Intersection of http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-claimresponse and http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-claimresponse

This is the set of resources that conform to both QICore ClaimResponse (http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-claimresponse) and QICore ClaimResponse (http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-claimresponse).

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.
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..*ExtensionAdditional content defined by implementations
... modifierExtension ?!0..*ExtensionExtensions that cannot be ignored
... identifier 0..*IdentifierBusiness Identifier for a claim response
... status ?!Σ1..1code(QI) active | cancelled | draft | entered-in-error
Binding: ?? (required): A code specifying the state of the resource instance.
... type Σ1..1CodeableConcept(QI) More 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..1code(QI) claim | preauthorization | predetermination
Binding: ?? (required): Claim, preauthorization, predetermination.
... patient Σ1..1Reference(QICore Patient | #sd-qicore-patient-qicore-patient)(QI) The recipient of the products and services
... created Σ1..1dateTime(QI) Response creation date
... insurer Σ1..1(QI) Party responsible for reimbursement
... requestor 0..1Reference(QICore Practitioner | QICore Organization | QICore PractitionerRole | #sd-qicore-practitioner-qicore-practitioner)(QI) Party responsible for the claim
... request Σ0..1Reference(QICore Claim | #sd-qicore-claim-qicore-claim)(QI) Id of resource triggering adjudication
... outcome Σ1..1codequeued | complete | error | partial
Binding: ?? (required): The result of the claim processing.
... disposition 0..1stringDisposition Message
... 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 0..*BackboneElement(QI) Adjudication for claim line items
.... extension 0..*ExtensionAdditional content defined by implementations
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
.... itemSequence 1..1positiveIntClaim item instance identifier
.... noteNumber 0..*positiveIntApplicable note numbers
.... adjudication 1..*BackboneElement(QI) Adjudication details
..... extension 0..*ExtensionAdditional content defined by implementations
..... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
..... category 1..1CodeableConcept(QI) This 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..1Money(QI) Monetary 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..1positiveInt(QI) Claim 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 1..1CodeableConcept(QI) This 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..1Money(QI) Monetary 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..*ExtensionAdditional content defined by implementations
....... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
....... category 1..1CodeableConcept(QI) This 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..1Money(QI) Monetary amount
....... value 0..1decimalNon-monetary value
... addItem 0..*BackboneElementInsurer added line items
.... extension 0..*ExtensionAdditional content defined by implementations
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
.... itemSequence 0..*positiveIntItem sequence number
.... detailSequence 0..*positiveIntDetail sequence number
.... subdetailSequence 0..*positiveIntSubdetail sequence number
.... provider 0..*Reference(Practitioner | PractitionerRole | Organization)Authorized providers
.... 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.
.... 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 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
.... 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 1..*Added items adjudication
..... extension 0..*ExtensionAdditional content defined by implementations
..... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
..... category 1..1CodeableConcept(QI) This 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..1Money(QI) Monetary 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..*ExtensionAdditional content defined by implementations
...... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
...... category 1..1CodeableConcept(QI) This 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..1Money(QI) Monetary 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..*ExtensionAdditional content defined by implementations
....... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
....... category 1..1CodeableConcept(QI) This 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..1Money(QI) Monetary amount
....... value 0..1decimalNon-monetary value
... adjudication 0..*Header-level adjudication
.... extension 0..*ExtensionAdditional content defined by implementations
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
.... category 1..1CodeableConcept(QI) This 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..1Money(QI) Monetary 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 0..*BackboneElementNote concerning adjudication
.... extension 0..*ExtensionAdditional content defined by implementations
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
.... number 0..1positiveIntNote instance identifier
.... type 0..1codedisplay | print | printoper
Binding: ?? (required): The presentation types of notes.
.... text 1..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 0..*BackboneElementProcessing errors
.... 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 1..1CodeableConceptError code detailing processing issues
Binding: ?? (example): The adjudication error codes.

doco Documentation for this format