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13.7.6 13.7.7 Resource ClaimResponse - Mappings

Financial Management Work Group

Maturity Level : N/A

Ballot Standards Status : Informative

Security Category : Patient

Compartments : Patient , Practitioner

Mappings for the claimresponse resource. resource (see Mappings to Other Standards for further information & status).

13.7.6.1 13.7.7.1 Mappings for RIM FiveWs Pattern Mapping (http://hl7.org/v3) ClaimResponse     identifier     status     patient     created     insurer     requestProvider     requestOrganization     request     outcome     disposition     payeeType     item         sequenceLinkId         noteNumber         adjudication             category             reason             amount             value         detail             sequenceLinkId             noteNumber             adjudication             subDetail                 sequenceLinkId                 noteNumber                 adjudication     addItem         sequenceLinkId         revenue         category         service         modifier 24.C, 24.D mods         fee         noteNumber         adjudication         detail             revenue             category             service             modifier 24.C, 24.D mods             fee             noteNumber             adjudication     error         sequenceLinkId         detailSequenceLinkId         subdetailSequenceLinkId         code     totalCost     unallocDeductable     totalBenefit     payment         type         adjustment         adjustmentReason         date         amount         identifier     reserved     form     processNote         number         type         text         language     communicationRequest     insurance Coverage         sequence         focal         coverage         businessArrangement         preAuthRef         claimResponse ( http://hl7.org/fhir/fivews )

    identifier     status     patient     created     insurer     requestProvider B01     requestOrganization     request A02|G01     outcome     disposition     payeeType     item         sequenceLinkId F07         noteNumber         adjudication             category             reason             amount             value

ClaimResponse	detail             sequenceLinkId F07
noteNumber             adjudication             subDetail                 sequenceLinkId F07                 noteNumber                 adjudication     addItem         sequenceLinkId         revenue         category         service         modifier         fee         noteNumber         adjudication         detail             revenue             category             service             modifier             fee             noteNumber             adjudication     error         sequenceLinkId         detailSequenceLinkId         subdetailSequenceLinkId         code     totalCost     unallocDeductable     totalBenefit     payment     identifier	type FiveWs.identifier
adjustment     status	adjustmentReason FiveWs.status
date     type	amount FiveWs.class
identifier     subType	reserved FiveWs.class
form G42     use	processNote FiveWs.class
number     patient	type FiveWs.subject[x]
text G32     created	language FiveWs.recorded
communicationRequest     requestor	insurance FiveWs.source
sequence     request	focal FiveWs.why[x]
coverage         provider	businessArrangement FiveWs.source
preAuthRef         serviced[x]	F03 FiveWs.done[x]
claimResponse         location[x]	EOB FiveWs.where[x]

13.7.6.3 13.7.7.2 Mappings for Workflow Mapping (http://hl7.org/fhir/workflow) Pattern ( http://hl7.org/fhir/workflow )

    payeeType     item         sequenceLinkId         noteNumber         adjudication             category             reason             amount             value         detail             sequenceLinkId             noteNumber             adjudication             subDetail

ClaimResponse	Event
identifier	Event.identifier
status	Event.status
patient     created	Event.occurrence Event.occurrence[x]
insurer	Event.performer.onBehalfOf     requestProvider     requestOrganization Event.performer
request	Event.basedOn
outcome     disposition	Event.note

                sequenceLinkId 13.7.7.3 RIM Mapping ( http://hl7.org/v3 )                 adjudication

        fee         noteNumber         adjudication         detail             revenue             category             service             modifier             fee             noteNumber             adjudication         sequence         focal         coverage         businessArrangement         preAuthRef

addItem         sequenceLinkId ClaimResponse         revenue	category         service
modifier	error 24.C, 24.D mods
sequenceLinkId         programCode	detailSequenceLinkId 24.H
subdetailSequenceLinkId         serviced[x]	code 24.A
totalCost         location[x]	unallocDeductable 24.B
totalBenefit         quantity	payment 24.G
type         net	adjustment 24.F
adjustmentReason             modifier	date 24.C, 24.D mods
amount             quantity	identifier 24.G
reserved             net	form 24.F
processNote                 modifier	number 24.C, 24.D mods
type                 quantity	text 24.G
language                 net	communicationRequest 24.F
insurance	claimResponse Coverage