Intersection of http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-claiminquiryresponse and http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-claiminquiryresponse

This is the set of resources that conform to both PAS Claim Inquiry Response (http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-claiminquiryresponse) and PAS Claim Inquiry Response (http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-claiminquiryresponse).

Structure

NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
.. ClaimResponse 0..*Response to a preauthorization query
... 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.
Additional BindingsPurpose
??Max Binding
... 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..*Extensionleft: Additional content defined by implementations; right: Extension
... modifierExtension ?!0..*ExtensionExtensions that cannot be ignored
... identifier S0..*??, ??left: An identifier intended for computation; right: Business Identifier for a claim response
.... 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 SΣ1..1uriShould use a scheme of 'urn:trnorg:<TRN03>'
Example General: http://www.acme.com/identifiers/patient
.... value SΣ1..1stringThe value that is unique
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..1codeactive | cancelled | draft | entered-in-error
Binding: ?? (required): A code specifying the state of the resource instance.
... type Σ1..1CodeableConceptMore granular claim type
Binding: ?? (extensible): The type or discipline-style of the claim.
... subType 0..1CodeableConceptMore granular claim type
Binding: ?? (example): A more granular claim typecode.
... use Σ1..1codeclaim | preauthorization | predetermination
Binding: ?? (required): Claim, preauthorization, predetermination.
... patient SΣ1..1Reference(PAS Beneficiary Patient | #sd-profile-beneficiary-profile-beneficiary)The recipient of the products and services
... created SΣ1..1dateTimeResponse creation date
... insurer SΣ1..1Reference(PAS Insurer Organization | #sd-profile-insurer-profile-insurer)Party responsible for reimbursement
... requestor S0..1Reference(PAS Requestor Organization | PAS PractitionerRole | #sd-profile-requestor-profile-requestor)Party responsible for the claim
... request SΣ1..1Id of resource triggering adjudication
... outcome SΣ1..1codeleft: queued | complete | error | partial; right: complete | error | partial
Binding: ?? (required): The result of the claim processing.
... disposition 0..1stringDisposition Message
... preAuthRef 0..1stringPreauthorization reference
... preAuthPeriod S0..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..*BackboneElementAdjudication for claim line items
.... extension 0..*ExtensionExtension
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
.... itemSequence S1..1positiveIntleft: Claim item instance identifier; right: Sequence numbers SHALL stay the same across all instances of the Prior Authorization, eg the Claim, ClaimResponse, ClaimUpdate, ClaimUpdateResponse
.... noteNumber S0..*positiveIntApplicable note numbers
.... adjudication S1..*BackboneElementAdjudication details
..... extension 0..*ExtensionExtension
..... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
..... category 1..1CodeableConceptThis code is fixed to 'submitted' to indicate that the adjudication result is on what was submitted.
Binding: ?? (example): The adjudication codes.
..... reason 0..1CodeableConceptExplanation of adjudication outcome
Binding: ?? (example): The adjudication reason codes.
..... amount 0..1MoneyMonetary amount
..... 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..*ExtensionExtension
...... extension S0..1(Complex)The details of the review action that is necessary for the authorization.
URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-reviewAction
...... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
...... category 1..1CodeableConceptThis code is fixed to 'submitted' to indicate that the adjudication result is on what was submitted.
Binding: ?? (example): The adjudication codes.
...... reason 0..1CodeableConceptExplanation of adjudication outcome
Binding: ?? (example): The adjudication reason codes.
...... amount 0..1MoneyMonetary amount
...... value 0..1decimalNon-monetary 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..*ExtensionExtension
....... extension S0..1(Complex)The details of the review action that is necessary for the authorization.
URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-reviewAction
....... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
....... category 1..1CodeableConceptThis code is fixed to 'submitted' to indicate that the adjudication result is on what was submitted.
Binding: ?? (example): The adjudication codes.
....... reason 0..1CodeableConceptExplanation of adjudication outcome
Binding: ?? (example): The adjudication reason codes.
....... amount 0..1MoneyMonetary amount
....... value 0..1decimalNon-monetary value
... addItem S0..*BackboneElementInsurer added line items
.... extension 0..*ExtensionExtension
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
.... itemSequence S1..1positiveIntItem sequence number
.... detailSequence 0..*positiveIntDetail sequence number
.... subdetailSequence 0..*positiveIntSubdetail sequence number
.... provider S0..*Reference(PAS Practitioner | PAS Organization Base Profile | #sd-profile-practitioner-profile-practitioner)Authorized providers
..... 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 Σ0..1IdentifierLogical reference, when literal reference is not known
..... display Σ0..1stringText alternative for the resource
.... productOrService S1..1CodeableConceptBilling, service, product, or drug code
Binding: ?? (required)
.... modifier S0..*CodeableConceptService/Product billing modifiers
Binding: ?? (required)
.... programCode 0..*CodeableConceptProgram the product or service is provided under
Binding: ?? (example): Program specific reason codes.
.... serviced[x] S0..1Date or dates of service or product delivery
..... servicedDatedate
..... servicedPeriodPeriod
.... location[x] S0..1Place of service or where product was supplied
Binding: ?? (example): Place of service: pharmacy, school, prison, etc.
..... locationCodeableConceptCodeableConcept
..... locationAddressAddress
..... locationReferenceReference(Location)
.... quantity SC0..1??, ??left: A fixed quantity (no comparator); right: Count of products or services
Constraints: qty-3, sqty-1
.... unitPrice S0..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 0..*positiveIntApplicable note numbers
.... adjudication S1..*BackboneElementAdded items adjudication
..... extension 0..*ExtensionExtension
..... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
..... category 1..1CodeableConceptThis code is fixed to 'submitted' to indicate that the adjudication result is on what was submitted.
Binding: ?? (example): The adjudication codes.
..... reason 0..1CodeableConceptExplanation of adjudication outcome
Binding: ?? (example): The adjudication reason codes.
..... amount 0..1MoneyMonetary amount
..... 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..*ExtensionExtension
...... extension S0..1(Complex)The details of the review action that is necessary for the authorization.
URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-reviewAction
...... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
...... category 1..1CodeableConceptThis code is fixed to 'submitted' to indicate that the adjudication result is on what was submitted.
Binding: ?? (example): The adjudication codes.
...... reason 0..1CodeableConceptExplanation of adjudication outcome
Binding: ?? (example): The adjudication reason codes.
...... amount 0..1MoneyMonetary amount
...... value 0..1decimalNon-monetary 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..*ExtensionExtension
....... extension S0..1(Complex)The details of the review action that is necessary for the authorization.
URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-reviewAction
....... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
....... category 1..1CodeableConceptThis code is fixed to 'submitted' to indicate that the adjudication result is on what was submitted.
Binding: ?? (example): The adjudication codes.
....... reason 0..1CodeableConceptExplanation of adjudication outcome
Binding: ?? (example): The adjudication reason codes.
....... amount 0..1MoneyMonetary amount
....... value 0..1decimalNon-monetary value
... adjudication S0..*BackboneElementHeader-level adjudication
.... extension 0..*ExtensionExtension
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
.... category 1..1CodeableConceptThis code is fixed to 'submitted' to indicate that the adjudication result is on what was submitted.
Binding: ?? (example): The adjudication codes.
.... reason 0..1CodeableConceptExplanation of adjudication outcome
Binding: ?? (example): The adjudication reason codes.
.... amount 0..1MoneyMonetary amount
.... value 0..1decimalNon-monetary 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..*BackboneElementNote concerning adjudication
.... extension 0..*ExtensionAdditional content defined by implementations
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
.... number S1..1positiveIntNote instance identifier
.... type 0..1codedisplay | print | printoper
Binding: ?? (required): The presentation types of notes.
.... text S1..1stringNote explanatory text
.... language 0..1CodeableConceptLanguage of the text
Binding: ?? (preferred): A human language.
Additional BindingsPurpose
??Max Binding
... 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..*BackboneElementProcessing errors
.... extension 0..*ExtensionExtension
.... 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..1CodeableConceptError code detailing processing issues
Binding: ?? (required)

doco Documentation for this format