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13.7.6 16.7.9 Resource ClaimResponse - Mappings

Maturity Level : N/A

Responsible Owner: Financial Management Work Group

Ballot Standards Status : Informative

Security Category : Patient

Compartments : Group , Patient , Practitioner

Mappings for the claimresponse resource. ClaimResponse resource (see Mappings to Other Standards for further information & status).

13.7.6.1 16.7.9.1 Mappings for RIM FiveWs Pattern Mapping (http://hl7.org/v3) ClaimResponse     identifier     status     patient     created     insurer     requestProvider     requestOrganization     request     outcome     disposition     payeeType     item         sequenceLinkId         noteNumber         adjudication             category             reason             amount             value         detail             sequenceLinkId             noteNumber             adjudication             subDetail                 sequenceLinkId                 noteNumber                 adjudication     addItem         sequenceLinkId         revenue         category         service         modifier 24.C, 24.D mods         fee         noteNumber         adjudication         detail             revenue             category             service             modifier 24.C, 24.D mods             fee             noteNumber             adjudication     error         sequenceLinkId         detailSequenceLinkId         subdetailSequenceLinkId         code     totalCost     unallocDeductable     totalBenefit     payment         type         adjustment         adjustmentReason         date         amount         identifier     reserved     form     processNote         number         type         text         language     communicationRequest     insurance Coverage         sequence         focal         coverage         businessArrangement         preAuthRef         claimResponse ( http://hl7.org/fhir/fivews )

    identifier     status     patient     created     insurer     requestProvider B01     requestOrganization     request A02|G01     outcome     disposition     payeeType     item         sequenceLinkId F07         noteNumber         adjudication             category             reason             amount             value         detail             sequenceLinkId F07             noteNumber             adjudication             subDetail                 sequenceLinkId F07                 noteNumber                 adjudication     addItem         sequenceLinkId         revenue         category         service         modifier         fee         noteNumber         adjudication         detail             revenue             category

ClaimResponse	service             modifier             fee             noteNumber             adjudication     error         sequenceLinkId         detailSequenceLinkId         subdetailSequenceLinkId         code     totalCost     unallocDeductable     totalBenefit financial.billing
payment     identifier	type FiveWs.identifier
adjustment     status	adjustmentReason FiveWs.status
date     type	amount FiveWs.class
identifier     subType	reserved FiveWs.class
form     use	G42 FiveWs.class
processNote     subject	number         type FiveWs.subject
text     created	G32 FiveWs.recorded
language     requestor	communicationRequest FiveWs.source
insurance     request	sequence         focal FiveWs.why[x]
coverage         provider	businessArrangement FiveWs.source
preAuthRef         serviced[x]	F03 FiveWs.done[x]
claimResponse         location[x]	EOB FiveWs.where[x]

13.7.6.3 16.7.9.2 Mappings for Workflow Mapping (http://hl7.org/fhir/workflow) Pattern ( http://hl7.org/fhir/workflow )

Event.performer.onBehalfOf     requestOrganization             subDetail

ClaimResponse	Event
identifier	Event.identifier
status	Event.status
patient     created	Event.occurrence Event.occurrence[x]
insurer	requestProvider Event.performer
request	Event.basedOn
outcome     disposition	Event.note
payeeType     item         sequenceLinkId         noteNumber         adjudication             category             reason             amount             value         detail             sequenceLinkId             noteNumber     supportingInfo	adjudication Request.supportingInfo

                sequenceLinkId

16.7.9.3 RIM Mapping ( http://hl7.org/v3 )                 noteNumber

        fee         noteNumber         adjudication         detail             revenue             category             service             modifier             fee         sequence         claimResponse

addItem         sequenceLinkId ClaimResponse         revenue	category         service
modifier	noteNumber             adjudication 24.C, 24.D mods
error         programCode	sequenceLinkId 24.H
detailSequenceLinkId         serviced[x]	subdetailSequenceLinkId 24.A
code         location[x]	totalCost 24.B
unallocDeductable         quantity	totalBenefit 24.G
payment         net	type 24.F
adjustment             modifier	adjustmentReason 24.C, 24.D mods
date             quantity	amount 24.G
identifier             net	reserved 24.F
form                 modifier	processNote 24.C, 24.D mods
number                 quantity	type         text 24.G
language                 net	communicationRequest 24.F
insurance	focal         coverage         businessArrangement         preAuthRef Coverage