EnrollEligCOB
Class Claim

"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." - HL7 FHIR, Claim

Attributes
Accident accident accident

"An accident which resulted in the need for healthcare services." - HL7 FHIR, Claim.accident

«IVL_TS» Period billablePeriod billablePeriod

"The billable period for which charges are being submitted." - HL7 FHIR, Claim.billablePeriod

«TS» PointInTime dateCreated dateCreated

"The date when the enclosed suite of services were performed or completed." - HL7 FHIR, Claim.created

DiagnosisListEntry diagnosis diagnosis

"List of patient diagnosis for which care is sought." - HL7 FHIR, Claim.diagnosis

Participation enterer enterer

"Person who created the invoice/claim/pre-determination or pre-authorization." - HL7 FHIR, Claim.enterer

«CS» Code fundsReserve 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." - HL7 FHIR, Claim.fundsReserve

«II» Id identifier identifier

"The business identifier for the instance: claim number, pre-determination or pre-authorization number." - HL7 FHIR, Claim.identifier

«IVL_TS» Period periodEmploymentImpacted periodEmploymentImpacted

"The start and optional end dates of when the patient was precluded from working due to the treatable condition(s)." - HL7 FHIR, Claim.employmentImpacted

«IVL_TS» Period periodHospitalized periodHospitalized

"The start and optional end dates of when the patient was confined to a treatment center." - HL7 FHIR, Claim.hospitalization

«CS» Code priority priority

"Immediate (STAT), best effort (NORMAL), deferred (DEFER)." - HL7 FHIR, Claim.priority

OrganizationalProvider requestOrganization requestOrganization
HealthcareProvider requestProvider requestProvider
«CS» Code status status

"The status of the resource instance." - HL7 FHIR, Claim.status

«CS» Code subType subType

"A finer grained suite of claim subtype codes which may convey Inpatient vs Outpatient and/or a specialty service. In the US the BillType." - HL7 FHIR, Claim.subType

«MO» MonetaryAmount total total

"The total value of the claim." - HL7 FHIR, Claim.total

«CS» Code type type

"The category of claim, eg, oral, pharmacy, vision, insitutional, professional." - HL7 FHIR, Claim.type

«CS» Code use use

"Complete (Bill or Claim), Proposed (Pre-Authorization), Exploratory (Pre-determination)." - HL7 FHIR, Claim.use


Properties:

Alias
Classifier Behavior
Is Abstractfalse
Is Activefalse
Is Leaffalse
Keywords
NameClaim
Name Expression
NamespaceEnrollEligCOB
Owned Template Signature
OwnerEnrollEligCOB
Owning Template Parameter
PackageEnrollEligCOB
Qualified NameFHIM::EnrollEligCOB::Claim
Representation
Stereotype
Template Parameter
VisibilityPublic

Attribute Details

 accident
Public Accident accident

"An accident which resulted in the need for healthcare services." - HL7 FHIR, Claim.accident

Constraints:
Properties:

AggregationNone
Alias
Associationclaim_accident
Association End
ClassClaim
Datatype
Default
Default Value
Is Compositefalse
Is Derivedfalse
Is Derived Unionfalse
Is Leaffalse
Is Orderedfalse
Is Read Onlyfalse
Is Staticfalse
Is Uniquetrue
Keywords
Lower0
Lower Value(0)
Multiplicity0..1
Nameaccident
Name Expression
NamespaceClaim
Opposite
OwnerClaim
Owning Association
Owning Template Parameter
Qualified NameFHIM::EnrollEligCOB::Claim::accident
Stereotype
Template Parameter
TypeAccident
Upper1
Upper Value(1)
VisibilityPublic


 billablePeriod
Public «IVL_TS» Period billablePeriod

"The billable period for which charges are being submitted." - HL7 FHIR, Claim.billablePeriod

Constraints:
Properties:

AggregationNone
Alias
Association
Association End
ClassClaim
Datatype
Default
Default Value
Is Compositefalse
Is Derivedfalse
Is Derived Unionfalse
Is Leaffalse
Is Orderedfalse
Is Read Onlyfalse
Is Staticfalse
Is Uniquetrue
Keywords
Lower0
Lower Value(0)
Multiplicity0..1
NamebillablePeriod
Name Expression
NamespaceClaim
Opposite
OwnerClaim
Owning Association
Owning Template Parameter
Qualified NameFHIM::EnrollEligCOB::Claim::billablePeriod
Stereotype
Template Parameter
Type«IVL_TS» Period
Upper1
Upper Value(1)
VisibilityPublic


 dateCreated
Public «TS» PointInTime dateCreated

"The date when the enclosed suite of services were performed or completed." - HL7 FHIR, Claim.created

Constraints:
Properties:

AggregationNone
Alias
Association
Association End
ClassClaim
Datatype
Default
Default Value
Is Compositefalse
Is Derivedfalse
Is Derived Unionfalse
Is Leaffalse
Is Orderedfalse
Is Read Onlyfalse
Is Staticfalse
Is Uniquetrue
Keywords
Lower0
Lower Value(0)
Multiplicity0..1
NamedateCreated
Name Expression
NamespaceClaim
Opposite
OwnerClaim
Owning Association
Owning Template Parameter
Qualified NameFHIM::EnrollEligCOB::Claim::dateCreated
Stereotype
Template Parameter
Type«TS» PointInTime
Upper1
Upper Value(1)
VisibilityPublic


 diagnosis
Public DiagnosisListEntry diagnosis

"List of patient diagnosis for which care is sought." - HL7 FHIR, Claim.diagnosis

Constraints:
Properties:

AggregationNone
Alias
Association
Association End
ClassClaim
Datatype
Default
Default Value
Is Compositefalse
Is Derivedfalse
Is Derived Unionfalse
Is Leaffalse
Is Orderedfalse
Is Read Onlyfalse
Is Staticfalse
Is Uniquetrue
Keywords
Lower0
Lower Value(0)
Multiplicity*
Namediagnosis
Name Expression
NamespaceClaim
Opposite
OwnerClaim
Owning Association
Owning Template Parameter
Qualified NameFHIM::EnrollEligCOB::Claim::diagnosis
Stereotype
Template Parameter
TypeDiagnosisListEntry
Upper*
Upper Value(*)
VisibilityPublic


 enterer
Public Participation enterer

"Person who created the invoice/claim/pre-determination or pre-authorization." - HL7 FHIR, Claim.enterer

Constraints:
Properties:

AggregationNone
Alias
Association
Association End
ClassClaim
Datatype
Default
Default Value
Is Compositefalse
Is Derivedfalse
Is Derived Unionfalse
Is Leaffalse
Is Orderedfalse
Is Read Onlyfalse
Is Staticfalse
Is Uniquetrue
Keywords
Lower0
Lower Value(0)
Multiplicity0..1
Nameenterer
Name Expression
NamespaceClaim
Opposite
OwnerClaim
Owning Association
Owning Template Parameter
Qualified NameFHIM::EnrollEligCOB::Claim::enterer
Stereotype
Template Parameter
TypeParticipation
Upper1
Upper Value(1)
VisibilityPublic


 fundsReserve
Public «CS» Code 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." - HL7 FHIR, Claim.fundsReserve

Constraints:
Properties:

AggregationNone
Alias
Association
Association End
ClassClaim
Terminologies[
HL7_FHIR_R4 Funds Reservation Codes http://hl7.org/fhir/ValueSet/fundsreserve
]
Datatype
Default
Default Value
Is Compositefalse
Is Derivedfalse
Is Derived Unionfalse
Is Leaffalse
Is Orderedfalse
Is Read Onlyfalse
Is Staticfalse
Is Uniquetrue
Keywords
Lower0
Lower Value(0)
Multiplicity0..1
NamefundsReserve
Name Expression
NamespaceClaim
Opposite
OwnerClaim
Owning Association
Owning Template Parameter
Qualified NameFHIM::EnrollEligCOB::Claim::fundsReserve
StereotypeValueSetConstraints
Template Parameter
Type«CS» Code
Upper1
Upper Value(1)
VisibilityPublic


 identifier
Public «II» Id identifier

"The business identifier for the instance: claim number, pre-determination or pre-authorization number." - HL7 FHIR, Claim.identifier

Constraints:
Properties:

AggregationNone
Alias
Association
Association End
ClassClaim
Datatype
Default
Default Value
Is Compositefalse
Is Derivedfalse
Is Derived Unionfalse
Is Leaffalse
Is Orderedfalse
Is Read Onlyfalse
Is Staticfalse
Is Uniquetrue
Keywords
Lower0
Lower Value(0)
Multiplicity*
Nameidentifier
Name Expression
NamespaceClaim
Opposite
OwnerClaim
Owning Association
Owning Template Parameter
Qualified NameFHIM::EnrollEligCOB::Claim::identifier
Stereotype
Template Parameter
Type«II» Id
Upper*
Upper Value(*)
VisibilityPublic


 periodEmploymentImpacted
Public «IVL_TS» Period periodEmploymentImpacted

"The start and optional end dates of when the patient was precluded from working due to the treatable condition(s)." - HL7 FHIR, Claim.employmentImpacted

Constraints:
Properties:

AggregationNone
Alias
Association
Association End
ClassClaim
Datatype
Default
Default Value
Is Compositefalse
Is Derivedfalse
Is Derived Unionfalse
Is Leaffalse
Is Orderedfalse
Is Read Onlyfalse
Is Staticfalse
Is Uniquetrue
Keywords
Lower0
Lower Value(0)
Multiplicity0..1
NameperiodEmploymentImpacted
Name Expression
NamespaceClaim
Opposite
OwnerClaim
Owning Association
Owning Template Parameter
Qualified NameFHIM::EnrollEligCOB::Claim::periodEmploymentImpacted
Stereotype
Template Parameter
Type«IVL_TS» Period
Upper1
Upper Value(1)
VisibilityPublic


 periodHospitalized
Public «IVL_TS» Period periodHospitalized

"The start and optional end dates of when the patient was confined to a treatment center." - HL7 FHIR, Claim.hospitalization

Constraints:
Properties:

AggregationNone
Alias
Association
Association End
ClassClaim
Datatype
Default
Default Value
Is Compositefalse
Is Derivedfalse
Is Derived Unionfalse
Is Leaffalse
Is Orderedfalse
Is Read Onlyfalse
Is Staticfalse
Is Uniquetrue
Keywords
Lower0
Lower Value(0)
Multiplicity0..1
NameperiodHospitalized
Name Expression
NamespaceClaim
Opposite
OwnerClaim
Owning Association
Owning Template Parameter
Qualified NameFHIM::EnrollEligCOB::Claim::periodHospitalized
Stereotype
Template Parameter
Type«IVL_TS» Period
Upper1
Upper Value(1)
VisibilityPublic


 priority
Public «CS» Code priority

"Immediate (STAT), best effort (NORMAL), deferred (DEFER)." - HL7 FHIR, Claim.priority

Constraints:
Properties:

AggregationNone
Alias
Association
Association End
ClassClaim
Terminologies[
HL7_FHIR_R4 Process Priority Codes http://hl7.org/fhir/ValueSet/process-priority
]
Datatype
Default
Default Value
Is Compositefalse
Is Derivedfalse
Is Derived Unionfalse
Is Leaffalse
Is Orderedfalse
Is Read Onlyfalse
Is Staticfalse
Is Uniquetrue
Keywords
Lower0
Lower Value(0)
Multiplicity0..1
Namepriority
Name Expression
NamespaceClaim
Opposite
OwnerClaim
Owning Association
Owning Template Parameter
Qualified NameFHIM::EnrollEligCOB::Claim::priority
StereotypeValueSetConstraints
Template Parameter
Type«CS» Code
Upper1
Upper Value(1)
VisibilityPublic


 requestOrganization
Public OrganizationalProvider requestOrganization
Constraints:
Properties:

AggregationNone
Alias
Association
Association End
ClassClaim
Datatype
Default
Default Value
Is Compositefalse
Is Derivedfalse
Is Derived Unionfalse
Is Leaffalse
Is Orderedfalse
Is Read Onlyfalse
Is Staticfalse
Is Uniquetrue
Keywords
Lower0
Lower Value(0)
Multiplicity0..1
NamerequestOrganization
Name Expression
NamespaceClaim
Opposite
OwnerClaim
Owning Association
Owning Template Parameter
Qualified NameFHIM::EnrollEligCOB::Claim::requestOrganization
Stereotype
Template Parameter
TypeOrganizationalProvider
Upper1
Upper Value(1)
VisibilityPublic


 requestProvider
Public HealthcareProvider requestProvider
Constraints:
Properties:

AggregationNone
Alias
Association
Association End
ClassClaim
Datatype
Default
Default Value
Is Compositefalse
Is Derivedfalse
Is Derived Unionfalse
Is Leaffalse
Is Orderedfalse
Is Read Onlyfalse
Is Staticfalse
Is Uniquetrue
Keywords
Lower0
Lower Value(0)
Multiplicity0..1
NamerequestProvider
Name Expression
NamespaceClaim
Opposite
OwnerClaim
Owning Association
Owning Template Parameter
Qualified NameFHIM::EnrollEligCOB::Claim::requestProvider
Stereotype
Template Parameter
TypeHealthcareProvider
Upper1
Upper Value(1)
VisibilityPublic


 status
Public «CS» Code status

"The status of the resource instance." - HL7 FHIR, Claim.status

Constraints:
Properties:

AggregationNone
Alias
Association
Association End
ClassClaim
Terminologies[
HL7_FHIR_R4 Financial Resource Status Codes http://hl7.org/fhir/ValueSet/fm-status
]
Datatype
Default
Default Value
Is Compositefalse
Is Derivedfalse
Is Derived Unionfalse
Is Leaffalse
Is Orderedfalse
Is Read Onlyfalse
Is Staticfalse
Is Uniquetrue
Keywords
Lower0
Lower Value(0)
Multiplicity0..1
Namestatus
Name Expression
NamespaceClaim
Opposite
OwnerClaim
Owning Association
Owning Template Parameter
Qualified NameFHIM::EnrollEligCOB::Claim::status
StereotypeValueSetConstraints
Template Parameter
Type«CS» Code
Upper1
Upper Value(1)
VisibilityPublic


 subType
Public «CS» Code subType

"A finer grained suite of claim subtype codes which may convey Inpatient vs Outpatient and/or a specialty service. In the US the BillType." - HL7 FHIR, Claim.subType

Constraints:
Properties:

AggregationNone
Alias
Association
Association End
ClassClaim
Terminologies[
HL7_FHIR_R4 Example Claim SubType Codes http://hl7.org/fhir/ValueSet/claim-subtype
]
Datatype
Default
Default Value
Is Compositefalse
Is Derivedfalse
Is Derived Unionfalse
Is Leaffalse
Is Orderedfalse
Is Read Onlyfalse
Is Staticfalse
Is Uniquetrue
Keywords
Lower0
Lower Value(0)
Multiplicity*
NamesubType
Name Expression
NamespaceClaim
Opposite
OwnerClaim
Owning Association
Owning Template Parameter
Qualified NameFHIM::EnrollEligCOB::Claim::subType
StereotypeValueSetConstraints
Template Parameter
Type«CS» Code
Upper*
Upper Value(*)
VisibilityPublic


 total
Public «MO» MonetaryAmount total

"The total value of the claim." - HL7 FHIR, Claim.total

Constraints:
Properties:

AggregationNone
Alias
Association
Association End
ClassClaim
Datatype
Default
Default Value
Is Compositefalse
Is Derivedfalse
Is Derived Unionfalse
Is Leaffalse
Is Orderedfalse
Is Read Onlyfalse
Is Staticfalse
Is Uniquetrue
Keywords
Lower0
Lower Value(0)
Multiplicity0..1
Nametotal
Name Expression
NamespaceClaim
Opposite
OwnerClaim
Owning Association
Owning Template Parameter
Qualified NameFHIM::EnrollEligCOB::Claim::total
Stereotype
Template Parameter
Type«MO» MonetaryAmount
Upper1
Upper Value(1)
VisibilityPublic


 type
Public «CS» Code type

"The category of claim, eg, oral, pharmacy, vision, insitutional, professional." - HL7 FHIR, Claim.type

Constraints:
Properties:

AggregationNone
Alias
Association
Association End
ClassClaim
Terminologies[
HL7_FHIR_R4 Claim Type Codes http://hl7.org/fhir/ValueSet/claim-type
]
Datatype
Default
Default Value
Is Compositefalse
Is Derivedfalse
Is Derived Unionfalse
Is Leaffalse
Is Orderedfalse
Is Read Onlyfalse
Is Staticfalse
Is Uniquetrue
Keywords
Lower0
Lower Value(0)
Multiplicity0..1
Nametype
Name Expression
NamespaceClaim
Opposite
OwnerClaim
Owning Association
Owning Template Parameter
Qualified NameFHIM::EnrollEligCOB::Claim::type
StereotypeValueSetConstraints
Template Parameter
Type«CS» Code
Upper1
Upper Value(1)
VisibilityPublic


 use
Public «CS» Code use

"Complete (Bill or Claim), Proposed (Pre-Authorization), Exploratory (Pre-determination)." - HL7 FHIR, Claim.use

Constraints:
Properties:

AggregationNone
Alias
Association
Association End
ClassClaim
Terminologies[
HL7_FHIR_R4 Use http://hl7.org/fhir/ValueSet/claim-use
]
Datatype
Default
Default Value
Is Compositefalse
Is Derivedfalse
Is Derived Unionfalse
Is Leaffalse
Is Orderedfalse
Is Read Onlyfalse
Is Staticfalse
Is Uniquetrue
Keywords
Lower0
Lower Value(0)
Multiplicity0..1
Nameuse
Name Expression
NamespaceClaim
Opposite
OwnerClaim
Owning Association
Owning Template Parameter
Qualified NameFHIM::EnrollEligCOB::Claim::use
StereotypeValueSetConstraints
Template Parameter
Type«CS» Code
Upper1
Upper Value(1)
VisibilityPublic