fhirtypes
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TypeScript
import { IClaimAccident, IClaimCareTeam, IClaimDiagnosis, IClaimInsurance, IClaimItem, IClaimPayee, IClaimProcedure, IClaimRelated, IClaimSupportingInfo } from '../backbones';
import { IDomainResource, IElement } from '../base';
import { ICodeableConcept, IIdentifier, IMoney, IPeriod, IReference } from '../datatypes';
import { ClaimUseType, FmStatusType } from '../types';
/**
* @name IClaim
* @description A provider issued list of professional services and products which have been provided, or are to be provided, to a patient which is sent to an insurer for reimbursement.
* @see <a href="https://hl7.org/fhir/R4/claim.html">Claim</a>
* @version R4
* @extends {IDomainResource}
* @author Claudia Alarcón Lazo
*/
export interface IClaim extends IDomainResource {
/**
* @description A unique identifier assigned to this claim.
*/
identifier?: IIdentifier[];
/**
* @description The status of the resource instance.
* @description active | cancelled | draft | entered-in-error
* @see <a href="https://hl7.org/fhir/R4/valueset-fm-status.html">FmStatus</a>
*/
status: FmStatusType;
/**
* @description Extensions for status
*/
_status?: IElement;
/**
* @description The category of claim, e.g. oral, pharmacy, vision, institutional, professional.
*/
type: ICodeableConcept;
/**
* @description A finer grained suite of claim type codes which may convey additional information such as Inpatient vs Outpatient and/or a specialty service.
*/
subType?: ICodeableConcept;
/**
* @description A code to indicate whether the nature of the request is: to request adjudication of products and services previously rendered; or requesting authorization and adjudication for provision in the future; or requesting the non-binding adjudication of the listed products and services which could be provided in the future.
* @description claim | preauthorization | predetermination
* @see <a href="https://hl7.org/fhir/R4/valueset-claim-use.html">ClaimUse</a>
*/
use: ClaimUseType;
/**
* @description Extensions for use
*/
_use?: IElement;
/**
* @description The party to whom the professional services and/or products have been supplied or are being considered and for whom actual or forecast reimbursement is sought.
*/
patient: IReference;
/**
* @description The period for which charges are being submitted.
*/
billablePeriod?: IPeriod;
/**
* @description The date this resource was created.
*/
created: string;
/**
* @description Extensions for created
*/
_created?: IElement;
/**
* @description Individual who created the claim, predetermination or preauthorization.
*/
enterer?: IReference;
/**
* @description The Insurer who is target of the request.
*/
insurer?: IReference;
/**
* @description The provider which is responsible for the claim, predetermination or preauthorization.
*/
provider: IReference;
/**
* @description The provider-required urgency of processing the request. Typical values include: stat, routine deferred.
*/
priority: ICodeableConcept;
/**
* @description A code to indicate whether and for whom funds are to be reserved for future claims.
*/
fundsReserve?: ICodeableConcept;
/**
* @description Other claims which are related to this claim such as prior submissions or claims for related services or for the same event.
*/
related?: IClaimRelated[];
/**
* @description Prescription to support the dispensing of pharmacy, device or vision products.
*/
prescription?: IReference;
/**
* @description Original prescription which has been superseded by this prescription to support the dispensing of pharmacy services, medications or products.
*/
originalPrescription?: IReference;
/**
* @description The party to be reimbursed for cost of the products and services according to the terms of the policy.
*/
payee?: IClaimPayee;
/**
* @description A reference to a referral resource.
*/
referral?: IReference;
/**
* @description Facility where the services were provided.
*/
facility?: IReference;
/**
* @description The members of the team who provided the products and services.
*/
careTeam?: IClaimCareTeam[];
/**
* @description Additional information codes regarding exceptions, special considerations, the condition, situation, prior or concurrent issues.
*/
supportingInfo?: IClaimSupportingInfo[];
/**
* @description Information about diagnoses relevant to the claim items.
*/
diagnosis?: IClaimDiagnosis[];
/**
* @description Procedures performed on the patient relevant to the billing items with the claim.
*/
procedure?: IClaimProcedure[];
/**
* @description Financial instruments for reimbursement for the health care products and services specified on the claim.
*/
insurance?: IClaimInsurance[];
/**
* @description Details of an accident which resulted in injuries which required the products and services listed in the claim.
*/
accident?: IClaimAccident;
/**
* @description A claim line. Either a simple product or service or a \u0027group\u0027 of details which can each be a simple items or groups of sub-details.
*/
item?: IClaimItem[];
/**
* @description The total value of the all the items in the claim.
*/
total?: IMoney;
}