R4
Ballot
#1
#2
(Mixed
Normative/Trial
use)
Financial
This
page
is
part
of
the
FHIR
Specification
(v3.3.0:
(v3.5.0:
R4
Ballot
2).
#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
| Financial Management Work Group | Maturity Level : N/A | Ballot Status : Informative | Compartments : Patient , Practitioner |
Raw JSON ( canonical form + also see JSON Format Specification )
StructureDefinition for claimresponse
{
"resourceType": "StructureDefinition",
"id": "ClaimResponse",
"meta": {
"lastUpdated": "2018-04-03T12:05:46.262+10:00"
"resourceType" : "StructureDefinition",
"id" : "ClaimResponse",
"meta" : {
"lastUpdated" : "2018-08-19T21:48:56.559+10:00"
},
"text": {
"status": "generated",
"div": "<div>!-- Snipped for Brevity --></div>"
"text" : {
"status" : "generated",
"div" : "<div>!-- Snipped for Brevity --></div>"
},
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-ballot-status",
"valueString": "Trial Use"
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-category",
"valueString" : "Financial.Billing"
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status",
"valueString" : "Trial Use"
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-fmm",
"valueInteger" : 2
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-wg",
"valueCode" : "fm"
}],
"url" : "http://hl7.org/fhir/StructureDefinition/ClaimResponse",
"name" : "ClaimResponse",
"status" : "draft",
"date" : "2018-08-19T21:48:56+10:00",
"publisher" : "Health Level Seven International (Financial Management)",
"contact" : [{
"telecom" : [{
"system" : "url",
"value" : "http://hl7.org/fhir"
}]
},
{
"telecom" : [{
"system" : "url",
"value" : "http://www.hl7.org/Special/committees/fm/index.cfm"
}]
}],
"description" : "This resource provides the adjudication details from the processing of a Claim resource.",
"fhirVersion" : "3.5.0",
"mapping" : [{
"identity" : "workflow",
"uri" : "http://hl7.org/fhir/workflow",
"name" : "Workflow Pattern"
},
{
"identity" : "w5",
"uri" : "http://hl7.org/fhir/fivews",
"name" : "FiveWs Pattern"
},
{
"identity" : "rim",
"uri" : "http://hl7.org/v3",
"name" : "RIM Mapping"
}],
"kind" : "resource",
"abstract" : false,
"type" : "ClaimResponse",
"baseDefinition" : "http://hl7.org/fhir/StructureDefinition/DomainResource",
"derivation" : "specialization",
"snapshot" : {
"element" : [{
"id" : "ClaimResponse",
"path" : "ClaimResponse",
"short" : "ClaimResponse resource",
"definition" : "This resource provides the adjudication details from the processing of a Claim resource.",
"alias" : ["Remittance Advice"],
"min" : 0,
"max" : "*",
"base" : {
"path" : "ClaimResponse",
"min" : 0,
"max" : "*"
},
"constraint" : [{
"key" : "dom-2",
"severity" : "error",
"human" : "If the resource is contained in another resource, it SHALL NOT contain nested Resources",
"expression" : "contained.contained.empty()",
"xpath" : "not(parent::f:contained and f:contained)",
"source" : "DomainResource"
},
{
"key" : "dom-4",
"severity" : "error",
"human" : "If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated",
"expression" : "contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()",
"xpath" : "not(exists(f:contained/*/f:meta/f:versionId)) and not(exists(f:contained/*/f:meta/f:lastUpdated))",
"source" : "DomainResource"
},
{
"key" : "dom-3",
"severity" : "error",
"human" : "If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource",
"expression" : "contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()",
"xpath" : "not(exists(for $contained in f:contained return $contained[not(parent::*/descendant::f:reference/@value=concat('#', $contained/*/id/@value) or descendant::f:reference[@value='#'])]))",
"source" : "DomainResource"
},
{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-bestpractice",
"valueBoolean" : true
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-bestpractice-explanation",
"valueMarkdown" : "When a resource has no narrative, only systems that fully understand the data can display the resource to a human safely. Including a guman readable representation in the resource makes for a much more robust eco-system and cheaper handling of resources by intermediary systems. Some ecosystems restrict distribution of resources to only those systems that do fully understand the resources, and as a consequence implementers may believe that the narrative is superfluous. However experience shows that such eco-systems often open up to new participants over time."
}],
"key" : "dom-6",
"severity" : "warning",
"human" : "A resource should have narrative for robust management",
"expression" : "text.div.exists()",
"xpath" : "exists(f:text/h:div)",
"source" : "DomainResource"
},
{
"key" : "dom-5",
"severity" : "error",
"human" : "If a resource is contained in another resource, it SHALL NOT have a security label",
"expression" : "contained.meta.security.empty()",
"xpath" : "not(exists(f:contained/*/f:meta/f:security))",
"source" : "DomainResource"
}],
"isModifier" : false,
"isSummary" : false,
"mapping" : [{
"identity" : "rim",
"map" : "Entity. Role, or Act"
},
{
"identity" : "workflow",
"map" : "Event"
}]
},
{
"url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-fmm",
"valueInteger": 2
"id" : "ClaimResponse.id",
"path" : "ClaimResponse.id",
"short" : "Logical id of this artifact",
"definition" : "The logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes.",
"comment" : "The only time that a resource does not have an id is when it is being submitted to the server using a create operation.",
"min" : 0,
"max" : "1",
"base" : {
"path" : "Resource.id",
"min" : 0,
"max" : "1"
},
"type" : [{
"code" : "id"
}],
"isModifier" : false,
"isSummary" : true
},
{
"url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-wg",
"valueCode": "fm"
}
],
"url": "http://hl7.org/fhir/StructureDefinition/ClaimResponse",
"name": "ClaimResponse",
"status": "draft",
"date": "2018-04-03T12:05:46+10:00",
"publisher": "Health Level Seven International (Financial Management)",
"contact": [
"id" : "ClaimResponse.meta",
"path" : "ClaimResponse.meta",
"short" : "Metadata about the resource",
"definition" : "The metadata about the resource. This is content that is maintained by the infrastructure. Changes to the content might not always be associated with version changes to the resource.",
"min" : 0,
"max" : "1",
"base" : {
"path" : "Resource.meta",
"min" : 0,
"max" : "1"
},
"type" : [{
"code" : "Meta"
}],
"isModifier" : false,
"isSummary" : true
},
{
"telecom": [
{
"system": "url",
"value": "http://hl7.org/fhir"
}
]
"id" : "ClaimResponse.implicitRules",
"path" : "ClaimResponse.implicitRules",
"short" : "A set of rules under which this content was created",
"definition" : "A reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content. Often, this is a reference to an implementation guide that defines the special rules along with other profiles etc.",
"comment" : "Asserting this rule set restricts the content to be only understood by a limited set of trading partners. This inherently limits the usefulness of the data in the long term. However, the existing health eco-system is highly fractured, and not yet ready to define, collect, and exchange data in a generally computable sense. Wherever possible, implementers and/or specification writers should avoid using this element. Often, when used, the URL is a reference to an implementation guide that defines these special rules as part of it's narrative along with other profiles, value sets, etc.",
"min" : 0,
"max" : "1",
"base" : {
"path" : "Resource.implicitRules",
"min" : 0,
"max" : "1"
},
"type" : [{
"code" : "uri"
}],
"isModifier" : true,
"isModifierReason" : "This element is labeled as a modifier because the implicit rules may provide additional knowledge about the resource that modifies it's meaning or interpretation",
"isSummary" : true
},
{
"telecom": [
"id" : "ClaimResponse.language",
"path" : "ClaimResponse.language",
"short" : "Language of the resource content",
"definition" : "The base language in which the resource is written.",
"comment" : "Language is provided to support indexing and accessibility (typically, services such as text to speech use the language tag). The html language tag in the narrative applies to the narrative. The language tag on the resource may be used to specify the language of other presentations generated from the data in the resource. Not all the content has to be in the base language. The Resource.language should not be assumed to apply to the narrative automatically. If a language is specified, it should it also be specified on the div element in the html (see rules in HTML5 for information about the relationship between xml:lang and the html lang attribute).",
"min" : 0,
"max" : "1",
"base" : {
"path" : "Resource.language",
"min" : 0,
"max" : "1"
},
"type" : [{
"code" : "code"
}],
"isModifier" : false,
"isSummary" : false,
"binding" : {
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-maxValueSet",
"valueCanonical" : "http://hl7.org/fhir/ValueSet/all-languages"
},
{
"system": "url",
"value": "http://www.hl7.org/Special/committees/fm/index.cfm"
}
]
}
],
"description": "This resource provides the adjudication details from the processing of a Claim resource.",
"fhirVersion": "3.3.0",
"mapping": [
{
"identity": "workflow",
"uri": "http://hl7.org/fhir/workflow",
"name": "Workflow Pattern"
"url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString" : "Language"
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-isCommonBinding",
"valueBoolean" : true
}],
"strength" : "preferred",
"description" : "A human language.",
"valueSet" : "http://hl7.org/fhir/ValueSet/languages"
}
},
{
"identity": "w5",
"uri": "http://hl7.org/fhir/fivews",
"name": "FiveWs Pattern"
"id" : "ClaimResponse.text",
"path" : "ClaimResponse.text",
"short" : "Text summary of the resource, for human interpretation",
"definition" : "A human-readable narrative that contains a summary of the resource and can be used to represent the content of the resource to a human. The narrative need not encode all the structured data, but is required to contain sufficient detail to make it \"clinically safe\" for a human to just read the narrative. Resource definitions may define what content should be represented in the narrative to ensure clinical safety.",
"comment" : "Contained resources do not have narrative. Resources that are not contained SHOULD have a narrative. In some cases, a resource may only have text with little or no additional discrete data (as long as all minOccurs=1 elements are satisfied). This may be necessary for data from legacy systems where information is captured as a \"text blob\" or where text is additionally entered raw or narrated and encoded information is added later.",
"alias" : ["narrative",
"html",
"xhtml",
"display"],
"min" : 0,
"max" : "1",
"base" : {
"path" : "DomainResource.text",
"min" : 0,
"max" : "1"
},
"type" : [{
"code" : "Narrative"
}],
"isModifier" : false,
"isSummary" : false,
"mapping" : [{
"identity" : "rim",
"map" : "Act.text?"
}]
},
{
"identity": "rim",
"uri": "http://hl7.org/v3",
"name": "RIM Mapping"
}
],
"kind": "resource",
"abstract": false,
"type": "ClaimResponse",
"baseDefinition": "http://hl7.org/fhir/StructureDefinition/DomainResource",
"derivation": "specialization",
"snapshot": {
"element": [
{
"id": "ClaimResponse",
"path": "ClaimResponse",
"short": "Remittance resource",
"definition": "This resource provides the adjudication details from the processing of a Claim resource.",
"alias": [
"Remittance Advice"
],
"min": 0,
"max": "*",
"base": {
"path": "ClaimResponse",
"min": 0,
"max": "*"
},
"constraint": [
{
"key": "dom-2",
"severity": "error",
"human": "If the resource is contained in another resource, it SHALL NOT contain nested Resources",
"expression": "contained.contained.empty()",
"xpath": "not(parent::f:contained and f:contained)",
"source": "DomainResource"
},
{
"key": "dom-1",
"severity": "error",
"human": "If the resource is contained in another resource, it SHALL NOT contain any narrative",
"expression": "contained.text.empty()",
"xpath": "not(parent::f:contained and f:text)",
"source": "DomainResource"
},
{
"key": "dom-4",
"severity": "error",
"human": "If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated",
"expression": "contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()",
"xpath": "not(exists(f:contained/*/f:meta/f:versionId)) and not(exists(f:contained/*/f:meta/f:lastUpdated))",
"source": "DomainResource"
},
{
"key": "dom-3",
"severity": "error",
"human": "If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource",
"expression": "contained.all(('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists())",
"xpath": "not(exists(for $contained in f:contained return $contained[not(parent::*/descendant::f:reference/@value=concat('#', $contained/*/id/@value) or descendant::f:reference[@value='#'])]))",
"source": "DomainResource"
}
],
"isModifier": false,
"isSummary": false,
"mapping": [
{
"identity": "rim",
"map": "Entity. Role, or Act"
},
{
"identity": "workflow",
"map": "Event"
}
]
"id" : "ClaimResponse.contained",
"path" : "ClaimResponse.contained",
"short" : "Contained, inline Resources",
"definition" : "These resources do not have an independent existence apart from the resource that contains them - they cannot be identified independently, and nor can they have their own independent transaction scope.",
"comment" : "This should never be done when the content can be identified properly, as once identification is lost, it is extremely difficult (and context dependent) to restore it again. Contained resources may have profiles and tags In their meta elements, but SHALL NOT have security labels.",
"alias" : ["inline resources",
"anonymous resources",
"contained resources"],
"min" : 0,
"max" : "*",
"base" : {
"path" : "DomainResource.contained",
"min" : 0,
"max" : "*"
},
{
"id": "ClaimResponse.id",
"path": "ClaimResponse.id",
"short": "Logical id of this artifact",
"definition": "The logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes.",
"comment": "The only time that a resource does not have an id is when it is being submitted to the server using a create operation.",
"min": 0,
"max": "1",
"base": {
"path": "Resource.id",
"min": 0,
"max": "1"
},
"type": [
{
"code": "id"
}
],
"isModifier": false,
"isSummary": true
"type" : [{
"code" : "Resource"
}],
"isModifier" : false,
"isSummary" : false,
"mapping" : [{
"identity" : "rim",
"map" : "N/A"
}]
},
{
"id" : "ClaimResponse.extension",
"path" : "ClaimResponse.extension",
"short" : "Additional Content defined by implementations",
"definition" : "May be used to represent additional information that is not part of the basic definition of the resource. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.",
"comment" : "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.",
"alias" : ["extensions",
"user content"],
"min" : 0,
"max" : "*",
"base" : {
"path" : "DomainResource.extension",
"min" : 0,
"max" : "*"
},
{
"id": "ClaimResponse.meta",
"path": "ClaimResponse.meta",
"short": "Metadata about the resource",
"definition": "The metadata about the resource. This is content that is maintained by the infrastructure. Changes to the content might not always be associated with version changes to the resource.",
"min": 0,
"max": "1",
"base": {
"path": "Resource.meta",
"min": 0,
"max": "1"
},
"type": [
{
"code": "Meta"
}
],
"isModifier": false,
"isSummary": true
"type" : [{
"code" : "Extension"
}],
"isModifier" : false,
"isSummary" : false,
"mapping" : [{
"identity" : "rim",
"map" : "N/A"
}]
},
{
"id" : "ClaimResponse.modifierExtension",
"path" : "ClaimResponse.modifierExtension",
"short" : "Extensions that cannot be ignored",
"definition" : "May be used to represent additional information that is not part of the basic definition of the resource, and that modifies the understanding of the element that contains it. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.\n\nModifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).",
"comment" : "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.",
"alias" : ["extensions",
"user content"],
"min" : 0,
"max" : "*",
"base" : {
"path" : "DomainResource.modifierExtension",
"min" : 0,
"max" : "*"
},
{
"id": "ClaimResponse.implicitRules",
"path": "ClaimResponse.implicitRules",
"short": "A set of rules under which this content was created",
"definition": "A reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content. Often, this is a reference to an implementation guide that defines the special rules along with other profiles etc.",
"comment": "Asserting this rule set restricts the content to be only understood by a limited set of trading partners. This inherently limits the usefulness of the data in the long term. However, the existing health eco-system is highly fractured, and not yet ready to define, collect, and exchange data in a generally computable sense. Wherever possible, implementers and/or specification writers should avoid using this element. Often, when used, the URL is a reference to an implementation guide that defines these special rules as part of it's narrative along with other profiles, value sets, etc.",
"min": 0,
"max": "1",
"base": {
"path": "Resource.implicitRules",
"min": 0,
"max": "1"
},
"type": [
{
"code": "uri"
}
],
"isModifier": true,
"isModifierReason": "This element is labeled as a modifier because the implicit rules may provide additional knowledge about the resource that modifies it's meaning or interpretation",
"isSummary": true
"type" : [{
"code" : "Extension"
}],
"isModifier" : true,
"isModifierReason" : "Modifier extensions are expected to modify the meaning or interpretation of the resource that contains them",
"isSummary" : false,
"mapping" : [{
"identity" : "rim",
"map" : "N/A"
}]
},
{
"id" : "ClaimResponse.identifier",
"path" : "ClaimResponse.identifier",
"short" : "Response number",
"definition" : "The response business identifier.",
"min" : 0,
"max" : "*",
"base" : {
"path" : "ClaimResponse.identifier",
"min" : 0,
"max" : "*"
},
{
"id": "ClaimResponse.language",
"path": "ClaimResponse.language",
"short": "Language of the resource content",
"definition": "The base language in which the resource is written.",
"comment": "Language is provided to support indexing and accessibility (typically, services such as text to speech use the language tag). The html language tag in the narrative applies to the narrative. The language tag on the resource may be used to specify the language of other presentations generated from the data in the resource. Not all the content has to be in the base language. The Resource.language should not be assumed to apply to the narrative automatically. If a language is specified, it should it also be specified on the div element in the html (see rules in HTML5 for information about the relationship between xml:lang and the html lang attribute).",
"min": 0,
"max": "1",
"base": {
"path": "Resource.language",
"min": 0,
"max": "1"
},
"type": [
{
"code": "code"
}
],
"isModifier": false,
"isSummary": false,
"binding": {
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-maxValueSet",
"valueReference": {
"reference": "http://hl7.org/fhir/ValueSet/all-languages"
}
},
{
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString": "Language"
},
{
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-isCommonBinding",
"valueBoolean": true
}
],
"strength": "extensible",
"description": "A human language.",
"valueSetCanonical": "http://hl7.org/fhir/ValueSet/languages"
}
"type" : [{
"code" : "Identifier"
}],
"isModifier" : false,
"isSummary" : false,
"mapping" : [{
"identity" : "workflow",
"map" : "Event.identifier"
},
{
"id": "ClaimResponse.text",
"path": "ClaimResponse.text",
"short": "Text summary of the resource, for human interpretation",
"definition": "A human-readable narrative that contains a summary of the resource and can be used to represent the content of the resource to a human. The narrative need not encode all the structured data, but is required to contain sufficient detail to make it \"clinically safe\" for a human to just read the narrative. Resource definitions may define what content should be represented in the narrative to ensure clinical safety.",
"comment": "Contained resources do not have narrative. Resources that are not contained SHOULD have a narrative. In some cases, a resource may only have text with little or no additional discrete data (as long as all minOccurs=1 elements are satisfied). This may be necessary for data from legacy systems where information is captured as a \"text blob\" or where text is additionally entered raw or narrated and encoded in formation is added later.",
"alias": [
"narrative",
"html",
"xhtml",
"display"
],
"min": 0,
"max": "1",
"base": {
"path": "DomainResource.text",
"min": 0,
"max": "1"
},
"type": [
{
"code": "Narrative"
}
],
"condition": [
"dom-1"
],
"isModifier": false,
"isSummary": false,
"mapping": [
{
"identity": "rim",
"map": "Act.text?"
}
]
"identity" : "w5",
"map" : "FiveWs.identifier"
}]
},
{
"id" : "ClaimResponse.status",
"path" : "ClaimResponse.status",
"short" : "active | cancelled | draft | entered-in-error",
"definition" : "The status of the resource instance.",
"comment" : "This element is labeled as a modifier because the status contains the code cancelled and entered-in-error that mark the response as not currently valid.",
"min" : 0,
"max" : "1",
"base" : {
"path" : "ClaimResponse.status",
"min" : 0,
"max" : "1"
},
{
"id": "ClaimResponse.contained",
"path": "ClaimResponse.contained",
"short": "Contained, inline Resources",
"definition": "These resources do not have an independent existence apart from the resource that contains them - they cannot be identified independently, and nor can they have their own independent transaction scope.",
"comment": "This should never be done when the content can be identified properly, as once identification is lost, it is extremely difficult (and context dependent) to restore it again.",
"alias": [
"inline resources",
"anonymous resources",
"contained resources"
],
"min": 0,
"max": "*",
"base": {
"path": "DomainResource.contained",
"min": 0,
"max": "*"
},
"type": [
{
"code": "Resource"
}
],
"isModifier": false,
"isSummary": false,
"mapping": [
{
"identity": "rim",
"map": "N/A"
}
]
"type" : [{
"code" : "code"
}],
"isModifier" : true,
"isModifierReason" : "This element is labeled as a modifier because it is a status element that contains status entered-in-error which means that the resource should not be treated as valid",
"isSummary" : true,
"binding" : {
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString" : "ClaimResponseStatus"
}],
"strength" : "required",
"description" : "A code specifying the state of the resource instance.",
"valueSet" : "http://hl7.org/fhir/ValueSet/fm-status"
},
{
"id": "ClaimResponse.extension",
"path": "ClaimResponse.extension",
"short": "Additional Content defined by implementations",
"definition": "May be used to represent additional information that is not part of the basic definition of the resource. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.",
"comment": "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.",
"alias": [
"extensions",
"user content"
],
"min": 0,
"max": "*",
"base": {
"path": "DomainResource.extension",
"min": 0,
"max": "*"
},
"type": [
{
"code": "Extension"
}
],
"isModifier": false,
"isSummary": false,
"mapping": [
{
"identity": "rim",
"map": "N/A"
}
]
"mapping" : [{
"identity" : "workflow",
"map" : "Event.status"
},
{
"id": "ClaimResponse.modifierExtension",
"path": "ClaimResponse.modifierExtension",
"short": "Extensions that cannot be ignored",
"definition": "May be used to represent additional information that is not part of the basic definition of the resource, and that modifies the understanding of the element that contains it. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.",
"comment": "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.",
"alias": [
"extensions",
"user content"
],
"min": 0,
"max": "*",
"base": {
"path": "DomainResource.modifierExtension",
"min": 0,
"max": "*"
},
"type": [
{
"code": "Extension"
}
],
"isModifier": true,
"isModifierReason": "Not known why this is labelled a modifier",
"isSummary": false,
"mapping": [
{
"identity": "rim",
"map": "N/A"
}
]
"identity" : "w5",
"map" : "FiveWs.status"
}]
},
{
"id" : "ClaimResponse.type",
"path" : "ClaimResponse.type",
"short" : "Type or discipline",
"definition" : "The category of claim, e.g, oral, pharmacy, vision, institutional, professional.",
"comment" : "Affects which fields and value sets are used.",
"min" : 0,
"max" : "1",
"base" : {
"path" : "ClaimResponse.type",
"min" : 0,
"max" : "1"
},
{
"id": "ClaimResponse.identifier",
"path": "ClaimResponse.identifier",
"short": "Response number",
"definition": "The Response business identifier.",
"min": 0,
"max": "*",
"base": {
"path": "ClaimResponse.identifier",
"min": 0,
"max": "*"
},
"type": [
{
"code": "Identifier"
}
],
"isModifier": false,
"isSummary": false,
"mapping": [
{
"identity": "workflow",
"map": "Event.identifier"
},
{
"identity": "w5",
"map": "FiveWs.identifier"
}
]
"type" : [{
"code" : "CodeableConcept"
}],
"isModifier" : false,
"isSummary" : false,
"binding" : {
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString" : "ClaimType"
}],
"strength" : "extensible",
"description" : "The type or discipline-style of the claim.",
"valueSet" : "http://hl7.org/fhir/ValueSet/claim-type"
},
{
"id": "ClaimResponse.status",
"path": "ClaimResponse.status",
"short": "active | cancelled | draft | entered-in-error",
"definition": "The status of the resource instance.",
"comment": "This element is labeled as a modifier because the status contains the code cancelled and entered-in-error that mark the response as not currently valid.",
"min": 0,
"max": "1",
"base": {
"path": "ClaimResponse.status",
"min": 0,
"max": "1"
},
"type": [
{
"code": "code"
}
],
"isModifier": true,
"isModifierReason": "This element is labelled as a modifier because it is a status element that contains status entered-in-error which means that the resource should not be treated as valid",
"isSummary": true,
"binding": {
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString": "ClaimResponseStatus"
}
],
"strength": "required",
"description": "A code specifying the state of the resource instance.",
"valueSetCanonical": "http://hl7.org/fhir/ValueSet/fm-status"
},
"mapping": [
{
"identity": "workflow",
"map": "Event.status"
},
{
"identity": "w5",
"map": "FiveWs.status"
}
]
"mapping" : [{
"identity" : "w5",
"map" : "FiveWs.class"
}]
},
{
"id" : "ClaimResponse.subType",
"path" : "ClaimResponse.subType",
"short" : "Finer grained claim type information",
"definition" : "A finer grained suite of claim subtype codes which may convey Inpatient vs Outpatient and/or a specialty service. In the US the CMS Bill Type.",
"comment" : "This may contain the local bill type codes such as the US UB-04 bill type code.",
"min" : 0,
"max" : "1",
"base" : {
"path" : "ClaimResponse.subType",
"min" : 0,
"max" : "1"
},
{
"id": "ClaimResponse.type",
"path": "ClaimResponse.type",
"short": "Type or discipline",
"definition": "The category of claim, eg, oral, pharmacy, vision, insitutional, professional.",
"comment": "Affects which fields and value sets are used.",
"min": 0,
"max": "1",
"base": {
"path": "ClaimResponse.type",
"min": 0,
"max": "1"
},
"type": [
{
"code": "CodeableConcept"
}
],
"isModifier": false,
"isSummary": false,
"binding": {
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString": "ClaimType"
}
],
"strength": "extensible",
"description": "The type or discipline-style of the claim",
"valueSetCanonical": "http://hl7.org/fhir/ValueSet/claim-type"
},
"mapping": [
{
"identity": "w5",
"map": "FiveWs.class"
}
]
"type" : [{
"code" : "CodeableConcept"
}],
"isModifier" : false,
"isSummary" : false,
"binding" : {
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString" : "ClaimSubType"
}],
"strength" : "example",
"description" : "A more granulat claim typecode.",
"valueSet" : "http://hl7.org/fhir/ValueSet/claim-subtype"
},
{
"id": "ClaimResponse.subType",
"path": "ClaimResponse.subType",
"short": "Finer grained claim type information",
"definition": "A finer grained suite of claim subtype codes which may convey Inpatient vs Outpatient and/or a specialty service. In the US the BillType.",
"comment": "This may contain the local bill type codes such as the US UB-04 bill type code.",
"min": 0,
"max": "*",
"base": {
"path": "ClaimResponse.subType",
"min": 0,
"max": "*"
},
"type": [
{
"code": "CodeableConcept"
}
],
"isModifier": false,
"isSummary": false,
"binding": {
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString": "ClaimSubType"
}
],
"strength": "example",
"description": "A more granulat claim typecode",
"valueSetCanonical": "http://hl7.org/fhir/ValueSet/claim-subtype"
},
"mapping": [
{
"identity": "w5",
"map": "FiveWs.class"
}
]
"mapping" : [{
"identity" : "w5",
"map" : "FiveWs.class"
}]
},
{
"id" : "ClaimResponse.use",
"path" : "ClaimResponse.use",
"short" : "claim | preauthorization | predetermination",
"definition" : "A claim, a list of completed goods and services; a preauthorization, a list or proposed goods and services; or a predetermination, a set of goods and services being considered, for which insurer adjudication is sought.",
"min" : 0,
"max" : "1",
"base" : {
"path" : "ClaimResponse.use",
"min" : 0,
"max" : "1"
},
{
"id": "ClaimResponse.use",
"path": "ClaimResponse.use",
"short": "complete | proposed | exploratory | other",
"definition": "Complete (Bill or Claim), Proposed (Pre-Authorization), Exploratory (Pre-determination).",
"min": 0,
"max": "1",
"base": {
"path": "ClaimResponse.use",
"min": 0,
"max": "1"
},
"type": [
{
"code": "code"
}
],
"isModifier": false,
"isSummary": false,
"binding": {
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString": "Use"
}
],
"strength": "required",
"description": "Complete, proposed, exploratory, other",
"valueSetCanonical": "http://hl7.org/fhir/ValueSet/claim-use"
},
"mapping": [
{
"identity": "w5",
"map": "FiveWs.class"
}
]
"type" : [{
"code" : "code"
}],
"isModifier" : false,
"isSummary" : true,
"binding" : {
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString" : "Use"
}],
"strength" : "required",
"description" : "Claim, preauthorization, predetermination.",
"valueSet" : "http://hl7.org/fhir/ValueSet/claim-use"
},
{
"id": "ClaimResponse.patient",
"path": "ClaimResponse.patient",
"short": "The subject of the Products and Services",
"definition": "Patient Resource.",
"min": 0,
"max": "1",
"base": {
"path": "ClaimResponse.patient",
"min": 0,
"max": "1"
},
"type": [
{
"code": "Reference",
"targetProfile": [
"http://hl7.org/fhir/StructureDefinition/Patient"
]
}
],
"isModifier": false,
"isSummary": false,
"mapping": [
{
"identity": "w5",
"map": "FiveWs.subject[x]"
},
{
"identity": "w5",
"map": "FiveWs.subject"
}
]
"mapping" : [{
"identity" : "w5",
"map" : "FiveWs.class"
}]
},
{
"id" : "ClaimResponse.patient",
"path" : "ClaimResponse.patient",
"short" : "The subject of the Products and Services",
"definition" : "Patient Resource.",
"min" : 0,
"max" : "1",
"base" : {
"path" : "ClaimResponse.patient",
"min" : 0,
"max" : "1"
},
{
"id": "ClaimResponse.created",
"path": "ClaimResponse.created",
"short": "Creation date",
"definition": "The date when the enclosed suite of services were performed or completed.",
"min": 0,
"max": "1",
"base": {
"path": "ClaimResponse.created",
"min": 0,
"max": "1"
},
"type": [
{
"code": "dateTime"
}
],
"isModifier": false,
"isSummary": false,
"mapping": [
{
"identity": "workflow",
"map": "Event.occurrence[x]"
},
{
"identity": "w5",
"map": "FiveWs.recorded"
}
]
"type" : [{
"code" : "Reference",
"targetProfile" : ["http://hl7.org/fhir/StructureDefinition/Patient"]
}],
"isModifier" : false,
"isSummary" : false,
"mapping" : [{
"identity" : "w5",
"map" : "FiveWs.subject[x]"
},
{
"id": "ClaimResponse.insurer",
"path": "ClaimResponse.insurer",
"short": "Insurance issuing organization",
"definition": "The Insurer who produced this adjudicated response.",
"min": 0,
"max": "1",
"base": {
"path": "ClaimResponse.insurer",
"min": 0,
"max": "1"
},
"type": [
{
"code": "Reference",
"targetProfile": [
"http://hl7.org/fhir/StructureDefinition/Organization"
]
}
],
"isModifier": false,
"isSummary": false,
"mapping": [
{
"identity": "workflow",
"map": "Event.performer"
}
]
"identity" : "w5",
"map" : "FiveWs.subject"
}]
},
{
"id" : "ClaimResponse.created",
"path" : "ClaimResponse.created",
"short" : "Creation date",
"definition" : "The date when this resource was created.",
"min" : 0,
"max" : "1",
"base" : {
"path" : "ClaimResponse.created",
"min" : 0,
"max" : "1"
},
{
"id": "ClaimResponse.requestProvider",
"path": "ClaimResponse.requestProvider",
"short": "Responsible practitioner",
"definition": "The practitioner who is responsible for the services rendered to the patient.",
"min": 0,
"max": "1",
"base": {
"path": "ClaimResponse.requestProvider",
"min": 0,
"max": "1"
},
"type": [
{
"code": "Reference",
"targetProfile": [
"http://hl7.org/fhir/StructureDefinition/Practitioner",
"http://hl7.org/fhir/StructureDefinition/PractitionerRole",
"http://hl7.org/fhir/StructureDefinition/Organization"
]
}
],
"isModifier": false,
"isSummary": false,
"mapping": [
{
"identity": "w5",
"map": "FiveWs.source"
}
]
"type" : [{
"code" : "dateTime"
}],
"isModifier" : false,
"isSummary" : false,
"mapping" : [{
"identity" : "workflow",
"map" : "Event.occurrence[x]"
},
{
"id": "ClaimResponse.request",
"path": "ClaimResponse.request",
"short": "Id of resource triggering adjudication",
"definition": "Original request resource referrence.",
"min": 0,
"max": "1",
"base": {
"path": "ClaimResponse.request",
"min": 0,
"max": "1"
},
"type": [
{
"code": "Reference",
"targetProfile": [
"http://hl7.org/fhir/StructureDefinition/Claim"
]
}
],
"isModifier": false,
"isSummary": false,
"mapping": [
{
"identity": "workflow",
"map": "Event.basedOn"
},
{
"identity": "w5",
"map": "FiveWs.why[x]"
}
]
"identity" : "w5",
"map" : "FiveWs.recorded"
}]
},
{
"id" : "ClaimResponse.insurer",
"path" : "ClaimResponse.insurer",
"short" : "Insurance issuing organization",
"definition" : "The Insurer who produced this adjudicated response.",
"min" : 0,
"max" : "1",
"base" : {
"path" : "ClaimResponse.insurer",
"min" : 0,
"max" : "1"
},
{
"id": "ClaimResponse.outcome",
"path": "ClaimResponse.outcome",
"short": "queued | complete | error | partial",
"definition": "Transaction: error, complete, partial processing.",
"min": 0,
"max": "1",
"base": {
"path": "ClaimResponse.outcome",
"min": 0,
"max": "1"
},
"type": [
{
"code": "code"
}
],
"isModifier": false,
"isSummary": false,
"binding": {
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString": "RemittanceOutcome"
}
],
"strength": "required",
"description": "The result of the claim processing",
"valueSetCanonical": "http://hl7.org/fhir/ValueSet/remittance-outcome"
}
"type" : [{
"code" : "Reference",
"targetProfile" : ["http://hl7.org/fhir/StructureDefinition/Organization"]
}],
"isModifier" : false,
"isSummary" : false,
"mapping" : [{
"identity" : "workflow",
"map" : "Event.performer"
}]
},
{
"id" : "ClaimResponse.requestProvider",
"path" : "ClaimResponse.requestProvider",
"short" : "Responsible practitioner",
"definition" : "The practitioner who is responsible for the services rendered to the patient.",
"min" : 0,
"max" : "1",
"base" : {
"path" : "ClaimResponse.requestProvider",
"min" : 0,
"max" : "1"
},
{
"id": "ClaimResponse.disposition",
"path": "ClaimResponse.disposition",
"short": "Disposition Message",
"definition": "A description of the status of the adjudication.",
"min": 0,
"max": "1",
"base": {
"path": "ClaimResponse.disposition",
"min": 0,
"max": "1"
},
"type": [
{
"code": "string"
}
],
"isModifier": false,
"isSummary": false,
"mapping": [
{
"identity": "workflow",
"map": "Event.note"
}
]
"type" : [{
"code" : "Reference",
"targetProfile" : ["http://hl7.org/fhir/StructureDefinition/Practitioner",
"http://hl7.org/fhir/StructureDefinition/PractitionerRole",
"http://hl7.org/fhir/StructureDefinition/Organization"]
}],
"isModifier" : false,
"isSummary" : false,
"mapping" : [{
"identity" : "w5",
"map" : "FiveWs.source"
}]
},
{
"id" : "ClaimResponse.request",
"path" : "ClaimResponse.request",
"short" : "Id of resource triggering adjudication",
"definition" : "Original request resource reference.",
"min" : 0,
"max" : "1",
"base" : {
"path" : "ClaimResponse.request",
"min" : 0,
"max" : "1"
},
{
"id": "ClaimResponse.payeeType",
"path": "ClaimResponse.payeeType",
"short": "Party to be paid any benefits payable",
"definition": "Party to be reimbursed: Subscriber, provider, other.",
"min": 0,
"max": "1",
"base": {
"path": "ClaimResponse.payeeType",
"min": 0,
"max": "1"
},
"type": [
{
"code": "CodeableConcept"
}
],
"isModifier": false,
"isSummary": false,
"binding": {
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString": "PayeeType"
},
{
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-isCommonBinding",
"valueBoolean": true
}
],
"strength": "example",
"description": "A code for the party to be reimbursed.",
"valueSetCanonical": "http://hl7.org/fhir/ValueSet/payeetype"
}
"type" : [{
"code" : "Reference",
"targetProfile" : ["http://hl7.org/fhir/StructureDefinition/Claim"]
}],
"isModifier" : false,
"isSummary" : false,
"mapping" : [{
"identity" : "workflow",
"map" : "Event.basedOn"
},
{
"id": "ClaimResponse.item",
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-explicit-type-name",
"valueString": "Item"
}
],
"path": "ClaimResponse.item",
"short": "Line items",
"definition": "The first tier service adjudications for submitted services.",
"min": 0,
"max": "*",
"base": {
"path": "ClaimResponse.item",
"min": 0,
"max": "*"
},
"type": [
{
"code": "BackboneElement"
}
],
"constraint": [
{
"key": "ele-1",
"severity": "error",
"human": "All FHIR elements must have a @value or children",
"expression": "hasValue() | (children().count() > id.count())",
"xpath": "@value|f:*|h:div",
"source": "Element"
}
],
"isModifier": false,
"isSummary": false
"identity" : "w5",
"map" : "FiveWs.why[x]"
}]
},
{
"id" : "ClaimResponse.outcome",
"path" : "ClaimResponse.outcome",
"short" : "queued | complete | error | partial",
"definition" : "Transaction: error, complete, partial processing.",
"min" : 0,
"max" : "1",
"base" : {
"path" : "ClaimResponse.outcome",
"min" : 0,
"max" : "1"
},
{
"id": "ClaimResponse.item.id",
"path": "ClaimResponse.item.id",
"representation": [
"xmlAttr"
],
"short": "xml:id (or equivalent in JSON)",
"definition": "Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.",
"min": 0,
"max": "1",
"base": {
"path": "Element.id",
"min": 0,
"max": "1"
},
"type": [
{
"code": "string"
}
],
"isModifier": false,
"isSummary": false,
"mapping": [
{
"identity": "rim",
"map": "n/a"
}
]
"type" : [{
"code" : "code"
}],
"isModifier" : false,
"isSummary" : false,
"binding" : {
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString" : "RemittanceOutcome"
}],
"strength" : "required",
"description" : "The result of the claim processing.",
"valueSet" : "http://hl7.org/fhir/ValueSet/remittance-outcome"
}
},
{
"id" : "ClaimResponse.disposition",
"path" : "ClaimResponse.disposition",
"short" : "Disposition Message",
"definition" : "A description of the status of the adjudication.",
"min" : 0,
"max" : "1",
"base" : {
"path" : "ClaimResponse.disposition",
"min" : 0,
"max" : "1"
},
{
"id": "ClaimResponse.item.extension",
"path": "ClaimResponse.item.extension",
"short": "Additional content defined by implementations",
"definition": "May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.",
"comment": "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.",
"alias": [
"extensions",
"user content"
],
"min": 0,
"max": "*",
"base": {
"path": "Element.extension",
"min": 0,
"max": "*"
},
"type": [
{
"code": "Extension"
}
],
"isModifier": false,
"isSummary": false,
"mapping": [
{
"identity": "rim",
"map": "n/a"
}
]
"type" : [{
"code" : "string"
}],
"isModifier" : false,
"isSummary" : false,
"mapping" : [{
"identity" : "workflow",
"map" : "Event.note"
}]
},
{
"id" : "ClaimResponse.preAuthRef",
"path" : "ClaimResponse.preAuthRef",
"short" : "Pre-Authorization/Determination Reference",
"definition" : "A list of references from the Insurer to which these services pertain.",
"requirements" : "To provide any pre-determination or prior authorization reference.",
"min" : 0,
"max" : "1",
"base" : {
"path" : "ClaimResponse.preAuthRef",
"min" : 0,
"max" : "1"
},
{
"id": "ClaimResponse.item.modifierExtension",
"path": "ClaimResponse.item.modifierExtension",
"short": "Extensions that cannot be ignored",
"definition": "May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.",
"comment": "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.",
"alias": [
"extensions",
"user content",
"modifiers"
],
"min": 0,
"max": "*",
"base": {
"path": "BackboneElement.modifierExtension",
"min": 0,
"max": "*"
},
"type": [
{
"code": "Extension"
}
],
"isModifier": true,
"isModifierReason": "modifierExtension is reserved for use where modifier extensions must be used",
"isSummary": true,
"mapping": [
{
"identity": "rim",
"map": "N/A"
}
]
"type" : [{
"code" : "string"
}],
"isModifier" : false,
"isSummary" : false
},
{
"id" : "ClaimResponse.payeeType",
"path" : "ClaimResponse.payeeType",
"short" : "Party to be paid any benefits payable",
"definition" : "Party to be reimbursed: Subscriber, provider, other.",
"min" : 0,
"max" : "1",
"base" : {
"path" : "ClaimResponse.payeeType",
"min" : 0,
"max" : "1"
},
{
"id": "ClaimResponse.item.itemSequence",
"path": "ClaimResponse.item.itemSequence",
"short": "Service instance",
"definition": "A service line number.",
"min": 1,
"max": "1",
"base": {
"path": "ClaimResponse.item.itemSequence",
"min": 1,
"max": "1"
"type" : [{
"code" : "CodeableConcept"
}],
"isModifier" : false,
"isSummary" : false,
"binding" : {
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString" : "PayeeType"
},
"type": [
{
"code": "positiveInt"
}
],
"isModifier": false,
"isSummary": false
{
"url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-isCommonBinding",
"valueBoolean" : true
}],
"strength" : "example",
"description" : "A code for the party to be reimbursed.",
"valueSet" : "http://hl7.org/fhir/ValueSet/payeetype"
}
},
{
"id" : "ClaimResponse.item",
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-explicit-type-name",
"valueString" : "Item"
}],
"path" : "ClaimResponse.item",
"short" : "Line items",
"definition" : "The first-tier service adjudications for submitted services.",
"min" : 0,
"max" : "*",
"base" : {
"path" : "ClaimResponse.item",
"min" : 0,
"max" : "*"
},
{
"id": "ClaimResponse.item.noteNumber",
"path": "ClaimResponse.item.noteNumber",
"short": "List of note numbers which apply",
"definition": "A list of note references to the notes provided below.",
"min": 0,
"max": "*",
"base": {
"path": "ClaimResponse.item.noteNumber",
"min": 0,
"max": "*"
},
"type": [
{
"code": "positiveInt"
}
],
"isModifier": false,
"isSummary": false
"type" : [{
"code" : "BackboneElement"
}],
"constraint" : [{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "Element"
}],
"isModifier" : false,
"isSummary" : false
},
{
"id" : "ClaimResponse.item.id",
"path" : "ClaimResponse.item.id",
"representation" : ["xmlAttr"],
"short" : "xml:id (or equivalent in JSON)",
"definition" : "Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.",
"min" : 0,
"max" : "1",
"base" : {
"path" : "Element.id",
"min" : 0,
"max" : "1"
},
{
"id": "ClaimResponse.item.adjudication",
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-explicit-type-name",
"valueString": "Adjudication"
}
],
"path": "ClaimResponse.item.adjudication",
"short": "Adjudication details",
"definition": "The adjudication results.",
"min": 0,
"max": "*",
"base": {
"path": "ClaimResponse.item.adjudication",
"min": 0,
"max": "*"
},
"type": [
{
"code": "BackboneElement"
}
],
"constraint": [
{
"key": "ele-1",
"severity": "error",
"human": "All FHIR elements must have a @value or children",
"expression": "hasValue() | (children().count() > id.count())",
"xpath": "@value|f:*|h:div",
"source": "Element"
}
],
"isModifier": false,
"isSummary": false
"type" : [{
"code" : "string"
}],
"isModifier" : false,
"isSummary" : false,
"mapping" : [{
"identity" : "rim",
"map" : "n/a"
}]
},
{
"id" : "ClaimResponse.item.extension",
"path" : "ClaimResponse.item.extension",
"short" : "Additional content defined by implementations",
"definition" : "May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.",
"comment" : "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.",
"alias" : ["extensions",
"user content"],
"min" : 0,
"max" : "*",
"base" : {
"path" : "Element.extension",
"min" : 0,
"max" : "*"
},
{
"id": "ClaimResponse.item.adjudication.id",
"path": "ClaimResponse.item.adjudication.id",
"representation": [
"xmlAttr"
],
"short": "xml:id (or equivalent in JSON)",
"definition": "Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.",
"min": 0,
"max": "1",
"base": {
"path": "Element.id",
"min": 0,
"max": "1"
},
"type": [
{
"code": "string"
}
],
"isModifier": false,
"isSummary": false,
"mapping": [
{
"identity": "rim",
"map": "n/a"
}
]
"type" : [{
"code" : "Extension"
}],
"isModifier" : false,
"isSummary" : false,
"mapping" : [{
"identity" : "rim",
"map" : "n/a"
}]
},
{
"id" : "ClaimResponse.item.modifierExtension",
"path" : "ClaimResponse.item.modifierExtension",
"short" : "Extensions that cannot be ignored if unrecognized",
"definition" : "May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.\n\nModifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).",
"comment" : "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.",
"alias" : ["extensions",
"user content",
"modifiers"],
"min" : 0,
"max" : "*",
"base" : {
"path" : "BackboneElement.modifierExtension",
"min" : 0,
"max" : "*"
},
{
"id": "ClaimResponse.item.adjudication.extension",
"path": "ClaimResponse.item.adjudication.extension",
"short": "Additional content defined by implementations",
"definition": "May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.",
"comment": "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.",
"alias": [
"extensions",
"user content"
],
"min": 0,
"max": "*",
"base": {
"path": "Element.extension",
"min": 0,
"max": "*"
},
"type": [
{
"code": "Extension"
}
],
"isModifier": false,
"isSummary": false,
"mapping": [
{
"identity": "rim",
"map": "n/a"
}
]
"type" : [{
"code" : "Extension"
}],
"isModifier" : true,
"isModifierReason" : "Modifier extensions are expected to modify the meaning or interpretation of the element that contains them",
"isSummary" : true,
"mapping" : [{
"identity" : "rim",
"map" : "N/A"
}]
},
{
"id" : "ClaimResponse.item.itemSequence",
"path" : "ClaimResponse.item.itemSequence",
"short" : "Service instance",
"definition" : "A service line number.",
"min" : 1,
"max" : "1",
"base" : {
"path" : "ClaimResponse.item.itemSequence",
"min" : 1,
"max" : "1"
},
{
"id": "ClaimResponse.item.adjudication.modifierExtension",
"path": "ClaimResponse.item.adjudication.modifierExtension",
"short": "Extensions that cannot be ignored",
"definition": "May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.",
"comment": "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.",
"alias": [
"extensions",
"user content",
"modifiers"
],
"min": 0,
"max": "*",
"base": {
"path": "BackboneElement.modifierExtension",
"min": 0,
"max": "*"
},
"type": [
{
"code": "Extension"
}
],
"isModifier": true,
"isModifierReason": "modifierExtension is reserved for use where modifier extensions must be used",
"isSummary": true,
"mapping": [
{
"identity": "rim",
"map": "N/A"
}
]
"type" : [{
"code" : "positiveInt"
}],
"isModifier" : false,
"isSummary" : false
},
{
"id" : "ClaimResponse.item.noteNumber",
"path" : "ClaimResponse.item.noteNumber",
"short" : "List of note numbers which apply",
"definition" : "A list of note references to the notes provided below.",
"min" : 0,
"max" : "*",
"base" : {
"path" : "ClaimResponse.item.noteNumber",
"min" : 0,
"max" : "*"
},
{
"id": "ClaimResponse.item.adjudication.category",
"path": "ClaimResponse.item.adjudication.category",
"short": "Adjudication category such as co-pay, eligible, benefit, etc.",
"definition": "Code indicating: Co-Pay, deductible, eligible, benefit, tax, etc.",
"min": 1,
"max": "1",
"base": {
"path": "ClaimResponse.item.adjudication.category",
"min": 1,
"max": "1"
},
"type": [
{
"code": "CodeableConcept"
}
],
"isModifier": false,
"isSummary": false,
"binding": {
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString": "Adjudication"
}
],
"strength": "example",
"description": "The adjudication codes.",
"valueSetCanonical": "http://hl7.org/fhir/ValueSet/adjudication"
}
"type" : [{
"code" : "positiveInt"
}],
"isModifier" : false,
"isSummary" : false
},
{
"id" : "ClaimResponse.item.adjudication",
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-explicit-type-name",
"valueString" : "Adjudication"
}],
"path" : "ClaimResponse.item.adjudication",
"short" : "Adjudication details",
"definition" : "The adjudication results.",
"min" : 0,
"max" : "*",
"base" : {
"path" : "ClaimResponse.item.adjudication",
"min" : 0,
"max" : "*"
},
{
"id": "ClaimResponse.item.adjudication.reason",
"path": "ClaimResponse.item.adjudication.reason",
"short": "Explanation of Adjudication outcome",
"definition": "Adjudication reason such as limit reached.",
"min": 0,
"max": "1",
"base": {
"path": "ClaimResponse.item.adjudication.reason",
"min": 0,
"max": "1"
},
"type": [
{
"code": "CodeableConcept"
}
],
"isModifier": false,
"isSummary": false,
"binding": {
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString": "AdjudicationReason"
}
],
"strength": "example",
"description": "The adjudication reason codes.",
"valueSetCanonical": "http://hl7.org/fhir/ValueSet/adjudication-reason"
}
"type" : [{
"code" : "BackboneElement"
}],
"constraint" : [{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "Element"
}],
"isModifier" : false,
"isSummary" : false
},
{
"id" : "ClaimResponse.item.adjudication.id",
"path" : "ClaimResponse.item.adjudication.id",
"representation" : ["xmlAttr"],
"short" : "xml:id (or equivalent in JSON)",
"definition" : "Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.",
"min" : 0,
"max" : "1",
"base" : {
"path" : "Element.id",
"min" : 0,
"max" : "1"
},
{
"id": "ClaimResponse.item.adjudication.amount",
"path": "ClaimResponse.item.adjudication.amount",
"short": "Monetary amount",
"definition": "Monetary amount associated with the code.",
"min": 0,
"max": "1",
"base": {
"path": "ClaimResponse.item.adjudication.amount",
"min": 0,
"max": "1"
},
"type": [
{
"code": "Money"
}
],
"isModifier": false,
"isSummary": false
"type" : [{
"code" : "string"
}],
"isModifier" : false,
"isSummary" : false,
"mapping" : [{
"identity" : "rim",
"map" : "n/a"
}]
},
{
"id" : "ClaimResponse.item.adjudication.extension",
"path" : "ClaimResponse.item.adjudication.extension",
"short" : "Additional content defined by implementations",
"definition" : "May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.",
"comment" : "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.",
"alias" : ["extensions",
"user content"],
"min" : 0,
"max" : "*",
"base" : {
"path" : "Element.extension",
"min" : 0,
"max" : "*"
},
{
"id": "ClaimResponse.item.adjudication.value",
"path": "ClaimResponse.item.adjudication.value",
"short": "Non-monetary value",
"definition": "A non-monetary value for example a percentage. Mutually exclusive to the amount element above.",
"min": 0,
"max": "1",
"base": {
"path": "ClaimResponse.item.adjudication.value",
"min": 0,
"max": "1"
},
"type": [
{
"code": "decimal"
}
],
"isModifier": false,
"isSummary": false
"type" : [{
"code" : "Extension"
}],
"isModifier" : false,
"isSummary" : false,
"mapping" : [{
"identity" : "rim",
"map" : "n/a"
}]
},
{
"id" : "ClaimResponse.item.adjudication.modifierExtension",
"path" : "ClaimResponse.item.adjudication.modifierExtension",
"short" : "Extensions that cannot be ignored if unrecognized",
"definition" : "May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.\n\nModifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).",
"comment" : "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.",
"alias" : ["extensions",
"user content",
"modifiers"],
"min" : 0,
"max" : "*",
"base" : {
"path" : "BackboneElement.modifierExtension",
"min" : 0,
"max" : "*"
},
{
"id": "ClaimResponse.item.detail",
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-explicit-type-name",
"valueString": "ItemDetail"
}
],
"path": "ClaimResponse.item.detail",
"short": "Detail line items",
"definition": "The second tier service adjudications for submitted services.",
"min": 0,
"max": "*",
"base": {
"path": "ClaimResponse.item.detail",
"min": 0,
"max": "*"
},
"type": [
{
"code": "BackboneElement"
}
],
"constraint": [
{
"key": "ele-1",
"severity": "error",
"human": "All FHIR elements must have a @value or children",
"expression": "hasValue() | (children().count() > id.count())",
"xpath": "@value|f:*|h:div",
"source": "Element"
}
],
"isModifier": false,
"isSummary": false
"type" : [{
"code" : "Extension"
}],
"isModifier" : true,
"isModifierReason" : "Modifier extensions are expected to modify the meaning or interpretation of the element that contains them",
"isSummary" : true,
"mapping" : [{
"identity" : "rim",
"map" : "N/A"
}]
},
{
"id" : "ClaimResponse.item.adjudication.category",
"path" : "ClaimResponse.item.adjudication.category",
"short" : "Adjudication category such as co-pay, eligible, benefit, etc.",
"definition" : "Code indicating: Co-Pay, deductible, eligible, benefit, tax, etc.",
"min" : 1,
"max" : "1",
"base" : {
"path" : "ClaimResponse.item.adjudication.category",
"min" : 1,
"max" : "1"
},
{
"id": "ClaimResponse.item.detail.id",
"path": "ClaimResponse.item.detail.id",
"representation": [
"xmlAttr"
],
"short": "xml:id (or equivalent in JSON)",
"definition": "Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.",
"min": 0,
"max": "1",
"base": {
"path": "Element.id",
"min": 0,
"max": "1"
},
"type": [
{
"code": "string"
}
],
"isModifier": false,
"isSummary": false,
"mapping": [
{
"identity": "rim",
"map": "n/a"
}
]
"type" : [{
"code" : "CodeableConcept"
}],
"isModifier" : false,
"isSummary" : false,
"binding" : {
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString" : "Adjudication"
}],
"strength" : "example",
"description" : "The adjudication codes.",
"valueSet" : "http://hl7.org/fhir/ValueSet/adjudication"
}
},
{
"id" : "ClaimResponse.item.adjudication.reason",
"path" : "ClaimResponse.item.adjudication.reason",
"short" : "Explanation of Adjudication outcome",
"definition" : "Adjudication reason such as limit reached.",
"min" : 0,
"max" : "1",
"base" : {
"path" : "ClaimResponse.item.adjudication.reason",
"min" : 0,
"max" : "1"
},
{
"id": "ClaimResponse.item.detail.extension",
"path": "ClaimResponse.item.detail.extension",
"short": "Additional content defined by implementations",
"definition": "May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.",
"comment": "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.",
"alias": [
"extensions",
"user content"
],
"min": 0,
"max": "*",
"base": {
"path": "Element.extension",
"min": 0,
"max": "*"
},
"type": [
{
"code": "Extension"
}
],
"isModifier": false,
"isSummary": false,
"mapping": [
{
"identity": "rim",
"map": "n/a"
}
]
"type" : [{
"code" : "CodeableConcept"
}],
"isModifier" : false,
"isSummary" : false,
"binding" : {
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString" : "AdjudicationReason"
}],
"strength" : "example",
"description" : "The adjudication reason codes.",
"valueSet" : "http://hl7.org/fhir/ValueSet/adjudication-reason"
}
},
{
"id" : "ClaimResponse.item.adjudication.amount",
"path" : "ClaimResponse.item.adjudication.amount",
"short" : "Monetary amount",
"definition" : "Monetary amount associated with the code.",
"min" : 0,
"max" : "1",
"base" : {
"path" : "ClaimResponse.item.adjudication.amount",
"min" : 0,
"max" : "1"
},
{
"id": "ClaimResponse.item.detail.modifierExtension",
"path": "ClaimResponse.item.detail.modifierExtension",
"short": "Extensions that cannot be ignored",
"definition": "May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.",
"comment": "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.",
"alias": [
"extensions",
"user content",
"modifiers"
],
"min": 0,
"max": "*",
"base": {
"path": "BackboneElement.modifierExtension",
"min": 0,
"max": "*"
},
"type": [
{
"code": "Extension"
}
],
"isModifier": true,
"isModifierReason": "modifierExtension is reserved for use where modifier extensions must be used",
"isSummary": true,
"mapping": [
{
"identity": "rim",
"map": "N/A"
}
]
"type" : [{
"code" : "Money"
}],
"isModifier" : false,
"isSummary" : false
},
{
"id" : "ClaimResponse.item.adjudication.value",
"path" : "ClaimResponse.item.adjudication.value",
"short" : "Non-monetary value",
"definition" : "A non-monetary value for example a percentage. Mutually exclusive to the amount element above.",
"min" : 0,
"max" : "1",
"base" : {
"path" : "ClaimResponse.item.adjudication.value",
"min" : 0,
"max" : "1"
},
{
"id": "ClaimResponse.item.detail.detailSequence",
"path": "ClaimResponse.item.detail.detailSequence",
"short": "Service instance",
"definition": "A service line number.",
"min": 1,
"max": "1",
"base": {
"path": "ClaimResponse.item.detail.detailSequence",
"min": 1,
"max": "1"
},
"type": [
{
"code": "positiveInt"
}
],
"isModifier": false,
"isSummary": false
"type" : [{
"code" : "decimal"
}],
"isModifier" : false,
"isSummary" : false
},
{
"id" : "ClaimResponse.item.detail",
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-explicit-type-name",
"valueString" : "ItemDetail"
}],
"path" : "ClaimResponse.item.detail",
"short" : "Detail line items",
"definition" : "The second-tier service adjudications for submitted services.",
"min" : 0,
"max" : "*",
"base" : {
"path" : "ClaimResponse.item.detail",
"min" : 0,
"max" : "*"
},
{
"id": "ClaimResponse.item.detail.noteNumber",
"path": "ClaimResponse.item.detail.noteNumber",
"short": "List of note numbers which apply",
"definition": "A list of note references to the notes provided below.",
"min": 0,
"max": "*",
"base": {
"path": "ClaimResponse.item.detail.noteNumber",
"min": 0,
"max": "*"
},
"type": [
{
"code": "positiveInt"
}
],
"isModifier": false,
"isSummary": false
"type" : [{
"code" : "BackboneElement"
}],
"constraint" : [{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "Element"
}],
"isModifier" : false,
"isSummary" : false
},
{
"id" : "ClaimResponse.item.detail.id",
"path" : "ClaimResponse.item.detail.id",
"representation" : ["xmlAttr"],
"short" : "xml:id (or equivalent in JSON)",
"definition" : "Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.",
"min" : 0,
"max" : "1",
"base" : {
"path" : "Element.id",
"min" : 0,
"max" : "1"
},
{
"id": "ClaimResponse.item.detail.adjudication",
"path": "ClaimResponse.item.detail.adjudication",
"short": "Detail level adjudication details",
"definition": "The adjudications results.",
"min": 0,
"max": "*",
"base": {
"path": "ClaimResponse.item.detail.adjudication",
"min": 0,
"max": "*"
},
"contentReference": "#ClaimResponse.item.adjudication",
"isModifier": false,
"isSummary": false
"type" : [{
"code" : "string"
}],
"isModifier" : false,
"isSummary" : false,
"mapping" : [{
"identity" : "rim",
"map" : "n/a"
}]
},
{
"id" : "ClaimResponse.item.detail.extension",
"path" : "ClaimResponse.item.detail.extension",
"short" : "Additional content defined by implementations",
"definition" : "May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.",
"comment" : "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.",
"alias" : ["extensions",
"user content"],
"min" : 0,
"max" : "*",
"base" : {
"path" : "Element.extension",
"min" : 0,
"max" : "*"
},
{
"id": "ClaimResponse.item.detail.subDetail",
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-explicit-type-name",
"valueString": "SubDetail"
}
],
"path": "ClaimResponse.item.detail.subDetail",
"short": "Subdetail line items",
"definition": "The third tier service adjudications for submitted services.",
"min": 0,
"max": "*",
"base": {
"path": "ClaimResponse.item.detail.subDetail",
"min": 0,
"max": "*"
},
"type": [
{
"code": "BackboneElement"
}
],
"constraint": [
{
"key": "ele-1",
"severity": "error",
"human": "All FHIR elements must have a @value or children",
"expression": "hasValue() | (children().count() > id.count())",
"xpath": "@value|f:*|h:div",
"source": "Element"
}
],
"isModifier": false,
"isSummary": false
"type" : [{
"code" : "Extension"
}],
"isModifier" : false,
"isSummary" : false,
"mapping" : [{
"identity" : "rim",
"map" : "n/a"
}]
},
{
"id" : "ClaimResponse.item.detail.modifierExtension",
"path" : "ClaimResponse.item.detail.modifierExtension",
"short" : "Extensions that cannot be ignored if unrecognized",
"definition" : "May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.\n\nModifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).",
"comment" : "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.",
"alias" : ["extensions",
"user content",
"modifiers"],
"min" : 0,
"max" : "*",
"base" : {
"path" : "BackboneElement.modifierExtension",
"min" : 0,
"max" : "*"
},
{
"id": "ClaimResponse.item.detail.subDetail.id",
"path": "ClaimResponse.item.detail.subDetail.id",
"representation": [
"xmlAttr"
],
"short": "xml:id (or equivalent in JSON)",
"definition": "Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.",
"min": 0,
"max": "1",
"base": {
"path": "Element.id",
"min": 0,
"max": "1"
},
"type": [
{
"code": "string"
}
],
"isModifier": false,
"isSummary": false,
"mapping": [
{
"identity": "rim",
"map": "n/a"
}
]
"type" : [{
"code" : "Extension"
}],
"isModifier" : true,
"isModifierReason" : "Modifier extensions are expected to modify the meaning or interpretation of the element that contains them",
"isSummary" : true,
"mapping" : [{
"identity" : "rim",
"map" : "N/A"
}]
},
{
"id" : "ClaimResponse.item.detail.detailSequence",
"path" : "ClaimResponse.item.detail.detailSequence",
"short" : "Service instance",
"definition" : "A service line number.",
"min" : 1,
"max" : "1",
"base" : {
"path" : "ClaimResponse.item.detail.detailSequence",
"min" : 1,
"max" : "1"
},
{
"id": "ClaimResponse.item.detail.subDetail.extension",
"path": "ClaimResponse.item.detail.subDetail.extension",
"short": "Additional content defined by implementations",
"definition": "May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.",
"comment": "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.",
"alias": [
"extensions",
"user content"
],
"min": 0,
"max": "*",
"base": {
"path": "Element.extension",
"min": 0,
"max": "*"
},
"type": [
{
"code": "Extension"
}
],
"isModifier": false,
"isSummary": false,
"mapping": [
{
"identity": "rim",
"map": "n/a"
}
]
"type" : [{
"code" : "positiveInt"
}],
"isModifier" : false,
"isSummary" : false
},
{
"id" : "ClaimResponse.item.detail.noteNumber",
"path" : "ClaimResponse.item.detail.noteNumber",
"short" : "List of note numbers which apply",
"definition" : "A list of note references to the notes provided below.",
"min" : 0,
"max" : "*",
"base" : {
"path" : "ClaimResponse.item.detail.noteNumber",
"min" : 0,
"max" : "*"
},
{
"id": "ClaimResponse.item.detail.subDetail.modifierExtension",
"path": "ClaimResponse.item.detail.subDetail.modifierExtension",
"short": "Extensions that cannot be ignored",
"definition": "May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.",
"comment": "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.",
"alias": [
"extensions",
"user content",
"modifiers"
],
"min": 0,
"max": "*",
"base": {
"path": "BackboneElement.modifierExtension",
"min": 0,
"max": "*"
},
"type": [
{
"code": "Extension"
}
],
"isModifier": true,
"isModifierReason": "modifierExtension is reserved for use where modifier extensions must be used",
"isSummary": true,
"mapping": [
{
"identity": "rim",
"map": "N/A"
}
]
"type" : [{
"code" : "positiveInt"
}],
"isModifier" : false,
"isSummary" : false
},
{
"id" : "ClaimResponse.item.detail.adjudication",
"path" : "ClaimResponse.item.detail.adjudication",
"short" : "Detail level adjudication details",
"definition" : "The adjudication results.",
"min" : 0,
"max" : "*",
"base" : {
"path" : "ClaimResponse.item.detail.adjudication",
"min" : 0,
"max" : "*"
},
{
"id": "ClaimResponse.item.detail.subDetail.subDetailSequence",
"path": "ClaimResponse.item.detail.subDetail.subDetailSequence",
"short": "Service instance",
"definition": "A service line number.",
"min": 1,
"max": "1",
"base": {
"path": "ClaimResponse.item.detail.subDetail.subDetailSequence",
"min": 1,
"max": "1"
},
"type": [
{
"code": "positiveInt"
}
],
"isModifier": false,
"isSummary": false
"contentReference" : "#ClaimResponse.item.adjudication",
"isModifier" : false,
"isSummary" : false
},
{
"id" : "ClaimResponse.item.detail.subDetail",
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-explicit-type-name",
"valueString" : "SubDetail"
}],
"path" : "ClaimResponse.item.detail.subDetail",
"short" : "Subdetail line items",
"definition" : "The third-tier service adjudications for submitted services.",
"min" : 0,
"max" : "*",
"base" : {
"path" : "ClaimResponse.item.detail.subDetail",
"min" : 0,
"max" : "*"
},
{
"id": "ClaimResponse.item.detail.subDetail.noteNumber",
"path": "ClaimResponse.item.detail.subDetail.noteNumber",
"short": "List of note numbers which apply",
"definition": "A list of note references to the notes provided below.",
"min": 0,
"max": "*",
"base": {
"path": "ClaimResponse.item.detail.subDetail.noteNumber",
"min": 0,
"max": "*"
},
"type": [
{
"code": "positiveInt"
}
],
"isModifier": false,
"isSummary": false
"type" : [{
"code" : "BackboneElement"
}],
"constraint" : [{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "Element"
}],
"isModifier" : false,
"isSummary" : false
},
{
"id" : "ClaimResponse.item.detail.subDetail.id",
"path" : "ClaimResponse.item.detail.subDetail.id",
"representation" : ["xmlAttr"],
"short" : "xml:id (or equivalent in JSON)",
"definition" : "Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.",
"min" : 0,
"max" : "1",
"base" : {
"path" : "Element.id",
"min" : 0,
"max" : "1"
},
{
"id": "ClaimResponse.item.detail.subDetail.adjudication",
"path": "ClaimResponse.item.detail.subDetail.adjudication",
"short": "Subdetail level adjudication details",
"definition": "The adjudications results.",
"min": 0,
"max": "*",
"base": {
"path": "ClaimResponse.item.detail.subDetail.adjudication",
"min": 0,
"max": "*"
},
"contentReference": "#ClaimResponse.item.adjudication",
"isModifier": false,
"isSummary": false
"type" : [{
"code" : "string"
}],
"isModifier" : false,
"isSummary" : false,
"mapping" : [{
"identity" : "rim",
"map" : "n/a"
}]
},
{
"id" : "ClaimResponse.item.detail.subDetail.extension",
"path" : "ClaimResponse.item.detail.subDetail.extension",
"short" : "Additional content defined by implementations",
"definition" : "May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.",
"comment" : "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.",
"alias" : ["extensions",
"user content"],
"min" : 0,
"max" : "*",
"base" : {
"path" : "Element.extension",
"min" : 0,
"max" : "*"
},
{
"id": "ClaimResponse.addItem",
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-explicit-type-name",
"valueString": "AddedItem"
}
],
"path": "ClaimResponse.addItem",
"short": "Insurer added line items",
"definition": "The first tier service adjudications for payor added services.",
"min": 0,
"max": "*",
"base": {
"path": "ClaimResponse.addItem",
"min": 0,
"max": "*"
},
"type": [
{
"code": "BackboneElement"
}
],
"constraint": [
{
"key": "ele-1",
"severity": "error",
"human": "All FHIR elements must have a @value or children",
"expression": "hasValue() | (children().count() > id.count())",
"xpath": "@value|f:*|h:div",
"source": "Element"
}
],
"isModifier": false,
"isSummary": false
"type" : [{
"code" : "Extension"
}],
"isModifier" : false,
"isSummary" : false,
"mapping" : [{
"identity" : "rim",
"map" : "n/a"
}]
},
{
"id" : "ClaimResponse.item.detail.subDetail.modifierExtension",
"path" : "ClaimResponse.item.detail.subDetail.modifierExtension",
"short" : "Extensions that cannot be ignored if unrecognized",
"definition" : "May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.\n\nModifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).",
"comment" : "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.",
"alias" : ["extensions",
"user content",
"modifiers"],
"min" : 0,
"max" : "*",
"base" : {
"path" : "BackboneElement.modifierExtension",
"min" : 0,
"max" : "*"
},
{
"id": "ClaimResponse.addItem.id",
"path": "ClaimResponse.addItem.id",
"representation": [
"xmlAttr"
],
"short": "xml:id (or equivalent in JSON)",
"definition": "Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.",
"min": 0,
"max": "1",
"base": {
"path": "Element.id",
"min": 0,
"max": "1"
},
"type": [
{
"code": "string"
}
],
"isModifier": false,
"isSummary": false,
"mapping": [
{
"identity": "rim",
"map": "n/a"
}
]
"type" : [{
"code" : "Extension"
}],
"isModifier" : true,
"isModifierReason" : "Modifier extensions are expected to modify the meaning or interpretation of the element that contains them",
"isSummary" : true,
"mapping" : [{
"identity" : "rim",
"map" : "N/A"
}]
},
{
"id" : "ClaimResponse.item.detail.subDetail.subDetailSequence",
"path" : "ClaimResponse.item.detail.subDetail.subDetailSequence",
"short" : "Service instance",
"definition" : "A service line number.",
"min" : 1,
"max" : "1",
"base" : {
"path" : "ClaimResponse.item.detail.subDetail.subDetailSequence",
"min" : 1,
"max" : "1"
},
{
"id": "ClaimResponse.addItem.extension",
"path": "ClaimResponse.addItem.extension",
"short": "Additional content defined by implementations",
"definition": "May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.",
"comment": "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.",
"alias": [
"extensions",
"user content"
],
"min": 0,
"max": "*",
"base": {
"path": "Element.extension",
"min": 0,
"max": "*"
},
"type": [
{
"code": "Extension"
}
],
"isModifier": false,
"isSummary": false,
"mapping": [
{
"identity": "rim",
"map": "n/a"
}
]
"type" : [{
"code" : "positiveInt"
}],
"isModifier" : false,
"isSummary" : false
},
{
"id" : "ClaimResponse.item.detail.subDetail.noteNumber",
"path" : "ClaimResponse.item.detail.subDetail.noteNumber",
"short" : "List of note numbers which apply",
"definition" : "A list of note references to the notes provided below.",
"min" : 0,
"max" : "*",
"base" : {
"path" : "ClaimResponse.item.detail.subDetail.noteNumber",
"min" : 0,
"max" : "*"
},
{
"id": "ClaimResponse.addItem.modifierExtension",
"path": "ClaimResponse.addItem.modifierExtension",
"short": "Extensions that cannot be ignored",
"definition": "May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.",
"comment": "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.",
"alias": [
"extensions",
"user content",
"modifiers"
],
"min": 0,
"max": "*",
"base": {
"path": "BackboneElement.modifierExtension",
"min": 0,
"max": "*"
},
"type": [
{
"code": "Extension"
}
],
"isModifier": true,
"isModifierReason": "modifierExtension is reserved for use where modifier extensions must be used",
"isSummary": true,
"mapping": [
{
"identity": "rim",
"map": "N/A"
}
]
"type" : [{
"code" : "positiveInt"
}],
"isModifier" : false,
"isSummary" : false
},
{
"id" : "ClaimResponse.item.detail.subDetail.adjudication",
"path" : "ClaimResponse.item.detail.subDetail.adjudication",
"short" : "Subdetail level adjudication details",
"definition" : "The adjudication results.",
"min" : 0,
"max" : "*",
"base" : {
"path" : "ClaimResponse.item.detail.subDetail.adjudication",
"min" : 0,
"max" : "*"
},
{
"id": "ClaimResponse.addItem.itemSequence",
"path": "ClaimResponse.addItem.itemSequence",
"short": "Service instances",
"definition": "List of input service items which this service line is intended to replace.",
"min": 0,
"max": "*",
"base": {
"path": "ClaimResponse.addItem.itemSequence",
"min": 0,
"max": "*"
},
"type": [
{
"code": "positiveInt"
}
],
"isModifier": false,
"isSummary": false
"contentReference" : "#ClaimResponse.item.adjudication",
"isModifier" : false,
"isSummary" : false
},
{
"id" : "ClaimResponse.addItem",
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-explicit-type-name",
"valueString" : "AddedItem"
}],
"path" : "ClaimResponse.addItem",
"short" : "Insurer added line items",
"definition" : "The first-tier service adjudications for payor added services.",
"min" : 0,
"max" : "*",
"base" : {
"path" : "ClaimResponse.addItem",
"min" : 0,
"max" : "*"
},
{
"id": "ClaimResponse.addItem.detailSequence",
"path": "ClaimResponse.addItem.detailSequence",
"short": "Detail sequence number",
"definition": "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.",
"min": 0,
"max": "*",
"base": {
"path": "ClaimResponse.addItem.detailSequence",
"min": 0,
"max": "*"
},
"type": [
{
"code": "positiveInt"
}
],
"isModifier": false,
"isSummary": false
"type" : [{
"code" : "BackboneElement"
}],
"constraint" : [{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "Element"
}],
"isModifier" : false,
"isSummary" : false
},
{
"id" : "ClaimResponse.addItem.id",
"path" : "ClaimResponse.addItem.id",
"representation" : ["xmlAttr"],
"short" : "xml:id (or equivalent in JSON)",
"definition" : "Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.",
"min" : 0,
"max" : "1",
"base" : {
"path" : "Element.id",
"min" : 0,
"max" : "1"
},
{
"id": "ClaimResponse.addItem.subdetailSequence",
"path": "ClaimResponse.addItem.subdetailSequence",
"short": "Subdetail sequence number",
"definition": "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.",
"min": 0,
"max": "*",
"base": {
"path": "ClaimResponse.addItem.subdetailSequence",
"min": 0,
"max": "*"
},
"type": [
{
"code": "positiveInt"
}
],
"isModifier": false,
"isSummary": false
"type" : [{
"code" : "string"
}],
"isModifier" : false,
"isSummary" : false,
"mapping" : [{
"identity" : "rim",
"map" : "n/a"
}]
},
{
"id" : "ClaimResponse.addItem.extension",
"path" : "ClaimResponse.addItem.extension",
"short" : "Additional content defined by implementations",
"definition" : "May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.",
"comment" : "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.",
"alias" : ["extensions",
"user content"],
"min" : 0,
"max" : "*",
"base" : {
"path" : "Element.extension",
"min" : 0,
"max" : "*"
},
{
"id": "ClaimResponse.addItem.service",
"path": "ClaimResponse.addItem.service",
"short": "Group, Service or Product",
"definition": "A code to indicate the Professional Service or Product supplied.",
"min": 0,
"max": "1",
"base": {
"path": "ClaimResponse.addItem.service",
"min": 0,
"max": "1"
},
"type": [
{
"code": "CodeableConcept"
}
],
"isModifier": false,
"isSummary": false,
"binding": {
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString": "ServiceProduct"
}
],
"strength": "example",
"description": "Allowable service and product codes.",
"valueSetCanonical": "http://hl7.org/fhir/ValueSet/service-uscls"
}
"type" : [{
"code" : "Extension"
}],
"isModifier" : false,
"isSummary" : false,
"mapping" : [{
"identity" : "rim",
"map" : "n/a"
}]
},
{
"id" : "ClaimResponse.addItem.modifierExtension",
"path" : "ClaimResponse.addItem.modifierExtension",
"short" : "Extensions that cannot be ignored if unrecognized",
"definition" : "May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.\n\nModifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).",
"comment" : "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.",
"alias" : ["extensions",
"user content",
"modifiers"],
"min" : 0,
"max" : "*",
"base" : {
"path" : "BackboneElement.modifierExtension",
"min" : 0,
"max" : "*"
},
{
"id": "ClaimResponse.addItem.modifier",
"path": "ClaimResponse.addItem.modifier",
"short": "Service/Product billing modifiers",
"definition": "Item typification or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or for medical whether the treatment was outside the clinic or out of office hours.",
"requirements": "May impact on adjudication.",
"min": 0,
"max": "*",
"base": {
"path": "ClaimResponse.addItem.modifier",
"min": 0,
"max": "*"
},
"type": [
{
"code": "CodeableConcept"
}
],
"isModifier": false,
"isSummary": false,
"binding": {
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString": "Modifiers"
}
],
"strength": "example",
"description": "Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen.",
"valueSetCanonical": "http://hl7.org/fhir/ValueSet/claim-modifiers"
},
"mapping": [
{
"identity": "rim",
"map": "24.C, 24.D mods"
}
]
"type" : [{
"code" : "Extension"
}],
"isModifier" : true,
"isModifierReason" : "Modifier extensions are expected to modify the meaning or interpretation of the element that contains them",
"isSummary" : true,
"mapping" : [{
"identity" : "rim",
"map" : "N/A"
}]
},
{
"id" : "ClaimResponse.addItem.itemSequence",
"path" : "ClaimResponse.addItem.itemSequence",
"short" : "Service instances",
"definition" : "List of input service items which this service line is intended to replace.",
"min" : 0,
"max" : "*",
"base" : {
"path" : "ClaimResponse.addItem.itemSequence",
"min" : 0,
"max" : "*"
},
{
"id": "ClaimResponse.addItem.fee",
"path": "ClaimResponse.addItem.fee",
"short": "Professional fee or Product charge",
"definition": "The fee charged for the professional service or product..",
"min": 0,
"max": "1",
"base": {
"path": "ClaimResponse.addItem.fee",
"min": 0,
"max": "1"
},
"type": [
{
"code": "Money"
}
],
"isModifier": false,
"isSummary": false
"type" : [{
"code" : "positiveInt"
}],
"isModifier" : false,
"isSummary" : false
},
{
"id" : "ClaimResponse.addItem.detailSequence",
"path" : "ClaimResponse.addItem.detailSequence",
"short" : "Detail sequence number",
"definition" : "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.",
"min" : 0,
"max" : "*",
"base" : {
"path" : "ClaimResponse.addItem.detailSequence",
"min" : 0,
"max" : "*"
},
{
"id": "ClaimResponse.addItem.noteNumber",
"path": "ClaimResponse.addItem.noteNumber",
"short": "List of note numbers which apply",
"definition": "A list of note references to the notes provided below.",
"min": 0,
"max": "*",
"base": {
"path": "ClaimResponse.addItem.noteNumber",
"min": 0,
"max": "*"
},
"type": [
{
"code": "positiveInt"
}
],
"isModifier": false,
"isSummary": false
"type" : [{
"code" : "positiveInt"
}],
"isModifier" : false,
"isSummary" : false
},
{
"id" : "ClaimResponse.addItem.subdetailSequence",
"path" : "ClaimResponse.addItem.subdetailSequence",
"short" : "Subdetail sequence number",
"definition" : "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.",
"min" : 0,
"max" : "*",
"base" : {
"path" : "ClaimResponse.addItem.subdetailSequence",
"min" : 0,
"max" : "*"
},
{
"id": "ClaimResponse.addItem.adjudication",
"path": "ClaimResponse.addItem.adjudication",
"short": "Added items adjudication",
"definition": "The adjudications results.",
"min": 0,
"max": "*",
"base": {
"path": "ClaimResponse.addItem.adjudication",
"min": 0,
"max": "*"
},
"contentReference": "#ClaimResponse.item.adjudication",
"isModifier": false,
"isSummary": false
"type" : [{
"code" : "positiveInt"
}],
"isModifier" : false,
"isSummary" : false
},
{
"id" : "ClaimResponse.addItem.provider",
"path" : "ClaimResponse.addItem.provider",
"short" : "Authorized providers",
"definition" : "The providers who are authorized for the services rendered to the patient.",
"min" : 0,
"max" : "*",
"base" : {
"path" : "ClaimResponse.addItem.provider",
"min" : 0,
"max" : "*"
},
{
"id": "ClaimResponse.error",
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-explicit-type-name",
"valueString": "Error"
}
],
"path": "ClaimResponse.error",
"short": "Processing errors",
"definition": "Mutually exclusive with Services Provided (Item).",
"min": 0,
"max": "*",
"base": {
"path": "ClaimResponse.error",
"min": 0,
"max": "*"
},
"type": [
{
"code": "BackboneElement"
}
],
"constraint": [
{
"key": "ele-1",
"severity": "error",
"human": "All FHIR elements must have a @value or children",
"expression": "hasValue() | (children().count() > id.count())",
"xpath": "@value|f:*|h:div",
"source": "Element"
}
],
"isModifier": false,
"isSummary": false
"type" : [{
"code" : "Reference",
"targetProfile" : ["http://hl7.org/fhir/StructureDefinition/Practitioner",
"http://hl7.org/fhir/StructureDefinition/PractitionerRole",
"http://hl7.org/fhir/StructureDefinition/Organization"]
}],
"isModifier" : false,
"isSummary" : false,
"mapping" : [{
"identity" : "w5",
"map" : "FiveWs.source"
}]
},
{
"id" : "ClaimResponse.addItem.billcode",
"path" : "ClaimResponse.addItem.billcode",
"short" : "Group, Service or Product",
"definition" : "A code to indicate the Professional Service or Product supplied.",
"min" : 0,
"max" : "1",
"base" : {
"path" : "ClaimResponse.addItem.billcode",
"min" : 0,
"max" : "1"
},
{
"id": "ClaimResponse.error.id",
"path": "ClaimResponse.error.id",
"representation": [
"xmlAttr"
],
"short": "xml:id (or equivalent in JSON)",
"definition": "Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.",
"min": 0,
"max": "1",
"base": {
"path": "Element.id",
"min": 0,
"max": "1"
},
"type": [
{
"code": "string"
}
],
"isModifier": false,
"isSummary": false,
"mapping": [
{
"identity": "rim",
"map": "n/a"
}
]
"type" : [{
"code" : "CodeableConcept"
}],
"isModifier" : false,
"isSummary" : false,
"binding" : {
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString" : "ServiceProduct"
}],
"strength" : "example",
"description" : "Allowable service and product codes.",
"valueSet" : "http://hl7.org/fhir/ValueSet/service-uscls"
}
},
{
"id" : "ClaimResponse.addItem.modifier",
"path" : "ClaimResponse.addItem.modifier",
"short" : "Service/Product billing modifiers",
"definition" : "Item typification or modifiers codes, e.g. for Oral whether the treatment is cosmetic or associated with TMJ, or for medical whether the treatment was outside the clinic or out of office hours.",
"requirements" : "May impact on adjudication.",
"min" : 0,
"max" : "*",
"base" : {
"path" : "ClaimResponse.addItem.modifier",
"min" : 0,
"max" : "*"
},
{
"id": "ClaimResponse.error.extension",
"path": "ClaimResponse.error.extension",
"short": "Additional content defined by implementations",
"definition": "May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.",
"comment": "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.",
"alias": [
"extensions",
"user content"
],
"min": 0,
"max": "*",
"base": {
"path": "Element.extension",
"min": 0,
"max": "*"
},
"type": [
{
"code": "Extension"
}
],
"isModifier": false,
"isSummary": false,
"mapping": [
{
"identity": "rim",
"map": "n/a"
}
]
"type" : [{
"code" : "CodeableConcept"
}],
"isModifier" : false,
"isSummary" : false,
"binding" : {
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString" : "Modifiers"
}],
"strength" : "example",
"description" : "Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen.",
"valueSet" : "http://hl7.org/fhir/ValueSet/claim-modifiers"
},
{
"id": "ClaimResponse.error.modifierExtension",
"path": "ClaimResponse.error.modifierExtension",
"short": "Extensions that cannot be ignored",
"definition": "May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.",
"comment": "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.",
"alias": [
"extensions",
"user content",
"modifiers"
],
"min": 0,
"max": "*",
"base": {
"path": "BackboneElement.modifierExtension",
"min": 0,
"max": "*"
},
"type": [
{
"code": "Extension"
}
],
"isModifier": true,
"isModifierReason": "modifierExtension is reserved for use where modifier extensions must be used",
"isSummary": true,
"mapping": [
{
"identity": "rim",
"map": "N/A"
}
]
"mapping" : [{
"identity" : "rim",
"map" : "24.C, 24.D mods"
}]
},
{
"id" : "ClaimResponse.addItem.programCode",
"path" : "ClaimResponse.addItem.programCode",
"short" : "Program specific reason for item inclusion",
"definition" : "For programs which require reason codes for the inclusion or covering of this billed item under the program or sub-program.",
"min" : 0,
"max" : "*",
"base" : {
"path" : "ClaimResponse.addItem.programCode",
"min" : 0,
"max" : "*"
},
{
"id": "ClaimResponse.error.itemSequence",
"path": "ClaimResponse.error.itemSequence",
"short": "Item sequence number",
"definition": "The sequence number of the line item submitted which contains the error. This value is omitted when the error is elsewhere.",
"min": 0,
"max": "1",
"base": {
"path": "ClaimResponse.error.itemSequence",
"min": 0,
"max": "1"
},
"type": [
{
"code": "positiveInt"
}
],
"isModifier": false,
"isSummary": false
"type" : [{
"code" : "CodeableConcept"
}],
"isModifier" : false,
"isSummary" : false,
"binding" : {
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString" : "ProgramCode"
}],
"strength" : "example",
"description" : "Program specific reason codes.",
"valueSet" : "http://hl7.org/fhir/ValueSet/ex-program-code"
},
{
"id": "ClaimResponse.error.detailSequence",
"path": "ClaimResponse.error.detailSequence",
"short": "Detail sequence number",
"definition": "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.",
"min": 0,
"max": "1",
"base": {
"path": "ClaimResponse.error.detailSequence",
"min": 0,
"max": "1"
},
"type": [
{
"code": "positiveInt"
}
],
"isModifier": false,
"isSummary": false
"mapping" : [{
"identity" : "rim",
"map" : "24.H"
}]
},
{
"id" : "ClaimResponse.addItem.serviced[x]",
"path" : "ClaimResponse.addItem.serviced[x]",
"short" : "Date or dates of Service",
"definition" : "The date or dates when the service or product was supplied, performed or completed.",
"min" : 0,
"max" : "1",
"base" : {
"path" : "ClaimResponse.addItem.serviced[x]",
"min" : 0,
"max" : "1"
},
{
"id": "ClaimResponse.error.subDetailSequence",
"path": "ClaimResponse.error.subDetailSequence",
"short": "Subdetail sequence number",
"definition": "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.",
"min": 0,
"max": "1",
"base": {
"path": "ClaimResponse.error.subDetailSequence",
"min": 0,
"max": "1"
},
"type": [
{
"code": "positiveInt"
}
],
"isModifier": false,
"isSummary": false
"type" : [{
"code" : "date"
},
{
"id": "ClaimResponse.error.code",
"path": "ClaimResponse.error.code",
"short": "Error code detailing processing issues",
"definition": "An error code,from a specified code system, which details why the claim could not be adjudicated.",
"min": 1,
"max": "1",
"base": {
"path": "ClaimResponse.error.code",
"min": 1,
"max": "1"
},
"type": [
{
"code": "CodeableConcept"
}
],
"isModifier": false,
"isSummary": false,
"binding": {
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString": "AdjudicationError"
}
],
"strength": "example",
"description": "The adjudication error codes.",
"valueSetCanonical": "http://hl7.org/fhir/ValueSet/adjudication-error"
}
"code" : "Period"
}],
"isModifier" : false,
"isSummary" : false,
"mapping" : [{
"identity" : "w5",
"map" : "FiveWs.done[x]"
},
{
"id": "ClaimResponse.total",
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-explicit-type-name",
"valueString": "Total"
}
],
"path": "ClaimResponse.total",
"short": "Adjudication totals",
"definition": "Totals for amounts submitted, co-pays, benefits payable etc.",
"min": 0,
"max": "*",
"base": {
"path": "ClaimResponse.total",
"min": 0,
"max": "*"
},
"type": [
{
"code": "BackboneElement"
}
],
"constraint": [
{
"key": "ele-1",
"severity": "error",
"human": "All FHIR elements must have a @value or children",
"expression": "hasValue() | (children().count() > id.count())",
"xpath": "@value|f:*|h:div",
"source": "Element"
}
],
"isModifier": false,
"isSummary": false
"identity" : "rim",
"map" : "24.A"
}]
},
{
"id" : "ClaimResponse.addItem.location[x]",
"path" : "ClaimResponse.addItem.location[x]",
"short" : "Place of service",
"definition" : "Where the service was provided.",
"min" : 0,
"max" : "1",
"base" : {
"path" : "ClaimResponse.addItem.location[x]",
"min" : 0,
"max" : "1"
},
{
"id": "ClaimResponse.total.id",
"path": "ClaimResponse.total.id",
"representation": [
"xmlAttr"
],
"short": "xml:id (or equivalent in JSON)",
"definition": "Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.",
"min": 0,
"max": "1",
"base": {
"path": "Element.id",
"min": 0,
"max": "1"
},
"type": [
{
"code": "string"
}
],
"isModifier": false,
"isSummary": false,
"mapping": [
{
"identity": "rim",
"map": "n/a"
}
]
"type" : [{
"code" : "CodeableConcept"
},
{
"id": "ClaimResponse.total.extension",
"path": "ClaimResponse.total.extension",
"short": "Additional content defined by implementations",
"definition": "May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.",
"comment": "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.",
"alias": [
"extensions",
"user content"
],
"min": 0,
"max": "*",
"base": {
"path": "Element.extension",
"min": 0,
"max": "*"
},
"type": [
{
"code": "Extension"
}
],
"isModifier": false,
"isSummary": false,
"mapping": [
{
"identity": "rim",
"map": "n/a"
}
]
"code" : "Address"
},
{
"id": "ClaimResponse.total.modifierExtension",
"path": "ClaimResponse.total.modifierExtension",
"short": "Extensions that cannot be ignored",
"definition": "May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.",
"comment": "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.",
"alias": [
"extensions",
"user content",
"modifiers"
],
"min": 0,
"max": "*",
"base": {
"path": "BackboneElement.modifierExtension",
"min": 0,
"max": "*"
},
"type": [
{
"code": "Extension"
}
],
"isModifier": true,
"isModifierReason": "modifierExtension is reserved for use where modifier extensions must be used",
"isSummary": true,
"mapping": [
{
"identity": "rim",
"map": "N/A"
}
]
"code" : "Reference",
"targetProfile" : ["http://hl7.org/fhir/StructureDefinition/Location"]
}],
"isModifier" : false,
"isSummary" : false,
"binding" : {
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString" : "ServicePlace"
}],
"strength" : "example",
"description" : "Place of service: pharmacy,school, prison, etc.",
"valueSet" : "http://hl7.org/fhir/ValueSet/service-place"
},
{
"id": "ClaimResponse.total.category",
"path": "ClaimResponse.total.category",
"short": "Adjudication category such as submitted, co-pay, eligible, benefit, etc.",
"definition": "Code indicating: Submitted, Co-Pay, deductable, elegible, benefit, tax, etc.",
"min": 1,
"max": "1",
"base": {
"path": "ClaimResponse.total.category",
"min": 1,
"max": "1"
},
"type": [
{
"code": "CodeableConcept"
}
],
"isModifier": false,
"isSummary": false,
"binding": {
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString": "Adjudication"
}
],
"strength": "example",
"description": "The adjudication codes.",
"valueSetCanonical": "http://hl7.org/fhir/ValueSet/adjudication"
}
"mapping" : [{
"identity" : "w5",
"map" : "FiveWs.where[x]"
},
{
"id": "ClaimResponse.total.amount",
"path": "ClaimResponse.total.amount",
"short": "Monetary amount",
"definition": "Monitory amount associated with the code.",
"min": 1,
"max": "1",
"base": {
"path": "ClaimResponse.total.amount",
"min": 1,
"max": "1"
},
"type": [
{
"code": "Money"
}
],
"isModifier": false,
"isSummary": false
"identity" : "rim",
"map" : "24.B"
}]
},
{
"id" : "ClaimResponse.addItem.quantity",
"path" : "ClaimResponse.addItem.quantity",
"short" : "Count of Products or Services",
"definition" : "The number of repetitions of a service or product.",
"min" : 0,
"max" : "1",
"base" : {
"path" : "ClaimResponse.addItem.quantity",
"min" : 0,
"max" : "1"
},
{
"id": "ClaimResponse.payment",
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-explicit-type-name",
"valueString": "Payment"
}
],
"path": "ClaimResponse.payment",
"short": "Payment details, if paid",
"definition": "Payment details for the claim if the claim has been paid.",
"min": 0,
"max": "1",
"base": {
"path": "ClaimResponse.payment",
"min": 0,
"max": "1"
},
"type": [
{
"code": "BackboneElement"
}
],
"constraint": [
{
"key": "ele-1",
"severity": "error",
"human": "All FHIR elements must have a @value or children",
"expression": "hasValue() | (children().count() > id.count())",
"xpath": "@value|f:*|h:div",
"source": "Element"
}
],
"isModifier": false,
"isSummary": false
"type" : [{
"code" : "Quantity",
"profile" : ["http://hl7.org/fhir/StructureDefinition/SimpleQuantity"]
}],
"isModifier" : false,
"isSummary" : false,
"mapping" : [{
"identity" : "rim",
"map" : "24.G"
}]
},
{
"id" : "ClaimResponse.addItem.unitPrice",
"path" : "ClaimResponse.addItem.unitPrice",
"short" : "Fee, charge or cost per point",
"definition" : "If the item is a node then this is the fee for the product or service, otherwise this is the total of the fees for the children of the group.",
"min" : 0,
"max" : "1",
"base" : {
"path" : "ClaimResponse.addItem.unitPrice",
"min" : 0,
"max" : "1"
},
{
"id": "ClaimResponse.payment.id",
"path": "ClaimResponse.payment.id",
"representation": [
"xmlAttr"
],
"short": "xml:id (or equivalent in JSON)",
"definition": "Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.",
"min": 0,
"max": "1",
"base": {
"path": "Element.id",
"min": 0,
"max": "1"
},
"type": [
{
"code": "string"
}
],
"isModifier": false,
"isSummary": false,
"mapping": [
{
"identity": "rim",
"map": "n/a"
}
]
"type" : [{
"code" : "Money"
}],
"isModifier" : false,
"isSummary" : false
},
{
"id" : "ClaimResponse.addItem.factor",
"path" : "ClaimResponse.addItem.factor",
"short" : "Price scaling factor",
"definition" : "A real number that represents a multiplier used in determining the overall value of services delivered and/or goods received. The concept of a Factor allows for a discount or surcharge multiplier to be applied to a monetary amount.",
"requirements" : "If a fee is present the associated product/service code must be present.",
"min" : 0,
"max" : "1",
"base" : {
"path" : "ClaimResponse.addItem.factor",
"min" : 0,
"max" : "1"
},
{
"id": "ClaimResponse.payment.extension",
"path": "ClaimResponse.payment.extension",
"short": "Additional content defined by implementations",
"definition": "May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.",
"comment": "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.",
"alias": [
"extensions",
"user content"
],
"min": 0,
"max": "*",
"base": {
"path": "Element.extension",
"min": 0,
"max": "*"
},
"type": [
{
"code": "Extension"
}
],
"isModifier": false,
"isSummary": false,
"mapping": [
{
"identity": "rim",
"map": "n/a"
}
]
"type" : [{
"code" : "decimal"
}],
"isModifier" : false,
"isSummary" : false
},
{
"id" : "ClaimResponse.addItem.net",
"path" : "ClaimResponse.addItem.net",
"short" : "Total item cost",
"definition" : "The quantity times the unit price for an additional service or product or charge. For example, the formula: unit Quantity * unit Price (Cost per Point) * factor Number * points = net Amount. Quantity, factor and points are assumed to be 1 if not supplied.",
"requirements" : "If a fee is present the associated product/service code must be present.",
"min" : 0,
"max" : "1",
"base" : {
"path" : "ClaimResponse.addItem.net",
"min" : 0,
"max" : "1"
},
{
"id": "ClaimResponse.payment.modifierExtension",
"path": "ClaimResponse.payment.modifierExtension",
"short": "Extensions that cannot be ignored",
"definition": "May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.",
"comment": "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.",
"alias": [
"extensions",
"user content",
"modifiers"
],
"min": 0,
"max": "*",
"base": {
"path": "BackboneElement.modifierExtension",
"min": 0,
"max": "*"
},
"type": [
{
"code": "Extension"
}
],
"isModifier": true,
"isModifierReason": "modifierExtension is reserved for use where modifier extensions must be used",
"isSummary": true,
"mapping": [
{
"identity": "rim",
"map": "N/A"
}
]
"type" : [{
"code" : "Money"
}],
"isModifier" : false,
"isSummary" : false,
"mapping" : [{
"identity" : "rim",
"map" : "24.F"
}]
},
{
"id" : "ClaimResponse.addItem.bodySite",
"path" : "ClaimResponse.addItem.bodySite",
"short" : "Service Location",
"definition" : "Physical service site on the patient (limb, tooth, etc.).",
"min" : 0,
"max" : "1",
"base" : {
"path" : "ClaimResponse.addItem.bodySite",
"min" : 0,
"max" : "1"
},
{
"id": "ClaimResponse.payment.type",
"path": "ClaimResponse.payment.type",
"short": "Partial or Complete",
"definition": "Whether this represents partial or complete payment of the claim.",
"min": 0,
"max": "1",
"base": {
"path": "ClaimResponse.payment.type",
"min": 0,
"max": "1"
},
"type": [
{
"code": "CodeableConcept"
}
],
"isModifier": false,
"isSummary": false,
"binding": {
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString": "PaymentType"
}
],
"strength": "example",
"description": "The type (partial, complete) of the payment",
"valueSetCanonical": "http://hl7.org/fhir/ValueSet/ex-paymenttype"
}
"type" : [{
"code" : "CodeableConcept"
}],
"isModifier" : false,
"isSummary" : false,
"binding" : {
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString" : "OralSites"
}],
"strength" : "example",
"description" : "The code for the teeth, quadrant, sextant and arch.",
"valueSet" : "http://hl7.org/fhir/ValueSet/tooth"
}
},
{
"id" : "ClaimResponse.addItem.subSite",
"path" : "ClaimResponse.addItem.subSite",
"short" : "Service Sub-location",
"definition" : "A region or surface of the site, e.g. limb region or tooth surface(s).",
"min" : 0,
"max" : "*",
"base" : {
"path" : "ClaimResponse.addItem.subSite",
"min" : 0,
"max" : "*"
},
{
"id": "ClaimResponse.payment.adjustment",
"path": "ClaimResponse.payment.adjustment",
"short": "Payment adjustment for non-Claim issues",
"definition": "Adjustment to the payment of this transaction which is not related to adjudication of this transaction.",
"min": 0,
"max": "1",
"base": {
"path": "ClaimResponse.payment.adjustment",
"min": 0,
"max": "1"
},
"type": [
{
"code": "Money"
}
],
"isModifier": false,
"isSummary": false
"type" : [{
"code" : "CodeableConcept"
}],
"isModifier" : false,
"isSummary" : false,
"binding" : {
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString" : "Surface"
}],
"strength" : "example",
"description" : "The code for the tooth surface and surface combinations.",
"valueSet" : "http://hl7.org/fhir/ValueSet/surface"
}
},
{
"id" : "ClaimResponse.addItem.noteNumber",
"path" : "ClaimResponse.addItem.noteNumber",
"short" : "List of note numbers which apply",
"definition" : "A list of note references to the notes provided below.",
"min" : 0,
"max" : "*",
"base" : {
"path" : "ClaimResponse.addItem.noteNumber",
"min" : 0,
"max" : "*"
},
{
"id": "ClaimResponse.payment.adjustmentReason",
"path": "ClaimResponse.payment.adjustmentReason",
"short": "Explanation for the non-claim adjustment",
"definition": "Reason for the payment adjustment.",
"min": 0,
"max": "1",
"base": {
"path": "ClaimResponse.payment.adjustmentReason",
"min": 0,
"max": "1"
},
"type": [
{
"code": "CodeableConcept"
}
],
"isModifier": false,
"isSummary": false,
"binding": {
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString": "PaymentAdjustmentReason"
}
],
"strength": "example",
"description": "Payment Adjustment reason codes.",
"valueSetCanonical": "http://hl7.org/fhir/ValueSet/payment-adjustment-reason"
}
"type" : [{
"code" : "positiveInt"
}],
"isModifier" : false,
"isSummary" : false
},
{
"id" : "ClaimResponse.addItem.adjudication",
"path" : "ClaimResponse.addItem.adjudication",
"short" : "Added items adjudication",
"definition" : "The adjudication results.",
"min" : 0,
"max" : "*",
"base" : {
"path" : "ClaimResponse.addItem.adjudication",
"min" : 0,
"max" : "*"
},
{
"id": "ClaimResponse.payment.date",
"path": "ClaimResponse.payment.date",
"short": "Expected data of Payment",
"definition": "Estimated payment data.",
"min": 0,
"max": "1",
"base": {
"path": "ClaimResponse.payment.date",
"min": 0,
"max": "1"
},
"type": [
{
"code": "date"
}
],
"isModifier": false,
"isSummary": false
"contentReference" : "#ClaimResponse.item.adjudication",
"isModifier" : false,
"isSummary" : false
},
{
"id" : "ClaimResponse.addItem.detail",
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-explicit-type-name",
"valueString" : "AddedItemDetail"
}],
"path" : "ClaimResponse.addItem.detail",
"short" : "Insurer added line items",
"definition" : "The second-tier service adjudications for payor added services.",
"min" : 0,
"max" : "*",
"base" : {
"path" : "ClaimResponse.addItem.detail",
"min" : 0,
"max" : "*"
},
{
"id": "ClaimResponse.payment.amount",
"path": "ClaimResponse.payment.amount",
"short": "Payable amount after adjustment",
"definition": "Payable less any payment adjustment.",
"min": 0,
"max": "1",
"base": {
"path": "ClaimResponse.payment.amount",
"min": 0,
"max": "1"
},
"type": [
{
"code": "Money"
}
],
"isModifier": false,
"isSummary": false
"type" : [{
"code" : "BackboneElement"
}],
"constraint" : [{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "Element"
}],
"isModifier" : false,
"isSummary" : false
},
{
"id" : "ClaimResponse.addItem.detail.id",
"path" : "ClaimResponse.addItem.detail.id",
"representation" : ["xmlAttr"],
"short" : "xml:id (or equivalent in JSON)",
"definition" : "Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.",
"min" : 0,
"max" : "1",
"base" : {
"path" : "Element.id",
"min" : 0,
"max" : "1"
},
{
"id": "ClaimResponse.payment.identifier",
"path": "ClaimResponse.payment.identifier",
"short": "Identifier of the payment instrument",
"definition": "Payment identifier.",
"min": 0,
"max": "1",
"base": {
"path": "ClaimResponse.payment.identifier",
"min": 0,
"max": "1"
},
"type": [
{
"code": "Identifier"
}
],
"isModifier": false,
"isSummary": false
"type" : [{
"code" : "string"
}],
"isModifier" : false,
"isSummary" : false,
"mapping" : [{
"identity" : "rim",
"map" : "n/a"
}]
},
{
"id" : "ClaimResponse.addItem.detail.extension",
"path" : "ClaimResponse.addItem.detail.extension",
"short" : "Additional content defined by implementations",
"definition" : "May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.",
"comment" : "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.",
"alias" : ["extensions",
"user content"],
"min" : 0,
"max" : "*",
"base" : {
"path" : "Element.extension",
"min" : 0,
"max" : "*"
},
{
"id": "ClaimResponse.reserved",
"path": "ClaimResponse.reserved",
"short": "Funds reserved status",
"definition": "Status of funds reservation (For provider, for Patient, None).",
"min": 0,
"max": "1",
"base": {
"path": "ClaimResponse.reserved",
"min": 0,
"max": "1"
},
"type": [
{
"code": "Coding"
}
],
"isModifier": false,
"isSummary": false,
"binding": {
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString": "FundsReserve"
},
{
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-isCommonBinding",
"valueBoolean": true
}
],
"strength": "example",
"description": "For whom funds are to be reserved: (Patient, Provider, None).",
"valueSetCanonical": "http://hl7.org/fhir/ValueSet/fundsreserve"
}
"type" : [{
"code" : "Extension"
}],
"isModifier" : false,
"isSummary" : false,
"mapping" : [{
"identity" : "rim",
"map" : "n/a"
}]
},
{
"id" : "ClaimResponse.addItem.detail.modifierExtension",
"path" : "ClaimResponse.addItem.detail.modifierExtension",
"short" : "Extensions that cannot be ignored if unrecognized",
"definition" : "May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.\n\nModifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).",
"comment" : "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.",
"alias" : ["extensions",
"user content",
"modifiers"],
"min" : 0,
"max" : "*",
"base" : {
"path" : "BackboneElement.modifierExtension",
"min" : 0,
"max" : "*"
},
{
"id": "ClaimResponse.form",
"path": "ClaimResponse.form",
"short": "Printed Form Identifier",
"definition": "The form to be used for printing the content.",
"min": 0,
"max": "1",
"base": {
"path": "ClaimResponse.form",
"min": 0,
"max": "1"
},
"type": [
{
"code": "CodeableConcept"
}
],
"isModifier": false,
"isSummary": false,
"binding": {
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString": "Forms"
},
{
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-isCommonBinding",
"valueBoolean": true
}
],
"strength": "example",
"description": "The forms codes.",
"valueSetCanonical": "http://hl7.org/fhir/ValueSet/forms"
}
"type" : [{
"code" : "Extension"
}],
"isModifier" : true,
"isModifierReason" : "Modifier extensions are expected to modify the meaning or interpretation of the element that contains them",
"isSummary" : true,
"mapping" : [{
"identity" : "rim",
"map" : "N/A"
}]
},
{
"id" : "ClaimResponse.addItem.detail.billcode",
"path" : "ClaimResponse.addItem.detail.billcode",
"short" : "Group, Service or Product",
"definition" : "A code to indicate the Professional Service or Product supplied.",
"min" : 0,
"max" : "1",
"base" : {
"path" : "ClaimResponse.addItem.detail.billcode",
"min" : 0,
"max" : "1"
},
{
"id": "ClaimResponse.processNote",
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-explicit-type-name",
"valueString": "Note"
}
],
"path": "ClaimResponse.processNote",
"short": "Processing notes",
"definition": "Note text.",
"min": 0,
"max": "*",
"base": {
"path": "ClaimResponse.processNote",
"min": 0,
"max": "*"
},
"type": [
{
"code": "BackboneElement"
}
],
"constraint": [
{
"key": "ele-1",
"severity": "error",
"human": "All FHIR elements must have a @value or children",
"expression": "hasValue() | (children().count() > id.count())",
"xpath": "@value|f:*|h:div",
"source": "Element"
}
],
"isModifier": false,
"isSummary": false
"type" : [{
"code" : "CodeableConcept"
}],
"isModifier" : false,
"isSummary" : false,
"binding" : {
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString" : "ServiceProduct"
}],
"strength" : "example",
"description" : "Allowable service and product codes.",
"valueSet" : "http://hl7.org/fhir/ValueSet/service-uscls"
}
},
{
"id" : "ClaimResponse.addItem.detail.modifier",
"path" : "ClaimResponse.addItem.detail.modifier",
"short" : "Service/Product billing modifiers",
"definition" : "Item typification or modifiers codes, e.g. for Oral whether the treatment is cosmetic or associated with TMJ, or for medical whether the treatment was outside the clinic or out of office hours.",
"requirements" : "May impact on adjudication.",
"min" : 0,
"max" : "*",
"base" : {
"path" : "ClaimResponse.addItem.detail.modifier",
"min" : 0,
"max" : "*"
},
{
"id": "ClaimResponse.processNote.id",
"path": "ClaimResponse.processNote.id",
"representation": [
"xmlAttr"
],
"short": "xml:id (or equivalent in JSON)",
"definition": "Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.",
"min": 0,
"max": "1",
"base": {
"path": "Element.id",
"min": 0,
"max": "1"
},
"type": [
{
"code": "string"
}
],
"isModifier": false,
"isSummary": false,
"mapping": [
{
"identity": "rim",
"map": "n/a"
}
]
"type" : [{
"code" : "CodeableConcept"
}],
"isModifier" : false,
"isSummary" : false,
"binding" : {
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString" : "Modifiers"
}],
"strength" : "example",
"description" : "Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen.",
"valueSet" : "http://hl7.org/fhir/ValueSet/claim-modifiers"
},
{
"id": "ClaimResponse.processNote.extension",
"path": "ClaimResponse.processNote.extension",
"short": "Additional content defined by implementations",
"definition": "May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.",
"comment": "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.",
"alias": [
"extensions",
"user content"
],
"min": 0,
"max": "*",
"base": {
"path": "Element.extension",
"min": 0,
"max": "*"
},
"type": [
{
"code": "Extension"
}
],
"isModifier": false,
"isSummary": false,
"mapping": [
{
"identity": "rim",
"map": "n/a"
}
]
"mapping" : [{
"identity" : "rim",
"map" : "24.C, 24.D mods"
}]
},
{
"id" : "ClaimResponse.addItem.detail.quantity",
"path" : "ClaimResponse.addItem.detail.quantity",
"short" : "Count of Products or Services",
"definition" : "The number of repetitions of a service or product.",
"min" : 0,
"max" : "1",
"base" : {
"path" : "ClaimResponse.addItem.detail.quantity",
"min" : 0,
"max" : "1"
},
{
"id": "ClaimResponse.processNote.modifierExtension",
"path": "ClaimResponse.processNote.modifierExtension",
"short": "Extensions that cannot be ignored",
"definition": "May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.",
"comment": "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.",
"alias": [
"extensions",
"user content",
"modifiers"
],
"min": 0,
"max": "*",
"base": {
"path": "BackboneElement.modifierExtension",
"min": 0,
"max": "*"
},
"type": [
{
"code": "Extension"
}
],
"isModifier": true,
"isModifierReason": "modifierExtension is reserved for use where modifier extensions must be used",
"isSummary": true,
"mapping": [
{
"identity": "rim",
"map": "N/A"
}
]
"type" : [{
"code" : "Quantity",
"profile" : ["http://hl7.org/fhir/StructureDefinition/SimpleQuantity"]
}],
"isModifier" : false,
"isSummary" : false,
"mapping" : [{
"identity" : "rim",
"map" : "24.G"
}]
},
{
"id" : "ClaimResponse.addItem.detail.unitPrice",
"path" : "ClaimResponse.addItem.detail.unitPrice",
"short" : "Fee, charge or cost per point",
"definition" : "If the item is a node then this is the fee for the product or service, otherwise this is the total of the fees for the children of the group.",
"min" : 0,
"max" : "1",
"base" : {
"path" : "ClaimResponse.addItem.detail.unitPrice",
"min" : 0,
"max" : "1"
},
{
"id": "ClaimResponse.processNote.number",
"path": "ClaimResponse.processNote.number",
"short": "Sequence Number for this note",
"definition": "An integer associated with each note which may be referred to from each service line item.",
"min": 0,
"max": "1",
"base": {
"path": "ClaimResponse.processNote.number",
"min": 0,
"max": "1"
},
"type": [
{
"code": "positiveInt"
}
],
"isModifier": false,
"isSummary": false
"type" : [{
"code" : "Money"
}],
"isModifier" : false,
"isSummary" : false
},
{
"id" : "ClaimResponse.addItem.detail.factor",
"path" : "ClaimResponse.addItem.detail.factor",
"short" : "Price scaling factor",
"definition" : "A real number that represents a multiplier used in determining the overall value of services delivered and/or goods received. The concept of a Factor allows for a discount or surcharge multiplier to be applied to a monetary amount.",
"requirements" : "If a fee is present the associated product/service code must be present.",
"min" : 0,
"max" : "1",
"base" : {
"path" : "ClaimResponse.addItem.detail.factor",
"min" : 0,
"max" : "1"
},
{
"id": "ClaimResponse.processNote.type",
"path": "ClaimResponse.processNote.type",
"short": "display | print | printoper",
"definition": "The note purpose: Print/Display.",
"min": 0,
"max": "1",
"base": {
"path": "ClaimResponse.processNote.type",
"min": 0,
"max": "1"
},
"type": [
{
"code": "code"
}
],
"isModifier": false,
"isSummary": false,
"binding": {
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString": "NoteType"
},
{
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-isCommonBinding",
"valueBoolean": true
}
],
"strength": "required",
"description": "The presentation types of notes.",
"valueSetCanonical": "http://hl7.org/fhir/ValueSet/note-type"
}
"type" : [{
"code" : "decimal"
}],
"isModifier" : false,
"isSummary" : false
},
{
"id" : "ClaimResponse.addItem.detail.net",
"path" : "ClaimResponse.addItem.detail.net",
"short" : "Total item cost",
"definition" : "The quantity times the unit price for an additional service or product or charge. For example, the formula: unit Quantity * unit Price (Cost per Point) * factor Number * points = net Amount. Quantity, factor and points are assumed to be 1 if not supplied.",
"requirements" : "If a fee is present the associated product/service code must be present.",
"min" : 0,
"max" : "1",
"base" : {
"path" : "ClaimResponse.addItem.detail.net",
"min" : 0,
"max" : "1"
},
{
"id": "ClaimResponse.processNote.text",
"path": "ClaimResponse.processNote.text",
"short": "Note explanatory text",
"definition": "The note text.",
"min": 0,
"max": "1",
"base": {
"path": "ClaimResponse.processNote.text",
"min": 0,
"max": "1"
},
"type": [
{
"code": "string"
}
],
"isModifier": false,
"isSummary": false
"type" : [{
"code" : "Money"
}],
"isModifier" : false,
"isSummary" : false,
"mapping" : [{
"identity" : "rim",
"map" : "24.F"
}]
},
{
"id" : "ClaimResponse.addItem.detail.noteNumber",
"path" : "ClaimResponse.addItem.detail.noteNumber",
"short" : "List of note numbers which apply",
"definition" : "A list of note references to the notes provided below.",
"min" : 0,
"max" : "*",
"base" : {
"path" : "ClaimResponse.addItem.detail.noteNumber",
"min" : 0,
"max" : "*"
},
{
"id": "ClaimResponse.processNote.language",
"path": "ClaimResponse.processNote.language",
"short": "Language if different from the resource",
"definition": "The ISO-639-1 alpha 2 code in lower case for the language, optionally followed by a hyphen and the ISO-3166-1 alpha 2 code for the region in upper case; e.g. \"en\" for English, or \"en-US\" for American English versus \"en-EN\" for England English.",
"min": 0,
"max": "1",
"base": {
"path": "ClaimResponse.processNote.language",
"min": 0,
"max": "1"
},
"type": [
{
"code": "CodeableConcept"
}
],
"isModifier": false,
"isSummary": false,
"binding": {
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-maxValueSet",
"valueReference": {
"reference": "http://hl7.org/fhir/ValueSet/all-languages"
}
},
{
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString": "Language"
},
{
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-isCommonBinding",
"valueBoolean": true
}
],
"strength": "extensible",
"description": "A human language.",
"valueSetCanonical": "http://hl7.org/fhir/ValueSet/languages"
}
"type" : [{
"code" : "positiveInt"
}],
"isModifier" : false,
"isSummary" : false
},
{
"id" : "ClaimResponse.addItem.detail.adjudication",
"path" : "ClaimResponse.addItem.detail.adjudication",
"short" : "Added items detail adjudication",
"definition" : "The adjudication results.",
"min" : 0,
"max" : "*",
"base" : {
"path" : "ClaimResponse.addItem.detail.adjudication",
"min" : 0,
"max" : "*"
},
{
"id": "ClaimResponse.communicationRequest",
"path": "ClaimResponse.communicationRequest",
"short": "Request for additional information",
"definition": "Request for additional supporting or authorizing information, such as: documents, images or resources.",
"min": 0,
"max": "*",
"base": {
"path": "ClaimResponse.communicationRequest",
"min": 0,
"max": "*"
},
"type": [
{
"code": "Reference",
"targetProfile": [
"http://hl7.org/fhir/StructureDefinition/CommunicationRequest"
]
}
],
"isModifier": false,
"isSummary": false
"contentReference" : "#ClaimResponse.item.adjudication",
"isModifier" : false,
"isSummary" : false
},
{
"id" : "ClaimResponse.addItem.detail.subDetail",
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-explicit-type-name",
"valueString" : "AddedItemSubDetail"
}],
"path" : "ClaimResponse.addItem.detail.subDetail",
"short" : "Insurer added line items",
"definition" : "The third-tier service adjudications for payor added services.",
"min" : 0,
"max" : "*",
"base" : {
"path" : "ClaimResponse.addItem.detail.subDetail",
"min" : 0,
"max" : "*"
},
{
"id": "ClaimResponse.insurance",
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-explicit-type-name",
"valueString": "Insurance"
}
],
"path": "ClaimResponse.insurance",
"short": "Insurance or medical plan",
"definition": "Financial instrument by which payment information for health care.",
"requirements": "Health care programs and insurers are significant payors of health service costs.",
"min": 0,
"max": "*",
"base": {
"path": "ClaimResponse.insurance",
"min": 0,
"max": "*"
},
"type": [
{
"code": "BackboneElement"
}
],
"constraint": [
{
"key": "ele-1",
"severity": "error",
"human": "All FHIR elements must have a @value or children",
"expression": "hasValue() | (children().count() > id.count())",
"xpath": "@value|f:*|h:div",
"source": "Element"
}
],
"isModifier": false,
"isSummary": false,
"mapping": [
{
"identity": "rim",
"map": "Coverage"
}
]
"type" : [{
"code" : "BackboneElement"
}],
"constraint" : [{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "Element"
}],
"isModifier" : false,
"isSummary" : false
},
{
"id" : "ClaimResponse.addItem.detail.subDetail.id",
"path" : "ClaimResponse.addItem.detail.subDetail.id",
"representation" : ["xmlAttr"],
"short" : "xml:id (or equivalent in JSON)",
"definition" : "Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.",
"min" : 0,
"max" : "1",
"base" : {
"path" : "Element.id",
"min" : 0,
"max" : "1"
},
{
"id": "ClaimResponse.insurance.id",
"path": "ClaimResponse.insurance.id",
"representation": [
"xmlAttr"
],
"short": "xml:id (or equivalent in JSON)",
"definition": "Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.",
"min": 0,
"max": "1",
"base": {
"path": "Element.id",
"min": 0,
"max": "1"
},
"type": [
{
"code": "string"
}
],
"isModifier": false,
"isSummary": false,
"mapping": [
{
"identity": "rim",
"map": "n/a"
}
]
"type" : [{
"code" : "string"
}],
"isModifier" : false,
"isSummary" : false,
"mapping" : [{
"identity" : "rim",
"map" : "n/a"
}]
},
{
"id" : "ClaimResponse.addItem.detail.subDetail.extension",
"path" : "ClaimResponse.addItem.detail.subDetail.extension",
"short" : "Additional content defined by implementations",
"definition" : "May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.",
"comment" : "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.",
"alias" : ["extensions",
"user content"],
"min" : 0,
"max" : "*",
"base" : {
"path" : "Element.extension",
"min" : 0,
"max" : "*"
},
{
"id": "ClaimResponse.insurance.extension",
"path": "ClaimResponse.insurance.extension",
"short": "Additional content defined by implementations",
"definition": "May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.",
"comment": "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.",
"alias": [
"extensions",
"user content"
],
"min": 0,
"max": "*",
"base": {
"path": "Element.extension",
"min": 0,
"max": "*"
},
"type": [
{
"code": "Extension"
}
],
"isModifier": false,
"isSummary": false,
"mapping": [
{
"identity": "rim",
"map": "n/a"
}
]
"type" : [{
"code" : "Extension"
}],
"isModifier" : false,
"isSummary" : false,
"mapping" : [{
"identity" : "rim",
"map" : "n/a"
}]
},
{
"id" : "ClaimResponse.addItem.detail.subDetail.modifierExtension",
"path" : "ClaimResponse.addItem.detail.subDetail.modifierExtension",
"short" : "Extensions that cannot be ignored if unrecognized",
"definition" : "May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.\n\nModifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).",
"comment" : "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.",
"alias" : ["extensions",
"user content",
"modifiers"],
"min" : 0,
"max" : "*",
"base" : {
"path" : "BackboneElement.modifierExtension",
"min" : 0,
"max" : "*"
},
{
"id": "ClaimResponse.insurance.modifierExtension",
"path": "ClaimResponse.insurance.modifierExtension",
"short": "Extensions that cannot be ignored",
"definition": "May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.",
"comment": "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.",
"alias": [
"extensions",
"user content",
"modifiers"
],
"min": 0,
"max": "*",
"base": {
"path": "BackboneElement.modifierExtension",
"min": 0,
"max": "*"
},
"type": [
{
"code": "Extension"
}
],
"isModifier": true,
"isModifierReason": "modifierExtension is reserved for use where modifier extensions must be used",
"isSummary": true,
"mapping": [
{
"identity": "rim",
"map": "N/A"
}
]
"type" : [{
"code" : "Extension"
}],
"isModifier" : true,
"isModifierReason" : "Modifier extensions are expected to modify the meaning or interpretation of the element that contains them",
"isSummary" : true,
"mapping" : [{
"identity" : "rim",
"map" : "N/A"
}]
},
{
"id" : "ClaimResponse.addItem.detail.subDetail.billcode",
"path" : "ClaimResponse.addItem.detail.subDetail.billcode",
"short" : "Group, Service or Product",
"definition" : "A code to indicate the Professional Service or Product supplied.",
"min" : 0,
"max" : "1",
"base" : {
"path" : "ClaimResponse.addItem.detail.subDetail.billcode",
"min" : 0,
"max" : "1"
},
{
"id": "ClaimResponse.insurance.sequence",
"path": "ClaimResponse.insurance.sequence",
"short": "Service instance identifier",
"definition": "A service line item.",
"requirements": "To maintain order of the coverages.",
"min": 1,
"max": "1",
"base": {
"path": "ClaimResponse.insurance.sequence",
"min": 1,
"max": "1"
},
"type": [
{
"code": "positiveInt"
}
],
"isModifier": false,
"isSummary": false
"type" : [{
"code" : "CodeableConcept"
}],
"isModifier" : false,
"isSummary" : false,
"binding" : {
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString" : "ServiceProduct"
}],
"strength" : "example",
"description" : "Allowable service and product codes.",
"valueSet" : "http://hl7.org/fhir/ValueSet/service-uscls"
}
},
{
"id" : "ClaimResponse.addItem.detail.subDetail.modifier",
"path" : "ClaimResponse.addItem.detail.subDetail.modifier",
"short" : "Service/Product billing modifiers",
"definition" : "Item typification or modifiers codes, e.g. for Oral whether the treatment is cosmetic or associated with TMJ, or for medical whether the treatment was outside the clinic or out of office hours.",
"requirements" : "May impact on adjudication.",
"min" : 0,
"max" : "*",
"base" : {
"path" : "ClaimResponse.addItem.detail.subDetail.modifier",
"min" : 0,
"max" : "*"
},
{
"id": "ClaimResponse.insurance.focal",
"path": "ClaimResponse.insurance.focal",
"short": "Is the focal Coverage",
"definition": "The instance number of the Coverage which is the focus for adjudication. The Coverage against which the claim is to be adjudicated.",
"requirements": "To identify which coverage is being adjudicated.",
"min": 1,
"max": "1",
"base": {
"path": "ClaimResponse.insurance.focal",
"min": 1,
"max": "1"
},
"type": [
{
"code": "boolean"
}
],
"isModifier": false,
"isSummary": false
"type" : [{
"code" : "CodeableConcept"
}],
"isModifier" : false,
"isSummary" : false,
"binding" : {
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString" : "Modifiers"
}],
"strength" : "example",
"description" : "Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen.",
"valueSet" : "http://hl7.org/fhir/ValueSet/claim-modifiers"
},
{
"id": "ClaimResponse.insurance.coverage",
"path": "ClaimResponse.insurance.coverage",
"short": "Insurance information",
"definition": "Reference to the program or plan identification, underwriter or payor.",
"requirements": "Need to identify the issuer to target for processing and for coordination of benefit processing.",
"min": 1,
"max": "1",
"base": {
"path": "ClaimResponse.insurance.coverage",
"min": 1,
"max": "1"
},
"type": [
{
"code": "Reference",
"targetProfile": [
"http://hl7.org/fhir/StructureDefinition/Coverage"
]
}
],
"isModifier": false,
"isSummary": false
"mapping" : [{
"identity" : "rim",
"map" : "24.C, 24.D mods"
}]
},
{
"id" : "ClaimResponse.addItem.detail.subDetail.quantity",
"path" : "ClaimResponse.addItem.detail.subDetail.quantity",
"short" : "Count of Products or Services",
"definition" : "The number of repetitions of a service or product.",
"min" : 0,
"max" : "1",
"base" : {
"path" : "ClaimResponse.addItem.detail.subDetail.quantity",
"min" : 0,
"max" : "1"
},
{
"id": "ClaimResponse.insurance.businessArrangement",
"path": "ClaimResponse.insurance.businessArrangement",
"short": "Business agreement",
"definition": "The contract number of a business agreement which describes the terms and conditions.",
"min": 0,
"max": "1",
"base": {
"path": "ClaimResponse.insurance.businessArrangement",
"min": 0,
"max": "1"
},
"type": [
{
"code": "string"
}
],
"isModifier": false,
"isSummary": false
"type" : [{
"code" : "Quantity",
"profile" : ["http://hl7.org/fhir/StructureDefinition/SimpleQuantity"]
}],
"isModifier" : false,
"isSummary" : false,
"mapping" : [{
"identity" : "rim",
"map" : "24.G"
}]
},
{
"id" : "ClaimResponse.addItem.detail.subDetail.unitPrice",
"path" : "ClaimResponse.addItem.detail.subDetail.unitPrice",
"short" : "Fee, charge or cost per point",
"definition" : "If the item is a node then this is the fee for the product or service, otherwise this is the total of the fees for the children of the group.",
"min" : 0,
"max" : "1",
"base" : {
"path" : "ClaimResponse.addItem.detail.subDetail.unitPrice",
"min" : 0,
"max" : "1"
},
{
"id": "ClaimResponse.insurance.preAuthRef",
"path": "ClaimResponse.insurance.preAuthRef",
"short": "Pre-Authorization/Determination Reference",
"definition": "A list of references from the Insurer to which these services pertain.",
"requirements": "To provide any pre-determination or prior authorization reference.",
"min": 0,
"max": "*",
"base": {
"path": "ClaimResponse.insurance.preAuthRef",
"min": 0,
"max": "*"
},
"type": [
{
"code": "string"
}
],
"isModifier": false,
"isSummary": false
"type" : [{
"code" : "Money"
}],
"isModifier" : false,
"isSummary" : false
},
{
"id" : "ClaimResponse.addItem.detail.subDetail.factor",
"path" : "ClaimResponse.addItem.detail.subDetail.factor",
"short" : "Price scaling factor",
"definition" : "A real number that represents a multiplier used in determining the overall value of services delivered and/or goods received. The concept of a Factor allows for a discount or surcharge multiplier to be applied to a monetary amount.",
"requirements" : "If a fee is present the associated product/service code must be present.",
"min" : 0,
"max" : "1",
"base" : {
"path" : "ClaimResponse.addItem.detail.subDetail.factor",
"min" : 0,
"max" : "1"
},
{
"id": "ClaimResponse.insurance.claimResponse",
"path": "ClaimResponse.insurance.claimResponse",
"short": "Adjudication results",
"definition": "The Coverages adjudication details.",
"requirements": "Used by downstream payers to determine what balance remains and the net payable.",
"min": 0,
"max": "1",
"base": {
"path": "ClaimResponse.insurance.claimResponse",
"min": 0,
"max": "1"
},
"type": [
{
"code": "Reference",
"targetProfile": [
"http://hl7.org/fhir/StructureDefinition/ClaimResponse"
]
}
],
"isModifier": false,
"isSummary": false
}
]
},
"differential": {
"element": [
{
"id": "ClaimResponse",
"path": "ClaimResponse",
"short": "Remittance resource",
"definition": "This resource provides the adjudication details from the processing of a Claim resource.",
"alias": [
"Remittance Advice"
],
"min": 0,
"max": "*",
"mapping": [
{
"identity": "workflow",
"map": "Event"
}
]
"type" : [{
"code" : "decimal"
}],
"isModifier" : false,
"isSummary" : false
},
{
"id" : "ClaimResponse.addItem.detail.subDetail.net",
"path" : "ClaimResponse.addItem.detail.subDetail.net",
"short" : "Total item cost",
"definition" : "The quantity times the unit price for an additional service or product or charge. For example, the formula: unit Quantity * unit Price (Cost per Point) * factor Number * points = net Amount. Quantity, factor and points are assumed to be 1 if not supplied.",
"requirements" : "If a fee is present the associated product/service code must be present.",
"min" : 0,
"max" : "1",
"base" : {
"path" : "ClaimResponse.addItem.detail.subDetail.net",
"min" : 0,
"max" : "1"
},
{
"id": "ClaimResponse.identifier",
"path": "ClaimResponse.identifier",
"short": "Response number",
"definition": "The Response business identifier.",
"min": 0,
"max": "*",
"type": [
{
"code": "Identifier"
}
],
"mapping": [
{
"identity": "workflow",
"map": "Event.identifier"
},
{
"identity": "w5",
"map": "FiveWs.identifier"
}
]
"type" : [{
"code" : "Money"
}],
"isModifier" : false,
"isSummary" : false,
"mapping" : [{
"identity" : "rim",
"map" : "24.F"
}]
},
{
"id" : "ClaimResponse.addItem.detail.subDetail.noteNumber",
"path" : "ClaimResponse.addItem.detail.subDetail.noteNumber",
"short" : "List of note numbers which apply",
"definition" : "A list of note references to the notes provided below.",
"min" : 0,
"max" : "*",
"base" : {
"path" : "ClaimResponse.addItem.detail.subDetail.noteNumber",
"min" : 0,
"max" : "*"
},
{
"id": "ClaimResponse.status",
"path": "ClaimResponse.status",
"short": "active | cancelled | draft | entered-in-error",
"definition": "The status of the resource instance.",
"comment": "This element is labeled as a modifier because the status contains the code cancelled and entered-in-error that mark the response as not currently valid.",
"min": 0,
"max": "1",
"type": [
{
"code": "code"
}
],
"isModifier": true,
"isModifierReason": "This element is labelled as a modifier because it is a status element that contains status entered-in-error which means that the resource should not be treated as valid",
"isSummary": true,
"binding": {
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString": "ClaimResponseStatus"
}
],
"strength": "required",
"description": "A code specifying the state of the resource instance.",
"valueSetCanonical": "http://hl7.org/fhir/ValueSet/fm-status"
},
"mapping": [
{
"identity": "workflow",
"map": "Event.status"
},
{
"identity": "w5",
"map": "FiveWs.status"
}
]
"type" : [{
"code" : "positiveInt"
}],
"isModifier" : false,
"isSummary" : false
},
{
"id" : "ClaimResponse.addItem.detail.subDetail.adjudication",
"path" : "ClaimResponse.addItem.detail.subDetail.adjudication",
"short" : "Added items detail adjudication",
"definition" : "The adjudication results.",
"min" : 0,
"max" : "*",
"base" : {
"path" : "ClaimResponse.addItem.detail.subDetail.adjudication",
"min" : 0,
"max" : "*"
},
{
"id": "ClaimResponse.type",
"path": "ClaimResponse.type",
"short": "Type or discipline",
"definition": "The category of claim, eg, oral, pharmacy, vision, insitutional, professional.",
"comment": "Affects which fields and value sets are used.",
"min": 0,
"max": "1",
"type": [
{
"code": "CodeableConcept"
}
],
"binding": {
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString": "ClaimType"
}
],
"strength": "extensible",
"description": "The type or discipline-style of the claim",
"valueSetCanonical": "http://hl7.org/fhir/ValueSet/claim-type"
},
"mapping": [
{
"identity": "w5",
"map": "FiveWs.class"
}
]
"contentReference" : "#ClaimResponse.item.adjudication",
"isModifier" : false,
"isSummary" : false
},
{
"id" : "ClaimResponse.error",
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-explicit-type-name",
"valueString" : "Error"
}],
"path" : "ClaimResponse.error",
"short" : "Processing errors",
"definition" : "Mutually exclusive with Services Provided (Item).",
"min" : 0,
"max" : "*",
"base" : {
"path" : "ClaimResponse.error",
"min" : 0,
"max" : "*"
},
{
"id": "ClaimResponse.subType",
"path": "ClaimResponse.subType",
"short": "Finer grained claim type information",
"definition": "A finer grained suite of claim subtype codes which may convey Inpatient vs Outpatient and/or a specialty service. In the US the BillType.",
"comment": "This may contain the local bill type codes such as the US UB-04 bill type code.",
"min": 0,
"max": "*",
"type": [
{
"code": "CodeableConcept"
}
],
"binding": {
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString": "ClaimSubType"
}
],
"strength": "example",
"description": "A more granulat claim typecode",
"valueSetCanonical": "http://hl7.org/fhir/ValueSet/claim-subtype"
},
"mapping": [
{
"identity": "w5",
"map": "FiveWs.class"
}
]
"type" : [{
"code" : "BackboneElement"
}],
"constraint" : [{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "Element"
}],
"isModifier" : false,
"isSummary" : false
},
{
"id" : "ClaimResponse.error.id",
"path" : "ClaimResponse.error.id",
"representation" : ["xmlAttr"],
"short" : "xml:id (or equivalent in JSON)",
"definition" : "Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.",
"min" : 0,
"max" : "1",
"base" : {
"path" : "Element.id",
"min" : 0,
"max" : "1"
},
{
"id": "ClaimResponse.use",
"path": "ClaimResponse.use",
"short": "complete | proposed | exploratory | other",
"definition": "Complete (Bill or Claim), Proposed (Pre-Authorization), Exploratory (Pre-determination).",
"min": 0,
"max": "1",
"type": [
{
"code": "code"
}
],
"binding": {
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString": "Use"
}
],
"strength": "required",
"description": "Complete, proposed, exploratory, other",
"valueSetCanonical": "http://hl7.org/fhir/ValueSet/claim-use"
},
"mapping": [
{
"identity": "w5",
"map": "FiveWs.class"
}
]
"type" : [{
"code" : "string"
}],
"isModifier" : false,
"isSummary" : false,
"mapping" : [{
"identity" : "rim",
"map" : "n/a"
}]
},
{
"id" : "ClaimResponse.error.extension",
"path" : "ClaimResponse.error.extension",
"short" : "Additional content defined by implementations",
"definition" : "May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.",
"comment" : "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.",
"alias" : ["extensions",
"user content"],
"min" : 0,
"max" : "*",
"base" : {
"path" : "Element.extension",
"min" : 0,
"max" : "*"
},
{
"id": "ClaimResponse.patient",
"path": "ClaimResponse.patient",
"short": "The subject of the Products and Services",
"definition": "Patient Resource.",
"min": 0,
"max": "1",
"type": [
{
"code": "Reference",
"targetProfile": [
"http://hl7.org/fhir/StructureDefinition/Patient"
]
}
],
"mapping": [
{
"identity": "w5",
"map": "FiveWs.subject[x]"
},
{
"identity": "w5",
"map": "FiveWs.subject"
}
]
"type" : [{
"code" : "Extension"
}],
"isModifier" : false,
"isSummary" : false,
"mapping" : [{
"identity" : "rim",
"map" : "n/a"
}]
},
{
"id" : "ClaimResponse.error.modifierExtension",
"path" : "ClaimResponse.error.modifierExtension",
"short" : "Extensions that cannot be ignored if unrecognized",
"definition" : "May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.\n\nModifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).",
"comment" : "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.",
"alias" : ["extensions",
"user content",
"modifiers"],
"min" : 0,
"max" : "*",
"base" : {
"path" : "BackboneElement.modifierExtension",
"min" : 0,
"max" : "*"
},
{
"id": "ClaimResponse.created",
"path": "ClaimResponse.created",
"short": "Creation date",
"definition": "The date when the enclosed suite of services were performed or completed.",
"min": 0,
"max": "1",
"type": [
{
"code": "dateTime"
}
],
"mapping": [
{
"identity": "workflow",
"map": "Event.occurrence[x]"
},
{
"identity": "w5",
"map": "FiveWs.recorded"
}
]
"type" : [{
"code" : "Extension"
}],
"isModifier" : true,
"isModifierReason" : "Modifier extensions are expected to modify the meaning or interpretation of the element that contains them",
"isSummary" : true,
"mapping" : [{
"identity" : "rim",
"map" : "N/A"
}]
},
{
"id" : "ClaimResponse.error.itemSequence",
"path" : "ClaimResponse.error.itemSequence",
"short" : "Item sequence number",
"definition" : "The sequence number of the line item submitted which contains the error. This value is omitted when the error is elsewhere.",
"min" : 0,
"max" : "1",
"base" : {
"path" : "ClaimResponse.error.itemSequence",
"min" : 0,
"max" : "1"
},
{
"id": "ClaimResponse.insurer",
"path": "ClaimResponse.insurer",
"short": "Insurance issuing organization",
"definition": "The Insurer who produced this adjudicated response.",
"min": 0,
"max": "1",
"type": [
{
"code": "Reference",
"targetProfile": [
"http://hl7.org/fhir/StructureDefinition/Organization"
]
}
],
"mapping": [
{
"identity": "workflow",
"map": "Event.performer"
}
]
"type" : [{
"code" : "positiveInt"
}],
"isModifier" : false,
"isSummary" : false
},
{
"id" : "ClaimResponse.error.detailSequence",
"path" : "ClaimResponse.error.detailSequence",
"short" : "Detail sequence number",
"definition" : "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.",
"min" : 0,
"max" : "1",
"base" : {
"path" : "ClaimResponse.error.detailSequence",
"min" : 0,
"max" : "1"
},
{
"id": "ClaimResponse.requestProvider",
"path": "ClaimResponse.requestProvider",
"short": "Responsible practitioner",
"definition": "The practitioner who is responsible for the services rendered to the patient.",
"min": 0,
"max": "1",
"type": [
{
"code": "Reference",
"targetProfile": [
"http://hl7.org/fhir/StructureDefinition/Practitioner",
"http://hl7.org/fhir/StructureDefinition/PractitionerRole",
"http://hl7.org/fhir/StructureDefinition/Organization"
]
}
],
"mapping": [
{
"identity": "w5",
"map": "FiveWs.source"
}
]
"type" : [{
"code" : "positiveInt"
}],
"isModifier" : false,
"isSummary" : false
},
{
"id" : "ClaimResponse.error.subDetailSequence",
"path" : "ClaimResponse.error.subDetailSequence",
"short" : "Subdetail sequence number",
"definition" : "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.",
"min" : 0,
"max" : "1",
"base" : {
"path" : "ClaimResponse.error.subDetailSequence",
"min" : 0,
"max" : "1"
},
{
"id": "ClaimResponse.request",
"path": "ClaimResponse.request",
"short": "Id of resource triggering adjudication",
"definition": "Original request resource referrence.",
"min": 0,
"max": "1",
"type": [
{
"code": "Reference",
"targetProfile": [
"http://hl7.org/fhir/StructureDefinition/Claim"
]
}
],
"mapping": [
{
"identity": "workflow",
"map": "Event.basedOn"
},
{
"identity": "w5",
"map": "FiveWs.why[x]"
}
]
"type" : [{
"code" : "positiveInt"
}],
"isModifier" : false,
"isSummary" : false
},
{
"id" : "ClaimResponse.error.code",
"path" : "ClaimResponse.error.code",
"short" : "Error code detailing processing issues",
"definition" : "An error code, from a specified code system, which details why the claim could not be adjudicated.",
"min" : 1,
"max" : "1",
"base" : {
"path" : "ClaimResponse.error.code",
"min" : 1,
"max" : "1"
},
{
"id": "ClaimResponse.outcome",
"path": "ClaimResponse.outcome",
"short": "queued | complete | error | partial",
"definition": "Transaction: error, complete, partial processing.",
"min": 0,
"max": "1",
"type": [
{
"code": "code"
}
],
"binding": {
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString": "RemittanceOutcome"
}
],
"strength": "required",
"description": "The result of the claim processing",
"valueSetCanonical": "http://hl7.org/fhir/ValueSet/remittance-outcome"
}
"type" : [{
"code" : "CodeableConcept"
}],
"isModifier" : false,
"isSummary" : false,
"binding" : {
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString" : "AdjudicationError"
}],
"strength" : "example",
"description" : "The adjudication error codes.",
"valueSet" : "http://hl7.org/fhir/ValueSet/adjudication-error"
}
},
{
"id" : "ClaimResponse.total",
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-explicit-type-name",
"valueString" : "Total"
}],
"path" : "ClaimResponse.total",
"short" : "Adjudication totals",
"definition" : "Totals for amounts submitted, co-pays, benefits payable etc.",
"min" : 0,
"max" : "*",
"base" : {
"path" : "ClaimResponse.total",
"min" : 0,
"max" : "*"
},
{
"id": "ClaimResponse.disposition",
"path": "ClaimResponse.disposition",
"short": "Disposition Message",
"definition": "A description of the status of the adjudication.",
"min": 0,
"max": "1",
"type": [
{
"code": "string"
}
],
"mapping": [
{
"identity": "workflow",
"map": "Event.note"
}
]
"type" : [{
"code" : "BackboneElement"
}],
"constraint" : [{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "Element"
}],
"isModifier" : false,
"isSummary" : false
},
{
"id" : "ClaimResponse.total.id",
"path" : "ClaimResponse.total.id",
"representation" : ["xmlAttr"],
"short" : "xml:id (or equivalent in JSON)",
"definition" : "Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.",
"min" : 0,
"max" : "1",
"base" : {
"path" : "Element.id",
"min" : 0,
"max" : "1"
},
{
"id": "ClaimResponse.payeeType",
"path": "ClaimResponse.payeeType",
"short": "Party to be paid any benefits payable",
"definition": "Party to be reimbursed: Subscriber, provider, other.",
"min": 0,
"max": "1",
"type": [
{
"code": "CodeableConcept"
}
],
"binding": {
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString": "PayeeType"
},
{
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-isCommonBinding",
"valueBoolean": true
}
],
"strength": "example",
"description": "A code for the party to be reimbursed.",
"valueSetCanonical": "http://hl7.org/fhir/ValueSet/payeetype"
}
"type" : [{
"code" : "string"
}],
"isModifier" : false,
"isSummary" : false,
"mapping" : [{
"identity" : "rim",
"map" : "n/a"
}]
},
{
"id" : "ClaimResponse.total.extension",
"path" : "ClaimResponse.total.extension",
"short" : "Additional content defined by implementations",
"definition" : "May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.",
"comment" : "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.",
"alias" : ["extensions",
"user content"],
"min" : 0,
"max" : "*",
"base" : {
"path" : "Element.extension",
"min" : 0,
"max" : "*"
},
{
"id": "ClaimResponse.item",
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-explicit-type-name",
"valueString": "Item"
}
],
"path": "ClaimResponse.item",
"short": "Line items",
"definition": "The first tier service adjudications for submitted services.",
"min": 0,
"max": "*",
"type": [
{
"code": "BackboneElement"
}
]
"type" : [{
"code" : "Extension"
}],
"isModifier" : false,
"isSummary" : false,
"mapping" : [{
"identity" : "rim",
"map" : "n/a"
}]
},
{
"id" : "ClaimResponse.total.modifierExtension",
"path" : "ClaimResponse.total.modifierExtension",
"short" : "Extensions that cannot be ignored if unrecognized",
"definition" : "May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.\n\nModifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).",
"comment" : "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.",
"alias" : ["extensions",
"user content",
"modifiers"],
"min" : 0,
"max" : "*",
"base" : {
"path" : "BackboneElement.modifierExtension",
"min" : 0,
"max" : "*"
},
{
"id": "ClaimResponse.item.itemSequence",
"path": "ClaimResponse.item.itemSequence",
"short": "Service instance",
"definition": "A service line number.",
"min": 1,
"max": "1",
"type": [
{
"code": "positiveInt"
}
]
"type" : [{
"code" : "Extension"
}],
"isModifier" : true,
"isModifierReason" : "Modifier extensions are expected to modify the meaning or interpretation of the element that contains them",
"isSummary" : true,
"mapping" : [{
"identity" : "rim",
"map" : "N/A"
}]
},
{
"id" : "ClaimResponse.total.category",
"path" : "ClaimResponse.total.category",
"short" : "Adjudication category such as submitted, co-pay, eligible, benefit, etc.",
"definition" : "Code indicating: Submitted, Co-Pay, deductible, eligible, benefit, tax, etc.",
"min" : 1,
"max" : "1",
"base" : {
"path" : "ClaimResponse.total.category",
"min" : 1,
"max" : "1"
},
{
"id": "ClaimResponse.item.noteNumber",
"path": "ClaimResponse.item.noteNumber",
"short": "List of note numbers which apply",
"definition": "A list of note references to the notes provided below.",
"min": 0,
"max": "*",
"type": [
{
"code": "positiveInt"
}
]
"type" : [{
"code" : "CodeableConcept"
}],
"isModifier" : false,
"isSummary" : false,
"binding" : {
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString" : "Adjudication"
}],
"strength" : "example",
"description" : "The adjudication codes.",
"valueSet" : "http://hl7.org/fhir/ValueSet/adjudication"
}
},
{
"id" : "ClaimResponse.total.amount",
"path" : "ClaimResponse.total.amount",
"short" : "Monetary amount",
"definition" : "Monitory amount associated with the code.",
"min" : 1,
"max" : "1",
"base" : {
"path" : "ClaimResponse.total.amount",
"min" : 1,
"max" : "1"
},
{
"id": "ClaimResponse.item.adjudication",
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-explicit-type-name",
"valueString": "Adjudication"
}
],
"path": "ClaimResponse.item.adjudication",
"short": "Adjudication details",
"definition": "The adjudication results.",
"min": 0,
"max": "*",
"type": [
{
"code": "BackboneElement"
}
]
"type" : [{
"code" : "Money"
}],
"isModifier" : false,
"isSummary" : false
},
{
"id" : "ClaimResponse.payment",
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-explicit-type-name",
"valueString" : "Payment"
}],
"path" : "ClaimResponse.payment",
"short" : "Payment Details",
"definition" : "Payment details for the claim if the claim has been paid.",
"min" : 0,
"max" : "1",
"base" : {
"path" : "ClaimResponse.payment",
"min" : 0,
"max" : "1"
},
{
"id": "ClaimResponse.item.adjudication.category",
"path": "ClaimResponse.item.adjudication.category",
"short": "Adjudication category such as co-pay, eligible, benefit, etc.",
"definition": "Code indicating: Co-Pay, deductible, eligible, benefit, tax, etc.",
"min": 1,
"max": "1",
"type": [
{
"code": "CodeableConcept"
}
],
"binding": {
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString": "Adjudication"
}
],
"strength": "example",
"description": "The adjudication codes.",
"valueSetCanonical": "http://hl7.org/fhir/ValueSet/adjudication"
}
"type" : [{
"code" : "BackboneElement"
}],
"constraint" : [{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "Element"
}],
"isModifier" : false,
"isSummary" : false
},
{
"id" : "ClaimResponse.payment.id",
"path" : "ClaimResponse.payment.id",
"representation" : ["xmlAttr"],
"short" : "xml:id (or equivalent in JSON)",
"definition" : "Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.",
"min" : 0,
"max" : "1",
"base" : {
"path" : "Element.id",
"min" : 0,
"max" : "1"
},
{
"id": "ClaimResponse.item.adjudication.reason",
"path": "ClaimResponse.item.adjudication.reason",
"short": "Explanation of Adjudication outcome",
"definition": "Adjudication reason such as limit reached.",
"min": 0,
"max": "1",
"type": [
{
"code": "CodeableConcept"
}
],
"binding": {
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString": "AdjudicationReason"
}
],
"strength": "example",
"description": "The adjudication reason codes.",
"valueSetCanonical": "http://hl7.org/fhir/ValueSet/adjudication-reason"
}
"type" : [{
"code" : "string"
}],
"isModifier" : false,
"isSummary" : false,
"mapping" : [{
"identity" : "rim",
"map" : "n/a"
}]
},
{
"id" : "ClaimResponse.payment.extension",
"path" : "ClaimResponse.payment.extension",
"short" : "Additional content defined by implementations",
"definition" : "May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.",
"comment" : "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.",
"alias" : ["extensions",
"user content"],
"min" : 0,
"max" : "*",
"base" : {
"path" : "Element.extension",
"min" : 0,
"max" : "*"
},
{
"id": "ClaimResponse.item.adjudication.amount",
"path": "ClaimResponse.item.adjudication.amount",
"short": "Monetary amount",
"definition": "Monetary amount associated with the code.",
"min": 0,
"max": "1",
"type": [
{
"code": "Money"
}
]
"type" : [{
"code" : "Extension"
}],
"isModifier" : false,
"isSummary" : false,
"mapping" : [{
"identity" : "rim",
"map" : "n/a"
}]
},
{
"id" : "ClaimResponse.payment.modifierExtension",
"path" : "ClaimResponse.payment.modifierExtension",
"short" : "Extensions that cannot be ignored if unrecognized",
"definition" : "May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.\n\nModifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).",
"comment" : "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.",
"alias" : ["extensions",
"user content",
"modifiers"],
"min" : 0,
"max" : "*",
"base" : {
"path" : "BackboneElement.modifierExtension",
"min" : 0,
"max" : "*"
},
{
"id": "ClaimResponse.item.adjudication.value",
"path": "ClaimResponse.item.adjudication.value",
"short": "Non-monetary value",
"definition": "A non-monetary value for example a percentage. Mutually exclusive to the amount element above.",
"min": 0,
"max": "1",
"type": [
{
"code": "decimal"
}
]
"type" : [{
"code" : "Extension"
}],
"isModifier" : true,
"isModifierReason" : "Modifier extensions are expected to modify the meaning or interpretation of the element that contains them",
"isSummary" : true,
"mapping" : [{
"identity" : "rim",
"map" : "N/A"
}]
},
{
"id" : "ClaimResponse.payment.type",
"path" : "ClaimResponse.payment.type",
"short" : "Partial or Complete",
"definition" : "Whether this represents partial or complete payment of the claim.",
"min" : 0,
"max" : "1",
"base" : {
"path" : "ClaimResponse.payment.type",
"min" : 0,
"max" : "1"
},
{
"id": "ClaimResponse.item.detail",
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-explicit-type-name",
"valueString": "ItemDetail"
}
],
"path": "ClaimResponse.item.detail",
"short": "Detail line items",
"definition": "The second tier service adjudications for submitted services.",
"min": 0,
"max": "*",
"type": [
{
"code": "BackboneElement"
}
]
"type" : [{
"code" : "CodeableConcept"
}],
"isModifier" : false,
"isSummary" : false,
"binding" : {
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString" : "PaymentType"
}],
"strength" : "example",
"description" : "The type (partial, complete) of the payment.",
"valueSet" : "http://hl7.org/fhir/ValueSet/ex-paymenttype"
}
},
{
"id" : "ClaimResponse.payment.adjustment",
"path" : "ClaimResponse.payment.adjustment",
"short" : "Payment adjustment for non-Claim issues",
"definition" : "Adjustment to the payment of this transaction which is not related to adjudication of this transaction.",
"min" : 0,
"max" : "1",
"base" : {
"path" : "ClaimResponse.payment.adjustment",
"min" : 0,
"max" : "1"
},
{
"id": "ClaimResponse.item.detail.detailSequence",
"path": "ClaimResponse.item.detail.detailSequence",
"short": "Service instance",
"definition": "A service line number.",
"min": 1,
"max": "1",
"type": [
{
"code": "positiveInt"
}
]
"type" : [{
"code" : "Money"
}],
"isModifier" : false,
"isSummary" : false
},
{
"id" : "ClaimResponse.payment.adjustmentReason",
"path" : "ClaimResponse.payment.adjustmentReason",
"short" : "Explanation for the non-claim adjustment",
"definition" : "Reason for the payment adjustment.",
"min" : 0,
"max" : "1",
"base" : {
"path" : "ClaimResponse.payment.adjustmentReason",
"min" : 0,
"max" : "1"
},
{
"id": "ClaimResponse.item.detail.noteNumber",
"path": "ClaimResponse.item.detail.noteNumber",
"short": "List of note numbers which apply",
"definition": "A list of note references to the notes provided below.",
"min": 0,
"max": "*",
"type": [
{
"code": "positiveInt"
}
]
"type" : [{
"code" : "CodeableConcept"
}],
"isModifier" : false,
"isSummary" : false,
"binding" : {
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString" : "PaymentAdjustmentReason"
}],
"strength" : "example",
"description" : "Payment Adjustment reason codes.",
"valueSet" : "http://hl7.org/fhir/ValueSet/payment-adjustment-reason"
}
},
{
"id" : "ClaimResponse.payment.date",
"path" : "ClaimResponse.payment.date",
"short" : "Expected data of Payment",
"definition" : "Estimated payment data.",
"min" : 0,
"max" : "1",
"base" : {
"path" : "ClaimResponse.payment.date",
"min" : 0,
"max" : "1"
},
{
"id": "ClaimResponse.item.detail.adjudication",
"path": "ClaimResponse.item.detail.adjudication",
"short": "Detail level adjudication details",
"definition": "The adjudications results.",
"min": 0,
"max": "*",
"contentReference": "#ClaimResponse.item.adjudication"
"type" : [{
"code" : "date"
}],
"isModifier" : false,
"isSummary" : false
},
{
"id" : "ClaimResponse.payment.amount",
"path" : "ClaimResponse.payment.amount",
"short" : "Payable amount after adjustment",
"definition" : "Payable less any payment adjustment.",
"min" : 0,
"max" : "1",
"base" : {
"path" : "ClaimResponse.payment.amount",
"min" : 0,
"max" : "1"
},
{
"id": "ClaimResponse.item.detail.subDetail",
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-explicit-type-name",
"valueString": "SubDetail"
}
],
"path": "ClaimResponse.item.detail.subDetail",
"short": "Subdetail line items",
"definition": "The third tier service adjudications for submitted services.",
"min": 0,
"max": "*",
"type": [
{
"code": "BackboneElement"
}
]
"type" : [{
"code" : "Money"
}],
"isModifier" : false,
"isSummary" : false
},
{
"id" : "ClaimResponse.payment.identifier",
"path" : "ClaimResponse.payment.identifier",
"short" : "Identifier of the payment instrument",
"definition" : "Payment identifier.",
"min" : 0,
"max" : "1",
"base" : {
"path" : "ClaimResponse.payment.identifier",
"min" : 0,
"max" : "1"
},
{
"id": "ClaimResponse.item.detail.subDetail.subDetailSequence",
"path": "ClaimResponse.item.detail.subDetail.subDetailSequence",
"short": "Service instance",
"definition": "A service line number.",
"min": 1,
"max": "1",
"type": [
{
"code": "positiveInt"
}
]
"type" : [{
"code" : "Identifier"
}],
"isModifier" : false,
"isSummary" : false
},
{
"id" : "ClaimResponse.reserved",
"path" : "ClaimResponse.reserved",
"short" : "Funds reserved status",
"definition" : "Status of funds reservation (For provider, for Patient, None).",
"min" : 0,
"max" : "1",
"base" : {
"path" : "ClaimResponse.reserved",
"min" : 0,
"max" : "1"
},
{
"id": "ClaimResponse.item.detail.subDetail.noteNumber",
"path": "ClaimResponse.item.detail.subDetail.noteNumber",
"short": "List of note numbers which apply",
"definition": "A list of note references to the notes provided below.",
"min": 0,
"max": "*",
"type": [
{
"code": "positiveInt"
}
]
"type" : [{
"code" : "Coding"
}],
"isModifier" : false,
"isSummary" : false,
"binding" : {
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString" : "FundsReserve"
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-isCommonBinding",
"valueBoolean" : true
}],
"strength" : "example",
"description" : "For whom funds are to be reserved: (Patient, Provider, None).",
"valueSet" : "http://hl7.org/fhir/ValueSet/fundsreserve"
}
},
{
"id" : "ClaimResponse.form",
"path" : "ClaimResponse.form",
"short" : "Printed Form Identifier",
"definition" : "The form to be used for printing the content.",
"min" : 0,
"max" : "1",
"base" : {
"path" : "ClaimResponse.form",
"min" : 0,
"max" : "1"
},
{
"id": "ClaimResponse.item.detail.subDetail.adjudication",
"path": "ClaimResponse.item.detail.subDetail.adjudication",
"short": "Subdetail level adjudication details",
"definition": "The adjudications results.",
"min": 0,
"max": "*",
"contentReference": "#ClaimResponse.item.adjudication"
"type" : [{
"code" : "CodeableConcept"
}],
"isModifier" : false,
"isSummary" : false,
"binding" : {
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString" : "Forms"
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-isCommonBinding",
"valueBoolean" : true
}],
"strength" : "example",
"description" : "The forms codes.",
"valueSet" : "http://hl7.org/fhir/ValueSet/forms"
}
},
{
"id" : "ClaimResponse.processNote",
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-explicit-type-name",
"valueString" : "Note"
}],
"path" : "ClaimResponse.processNote",
"short" : "Processing notes",
"definition" : "Note text.",
"min" : 0,
"max" : "*",
"base" : {
"path" : "ClaimResponse.processNote",
"min" : 0,
"max" : "*"
},
{
"id": "ClaimResponse.addItem",
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-explicit-type-name",
"valueString": "AddedItem"
}
],
"path": "ClaimResponse.addItem",
"short": "Insurer added line items",
"definition": "The first tier service adjudications for payor added services.",
"min": 0,
"max": "*",
"type": [
{
"code": "BackboneElement"
}
]
"type" : [{
"code" : "BackboneElement"
}],
"constraint" : [{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "Element"
}],
"isModifier" : false,
"isSummary" : false
},
{
"id" : "ClaimResponse.processNote.id",
"path" : "ClaimResponse.processNote.id",
"representation" : ["xmlAttr"],
"short" : "xml:id (or equivalent in JSON)",
"definition" : "Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.",
"min" : 0,
"max" : "1",
"base" : {
"path" : "Element.id",
"min" : 0,
"max" : "1"
},
{
"id": "ClaimResponse.addItem.itemSequence",
"path": "ClaimResponse.addItem.itemSequence",
"short": "Service instances",
"definition": "List of input service items which this service line is intended to replace.",
"min": 0,
"max": "*",
"type": [
{
"code": "positiveInt"
}
]
"type" : [{
"code" : "string"
}],
"isModifier" : false,
"isSummary" : false,
"mapping" : [{
"identity" : "rim",
"map" : "n/a"
}]
},
{
"id" : "ClaimResponse.processNote.extension",
"path" : "ClaimResponse.processNote.extension",
"short" : "Additional content defined by implementations",
"definition" : "May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.",
"comment" : "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.",
"alias" : ["extensions",
"user content"],
"min" : 0,
"max" : "*",
"base" : {
"path" : "Element.extension",
"min" : 0,
"max" : "*"
},
{
"id": "ClaimResponse.addItem.detailSequence",
"path": "ClaimResponse.addItem.detailSequence",
"short": "Detail sequence number",
"definition": "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.",
"min": 0,
"max": "*",
"type": [
{
"code": "positiveInt"
}
]
"type" : [{
"code" : "Extension"
}],
"isModifier" : false,
"isSummary" : false,
"mapping" : [{
"identity" : "rim",
"map" : "n/a"
}]
},
{
"id" : "ClaimResponse.processNote.modifierExtension",
"path" : "ClaimResponse.processNote.modifierExtension",
"short" : "Extensions that cannot be ignored if unrecognized",
"definition" : "May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.\n\nModifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).",
"comment" : "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.",
"alias" : ["extensions",
"user content",
"modifiers"],
"min" : 0,
"max" : "*",
"base" : {
"path" : "BackboneElement.modifierExtension",
"min" : 0,
"max" : "*"
},
{
"id": "ClaimResponse.addItem.subdetailSequence",
"path": "ClaimResponse.addItem.subdetailSequence",
"short": "Subdetail sequence number",
"definition": "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.",
"min": 0,
"max": "*",
"type": [
{
"code": "positiveInt"
}
]
"type" : [{
"code" : "Extension"
}],
"isModifier" : true,
"isModifierReason" : "Modifier extensions are expected to modify the meaning or interpretation of the element that contains them",
"isSummary" : true,
"mapping" : [{
"identity" : "rim",
"map" : "N/A"
}]
},
{
"id" : "ClaimResponse.processNote.number",
"path" : "ClaimResponse.processNote.number",
"short" : "Sequence Number for this note",
"definition" : "An integer associated with each note which may be referred to from each service line item.",
"min" : 0,
"max" : "1",
"base" : {
"path" : "ClaimResponse.processNote.number",
"min" : 0,
"max" : "1"
},
{
"id": "ClaimResponse.addItem.service",
"path": "ClaimResponse.addItem.service",
"short": "Group, Service or Product",
"definition": "A code to indicate the Professional Service or Product supplied.",
"min": 0,
"max": "1",
"type": [
{
"code": "CodeableConcept"
}
],
"binding": {
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString": "ServiceProduct"
}
],
"strength": "example",
"description": "Allowable service and product codes.",
"valueSetCanonical": "http://hl7.org/fhir/ValueSet/service-uscls"
}
"type" : [{
"code" : "positiveInt"
}],
"isModifier" : false,
"isSummary" : false
},
{
"id" : "ClaimResponse.processNote.type",
"path" : "ClaimResponse.processNote.type",
"short" : "display | print | printoper",
"definition" : "The note purpose: Print/Display.",
"min" : 0,
"max" : "1",
"base" : {
"path" : "ClaimResponse.processNote.type",
"min" : 0,
"max" : "1"
},
{
"id": "ClaimResponse.addItem.modifier",
"path": "ClaimResponse.addItem.modifier",
"short": "Service/Product billing modifiers",
"definition": "Item typification or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or for medical whether the treatment was outside the clinic or out of office hours.",
"requirements": "May impact on adjudication.",
"min": 0,
"max": "*",
"type": [
{
"code": "CodeableConcept"
}
],
"binding": {
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString": "Modifiers"
}
],
"strength": "example",
"description": "Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen.",
"valueSetCanonical": "http://hl7.org/fhir/ValueSet/claim-modifiers"
"type" : [{
"code" : "code"
}],
"isModifier" : false,
"isSummary" : false,
"binding" : {
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString" : "NoteType"
},
"mapping": [
{
"identity": "rim",
"map": "24.C, 24.D mods"
}
]
},
{
"id": "ClaimResponse.addItem.fee",
"path": "ClaimResponse.addItem.fee",
"short": "Professional fee or Product charge",
"definition": "The fee charged for the professional service or product..",
"min": 0,
"max": "1",
"type": [
{
"code": "Money"
}
]
},
{
"id": "ClaimResponse.addItem.noteNumber",
"path": "ClaimResponse.addItem.noteNumber",
"short": "List of note numbers which apply",
"definition": "A list of note references to the notes provided below.",
"min": 0,
"max": "*",
"type": [
{
"code": "positiveInt"
}
]
{
"url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-isCommonBinding",
"valueBoolean" : true
}],
"strength" : "required",
"description" : "The presentation types of notes.",
"valueSet" : "http://hl7.org/fhir/ValueSet/note-type"
}
},
{
"id" : "ClaimResponse.processNote.text",
"path" : "ClaimResponse.processNote.text",
"short" : "Note explanatory text",
"definition" : "The note text.",
"min" : 0,
"max" : "1",
"base" : {
"path" : "ClaimResponse.processNote.text",
"min" : 0,
"max" : "1"
},
{
"id": "ClaimResponse.addItem.adjudication",
"path": "ClaimResponse.addItem.adjudication",
"short": "Added items adjudication",
"definition": "The adjudications results.",
"min": 0,
"max": "*",
"contentReference": "#ClaimResponse.item.adjudication"
"type" : [{
"code" : "string"
}],
"isModifier" : false,
"isSummary" : false
},
{
"id" : "ClaimResponse.processNote.language",
"path" : "ClaimResponse.processNote.language",
"short" : "Language if different from the resource",
"definition" : "The ISO-639-1 alpha 2 code in lower case for the language, optionally followed by a hyphen and the ISO-3166-1 alpha 2 code for the region in upper case; e.g. \"en\" for English, or \"en-US\" for American English versus \"en-EN\" for England English.",
"min" : 0,
"max" : "1",
"base" : {
"path" : "ClaimResponse.processNote.language",
"min" : 0,
"max" : "1"
},
{
"id": "ClaimResponse.error",
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-explicit-type-name",
"valueString": "Error"
}
],
"path": "ClaimResponse.error",
"short": "Processing errors",
"definition": "Mutually exclusive with Services Provided (Item).",
"min": 0,
"max": "*",
"type": [
{
"code": "BackboneElement"
}
]
"type" : [{
"code" : "CodeableConcept"
}],
"isModifier" : false,
"isSummary" : false,
"binding" : {
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-maxValueSet",
"valueCanonical" : "http://hl7.org/fhir/ValueSet/all-languages"
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString" : "Language"
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-isCommonBinding",
"valueBoolean" : true
}],
"strength" : "preferred",
"description" : "A human language.",
"valueSet" : "http://hl7.org/fhir/ValueSet/languages"
}
},
{
"id" : "ClaimResponse.communicationRequest",
"path" : "ClaimResponse.communicationRequest",
"short" : "Request for additional information",
"definition" : "Request for additional supporting or authorizing information, such as: documents, images or resources.",
"min" : 0,
"max" : "*",
"base" : {
"path" : "ClaimResponse.communicationRequest",
"min" : 0,
"max" : "*"
},
{
"id": "ClaimResponse.error.itemSequence",
"path": "ClaimResponse.error.itemSequence",
"short": "Item sequence number",
"definition": "The sequence number of the line item submitted which contains the error. This value is omitted when the error is elsewhere.",
"min": 0,
"max": "1",
"type": [
{
"code": "positiveInt"
}
]
"type" : [{
"code" : "Reference",
"targetProfile" : ["http://hl7.org/fhir/StructureDefinition/CommunicationRequest"]
}],
"isModifier" : false,
"isSummary" : false
},
{
"id" : "ClaimResponse.insurance",
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-explicit-type-name",
"valueString" : "Insurance"
}],
"path" : "ClaimResponse.insurance",
"short" : "Insurance or medical plan",
"definition" : "Financial instrument by which payment information for health care.",
"requirements" : "Health care programs and insurers are significant payors of health service costs.",
"min" : 0,
"max" : "*",
"base" : {
"path" : "ClaimResponse.insurance",
"min" : 0,
"max" : "*"
},
{
"id": "ClaimResponse.error.detailSequence",
"path": "ClaimResponse.error.detailSequence",
"short": "Detail sequence number",
"definition": "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.",
"min": 0,
"max": "1",
"type": [
{
"code": "positiveInt"
}
]
"type" : [{
"code" : "BackboneElement"
}],
"constraint" : [{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "Element"
}],
"isModifier" : false,
"isSummary" : false,
"mapping" : [{
"identity" : "rim",
"map" : "Coverage"
}]
},
{
"id" : "ClaimResponse.insurance.id",
"path" : "ClaimResponse.insurance.id",
"representation" : ["xmlAttr"],
"short" : "xml:id (or equivalent in JSON)",
"definition" : "Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.",
"min" : 0,
"max" : "1",
"base" : {
"path" : "Element.id",
"min" : 0,
"max" : "1"
},
{
"id": "ClaimResponse.error.subDetailSequence",
"path": "ClaimResponse.error.subDetailSequence",
"short": "Subdetail sequence number",
"definition": "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.",
"min": 0,
"max": "1",
"type": [
{
"code": "positiveInt"
}
]
"type" : [{
"code" : "string"
}],
"isModifier" : false,
"isSummary" : false,
"mapping" : [{
"identity" : "rim",
"map" : "n/a"
}]
},
{
"id" : "ClaimResponse.insurance.extension",
"path" : "ClaimResponse.insurance.extension",
"short" : "Additional content defined by implementations",
"definition" : "May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.",
"comment" : "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.",
"alias" : ["extensions",
"user content"],
"min" : 0,
"max" : "*",
"base" : {
"path" : "Element.extension",
"min" : 0,
"max" : "*"
},
{
"id": "ClaimResponse.error.code",
"path": "ClaimResponse.error.code",
"short": "Error code detailing processing issues",
"definition": "An error code,from a specified code system, which details why the claim could not be adjudicated.",
"min": 1,
"max": "1",
"type": [
{
"code": "CodeableConcept"
}
],
"binding": {
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString": "AdjudicationError"
}
],
"strength": "example",
"description": "The adjudication error codes.",
"valueSetCanonical": "http://hl7.org/fhir/ValueSet/adjudication-error"
}
"type" : [{
"code" : "Extension"
}],
"isModifier" : false,
"isSummary" : false,
"mapping" : [{
"identity" : "rim",
"map" : "n/a"
}]
},
{
"id" : "ClaimResponse.insurance.modifierExtension",
"path" : "ClaimResponse.insurance.modifierExtension",
"short" : "Extensions that cannot be ignored if unrecognized",
"definition" : "May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.\n\nModifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).",
"comment" : "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.",
"alias" : ["extensions",
"user content",
"modifiers"],
"min" : 0,
"max" : "*",
"base" : {
"path" : "BackboneElement.modifierExtension",
"min" : 0,
"max" : "*"
},
{
"id": "ClaimResponse.total",
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-explicit-type-name",
"valueString": "Total"
}
],
"path": "ClaimResponse.total",
"short": "Adjudication totals",
"definition": "Totals for amounts submitted, co-pays, benefits payable etc.",
"min": 0,
"max": "*",
"type": [
{
"code": "BackboneElement"
}
]
"type" : [{
"code" : "Extension"
}],
"isModifier" : true,
"isModifierReason" : "Modifier extensions are expected to modify the meaning or interpretation of the element that contains them",
"isSummary" : true,
"mapping" : [{
"identity" : "rim",
"map" : "N/A"
}]
},
{
"id" : "ClaimResponse.insurance.sequence",
"path" : "ClaimResponse.insurance.sequence",
"short" : "Service instance identifier",
"definition" : "A service line item.",
"requirements" : "To maintain order of the coverages.",
"min" : 1,
"max" : "1",
"base" : {
"path" : "ClaimResponse.insurance.sequence",
"min" : 1,
"max" : "1"
},
{
"id": "ClaimResponse.total.category",
"path": "ClaimResponse.total.category",
"short": "Adjudication category such as submitted, co-pay, eligible, benefit, etc.",
"definition": "Code indicating: Submitted, Co-Pay, deductable, elegible, benefit, tax, etc.",
"min": 1,
"max": "1",
"type": [
{
"code": "CodeableConcept"
}
],
"binding": {
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString": "Adjudication"
}
],
"strength": "example",
"description": "The adjudication codes.",
"valueSetCanonical": "http://hl7.org/fhir/ValueSet/adjudication"
}
"type" : [{
"code" : "positiveInt"
}],
"isModifier" : false,
"isSummary" : false
},
{
"id" : "ClaimResponse.insurance.focal",
"path" : "ClaimResponse.insurance.focal",
"short" : "Is the focal Coverage",
"definition" : "The instance number of the Coverage which is the focus for adjudication. The Coverage against which the claim is to be adjudicated.",
"requirements" : "To identify which coverage is being adjudicated.",
"min" : 1,
"max" : "1",
"base" : {
"path" : "ClaimResponse.insurance.focal",
"min" : 1,
"max" : "1"
},
{
"id": "ClaimResponse.total.amount",
"path": "ClaimResponse.total.amount",
"short": "Monetary amount",
"definition": "Monitory amount associated with the code.",
"min": 1,
"max": "1",
"type": [
{
"code": "Money"
}
]
"type" : [{
"code" : "boolean"
}],
"isModifier" : false,
"isSummary" : false
},
{
"id" : "ClaimResponse.insurance.coverage",
"path" : "ClaimResponse.insurance.coverage",
"short" : "Insurance information",
"definition" : "Reference to the program or plan identification, underwriter or payor.",
"requirements" : "Need to identify the issuer to target for processing and for coordination of benefit processing.",
"min" : 1,
"max" : "1",
"base" : {
"path" : "ClaimResponse.insurance.coverage",
"min" : 1,
"max" : "1"
},
{
"id": "ClaimResponse.payment",
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-explicit-type-name",
"valueString": "Payment"
}
],
"path": "ClaimResponse.payment",
"short": "Payment details, if paid",
"definition": "Payment details for the claim if the claim has been paid.",
"min": 0,
"max": "1",
"type": [
{
"code": "BackboneElement"
}
]
"type" : [{
"code" : "Reference",
"targetProfile" : ["http://hl7.org/fhir/StructureDefinition/Coverage"]
}],
"isModifier" : false,
"isSummary" : false
},
{
"id" : "ClaimResponse.insurance.businessArrangement",
"path" : "ClaimResponse.insurance.businessArrangement",
"short" : "Business agreement",
"definition" : "The contract number of a business agreement which describes the terms and conditions.",
"min" : 0,
"max" : "1",
"base" : {
"path" : "ClaimResponse.insurance.businessArrangement",
"min" : 0,
"max" : "1"
},
{
"id": "ClaimResponse.payment.type",
"path": "ClaimResponse.payment.type",
"short": "Partial or Complete",
"definition": "Whether this represents partial or complete payment of the claim.",
"min": 0,
"max": "1",
"type": [
{
"code": "CodeableConcept"
}
],
"binding": {
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString": "PaymentType"
}
],
"strength": "example",
"description": "The type (partial, complete) of the payment",
"valueSetCanonical": "http://hl7.org/fhir/ValueSet/ex-paymenttype"
}
"type" : [{
"code" : "string"
}],
"isModifier" : false,
"isSummary" : false
},
{
"id" : "ClaimResponse.insurance.claimResponse",
"path" : "ClaimResponse.insurance.claimResponse",
"short" : "Adjudication results",
"definition" : "The Coverages adjudication details.",
"requirements" : "Used by downstream payers to determine what balance remains and the net payable.",
"min" : 0,
"max" : "1",
"base" : {
"path" : "ClaimResponse.insurance.claimResponse",
"min" : 0,
"max" : "1"
},
{
"id": "ClaimResponse.payment.adjustment",
"path": "ClaimResponse.payment.adjustment",
"short": "Payment adjustment for non-Claim issues",
"definition": "Adjustment to the payment of this transaction which is not related to adjudication of this transaction.",
"min": 0,
"max": "1",
"type": [
{
"code": "Money"
}
]
"type" : [{
"code" : "Reference",
"targetProfile" : ["http://hl7.org/fhir/StructureDefinition/ClaimResponse"]
}],
"isModifier" : false,
"isSummary" : false
}]
},
"differential" : {
"element" : [{
"id" : "ClaimResponse",
"path" : "ClaimResponse",
"short" : "ClaimResponse resource",
"definition" : "This resource provides the adjudication details from the processing of a Claim resource.",
"alias" : ["Remittance Advice"],
"min" : 0,
"max" : "*",
"mapping" : [{
"identity" : "workflow",
"map" : "Event"
}]
},
{
"id" : "ClaimResponse.identifier",
"path" : "ClaimResponse.identifier",
"short" : "Response number",
"definition" : "The response business identifier.",
"min" : 0,
"max" : "*",
"type" : [{
"code" : "Identifier"
}],
"mapping" : [{
"identity" : "workflow",
"map" : "Event.identifier"
},
{
"id": "ClaimResponse.payment.adjustmentReason",
"path": "ClaimResponse.payment.adjustmentReason",
"short": "Explanation for the non-claim adjustment",
"definition": "Reason for the payment adjustment.",
"min": 0,
"max": "1",
"type": [
{
"code": "CodeableConcept"
}
],
"binding": {
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString": "PaymentAdjustmentReason"
}
],
"strength": "example",
"description": "Payment Adjustment reason codes.",
"valueSetCanonical": "http://hl7.org/fhir/ValueSet/payment-adjustment-reason"
}
"identity" : "w5",
"map" : "FiveWs.identifier"
}]
},
{
"id" : "ClaimResponse.status",
"path" : "ClaimResponse.status",
"short" : "active | cancelled | draft | entered-in-error",
"definition" : "The status of the resource instance.",
"comment" : "This element is labeled as a modifier because the status contains the code cancelled and entered-in-error that mark the response as not currently valid.",
"min" : 0,
"max" : "1",
"type" : [{
"code" : "code"
}],
"isModifier" : true,
"isModifierReason" : "This element is labeled as a modifier because it is a status element that contains status entered-in-error which means that the resource should not be treated as valid",
"isSummary" : true,
"binding" : {
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString" : "ClaimResponseStatus"
}],
"strength" : "required",
"description" : "A code specifying the state of the resource instance.",
"valueSet" : "http://hl7.org/fhir/ValueSet/fm-status"
},
{
"id": "ClaimResponse.payment.date",
"path": "ClaimResponse.payment.date",
"short": "Expected data of Payment",
"definition": "Estimated payment data.",
"min": 0,
"max": "1",
"type": [
{
"code": "date"
}
]
"mapping" : [{
"identity" : "workflow",
"map" : "Event.status"
},
{
"id": "ClaimResponse.payment.amount",
"path": "ClaimResponse.payment.amount",
"short": "Payable amount after adjustment",
"definition": "Payable less any payment adjustment.",
"min": 0,
"max": "1",
"type": [
{
"code": "Money"
}
]
"identity" : "w5",
"map" : "FiveWs.status"
}]
},
{
"id" : "ClaimResponse.type",
"path" : "ClaimResponse.type",
"short" : "Type or discipline",
"definition" : "The category of claim, e.g, oral, pharmacy, vision, institutional, professional.",
"comment" : "Affects which fields and value sets are used.",
"min" : 0,
"max" : "1",
"type" : [{
"code" : "CodeableConcept"
}],
"binding" : {
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString" : "ClaimType"
}],
"strength" : "extensible",
"description" : "The type or discipline-style of the claim.",
"valueSet" : "http://hl7.org/fhir/ValueSet/claim-type"
},
{
"id": "ClaimResponse.payment.identifier",
"path": "ClaimResponse.payment.identifier",
"short": "Identifier of the payment instrument",
"definition": "Payment identifier.",
"min": 0,
"max": "1",
"type": [
{
"code": "Identifier"
}
]
"mapping" : [{
"identity" : "w5",
"map" : "FiveWs.class"
}]
},
{
"id" : "ClaimResponse.subType",
"path" : "ClaimResponse.subType",
"short" : "Finer grained claim type information",
"definition" : "A finer grained suite of claim subtype codes which may convey Inpatient vs Outpatient and/or a specialty service. In the US the CMS Bill Type.",
"comment" : "This may contain the local bill type codes such as the US UB-04 bill type code.",
"min" : 0,
"max" : "1",
"type" : [{
"code" : "CodeableConcept"
}],
"binding" : {
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString" : "ClaimSubType"
}],
"strength" : "example",
"description" : "A more granulat claim typecode.",
"valueSet" : "http://hl7.org/fhir/ValueSet/claim-subtype"
},
{
"id": "ClaimResponse.reserved",
"path": "ClaimResponse.reserved",
"short": "Funds reserved status",
"definition": "Status of funds reservation (For provider, for Patient, None).",
"min": 0,
"max": "1",
"type": [
{
"code": "Coding"
}
],
"binding": {
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString": "FundsReserve"
},
{
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-isCommonBinding",
"valueBoolean": true
}
],
"strength": "example",
"description": "For whom funds are to be reserved: (Patient, Provider, None).",
"valueSetCanonical": "http://hl7.org/fhir/ValueSet/fundsreserve"
}
"mapping" : [{
"identity" : "w5",
"map" : "FiveWs.class"
}]
},
{
"id" : "ClaimResponse.use",
"path" : "ClaimResponse.use",
"short" : "claim | preauthorization | predetermination",
"definition" : "A claim, a list of completed goods and services; a preauthorization, a list or proposed goods and services; or a predetermination, a set of goods and services being considered, for which insurer adjudication is sought.",
"min" : 0,
"max" : "1",
"type" : [{
"code" : "code"
}],
"isSummary" : true,
"binding" : {
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString" : "Use"
}],
"strength" : "required",
"description" : "Claim, preauthorization, predetermination.",
"valueSet" : "http://hl7.org/fhir/ValueSet/claim-use"
},
{
"id": "ClaimResponse.form",
"path": "ClaimResponse.form",
"short": "Printed Form Identifier",
"definition": "The form to be used for printing the content.",
"min": 0,
"max": "1",
"type": [
{
"code": "CodeableConcept"
}
],
"binding": {
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString": "Forms"
},
{
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-isCommonBinding",
"valueBoolean": true
}
],
"strength": "example",
"description": "The forms codes.",
"valueSetCanonical": "http://hl7.org/fhir/ValueSet/forms"
}
"mapping" : [{
"identity" : "w5",
"map" : "FiveWs.class"
}]
},
{
"id" : "ClaimResponse.patient",
"path" : "ClaimResponse.patient",
"short" : "The subject of the Products and Services",
"definition" : "Patient Resource.",
"min" : 0,
"max" : "1",
"type" : [{
"code" : "Reference",
"targetProfile" : ["http://hl7.org/fhir/StructureDefinition/Patient"]
}],
"mapping" : [{
"identity" : "w5",
"map" : "FiveWs.subject[x]"
},
{
"id": "ClaimResponse.processNote",
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-explicit-type-name",
"valueString": "Note"
}
],
"path": "ClaimResponse.processNote",
"short": "Processing notes",
"definition": "Note text.",
"min": 0,
"max": "*",
"type": [
{
"code": "BackboneElement"
}
]
"identity" : "w5",
"map" : "FiveWs.subject"
}]
},
{
"id" : "ClaimResponse.created",
"path" : "ClaimResponse.created",
"short" : "Creation date",
"definition" : "The date when this resource was created.",
"min" : 0,
"max" : "1",
"type" : [{
"code" : "dateTime"
}],
"mapping" : [{
"identity" : "workflow",
"map" : "Event.occurrence[x]"
},
{
"id": "ClaimResponse.processNote.number",
"path": "ClaimResponse.processNote.number",
"short": "Sequence Number for this note",
"definition": "An integer associated with each note which may be referred to from each service line item.",
"min": 0,
"max": "1",
"type": [
{
"code": "positiveInt"
}
]
"identity" : "w5",
"map" : "FiveWs.recorded"
}]
},
{
"id" : "ClaimResponse.insurer",
"path" : "ClaimResponse.insurer",
"short" : "Insurance issuing organization",
"definition" : "The Insurer who produced this adjudicated response.",
"min" : 0,
"max" : "1",
"type" : [{
"code" : "Reference",
"targetProfile" : ["http://hl7.org/fhir/StructureDefinition/Organization"]
}],
"mapping" : [{
"identity" : "workflow",
"map" : "Event.performer"
}]
},
{
"id" : "ClaimResponse.requestProvider",
"path" : "ClaimResponse.requestProvider",
"short" : "Responsible practitioner",
"definition" : "The practitioner who is responsible for the services rendered to the patient.",
"min" : 0,
"max" : "1",
"type" : [{
"code" : "Reference",
"targetProfile" : ["http://hl7.org/fhir/StructureDefinition/Practitioner",
"http://hl7.org/fhir/StructureDefinition/PractitionerRole",
"http://hl7.org/fhir/StructureDefinition/Organization"]
}],
"mapping" : [{
"identity" : "w5",
"map" : "FiveWs.source"
}]
},
{
"id" : "ClaimResponse.request",
"path" : "ClaimResponse.request",
"short" : "Id of resource triggering adjudication",
"definition" : "Original request resource reference.",
"min" : 0,
"max" : "1",
"type" : [{
"code" : "Reference",
"targetProfile" : ["http://hl7.org/fhir/StructureDefinition/Claim"]
}],
"mapping" : [{
"identity" : "workflow",
"map" : "Event.basedOn"
},
{
"id": "ClaimResponse.processNote.type",
"path": "ClaimResponse.processNote.type",
"short": "display | print | printoper",
"definition": "The note purpose: Print/Display.",
"min": 0,
"max": "1",
"type": [
{
"code": "code"
}
],
"binding": {
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString": "NoteType"
},
{
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-isCommonBinding",
"valueBoolean": true
}
],
"strength": "required",
"description": "The presentation types of notes.",
"valueSetCanonical": "http://hl7.org/fhir/ValueSet/note-type"
}
"identity" : "w5",
"map" : "FiveWs.why[x]"
}]
},
{
"id" : "ClaimResponse.outcome",
"path" : "ClaimResponse.outcome",
"short" : "queued | complete | error | partial",
"definition" : "Transaction: error, complete, partial processing.",
"min" : 0,
"max" : "1",
"type" : [{
"code" : "code"
}],
"binding" : {
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString" : "RemittanceOutcome"
}],
"strength" : "required",
"description" : "The result of the claim processing.",
"valueSet" : "http://hl7.org/fhir/ValueSet/remittance-outcome"
}
},
{
"id" : "ClaimResponse.disposition",
"path" : "ClaimResponse.disposition",
"short" : "Disposition Message",
"definition" : "A description of the status of the adjudication.",
"min" : 0,
"max" : "1",
"type" : [{
"code" : "string"
}],
"mapping" : [{
"identity" : "workflow",
"map" : "Event.note"
}]
},
{
"id" : "ClaimResponse.preAuthRef",
"path" : "ClaimResponse.preAuthRef",
"short" : "Pre-Authorization/Determination Reference",
"definition" : "A list of references from the Insurer to which these services pertain.",
"requirements" : "To provide any pre-determination or prior authorization reference.",
"min" : 0,
"max" : "1",
"type" : [{
"code" : "string"
}]
},
{
"id" : "ClaimResponse.payeeType",
"path" : "ClaimResponse.payeeType",
"short" : "Party to be paid any benefits payable",
"definition" : "Party to be reimbursed: Subscriber, provider, other.",
"min" : 0,
"max" : "1",
"type" : [{
"code" : "CodeableConcept"
}],
"binding" : {
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString" : "PayeeType"
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-isCommonBinding",
"valueBoolean" : true
}],
"strength" : "example",
"description" : "A code for the party to be reimbursed.",
"valueSet" : "http://hl7.org/fhir/ValueSet/payeetype"
}
},
{
"id" : "ClaimResponse.item",
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-explicit-type-name",
"valueString" : "Item"
}],
"path" : "ClaimResponse.item",
"short" : "Line items",
"definition" : "The first-tier service adjudications for submitted services.",
"min" : 0,
"max" : "*",
"type" : [{
"code" : "BackboneElement"
}]
},
{
"id" : "ClaimResponse.item.itemSequence",
"path" : "ClaimResponse.item.itemSequence",
"short" : "Service instance",
"definition" : "A service line number.",
"min" : 1,
"max" : "1",
"type" : [{
"code" : "positiveInt"
}]
},
{
"id" : "ClaimResponse.item.noteNumber",
"path" : "ClaimResponse.item.noteNumber",
"short" : "List of note numbers which apply",
"definition" : "A list of note references to the notes provided below.",
"min" : 0,
"max" : "*",
"type" : [{
"code" : "positiveInt"
}]
},
{
"id" : "ClaimResponse.item.adjudication",
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-explicit-type-name",
"valueString" : "Adjudication"
}],
"path" : "ClaimResponse.item.adjudication",
"short" : "Adjudication details",
"definition" : "The adjudication results.",
"min" : 0,
"max" : "*",
"type" : [{
"code" : "BackboneElement"
}]
},
{
"id" : "ClaimResponse.item.adjudication.category",
"path" : "ClaimResponse.item.adjudication.category",
"short" : "Adjudication category such as co-pay, eligible, benefit, etc.",
"definition" : "Code indicating: Co-Pay, deductible, eligible, benefit, tax, etc.",
"min" : 1,
"max" : "1",
"type" : [{
"code" : "CodeableConcept"
}],
"binding" : {
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString" : "Adjudication"
}],
"strength" : "example",
"description" : "The adjudication codes.",
"valueSet" : "http://hl7.org/fhir/ValueSet/adjudication"
}
},
{
"id" : "ClaimResponse.item.adjudication.reason",
"path" : "ClaimResponse.item.adjudication.reason",
"short" : "Explanation of Adjudication outcome",
"definition" : "Adjudication reason such as limit reached.",
"min" : 0,
"max" : "1",
"type" : [{
"code" : "CodeableConcept"
}],
"binding" : {
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString" : "AdjudicationReason"
}],
"strength" : "example",
"description" : "The adjudication reason codes.",
"valueSet" : "http://hl7.org/fhir/ValueSet/adjudication-reason"
}
},
{
"id" : "ClaimResponse.item.adjudication.amount",
"path" : "ClaimResponse.item.adjudication.amount",
"short" : "Monetary amount",
"definition" : "Monetary amount associated with the code.",
"min" : 0,
"max" : "1",
"type" : [{
"code" : "Money"
}]
},
{
"id" : "ClaimResponse.item.adjudication.value",
"path" : "ClaimResponse.item.adjudication.value",
"short" : "Non-monetary value",
"definition" : "A non-monetary value for example a percentage. Mutually exclusive to the amount element above.",
"min" : 0,
"max" : "1",
"type" : [{
"code" : "decimal"
}]
},
{
"id" : "ClaimResponse.item.detail",
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-explicit-type-name",
"valueString" : "ItemDetail"
}],
"path" : "ClaimResponse.item.detail",
"short" : "Detail line items",
"definition" : "The second-tier service adjudications for submitted services.",
"min" : 0,
"max" : "*",
"type" : [{
"code" : "BackboneElement"
}]
},
{
"id" : "ClaimResponse.item.detail.detailSequence",
"path" : "ClaimResponse.item.detail.detailSequence",
"short" : "Service instance",
"definition" : "A service line number.",
"min" : 1,
"max" : "1",
"type" : [{
"code" : "positiveInt"
}]
},
{
"id" : "ClaimResponse.item.detail.noteNumber",
"path" : "ClaimResponse.item.detail.noteNumber",
"short" : "List of note numbers which apply",
"definition" : "A list of note references to the notes provided below.",
"min" : 0,
"max" : "*",
"type" : [{
"code" : "positiveInt"
}]
},
{
"id" : "ClaimResponse.item.detail.adjudication",
"path" : "ClaimResponse.item.detail.adjudication",
"short" : "Detail level adjudication details",
"definition" : "The adjudication results.",
"min" : 0,
"max" : "*",
"contentReference" : "#ClaimResponse.item.adjudication"
},
{
"id" : "ClaimResponse.item.detail.subDetail",
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-explicit-type-name",
"valueString" : "SubDetail"
}],
"path" : "ClaimResponse.item.detail.subDetail",
"short" : "Subdetail line items",
"definition" : "The third-tier service adjudications for submitted services.",
"min" : 0,
"max" : "*",
"type" : [{
"code" : "BackboneElement"
}]
},
{
"id" : "ClaimResponse.item.detail.subDetail.subDetailSequence",
"path" : "ClaimResponse.item.detail.subDetail.subDetailSequence",
"short" : "Service instance",
"definition" : "A service line number.",
"min" : 1,
"max" : "1",
"type" : [{
"code" : "positiveInt"
}]
},
{
"id" : "ClaimResponse.item.detail.subDetail.noteNumber",
"path" : "ClaimResponse.item.detail.subDetail.noteNumber",
"short" : "List of note numbers which apply",
"definition" : "A list of note references to the notes provided below.",
"min" : 0,
"max" : "*",
"type" : [{
"code" : "positiveInt"
}]
},
{
"id" : "ClaimResponse.item.detail.subDetail.adjudication",
"path" : "ClaimResponse.item.detail.subDetail.adjudication",
"short" : "Subdetail level adjudication details",
"definition" : "The adjudication results.",
"min" : 0,
"max" : "*",
"contentReference" : "#ClaimResponse.item.adjudication"
},
{
"id" : "ClaimResponse.addItem",
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-explicit-type-name",
"valueString" : "AddedItem"
}],
"path" : "ClaimResponse.addItem",
"short" : "Insurer added line items",
"definition" : "The first-tier service adjudications for payor added services.",
"min" : 0,
"max" : "*",
"type" : [{
"code" : "BackboneElement"
}]
},
{
"id" : "ClaimResponse.addItem.itemSequence",
"path" : "ClaimResponse.addItem.itemSequence",
"short" : "Service instances",
"definition" : "List of input service items which this service line is intended to replace.",
"min" : 0,
"max" : "*",
"type" : [{
"code" : "positiveInt"
}]
},
{
"id" : "ClaimResponse.addItem.detailSequence",
"path" : "ClaimResponse.addItem.detailSequence",
"short" : "Detail sequence number",
"definition" : "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.",
"min" : 0,
"max" : "*",
"type" : [{
"code" : "positiveInt"
}]
},
{
"id" : "ClaimResponse.addItem.subdetailSequence",
"path" : "ClaimResponse.addItem.subdetailSequence",
"short" : "Subdetail sequence number",
"definition" : "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.",
"min" : 0,
"max" : "*",
"type" : [{
"code" : "positiveInt"
}]
},
{
"id" : "ClaimResponse.addItem.provider",
"path" : "ClaimResponse.addItem.provider",
"short" : "Authorized providers",
"definition" : "The providers who are authorized for the services rendered to the patient.",
"min" : 0,
"max" : "*",
"type" : [{
"code" : "Reference",
"targetProfile" : ["http://hl7.org/fhir/StructureDefinition/Practitioner",
"http://hl7.org/fhir/StructureDefinition/PractitionerRole",
"http://hl7.org/fhir/StructureDefinition/Organization"]
}],
"mapping" : [{
"identity" : "w5",
"map" : "FiveWs.source"
}]
},
{
"id" : "ClaimResponse.addItem.billcode",
"path" : "ClaimResponse.addItem.billcode",
"short" : "Group, Service or Product",
"definition" : "A code to indicate the Professional Service or Product supplied.",
"min" : 0,
"max" : "1",
"type" : [{
"code" : "CodeableConcept"
}],
"binding" : {
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString" : "ServiceProduct"
}],
"strength" : "example",
"description" : "Allowable service and product codes.",
"valueSet" : "http://hl7.org/fhir/ValueSet/service-uscls"
}
},
{
"id" : "ClaimResponse.addItem.modifier",
"path" : "ClaimResponse.addItem.modifier",
"short" : "Service/Product billing modifiers",
"definition" : "Item typification or modifiers codes, e.g. for Oral whether the treatment is cosmetic or associated with TMJ, or for medical whether the treatment was outside the clinic or out of office hours.",
"requirements" : "May impact on adjudication.",
"min" : 0,
"max" : "*",
"type" : [{
"code" : "CodeableConcept"
}],
"binding" : {
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString" : "Modifiers"
}],
"strength" : "example",
"description" : "Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen.",
"valueSet" : "http://hl7.org/fhir/ValueSet/claim-modifiers"
},
{
"id": "ClaimResponse.processNote.text",
"path": "ClaimResponse.processNote.text",
"short": "Note explanatory text",
"definition": "The note text.",
"min": 0,
"max": "1",
"type": [
{
"code": "string"
}
]
"mapping" : [{
"identity" : "rim",
"map" : "24.C, 24.D mods"
}]
},
{
"id" : "ClaimResponse.addItem.programCode",
"path" : "ClaimResponse.addItem.programCode",
"short" : "Program specific reason for item inclusion",
"definition" : "For programs which require reason codes for the inclusion or covering of this billed item under the program or sub-program.",
"min" : 0,
"max" : "*",
"type" : [{
"code" : "CodeableConcept"
}],
"binding" : {
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString" : "ProgramCode"
}],
"strength" : "example",
"description" : "Program specific reason codes.",
"valueSet" : "http://hl7.org/fhir/ValueSet/ex-program-code"
},
{
"id": "ClaimResponse.processNote.language",
"path": "ClaimResponse.processNote.language",
"short": "Language if different from the resource",
"definition": "The ISO-639-1 alpha 2 code in lower case for the language, optionally followed by a hyphen and the ISO-3166-1 alpha 2 code for the region in upper case; e.g. \"en\" for English, or \"en-US\" for American English versus \"en-EN\" for England English.",
"min": 0,
"max": "1",
"type": [
{
"code": "CodeableConcept"
}
],
"binding": {
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-maxValueSet",
"valueReference": {
"reference": "http://hl7.org/fhir/ValueSet/all-languages"
}
},
{
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString": "Language"
},
{
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-isCommonBinding",
"valueBoolean": true
}
],
"strength": "extensible",
"description": "A human language.",
"valueSetCanonical": "http://hl7.org/fhir/ValueSet/languages"
}
"mapping" : [{
"identity" : "rim",
"map" : "24.H"
}]
},
{
"id" : "ClaimResponse.addItem.serviced[x]",
"path" : "ClaimResponse.addItem.serviced[x]",
"short" : "Date or dates of Service",
"definition" : "The date or dates when the service or product was supplied, performed or completed.",
"min" : 0,
"max" : "1",
"type" : [{
"code" : "date"
},
{
"id": "ClaimResponse.communicationRequest",
"path": "ClaimResponse.communicationRequest",
"short": "Request for additional information",
"definition": "Request for additional supporting or authorizing information, such as: documents, images or resources.",
"min": 0,
"max": "*",
"type": [
{
"code": "Reference",
"targetProfile": [
"http://hl7.org/fhir/StructureDefinition/CommunicationRequest"
]
}
]
"code" : "Period"
}],
"mapping" : [{
"identity" : "w5",
"map" : "FiveWs.done[x]"
},
{
"id": "ClaimResponse.insurance",
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-explicit-type-name",
"valueString": "Insurance"
}
],
"path": "ClaimResponse.insurance",
"short": "Insurance or medical plan",
"definition": "Financial instrument by which payment information for health care.",
"requirements": "Health care programs and insurers are significant payors of health service costs.",
"min": 0,
"max": "*",
"type": [
{
"code": "BackboneElement"
}
],
"mapping": [
{
"identity": "rim",
"map": "Coverage"
}
]
"identity" : "rim",
"map" : "24.A"
}]
},
{
"id" : "ClaimResponse.addItem.location[x]",
"path" : "ClaimResponse.addItem.location[x]",
"short" : "Place of service",
"definition" : "Where the service was provided.",
"min" : 0,
"max" : "1",
"type" : [{
"code" : "CodeableConcept"
},
{
"id": "ClaimResponse.insurance.sequence",
"path": "ClaimResponse.insurance.sequence",
"short": "Service instance identifier",
"definition": "A service line item.",
"requirements": "To maintain order of the coverages.",
"min": 1,
"max": "1",
"type": [
{
"code": "positiveInt"
}
]
"code" : "Address"
},
{
"id": "ClaimResponse.insurance.focal",
"path": "ClaimResponse.insurance.focal",
"short": "Is the focal Coverage",
"definition": "The instance number of the Coverage which is the focus for adjudication. The Coverage against which the claim is to be adjudicated.",
"requirements": "To identify which coverage is being adjudicated.",
"min": 1,
"max": "1",
"type": [
{
"code": "boolean"
}
]
"code" : "Reference",
"targetProfile" : ["http://hl7.org/fhir/StructureDefinition/Location"]
}],
"binding" : {
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString" : "ServicePlace"
}],
"strength" : "example",
"description" : "Place of service: pharmacy,school, prison, etc.",
"valueSet" : "http://hl7.org/fhir/ValueSet/service-place"
},
{
"id": "ClaimResponse.insurance.coverage",
"path": "ClaimResponse.insurance.coverage",
"short": "Insurance information",
"definition": "Reference to the program or plan identification, underwriter or payor.",
"requirements": "Need to identify the issuer to target for processing and for coordination of benefit processing.",
"min": 1,
"max": "1",
"type": [
{
"code": "Reference",
"targetProfile": [
"http://hl7.org/fhir/StructureDefinition/Coverage"
]
}
]
"mapping" : [{
"identity" : "w5",
"map" : "FiveWs.where[x]"
},
{
"id": "ClaimResponse.insurance.businessArrangement",
"path": "ClaimResponse.insurance.businessArrangement",
"short": "Business agreement",
"definition": "The contract number of a business agreement which describes the terms and conditions.",
"min": 0,
"max": "1",
"type": [
{
"code": "string"
}
]
"identity" : "rim",
"map" : "24.B"
}]
},
{
"id" : "ClaimResponse.addItem.quantity",
"path" : "ClaimResponse.addItem.quantity",
"short" : "Count of Products or Services",
"definition" : "The number of repetitions of a service or product.",
"min" : 0,
"max" : "1",
"type" : [{
"code" : "Quantity",
"profile" : ["http://hl7.org/fhir/StructureDefinition/SimpleQuantity"]
}],
"mapping" : [{
"identity" : "rim",
"map" : "24.G"
}]
},
{
"id" : "ClaimResponse.addItem.unitPrice",
"path" : "ClaimResponse.addItem.unitPrice",
"short" : "Fee, charge or cost per point",
"definition" : "If the item is a node then this is the fee for the product or service, otherwise this is the total of the fees for the children of the group.",
"min" : 0,
"max" : "1",
"type" : [{
"code" : "Money"
}]
},
{
"id" : "ClaimResponse.addItem.factor",
"path" : "ClaimResponse.addItem.factor",
"short" : "Price scaling factor",
"definition" : "A real number that represents a multiplier used in determining the overall value of services delivered and/or goods received. The concept of a Factor allows for a discount or surcharge multiplier to be applied to a monetary amount.",
"requirements" : "If a fee is present the associated product/service code must be present.",
"min" : 0,
"max" : "1",
"type" : [{
"code" : "decimal"
}]
},
{
"id" : "ClaimResponse.addItem.net",
"path" : "ClaimResponse.addItem.net",
"short" : "Total item cost",
"definition" : "The quantity times the unit price for an additional service or product or charge. For example, the formula: unit Quantity * unit Price (Cost per Point) * factor Number * points = net Amount. Quantity, factor and points are assumed to be 1 if not supplied.",
"requirements" : "If a fee is present the associated product/service code must be present.",
"min" : 0,
"max" : "1",
"type" : [{
"code" : "Money"
}],
"mapping" : [{
"identity" : "rim",
"map" : "24.F"
}]
},
{
"id" : "ClaimResponse.addItem.bodySite",
"path" : "ClaimResponse.addItem.bodySite",
"short" : "Service Location",
"definition" : "Physical service site on the patient (limb, tooth, etc.).",
"min" : 0,
"max" : "1",
"type" : [{
"code" : "CodeableConcept"
}],
"binding" : {
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString" : "OralSites"
}],
"strength" : "example",
"description" : "The code for the teeth, quadrant, sextant and arch.",
"valueSet" : "http://hl7.org/fhir/ValueSet/tooth"
}
},
{
"id" : "ClaimResponse.addItem.subSite",
"path" : "ClaimResponse.addItem.subSite",
"short" : "Service Sub-location",
"definition" : "A region or surface of the site, e.g. limb region or tooth surface(s).",
"min" : 0,
"max" : "*",
"type" : [{
"code" : "CodeableConcept"
}],
"binding" : {
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString" : "Surface"
}],
"strength" : "example",
"description" : "The code for the tooth surface and surface combinations.",
"valueSet" : "http://hl7.org/fhir/ValueSet/surface"
}
},
{
"id" : "ClaimResponse.addItem.noteNumber",
"path" : "ClaimResponse.addItem.noteNumber",
"short" : "List of note numbers which apply",
"definition" : "A list of note references to the notes provided below.",
"min" : 0,
"max" : "*",
"type" : [{
"code" : "positiveInt"
}]
},
{
"id" : "ClaimResponse.addItem.adjudication",
"path" : "ClaimResponse.addItem.adjudication",
"short" : "Added items adjudication",
"definition" : "The adjudication results.",
"min" : 0,
"max" : "*",
"contentReference" : "#ClaimResponse.item.adjudication"
},
{
"id" : "ClaimResponse.addItem.detail",
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-explicit-type-name",
"valueString" : "AddedItemDetail"
}],
"path" : "ClaimResponse.addItem.detail",
"short" : "Insurer added line items",
"definition" : "The second-tier service adjudications for payor added services.",
"min" : 0,
"max" : "*",
"type" : [{
"code" : "BackboneElement"
}]
},
{
"id" : "ClaimResponse.addItem.detail.billcode",
"path" : "ClaimResponse.addItem.detail.billcode",
"short" : "Group, Service or Product",
"definition" : "A code to indicate the Professional Service or Product supplied.",
"min" : 0,
"max" : "1",
"type" : [{
"code" : "CodeableConcept"
}],
"binding" : {
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString" : "ServiceProduct"
}],
"strength" : "example",
"description" : "Allowable service and product codes.",
"valueSet" : "http://hl7.org/fhir/ValueSet/service-uscls"
}
},
{
"id" : "ClaimResponse.addItem.detail.modifier",
"path" : "ClaimResponse.addItem.detail.modifier",
"short" : "Service/Product billing modifiers",
"definition" : "Item typification or modifiers codes, e.g. for Oral whether the treatment is cosmetic or associated with TMJ, or for medical whether the treatment was outside the clinic or out of office hours.",
"requirements" : "May impact on adjudication.",
"min" : 0,
"max" : "*",
"type" : [{
"code" : "CodeableConcept"
}],
"binding" : {
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString" : "Modifiers"
}],
"strength" : "example",
"description" : "Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen.",
"valueSet" : "http://hl7.org/fhir/ValueSet/claim-modifiers"
},
{
"id": "ClaimResponse.insurance.preAuthRef",
"path": "ClaimResponse.insurance.preAuthRef",
"short": "Pre-Authorization/Determination Reference",
"definition": "A list of references from the Insurer to which these services pertain.",
"requirements": "To provide any pre-determination or prior authorization reference.",
"min": 0,
"max": "*",
"type": [
{
"code": "string"
}
]
"mapping" : [{
"identity" : "rim",
"map" : "24.C, 24.D mods"
}]
},
{
"id" : "ClaimResponse.addItem.detail.quantity",
"path" : "ClaimResponse.addItem.detail.quantity",
"short" : "Count of Products or Services",
"definition" : "The number of repetitions of a service or product.",
"min" : 0,
"max" : "1",
"type" : [{
"code" : "Quantity",
"profile" : ["http://hl7.org/fhir/StructureDefinition/SimpleQuantity"]
}],
"mapping" : [{
"identity" : "rim",
"map" : "24.G"
}]
},
{
"id" : "ClaimResponse.addItem.detail.unitPrice",
"path" : "ClaimResponse.addItem.detail.unitPrice",
"short" : "Fee, charge or cost per point",
"definition" : "If the item is a node then this is the fee for the product or service, otherwise this is the total of the fees for the children of the group.",
"min" : 0,
"max" : "1",
"type" : [{
"code" : "Money"
}]
},
{
"id" : "ClaimResponse.addItem.detail.factor",
"path" : "ClaimResponse.addItem.detail.factor",
"short" : "Price scaling factor",
"definition" : "A real number that represents a multiplier used in determining the overall value of services delivered and/or goods received. The concept of a Factor allows for a discount or surcharge multiplier to be applied to a monetary amount.",
"requirements" : "If a fee is present the associated product/service code must be present.",
"min" : 0,
"max" : "1",
"type" : [{
"code" : "decimal"
}]
},
{
"id" : "ClaimResponse.addItem.detail.net",
"path" : "ClaimResponse.addItem.detail.net",
"short" : "Total item cost",
"definition" : "The quantity times the unit price for an additional service or product or charge. For example, the formula: unit Quantity * unit Price (Cost per Point) * factor Number * points = net Amount. Quantity, factor and points are assumed to be 1 if not supplied.",
"requirements" : "If a fee is present the associated product/service code must be present.",
"min" : 0,
"max" : "1",
"type" : [{
"code" : "Money"
}],
"mapping" : [{
"identity" : "rim",
"map" : "24.F"
}]
},
{
"id" : "ClaimResponse.addItem.detail.noteNumber",
"path" : "ClaimResponse.addItem.detail.noteNumber",
"short" : "List of note numbers which apply",
"definition" : "A list of note references to the notes provided below.",
"min" : 0,
"max" : "*",
"type" : [{
"code" : "positiveInt"
}]
},
{
"id" : "ClaimResponse.addItem.detail.adjudication",
"path" : "ClaimResponse.addItem.detail.adjudication",
"short" : "Added items detail adjudication",
"definition" : "The adjudication results.",
"min" : 0,
"max" : "*",
"contentReference" : "#ClaimResponse.item.adjudication"
},
{
"id" : "ClaimResponse.addItem.detail.subDetail",
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-explicit-type-name",
"valueString" : "AddedItemSubDetail"
}],
"path" : "ClaimResponse.addItem.detail.subDetail",
"short" : "Insurer added line items",
"definition" : "The third-tier service adjudications for payor added services.",
"min" : 0,
"max" : "*",
"type" : [{
"code" : "BackboneElement"
}]
},
{
"id" : "ClaimResponse.addItem.detail.subDetail.billcode",
"path" : "ClaimResponse.addItem.detail.subDetail.billcode",
"short" : "Group, Service or Product",
"definition" : "A code to indicate the Professional Service or Product supplied.",
"min" : 0,
"max" : "1",
"type" : [{
"code" : "CodeableConcept"
}],
"binding" : {
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString" : "ServiceProduct"
}],
"strength" : "example",
"description" : "Allowable service and product codes.",
"valueSet" : "http://hl7.org/fhir/ValueSet/service-uscls"
}
},
{
"id" : "ClaimResponse.addItem.detail.subDetail.modifier",
"path" : "ClaimResponse.addItem.detail.subDetail.modifier",
"short" : "Service/Product billing modifiers",
"definition" : "Item typification or modifiers codes, e.g. for Oral whether the treatment is cosmetic or associated with TMJ, or for medical whether the treatment was outside the clinic or out of office hours.",
"requirements" : "May impact on adjudication.",
"min" : 0,
"max" : "*",
"type" : [{
"code" : "CodeableConcept"
}],
"binding" : {
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString" : "Modifiers"
}],
"strength" : "example",
"description" : "Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen.",
"valueSet" : "http://hl7.org/fhir/ValueSet/claim-modifiers"
},
{
"id": "ClaimResponse.insurance.claimResponse",
"path": "ClaimResponse.insurance.claimResponse",
"short": "Adjudication results",
"definition": "The Coverages adjudication details.",
"requirements": "Used by downstream payers to determine what balance remains and the net payable.",
"min": 0,
"max": "1",
"type": [
{
"code": "Reference",
"targetProfile": [
"http://hl7.org/fhir/StructureDefinition/ClaimResponse"
]
}
]
"mapping" : [{
"identity" : "rim",
"map" : "24.C, 24.D mods"
}]
},
{
"id" : "ClaimResponse.addItem.detail.subDetail.quantity",
"path" : "ClaimResponse.addItem.detail.subDetail.quantity",
"short" : "Count of Products or Services",
"definition" : "The number of repetitions of a service or product.",
"min" : 0,
"max" : "1",
"type" : [{
"code" : "Quantity",
"profile" : ["http://hl7.org/fhir/StructureDefinition/SimpleQuantity"]
}],
"mapping" : [{
"identity" : "rim",
"map" : "24.G"
}]
},
{
"id" : "ClaimResponse.addItem.detail.subDetail.unitPrice",
"path" : "ClaimResponse.addItem.detail.subDetail.unitPrice",
"short" : "Fee, charge or cost per point",
"definition" : "If the item is a node then this is the fee for the product or service, otherwise this is the total of the fees for the children of the group.",
"min" : 0,
"max" : "1",
"type" : [{
"code" : "Money"
}]
},
{
"id" : "ClaimResponse.addItem.detail.subDetail.factor",
"path" : "ClaimResponse.addItem.detail.subDetail.factor",
"short" : "Price scaling factor",
"definition" : "A real number that represents a multiplier used in determining the overall value of services delivered and/or goods received. The concept of a Factor allows for a discount or surcharge multiplier to be applied to a monetary amount.",
"requirements" : "If a fee is present the associated product/service code must be present.",
"min" : 0,
"max" : "1",
"type" : [{
"code" : "decimal"
}]
},
{
"id" : "ClaimResponse.addItem.detail.subDetail.net",
"path" : "ClaimResponse.addItem.detail.subDetail.net",
"short" : "Total item cost",
"definition" : "The quantity times the unit price for an additional service or product or charge. For example, the formula: unit Quantity * unit Price (Cost per Point) * factor Number * points = net Amount. Quantity, factor and points are assumed to be 1 if not supplied.",
"requirements" : "If a fee is present the associated product/service code must be present.",
"min" : 0,
"max" : "1",
"type" : [{
"code" : "Money"
}],
"mapping" : [{
"identity" : "rim",
"map" : "24.F"
}]
},
{
"id" : "ClaimResponse.addItem.detail.subDetail.noteNumber",
"path" : "ClaimResponse.addItem.detail.subDetail.noteNumber",
"short" : "List of note numbers which apply",
"definition" : "A list of note references to the notes provided below.",
"min" : 0,
"max" : "*",
"type" : [{
"code" : "positiveInt"
}]
},
{
"id" : "ClaimResponse.addItem.detail.subDetail.adjudication",
"path" : "ClaimResponse.addItem.detail.subDetail.adjudication",
"short" : "Added items detail adjudication",
"definition" : "The adjudication results.",
"min" : 0,
"max" : "*",
"contentReference" : "#ClaimResponse.item.adjudication"
},
{
"id" : "ClaimResponse.error",
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-explicit-type-name",
"valueString" : "Error"
}],
"path" : "ClaimResponse.error",
"short" : "Processing errors",
"definition" : "Mutually exclusive with Services Provided (Item).",
"min" : 0,
"max" : "*",
"type" : [{
"code" : "BackboneElement"
}]
},
{
"id" : "ClaimResponse.error.itemSequence",
"path" : "ClaimResponse.error.itemSequence",
"short" : "Item sequence number",
"definition" : "The sequence number of the line item submitted which contains the error. This value is omitted when the error is elsewhere.",
"min" : 0,
"max" : "1",
"type" : [{
"code" : "positiveInt"
}]
},
{
"id" : "ClaimResponse.error.detailSequence",
"path" : "ClaimResponse.error.detailSequence",
"short" : "Detail sequence number",
"definition" : "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.",
"min" : 0,
"max" : "1",
"type" : [{
"code" : "positiveInt"
}]
},
{
"id" : "ClaimResponse.error.subDetailSequence",
"path" : "ClaimResponse.error.subDetailSequence",
"short" : "Subdetail sequence number",
"definition" : "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.",
"min" : 0,
"max" : "1",
"type" : [{
"code" : "positiveInt"
}]
},
{
"id" : "ClaimResponse.error.code",
"path" : "ClaimResponse.error.code",
"short" : "Error code detailing processing issues",
"definition" : "An error code, from a specified code system, which details why the claim could not be adjudicated.",
"min" : 1,
"max" : "1",
"type" : [{
"code" : "CodeableConcept"
}],
"binding" : {
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString" : "AdjudicationError"
}],
"strength" : "example",
"description" : "The adjudication error codes.",
"valueSet" : "http://hl7.org/fhir/ValueSet/adjudication-error"
}
]
},
{
"id" : "ClaimResponse.total",
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-explicit-type-name",
"valueString" : "Total"
}],
"path" : "ClaimResponse.total",
"short" : "Adjudication totals",
"definition" : "Totals for amounts submitted, co-pays, benefits payable etc.",
"min" : 0,
"max" : "*",
"type" : [{
"code" : "BackboneElement"
}]
},
{
"id" : "ClaimResponse.total.category",
"path" : "ClaimResponse.total.category",
"short" : "Adjudication category such as submitted, co-pay, eligible, benefit, etc.",
"definition" : "Code indicating: Submitted, Co-Pay, deductible, eligible, benefit, tax, etc.",
"min" : 1,
"max" : "1",
"type" : [{
"code" : "CodeableConcept"
}],
"binding" : {
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString" : "Adjudication"
}],
"strength" : "example",
"description" : "The adjudication codes.",
"valueSet" : "http://hl7.org/fhir/ValueSet/adjudication"
}
},
{
"id" : "ClaimResponse.total.amount",
"path" : "ClaimResponse.total.amount",
"short" : "Monetary amount",
"definition" : "Monitory amount associated with the code.",
"min" : 1,
"max" : "1",
"type" : [{
"code" : "Money"
}]
},
{
"id" : "ClaimResponse.payment",
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-explicit-type-name",
"valueString" : "Payment"
}],
"path" : "ClaimResponse.payment",
"short" : "Payment Details",
"definition" : "Payment details for the claim if the claim has been paid.",
"min" : 0,
"max" : "1",
"type" : [{
"code" : "BackboneElement"
}]
},
{
"id" : "ClaimResponse.payment.type",
"path" : "ClaimResponse.payment.type",
"short" : "Partial or Complete",
"definition" : "Whether this represents partial or complete payment of the claim.",
"min" : 0,
"max" : "1",
"type" : [{
"code" : "CodeableConcept"
}],
"binding" : {
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString" : "PaymentType"
}],
"strength" : "example",
"description" : "The type (partial, complete) of the payment.",
"valueSet" : "http://hl7.org/fhir/ValueSet/ex-paymenttype"
}
},
{
"id" : "ClaimResponse.payment.adjustment",
"path" : "ClaimResponse.payment.adjustment",
"short" : "Payment adjustment for non-Claim issues",
"definition" : "Adjustment to the payment of this transaction which is not related to adjudication of this transaction.",
"min" : 0,
"max" : "1",
"type" : [{
"code" : "Money"
}]
},
{
"id" : "ClaimResponse.payment.adjustmentReason",
"path" : "ClaimResponse.payment.adjustmentReason",
"short" : "Explanation for the non-claim adjustment",
"definition" : "Reason for the payment adjustment.",
"min" : 0,
"max" : "1",
"type" : [{
"code" : "CodeableConcept"
}],
"binding" : {
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString" : "PaymentAdjustmentReason"
}],
"strength" : "example",
"description" : "Payment Adjustment reason codes.",
"valueSet" : "http://hl7.org/fhir/ValueSet/payment-adjustment-reason"
}
},
{
"id" : "ClaimResponse.payment.date",
"path" : "ClaimResponse.payment.date",
"short" : "Expected data of Payment",
"definition" : "Estimated payment data.",
"min" : 0,
"max" : "1",
"type" : [{
"code" : "date"
}]
},
{
"id" : "ClaimResponse.payment.amount",
"path" : "ClaimResponse.payment.amount",
"short" : "Payable amount after adjustment",
"definition" : "Payable less any payment adjustment.",
"min" : 0,
"max" : "1",
"type" : [{
"code" : "Money"
}]
},
{
"id" : "ClaimResponse.payment.identifier",
"path" : "ClaimResponse.payment.identifier",
"short" : "Identifier of the payment instrument",
"definition" : "Payment identifier.",
"min" : 0,
"max" : "1",
"type" : [{
"code" : "Identifier"
}]
},
{
"id" : "ClaimResponse.reserved",
"path" : "ClaimResponse.reserved",
"short" : "Funds reserved status",
"definition" : "Status of funds reservation (For provider, for Patient, None).",
"min" : 0,
"max" : "1",
"type" : [{
"code" : "Coding"
}],
"binding" : {
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString" : "FundsReserve"
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-isCommonBinding",
"valueBoolean" : true
}],
"strength" : "example",
"description" : "For whom funds are to be reserved: (Patient, Provider, None).",
"valueSet" : "http://hl7.org/fhir/ValueSet/fundsreserve"
}
},
{
"id" : "ClaimResponse.form",
"path" : "ClaimResponse.form",
"short" : "Printed Form Identifier",
"definition" : "The form to be used for printing the content.",
"min" : 0,
"max" : "1",
"type" : [{
"code" : "CodeableConcept"
}],
"binding" : {
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString" : "Forms"
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-isCommonBinding",
"valueBoolean" : true
}],
"strength" : "example",
"description" : "The forms codes.",
"valueSet" : "http://hl7.org/fhir/ValueSet/forms"
}
},
{
"id" : "ClaimResponse.processNote",
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-explicit-type-name",
"valueString" : "Note"
}],
"path" : "ClaimResponse.processNote",
"short" : "Processing notes",
"definition" : "Note text.",
"min" : 0,
"max" : "*",
"type" : [{
"code" : "BackboneElement"
}]
},
{
"id" : "ClaimResponse.processNote.number",
"path" : "ClaimResponse.processNote.number",
"short" : "Sequence Number for this note",
"definition" : "An integer associated with each note which may be referred to from each service line item.",
"min" : 0,
"max" : "1",
"type" : [{
"code" : "positiveInt"
}]
},
{
"id" : "ClaimResponse.processNote.type",
"path" : "ClaimResponse.processNote.type",
"short" : "display | print | printoper",
"definition" : "The note purpose: Print/Display.",
"min" : 0,
"max" : "1",
"type" : [{
"code" : "code"
}],
"binding" : {
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString" : "NoteType"
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-isCommonBinding",
"valueBoolean" : true
}],
"strength" : "required",
"description" : "The presentation types of notes.",
"valueSet" : "http://hl7.org/fhir/ValueSet/note-type"
}
},
{
"id" : "ClaimResponse.processNote.text",
"path" : "ClaimResponse.processNote.text",
"short" : "Note explanatory text",
"definition" : "The note text.",
"min" : 0,
"max" : "1",
"type" : [{
"code" : "string"
}]
},
{
"id" : "ClaimResponse.processNote.language",
"path" : "ClaimResponse.processNote.language",
"short" : "Language if different from the resource",
"definition" : "The ISO-639-1 alpha 2 code in lower case for the language, optionally followed by a hyphen and the ISO-3166-1 alpha 2 code for the region in upper case; e.g. \"en\" for English, or \"en-US\" for American English versus \"en-EN\" for England English.",
"min" : 0,
"max" : "1",
"type" : [{
"code" : "CodeableConcept"
}],
"binding" : {
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-maxValueSet",
"valueCanonical" : "http://hl7.org/fhir/ValueSet/all-languages"
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString" : "Language"
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-isCommonBinding",
"valueBoolean" : true
}],
"strength" : "preferred",
"description" : "A human language.",
"valueSet" : "http://hl7.org/fhir/ValueSet/languages"
}
},
{
"id" : "ClaimResponse.communicationRequest",
"path" : "ClaimResponse.communicationRequest",
"short" : "Request for additional information",
"definition" : "Request for additional supporting or authorizing information, such as: documents, images or resources.",
"min" : 0,
"max" : "*",
"type" : [{
"code" : "Reference",
"targetProfile" : ["http://hl7.org/fhir/StructureDefinition/CommunicationRequest"]
}]
},
{
"id" : "ClaimResponse.insurance",
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-explicit-type-name",
"valueString" : "Insurance"
}],
"path" : "ClaimResponse.insurance",
"short" : "Insurance or medical plan",
"definition" : "Financial instrument by which payment information for health care.",
"requirements" : "Health care programs and insurers are significant payors of health service costs.",
"min" : 0,
"max" : "*",
"type" : [{
"code" : "BackboneElement"
}],
"mapping" : [{
"identity" : "rim",
"map" : "Coverage"
}]
},
{
"id" : "ClaimResponse.insurance.sequence",
"path" : "ClaimResponse.insurance.sequence",
"short" : "Service instance identifier",
"definition" : "A service line item.",
"requirements" : "To maintain order of the coverages.",
"min" : 1,
"max" : "1",
"type" : [{
"code" : "positiveInt"
}]
},
{
"id" : "ClaimResponse.insurance.focal",
"path" : "ClaimResponse.insurance.focal",
"short" : "Is the focal Coverage",
"definition" : "The instance number of the Coverage which is the focus for adjudication. The Coverage against which the claim is to be adjudicated.",
"requirements" : "To identify which coverage is being adjudicated.",
"min" : 1,
"max" : "1",
"type" : [{
"code" : "boolean"
}]
},
{
"id" : "ClaimResponse.insurance.coverage",
"path" : "ClaimResponse.insurance.coverage",
"short" : "Insurance information",
"definition" : "Reference to the program or plan identification, underwriter or payor.",
"requirements" : "Need to identify the issuer to target for processing and for coordination of benefit processing.",
"min" : 1,
"max" : "1",
"type" : [{
"code" : "Reference",
"targetProfile" : ["http://hl7.org/fhir/StructureDefinition/Coverage"]
}]
},
{
"id" : "ClaimResponse.insurance.businessArrangement",
"path" : "ClaimResponse.insurance.businessArrangement",
"short" : "Business agreement",
"definition" : "The contract number of a business agreement which describes the terms and conditions.",
"min" : 0,
"max" : "1",
"type" : [{
"code" : "string"
}]
},
{
"id" : "ClaimResponse.insurance.claimResponse",
"path" : "ClaimResponse.insurance.claimResponse",
"short" : "Adjudication results",
"definition" : "The Coverages adjudication details.",
"requirements" : "Used by downstream payers to determine what balance remains and the net payable.",
"min" : 0,
"max" : "1",
"type" : [{
"code" : "Reference",
"targetProfile" : ["http://hl7.org/fhir/StructureDefinition/ClaimResponse"]
}]
}]
}
}
Usage note: every effort has been made to ensure that the examples are correct and useful, but they are not a normative part of the specification.
®©
HL7.org
2011+.
FHIR
Mixed
Nomative/Trial
Use
Ballot
(v3.3.0-13671)
#2
(v3.5.0-14907)
generated
on
Tue,
Apr
3,
Sun,
Aug
19,
2018
12:14+1000.
21:52+1000.
QA
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