Introdução

O recurso Claim no contexto OCI/APAC é projetado para capturar as solicitações de autorização e reembolso de procedimentos médicos. Este recurso segue as especificações HL7 FHIR R4 e é adaptado às necessidades regulatórias e operacionais do Sistema Único de Saúde (SUS) no Brasil.

Objetivo

Fornecer uma estrutura padronizada para documentar e comunicar as solicitações de procedimentos realizados sob o sistema APAC, promovendo interoperabilidade, precisão e conformidade com as regulamentações estabelecidas pelo Ministério da Saúde.

Escopo

O Claim é utilizado para registrar os seguintes aspectos:

• Identificação da Solicitação: Um identificador único (ex.: número APAC) para rastreabilidade.
• Informações do Paciente: Dados de identificação do paciente que recebeu o cuidado.
• Detalhes do Atendimento: Inclui informações sobre a equipe de cuidado, datas relevantes e características do atendimento prestado.
• Procedimentos: Lista abrangente dos procedimentos realizados, incluindo primários e secundários.

Elementos Chave

Elementos Obrigatórios

• Identificador da Reivindicação: Cada solicitação deve conter um identificador exclusivo para rastreamento e validação.
• Paciente: Referência ao paciente que recebeu os serviços descritos.
• Equipe de Cuidado: Informações sobre os profissionais responsáveis pelo atendimento.
• Procedimentos: Inclui os códigos e descrições dos procedimentos realizados, como consultas, teleconsultas e exames.
• Período de Cobrança: Especifica o período durante o qual os serviços foram realizados e são elegíveis para reembolso.

Elementos Must Support

• Care Team: Detalhamento da equipe médica que participou dos procedimentos.
• Diagnosis: CID-10 referente ao diagnóstico que justifica os procedimentos.
• Insurance: Informações sobre o plano de saúde utilizado (ex.: SUS).

Limites e Relacionamentos

• Cada recurso Claim deve estar relacionado a um ClaimResponse, representando o resultado do processamento da solicitação.
• O identificador APAC deve ser único por período de competência.
• Procedimentos devem seguir os valores definidos na tabela SIGTAP.

Casos de Uso

Uso Principal

Registrar solicitações de procedimentos realizados sob o contexto OCI/APAC para análise e autorização de reembolso.

Exemplos

• Solicitação de reembolso para avaliação cirúrgica.
• Registro de consultas e teleconsultas realizadas no período.

Uso Indevido

• Solicitações duplicadas para o mesmo procedimento e período.
• Dados incompletos ou inválidos, como ausência de CID-10 ou código de procedimento.

Identificadores e Extensões

• Identificadores: O número APAC é obrigatório e deve seguir o formato definido pelo SUS.
• Extensões:
  • Competência APAC: Indica o período de validade da autorização.
  • Modalidade Assistencial: Define se o atendimento foi ambulatorial, hospitalar ou outro.
  • Prioridade do Atendimento: Determina se o atendimento foi eletivo ou de urgência.

Benefícios

• Padronização: Garante uniformidade nas solicitações de procedimentos e reembolsos.
• Interoperabilidade: Facilita a integração entre sistemas regionais e nacionais de saúde.
• Rastreabilidade: Melhora o acompanhamento e a validação das autorizações e pagamentos.

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

Nome	Bandeiras	Card.	Tipo	Descrição e condicionalismos    Filter: Condicionantes Obrigações Vínculos
Claim		1..*	Claim	Solicitação de reembolso ou cobertura de um procedimento de saúde.
implicitRules	?!Σ	0..1	uri	A set of rules under which this content was created
Fatias para extension		0..*	Extension	Extensões utilizadas pela GuiaOCIBRIPES. Fatia: Não ordenado, Aberto por value:url
extension:Competencia		0..1	dateTime	Extensão de Competencia URL: https://fhir.ecoinfo.ipes.tech/fhir/StructureDefinition/Competencia
extension:ModalidadeAssistencial		0..1	CodeableConcept	Extensão de Modalidade Assistencial URL: https://fhir.ecoinfo.ipes.tech/fhir/StructureDefinition/ModalidadeAssistencial Vínculo: https://terminologia.saude.gov.br/fhir/ValueSet/BRModalidadeAssistencialMIRA (required)
extension:DataSolicitacao		0..1	dateTime	Extensão de DataSolicitacao URL: https://fhir.ecoinfo.ipes.tech/fhir/StructureDefinition/DataSolicitacao
extension:DataDesfecho		0..1	dateTime	Extensão de DataDesfecho URL: https://fhir.ecoinfo.ipes.tech/fhir/StructureDefinition/DataDesfecho
extension:Prioridade		0..1	CodeableConcept	Extensão de Prioridade URL: https://fhir.ecoinfo.ipes.tech/fhir/StructureDefinition/Prioridade Vínculo: https://terminologia.saude.gov.br/fhir/ValueSet/BRCaraterAtendimento (required)
extension:DataAutorizacao		0..1	dateTime	Extensão de DataAutorizacao URL: https://fhir.ecoinfo.ipes.tech/fhir/StructureDefinition/DataAutorizacao
extension:MotivoDesfecho		0..1	CodeableConcept	Extensão de MotivoDesfecho URL: https://fhir.ecoinfo.ipes.tech/fhir/StructureDefinition/MotivoDesfecho Vínculo: https://terminologia.saude.gov.br/fhir/ValueSet/BRCaraterAtendimento (required)
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored
identifier		0..1	Identifier	Business Identifier for claim
use	?!Σ	0..1	code	usual | official | temp | secondary | old (If known) Vínculo: IdentifierUse (required): Identifies the purpose for this identifier, if known .
system	Σ	0..1	uri	The namespace for the identifier value Valor fixo: urn:oid:1.3.6.1.4.1.54413.1.1.5.19.1
status	?!Σ	1..1	code	active | cancelled | draft | entered-in-error Vínculo: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance.
type	Σ	1..1	CodeableConcept	Category or discipline Vínculo: ClaimTypeCodes (extensible): The type or discipline-style of the claim.
use	Σ	1..1	code	claim | preauthorization | predetermination Vínculo: Use (required): The purpose of the Claim: predetermination, preauthorization, claim. Valor fixo: claim
patient	Σ	1..1	Reference(Patient)	The recipient of the products and services
created	Σ	1..1	dateTime	Resource creation date
provider	Σ	1..1	Reference(Organization)	Party responsible for the claim
priority	Σ	1..1	CodeableConcept	Desired processing ugency Vínculo: ProcessPriorityCodes (example): The timeliness with which processing is required: stat, normal, deferred.
insurance	Σ	1..*	BackboneElement	Patient insurance information
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
sequence	Σ	1..1	positiveInt	Insurance instance identifier
focal	Σ	1..1	boolean	Coverage to be used for adjudication
coverage	Σ	1..1	Reference(Coverage)	Insurance information
display	Σ	0..1	string	Text alternative for the resource Valor fixo: SUS
Documentação para este formato

Terminologia Ligações

Caminho	Conformidade	ValueSet / Código	URI
Claim.identifier.use	required	IdentifierUse http://hl7.org/fhir/ValueSet/identifier-use|4.0.1 From a norma FHIR
Claim.status	required	FinancialResourceStatusCodes http://hl7.org/fhir/ValueSet/fm-status|4.0.1 From a norma FHIR
Claim.type	extensible	ClaimTypeCodes http://hl7.org/fhir/ValueSet/claim-type From a norma FHIR
Claim.use	required	Fixed Value: claim http://hl7.org/fhir/ValueSet/claim-use|4.0.1 From a norma FHIR
Claim.priority	example	ProcessPriorityCodes http://hl7.org/fhir/ValueSet/process-priority From a norma FHIR

Restrições

Id	Grau	Caminho(s)	Detalhes	Requisitos
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 Claim

Nome	Bandeiras	Card.	Tipo	Descrição e condicionalismos    Filter: Condicionantes Obrigações Vínculos
Claim		1..*	Claim	Solicitação de reembolso ou cobertura de um procedimento de saúde.
Fatias para extension		0..*	Extension	Extensões utilizadas pela GuiaOCIBRIPES. Fatia: Não ordenado, Aberto por value:url
extension:Competencia		0..1	dateTime	Extensão de Competencia URL: https://fhir.ecoinfo.ipes.tech/fhir/StructureDefinition/Competencia
extension:ModalidadeAssistencial		0..1	CodeableConcept	Extensão de Modalidade Assistencial URL: https://fhir.ecoinfo.ipes.tech/fhir/StructureDefinition/ModalidadeAssistencial Vínculo: https://terminologia.saude.gov.br/fhir/ValueSet/BRModalidadeAssistencialMIRA (required)
extension:DataSolicitacao		0..1	dateTime	Extensão de DataSolicitacao URL: https://fhir.ecoinfo.ipes.tech/fhir/StructureDefinition/DataSolicitacao
extension:DataDesfecho		0..1	dateTime	Extensão de DataDesfecho URL: https://fhir.ecoinfo.ipes.tech/fhir/StructureDefinition/DataDesfecho
extension:Prioridade		0..1	CodeableConcept	Extensão de Prioridade URL: https://fhir.ecoinfo.ipes.tech/fhir/StructureDefinition/Prioridade Vínculo: https://terminologia.saude.gov.br/fhir/ValueSet/BRCaraterAtendimento (required)
extension:DataAutorizacao		0..1	dateTime	Extensão de DataAutorizacao URL: https://fhir.ecoinfo.ipes.tech/fhir/StructureDefinition/DataAutorizacao
extension:MotivoDesfecho		0..1	CodeableConcept	Extensão de MotivoDesfecho URL: https://fhir.ecoinfo.ipes.tech/fhir/StructureDefinition/MotivoDesfecho Vínculo: https://terminologia.saude.gov.br/fhir/ValueSet/BRCaraterAtendimento (required)
identifier		0..1	Identifier	Business Identifier for claim
system		0..1	uri	The namespace for the identifier value Valor fixo: urn:oid:1.3.6.1.4.1.54413.1.1.5.19.1
type
coding
system		0..1	uri	Identity of the terminology system Valor fixo: https://fhir.ecoinfo.ipes.tech/CodeSystem/claim-type
code		0..1	code	Symbol in syntax defined by the system Valor fixo: apac
subType
coding
system		0..1	uri	Identity of the terminology system Valor fixo: https://fhir.ecoinfo.ipes.tech/CodeSystem/claim-subtype
code		0..1	code	Symbol in syntax defined by the system Vínculo: https://fhir.ecoinfo.ipes.tech/ValueSet/claim-subtype (required)
use		1..1	code	claim | preauthorization | predetermination Valor fixo: claim
provider		1..1	Reference(Organization)	Party responsible for the claim
payee
type
coding
system		0..1	uri	Identity of the terminology system Valor fixo: https://fhir.ecoinfo.ipes.tech/CodeSystem/payee-type
code		0..1	code	Symbol in syntax defined by the system Vínculo: https://fhir.ecoinfo.ipes.tech/ValueSet/payee-type (required)
party		0..1	Reference(Organization)	Recipient reference
careTeam
provider		1..1	Reference(Practitioner)	Practitioner or organization
identifier
system		0..1	uri	The namespace for the identifier value Valor fixo: urn:oid:2.16.840.1.113883.13.236
diagnosis
diagnosis[x]		1..1	CodeableConcept	Nature of illness or problem Vínculo: https://terminologia.saude.gov.br/fhir/ValueSet/BRCID10 (required)
procedure
type		0..*	CodeableConcept	​Category of Procedure Vínculo: https://fhir.ecoinfo.ipes.tech/fhir/CodeSystem/GuiaOCIBRIPES/tipoprocedimento (required)
procedure[x]		1..1	CodeableConcept	Specific clinical procedure Vínculo: https://terminologia.saude.gov.br/fhir/ValueSet/BRProcedimentosNacionais (required)
insurance
coverage
display		0..1	string	Text alternative for the resource Valor fixo: SUS
item
productOrService		1..1	CodeableConcept	Billing, service, product, or drug code Vínculo: https://terminologia.saude.gov.br/fhir/ValueSet/BRProcedimentosNacionais (required)
Documentação para este formato

Terminologia Ligações (Diferencial)

Caminho	Conformidade	Conjunto de valores	URI
Claim.subType.coding.code	required	https://fhir.ecoinfo.ipes.tech/ValueSet/claim-subtype https://fhir.ecoinfo.ipes.tech/ValueSet/claim-subtype
Claim.payee.type.coding.code	required	https://fhir.ecoinfo.ipes.tech/ValueSet/payee-type https://fhir.ecoinfo.ipes.tech/ValueSet/payee-type
Claim.diagnosis.diagnosis[x]	required	https://terminologia.saude.gov.br/fhir/ValueSet/BRCID10 https://terminologia.saude.gov.br/fhir/ValueSet/BRCID10
Claim.procedure.type	required	​https://fhir.ecoinfo.ipes.tech/fhir/CodeSystem/GuiaOCIBRIPES/tipoprocedimento https://fhir.ecoinfo.ipes.tech/fhir/CodeSystem/GuiaOCIBRIPES/tipoprocedimento
Claim.procedure.procedure[x]	required	https://terminologia.saude.gov.br/fhir/ValueSet/BRProcedimentosNacionais https://terminologia.saude.gov.br/fhir/ValueSet/BRProcedimentosNacionais
Claim.item.productOrService	required	https://terminologia.saude.gov.br/fhir/ValueSet/BRProcedimentosNacionais https://terminologia.saude.gov.br/fhir/ValueSet/BRProcedimentosNacionais

Nome	Bandeiras	Card.	Tipo	Descrição e condicionalismos    Filter: Condicionantes Obrigações Vínculos
Claim		1..*	Claim	Solicitação de reembolso ou cobertura de um procedimento de saúde.
id	Σ	0..1	id	Logical id of this artifact
meta	Σ	0..1	Meta	Metadata about the resource
implicitRules	?!Σ	0..1	uri	A set of rules under which this content was created
language		0..1	code	Language of the resource content Vínculo: CommonLanguages (preferred): A human language. Vínculos adicionais Objetivo AllLanguages Vínculo máximo
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
Fatias para extension		0..*	Extension	Extensões utilizadas pela GuiaOCIBRIPES. Fatia: Não ordenado, Aberto por value:url
extension:Competencia		0..1	dateTime	Extensão de Competencia URL: https://fhir.ecoinfo.ipes.tech/fhir/StructureDefinition/Competencia
extension:ModalidadeAssistencial		0..1	CodeableConcept	Extensão de Modalidade Assistencial URL: https://fhir.ecoinfo.ipes.tech/fhir/StructureDefinition/ModalidadeAssistencial Vínculo: https://terminologia.saude.gov.br/fhir/ValueSet/BRModalidadeAssistencialMIRA (required)
extension:DataSolicitacao		0..1	dateTime	Extensão de DataSolicitacao URL: https://fhir.ecoinfo.ipes.tech/fhir/StructureDefinition/DataSolicitacao
extension:DataDesfecho		0..1	dateTime	Extensão de DataDesfecho URL: https://fhir.ecoinfo.ipes.tech/fhir/StructureDefinition/DataDesfecho
extension:Prioridade		0..1	CodeableConcept	Extensão de Prioridade URL: https://fhir.ecoinfo.ipes.tech/fhir/StructureDefinition/Prioridade Vínculo: https://terminologia.saude.gov.br/fhir/ValueSet/BRCaraterAtendimento (required)
extension:DataAutorizacao		0..1	dateTime	Extensão de DataAutorizacao URL: https://fhir.ecoinfo.ipes.tech/fhir/StructureDefinition/DataAutorizacao
extension:MotivoDesfecho		0..1	CodeableConcept	Extensão de MotivoDesfecho URL: https://fhir.ecoinfo.ipes.tech/fhir/StructureDefinition/MotivoDesfecho Vínculo: https://terminologia.saude.gov.br/fhir/ValueSet/BRCaraterAtendimento (required)
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored
identifier		0..1	Identifier	Business Identifier for claim
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Fatia: Não ordenado, Aberto por value:url
use	?!Σ	0..1	code	usual | official | temp | secondary | old (If known) Vínculo: IdentifierUse (required): Identifies the purpose for this identifier, if known .
type	Σ	0..1	CodeableConcept	Description of identifier Vínculo: Identifier Type Codes (extensible): A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.
system	Σ	0..1	uri	The namespace for the identifier value Valor fixo: urn:oid:1.3.6.1.4.1.54413.1.1.5.19.1
value	Σ	0..1	string	The value that is unique Exemplo 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)
status	?!Σ	1..1	code	active | cancelled | draft | entered-in-error Vínculo: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance.
type	Σ	1..1	CodeableConcept	Category or discipline Vínculo: ClaimTypeCodes (extensible): The type or discipline-style of the claim.
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Fatia: Não ordenado, Aberto por value:url
coding	Σ	0..*	Coding	Code defined by a terminology system
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Fatia: Não ordenado, Aberto por value:url
system	Σ	0..1	uri	Identity of the terminology system Valor fixo: https://fhir.ecoinfo.ipes.tech/CodeSystem/claim-type
version	Σ	0..1	string	Version of the system - if relevant
code	Σ	0..1	code	Symbol in syntax defined by the system Valor fixo: apac
display	Σ	0..1	string	Representation defined by the system
userSelected	Σ	0..1	boolean	If this coding was chosen directly by the user
text	Σ	0..1	string	Plain text representation of the concept
subType		0..1	CodeableConcept	More granular claim type Vínculo: ExampleClaimSubTypeCodes (example): A more granular claim typecode.
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Fatia: Não ordenado, Aberto por value:url
coding	Σ	0..*	Coding	Code defined by a terminology system
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Fatia: Não ordenado, Aberto por value:url
system	Σ	0..1	uri	Identity of the terminology system Valor fixo: https://fhir.ecoinfo.ipes.tech/CodeSystem/claim-subtype
version	Σ	0..1	string	Version of the system - if relevant
code	Σ	0..1	code	Symbol in syntax defined by the system Vínculo: https://fhir.ecoinfo.ipes.tech/ValueSet/claim-subtype (required)
display	Σ	0..1	string	Representation defined by the system
userSelected	Σ	0..1	boolean	If this coding was chosen directly by the user
text	Σ	0..1	string	Plain text representation of the concept
use	Σ	1..1	code	claim | preauthorization | predetermination Vínculo: Use (required): The purpose of the Claim: predetermination, preauthorization, claim. Valor fixo: claim
patient	Σ	1..1	Reference(Patient)	The recipient of the products and services
billablePeriod	Σ	0..1	Period	Relevant time frame for the claim
created	Σ	1..1	dateTime	Resource creation date
enterer		0..1	Reference(Practitioner | PractitionerRole)	Author of the claim
insurer	Σ	0..1	Reference(Organization)	Target
provider	Σ	1..1	Reference(Organization)	Party responsible for the claim
priority	Σ	1..1	CodeableConcept	Desired processing ugency Vínculo: ProcessPriorityCodes (example): The timeliness with which processing is required: stat, normal, deferred.
fundsReserve		0..1	CodeableConcept	For whom to reserve funds Vínculo: Funds Reservation Codes (example): For whom funds are to be reserved: (Patient, Provider, None).
related		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		0..1	Reference(Claim)	Reference to the related claim
relationship		0..1	CodeableConcept	How the reference claim is related Vínculo: ExampleRelatedClaimRelationshipCodes (example): Relationship of this claim to a related Claim.
reference		0..1	Identifier	File or case reference
prescription		0..1	Reference(DeviceRequest | MedicationRequest | VisionPrescription)	Prescription authorizing services and products
originalPrescription		0..1	Reference(DeviceRequest | MedicationRequest | VisionPrescription)	Original prescription if superseded by fulfiller
payee		0..1	BackboneElement	Recipient of benefits payable
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	CodeableConcept	Category of recipient Vínculo: Claim Payee Type Codes (example): A code for the party to be reimbursed.
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Fatia: Não ordenado, Aberto por value:url
coding	Σ	0..*	Coding	Code defined by a terminology system
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Fatia: Não ordenado, Aberto por value:url
system	Σ	0..1	uri	Identity of the terminology system Valor fixo: https://fhir.ecoinfo.ipes.tech/CodeSystem/payee-type
version	Σ	0..1	string	Version of the system - if relevant
code	Σ	0..1	code	Symbol in syntax defined by the system Vínculo: https://fhir.ecoinfo.ipes.tech/ValueSet/payee-type (required)
display	Σ	0..1	string	Representation defined by the system
userSelected	Σ	0..1	boolean	If this coding was chosen directly by the user
text	Σ	0..1	string	Plain text representation of the concept
party		0..1	Reference(Organization)	Recipient reference
referral		0..1	Reference(ServiceRequest)	Treatment referral
facility		0..1	Reference(Location)	Servicing facility
careTeam		0..*	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	positiveInt	Order of care team
provider		1..1	Reference(Practitioner)	Practitioner or organization
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Fatia: Não ordenado, Aberto por 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") Vínculo: 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 Fatia: Não ordenado, Aberto por value:url
use	?!Σ	0..1	code	usual | official | temp | secondary | old (If known) Vínculo: IdentifierUse (required): Identifies the purpose for this identifier, if known .
type	Σ	0..1	CodeableConcept	Description of identifier Vínculo: Identifier Type Codes (extensible): A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.
system	Σ	0..1	uri	The namespace for the identifier value Valor fixo: urn:oid:2.16.840.1.113883.13.236
value	Σ	0..1	string	The value that is unique Exemplo 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		0..1	CodeableConcept	Function within the team Vínculo: ClaimCareTeamRoleCodes (example): The role codes for the care team members.
qualification		0..1	CodeableConcept	Practitioner credential or specialization Vínculo: ExampleProviderQualificationCodes (example): Provider professional qualifications.
supportingInfo		0..*	BackboneElement	Supporting 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	positiveInt	Information instance identifier
category		1..1	CodeableConcept	Classification of the supplied information Vínculo: ClaimInformationCategoryCodes (example): The valuset used for additional information category codes.
code		0..1	CodeableConcept	Type of information Vínculo: 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 Vínculo: MissingToothReasonCodes (example): Reason codes for the missing teeth.
diagnosis		0..*	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	positiveInt	Diagnosis instance identifier
diagnosis[x]		1..1	CodeableConcept	Nature of illness or problem Vínculo: https://terminologia.saude.gov.br/fhir/ValueSet/BRCID10 (required)
type		0..*	CodeableConcept	Timing or nature of the diagnosis Vínculo: ExampleDiagnosisTypeCodes (example): The type of the diagnosis: admitting, principal, discharge.
onAdmission		0..1	CodeableConcept	Present on admission Vínculo: ExampleDiagnosisOnAdmissionCodes (example): Present on admission.
packageCode		0..1	CodeableConcept	Package billing code Vínculo: 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 Vínculo: https://fhir.ecoinfo.ipes.tech/fhir/CodeSystem/GuiaOCIBRIPES/tipoprocedimento (required)
date		0..1	dateTime	When the procedure was performed
procedure[x]		1..1	CodeableConcept	Specific clinical procedure Vínculo: https://terminologia.saude.gov.br/fhir/ValueSet/BRProcedimentosNacionais (required)
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	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	Reference(Coverage)	Insurance information
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Fatia: Não ordenado, Aberto por 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") Vínculo: 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
display	Σ	0..1	string	Text alternative for the resource Valor fixo: SUS
businessArrangement		0..1	string	Additional provider contract number
preAuthRef		0..*	string	Prior authorization reference number
claimResponse		0..1	Reference(ClaimResponse)	Adjudication results
accident		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	date	When the incident occurred
type		0..1	CodeableConcept	The nature of the accident Vínculo: ActIncidentCode (extensible): Type of accident: work place, auto, etc.
location[x]		0..1		Where the event occurred
locationAddress			Address
locationReference			Reference(Location)
item		0..*	BackboneElement	Product or service provided
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	Item instance identifier
careTeamSequence		0..*	positiveInt	Applicable careTeam members
diagnosisSequence		0..*	positiveInt	Applicable diagnoses
procedureSequence		0..*	positiveInt	Applicable procedures
informationSequence		0..*	positiveInt	Applicable exception and supporting information
revenue		0..1	CodeableConcept	Revenue or cost center code Vínculo: ExampleRevenueCenterCodes (example): Codes for the revenue or cost centers supplying the service and/or products.
category		0..1	CodeableConcept	Benefit classification Vínculo: BenefitCategoryCodes (example): Benefit categories such as: oral-basic, major, glasses.
productOrService		1..1	CodeableConcept	Billing, service, product, or drug code Vínculo: https://terminologia.saude.gov.br/fhir/ValueSet/BRProcedimentosNacionais (required)
modifier		0..*	CodeableConcept	Product or service billing modifiers Vínculo: 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 Vínculo: ExampleProgramReasonCodes (example): Program specific reason codes.
serviced[x]		0..1		Date or dates of service or product delivery
servicedDate			date
servicedPeriod			Period
location[x]		0..1		Place of service or where product was supplied Vínculo: ExampleServicePlaceCodes (example): Place of service: pharmacy, school, prison, etc.
locationCodeableConcept			CodeableConcept
locationAddress			Address
locationReference			Reference(Location)
quantity		0..1	SimpleQuantity	Count of products or services
unitPrice		0..1	Money	Fee, charge or cost per item
factor		0..1	decimal	Price scaling factor
net		0..1	Money	Total item cost
udi		0..*	Reference(Device)	Unique device identifier
bodySite		0..1	CodeableConcept	Anatomical location Vínculo: OralSiteCodes (example): The code for the teeth, quadrant, sextant and arch.
subSite		0..*	CodeableConcept	Anatomical sub-location Vínculo: SurfaceCodes (example): The code for the tooth surface and surface combinations.
encounter		0..*	Reference(Encounter)	Encounters related to this billed item
detail		0..*	BackboneElement	Product or service provided
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	Item instance identifier
revenue		0..1	CodeableConcept	Revenue or cost center code Vínculo: ExampleRevenueCenterCodes (example): Codes for the revenue or cost centers supplying the service and/or products.
category		0..1	CodeableConcept	Benefit classification Vínculo: BenefitCategoryCodes (example): Benefit categories such as: oral-basic, major, glasses.
productOrService		1..1	CodeableConcept	Billing, service, product, or drug code Vínculo: USCLSCodes (example): Allowable service and product codes.
modifier		0..*	CodeableConcept	Service/Product billing modifiers Vínculo: 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 Vínculo: ExampleProgramReasonCodes (example): Program specific reason codes.
quantity		0..1	SimpleQuantity	Count of products or services
unitPrice		0..1	Money	Fee, charge or cost per item
factor		0..1	decimal	Price scaling factor
net		0..1	Money	Total item cost
udi		0..*	Reference(Device)	Unique device identifier
subDetail		0..*	BackboneElement	Product or service provided
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	Item instance identifier
revenue		0..1	CodeableConcept	Revenue or cost center code Vínculo: ExampleRevenueCenterCodes (example): Codes for the revenue or cost centers supplying the service and/or products.
category		0..1	CodeableConcept	Benefit classification Vínculo: BenefitCategoryCodes (example): Benefit categories such as: oral-basic, major, glasses.
productOrService		1..1	CodeableConcept	Billing, service, product, or drug code Vínculo: USCLSCodes (example): Allowable service and product codes.
modifier		0..*	CodeableConcept	Service/Product billing modifiers Vínculo: 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 Vínculo: ExampleProgramReasonCodes (example): Program specific reason codes.
quantity		0..1	SimpleQuantity	Count of products or services
unitPrice		0..1	Money	Fee, charge or cost per item
factor		0..1	decimal	Price scaling factor
net		0..1	Money	Total item cost
udi		0..*	Reference(Device)	Unique device identifier
total		0..1	Money	Total claim cost
Documentação para este formato

Terminologia Ligações

Caminho	Conformidade	ValueSet / Código	URI
Claim.language	preferred	CommonLanguages http://hl7.org/fhir/ValueSet/languages From a norma FHIR Vínculos adicionais Objetivo AllLanguages Vínculo máximo
Claim.identifier.use	required	IdentifierUse http://hl7.org/fhir/ValueSet/identifier-use|4.0.1 From a norma FHIR
Claim.identifier.type	extensible	Identifier Type Codes http://hl7.org/fhir/ValueSet/identifier-type From a norma FHIR
Claim.status	required	FinancialResourceStatusCodes http://hl7.org/fhir/ValueSet/fm-status|4.0.1 From a norma FHIR
Claim.type	extensible	ClaimTypeCodes http://hl7.org/fhir/ValueSet/claim-type From a norma FHIR
Claim.subType	example	ExampleClaimSubTypeCodes http://hl7.org/fhir/ValueSet/claim-subtype From a norma FHIR
Claim.subType.coding.code	required	https://fhir.ecoinfo.ipes.tech/ValueSet/claim-subtype https://fhir.ecoinfo.ipes.tech/ValueSet/claim-subtype
Claim.use	required	Fixed Value: claim http://hl7.org/fhir/ValueSet/claim-use|4.0.1 From a norma FHIR
Claim.priority	example	ProcessPriorityCodes http://hl7.org/fhir/ValueSet/process-priority From a norma FHIR
Claim.fundsReserve	example	Funds Reservation Codes http://hl7.org/fhir/ValueSet/fundsreserve From a norma FHIR
Claim.related.relationship	example	ExampleRelatedClaimRelationshipCodes http://hl7.org/fhir/ValueSet/related-claim-relationship From a norma FHIR
Claim.payee.type	example	Claim Payee Type Codes http://hl7.org/fhir/ValueSet/payeetype From a norma FHIR
Claim.payee.type.coding.code	required	https://fhir.ecoinfo.ipes.tech/ValueSet/payee-type https://fhir.ecoinfo.ipes.tech/ValueSet/payee-type
Claim.careTeam.provider.type	extensible	ResourceType http://hl7.org/fhir/ValueSet/resource-types From a norma FHIR
Claim.careTeam.provider.identifier.use	required	IdentifierUse http://hl7.org/fhir/ValueSet/identifier-use|4.0.1 From a norma FHIR
Claim.careTeam.provider.identifier.type	extensible	Identifier Type Codes http://hl7.org/fhir/ValueSet/identifier-type From a norma FHIR
Claim.careTeam.role	example	ClaimCareTeamRoleCodes http://hl7.org/fhir/ValueSet/claim-careteamrole From a norma FHIR
Claim.careTeam.qualification	example	ExampleProviderQualificationCodes http://hl7.org/fhir/ValueSet/provider-qualification From a norma FHIR
Claim.supportingInfo.category	example	ClaimInformationCategoryCodes http://hl7.org/fhir/ValueSet/claim-informationcategory From a norma FHIR
Claim.supportingInfo.code	example	ExceptionCodes http://hl7.org/fhir/ValueSet/claim-exception From a norma FHIR
Claim.supportingInfo.reason	example	MissingToothReasonCodes http://hl7.org/fhir/ValueSet/missing-tooth-reason From a norma FHIR
Claim.diagnosis.diagnosis[x]	required	https://terminologia.saude.gov.br/fhir/ValueSet/BRCID10 https://terminologia.saude.gov.br/fhir/ValueSet/BRCID10
Claim.diagnosis.type	example	ExampleDiagnosisTypeCodes http://hl7.org/fhir/ValueSet/ex-diagnosistype From a norma FHIR
Claim.diagnosis.onAdmission	example	ExampleDiagnosisOnAdmissionCodes http://hl7.org/fhir/ValueSet/ex-diagnosis-on-admission From a norma FHIR
Claim.diagnosis.packageCode	example	ExampleDiagnosisRelatedGroupCodes http://hl7.org/fhir/ValueSet/ex-diagnosisrelatedgroup From a norma FHIR
Claim.procedure.type	required	​https://fhir.ecoinfo.ipes.tech/fhir/CodeSystem/GuiaOCIBRIPES/tipoprocedimento https://fhir.ecoinfo.ipes.tech/fhir/CodeSystem/GuiaOCIBRIPES/tipoprocedimento
Claim.procedure.procedure[x]	required	https://terminologia.saude.gov.br/fhir/ValueSet/BRProcedimentosNacionais https://terminologia.saude.gov.br/fhir/ValueSet/BRProcedimentosNacionais
Claim.insurance.coverage.type	extensible	ResourceType http://hl7.org/fhir/ValueSet/resource-types From a norma FHIR
Claim.accident.type	extensible	ActIncidentCode http://terminology.hl7.org/ValueSet/v3-ActIncidentCode
Claim.item.revenue	example	ExampleRevenueCenterCodes http://hl7.org/fhir/ValueSet/ex-revenue-center From a norma FHIR
Claim.item.category	example	BenefitCategoryCodes http://hl7.org/fhir/ValueSet/ex-benefitcategory From a norma FHIR
Claim.item.productOrService	required	https://terminologia.saude.gov.br/fhir/ValueSet/BRProcedimentosNacionais https://terminologia.saude.gov.br/fhir/ValueSet/BRProcedimentosNacionais
Claim.item.modifier	example	ModifierTypeCodes http://hl7.org/fhir/ValueSet/claim-modifiers From a norma FHIR
Claim.item.programCode	example	ExampleProgramReasonCodes http://hl7.org/fhir/ValueSet/ex-program-code From a norma FHIR
Claim.item.location[x]	example	ExampleServicePlaceCodes http://hl7.org/fhir/ValueSet/service-place From a norma FHIR
Claim.item.bodySite	example	OralSiteCodes http://hl7.org/fhir/ValueSet/tooth From a norma FHIR
Claim.item.subSite	example	SurfaceCodes http://hl7.org/fhir/ValueSet/surface From a norma FHIR
Claim.item.detail.revenue	example	ExampleRevenueCenterCodes http://hl7.org/fhir/ValueSet/ex-revenue-center From a norma FHIR
Claim.item.detail.category	example	BenefitCategoryCodes http://hl7.org/fhir/ValueSet/ex-benefitcategory From a norma FHIR
Claim.item.detail.productOrService	example	USCLSCodes http://hl7.org/fhir/ValueSet/service-uscls From a norma FHIR
Claim.item.detail.modifier	example	ModifierTypeCodes http://hl7.org/fhir/ValueSet/claim-modifiers From a norma FHIR
Claim.item.detail.programCode	example	ExampleProgramReasonCodes http://hl7.org/fhir/ValueSet/ex-program-code From a norma FHIR
Claim.item.detail.subDetail.revenue	example	ExampleRevenueCenterCodes http://hl7.org/fhir/ValueSet/ex-revenue-center From a norma FHIR
Claim.item.detail.subDetail.category	example	BenefitCategoryCodes http://hl7.org/fhir/ValueSet/ex-benefitcategory From a norma FHIR
Claim.item.detail.subDetail.productOrService	example	USCLSCodes http://hl7.org/fhir/ValueSet/service-uscls From a norma FHIR
Claim.item.detail.subDetail.modifier	example	ModifierTypeCodes http://hl7.org/fhir/ValueSet/claim-modifiers From a norma FHIR
Claim.item.detail.subDetail.programCode	example	ExampleProgramReasonCodes http://hl7.org/fhir/ValueSet/ex-program-code From a norma FHIR

Restrições

Id	Grau	Caminho(s)	Detalhes	Requisitos
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()

Key Elements View

Nome	Bandeiras	Card.	Tipo	Descrição e condicionalismos    Filter: Condicionantes Obrigações Vínculos
Claim		1..*	Claim	Solicitação de reembolso ou cobertura de um procedimento de saúde.
implicitRules	?!Σ	0..1	uri	A set of rules under which this content was created
Fatias para extension		0..*	Extension	Extensões utilizadas pela GuiaOCIBRIPES. Fatia: Não ordenado, Aberto por value:url
extension:Competencia		0..1	dateTime	Extensão de Competencia URL: https://fhir.ecoinfo.ipes.tech/fhir/StructureDefinition/Competencia
extension:ModalidadeAssistencial		0..1	CodeableConcept	Extensão de Modalidade Assistencial URL: https://fhir.ecoinfo.ipes.tech/fhir/StructureDefinition/ModalidadeAssistencial Vínculo: https://terminologia.saude.gov.br/fhir/ValueSet/BRModalidadeAssistencialMIRA (required)
extension:DataSolicitacao		0..1	dateTime	Extensão de DataSolicitacao URL: https://fhir.ecoinfo.ipes.tech/fhir/StructureDefinition/DataSolicitacao
extension:DataDesfecho		0..1	dateTime	Extensão de DataDesfecho URL: https://fhir.ecoinfo.ipes.tech/fhir/StructureDefinition/DataDesfecho
extension:Prioridade		0..1	CodeableConcept	Extensão de Prioridade URL: https://fhir.ecoinfo.ipes.tech/fhir/StructureDefinition/Prioridade Vínculo: https://terminologia.saude.gov.br/fhir/ValueSet/BRCaraterAtendimento (required)
extension:DataAutorizacao		0..1	dateTime	Extensão de DataAutorizacao URL: https://fhir.ecoinfo.ipes.tech/fhir/StructureDefinition/DataAutorizacao
extension:MotivoDesfecho		0..1	CodeableConcept	Extensão de MotivoDesfecho URL: https://fhir.ecoinfo.ipes.tech/fhir/StructureDefinition/MotivoDesfecho Vínculo: https://terminologia.saude.gov.br/fhir/ValueSet/BRCaraterAtendimento (required)
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored
identifier		0..1	Identifier	Business Identifier for claim
use	?!Σ	0..1	code	usual | official | temp | secondary | old (If known) Vínculo: IdentifierUse (required): Identifies the purpose for this identifier, if known .
system	Σ	0..1	uri	The namespace for the identifier value Valor fixo: urn:oid:1.3.6.1.4.1.54413.1.1.5.19.1
status	?!Σ	1..1	code	active | cancelled | draft | entered-in-error Vínculo: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance.
type	Σ	1..1	CodeableConcept	Category or discipline Vínculo: ClaimTypeCodes (extensible): The type or discipline-style of the claim.
use	Σ	1..1	code	claim | preauthorization | predetermination Vínculo: Use (required): The purpose of the Claim: predetermination, preauthorization, claim. Valor fixo: claim
patient	Σ	1..1	Reference(Patient)	The recipient of the products and services
created	Σ	1..1	dateTime	Resource creation date
provider	Σ	1..1	Reference(Organization)	Party responsible for the claim
priority	Σ	1..1	CodeableConcept	Desired processing ugency Vínculo: ProcessPriorityCodes (example): The timeliness with which processing is required: stat, normal, deferred.
insurance	Σ	1..*	BackboneElement	Patient insurance information
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
sequence	Σ	1..1	positiveInt	Insurance instance identifier
focal	Σ	1..1	boolean	Coverage to be used for adjudication
coverage	Σ	1..1	Reference(Coverage)	Insurance information
display	Σ	0..1	string	Text alternative for the resource Valor fixo: SUS
Documentação para este formato

Terminologia Ligações

Caminho	Conformidade	ValueSet / Código	URI
Claim.identifier.use	required	IdentifierUse http://hl7.org/fhir/ValueSet/identifier-use|4.0.1 From a norma FHIR
Claim.status	required	FinancialResourceStatusCodes http://hl7.org/fhir/ValueSet/fm-status|4.0.1 From a norma FHIR
Claim.type	extensible	ClaimTypeCodes http://hl7.org/fhir/ValueSet/claim-type From a norma FHIR
Claim.use	required	Fixed Value: claim http://hl7.org/fhir/ValueSet/claim-use|4.0.1 From a norma FHIR
Claim.priority	example	ProcessPriorityCodes http://hl7.org/fhir/ValueSet/process-priority From a norma FHIR

Restrições

Id	Grau	Caminho(s)	Detalhes	Requisitos
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 Claim

Nome	Bandeiras	Card.	Tipo	Descrição e condicionalismos    Filter: Condicionantes Obrigações Vínculos
Claim		1..*	Claim	Solicitação de reembolso ou cobertura de um procedimento de saúde.
Fatias para extension		0..*	Extension	Extensões utilizadas pela GuiaOCIBRIPES. Fatia: Não ordenado, Aberto por value:url
extension:Competencia		0..1	dateTime	Extensão de Competencia URL: https://fhir.ecoinfo.ipes.tech/fhir/StructureDefinition/Competencia
extension:ModalidadeAssistencial		0..1	CodeableConcept	Extensão de Modalidade Assistencial URL: https://fhir.ecoinfo.ipes.tech/fhir/StructureDefinition/ModalidadeAssistencial Vínculo: https://terminologia.saude.gov.br/fhir/ValueSet/BRModalidadeAssistencialMIRA (required)
extension:DataSolicitacao		0..1	dateTime	Extensão de DataSolicitacao URL: https://fhir.ecoinfo.ipes.tech/fhir/StructureDefinition/DataSolicitacao
extension:DataDesfecho		0..1	dateTime	Extensão de DataDesfecho URL: https://fhir.ecoinfo.ipes.tech/fhir/StructureDefinition/DataDesfecho
extension:Prioridade		0..1	CodeableConcept	Extensão de Prioridade URL: https://fhir.ecoinfo.ipes.tech/fhir/StructureDefinition/Prioridade Vínculo: https://terminologia.saude.gov.br/fhir/ValueSet/BRCaraterAtendimento (required)
extension:DataAutorizacao		0..1	dateTime	Extensão de DataAutorizacao URL: https://fhir.ecoinfo.ipes.tech/fhir/StructureDefinition/DataAutorizacao
extension:MotivoDesfecho		0..1	CodeableConcept	Extensão de MotivoDesfecho URL: https://fhir.ecoinfo.ipes.tech/fhir/StructureDefinition/MotivoDesfecho Vínculo: https://terminologia.saude.gov.br/fhir/ValueSet/BRCaraterAtendimento (required)
identifier		0..1	Identifier	Business Identifier for claim
system		0..1	uri	The namespace for the identifier value Valor fixo: urn:oid:1.3.6.1.4.1.54413.1.1.5.19.1
type
coding
system		0..1	uri	Identity of the terminology system Valor fixo: https://fhir.ecoinfo.ipes.tech/CodeSystem/claim-type
code		0..1	code	Symbol in syntax defined by the system Valor fixo: apac
subType
coding
system		0..1	uri	Identity of the terminology system Valor fixo: https://fhir.ecoinfo.ipes.tech/CodeSystem/claim-subtype
code		0..1	code	Symbol in syntax defined by the system Vínculo: https://fhir.ecoinfo.ipes.tech/ValueSet/claim-subtype (required)
use		1..1	code	claim | preauthorization | predetermination Valor fixo: claim
provider		1..1	Reference(Organization)	Party responsible for the claim
payee
type
coding
system		0..1	uri	Identity of the terminology system Valor fixo: https://fhir.ecoinfo.ipes.tech/CodeSystem/payee-type
code		0..1	code	Symbol in syntax defined by the system Vínculo: https://fhir.ecoinfo.ipes.tech/ValueSet/payee-type (required)
party		0..1	Reference(Organization)	Recipient reference
careTeam
provider		1..1	Reference(Practitioner)	Practitioner or organization
identifier
system		0..1	uri	The namespace for the identifier value Valor fixo: urn:oid:2.16.840.1.113883.13.236
diagnosis
diagnosis[x]		1..1	CodeableConcept	Nature of illness or problem Vínculo: https://terminologia.saude.gov.br/fhir/ValueSet/BRCID10 (required)
procedure
type		0..*	CodeableConcept	​Category of Procedure Vínculo: https://fhir.ecoinfo.ipes.tech/fhir/CodeSystem/GuiaOCIBRIPES/tipoprocedimento (required)
procedure[x]		1..1	CodeableConcept	Specific clinical procedure Vínculo: https://terminologia.saude.gov.br/fhir/ValueSet/BRProcedimentosNacionais (required)
insurance
coverage
display		0..1	string	Text alternative for the resource Valor fixo: SUS
item
productOrService		1..1	CodeableConcept	Billing, service, product, or drug code Vínculo: https://terminologia.saude.gov.br/fhir/ValueSet/BRProcedimentosNacionais (required)
Documentação para este formato

Terminologia Ligações (Diferencial)

Caminho	Conformidade	Conjunto de valores	URI
Claim.subType.coding.code	required	https://fhir.ecoinfo.ipes.tech/ValueSet/claim-subtype https://fhir.ecoinfo.ipes.tech/ValueSet/claim-subtype
Claim.payee.type.coding.code	required	https://fhir.ecoinfo.ipes.tech/ValueSet/payee-type https://fhir.ecoinfo.ipes.tech/ValueSet/payee-type
Claim.diagnosis.diagnosis[x]	required	https://terminologia.saude.gov.br/fhir/ValueSet/BRCID10 https://terminologia.saude.gov.br/fhir/ValueSet/BRCID10
Claim.procedure.type	required	​https://fhir.ecoinfo.ipes.tech/fhir/CodeSystem/GuiaOCIBRIPES/tipoprocedimento https://fhir.ecoinfo.ipes.tech/fhir/CodeSystem/GuiaOCIBRIPES/tipoprocedimento
Claim.procedure.procedure[x]	required	https://terminologia.saude.gov.br/fhir/ValueSet/BRProcedimentosNacionais https://terminologia.saude.gov.br/fhir/ValueSet/BRProcedimentosNacionais
Claim.item.productOrService	required	https://terminologia.saude.gov.br/fhir/ValueSet/BRProcedimentosNacionais https://terminologia.saude.gov.br/fhir/ValueSet/BRProcedimentosNacionais

Snapshot View

Nome	Bandeiras	Card.	Tipo	Descrição e condicionalismos    Filter: Condicionantes Obrigações Vínculos
Claim		1..*	Claim	Solicitação de reembolso ou cobertura de um procedimento de saúde.
id	Σ	0..1	id	Logical id of this artifact
meta	Σ	0..1	Meta	Metadata about the resource
implicitRules	?!Σ	0..1	uri	A set of rules under which this content was created
language		0..1	code	Language of the resource content Vínculo: CommonLanguages (preferred): A human language. Vínculos adicionais Objetivo AllLanguages Vínculo máximo
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
Fatias para extension		0..*	Extension	Extensões utilizadas pela GuiaOCIBRIPES. Fatia: Não ordenado, Aberto por value:url
extension:Competencia		0..1	dateTime	Extensão de Competencia URL: https://fhir.ecoinfo.ipes.tech/fhir/StructureDefinition/Competencia
extension:ModalidadeAssistencial		0..1	CodeableConcept	Extensão de Modalidade Assistencial URL: https://fhir.ecoinfo.ipes.tech/fhir/StructureDefinition/ModalidadeAssistencial Vínculo: https://terminologia.saude.gov.br/fhir/ValueSet/BRModalidadeAssistencialMIRA (required)
extension:DataSolicitacao		0..1	dateTime	Extensão de DataSolicitacao URL: https://fhir.ecoinfo.ipes.tech/fhir/StructureDefinition/DataSolicitacao
extension:DataDesfecho		0..1	dateTime	Extensão de DataDesfecho URL: https://fhir.ecoinfo.ipes.tech/fhir/StructureDefinition/DataDesfecho
extension:Prioridade		0..1	CodeableConcept	Extensão de Prioridade URL: https://fhir.ecoinfo.ipes.tech/fhir/StructureDefinition/Prioridade Vínculo: https://terminologia.saude.gov.br/fhir/ValueSet/BRCaraterAtendimento (required)
extension:DataAutorizacao		0..1	dateTime	Extensão de DataAutorizacao URL: https://fhir.ecoinfo.ipes.tech/fhir/StructureDefinition/DataAutorizacao
extension:MotivoDesfecho		0..1	CodeableConcept	Extensão de MotivoDesfecho URL: https://fhir.ecoinfo.ipes.tech/fhir/StructureDefinition/MotivoDesfecho Vínculo: https://terminologia.saude.gov.br/fhir/ValueSet/BRCaraterAtendimento (required)
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored
identifier		0..1	Identifier	Business Identifier for claim
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Fatia: Não ordenado, Aberto por value:url
use	?!Σ	0..1	code	usual | official | temp | secondary | old (If known) Vínculo: IdentifierUse (required): Identifies the purpose for this identifier, if known .
type	Σ	0..1	CodeableConcept	Description of identifier Vínculo: Identifier Type Codes (extensible): A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.
system	Σ	0..1	uri	The namespace for the identifier value Valor fixo: urn:oid:1.3.6.1.4.1.54413.1.1.5.19.1
value	Σ	0..1	string	The value that is unique Exemplo 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)
status	?!Σ	1..1	code	active | cancelled | draft | entered-in-error Vínculo: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance.
type	Σ	1..1	CodeableConcept	Category or discipline Vínculo: ClaimTypeCodes (extensible): The type or discipline-style of the claim.
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Fatia: Não ordenado, Aberto por value:url
coding	Σ	0..*	Coding	Code defined by a terminology system
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Fatia: Não ordenado, Aberto por value:url
system	Σ	0..1	uri	Identity of the terminology system Valor fixo: https://fhir.ecoinfo.ipes.tech/CodeSystem/claim-type
version	Σ	0..1	string	Version of the system - if relevant
code	Σ	0..1	code	Symbol in syntax defined by the system Valor fixo: apac
display	Σ	0..1	string	Representation defined by the system
userSelected	Σ	0..1	boolean	If this coding was chosen directly by the user
text	Σ	0..1	string	Plain text representation of the concept
subType		0..1	CodeableConcept	More granular claim type Vínculo: ExampleClaimSubTypeCodes (example): A more granular claim typecode.
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Fatia: Não ordenado, Aberto por value:url
coding	Σ	0..*	Coding	Code defined by a terminology system
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Fatia: Não ordenado, Aberto por value:url
system	Σ	0..1	uri	Identity of the terminology system Valor fixo: https://fhir.ecoinfo.ipes.tech/CodeSystem/claim-subtype
version	Σ	0..1	string	Version of the system - if relevant
code	Σ	0..1	code	Symbol in syntax defined by the system Vínculo: https://fhir.ecoinfo.ipes.tech/ValueSet/claim-subtype (required)
display	Σ	0..1	string	Representation defined by the system
userSelected	Σ	0..1	boolean	If this coding was chosen directly by the user
text	Σ	0..1	string	Plain text representation of the concept
use	Σ	1..1	code	claim | preauthorization | predetermination Vínculo: Use (required): The purpose of the Claim: predetermination, preauthorization, claim. Valor fixo: claim
patient	Σ	1..1	Reference(Patient)	The recipient of the products and services
billablePeriod	Σ	0..1	Period	Relevant time frame for the claim
created	Σ	1..1	dateTime	Resource creation date
enterer		0..1	Reference(Practitioner | PractitionerRole)	Author of the claim
insurer	Σ	0..1	Reference(Organization)	Target
provider	Σ	1..1	Reference(Organization)	Party responsible for the claim
priority	Σ	1..1	CodeableConcept	Desired processing ugency Vínculo: ProcessPriorityCodes (example): The timeliness with which processing is required: stat, normal, deferred.
fundsReserve		0..1	CodeableConcept	For whom to reserve funds Vínculo: Funds Reservation Codes (example): For whom funds are to be reserved: (Patient, Provider, None).
related		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		0..1	Reference(Claim)	Reference to the related claim
relationship		0..1	CodeableConcept	How the reference claim is related Vínculo: ExampleRelatedClaimRelationshipCodes (example): Relationship of this claim to a related Claim.
reference		0..1	Identifier	File or case reference
prescription		0..1	Reference(DeviceRequest | MedicationRequest | VisionPrescription)	Prescription authorizing services and products
originalPrescription		0..1	Reference(DeviceRequest | MedicationRequest | VisionPrescription)	Original prescription if superseded by fulfiller
payee		0..1	BackboneElement	Recipient of benefits payable
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	CodeableConcept	Category of recipient Vínculo: Claim Payee Type Codes (example): A code for the party to be reimbursed.
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Fatia: Não ordenado, Aberto por value:url
coding	Σ	0..*	Coding	Code defined by a terminology system
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Fatia: Não ordenado, Aberto por value:url
system	Σ	0..1	uri	Identity of the terminology system Valor fixo: https://fhir.ecoinfo.ipes.tech/CodeSystem/payee-type
version	Σ	0..1	string	Version of the system - if relevant
code	Σ	0..1	code	Symbol in syntax defined by the system Vínculo: https://fhir.ecoinfo.ipes.tech/ValueSet/payee-type (required)
display	Σ	0..1	string	Representation defined by the system
userSelected	Σ	0..1	boolean	If this coding was chosen directly by the user
text	Σ	0..1	string	Plain text representation of the concept
party		0..1	Reference(Organization)	Recipient reference
referral		0..1	Reference(ServiceRequest)	Treatment referral
facility		0..1	Reference(Location)	Servicing facility
careTeam		0..*	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	positiveInt	Order of care team
provider		1..1	Reference(Practitioner)	Practitioner or organization
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Fatia: Não ordenado, Aberto por 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") Vínculo: 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 Fatia: Não ordenado, Aberto por value:url
use	?!Σ	0..1	code	usual | official | temp | secondary | old (If known) Vínculo: IdentifierUse (required): Identifies the purpose for this identifier, if known .
type	Σ	0..1	CodeableConcept	Description of identifier Vínculo: Identifier Type Codes (extensible): A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.
system	Σ	0..1	uri	The namespace for the identifier value Valor fixo: urn:oid:2.16.840.1.113883.13.236
value	Σ	0..1	string	The value that is unique Exemplo 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		0..1	CodeableConcept	Function within the team Vínculo: ClaimCareTeamRoleCodes (example): The role codes for the care team members.
qualification		0..1	CodeableConcept	Practitioner credential or specialization Vínculo: ExampleProviderQualificationCodes (example): Provider professional qualifications.
supportingInfo		0..*	BackboneElement	Supporting 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	positiveInt	Information instance identifier
category		1..1	CodeableConcept	Classification of the supplied information Vínculo: ClaimInformationCategoryCodes (example): The valuset used for additional information category codes.
code		0..1	CodeableConcept	Type of information Vínculo: 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 Vínculo: MissingToothReasonCodes (example): Reason codes for the missing teeth.
diagnosis		0..*	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	positiveInt	Diagnosis instance identifier
diagnosis[x]		1..1	CodeableConcept	Nature of illness or problem Vínculo: https://terminologia.saude.gov.br/fhir/ValueSet/BRCID10 (required)
type		0..*	CodeableConcept	Timing or nature of the diagnosis Vínculo: ExampleDiagnosisTypeCodes (example): The type of the diagnosis: admitting, principal, discharge.
onAdmission		0..1	CodeableConcept	Present on admission Vínculo: ExampleDiagnosisOnAdmissionCodes (example): Present on admission.
packageCode		0..1	CodeableConcept	Package billing code Vínculo: 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 Vínculo: https://fhir.ecoinfo.ipes.tech/fhir/CodeSystem/GuiaOCIBRIPES/tipoprocedimento (required)
date		0..1	dateTime	When the procedure was performed
procedure[x]		1..1	CodeableConcept	Specific clinical procedure Vínculo: https://terminologia.saude.gov.br/fhir/ValueSet/BRProcedimentosNacionais (required)
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	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	Reference(Coverage)	Insurance information
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Fatia: Não ordenado, Aberto por 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") Vínculo: 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
display	Σ	0..1	string	Text alternative for the resource Valor fixo: SUS
businessArrangement		0..1	string	Additional provider contract number
preAuthRef		0..*	string	Prior authorization reference number
claimResponse		0..1	Reference(ClaimResponse)	Adjudication results
accident		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	date	When the incident occurred
type		0..1	CodeableConcept	The nature of the accident Vínculo: ActIncidentCode (extensible): Type of accident: work place, auto, etc.
location[x]		0..1		Where the event occurred
locationAddress			Address
locationReference			Reference(Location)
item		0..*	BackboneElement	Product or service provided
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	Item instance identifier
careTeamSequence		0..*	positiveInt	Applicable careTeam members
diagnosisSequence		0..*	positiveInt	Applicable diagnoses
procedureSequence		0..*	positiveInt	Applicable procedures
informationSequence		0..*	positiveInt	Applicable exception and supporting information
revenue		0..1	CodeableConcept	Revenue or cost center code Vínculo: ExampleRevenueCenterCodes (example): Codes for the revenue or cost centers supplying the service and/or products.
category		0..1	CodeableConcept	Benefit classification Vínculo: BenefitCategoryCodes (example): Benefit categories such as: oral-basic, major, glasses.
productOrService		1..1	CodeableConcept	Billing, service, product, or drug code Vínculo: https://terminologia.saude.gov.br/fhir/ValueSet/BRProcedimentosNacionais (required)
modifier		0..*	CodeableConcept	Product or service billing modifiers Vínculo: 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 Vínculo: ExampleProgramReasonCodes (example): Program specific reason codes.
serviced[x]		0..1		Date or dates of service or product delivery
servicedDate			date
servicedPeriod			Period
location[x]		0..1		Place of service or where product was supplied Vínculo: ExampleServicePlaceCodes (example): Place of service: pharmacy, school, prison, etc.
locationCodeableConcept			CodeableConcept
locationAddress			Address
locationReference			Reference(Location)
quantity		0..1	SimpleQuantity	Count of products or services
unitPrice		0..1	Money	Fee, charge or cost per item
factor		0..1	decimal	Price scaling factor
net		0..1	Money	Total item cost
udi		0..*	Reference(Device)	Unique device identifier
bodySite		0..1	CodeableConcept	Anatomical location Vínculo: OralSiteCodes (example): The code for the teeth, quadrant, sextant and arch.
subSite		0..*	CodeableConcept	Anatomical sub-location Vínculo: SurfaceCodes (example): The code for the tooth surface and surface combinations.
encounter		0..*	Reference(Encounter)	Encounters related to this billed item
detail		0..*	BackboneElement	Product or service provided
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	Item instance identifier
revenue		0..1	CodeableConcept	Revenue or cost center code Vínculo: ExampleRevenueCenterCodes (example): Codes for the revenue or cost centers supplying the service and/or products.
category		0..1	CodeableConcept	Benefit classification Vínculo: BenefitCategoryCodes (example): Benefit categories such as: oral-basic, major, glasses.
productOrService		1..1	CodeableConcept	Billing, service, product, or drug code Vínculo: USCLSCodes (example): Allowable service and product codes.
modifier		0..*	CodeableConcept	Service/Product billing modifiers Vínculo: 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 Vínculo: ExampleProgramReasonCodes (example): Program specific reason codes.
quantity		0..1	SimpleQuantity	Count of products or services
unitPrice		0..1	Money	Fee, charge or cost per item
factor		0..1	decimal	Price scaling factor
net		0..1	Money	Total item cost
udi		0..*	Reference(Device)	Unique device identifier
subDetail		0..*	BackboneElement	Product or service provided
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	Item instance identifier
revenue		0..1	CodeableConcept	Revenue or cost center code Vínculo: ExampleRevenueCenterCodes (example): Codes for the revenue or cost centers supplying the service and/or products.
category		0..1	CodeableConcept	Benefit classification Vínculo: BenefitCategoryCodes (example): Benefit categories such as: oral-basic, major, glasses.
productOrService		1..1	CodeableConcept	Billing, service, product, or drug code Vínculo: USCLSCodes (example): Allowable service and product codes.
modifier		0..*	CodeableConcept	Service/Product billing modifiers Vínculo: 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 Vínculo: ExampleProgramReasonCodes (example): Program specific reason codes.
quantity		0..1	SimpleQuantity	Count of products or services
unitPrice		0..1	Money	Fee, charge or cost per item
factor		0..1	decimal	Price scaling factor
net		0..1	Money	Total item cost
udi		0..*	Reference(Device)	Unique device identifier
total		0..1	Money	Total claim cost
Documentação para este formato

Terminologia Ligações

Caminho	Conformidade	ValueSet / Código	URI
Claim.language	preferred	CommonLanguages http://hl7.org/fhir/ValueSet/languages From a norma FHIR Vínculos adicionais Objetivo AllLanguages Vínculo máximo
Claim.identifier.use	required	IdentifierUse http://hl7.org/fhir/ValueSet/identifier-use|4.0.1 From a norma FHIR
Claim.identifier.type	extensible	Identifier Type Codes http://hl7.org/fhir/ValueSet/identifier-type From a norma FHIR
Claim.status	required	FinancialResourceStatusCodes http://hl7.org/fhir/ValueSet/fm-status|4.0.1 From a norma FHIR
Claim.type	extensible	ClaimTypeCodes http://hl7.org/fhir/ValueSet/claim-type From a norma FHIR
Claim.subType	example	ExampleClaimSubTypeCodes http://hl7.org/fhir/ValueSet/claim-subtype From a norma FHIR
Claim.subType.coding.code	required	https://fhir.ecoinfo.ipes.tech/ValueSet/claim-subtype https://fhir.ecoinfo.ipes.tech/ValueSet/claim-subtype
Claim.use	required	Fixed Value: claim http://hl7.org/fhir/ValueSet/claim-use|4.0.1 From a norma FHIR
Claim.priority	example	ProcessPriorityCodes http://hl7.org/fhir/ValueSet/process-priority From a norma FHIR
Claim.fundsReserve	example	Funds Reservation Codes http://hl7.org/fhir/ValueSet/fundsreserve From a norma FHIR
Claim.related.relationship	example	ExampleRelatedClaimRelationshipCodes http://hl7.org/fhir/ValueSet/related-claim-relationship From a norma FHIR
Claim.payee.type	example	Claim Payee Type Codes http://hl7.org/fhir/ValueSet/payeetype From a norma FHIR
Claim.payee.type.coding.code	required	https://fhir.ecoinfo.ipes.tech/ValueSet/payee-type https://fhir.ecoinfo.ipes.tech/ValueSet/payee-type
Claim.careTeam.provider.type	extensible	ResourceType http://hl7.org/fhir/ValueSet/resource-types From a norma FHIR
Claim.careTeam.provider.identifier.use	required	IdentifierUse http://hl7.org/fhir/ValueSet/identifier-use|4.0.1 From a norma FHIR
Claim.careTeam.provider.identifier.type	extensible	Identifier Type Codes http://hl7.org/fhir/ValueSet/identifier-type From a norma FHIR
Claim.careTeam.role	example	ClaimCareTeamRoleCodes http://hl7.org/fhir/ValueSet/claim-careteamrole From a norma FHIR
Claim.careTeam.qualification	example	ExampleProviderQualificationCodes http://hl7.org/fhir/ValueSet/provider-qualification From a norma FHIR
Claim.supportingInfo.category	example	ClaimInformationCategoryCodes http://hl7.org/fhir/ValueSet/claim-informationcategory From a norma FHIR
Claim.supportingInfo.code	example	ExceptionCodes http://hl7.org/fhir/ValueSet/claim-exception From a norma FHIR
Claim.supportingInfo.reason	example	MissingToothReasonCodes http://hl7.org/fhir/ValueSet/missing-tooth-reason From a norma FHIR
Claim.diagnosis.diagnosis[x]	required	https://terminologia.saude.gov.br/fhir/ValueSet/BRCID10 https://terminologia.saude.gov.br/fhir/ValueSet/BRCID10
Claim.diagnosis.type	example	ExampleDiagnosisTypeCodes http://hl7.org/fhir/ValueSet/ex-diagnosistype From a norma FHIR
Claim.diagnosis.onAdmission	example	ExampleDiagnosisOnAdmissionCodes http://hl7.org/fhir/ValueSet/ex-diagnosis-on-admission From a norma FHIR
Claim.diagnosis.packageCode	example	ExampleDiagnosisRelatedGroupCodes http://hl7.org/fhir/ValueSet/ex-diagnosisrelatedgroup From a norma FHIR
Claim.procedure.type	required	​https://fhir.ecoinfo.ipes.tech/fhir/CodeSystem/GuiaOCIBRIPES/tipoprocedimento https://fhir.ecoinfo.ipes.tech/fhir/CodeSystem/GuiaOCIBRIPES/tipoprocedimento
Claim.procedure.procedure[x]	required	https://terminologia.saude.gov.br/fhir/ValueSet/BRProcedimentosNacionais https://terminologia.saude.gov.br/fhir/ValueSet/BRProcedimentosNacionais
Claim.insurance.coverage.type	extensible	ResourceType http://hl7.org/fhir/ValueSet/resource-types From a norma FHIR
Claim.accident.type	extensible	ActIncidentCode http://terminology.hl7.org/ValueSet/v3-ActIncidentCode
Claim.item.revenue	example	ExampleRevenueCenterCodes http://hl7.org/fhir/ValueSet/ex-revenue-center From a norma FHIR
Claim.item.category	example	BenefitCategoryCodes http://hl7.org/fhir/ValueSet/ex-benefitcategory From a norma FHIR
Claim.item.productOrService	required	https://terminologia.saude.gov.br/fhir/ValueSet/BRProcedimentosNacionais https://terminologia.saude.gov.br/fhir/ValueSet/BRProcedimentosNacionais
Claim.item.modifier	example	ModifierTypeCodes http://hl7.org/fhir/ValueSet/claim-modifiers From a norma FHIR
Claim.item.programCode	example	ExampleProgramReasonCodes http://hl7.org/fhir/ValueSet/ex-program-code From a norma FHIR
Claim.item.location[x]	example	ExampleServicePlaceCodes http://hl7.org/fhir/ValueSet/service-place From a norma FHIR
Claim.item.bodySite	example	OralSiteCodes http://hl7.org/fhir/ValueSet/tooth From a norma FHIR
Claim.item.subSite	example	SurfaceCodes http://hl7.org/fhir/ValueSet/surface From a norma FHIR
Claim.item.detail.revenue	example	ExampleRevenueCenterCodes http://hl7.org/fhir/ValueSet/ex-revenue-center From a norma FHIR
Claim.item.detail.category	example	BenefitCategoryCodes http://hl7.org/fhir/ValueSet/ex-benefitcategory From a norma FHIR
Claim.item.detail.productOrService	example	USCLSCodes http://hl7.org/fhir/ValueSet/service-uscls From a norma FHIR
Claim.item.detail.modifier	example	ModifierTypeCodes http://hl7.org/fhir/ValueSet/claim-modifiers From a norma FHIR
Claim.item.detail.programCode	example	ExampleProgramReasonCodes http://hl7.org/fhir/ValueSet/ex-program-code From a norma FHIR
Claim.item.detail.subDetail.revenue	example	ExampleRevenueCenterCodes http://hl7.org/fhir/ValueSet/ex-revenue-center From a norma FHIR
Claim.item.detail.subDetail.category	example	BenefitCategoryCodes http://hl7.org/fhir/ValueSet/ex-benefitcategory From a norma FHIR
Claim.item.detail.subDetail.productOrService	example	USCLSCodes http://hl7.org/fhir/ValueSet/service-uscls From a norma FHIR
Claim.item.detail.subDetail.modifier	example	ModifierTypeCodes http://hl7.org/fhir/ValueSet/claim-modifiers From a norma FHIR
Claim.item.detail.subDetail.programCode	example	ExampleProgramReasonCodes http://hl7.org/fhir/ValueSet/ex-program-code From a norma FHIR

Restrições

Id	Grau	Caminho(s)	Detalhes	Requisitos
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 Claim

Resumo

Fixo: 8 elementos

Extensões

Esta estrutura refere-se a estas extensões:

• https://fhir.ecoinfo.ipes.tech/fhir/StructureDefinition/Competencia
• https://fhir.ecoinfo.ipes.tech/fhir/StructureDefinition/ModalidadeAssistencial
• https://fhir.ecoinfo.ipes.tech/fhir/StructureDefinition/DataSolicitacao
• https://fhir.ecoinfo.ipes.tech/fhir/StructureDefinition/DataDesfecho
• https://fhir.ecoinfo.ipes.tech/fhir/StructureDefinition/Prioridade
• https://fhir.ecoinfo.ipes.tech/fhir/StructureDefinition/DataAutorizacao
• https://fhir.ecoinfo.ipes.tech/fhir/StructureDefinition/MotivoDesfecho