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7.2.6 13.7.6 Resource ClaimResponse - Mappings

Financial Management Work Group

Maturity Level : N/A

Ballot Status : Informative

Compartments : Patient , Practitioner

Mappings for the claimresponse resource.

7.2.6.1 13.7.6.1 Mappings for RIM Mapping (http://hl7.org/v3)

Coverage

ClaimResponse
identifier     identifier
request     status
ruleset     patient
originalRuleset     created
created     insurer
organization     requestProvider
requestProvider     requestOrganization
requestOrganization     request
outcome     outcome
disposition     disposition
payeeType     payeeType
item     item
sequenceLinkId         sequenceLinkId
noteNumber         noteNumber
adjudication         adjudication
code             category
amount             reason
value             amount
detail             value
sequenceLinkId         detail
adjudication             sequenceLinkId
code             noteNumber
amount             adjudication
value             subDetail
subDetail                 sequenceLinkId
sequenceLinkId                 noteNumber
adjudication                 adjudication
code     addItem
amount         sequenceLinkId
value         revenue
addItem         category
sequenceLinkId         service
service         modifier	24.C, 24.D mods
fee         fee
noteNumberLinkId         noteNumber
adjudication         adjudication
code         detail
amount             revenue
value             category
detail             service
service             modifier	24.C, 24.D mods
fee             fee
adjudication             noteNumber
code             adjudication
amount     error
value         sequenceLinkId
error         detailSequenceLinkId
sequenceLinkId         subdetailSequenceLinkId
detailSequenceLinkId         code
subdetailSequenceLinkId     totalCost
code     unallocDeductable
totalCost     totalBenefit
unallocDeductable     payment
totalBenefit         type
paymentAdjustment         adjustment
paymentAdjustmentReason         adjustmentReason
paymentDate         date
paymentAmount         amount
paymentRef         identifier
reserved     reserved
form     form
note     processNote
number         number
type         type
text         text
coverage         language
sequence     communicationRequest
focal     insurance	Coverage
coverage         sequence
businessArrangement         focal
relationship         coverage
preAuthRef         businessArrangement
claimResponse         preAuthRef
originalRuleset         claimResponse

7.2.6.2 13.7.6.2 Mappings for Canadian Dental Association eclaims standard (http://www.cda-adc.ca/en/services/cdanet/)

ClaimResponse
identifier     identifier
request     status
patient
created
insurer
requestProvider	B01
requestOrganization
request	A02|G01
ruleset     outcome
originalRuleset     disposition
created     payeeType
organization     item
requestProvider         sequenceLinkId	B01 F07
requestOrganization         noteNumber
outcome         adjudication
disposition             category
payeeType             reason
item             amount
sequenceLinkId             value
detail
sequenceLinkId	F07
noteNumber             noteNumber
adjudication             adjudication
code             subDetail
amount                 sequenceLinkId	F07
noteNumber
value                 adjudication
detail     addItem
sequenceLinkId         sequenceLinkId
F07         revenue
adjudication         category
code         service
amount         modifier
value         fee
subDetail         noteNumber
sequenceLinkId         adjudication
F07         detail
adjudication             revenue
code             category
amount             service
value             modifier
addItem             fee
sequenceLinkId             noteNumber
service             adjudication
fee     error
noteNumberLinkId         sequenceLinkId
adjudication         detailSequenceLinkId
code         subdetailSequenceLinkId
amount         code
value     totalCost
detail     unallocDeductable
service     totalBenefit
fee     payment
adjudication         type
code         adjustment
amount         adjustmentReason
value         date
error         amount
sequenceLinkId         identifier
detailSequenceLinkId     reserved
subdetailSequenceLinkId     form	G42
processNote
code         number
totalCost         type
unallocDeductable         text	G32
language
totalBenefit     communicationRequest
paymentAdjustment     insurance
paymentAdjustmentReason         sequence
paymentDate         focal
paymentAmount         coverage
paymentRef         businessArrangement
reserved         preAuthRef	F03
claimResponse	EOB

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

ClaimResponse	Event
identifier	Event.identifier
status	Event.status
patient
form     created	G42 Event.occurrence
note     insurer	Event.performer.onBehalfOf
requestProvider
number     requestOrganization
type     request	Event.basedOn
outcome
text     disposition	G32 Event.note
coverage     payeeType
sequence     item
focal         sequenceLinkId
coverage         noteNumber
businessArrangement         adjudication
relationship             category
C03             reason
preAuthRef             amount
F03             value
claimResponse         detail
EOB             sequenceLinkId
originalRuleset             noteNumber
adjudication
subDetail
sequenceLinkId
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
type
adjustment
adjustmentReason
date
amount
identifier
reserved
form
processNote
number
type
text
language
communicationRequest
insurance
sequence
focal
coverage
businessArrangement
preAuthRef
claimResponse