Structure Definition: Supporting info

Base Definition: http://hl7.org/fhir/StructureDefinition/Base

Status: draft

Kind: logical

Type: SupportingInfoComponent

Elements (Differential)

Path	Cardinality	Type	Short
`SupportingInfoComponent`	0..*		SupportingInfoComponent
`SupportingInfoComponent.ROW_NUM`	1..1	string	Supporting Info Sequence Number
`SupportingInfoComponent.CLM_DSCHRG_DT`	0..1	date	Beneficiary Discharge Date
`SupportingInfoComponent.CLM_SUBMSN_DT`	0..1	date	Claim Submission Date
`SupportingInfoComponent.CLM_MDCR_EXHSTD_DT`	0..1	date	Medicare Benefits Exhausted Date
`SupportingInfoComponent.CLM_ADMSN_SRC_CD`	0..1	string	Source Admission Code
`SupportingInfoComponent.DGNS_DRG_CD`	0..1	string	Related Diagnosis Group Code
`SupportingInfoComponent.BENE_PTNT_STUS_CD`	0..1	string	Patient Discharge Status Code
`SupportingInfoComponent.CLM_ADMSN_TYPE_CD`	0..1	string	Claim Admission Type Code
`SupportingInfoComponent.CLM_BLOOD_PT_FRNSH_QTY`	0..1	string	Blood Pints Furnished Quantity
`SupportingInfoComponent.CLM_MDCR_INSTNL_MCO_PD_SW`	0..1	string	MCO Paid Switch
`SupportingInfoComponent.CLM_MDCR_NCH_PTNT_STUS_IND_CD`	0..1	string	Patient Status Code
`SupportingInfoComponent.TYPE_OF_BILL_CD`	0..1	string	Type of Bill Code
`SupportingInfoComponent.CLM_NCH_WKLY_PROC_DT`	0..1	date	Weekly Process Date
`SupportingInfoComponent.CLM_ACTV_CARE_FROM_DT`	0..1	date	Claim Active Care From Date
`SupportingInfoComponent.CLM_ACTV_CARE_THRU_DT`	0..1	date	Covered Care Through Date
`SupportingInfoComponent.CLM_NCVRD_FROM_DT`	0..1	date	Noncovered Stay From Date
`SupportingInfoComponent.CLM_NCVRD_THRU_DT`	0..1	date	Noncovered Stay Through Date
`SupportingInfoComponent.CLM_PPS_IND_CD`	0..1	string	Claim PPS Indicator Code NCH
`SupportingInfoComponent.CLM_PPS_IND`	0..1	string	Claim PPS Indicator Code FISS
`SupportingInfoComponent.CLM_NCH_PRMRY_PYR_CD`	0..1	string	The code outlining the primary payer.
`SupportingInfoComponent.CLM_QLFY_STAY_FROM_DT`	0..1	date	Qualified Stay From Date
`SupportingInfoComponent.CLM_QLFY_STAY_THRU_DT`	0..1	date	Qualified Stay Through Date
`SupportingInfoComponent.CLM_HHA_LUP_IND_CD`	0..1	date	Claim LUPA Indicator Code
`SupportingInfoComponent.CLM_HHA_RFRL_CD`	0..1	date	Claim Referral Code
`SupportingInfoComponent.CLM_PHRMCY_SRVC_TYPE_CD`	0..1	string	Pharmacy Service Type Code
`SupportingInfoComponent.CLM_LINE_HCT_HGB_RSLT_NUM`	0..1	string	HCT/HGB Test Result Value
`SupportingInfoComponent.CLM_LINE_HCT_HGB_TYPE_CD`	0..1	string	HCT/HGB Test Type
`SupportingInfoComponent.CLM_LINE_RX_ORGN_CD`	0..1	string	Prescription Origin Code
`SupportingInfoComponent.CLM_BRND_GNRC_CD`	0..1	string	Brand Generic Indicator Code
`SupportingInfoComponent.CLM_PTNT_RSDNC_CD`	0..1	string	Patient Residence Code
`SupportingInfoComponent.CLM_LTC_DSPNSNG_MTHD_CD`	0..1	string	Submission Clarification Code
`SupportingInfoComponent.CLM_CMPND_CD`	0..1	string	Compound Code
`SupportingInfoComponent.CLM_LINE_DAYS_SUPLY_QTY`	0..1	string	Days Supply Quantity
`SupportingInfoComponent.CLM_LINE_RX_FILL_NUM`	0..1	string	Fill Number
`SupportingInfoComponent.CLM_DSPNSNG_STUS_CD`	0..1	string	Claim Dispensing Status Code
`SupportingInfoComponent.CLM_DAW_PROD_SLCTN_CD`	0..1	string	Dispense As Written Product Selection Code
`SupportingInfoComponent.CLM_DRUG_CVRG_STUS_CD`	0..1	string	Catastrophic Coverage Indicator Code
`SupportingInfoComponent.CLM_LINE_AUTHRZD_FILL_NUM`	0..1	string	Refills Authorized
`SupportingInfoComponent.CLM_LINE_CARR_CLNCL_LAB_NUM`	0..1	string	CLIA Lab Number
`SupportingInfoComponent.CLM_LINE_RX_NUM`	0..1	string	RX Reference Number
`SupportingInfoComponent.DGNS_DRG_OUTLIER_CD`	0..1	string	Claim Diagnosis Related Group Outlier Stay Code
`SupportingInfoComponent.CLM_NRLN_RIC_CD`	0..1	string	Near Line Record Identification Code
`SupportingInfoComponent.CLM_RIC_CD`	0..1	string	Record Identification Code
`SupportingInfoComponent.CLM_RLT_COND_CD`	0..1	string	Claim Related Condition Code
`SupportingInfoComponent.CLM_QUERY_CD`	1..1	string	Claim Query Code
`SupportingInfoComponent.CLM_IDR_LD_DT`	1..1	date	Claim IDR Load Date
`SupportingInfoComponent.CLM_CNTRCTR_NUM`	0..1	string	FI Number
`SupportingInfoComponent.CLM_ADJSTMT_TYPE_CD`	0..1	string	Claim Adjustment Type Code
`SupportingInfoComponent.CLM_DISP_CD`	0..1	string	Claim Disposition Code
`SupportingInfoComponent.CLM_CMS_PROC_DT`	0..1	date	Claim Process Date
`SupportingInfoComponent.CLM_SBMT_FRMT_CD`	0..1	string	Claim Submission Format Code
`SupportingInfoComponent.CLM_SBMTR_CNTRCT_NUM`	0..1	string	Submitter Contract Number
`SupportingInfoComponent.CLM_SBMTR_CNTRCT_PBP_NUM`	0..1	string	Submitter Contract PBP Number
`SupportingInfoComponent.CLM_CARR_PMT_DNL_CD`	0..1	string	Claim Payment Denial Code
`SupportingInfoComponent.CLM_MDCR_PRFNL_PRVDR_ASGNMT_SW`	0..1	string	Provider Assignment Indicator
`SupportingInfoComponent.CLM_CLNCL_TRIL_NUM`	0..1	string	Clinical Trial Number
`SupportingInfoComponent.CLM_MDCR_NPMT_RSN_CD`	0..1	string	Claim Non Payment Reason Code
`SupportingInfoComponent.CLM_FI_ACTN_CD`	0..1	string	FI Claim Action Code
`SupportingInfoComponent.CLM_OP_SRVC_TYPE_CD`	0..1	string	Claim Outpatient Service Type Code
`SupportingInfoComponent.CLM_AUDT_TRL_STUS_CD`	0..1	string	Claim Status Code
`SupportingInfoComponent.CLM_PD_STUS_CD`	0..1	string	Claim Paid Status Code
`SupportingInfoComponent.CLM_CTSTRPHC_CVRG_IND_CD`	0..1	string	Catastrophic Coverage Code
`SupportingInfoComponent.CLM_BNFT_ENHNCMT_CD`	0..1	string	Claim Benefit Enhancement Code 1
`SupportingInfoComponent.CLM_NGACO_PBPMT_SW`	0..1	string	Claim NGACO PBPMT Switch
`SupportingInfoComponent.CLM_NGACO_PDSCHRG_HCBS_SW`	0..1	string	Claim NGACO Post Discharge HCBS Switch
`SupportingInfoComponent.CLM_NGACO_SNF_WVR_SW`	0..1	string	Claim NGACO SNF Waiver Switch
`SupportingInfoComponent.CLM_NGACO_TLHLTH_SW`	0..1	string	Claim NGACO Telehealth Switch
`SupportingInfoComponent.CLM_NGACO_CPTATN_SW`	0..1	string	Claim NGACO Capitation Switch
`SupportingInfoComponent.CLM_ACO_CARE_MGMT_HCBS_SW`	0..1	string	Claim ACO Care Management HCBS Switch
`SupportingInfoComponent.GEO_BLG_SSA_STATE_CD`	0..1	string	State FIPS Code
`SupportingInfoComponent.GEO_RNDRG_SSA_STATE_CD`	0..1	string	State FIPS Code