Struct ClaimBuilder

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pub struct ClaimBuilder { /* private fields */ }
Expand description

Builder for ClaimInner.

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impl ClaimBuilder

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pub fn id(self, value: String) -> ClaimBuilder

Logical id of this artifact

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

Within the context of the FHIR RESTful interactions, the resource has an id except for cases like the create and conditional update. Otherwise, the use of the resouce id depends on the given use case.

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pub fn meta(self, value: Meta) -> ClaimBuilder

Metadata about the resource

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

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pub fn implicit_rules(self, value: String) -> ClaimBuilder

A set of rules under which this content was created

A reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content. Often, this is a reference to an implementation guide that defines the special rules along with other profiles etc.

Asserting this rule set restricts the content to be only understood by a limited set of trading partners. This inherently limits the usefulness of the data in the long term. However, the existing health eco-system is highly fractured, and not yet ready to define, collect, and exchange data in a generally computable sense. Wherever possible, implementers and/or specification writers should avoid using this element. Often, when used, the URL is a reference to an implementation guide that defines these special rules as part of its narrative along with other profiles, value sets, etc.

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pub fn language(self, value: String) -> ClaimBuilder

Language; Language of the resource content

The base language in which the resource is written.

Language is provided to support indexing and accessibility (typically, services such as text to speech use the language tag). The html language tag in the narrative applies to the narrative. The language tag on the resource may be used to specify the language of other presentations generated from the data in the resource. Not all the content has to be in the base language. The Resource.language should not be assumed to apply to the narrative automatically. If a language is specified, it should it also be specified on the div element in the html (see rules in HTML5 for information about the relationship between xml:lang and the html lang attribute).

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pub fn text(self, value: Narrative) -> ClaimBuilder

Text summary of the resource, for human interpretation

A human-readable narrative that contains a summary of the resource and can be used to represent the content of the resource to a human. The narrative need not encode all the structured data, but is required to contain sufficient detail to make it “clinically safe” for a human to just read the narrative. Resource definitions may define what content should be represented in the narrative to ensure clinical safety.

Contained resources do not have a narrative. Resources that are not contained SHOULD have a narrative. In some cases, a resource may only have text with little or no additional discrete data (as long as all minOccurs=1 elements are satisfied). This may be necessary for data from legacy systems where information is captured as a “text blob” or where text is additionally entered raw or narrated and encoded information is added later.

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pub fn contained(self, value: Vec<Resource>) -> ClaimBuilder

Contained, inline Resources

These resources do not have an independent existence apart from the resource that contains them - they cannot be identified independently, nor can they have their own independent transaction scope. This is allowed to be a Parameters resource if and only if it is referenced by a resource that provides context/meaning.

This should never be done when the content can be identified properly, as once identification is lost, it is extremely difficult (and context dependent) to restore it again. Contained resources may have profiles and tags in their meta elements, but SHALL NOT have security labels.

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pub fn extension(self, value: Vec<Extension>) -> ClaimBuilder

Additional content defined by implementations

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

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

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pub fn modifier_extension(self, value: Vec<Extension>) -> ClaimBuilder

Extensions that cannot be ignored

May be used to represent additional information that is not part of the basic definition of the resource and that modifies the understanding of the element that contains it and/or the understanding of the containing element’s descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and managable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

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

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pub fn identifier(self, value: Vec<Option<Identifier>>) -> ClaimBuilder

Business Identifier for claim

A unique identifier assigned to this claim.

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pub fn identifier_ext(self, value: Vec<Option<FieldExtension>>) -> ClaimBuilder

Extension field.

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pub fn trace_number(self, value: Vec<Option<Identifier>>) -> ClaimBuilder

Number for tracking

Trace number for tracking purposes. May be defined at the jurisdiction level or between trading partners.

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pub fn trace_number_ext( self, value: Vec<Option<FieldExtension>>, ) -> ClaimBuilder

Extension field.

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pub fn status(self, value: String) -> ClaimBuilder

ClaimStatus; active | cancelled | draft | entered-in-error

The status of the resource instance.

This element is labeled as a modifier because the status contains codes that mark the resource as not currently valid.

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pub fn status_ext(self, value: FieldExtension) -> ClaimBuilder

Extension field.

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pub fn type(self, value: CodeableConcept) -> ClaimBuilder

ClaimType; Category or discipline

The category of claim, e.g. oral, pharmacy, vision, institutional, professional.

The code system provides oral, pharmacy, vision, professional and institutional claim types. Those supported depends on the requirements of the jurisdiction. The valueset is extensible to accommodate other types of claims as required by the jurisdiction.

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pub fn type_ext(self, value: FieldExtension) -> ClaimBuilder

Extension field.

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pub fn sub_type(self, value: CodeableConcept) -> ClaimBuilder

ClaimSubType; More granular claim type

A finer grained suite of claim type codes which may convey additional information such as Inpatient vs Outpatient and/or a specialty service.

This may contain the local bill type codes, for example the US UB-04 bill type code or the CMS bill type.

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pub fn sub_type_ext(self, value: FieldExtension) -> ClaimBuilder

Extension field.

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pub fn use(self, value: Use) -> ClaimBuilder

Use; claim | preauthorization | predetermination

A code to indicate whether the nature of the request is: Claim - A request to an Insurer to adjudicate the supplied charges for health care goods and services under the identified policy and to pay the determined Benefit amount, if any; Preauthorization - A request to an Insurer to adjudicate the supplied proposed future charges for health care goods and services under the identified policy and to approve the services and provide the expected benefit amounts and potentially to reserve funds to pay the benefits when Claims for the indicated services are later submitted; or, Pre-determination - A request to an Insurer to adjudicate the supplied ‘what if’ charges for health care goods and services under the identified policy and report back what the Benefit payable would be had the services actually been provided.

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pub fn use_ext(self, value: FieldExtension) -> ClaimBuilder

Extension field.

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pub fn patient(self, value: Reference) -> ClaimBuilder

The recipient of the products and services

The party to whom the professional services and/or products have been supplied or are being considered and for whom actual or forecast reimbursement is sought.

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pub fn patient_ext(self, value: FieldExtension) -> ClaimBuilder

Extension field.

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pub fn billable_period(self, value: Period) -> ClaimBuilder

Relevant time frame for the claim

The period for which charges are being submitted.

Typically this would be today or in the past for a claim, and today or in the future for preauthorizations and predeterminations. Typically line item dates of service should fall within the billing period if one is specified.

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pub fn billable_period_ext(self, value: FieldExtension) -> ClaimBuilder

Extension field.

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pub fn created(self, value: DateTime) -> ClaimBuilder

Resource creation date

The date this resource was created.

This field is independent of the date of creation of the resource as it may reflect the creation date of a source document prior to digitization. Typically for claims all services must be completed as of this date.

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pub fn created_ext(self, value: FieldExtension) -> ClaimBuilder

Extension field.

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pub fn enterer(self, value: Reference) -> ClaimBuilder

Author of the claim

Individual who created the claim, predetermination or preauthorization.

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pub fn enterer_ext(self, value: FieldExtension) -> ClaimBuilder

Extension field.

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pub fn insurer(self, value: Reference) -> ClaimBuilder

Target

The Insurer who is target of the request.

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pub fn insurer_ext(self, value: FieldExtension) -> ClaimBuilder

Extension field.

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pub fn provider(self, value: Reference) -> ClaimBuilder

Party responsible for the claim

The provider which is responsible for the claim, predetermination or preauthorization.

Typically this field would be 1..1 where this party is accountable for the data content within the claim but is not necessarily the facility, provider group or practitioner who provided the products and services listed within this claim resource. This field is the Billing Provider, for example, a facility, provider group, lab or practitioner.

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pub fn provider_ext(self, value: FieldExtension) -> ClaimBuilder

Extension field.

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pub fn priority(self, value: CodeableConcept) -> ClaimBuilder

ProcessPriority; Desired processing urgency

The provider-required urgency of processing the request. Typical values include: stat, normal, deferred.

If a claim processor is unable to complete the processing as per the priority then they should generate an error and not process the request.

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pub fn priority_ext(self, value: FieldExtension) -> ClaimBuilder

Extension field.

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pub fn funds_reserve(self, value: CodeableConcept) -> ClaimBuilder

FundsReserve; For whom to reserve funds

A code to indicate whether and for whom funds are to be reserved for future claims.

This field is only used for preauthorizations.

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pub fn funds_reserve_ext(self, value: FieldExtension) -> ClaimBuilder

Extension field.

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pub fn related(self, value: Vec<Option<ClaimRelated>>) -> ClaimBuilder

Prior or corollary claims

Other claims which are related to this claim such as prior submissions or claims for related services or for the same event.

For example, for the original treatment and follow-up exams.

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pub fn related_ext(self, value: Vec<Option<FieldExtension>>) -> ClaimBuilder

Extension field.

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pub fn prescription(self, value: Reference) -> ClaimBuilder

Prescription authorizing services and products

Prescription is the document/authorization given to the claim author for them to provide products and services for which consideration (reimbursement) is sought. Could be a RX for medications, an ‘order’ for oxygen or wheelchair or physiotherapy treatments.

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pub fn prescription_ext(self, value: FieldExtension) -> ClaimBuilder

Extension field.

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pub fn original_prescription(self, value: Reference) -> ClaimBuilder

Original prescription if superseded by fulfiller

Original prescription which has been superseded by this prescription to support the dispensing of pharmacy services, medications or products.

For example, a physician may prescribe a medication which the pharmacy determines is contraindicated, or for which the patient has an intolerance, and therefore issues a new prescription for an alternate medication which has the same therapeutic intent. The prescription from the pharmacy becomes the ‘prescription’ and that from the physician becomes the ‘original prescription’.

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pub fn original_prescription_ext(self, value: FieldExtension) -> ClaimBuilder

Extension field.

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pub fn payee(self, value: ClaimPayee) -> ClaimBuilder

Recipient of benefits payable

The party to be reimbursed for cost of the products and services according to the terms of the policy.

Often providers agree to receive the benefits payable to reduce the near-term costs to the patient. The insurer may decline to pay the provider and choose to pay the subscriber instead.

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pub fn payee_ext(self, value: FieldExtension) -> ClaimBuilder

Extension field.

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pub fn referral(self, value: Reference) -> ClaimBuilder

Treatment referral

The referral information received by the claim author, it is not to be used when the author generates a referral for a patient. A copy of that referral may be provided as supporting information. Some insurers require proof of referral to pay for services or to pay specialist rates for services.

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

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pub fn referral_ext(self, value: FieldExtension) -> ClaimBuilder

Extension field.

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pub fn encounter(self, value: Vec<Option<Reference>>) -> ClaimBuilder

Encounters associated with the listed treatments

Healthcare encounters related to this claim.

This will typically be the encounter the event occurred within, but some activities may be initiated prior to or after the official completion of an encounter but still be tied to the context of the encounter.

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pub fn encounter_ext(self, value: Vec<Option<FieldExtension>>) -> ClaimBuilder

Extension field.

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pub fn facility(self, value: Reference) -> ClaimBuilder

Servicing facility

Facility where the services were provided.

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pub fn facility_ext(self, value: FieldExtension) -> ClaimBuilder

Extension field.

DiagnosisRelatedGroup; Package billing code

A package billing code or bundle code used to group products and services to a particular health condition (such as heart attack) which is based on a predetermined grouping code system.

For example DRG (Diagnosis Related Group) or a bundled billing code. A patient may have a diagnosis of a Myocardial Infarction and a DRG for HeartAttack would be assigned. The Claim item (and possible subsequent claims) would refer to the DRG for those line items that were for services related to the heart attack event.

Extension field.

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pub fn event(self, value: Vec<Option<ClaimEvent>>) -> ClaimBuilder

Event information

Information code for an event with a corresponding date or period.

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pub fn event_ext(self, value: Vec<Option<FieldExtension>>) -> ClaimBuilder

Extension field.

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pub fn care_team(self, value: Vec<Option<ClaimCareTeam>>) -> ClaimBuilder

Members of the care team

The members of the team who provided the products and services.

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pub fn care_team_ext(self, value: Vec<Option<FieldExtension>>) -> ClaimBuilder

Extension field.

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pub fn supporting_info( self, value: Vec<Option<ClaimSupportingInfo>>, ) -> ClaimBuilder

Supporting information

Additional information codes regarding exceptions, special considerations, the condition, situation, prior or concurrent issues.

Often there are multiple jurisdiction specific valuesets which are required.

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pub fn supporting_info_ext( self, value: Vec<Option<FieldExtension>>, ) -> ClaimBuilder

Extension field.

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pub fn diagnosis(self, value: Vec<Option<ClaimDiagnosis>>) -> ClaimBuilder

Pertinent diagnosis information

Information about diagnoses relevant to the claim items.

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pub fn diagnosis_ext(self, value: Vec<Option<FieldExtension>>) -> ClaimBuilder

Extension field.

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pub fn procedure(self, value: Vec<Option<ClaimProcedure>>) -> ClaimBuilder

Clinical procedures performed

Procedures performed on the patient relevant to the billing items with the claim.

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pub fn procedure_ext(self, value: Vec<Option<FieldExtension>>) -> ClaimBuilder

Extension field.

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pub fn insurance(self, value: Vec<Option<ClaimInsurance>>) -> ClaimBuilder

Patient insurance information

Financial instruments for reimbursement for the health care products and services specified on the claim.

All insurance coverages for the patient which may be applicable for reimbursement, of the products and services listed in the claim, are typically provided in the claim to allow insurers to confirm the ordering of the insurance coverages relative to local ‘coordination of benefit’ rules. One coverage (and only one) with ‘focal=true’ is to be used in the adjudication of this claim. Coverages appearing before the focal Coverage in the list, and where ‘Coverage.subrogation=false’, should provide a reference to the ClaimResponse containing the adjudication results of the prior claim.

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pub fn insurance_ext(self, value: Vec<Option<FieldExtension>>) -> ClaimBuilder

Extension field.

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pub fn accident(self, value: ClaimAccident) -> ClaimBuilder

Details of the event

Details of an accident which resulted in injuries which required the products and services listed in the claim.

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pub fn accident_ext(self, value: FieldExtension) -> ClaimBuilder

Extension field.

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pub fn patient_paid(self, value: Money) -> ClaimBuilder

Paid by the patient

The amount paid by the patient, in total at the claim claim level or specifically for the item and detail level, to the provider for goods and services.

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pub fn patient_paid_ext(self, value: FieldExtension) -> ClaimBuilder

Extension field.

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pub fn item(self, value: Vec<Option<ClaimItem>>) -> ClaimBuilder

Product or service provided

A claim line. Either a simple product or service or a ‘group’ of details which can each be a simple items or groups of sub-details.

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pub fn item_ext(self, value: Vec<Option<FieldExtension>>) -> ClaimBuilder

Extension field.

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pub fn total(self, value: Money) -> ClaimBuilder

Total claim cost

The total value of the all the items in the claim.

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pub fn total_ext(self, value: FieldExtension) -> ClaimBuilder

Extension field.

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pub fn build_inner(self) -> Result<ClaimInner, BuilderError>

Builds a new ClaimInner.

§Errors

If a required field has not been initialized.

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impl ClaimBuilder

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pub fn build(self) -> Result<Claim, BuilderError>

Finalize building Claim.

Trait Implementations§

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impl Default for ClaimBuilder

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fn default() -> ClaimBuilder

Returns the “default value” for a type. Read more

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