Class Claim

A provider issued list of services and products provided, or to be provided, to a patient which is provided to an insurer for payment recovery.

Inheritance
System.Object
Resource
DomainResource
Claim
Implements
Inherited Members
Namespace: fhirCsR2.Models
Assembly: fhirCsR2.dll
Syntax
public class Claim : DomainResource, IFhirJsonSerializable

Properties

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_Accident

Extension container element for Accident

Declaration
public Element _Accident { get; set; }
Property Value
Type Description
Element
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_Created

Extension container element for Created

Declaration
public Element _Created { get; set; }
Property Value
Type Description
Element
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_School

Extension container element for School

Declaration
public Element _School { get; set; }
Property Value
Type Description
Element
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_Type

Extension container element for Type

Declaration
public Element _Type { get; set; }
Property Value
Type Description
Element
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_Use

Extension container element for Use

Declaration
public Element _Use { get; set; }
Property Value
Type Description
Element
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Accident

Coverage may be dependent on accidents.

Declaration
public string Accident { get; set; }
Property Value
Type Description
System.String
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AccidentType

Coverage may be dependent on the type of accident.

Declaration
public Coding AccidentType { get; set; }
Property Value
Type Description
Coding
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AdditionalMaterials

Code to indicate that Xrays, images, emails, documents, models or attachments are being sent in support of this submission.

Declaration
public List<Coding> AdditionalMaterials { get; set; }
Property Value
Type Description
fhirCsR2.Models.List<Coding>
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Condition

List of patient conditions for which care is sought.

Declaration
public List<Coding> Condition { get; set; }
Property Value
Type Description
fhirCsR2.Models.List<Coding>
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Coverage

Health care programs and insurers are significant payors of health service costs.

Declaration
public List<ClaimCoverage> Coverage { get; set; }
Property Value
Type Description
fhirCsR2.Models.List<ClaimCoverage>
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Created

The date when the enclosed suite of services were performed or completed.

Declaration
public string Created { get; set; }
Property Value
Type Description
System.String
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Diagnosis

Ordered list of patient diagnosis for which care is sought.

Declaration
public List<ClaimDiagnosis> Diagnosis { get; set; }
Property Value
Type Description
fhirCsR2.Models.List<ClaimDiagnosis>
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Enterer

Person who created the invoice/claim/pre-determination or pre-authorization.

Declaration
public Reference Enterer { get; set; }
Property Value
Type Description
Reference
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Exception

To determine extenuating circumstances for coverage.

Declaration
public List<Coding> Exception { get; set; }
Property Value
Type Description
fhirCsR2.Models.List<Coding>
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Facility

Facility where the services were provided.

Declaration
public Reference Facility { get; set; }
Property Value
Type Description
Reference
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FundsReserve

In the case of a Pre-Determination/Pre-Authorization the provider may request that funds in the amount of the expected Benefit be reserved ('Patient' or 'Provider') to pay for the Benefits determined on the subsequent claim(s). 'None' explicitly indicates no funds reserving is requested.

Declaration
public Coding FundsReserve { get; set; }
Property Value
Type Description
Coding
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Identifier

The business identifier for the instance: invoice number, claim number, pre-determination or pre-authorization number.

Declaration
public List<Identifier> Identifier { get; set; }
Property Value
Type Description
fhirCsR2.Models.List<Identifier>
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InterventionException

Coverage may be modified based on exception information provided.

Declaration
public List<Coding> InterventionException { get; set; }
Property Value
Type Description
fhirCsR2.Models.List<Coding>
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Item

First tier of goods and services.

Declaration
public List<ClaimItem> Item { get; set; }
Property Value
Type Description
fhirCsR2.Models.List<ClaimItem>
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MissingTeeth

The list of missing teeth may influence the adjudication of services for example with Bridges.

Declaration
public List<ClaimMissingTeeth> MissingTeeth { get; set; }
Property Value
Type Description
fhirCsR2.Models.List<ClaimMissingTeeth>
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Organization

The organization which is responsible for the bill, claim pre-determination, pre-authorization.

Declaration
public Reference Organization { get; set; }
Property Value
Type Description
Reference
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OriginalPrescription

Original prescription to support the dispensing of pharmacy services, medications or products.

Declaration
public Reference OriginalPrescription { get; set; }
Property Value
Type Description
Reference
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OriginalRuleset

The version of the specification from which the original instance was created.

Declaration
public Coding OriginalRuleset { get; set; }
Property Value
Type Description
Coding
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Patient

Patient Resource.

Declaration
public Reference Patient { get; set; }
Property Value
Type Description
Reference
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Payee

The party to be reimbursed for the services.

Declaration
public ClaimPayee Payee { get; set; }
Property Value
Type Description
ClaimPayee
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Prescription

For type=Pharmacy and Vision only.

Declaration
public Reference Prescription { get; set; }
Property Value
Type Description
Reference
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Priority

Immediate (stat), best effort (normal), deferred (deferred).

Declaration
public Coding Priority { get; set; }
Property Value
Type Description
Coding
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Provider

The provider which is responsible for the bill, claim pre-determination, pre-authorization.

Declaration
public Reference Provider { get; set; }
Property Value
Type Description
Reference
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Referral

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

Declaration
public Reference Referral { get; set; }
Property Value
Type Description
Reference
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ResourceType

Resource Type Name

Declaration
public override string ResourceType { get; }
Property Value
Type Description
System.String
Overrides
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Ruleset

The version of the specification on which this instance relies.

Declaration
public Coding Ruleset { get; set; }
Property Value
Type Description
Coding
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School

Often required for over-age dependents.

Declaration
public string School { get; set; }
Property Value
Type Description
System.String
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Target

Insurer Identifier, typical BIN number (6 digit).

Declaration
public Reference Target { get; set; }
Property Value
Type Description
Reference
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Type

The category of claim this is.

Declaration
public string Type { get; set; }
Property Value
Type Description
System.String
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Use

Complete (Bill or Claim), Proposed (Pre-Authorization), Exploratory (Pre-determination).

Declaration
public string Use { get; set; }
Property Value
Type Description
System.String

Methods

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DeserializeJson(ref Utf8JsonReader, JsonSerializerOptions)

Deserialize a JSON object

Declaration
public void DeserializeJson(ref Utf8JsonReader reader, JsonSerializerOptions options)
Parameters
Type Name Description
Utf8JsonReader reader
JsonSerializerOptions options
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DeserializeJsonProperty(ref Utf8JsonReader, JsonSerializerOptions, String)

Deserialize a JSON property

Declaration
public void DeserializeJsonProperty(ref Utf8JsonReader reader, JsonSerializerOptions options, string propertyName)
Parameters
Type Name Description
Utf8JsonReader reader
JsonSerializerOptions options
System.String propertyName
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SerializeJson(Utf8JsonWriter, JsonSerializerOptions, Boolean)

Serialize to a JSON object

Declaration
public void SerializeJson(Utf8JsonWriter writer, JsonSerializerOptions options, bool includeStartObject = true)
Parameters
Type Name Description
Utf8JsonWriter writer
JsonSerializerOptions options
System.Boolean includeStartObject

Implements