DSTU2 STU 3 Candidate
This page is part of the FHIR Specification (v1.0.2: DSTU 2). The current version which supercedes this version is

This page is part of the FHIR Specification (v1.4.0: STU 3 Ballot 3). The current version which supercedes this version is 5.0.0 . For a full list of available versions, see the Directory of published versions . For a full list of available versions, see the Directory of published versions . Page versions: . Page versions: R5 R4B R4 R3 R2

7.2 Resource ClaimResponse - Content Resource ClaimResponse - Content

This resource provides the adjudication details from the processing of a Claim resource.
Financial Management Financial Management Work Group Work Group Maturity Level : 0 Maturity Level : 0 Compartments : Not linked to any defined compartments : Not linked to any defined compartments

This resource provides the adjudication details from the processing of a Claim resource.

7.2.1 Scope and Usage Scope and Usage The ClaimResponse resource provides application level error or application level adjudication results which are the result of processing a submitted disciplineClaim which is the functional corollary of a Claim, Pre-Determination or a Pre-Authorization. This is the adjudicated response to a Claim, Pre-determination or Pre-Authorization. The strength of the payment aspect of the response is matching to the strength of the original request. For a

The ClaimResponse resource provides application level error or application level adjudication results which are the result of processing a submitted disciplineClaim which is the functional corollary of a Claim, Pre-Determination or a Pre-Authorization.

This is the adjudicated response to a Claim, Pre-determination or Pre-Authorization. The strength of the payment aspect of the response is matching to the strength of the original request. For a Claim the adjudication indicates payment which is intended to be made, for Pre-Authorization and Pre-Determination no payment will actually be made however funds may be reserved to settle a claim submitted later. Only an actual claim may be expected to result in actual payment.

The ClaimResponse resource is the response for the submission of: OralHealthClaim, VisionClaim etc. and Reversals.

Todo

This resource is referenced by Claim the adjudication indicates payment which is intended to be made, for Pre-Authorization and Pre-Determination no payment will actually be made however funds may be reserved to settle a claim submitted later. Only an actual claim may be expected to result in actual payment. The ClaimResponse resource is the response for the submission of: OralHealthClaim, VisionClaim etc. and Reversals. Todo This resource is referenced by claim and ExplanationOfBenefit

7.2.2 Resource Content Resource Content

Structure

Id of resource triggering adjudication Insurer Responsible practitioner Responsible organization Reference ( Coverage ) 0..1 Business agreement Coding
Name Flags Card. Type Description & Constraints Description & Constraints doco
. . ClaimResponse Σ DomainResource Remittance resource Remittance resource
. . . identifier Σ 0..* Identifier Response number Response number
. . request . request[x] Σ 0..1 Id of resource triggering adjudication
.... requestIdentifier Identifier
.... requestReference Reference ( Claim )
. . . ruleset Σ 0..1 Coding Resource version Resource version
Ruleset Codes ( Ruleset Codes ( Example )
. . . originalRuleset Σ 0..1 Coding Original version Original version
Ruleset Codes ( Ruleset Codes ( Example )
. . . created Σ 0..1 dateTime Creation date Creation date
. . organization . organization[x] Σ 0..1 Insurer
.... organizationIdentifier Identifier
.... organizationReference Reference ( Organization )
. . requestProvider . requestProvider[x] Σ 0..1 Responsible practitioner
.... requestProviderIdentifier Identifier
.... requestProviderReference Reference ( Practitioner )
. . requestOrganization . requestOrganization[x] Σ 0..1 Responsible organization
.... requestOrganizationIdentifier Identifier
.... requestOrganizationReference Reference ( Organization )
. . . outcome Σ 0..1 code complete | error complete | error
RemittanceOutcome ( ( Required )
. . . disposition Σ 0..1 string Disposition Message Disposition Message
. . . payeeType Σ 0..1 Coding Party to be paid any benefits payable Party to be paid any benefits payable
Payee Type Codes ( Payee Type Codes ( Example )
. . . item Σ 0..* BackboneElement Line items Line items
. . . . sequenceLinkId Σ 1..1 positiveInt Service instance Service instance
. . . . noteNumber Σ 0..* positiveInt List of note numbers which apply List of note numbers which apply
. . . . adjudication Σ 0..* BackboneElement Adjudication details Adjudication details
. . . . code . category Σ 1..1 Coding Adjudication category such as co-pay, eligible, benefit, etc. Adjudication category such as co-pay, eligible, benefit, etc.
Adjudication Codes Adjudication Codes ( Extensible ( )
..... reason Σ 0..1 Coding Adjudication reason
Adjudication Reason Codes ( Extensible )
. . . . . amount Σ 0..1 Money Monetary amount Monetary amount
. . . . . value Σ 0..1 decimal Non-monetary value Non-monetary value
. . . . detail Σ 0..* BackboneElement Detail line items Detail line items
. . . . . sequenceLinkId Σ 1..1 positiveInt Service instance Service instance
. . . . . adjudication Σ 0..* BackboneElement Detail adjudication Detail adjudication
. . . . . code . category Σ 1..1 Coding Adjudication category such as co-pay, eligible, benefit, etc. Adjudication category such as co-pay, eligible, benefit, etc.
Adjudication Codes Adjudication Codes ( Extensible ( )
...... reason Σ 0..1 Coding Adjudication reason
Adjudication Reason Codes ( Extensible )
. . . . . . amount Σ 0..1 Money Monetary amount Monetary amount
. . . . . . value Σ 0..1 decimal Non-monetary value Non-monetary value
. . . . . subDetail Σ 0..* BackboneElement Subdetail line items Subdetail line items
. . . . . . sequenceLinkId Σ 1..1 positiveInt Service instance Service instance
. . . . . . adjudication Σ 0..* BackboneElement Subdetail adjudication Subdetail adjudication
. . . . . . code . category Σ 1..1 Coding Adjudication category such as co-pay, eligible, benefit, etc. Adjudication category such as co-pay, eligible, benefit, etc.
Adjudication Codes Adjudication Codes ( Extensible ( )
....... reason Σ 0..1 Coding Adjudication reason
Adjudication Reason Codes ( Extensible )
. . . . . . . amount Σ 0..1 Money Monetary amount Monetary amount
. . . . . . . value Σ 0..1 decimal Non-monetary value Non-monetary value
. . . addItem Σ 0..* BackboneElement Insurer added line items Insurer added line items
. . . . sequenceLinkId Σ 0..* positiveInt Service instances Service instances
. . . . service Σ 1..1 Coding Group, Service or Product Group, Service or Product
USCLS Codes ( USCLS Codes ( Example )
. . . . fee Σ 0..1 Money Professional fee or Product charge Professional fee or Product charge
. . . . noteNumberLinkId Σ 0..* positiveInt List of note numbers which apply List of note numbers which apply
. . . . adjudication Σ 0..* BackboneElement Added items adjudication Added items adjudication
. . . . code . category Σ 1..1 Coding Adjudication category such as co-pay, eligible, benefit, etc. Adjudication category such as co-pay, eligible, benefit, etc.
Adjudication Codes Adjudication Codes ( Extensible ( )
..... reason Σ 0..1 Coding Adjudication reason
Adjudication Reason Codes ( Extensible )
. . . . . amount Σ 0..1 Money Monetary amount Monetary amount
. . . . . value Σ 0..1 decimal Non-monetary value Non-monetary value
. . . . detail Σ 0..* BackboneElement Added items details Added items details
. . . . . service Σ 1..1 Coding Service or Product Service or Product
USCLS Codes ( USCLS Codes ( Example )
. . . . . fee Σ 0..1 Money Professional fee or Product charge Professional fee or Product charge
. . . . . adjudication Σ 0..* BackboneElement Added items detail adjudication Added items detail adjudication
. . . . . code . category Σ 1..1 Coding Adjudication category such as co-pay, eligible, benefit, etc. Adjudication category such as co-pay, eligible, benefit, etc.
Adjudication Codes Adjudication Codes ( Extensible ( )
...... reason Σ 0..1 Coding Adjudication reason
Adjudication Reason Codes ( Extensible )
. . . . . . amount Σ 0..1 Money Monetary amount Monetary amount
. . . . . . value Σ 0..1 decimal Non-monetary value Non-monetary value
. . . error Σ 0..* BackboneElement Processing errors Processing errors
. . . . sequenceLinkId Σ 0..1 positiveInt Item sequence number Item sequence number
. . . . detailSequenceLinkId Σ 0..1 positiveInt Detail sequence number Detail sequence number
. . . . subdetailSequenceLinkId Σ 0..1 positiveInt Subdetail sequence number Subdetail sequence number
. . . . code Σ 1..1 Coding Error code detailing processing issues Error code detailing processing issues
Adjudication Error Codes ( Required Adjudication Error Codes ( Extensible )
. . . totalCost Σ 0..1 Money Total Cost of service from the Claim Total Cost of service from the Claim
. . . unallocDeductable Σ 0..1 Money Unallocated deductible Unallocated deductible
. . . totalBenefit Σ 0..1 Money Total benefit payable for the Claim Total benefit payable for the Claim
. . . paymentAdjustment Σ 0..1 Money Payment adjustment for non-Claim issues Payment adjustment for non-Claim issues
. . . paymentAdjustmentReason Σ 0..1 Coding Reason for Payment adjustment Reason for Payment adjustment
Adjustment Reason Codes ( Payment Adjustment Reason Codes ( Extensible )
. . . paymentDate Σ 0..1 date Expected data of Payment Expected data of Payment
. . . paymentAmount Σ 0..1 Money Payment amount Payment amount
. . . paymentRef Σ 0..1 Identifier Payment identifier Payment identifier
. . . reserved Σ 0..1 Coding Funds reserved status Funds reserved status
Funds Reservation Codes ( Funds Reservation Codes ( Example )
. . . form Σ 0..1 Coding Printed Form Identifier Printed Form Identifier
Form Codes ( Form Codes ( Required )
. . . note Σ 0..* BackboneElement Processing notes Processing notes
. . . . number Σ 0..1 positiveInt Note Number for this note Note Number for this note
. . . . type Σ 0..1 Coding display | print | printoper display | print | printoper
NoteType ( ( Required )
. . . . text Σ 0..1 string Note explanatory text Note explanatory text
. . . coverage Σ 0..* BackboneElement Insurance or medical plan Insurance or medical plan
. . . . sequence Σ 1..1 positiveInt Service instance identifier Service instance identifier
. . . . focal Σ 1..1 boolean Is the focal Coverage Is the focal Coverage
. . . coverage . coverage[x] Σ 1..1 Insurance information Insurance information
. . businessArrangement . . Σ . coverageIdentifier string Identifier
. . relationship Σ . . 1..1 . coverageReference Patient relationship to subscriber Surface Codes Reference ( Example Coverage )
. . . preAuthRef . businessArrangement Σ 0..* 0..1 string Pre-Authorization/Determination Reference Business agreement
. . . claimResponse . preAuthRef Σ 0..1 0..* Reference ( ClaimResponse string ) Adjudication results Pre-Authorization/Determination Reference
. . . originalRuleset . claimResponse Σ 0..1 Coding Original version Ruleset Codes Reference ( Example ClaimResponse ) Adjudication results

Documentation for this format doco Documentation for this format

UML Diagram UML Diagram

ClaimResponse ( ( DomainResource ) The Response business identifier The Response business identifier identifier : : Identifier [0..*] [0..*] Original request resource referrence Original request resource referrence request request[x] : Type [0..1] « Identifier : | Reference [0..1] « ( Claim » ) » The version of the style of resource contents. This should be mapped to the allowable profiles for this and supporting resources The version of the style of resource contents. This should be mapped to the allowable profiles for this and supporting resources ruleset : : Coding [0..1] « [0..1] « The static and dynamic model to which contents conform, which may be business version or standard/version. (Strength=Example) The static and dynamic model to which contents conform, which may be business version or standard/version. (Strength=Example) Ruleset ?? » Ruleset ?? » The style (standard) and version of the original material which was converted into this resource The style (standard) and version of the original material which was converted into this resource originalRuleset : : Coding [0..1] « [0..1] « The static and dynamic model to which contents conform, which may be business version or standard/version. (Strength=Example) The static and dynamic model to which contents conform, which may be business version or standard/version. (Strength=Example) Ruleset ?? » Ruleset ?? » The date when the enclosed suite of services were performed or completed The date when the enclosed suite of services were performed or completed created : : dateTime [0..1] [0..1] The Insurer who produced this adjudicated response The Insurer who produced this adjudicated response organization organization[x] : Type [0..1] « Identifier : | Reference [0..1] « ( Organization » ) » The practitioner who is responsible for the services rendered to the patient The practitioner who is responsible for the services rendered to the patient requestProvider requestProvider[x] : Type [0..1] « Identifier : | Reference [0..1] « ( Practitioner » ) » The organization which is responsible for the services rendered to the patient The organization which is responsible for the services rendered to the patient requestOrganization requestOrganization[x] : Type [0..1] « Identifier : | Reference [0..1] « ( Organization » ) » Transaction status: error, complete Transaction status: error, complete outcome : : code [0..1] « [0..1] « The outcome of the processing. (Strength=Required) The outcome of the processing. (Strength=Required) RemittanceOutcome ! » ! » A description of the status of the adjudication A description of the status of the adjudication disposition : : string [0..1] [0..1] Party to be reimbursed: Subscriber, provider, other Party to be reimbursed: Subscriber, provider, other payeeType : : Coding [0..1] « [0..1] « A code for the party to be reimbursed. (Strength=Example) A code for the party to be reimbursed. (Strength=Example) Payee Type ?? » Payee Type ?? » The total cost of the services reported The total cost of the services reported totalCost : : Quantity ( Money ) [0..1] ) [0..1] The amount of deductible applied which was not allocated to any particular service line The amount of deductible applied which was not allocated to any particular service line unallocDeductable : : Quantity ( Money ) [0..1] ) [0..1] Total amount of benefit payable (Equal to sum of the Benefit amounts from all detail lines and additions less the Unallocated Deductible) Total amount of benefit payable (Equal to sum of the Benefit amounts from all detail lines and additions less the Unallocated Deductible) totalBenefit : : Quantity ( Money ) [0..1] ) [0..1] Adjustment to the payment of this transaction which is not related to adjudication of this transaction Adjustment to the payment of this transaction which is not related to adjudication of this transaction paymentAdjustment : : Quantity ( Money ) [0..1] ) [0..1] Reason for the payment adjustment Reason for the payment adjustment paymentAdjustmentReason : : Coding [0..1] « [0..1] « Adjustment reason codes. (Strength=Extensible) Payment Adjustment reason codes. (Strength=Extensible) Adjustment Reason + » Payment Adjustment Reason + » Estimated payment data Estimated payment data paymentDate : : date [0..1] [0..1] Payable less any payment adjustment Payable less any payment adjustment paymentAmount : : Quantity ( Money ) [0..1] ) [0..1] Payment identifier Payment identifier paymentRef : : Identifier [0..1] [0..1] Status of funds reservation (For provider, for Patient, None) Status of funds reservation (For provider, for Patient, None) reserved : : Coding [0..1] « [0..1] « For whom funds are to be reserved: (Patient, Provider, None). (Strength=Example) For whom funds are to be reserved: (Patient, Provider, None). (Strength=Example) Funds Reservation ?? » Funds Reservation ?? » The form to be used for printing the content The form to be used for printing the content form : : Coding [0..1] « [0..1] « The forms codes. (Strength=Required) The forms codes. (Strength=Required) Form ! » Form ! » Items A service line number A service line number sequenceLinkId : : positiveInt [1..1] [1..1] A list of note references to the notes provided below A list of note references to the notes provided below noteNumber : : positiveInt [0..*] [0..*] ItemAdjudication Code indicating: Co-Pay, deductible, eligible, benefit, tax, etc Code indicating: Co-Pay, deductible, eligible, benefit, tax, etc code : category : Coding [1..1] « [1..1] « The adjudication codes. (Strength=Extensible) The adjudication codes. (Strength=Extensible) Adjudication + » Adjudication + » Adjudication reason such as limit reached reason : Coding [0..1] « The adjudication reason codes. (Strength=Extensible) Adjudication Reason + » Monetary amount associated with the code Monetary amount associated with the code amount : : Quantity ( Money ) [0..1] ) [0..1] A non-monetary value for example a percentage. Mutually exclusive to the amount element above A non-monetary value for example a percentage. Mutually exclusive to the amount element above value : : decimal [0..1] [0..1] ItemDetail A service line number A service line number sequenceLinkId : : positiveInt [1..1] [1..1] DetailAdjudication Code indicating: Co-Pay, deductible, eligible, benefit, tax, etc Code indicating: Co-Pay, deductible, eligible, benefit, tax, etc code : category : Coding [1..1] « [1..1] « The adjudication codes. (Strength=Extensible) The adjudication codes. (Strength=Extensible) Adjudication + » Adjudication + » Adjudication reason such as limit reached reason : Coding [0..1] « The adjudication reason codes. (Strength=Extensible) Adjudication Reason + » Monetary amount associated with the code Monetary amount associated with the code amount : : Quantity ( Money ) [0..1] ) [0..1] A non-monetary value for example a percentage. Mutually exclusive to the amount element above A non-monetary value for example a percentage. Mutually exclusive to the amount element above value : : decimal [0..1] [0..1] SubDetail A service line number A service line number sequenceLinkId : : positiveInt [1..1] [1..1] SubdetailAdjudication Code indicating: Co-Pay, deductible, eligible, benefit, tax, etc Code indicating: Co-Pay, deductible, eligible, benefit, tax, etc code : category : Coding [1..1] « [1..1] « The adjudication codes. (Strength=Extensible) The adjudication codes. (Strength=Extensible) Adjudication + » Adjudication + » Adjudication reason such as limit reached reason : Coding [0..1] « The adjudication reason codes. (Strength=Extensible) Adjudication Reason + » Monetary amount associated with the code Monetary amount associated with the code amount : : Quantity ( Money ) [0..1] ) [0..1] A non-monetary value for example a percentage. Mutually exclusive to the amount element above A non-monetary value for example a percentage. Mutually exclusive to the amount element above value : : decimal [0..1] [0..1] AddedItem List of input service items which this service line is intended to replace List of input service items which this service line is intended to replace sequenceLinkId : : positiveInt [0..*] [0..*] A code to indicate the Professional Service or Product supplied A code to indicate the Professional Service or Product supplied service : : Coding [1..1] « [1..1] « Allowable service and product codes. (Strength=Example) Allowable service and product codes. (Strength=Example) USCLS ?? » USCLS ?? » The fee charged for the professional service or product. The fee charged for the professional service or product. fee : : Quantity ( Money ) [0..1] ) [0..1] A list of note references to the notes provided below A list of note references to the notes provided below noteNumberLinkId : : positiveInt [0..*] [0..*] AddedItemAdjudication Code indicating: Co-Pay, deductible, eligible, benefit, tax, etc Code indicating: Co-Pay, deductible, eligible, benefit, tax, etc code : category : Coding [1..1] « [1..1] « The adjudication codes. (Strength=Extensible) The adjudication codes. (Strength=Extensible) Adjudication + » Adjudication + » Adjudication reason such as limit reached reason : Coding [0..1] « The adjudication reason codes. (Strength=Extensible) Adjudication Reason + » Monetary amount associated with the code Monetary amount associated with the code amount : : Quantity ( Money ) [0..1] ) [0..1] A non-monetary value for example a percentage. Mutually exclusive to the amount element above A non-monetary value for example a percentage. Mutually exclusive to the amount element above value : : decimal [0..1] [0..1] AddedItemsDetail A code to indicate the Professional Service or Product supplied A code to indicate the Professional Service or Product supplied service : : Coding [1..1] « [1..1] « Allowable service and product codes. (Strength=Example) Allowable service and product codes. (Strength=Example) USCLS ?? » USCLS ?? » The fee charged for the professional service or product. The fee charged for the professional service or product. fee : : Quantity ( Money ) [0..1] ) [0..1] AddedItemDetailAdjudication Code indicating: Co-Pay, deductible, eligible, benefit, tax, etc Code indicating: Co-Pay, deductible, eligible, benefit, tax, etc code : category : Coding [1..1] « [1..1] « The adjudication codes. (Strength=Extensible) The adjudication codes. (Strength=Extensible) Adjudication + » Adjudication + » Adjudication reason such as limit reached reason : Coding [0..1] « The adjudication reason codes. (Strength=Extensible) Adjudication Reason + » Monetary amount associated with the code Monetary amount associated with the code amount : : Quantity ( Money ) [0..1] ) [0..1] A non-monetary value for example a percentage. Mutually exclusive to the amount element above A non-monetary value for example a percentage. Mutually exclusive to the amount element above value : : decimal [0..1] [0..1] Errors The sequence number of the line item submitted which contains the error. This value is omitted when the error is elsewhere The sequence number of the line item submitted which contains the error. This value is omitted when the error is elsewhere sequenceLinkId : : positiveInt [0..1] [0..1] The sequence number of the addition within the line item submitted which contains the error. This value is omitted when the error is not related to an Addition The sequence number of the addition within the line item submitted which contains the error. This value is omitted when the error is not related to an Addition detailSequenceLinkId : : positiveInt [0..1] [0..1] The sequence number of the addition within the line item submitted which contains the error. This value is omitted when the error is not related to an Addition The sequence number of the addition within the line item submitted which contains the error. This value is omitted when the error is not related to an Addition subdetailSequenceLinkId : : positiveInt [0..1] [0..1] An error code,froma specified code system, which details why the claim could not be adjudicated An error code,from a specified code system, which details why the claim could not be adjudicated code : : Coding [1..1] « [1..1] « The error codes for adjudication processing. (Strength=Required) The adjudication error codes. (Strength=Extensible) Adjudication Error ! » Adjudication Error + » Notes An integer associated with each note which may be referred to from each service line item An integer associated with each note which may be referred to from each service line item number : : positiveInt [0..1] [0..1] The note purpose: Print/Display The note purpose: Print/Display type : : Coding [0..1] « [0..1] « The presentation types of notes. (Strength=Required) The presentation types of notes. (Strength=Required) NoteType ! » ! » The note text The note text text : : string [0..1] [0..1] Coverage A service line item A service line item sequence : : positiveInt [1..1] [1..1] The instance number of the Coverage which is the focus for adjudication. The Coverage against which the claim is to be adjudicated The instance number of the Coverage which is the focus for adjudication. The Coverage against which the claim is to be adjudicated focal : : boolean [1..1] [1..1] Reference to the program or plan identification, underwriter or payor Reference to the program or plan identification, underwriter or payor coverage coverage[x] : Type [1..1] « Identifier : | Reference [1..1] « ( Coverage » ) » The contract number of a business agreement which describes the terms and conditions The contract number of a business agreement which describes the terms and conditions businessArrangement : : string [0..1] [0..1] The relationship of the patient to the subscriber relationship : Coding [1..1] « The code for the relationship of the patient to the subscriber. (Strength=Example) Surface ?? » A list of references from the Insurer to which these services pertain A list of references from the Insurer to which these services pertain preAuthRef : : string [0..*] [0..*] The Coverages adjudication details The Coverages adjudication details claimResponse : : Reference [0..1] « [0..1] « ClaimResponse » The style (standard) and version of the original material which was converted into this resource originalRuleset : Coding [0..1] « The static and dynamic model to which contents conform, which may be business version or standard/version. (Strength=Example) Ruleset ?? » » The adjudications results The adjudications results adjudication [0..*] The adjudications results The adjudications results adjudication [0..*] The adjudications results The adjudications results adjudication [0..*] The third tier service adjudications for submitted services The third tier service adjudications for submitted services subDetail [0..*] The second tier service adjudications for submitted services The second tier service adjudications for submitted services detail [0..*] The first tier service adjudications for submitted services The first tier service adjudications for submitted services item [0..*] The adjudications results The adjudications results adjudication [0..*] The adjudications results The adjudications results adjudication [0..*] The second tier service adjudications for payor added services The second tier service adjudications for payor added services detail [0..*] The first tier service adjudications for payor added services The first tier service adjudications for payor added services addItem [0..*] Mutually exclusive with Services Provided (Item) Mutually exclusive with Services Provided (Item) error [0..*] Note text Note text note [0..*] Financial instrument by which payment information for health care Financial instrument by which payment information for health care coverage [0..*]

XML Template XML Template 

<ClaimResponse xmlns="http://hl7.org/fhir"> doco
 <!-- from Resource: id, meta, implicitRules, and language -->
 <!-- from DomainResource: text, contained, extension, and modifierExtension -->
 <identifier><!-- 0..* Identifier Response  number --></identifier>
 <</request>

 <request[x]><!-- 0..1 Identifier|Reference(Claim) Id of resource triggering adjudication --></request[x]>

 <ruleset><!-- 0..1 Coding Resource version --></ruleset>
 <originalRuleset><!-- 0..1 Coding Original version --></originalRuleset>
 <created value="[dateTime]"/><!-- 0..1 Creation date -->
 <</organization>
 <</requestProvider>
 <</requestOrganization>

 <organization[x]><!-- 0..1 Identifier|Reference(Organization) Insurer --></organization[x]>
 <requestProvider[x]><!-- 0..1 Identifier|Reference(Practitioner) Responsible practitioner --></requestProvider[x]>
 <requestOrganization[x]><!-- 0..1 Identifier|Reference(Organization) Responsible organization --></requestOrganization[x]>

 <outcome value="[code]"/><!-- 0..1 complete | error -->
 <disposition value="[string]"/><!-- 0..1 Disposition Message -->
 <payeeType><!-- 0..1 Coding Party to be paid any benefits payable --></payeeType>
 <item>  <!-- 0..* Line items -->
  <sequenceLinkId value="[positiveInt]"/><!-- 1..1 Service instance -->
  <noteNumber value="[positiveInt]"/><!-- 0..* List of note numbers which apply -->
  <adjudication>  <!-- 0..* Adjudication details -->
   <</code>

   <category><!-- 1..1 Coding Adjudication category such as co-pay, eligible, benefit, etc. --></category>
   <reason><!-- 0..1 Coding Adjudication reason --></reason>

   <amount><!-- 0..1 Quantity(Money) Monetary amount --></amount>
   <value value="[decimal]"/><!-- 0..1 Non-monetary value -->
  </adjudication>
  <detail>  <!-- 0..* Detail line items -->
   <sequenceLinkId value="[positiveInt]"/><!-- 1..1 Service instance -->
   <adjudication>  <!-- 0..* Detail adjudication -->
    <</code>

    <category><!-- 1..1 Coding Adjudication category such as co-pay, eligible, benefit, etc. --></category>
    <reason><!-- 0..1 Coding Adjudication reason --></reason>

    <amount><!-- 0..1 Quantity(Money) Monetary amount --></amount>
    <value value="[decimal]"/><!-- 0..1 Non-monetary value -->
   </adjudication>
   <subDetail>  <!-- 0..* Subdetail line items -->
    <sequenceLinkId value="[positiveInt]"/><!-- 1..1 Service instance -->
    <adjudication>  <!-- 0..* Subdetail adjudication -->
     <</code>

     <category><!-- 1..1 Coding Adjudication category such as co-pay, eligible, benefit, etc. --></category>
     <reason><!-- 0..1 Coding Adjudication reason --></reason>

     <amount><!-- 0..1 Quantity(Money) Monetary amount --></amount>
     <value value="[decimal]"/><!-- 0..1 Non-monetary value -->
    </adjudication>
   </subDetail>
  </detail>
 </item>
 <addItem>  <!-- 0..* Insurer added line items -->
  <sequenceLinkId value="[positiveInt]"/><!-- 0..* Service instances -->
  <service><!-- 1..1 Coding Group, Service or Product --></service>
  <fee><!-- 0..1 Quantity(Money) Professional fee or Product charge --></fee>
  <noteNumberLinkId value="[positiveInt]"/><!-- 0..* List of note numbers which apply -->
  <adjudication>  <!-- 0..* Added items adjudication -->
   <</code>

   <category><!-- 1..1 Coding Adjudication category such as co-pay, eligible, benefit, etc. --></category>
   <reason><!-- 0..1 Coding Adjudication reason --></reason>

   <amount><!-- 0..1 Quantity(Money) Monetary amount --></amount>
   <value value="[decimal]"/><!-- 0..1 Non-monetary value -->
  </adjudication>
  <detail>  <!-- 0..* Added items details -->
   <service><!-- 1..1 Coding Service or Product --></service>
   <fee><!-- 0..1 Quantity(Money) Professional fee or Product charge --></fee>
   <adjudication>  <!-- 0..* Added items detail adjudication -->
    <</code>

    <category><!-- 1..1 Coding Adjudication category such as co-pay, eligible, benefit, etc. --></category>
    <reason><!-- 0..1 Coding Adjudication reason --></reason>

    <amount><!-- 0..1 Quantity(Money) Monetary amount --></amount>
    <value value="[decimal]"/><!-- 0..1 Non-monetary value -->
   </adjudication>
  </detail>
 </addItem>
 <error>  <!-- 0..* Processing errors -->
  <sequenceLinkId value="[positiveInt]"/><!-- 0..1 Item sequence number -->
  <detailSequenceLinkId value="[positiveInt]"/><!-- 0..1 Detail sequence number -->
  <subdetailSequenceLinkId value="[positiveInt]"/><!-- 0..1 Subdetail sequence number -->
  <</code>

  <code><!-- 1..1 Coding Error code detailing processing issues --></code>

 </error>
 <totalCost><!-- 0..1 Quantity(Money) Total Cost of service from the Claim --></totalCost>
 <unallocDeductable><!-- 0..1 Quantity(Money) Unallocated deductible --></unallocDeductable>
 <totalBenefit><!-- 0..1 Quantity(Money) Total benefit payable for the Claim --></totalBenefit>
 <paymentAdjustment><!-- 0..1 Quantity(Money) Payment adjustment for non-Claim issues --></paymentAdjustment>
 <</paymentAdjustmentReason>

 <paymentAdjustmentReason><!-- 0..1 Coding Reason for Payment adjustment --></paymentAdjustmentReason>

 <paymentDate value="[date]"/><!-- 0..1 Expected data of Payment -->
 <paymentAmount><!-- 0..1 Quantity(Money) Payment amount --></paymentAmount>
 <paymentRef><!-- 0..1 Identifier Payment identifier --></paymentRef>
 <reserved><!-- 0..1 Coding Funds reserved status --></reserved>
 <form><!-- 0..1 Coding Printed Form Identifier --></form>
 <note>  <!-- 0..* Processing notes -->
  <number value="[positiveInt]"/><!-- 0..1 Note Number for this note -->
  <type><!-- 0..1 Coding display | print | printoper --></type>
  <text value="[string]"/><!-- 0..1 Note explanatory text -->
 </note>
 <coverage>  <!-- 0..* Insurance or medical plan -->
  <sequence value="[positiveInt]"/><!-- 1..1 Service instance identifier -->
  <focal value="[boolean]"/><!-- 1..1 Is the focal Coverage -->
  <</coverage>

  <coverage[x]><!-- 1..1 Identifier|Reference(Coverage) Insurance information --></coverage[x]>

  <businessArrangement value="[string]"/><!-- 0..1 Business agreement -->
  <</relationship>

  <preAuthRef value="[string]"/><!-- 0..* Pre-Authorization/Determination Reference -->
  <claimResponse><!-- 0..1 Reference(ClaimResponse) Adjudication results --></claimResponse>
  <</originalRuleset>

 </coverage>
</ClaimResponse>

JSON Template JSON Template 

{doco
  "resourceType" : "ClaimResponse",
  // from Resource: id, meta, implicitRules, and language
  // from DomainResource: text, contained, extension, and modifierExtension
  "identifier" : [{ Identifier }], // Response  number
  "

  // request[x]: Id of resource triggering adjudication. One of these 2:
  "requestIdentifier" : { Identifier },
  "requestReference" : { Reference(Claim) },

  "ruleset" : { Coding }, // Resource version
  "originalRuleset" : { Coding }, // Original version
  "created" : "<dateTime>", // Creation date
  "
  "
  "

  // organization[x]: Insurer. One of these 2:
  "organizationIdentifier" : { Identifier },
  "organizationReference" : { Reference(Organization) },
  // requestProvider[x]: Responsible practitioner. One of these 2:

  "requestProviderIdentifier" : { Identifier },
  "requestProviderReference" : { Reference(Practitioner) },
  // requestOrganization[x]: Responsible organization. One of these 2:

  "requestOrganizationIdentifier" : { Identifier },
  "requestOrganizationReference" : { Reference(Organization) },

  "outcome" : "<code>", // complete | error
  "disposition" : "<string>", // Disposition Message
  "payeeType" : { Coding }, // Party to be paid any benefits payable
  "item" : [{ // Line items
    "sequenceLinkId" : "<positiveInt>", // R!  Service instance
    "noteNumber" : ["<positiveInt>"], // List of note numbers which apply
    "adjudication" : [{ // Adjudication details
      "

      "category" : { Coding }, // R!  Adjudication category such as co-pay, eligible, benefit, etc.
      "reason" : { Coding }, // Adjudication reason

      "amount" : { Quantity(Money) }, // Monetary amount
      "value" : <decimal> // Non-monetary value
    }],
    "detail" : [{ // Detail line items
      "sequenceLinkId" : "<positiveInt>", // R!  Service instance
      "adjudication" : [{ // Detail adjudication
        "

        "category" : { Coding }, // R!  Adjudication category such as co-pay, eligible, benefit, etc.
        "reason" : { Coding }, // Adjudication reason

        "amount" : { Quantity(Money) }, // Monetary amount
        "value" : <decimal> // Non-monetary value
      }],
      "subDetail" : [{ // Subdetail line items
        "sequenceLinkId" : "<positiveInt>", // R!  Service instance
        "adjudication" : [{ // Subdetail adjudication
          "

          "category" : { Coding }, // R!  Adjudication category such as co-pay, eligible, benefit, etc.
          "reason" : { Coding }, // Adjudication reason

          "amount" : { Quantity(Money) }, // Monetary amount
          "value" : <decimal> // Non-monetary value
        }]
      }]
    }]
  }],
  "addItem" : [{ // Insurer added line items
    "sequenceLinkId" : ["<positiveInt>"], // Service instances
    "service" : { Coding }, // R!  Group, Service or Product
    "fee" : { Quantity(Money) }, // Professional fee or Product charge
    "noteNumberLinkId" : ["<positiveInt>"], // List of note numbers which apply
    "adjudication" : [{ // Added items adjudication
      "

      "category" : { Coding }, // R!  Adjudication category such as co-pay, eligible, benefit, etc.
      "reason" : { Coding }, // Adjudication reason

      "amount" : { Quantity(Money) }, // Monetary amount
      "value" : <decimal> // Non-monetary value
    }],
    "detail" : [{ // Added items details
      "service" : { Coding }, // R!  Service or Product
      "fee" : { Quantity(Money) }, // Professional fee or Product charge
      "adjudication" : [{ // Added items detail adjudication
        "

        "category" : { Coding }, // R!  Adjudication category such as co-pay, eligible, benefit, etc.
        "reason" : { Coding }, // Adjudication reason

        "amount" : { Quantity(Money) }, // Monetary amount
        "value" : <decimal> // Non-monetary value
      }]
    }]
  }],
  "error" : [{ // Processing errors
    "sequenceLinkId" : "<positiveInt>", // Item sequence number
    "detailSequenceLinkId" : "<positiveInt>", // Detail sequence number
    "subdetailSequenceLinkId" : "<positiveInt>", // Subdetail sequence number
    "

    "code" : { Coding } // R!  Error code detailing processing issues

  }],
  "totalCost" : { Quantity(Money) }, // Total Cost of service from the Claim
  "unallocDeductable" : { Quantity(Money) }, // Unallocated deductible
  "totalBenefit" : { Quantity(Money) }, // Total benefit payable for the Claim
  "paymentAdjustment" : { Quantity(Money) }, // Payment adjustment for non-Claim issues
  "

  "paymentAdjustmentReason" : { Coding }, // Reason for Payment adjustment

  "paymentDate" : "<date>", // Expected data of Payment
  "paymentAmount" : { Quantity(Money) }, // Payment amount
  "paymentRef" : { Identifier }, // Payment identifier
  "reserved" : { Coding }, // Funds reserved status
  "form" : { Coding }, // Printed Form Identifier
  "note" : [{ // Processing notes
    "number" : "<positiveInt>", // Note Number for this note
    "type" : { Coding }, // display | print | printoper
    "text" : "<string>" // Note explanatory text
  }],
  "coverage" : [{ // Insurance or medical plan
    "sequence" : "<positiveInt>", // R!  Service instance identifier
    "focal" : <boolean>, // R!  Is the focal Coverage
    "

    // coverage[x]: Insurance information. One of these 2:
    "coverageIdentifier" : { Identifier },
    "coverageReference" : { Reference(Coverage) },

    "businessArrangement" : "<string>", // Business agreement
    "

    "preAuthRef" : ["<string>"], // Pre-Authorization/Determination Reference
    "
    "

    "claimResponse" : { Reference(ClaimResponse) } // Adjudication results

  }]
}

Structure

Id of resource triggering adjudication Insurer Responsible practitioner Responsible organization Reference ( Coverage ) 0..1 Business agreement Coding
Name Flags Card. Type Description & Constraints Description & Constraints doco
. . ClaimResponse Σ DomainResource Remittance resource Remittance resource
. . . identifier Σ 0..* Identifier Response number Response number
. . request . request[x] Σ 0..1 Id of resource triggering adjudication
.... requestIdentifier Identifier
.... requestReference Reference ( Claim )
. . . ruleset Σ 0..1 Coding Resource version Resource version
Ruleset Codes ( Ruleset Codes ( Example )
. . . originalRuleset Σ 0..1 Coding Original version Original version
Ruleset Codes ( Ruleset Codes ( Example )
. . . created Σ 0..1 dateTime Creation date Creation date
. . organization . organization[x] Σ 0..1 Insurer
.... organizationIdentifier Identifier
.... organizationReference Reference ( Organization )
. . requestProvider . requestProvider[x] Σ 0..1 Responsible practitioner
.... requestProviderIdentifier Identifier
.... requestProviderReference Reference ( Practitioner )
. . requestOrganization . requestOrganization[x] Σ 0..1 Responsible organization
.... requestOrganizationIdentifier Identifier
.... requestOrganizationReference Reference ( Organization )
. . . outcome Σ 0..1 code complete | error complete | error
RemittanceOutcome ( ( Required )
. . . disposition Σ 0..1 string Disposition Message Disposition Message
. . . payeeType Σ 0..1 Coding Party to be paid any benefits payable Party to be paid any benefits payable
Payee Type Codes ( Payee Type Codes ( Example )
. . . item Σ 0..* BackboneElement Line items Line items
. . . . sequenceLinkId Σ 1..1 positiveInt Service instance Service instance
. . . . noteNumber Σ 0..* positiveInt List of note numbers which apply List of note numbers which apply
. . . . adjudication Σ 0..* BackboneElement Adjudication details Adjudication details
. . . . code . category Σ 1..1 Coding Adjudication category such as co-pay, eligible, benefit, etc. Adjudication category such as co-pay, eligible, benefit, etc.
Adjudication Codes Adjudication Codes ( Extensible ( )
..... reason Σ 0..1 Coding Adjudication reason
Adjudication Reason Codes ( Extensible )
. . . . . amount Σ 0..1 Money Monetary amount Monetary amount
. . . . . value Σ 0..1 decimal Non-monetary value Non-monetary value
. . . . detail Σ 0..* BackboneElement Detail line items Detail line items
. . . . . sequenceLinkId Σ 1..1 positiveInt Service instance Service instance
. . . . . adjudication Σ 0..* BackboneElement Detail adjudication Detail adjudication
. . . . . code . category Σ 1..1 Coding Adjudication category such as co-pay, eligible, benefit, etc. Adjudication category such as co-pay, eligible, benefit, etc.
Adjudication Codes Adjudication Codes ( Extensible ( )
...... reason Σ 0..1 Coding Adjudication reason
Adjudication Reason Codes ( Extensible )
. . . . . . amount Σ 0..1 Money Monetary amount Monetary amount
. . . . . . value Σ 0..1 decimal Non-monetary value Non-monetary value
. . . . . subDetail Σ 0..* BackboneElement Subdetail line items Subdetail line items
. . . . . . sequenceLinkId Σ 1..1 positiveInt Service instance Service instance
. . . . . . adjudication Σ 0..* BackboneElement Subdetail adjudication Subdetail adjudication
. . . . . . code . category Σ 1..1 Coding Adjudication category such as co-pay, eligible, benefit, etc. Adjudication category such as co-pay, eligible, benefit, etc.
Adjudication Codes Adjudication Codes ( Extensible ( )
....... reason Σ 0..1 Coding Adjudication reason
Adjudication Reason Codes ( Extensible )
. . . . . . . amount Σ 0..1 Money Monetary amount Monetary amount
. . . . . . . value Σ 0..1 decimal Non-monetary value Non-monetary value
. . . addItem Σ 0..* BackboneElement Insurer added line items Insurer added line items
. . . . sequenceLinkId Σ 0..* positiveInt Service instances Service instances
. . . . service Σ 1..1 Coding Group, Service or Product Group, Service or Product
USCLS Codes ( USCLS Codes ( Example )
. . . . fee Σ 0..1 Money Professional fee or Product charge Professional fee or Product charge
. . . . noteNumberLinkId Σ 0..* positiveInt List of note numbers which apply List of note numbers which apply
. . . . adjudication Σ 0..* BackboneElement Added items adjudication Added items adjudication
. . . . code . category Σ 1..1 Coding Adjudication category such as co-pay, eligible, benefit, etc. Adjudication category such as co-pay, eligible, benefit, etc.
Adjudication Codes Adjudication Codes ( Extensible ( )
..... reason Σ 0..1 Coding Adjudication reason
Adjudication Reason Codes ( Extensible )
. . . . . amount Σ 0..1 Money Monetary amount Monetary amount
. . . . . value Σ 0..1 decimal Non-monetary value Non-monetary value
. . . . detail Σ 0..* BackboneElement Added items details Added items details
. . . . . service Σ 1..1 Coding Service or Product Service or Product
USCLS Codes ( USCLS Codes ( Example )
. . . . . fee Σ 0..1 Money Professional fee or Product charge Professional fee or Product charge
. . . . . adjudication Σ 0..* BackboneElement Added items detail adjudication Added items detail adjudication
. . . . . code . category Σ 1..1 Coding Adjudication category such as co-pay, eligible, benefit, etc. Adjudication category such as co-pay, eligible, benefit, etc.
Adjudication Codes Adjudication Codes ( Extensible ( )
...... reason Σ 0..1 Coding Adjudication reason
Adjudication Reason Codes ( Extensible )
. . . . . . amount Σ 0..1 Money Monetary amount Monetary amount
. . . . . . value Σ 0..1 decimal Non-monetary value Non-monetary value
. . . error Σ 0..* BackboneElement Processing errors Processing errors
. . . . sequenceLinkId Σ 0..1 positiveInt Item sequence number Item sequence number
. . . . detailSequenceLinkId Σ 0..1 positiveInt Detail sequence number Detail sequence number
. . . . subdetailSequenceLinkId Σ 0..1 positiveInt Subdetail sequence number Subdetail sequence number
. . . . code Σ 1..1 Coding Error code detailing processing issues Error code detailing processing issues
Adjudication Error Codes ( Required Adjudication Error Codes ( Extensible )
. . . totalCost Σ 0..1 Money Total Cost of service from the Claim Total Cost of service from the Claim
. . . unallocDeductable Σ 0..1 Money Unallocated deductible Unallocated deductible
. . . totalBenefit Σ 0..1 Money Total benefit payable for the Claim Total benefit payable for the Claim
. . . paymentAdjustment Σ 0..1 Money Payment adjustment for non-Claim issues Payment adjustment for non-Claim issues
. . . paymentAdjustmentReason Σ 0..1 Coding Reason for Payment adjustment Reason for Payment adjustment
Adjustment Reason Codes ( Payment Adjustment Reason Codes ( Extensible )
. . . paymentDate Σ 0..1 date Expected data of Payment Expected data of Payment
. . . paymentAmount Σ 0..1 Money Payment amount Payment amount
. . . paymentRef Σ 0..1 Identifier Payment identifier Payment identifier
. . . reserved Σ 0..1 Coding Funds reserved status Funds reserved status
Funds Reservation Codes ( Funds Reservation Codes ( Example )
. . . form Σ 0..1 Coding Printed Form Identifier Printed Form Identifier
Form Codes ( Form Codes ( Required )
. . . note Σ 0..* BackboneElement Processing notes Processing notes
. . . . number Σ 0..1 positiveInt Note Number for this note Note Number for this note
. . . . type Σ 0..1 Coding display | print | printoper display | print | printoper
NoteType ( ( Required )
. . . . text Σ 0..1 string Note explanatory text Note explanatory text
. . . coverage Σ 0..* BackboneElement Insurance or medical plan Insurance or medical plan
. . . . sequence Σ 1..1 positiveInt Service instance identifier Service instance identifier
. . . . focal Σ 1..1 boolean Is the focal Coverage Is the focal Coverage
. . . coverage . coverage[x] Σ 1..1 Insurance information Insurance information
. . businessArrangement . . Σ . coverageIdentifier string Identifier
. . relationship Σ . . 1..1 . coverageReference Patient relationship to subscriber Surface Codes Reference ( Example Coverage )
. . . preAuthRef . businessArrangement Σ 0..* 0..1 string Pre-Authorization/Determination Reference Business agreement
. . . claimResponse . preAuthRef Σ 0..1 0..* Reference ( ClaimResponse string ) Adjudication results Pre-Authorization/Determination Reference
. . . originalRuleset . claimResponse Σ 0..1 Coding Original version Ruleset Codes Reference ( Example ClaimResponse ) Adjudication results

Documentation for this format doco Documentation for this format

UML Diagram UML Diagram

ClaimResponse ( ( DomainResource ) The Response business identifier The Response business identifier identifier : : Identifier [0..*] [0..*] Original request resource referrence Original request resource referrence request request[x] : Type [0..1] « Identifier : | Reference [0..1] « ( Claim » ) » The version of the style of resource contents. This should be mapped to the allowable profiles for this and supporting resources The version of the style of resource contents. This should be mapped to the allowable profiles for this and supporting resources ruleset : : Coding [0..1] « [0..1] « The static and dynamic model to which contents conform, which may be business version or standard/version. (Strength=Example) The static and dynamic model to which contents conform, which may be business version or standard/version. (Strength=Example) Ruleset ?? » Ruleset ?? » The style (standard) and version of the original material which was converted into this resource The style (standard) and version of the original material which was converted into this resource originalRuleset : : Coding [0..1] « [0..1] « The static and dynamic model to which contents conform, which may be business version or standard/version. (Strength=Example) The static and dynamic model to which contents conform, which may be business version or standard/version. (Strength=Example) Ruleset ?? » Ruleset ?? » The date when the enclosed suite of services were performed or completed The date when the enclosed suite of services were performed or completed created : : dateTime [0..1] [0..1] The Insurer who produced this adjudicated response The Insurer who produced this adjudicated response organization organization[x] : Type [0..1] « Identifier : | Reference [0..1] « ( Organization » ) » The practitioner who is responsible for the services rendered to the patient The practitioner who is responsible for the services rendered to the patient requestProvider requestProvider[x] : Type [0..1] « Identifier : | Reference [0..1] « ( Practitioner » ) » The organization which is responsible for the services rendered to the patient The organization which is responsible for the services rendered to the patient requestOrganization requestOrganization[x] : Type [0..1] « Identifier : | Reference [0..1] « ( Organization » ) » Transaction status: error, complete Transaction status: error, complete outcome : : code [0..1] « [0..1] « The outcome of the processing. (Strength=Required) The outcome of the processing. (Strength=Required) RemittanceOutcome ! » ! » A description of the status of the adjudication A description of the status of the adjudication disposition : : string [0..1] [0..1] Party to be reimbursed: Subscriber, provider, other Party to be reimbursed: Subscriber, provider, other payeeType : : Coding [0..1] « [0..1] « A code for the party to be reimbursed. (Strength=Example) A code for the party to be reimbursed. (Strength=Example) Payee Type ?? » Payee Type ?? » The total cost of the services reported The total cost of the services reported totalCost : : Quantity ( Money ) [0..1] ) [0..1] The amount of deductible applied which was not allocated to any particular service line The amount of deductible applied which was not allocated to any particular service line unallocDeductable : : Quantity ( Money ) [0..1] ) [0..1] Total amount of benefit payable (Equal to sum of the Benefit amounts from all detail lines and additions less the Unallocated Deductible) Total amount of benefit payable (Equal to sum of the Benefit amounts from all detail lines and additions less the Unallocated Deductible) totalBenefit : : Quantity ( Money ) [0..1] ) [0..1] Adjustment to the payment of this transaction which is not related to adjudication of this transaction Adjustment to the payment of this transaction which is not related to adjudication of this transaction paymentAdjustment : : Quantity ( Money ) [0..1] ) [0..1] Reason for the payment adjustment Reason for the payment adjustment paymentAdjustmentReason : : Coding [0..1] « [0..1] « Adjustment reason codes. (Strength=Extensible) Payment Adjustment reason codes. (Strength=Extensible) Adjustment Reason + » Payment Adjustment Reason + » Estimated payment data Estimated payment data paymentDate : : date [0..1] [0..1] Payable less any payment adjustment Payable less any payment adjustment paymentAmount : : Quantity ( Money ) [0..1] ) [0..1] Payment identifier Payment identifier paymentRef : : Identifier [0..1] [0..1] Status of funds reservation (For provider, for Patient, None) Status of funds reservation (For provider, for Patient, None) reserved : : Coding [0..1] « [0..1] « For whom funds are to be reserved: (Patient, Provider, None). (Strength=Example) For whom funds are to be reserved: (Patient, Provider, None). (Strength=Example) Funds Reservation ?? » Funds Reservation ?? » The form to be used for printing the content The form to be used for printing the content form : : Coding [0..1] « [0..1] « The forms codes. (Strength=Required) The forms codes. (Strength=Required) Form ! » Form ! » Items A service line number A service line number sequenceLinkId : : positiveInt [1..1] [1..1] A list of note references to the notes provided below A list of note references to the notes provided below noteNumber : : positiveInt [0..*] [0..*] ItemAdjudication Code indicating: Co-Pay, deductible, eligible, benefit, tax, etc Code indicating: Co-Pay, deductible, eligible, benefit, tax, etc code : category : Coding [1..1] « [1..1] « The adjudication codes. (Strength=Extensible) The adjudication codes. (Strength=Extensible) Adjudication + » Adjudication + » Adjudication reason such as limit reached reason : Coding [0..1] « The adjudication reason codes. (Strength=Extensible) Adjudication Reason + » Monetary amount associated with the code Monetary amount associated with the code amount : : Quantity ( Money ) [0..1] ) [0..1] A non-monetary value for example a percentage. Mutually exclusive to the amount element above A non-monetary value for example a percentage. Mutually exclusive to the amount element above value : : decimal [0..1] [0..1] ItemDetail A service line number A service line number sequenceLinkId : : positiveInt [1..1] [1..1] DetailAdjudication Code indicating: Co-Pay, deductible, eligible, benefit, tax, etc Code indicating: Co-Pay, deductible, eligible, benefit, tax, etc code : category : Coding [1..1] « [1..1] « The adjudication codes. (Strength=Extensible) The adjudication codes. (Strength=Extensible) Adjudication + » Adjudication + » Adjudication reason such as limit reached reason : Coding [0..1] « The adjudication reason codes. (Strength=Extensible) Adjudication Reason + » Monetary amount associated with the code Monetary amount associated with the code amount : : Quantity ( Money ) [0..1] ) [0..1] A non-monetary value for example a percentage. Mutually exclusive to the amount element above A non-monetary value for example a percentage. Mutually exclusive to the amount element above value : : decimal [0..1] [0..1] SubDetail A service line number A service line number sequenceLinkId : : positiveInt [1..1] [1..1] SubdetailAdjudication Code indicating: Co-Pay, deductible, eligible, benefit, tax, etc Code indicating: Co-Pay, deductible, eligible, benefit, tax, etc code : category : Coding [1..1] « [1..1] « The adjudication codes. (Strength=Extensible) The adjudication codes. (Strength=Extensible) Adjudication + » Adjudication + » Adjudication reason such as limit reached reason : Coding [0..1] « The adjudication reason codes. (Strength=Extensible) Adjudication Reason + » Monetary amount associated with the code Monetary amount associated with the code amount : : Quantity ( Money ) [0..1] ) [0..1] A non-monetary value for example a percentage. Mutually exclusive to the amount element above A non-monetary value for example a percentage. Mutually exclusive to the amount element above value : : decimal [0..1] [0..1] AddedItem List of input service items which this service line is intended to replace List of input service items which this service line is intended to replace sequenceLinkId : : positiveInt [0..*] [0..*] A code to indicate the Professional Service or Product supplied A code to indicate the Professional Service or Product supplied service : : Coding [1..1] « [1..1] « Allowable service and product codes. (Strength=Example) Allowable service and product codes. (Strength=Example) USCLS ?? » USCLS ?? » The fee charged for the professional service or product. The fee charged for the professional service or product. fee : : Quantity ( Money ) [0..1] ) [0..1] A list of note references to the notes provided below A list of note references to the notes provided below noteNumberLinkId : : positiveInt [0..*] [0..*] AddedItemAdjudication Code indicating: Co-Pay, deductible, eligible, benefit, tax, etc Code indicating: Co-Pay, deductible, eligible, benefit, tax, etc code : category : Coding [1..1] « [1..1] « The adjudication codes. (Strength=Extensible) The adjudication codes. (Strength=Extensible) Adjudication + » Adjudication + » Adjudication reason such as limit reached reason : Coding [0..1] « The adjudication reason codes. (Strength=Extensible) Adjudication Reason + » Monetary amount associated with the code Monetary amount associated with the code amount : : Quantity ( Money ) [0..1] ) [0..1] A non-monetary value for example a percentage. Mutually exclusive to the amount element above A non-monetary value for example a percentage. Mutually exclusive to the amount element above value : : decimal [0..1] [0..1] AddedItemsDetail A code to indicate the Professional Service or Product supplied A code to indicate the Professional Service or Product supplied service : : Coding [1..1] « [1..1] « Allowable service and product codes. (Strength=Example) Allowable service and product codes. (Strength=Example) USCLS ?? » USCLS ?? » The fee charged for the professional service or product. The fee charged for the professional service or product. fee : : Quantity ( Money ) [0..1] ) [0..1] AddedItemDetailAdjudication Code indicating: Co-Pay, deductible, eligible, benefit, tax, etc Code indicating: Co-Pay, deductible, eligible, benefit, tax, etc code : category : Coding [1..1] « [1..1] « The adjudication codes. (Strength=Extensible) The adjudication codes. (Strength=Extensible) Adjudication + » Adjudication + » Adjudication reason such as limit reached reason : Coding [0..1] « The adjudication reason codes. (Strength=Extensible) Adjudication Reason + » Monetary amount associated with the code Monetary amount associated with the code amount : : Quantity ( Money ) [0..1] ) [0..1] A non-monetary value for example a percentage. Mutually exclusive to the amount element above A non-monetary value for example a percentage. Mutually exclusive to the amount element above value : : decimal [0..1] [0..1] Errors The sequence number of the line item submitted which contains the error. This value is omitted when the error is elsewhere The sequence number of the line item submitted which contains the error. This value is omitted when the error is elsewhere sequenceLinkId : : positiveInt [0..1] [0..1] The sequence number of the addition within the line item submitted which contains the error. This value is omitted when the error is not related to an Addition The sequence number of the addition within the line item submitted which contains the error. This value is omitted when the error is not related to an Addition detailSequenceLinkId : : positiveInt [0..1] [0..1] The sequence number of the addition within the line item submitted which contains the error. This value is omitted when the error is not related to an Addition The sequence number of the addition within the line item submitted which contains the error. This value is omitted when the error is not related to an Addition subdetailSequenceLinkId : : positiveInt [0..1] [0..1] An error code,froma specified code system, which details why the claim could not be adjudicated An error code,from a specified code system, which details why the claim could not be adjudicated code : : Coding [1..1] « [1..1] « The error codes for adjudication processing. (Strength=Required) The adjudication error codes. (Strength=Extensible) Adjudication Error ! » Adjudication Error + » Notes An integer associated with each note which may be referred to from each service line item An integer associated with each note which may be referred to from each service line item number : : positiveInt [0..1] [0..1] The note purpose: Print/Display The note purpose: Print/Display type : : Coding [0..1] « [0..1] « The presentation types of notes. (Strength=Required) The presentation types of notes. (Strength=Required) NoteType ! » ! » The note text The note text text : : string [0..1] [0..1] Coverage A service line item A service line item sequence : : positiveInt [1..1] [1..1] The instance number of the Coverage which is the focus for adjudication. The Coverage against which the claim is to be adjudicated The instance number of the Coverage which is the focus for adjudication. The Coverage against which the claim is to be adjudicated focal : : boolean [1..1] [1..1] Reference to the program or plan identification, underwriter or payor Reference to the program or plan identification, underwriter or payor coverage coverage[x] : Type [1..1] « Identifier : | Reference [1..1] « ( Coverage » ) » The contract number of a business agreement which describes the terms and conditions The contract number of a business agreement which describes the terms and conditions businessArrangement : : string [0..1] [0..1] The relationship of the patient to the subscriber relationship : Coding [1..1] « The code for the relationship of the patient to the subscriber. (Strength=Example) Surface ?? » A list of references from the Insurer to which these services pertain A list of references from the Insurer to which these services pertain preAuthRef : : string [0..*] [0..*] The Coverages adjudication details The Coverages adjudication details claimResponse : : Reference [0..1] « [0..1] « ClaimResponse » The style (standard) and version of the original material which was converted into this resource originalRuleset : Coding [0..1] « The static and dynamic model to which contents conform, which may be business version or standard/version. (Strength=Example) Ruleset ?? » » The adjudications results The adjudications results adjudication [0..*] The adjudications results The adjudications results adjudication [0..*] The adjudications results The adjudications results adjudication [0..*] The third tier service adjudications for submitted services The third tier service adjudications for submitted services subDetail [0..*] The second tier service adjudications for submitted services The second tier service adjudications for submitted services detail [0..*] The first tier service adjudications for submitted services The first tier service adjudications for submitted services item [0..*] The adjudications results The adjudications results adjudication [0..*] The adjudications results The adjudications results adjudication [0..*] The second tier service adjudications for payor added services The second tier service adjudications for payor added services detail [0..*] The first tier service adjudications for payor added services The first tier service adjudications for payor added services addItem [0..*] Mutually exclusive with Services Provided (Item) Mutually exclusive with Services Provided (Item) error [0..*] Note text Note text note [0..*] Financial instrument by which payment information for health care Financial instrument by which payment information for health care coverage [0..*]

XML Template XML Template 

<ClaimResponse xmlns="http://hl7.org/fhir"> doco
 <!-- from Resource: id, meta, implicitRules, and language -->
 <!-- from DomainResource: text, contained, extension, and modifierExtension -->
 <identifier><!-- 0..* Identifier Response  number --></identifier>
 <</request>

 <request[x]><!-- 0..1 Identifier|Reference(Claim) Id of resource triggering adjudication --></request[x]>

 <ruleset><!-- 0..1 Coding Resource version --></ruleset>
 <originalRuleset><!-- 0..1 Coding Original version --></originalRuleset>
 <created value="[dateTime]"/><!-- 0..1 Creation date -->
 <</organization>
 <</requestProvider>
 <</requestOrganization>

 <organization[x]><!-- 0..1 Identifier|Reference(Organization) Insurer --></organization[x]>
 <requestProvider[x]><!-- 0..1 Identifier|Reference(Practitioner) Responsible practitioner --></requestProvider[x]>
 <requestOrganization[x]><!-- 0..1 Identifier|Reference(Organization) Responsible organization --></requestOrganization[x]>

 <outcome value="[code]"/><!-- 0..1 complete | error -->
 <disposition value="[string]"/><!-- 0..1 Disposition Message -->
 <payeeType><!-- 0..1 Coding Party to be paid any benefits payable --></payeeType>
 <item>  <!-- 0..* Line items -->
  <sequenceLinkId value="[positiveInt]"/><!-- 1..1 Service instance -->
  <noteNumber value="[positiveInt]"/><!-- 0..* List of note numbers which apply -->
  <adjudication>  <!-- 0..* Adjudication details -->
   <</code>

   <category><!-- 1..1 Coding Adjudication category such as co-pay, eligible, benefit, etc. --></category>
   <reason><!-- 0..1 Coding Adjudication reason --></reason>

   <amount><!-- 0..1 Quantity(Money) Monetary amount --></amount>
   <value value="[decimal]"/><!-- 0..1 Non-monetary value -->
  </adjudication>
  <detail>  <!-- 0..* Detail line items -->
   <sequenceLinkId value="[positiveInt]"/><!-- 1..1 Service instance -->
   <adjudication>  <!-- 0..* Detail adjudication -->
    <</code>

    <category><!-- 1..1 Coding Adjudication category such as co-pay, eligible, benefit, etc. --></category>
    <reason><!-- 0..1 Coding Adjudication reason --></reason>

    <amount><!-- 0..1 Quantity(Money) Monetary amount --></amount>
    <value value="[decimal]"/><!-- 0..1 Non-monetary value -->
   </adjudication>
   <subDetail>  <!-- 0..* Subdetail line items -->
    <sequenceLinkId value="[positiveInt]"/><!-- 1..1 Service instance -->
    <adjudication>  <!-- 0..* Subdetail adjudication -->
     <</code>

     <category><!-- 1..1 Coding Adjudication category such as co-pay, eligible, benefit, etc. --></category>
     <reason><!-- 0..1 Coding Adjudication reason --></reason>

     <amount><!-- 0..1 Quantity(Money) Monetary amount --></amount>
     <value value="[decimal]"/><!-- 0..1 Non-monetary value -->
    </adjudication>
   </subDetail>
  </detail>
 </item>
 <addItem>  <!-- 0..* Insurer added line items -->
  <sequenceLinkId value="[positiveInt]"/><!-- 0..* Service instances -->
  <service><!-- 1..1 Coding Group, Service or Product --></service>
  <fee><!-- 0..1 Quantity(Money) Professional fee or Product charge --></fee>
  <noteNumberLinkId value="[positiveInt]"/><!-- 0..* List of note numbers which apply -->
  <adjudication>  <!-- 0..* Added items adjudication -->
   <</code>

   <category><!-- 1..1 Coding Adjudication category such as co-pay, eligible, benefit, etc. --></category>
   <reason><!-- 0..1 Coding Adjudication reason --></reason>

   <amount><!-- 0..1 Quantity(Money) Monetary amount --></amount>
   <value value="[decimal]"/><!-- 0..1 Non-monetary value -->
  </adjudication>
  <detail>  <!-- 0..* Added items details -->
   <service><!-- 1..1 Coding Service or Product --></service>
   <fee><!-- 0..1 Quantity(Money) Professional fee or Product charge --></fee>
   <adjudication>  <!-- 0..* Added items detail adjudication -->
    <</code>

    <category><!-- 1..1 Coding Adjudication category such as co-pay, eligible, benefit, etc. --></category>
    <reason><!-- 0..1 Coding Adjudication reason --></reason>

    <amount><!-- 0..1 Quantity(Money) Monetary amount --></amount>
    <value value="[decimal]"/><!-- 0..1 Non-monetary value -->
   </adjudication>
  </detail>
 </addItem>
 <error>  <!-- 0..* Processing errors -->
  <sequenceLinkId value="[positiveInt]"/><!-- 0..1 Item sequence number -->
  <detailSequenceLinkId value="[positiveInt]"/><!-- 0..1 Detail sequence number -->
  <subdetailSequenceLinkId value="[positiveInt]"/><!-- 0..1 Subdetail sequence number -->
  <</code>

  <code><!-- 1..1 Coding Error code detailing processing issues --></code>

 </error>
 <totalCost><!-- 0..1 Quantity(Money) Total Cost of service from the Claim --></totalCost>
 <unallocDeductable><!-- 0..1 Quantity(Money) Unallocated deductible --></unallocDeductable>
 <totalBenefit><!-- 0..1 Quantity(Money) Total benefit payable for the Claim --></totalBenefit>
 <paymentAdjustment><!-- 0..1 Quantity(Money) Payment adjustment for non-Claim issues --></paymentAdjustment>
 <</paymentAdjustmentReason>

 <paymentAdjustmentReason><!-- 0..1 Coding Reason for Payment adjustment --></paymentAdjustmentReason>

 <paymentDate value="[date]"/><!-- 0..1 Expected data of Payment -->
 <paymentAmount><!-- 0..1 Quantity(Money) Payment amount --></paymentAmount>
 <paymentRef><!-- 0..1 Identifier Payment identifier --></paymentRef>
 <reserved><!-- 0..1 Coding Funds reserved status --></reserved>
 <form><!-- 0..1 Coding Printed Form Identifier --></form>
 <note>  <!-- 0..* Processing notes -->
  <number value="[positiveInt]"/><!-- 0..1 Note Number for this note -->
  <type><!-- 0..1 Coding display | print | printoper --></type>
  <text value="[string]"/><!-- 0..1 Note explanatory text -->
 </note>
 <coverage>  <!-- 0..* Insurance or medical plan -->
  <sequence value="[positiveInt]"/><!-- 1..1 Service instance identifier -->
  <focal value="[boolean]"/><!-- 1..1 Is the focal Coverage -->
  <</coverage>

  <coverage[x]><!-- 1..1 Identifier|Reference(Coverage) Insurance information --></coverage[x]>

  <businessArrangement value="[string]"/><!-- 0..1 Business agreement -->
  <</relationship>

  <preAuthRef value="[string]"/><!-- 0..* Pre-Authorization/Determination Reference -->
  <claimResponse><!-- 0..1 Reference(ClaimResponse) Adjudication results --></claimResponse>
  <</originalRuleset>

 </coverage>
</ClaimResponse>

JSON Template JSON Template 

{doco
  "resourceType" : "ClaimResponse",
  // from Resource: id, meta, implicitRules, and language
  // from DomainResource: text, contained, extension, and modifierExtension
  "identifier" : [{ Identifier }], // Response  number
  "

  // request[x]: Id of resource triggering adjudication. One of these 2:
  "requestIdentifier" : { Identifier },
  "requestReference" : { Reference(Claim) },

  "ruleset" : { Coding }, // Resource version
  "originalRuleset" : { Coding }, // Original version
  "created" : "<dateTime>", // Creation date
  "
  "
  "

  // organization[x]: Insurer. One of these 2:
  "organizationIdentifier" : { Identifier },
  "organizationReference" : { Reference(Organization) },
  // requestProvider[x]: Responsible practitioner. One of these 2:

  "requestProviderIdentifier" : { Identifier },
  "requestProviderReference" : { Reference(Practitioner) },
  // requestOrganization[x]: Responsible organization. One of these 2:

  "requestOrganizationIdentifier" : { Identifier },
  "requestOrganizationReference" : { Reference(Organization) },

  "outcome" : "<code>", // complete | error
  "disposition" : "<string>", // Disposition Message
  "payeeType" : { Coding }, // Party to be paid any benefits payable
  "item" : [{ // Line items
    "sequenceLinkId" : "<positiveInt>", // R!  Service instance
    "noteNumber" : ["<positiveInt>"], // List of note numbers which apply
    "adjudication" : [{ // Adjudication details
      "

      "category" : { Coding }, // R!  Adjudication category such as co-pay, eligible, benefit, etc.
      "reason" : { Coding }, // Adjudication reason

      "amount" : { Quantity(Money) }, // Monetary amount
      "value" : <decimal> // Non-monetary value
    }],
    "detail" : [{ // Detail line items
      "sequenceLinkId" : "<positiveInt>", // R!  Service instance
      "adjudication" : [{ // Detail adjudication
        "

        "category" : { Coding }, // R!  Adjudication category such as co-pay, eligible, benefit, etc.
        "reason" : { Coding }, // Adjudication reason

        "amount" : { Quantity(Money) }, // Monetary amount
        "value" : <decimal> // Non-monetary value
      }],
      "subDetail" : [{ // Subdetail line items
        "sequenceLinkId" : "<positiveInt>", // R!  Service instance
        "adjudication" : [{ // Subdetail adjudication
          "

          "category" : { Coding }, // R!  Adjudication category such as co-pay, eligible, benefit, etc.
          "reason" : { Coding }, // Adjudication reason

          "amount" : { Quantity(Money) }, // Monetary amount
          "value" : <decimal> // Non-monetary value
        }]
      }]
    }]
  }],
  "addItem" : [{ // Insurer added line items
    "sequenceLinkId" : ["<positiveInt>"], // Service instances
    "service" : { Coding }, // R!  Group, Service or Product
    "fee" : { Quantity(Money) }, // Professional fee or Product charge
    "noteNumberLinkId" : ["<positiveInt>"], // List of note numbers which apply
    "adjudication" : [{ // Added items adjudication
      "

      "category" : { Coding }, // R!  Adjudication category such as co-pay, eligible, benefit, etc.
      "reason" : { Coding }, // Adjudication reason

      "amount" : { Quantity(Money) }, // Monetary amount
      "value" : <decimal> // Non-monetary value
    }],
    "detail" : [{ // Added items details
      "service" : { Coding }, // R!  Service or Product
      "fee" : { Quantity(Money) }, // Professional fee or Product charge
      "adjudication" : [{ // Added items detail adjudication
        "

        "category" : { Coding }, // R!  Adjudication category such as co-pay, eligible, benefit, etc.
        "reason" : { Coding }, // Adjudication reason

        "amount" : { Quantity(Money) }, // Monetary amount
        "value" : <decimal> // Non-monetary value
      }]
    }]
  }],
  "error" : [{ // Processing errors
    "sequenceLinkId" : "<positiveInt>", // Item sequence number
    "detailSequenceLinkId" : "<positiveInt>", // Detail sequence number
    "subdetailSequenceLinkId" : "<positiveInt>", // Subdetail sequence number
    "

    "code" : { Coding } // R!  Error code detailing processing issues

  }],
  "totalCost" : { Quantity(Money) }, // Total Cost of service from the Claim
  "unallocDeductable" : { Quantity(Money) }, // Unallocated deductible
  "totalBenefit" : { Quantity(Money) }, // Total benefit payable for the Claim
  "paymentAdjustment" : { Quantity(Money) }, // Payment adjustment for non-Claim issues
  "

  "paymentAdjustmentReason" : { Coding }, // Reason for Payment adjustment

  "paymentDate" : "<date>", // Expected data of Payment
  "paymentAmount" : { Quantity(Money) }, // Payment amount
  "paymentRef" : { Identifier }, // Payment identifier
  "reserved" : { Coding }, // Funds reserved status
  "form" : { Coding }, // Printed Form Identifier
  "note" : [{ // Processing notes
    "number" : "<positiveInt>", // Note Number for this note
    "type" : { Coding }, // display | print | printoper
    "text" : "<string>" // Note explanatory text
  }],
  "coverage" : [{ // Insurance or medical plan
    "sequence" : "<positiveInt>", // R!  Service instance identifier
    "focal" : <boolean>, // R!  Is the focal Coverage
    "

    // coverage[x]: Insurance information. One of these 2:
    "coverageIdentifier" : { Identifier },
    "coverageReference" : { Reference(Coverage) },

    "businessArrangement" : "<string>", // Business agreement
    "

    "preAuthRef" : ["<string>"], // Pre-Authorization/Determination Reference
    "
    "

    "claimResponse" : { Reference(ClaimResponse) } // Adjudication results

  }]
}

  Alternate definitions:

Alternate definitions: Schema / Schematron , Resource Profile ( , Resource Profile ( XML , , JSON ), ), Questionnaire

7.2.2.1 Terminology Bindings Terminology Bindings

ClaimResponse.paymentAdjustmentReason
Path Definition Type Reference
ClaimResponse.ruleset
ClaimResponse.originalRuleset ClaimResponse.coverage.originalRuleset ClaimResponse.originalRuleset 		The static and dynamic model to which contents conform, which may be business version or standard/version. The static and dynamic model to which contents conform, which may be business version or standard/version. Example Ruleset Codes Ruleset Codes
ClaimResponse.outcome ClaimResponse.outcome The outcome of the processing. The outcome of the processing. Required RemittanceOutcome
ClaimResponse.payeeType ClaimResponse.payeeType A code for the party to be reimbursed. A code for the party to be reimbursed. Example Payee Type Codes Payee Type Codes
ClaimResponse.item.adjudication.code ClaimResponse.item.adjudication.category
ClaimResponse.item.detail.adjudication.code ClaimResponse.item.detail.adjudication.category
ClaimResponse.item.detail.subDetail.adjudication.code ClaimResponse.item.detail.subDetail.adjudication.category
ClaimResponse.addItem.adjudication.code ClaimResponse.addItem.adjudication.category
ClaimResponse.addItem.detail.adjudication.code ClaimResponse.addItem.detail.adjudication.category 		The adjudication codes. The adjudication codes. Extensible Adjudication Codes Adjudication Codes
ClaimResponse.item.adjudication.reason
ClaimResponse.item.detail.adjudication.reason
ClaimResponse.item.detail.subDetail.adjudication.reason
ClaimResponse.addItem.adjudication.reason
ClaimResponse.addItem.detail.adjudication.reason 		The adjudication reason codes. Extensible Adjudication Reason Codes
ClaimResponse.addItem.service
ClaimResponse.addItem.detail.service ClaimResponse.addItem.detail.service 		Allowable service and product codes. Allowable service and product codes. Example USCLS Codes USCLS Codes
ClaimResponse.error.code ClaimResponse.error.code The error codes for adjudication processing. The adjudication error codes. Required Extensible Adjudication Error Codes Adjudication Error Codes
ClaimResponse.paymentAdjustmentReason Adjustment reason codes. Payment Adjustment reason codes. Extensible Adjustment Reason Codes Payment Adjustment Reason Codes
ClaimResponse.reserved ClaimResponse.reserved For whom funds are to be reserved: (Patient, Provider, None). For whom funds are to be reserved: (Patient, Provider, None). Example Funds Reservation Codes Funds Reservation Codes
ClaimResponse.form ClaimResponse.form The forms codes. The forms codes. Required Form Codes Form Codes
ClaimResponse.note.type ClaimResponse.note.type The presentation types of notes. The presentation types of notes. Required NoteType ClaimResponse.coverage.relationship The code for the relationship of the patient to the subscriber. Example Surface Codes

7.2.3 Search Parameters Search Parameters Search parameters for this resource. The common parameters also apply. See

Search parameters for this resource. The common parameters also apply. See Searching for more information about searching in REST, messaging, and services. for more information about searching in REST, messaging, and services.

© HL7.org 2011+. FHIR DSTU2 (v1.0.2-7202) generated on Sat, Oct 24, 2015 07:43+1100. Links: Search
Name Type Description Paths
created date The creation date ClaimResponse.created
disposition string The contents of the disposition message ClaimResponse.disposition
identifier token The identity of the insurer The identity of the insurer ClaimResponse.identifier
organizationidentifier token | Version History The organization who generated this resource ClaimResponse.organizationIdentifier
organizationreference reference | Table of Contents The organization who generated this resource ClaimResponse.organizationReference
( Organization | Compare to DSTU1 )
outcome token | The processing outcome ClaimResponse.outcome
paymentdate date | Propose a change The expected paymentDate ClaimResponse.paymentDate
requestidentifier token The claim reference ClaimResponse.requestIdentifier
requestreference reference The claim reference ClaimResponse.requestReference
( Claim try { var currentTabIndex = sessionStorage.getItem('fhir-resource-tab-index'); } catch(exception){ } if (!currentTabIndex) currentTabIndex = '0'; $( '#tabs' ).tabs({ active: currentTabIndex, activate: function( event, ui ) { var active = $('.selector').tabs('option', 'active'); currentTabIndex = ui.newTab.index(); document.activeElement.blur(); try { sessionStorage.setItem('fhir-resource-tab-index', currentTabIndex); } catch(exception){ } } });