~~FHIR Release 3 (STU)~~ R4 Ballot #1 (Mixed Normative/Trial use)

This page is part of the FHIR Specification ~~(v3.0.2: STU 3).~~ (v3.3.0: R4 Ballot 2). The current version which supercedes this version is 5.0.0 . For a full list of available versions, see the Directory of published versions . Page versions: R5 R4B R4 R3 R2

13.7 Resource ClaimResponse - Content

Financial Management

Work Group

Maturity Level : 2

Trial Use

Compartments : Patient , Practitioner

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

13.7.1 Scope and Usage

The ClaimResponse resource provides application level error or application level adjudication results which are the result of processing a submitted Claim resource where that Claim may be 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: Claim, Re-adjudication and Reversals.

The ClaimResponse may have been created by interpreting the corresponding Claim resource as a request for payment (the oldest sense of a claim), a request for preauthorization or a request for predetermination. These interpretations are described at the Claim resource. It is possible for the consumer of the ClaimResponse resource to know the manner in which the Claim resource was processed by checking the Claim.use code.

Where the producer of the ClaimResponse resource interpreted the Claim as a traditional claim, the contents of the ClaimResponse includes information that the producer of the ClaimResponse intends to pay. The actual payment, however, is conveyed separately, perhaps through an eletronic funds transfer protocol outside the domain of FHIR or possibly by a paper check.

However, when the producer of the ClaimResponse interpreted the Claim as request for preauthorization or predetermination, the ClaimResponse does not imply that such a payment is pending. Actual payment would only follow the interpretation fo a Claim resource as a traditional claim.

This resource is referenced by Claim ~~and~~ , DeviceRequest , ExplanationOfBenefit , MedicationRequest and ServiceRequest

Structure

~~0..* see adjudication~~ detail 0..* BackboneElement Added items details revenue 0..1 CodeableConcept Revenue or cost center code Example Revenue Center Codes ( Example ) category 0..1 CodeableConcept Type of service or product Benefit SubCategory Codes ( Example ) service 0..1 CodeableConcept Service or Product USCLS Codes ( Example ) modifier 0..* CodeableConcept Service/Product billing modifiers Modifier type Codes ( Example ) fee 0..1 Money Professional fee or Product charge noteNumber 0..* positiveInt List of note numbers which apply adjudication

Name	Flags	Card.	Type	Description & Constraints
ClaimResponse	TU		DomainResource	Remittance resource Elements defined in Ancestors: id , meta , implicitRules , language , text , contained , extension , modifierExtension
identifier		0..*	Identifier	Response number
status	?! Σ	0..1	code	active \| cancelled \| draft \| entered-in-error Financial Resource Status Codes ( Required )
type		0..1	CodeableConcept	Type or discipline Claim Type Codes ( Extensible )
subType		0..*	CodeableConcept	Finer grained claim type information Example Claim SubType Codes ( Example )
use		0..1	code	complete \| proposed \| exploratory \| other Use ( Required )
patient		0..1	Reference ( Patient )	The subject of the Products and Services
created		0..1	dateTime	Creation date
insurer		0..1	Reference ( Organization )	Insurance issuing organization
requestProvider		0..1	Reference ( Practitioner ~~) Responsible practitioner requestOrganization 0..1 Reference~~ \| PractitionerRole ( \| Organization )	Responsible ~~organization~~ practitioner
request		0..1	Reference ( Claim )	Id of resource triggering adjudication
outcome		0..1	~~CodeableConcept~~ code	queued \| complete \| error \| partial Claim Processing Codes ( ~~Example~~ Required )
disposition		0..1	string	Disposition Message
payeeType		0..1	CodeableConcept	Party to be paid any benefits payable Claim Payee Type Codes ( Example )
item		0..*	BackboneElement	Line items
~~sequenceLinkId~~ itemSequence		1..1	positiveInt	Service instance
noteNumber		0..*	positiveInt	List of note numbers which apply
adjudication		0..*	BackboneElement	Adjudication details
category		1..1	CodeableConcept	Adjudication category such as co-pay, eligible, benefit, etc. Adjudication Value Codes ( Example )
reason		0..1	CodeableConcept	Explanation of Adjudication outcome Adjudication Reason Codes ( Example )
amount		0..1	Money	Monetary amount
value		0..1	decimal	Non-monetary value
detail		0..*	BackboneElement	Detail line items
~~sequenceLinkId~~ detailSequence		1..1	positiveInt	Service instance
noteNumber		0..*	positiveInt	List of note numbers which apply
adjudication		0..*	see adjudication	Detail level adjudication details
subDetail		0..*	BackboneElement	Subdetail line items
~~sequenceLinkId~~ subDetailSequence		1..1	positiveInt	Service instance
noteNumber		0..*	positiveInt	List of note numbers which apply
adjudication		0..*	see adjudication	Subdetail level adjudication details
addItem		0..*	BackboneElement	Insurer added line items
~~sequenceLinkId~~ itemSequence		0..*	positiveInt	Service instances
~~revenue~~ detailSequence		~~0..1~~ 0..*	~~CodeableConcept~~ positiveInt	~~Revenue or cost center code~~ Detail sequence number ~~Example Revenue Center Codes ( Example )~~
~~category~~ subdetailSequence		~~0..1~~ 0..*	~~CodeableConcept~~ positiveInt	~~Type of service or product~~ Subdetail sequence number ~~Benefit SubCategory Codes ( Example )~~
service		0..1	CodeableConcept	Group, Service or Product USCLS Codes ( Example )
modifier		0..*	CodeableConcept	Service/Product billing modifiers Modifier type Codes ( Example )
fee		0..1	Money	Professional fee or Product charge
noteNumber		0..*	positiveInt	List of note numbers which apply
adjudication	~~Added items adjudication~~	0..*	see adjudication	Added items ~~detail~~ adjudication
error		0..*	BackboneElement	Processing errors
~~sequenceLinkId~~ itemSequence		0..1	positiveInt	Item sequence number
~~detailSequenceLinkId~~ detailSequence		0..1	positiveInt	Detail sequence number
~~subdetailSequenceLinkId~~ subDetailSequence		0..1	positiveInt	Subdetail sequence number
code		1..1	CodeableConcept	Error code detailing processing issues Adjudication Error Codes ( Example )
~~totalCost~~ total		~~0..1~~ 0..*	~~Money~~ BackboneElement	~~Total Cost of service from the Claim~~ Adjudication totals
~~unallocDeductable~~ category		~~0..1~~ 1..1	~~Money~~ CodeableConcept	~~Unallocated deductible~~ Adjudication category such as submitted, co-pay, eligible, benefit, etc. Adjudication Value Codes ( Example )
~~totalBenefit~~ amount		~~0..1~~ 1..1	Money	~~Total benefit payable for the Claim~~ Monetary amount
payment		0..1	BackboneElement	Payment details, if paid
type		0..1	CodeableConcept	Partial or Complete Example Payment Type Codes ( Example )
adjustment		0..1	Money	Payment adjustment for non-Claim issues
adjustmentReason		0..1	CodeableConcept	Explanation for the non-claim adjustment Payment Adjustment Reason Codes ( Example )
date		0..1	date	Expected data of Payment
amount		0..1	Money	Payable amount after adjustment
identifier		0..1	Identifier	Identifier of the payment instrument
reserved		0..1	Coding	Funds reserved status Funds Reservation Codes ( Example )
form		0..1	CodeableConcept	Printed Form Identifier Form Codes ( Example )
processNote		0..*	BackboneElement	Processing notes
number		0..1	positiveInt	Sequence Number for this note
type		0..1	~~CodeableConcept~~ code	display \| print \| printoper NoteType ( Required )
text		0..1	string	Note explanatory text
language		0..1	CodeableConcept	Language if different from the resource Common Languages ( Extensible but limited to All Languages )
communicationRequest		0..*	Reference ( CommunicationRequest )	Request for additional information
insurance		0..*	BackboneElement	Insurance or medical plan
sequence		1..1	positiveInt	Service instance identifier
focal		1..1	boolean	Is the focal Coverage
coverage		1..1	Reference ( Coverage )	Insurance information
businessArrangement		0..1	string	Business agreement
preAuthRef		0..*	string	Pre-Authorization/Determination Reference
claimResponse		0..1	Reference ( ClaimResponse )	Adjudication results
Documentation for this format

UML Diagram ( Legend )

XML Template

<

<ClaimResponse xmlns="http://hl7.org/fhir"> 

 <!-- from Resource: id, meta, implicitRules, and language -->
 <!-- from DomainResource: text, contained, extension, and modifierExtension -->
 <identifier><!-- 0..* Identifier Response  number --></identifier>
 <

 <status value="[code]"/><!-- 0..1 active | cancelled | draft | entered-in-error -->
 <type><!-- 0..1 CodeableConcept Type or discipline --></type>
 <subType><!-- 0..* CodeableConcept Finer grained claim type information --></subType>
 <use value="[code]"/><!-- 0..1 complete | proposed | exploratory | other -->

 <patient><!-- 0..1 Reference(Patient) The subject of the Products and Services --></patient>
 <

 <created value="[dateTime]"/><!-- 0..1 Creation date -->

 <insurer><!-- 0..1 Reference(Organization) Insurance issuing organization --></insurer>
 <</requestProvider>
 <</requestOrganization>

 <requestProvider><!-- 0..1 Reference(Practitioner|PractitionerRole|Organization) Responsible practitioner --></requestProvider>

 <request><!-- 0..1 Reference(Claim) Id of resource triggering adjudication --></request>
 <</outcome>
 <

 <outcome value="[code]"/><!-- 0..1 queued | complete | error | partial -->
 <disposition value="[string]"/><!-- 0..1 Disposition Message -->

 <payeeType><!-- 0..1 CodeableConcept Party to be paid any benefits payable --></payeeType>
 <item>  <!-- 0..* Line items -->
  <
  <

  <itemSequence value="[positiveInt]"/><!-- 1..1 Service instance -->
  <noteNumber value="[positiveInt]"/><!-- 0..* List of note numbers which apply -->

  <adjudication>  <!-- 0..* Adjudication details -->
   <category><!-- 1..1 CodeableConcept Adjudication category such as co-pay, eligible, benefit, etc. --></category>
   <reason><!-- 0..1 CodeableConcept Explanation of Adjudication outcome --></reason>
   <amount><!-- 0..1 Money Monetary amount --></amount>
   <

   <value value="[decimal]"/><!-- 0..1 Non-monetary value -->

  </adjudication>
  <detail>  <!-- 0..* Detail line items -->
   <
   <

   <detailSequence value="[positiveInt]"/><!-- 1..1 Service instance -->
   <noteNumber value="[positiveInt]"/><!-- 0..* List of note numbers which apply -->

   <adjudication><!-- 0..* Content as for ClaimResponse.item.adjudication Detail level adjudication details --></adjudication>
   <subDetail>  <!-- 0..* Subdetail line items -->
    <
    <

    <subDetailSequence value="[positiveInt]"/><!-- 1..1 Service instance -->
    <noteNumber value="[positiveInt]"/><!-- 0..* List of note numbers which apply -->

    <adjudication><!-- 0..* Content as for ClaimResponse.item.adjudication Subdetail level adjudication details --></adjudication>
   </subDetail>
  </detail>
 </item>
 <addItem>  <!-- 0..* Insurer added line items -->
  <
  <</revenue>
  <</category>

  <itemSequence value="[positiveInt]"/><!-- 0..* Service instances -->
  <detailSequence value="[positiveInt]"/><!-- 0..* Detail sequence number -->
  <subdetailSequence value="[positiveInt]"/><!-- 0..* Subdetail sequence number -->

  <service><!-- 0..1 CodeableConcept Group, Service or Product --></service>
  <modifier><!-- 0..* CodeableConcept Service/Product billing modifiers --></modifier>
  <fee><!-- 0..1 Money Professional fee or Product charge --></fee>
  <

  <noteNumber value="[positiveInt]"/><!-- 0..* List of note numbers which apply -->

  <adjudication><!-- 0..* Content as for ClaimResponse.item.adjudication Added items adjudication --></adjudication>
  <
   <</revenue>
   <</category>
   <</service>
   <</modifier>
   <</fee>
   <
   <</adjudication>
  </detail>

 </addItem>
 <error>  <!-- 0..* Processing errors -->
  <
  <
  <

  <itemSequence value="[positiveInt]"/><!-- 0..1 Item sequence number -->
  <detailSequence value="[positiveInt]"/><!-- 0..1 Detail sequence number -->
  <subDetailSequence value="[positiveInt]"/><!-- 0..1 Subdetail sequence number -->

  <code><!-- 1..1 CodeableConcept Error code detailing processing issues --></code>
 </error>
 <</totalCost>
 <</unallocDeductable>
 <</totalBenefit>

 <total>  <!-- 0..* Adjudication totals -->
  <category><!-- 1..1 CodeableConcept Adjudication category such as submitted, co-pay, eligible, benefit, etc. --></category>
  <amount><!-- 1..1 Money Monetary amount --></amount>
 </total>

 <payment>  <!-- 0..1 Payment details, if paid -->
  <type><!-- 0..1 CodeableConcept Partial or Complete --></type>
  <adjustment><!-- 0..1 Money Payment adjustment for non-Claim issues --></adjustment>
  <adjustmentReason><!-- 0..1 CodeableConcept Explanation for the non-claim adjustment --></adjustmentReason>
  <

  <date value="[date]"/><!-- 0..1 Expected data of Payment -->

  <amount><!-- 0..1 Money Payable amount after adjustment --></amount>
  <identifier><!-- 0..1 Identifier Identifier of the payment instrument --></identifier>
 </payment>
 <reserved><!-- 0..1 Coding Funds reserved status --></reserved>
 <form><!-- 0..1 CodeableConcept Printed Form Identifier --></form>
 <processNote>  <!-- 0..* Processing notes -->
  <
  <</type>
  <

  <number value="[positiveInt]"/><!-- 0..1 Sequence Number for this note -->
  <type value="[code]"/><!-- 0..1 display | print | printoper -->
  <text value="[string]"/><!-- 0..1 Note explanatory text -->

  <language><!-- 0..1 CodeableConcept Language if different from the resource --></language>
 </processNote>
 <communicationRequest><!-- 0..* Reference(CommunicationRequest) Request for additional information --></communicationRequest>
 <insurance>  <!-- 0..* Insurance or medical plan -->
  <
  <

  <sequence value="[positiveInt]"/><!-- 1..1 Service instance identifier -->
  <focal value="[boolean]"/><!-- 1..1 Is the focal Coverage -->

  <coverage><!-- 1..1 Reference(Coverage) Insurance information --></coverage>
  <
  <

  <businessArrangement value="[string]"/><!-- 0..1 Business agreement -->
  <preAuthRef value="[string]"/><!-- 0..* Pre-Authorization/Determination Reference -->

  <claimResponse><!-- 0..1 Reference(ClaimResponse) Adjudication results --></claimResponse>
 </insurance>
</ClaimResponse>

JSON Template

{
  "resourceType" : "",

  "resourceType" : "ClaimResponse",

  // from Resource: id, meta, implicitRules, and language
  // from DomainResource: text, contained, extension, and modifierExtension
  "
  "
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  "identifier" : [{ Identifier }], // Response  number
  "status" : "<code>", // active | cancelled | draft | entered-in-error
  "type" : { CodeableConcept }, // Type or discipline
  "subType" : [{ CodeableConcept }], // Finer grained claim type information
  "use" : "<code>", // complete | proposed | exploratory | other
  "patient" : { Reference(Patient) }, // The subject of the Products and Services
  "created" : "<dateTime>", // Creation date
  "insurer" : { Reference(Organization) }, // Insurance issuing organization
  "requestProvider" : { Reference(Practitioner|PractitionerRole|Organization) }, // Responsible practitioner
  "request" : { Reference(Claim) }, // Id of resource triggering adjudication
  "outcome" : "<code>", // queued | complete | error | partial
  "disposition" : "<string>", // Disposition Message
  "payeeType" : { CodeableConcept }, // Party to be paid any benefits payable
  "item" : [{ // Line items
    "itemSequence" : "<positiveInt>", // R!  Service instance
    "noteNumber" : ["<positiveInt>"], // List of note numbers which apply
    "adjudication" : [{ // Adjudication details
      "category" : { CodeableConcept }, // R!  Adjudication category such as co-pay, eligible, benefit, etc.
      "reason" : { CodeableConcept }, // Explanation of Adjudication outcome
      "amount" : { Money }, // Monetary amount
      "value" : <decimal> // Non-monetary value

    }],
    "
      "
      "
      "
      "
        "
        "
        "

    "detail" : [{ // Detail line items
      "detailSequence" : "<positiveInt>", // R!  Service instance
      "noteNumber" : ["<positiveInt>"], // List of note numbers which apply
      "adjudication" : [{ Content as for ClaimResponse.item.adjudication }], // Detail level adjudication details
      "subDetail" : [{ // Subdetail line items
        "subDetailSequence" : "<positiveInt>", // R!  Service instance
        "noteNumber" : ["<positiveInt>"], // List of note numbers which apply
        "adjudication" : [{ Content as for ClaimResponse.item.adjudication }] // Subdetail level adjudication details

      }]
    }]
  }],
  "
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    }]

  "addItem" : [{ // Insurer added line items
    "itemSequence" : ["<positiveInt>"], // Service instances
    "detailSequence" : ["<positiveInt>"], // Detail sequence number
    "subdetailSequence" : ["<positiveInt>"], // Subdetail sequence number
    "service" : { CodeableConcept }, // Group, Service or Product
    "modifier" : [{ CodeableConcept }], // Service/Product billing modifiers
    "fee" : { Money }, // Professional fee or Product charge
    "noteNumber" : ["<positiveInt>"], // List of note numbers which apply
    "adjudication" : [{ Content as for ClaimResponse.item.adjudication }] // Added items adjudication

  }],
  "
    "
    "
    "
    "

  "error" : [{ // Processing errors
    "itemSequence" : "<positiveInt>", // Item sequence number
    "detailSequence" : "<positiveInt>", // Detail sequence number
    "subDetailSequence" : "<positiveInt>", // Subdetail sequence number
    "code" : { CodeableConcept } // R!  Error code detailing processing issues

  }],
  "
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  "
  "
    "
    "
    "
    "
    "
    "

  "total" : [{ // Adjudication totals
    "category" : { CodeableConcept }, // R!  Adjudication category such as submitted, co-pay, eligible, benefit, etc.
    "amount" : { Money } // R!  Monetary amount
  }],
  "payment" : { // Payment details, if paid
    "type" : { CodeableConcept }, // Partial or Complete
    "adjustment" : { Money }, // Payment adjustment for non-Claim issues
    "adjustmentReason" : { CodeableConcept }, // Explanation for the non-claim adjustment
    "date" : "<date>", // Expected data of Payment
    "amount" : { Money }, // Payable amount after adjustment
    "identifier" : { Identifier } // Identifier of the payment instrument

  },
  "
  "
  "
    "
    "
    "
    "

  "reserved" : { Coding }, // Funds reserved status
  "form" : { CodeableConcept }, // Printed Form Identifier
  "processNote" : [{ // Processing notes
    "number" : "<positiveInt>", // Sequence Number for this note
    "type" : "<code>", // display | print | printoper
    "text" : "<string>", // Note explanatory text
    "language" : { CodeableConcept } // Language if different from the resource

  }],
  "
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    "

  "communicationRequest" : [{ Reference(CommunicationRequest) }], // Request for additional information
  "insurance" : [{ // Insurance or medical plan
    "sequence" : "<positiveInt>", // R!  Service instance identifier
    "focal" : <boolean>, // R!  Is the focal Coverage
    "coverage" : { Reference(Coverage) }, // R!  Insurance information
    "businessArrangement" : "<string>", // Business agreement
    "preAuthRef" : ["<string>"], // Pre-Authorization/Determination Reference
    "claimResponse" : { Reference(ClaimResponse) } // Adjudication results

  }]
}

Turtle Template

@prefix fhir: <http://hl7.org/fhir/> .


[ a fhir:ClaimResponse;
  fhir:nodeRole fhir:treeRoot; # if this is the parser root

  # from Resource: .id, .meta, .implicitRules, and .language
  # from DomainResource: .text, .contained, .extension, and .modifierExtension
  fhir:ClaimResponse.identifier [ Identifier ], ... ; # 0..* Response  number
  fhir:ClaimResponse.status [ code ]; # 0..1 active | cancelled | draft | entered-in-error
  fhir:ClaimResponse.type [ CodeableConcept ]; # 0..1 Type or discipline
  fhir:ClaimResponse.subType [ CodeableConcept ], ... ; # 0..* Finer grained claim type information
  fhir:ClaimResponse.use [ code ]; # 0..1 complete | proposed | exploratory | other

  fhir:ClaimResponse.patient [ Reference(Patient) ]; # 0..1 The subject of the Products and Services
  fhir:ClaimResponse.created [ dateTime ]; # 0..1 Creation date
  fhir:ClaimResponse.insurer [ Reference(Organization) ]; # 0..1 Insurance issuing organization
  fhir:
  fhir:

  fhir:ClaimResponse.requestProvider [ Reference(Practitioner|PractitionerRole|Organization) ]; # 0..1 Responsible practitioner

  fhir:ClaimResponse.request [ Reference(Claim) ]; # 0..1 Id of resource triggering adjudication
  fhir:

  fhir:ClaimResponse.outcome [ code ]; # 0..1 queued | complete | error | partial

  fhir:ClaimResponse.disposition [ string ]; # 0..1 Disposition Message
  fhir:ClaimResponse.payeeType [ CodeableConcept ]; # 0..1 Party to be paid any benefits payable
  fhir:ClaimResponse.item [ # 0..* Line items
    fhir:

    fhir:ClaimResponse.item.itemSequence [ positiveInt ]; # 1..1 Service instance

    fhir:ClaimResponse.item.noteNumber [ positiveInt ], ... ; # 0..* List of note numbers which apply
    fhir:ClaimResponse.item.adjudication [ # 0..* Adjudication details
      fhir:ClaimResponse.item.adjudication.category [ CodeableConcept ]; # 1..1 Adjudication category such as co-pay, eligible, benefit, etc.
      fhir:ClaimResponse.item.adjudication.reason [ CodeableConcept ]; # 0..1 Explanation of Adjudication outcome
      fhir:ClaimResponse.item.adjudication.amount [ Money ]; # 0..1 Monetary amount
      fhir:ClaimResponse.item.adjudication.value [ decimal ]; # 0..1 Non-monetary value
    ], ...;
    fhir:ClaimResponse.item.detail [ # 0..* Detail line items
      fhir:

      fhir:ClaimResponse.item.detail.detailSequence [ positiveInt ]; # 1..1 Service instance

      fhir:ClaimResponse.item.detail.noteNumber [ positiveInt ], ... ; # 0..* List of note numbers which apply
      fhir:ClaimResponse.item.detail.adjudication [ See ClaimResponse.item.adjudication ], ... ; # 0..* Detail level adjudication details
      fhir:ClaimResponse.item.detail.subDetail [ # 0..* Subdetail line items
        fhir:

        fhir:ClaimResponse.item.detail.subDetail.subDetailSequence [ positiveInt ]; # 1..1 Service instance

        fhir:ClaimResponse.item.detail.subDetail.noteNumber [ positiveInt ], ... ; # 0..* List of note numbers which apply
        fhir:ClaimResponse.item.detail.subDetail.adjudication [ See ClaimResponse.item.adjudication ], ... ; # 0..* Subdetail level adjudication details
      ], ...;
    ], ...;
  ], ...;
  fhir:ClaimResponse.addItem [ # 0..* Insurer added line items
    fhir:
    fhir:
    fhir:

    fhir:ClaimResponse.addItem.itemSequence [ positiveInt ], ... ; # 0..* Service instances
    fhir:ClaimResponse.addItem.detailSequence [ positiveInt ], ... ; # 0..* Detail sequence number
    fhir:ClaimResponse.addItem.subdetailSequence [ positiveInt ], ... ; # 0..* Subdetail sequence number

    fhir:ClaimResponse.addItem.service [ CodeableConcept ]; # 0..1 Group, Service or Product
    fhir:ClaimResponse.addItem.modifier [ CodeableConcept ], ... ; # 0..* Service/Product billing modifiers
    fhir:ClaimResponse.addItem.fee [ Money ]; # 0..1 Professional fee or Product charge
    fhir:ClaimResponse.addItem.noteNumber [ positiveInt ], ... ; # 0..* List of note numbers which apply
    fhir:ClaimResponse.addItem.adjudication [ See ClaimResponse.item.adjudication ], ... ; # 0..* Added items adjudication
    fhir:
      fhir:
      fhir:
      fhir:
      fhir:
      fhir:
      fhir:
      fhir:
    ], ...;

  ], ...;
  fhir:ClaimResponse.error [ # 0..* Processing errors
    fhir:
    fhir:
    fhir:

    fhir:ClaimResponse.error.itemSequence [ positiveInt ]; # 0..1 Item sequence number
    fhir:ClaimResponse.error.detailSequence [ positiveInt ]; # 0..1 Detail sequence number
    fhir:ClaimResponse.error.subDetailSequence [ positiveInt ]; # 0..1 Subdetail sequence number

    fhir:ClaimResponse.error.code [ CodeableConcept ]; # 1..1 Error code detailing processing issues
  ], ...;
  fhir:
  fhir:
  fhir:

  fhir:ClaimResponse.total [ # 0..* Adjudication totals
    fhir:ClaimResponse.total.category [ CodeableConcept ]; # 1..1 Adjudication category such as submitted, co-pay, eligible, benefit, etc.
    fhir:ClaimResponse.total.amount [ Money ]; # 1..1 Monetary amount
  ], ...;

  fhir:ClaimResponse.payment [ # 0..1 Payment details, if paid
    fhir:ClaimResponse.payment.type [ CodeableConcept ]; # 0..1 Partial or Complete
    fhir:ClaimResponse.payment.adjustment [ Money ]; # 0..1 Payment adjustment for non-Claim issues
    fhir:ClaimResponse.payment.adjustmentReason [ CodeableConcept ]; # 0..1 Explanation for the non-claim adjustment
    fhir:ClaimResponse.payment.date [ date ]; # 0..1 Expected data of Payment
    fhir:ClaimResponse.payment.amount [ Money ]; # 0..1 Payable amount after adjustment
    fhir:ClaimResponse.payment.identifier [ Identifier ]; # 0..1 Identifier of the payment instrument
  ];
  fhir:ClaimResponse.reserved [ Coding ]; # 0..1 Funds reserved status
  fhir:ClaimResponse.form [ CodeableConcept ]; # 0..1 Printed Form Identifier
  fhir:ClaimResponse.processNote [ # 0..* Processing notes
    fhir:ClaimResponse.processNote.number [ positiveInt ]; # 0..1 Sequence Number for this note
    fhir:

    fhir:ClaimResponse.processNote.type [ code ]; # 0..1 display | print | printoper

    fhir:ClaimResponse.processNote.text [ string ]; # 0..1 Note explanatory text
    fhir:ClaimResponse.processNote.language [ CodeableConcept ]; # 0..1 Language if different from the resource
  ], ...;
  fhir:ClaimResponse.communicationRequest [ Reference(CommunicationRequest) ], ... ; # 0..* Request for additional information
  fhir:ClaimResponse.insurance [ # 0..* Insurance or medical plan
    fhir:ClaimResponse.insurance.sequence [ positiveInt ]; # 1..1 Service instance identifier
    fhir:ClaimResponse.insurance.focal [ boolean ]; # 1..1 Is the focal Coverage
    fhir:ClaimResponse.insurance.coverage [ Reference(Coverage) ]; # 1..1 Insurance information
    fhir:ClaimResponse.insurance.businessArrangement [ string ]; # 0..1 Business agreement
    fhir:ClaimResponse.insurance.preAuthRef [ string ], ... ; # 0..* Pre-Authorization/Determination Reference
    fhir:ClaimResponse.insurance.claimResponse [ Reference(ClaimResponse) ]; # 0..1 Adjudication results
  ], ...;
]

Changes since ~~DSTU2~~ R3

~~ClaimResponse.status~~ ~~ClaimResponse.addItem.adjudication Remove BackboneElement~~ ~~ClaimResponse.addItem.detail.service Min Cardinality changed from 1 to 0 Type changed from Coding to CodeableConcept~~ ~~ClaimResponse.addItem.detail.fee Type changed from Quantity{http://hl7.org/fhir/StructureDefinition/Money} to Money~~ ClaimResponse.addItem.detail.adjudication Remove BackboneElement ClaimResponse.error.code Type changed from Coding to CodeableConcept Remove Binding http://hl7.org/fhir/ValueSet/adjudication-error (required) ClaimResponse.totalCost Type changed from Quantity{http://hl7.org/fhir/StructureDefinition/Money} to Money ClaimResponse.unallocDeductable Type changed from Quantity{http://hl7.org/fhir/StructureDefinition/Money} to Money ClaimResponse.totalBenefit Type changed from Quantity{http://hl7.org/fhir/StructureDefinition/Money} to Money

ClaimResponse

~~Added Element~~

~~ClaimResponse.patient~~ ClaimResponse.type

Added Element

ClaimResponse.insurer Added Element ClaimResponse.outcome Type changed from code to CodeableConcept Remove Binding http://hl7.org/fhir/ValueSet/remittance-outcome (required) ClaimResponse.payeeType Type changed from Coding to CodeableConcept ClaimResponse.item.adjudication.category ClaimResponse.subType

Added Element

~~ClaimResponse.item.adjudication.reason~~ ClaimResponse.use

Added Element

~~ClaimResponse.item.adjudication.amount~~ ClaimResponse.requestProvider

Type changed from ~~Quantity{http://hl7.org/fhir/StructureDefinition/Money}~~ Reference(Practitioner) to Money ClaimResponse.item.detail.noteNumber Added Element ClaimResponse.item.detail.adjudication Remove BackboneElement ClaimResponse.item.detail.subDetail.noteNumber Added Element ClaimResponse.item.detail.subDetail.adjudication Remove BackboneElement ClaimResponse.addItem.revenue Added Element ClaimResponse.addItem.category Added Element Reference(Practitioner|PractitionerRole|Organization)

~~ClaimResponse.addItem.service~~ ClaimResponse.outcome

~~Min Cardinality changed from 1 to 0~~ Type changed from ~~Coding to~~ CodeableConcept to code

~~ClaimResponse.addItem.modifier Added Element ClaimResponse.addItem.fee~~

~~Type changed from Quantity{http://hl7.org/fhir/StructureDefinition/Money} to Money~~ Add Binding http://hl7.org/fhir/ValueSet/remittance-outcome (required)

~~ClaimResponse.addItem.noteNumber~~ ClaimResponse.item.itemSequence

Added Element

~~ClaimResponse.addItem.detail.revenue~~ ClaimResponse.item.detail.detailSequence

Added Element

~~ClaimResponse.addItem.detail.category~~ ClaimResponse.item.detail.subDetail.subDetailSequence

Added Element

~~ClaimResponse.addItem.detail.modifier~~ ClaimResponse.addItem.itemSequence

Added Element

~~ClaimResponse.addItem.detail.noteNumber~~ ClaimResponse.addItem.detailSequence

Added Element

~~ClaimResponse.payment~~ ClaimResponse.addItem.subdetailSequence

Added Element

~~ClaimResponse.payment.type~~ ClaimResponse.error.itemSequence

Added Element

~~ClaimResponse.payment.adjustment~~ ClaimResponse.error.detailSequence

Added Element

~~ClaimResponse.payment.adjustmentReason~~ ClaimResponse.error.subDetailSequence

Added Element

~~ClaimResponse.payment.date~~ ClaimResponse.total

Added Element

~~ClaimResponse.payment.amount~~ ClaimResponse.total.category

Added Element

~~ClaimResponse.payment.identifier~~ ClaimResponse.total.amount

Added Element

~~ClaimResponse.form~~ ClaimResponse.processNote.type

Type changed from ~~Coding to~~ CodeableConcept Remove Binding http://hl7.org/fhir/ValueSet/forms (required) ClaimResponse.processNote Added Element ClaimResponse.processNote.number Added Element ClaimResponse.processNote.type Added Element ClaimResponse.processNote.text Added Element ClaimResponse.processNote.language Added Element ClaimResponse.communicationRequest Added Element ClaimResponse.insurance Added Element ClaimResponse.insurance.sequence Added Element ClaimResponse.insurance.focal Added Element ClaimResponse.insurance.coverage Added Element ClaimResponse.insurance.businessArrangement Added Element ClaimResponse.insurance.preAuthRef Added Element ClaimResponse.insurance.claimResponse Added Element ClaimResponse.ruleset deleted ClaimResponse.originalRuleset deleted ClaimResponse.organization deleted ClaimResponse.item.adjudication.code deleted ClaimResponse.item.detail.adjudication.code deleted ClaimResponse.item.detail.adjudication.amount deleted ClaimResponse.item.detail.adjudication.value deleted ClaimResponse.item.detail.subDetail.adjudication.code deleted ClaimResponse.item.detail.subDetail.adjudication.amount deleted ClaimResponse.item.detail.subDetail.adjudication.value deleted to code

~~ClaimResponse.addItem.noteNumberLinkId~~ ClaimResponse.requestOrganization

deleted

~~ClaimResponse.addItem.adjudication.code~~ ClaimResponse.item.sequenceLinkId

deleted

~~ClaimResponse.addItem.adjudication.amount~~ ClaimResponse.item.detail.sequenceLinkId

deleted

~~ClaimResponse.addItem.adjudication.value~~ ClaimResponse.item.detail.subDetail.sequenceLinkId

deleted

~~ClaimResponse.addItem.detail.adjudication.code~~ ClaimResponse.addItem.sequenceLinkId

deleted

~~ClaimResponse.addItem.detail.adjudication.amount~~ ClaimResponse.addItem.revenue

deleted

~~ClaimResponse.addItem.detail.adjudication.value~~ ClaimResponse.addItem.category

deleted

~~ClaimResponse.paymentAdjustment~~ ClaimResponse.addItem.detail

deleted

~~ClaimResponse.paymentAdjustmentReason~~ ClaimResponse.error.sequenceLinkId

deleted

~~ClaimResponse.paymentDate~~ ClaimResponse.error.detailSequenceLinkId

deleted

~~ClaimResponse.paymentAmount~~ ClaimResponse.error.subdetailSequenceLinkId

deleted

~~ClaimResponse.paymentRef~~ ClaimResponse.totalCost

deleted

~~ClaimResponse.note~~ ClaimResponse.unallocDeductable

deleted

~~ClaimResponse.coverage~~ ClaimResponse.totalBenefit

deleted

See the Full Difference for further information

This analysis is available as XML or JSON .

Structure

~~0..* see adjudication~~ detail 0..* BackboneElement Added items details revenue 0..1 CodeableConcept Revenue or cost center code Example Revenue Center Codes ( Example ) category 0..1 CodeableConcept Type of service or product Benefit SubCategory Codes ( Example ) service 0..1 CodeableConcept Service or Product USCLS Codes ( Example ) modifier 0..* CodeableConcept Service/Product billing modifiers Modifier type Codes ( Example ) fee 0..1 Money Professional fee or Product charge noteNumber 0..* positiveInt List of note numbers which apply adjudication

Name	Flags	Card.	Type	Description & Constraints
ClaimResponse	TU		DomainResource	Remittance resource Elements defined in Ancestors: id , meta , implicitRules , language , text , contained , extension , modifierExtension
identifier		0..*	Identifier	Response number
status	?! Σ	0..1	code	active \| cancelled \| draft \| entered-in-error Financial Resource Status Codes ( Required )
type		0..1	CodeableConcept	Type or discipline Claim Type Codes ( Extensible )
subType		0..*	CodeableConcept	Finer grained claim type information Example Claim SubType Codes ( Example )
use		0..1	code	complete \| proposed \| exploratory \| other Use ( Required )
patient		0..1	Reference ( Patient )	The subject of the Products and Services
created		0..1	dateTime	Creation date
insurer		0..1	Reference ( Organization )	Insurance issuing organization
requestProvider		0..1	Reference ( Practitioner ~~) Responsible practitioner requestOrganization 0..1 Reference~~ \| PractitionerRole ( \| Organization )	Responsible ~~organization~~ practitioner
request		0..1	Reference ( Claim )	Id of resource triggering adjudication
outcome		0..1	~~CodeableConcept~~ code	queued \| complete \| error \| partial Claim Processing Codes ( ~~Example~~ Required )
disposition		0..1	string	Disposition Message
payeeType		0..1	CodeableConcept	Party to be paid any benefits payable Claim Payee Type Codes ( Example )
item		0..*	BackboneElement	Line items
~~sequenceLinkId~~ itemSequence		1..1	positiveInt	Service instance
noteNumber		0..*	positiveInt	List of note numbers which apply
adjudication		0..*	BackboneElement	Adjudication details
category		1..1	CodeableConcept	Adjudication category such as co-pay, eligible, benefit, etc. Adjudication Value Codes ( Example )
reason		0..1	CodeableConcept	Explanation of Adjudication outcome Adjudication Reason Codes ( Example )
amount		0..1	Money	Monetary amount
value		0..1	decimal	Non-monetary value
detail		0..*	BackboneElement	Detail line items
~~sequenceLinkId~~ detailSequence		1..1	positiveInt	Service instance
noteNumber		0..*	positiveInt	List of note numbers which apply
adjudication		0..*	see adjudication	Detail level adjudication details
subDetail		0..*	BackboneElement	Subdetail line items
~~sequenceLinkId~~ subDetailSequence		1..1	positiveInt	Service instance
noteNumber		0..*	positiveInt	List of note numbers which apply
adjudication		0..*	see adjudication	Subdetail level adjudication details
addItem		0..*	BackboneElement	Insurer added line items
~~sequenceLinkId~~ itemSequence		0..*	positiveInt	Service instances
~~revenue~~ detailSequence		~~0..1~~ 0..*	~~CodeableConcept~~ positiveInt	~~Revenue or cost center code~~ Detail sequence number ~~Example Revenue Center Codes ( Example )~~
~~category~~ subdetailSequence		~~0..1~~ 0..*	~~CodeableConcept~~ positiveInt	~~Type of service or product~~ Subdetail sequence number ~~Benefit SubCategory Codes ( Example )~~
service		0..1	CodeableConcept	Group, Service or Product USCLS Codes ( Example )
modifier		0..*	CodeableConcept	Service/Product billing modifiers Modifier type Codes ( Example )
fee		0..1	Money	Professional fee or Product charge
noteNumber		0..*	positiveInt	List of note numbers which apply
adjudication	~~Added items adjudication~~	0..*	see adjudication	Added items ~~detail~~ adjudication
error		0..*	BackboneElement	Processing errors
~~sequenceLinkId~~ itemSequence		0..1	positiveInt	Item sequence number
~~detailSequenceLinkId~~ detailSequence		0..1	positiveInt	Detail sequence number
~~subdetailSequenceLinkId~~ subDetailSequence		0..1	positiveInt	Subdetail sequence number
code		1..1	CodeableConcept	Error code detailing processing issues Adjudication Error Codes ( Example )
~~totalCost~~ total		~~0..1~~ 0..*	~~Money~~ BackboneElement	~~Total Cost of service from the Claim~~ Adjudication totals
~~unallocDeductable~~ category		~~0..1~~ 1..1	~~Money~~ CodeableConcept	~~Unallocated deductible~~ Adjudication category such as submitted, co-pay, eligible, benefit, etc. Adjudication Value Codes ( Example )
~~totalBenefit~~ amount		~~0..1~~ 1..1	Money	~~Total benefit payable for the Claim~~ Monetary amount
payment		0..1	BackboneElement	Payment details, if paid
type		0..1	CodeableConcept	Partial or Complete Example Payment Type Codes ( Example )
adjustment		0..1	Money	Payment adjustment for non-Claim issues
adjustmentReason		0..1	CodeableConcept	Explanation for the non-claim adjustment Payment Adjustment Reason Codes ( Example )
date		0..1	date	Expected data of Payment
amount		0..1	Money	Payable amount after adjustment
identifier		0..1	Identifier	Identifier of the payment instrument
reserved		0..1	Coding	Funds reserved status Funds Reservation Codes ( Example )
form		0..1	CodeableConcept	Printed Form Identifier Form Codes ( Example )
processNote		0..*	BackboneElement	Processing notes
number		0..1	positiveInt	Sequence Number for this note
type		0..1	~~CodeableConcept~~ code	display \| print \| printoper NoteType ( Required )
text		0..1	string	Note explanatory text
language		0..1	CodeableConcept	Language if different from the resource Common Languages ( Extensible but limited to All Languages )
communicationRequest		0..*	Reference ( CommunicationRequest )	Request for additional information
insurance		0..*	BackboneElement	Insurance or medical plan
sequence		1..1	positiveInt	Service instance identifier
focal		1..1	boolean	Is the focal Coverage
coverage		1..1	Reference ( Coverage )	Insurance information
businessArrangement		0..1	string	Business agreement
preAuthRef		0..*	string	Pre-Authorization/Determination Reference
claimResponse		0..1	Reference ( ClaimResponse )	Adjudication results
Documentation for this format

UML Diagram ( Legend )

XML Template

<

<ClaimResponse xmlns="http://hl7.org/fhir"> 

 <!-- from Resource: id, meta, implicitRules, and language -->
 <!-- from DomainResource: text, contained, extension, and modifierExtension -->
 <identifier><!-- 0..* Identifier Response  number --></identifier>
 <

 <status value="[code]"/><!-- 0..1 active | cancelled | draft | entered-in-error -->
 <type><!-- 0..1 CodeableConcept Type or discipline --></type>
 <subType><!-- 0..* CodeableConcept Finer grained claim type information --></subType>
 <use value="[code]"/><!-- 0..1 complete | proposed | exploratory | other -->

 <patient><!-- 0..1 Reference(Patient) The subject of the Products and Services --></patient>
 <

 <created value="[dateTime]"/><!-- 0..1 Creation date -->

 <insurer><!-- 0..1 Reference(Organization) Insurance issuing organization --></insurer>
 <</requestProvider>
 <</requestOrganization>

 <requestProvider><!-- 0..1 Reference(Practitioner|PractitionerRole|Organization) Responsible practitioner --></requestProvider>

 <request><!-- 0..1 Reference(Claim) Id of resource triggering adjudication --></request>
 <</outcome>
 <

 <outcome value="[code]"/><!-- 0..1 queued | complete | error | partial -->
 <disposition value="[string]"/><!-- 0..1 Disposition Message -->

 <payeeType><!-- 0..1 CodeableConcept Party to be paid any benefits payable --></payeeType>
 <item>  <!-- 0..* Line items -->
  <
  <

  <itemSequence value="[positiveInt]"/><!-- 1..1 Service instance -->
  <noteNumber value="[positiveInt]"/><!-- 0..* List of note numbers which apply -->

  <adjudication>  <!-- 0..* Adjudication details -->
   <category><!-- 1..1 CodeableConcept Adjudication category such as co-pay, eligible, benefit, etc. --></category>
   <reason><!-- 0..1 CodeableConcept Explanation of Adjudication outcome --></reason>
   <amount><!-- 0..1 Money Monetary amount --></amount>
   <

   <value value="[decimal]"/><!-- 0..1 Non-monetary value -->

  </adjudication>
  <detail>  <!-- 0..* Detail line items -->
   <
   <

   <detailSequence value="[positiveInt]"/><!-- 1..1 Service instance -->
   <noteNumber value="[positiveInt]"/><!-- 0..* List of note numbers which apply -->

   <adjudication><!-- 0..* Content as for ClaimResponse.item.adjudication Detail level adjudication details --></adjudication>
   <subDetail>  <!-- 0..* Subdetail line items -->
    <
    <

    <subDetailSequence value="[positiveInt]"/><!-- 1..1 Service instance -->
    <noteNumber value="[positiveInt]"/><!-- 0..* List of note numbers which apply -->

    <adjudication><!-- 0..* Content as for ClaimResponse.item.adjudication Subdetail level adjudication details --></adjudication>
   </subDetail>
  </detail>
 </item>
 <addItem>  <!-- 0..* Insurer added line items -->
  <
  <</revenue>
  <</category>

  <itemSequence value="[positiveInt]"/><!-- 0..* Service instances -->
  <detailSequence value="[positiveInt]"/><!-- 0..* Detail sequence number -->
  <subdetailSequence value="[positiveInt]"/><!-- 0..* Subdetail sequence number -->

  <service><!-- 0..1 CodeableConcept Group, Service or Product --></service>
  <modifier><!-- 0..* CodeableConcept Service/Product billing modifiers --></modifier>
  <fee><!-- 0..1 Money Professional fee or Product charge --></fee>
  <

  <noteNumber value="[positiveInt]"/><!-- 0..* List of note numbers which apply -->

  <adjudication><!-- 0..* Content as for ClaimResponse.item.adjudication Added items adjudication --></adjudication>
  <
   <</revenue>
   <</category>
   <</service>
   <</modifier>
   <</fee>
   <
   <</adjudication>
  </detail>

 </addItem>
 <error>  <!-- 0..* Processing errors -->
  <
  <
  <

  <itemSequence value="[positiveInt]"/><!-- 0..1 Item sequence number -->
  <detailSequence value="[positiveInt]"/><!-- 0..1 Detail sequence number -->
  <subDetailSequence value="[positiveInt]"/><!-- 0..1 Subdetail sequence number -->

  <code><!-- 1..1 CodeableConcept Error code detailing processing issues --></code>
 </error>
 <</totalCost>
 <</unallocDeductable>
 <</totalBenefit>

 <total>  <!-- 0..* Adjudication totals -->
  <category><!-- 1..1 CodeableConcept Adjudication category such as submitted, co-pay, eligible, benefit, etc. --></category>
  <amount><!-- 1..1 Money Monetary amount --></amount>
 </total>

 <payment>  <!-- 0..1 Payment details, if paid -->
  <type><!-- 0..1 CodeableConcept Partial or Complete --></type>
  <adjustment><!-- 0..1 Money Payment adjustment for non-Claim issues --></adjustment>
  <adjustmentReason><!-- 0..1 CodeableConcept Explanation for the non-claim adjustment --></adjustmentReason>
  <

  <date value="[date]"/><!-- 0..1 Expected data of Payment -->

  <amount><!-- 0..1 Money Payable amount after adjustment --></amount>
  <identifier><!-- 0..1 Identifier Identifier of the payment instrument --></identifier>
 </payment>
 <reserved><!-- 0..1 Coding Funds reserved status --></reserved>
 <form><!-- 0..1 CodeableConcept Printed Form Identifier --></form>
 <processNote>  <!-- 0..* Processing notes -->
  <
  <</type>
  <

  <number value="[positiveInt]"/><!-- 0..1 Sequence Number for this note -->
  <type value="[code]"/><!-- 0..1 display | print | printoper -->
  <text value="[string]"/><!-- 0..1 Note explanatory text -->

  <language><!-- 0..1 CodeableConcept Language if different from the resource --></language>
 </processNote>
 <communicationRequest><!-- 0..* Reference(CommunicationRequest) Request for additional information --></communicationRequest>
 <insurance>  <!-- 0..* Insurance or medical plan -->
  <
  <

  <sequence value="[positiveInt]"/><!-- 1..1 Service instance identifier -->
  <focal value="[boolean]"/><!-- 1..1 Is the focal Coverage -->

  <coverage><!-- 1..1 Reference(Coverage) Insurance information --></coverage>
  <
  <

  <businessArrangement value="[string]"/><!-- 0..1 Business agreement -->
  <preAuthRef value="[string]"/><!-- 0..* Pre-Authorization/Determination Reference -->

  <claimResponse><!-- 0..1 Reference(ClaimResponse) Adjudication results --></claimResponse>
 </insurance>
</ClaimResponse>

JSON Template

{
  "resourceType" : "",

  "resourceType" : "ClaimResponse",

  // from Resource: id, meta, implicitRules, and language
  // from DomainResource: text, contained, extension, and modifierExtension
  "
  "
  "
  "
  "
  "
  "
  "
  "
  "
  "
  "
    "
    "
    "
      "
      "
      "
      "

  "identifier" : [{ Identifier }], // Response  number
  "status" : "<code>", // active | cancelled | draft | entered-in-error
  "type" : { CodeableConcept }, // Type or discipline
  "subType" : [{ CodeableConcept }], // Finer grained claim type information
  "use" : "<code>", // complete | proposed | exploratory | other
  "patient" : { Reference(Patient) }, // The subject of the Products and Services
  "created" : "<dateTime>", // Creation date
  "insurer" : { Reference(Organization) }, // Insurance issuing organization
  "requestProvider" : { Reference(Practitioner|PractitionerRole|Organization) }, // Responsible practitioner
  "request" : { Reference(Claim) }, // Id of resource triggering adjudication
  "outcome" : "<code>", // queued | complete | error | partial
  "disposition" : "<string>", // Disposition Message
  "payeeType" : { CodeableConcept }, // Party to be paid any benefits payable
  "item" : [{ // Line items
    "itemSequence" : "<positiveInt>", // R!  Service instance
    "noteNumber" : ["<positiveInt>"], // List of note numbers which apply
    "adjudication" : [{ // Adjudication details
      "category" : { CodeableConcept }, // R!  Adjudication category such as co-pay, eligible, benefit, etc.
      "reason" : { CodeableConcept }, // Explanation of Adjudication outcome
      "amount" : { Money }, // Monetary amount
      "value" : <decimal> // Non-monetary value

    }],
    "
      "
      "
      "
      "
        "
        "
        "

    "detail" : [{ // Detail line items
      "detailSequence" : "<positiveInt>", // R!  Service instance
      "noteNumber" : ["<positiveInt>"], // List of note numbers which apply
      "adjudication" : [{ Content as for ClaimResponse.item.adjudication }], // Detail level adjudication details
      "subDetail" : [{ // Subdetail line items
        "subDetailSequence" : "<positiveInt>", // R!  Service instance
        "noteNumber" : ["<positiveInt>"], // List of note numbers which apply
        "adjudication" : [{ Content as for ClaimResponse.item.adjudication }] // Subdetail level adjudication details

      }]
    }]
  }],
  "
    "
    "
    "
    "
    "
    "
    "
    "
    "
      "
      "
      "
      "
      "
      "
      "
    }]

  "addItem" : [{ // Insurer added line items
    "itemSequence" : ["<positiveInt>"], // Service instances
    "detailSequence" : ["<positiveInt>"], // Detail sequence number
    "subdetailSequence" : ["<positiveInt>"], // Subdetail sequence number
    "service" : { CodeableConcept }, // Group, Service or Product
    "modifier" : [{ CodeableConcept }], // Service/Product billing modifiers
    "fee" : { Money }, // Professional fee or Product charge
    "noteNumber" : ["<positiveInt>"], // List of note numbers which apply
    "adjudication" : [{ Content as for ClaimResponse.item.adjudication }] // Added items adjudication

  }],
  "
    "
    "
    "
    "

  "error" : [{ // Processing errors
    "itemSequence" : "<positiveInt>", // Item sequence number
    "detailSequence" : "<positiveInt>", // Detail sequence number
    "subDetailSequence" : "<positiveInt>", // Subdetail sequence number
    "code" : { CodeableConcept } // R!  Error code detailing processing issues

  }],
  "
  "
  "
  "
    "
    "
    "
    "
    "
    "

  "total" : [{ // Adjudication totals
    "category" : { CodeableConcept }, // R!  Adjudication category such as submitted, co-pay, eligible, benefit, etc.
    "amount" : { Money } // R!  Monetary amount
  }],
  "payment" : { // Payment details, if paid
    "type" : { CodeableConcept }, // Partial or Complete
    "adjustment" : { Money }, // Payment adjustment for non-Claim issues
    "adjustmentReason" : { CodeableConcept }, // Explanation for the non-claim adjustment
    "date" : "<date>", // Expected data of Payment
    "amount" : { Money }, // Payable amount after adjustment
    "identifier" : { Identifier } // Identifier of the payment instrument

  },
  "
  "
  "
    "
    "
    "
    "

  "reserved" : { Coding }, // Funds reserved status
  "form" : { CodeableConcept }, // Printed Form Identifier
  "processNote" : [{ // Processing notes
    "number" : "<positiveInt>", // Sequence Number for this note
    "type" : "<code>", // display | print | printoper
    "text" : "<string>", // Note explanatory text
    "language" : { CodeableConcept } // Language if different from the resource

  }],
  "
  "
    "
    "
    "
    "
    "
    "

  "communicationRequest" : [{ Reference(CommunicationRequest) }], // Request for additional information
  "insurance" : [{ // Insurance or medical plan
    "sequence" : "<positiveInt>", // R!  Service instance identifier
    "focal" : <boolean>, // R!  Is the focal Coverage
    "coverage" : { Reference(Coverage) }, // R!  Insurance information
    "businessArrangement" : "<string>", // Business agreement
    "preAuthRef" : ["<string>"], // Pre-Authorization/Determination Reference
    "claimResponse" : { Reference(ClaimResponse) } // Adjudication results

  }]
}

Turtle Template

@prefix fhir: <http://hl7.org/fhir/> .


[ a fhir:ClaimResponse;
  fhir:nodeRole fhir:treeRoot; # if this is the parser root

  # from Resource: .id, .meta, .implicitRules, and .language
  # from DomainResource: .text, .contained, .extension, and .modifierExtension
  fhir:ClaimResponse.identifier [ Identifier ], ... ; # 0..* Response  number
  fhir:ClaimResponse.status [ code ]; # 0..1 active | cancelled | draft | entered-in-error
  fhir:ClaimResponse.type [ CodeableConcept ]; # 0..1 Type or discipline
  fhir:ClaimResponse.subType [ CodeableConcept ], ... ; # 0..* Finer grained claim type information
  fhir:ClaimResponse.use [ code ]; # 0..1 complete | proposed | exploratory | other

  fhir:ClaimResponse.patient [ Reference(Patient) ]; # 0..1 The subject of the Products and Services
  fhir:ClaimResponse.created [ dateTime ]; # 0..1 Creation date
  fhir:ClaimResponse.insurer [ Reference(Organization) ]; # 0..1 Insurance issuing organization
  fhir:
  fhir:

  fhir:ClaimResponse.requestProvider [ Reference(Practitioner|PractitionerRole|Organization) ]; # 0..1 Responsible practitioner

  fhir:ClaimResponse.request [ Reference(Claim) ]; # 0..1 Id of resource triggering adjudication
  fhir:

  fhir:ClaimResponse.outcome [ code ]; # 0..1 queued | complete | error | partial

  fhir:ClaimResponse.disposition [ string ]; # 0..1 Disposition Message
  fhir:ClaimResponse.payeeType [ CodeableConcept ]; # 0..1 Party to be paid any benefits payable
  fhir:ClaimResponse.item [ # 0..* Line items
    fhir:

    fhir:ClaimResponse.item.itemSequence [ positiveInt ]; # 1..1 Service instance

    fhir:ClaimResponse.item.noteNumber [ positiveInt ], ... ; # 0..* List of note numbers which apply
    fhir:ClaimResponse.item.adjudication [ # 0..* Adjudication details
      fhir:ClaimResponse.item.adjudication.category [ CodeableConcept ]; # 1..1 Adjudication category such as co-pay, eligible, benefit, etc.
      fhir:ClaimResponse.item.adjudication.reason [ CodeableConcept ]; # 0..1 Explanation of Adjudication outcome
      fhir:ClaimResponse.item.adjudication.amount [ Money ]; # 0..1 Monetary amount
      fhir:ClaimResponse.item.adjudication.value [ decimal ]; # 0..1 Non-monetary value
    ], ...;
    fhir:ClaimResponse.item.detail [ # 0..* Detail line items
      fhir:

      fhir:ClaimResponse.item.detail.detailSequence [ positiveInt ]; # 1..1 Service instance

      fhir:ClaimResponse.item.detail.noteNumber [ positiveInt ], ... ; # 0..* List of note numbers which apply
      fhir:ClaimResponse.item.detail.adjudication [ See ClaimResponse.item.adjudication ], ... ; # 0..* Detail level adjudication details
      fhir:ClaimResponse.item.detail.subDetail [ # 0..* Subdetail line items
        fhir:

        fhir:ClaimResponse.item.detail.subDetail.subDetailSequence [ positiveInt ]; # 1..1 Service instance

        fhir:ClaimResponse.item.detail.subDetail.noteNumber [ positiveInt ], ... ; # 0..* List of note numbers which apply
        fhir:ClaimResponse.item.detail.subDetail.adjudication [ See ClaimResponse.item.adjudication ], ... ; # 0..* Subdetail level adjudication details
      ], ...;
    ], ...;
  ], ...;
  fhir:ClaimResponse.addItem [ # 0..* Insurer added line items
    fhir:
    fhir:
    fhir:

    fhir:ClaimResponse.addItem.itemSequence [ positiveInt ], ... ; # 0..* Service instances
    fhir:ClaimResponse.addItem.detailSequence [ positiveInt ], ... ; # 0..* Detail sequence number
    fhir:ClaimResponse.addItem.subdetailSequence [ positiveInt ], ... ; # 0..* Subdetail sequence number

    fhir:ClaimResponse.addItem.service [ CodeableConcept ]; # 0..1 Group, Service or Product
    fhir:ClaimResponse.addItem.modifier [ CodeableConcept ], ... ; # 0..* Service/Product billing modifiers
    fhir:ClaimResponse.addItem.fee [ Money ]; # 0..1 Professional fee or Product charge
    fhir:ClaimResponse.addItem.noteNumber [ positiveInt ], ... ; # 0..* List of note numbers which apply
    fhir:ClaimResponse.addItem.adjudication [ See ClaimResponse.item.adjudication ], ... ; # 0..* Added items adjudication
    fhir:
      fhir:
      fhir:
      fhir:
      fhir:
      fhir:
      fhir:
      fhir:
    ], ...;

  ], ...;
  fhir:ClaimResponse.error [ # 0..* Processing errors
    fhir:
    fhir:
    fhir:

    fhir:ClaimResponse.error.itemSequence [ positiveInt ]; # 0..1 Item sequence number
    fhir:ClaimResponse.error.detailSequence [ positiveInt ]; # 0..1 Detail sequence number
    fhir:ClaimResponse.error.subDetailSequence [ positiveInt ]; # 0..1 Subdetail sequence number

    fhir:ClaimResponse.error.code [ CodeableConcept ]; # 1..1 Error code detailing processing issues
  ], ...;
  fhir:
  fhir:
  fhir:

  fhir:ClaimResponse.total [ # 0..* Adjudication totals
    fhir:ClaimResponse.total.category [ CodeableConcept ]; # 1..1 Adjudication category such as submitted, co-pay, eligible, benefit, etc.
    fhir:ClaimResponse.total.amount [ Money ]; # 1..1 Monetary amount
  ], ...;

  fhir:ClaimResponse.payment [ # 0..1 Payment details, if paid
    fhir:ClaimResponse.payment.type [ CodeableConcept ]; # 0..1 Partial or Complete
    fhir:ClaimResponse.payment.adjustment [ Money ]; # 0..1 Payment adjustment for non-Claim issues
    fhir:ClaimResponse.payment.adjustmentReason [ CodeableConcept ]; # 0..1 Explanation for the non-claim adjustment
    fhir:ClaimResponse.payment.date [ date ]; # 0..1 Expected data of Payment
    fhir:ClaimResponse.payment.amount [ Money ]; # 0..1 Payable amount after adjustment
    fhir:ClaimResponse.payment.identifier [ Identifier ]; # 0..1 Identifier of the payment instrument
  ];
  fhir:ClaimResponse.reserved [ Coding ]; # 0..1 Funds reserved status
  fhir:ClaimResponse.form [ CodeableConcept ]; # 0..1 Printed Form Identifier
  fhir:ClaimResponse.processNote [ # 0..* Processing notes
    fhir:ClaimResponse.processNote.number [ positiveInt ]; # 0..1 Sequence Number for this note
    fhir:

    fhir:ClaimResponse.processNote.type [ code ]; # 0..1 display | print | printoper

    fhir:ClaimResponse.processNote.text [ string ]; # 0..1 Note explanatory text
    fhir:ClaimResponse.processNote.language [ CodeableConcept ]; # 0..1 Language if different from the resource
  ], ...;
  fhir:ClaimResponse.communicationRequest [ Reference(CommunicationRequest) ], ... ; # 0..* Request for additional information
  fhir:ClaimResponse.insurance [ # 0..* Insurance or medical plan
    fhir:ClaimResponse.insurance.sequence [ positiveInt ]; # 1..1 Service instance identifier
    fhir:ClaimResponse.insurance.focal [ boolean ]; # 1..1 Is the focal Coverage
    fhir:ClaimResponse.insurance.coverage [ Reference(Coverage) ]; # 1..1 Insurance information
    fhir:ClaimResponse.insurance.businessArrangement [ string ]; # 0..1 Business agreement
    fhir:ClaimResponse.insurance.preAuthRef [ string ], ... ; # 0..* Pre-Authorization/Determination Reference
    fhir:ClaimResponse.insurance.claimResponse [ Reference(ClaimResponse) ]; # 0..1 Adjudication results
  ], ...;
]

Changes since DSTU2

~~ClaimResponse.status~~ ~~ClaimResponse.addItem.adjudication Remove BackboneElement~~ ~~ClaimResponse.addItem.detail.service Min Cardinality changed from 1 to 0 Type changed from Coding to CodeableConcept~~ ~~ClaimResponse.addItem.detail.fee Type changed from Quantity{http://hl7.org/fhir/StructureDefinition/Money} to Money~~ ClaimResponse.addItem.detail.adjudication Remove BackboneElement ClaimResponse.error.code Type changed from Coding to CodeableConcept Remove Binding http://hl7.org/fhir/ValueSet/adjudication-error (required) ClaimResponse.totalCost Type changed from Quantity{http://hl7.org/fhir/StructureDefinition/Money} to Money ClaimResponse.unallocDeductable Type changed from Quantity{http://hl7.org/fhir/StructureDefinition/Money} to Money ClaimResponse.totalBenefit Type changed from Quantity{http://hl7.org/fhir/StructureDefinition/Money} to Money

ClaimResponse

~~Added Element~~

~~ClaimResponse.patient~~ ClaimResponse.type

Added Element

ClaimResponse.insurer Added Element ClaimResponse.outcome Type changed from code to CodeableConcept Remove Binding http://hl7.org/fhir/ValueSet/remittance-outcome (required) ClaimResponse.payeeType Type changed from Coding to CodeableConcept ClaimResponse.item.adjudication.category ClaimResponse.subType

Added Element

~~ClaimResponse.item.adjudication.reason~~ ClaimResponse.use

Added Element

~~ClaimResponse.item.adjudication.amount~~ ClaimResponse.requestProvider

Type changed from ~~Quantity{http://hl7.org/fhir/StructureDefinition/Money}~~ Reference(Practitioner) to Money ClaimResponse.item.detail.noteNumber Added Element ClaimResponse.item.detail.adjudication Remove BackboneElement ClaimResponse.item.detail.subDetail.noteNumber Added Element ClaimResponse.item.detail.subDetail.adjudication Remove BackboneElement ClaimResponse.addItem.revenue Added Element ClaimResponse.addItem.category Added Element Reference(Practitioner|PractitionerRole|Organization)

~~ClaimResponse.addItem.service~~ ClaimResponse.outcome

~~Min Cardinality changed from 1 to 0~~ Type changed from ~~Coding to~~ CodeableConcept to code

~~ClaimResponse.addItem.modifier Added Element ClaimResponse.addItem.fee~~

~~Type changed from Quantity{http://hl7.org/fhir/StructureDefinition/Money} to Money~~ Add Binding http://hl7.org/fhir/ValueSet/remittance-outcome (required)

~~ClaimResponse.addItem.noteNumber~~ ClaimResponse.item.itemSequence

Added Element

~~ClaimResponse.addItem.detail.revenue~~ ClaimResponse.item.detail.detailSequence

Added Element

~~ClaimResponse.addItem.detail.category~~ ClaimResponse.item.detail.subDetail.subDetailSequence

Added Element

~~ClaimResponse.addItem.detail.modifier~~ ClaimResponse.addItem.itemSequence

Added Element

~~ClaimResponse.addItem.detail.noteNumber~~ ClaimResponse.addItem.detailSequence

Added Element

~~ClaimResponse.payment~~ ClaimResponse.addItem.subdetailSequence

Added Element

~~ClaimResponse.payment.type~~ ClaimResponse.error.itemSequence

Added Element

~~ClaimResponse.payment.adjustment~~ ClaimResponse.error.detailSequence

Added Element

~~ClaimResponse.payment.adjustmentReason~~ ClaimResponse.error.subDetailSequence

Added Element

~~ClaimResponse.payment.date~~ ClaimResponse.total

Added Element

~~ClaimResponse.payment.amount~~ ClaimResponse.total.category

Added Element

~~ClaimResponse.payment.identifier~~ ClaimResponse.total.amount

Added Element

~~ClaimResponse.form~~ ClaimResponse.processNote.type

Type changed from ~~Coding to~~ CodeableConcept Remove Binding http://hl7.org/fhir/ValueSet/forms (required) ClaimResponse.processNote Added Element ClaimResponse.processNote.number Added Element ClaimResponse.processNote.type Added Element ClaimResponse.processNote.text Added Element ClaimResponse.processNote.language Added Element ClaimResponse.communicationRequest Added Element ClaimResponse.insurance Added Element ClaimResponse.insurance.sequence Added Element ClaimResponse.insurance.focal Added Element ClaimResponse.insurance.coverage Added Element ClaimResponse.insurance.businessArrangement Added Element ClaimResponse.insurance.preAuthRef Added Element ClaimResponse.insurance.claimResponse Added Element ClaimResponse.ruleset deleted ClaimResponse.originalRuleset deleted ClaimResponse.organization deleted ClaimResponse.item.adjudication.code deleted ClaimResponse.item.detail.adjudication.code deleted ClaimResponse.item.detail.adjudication.amount deleted ClaimResponse.item.detail.adjudication.value deleted ClaimResponse.item.detail.subDetail.adjudication.code deleted ClaimResponse.item.detail.subDetail.adjudication.amount deleted ClaimResponse.item.detail.subDetail.adjudication.value deleted to code

~~ClaimResponse.addItem.noteNumberLinkId~~ ClaimResponse.requestOrganization

deleted

~~ClaimResponse.addItem.adjudication.code~~ ClaimResponse.item.sequenceLinkId

deleted

~~ClaimResponse.addItem.adjudication.amount~~ ClaimResponse.item.detail.sequenceLinkId

deleted

~~ClaimResponse.addItem.adjudication.value~~ ClaimResponse.item.detail.subDetail.sequenceLinkId

deleted

~~ClaimResponse.addItem.detail.adjudication.code~~ ClaimResponse.addItem.sequenceLinkId

deleted

~~ClaimResponse.addItem.detail.adjudication.amount~~ ClaimResponse.addItem.revenue

deleted

~~ClaimResponse.addItem.detail.adjudication.value~~ ClaimResponse.addItem.category

deleted

~~ClaimResponse.paymentAdjustment~~ ClaimResponse.addItem.detail

deleted

~~ClaimResponse.paymentAdjustmentReason~~ ClaimResponse.error.sequenceLinkId

deleted

~~ClaimResponse.paymentDate~~ ClaimResponse.error.detailSequenceLinkId

deleted

~~ClaimResponse.paymentAmount~~ ClaimResponse.error.subdetailSequenceLinkId

deleted

~~ClaimResponse.paymentRef~~ ClaimResponse.totalCost

deleted

~~ClaimResponse.note~~ ClaimResponse.unallocDeductable

deleted

~~ClaimResponse.coverage~~ ClaimResponse.totalBenefit

deleted

See the Full Difference for further information

This analysis is available as XML or JSON .

Alternate definitions: Master Definition ( XML , + JSON ), , XML Schema / Schematron ~~(for )~~ + JSON Schema , ShEx (for Turtle ) + see the extensions & the dependency analysis

13.7.2.1 Terminology Bindings

~~ClaimResponse.outcome~~ ~~ClaimResponse.payeeType~~ ~~ClaimResponse.item.adjudication.category~~ ~~ClaimResponse.item.adjudication.reason~~ ~~ClaimResponse.addItem.revenue~~ ~~ClaimResponse.addItem.category ClaimResponse.addItem.detail.category~~

Path	Definition	Type	Reference
ClaimResponse.status	A code specifying the state of the resource instance.	Required	Financial Resource Status Codes
ClaimResponse.type	The ~~result~~ type or discipline-style of the claim ~~processing~~	~~Example~~ Extensible	Claim ~~Processing~~ Type Codes
ClaimResponse.subType	A ~~code for the party to be reimbursed.~~ more granulat claim typecode	Example	Example Claim ~~Payee Type~~ SubType Codes
ClaimResponse.use	Complete, proposed, exploratory, other	Required	Use
ClaimResponse.outcome	The ~~adjudication codes.~~ result of the claim processing	~~Example~~ Required	~~Adjudication Value~~ Claim Processing Codes
ClaimResponse.payeeType	~~The adjudication reason codes.~~ A code for the party to be reimbursed.	Example	~~Adjudication Reason~~ Claim Payee Type Codes
ClaimResponse.item.adjudication.category ~~ClaimResponse.addItem.detail.revenue~~ ClaimResponse.total.category	~~Codes for the revenue or cost centers supplying the service and/or products.~~ The adjudication codes.	Example	~~Example Revenue Center~~ Adjudication Value Codes
ClaimResponse.item.adjudication.reason	~~Benefit subcategories such as: oral-basic, major, glasses~~ The adjudication reason codes.	Example	~~Benefit SubCategory~~ Adjudication Reason Codes
ClaimResponse.addItem.service ~~ClaimResponse.addItem.detail.service~~	Allowable service and product codes.	Example	USCLS Codes
ClaimResponse.addItem.modifier ~~ClaimResponse.addItem.detail.modifier~~	Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen.	Example	Modifier type Codes
ClaimResponse.error.code	The adjudication error codes.	Example	Adjudication Error Codes
ClaimResponse.payment.type	The type (partial, complete) of the payment	Example	Example Payment Type Codes
ClaimResponse.payment.adjustmentReason	Payment Adjustment reason codes.	Example	Payment Adjustment Reason Codes
ClaimResponse.reserved	For whom funds are to be reserved: (Patient, Provider, None).	Example	Funds Reservation Codes
ClaimResponse.form	The forms codes.	Example	Form Codes
ClaimResponse.processNote.type	The presentation types of notes.	Required	NoteType
ClaimResponse.processNote.language	A human language.	Extensible , but limited to All Languages	Common Languages

Path

Definition

Type

Reference

ClaimResponse.status

A code specifying the state of the resource instance.

Required

Financial Resource Status Codes

ClaimResponse.type

The ~~result~~ type or discipline-style of the claim ~~processing~~

~~Example~~ Extensible

Claim ~~Processing~~ Type Codes

ClaimResponse.subType

A ~~code for the party to be reimbursed.~~ more granulat claim typecode

Example

Example Claim ~~Payee Type~~ SubType Codes

ClaimResponse.use

Complete, proposed, exploratory, other

Required

Use

ClaimResponse.outcome

The ~~adjudication codes.~~ result of the claim processing

~~Example~~ Required

~~Adjudication Value~~ Claim Processing Codes

ClaimResponse.payeeType

~~The adjudication reason codes.~~ A code for the party to be reimbursed.

Example

~~Adjudication Reason~~ Claim Payee Type Codes

ClaimResponse.item.adjudication.category
~~ClaimResponse.addItem.detail.revenue~~ ClaimResponse.total.category

~~Codes for the revenue or cost centers supplying the service and/or products.~~ The adjudication codes.

Example

~~Example Revenue Center~~ Adjudication Value Codes

ClaimResponse.item.adjudication.reason

~~Benefit subcategories such as: oral-basic, major, glasses~~ The adjudication reason codes.

Example

~~Benefit SubCategory~~ Adjudication Reason Codes

ClaimResponse.addItem.service ~~ClaimResponse.addItem.detail.service~~

Allowable service and product codes.

Example

USCLS Codes

ClaimResponse.addItem.modifier ~~ClaimResponse.addItem.detail.modifier~~

Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen.

Example

Modifier type Codes

ClaimResponse.error.code

The adjudication error codes.

Example

Adjudication Error Codes

ClaimResponse.payment.type

The type (partial, complete) of the payment

Example

Example Payment Type Codes

ClaimResponse.payment.adjustmentReason

Payment Adjustment reason codes.

Example

Payment Adjustment Reason Codes

ClaimResponse.reserved

For whom funds are to be reserved: (Patient, Provider, None).

Example

Funds Reservation Codes

ClaimResponse.form

The forms codes.

Example

Form Codes

ClaimResponse.processNote.type

The presentation types of notes.

Required

NoteType

ClaimResponse.processNote.language

A human language.

Extensible , but limited to All Languages

Common Languages

13.7.3 Search Parameters

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

Name	Type	Description	Expression	In Common
created	date	The creation date	ClaimResponse.created
disposition	string	The contents of the disposition message	ClaimResponse.disposition
identifier	token	The identity of the claimresponse	ClaimResponse.identifier
insurer	reference	The organization who generated this resource	ClaimResponse.insurer ( Organization )
outcome	token	The processing outcome	ClaimResponse.outcome
patient	reference	The subject of care.	ClaimResponse.patient ( Patient )
payment-date	date	The expected paymentDate	ClaimResponse.payment.date
request	reference	The claim reference	ClaimResponse.request ( Claim )
request-provider	reference	The Provider of the claim	ClaimResponse.requestProvider ( Practitioner , Organization , PractitionerRole )
status	token	The status of the claim response	ClaimResponse.status

®© HL7.org 2011+. FHIR ~~Release 3 (STU; v3.0.2-11200)~~ Mixed Nomative/Trial Use Ballot (v3.3.0-13671) generated on ~~Thurs, Oct 24, 2019 11:53+1100.~~ Tue, Apr 3, 2018 12:14+1000. QA Page
Links: Search | Version History | Table of Contents | Credits | Compare to ~~DSTU2~~ DSTU3 | | Propose a change