## 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

Name | Flags | Card. | Type | Description & Constraints Filter: Bindings Constraints Obligations
--- | --- | --- | --- | ---
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 content Binding: ?? (preferred): A human language.
text |  | 0..1 | Narrative | Text 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..* | 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 identifier Binding: ?? (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 value Example General: http://www.acme.com/identifiers/patient
value | S Σ | 1..1 | string | Unique RTPBC response ID Example 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 status Binding: ?? (required): A code specifying the state of the resource instance.
type | S Σ | 1..1 | CodeableConcept | Requested Service Type Binding: ?? (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 type Binding: ?? (example): A more granular claim typecode.
use | S Σ | 1..1 | code | Processing Mode Binding: ?? (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 identifier Binding: ?? (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 value Example General: http://www.acme.com/identifiers/patient
value | S Σ | 1..1 | string | Payer ID Example 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 identifier Binding: ?? (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 value Example General: http://www.acme.com/identifiers/patient
value | S Σ | 1..1 | string | RTPBC Request ID Example 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 Outcome Binding: ?? (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 payable Binding: ?? (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 Component Binding: ?? (required): RTPBC Patient Pay Categories
reason |  | 0..1 | CodeableConcept | Explanation of adjudication outcome Binding: ?? (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 Currency Binding: ?? (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 Component Binding: ?? (required): RTPBC Patient Pay Categories
reason |  | 0..1 | CodeableConcept | Explanation of adjudication outcome Binding: ?? (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 Currency Binding: ?? (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 Currency Binding: ?? (required): Currencies
value | S | 0..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 Component Binding: ?? (required): RTPBC Patient Pay Categories
reason |  | 0..1 | CodeableConcept | Explanation of adjudication outcome Binding: ?? (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 Currency Binding: ?? (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 Currency Binding: ?? (required): Currencies
value | S | 0..1 | decimal | left: Non-monetary value; right: Patient Pay Amount Value
addItem | S | 0..* | BackboneElement | Insurer added line items
extension |  | 0..* | 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 | Product Binding: ?? (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 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..* | CodeableConcept | Program the product or service is provided under Binding: ?? (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 supplied Binding: ?? (example): Place of service: pharmacy, school, prison, etc.
locationCodeableConcept |  |  | CodeableConcept |
locationAddress |  |  | Address |
locationReference |  |  | 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 measure Binding: ?? (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 location Binding: ?? (example): The code for the teeth, quadrant, sextant and arch.
subSite |  | 0..* | CodeableConcept | Anatomical sub-location Binding: ?? (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 Component Binding: ?? (required): RTPBC Patient Pay Categories
reason |  | 0..1 | CodeableConcept | Explanation of adjudication outcome Binding: ?? (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 Currency Binding: ?? (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 code Binding: ?? (example): Allowable service and product codes.
modifier |  | 0..* | CodeableConcept | Service/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..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 Component Binding: ?? (required): RTPBC Patient Pay Categories
reason |  | 0..1 | CodeableConcept | Explanation of adjudication outcome Binding: ?? (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 Currency Binding: ?? (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 Currency Binding: ?? (required): Currencies
value | S | 0..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 code Binding: ?? (example): Allowable service and product codes.
modifier |  | 0..* | CodeableConcept | Service/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..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 Component Binding: ?? (required): RTPBC Patient Pay Categories
reason |  | 0..1 | CodeableConcept | Explanation of adjudication outcome Binding: ?? (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 Currency Binding: ?? (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 Currency Binding: ?? (required): Currencies
value | S | 0..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 Component Binding: ?? (required): RTPBC Patient Pay Categories
reason |  | 0..1 | CodeableConcept | Explanation of adjudication outcome Binding: ?? (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 Currency Binding: ?? (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 Currency Binding: ?? (required): Currencies
value | S | 0..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 information Binding: ?? (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 payment Binding: ?? (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 adjustment Binding: ?? (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 status Binding: ?? (example): For whom funds are to be reserved: (Patient, Provider, None).
formCode |  | 0..1 | CodeableConcept | Printed form identifier Binding: ?? (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 | printoper Binding: ?? (required): The presentation types of notes.
text | S | 1..1 | string | Determination Note Text
language |  | 0..1 | CodeableConcept | Language of the text Binding: ?? (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 Reason Binding: ?? (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
Documentation for this format