FHIR Release 3 (STU) CI-Build

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Claimresponse.shex

Maturity Level : N/A
Responsible Owner: Financial Management Work Group Ballot Standards Status : Informative Compartments : Group , Patient , Practitioner

Raw ShEx

ShEx statement for claimresponse

PREFIX fhir: <http://hl7.org/fhir/> PREFIX fhirvs: <http://hl7.org/fhir/ValueSet/> PREFIX xsd: <http://www.w3.org/2001/XMLSchema#> BASE <http://hl7.org/fhir/shape/> start=@<ClaimResponse> AND {fhir:nodeRole [fhir:treeRoot]} # Remittance resource <ClaimResponse> CLOSED { a [fhir:ClaimResponse]; fhir:nodeRole [fhir:treeRoot]?; fhir:Resource.id @<id>?; # Logical id of this artifact fhir:Resource.meta @<Meta>?; # Metadata about the resource fhir:Resource.implicitRules @<uri>?; # A set of rules under which this # content was created fhir:Resource.language @<code>?; # Language of the resource content fhir:DomainResource.text @<Narrative>?; # Text summary of the resource, for # human interpretation fhir:DomainResource.contained @<Resource>*; # Contained, inline Resources fhir:DomainResource.extension @<Extension>*; # Additional Content defined by # implementations fhir:DomainResource.modifierExtension @<Extension>*; # Extensions that cannot be ignored fhir:ClaimResponse.identifier @<Identifier>*; # Response number fhir:ClaimResponse.status @<code> AND {fhir:value @fhirvs:fm-status}?; # active | cancelled | draft | # entered-in-error fhir:ClaimResponse.patient @<Reference>?; # The subject of the Products and # Services fhir:ClaimResponse.created @<dateTime>?; # Creation date fhir:ClaimResponse.insurer @<Reference>?; # Insurance issuing organization fhir:ClaimResponse.requestProvider @<Reference>?; # Responsible practitioner fhir:ClaimResponse.requestOrganization @<Reference>?; # Responsible organization fhir:ClaimResponse.request @<Reference>?; # Id of resource triggering # adjudication fhir:ClaimResponse.outcome @<CodeableConcept>?; # complete | error | partial fhir:ClaimResponse.disposition @<string>?; # Disposition Message fhir:ClaimResponse.payeeType @<CodeableConcept>?; # Party to be paid any benefits # payable fhir:ClaimResponse.item @<ClaimResponse.item>*; # Line items fhir:ClaimResponse.addItem @<ClaimResponse.addItem>*; # Insurer added line items fhir:ClaimResponse.error @<ClaimResponse.error>*; # Processing errors fhir:ClaimResponse.totalCost @<Money>?; # Total Cost of service from the # Claim fhir:ClaimResponse.unallocDeductable @<Money>?; # Unallocated deductible fhir:ClaimResponse.totalBenefit @<Money>?; # Total benefit payable for the Claim fhir:ClaimResponse.payment @<ClaimResponse.payment>?; # Payment details, if paid fhir:ClaimResponse.reserved @<Coding>?; # Funds reserved status fhir:ClaimResponse.form @<CodeableConcept>?; # Printed Form Identifier fhir:ClaimResponse.processNote @<ClaimResponse.processNote>*; # Processing notes fhir:ClaimResponse.communicationRequest @<Reference>*; # Request for additional information fhir:ClaimResponse.insurance @<ClaimResponse.insurance>*; # Insurance or medical plan fhir:index xsd:integer? # Relative position in a list } # Insurance or medical plan <ClaimResponse.insurance> CLOSED { fhir:Element.id @<string>?; # xml:id (or equivalent in JSON) fhir:Element.extension @<Extension>*; # Additional Content defined by # implementations fhir:BackboneElement.modifierExtension @<Extension>*; # Extensions that cannot be ignored fhir:ClaimResponse.insurance.sequence @<positiveInt>; # Service instance identifier fhir:ClaimResponse.insurance.focal @<boolean>; # Is the focal Coverage fhir:ClaimResponse.insurance.coverage @<Reference>; # Insurance information fhir:ClaimResponse.insurance.businessArrangement @<string>?; # Business agreement fhir:ClaimResponse.insurance.preAuthRef @<string>*; # Pre-Authorization/Determination # Reference fhir:ClaimResponse.insurance.claimResponse @<Reference>?; # Adjudication results fhir:index xsd:integer? # Relative position in a list } # Line items <ClaimResponse.item> CLOSED { fhir:Element.id @<string>?; # xml:id (or equivalent in JSON) fhir:Element.extension @<Extension>*; # Additional Content defined by # implementations fhir:BackboneElement.modifierExtension @<Extension>*; # Extensions that cannot be ignored fhir:ClaimResponse.item.sequenceLinkId @<positiveInt>; # Service instance fhir:ClaimResponse.item.noteNumber @<positiveInt>*; # List of note numbers which apply fhir:ClaimResponse.item.adjudication @<ClaimResponse.item.adjudication>*; # Adjudication details fhir:ClaimResponse.item.detail @<ClaimResponse.item.detail>*; # Detail line items fhir:index xsd:integer? # Relative position in a list } # Insurer added line items <ClaimResponse.addItem> CLOSED { fhir:Element.id @<string>?; # xml:id (or equivalent in JSON) fhir:Element.extension @<Extension>*; # Additional Content defined by # implementations fhir:BackboneElement.modifierExtension @<Extension>*; # Extensions that cannot be ignored fhir:ClaimResponse.addItem.sequenceLinkId @<positiveInt>*; # Service instances fhir:ClaimResponse.addItem.revenue @<CodeableConcept>?; # Revenue or cost center code fhir:ClaimResponse.addItem.category @<CodeableConcept>?; # Type of service or product fhir:ClaimResponse.addItem.service @<CodeableConcept>?; # Group, Service or Product fhir:ClaimResponse.addItem.modifier @<CodeableConcept>*; # Service/Product billing modifiers fhir:ClaimResponse.addItem.fee @<Money>?; # Professional fee or Product charge fhir:ClaimResponse.addItem.noteNumber @<positiveInt>*; # List of note numbers which apply fhir:ClaimResponse.addItem.adjudication @<ClaimResponse.item.adjudication>*; # Added items adjudication fhir:ClaimResponse.addItem.detail @<ClaimResponse.addItem.detail>*; # Added items details fhir:index xsd:integer? # Relative position in a list } # Processing notes <ClaimResponse.processNote> CLOSED { fhir:Element.id @<string>?; # xml:id (or equivalent in JSON) fhir:Element.extension @<Extension>*; # Additional Content defined by # implementations fhir:BackboneElement.modifierExtension @<Extension>*; # Extensions that cannot be ignored fhir:ClaimResponse.processNote.number @<positiveInt>?; # Sequence Number for this note fhir:ClaimResponse.processNote.type @<CodeableConcept>?; # display | print | printoper fhir:ClaimResponse.processNote.text @<string>?; # Note explanatory text fhir:ClaimResponse.processNote.language @<CodeableConcept>?; # Language if different from the # resource fhir:index xsd:integer? # Relative position in a list } # Payment details, if paid <ClaimResponse.payment> CLOSED { fhir:Element.id @<string>?; # xml:id (or equivalent in JSON) fhir:Element.extension @<Extension>*; # Additional Content defined by # implementations fhir:BackboneElement.modifierExtension @<Extension>*; # Extensions that cannot be ignored fhir:ClaimResponse.payment.type @<CodeableConcept>?; # Partial or Complete fhir:ClaimResponse.payment.adjustment @<Money>?; # Payment adjustment for non-Claim # issues fhir:ClaimResponse.payment.adjustmentReason @<CodeableConcept>?; # Explanation for the non-claim # adjustment fhir:ClaimResponse.payment.date @<date>?; # Expected data of Payment fhir:ClaimResponse.payment.amount @<Money>?; # Payable amount after adjustment fhir:ClaimResponse.payment.identifier @<Identifier>?; # Identifier of the payment # instrument fhir:index xsd:integer? # Relative position in a list } # Processing errors <ClaimResponse.error> CLOSED { fhir:Element.id @<string>?; # xml:id (or equivalent in JSON) fhir:Element.extension @<Extension>*; # Additional Content defined by # implementations fhir:BackboneElement.modifierExtension @<Extension>*; # Extensions that cannot be ignored fhir:ClaimResponse.error.sequenceLinkId @<positiveInt>?; # Item sequence number fhir:ClaimResponse.error.detailSequenceLinkId @<positiveInt>?; # Detail sequence number fhir:ClaimResponse.error.subdetailSequenceLinkId @<positiveInt>?; # Subdetail sequence number fhir:ClaimResponse.error.code @<CodeableConcept>; # Error code detailing processing # issues fhir:index xsd:integer? # Relative position in a list } # Detail line items <ClaimResponse.item.detail> CLOSED { fhir:Element.id @<string>?; # xml:id (or equivalent in JSON) fhir:Element.extension @<Extension>*; # Additional Content defined by # implementations fhir:BackboneElement.modifierExtension @<Extension>*; # Extensions that cannot be ignored fhir:ClaimResponse.item.detail.sequenceLinkId @<positiveInt>; # Service instance fhir:ClaimResponse.item.detail.noteNumber @<positiveInt>*; # List of note numbers which apply fhir:ClaimResponse.item.detail.adjudication @<ClaimResponse.item.adjudication>*; # Detail level adjudication details fhir:ClaimResponse.item.detail.subDetail @<ClaimResponse.item.detail.subDetail>*; # Subdetail line items fhir:index xsd:integer? # Relative position in a list } # Adjudication details <ClaimResponse.item.adjudication> CLOSED { fhir:Element.id @<string>?; # xml:id (or equivalent in JSON) fhir:Element.extension @<Extension>*; # Additional Content defined by # implementations fhir:BackboneElement.modifierExtension @<Extension>*; # Extensions that cannot be ignored fhir:ClaimResponse.item.adjudication.category @<CodeableConcept>; # Adjudication category such as # co-pay, eligible, benefit, etc. fhir:ClaimResponse.item.adjudication.reason @<CodeableConcept>?; # Explanation of Adjudication outcome fhir:ClaimResponse.item.adjudication.amount @<Money>?; # Monetary amount fhir:ClaimResponse.item.adjudication.value @<decimal>?; # Non-monetary value fhir:index xsd:integer? # Relative position in a list } # Added items details <ClaimResponse.addItem.detail> CLOSED { fhir:Element.id @<string>?; # xml:id (or equivalent in JSON) fhir:Element.extension @<Extension>*; # Additional Content defined by # implementations fhir:BackboneElement.modifierExtension @<Extension>*; # Extensions that cannot be ignored fhir:ClaimResponse.addItem.detail.revenue @<CodeableConcept>?; # Revenue or cost center code fhir:ClaimResponse.addItem.detail.category @<CodeableConcept>?; # Type of service or product fhir:ClaimResponse.addItem.detail.service @<CodeableConcept>?; # Service or Product fhir:ClaimResponse.addItem.detail.modifier @<CodeableConcept>*; # Service/Product billing modifiers fhir:ClaimResponse.addItem.detail.fee @<Money>?; # Professional fee or Product charge fhir:ClaimResponse.addItem.detail.noteNumber @<positiveInt>*; # List of note numbers which apply fhir:ClaimResponse.addItem.detail.adjudication @<ClaimResponse.item.adjudication>*; # Added items detail adjudication fhir:index xsd:integer? # Relative position in a list } # Subdetail line items <ClaimResponse.item.detail.subDetail> CLOSED { fhir:Element.id @<string>?; # xml:id (or equivalent in JSON) fhir:Element.extension @<Extension>*; # Additional Content defined by # implementations fhir:BackboneElement.modifierExtension @<Extension>*; # Extensions that cannot be ignored fhir:ClaimResponse.item.detail.subDetail.sequenceLinkId @<positiveInt>; # Service instance fhir:ClaimResponse.item.detail.subDetail.noteNumber @<positiveInt>*; # List of note numbers which apply fhir:ClaimResponse.item.detail.subDetail.adjudication @<ClaimResponse.item.adjudication>*; # Subdetail level adjudication # details fhir:index xsd:integer? # Relative position in a list } #---------------------- Data Types ------------------- # Primitive Type dateTime <dateTime> CLOSED { fhir:Element.id @<string>?; # xml:id (or equivalent in JSON) fhir:Element.extension @<Extension>*; # Additional Content defined by # implementations fhir:value xsd:gYear OR xsd:gYearMonth OR xsd:date OR xsd:dateTime?; # Primitive value for dateTime fhir:index xsd:integer? # Relative position in a list } # Primitive Type date <date> CLOSED { fhir:Element.id @<string>?; # xml:id (or equivalent in JSON) fhir:Element.extension @<Extension>*; # Additional Content defined by # implementations fhir:value xsd:gYear OR xsd:gYearMonth OR xsd:date?; # Primitive value for date fhir:index xsd:integer? # Relative position in a list } # Metadata about a resource <Meta> CLOSED { fhir:Element.id @<string>?; # xml:id (or equivalent in JSON) fhir:Element.extension @<Extension>*; # Additional Content defined by # implementations fhir:Meta.versionId @<id>?; # Version specific identifier fhir:Meta.lastUpdated @<instant>?; # When the resource version last # changed fhir:Meta.profile @<uri>*; # Profiles this resource claims to # conform to fhir:Meta.security @<Coding>*; # Security Labels applied to this # resource fhir:Meta.tag @<Coding>*; # Tags applied to this resource fhir:index xsd:integer? # Relative position in a list } # Primitive Type code <code> CLOSED { fhir:Element.id @<string>?; # xml:id (or equivalent in JSON) fhir:Element.extension @<Extension>*; # Additional Content defined by # implementations fhir:value xsd:string?; # Primitive value for code fhir:index xsd:integer? # Relative position in a list } # Primitive Type string <string> CLOSED { fhir:Element.id @<string>?; # xml:id (or equivalent in JSON) fhir:Element.extension @<Extension>*; # Additional Content defined by # implementations fhir:value xsd:string MAXLENGTH 1048576?; # Primitive value for string fhir:index xsd:integer? # Relative position in a list } # A reference from one resource to another <Reference> CLOSED { fhir:link IRI?; fhir:Element.id @<string>?; # xml:id (or equivalent in JSON) fhir:Element.extension @<Extension>*; # Additional Content defined by # implementations fhir:Reference.reference @<string>?; # Literal reference, Relative, # internal or absolute URL fhir:Reference.identifier @<Identifier>?; # Logical reference, when literal # reference is not known fhir:Reference.display @<string>?; # Text alternative for the resource fhir:index xsd:integer? # Relative position in a list } # Base Resource <Resource> {a .+; fhir:Resource.id @<id>?; # Logical id of this artifact fhir:Resource.meta @<Meta>?; # Metadata about the resource fhir:Resource.implicitRules @<uri>?; # A set of rules under which this # content was created fhir:Resource.language @<code>?; # Language of the resource content fhir:index xsd:integer? } # Primitive Type uri <uri> CLOSED { fhir:Element.id @<string>?; # xml:id (or equivalent in JSON) fhir:Element.extension @<Extension>*; # Additional Content defined by # implementations fhir:value xsd:string?; # Primitive value for uri fhir:index xsd:integer? # Relative position in a list } # Optional Extensions Element <Extension> CLOSED { fhir:Element.id @<string>?; fhir:Element.extension @<Extension>*; fhir:Extension.url @<uri>; ( fhir:Extension.valueBase64Binary @<base64Binary> | fhir:Extension.valueBoolean @<boolean> | fhir:Extension.valueCode @<code> | fhir:Extension.valueDate @<date> | fhir:Extension.valueDateTime @<dateTime> | fhir:Extension.valueDecimal @<decimal> | fhir:Extension.valueId @<id> | fhir:Extension.valueInstant @<instant> | fhir:Extension.valueInteger @<integer> | fhir:Extension.valueMarkdown @<markdown> | fhir:Extension.valueOid @<oid> | fhir:Extension.valuePositiveInt @<positiveInt> | fhir:Extension.valueString @<string> | fhir:Extension.valueTime @<time> | fhir:Extension.valueUnsignedInt @<unsignedInt> | fhir:Extension.valueUri @<uri> | fhir:Extension.valueAddress @<Address> | fhir:Extension.valueAge @<Age> | fhir:Extension.valueAnnotation @<Annotation> | fhir:Extension.valueAttachment @<Attachment> | fhir:Extension.valueCodeableConcept @<CodeableConcept> | fhir:Extension.valueCoding @<Coding> | fhir:Extension.valueContactPoint @<ContactPoint> | fhir:Extension.valueCount @<Count> | fhir:Extension.valueDistance @<Distance> | fhir:Extension.valueDuration @<Duration> | fhir:Extension.valueHumanName @<HumanName> | fhir:Extension.valueIdentifier @<Identifier> | fhir:Extension.valueMoney @<Money> | fhir:Extension.valuePeriod @<Period> | fhir:Extension.valueQuantity @<Quantity> | fhir:Extension.valueRange @<Range> | fhir:Extension.valueRatio @<Ratio> | fhir:Extension.valueReference @<Reference> | fhir:Extension.valueSampledData @<SampledData> | fhir:Extension.valueSignature @<Signature> | fhir:Extension.valueTiming @<Timing> | fhir:Extension.valueMeta @<Meta> )?; fhir:index xsd:integer? # Relative position in a list } # An amount of economic utility in some recognized currency <Money> CLOSED { fhir:Element.id @<string>?; # xml:id (or equivalent in JSON) fhir:Element.extension @<Extension>*; # Additional Content defined by # implementations fhir:Quantity.value @<decimal>?; # Numerical value (with implicit # precision) fhir:Quantity.comparator @<code> AND {fhir:value @fhirvs:quantity-comparator}?; # < | <= | >= | > - how to # understand the value fhir:Quantity.unit @<string>?; # Unit representation fhir:Quantity.system @<uri>?; # System that defines coded unit form fhir:Quantity.code @<code>?; # Coded form of the unit fhir:index xsd:integer? # Relative position in a list } # An identifier intended for computation <Identifier> CLOSED { fhir:Element.id @<string>?; # xml:id (or equivalent in JSON) fhir:Element.extension @<Extension>*; # Additional Content defined by # implementations fhir:Identifier.use @<code> AND {fhir:value @fhirvs:identifier-use}?; # usual | official | temp | # secondary (If known) fhir:Identifier.type @<CodeableConcept>?; # Description of identifier fhir:Identifier.system @<uri>?; # The namespace for the identifier # value fhir:Identifier.value @<string>?; # The value that is unique fhir:Identifier.period @<Period>?; # Time period when id is/was valid # for use fhir:Identifier.assigner @<Reference>?; # Organization that issued id (may # be just text) fhir:index xsd:integer? # Relative position in a list } # Primitive Type boolean <boolean> CLOSED { fhir:Element.id @<string>?; # xml:id (or equivalent in JSON) fhir:Element.extension @<Extension>*; # Additional Content defined by # implementations fhir:value xsd:boolean?; # Primitive value for boolean fhir:index xsd:integer? # Relative position in a list } # A human-readable formatted text, including images <Narrative> CLOSED { fhir:Element.id @<string>?; # xml:id (or equivalent in JSON) fhir:Element.extension @<Extension>*; # Additional Content defined by # implementations fhir:Narrative.status @<code> AND {fhir:value @fhirvs:narrative-status}; # generated | extensions | # additional | empty fhir:Narrative.div xsd:string; # Limited xhtml content fhir:index xsd:integer? # Relative position in a list } # A reference to a code defined by a terminology system <Coding> CLOSED { a NONLITERAL?; fhir:Element.id @<string>?; # xml:id (or equivalent in JSON) fhir:Element.extension @<Extension>*; # Additional Content defined by # implementations fhir:Coding.system @<uri>?; # Identity of the terminology system fhir:Coding.version @<string>?; # Version of the system - if relevant fhir:Coding.code @<code>?; # Symbol in syntax defined by the # system fhir:Coding.display @<string>?; # Representation defined by the # system fhir:Coding.userSelected @<boolean>?; # If this coding was chosen directly # by the user fhir:index xsd:integer? # Relative position in a list } # Primitive Type id <id> CLOSED { fhir:Element.id @<string>?; # xml:id (or equivalent in JSON) fhir:Element.extension @<Extension>*; # Additional Content defined by # implementations fhir:value xsd:string?; # Primitive value for id fhir:index xsd:integer? # Relative position in a list } # Primitive Type positiveInt <positiveInt> CLOSED { fhir:Element.id @<string>?; # xml:id (or equivalent in JSON) fhir:Element.extension @<Extension>*; # Additional Content defined by # implementations fhir:value xsd:positiveInteger?; # Primitive value for positiveInt fhir:index xsd:integer? # Relative position in a list } # Primitive Type decimal <decimal> CLOSED { fhir:Element.id @<string>?; # xml:id (or equivalent in JSON) fhir:Element.extension @<Extension>*; # Additional Content defined by # implementations fhir:value xsd:decimal?; # Primitive value for decimal fhir:index xsd:integer? # Relative position in a list } # Concept - reference to a terminology or just text <CodeableConcept> CLOSED { a NONLITERAL*; fhir:Element.id @<string>?; # xml:id (or equivalent in JSON) fhir:Element.extension @<Extension>*; # Additional Content defined by # implementations fhir:CodeableConcept.coding @<Coding>*; # Code defined by a terminology # system fhir:CodeableConcept.text @<string>?; # Plain text representation of the # concept fhir:index xsd:integer? # Relative position in a list } # An address expressed using postal conventions (as opposed to GPS or other location definition formats) <Address> CLOSED { fhir:Element.id @<string>?; # xml:id (or equivalent in JSON) fhir:Element.extension @<Extension>*; # Additional Content defined by # implementations fhir:Address.use @<code> AND {fhir:value @fhirvs:address-use}?; # home | work | temp | old - purpose # of this address fhir:Address.type @<code> AND {fhir:value @fhirvs:address-type}?; # postal | physical | both fhir:Address.text @<string>?; # Text representation of the address fhir:Address.line @<string>*; # Street name, number, direction & # P.O. Box etc. fhir:Address.city @<string>?; # Name of city, town etc. fhir:Address.district @<string>?; # District name (aka county) fhir:Address.state @<string>?; # Sub-unit of country (abbreviations # ok) fhir:Address.postalCode @<string>?; # Postal code for area fhir:Address.country @<string>?; # Country (e.g. can be ISO 3166 2 or # 3 letter code) fhir:Address.period @<Period>?; # Time period when address was/is in # use fhir:index xsd:integer? # Relative position in a list } # Content in a format defined elsewhere <Attachment> CLOSED { fhir:Element.id @<string>?; # xml:id (or equivalent in JSON) fhir:Element.extension @<Extension>*; # Additional Content defined by # implementations fhir:Attachment.contentType @<code>?; # Mime type of the content, with # charset etc. fhir:Attachment.language @<code>?; # Human language of the content # (BCP-47) fhir:Attachment.data @<base64Binary>?; # Data inline, base64ed fhir:Attachment.url @<uri>?; # Uri where the data can be found fhir:Attachment.size @<unsignedInt>?; # Number of bytes of content (if url # provided) fhir:Attachment.hash @<base64Binary>?; # Hash of the data (sha-1, base64ed) fhir:Attachment.title @<string>?; # Label to display in place of the # data fhir:Attachment.creation @<dateTime>?; # Date attachment was first created fhir:index xsd:integer? # Relative position in a list } # Primitive Type integer <integer> CLOSED { fhir:Element.id @<string>?; # xml:id (or equivalent in JSON) fhir:Element.extension @<Extension>*; # Additional Content defined by # implementations fhir:value xsd:integer MININCLUSIVE "-2147483648"^^xsd:integer MAXINCLUSIVE "2147483647"^^xsd:integer?; # Primitive value for integer fhir:index xsd:integer? # Relative position in a list } # Primitive Type oid <oid> CLOSED { fhir:Element.id @<string>?; # xml:id (or equivalent in JSON) fhir:Element.extension @<Extension>*; # Additional Content defined by # implementations fhir:value xsd:string?; # Primitive value for oid fhir:index xsd:integer? # Relative position in a list } # A measured or measurable amount <Count> CLOSED { fhir:Element.id @<string>?; # xml:id (or equivalent in JSON) fhir:Element.extension @<Extension>*; # Additional Content defined by # implementations fhir:Quantity.value @<decimal>?; # Numerical value (with implicit # precision) fhir:Quantity.comparator @<code> AND {fhir:value @fhirvs:quantity-comparator}?; # < | <= | >= | > - how to # understand the value fhir:Quantity.unit @<string>?; # Unit representation fhir:Quantity.system @<uri>?; # System that defines coded unit form fhir:Quantity.code @<code>?; # Coded form of the unit fhir:index xsd:integer? # Relative position in a list } # Primitive Type instant <instant> CLOSED { fhir:Element.id @<string>?; # xml:id (or equivalent in JSON) fhir:Element.extension @<Extension>*; # Additional Content defined by # implementations fhir:value xsd:dateTime?; # Primitive value for instant fhir:index xsd:integer? # Relative position in a list } # Details of a Technology mediated contact point (phone, fax, email, etc.) <ContactPoint> CLOSED { fhir:Element.id @<string>?; # xml:id (or equivalent in JSON) fhir:Element.extension @<Extension>*; # Additional Content defined by # implementations fhir:ContactPoint.system @<code> AND {fhir:value @fhirvs:contact-point-system}?; # phone | fax | email | pager | url # | sms | other fhir:ContactPoint.value @<string>?; # The actual contact point details fhir:ContactPoint.use @<code> AND {fhir:value @fhirvs:contact-point-use}?; # home | work | temp | old | mobile # - purpose of this contact point fhir:ContactPoint.rank @<positiveInt>?; # Specify preferred order of use (1 # = highest) fhir:ContactPoint.period @<Period>?; # Time period when the contact point # was/is in use fhir:index xsd:integer? # Relative position in a list } # Name of a human - parts and usage <HumanName> CLOSED { fhir:Element.id @<string>?; # xml:id (or equivalent in JSON) fhir:Element.extension @<Extension>*; # Additional Content defined by # implementations fhir:HumanName.use @<code> AND {fhir:value @fhirvs:name-use}?; # usual | official | temp | nickname # | anonymous | old | maiden fhir:HumanName.text @<string>?; # Text representation of the full # name fhir:HumanName.family @<string>?; # Family name (often called # 'Surname') fhir:HumanName.given @<string>*; # Given names (not always 'first'). # Includes middle names fhir:HumanName.prefix @<string>*; # Parts that come before the name fhir:HumanName.suffix @<string>*; # Parts that come after the name fhir:HumanName.period @<Period>?; # Time period when name was/is in use fhir:index xsd:integer? # Relative position in a list } # Primitive Type markdown <markdown> CLOSED { fhir:Element.id @<string>?; # xml:id (or equivalent in JSON) fhir:Element.extension @<Extension>*; # Additional Content defined by # implementations fhir:value xsd:string?; # Primitive value for markdown fhir:index xsd:integer? # Relative position in a list } # A series of measurements taken by a device <SampledData> CLOSED { fhir:Element.id @<string>?; # xml:id (or equivalent in JSON) fhir:Element.extension @<Extension>*; # Additional Content defined by # implementations fhir:SampledData.origin @<SimpleQuantity>; # Zero value and units fhir:SampledData.period @<decimal>; # Number of milliseconds between # samples fhir:SampledData.factor @<decimal>?; # Multiply data by this before # adding to origin fhir:SampledData.lowerLimit @<decimal>?; # Lower limit of detection fhir:SampledData.upperLimit @<decimal>?; # Upper limit of detection fhir:SampledData.dimensions @<positiveInt>; # Number of sample points at each # time point fhir:SampledData.data @<string>; # Decimal values with spaces, or "E" # | "U" | "L" fhir:index xsd:integer? # Relative position in a list } # A ratio of two Quantity values - a numerator and a denominator <Ratio> CLOSED { fhir:Element.id @<string>?; # xml:id (or equivalent in JSON) fhir:Element.extension @<Extension>*; # Additional Content defined by # implementations fhir:Ratio.numerator @<Quantity>?; # Numerator value fhir:Ratio.denominator @<Quantity>?; # Denominator value fhir:index xsd:integer? # Relative position in a list } # A duration of time during which an organism (or a process) has existed <Age> CLOSED { fhir:Element.id @<string>?; # xml:id (or equivalent in JSON) fhir:Element.extension @<Extension>*; # Additional Content defined by # implementations fhir:Quantity.value @<decimal>?; # Numerical value (with implicit # precision) fhir:Quantity.comparator @<code> AND {fhir:value @fhirvs:quantity-comparator}?; # < | <= | >= | > - how to # understand the value fhir:Quantity.unit @<string>?; # Unit representation fhir:Quantity.system @<uri>?; # System that defines coded unit form fhir:Quantity.code @<code>?; # Coded form of the unit fhir:index xsd:integer? # Relative position in a list } # A length - a value with a unit that is a physical distance <Distance> CLOSED { fhir:Element.id @<string>?; # xml:id (or equivalent in JSON) fhir:Element.extension @<Extension>*; # Additional Content defined by # implementations fhir:Quantity.value @<decimal>?; # Numerical value (with implicit # precision) fhir:Quantity.comparator @<code> AND {fhir:value @fhirvs:quantity-comparator}?; # < | <= | >= | > - how to # understand the value fhir:Quantity.unit @<string>?; # Unit representation fhir:Quantity.system @<uri>?; # System that defines coded unit form fhir:Quantity.code @<code>?; # Coded form of the unit fhir:index xsd:integer? # Relative position in a list } # Time range defined by start and end date/time <Period> CLOSED { fhir:Element.id @<string>?; # xml:id (or equivalent in JSON) fhir:Element.extension @<Extension>*; # Additional Content defined by # implementations fhir:Period.start @<dateTime>?; # Starting time with inclusive # boundary fhir:Period.end @<dateTime>?; # End time with inclusive boundary, # if not ongoing fhir:index xsd:integer? # Relative position in a list } # A measured or measurable amount <Quantity> CLOSED { fhir:Element.id @<string>?; # xml:id (or equivalent in JSON) fhir:Element.extension @<Extension>*; # Additional Content defined by # implementations fhir:Quantity.value @<decimal>?; # Numerical value (with implicit # precision) fhir:Quantity.comparator @<code> AND {fhir:value @fhirvs:quantity-comparator}?; # < | <= | >= | > - how to # understand the value fhir:Quantity.unit @<string>?; # Unit representation fhir:Quantity.system @<uri>?; # System that defines coded unit form fhir:Quantity.code @<code>?; # Coded form of the unit fhir:index xsd:integer? # Relative position in a list } # A length of time <Duration> CLOSED { fhir:Element.id @<string>?; # xml:id (or equivalent in JSON) fhir:Element.extension @<Extension>*; # Additional Content defined by # implementations fhir:Quantity.value @<decimal>?; # Numerical value (with implicit # precision) fhir:Quantity.comparator @<code> AND {fhir:value @fhirvs:quantity-comparator}?; # < | <= | >= | > - how to # understand the value fhir:Quantity.unit @<string>?; # Unit representation fhir:Quantity.system @<uri>?; # System that defines coded unit form fhir:Quantity.code @<code>?; # Coded form of the unit fhir:index xsd:integer? # Relative position in a list } # Set of values bounded by low and high <Range> CLOSED { fhir:Element.id @<string>?; # xml:id (or equivalent in JSON) fhir:Element.extension @<Extension>*; # Additional Content defined by # implementations fhir:Range.low @<SimpleQuantity>?; # Low limit fhir:Range.high @<SimpleQuantity>?; # High limit fhir:index xsd:integer? # Relative position in a list } # Text node with attribution <Annotation> CLOSED { fhir:Element.id @<string>?; # xml:id (or equivalent in JSON) fhir:Element.extension @<Extension>*; # Additional Content defined by # implementations ( # Individual responsible for the # annotation fhir:Annotation.authorReference @<Reference> | fhir:Annotation.authorReference @<Reference> | fhir:Annotation.authorReference @<Reference> | fhir:Annotation.authorString @<string> )?; fhir:Annotation.time @<dateTime>?; # When the annotation was made fhir:Annotation.text @<string>; # The annotation - text content fhir:index xsd:integer? # Relative position in a list } # Primitive Type base64Binary <base64Binary> CLOSED { fhir:Element.id @<string>?; # xml:id (or equivalent in JSON) fhir:Element.extension @<Extension>*; # Additional Content defined by # implementations fhir:value xsd:base64Binary?; # Primitive value for base64Binary fhir:index xsd:integer? # Relative position in a list } # A digital Signature - XML DigSig, JWT, Graphical image of signature, etc. <Signature> CLOSED { fhir:Element.id @<string>?; # xml:id (or equivalent in JSON) fhir:Element.extension @<Extension>*; # Additional Content defined by # implementations fhir:Signature.type @<Coding>+; # Indication of the reason the # entity signed the object(s) fhir:Signature.when @<instant>; # When the signature was created ( # Who signed fhir:Signature.whoUri @<uri> | fhir:Signature.whoReference @<Reference> | fhir:Signature.whoReference @<Reference> | fhir:Signature.whoReference @<Reference> | fhir:Signature.whoReference @<Reference> | fhir:Signature.whoReference @<Reference> ); ( # The party represented fhir:Signature.onBehalfOfUri @<uri> | fhir:Signature.onBehalfOfReference @<Reference> | fhir:Signature.onBehalfOfReference @<Reference> | fhir:Signature.onBehalfOfReference @<Reference> | fhir:Signature.onBehalfOfReference @<Reference> | fhir:Signature.onBehalfOfReference @<Reference> )?; fhir:Signature.contentType @<code>?; # The technical format of the # signature fhir:Signature.blob @<base64Binary>?; # The actual signature content (XML # DigSig. JWT, picture, etc.) fhir:index xsd:integer? # Relative position in a list } # Primitive Type unsignedInt <unsignedInt> CLOSED { fhir:Element.id @<string>?; # xml:id (or equivalent in JSON) fhir:Element.extension @<Extension>*; # Additional Content defined by # implementations fhir:value xsd:nonNegativeInteger?; # Primitive value for unsignedInt fhir:index xsd:integer? # Relative position in a list } # Primitive Type time <time> CLOSED { fhir:Element.id @<string>?; # xml:id (or equivalent in JSON) fhir:Element.extension @<Extension>*; # Additional Content defined by # implementations fhir:value xsd:time?; # Primitive value for time fhir:index xsd:integer? # Relative position in a list } # A timing schedule that specifies an event that may occur multiple times <Timing> CLOSED { fhir:Element.id @<string>?; # xml:id (or equivalent in JSON) fhir:Element.extension @<Extension>*; # Additional Content defined by # implementations fhir:Timing.event @<dateTime>*; # When the event occurs fhir:Timing.repeat @<Timing.repeat>?; # When the event is to occur fhir:Timing.code @<CodeableConcept>?; # BID | TID | QID | AM | PM | QD | # QOD | Q4H | Q6H + fhir:index xsd:integer? # Relative position in a list } # A fixed quantity (no comparator) <SimpleQuantity> CLOSED { fhir:Element.id @<string>?; # xml:id (or equivalent in JSON) fhir:Element.extension @<Extension>*; # Additional Content defined by # implementations fhir:Quantity.value @<decimal>?; # Numerical value (with implicit # precision) fhir:Quantity.unit @<string>?; # Unit representation fhir:Quantity.system @<uri>?; # System that defines coded unit form fhir:Quantity.code @<code>?; # Coded form of the unit fhir:index xsd:integer? # Relative position in a list } # When the event is to occur <Timing.repeat> CLOSED { fhir:Element.id @<string>?; # xml:id (or equivalent in JSON) fhir:Element.extension @<Extension>*; # Additional Content defined by # implementations ( # Length/Range of lengths, or (Start # and/or end) limits fhir:Timing.repeat.boundsDuration @<Duration> | fhir:Timing.repeat.boundsRange @<Range> | fhir:Timing.repeat.boundsPeriod @<Period> )?; fhir:Timing.repeat.count @<integer>?; # Number of times to repeat fhir:Timing.repeat.countMax @<integer>?; # Maximum number of times to repeat fhir:Timing.repeat.duration @<decimal>?; # How long when it happens fhir:Timing.repeat.durationMax @<decimal>?; # How long when it happens (Max) fhir:Timing.repeat.durationUnit @<code> AND {fhir:value @fhirvs:units-of-time}?; # s | min | h | d | wk | mo | a - # unit of time (UCUM) fhir:Timing.repeat.frequency @<integer>?; # Event occurs frequency times per # period fhir:Timing.repeat.frequencyMax @<integer>?; # Event occurs up to frequencyMax # times per period fhir:Timing.repeat.period @<decimal>?; # Event occurs frequency times per # period fhir:Timing.repeat.periodMax @<decimal>?; # Upper limit of period (3-4 hours) fhir:Timing.repeat.periodUnit @<code> AND {fhir:value @fhirvs:units-of-time}?; # s | min | h | d | wk | mo | a - # unit of time (UCUM) fhir:Timing.repeat.dayOfWeek @<code> AND {fhir:value @fhirvs:days-of-week}*; # mon | tue | wed | thu | fri | sat # | sun fhir:Timing.repeat.timeOfDay @<time>*; # Time of day for action fhir:Timing.repeat.when @<code> AND {fhir:value @fhirvs:event-timing}*; # Regular life events the event is # tied to fhir:Timing.repeat.offset @<unsignedInt>?; # Minutes from event (before or # after) fhir:index xsd:integer? # Relative position in a list } #---------------------- Reference Types ------------------- #---------------------- Value Sets ------------------------ # The status of a resource narrative fhirvs:narrative-status ["generated" "extensions" "additional" "empty"] # The type of an address (physical / postal) fhirvs:address-type ["postal" "physical" "both"] # Use of contact point fhirvs:contact-point-use ["home" "work" "temp" "old" "mobile"] # Real world event relating to the schedule. fhirvs:event-timing ["MORN" "AFT" "EVE" "NIGHT" "PHS" "HS" "WAKE" "C" "CM" "CD" "CV" "AC" "ACM" "ACD" "ACV" "PC" "PCM" "PCD" "PCV"] # The days of the week. fhirvs:days-of-week ["mon" "tue" "wed" "thu" "fri" "sat" "sun"] # Identifies the purpose for this identifier, if known . fhirvs:identifier-use ["usual" "official" "temp" "secondary"] # A unit of time (units from UCUM). fhirvs:units-of-time ["s" "min" "h" "d" "wk" "mo" "a"] # The use of an address fhirvs:address-use ["home" "work" "temp" "old"] # The use of a human name fhirvs:name-use ["usual" "official" "temp" "nickname" "anonymous" "old" "maiden"] # How the Quantity should be understood and represented. fhirvs:quantity-comparator ["<" "<=" ">=" ">"] # Telecommunications form for contact point fhirvs:contact-point-system ["phone" "fax" "email" "pager" "url" "sms" "other"] # This value set includes Status codes. fhirvs:fm-status ["active" "cancelled" "draft" "entered-in-error"]
PREFIX fhir: <http://hl7.org/fhir/> 
PREFIX fhirvs: <http://hl7.org/fhir/ValueSet/>
PREFIX xsd: <http://www.w3.org/2001/XMLSchema#> 
PREFIX rdf: <http://www.w3.org/1999/02/22-rdf-syntax-ns#> 
# ShEx Version 2.2
IMPORT <Id.shex>
IMPORT <Oid.shex>
IMPORT <Uri.shex>
IMPORT <Url.shex>
IMPORT <Age.shex>
IMPORT <Code.shex>
IMPORT <Date.shex>
IMPORT <Time.shex>
IMPORT <Uuid.shex>
IMPORT <Meta.shex>
IMPORT <Group.shex>
IMPORT <Claim.shex>
IMPORT <Money.shex>
IMPORT <Count.shex>
IMPORT <Range.shex>
IMPORT <Ratio.shex>
IMPORT <String.shex>
IMPORT <Period.shex>
IMPORT <Timing.shex>
IMPORT <Coding.shex>
IMPORT <Dosage.shex>
IMPORT <Patient.shex>
IMPORT <Decimal.shex>
IMPORT <Boolean.shex>
IMPORT <Instant.shex>
IMPORT <Integer.shex>
IMPORT <Address.shex>
IMPORT <DateTime.shex>
IMPORT <Quantity.shex>
IMPORT <Markdown.shex>
IMPORT <Coverage.shex>
IMPORT <Distance.shex>
IMPORT <Duration.shex>
IMPORT <Location.shex>
IMPORT <Reference.shex>
IMPORT <Canonical.shex>
IMPORT <Integer64.shex>
IMPORT <HumanName.shex>
IMPORT <Signature.shex>
IMPORT <Encounter.shex>
IMPORT <Identifier.shex>
IMPORT <Attachment.shex>
IMPORT <Annotation.shex>
IMPORT <RatioRange.shex>
IMPORT <Expression.shex>
IMPORT <PositiveInt.shex>
IMPORT <UnsignedInt.shex>
IMPORT <SampledData.shex>
IMPORT <Organization.shex>
IMPORT <Practitioner.shex>
IMPORT <Base64Binary.shex>
IMPORT <ContactPoint.shex>
IMPORT <UsageContext.shex>
IMPORT <Availability.shex>
IMPORT <ContactDetail.shex>
IMPORT <DeviceRequest.shex>
IMPORT <DomainResource.shex>
IMPORT <NutritionOrder.shex>
IMPORT <ServiceRequest.shex>
IMPORT <CodeableConcept.shex>
IMPORT <BackboneElement.shex>
IMPORT <DataRequirement.shex>
IMPORT <RelatedArtifact.shex>
IMPORT <PractitionerRole.shex>
IMPORT <CodeableReference.shex>
IMPORT <TriggerDefinition.shex>
IMPORT <MedicationRequest.shex>
IMPORT <VisionPrescription.shex>
IMPORT <ParameterDefinition.shex>
IMPORT <VirtualServiceDetail.shex>
IMPORT <CommunicationRequest.shex>
IMPORT <ExtendedContactDetail.shex>
start=@<ClaimResponse> AND {fhir:nodeRole [fhir:treeRoot]}
# Response to a claim predetermination or preauthorization
<ClaimResponse> EXTENDS @<DomainResource> CLOSED {   
    a [fhir:ClaimResponse]?;fhir:nodeRole [fhir:treeRoot]?;
    fhir:identifier @<OneOrMore_Identifier>?;  # Business Identifier for a claim 
                                            # response 
    fhir:traceNumber @<OneOrMore_Identifier>?;  # Number for tracking
    fhir:status @<Code> AND
    	{fhir:v @fhirvs:fm-status};  # active | cancelled | draft | 
                                            # entered-in-error 
    fhir:statusReason @<String>?;           # Reason for status change
    fhir:type @<CodeableConcept>;           # More granular claim type
    fhir:subType @<CodeableConcept>?;       # More granular claim type
    fhir:use @<Code> AND
    	{fhir:v @fhirvs:claim-use};  # claim | preauthorization | 
                                            # predetermination 
    fhir:subject @<Reference> AND {fhir:l 
    			@<Group> OR 
    			@<Patient> ? };  # The recipient(s) of the products 
                                            # and services 
    fhir:created @<DateTime>;               # Response creation date
    fhir:insurer @<Reference> AND {fhir:l 
    			@<Organization> ? }?;  # Party responsible for reimbursement
    fhir:requestor @<Reference> AND {fhir:l 
    			@<Organization> OR 
    			@<Practitioner> OR 
    			@<PractitionerRole> ? }?;  # Party responsible for the claim
    fhir:request @<Reference> AND {fhir:l 
    			@<Claim> ? }?;  # Id of resource triggering 
                                            # adjudication 
    fhir:outcome @<Code> AND
    	{fhir:v @fhirvs:claim-outcome};  # queued | complete | error | partial
    fhir:decision @<CodeableConcept>?;      # Result of the adjudication
    fhir:disposition @<String>?;            # Disposition Message
    fhir:preAuthRef @<String>?;             # Preauthorization reference
    fhir:preAuthPeriod @<Period>?;          # Preauthorization reference 
                                            # effective period 
    fhir:event @<OneOrMore_ClaimResponse.event>?;  # Event information
    fhir:payeeType @<CodeableConcept>?;     # Party to be paid any benefits 
                                            # payable 
    fhir:encounter @<OneOrMore_Reference_Encounter>?;  # Encounters associated with the 
                                            # listed treatments 
    fhir:diagnosisRelatedGroup @<CodeableConcept>?;  # Package billing code
    fhir:supportingInfo @<OneOrMore_ClaimResponse.supportingInfo>?;  # Supporting information
    fhir:item @<OneOrMore_ClaimResponse.item>?;  # Adjudication for claim line items
    fhir:addItem @<OneOrMore_ClaimResponse.addItem>?;  # Insurer added line items
    fhir:adjudication @<OneOrMore_ClaimResponse.item.adjudication>?;  # Header-level adjudication
    fhir:total @<OneOrMore_ClaimResponse.total>?;  # Adjudication totals
    fhir:payment @<ClaimResponse.payment>?;  # Payment Details
    fhir:fundsReserve @<CodeableConcept>?;  # Funds reserved status
    fhir:formCode @<CodeableConcept>?;      # Printed form identifier
    fhir:form @<Attachment>?;               # Printed reference or actual form
    fhir:processNote @<OneOrMore_ClaimResponse.processNote>?;  # Note concerning adjudication
    fhir:communicationRequest @<OneOrMore_Reference_CommunicationRequest>?;  # Request for additional information
    fhir:insurance @<OneOrMore_ClaimResponse.insurance>?;  # Patient insurance information
    fhir:error @<OneOrMore_ClaimResponse.error>?;  # Processing errors
}  
# Adjudication for claim line items
<ClaimResponse.item> EXTENDS @<BackboneElement> CLOSED {   
    fhir:itemSequence @<PositiveInt>;       # Claim item instance identifier
    fhir:traceNumber @<OneOrMore_Identifier>?;  # Number for tracking
    fhir:informationSequence @<OneOrMore_PositiveInt>?;  # Applicable exception and 
                                            # supporting information 
    fhir:noteNumber @<OneOrMore_PositiveInt>?;  # Applicable note numbers
    fhir:reviewOutcome @<ClaimResponse.item.reviewOutcome>?;  # Adjudication results
    fhir:adjudication @<OneOrMore_ClaimResponse.item.adjudication>?;  # Adjudication details
    fhir:detail @<OneOrMore_ClaimResponse.item.detail>?;  # Adjudication for claim details
}  
# Insurer added line items
<ClaimResponse.addItem.detail.subDetail> EXTENDS @<BackboneElement> CLOSED {   
    fhir:traceNumber @<OneOrMore_Identifier>?;  # Number for tracking
    fhir:revenue @<CodeableConcept>?;       # Revenue or cost center code
    fhir:productOrService @<CodeableConcept>?;  # Billing, service, product, or drug 
                                            # code 
    fhir:productOrServiceEnd @<CodeableConcept>?;  # End of a range of codes
    fhir:modifier @<OneOrMore_CodeableConcept>?;  # Service/Product billing modifiers
    fhir:quantity @<Quantity>?;             # Count of products or services
    fhir:unitPrice @<Money>?;               # Fee, charge or cost per item
    fhir:factor @<Decimal>?;                # Price scaling factor
    fhir:tax @<Money>?;                     # Total tax
    fhir:net @<Money>?;                     # Total item cost
    fhir:noteNumber @<OneOrMore_PositiveInt>?;  # Applicable note numbers
    fhir:reviewOutcome @<ClaimResponse.item.reviewOutcome>?;  # Added items subdetail level 
                                            # adjudication results 
    fhir:adjudication @<OneOrMore_ClaimResponse.item.adjudication>?;  # Added items subdetail adjudication
}  
# Note concerning adjudication
<ClaimResponse.processNote> EXTENDS @<BackboneElement> CLOSED {   
    fhir:class @<CodeableConcept>?;         # Business kind of note
    fhir:number @<PositiveInt>?;            # Note instance identifier
    fhir:type @<CodeableConcept>?;          # Note purpose
    fhir:text @<Markdown>;                  # Note explanatory text
    fhir:language @<CodeableConcept>?;      # Language of the text
}  
# Insurer added line details
<ClaimResponse.addItem.detail> EXTENDS @<BackboneElement> CLOSED {   
    fhir:traceNumber @<OneOrMore_Identifier>?;  # Number for tracking
    fhir:revenue @<CodeableConcept>?;       # Revenue or cost center code
    fhir:productOrService @<CodeableConcept>?;  # Billing, service, product, or drug 
                                            # code 
    fhir:productOrServiceEnd @<CodeableConcept>?;  # End of a range of codes
    fhir:modifier @<OneOrMore_CodeableConcept>?;  # Service/Product billing modifiers
    fhir:quantity @<Quantity>?;             # Count of products or services
    fhir:unitPrice @<Money>?;               # Fee, charge or cost per item
    fhir:factor @<Decimal>?;                # Price scaling factor
    fhir:tax @<Money>?;                     # Total tax
    fhir:net @<Money>?;                     # Total item cost
    fhir:noteNumber @<OneOrMore_PositiveInt>?;  # Applicable note numbers
    fhir:reviewOutcome @<ClaimResponse.item.reviewOutcome>?;  # Added items detail level 
                                            # adjudication results 
    fhir:adjudication @<OneOrMore_ClaimResponse.item.adjudication>?;  # Added items detail adjudication
    fhir:subDetail @<OneOrMore_ClaimResponse.addItem.detail.subDetail>?;  # Insurer added line items
}  
# Anatomical location
<ClaimResponse.addItem.bodySite> EXTENDS @<BackboneElement> CLOSED {   
    fhir:site @<OneOrMore_CodeableReference>;  # Location
    fhir:subSite @<OneOrMore_CodeableConcept>?;  # Sub-location
}  
# Payment Details
<ClaimResponse.payment> EXTENDS @<BackboneElement> CLOSED {   
    fhir:type @<CodeableConcept>;           # Partial or complete payment
    fhir:adjustment @<Money>?;              # Payment adjustment for non-claim 
                                            # issues 
    fhir:adjustmentReason @<CodeableConcept>?;  # Explanation for the adjustment
    fhir:date @<Date>?;                     # Expected date of payment
    fhir:amount @<Money>;                   # Payable amount after adjustment
    fhir:identifier @<Identifier>?;         # Business identifier for the payment
}  
# Patient insurance information
<ClaimResponse.insurance> EXTENDS @<BackboneElement> CLOSED {   
    fhir:sequence @<PositiveInt>;           # Insurance instance identifier
    fhir:focal @<Boolean>;                  # Coverage to be used for 
                                            # adjudication 
    fhir:coverage @<Reference> AND {fhir:l 
    			@<Coverage> ? };  # Insurance information
    fhir:businessArrangement @<String>?;    # Additional provider contract number
    fhir:claimResponse @<Reference> AND {fhir:l 
    			@<ClaimResponse> ? }?;  # Adjudication results
}  
# Adjudication totals
<ClaimResponse.total> EXTENDS @<BackboneElement> CLOSED {   
    fhir:category @<CodeableConcept>;       # Type of adjudication information
    fhir:amount @<Money>;                   # Financial total for the category
}  
# Event information
<ClaimResponse.event> EXTENDS @<BackboneElement> CLOSED {   
    fhir:type @<CodeableConcept>;           # Specific event
    fhir:when @<DateTime>  OR 
    			@<Period>  ;  # Occurance date or period
}  
# Adjudication details
<ClaimResponse.item.adjudication> EXTENDS @<BackboneElement> CLOSED {   
    fhir:category @<CodeableConcept>;       # Type of adjudication information
    fhir:reason @<CodeableConcept>?;        # Explanation of adjudication outcome
    fhir:amount @<Money>?;                  # Monetary amount
    fhir:quantity @<Quantity>?;             # Non-monetary value
    fhir:decisionDate @<DateTime>?;         # When was adjudication performed
}  
# Adjudication for claim details
<ClaimResponse.item.detail> EXTENDS @<BackboneElement> CLOSED {   
    fhir:detailSequence @<PositiveInt>;     # Claim detail instance identifier
    fhir:traceNumber @<OneOrMore_Identifier>?;  # Number for tracking
    fhir:noteNumber @<OneOrMore_PositiveInt>?;  # Applicable note numbers
    fhir:reviewOutcome @<ClaimResponse.item.reviewOutcome>?;  # Detail level adjudication results
    fhir:adjudication @<OneOrMore_ClaimResponse.item.adjudication>?;  # Detail level adjudication details
    fhir:subDetail @<OneOrMore_ClaimResponse.item.detail.subDetail>?;  # Adjudication for claim sub-details
}  
# Processing errors
<ClaimResponse.error> EXTENDS @<BackboneElement> CLOSED {   
    fhir:itemSequence @<PositiveInt>?;      # Item sequence number
    fhir:detailSequence @<PositiveInt>?;    # Detail sequence number
    fhir:subDetailSequence @<PositiveInt>?;  # Subdetail sequence number
    fhir:code @<CodeableConcept>;           # Error code detailing processing 
                                            # issues 
    fhir:expression @<OneOrMore_String>?;   # FHIRPath of element(s) related to 
                                            # issue 
}  
# Adjudication for claim sub-details
<ClaimResponse.item.detail.subDetail> EXTENDS @<BackboneElement> CLOSED {   
    fhir:subDetailSequence @<PositiveInt>;  # Claim sub-detail instance 
                                            # identifier 
    fhir:traceNumber @<OneOrMore_Identifier>?;  # Number for tracking
    fhir:noteNumber @<OneOrMore_PositiveInt>?;  # Applicable note numbers
    fhir:reviewOutcome @<ClaimResponse.item.reviewOutcome>?;  # Subdetail level adjudication 
                                            # results 
    fhir:adjudication @<OneOrMore_ClaimResponse.item.adjudication>?;  # Subdetail level adjudication 
                                            # details 
}  
# Adjudication results
<ClaimResponse.item.reviewOutcome> EXTENDS @<BackboneElement> CLOSED {   
    fhir:decision @<CodeableConcept>?;      # Result of the adjudication
    fhir:reason @<OneOrMore_CodeableConcept>?;  # Reason for result of the 
                                            # adjudication 
    fhir:preAuthRef @<String>?;             # Preauthorization reference
    fhir:preAuthPeriod @<Period>?;          # Preauthorization reference 
                                            # effective period 
}  
# Supporting information
<ClaimResponse.supportingInfo> EXTENDS @<BackboneElement> CLOSED {   
    fhir:sequence @<PositiveInt>;           # Information instance identifier
    fhir:category @<CodeableConcept>;       # Classification of the supplied 
                                            # information 
    fhir:code @<CodeableConcept>?;          # Type of information
    fhir:timing @<DateTime>  OR 
    			@<Period>  OR 
    			@<Timing>  ?;  # When it occurred
    fhir:value @<Base64Binary>  OR 
    			@<Boolean>  OR 
    			@<Canonical>  OR 
    			@<Code>  OR 
    			@<Date>  OR 
    			@<DateTime>  OR 
    			@<Decimal>  OR 
    			@<Id>  OR 
    			@<Instant>  OR 
    			@<Integer>  OR 
    			@<Integer64>  OR 
    			@<Markdown>  OR 
    			@<Oid>  OR 
    			@<PositiveInt>  OR 
    			@<String>  OR 
    			@<Time>  OR 
    			@<UnsignedInt>  OR 
    			@<Uri>  OR 
    			@<Url>  OR 
    			@<Uuid>  OR 
    			@<Address>  OR 
    			@<Age>  OR 
    			@<Annotation>  OR 
    			@<Attachment>  OR 
    			@<CodeableConcept>  OR 
    			@<CodeableReference>  OR 
    			@<Coding>  OR 
    			@<ContactPoint>  OR 
    			@<Count>  OR 
    			@<Distance>  OR 
    			@<Duration>  OR 
    			@<HumanName>  OR 
    			@<Identifier>  OR 
    			@<Money>  OR 
    			@<Period>  OR 
    			@<Quantity>  OR 
    			@<Range>  OR 
    			@<Ratio>  OR 
    			@<RatioRange>  OR 
    			@<Reference>  OR 
    			@<SampledData>  OR 
    			@<Signature>  OR 
    			@<Timing>  OR 
    			@<ContactDetail>  OR 
    			@<DataRequirement>  OR 
    			@<Expression>  OR 
    			@<ParameterDefinition>  OR 
    			@<RelatedArtifact>  OR 
    			@<TriggerDefinition>  OR 
    			@<UsageContext>  OR 
    			@<Availability>  OR 
    			@<ExtendedContactDetail>  OR 
    			@<VirtualServiceDetail>  OR 
    			@<Dosage>  OR 
    			@<Meta>  ?;  # Data to be provided
    fhir:reason @<CodeableConcept>?;        # Explanation for the information
}  
# Insurer added line items
<ClaimResponse.addItem> EXTENDS @<BackboneElement> CLOSED {   
    fhir:itemSequence @<OneOrMore_PositiveInt>?;  # Item sequence number
    fhir:detailSequence @<OneOrMore_PositiveInt>?;  # Detail sequence number
    fhir:subdetailSequence @<OneOrMore_PositiveInt>?;  # Subdetail sequence number
    fhir:traceNumber @<OneOrMore_Identifier>?;  # Number for tracking
    fhir:subject @<Reference> AND {fhir:l 
    			@<Group> OR 
    			@<Patient> ? }?;  # The recipient of the products and 
                                            # services 
    fhir:informationSequence @<OneOrMore_PositiveInt>?;  # Applicable exception and 
                                            # supporting information 
    fhir:provider @<OneOrMore_Reference_Organization_OR_Practitioner_OR_PractitionerRole>?;  # Authorized providers
    fhir:revenue @<CodeableConcept>?;       # Revenue or cost center code
    fhir:category @<CodeableConcept>?;      # Benefit classification
    fhir:productOrService @<CodeableConcept>?;  # Billing, service, product, or drug 
                                            # code 
    fhir:productOrServiceEnd @<CodeableConcept>?;  # End of a range of codes
    fhir:request @<OneOrMore_Reference_DeviceRequest_OR_MedicationRequest_OR_NutritionOrder_OR_ServiceRequest_OR_VisionPrescription>?;  # Request or Referral for Service
    fhir:modifier @<OneOrMore_CodeableConcept>?;  # Service/Product billing modifiers
    fhir:programCode @<OneOrMore_CodeableConcept>?;  # Program the product or service is 
                                            # provided under 
    fhir:serviced @<Date>  OR 
    			@<Period>  ?;  # Date or dates of service or 
                                            # product delivery 
    fhir:location @<CodeableConcept>  OR 
    			@<Address>  OR 
    			(@<Reference>  AND {fhir:l @<Location> })  ?;  # Place of service or where product 
                                            # was supplied 
    fhir:quantity @<Quantity>?;             # Count of products or services
    fhir:unitPrice @<Money>?;               # Fee, charge or cost per item
    fhir:factor @<Decimal>?;                # Price scaling factor
    fhir:tax @<Money>?;                     # Total tax
    fhir:net @<Money>?;                     # Total item cost
    fhir:bodySite @<OneOrMore_ClaimResponse.addItem.bodySite>?;  # Anatomical location
    fhir:noteNumber @<OneOrMore_PositiveInt>?;  # Applicable note numbers
    fhir:reviewOutcome @<ClaimResponse.item.reviewOutcome>?;  # Added items adjudication results
    fhir:adjudication @<OneOrMore_ClaimResponse.item.adjudication>?;  # Added items adjudication
    fhir:detail @<OneOrMore_ClaimResponse.addItem.detail>?;  # Insurer added line details
}  
#---------------------- Cardinality Types (OneOrMore) -------------------
<OneOrMore_Identifier> CLOSED {
    rdf:first @<Identifier>  ;
    rdf:rest [rdf:nil] OR @<OneOrMore_Identifier> 
}
<OneOrMore_ClaimResponse.event> CLOSED {
    rdf:first @<ClaimResponse.event>  ;
    rdf:rest [rdf:nil] OR @<OneOrMore_ClaimResponse.event> 
}
<OneOrMore_Reference_Encounter> CLOSED {
    rdf:first @<Reference> AND {fhir:l 
			@<Encounter> } ;
    rdf:rest [rdf:nil] OR @<OneOrMore_Reference_Encounter> 
}
<OneOrMore_ClaimResponse.supportingInfo> CLOSED {
    rdf:first @<ClaimResponse.supportingInfo>  ;
    rdf:rest [rdf:nil] OR @<OneOrMore_ClaimResponse.supportingInfo> 
}
<OneOrMore_ClaimResponse.item> CLOSED {
    rdf:first @<ClaimResponse.item>  ;
    rdf:rest [rdf:nil] OR @<OneOrMore_ClaimResponse.item> 
}
<OneOrMore_ClaimResponse.addItem> CLOSED {
    rdf:first @<ClaimResponse.addItem>  ;
    rdf:rest [rdf:nil] OR @<OneOrMore_ClaimResponse.addItem> 
}
<OneOrMore_ClaimResponse.item.adjudication> CLOSED {
    rdf:first @<ClaimResponse.item.adjudication>  ;
    rdf:rest [rdf:nil] OR @<OneOrMore_ClaimResponse.item.adjudication> 
}
<OneOrMore_ClaimResponse.total> CLOSED {
    rdf:first @<ClaimResponse.total>  ;
    rdf:rest [rdf:nil] OR @<OneOrMore_ClaimResponse.total> 
}
<OneOrMore_ClaimResponse.processNote> CLOSED {
    rdf:first @<ClaimResponse.processNote>  ;
    rdf:rest [rdf:nil] OR @<OneOrMore_ClaimResponse.processNote> 
}
<OneOrMore_Reference_CommunicationRequest> CLOSED {
    rdf:first @<Reference> AND {fhir:l 
			@<CommunicationRequest> } ;
    rdf:rest [rdf:nil] OR @<OneOrMore_Reference_CommunicationRequest> 
}
<OneOrMore_ClaimResponse.insurance> CLOSED {
    rdf:first @<ClaimResponse.insurance>  ;
    rdf:rest [rdf:nil] OR @<OneOrMore_ClaimResponse.insurance> 
}
<OneOrMore_ClaimResponse.error> CLOSED {
    rdf:first @<ClaimResponse.error>  ;
    rdf:rest [rdf:nil] OR @<OneOrMore_ClaimResponse.error> 
}
<OneOrMore_PositiveInt> CLOSED {
    rdf:first @<PositiveInt>  ;
    rdf:rest [rdf:nil] OR @<OneOrMore_PositiveInt> 
}
<OneOrMore_ClaimResponse.item.detail> CLOSED {
    rdf:first @<ClaimResponse.item.detail>  ;
    rdf:rest [rdf:nil] OR @<OneOrMore_ClaimResponse.item.detail> 
}
<OneOrMore_CodeableConcept> CLOSED {
    rdf:first @<CodeableConcept>  ;
    rdf:rest [rdf:nil] OR @<OneOrMore_CodeableConcept> 
}
<OneOrMore_ClaimResponse.addItem.detail.subDetail> CLOSED {
    rdf:first @<ClaimResponse.addItem.detail.subDetail>  ;
    rdf:rest [rdf:nil] OR @<OneOrMore_ClaimResponse.addItem.detail.subDetail> 
}
<OneOrMore_CodeableReference> CLOSED {
    rdf:first @<CodeableReference>  ;
    rdf:rest [rdf:nil] OR @<OneOrMore_CodeableReference> 
}
<OneOrMore_ClaimResponse.item.detail.subDetail> CLOSED {
    rdf:first @<ClaimResponse.item.detail.subDetail>  ;
    rdf:rest [rdf:nil] OR @<OneOrMore_ClaimResponse.item.detail.subDetail> 
}
<OneOrMore_String> CLOSED {
    rdf:first @<String>  ;
    rdf:rest [rdf:nil] OR @<OneOrMore_String> 
}
<OneOrMore_Reference_Organization_OR_Practitioner_OR_PractitionerRole> CLOSED {
    rdf:first @<Reference> AND {fhir:l 
			@<Organization> OR 
			@<Practitioner> OR 
			@<PractitionerRole> } ;
    rdf:rest [rdf:nil] OR @<OneOrMore_Reference_Organization_OR_Practitioner_OR_PractitionerRole> 
}
<OneOrMore_Reference_DeviceRequest_OR_MedicationRequest_OR_NutritionOrder_OR_ServiceRequest_OR_VisionPrescription> CLOSED {
    rdf:first @<Reference> AND {fhir:l 
			@<DeviceRequest> OR 
			@<MedicationRequest> OR 
			@<NutritionOrder> OR 
			@<ServiceRequest> OR 
			@<VisionPrescription> } ;
    rdf:rest [rdf:nil] OR @<OneOrMore_Reference_DeviceRequest_OR_MedicationRequest_OR_NutritionOrder_OR_ServiceRequest_OR_VisionPrescription> 
}
<OneOrMore_ClaimResponse.addItem.bodySite> CLOSED {
    rdf:first @<ClaimResponse.addItem.bodySite>  ;
    rdf:rest [rdf:nil] OR @<OneOrMore_ClaimResponse.addItem.bodySite> 
}
<OneOrMore_ClaimResponse.addItem.detail> CLOSED {
    rdf:first @<ClaimResponse.addItem.detail>  ;
    rdf:rest [rdf:nil] OR @<OneOrMore_ClaimResponse.addItem.detail> 
}
#---------------------- Value Sets ------------------------
# This value set includes Claim Processing Outcome codes.
fhirvs:claim-outcome ["queued" "complete" "error" "partial"]
# The purpose of the Claim: predetermination, preauthorization, claim.
fhirvs:claim-use ["claim" "preauthorization" "predetermination"]
# This value set includes Status codes.
fhirvs:fm-status ["active" "cancelled" "draft" "entered-in-error"]


Usage note: every effort has been made to ensure that the ShEx files are correct and useful, but they are not a normative part of the specification.