FHIR Implementation Guide for ABDM
6.5.0 - active
FHIR Implementation Guide for ABDM
6.5.0 - active
FHIR Implementation Guide for ABDM - Local Development build (v6.5.0) built by the FHIR (HL7® FHIR® Standard) Build Tools. See the Directory of published versions
| Official URL: https://nrces.in/ndhm/fhir/r4/StructureDefinition/Claim-Exclusion | Version: 6.5.0 | |||
| Draft as of 2025-03-18 | Computable Name: ClaimExclusion | |||
This extension specifies excluded coverage details within a health insurance product. It outlines services, treatments or conditions not covered.
Context of Use
This extension may be used on the following element(s)
InsurancePlan
InsurancePlan.plan
Usage info
Usages:
You can also check for usages in the FHIR IG Statistics
Description of Profiles, Differentials, Snapshots, and how the XML and JSON presentations work.
This structure is derived from Extension
| Name | Flags | Card. | Type | Description & Constraints Filter:   |
|---|---|---|---|---|
  Extension |
0..* | Extension | Excluded coverage details within a health insurance product. It outlines services, treatments or conditions not covered. | |
  Slices for extension |
Content/Rules for all slices | |||
   extension:category |
0..1 | Extension | Illustrates a standard or specific exclusion category e.g: pre-existing diseases, specific disease/procedure waiting period. | |
   extension |
0..0 | |||
| url |
1..1 | uri | "category" | |
  value[x] |
0..1 | CodeableConcept | Value of extension Binding: Claim Exclusion (example): standard or specific exclusion category e.g: pre-existing diseases, specific disease/procedure waiting period. | |
| extension:statement |
0..* | Extension | General statement about the exclusion. | |
| extension |
0..0 | |||
| url |
1..1 | uri | "statement" | |
 value[x] |
0..1 | string | Value of extension | |
 extension:item |
0..* | Extension | Outline list of medical illness, associated treatments, as well as other non-medical items that are excluded from the health insurance product. e.g. cataract surgery, skin tumour, baby food etc. | |
 extension |
0..0 | |||
| url |
1..1 | uri | "item" | |
| value[x] |
0..1 | CodeableConcept | Value of extension | |
 url |
1..1 | uri | "https://nrces.in/ndhm/fhir/r4/StructureDefinition/Claim-Exclusion" | |
 value[x] |
0..0 | |||
| Documentation for this format | ||||
| Name | Flags | Card. | Type | Description & Constraints Filter: |
|---|---|---|---|---|
| Extension |
0..* | Extension | Excluded coverage details within a health insurance product. It outlines services, treatments or conditions not covered. | |
| id |
0..1 | string | Unique id for inter-element referencing | |
| Slices for extension |
0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | |
| extension:category |
0..1 | Extension | Illustrates a standard or specific exclusion category e.g: pre-existing diseases, specific disease/procedure waiting period. | |
| id |
0..1 | string | Unique id for inter-element referencing | |
| extension |
0..0 | |||
| url |
1..1 | uri | "category" | |
| value[x] |
0..1 | CodeableConcept | Value of extension Binding: Claim Exclusion (example): standard or specific exclusion category e.g: pre-existing diseases, specific disease/procedure waiting period. | |
| extension:statement |
0..* | Extension | General statement about the exclusion. | |
| id |
0..1 | string | Unique id for inter-element referencing | |
| extension |
0..0 | |||
| url |
1..1 | uri | "statement" | |
| value[x] |
0..1 | string | Value of extension | |
| extension:item |
0..* | Extension | Outline list of medical illness, associated treatments, as well as other non-medical items that are excluded from the health insurance product. e.g. cataract surgery, skin tumour, baby food etc. | |
| id |
0..1 | string | Unique id for inter-element referencing | |
| extension |
0..0 | |||
| url |
1..1 | uri | "item" | |
| value[x] |
0..1 | CodeableConcept | Value of extension | |
| url |
1..1 | uri | "https://nrces.in/ndhm/fhir/r4/StructureDefinition/Claim-Exclusion" | |
| Documentation for this format | ||||
This structure is derived from Extension
Differential View
This structure is derived from Extension
| Name | Flags | Card. | Type | Description & Constraints Filter: |
|---|---|---|---|---|
| Extension |
0..* | Extension | Excluded coverage details within a health insurance product. It outlines services, treatments or conditions not covered. | |
| Slices for extension |
Content/Rules for all slices | |||
| extension:category |
0..1 | Extension | Illustrates a standard or specific exclusion category e.g: pre-existing diseases, specific disease/procedure waiting period. | |
| extension |
0..0 | |||
| url |
1..1 | uri | "category" | |
| value[x] |
0..1 | CodeableConcept | Value of extension Binding: Claim Exclusion (example): standard or specific exclusion category e.g: pre-existing diseases, specific disease/procedure waiting period. | |
| extension:statement |
0..* | Extension | General statement about the exclusion. | |
| extension |
0..0 | |||
| url |
1..1 | uri | "statement" | |
| value[x] |
0..1 | string | Value of extension | |
| extension:item |
0..* | Extension | Outline list of medical illness, associated treatments, as well as other non-medical items that are excluded from the health insurance product. e.g. cataract surgery, skin tumour, baby food etc. | |
| extension |
0..0 | |||
| url |
1..1 | uri | "item" | |
| value[x] |
0..1 | CodeableConcept | Value of extension | |
| url |
1..1 | uri | "https://nrces.in/ndhm/fhir/r4/StructureDefinition/Claim-Exclusion" | |
| value[x] |
0..0 | |||
| Documentation for this format | ||||
Snapshot View
| Name | Flags | Card. | Type | Description & Constraints Filter: |
|---|---|---|---|---|
| Extension |
0..* | Extension | Excluded coverage details within a health insurance product. It outlines services, treatments or conditions not covered. | |
| id |
0..1 | string | Unique id for inter-element referencing | |
| Slices for extension |
0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | |
| extension:category |
0..1 | Extension | Illustrates a standard or specific exclusion category e.g: pre-existing diseases, specific disease/procedure waiting period. | |
| id |
0..1 | string | Unique id for inter-element referencing | |
| extension |
0..0 | |||
| url |
1..1 | uri | "category" | |
| value[x] |
0..1 | CodeableConcept | Value of extension Binding: Claim Exclusion (example): standard or specific exclusion category e.g: pre-existing diseases, specific disease/procedure waiting period. | |
| extension:statement |
0..* | Extension | General statement about the exclusion. | |
| id |
0..1 | string | Unique id for inter-element referencing | |
| extension |
0..0 | |||
| url |
1..1 | uri | "statement" | |
| value[x] |
0..1 | string | Value of extension | |
| extension:item |
0..* | Extension | Outline list of medical illness, associated treatments, as well as other non-medical items that are excluded from the health insurance product. e.g. cataract surgery, skin tumour, baby food etc. | |
| id |
0..1 | string | Unique id for inter-element referencing | |
| extension |
0..0 | |||
| url |
1..1 | uri | "item" | |
| value[x] |
0..1 | CodeableConcept | Value of extension | |
| url |
1..1 | uri | "https://nrces.in/ndhm/fhir/r4/StructureDefinition/Claim-Exclusion" | |
| Documentation for this format | ||||
This structure is derived from Extension
Other representations of profile: CSV, Excel, Schematron
| Path | Conformance | ValueSet | URI |
| Extension.extension:category.value[x] | example | ClaimExclusion(a valid code from Claim Exclusion)https://nrces.in/ndhm/fhir/r4/ValueSet/ndhm-claim-exclusionFrom this IG |
| Id | Grade | Path(s) | Details | Requirements |
| 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() |