This is the set of resources that conform to both RTPBC Response Using ClaimResponse (http://hl7.org/fhir/us/carin-rtpbc/StructureDefinition/rtpbc-response-claimresponse) and RTPBC Response Using ClaimResponse (http://hl7.org/fhir/us/carin-rtpbc/StructureDefinition/rtpbc-response-claimresponse).
Name Flags Card. Type Description & Constraints Filter: Bindings
ClaimResponse 0..* Response to a claim predetermination or preauthorization meta Σ 0..1 Meta Metadata about the resource implicitRules ?! Σ 0..1 uri A set of rules under which this content was created language 0..1 code Language of the resource contentBinding: ?? ( preferred ) : A human language. text 0..1 Narrative Text summary of the resource, for human interpretationThis profile does not constrain the narrative in regard to content, language, or traceability to data elements contained 0..* Resource Contained, inline Resources extension 0..* Extension Additional content defined by implementations modifierExtension ?! 0..* Extension Extensions that cannot be ignored identifier S 1..* Identifier RTPBC Response Identifier extension 0..* Extension Additional content defined by implementations use ?! Σ 0..1 code usual | official | temp | secondary | old (If known)Binding: ?? ( required ) : Identifies the purpose for this identifier, if known . type Σ 0..1 CodeableConcept Description of identifierBinding: ?? ( extensible ) : A coded type for an identifier that can be used to determine which identifier to use for a specific purpose. system Σ 0..1 uri The namespace for the identifier valueExample General: http://www.acme.com/identifiers/patient value S Σ 1..1 string Unique RTPBC response IDExample General: 123456 period Σ 0..1 Period Time period when id is/was valid for use assigner Σ 0..1 Reference (Organization )Organization that issued id (may be just text) status ?! S Σ 1..1 code Response statusBinding: ?? ( required ) : A code specifying the state of the resource instance. type S Σ 1..1 CodeableConcept Requested Service TypeBinding: ?? ( extensible ) : The type or discipline-style of the claim. extension 0..* Extension Additional content defined by implementations coding S Σ 1..1 Coding Code defined by a terminology system extension 0..* Extension Additional content defined by implementations system S Σ 1..1 uri Identity of the terminology system version Σ 0..1 string Version of the system - if relevant code S Σ 1..1 code Symbol in syntax defined by the system display S Σ 1..1 string Representation defined by the system userSelected Σ 0..1 boolean If this coding was chosen directly by the user text Σ 0..1 string Plain text representation of the concept subType 0..1 CodeableConcept More granular claim typeBinding: ?? ( example ) : A more granular claim typecode. use S Σ 1..1 code Processing ModeBinding: ?? ( required ) : Claim, preauthorization, predetermination. patient S Σ 1..1 Reference (RTPBC Patient | #sd-rtpbc-patient-rtpbc-patient )Response Patient Information created Σ 1..1 dateTime Response creation date insurer S Σ 1..1 Reference (Organization )Party responsible for reimbursement extension 0..* Extension Additional content defined by implementations reference Σ 0..1 string Literal reference, Relative, internal or absolute URL type Σ 0..1 uri Type the reference refers to (e.g. "Patient")Binding: ?? ( extensible ) : Aa resource (or, for logical models, the URI of the logical model). identifier S Σ 1..1 Identifier Logical reference, when literal reference is not known extension 0..* Extension Additional content defined by implementations use ?! Σ 0..1 code usual | official | temp | secondary | old (If known)Binding: ?? ( required ) : Identifies the purpose for this identifier, if known . type Σ 0..1 CodeableConcept Description of identifierBinding: ?? ( extensible ) : A coded type for an identifier that can be used to determine which identifier to use for a specific purpose. system Σ 0..1 uri The namespace for the identifier valueExample General: http://www.acme.com/identifiers/patient value S Σ 1..1 string Payer IDExample General: 123456 period Σ 0..1 Period Time period when id is/was valid for use assigner Σ 0..1 Reference (Organization )Organization that issued id (may be just text) display Σ 0..1 string Text alternative for the resource requestor 0..1 Reference (Practitioner | PractitionerRole | Organization )Party responsible for the claim request S Σ 1..1 Reference (Claim )Submitter's RTPBC Request ID extension 0..* Extension Additional content defined by implementations reference Σ 0..1 string Literal reference, Relative, internal or absolute URL type Σ 0..1 uri Type the reference refers to (e.g. "Patient")Binding: ?? ( extensible ) : Aa resource (or, for logical models, the URI of the logical model). identifier S Σ 1..1 Identifier Logical reference, when literal reference is not known extension 0..* Extension Additional content defined by implementations use ?! Σ 0..1 code usual | official | temp | secondary | old (If known)Binding: ?? ( required ) : Identifies the purpose for this identifier, if known . type Σ 0..1 CodeableConcept Description of identifierBinding: ?? ( extensible ) : A coded type for an identifier that can be used to determine which identifier to use for a specific purpose. system Σ 0..1 uri The namespace for the identifier valueExample General: http://www.acme.com/identifiers/patient value S Σ 1..1 string RTPBC Request IDExample General: 123456 period Σ 0..1 Period Time period when id is/was valid for use assigner Σ 0..1 Reference (Organization )Organization that issued id (may be just text) display Σ 0..1 string Text alternative for the resource outcome S Σ 1..1 code Processing OutcomeBinding: ?? ( required ) : The result of the claim processing. disposition S 0..1 string Completed Note preAuthRef 0..1 string Preauthorization reference preAuthPeriod 0..1 Period Preauthorization reference effective period payeeType 0..1 CodeableConcept Party to be paid any benefits payableBinding: ?? ( example ) : A code for the party to be reimbursed. item S 0..* BackboneElement Requested Product and Pharmacy extension 0..* Extension Extension modifierExtension ?! Σ 0..* Extension Extensions that cannot be ignored even if unrecognized itemSequence S 1..1 positiveInt Claim item instance identifier noteNumber S 0..* positiveInt Determination Note Number adjudication S 1..* BackboneElement Requested Product and Pharmacy Determination extension 0..* Extension Additional content defined by implementations modifierExtension ?! Σ 0..* Extension Extensions that cannot be ignored even if unrecognized category S 1..1 CodeableConcept Patient Pay ComponentBinding: ?? ( required ) : RTPBC Patient Pay Categories reason 0..1 CodeableConcept Explanation of adjudication outcomeBinding: ?? ( example ) : The adjudication reason codes. amount S 1..1 Money Patient Pay Component Amount extension 0..* Extension Additional content defined by implementations value S Σ 1..1 decimal Patient Pay Amount Value currency S Σ 1..1 code Patient Pay Amount CurrencyBinding: ?? ( required ) : Currencies value 0..1 decimal Non-monetary value detail 0..* BackboneElement Adjudication for claim details extension 0..* Extension Additional content defined by implementations modifierExtension ?! Σ 0..* Extension Extensions that cannot be ignored even if unrecognized detailSequence 1..1 positiveInt Claim detail instance identifier noteNumber 0..* positiveInt Applicable note numbers adjudication 1..* Detail level adjudication details extension 0..* Extension Additional content defined by implementations modifierExtension ?! Σ 0..* Extension Extensions that cannot be ignored even if unrecognized category S 1..1 CodeableConcept Patient Pay ComponentBinding: ?? ( required ) : RTPBC Patient Pay Categories reason 0..1 CodeableConcept Explanation of adjudication outcomeBinding: ?? ( example ) : The adjudication reason codes. amount S 1..1 Money Patient Pay Component Amount extension 0..* Extension Additional content defined by implementations value S Σ 1..1 decimal Patient Pay Amount Value currency S Σ 1..1 code Patient Pay Amount CurrencyBinding: ?? ( required ) : Currencies extension 0..* Extension Additional content defined by implementations value S Σ 1..1 decimal Patient Pay Amount Value currency S Σ 1..1 code Patient Pay Amount CurrencyBinding: ?? ( required ) : Currencies value S 1..1 decimal left: Non-monetary value; right: Patient Pay Amount Value subDetail 0..* BackboneElement Adjudication for claim sub-details extension 0..* Extension Additional content defined by implementations modifierExtension ?! Σ 0..* Extension Extensions that cannot be ignored even if unrecognized subDetailSequence 1..1 positiveInt Claim sub-detail instance identifier noteNumber 0..* positiveInt Applicable note numbers adjudication 0..* Subdetail level adjudication details extension 0..* Extension Additional content defined by implementations modifierExtension ?! Σ 0..* Extension Extensions that cannot be ignored even if unrecognized category S 1..1 CodeableConcept Patient Pay ComponentBinding: ?? ( required ) : RTPBC Patient Pay Categories reason 0..1 CodeableConcept Explanation of adjudication outcomeBinding: ?? ( example ) : The adjudication reason codes. amount S 1..1 Money Patient Pay Component Amount extension 0..* Extension Additional content defined by implementations value S Σ 1..1 decimal Patient Pay Amount Value currency S Σ 1..1 code Patient Pay Amount CurrencyBinding: ?? ( required ) : Currencies extension 0..* Extension Additional content defined by implementations value S Σ 1..1 decimal Patient Pay Amount Value currency S Σ 1..1 code Patient Pay Amount CurrencyBinding: ?? ( required ) : Currencies value S 1..1 decimal left: Non-monetary value; right: Patient Pay Amount Value addItem S 0..* BackboneElement Insurer added line items extension 1..* Extension Extension modifierExtension ?! Σ 0..* Extension Extensions that cannot be ignored even if unrecognized itemSequence S 1..* positiveInt Associated request Item Sequence detailSequence 0..* positiveInt Detail sequence number subdetailSequence 0..* positiveInt Subdetail sequence number provider S 1..* Reference (RTPBC Pharmacy Organization | #sd-rtpbc-pharmacy-organization-rtpbc-pharmacy-organization )Priced Pharmacy extension 0..* Extension Additional content defined by implementations reference S Σ 1..1 string Reference to Priced Pharmacy type Σ 0..1 uri Type the reference refers to (e.g. "Patient")Binding: ?? ( extensible ) : Aa resource (or, for logical models, the URI of the logical model). identifier Σ 0..1 Identifier Logical reference, when literal reference is not known display Σ 0..1 string Text alternative for the resource productOrService S 1..1 CodeableConcept ProductBinding: ?? ( extensible ) : RTPBC prescribable product codes (NDC11 and RxNorm) extension 0..* Extension Additional content defined by implementations coding S Σ 1..* Coding Code defined by a terminology system extension 0..* Extension Additional content defined by implementations system S Σ 1..1 uri Identity of the terminology system version Σ 0..1 string Version of the system - if relevant code S Σ 1..1 code Symbol in syntax defined by the system display S Σ 1..1 string Product Description userSelected Σ 0..1 boolean If this coding was chosen directly by the user text Σ 0..1 string Plain text representation of the concept modifier 0..* CodeableConcept Service/Product billing modifiersBinding: ?? ( example ) : Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen. programCode 0..* CodeableConcept Program the product or service is provided underBinding: ?? ( example ) : Program specific reason codes. serviced[x] 0..1 Date or dates of service or product delivery servicedDate date servicedPeriod Period location[x] 0..1 Place of service or where product was suppliedBinding: ?? ( example ) : Place of service: pharmacy, school, prison, etc. locationCodeableConcept CodeableConcept locationAddress Address Reference (Location )quantity S 1..1 ?? , ?? Priced Quantity extension 0..* Extension Additional content defined by implementations value S Σ 1..1 decimal Quantity in Billing Units unit S Σ 1..1 string Billing unit of measureBinding: ?? ( extensible ) : Billing quantity unit of measure system Σ 0..1 uri System that defines coded unit form code Σ 0..1 code Coded form of the unit unitPrice 0..1 Money Fee, charge or cost per item factor 0..1 decimal Price scaling factor net 0..1 Money Total item cost bodySite 0..1 CodeableConcept Anatomical locationBinding: ?? ( example ) : The code for the teeth, quadrant, sextant and arch. subSite 0..* CodeableConcept Anatomical sub-locationBinding: ?? ( example ) : The code for the tooth surface and surface combinations. noteNumber S 0..* positiveInt Determination Note Number adjudication S 1..* BackboneElement Alternative Product and Pharmacy Determination extension 0..* Extension Additional content defined by implementations modifierExtension ?! Σ 0..* Extension Extensions that cannot be ignored even if unrecognized category S 1..1 CodeableConcept Patient Pay ComponentBinding: ?? ( required ) : RTPBC Patient Pay Categories reason 0..1 CodeableConcept Explanation of adjudication outcomeBinding: ?? ( example ) : The adjudication reason codes. amount S 1..1 Money Patient Pay Component Amount extension 0..* Extension Additional content defined by implementations value S Σ 1..1 decimal Patient Pay Amount Value currency S Σ 1..1 code Patient Pay Amount CurrencyBinding: ?? ( required ) : Currencies value 0..1 decimal Non-monetary value detail 0..* BackboneElement Insurer added line details extension 0..* Extension Additional content defined by implementations modifierExtension ?! Σ 0..* Extension Extensions that cannot be ignored even if unrecognized productOrService 1..1 CodeableConcept Billing, service, product, or drug codeBinding: ?? ( example ) : Allowable service and product codes. modifier 0..* CodeableConcept Service/Product billing modifiersBinding: ?? ( example ) : Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen. quantity 0..1 ?? , ?? Count of products or services unitPrice 0..1 Money Fee, charge or cost per item factor 0..1 decimal Price scaling factor net 0..1 Money Total item cost noteNumber 0..* positiveInt Applicable note numbers adjudication 1..* Added items detail adjudication extension 0..* Extension Additional content defined by implementations modifierExtension ?! Σ 0..* Extension Extensions that cannot be ignored even if unrecognized category S 1..1 CodeableConcept Patient Pay ComponentBinding: ?? ( required ) : RTPBC Patient Pay Categories reason 0..1 CodeableConcept Explanation of adjudication outcomeBinding: ?? ( example ) : The adjudication reason codes. amount S 1..1 Money Patient Pay Component Amount extension 0..* Extension Additional content defined by implementations value S Σ 1..1 decimal Patient Pay Amount Value currency S Σ 1..1 code Patient Pay Amount CurrencyBinding: ?? ( required ) : Currencies extension 0..* Extension Additional content defined by implementations value S Σ 1..1 decimal Patient Pay Amount Value currency S Σ 1..1 code Patient Pay Amount CurrencyBinding: ?? ( required ) : Currencies value S 1..1 decimal left: Non-monetary value; right: Patient Pay Amount Value subDetail 0..* BackboneElement Insurer added line items extension 0..* Extension Additional content defined by implementations modifierExtension ?! Σ 0..* Extension Extensions that cannot be ignored even if unrecognized productOrService 1..1 CodeableConcept Billing, service, product, or drug codeBinding: ?? ( example ) : Allowable service and product codes. modifier 0..* CodeableConcept Service/Product billing modifiersBinding: ?? ( example ) : Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen. quantity 0..1 ?? , ?? Count of products or services unitPrice 0..1 Money Fee, charge or cost per item factor 0..1 decimal Price scaling factor net 0..1 Money Total item cost noteNumber 0..* positiveInt Applicable note numbers adjudication 1..* Added items detail adjudication extension 0..* Extension Additional content defined by implementations modifierExtension ?! Σ 0..* Extension Extensions that cannot be ignored even if unrecognized category S 1..1 CodeableConcept Patient Pay ComponentBinding: ?? ( required ) : RTPBC Patient Pay Categories reason 0..1 CodeableConcept Explanation of adjudication outcomeBinding: ?? ( example ) : The adjudication reason codes. amount S 1..1 Money Patient Pay Component Amount extension 0..* Extension Additional content defined by implementations value S Σ 1..1 decimal Patient Pay Amount Value currency S Σ 1..1 code Patient Pay Amount CurrencyBinding: ?? ( required ) : Currencies extension 0..* Extension Additional content defined by implementations value S Σ 1..1 decimal Patient Pay Amount Value currency S Σ 1..1 code Patient Pay Amount CurrencyBinding: ?? ( required ) : Currencies value S 1..1 decimal left: Non-monetary value; right: Patient Pay Amount Value adjudication 0..* Header-level adjudication extension 0..* Extension Additional content defined by implementations modifierExtension ?! Σ 0..* Extension Extensions that cannot be ignored even if unrecognized category S 1..1 CodeableConcept Patient Pay ComponentBinding: ?? ( required ) : RTPBC Patient Pay Categories reason 0..1 CodeableConcept Explanation of adjudication outcomeBinding: ?? ( example ) : The adjudication reason codes. amount S 1..1 Money Patient Pay Component Amount extension 0..* Extension Additional content defined by implementations value S Σ 1..1 decimal Patient Pay Amount Value currency S Σ 1..1 code Patient Pay Amount CurrencyBinding: ?? ( required ) : Currencies extension 0..* Extension Additional content defined by implementations value S Σ 1..1 decimal Patient Pay Amount Value currency S Σ 1..1 code Patient Pay Amount CurrencyBinding: ?? ( required ) : Currencies value S 1..1 decimal left: Non-monetary value; right: Patient Pay Amount Value total Σ 0..* BackboneElement Adjudication totals extension 0..* Extension Additional content defined by implementations modifierExtension ?! Σ 0..* Extension Extensions that cannot be ignored even if unrecognized category Σ 1..1 CodeableConcept Type of adjudication informationBinding: ?? ( example ) : The adjudication codes. amount Σ 1..1 Money Financial total for the category payment 0..1 BackboneElement Payment Details extension 0..* Extension Additional content defined by implementations modifierExtension ?! Σ 0..* Extension Extensions that cannot be ignored even if unrecognized type 1..1 CodeableConcept Partial or complete paymentBinding: ?? ( example ) : The type (partial, complete) of the payment. adjustment 0..1 Money Payment adjustment for non-claim issues adjustmentReason 0..1 CodeableConcept Explanation for the adjustmentBinding: ?? ( example ) : Payment Adjustment reason codes. date 0..1 date Expected date of payment amount 1..1 Money Payable amount after adjustment identifier 0..1 Identifier Business identifier for the payment fundsReserve 0..1 CodeableConcept Funds reserved statusBinding: ?? ( example ) : For whom funds are to be reserved: (Patient, Provider, None). formCode 0..1 CodeableConcept Printed form identifierBinding: ?? ( example ) : The forms codes. form 0..1 Attachment Printed reference or actual form processNote S 0..* BackboneElement Determination Note extension 0..* Extension Additional content defined by implementations modifierExtension ?! Σ 0..* Extension Extensions that cannot be ignored even if unrecognized number S 1..1 positiveInt Determination Note Number type 0..1 code display | print | printoperBinding: ?? ( required ) : The presentation types of notes. text S 1..1 string Determination Note Text language 0..1 CodeableConcept Language of the textBinding: ?? ( preferred ) : A human language. communicationRequest 0..* Reference (CommunicationRequest )Request for additional information insurance 0..* BackboneElement Patient insurance information extension 0..* Extension Additional content defined by implementations modifierExtension ?! Σ 0..* Extension Extensions that cannot be ignored even if unrecognized sequence 1..1 positiveInt Insurance instance identifier focal 1..1 boolean Coverage to be used for adjudication coverage 1..1 Reference (Coverage )Insurance information businessArrangement 0..1 string Additional provider contract number claimResponse 0..1 Reference (ClaimResponse )Adjudication results error S 0..* BackboneElement Error Information extension 0..* Extension Additional content defined by implementations modifierExtension ?! Σ 0..* Extension Extensions that cannot be ignored even if unrecognized itemSequence 0..1 positiveInt Item sequence number detailSequence 0..1 positiveInt Detail sequence number subDetailSequence 0..1 positiveInt Subdetail sequence number code S 1..1 CodeableConcept Reject ReasonBinding: ?? ( preferred ) : RTPBC Error Codes extension 0..* Extension Additional content defined by implementations coding S Σ 1..* Coding Code defined by a terminology system extension 0..* Extension Additional content defined by implementations system S Σ 1..1 uri Identity of the terminology system version Σ 0..1 string Version of the system - if relevant code S Σ 1..1 code Reject Code display S Σ 1..1 string Representation defined by the system userSelected Σ 0..1 boolean If this coding was chosen directly by the user text S Σ 0..1 string Reject Message
ClaimResponse 
meta 
implicitRules 
contained 
extension 
modifierExtension 
assigner 
serviced[x]