claim	The claim identifier does not exist. : identifier.exists()
BV-00316	error	Claim.supportingInfo, Claim.supportingInfo:attachment, Claim.supportingInfo:info	Claim 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-00330	error	Claim	Claim status is not using the specified value 'active'. : status.exists() implies status='active'
BV-00347	error	Claim.extension:eligibilityOffLineDate	Claim eligibility OfflineDate is greater than current date. : value.ofType(dateTime) <= now()
BV-00348	error	Claim.extension:authorizationOffLineDate	Claim authorization OfflineDate is greater than current date. : value.ofType(dateTime) <= now()
BV-00367	error	Claim	Claim subtype is using an incorrect value when Claim type is 'Vision'. : subType.coding.first().code = 'op'
BV-00402	error	Claim.supportingInfo:info	Supporting information 'info' requires textual information in valueString. : value.ofType(string).exists()
BV-00404	error	Claim.supportingInfo:attachment	Supporting information 'attachment' requires the content to be provided. : value.ofType(Attachment).exists()
BV-00439	error	Claim.item	If period is provided then Claim.item.servicedDate must not be used. : serviced.exists() implies (serviced.ofType(date).exists() xor serviced.ofType(Period).exists())
BV-00453	error	Claim	Claim supportingInfo sequence value is not unique within the claim request. : supportingInfo.sequence.exists() implies supportingInfo.sequence.isDistinct()
BV-00454	error	Claim	Claim diagnosis sequence value is not unique within the claim request. : diagnosis.sequence.isDistinct()
BV-00482	error	Claim.item	Item factor must be a positive decimal value. : factor.exists() implies factor >= 0
BV-00484	error	Claim.item	The subSite shall not be allowed if the bodySite is not provided. : subSite.exists() implies bodySite.exists()
BV-00492	error	Claim	The payee type can only be one of ('provider', 'other') in a claim or claim response. : payee.exists() implies (payee.type.coding.first().code = 'provider' or payee.type.coding.first().code = 'other')
BV-00494	error	Claim.payee	Claim 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-00502	error	Claim.item	Claim item informationSequence is not unique within the Claim item. : informationSequence.isDistinct()
BV-00508	error	Claim	The transfer extension cannot be used in a claim or predetermination transaction. : extension('http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-transfer').exists().not()
BV-00530	error	Claim.supportingInfo, Claim.supportingInfo:attachment, Claim.supportingInfo:info	If 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-00531	error	Claim.supportingInfo, Claim.supportingInfo:attachment, Claim.supportingInfo:info	The supportingInfo code element is required if supportingInfo category is 'chief-complaint'. : category.exists() implies (category.coding.first().code = 'chief-complaint') implies code.exists()
BV-00782	error	Claim.supportingInfo, Claim.supportingInfo:attachment, Claim.supportingInfo:info	Supporting information 'treatment-plan' requires textual information. : category.coding.where(code='treatment-plan').count() > 0 implies value.ofType(string).exists()
BV-00783	error	Claim.supportingInfo, Claim.supportingInfo:attachment, Claim.supportingInfo:info	Supporting information 'patient-history' requires textual information. : category.coding.where(code='patient-history').count() > 0 implies value.ofType(string).exists()
BV-00784	error	Claim.supportingInfo, Claim.supportingInfo:attachment, Claim.supportingInfo:info	Supporting information 'physical-examination' requires textual information . : category.coding.where(code='physical-examination').count() > 0 implies value.ofType(string).exists()
BV-00785	error	Claim.supportingInfo, Claim.supportingInfo:attachment, Claim.supportingInfo:info	Supporting information 'history-of-present-illness' requires textual information . : category.coding.where(code='history-of-present-illness').count() > 0 implies value.ofType(string).exists()
dom-2	error	Claim	If the resource is contained in another resource, it SHALL NOT contain nested Resources : contained.contained.empty()
dom-3	error	Claim	If 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-4	error	Claim	If 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-5	error	Claim	If a resource is contained in another resource, it SHALL NOT have a security label : contained.meta.security.empty()
dom-6	best practice	Claim	A resource should have narrative for robust management : text.`div`.exists()
ele-1	error	**ALL** elements	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ext-1	error	**ALL** extensions	Must have either extensions or value[x], not both : extension.exists() != value.exists()

This structure is derived from NphiesClaimBase

Summary

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

Structures

This structure refers to these other structures:

• DP_Reference_1 (http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/DP-Reference-1)
• Nphies Encounter AMB (Claim) (http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/encounter-claim-AMB)
• DP_Reference_1or3a (http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/DP-Reference-1or3a)
• Nphies Claim Vision (http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/vision-claim)
• DP_Reference_1or4 (http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/DP-Reference-1or4)
• Nphies VisionPrescription (http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/vision-prescription)
• DP_Reference_1or2a (http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/DP-Reference-1or2a)
• Nphies Practitioner (http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/practitioner)
• DP_Attachment (http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/DP-Attachment)
• DP_string (http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/DP-string)

Extensions

This structure refers to these extensions:

• http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-encounter

Slices

This structure defines the following Slices:

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

Key Elements View

Name	Flags	Card.	Type	Description & Constraints    Filter: Bindings Constraints Obligations
Claim	C	0..*	NphiesClaimBase	Claim, Pre-determination or Pre-authorization Constraints: BV-00002, BV-00027, BV-00044, BV-00054, BV-00057, BV-00137, BV-00330, BV-00453, BV-00454, BV-00492, BV-00508, BV-00367
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		1..*	Extension	Extension Slice: Unordered, Open by value:url
extension:batch-identifier	S	0..1	DP_Identifier_A	Claim Batch Identifier URL: http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-batch-identifier
extension:batch-number	S	0..1	DP_positiveInt	Claim Batch Number URL: http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-batch-number
extension:batch-period	S	0..1	DP_Period_2	Claim Batch Period URL: http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-batch-period
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:authorizationOffLineDate	SC	0..1	DP_dateTime	Authorization Offline Date URL: http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-authorization-offline-date Constraints: BV-00348
extension:priorauthResponse	S	0..1	DP_Reference_3a(Nphies Authorization Response | Nphies Advanced Authorization)	Prior Authorization Response URL: http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-priorauthresponse
extension:newborn	S	0..1	boolean	Newborn URL: http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-newborn
extension:episode	S	1..1	DP_Identifier_A	Episode URL: http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-episode
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 (Claim))	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: vision
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: claim
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)
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 Claim Vision)	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_1or4(Nphies VisionPrescription)	Prescription authorizing services and products
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
careTeam		1..*	BackboneElement	Members of the care team
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
sequence		1..1	DP_positiveInt	Order of care team
provider		1..1	DP_Reference_1or2a(Nphies Practitioner)	Practitioner or organization
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
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:info	SC	0..*	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
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:$this Binding: ICD-10Codes (example): Example ICD10 Diagnostic codes.
diagnosis[x]:diagnosisCodeableConcept		1..1	DP_CodeableConcept	Nature of illness or problem Binding: ICD-10-AM (required)
type		1..1	DP_CodeableConcept	Timing or nature of the diagnosis Binding: Diagnosis Type (required)
insurance	Σ	1..*	BackboneElement	Patient insurance information
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
sequence	Σ	1..1	DP_positiveInt	Insurance instance identifier
focal	Σ	1..1	boolean	Coverage to be used for adjudication
coverage	Σ	1..1	DP_Reference_1(Nphies Coverage)	Insurance information
preAuthRef	S	0..*	string	Prior authorization reference number
claimResponse	S	0..1	DP_Reference_1or3a(Nphies Claim Response)	Adjudication results
accident	S	0..1	BackboneElement	Details of the event
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
date		1..1	DP_date	When the incident occurred
type		1..1	DP_CodeableConcept	The nature of the accident Binding: ActIncidentCode (required)
Slices for location[x]		0..1		Where the event occurred Slice: Unordered, Open by type:$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-00066, BV-00122, BV-00439, BV-00482, BV-00484, BV-00502
Slices for extension	S	2..*	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		1..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:patientInvoice		1..1	DP_Identifier_A	Patient Invoice URL: http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-patientInvoice
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
sequence		1..1	DP_positiveInt	Item instance identifier
careTeamSequence		1..*	positiveInt	Applicable careTeam members
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: Vision 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
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: Vision 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: Vision 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
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet / Code	URI
Claim.status	required	Pattern Value: active http://hl7.org/fhir/ValueSet/fm-status|4.0.1 From the FHIR Standard
Claim.type	required	Pattern Value: vision http://nphies.sa/terminology/ValueSet/claim-type From this IG
Claim.subType	required	Pattern Value: op http://nphies.sa/terminology/ValueSet/claim-subtype From this IG
Claim.use	required	Pattern Value: claim http://hl7.org/fhir/ValueSet/claim-use|4.0.1 From the FHIR Standard
Claim.patient.identifier.use	required	IdentifierUse http://hl7.org/fhir/ValueSet/identifier-use|4.0.1 From the FHIR Standard
Claim.patient.identifier.type	required	PatientIdentifierType http://nphies.sa/terminology/ValueSet/patient-identifier-type From this IG
Claim.insurer.identifier.use	required	IdentifierUse http://hl7.org/fhir/ValueSet/identifier-use|4.0.1 From the FHIR Standard
Claim.insurer.identifier.type	extensible	Pattern Value: NII http://hl7.org/fhir/ValueSet/identifier-type From the FHIR Standard
Claim.provider.identifier.use	required	IdentifierUse http://hl7.org/fhir/ValueSet/identifier-use|4.0.1 From the FHIR Standard
Claim.provider.identifier.type	extensible	Pattern Value: PRN http://hl7.org/fhir/ValueSet/identifier-type From the FHIR Standard
Claim.priority	required	ProcessPriorityCodes http://hl7.org/fhir/ValueSet/process-priority From the FHIR Standard
Claim.related.relationship	required	RelatedClaimRelationship(a valid code from Related Claim Relationship) http://nphies.sa/terminology/ValueSet/related-claim-relationship From this IG
Claim.payee.type	required	Claim Payee Type Codes http://hl7.org/fhir/ValueSet/payeetype From the FHIR Standard
Claim.careTeam.role	required	ClaimCareTeamRoleCodes http://hl7.org/fhir/ValueSet/claim-careteamrole From the FHIR Standard
Claim.careTeam.qualification	required	PracticeCodes http://nphies.sa/terminology/ValueSet/practice-codes From this IG
Claim.supportingInfo.category	required	ClaimInformationCategory(a valid code from Claim Information Category) http://nphies.sa/terminology/ValueSet/claim-information-category From this IG
Claim.supportingInfo:attachment.category	required	Pattern Value: attachment http://nphies.sa/terminology/ValueSet/claim-information-category From this IG
Claim.supportingInfo:info.category	required	Pattern Value: info http://nphies.sa/terminology/ValueSet/claim-information-category From this IG
Claim.diagnosis.diagnosis[x]	example	ICD-10Codes http://hl7.org/fhir/ValueSet/icd-10 From the FHIR Standard
Claim.diagnosis.diagnosis[x]:diagnosisCodeableConcept	required	ICD_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.type	required	DiagnosisType(a valid code from Diagnosis Type) http://nphies.sa/terminology/ValueSet/diagnosis-type From this IG
Claim.accident.type	required	ActIncidentCode http://terminology.hl7.org/ValueSet/v3-ActIncidentCode
Claim.item.productOrService	required	VisionBilling http://nphies.sa/terminology/ValueSet/vision-billing From this IG
Claim.item.bodySite	required	SNOMEDCTBodyStructures http://hl7.org/fhir/ValueSet/body-site From the FHIR Standard
Claim.item.subSite	required	SubSite(a valid code from Sub Site) http://nphies.sa/terminology/ValueSet/subsite From this IG
Claim.item.detail.productOrService	required	VisionBilling http://nphies.sa/terminology/ValueSet/vision-billing From this IG
Claim.item.detail.subDetail.productOrService	required	VisionBilling http://nphies.sa/terminology/ValueSet/vision-billing From this IG

Constraints

Id	Grade	Path(s)	Details	Requirements
BV-00002	error	Claim	Claim care team sequence is not unique within the submitted claim resource. : careTeam.exists() implies careTeam.sequence.isDistinct()
BV-00027	error	Claim	Claim diagnosis onAdmission is required for institutional claim type but is not to be used for non-institutional claim type. : iif(type.coding.first().code = 'institutional', diagnosis.onAdmission.exists(), diagnosis.onAdmission.exists().not())
BV-00036	error	Claim.item	No 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-00042	error	Claim.item	Claim item detail sequence in not unique within the Claim item. : detail.sequence.exists() implies detail.sequence.isDistinct()
BV-00043	error	Claim.item.detail	Claim item subDetail sequence in not unique within the Claim item detail. : subDetail.sequence.exists() implies subDetail.sequence.isDistinct()
BV-00044	error	Claim	Item sequence value is not unique within the Claim resource. : item.sequence.exists() implies item.sequence.isDistinct()
BV-00054	error	Claim	One and only one principal diagnosis is required. : diagnosis.type.coding.where(code='principal').count() = 1
BV-00056	error	Claim.payee	Payee party is not provided when payee type='other'. : type.coding.where(code='other').count() > 0 implies party.exists()
BV-00057	error	Claim	Diagnosis is not unique in the submitted request. : diagnosis.diagnosis.ofType(CodeableConcept).isDistinct()
BV-00066	error	Claim.item	Either item serviced date or item serviced period must be provided. : serviced.exists()
BV-00092	error	Claim.item.unitPrice	Claim Item UnitPrice Currency is not SAR. : currency = 'SAR'
BV-00093	error	Claim.item.net	Claim Item Net Currency is not SAR. : currency = 'SAR'
BV-00094	error	Claim.item.detail.unitPrice	Claim Item Detail UnitPrice Currency is not SAR. : currency = 'SAR'
BV-00095	error	Claim.item.detail.net	Claim Item Detail Net Currency is not SAR. : currency = 'SAR'
BV-00096	error	Claim.total	Claim Total Net Currency is not SAR. : currency = 'SAR'
BV-00122	error	Claim.item	Claim servicedate is not using a correct data type. : serviced.ofType(date).exists() or serviced.ofType(Period).exists()
BV-00137	error	Claim	The claim identifier does not exist. : identifier.exists()
BV-00316	error	Claim.supportingInfo, Claim.supportingInfo:attachment, Claim.supportingInfo:info	Claim 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-00330	error	Claim	Claim status is not using the specified value 'active'. : status.exists() implies status='active'
BV-00347	error	Claim.extension:eligibilityOffLineDate	Claim eligibility OfflineDate is greater than current date. : value.ofType(dateTime) <= now()
BV-00348	error	Claim.extension:authorizationOffLineDate	Claim authorization OfflineDate is greater than current date. : value.ofType(dateTime) <= now()
BV-00367	error	Claim	Claim subtype is using an incorrect value when Claim type is 'Vision'. : subType.coding.first().code = 'op'
BV-00402	error	Claim.supportingInfo:info	Supporting information 'info' requires textual information in valueString. : value.ofType(string).exists()
BV-00404	error	Claim.supportingInfo:attachment	Supporting information 'attachment' requires the content to be provided. : value.ofType(Attachment).exists()
BV-00439	error	Claim.item	If period is provided then Claim.item.servicedDate must not be used. : serviced.exists() implies (serviced.ofType(date).exists() xor serviced.ofType(Period).exists())
BV-00453	error	Claim	Claim supportingInfo sequence value is not unique within the claim request. : supportingInfo.sequence.exists() implies supportingInfo.sequence.isDistinct()
BV-00454	error	Claim	Claim diagnosis sequence value is not unique within the claim request. : diagnosis.sequence.isDistinct()
BV-00482	error	Claim.item	Item factor must be a positive decimal value. : factor.exists() implies factor >= 0
BV-00484	error	Claim.item	The subSite shall not be allowed if the bodySite is not provided. : subSite.exists() implies bodySite.exists()
BV-00492	error	Claim	The payee type can only be one of ('provider', 'other') in a claim or claim response. : payee.exists() implies (payee.type.coding.first().code = 'provider' or payee.type.coding.first().code = 'other')
BV-00494	error	Claim.payee	Claim 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-00502	error	Claim.item	Claim item informationSequence is not unique within the Claim item. : informationSequence.isDistinct()
BV-00508	error	Claim	The transfer extension cannot be used in a claim or predetermination transaction. : extension('http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-transfer').exists().not()
BV-00530	error	Claim.supportingInfo, Claim.supportingInfo:attachment, Claim.supportingInfo:info	If 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-00531	error	Claim.supportingInfo, Claim.supportingInfo:attachment, Claim.supportingInfo:info	The supportingInfo code element is required if supportingInfo category is 'chief-complaint'. : category.exists() implies (category.coding.first().code = 'chief-complaint') implies code.exists()
BV-00782	error	Claim.supportingInfo, Claim.supportingInfo:attachment, Claim.supportingInfo:info	Supporting information 'treatment-plan' requires textual information. : category.coding.where(code='treatment-plan').count() > 0 implies value.ofType(string).exists()
BV-00783	error	Claim.supportingInfo, Claim.supportingInfo:attachment, Claim.supportingInfo:info	Supporting information 'patient-history' requires textual information. : category.coding.where(code='patient-history').count() > 0 implies value.ofType(string).exists()
BV-00784	error	Claim.supportingInfo, Claim.supportingInfo:attachment, Claim.supportingInfo:info	Supporting information 'physical-examination' requires textual information . : category.coding.where(code='physical-examination').count() > 0 implies value.ofType(string).exists()
BV-00785	error	Claim.supportingInfo, Claim.supportingInfo:attachment, Claim.supportingInfo:info	Supporting information 'history-of-present-illness' requires textual information . : category.coding.where(code='history-of-present-illness').count() > 0 implies value.ofType(string).exists()
dom-2	error	Claim	If the resource is contained in another resource, it SHALL NOT contain nested Resources : contained.contained.empty()
dom-3	error	Claim	If 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-4	error	Claim	If 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-5	error	Claim	If a resource is contained in another resource, it SHALL NOT have a security label : contained.meta.security.empty()
dom-6	best practice	Claim	A resource should have narrative for robust management : text.`div`.exists()
ele-1	error	**ALL** elements	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ext-1	error	**ALL** extensions	Must have either extensions or value[x], not both : extension.exists() != value.exists()

Differential View

This structure is derived from NphiesClaimBase

Name	Flags	Card.	Type	Description & Constraints    Filter: Bindings Constraints Obligations
Claim	C	0..*	NphiesClaimBase	Claim, Pre-determination or Pre-authorization Constraints: BV-00367
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 (Claim))	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: vision
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
related
claim		1..1	DP_Reference_1or3a(Nphies Claim Vision)	Reference to the related claim
prescription	S	0..1	DP_Reference_1or4(Nphies VisionPrescription)	Prescription authorizing services and products
careTeam		1..*	BackboneElement	Members of the care team
provider		1..1	DP_Reference_1or2a(Nphies Practitioner)	Practitioner or organization
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:info	C	0..*	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
item
careTeamSequence		1..*	positiveInt	Applicable careTeam members
productOrService		1..1	DP_CodeableConcept_2	Billing, service, product, or drug code Binding: Vision 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
productOrService		1..1	DP_CodeableConcept_2	Billing, service, product, or drug code Binding: Vision Billing (required)
subDetail
productOrService		1..1	DP_CodeableConcept_2	Billing, service, product, or drug code Binding: Vision Billing (required)
Documentation for this format

Terminology Bindings (Differential)

Path	Conformance	ValueSet	URI
Claim.item.productOrService	required	VisionBilling http://nphies.sa/terminology/ValueSet/vision-billing From this IG
Claim.item.bodySite	required	SNOMEDCTBodyStructures http://hl7.org/fhir/ValueSet/body-site From the FHIR Standard
Claim.item.subSite	required	SubSite(a valid code from Sub Site) http://nphies.sa/terminology/ValueSet/subsite From this IG
Claim.item.detail.productOrService	required	VisionBilling http://nphies.sa/terminology/ValueSet/vision-billing From this IG
Claim.item.detail.subDetail.productOrService	required	VisionBilling http://nphies.sa/terminology/ValueSet/vision-billing From this IG

Constraints

Id	Grade	Path(s)	Details	Requirements
BV-00367	error	Claim	Claim subtype is using an incorrect value when Claim type is 'Vision'. : subType.coding.first().code = 'op'
BV-00402	error	Claim.supportingInfo:info	Supporting information 'info' requires textual information in valueString. : value.ofType(string).exists()
BV-00404	error	Claim.supportingInfo:attachment	Supporting information 'attachment' requires the content to be provided. : value.ofType(Attachment).exists()

Snapshot View

Name	Flags	Card.	Type	Description & Constraints    Filter: Bindings Constraints Obligations
Claim	C	0..*	NphiesClaimBase	Claim, Pre-determination or Pre-authorization Constraints: BV-00002, BV-00027, BV-00044, BV-00054, BV-00057, BV-00137, BV-00330, BV-00453, BV-00454, BV-00492, BV-00508, BV-00367
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 Bindings Purpose 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		1..*	Extension	Extension Slice: Unordered, Open by value:url
extension:batch-identifier	S	0..1	DP_Identifier_A	Claim Batch Identifier URL: http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-batch-identifier
extension:batch-number	S	0..1	DP_positiveInt	Claim Batch Number URL: http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-batch-number
extension:batch-period	S	0..1	DP_Period_2	Claim Batch Period URL: http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-batch-period
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:authorizationOffLineDate	SC	0..1	DP_dateTime	Authorization Offline Date URL: http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-authorization-offline-date Constraints: BV-00348
extension:priorauthResponse	S	0..1	DP_Reference_3a(Nphies Authorization Response | Nphies Advanced Authorization)	Prior Authorization Response URL: http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-priorauthresponse
extension:newborn	S	0..1	boolean	Newborn URL: http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-newborn
extension:episode	S	1..1	DP_Identifier_A	Episode URL: http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-episode
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 (Claim))	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: vision
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: claim
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		0..1	CodeableConcept	For whom to reserve funds Binding: Funds Reservation Codes (example): For whom funds are to be reserved: (Patient, Provider, None).
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 Claim Vision)	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_1or4(Nphies VisionPrescription)	Prescription authorizing services and products
originalPrescription		0..1	Reference(DeviceRequest | MedicationRequest | VisionPrescription)	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		1..*	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	DP_Reference_1or2a(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:info	SC	0..*	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.
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 Claim 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-00066, BV-00122, BV-00439, BV-00482, BV-00484, BV-00502
id		0..1	string	Unique id for inter-element referencing
Slices for extension	S	2..*	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		1..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:patientInvoice		1..1	DP_Identifier_A	Patient Invoice URL: http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-patientInvoice
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
sequence		1..1	DP_positiveInt	Item instance identifier
careTeamSequence		1..*	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: Vision 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
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: Vision 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: Vision 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
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet / Code	URI
Claim.meta.security	extensible	All Security Labels http://hl7.org/fhir/ValueSet/security-labels From the FHIR Standard
Claim.meta.tag	example	CommonTags http://hl7.org/fhir/ValueSet/common-tags From the FHIR Standard
Claim.language	preferred	CommonLanguages http://hl7.org/fhir/ValueSet/languages From the FHIR Standard Additional Bindings Purpose AllLanguages Max Binding
Claim.status	required	Pattern Value: active http://hl7.org/fhir/ValueSet/fm-status|4.0.1 From the FHIR Standard
Claim.type	required	Pattern Value: vision http://nphies.sa/terminology/ValueSet/claim-type From this IG
Claim.subType	required	Pattern Value: op http://nphies.sa/terminology/ValueSet/claim-subtype From this IG
Claim.use	required	Pattern Value: claim http://hl7.org/fhir/ValueSet/claim-use|4.0.1 From the FHIR Standard
Claim.patient.type	extensible	ResourceType http://hl7.org/fhir/ValueSet/resource-types From the FHIR Standard
Claim.patient.identifier.use	required	IdentifierUse http://hl7.org/fhir/ValueSet/identifier-use|4.0.1 From the FHIR Standard
Claim.patient.identifier.type	required	PatientIdentifierType http://nphies.sa/terminology/ValueSet/patient-identifier-type From this IG
Claim.insurer.type	extensible	ResourceType http://hl7.org/fhir/ValueSet/resource-types From the FHIR Standard
Claim.insurer.identifier.use	required	IdentifierUse http://hl7.org/fhir/ValueSet/identifier-use|4.0.1 From the FHIR Standard
Claim.insurer.identifier.type	extensible	Pattern Value: NII http://hl7.org/fhir/ValueSet/identifier-type From the FHIR Standard
Claim.provider.type	extensible	ResourceType http://hl7.org/fhir/ValueSet/resource-types From the FHIR Standard
Claim.provider.identifier.use	required	IdentifierUse http://hl7.org/fhir/ValueSet/identifier-use|4.0.1 From the FHIR Standard
Claim.provider.identifier.type	extensible	Pattern Value: PRN http://hl7.org/fhir/ValueSet/identifier-type From the FHIR Standard
Claim.priority	required	ProcessPriorityCodes http://hl7.org/fhir/ValueSet/process-priority From the FHIR Standard
Claim.fundsReserve	example	Funds Reservation Codes http://hl7.org/fhir/ValueSet/fundsreserve From the FHIR Standard
Claim.related.relationship	required	RelatedClaimRelationship(a valid code from Related Claim Relationship) http://nphies.sa/terminology/ValueSet/related-claim-relationship From this IG
Claim.payee.type	required	Claim Payee Type Codes http://hl7.org/fhir/ValueSet/payeetype From the FHIR Standard
Claim.careTeam.provider.type	extensible	ResourceType http://hl7.org/fhir/ValueSet/resource-types From the FHIR Standard
Claim.careTeam.provider.identifier.use	required	IdentifierUse http://hl7.org/fhir/ValueSet/identifier-use|4.0.1 From the FHIR Standard
Claim.careTeam.provider.identifier.type	required	PractitionerIdentifier http://nphies.sa/terminology/ValueSet/practitioner-identifier-type From this IG
Claim.careTeam.role	required	ClaimCareTeamRoleCodes http://hl7.org/fhir/ValueSet/claim-careteamrole From the FHIR Standard
Claim.careTeam.qualification	required	PracticeCodes http://nphies.sa/terminology/ValueSet/practice-codes From this IG
Claim.supportingInfo.category	required	ClaimInformationCategory(a valid code from Claim Information Category) http://nphies.sa/terminology/ValueSet/claim-information-category From this IG
Claim.supportingInfo.code	example	ExceptionCodes http://hl7.org/fhir/ValueSet/claim-exception From the FHIR Standard
Claim.supportingInfo.reason	example	MissingToothReasonCodes http://hl7.org/fhir/ValueSet/missing-tooth-reason From the FHIR Standard
Claim.supportingInfo:attachment.category	required	Pattern Value: attachment http://nphies.sa/terminology/ValueSet/claim-information-category From this IG
Claim.supportingInfo:attachment.code	example	ExceptionCodes http://hl7.org/fhir/ValueSet/claim-exception From the FHIR Standard
Claim.supportingInfo:attachment.reason	example	MissingToothReasonCodes http://hl7.org/fhir/ValueSet/missing-tooth-reason From the FHIR Standard
Claim.supportingInfo:info.category	required	Pattern Value: info http://nphies.sa/terminology/ValueSet/claim-information-category From this IG
Claim.supportingInfo:info.code	example	ExceptionCodes http://hl7.org/fhir/ValueSet/claim-exception From the FHIR Standard
Claim.supportingInfo:info.reason	example	MissingToothReasonCodes http://hl7.org/fhir/ValueSet/missing-tooth-reason From the FHIR Standard
Claim.diagnosis.diagnosis[x]	example	ICD-10Codes http://hl7.org/fhir/ValueSet/icd-10 From the FHIR Standard
Claim.diagnosis.diagnosis[x]:diagnosisCodeableConcept	required	ICD_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.type	required	DiagnosisType(a valid code from Diagnosis Type) http://nphies.sa/terminology/ValueSet/diagnosis-type From this IG
Claim.diagnosis.onAdmission	example	ExampleDiagnosisOnAdmissionCodes http://hl7.org/fhir/ValueSet/ex-diagnosis-on-admission From the FHIR Standard
Claim.diagnosis.packageCode	example	ExampleDiagnosisRelatedGroupCodes http://hl7.org/fhir/ValueSet/ex-diagnosisrelatedgroup From the FHIR Standard
Claim.procedure.type	example	ExampleProcedureTypeCodes http://hl7.org/fhir/ValueSet/ex-procedure-type From the FHIR Standard
Claim.procedure.procedure[x]	example	ICD-10ProcedureCodes http://hl7.org/fhir/ValueSet/icd-10-procedures From the FHIR Standard
Claim.accident.type	required	ActIncidentCode http://terminology.hl7.org/ValueSet/v3-ActIncidentCode
Claim.item.revenue	example	ExampleRevenueCenterCodes http://hl7.org/fhir/ValueSet/ex-revenue-center From the FHIR Standard
Claim.item.category	example	BenefitCategoryCodes http://hl7.org/fhir/ValueSet/ex-benefitcategory From the FHIR Standard
Claim.item.productOrService	required	VisionBilling http://nphies.sa/terminology/ValueSet/vision-billing From this IG
Claim.item.modifier	example	ModifierTypeCodes http://hl7.org/fhir/ValueSet/claim-modifiers From the FHIR Standard
Claim.item.programCode	example	ExampleProgramReasonCodes http://hl7.org/fhir/ValueSet/ex-program-code From the FHIR Standard
Claim.item.location[x]	example	ExampleServicePlaceCodes http://hl7.org/fhir/ValueSet/service-place From the FHIR Standard
Claim.item.bodySite	required	SNOMEDCTBodyStructures http://hl7.org/fhir/ValueSet/body-site From the FHIR Standard
Claim.item.subSite	required	SubSite(a valid code from Sub Site) http://nphies.sa/terminology/ValueSet/subsite From this IG
Claim.item.detail.revenue	example	ExampleRevenueCenterCodes http://hl7.org/fhir/ValueSet/ex-revenue-center From the FHIR Standard
Claim.item.detail.category	example	BenefitCategoryCodes http://hl7.org/fhir/ValueSet/ex-benefitcategory From the FHIR Standard
Claim.item.detail.productOrService	required	VisionBilling http://nphies.sa/terminology/ValueSet/vision-billing From this IG
Claim.item.detail.modifier	example	ModifierTypeCodes http://hl7.org/fhir/ValueSet/claim-modifiers From the FHIR Standard
Claim.item.detail.programCode	example	ExampleProgramReasonCodes http://hl7.org/fhir/ValueSet/ex-program-code From the FHIR Standard
Claim.item.detail.subDetail.revenue	example	ExampleRevenueCenterCodes http://hl7.org/fhir/ValueSet/ex-revenue-center From the FHIR Standard
Claim.item.detail.subDetail.category	example	BenefitCategoryCodes http://hl7.org/fhir/ValueSet/ex-benefitcategory From the FHIR Standard
Claim.item.detail.subDetail.productOrService	required	VisionBilling http://nphies.sa/terminology/ValueSet/vision-billing From this IG
Claim.item.detail.subDetail.modifier	example	ModifierTypeCodes http://hl7.org/fhir/ValueSet/claim-modifiers From the FHIR Standard
Claim.item.detail.subDetail.programCode	example	ExampleProgramReasonCodes http://hl7.org/fhir/ValueSet/ex-program-code From the FHIR Standard

Constraints

Id	Grade	Path(s)	Details	Requirements
BV-00002	error	Claim	Claim care team sequence is not unique within the submitted claim resource. : careTeam.exists() implies careTeam.sequence.isDistinct()
BV-00027	error	Claim	Claim diagnosis onAdmission is required for institutional claim type but is not to be used for non-institutional claim type. : iif(type.coding.first().code = 'institutional', diagnosis.onAdmission.exists(), diagnosis.onAdmission.exists().not())
BV-00036	error	Claim.item	No 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-00042	error	Claim.item	Claim item detail sequence in not unique within the Claim item. : detail.sequence.exists() implies detail.sequence.isDistinct()
BV-00043	error	Claim.item.detail	Claim item subDetail sequence in not unique within the Claim item detail. : subDetail.sequence.exists() implies subDetail.sequence.isDistinct()
BV-00044	error	Claim	Item sequence value is not unique within the Claim resource. : item.sequence.exists() implies item.sequence.isDistinct()
BV-00054	error	Claim	One and only one principal diagnosis is required. : diagnosis.type.coding.where(code='principal').count() = 1
BV-00056	error	Claim.payee	Payee party is not provided when payee type='other'. : type.coding.where(code='other').count() > 0 implies party.exists()
BV-00057	error	Claim	Diagnosis is not unique in the submitted request. : diagnosis.diagnosis.ofType(CodeableConcept).isDistinct()
BV-00066	error	Claim.item	Either item serviced date or item serviced period must be provided. : serviced.exists()
BV-00092	error	Claim.item.unitPrice	Claim Item UnitPrice Currency is not SAR. : currency = 'SAR'
BV-00093	error	Claim.item.net	Claim Item Net Currency is not SAR. : currency = 'SAR'
BV-00094	error	Claim.item.detail.unitPrice	Claim Item Detail UnitPrice Currency is not SAR. : currency = 'SAR'
BV-00095	error	Claim.item.detail.net	Claim Item Detail Net Currency is not SAR. : currency = 'SAR'
BV-00096	error	Claim.total	Claim Total Net Currency is not SAR. : currency = 'SAR'
BV-00122	error	Claim.item	Claim servicedate is not using a correct data type. : serviced.ofType(date).exists() or serviced.ofType(Period).exists()
BV-00137	error	Claim	The claim identifier does not exist. : identifier.exists()
BV-00316	error	Claim.supportingInfo, Claim.supportingInfo:attachment, Claim.supportingInfo:info	Claim 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-00330	error	Claim	Claim status is not using the specified value 'active'. : status.exists() implies status='active'
BV-00347	error	Claim.extension:eligibilityOffLineDate	Claim eligibility OfflineDate is greater than current date. : value.ofType(dateTime) <= now()
BV-00348	error	Claim.extension:authorizationOffLineDate	Claim authorization OfflineDate is greater than current date. : value.ofType(dateTime) <= now()
BV-00367	error	Claim	Claim subtype is using an incorrect value when Claim type is 'Vision'. : subType.coding.first().code = 'op'
BV-00402	error	Claim.supportingInfo:info	Supporting information 'info' requires textual information in valueString. : value.ofType(string).exists()
BV-00404	error	Claim.supportingInfo:attachment	Supporting information 'attachment' requires the content to be provided. : value.ofType(Attachment).exists()
BV-00439	error	Claim.item	If period is provided then Claim.item.servicedDate must not be used. : serviced.exists() implies (serviced.ofType(date).exists() xor serviced.ofType(Period).exists())
BV-00453	error	Claim	Claim supportingInfo sequence value is not unique within the claim request. : supportingInfo.sequence.exists() implies supportingInfo.sequence.isDistinct()
BV-00454	error	Claim	Claim diagnosis sequence value is not unique within the claim request. : diagnosis.sequence.isDistinct()
BV-00482	error	Claim.item	Item factor must be a positive decimal value. : factor.exists() implies factor >= 0
BV-00484	error	Claim.item	The subSite shall not be allowed if the bodySite is not provided. : subSite.exists() implies bodySite.exists()
BV-00492	error	Claim	The payee type can only be one of ('provider', 'other') in a claim or claim response. : payee.exists() implies (payee.type.coding.first().code = 'provider' or payee.type.coding.first().code = 'other')
BV-00494	error	Claim.payee	Claim 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-00502	error	Claim.item	Claim item informationSequence is not unique within the Claim item. : informationSequence.isDistinct()
BV-00508	error	Claim	The transfer extension cannot be used in a claim or predetermination transaction. : extension('http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-transfer').exists().not()
BV-00530	error	Claim.supportingInfo, Claim.supportingInfo:attachment, Claim.supportingInfo:info	If 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-00531	error	Claim.supportingInfo, Claim.supportingInfo:attachment, Claim.supportingInfo:info	The supportingInfo code element is required if supportingInfo category is 'chief-complaint'. : category.exists() implies (category.coding.first().code = 'chief-complaint') implies code.exists()
BV-00782	error	Claim.supportingInfo, Claim.supportingInfo:attachment, Claim.supportingInfo:info	Supporting information 'treatment-plan' requires textual information. : category.coding.where(code='treatment-plan').count() > 0 implies value.ofType(string).exists()
BV-00783	error	Claim.supportingInfo, Claim.supportingInfo:attachment, Claim.supportingInfo:info	Supporting information 'patient-history' requires textual information. : category.coding.where(code='patient-history').count() > 0 implies value.ofType(string).exists()
BV-00784	error	Claim.supportingInfo, Claim.supportingInfo:attachment, Claim.supportingInfo:info	Supporting information 'physical-examination' requires textual information . : category.coding.where(code='physical-examination').count() > 0 implies value.ofType(string).exists()
BV-00785	error	Claim.supportingInfo, Claim.supportingInfo:attachment, Claim.supportingInfo:info	Supporting information 'history-of-present-illness' requires textual information . : category.coding.where(code='history-of-present-illness').count() > 0 implies value.ofType(string).exists()
dom-2	error	Claim	If the resource is contained in another resource, it SHALL NOT contain nested Resources : contained.contained.empty()
dom-3	error	Claim	If 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-4	error	Claim	If 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-5	error	Claim	If a resource is contained in another resource, it SHALL NOT have a security label : contained.meta.security.empty()
dom-6	best practice	Claim	A resource should have narrative for robust management : text.`div`.exists()
ele-1	error	**ALL** elements	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ext-1	error	**ALL** extensions	Must have either extensions or value[x], not both : extension.exists() != value.exists()

This structure is derived from NphiesClaimBase

Summary

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

Structures

This structure refers to these other structures:

• DP_Reference_1 (http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/DP-Reference-1)
• Nphies Encounter AMB (Claim) (http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/encounter-claim-AMB)
• DP_Reference_1or3a (http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/DP-Reference-1or3a)
• Nphies Claim Vision (http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/vision-claim)
• DP_Reference_1or4 (http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/DP-Reference-1or4)
• Nphies VisionPrescription (http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/vision-prescription)
• DP_Reference_1or2a (http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/DP-Reference-1or2a)
• Nphies Practitioner (http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/practitioner)
• DP_Attachment (http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/DP-Attachment)
• DP_string (http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/DP-string)

Extensions

This structure refers to these extensions:

• http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-encounter

Slices

This structure defines the following Slices:

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