Union of http://hl7.org/fhir/us/carin-rtpbc/StructureDefinition/rtpbc-response-claimresponse and http://hl7.org/fhir/us/carin-rtpbc/StructureDefinition/rtpbc-response-claimresponse

This is the set of resources that conform to either of the profiles 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). E.g. what you have to deal with if you get resources conforming to one of them

Structure

NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
.. ClaimResponse 0..*Response to a claim predetermination or preauthorization
... meta Σ0..1MetaMetadata about the resource
... implicitRules ?!Σ0..1uriA set of rules under which this content was created
... language 0..1codeLanguage of the resource content
Binding: ?? (preferred): A human language.
... text 0..1NarrativeText summary of the resource, for human interpretation
This profile does not constrain the narrative in regard to content, language, or traceability to data elements
... contained 0..*ResourceContained, inline Resources
... extension 0..*ExtensionAdditional content defined by implementations
... modifierExtension ?!0..*ExtensionExtensions that cannot be ignored
... identifier S1..*IdentifierRTPBC Response Identifier
.... extension 0..*ExtensionAdditional content defined by implementations
.... use ?!Σ0..1codeusual | official | temp | secondary | old (If known)
Binding: ?? (required): Identifies the purpose for this identifier, if known .
.... type Σ0..1CodeableConceptDescription of identifier
Binding: ?? (extensible): A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.
.... system Σ0..1uriThe namespace for the identifier value
Example General: http://www.acme.com/identifiers/patient
.... value SΣ1..1stringUnique RTPBC response ID
Example General: 123456
.... period Σ0..1PeriodTime period when id is/was valid for use
.... assigner Σ0..1Reference(Organization)Organization that issued id (may be just text)
... status ?!SΣ1..1codeResponse status
Binding: ?? (required): A code specifying the state of the resource instance.
... type SΣ1..1CodeableConceptRequested Service Type
Binding: ?? (extensible): The type or discipline-style of the claim.
.... extension 0..*ExtensionAdditional content defined by implementations
.... coding SΣ1..1CodingCode defined by a terminology system
..... extension 0..*ExtensionAdditional content defined by implementations
..... system SΣ1..1uriIdentity of the terminology system
..... version Σ0..1stringVersion of the system - if relevant
..... code SΣ1..1codeSymbol in syntax defined by the system
..... display SΣ1..1stringRepresentation defined by the system
..... userSelected Σ0..1booleanIf this coding was chosen directly by the user
.... text Σ0..1stringPlain text representation of the concept
... subType 0..1CodeableConceptMore granular claim type
Binding: ?? (example): A more granular claim typecode.
... use SΣ1..1codeProcessing Mode
Binding: ?? (required): Claim, preauthorization, predetermination.
... patient SΣ1..1Reference(RTPBC Patient | #sd-rtpbc-patient-rtpbc-patient)Response Patient Information
... created Σ1..1dateTimeResponse creation date
... insurer SΣ1..1Reference(Organization)Party responsible for reimbursement
.... extension 0..*ExtensionAdditional content defined by implementations
.... reference Σ0..1stringLiteral reference, Relative, internal or absolute URL
.... type Σ0..1uriType the reference refers to (e.g. "Patient")
Binding: ?? (extensible): Aa resource (or, for logical models, the URI of the logical model).
.... identifier SΣ1..1IdentifierLogical reference, when literal reference is not known
..... extension 0..*ExtensionAdditional content defined by implementations
..... use ?!Σ0..1codeusual | official | temp | secondary | old (If known)
Binding: ?? (required): Identifies the purpose for this identifier, if known .
..... type Σ0..1CodeableConceptDescription of identifier
Binding: ?? (extensible): A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.
..... system Σ0..1uriThe namespace for the identifier value
Example General: http://www.acme.com/identifiers/patient
..... value SΣ1..1stringPayer ID
Example General: 123456
..... period Σ0..1PeriodTime period when id is/was valid for use
..... assigner Σ0..1Reference(Organization)Organization that issued id (may be just text)
.... display Σ0..1stringText alternative for the resource
... requestor 0..1Reference(Practitioner | PractitionerRole | Organization)Party responsible for the claim
... request SΣ1..1Reference(Claim)Submitter's RTPBC Request ID
.... extension 0..*ExtensionAdditional content defined by implementations
.... reference Σ0..1stringLiteral reference, Relative, internal or absolute URL
.... type Σ0..1uriType the reference refers to (e.g. "Patient")
Binding: ?? (extensible): Aa resource (or, for logical models, the URI of the logical model).
.... identifier SΣ1..1IdentifierLogical reference, when literal reference is not known
..... extension 0..*ExtensionAdditional content defined by implementations
..... use ?!Σ0..1codeusual | official | temp | secondary | old (If known)
Binding: ?? (required): Identifies the purpose for this identifier, if known .
..... type Σ0..1CodeableConceptDescription of identifier
Binding: ?? (extensible): A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.
..... system Σ0..1uriThe namespace for the identifier value
Example General: http://www.acme.com/identifiers/patient
..... value SΣ1..1stringRTPBC Request ID
Example General: 123456
..... period Σ0..1PeriodTime period when id is/was valid for use
..... assigner Σ0..1Reference(Organization)Organization that issued id (may be just text)
.... display Σ0..1stringText alternative for the resource
... outcome SΣ1..1codeProcessing Outcome
Binding: ?? (required): The result of the claim processing.
... disposition S0..1stringCompleted Note
... preAuthRef 0..1stringPreauthorization reference
... preAuthPeriod 0..1PeriodPreauthorization reference effective period
... payeeType 0..1CodeableConceptParty to be paid any benefits payable
Binding: ?? (example): A code for the party to be reimbursed.
... item S0..*BackboneElementRequested Product and Pharmacy
.... extension 0..*ExtensionExtension
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
.... itemSequence S1..1positiveIntClaim item instance identifier
.... noteNumber S0..*positiveIntDetermination Note Number
.... adjudication S1..*BackboneElementRequested Product and Pharmacy Determination
..... extension 0..*ExtensionAdditional content defined by implementations
..... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
..... category S1..1CodeableConceptPatient Pay Component
Binding: ?? (required): RTPBC Patient Pay Categories
..... reason 0..1CodeableConceptExplanation of adjudication outcome
Binding: ?? (example): The adjudication reason codes.
..... amount S1..1MoneyPatient Pay Component Amount
...... extension 0..*ExtensionAdditional content defined by implementations
...... value SΣ1..1decimalPatient Pay Amount Value
...... currency SΣ1..1codePatient Pay Amount Currency
Binding: ?? (required): Currencies
..... value 0..1decimalNon-monetary value
.... detail 0..*BackboneElementAdjudication for claim details
..... extension 0..*ExtensionAdditional content defined by implementations
..... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
..... detailSequence 1..1positiveIntClaim detail instance identifier
..... noteNumber 0..*positiveIntApplicable note numbers
..... adjudication 1..*Detail level adjudication details
...... extension 0..*ExtensionAdditional content defined by implementations
...... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
...... category S1..1CodeableConceptPatient Pay Component
Binding: ?? (required): RTPBC Patient Pay Categories
...... reason 0..1CodeableConceptExplanation of adjudication outcome
Binding: ?? (example): The adjudication reason codes.
...... amount S1..1MoneyPatient Pay Component Amount
....... extension 0..*ExtensionAdditional content defined by implementations
....... value SΣ1..1decimalPatient Pay Amount Value
....... currency SΣ1..1codePatient Pay Amount Currency
Binding: ?? (required): Currencies
...... extension 0..*ExtensionAdditional content defined by implementations
...... value SΣ1..1decimalPatient Pay Amount Value
...... currency SΣ1..1codePatient Pay Amount Currency
Binding: ?? (required): Currencies
...... value S0..1decimalleft: Non-monetary value; right: Patient Pay Amount Value
..... subDetail 0..*BackboneElementAdjudication for claim sub-details
...... extension 0..*ExtensionAdditional content defined by implementations
...... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
...... subDetailSequence 1..1positiveIntClaim sub-detail instance identifier
...... noteNumber 0..*positiveIntApplicable note numbers
...... adjudication 0..*Subdetail level adjudication details
....... extension 0..*ExtensionAdditional content defined by implementations
....... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
....... category S1..1CodeableConceptPatient Pay Component
Binding: ?? (required): RTPBC Patient Pay Categories
....... reason 0..1CodeableConceptExplanation of adjudication outcome
Binding: ?? (example): The adjudication reason codes.
....... amount S1..1MoneyPatient Pay Component Amount
........ extension 0..*ExtensionAdditional content defined by implementations
........ value SΣ1..1decimalPatient Pay Amount Value
........ currency SΣ1..1codePatient Pay Amount Currency
Binding: ?? (required): Currencies
....... extension 0..*ExtensionAdditional content defined by implementations
....... value SΣ1..1decimalPatient Pay Amount Value
....... currency SΣ1..1codePatient Pay Amount Currency
Binding: ?? (required): Currencies
....... value S0..1decimalleft: Non-monetary value; right: Patient Pay Amount Value
... addItem S0..*BackboneElementInsurer added line items
.... extension 0..*ExtensionExtension
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
.... itemSequence S1..*positiveIntAssociated request Item Sequence
.... detailSequence 0..*positiveIntDetail sequence number
.... subdetailSequence 0..*positiveIntSubdetail sequence number
.... provider S1..*Reference(RTPBC Pharmacy Organization | #sd-rtpbc-pharmacy-organization-rtpbc-pharmacy-organization)Priced Pharmacy
..... extension 0..*ExtensionAdditional content defined by implementations
..... reference SΣ1..1stringReference to Priced Pharmacy
..... type Σ0..1uriType the reference refers to (e.g. "Patient")
Binding: ?? (extensible): Aa resource (or, for logical models, the URI of the logical model).
..... identifier Σ0..1IdentifierLogical reference, when literal reference is not known
..... display Σ0..1stringText alternative for the resource
.... productOrService S1..1CodeableConceptProduct
Binding: ?? (extensible): RTPBC prescribable product codes (NDC11 and RxNorm)
..... extension 0..*ExtensionAdditional content defined by implementations
..... coding SΣ1..*CodingCode defined by a terminology system
...... extension 0..*ExtensionAdditional content defined by implementations
...... system SΣ1..1uriIdentity of the terminology system
...... version Σ0..1stringVersion of the system - if relevant
...... code SΣ1..1codeSymbol in syntax defined by the system
...... display SΣ1..1stringProduct Description
...... userSelected Σ0..1booleanIf this coding was chosen directly by the user
..... text Σ0..1stringPlain text representation of the concept
.... modifier 0..*CodeableConceptService/Product billing modifiers
Binding: ?? (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..*CodeableConceptProgram the product or service is provided under
Binding: ?? (example): Program specific reason codes.
.... serviced[x] 0..1Date or dates of service or product delivery
..... servicedDatedate
..... servicedPeriodPeriod
.... location[x] 0..1Place of service or where product was supplied
Binding: ?? (example): Place of service: pharmacy, school, prison, etc.
..... locationCodeableConceptCodeableConcept
..... locationAddressAddress
..... locationReferenceReference(Location)
.... quantity S1..1??Priced Quantity
..... extension 0..*ExtensionAdditional content defined by implementations
..... value SΣ1..1decimalQuantity in Billing Units
..... unit SΣ1..1stringBilling unit of measure
Binding: ?? (extensible): Billing quantity unit of measure
..... system Σ0..1uriSystem that defines coded unit form
..... code Σ0..1codeCoded form of the unit
.... unitPrice 0..1MoneyFee, charge or cost per item
.... factor 0..1decimalPrice scaling factor
.... net 0..1MoneyTotal item cost
.... bodySite 0..1CodeableConceptAnatomical location
Binding: ?? (example): The code for the teeth, quadrant, sextant and arch.
.... subSite 0..*CodeableConceptAnatomical sub-location
Binding: ?? (example): The code for the tooth surface and surface combinations.
.... noteNumber S0..*positiveIntDetermination Note Number
.... adjudication S1..*BackboneElementAlternative Product and Pharmacy Determination
..... extension 0..*ExtensionAdditional content defined by implementations
..... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
..... category S1..1CodeableConceptPatient Pay Component
Binding: ?? (required): RTPBC Patient Pay Categories
..... reason 0..1CodeableConceptExplanation of adjudication outcome
Binding: ?? (example): The adjudication reason codes.
..... amount S1..1MoneyPatient Pay Component Amount
...... extension 0..*ExtensionAdditional content defined by implementations
...... value SΣ1..1decimalPatient Pay Amount Value
...... currency SΣ1..1codePatient Pay Amount Currency
Binding: ?? (required): Currencies
..... value 0..1decimalNon-monetary value
.... detail 0..*BackboneElementInsurer added line details
..... extension 0..*ExtensionAdditional content defined by implementations
..... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
..... productOrService 1..1CodeableConceptBilling, service, product, or drug code
Binding: ?? (example): Allowable service and product codes.
..... modifier 0..*CodeableConceptService/Product billing modifiers
Binding: ?? (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..1MoneyFee, charge or cost per item
..... factor 0..1decimalPrice scaling factor
..... net 0..1MoneyTotal item cost
..... noteNumber 0..*positiveIntApplicable note numbers
..... adjudication 1..*Added items detail adjudication
...... extension 0..*ExtensionAdditional content defined by implementations
...... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
...... category S1..1CodeableConceptPatient Pay Component
Binding: ?? (required): RTPBC Patient Pay Categories
...... reason 0..1CodeableConceptExplanation of adjudication outcome
Binding: ?? (example): The adjudication reason codes.
...... amount S1..1MoneyPatient Pay Component Amount
....... extension 0..*ExtensionAdditional content defined by implementations
....... value SΣ1..1decimalPatient Pay Amount Value
....... currency SΣ1..1codePatient Pay Amount Currency
Binding: ?? (required): Currencies
...... extension 0..*ExtensionAdditional content defined by implementations
...... value SΣ1..1decimalPatient Pay Amount Value
...... currency SΣ1..1codePatient Pay Amount Currency
Binding: ?? (required): Currencies
...... value S0..1decimalleft: Non-monetary value; right: Patient Pay Amount Value
..... subDetail 0..*BackboneElementInsurer added line items
...... extension 0..*ExtensionAdditional content defined by implementations
...... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
...... productOrService 1..1CodeableConceptBilling, service, product, or drug code
Binding: ?? (example): Allowable service and product codes.
...... modifier 0..*CodeableConceptService/Product billing modifiers
Binding: ?? (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..1MoneyFee, charge or cost per item
...... factor 0..1decimalPrice scaling factor
...... net 0..1MoneyTotal item cost
...... noteNumber 0..*positiveIntApplicable note numbers
...... adjudication 1..*Added items detail adjudication
....... extension 0..*ExtensionAdditional content defined by implementations
....... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
....... category S1..1CodeableConceptPatient Pay Component
Binding: ?? (required): RTPBC Patient Pay Categories
....... reason 0..1CodeableConceptExplanation of adjudication outcome
Binding: ?? (example): The adjudication reason codes.
....... amount S1..1MoneyPatient Pay Component Amount
........ extension 0..*ExtensionAdditional content defined by implementations
........ value SΣ1..1decimalPatient Pay Amount Value
........ currency SΣ1..1codePatient Pay Amount Currency
Binding: ?? (required): Currencies
....... extension 0..*ExtensionAdditional content defined by implementations
....... value SΣ1..1decimalPatient Pay Amount Value
....... currency SΣ1..1codePatient Pay Amount Currency
Binding: ?? (required): Currencies
....... value S0..1decimalleft: Non-monetary value; right: Patient Pay Amount Value
... adjudication 0..*Header-level adjudication
.... extension 0..*ExtensionAdditional content defined by implementations
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
.... category S1..1CodeableConceptPatient Pay Component
Binding: ?? (required): RTPBC Patient Pay Categories
.... reason 0..1CodeableConceptExplanation of adjudication outcome
Binding: ?? (example): The adjudication reason codes.
.... amount S1..1MoneyPatient Pay Component Amount
..... extension 0..*ExtensionAdditional content defined by implementations
..... value SΣ1..1decimalPatient Pay Amount Value
..... currency SΣ1..1codePatient Pay Amount Currency
Binding: ?? (required): Currencies
.... extension 0..*ExtensionAdditional content defined by implementations
.... value SΣ1..1decimalPatient Pay Amount Value
.... currency SΣ1..1codePatient Pay Amount Currency
Binding: ?? (required): Currencies
.... value S0..1decimalleft: Non-monetary value; right: Patient Pay Amount Value
... total Σ0..*BackboneElementAdjudication totals
.... extension 0..*ExtensionAdditional content defined by implementations
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
.... category Σ1..1CodeableConceptType of adjudication information
Binding: ?? (example): The adjudication codes.
.... amount Σ1..1MoneyFinancial total for the category
... payment 0..1BackboneElementPayment Details
.... extension 0..*ExtensionAdditional content defined by implementations
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
.... type 1..1CodeableConceptPartial or complete payment
Binding: ?? (example): The type (partial, complete) of the payment.
.... adjustment 0..1MoneyPayment adjustment for non-claim issues
.... adjustmentReason 0..1CodeableConceptExplanation for the adjustment
Binding: ?? (example): Payment Adjustment reason codes.
.... date 0..1dateExpected date of payment
.... amount 1..1MoneyPayable amount after adjustment
.... identifier 0..1IdentifierBusiness identifier for the payment
... fundsReserve 0..1CodeableConceptFunds reserved status
Binding: ?? (example): For whom funds are to be reserved: (Patient, Provider, None).
... formCode 0..1CodeableConceptPrinted form identifier
Binding: ?? (example): The forms codes.
... form 0..1AttachmentPrinted reference or actual form
... processNote S0..*BackboneElementDetermination Note
.... extension 0..*ExtensionAdditional content defined by implementations
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
.... number S1..1positiveIntDetermination Note Number
.... type 0..1codedisplay | print | printoper
Binding: ?? (required): The presentation types of notes.
.... text S1..1stringDetermination Note Text
.... language 0..1CodeableConceptLanguage of the text
Binding: ?? (preferred): A human language.
... communicationRequest 0..*Reference(CommunicationRequest)Request for additional information
... insurance 0..*BackboneElementPatient insurance information
.... extension 0..*ExtensionAdditional content defined by implementations
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
.... sequence 1..1positiveIntInsurance instance identifier
.... focal 1..1booleanCoverage to be used for adjudication
.... coverage 1..1Reference(Coverage)Insurance information
.... businessArrangement 0..1stringAdditional provider contract number
.... claimResponse 0..1Reference(ClaimResponse)Adjudication results
... error S0..*BackboneElementError Information
.... extension 0..*ExtensionAdditional content defined by implementations
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
.... itemSequence 0..1positiveIntItem sequence number
.... detailSequence 0..1positiveIntDetail sequence number
.... subDetailSequence 0..1positiveIntSubdetail sequence number
.... code S1..1CodeableConceptReject Reason
Binding: ?? (preferred): RTPBC Error Codes
..... extension 0..*ExtensionAdditional content defined by implementations
..... coding SΣ1..*CodingCode defined by a terminology system
...... extension 0..*ExtensionAdditional content defined by implementations
...... system SΣ1..1uriIdentity of the terminology system
...... version Σ0..1stringVersion of the system - if relevant
...... code SΣ1..1codeReject Code
...... display SΣ1..1stringRepresentation defined by the system
...... userSelected Σ0..1booleanIf this coding was chosen directly by the user
..... text SΣ0..1stringReject Message

doco Documentation for this format