Claim resource (FHIR R4)

Claim is the FHIR R4 resource for 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.

Example

{
  "resourceType": "Claim",
  "id": "claim-2555bd4c150621d150d8f1bcd8a3b705",
  "status": "active",
  "type": {
    "coding": [
      {
        "system": "http://terminology.hl7.org/CodeSystem/claim-type",
        "code": "professional",
        "display": "Professional"
      }
    ]
  },
  "use": "claim",
  "patient": {
    "reference": "Patient/patient-L46A6EIB9J"
  },
  "created": "2026-07-01",
  "provider": {
    "display": "General Hospital"
  },
  "priority": {
    "coding": [
      {
        "system": "http://terminology.hl7.org/CodeSystem/processpriority",
        "code": "normal"
      }
    ]
  },
  "diagnosis": [
    {
      "sequence": 1,
      "diagnosisCodeableConcept": {
        "coding": [
          {
            "system": "http://hl7.org/fhir/sid/icd-10-cm",
            "code": "E11.9",
            "display": "Type 2 diabetes mellitus without complications"
          }
        ]
      }
    }
  ],
  "procedure": [
    {
      "sequence": 1,
      "procedureCodeableConcept": {
        "coding": [
          {
            "system": "http://www.ama-assn.org/go/cpt",
            "code": "omitted",
            "display": "CPT code omitted from this published example"
          }
        ]
      }
    }
  ],
  "item": [
    {
      "sequence": 1,
  ...

Generated by the Pidgeon engine: pidgeon generate Claim --seed 20260722. Codes from licensed terminologies (LOINC, SNOMED CT, CPT, RxNorm) are omitted from published examples. Truncated for display; the command reproduces the full resource.

Validation context

• strict pidgeon validate grades a Claim instance against the base R4 structure definition: missing required elements raise REQUIRED_FIELD_MISSING and cardinality violations raise CARDINALITY_MIN or CARDINALITY_MAX.(REQUIRED_FIELD_MISSING)
• strict Profile validation grades the same instance against an installed IG profile: profile cardinality findings carry FHIR-PROFILE-CARDINALITY and terminology binding findings carry FHIR-PROFILE-BINDING.(FHIR-PROFILE-CARDINALITY)