FHIR Implementation Guide for ABDM
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FHIR Implementation Guide for ABDM - Local Development build (v4.0.0). See the Directory of published versions

Extension: StructureDefinition/Claim-Condition

Official URL: https://nrces.in/ndhm/fhir/r4/StructureDefinition/Claim-Condition Version: 4.0.0
Draft as of 2023-11-06 Computable Name: ClaimCondition

This extension outlines specific conditions and criteria that may be required to successfully claim benefits under a coverage within a insurance plan.

Context of Use

This extension may be used on the following element(s):

  • Element ID InsurancePlan.coverage
  • Element ID InsurancePlan.coverage.benefit

Usage info

Usage:

Formal Views of Extension Content

Description of Profiles, Differentials, Snapshots, and how the XML and JSON presentations work.

This structure is derived from Extension

Summary

Complex Extension: This extension outlines specific conditions and criteria that may be required to successfully claim benefits under a coverage within a insurance plan.

  • claim-condition: string: An Extension

This structure is derived from Extension

NameFlagsCard.TypeDescription & Constraintsdoco
.. Extension 0..*ExtensionOutlines specific conditions and criteria that may be required to successfully claim benefits under a coverage within a insurance product.
... extension:claim-condition 0..*ExtensionExtension
.... url 1..1uri"claim-condition"
.... value[x] 0..1stringValue of extension
... url 1..1uri"https://nrces.in/ndhm/fhir/r4/StructureDefinition/Claim-Condition"
... value[x] 0..0

doco Documentation for this format
NameFlagsCard.TypeDescription & Constraintsdoco
.. Extension 0..*ExtensionOutlines specific conditions and criteria that may be required to successfully claim benefits under a coverage within a insurance product.
... id 0..1stringUnique id for inter-element referencing
... Slices for extension 0..*ExtensionAdditional content defined by implementations
Slice: Unordered, Open by value:url
... extension:claim-condition 0..*ExtensionExtension
.... id 0..1stringUnique id for inter-element referencing
.... extension 0..*ExtensionAdditional content defined by implementations
Slice: Unordered, Open by value:url
.... url 1..1uri"claim-condition"
.... value[x] 0..1stringValue of extension

doco Documentation for this format

This structure is derived from Extension

Summary

Complex Extension: This extension outlines specific conditions and criteria that may be required to successfully claim benefits under a coverage within a insurance plan.

  • claim-condition: string: An Extension

Differential View

This structure is derived from Extension

NameFlagsCard.TypeDescription & Constraintsdoco
.. Extension 0..*ExtensionOutlines specific conditions and criteria that may be required to successfully claim benefits under a coverage within a insurance product.
... extension:claim-condition 0..*ExtensionExtension
.... url 1..1uri"claim-condition"
.... value[x] 0..1stringValue of extension
... url 1..1uri"https://nrces.in/ndhm/fhir/r4/StructureDefinition/Claim-Condition"
... value[x] 0..0

doco Documentation for this format

Snapshot View

NameFlagsCard.TypeDescription & Constraintsdoco
.. Extension 0..*ExtensionOutlines specific conditions and criteria that may be required to successfully claim benefits under a coverage within a insurance product.
... id 0..1stringUnique id for inter-element referencing
... Slices for extension 0..*ExtensionAdditional content defined by implementations
Slice: Unordered, Open by value:url
... extension:claim-condition 0..*ExtensionExtension
.... id 0..1stringUnique id for inter-element referencing
.... extension 0..*ExtensionAdditional content defined by implementations
Slice: Unordered, Open by value:url
.... url 1..1uri"claim-condition"
.... value[x] 0..1stringValue of extension

doco Documentation for this format

 

Other representations of profile: CSV, Excel, Schematron

Constraints

IdGradePath(s)DetailsRequirements
ele-1error**ALL** elementsAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ext-1error**ALL** extensionsMust have either extensions or value[x], not both
: extension.exists() != value.exists()