Financial
This
page
is
part
of
the
FHIR
Specification
(v3.0.2:
STU
3).
(v3.5.0:
R4
Ballot
#2).
The
current
version
which
supercedes
this
version
is
5.0.0
.
For
a
full
list
of
available
versions,
see
the
Directory
of
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versions
.
Page
versions:
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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": "2019-10-24T11:53:00+11:00"
"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-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": "2019-10-24T11:53:00+11:00",
"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": "Base StructureDefinition for ClaimResponse Resource",
"fhirVersion": "3.0.2",
"mapping": [
{
"identity": "workflow",
"uri": "http://hl7.org/fhir/workflow",
"name": "Workflow Mapping"
},
{
"identity": "w5",
"uri": "http://hl7.org/fhir/w5",
"name": "W5 Mapping"
},
{
"identity": "cdanetv4",
"uri": "http://www.cda-adc.ca/en/services/cdanet/",
"name": "Canadian Dental Association eclaims standard"
},
{
"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": "*",
"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",
"expression": "contained.where(('#'+id in %resource.descendants().reference).not()).empty()",
"xpath": "not(exists(for $id in f:contained/*/@id return $id[not(ancestor::f:contained/parent::*/descendant::f:reference/@value=concat('#', $id))]))",
"source": "DomainResource"
}
],
"mapping": [
{
"identity": "rim",
"map": "Entity. Role, or Act"
},
{
"identity": "workflow",
"map": "Event"
},
{
"identity": "w5",
"map": "financial.billing"
}
]
"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" : "*"
},
{
"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"
}
],
"isSummary": true
"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"
},
{
"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 may 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"
}
],
"isSummary": true
"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"
},
{
"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.",
"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. \n\nThis element is labelled as a modifier because the implicit rules may provide additional knowledge about the resource that modifies it's meaning or interpretation.",
"min": 0,
"max": "1",
"base": {
"path": "Resource.implicitRules",
"min": 0,
"max": "1"
},
"type": [
{
"code": "uri"
}
],
"isModifier": true,
"isSummary": true
"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"
},
{
"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"
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-bestpractice",
"valueBoolean" : true
},
"type": [
{
"code": "code"
}
],
"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.",
"valueSetReference": {
"reference": "http://hl7.org/fhir/ValueSet/languages"
}
}
{
"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"
},
{
"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 may 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"
],
"mapping": [
{
"identity": "rim",
"map": "Act.text?"
}
]
"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"
},
{
"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"
}
],
"mapping": [
{
"identity": "rim",
"map": "N/A"
}
]
"identity" : "workflow",
"map" : "Event"
}]
},
{
"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"
},
{
"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. In order 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.",
"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"
}
],
"mapping": [
{
"identity": "rim",
"map": "N/A"
}
]
"type" : [{
"code" : "id"
}],
"isModifier" : false,
"isSummary" : true
},
{
"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"
},
{
"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. In order 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,
"mapping": [
{
"identity": "rim",
"map": "N/A"
}
]
"type" : [{
"code" : "Meta"
}],
"isModifier" : false,
"isSummary" : true
},
{
"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"
},
{
"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": "id"
}
]
"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
},
{
"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"
},
{
"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,
"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.",
"valueSetReference": {
"reference": "http://hl7.org/fhir/ValueSet/fm-status"
}
"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"
},
"mapping": [
{
"identity": "workflow",
"map": "Event.status"
},
{
"identity": "w5",
"map": "status"
}
]
{
"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.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"
},
{
"id": "ClaimResponse.patient",
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-display-hint",
"valueString": "who.focus"
}
],
"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"
}
]
"type" : [{
"code" : "Narrative"
}],
"isModifier" : false,
"isSummary" : false,
"mapping" : [{
"identity" : "rim",
"map" : "Act.text?"
}]
},
{
"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.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"
},
{
"identity": "w5",
"map": "when.recorded"
}
]
"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.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.onBehalfOf"
}
]
"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.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"
}
],
"mapping": [
{
"identity": "cdanetv4",
"map": "B01"
},
{
"identity": "w5",
"map": "who.source"
}
]
"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.requestOrganization",
"path": "ClaimResponse.requestOrganization",
"short": "Responsible organization",
"definition": "The organization which is responsible for the services rendered to the patient.",
"min": 0,
"max": "1",
"type": [
{
"code": "Reference",
"targetProfile": "http://hl7.org/fhir/StructureDefinition/Organization"
}
],
"mapping": [
{
"identity": "w5",
"map": "who.source"
}
]
"type" : [{
"code" : "Identifier"
}],
"isModifier" : false,
"isSummary" : false,
"mapping" : [{
"identity" : "workflow",
"map" : "Event.identifier"
},
{
"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": "cdanetv4",
"map": "A02|G01"
},
{
"identity": "w5",
"map": "why"
}
]
"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.outcome",
"path": "ClaimResponse.outcome",
"short": "complete | error | partial",
"definition": "Processing outcome errror, partial or complete processing.",
"min": 0,
"max": "1",
"type": [
{
"code": "CodeableConcept"
}
],
"binding": {
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString": "RemittanceOutcome"
}
],
"strength": "example",
"description": "The result of the claim processing",
"valueSetReference": {
"reference": "http://hl7.org/fhir/ValueSet/remittance-outcome"
}
}
"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.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"
}
]
"mapping" : [{
"identity" : "workflow",
"map" : "Event.status"
},
{
"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.",
"valueSetReference": {
"reference": "http://hl7.org/fhir/ValueSet/payeetype"
}
}
"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.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"
}
],
"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"
}
]
"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.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"
}
],
"mapping": [
{
"identity": "rim",
"map": "n/a"
}
]
"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.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. In order 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.",
"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"
}
],
"mapping": [
{
"identity": "rim",
"map": "n/a"
}
]
"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.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 that contains it. Usually modifier elements provide negation or qualification. In order 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",
"modifiers"
],
"min": 0,
"max": "*",
"base": {
"path": "BackboneElement.modifierExtension",
"min": 0,
"max": "*"
},
"type": [
{
"code": "Extension"
}
],
"isModifier": true,
"isSummary": true,
"mapping": [
{
"identity": "rim",
"map": "N/A"
}
]
"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.item.sequenceLinkId",
"path": "ClaimResponse.item.sequenceLinkId",
"short": "Service instance",
"definition": "A service line number.",
"min": 1,
"max": "1",
"type": [
{
"code": "positiveInt"
}
],
"mapping": [
{
"identity": "cdanetv4",
"map": "F07"
}
]
"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.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"
}
]
"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.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"
}
],
"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"
}
]
"type" : [{
"code" : "Reference",
"targetProfile" : ["http://hl7.org/fhir/StructureDefinition/Patient"]
}],
"isModifier" : false,
"isSummary" : false,
"mapping" : [{
"identity" : "w5",
"map" : "FiveWs.subject[x]"
},
{
"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"
}
],
"mapping": [
{
"identity": "rim",
"map": "n/a"
}
]
"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.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. In order 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.",
"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"
}
],
"mapping": [
{
"identity": "rim",
"map": "n/a"
}
]
"type" : [{
"code" : "dateTime"
}],
"isModifier" : false,
"isSummary" : false,
"mapping" : [{
"identity" : "workflow",
"map" : "Event.occurrence[x]"
},
{
"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 that contains it. Usually modifier elements provide negation or qualification. In order 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",
"modifiers"
],
"min": 0,
"max": "*",
"base": {
"path": "BackboneElement.modifierExtension",
"min": 0,
"max": "*"
},
"type": [
{
"code": "Extension"
}
],
"isModifier": true,
"isSummary": true,
"mapping": [
{
"identity": "rim",
"map": "N/A"
}
]
"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.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.",
"valueSetReference": {
"reference": "http://hl7.org/fhir/ValueSet/adjudication"
}
}
"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.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.",
"valueSetReference": {
"reference": "http://hl7.org/fhir/ValueSet/adjudication-reason"
}
}
"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.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" : "Reference",
"targetProfile" : ["http://hl7.org/fhir/StructureDefinition/Claim"]
}],
"isModifier" : false,
"isSummary" : false,
"mapping" : [{
"identity" : "workflow",
"map" : "Event.basedOn"
},
{
"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"
}
]
"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.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"
}
],
"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"
}
]
"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.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"
}
],
"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.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. In order 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.",
"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"
}
],
"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.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 that contains it. Usually modifier elements provide negation or qualification. In order 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",
"modifiers"
],
"min": 0,
"max": "*",
"base": {
"path": "BackboneElement.modifierExtension",
"min": 0,
"max": "*"
"type" : [{
"code" : "CodeableConcept"
}],
"isModifier" : false,
"isSummary" : false,
"binding" : {
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString" : "PayeeType"
},
"type": [
{
"code": "Extension"
}
],
"isModifier": true,
"isSummary": true,
"mapping": [
{
"identity": "rim",
"map": "N/A"
}
]
{
"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.detail.sequenceLinkId",
"path": "ClaimResponse.item.detail.sequenceLinkId",
"short": "Service instance",
"definition": "A service line number.",
"min": 1,
"max": "1",
"type": [
{
"code": "positiveInt"
}
],
"mapping": [
{
"identity": "cdanetv4",
"map": "F07"
}
]
"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.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" : "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.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" : "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.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"
}
],
"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"
}
]
"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.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"
}
],
"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.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. In order 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.",
"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"
}
],
"mapping": [
{
"identity": "rim",
"map": "n/a"
}
]
"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.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 that contains it. Usually modifier elements provide negation or qualification. In order 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",
"modifiers"
],
"min": 0,
"max": "*",
"base": {
"path": "BackboneElement.modifierExtension",
"min": 0,
"max": "*"
},
"type": [
{
"code": "Extension"
}
],
"isModifier": true,
"isSummary": true,
"mapping": [
{
"identity": "rim",
"map": "N/A"
}
]
"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.detail.subDetail.sequenceLinkId",
"path": "ClaimResponse.item.detail.subDetail.sequenceLinkId",
"short": "Service instance",
"definition": "A service line number.",
"min": 1,
"max": "1",
"type": [
{
"code": "positiveInt"
}
],
"mapping": [
{
"identity": "cdanetv4",
"map": "F07"
}
]
"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.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" : "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.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" : "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.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"
}
],
"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"
}
]
"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.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"
}
],
"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.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. In order 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.",
"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"
}
],
"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.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 that contains it. Usually modifier elements provide negation or qualification. In order 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",
"modifiers"
],
"min": 0,
"max": "*",
"base": {
"path": "BackboneElement.modifierExtension",
"min": 0,
"max": "*"
},
"type": [
{
"code": "Extension"
}
],
"isModifier": true,
"isSummary": true,
"mapping": [
{
"identity": "rim",
"map": "N/A"
}
]
"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.addItem.sequenceLinkId",
"path": "ClaimResponse.addItem.sequenceLinkId",
"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" : "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.addItem.revenue",
"path": "ClaimResponse.addItem.revenue",
"short": "Revenue or cost center code",
"definition": "The type of reveneu or cost center providing the product and/or service.",
"min": 0,
"max": "1",
"type": [
{
"code": "CodeableConcept"
}
],
"binding": {
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString": "RevenueCenter"
}
],
"strength": "example",
"description": "Codes for the revenue or cost centers supplying the service and/or products.",
"valueSetReference": {
"reference": "http://hl7.org/fhir/ValueSet/ex-revenue-center"
}
}
"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.addItem.category",
"path": "ClaimResponse.addItem.category",
"short": "Type of service or product",
"definition": "Health Care Service Type Codes to identify the classification of service or benefits.",
"min": 0,
"max": "1",
"type": [
{
"code": "CodeableConcept"
}
],
"binding": {
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString": "BenefitSubCategory"
}
],
"strength": "example",
"description": "Benefit subcategories such as: oral-basic, major, glasses",
"valueSetReference": {
"reference": "http://hl7.org/fhir/ValueSet/benefit-subcategory"
}
}
"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.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.",
"valueSetReference": {
"reference": "http://hl7.org/fhir/ValueSet/service-uscls"
}
}
"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.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.",
"valueSetReference": {
"reference": "http://hl7.org/fhir/ValueSet/claim-modifiers"
}
},
"mapping": [
{
"identity": "rim",
"map": "24.C, 24.D mods"
}
]
"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.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"
}
]
"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.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"
}
]
"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.addItem.adjudication",
"path": "ClaimResponse.addItem.adjudication",
"short": "Added items adjudication",
"definition": "The adjudications results.",
"min": 0,
"max": "*",
"contentReference": "#ClaimResponse.item.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.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.addItem.detail",
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-explicit-type-name",
"valueString": "AddedItemsDetail"
}
],
"path": "ClaimResponse.addItem.detail",
"short": "Added items details",
"definition": "The second tier service adjudications for payor added services.",
"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"
}
]
"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.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"
},
"type": [
{
"code": "string"
}
],
"mapping": [
{
"identity": "rim",
"map": "n/a"
}
]
"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.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. In order 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.",
"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"
}
],
"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.detail.modifierExtension",
"path": "ClaimResponse.addItem.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 that contains it. Usually modifier elements provide negation or qualification. In order 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",
"modifiers"
],
"min": 0,
"max": "*",
"base": {
"path": "BackboneElement.modifierExtension",
"min": 0,
"max": "*"
},
"type": [
{
"code": "Extension"
}
],
"isModifier": true,
"isSummary": true,
"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.detail.revenue",
"path": "ClaimResponse.addItem.detail.revenue",
"short": "Revenue or cost center code",
"definition": "The type of reveneu or cost center providing the product and/or service.",
"min": 0,
"max": "1",
"type": [
{
"code": "CodeableConcept"
}
],
"binding": {
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString": "RevenueCenter"
}
],
"strength": "example",
"description": "Codes for the revenue or cost centers supplying the service and/or products.",
"valueSetReference": {
"reference": "http://hl7.org/fhir/ValueSet/ex-revenue-center"
}
}
"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.detail.category",
"path": "ClaimResponse.addItem.detail.category",
"short": "Type of service or product",
"definition": "Health Care Service Type Codes to identify the classification of service or benefits.",
"min": 0,
"max": "1",
"type": [
{
"code": "CodeableConcept"
}
],
"binding": {
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString": "BenefitSubCategory"
}
],
"strength": "example",
"description": "Benefit subcategories such as: oral-basic, major, glasses",
"valueSetReference": {
"reference": "http://hl7.org/fhir/ValueSet/benefit-subcategory"
}
}
"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.detail.service",
"path": "ClaimResponse.addItem.detail.service",
"short": "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.",
"valueSetReference": {
"reference": "http://hl7.org/fhir/ValueSet/service-uscls"
}
}
"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.detail.modifier",
"path": "ClaimResponse.addItem.detail.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.",
"valueSetReference": {
"reference": "http://hl7.org/fhir/ValueSet/claim-modifiers"
}
},
"mapping": [
{
"identity": "rim",
"map": "24.C, 24.D mods"
}
]
"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.detail.fee",
"path": "ClaimResponse.addItem.detail.fee",
"short": "Professional fee or Product charge",
"definition": "The fee charged for the professional service or product..",
"min": 0,
"max": "1",
"type": [
{
"code": "Money"
}
]
"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.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"
}
]
"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.detail.adjudication",
"path": "ClaimResponse.addItem.detail.adjudication",
"short": "Added items detail adjudication",
"definition": "The adjudications results.",
"min": 0,
"max": "*",
"contentReference": "#ClaimResponse.item.adjudication"
"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.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"
}
],
"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"
}
]
"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.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"
}
],
"mapping": [
{
"identity": "rim",
"map": "n/a"
}
]
"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",
"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. In order 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.",
"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"
}
],
"mapping": [
{
"identity": "rim",
"map": "n/a"
}
]
"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.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 that contains it. Usually modifier elements provide negation or qualification. In order 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",
"modifiers"
],
"min": 0,
"max": "*",
"base": {
"path": "BackboneElement.modifierExtension",
"min": 0,
"max": "*"
},
"type": [
{
"code": "Extension"
}
],
"isModifier": true,
"isSummary": true,
"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.sequenceLinkId",
"path": "ClaimResponse.error.sequenceLinkId",
"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" : "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.detailSequenceLinkId",
"path": "ClaimResponse.error.detailSequenceLinkId",
"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"
}
]
"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.subdetailSequenceLinkId",
"path": "ClaimResponse.error.subdetailSequenceLinkId",
"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" : "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.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.",
"valueSetReference": {
"reference": "http://hl7.org/fhir/ValueSet/adjudication-error"
}
}
"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.totalCost",
"path": "ClaimResponse.totalCost",
"short": "Total Cost of service from the Claim",
"definition": "The total cost of the services reported.",
"requirements": "This is a check value that the receiver calculates and returns.",
"min": 0,
"max": "1",
"type": [
{
"code": "Money"
}
]
"type" : [{
"code" : "date"
},
{
"id": "ClaimResponse.unallocDeductable",
"path": "ClaimResponse.unallocDeductable",
"short": "Unallocated deductible",
"definition": "The amount of deductible applied which was not allocated to any particular service line.",
"min": 0,
"max": "1",
"type": [
{
"code": "Money"
}
]
"code" : "Period"
}],
"isModifier" : false,
"isSummary" : false,
"mapping" : [{
"identity" : "w5",
"map" : "FiveWs.done[x]"
},
{
"id": "ClaimResponse.totalBenefit",
"path": "ClaimResponse.totalBenefit",
"short": "Total benefit payable for the Claim",
"definition": "Total amount of benefit payable (Equal to sum of the Benefit amounts from all detail lines and additions less the Unallocated Deductible).",
"min": 0,
"max": "1",
"type": [
{
"code": "Money"
}
]
"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.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"
}
],
"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"
}
]
"type" : [{
"code" : "CodeableConcept"
},
{
"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"
}
],
"mapping": [
{
"identity": "rim",
"map": "n/a"
}
]
"code" : "Address"
},
{
"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. In order 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.",
"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"
}
],
"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.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 that contains it. Usually modifier elements provide negation or qualification. In order 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",
"modifiers"
],
"min": 0,
"max": "*",
"base": {
"path": "BackboneElement.modifierExtension",
"min": 0,
"max": "*"
},
"type": [
{
"code": "Extension"
}
],
"isModifier": true,
"isSummary": true,
"mapping": [
{
"identity": "rim",
"map": "N/A"
}
]
"mapping" : [{
"identity" : "w5",
"map" : "FiveWs.where[x]"
},
{
"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",
"valueSetReference": {
"reference": "http://hl7.org/fhir/ValueSet/ex-paymenttype"
}
}
"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.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" : "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.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.",
"valueSetReference": {
"reference": "http://hl7.org/fhir/ValueSet/payment-adjustment-reason"
}
}
"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.date",
"path": "ClaimResponse.payment.date",
"short": "Expected data of Payment",
"definition": "Estimated payment data.",
"min": 0,
"max": "1",
"type": [
{
"code": "date"
}
]
"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.amount",
"path": "ClaimResponse.payment.amount",
"short": "Payable amount after adjustment",
"definition": "Payable less any payment adjustment.",
"min": 0,
"max": "1",
"type": [
{
"code": "Money"
}
]
"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.identifier",
"path": "ClaimResponse.payment.identifier",
"short": "Identifier of the payment instrument",
"definition": "Payment identifier.",
"min": 0,
"max": "1",
"type": [
{
"code": "Identifier"
}
]
"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.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).",
"valueSetReference": {
"reference": "http://hl7.org/fhir/ValueSet/fundsreserve"
}
}
"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.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.",
"valueSetReference": {
"reference": "http://hl7.org/fhir/ValueSet/forms"
}
},
"mapping": [
{
"identity": "cdanetv4",
"map": "G42"
}
]
"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.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"
}
],
"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"
}
]
"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.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"
}
],
"mapping": [
{
"identity": "rim",
"map": "n/a"
}
]
"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.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. In order 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.",
"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"
}
],
"mapping": [
{
"identity": "rim",
"map": "n/a"
}
]
"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.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 that contains it. Usually modifier elements provide negation or qualification. In order 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",
"modifiers"
],
"min": 0,
"max": "*",
"base": {
"path": "BackboneElement.modifierExtension",
"min": 0,
"max": "*"
},
"type": [
{
"code": "Extension"
}
],
"isModifier": true,
"isSummary": true,
"mapping": [
{
"identity": "rim",
"map": "N/A"
}
]
"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.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"
}
]
"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.type",
"path": "ClaimResponse.processNote.type",
"short": "display | print | printoper",
"definition": "The note purpose: Print/Display.",
"min": 0,
"max": "1",
"type": [
{
"code": "CodeableConcept"
}
],
"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.",
"valueSetReference": {
"reference": "http://hl7.org/fhir/ValueSet/note-type"
}
}
"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.text",
"path": "ClaimResponse.processNote.text",
"short": "Note explanatory text",
"definition": "The note text.",
"min": 0,
"max": "1",
"type": [
{
"code": "string"
}
],
"mapping": [
{
"identity": "cdanetv4",
"map": "G32"
}
]
"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.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.",
"valueSetReference": {
"reference": "http://hl7.org/fhir/ValueSet/languages"
}
}
"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.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"
}
]
"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.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"
}
],
"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"
}
],
"mapping": [
{
"identity": "rim",
"map": "Coverage"
}
]
"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.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"
}
],
"mapping": [
{
"identity": "rim",
"map": "n/a"
}
]
"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.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. In order 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.",
"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"
}
],
"mapping": [
{
"identity": "rim",
"map": "n/a"
}
]
"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.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 that contains it. Usually modifier elements provide negation or qualification. In order 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",
"modifiers"
],
"min": 0,
"max": "*",
"base": {
"path": "BackboneElement.modifierExtension",
"min": 0,
"max": "*"
},
"type": [
{
"code": "Extension"
}
],
"isModifier": true,
"isSummary": true,
"mapping": [
{
"identity": "rim",
"map": "N/A"
}
]
"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.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"
}
]
"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.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"
}
]
"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.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"
}
]
"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.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"
}
]
"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.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": "cdanetv4",
"map": "F03"
}
]
"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.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": "cdanetv4",
"map": "EOB"
}
]
"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"
}
]
},
"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"
},
{
"identity": "w5",
"map": "financial.billing"
}
]
},
{
"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.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": "id"
}
]
"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.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,
"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.",
"valueSetReference": {
"reference": "http://hl7.org/fhir/ValueSet/fm-status"
}
},
"mapping": [
{
"identity": "workflow",
"map": "Event.status"
},
{
"identity": "w5",
"map": "status"
}
]
"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.patient",
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-display-hint",
"valueString": "who.focus"
}
],
"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"
}
]
"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.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"
},
{
"identity": "w5",
"map": "when.recorded"
}
]
"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.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.onBehalfOf"
}
]
"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.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"
}
],
"mapping": [
{
"identity": "cdanetv4",
"map": "B01"
},
{
"identity": "w5",
"map": "who.source"
}
]
"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.requestOrganization",
"path": "ClaimResponse.requestOrganization",
"short": "Responsible organization",
"definition": "The organization which is responsible for the services rendered to the patient.",
"min": 0,
"max": "1",
"type": [
{
"code": "Reference",
"targetProfile": "http://hl7.org/fhir/StructureDefinition/Organization"
}
],
"mapping": [
{
"identity": "w5",
"map": "who.source"
}
]
"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.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": "cdanetv4",
"map": "A02|G01"
},
{
"identity": "w5",
"map": "why"
}
]
"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.outcome",
"path": "ClaimResponse.outcome",
"short": "complete | error | partial",
"definition": "Processing outcome errror, partial or complete processing.",
"min": 0,
"max": "1",
"type": [
{
"code": "CodeableConcept"
}
],
"binding": {
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString": "RemittanceOutcome"
}
],
"strength": "example",
"description": "The result of the claim processing",
"valueSetReference": {
"reference": "http://hl7.org/fhir/ValueSet/remittance-outcome"
}
}
"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.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" : "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.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.",
"valueSetReference": {
"reference": "http://hl7.org/fhir/ValueSet/payeetype"
}
}
"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.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" : 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.item.sequenceLinkId",
"path": "ClaimResponse.item.sequenceLinkId",
"short": "Service instance",
"definition": "A service line number.",
"min": 1,
"max": "1",
"type": [
{
"code": "positiveInt"
}
],
"mapping": [
{
"identity": "cdanetv4",
"map": "F07"
}
]
"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.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" : "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.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" : "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.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.",
"valueSetReference": {
"reference": "http://hl7.org/fhir/ValueSet/adjudication"
}
}
"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.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.",
"valueSetReference": {
"reference": "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.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.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" : "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.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" : 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.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" : "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.detail.sequenceLinkId",
"path": "ClaimResponse.item.detail.sequenceLinkId",
"short": "Service instance",
"definition": "A service line number.",
"min": 1,
"max": "1",
"type": [
{
"code": "positiveInt"
}
],
"mapping": [
{
"identity": "cdanetv4",
"map": "F07"
}
]
"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.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" : "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.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" : "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.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" : "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.detail.subDetail.sequenceLinkId",
"path": "ClaimResponse.item.detail.subDetail.sequenceLinkId",
"short": "Service instance",
"definition": "A service line number.",
"min": 1,
"max": "1",
"type": [
{
"code": "positiveInt"
}
],
"mapping": [
{
"identity": "cdanetv4",
"map": "F07"
}
]
"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.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" : "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.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" : "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.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" : "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.addItem.sequenceLinkId",
"path": "ClaimResponse.addItem.sequenceLinkId",
"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" : "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.addItem.revenue",
"path": "ClaimResponse.addItem.revenue",
"short": "Revenue or cost center code",
"definition": "The type of reveneu or cost center providing the product and/or service.",
"min": 0,
"max": "1",
"type": [
{
"code": "CodeableConcept"
}
],
"binding": {
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString": "RevenueCenter"
}
],
"strength": "example",
"description": "Codes for the revenue or cost centers supplying the service and/or products.",
"valueSetReference": {
"reference": "http://hl7.org/fhir/ValueSet/ex-revenue-center"
}
}
"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.addItem.category",
"path": "ClaimResponse.addItem.category",
"short": "Type of service or product",
"definition": "Health Care Service Type Codes to identify the classification of service or benefits.",
"min": 0,
"max": "1",
"type": [
{
"code": "CodeableConcept"
}
],
"binding": {
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString": "BenefitSubCategory"
}
],
"strength": "example",
"description": "Benefit subcategories such as: oral-basic, major, glasses",
"valueSetReference": {
"reference": "http://hl7.org/fhir/ValueSet/benefit-subcategory"
}
}
"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.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.",
"valueSetReference": {
"reference": "http://hl7.org/fhir/ValueSet/service-uscls"
}
}
"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.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.",
"valueSetReference": {
"reference": "http://hl7.org/fhir/ValueSet/claim-modifiers"
}
"type" : [{
"code" : "Coding"
}],
"isModifier" : false,
"isSummary" : false,
"binding" : {
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString" : "FundsReserve"
},
"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"
}
]
{
"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.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"
}
]
"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.adjudication",
"path": "ClaimResponse.addItem.adjudication",
"short": "Added items adjudication",
"definition": "The adjudications results.",
"min": 0,
"max": "*",
"contentReference": "#ClaimResponse.item.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.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.detail",
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-explicit-type-name",
"valueString": "AddedItemsDetail"
}
],
"path": "ClaimResponse.addItem.detail",
"short": "Added items details",
"definition": "The second tier service adjudications for payor added services.",
"min": 0,
"max": "*",
"type": [
{
"code": "BackboneElement"
}
]
"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.detail.revenue",
"path": "ClaimResponse.addItem.detail.revenue",
"short": "Revenue or cost center code",
"definition": "The type of reveneu or cost center providing the product and/or service.",
"min": 0,
"max": "1",
"type": [
{
"code": "CodeableConcept"
}
],
"binding": {
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString": "RevenueCenter"
}
],
"strength": "example",
"description": "Codes for the revenue or cost centers supplying the service and/or products.",
"valueSetReference": {
"reference": "http://hl7.org/fhir/ValueSet/ex-revenue-center"
}
}
"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.detail.category",
"path": "ClaimResponse.addItem.detail.category",
"short": "Type of service or product",
"definition": "Health Care Service Type Codes to identify the classification of service or benefits.",
"min": 0,
"max": "1",
"type": [
{
"code": "CodeableConcept"
}
],
"binding": {
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString": "BenefitSubCategory"
}
],
"strength": "example",
"description": "Benefit subcategories such as: oral-basic, major, glasses",
"valueSetReference": {
"reference": "http://hl7.org/fhir/ValueSet/benefit-subcategory"
}
}
"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.detail.service",
"path": "ClaimResponse.addItem.detail.service",
"short": "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.",
"valueSetReference": {
"reference": "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.detail.modifier",
"path": "ClaimResponse.addItem.detail.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.",
"valueSetReference": {
"reference": "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.detail.fee",
"path": "ClaimResponse.addItem.detail.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.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"
}
]
{
"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.detail.adjudication",
"path": "ClaimResponse.addItem.detail.adjudication",
"short": "Added items detail 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.sequenceLinkId",
"path": "ClaimResponse.error.sequenceLinkId",
"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.detailSequenceLinkId",
"path": "ClaimResponse.error.detailSequenceLinkId",
"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.subdetailSequenceLinkId",
"path": "ClaimResponse.error.subdetailSequenceLinkId",
"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.",
"valueSetReference": {
"reference": "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.totalCost",
"path": "ClaimResponse.totalCost",
"short": "Total Cost of service from the Claim",
"definition": "The total cost of the services reported.",
"requirements": "This is a check value that the receiver calculates and returns.",
"min": 0,
"max": "1",
"type": [
{
"code": "Money"
}
]
"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.unallocDeductable",
"path": "ClaimResponse.unallocDeductable",
"short": "Unallocated deductible",
"definition": "The amount of deductible applied which was not allocated to any particular service line.",
"min": 0,
"max": "1",
"type": [
{
"code": "Money"
}
]
"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.totalBenefit",
"path": "ClaimResponse.totalBenefit",
"short": "Total benefit payable for the Claim",
"definition": "Total amount of benefit payable (Equal to sum of the Benefit amounts from all detail lines and additions less the Unallocated Deductible).",
"min": 0,
"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",
"valueSetReference": {
"reference": "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.",
"valueSetReference": {
"reference": "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).",
"valueSetReference": {
"reference": "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.",
"valueSetReference": {
"reference": "http://hl7.org/fhir/ValueSet/forms"
}
},
"mapping": [
{
"identity": "cdanetv4",
"map": "G42"
}
]
"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": "CodeableConcept"
}
],
"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.",
"valueSetReference": {
"reference": "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": "cdanetv4",
"map": "G32"
}
]
"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.",
"valueSetReference": {
"reference": "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": "cdanetv4",
"map": "F03"
}
]
"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": "cdanetv4",
"map": "EOB"
}
]
"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
Release
3
(STU;
v3.0.2-11200)
Mixed
Nomative/Trial
Use
Ballot
#2
(v3.5.0-14907)
generated
on
Thurs,
Oct
24,
2019
11:53+1100.
Sun,
Aug
19,
2018
21:52+1000.
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