This page is part of the FHIR Implementation Guide for ABDM (v6.5.0: Release) based on FHIR (HL7® FHIR® Standard) R4. This is the current published version. For a full list of available versions, see the Directory of published versions

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Resource Profile: Claim - Mappings

Draft as of 2025-03-18

Mappings for the Claim resource profile.

Mappings for Workflow Pattern (http://hl7.org/fhir/workflow)

Claim
Claim	Request
identifier	Request.identifier
status	Request.status
patient	Request.subject
created	Request.authoredOn
insurer	Request.performer
provider	Request.requester
priority	Request.priority
related
claim	Request.replaces
supportingInfo	Request.supportingInfo
diagnosis	Request.reasonReference
insurance
identifier	Request.identifier
item
encounter	Request.context

Mappings for FiveWs Pattern Mapping (http://hl7.org/fhir/fivews)

Claim
Claim
identifier	FiveWs.identifier
status	FiveWs.status
type	FiveWs.class
subType	FiveWs.class
use	FiveWs.class
patient	FiveWs.subject[x], FiveWs.subject
billablePeriod	FiveWs.done[x]
created	FiveWs.recorded
enterer	FiveWs.author
provider	FiveWs.source
referral	FiveWs.cause
facility	FiveWs.where[x]
careTeam
provider	FiveWs.actor
insurance
identifier	FiveWs.identifier
item
serviced[x]	FiveWs.done[x]
location[x]	FiveWs.where[x]

Mappings for RIM Mapping (http://hl7.org/v3)

Claim
Claim	Entity. Role, or Act
text	Act.text?
contained	N/A
extension	N/A
modifierExtension	N/A
related
id	n/a
extension	n/a
modifierExtension	N/A
relationship
id	n/a
extension	n/a
coding	union(., ./translation)
id	n/a
extension	n/a
system	./codeSystem
version	./codeSystemVersion
code	./code
display	CV.displayName
userSelected	CD.codingRationale
text	./originalText[mediaType/code="text/plain"]/data
payee
id	n/a
extension	n/a
modifierExtension	N/A
careTeam
id	n/a
extension	n/a
modifierExtension	N/A
role
id	n/a
extension	n/a
coding	union(., ./translation)
id	n/a
extension	n/a
system	./codeSystem
version	./codeSystemVersion
code	./code
display	CV.displayName
userSelected	CD.codingRationale
text	./originalText[mediaType/code="text/plain"]/data
qualification
id	n/a
extension	n/a
coding	union(., ./translation)
id	n/a
extension	n/a
system	./codeSystem
version	./codeSystemVersion
code	./code
display	CV.displayName
userSelected	CD.codingRationale
text	./originalText[mediaType/code="text/plain"]/data
supportingInfo
id	n/a
extension	n/a
modifierExtension	N/A
category
id	n/a
extension	n/a
coding	union(., ./translation)
id	n/a
extension	n/a
system	./codeSystem
version	./codeSystemVersion
code	./code
display	CV.displayName
userSelected	CD.codingRationale
text	./originalText[mediaType/code="text/plain"]/data
code
id	n/a
extension	n/a
coding	union(., ./translation)
id	n/a
extension	n/a
system	./codeSystem
version	./codeSystemVersion
code	./code
display	CV.displayName
userSelected	CD.codingRationale
text	./originalText[mediaType/code="text/plain"]/data
diagnosis
id	n/a
extension	n/a
modifierExtension	N/A
type
id	n/a
extension	n/a
coding	union(., ./translation)
id	n/a
extension	n/a
system	./codeSystem
version	./codeSystemVersion
code	./code
display	CV.displayName
userSelected	CD.codingRationale
text	./originalText[mediaType/code="text/plain"]/data
procedure
id	n/a
extension	n/a
modifierExtension	N/A
insurance	Coverage
id	n/a
extension	n/a
modifierExtension	N/A
accident
id	n/a
extension	n/a
modifierExtension	N/A
item
id	n/a
extension	n/a
modifierExtension	N/A
category
id	n/a
extension	n/a
coding	union(., ./translation)
id	n/a
extension	n/a
system	./codeSystem
version	./codeSystemVersion
code	./code
display	CV.displayName
userSelected	CD.codingRationale
text	./originalText[mediaType/code="text/plain"]/data
productOrService
id	n/a
extension	n/a
coding	union(., ./translation)
id	n/a
extension	n/a
system	./codeSystem
version	./codeSystemVersion
code	./code
display	CV.displayName
userSelected	CD.codingRationale
text	./originalText[mediaType/code="text/plain"]/data
programCode
id	n/a
extension	n/a
coding	union(., ./translation)
id	n/a
extension	n/a
system	./codeSystem
version	./codeSystemVersion
code	./code
display	CV.displayName
userSelected	CD.codingRationale
text	./originalText[mediaType/code="text/plain"]/data
detail
id	n/a
extension	n/a
modifierExtension	N/A
category
id	n/a
extension	n/a
coding	union(., ./translation)
id	n/a
extension	n/a
system	./codeSystem
version	./codeSystemVersion
code	./code
display	CV.displayName
userSelected	CD.codingRationale
text	./originalText[mediaType/code="text/plain"]/data
productOrService
id	n/a
extension	n/a
coding	union(., ./translation)
id	n/a
extension	n/a
system	./codeSystem
version	./codeSystemVersion
code	./code
display	CV.displayName
userSelected	CD.codingRationale
text	./originalText[mediaType/code="text/plain"]/data
programCode
id	n/a
extension	n/a
coding	union(., ./translation)
id	n/a
extension	n/a
system	./codeSystem
version	./codeSystemVersion
code	./code
display	CV.displayName
userSelected	CD.codingRationale
text	./originalText[mediaType/code="text/plain"]/data
subDetail
id	n/a
extension	n/a
modifierExtension	N/A
category
id	n/a
extension	n/a
coding	union(., ./translation)
id	n/a
extension	n/a
system	./codeSystem
version	./codeSystemVersion
code	./code
display	CV.displayName
userSelected	CD.codingRationale
text	./originalText[mediaType/code="text/plain"]/data
productOrService
id	n/a
extension	n/a
coding	union(., ./translation)
id	n/a
extension	n/a
system	./codeSystem
version	./codeSystemVersion
code	./code
display	CV.displayName
userSelected	CD.codingRationale
text	./originalText[mediaType/code="text/plain"]/data
programCode
id	n/a
extension	n/a
coding	union(., ./translation)
id	n/a
extension	n/a
system	./codeSystem
version	./codeSystemVersion
code	./code
display	CV.displayName
userSelected	CD.codingRationale
text	./originalText[mediaType/code="text/plain"]/data