Package org.hl7.fhir.dstu2.model

Class Claim

java.lang.Object
org.hl7.fhir.dstu2.model.Base
org.hl7.fhir.dstu2.model.BaseResource
org.hl7.fhir.dstu2.model.Resource
org.hl7.fhir.dstu2.model.DomainResource
org.hl7.fhir.dstu2.model.Claim
All Implemented Interfaces:
ca.uhn.fhir.model.api.IElement, Serializable, org.hl7.fhir.instance.model.api.IAnyResource, org.hl7.fhir.instance.model.api.IBase, org.hl7.fhir.instance.model.api.IBaseHasExtensions, org.hl7.fhir.instance.model.api.IBaseHasModifierExtensions, org.hl7.fhir.instance.model.api.IBaseResource, org.hl7.fhir.instance.model.api.IDomainResource
public class Claim extends DomainResource
A provider issued list of services and products provided, or to be provided, to a patient which is provided to an insurer for payment recovery.
See Also:

  • Field Details

    • type

      protected Enumeration<Claim.ClaimType> type
      The category of claim this is.

    • identifier

      protected List<Identifier> identifier
      The business identifier for the instance: invoice number, claim number, pre-determination or pre-authorization number.

    • ruleset

      protected Coding ruleset
      The version of the specification on which this instance relies.

    • originalRuleset

      protected Coding originalRuleset
      The version of the specification from which the original instance was created.

    • created

      protected DateTimeType created
      The date when the enclosed suite of services were performed or completed.

    • target

      protected Reference target
      Insurer Identifier, typical BIN number (6 digit).

    • targetTarget

      protected Organization targetTarget
      The actual object that is the target of the reference (Insurer Identifier, typical BIN number (6 digit).)

    • provider

      protected Reference provider
      The provider which is responsible for the bill, claim pre-determination, pre-authorization.

    • providerTarget

      protected Practitioner providerTarget
      The actual object that is the target of the reference (The provider which is responsible for the bill, claim pre-determination, pre-authorization.)

    • organization

      protected Reference organization
      The organization which is responsible for the bill, claim pre-determination, pre-authorization.

    • organizationTarget

      protected Organization organizationTarget
      The actual object that is the target of the reference (The organization which is responsible for the bill, claim pre-determination, pre-authorization.)

    • use

      protected Enumeration<Claim.Use> use
      Complete (Bill or Claim), Proposed (Pre-Authorization), Exploratory (Pre-determination).

    • priority

      protected Coding priority
      Immediate (stat), best effort (normal), deferred (deferred).

    • fundsReserve

      protected Coding fundsReserve
      In the case of a Pre-Determination/Pre-Authorization the provider may request that funds in the amount of the expected Benefit be reserved ('Patient' or 'Provider') to pay for the Benefits determined on the subsequent claim(s). 'None' explicitly indicates no funds reserving is requested.

    • enterer

      protected Reference enterer
      Person who created the invoice/claim/pre-determination or pre-authorization.

    • entererTarget

      protected Practitioner entererTarget
      The actual object that is the target of the reference (Person who created the invoice/claim/pre-determination or pre-authorization.)

    • facility

      protected Reference facility
      Facility where the services were provided.

    • facilityTarget

      protected Location facilityTarget
      The actual object that is the target of the reference (Facility where the services were provided.)

    • prescription

      protected Reference prescription
      Prescription to support the dispensing of Pharmacy or Vision products.

    • prescriptionTarget

      protected Resource prescriptionTarget
      The actual object that is the target of the reference (Prescription to support the dispensing of Pharmacy or Vision products.)

    • originalPrescription

      protected Reference originalPrescription
      Original prescription to support the dispensing of pharmacy services, medications or products.

    • originalPrescriptionTarget

      protected MedicationOrder originalPrescriptionTarget
      The actual object that is the target of the reference (Original prescription to support the dispensing of pharmacy services, medications or products.)

    • payee

      protected Claim.PayeeComponent payee
      The party to be reimbursed for the services.

    • referral

      protected Reference referral
      The referral resource which lists the date, practitioner, reason and other supporting information.

    • referralTarget

      protected ReferralRequest referralTarget
      The actual object that is the target of the reference (The referral resource which lists the date, practitioner, reason and other supporting information.)

    • diagnosis

      protected List<Claim.DiagnosisComponent> diagnosis
      Ordered list of patient diagnosis for which care is sought.

    • condition

      protected List<Coding> condition
      List of patient conditions for which care is sought.

    • patient

      protected Reference patient
      Patient Resource.

    • patientTarget

      protected Patient patientTarget
      The actual object that is the target of the reference (Patient Resource.)

    • coverage

      protected List<Claim.CoverageComponent> coverage
      Financial instrument by which payment information for health care.

    • exception

      protected List<Coding> exception
      Factors which may influence the applicability of coverage.

    • school

      protected StringType school
      Name of school for over-aged dependents.

    • accident

      protected DateType accident
      Date of an accident which these services are addressing.

    • accidentType

      protected Coding accidentType
      Type of accident: work, auto, etc.

    • interventionException

      protected List<Coding> interventionException
      A list of intervention and exception codes which may influence the adjudication of the claim.

    • item

      protected List<Claim.ItemsComponent> item
      First tier of goods and services.

    • additionalMaterials

      protected List<Coding> additionalMaterials
      Code to indicate that Xrays, images, emails, documents, models or attachments are being sent in support of this submission.

    • missingTeeth

      protected List<Claim.MissingTeethComponent> missingTeeth
      A list of teeth which would be expected but are not found due to having been previously extracted or for other reasons.

    • SP_IDENTIFIER

      public static final String SP_IDENTIFIER
      See Also:

    • SP_PROVIDER

      public static final String SP_PROVIDER
      See Also:

    • SP_USE

      public static final String SP_USE
      See Also:

    • SP_PATIENT

      public static final String SP_PATIENT
      See Also:

    • SP_PRIORITY

      public static final String SP_PRIORITY
      See Also:

  • Constructor Details

  • Method Details