Besa Fhir Help File

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Identifiers

Class TClaim

Description
Hierarchy
Fields
Methods
Properties

Unit

bsFhir_r5

Declaration

type TClaim = class(TDomainResource)

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. If the element is present, it must have either a @value, an @id, or extensions

Hierarchy

Overview

Methods

Public constructor Create; override;

Properties

Public property identifier : TIdentifierArray read GetidentifierArray;
Public property traceNumber : TIdentifierArray read GettraceNumberArray;
Public property status : string read Getstatus write Setstatus;
Public property statusElement : TFinancialResourceStatusCodes read GetstatusElement write SetstatusElement;
Public property type_ : TCodeableConcept read Gettype_ write Settype_;
Public property subType : TCodeableConcept read GetsubType write SetsubType;
Public property use : string read Getuse write Setuse;
Public property useElement : TUse read GetuseElement write SetuseElement;
Public property patient : TReference read Getpatient write Setpatient;
Public property billablePeriod : TPeriod read GetbillablePeriod write SetbillablePeriod;
Public property created : string read Getcreated write Setcreated;
Public property createdElement : TdateTime_ read GetcreatedElement write SetcreatedElement;
Public property enterer : TReference read Getenterer write Setenterer;
Public property insurer : TReference read Getinsurer write Setinsurer;
Public property provider : TReference read Getprovider write Setprovider;
Public property priority : TCodeableConcept read Getpriority write Setpriority;
Public property fundsReserve : TCodeableConcept read GetfundsReserve write SetfundsReserve;
Public property related : TClaimRelatedArray read GetrelatedArray;
Public property prescription : TReference read Getprescription write Setprescription;
Public property originalPrescription : TReference read GetoriginalPrescription write SetoriginalPrescription;
Public property payee : TClaimPayee read Getpayee write Setpayee;
Public property referral : TReference read Getreferral write Setreferral;
Public property encounter : TReferenceArray read GetencounterArray;
Public property facility : TReference read Getfacility write Setfacility;
Public property diagnosisRelatedGroup : TCodeableConcept read GetdiagnosisRelatedGroup write SetdiagnosisRelatedGroup;
Public property event : TClaimEventArray read GeteventArray;
Public property careTeam : TClaimCareTeamArray read GetcareTeamArray;
Public property supportingInfo : TClaimSupportingInfoArray read GetsupportingInfoArray;
Public property diagnosis : TClaimDiagnosisArray read GetdiagnosisArray;
Public property procedure_ : TClaimProcedureArray read Getprocedure_Array;
Public property insurance : TClaimInsuranceArray read GetinsuranceArray;
Public property accident : TClaimAccident read Getaccident write Setaccident;
Public property patientPaid : TMoney read GetpatientPaid write SetpatientPaid;
Public property item : TClaimItemArray read GetitemArray;
Public property total : TMoney read Gettotal write Settotal;

Description

Methods

Public constructor Create; override;
 

Properties

Public property identifier : TIdentifierArray read GetidentifierArray;

A unique identifier assigned to this claim.

Public property traceNumber : TIdentifierArray read GettraceNumberArray;

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

Public property status : string read Getstatus write Setstatus;

The status of the resource instance.

Public property statusElement : TFinancialResourceStatusCodes read GetstatusElement write SetstatusElement;
 
Public property type_ : TCodeableConcept read Gettype_ write Settype_;

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

Public property subType : TCodeableConcept read GetsubType write SetsubType;

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

Public property use : string read Getuse write Setuse;

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.

Public property useElement : TUse read GetuseElement write SetuseElement;
 
Public property patient : TReference read Getpatient write Setpatient;

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.

Public property billablePeriod : TPeriod read GetbillablePeriod write SetbillablePeriod;

The period for which charges are being submitted.

Public property created : string read Getcreated write Setcreated;

The date this resource was created.

Public property createdElement : TdateTime_ read GetcreatedElement write SetcreatedElement;
 
Public property enterer : TReference read Getenterer write Setenterer;

Individual who created the claim, predetermination or preauthorization.

Public property insurer : TReference read Getinsurer write Setinsurer;

The Insurer who is target of the request.

Public property provider : TReference read Getprovider write Setprovider;

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

Public property priority : TCodeableConcept read Getpriority write Setpriority;

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

Public property fundsReserve : TCodeableConcept read GetfundsReserve write SetfundsReserve;

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

Public property related : TClaimRelatedArray read GetrelatedArray;

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

Public property prescription : TReference read Getprescription write Setprescription;

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.

Public property originalPrescription : TReference read GetoriginalPrescription write SetoriginalPrescription;

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

Public property payee : TClaimPayee read Getpayee write Setpayee;

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

Public property referral : TReference read Getreferral write Setreferral;

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.

Public property encounter : TReferenceArray read GetencounterArray;

Healthcare encounters related to this claim.

Public property facility : TReference read Getfacility write Setfacility;

Facility where the services were provided.

Public property diagnosisRelatedGroup : TCodeableConcept read GetdiagnosisRelatedGroup write SetdiagnosisRelatedGroup;

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.

Public property event : TClaimEventArray read GeteventArray;

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

Public property careTeam : TClaimCareTeamArray read GetcareTeamArray;

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

Public property supportingInfo : TClaimSupportingInfoArray read GetsupportingInfoArray;

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

Public property diagnosis : TClaimDiagnosisArray read GetdiagnosisArray;

Information about diagnoses relevant to the claim items.

Public property procedure_ : TClaimProcedureArray read Getprocedure_Array;

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

Public property insurance : TClaimInsuranceArray read GetinsuranceArray;

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

Public property accident : TClaimAccident read Getaccident write Setaccident;

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

Public property patientPaid : TMoney read GetpatientPaid write SetpatientPaid;

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.

Public property item : TClaimItemArray read GetitemArray;

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.

Public property total : TMoney read Gettotal write Settotal;

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

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