Implementation Guide
23.1.0 - R4 APIs

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Logical Model: Claim - Detailed Descriptions

Active as of 2023-03-01

Definitions for the athena-claim-profile logical model.

Guidance on how to interpret the contents of this table can be found here

0. athena-claim-profile
Logical ModelInstances of this logical model are not marked to be the target of a Reference
2. athena-claim-profile.id
Definition

The logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes.

ShortLogical id of this artifact
Comments

The only time that a resource does not have an id is when it is being submitted to the server using a create operation.

Control1..1
Typeid
Is Modifierfalse
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
Must Supporttrue
4. athena-claim-profile.meta
Definition

The metadata about the resource. This is content that is maintained by the infrastructure. Changes to the content might not always be associated with version changes to the resource.

ShortMetadata about the resource
Comments

Unique Id for this particular athena-claim-profile.

Control0..1
TypeMeta
Is Modifierfalse
Must Supportfalse
6. athena-claim-profile.pid
Definition

Who/What Claimed

ShortPID is internal numeric value used in the Chart module and clinical data. This will be the same as the resource id in the Patient resource.
Comments

PID is internal numeric value used in the Chart module and clinical data. This will be the same as the resource id in the Patient resource.

Control1..1
Typeinteger
Is Modifierfalse
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
Must Supportfalse
8. athena-claim-profile.patient
Definition

Who or what the athena-claim-profile is about. The athena-claim-profile can be about a person.

ShortWho/what is the patient of claim
Control1..1
TypeReference(Patient)
10. athena-claim-profile.patient.reference
Definition

Who or what the athena-claim-profile is about. The athena-claim-profile can be about a person.

ShortReference to the Patient
Control0..1
Typestring
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
12. athena-claim-profile.patient.display
Definition

Patient name for the athena-claim-profile is about.

ShortPatient name
Control0..1
Typestring
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
14. athena-claim-profile.patientProfileId
Definition

Internal ID of patient used in non-clinical practice management data.

ShortPatient specific id for practice management data including financial information
Comments

Patient profile ID

Control1..1
TypeunsignedInt
Is Modifierfalse
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
Must Supporttrue
16. athena-claim-profile.batchNumber
Definition

Batch no specific to the patient visit

ShortBatch containing this claim
Comments

The batch number of the batch containing this athena-claim-profile

Control0..1
TypeunsignedInt
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
18. athena-claim-profile.charges
Definition

batch no specific to the patient visit

ShortThe sum of the charges to be claimed.
Comments

The sum of the charges for this electronic athena-claim-profile.

Control0..1
TypeMoney
20. athena-claim-profile.charges.value
Definition

Charged value of the athena-claim-profile

ShortAmount of money
Comments

The sum of the charges for this electronic athena-claim-profile.

Control0..1
Typedecimal
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
22. athena-claim-profile.charges.currency
Definition

Name of the the Currency

ShortCurrency
Comments

The sum of the charges for this electronic athena-claim-profile.

Control0..1
Typecode
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
24. athena-claim-profile.filingMethod
Definition

Claim filing type

ShortThe ID of the filing method for ths electronic athena-claim-profile. This column should be linked to the MedLists table MedListsId column with a TableName of FilingMethods.
Comments

The ID of the filing method for ths electronic athena-claim-profile. This column should be linked to the MedLists table MedListsId column with a TableName of FilingMethods.

Control0..1
Typestring
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
26. athena-claim-profile.claimFileId
Definition

Claim associated filed id

ShortThe ID of the EDICLaim.
Comments

The ID of the EDIClaim that contains this electronic athena-claim-profile.

Control0..1
TypeunsignedInt
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
28. athena-claim-profile.fileName
Definition

athena-claim-profileed file name

ShortEDI Claim file name
Comments

Edi Claim file name

Control0..1
Typestring
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
30. athena-claim-profile.fileCreated
Definition

Claim file created date

ShortDate that claim file was created.
Comments

The date that this electronic athena-claim-profile file was created.

Control0..1
TypedateTime
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
32. athena-claim-profile.filedBy
Definition

Person name who filed claim

ShortPerson name who filed claim
Comments

The name of the user who filed this electronic athena-claim-profile.

Control0..1
Typestring
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
34. athena-claim-profile.fileTransmitted
Definition

Claim file transmission date

ShortClaim file transmission date
Comments

Claim file transmission date

Control0..1
Typestring
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
36. athena-claim-profile.submissionNumber
Definition

Electronic claim submission Number

ShortElectronic claim submission Number
Comments

The reference number for a given claim

Control0..1
Typeinteger
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
38. athena-claim-profile.transmissionStatus
Definition

Status of claim

ShortThe transmission status of this electronic claim file (i.e. 'Ready To Transmit', 'Transmission Failed', 'Transmitted')
Comments

The transmission status of this electronic athena-claim-profile file (i.e. 'Ready To Transmit', 'Transmission Failed', 'Transmitted')

Control0..1
Typestring
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
40. athena-claim-profile.failureReason
Definition

Transmission status failure reason

ShortA description of the reason for the unsuccessful transmission of this electronic claim (applies only to files with TransmissionStatus = 'Transmission Failed'))
Comments

A description of the reason for the unsuccessful transmission of this electronic athena-claim-profile file (applies only to files with TransmissionStatus = 'Transmission Failed')

Control0..1
Typestring
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
42. athena-claim-profile.claimData
Definition

Claim file data

ShortThe actual contents of this electronic claim file.
Comments

The actual contents of this electronic claim file.

Control0..1
Typestring
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
44. athena-claim-profile.lineDelimiter
ShortThe line delimiter used when this electronic claim file was created by the plug-in.
Comments

The record delimiter used when this electronic claim file was created by the plug-in.

Control0..1
Typestring
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
46. athena-claim-profile.fieldDelimiter
ShortThe field delimiter used when this electronic claim file was created by the plug-in.
Comments

The record delimiter used when this electronic claim file was created by the plug-in.

Control0..1
Typestring
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
48. athena-claim-profile.recordDelimiter
ShortThe record delimiter used when this electronic claim file was created by the plug-in.
Comments

The record delimiter used when this electronic claim file was created by the plug-in.

Control0..1
Typestring
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
50. athena-claim-profile.lineLength
ShortThe maximum line length allowed when this electronic claim file was created by the plug-in.
Comments

The maximum line length allowed when this electronic claim file was created by the plug-in.

Control0..1
Typestring
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
52. athena-claim-profile.recordLength
ShortThe maximum record length allowed when this electronic claim file was created by the plug-in.
Comments

The maximum record length allowed when this electronic claim file was created by the plug-in.

Control0..1
Typestring
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
54. athena-claim-profile.clearinghouseName
Definition

name of clearing house

ShortClearinghouse for the electronic claim file.
Comments

clearinghouse for this electronic claim file

Control0..1
Typestring
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
56. athena-claim-profile.insuranceCarrier
Definition

Reference to Organization

ShortInsurance carrier for the electronic claim.
Control0..1
TypeReference(Organization)
58. athena-claim-profile.insuranceCarrier.reference
Definition

Reference to Organization

ShortInsurance Carrier Id refering to Organization
Comments

Insurance Carrier Id refering to Organization

Control0..1
Typestring
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
60. athena-claim-profile.insuranceCarrier.display
Definition

Name of the the insurance Carrier

ShortInsurance carrier Name
Comments

Insurance carrier Name

Control0..1
Typestring
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension

Guidance on how to interpret the contents of this table can be found here

0. athena-claim-profile
Control0..*
Is Modifierfalse
Logical ModelInstances of this logical model are not marked to be the target of a Reference
2. athena-claim-profile.id
Definition

The logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes.

ShortLogical id of this artifact
Comments

The only time that a resource does not have an id is when it is being submitted to the server using a create operation.

Control1..1
Typeid
Is Modifierfalse
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
Must Supporttrue
Summarytrue
4. athena-claim-profile.meta
Definition

The metadata about the resource. This is content that is maintained by the infrastructure. Changes to the content might not always be associated with version changes to the resource.

ShortMetadata about the resource
Comments

Unique Id for this particular athena-claim-profile.

Control0..1
TypeMeta
Is Modifierfalse
Must Supportfalse
Summarytrue
6. athena-claim-profile.pid
Definition

Who/What Claimed

ShortPID is internal numeric value used in the Chart module and clinical data. This will be the same as the resource id in the Patient resource.
Comments

PID is internal numeric value used in the Chart module and clinical data. This will be the same as the resource id in the Patient resource.

Control1..1
Typeinteger
Is Modifierfalse
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
Must Supportfalse
Summarytrue
8. athena-claim-profile.patient
Definition

Who or what the athena-claim-profile is about. The athena-claim-profile can be about a person.

ShortWho/what is the patient of claim
Control1..1
TypeReference(Patient)
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
ref-1: SHALL have a contained resource if a local reference is provided (reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids')))
10. athena-claim-profile.patient.reference
Definition

Who or what the athena-claim-profile is about. The athena-claim-profile can be about a person.


A reference to a location at which the other resource is found. The reference may be a relative reference, in which case it is relative to the service base URL, or an absolute URL that resolves to the location where the resource is found. The reference may be version specific or not. If the reference is not to a FHIR RESTful server, then it should be assumed to be version specific. Internal fragment references (start with '#') refer to contained resources.

ShortReference to the PatientLiteral reference, Relative, internal or absolute URL
Comments

Using absolute URLs provides a stable scalable approach suitable for a cloud/web context, while using relative/logical references provides a flexible approach suitable for use when trading across closed eco-system boundaries. Absolute URLs do not need to point to a FHIR RESTful server, though this is the preferred approach. If the URL conforms to the structure "/[type]/[id]" then it should be assumed that the reference is to a FHIR RESTful server.

Control0..1
This element is affected by the following invariants: ref-1
Typestring
Is Modifierfalse
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
Summarytrue
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
12. athena-claim-profile.patient.display
Definition

Patient name for the athena-claim-profile is about.


Plain text narrative that identifies the resource in addition to the resource reference.

ShortPatient nameText alternative for the resource
Comments

This is generally not the same as the Resource.text of the referenced resource. The purpose is to identify what's being referenced, not to fully describe it.

Control0..1
Typestring
Is Modifierfalse
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
Summarytrue
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
14. athena-claim-profile.patientProfileId
Definition

Internal ID of patient used in non-clinical practice management data.

ShortPatient specific id for practice management data including financial information
Comments

Patient profile ID

Control1..1
TypeunsignedInt
Is Modifierfalse
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
Must Supporttrue
Summarytrue
16. athena-claim-profile.batchNumber
Definition

Batch no specific to the patient visit

ShortBatch containing this claim
Comments

The batch number of the batch containing this athena-claim-profile

Control0..1
TypeunsignedInt
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
18. athena-claim-profile.charges
Definition

batch no specific to the patient visit

ShortThe sum of the charges to be claimed.
Comments

The sum of the charges for this electronic athena-claim-profile.

Control0..1
TypeMoney
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
20. athena-claim-profile.charges.value
Definition

Charged value of the athena-claim-profile


Numerical value (with implicit precision).

ShortAmount of moneyNumerical value (with implicit precision)
Comments

The sum of the charges for this electronic athena-claim-profile.


Monetary values have their own rules for handling precision (refer to standard accounting text books).

Control0..1
Typedecimal
Is Modifierfalse
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
Summarytrue
Requirements

The amount of the currency. The value includes an implicit precision in the presentation of the value.

Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
22. athena-claim-profile.charges.currency
Definition

Name of the the Currency


ISO 4217 Currency Code.

ShortCurrencyISO 4217 Currency Code
Comments

The sum of the charges for this electronic athena-claim-profile.

Control0..1
BindingThe codes SHALL be taken from Currencieshttp://hl7.org/fhir/ValueSet/currencies|4.0.1
(required to http://hl7.org/fhir/ValueSet/currencies|4.0.1)

A code indicating the currency, taken from ISO 4217.

Typecode
Is Modifierfalse
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
Summarytrue
Requirements

A code indicating the currency, taken from ISO 4217.

Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
24. athena-claim-profile.filingMethod
Definition

Claim filing type

ShortThe ID of the filing method for ths electronic athena-claim-profile. This column should be linked to the MedLists table MedListsId column with a TableName of FilingMethods.
Comments

The ID of the filing method for ths electronic athena-claim-profile. This column should be linked to the MedLists table MedListsId column with a TableName of FilingMethods.

Control0..1
Typestring
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
26. athena-claim-profile.claimFileId
Definition

Claim associated filed id

ShortThe ID of the EDICLaim.
Comments

The ID of the EDIClaim that contains this electronic athena-claim-profile.

Control0..1
TypeunsignedInt
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
28. athena-claim-profile.fileName
Definition

athena-claim-profileed file name

ShortEDI Claim file name
Comments

Edi Claim file name

Control0..1
Typestring
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
30. athena-claim-profile.fileCreated
Definition

Claim file created date

ShortDate that claim file was created.
Comments

The date that this electronic athena-claim-profile file was created.

Control0..1
TypedateTime
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
32. athena-claim-profile.filedBy
Definition

Person name who filed claim

ShortPerson name who filed claim
Comments

The name of the user who filed this electronic athena-claim-profile.

Control0..1
Typestring
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
34. athena-claim-profile.fileTransmitted
Definition

Claim file transmission date

ShortClaim file transmission date
Comments

Claim file transmission date

Control0..1
Typestring
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
36. athena-claim-profile.submissionNumber
Definition

Electronic claim submission Number

ShortElectronic claim submission Number
Comments

The reference number for a given claim

Control0..1
Typeinteger
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
38. athena-claim-profile.transmissionStatus
Definition

Status of claim

ShortThe transmission status of this electronic claim file (i.e. 'Ready To Transmit', 'Transmission Failed', 'Transmitted')
Comments

The transmission status of this electronic athena-claim-profile file (i.e. 'Ready To Transmit', 'Transmission Failed', 'Transmitted')

Control0..1
Typestring
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
40. athena-claim-profile.failureReason
Definition

Transmission status failure reason

ShortA description of the reason for the unsuccessful transmission of this electronic claim (applies only to files with TransmissionStatus = 'Transmission Failed'))
Comments

A description of the reason for the unsuccessful transmission of this electronic athena-claim-profile file (applies only to files with TransmissionStatus = 'Transmission Failed')

Control0..1
Typestring
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
42. athena-claim-profile.claimData
Definition

Claim file data

ShortThe actual contents of this electronic claim file.
Comments

The actual contents of this electronic claim file.

Control0..1
Typestring
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
44. athena-claim-profile.lineDelimiter
ShortThe line delimiter used when this electronic claim file was created by the plug-in.
Comments

The record delimiter used when this electronic claim file was created by the plug-in.

Control0..1
Typestring
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
46. athena-claim-profile.fieldDelimiter
ShortThe field delimiter used when this electronic claim file was created by the plug-in.
Comments

The record delimiter used when this electronic claim file was created by the plug-in.

Control0..1
Typestring
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
48. athena-claim-profile.recordDelimiter
ShortThe record delimiter used when this electronic claim file was created by the plug-in.
Comments

The record delimiter used when this electronic claim file was created by the plug-in.

Control0..1
Typestring
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
50. athena-claim-profile.lineLength
ShortThe maximum line length allowed when this electronic claim file was created by the plug-in.
Comments

The maximum line length allowed when this electronic claim file was created by the plug-in.

Control0..1
Typestring
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
52. athena-claim-profile.recordLength
ShortThe maximum record length allowed when this electronic claim file was created by the plug-in.
Comments

The maximum record length allowed when this electronic claim file was created by the plug-in.

Control0..1
Typestring
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
54. athena-claim-profile.clearinghouseName
Definition

name of clearing house

ShortClearinghouse for the electronic claim file.
Comments

clearinghouse for this electronic claim file

Control0..1
Typestring
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
56. athena-claim-profile.insuranceCarrier
Definition

Reference to Organization

ShortInsurance carrier for the electronic claim.
Control0..1
TypeReference(Organization)
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
ref-1: SHALL have a contained resource if a local reference is provided (reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids')))
58. athena-claim-profile.insuranceCarrier.reference
Definition

Reference to Organization


A reference to a location at which the other resource is found. The reference may be a relative reference, in which case it is relative to the service base URL, or an absolute URL that resolves to the location where the resource is found. The reference may be version specific or not. If the reference is not to a FHIR RESTful server, then it should be assumed to be version specific. Internal fragment references (start with '#') refer to contained resources.

ShortInsurance Carrier Id refering to OrganizationLiteral reference, Relative, internal or absolute URL
Comments

Insurance Carrier Id refering to Organization


Using absolute URLs provides a stable scalable approach suitable for a cloud/web context, while using relative/logical references provides a flexible approach suitable for use when trading across closed eco-system boundaries. Absolute URLs do not need to point to a FHIR RESTful server, though this is the preferred approach. If the URL conforms to the structure "/[type]/[id]" then it should be assumed that the reference is to a FHIR RESTful server.

Control0..1
This element is affected by the following invariants: ref-1
Typestring
Is Modifierfalse
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
Summarytrue
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
60. athena-claim-profile.insuranceCarrier.display
Definition

Name of the the insurance Carrier


Plain text narrative that identifies the resource in addition to the resource reference.

ShortInsurance carrier NameText alternative for the resource
Comments

Insurance carrier Name


This is generally not the same as the Resource.text of the referenced resource. The purpose is to identify what's being referenced, not to fully describe it.

Control0..1
Typestring
Is Modifierfalse
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
Summarytrue
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

Guidance on how to interpret the contents of this table can be found here

0. athena-claim-profile
Control0..*
Is Modifierfalse
Logical ModelInstances of this logical model are not marked to be the target of a Reference
2. athena-claim-profile.id
Definition

The logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes.

ShortLogical id of this artifact
Comments

The only time that a resource does not have an id is when it is being submitted to the server using a create operation.

Control1..1
Typeid
Is Modifierfalse
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
Must Supporttrue
Summarytrue
4. athena-claim-profile.meta
Definition

The metadata about the resource. This is content that is maintained by the infrastructure. Changes to the content might not always be associated with version changes to the resource.

ShortMetadata about the resource
Comments

Unique Id for this particular athena-claim-profile.

Control0..1
TypeMeta
Is Modifierfalse
Must Supportfalse
Summarytrue
6. athena-claim-profile.pid
Definition

Who/What Claimed

ShortPID is internal numeric value used in the Chart module and clinical data. This will be the same as the resource id in the Patient resource.
Comments

PID is internal numeric value used in the Chart module and clinical data. This will be the same as the resource id in the Patient resource.

Control1..1
Typeinteger
Is Modifierfalse
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
Must Supportfalse
Summarytrue
8. athena-claim-profile.patient
Definition

Who or what the athena-claim-profile is about. The athena-claim-profile can be about a person.

ShortWho/what is the patient of claim
Control1..1
TypeReference(Patient)
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
ref-1: SHALL have a contained resource if a local reference is provided (reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids')))
10. athena-claim-profile.patient.id
Definition

Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

ShortUnique id for inter-element referencing
Control0..1
Typestring
Is Modifierfalse
XML FormatIn the XML format, this property is represented as an attribute.
Summaryfalse
12. athena-claim-profile.patient.extension
Definition

May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

ShortAdditional content defined by implementations
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

Control0..*
TypeExtension
Is Modifierfalse
Summaryfalse
Alternate Namesextensions, user content
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
SlicingThis element introduces a set of slices on athena-claim-profile.patient.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
  • value @ url
  • 14. athena-claim-profile.patient.reference
    Definition

    Who or what the athena-claim-profile is about. The athena-claim-profile can be about a person.

    ShortReference to the Patient
    Comments

    Using absolute URLs provides a stable scalable approach suitable for a cloud/web context, while using relative/logical references provides a flexible approach suitable for use when trading across closed eco-system boundaries. Absolute URLs do not need to point to a FHIR RESTful server, though this is the preferred approach. If the URL conforms to the structure "/[type]/[id]" then it should be assumed that the reference is to a FHIR RESTful server.

    Control0..1
    This element is affected by the following invariants: ref-1
    Typestring
    Is Modifierfalse
    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
    Summarytrue
    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    16. athena-claim-profile.patient.type
    Definition

    The expected type of the target of the reference. If both Reference.type and Reference.reference are populated and Reference.reference is a FHIR URL, both SHALL be consistent.

    The type is the Canonical URL of Resource Definition that is the type this reference refers to. References are URLs that are relative to http://hl7.org/fhir/StructureDefinition/ e.g. "Patient" is a reference to http://hl7.org/fhir/StructureDefinition/Patient. Absolute URLs are only allowed for logical models (and can only be used in references in logical models, not resources).

    ShortType the reference refers to (e.g. "Patient")
    Comments

    This element is used to indicate the type of the target of the reference. This may be used which ever of the other elements are populated (or not). In some cases, the type of the target may be determined by inspection of the reference (e.g. a RESTful URL) or by resolving the target of the reference; if both the type and a reference is provided, the reference SHALL resolve to a resource of the same type as that specified.

    Control0..1
    BindingUnless not suitable, these codes SHALL be taken from ResourceType
    (extensible to http://hl7.org/fhir/ValueSet/resource-types)

    Aa resource (or, for logical models, the URI of the logical model).

    Typeuri
    Is Modifierfalse
    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
    Summarytrue
    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    18. athena-claim-profile.patient.identifier
    Definition

    An identifier for the target resource. This is used when there is no way to reference the other resource directly, either because the entity it represents is not available through a FHIR server, or because there is no way for the author of the resource to convert a known identifier to an actual location. There is no requirement that a Reference.identifier point to something that is actually exposed as a FHIR instance, but it SHALL point to a business concept that would be expected to be exposed as a FHIR instance, and that instance would need to be of a FHIR resource type allowed by the reference.

    ShortLogical reference, when literal reference is not known
    Comments

    When an identifier is provided in place of a reference, any system processing the reference will only be able to resolve the identifier to a reference if it understands the business context in which the identifier is used. Sometimes this is global (e.g. a national identifier) but often it is not. For this reason, none of the useful mechanisms described for working with references (e.g. chaining, includes) are possible, nor should servers be expected to be able resolve the reference. Servers may accept an identifier based reference untouched, resolve it, and/or reject it - see CapabilityStatement.rest.resource.referencePolicy.

    When both an identifier and a literal reference are provided, the literal reference is preferred. Applications processing the resource are allowed - but not required - to check that the identifier matches the literal reference

    Applications converting a logical reference to a literal reference may choose to leave the logical reference present, or remove it.

    Reference is intended to point to a structure that can potentially be expressed as a FHIR resource, though there is no need for it to exist as an actual FHIR resource instance - except in as much as an application wishes to actual find the target of the reference. The content referred to be the identifier must meet the logical constraints implied by any limitations on what resource types are permitted for the reference. For example, it would not be legitimate to send the identifier for a drug prescription if the type were Reference(Observation|DiagnosticReport). One of the use-cases for Reference.identifier is the situation where no FHIR representation exists (where the type is Reference (Any).

    NoteThis is a business identifier, not a resource identifier (see discussion)
    Control0..1
    TypeIdentifier
    Is Modifierfalse
    Summarytrue
    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    20. athena-claim-profile.patient.display
    Definition

    Patient name for the athena-claim-profile is about.

    ShortPatient name
    Comments

    This is generally not the same as the Resource.text of the referenced resource. The purpose is to identify what's being referenced, not to fully describe it.

    Control0..1
    Typestring
    Is Modifierfalse
    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
    Summarytrue
    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    22. athena-claim-profile.patientProfileId
    Definition

    Internal ID of patient used in non-clinical practice management data.

    ShortPatient specific id for practice management data including financial information
    Comments

    Patient profile ID

    Control1..1
    TypeunsignedInt
    Is Modifierfalse
    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
    Must Supporttrue
    Summarytrue
    24. athena-claim-profile.batchNumber
    Definition

    Batch no specific to the patient visit

    ShortBatch containing this claim
    Comments

    The batch number of the batch containing this athena-claim-profile

    Control0..1
    TypeunsignedInt
    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
    26. athena-claim-profile.charges
    Definition

    batch no specific to the patient visit

    ShortThe sum of the charges to be claimed.
    Comments

    The sum of the charges for this electronic athena-claim-profile.

    Control0..1
    TypeMoney
    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    28. athena-claim-profile.charges.id
    Definition

    Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

    ShortUnique id for inter-element referencing
    Control0..1
    Typestring
    Is Modifierfalse
    XML FormatIn the XML format, this property is represented as an attribute.
    Summaryfalse
    30. athena-claim-profile.charges.extension
    Definition

    May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

    ShortAdditional content defined by implementations
    Comments

    There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

    Control0..*
    TypeExtension
    Is Modifierfalse
    Summaryfalse
    Alternate Namesextensions, user content
    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
    SlicingThis element introduces a set of slices on athena-claim-profile.charges.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
    • value @ url
    • 32. athena-claim-profile.charges.value
      Definition

      Charged value of the athena-claim-profile

      ShortAmount of money
      Comments

      The sum of the charges for this electronic athena-claim-profile.

      Control0..1
      Typedecimal
      Is Modifierfalse
      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
      Summarytrue
      Requirements

      The amount of the currency. The value includes an implicit precision in the presentation of the value.

      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      34. athena-claim-profile.charges.currency
      Definition

      Name of the the Currency

      ShortCurrency
      Comments

      The sum of the charges for this electronic athena-claim-profile.

      Control0..1
      BindingThe codes SHALL be taken from Currencies
      (required to http://hl7.org/fhir/ValueSet/currencies|4.0.1)

      A code indicating the currency, taken from ISO 4217.

      Typecode
      Is Modifierfalse
      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
      Summarytrue
      Requirements

      A code indicating the currency, taken from ISO 4217.

      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      36. athena-claim-profile.filingMethod
      Definition

      Claim filing type

      ShortThe ID of the filing method for ths electronic athena-claim-profile. This column should be linked to the MedLists table MedListsId column with a TableName of FilingMethods.
      Comments

      The ID of the filing method for ths electronic athena-claim-profile. This column should be linked to the MedLists table MedListsId column with a TableName of FilingMethods.

      Control0..1
      Typestring
      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
      38. athena-claim-profile.claimFileId
      Definition

      Claim associated filed id

      ShortThe ID of the EDICLaim.
      Comments

      The ID of the EDIClaim that contains this electronic athena-claim-profile.

      Control0..1
      TypeunsignedInt
      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
      40. athena-claim-profile.fileName
      Definition

      athena-claim-profileed file name

      ShortEDI Claim file name
      Comments

      Edi Claim file name

      Control0..1
      Typestring
      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
      42. athena-claim-profile.fileCreated
      Definition

      Claim file created date

      ShortDate that claim file was created.
      Comments

      The date that this electronic athena-claim-profile file was created.

      Control0..1
      TypedateTime
      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
      44. athena-claim-profile.filedBy
      Definition

      Person name who filed claim

      ShortPerson name who filed claim
      Comments

      The name of the user who filed this electronic athena-claim-profile.

      Control0..1
      Typestring
      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
      46. athena-claim-profile.fileTransmitted
      Definition

      Claim file transmission date

      ShortClaim file transmission date
      Comments

      Claim file transmission date

      Control0..1
      Typestring
      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
      48. athena-claim-profile.submissionNumber
      Definition

      Electronic claim submission Number

      ShortElectronic claim submission Number
      Comments

      The reference number for a given claim

      Control0..1
      Typeinteger
      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
      50. athena-claim-profile.transmissionStatus
      Definition

      Status of claim

      ShortThe transmission status of this electronic claim file (i.e. 'Ready To Transmit', 'Transmission Failed', 'Transmitted')
      Comments

      The transmission status of this electronic athena-claim-profile file (i.e. 'Ready To Transmit', 'Transmission Failed', 'Transmitted')

      Control0..1
      Typestring
      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
      52. athena-claim-profile.failureReason
      Definition

      Transmission status failure reason

      ShortA description of the reason for the unsuccessful transmission of this electronic claim (applies only to files with TransmissionStatus = 'Transmission Failed'))
      Comments

      A description of the reason for the unsuccessful transmission of this electronic athena-claim-profile file (applies only to files with TransmissionStatus = 'Transmission Failed')

      Control0..1
      Typestring
      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
      54. athena-claim-profile.claimData
      Definition

      Claim file data

      ShortThe actual contents of this electronic claim file.
      Comments

      The actual contents of this electronic claim file.

      Control0..1
      Typestring
      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
      56. athena-claim-profile.lineDelimiter
      ShortThe line delimiter used when this electronic claim file was created by the plug-in.
      Comments

      The record delimiter used when this electronic claim file was created by the plug-in.

      Control0..1
      Typestring
      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
      58. athena-claim-profile.fieldDelimiter
      ShortThe field delimiter used when this electronic claim file was created by the plug-in.
      Comments

      The record delimiter used when this electronic claim file was created by the plug-in.

      Control0..1
      Typestring
      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
      60. athena-claim-profile.recordDelimiter
      ShortThe record delimiter used when this electronic claim file was created by the plug-in.
      Comments

      The record delimiter used when this electronic claim file was created by the plug-in.

      Control0..1
      Typestring
      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
      62. athena-claim-profile.lineLength
      ShortThe maximum line length allowed when this electronic claim file was created by the plug-in.
      Comments

      The maximum line length allowed when this electronic claim file was created by the plug-in.

      Control0..1
      Typestring
      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
      64. athena-claim-profile.recordLength
      ShortThe maximum record length allowed when this electronic claim file was created by the plug-in.
      Comments

      The maximum record length allowed when this electronic claim file was created by the plug-in.

      Control0..1
      Typestring
      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
      66. athena-claim-profile.clearinghouseName
      Definition

      name of clearing house

      ShortClearinghouse for the electronic claim file.
      Comments

      clearinghouse for this electronic claim file

      Control0..1
      Typestring
      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
      68. athena-claim-profile.insuranceCarrier
      Definition

      Reference to Organization

      ShortInsurance carrier for the electronic claim.
      Control0..1
      TypeReference(Organization)
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      ref-1: SHALL have a contained resource if a local reference is provided (reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids')))
      70. athena-claim-profile.insuranceCarrier.id
      Definition

      Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

      ShortUnique id for inter-element referencing
      Control0..1
      Typestring
      Is Modifierfalse
      XML FormatIn the XML format, this property is represented as an attribute.
      Summaryfalse
      72. athena-claim-profile.insuranceCarrier.extension
      Definition

      May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

      ShortAdditional content defined by implementations
      Comments

      There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

      Control0..*
      TypeExtension
      Is Modifierfalse
      Summaryfalse
      Alternate Namesextensions, user content
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
      SlicingThis element introduces a set of slices on athena-claim-profile.insuranceCarrier.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
      • value @ url
      • 74. athena-claim-profile.insuranceCarrier.reference
        Definition

        Reference to Organization

        ShortInsurance Carrier Id refering to Organization
        Comments

        Insurance Carrier Id refering to Organization

        Control0..1
        This element is affected by the following invariants: ref-1
        Typestring
        Is Modifierfalse
        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
        Summarytrue
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        76. athena-claim-profile.insuranceCarrier.type
        Definition

        The expected type of the target of the reference. If both Reference.type and Reference.reference are populated and Reference.reference is a FHIR URL, both SHALL be consistent.

        The type is the Canonical URL of Resource Definition that is the type this reference refers to. References are URLs that are relative to http://hl7.org/fhir/StructureDefinition/ e.g. "Patient" is a reference to http://hl7.org/fhir/StructureDefinition/Patient. Absolute URLs are only allowed for logical models (and can only be used in references in logical models, not resources).

        ShortType the reference refers to (e.g. "Patient")
        Comments

        This element is used to indicate the type of the target of the reference. This may be used which ever of the other elements are populated (or not). In some cases, the type of the target may be determined by inspection of the reference (e.g. a RESTful URL) or by resolving the target of the reference; if both the type and a reference is provided, the reference SHALL resolve to a resource of the same type as that specified.

        Control0..1
        BindingUnless not suitable, these codes SHALL be taken from ResourceType
        (extensible to http://hl7.org/fhir/ValueSet/resource-types)

        Aa resource (or, for logical models, the URI of the logical model).

        Typeuri
        Is Modifierfalse
        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
        Summarytrue
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        78. athena-claim-profile.insuranceCarrier.identifier
        Definition

        An identifier for the target resource. This is used when there is no way to reference the other resource directly, either because the entity it represents is not available through a FHIR server, or because there is no way for the author of the resource to convert a known identifier to an actual location. There is no requirement that a Reference.identifier point to something that is actually exposed as a FHIR instance, but it SHALL point to a business concept that would be expected to be exposed as a FHIR instance, and that instance would need to be of a FHIR resource type allowed by the reference.

        ShortLogical reference, when literal reference is not known
        Comments

        When an identifier is provided in place of a reference, any system processing the reference will only be able to resolve the identifier to a reference if it understands the business context in which the identifier is used. Sometimes this is global (e.g. a national identifier) but often it is not. For this reason, none of the useful mechanisms described for working with references (e.g. chaining, includes) are possible, nor should servers be expected to be able resolve the reference. Servers may accept an identifier based reference untouched, resolve it, and/or reject it - see CapabilityStatement.rest.resource.referencePolicy.

        When both an identifier and a literal reference are provided, the literal reference is preferred. Applications processing the resource are allowed - but not required - to check that the identifier matches the literal reference

        Applications converting a logical reference to a literal reference may choose to leave the logical reference present, or remove it.

        Reference is intended to point to a structure that can potentially be expressed as a FHIR resource, though there is no need for it to exist as an actual FHIR resource instance - except in as much as an application wishes to actual find the target of the reference. The content referred to be the identifier must meet the logical constraints implied by any limitations on what resource types are permitted for the reference. For example, it would not be legitimate to send the identifier for a drug prescription if the type were Reference(Observation|DiagnosticReport). One of the use-cases for Reference.identifier is the situation where no FHIR representation exists (where the type is Reference (Any).

        NoteThis is a business identifier, not a resource identifier (see discussion)
        Control0..1
        TypeIdentifier
        Is Modifierfalse
        Summarytrue
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        80. athena-claim-profile.insuranceCarrier.display
        Definition

        Name of the the insurance Carrier

        ShortInsurance carrier Name
        Comments

        Insurance carrier Name

        Control0..1
        Typestring
        Is Modifierfalse
        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
        Summarytrue
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))