Struct ClaimInner

Source
pub struct ClaimInner {
Show 72 fields pub id: Option<String>, pub meta: Option<Meta>, pub implicit_rules: Option<String>, pub language: Option<String>, pub text: Option<Narrative>, pub contained: Vec<Resource>, pub extension: Vec<Extension>, pub modifier_extension: Vec<Extension>, pub identifier: Vec<Option<Identifier>>, pub identifier_ext: Vec<Option<FieldExtension>>, pub trace_number: Vec<Option<Identifier>>, pub trace_number_ext: Vec<Option<FieldExtension>>, pub status: String, pub status_ext: Option<FieldExtension>, pub type: CodeableConcept, pub type_ext: Option<FieldExtension>, pub sub_type: Option<CodeableConcept>, pub sub_type_ext: Option<FieldExtension>, pub use: Use, pub use_ext: Option<FieldExtension>, pub patient: Reference, pub patient_ext: Option<FieldExtension>, pub billable_period: Option<Period>, pub billable_period_ext: Option<FieldExtension>, pub created: DateTime, pub created_ext: Option<FieldExtension>, pub enterer: Option<Reference>, pub enterer_ext: Option<FieldExtension>, pub insurer: Option<Reference>, pub insurer_ext: Option<FieldExtension>, pub provider: Option<Reference>, pub provider_ext: Option<FieldExtension>, pub priority: Option<CodeableConcept>, pub priority_ext: Option<FieldExtension>, pub funds_reserve: Option<CodeableConcept>, pub funds_reserve_ext: Option<FieldExtension>, pub related: Vec<Option<ClaimRelated>>, pub related_ext: Vec<Option<FieldExtension>>, pub prescription: Option<Reference>, pub prescription_ext: Option<FieldExtension>, pub original_prescription: Option<Reference>, pub original_prescription_ext: Option<FieldExtension>, pub payee: Option<ClaimPayee>, pub payee_ext: Option<FieldExtension>, pub referral: Option<Reference>, pub referral_ext: Option<FieldExtension>, pub encounter: Vec<Option<Reference>>, pub encounter_ext: Vec<Option<FieldExtension>>, pub facility: Option<Reference>, pub facility_ext: Option<FieldExtension>, pub diagnosis_related_group: Option<CodeableConcept>, pub diagnosis_related_group_ext: Option<FieldExtension>, pub event: Vec<Option<ClaimEvent>>, pub event_ext: Vec<Option<FieldExtension>>, pub care_team: Vec<Option<ClaimCareTeam>>, pub care_team_ext: Vec<Option<FieldExtension>>, pub supporting_info: Vec<Option<ClaimSupportingInfo>>, pub supporting_info_ext: Vec<Option<FieldExtension>>, pub diagnosis: Vec<Option<ClaimDiagnosis>>, pub diagnosis_ext: Vec<Option<FieldExtension>>, pub procedure: Vec<Option<ClaimProcedure>>, pub procedure_ext: Vec<Option<FieldExtension>>, pub insurance: Vec<Option<ClaimInsurance>>, pub insurance_ext: Vec<Option<FieldExtension>>, pub accident: Option<ClaimAccident>, pub accident_ext: Option<FieldExtension>, pub patient_paid: Option<Money>, pub patient_paid_ext: Option<FieldExtension>, pub item: Vec<Option<ClaimItem>>, pub item_ext: Vec<Option<FieldExtension>>, pub total: Option<Money>, pub total_ext: Option<FieldExtension>, /* private fields */
}
Expand description

A provider issued list of professional services and products which have been provided, or are to be provided, to a patient which is sent to an insurer for reimbursement.

Claim v5.0.0

Claim, Pre-determination or Pre-authorization

A provider issued list of professional services and products which have been provided, or are to be provided, to a patient which is sent to an insurer for reimbursement.

The Claim resource fulfills three information request requirements: Claim - a request for adjudication for reimbursement for products and/or services provided; Preauthorization - a request to authorize the future provision of products and/or services including an anticipated adjudication; and, Predetermination - a request for a non-bind adjudication of possible future products and/or services.

Fields§

§id: Option<String>

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.

§meta: Option<Meta>

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.

§implicit_rules: Option<String>

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.

§language: Option<String>

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).

§text: Option<Narrative>

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.

§contained: Vec<Resource>

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.

§extension: Vec<Extension>

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.

§modifier_extension: Vec<Extension>

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.

§identifier: Vec<Option<Identifier>>

Business Identifier for claim

A unique identifier assigned to this claim.

§identifier_ext: Vec<Option<FieldExtension>>

Extension field.

§trace_number: Vec<Option<Identifier>>

Number for tracking

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

§trace_number_ext: Vec<Option<FieldExtension>>

Extension field.

§status: String

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.

§status_ext: Option<FieldExtension>

Extension field.

§type: CodeableConcept

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.

§type_ext: Option<FieldExtension>

Extension field.

§sub_type: Option<CodeableConcept>

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.

§sub_type_ext: Option<FieldExtension>

Extension field.

§use: Use

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.

§use_ext: Option<FieldExtension>

Extension field.

§patient: Reference

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.

§patient_ext: Option<FieldExtension>

Extension field.

§billable_period: Option<Period>

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.

§billable_period_ext: Option<FieldExtension>

Extension field.

§created: DateTime

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.

§created_ext: Option<FieldExtension>

Extension field.

§enterer: Option<Reference>

Author of the claim

Individual who created the claim, predetermination or preauthorization.

§enterer_ext: Option<FieldExtension>

Extension field.

§insurer: Option<Reference>

Target

The Insurer who is target of the request.

§insurer_ext: Option<FieldExtension>

Extension field.

§provider: Option<Reference>

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.

§provider_ext: Option<FieldExtension>

Extension field.

§priority: Option<CodeableConcept>

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.

§priority_ext: Option<FieldExtension>

Extension field.

§funds_reserve: Option<CodeableConcept>

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.

§funds_reserve_ext: Option<FieldExtension>

Extension field.

§related: Vec<Option<ClaimRelated>>

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.

§related_ext: Vec<Option<FieldExtension>>

Extension field.

§prescription: Option<Reference>

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.

§prescription_ext: Option<FieldExtension>

Extension field.

§original_prescription: Option<Reference>

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’.

§original_prescription_ext: Option<FieldExtension>

Extension field.

§payee: Option<ClaimPayee>

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.

§payee_ext: Option<FieldExtension>

Extension field.

§referral: Option<Reference>

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.

§referral_ext: Option<FieldExtension>

Extension field.

§encounter: Vec<Option<Reference>>

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.

§encounter_ext: Vec<Option<FieldExtension>>

Extension field.

§facility: Option<Reference>

Servicing facility

Facility where the services were provided.

§facility_ext: Option<FieldExtension>

Extension field.

§diagnosis_related_group: Option<CodeableConcept>

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.

§diagnosis_related_group_ext: Option<FieldExtension>

Extension field.

§event: Vec<Option<ClaimEvent>>

Event information

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

§event_ext: Vec<Option<FieldExtension>>

Extension field.

§care_team: Vec<Option<ClaimCareTeam>>

Members of the care team

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

§care_team_ext: Vec<Option<FieldExtension>>

Extension field.

§supporting_info: Vec<Option<ClaimSupportingInfo>>

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.

§supporting_info_ext: Vec<Option<FieldExtension>>

Extension field.

§diagnosis: Vec<Option<ClaimDiagnosis>>

Pertinent diagnosis information

Information about diagnoses relevant to the claim items.

§diagnosis_ext: Vec<Option<FieldExtension>>

Extension field.

§procedure: Vec<Option<ClaimProcedure>>

Clinical procedures performed

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

§procedure_ext: Vec<Option<FieldExtension>>

Extension field.

§insurance: Vec<Option<ClaimInsurance>>

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.

§insurance_ext: Vec<Option<FieldExtension>>

Extension field.

§accident: Option<ClaimAccident>

Details of the event

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

§accident_ext: Option<FieldExtension>

Extension field.

§patient_paid: Option<Money>

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.

§patient_paid_ext: Option<FieldExtension>

Extension field.

§item: Vec<Option<ClaimItem>>

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.

§item_ext: Vec<Option<FieldExtension>>

Extension field.

§total: Option<Money>

Total claim cost

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

§total_ext: Option<FieldExtension>

Extension field.

Trait Implementations§

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impl Clone for ClaimInner

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fn clone(&self) -> ClaimInner

Returns a duplicate of the value. Read more
1.0.0 · Source§

fn clone_from(&mut self, source: &Self)

Performs copy-assignment from source. Read more
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impl Debug for ClaimInner

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fn fmt(&self, f: &mut Formatter<'_>) -> Result<(), Error>

Formats the value using the given formatter. Read more
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impl<'de> Deserialize<'de> for ClaimInner

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fn deserialize<__D>( __deserializer: __D, ) -> Result<ClaimInner, <__D as Deserializer<'de>>::Error>
where __D: Deserializer<'de>,

Deserialize this value from the given Serde deserializer. Read more
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impl From<ClaimInner> for Claim

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fn from(inner: ClaimInner) -> Claim

Converts to this type from the input type.
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impl PartialEq for ClaimInner

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fn eq(&self, other: &ClaimInner) -> bool

Tests for self and other values to be equal, and is used by ==.
1.0.0 · Source§

fn ne(&self, other: &Rhs) -> bool

Tests for !=. The default implementation is almost always sufficient, and should not be overridden without very good reason.
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impl Serialize for ClaimInner

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fn serialize<__S>( &self, __serializer: __S, ) -> Result<<__S as Serializer>::Ok, <__S as Serializer>::Error>
where __S: Serializer,

Serialize this value into the given Serde serializer. Read more
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impl StructuralPartialEq for ClaimInner

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