## Profile Comparison between http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-claimresponse vs http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-claimresponse

Left: | QICore ClaimResponse (http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-claimresponse)
Right: | QICore ClaimResponse (http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-claimresponse)

### Messages

Error | StructureDefinition.version | Values for version differ: '8.0.0-ballot' vs '7.0.2'
Information | ClaimResponse.language | Example/preferred bindings differ at ClaimResponse.language using binding from QICoreClaimResponse
Error | ClaimResponse.insurer | Type Mismatch: Reference([CanonicalType[http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-organization]]) vs Reference([CanonicalType[http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-organization]])
Information | ClaimResponse.processNote.language | Example/preferred bindings differ at ClaimResponse.processNote.language using binding from QICoreClaimResponse

### Metadata

Name | Value | Comments
--- | --- | ---
abstract | false |
baseDefinition | http://hl7.org/fhir/StructureDefinition/ClaimResponse |
copyright | Used by permission of HL7 International, all rights reserved Creative Commons License |
date | 2022-04-20 |
description | The QI-Core ClaimResponse profile is used to provide the results of the adjudication and/or authorization of a set of healthcare-related products and services for a patient against the patient's insurance coverages, or to respond with what the adjudication would be for a supplied set of products or services should they be actually supplied to the patient. It identifies the mandatory core elements, extensions, vocabularies and value sets which **SHALL** be present in the ClaimResponse resource when using this profile |
experimental | false |
fhirVersion | 4.0.1 |
jurisdiction |  |
jurisdiction[0] | urn:iso:std:iso:3166#US |
kind | resource |
name | QICoreClaimResponse |
publisher | HL7 International / Clinical Quality Information |
purpose |  |
status | draft |
title | QICore ClaimResponse |
type | ClaimResponse |
url | http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-claimresponse |
version | 8.0.0-ballot | 7.0.2 | Values Differ

### Structure

Name | L Flags | L Card. | L Type | L Description & Constraints | R Flags | R Card. | R Type | R Description & Constraints | Comments
--- | --- | --- | --- | --- | --- | --- | --- | --- | ---
ClaimResponse |  | 0..* | ClaimResponse | Response to a claim predetermination or preauthorization |  | 0..* | ClaimResponse | Response to a claim predetermination or preauthorization |
id | Σ | 0..1 | id | Logical id of this artifact | Σ | 0..1 | id | Logical id of this artifact |
meta | Σ | 0..1 | Meta | Metadata about the resource | Σ | 0..1 | Meta | Metadata about the resource |
implicitRules | ?!Σ | 0..1 | uri | A set of rules under which this content was created | ?!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.
Additional Bindings | Purpose
?? | Max Binding
|  | 0..1 | code | Language of the resource content Binding: ?? (preferred): A human language.
Additional Bindings | Purpose
?? | Max Binding
| Example/preferred bindings differ at ClaimResponse.language using binding from QICoreClaimResponse
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 |  | 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 |  | 0..* | Resource | Contained, inline Resources |
extension |  | 0..* | Extension | Additional content defined by implementations |  | 0..* | Extension | Additional content defined by implementations |
modifierExtension | ?! | 0..* | Extension | Extensions that cannot be ignored | ?! | 0..* | Extension | Extensions that cannot be ignored |
identifier |  | 0..* | Identifier | Business Identifier for a claim response |  | 0..* | Identifier | Business Identifier for a claim response |
status | ?!Σ | 1..1 | code | (QI) active | cancelled | draft | entered-in-error Binding: ?? (required): A code specifying the state of the resource instance. Fixed Value: active | ?!Σ | 1..1 | code | (QI) active | cancelled | draft | entered-in-error Binding: ?? (required): A code specifying the state of the resource instance. Fixed Value: active |
type | Σ | 1..1 | CodeableConcept | (QI) More granular claim type Binding: ?? (extensible): The type or discipline-style of the claim. | Σ | 1..1 | CodeableConcept | (QI) More granular claim type Binding: ?? (extensible): The type or discipline-style of the claim. |
subType |  | 0..1 | CodeableConcept | More granular claim type Binding: ?? (example): A more granular claim typecode. |  | 0..1 | CodeableConcept | More granular claim type Binding: ?? (example): A more granular claim typecode. |
use | Σ | 1..1 | code | (QI) claim | preauthorization | predetermination Binding: ?? (required): Claim, preauthorization, predetermination. Fixed Value: preauthorization | Σ | 1..1 | code | (QI) claim | preauthorization | predetermination Binding: ?? (required): Claim, preauthorization, predetermination. Fixed Value: preauthorization |
patient | Σ | 1..1 | Reference(QICore Patient) | (QI) The recipient of the products and services | Σ | 1..1 | Reference(QICore Patient) | (QI) The recipient of the products and services |
created | Σ | 1..1 | dateTime | (QI) Response creation date | Σ | 1..1 | dateTime | (QI) Response creation date |
insurer | Σ | 1..1 | Reference(QICore Organization) | (QI) Party responsible for reimbursement | Σ | 1..1 | Reference(QICore Organization) | (QI) Party responsible for reimbursement | Type Mismatch: Reference([CanonicalType[http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-organization]]) vs Reference([CanonicalType[http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-organization]])
requestor |  | 0..1 | Reference(QICore Practitioner | QICore Organization | QICore PractitionerRole) | (QI) Party responsible for the claim |  | 0..1 | Reference(QICore Practitioner | QICore Organization | QICore PractitionerRole) | (QI) Party responsible for the claim |
request | Σ | 0..1 | Reference(QICore Claim) | (QI) Id of resource triggering adjudication | Σ | 0..1 | Reference(QICore Claim) | (QI) Id of resource triggering adjudication |
outcome | Σ | 1..1 | code | queued | complete | error | partial Binding: ?? (required): The result of the claim processing. | Σ | 1..1 | code | queued | complete | error | partial Binding: ?? (required): The result of the claim processing. |
disposition |  | 0..1 | string | Disposition Message |  | 0..1 | string | Disposition Message |
preAuthRef |  | 0..1 | string | Preauthorization reference |  | 0..1 | string | Preauthorization reference |
preAuthPeriod |  | 0..1 | Period | Preauthorization reference effective period |  | 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. |  | 0..1 | CodeableConcept | Party 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 |  | 0..* | BackboneElement | (QI) Adjudication for claim line items |
id |  | 0..1 | string | Unique id for inter-element referencing |  | 0..1 | string | Unique id for inter-element referencing |
extension |  | 0..* | Extension | Additional content defined by implementations |  | 0..* | Extension | Additional content defined by implementations |
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
itemSequence |  | 1..1 | positiveInt | Claim item instance identifier |  | 1..1 | positiveInt | Claim item instance identifier |
noteNumber |  | 0..* | positiveInt | Applicable note numbers |  | 0..* | positiveInt | Applicable note numbers |
adjudication |  | 1..* | BackboneElement | (QI) Adjudication details |  | 1..* | BackboneElement | (QI) Adjudication details |
id |  | 0..1 | string | Unique id for inter-element referencing |  | 0..1 | string | Unique id for inter-element referencing |
extension |  | 0..* | Extension | Additional content defined by implementations |  | 0..* | Extension | Additional content defined by implementations |
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
category |  | 1..1 | CodeableConcept | (QI) This code is fixed to 'submitted' to indicate that the adjudication result is on what was submitted. Binding: ?? (example): The adjudication codes. Required Pattern: {"coding":[{"system":"http://terminology.hl7.org/CodeSystem/adjudication","code":"submitted"}]} |  | 1..1 | CodeableConcept | (QI) This code is fixed to 'submitted' to indicate that the adjudication result is on what was submitted. Binding: ?? (example): The adjudication codes. Required Pattern: {"coding":[{"system":"http://terminology.hl7.org/CodeSystem/adjudication","code":"submitted"}]} |
reason |  | 0..1 | CodeableConcept | Explanation of adjudication outcome Binding: ?? (example): The adjudication reason codes. |  | 0..1 | CodeableConcept | Explanation of adjudication outcome Binding: ?? (example): The adjudication reason codes. |
amount |  | 0..1 | Money | (QI) Monetary amount |  | 0..1 | Money | (QI) Monetary amount |
value |  | 0..1 | decimal | Non-monetary value |  | 0..1 | decimal | Non-monetary value |
detail |  | 0..* | BackboneElement | Adjudication for claim details |  | 0..* | BackboneElement | Adjudication for claim details |
id |  | 0..1 | string | Unique id for inter-element referencing |  | 0..1 | string | Unique id for inter-element referencing |
extension |  | 0..* | Extension | Additional content defined by implementations |  | 0..* | Extension | Additional content defined by implementations |
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
detailSequence |  | 1..1 | positiveInt | (QI) Claim detail instance identifier |  | 1..1 | positiveInt | (QI) Claim detail instance identifier |
noteNumber |  | 0..* | positiveInt | Applicable note numbers |  | 0..* | positiveInt | Applicable note numbers |
adjudication |  | 1..* | See adjudication (ClaimResponse) | Detail level adjudication details |  | 1..* | See adjudication (ClaimResponse) | Detail level adjudication details |
id |  | 0..1 | string | Unique id for inter-element referencing |  | 0..1 | string | Unique id for inter-element referencing |
extension |  | 0..* | Extension | Additional content defined by implementations |  | 0..* | Extension | Additional content defined by implementations |
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
category |  | 1..1 | CodeableConcept | (QI) This code is fixed to 'submitted' to indicate that the adjudication result is on what was submitted. Binding: ?? (example): The adjudication codes. Required Pattern: {"coding":[{"system":"http://terminology.hl7.org/CodeSystem/adjudication","code":"submitted"}]} |  | 1..1 | CodeableConcept | (QI) This code is fixed to 'submitted' to indicate that the adjudication result is on what was submitted. Binding: ?? (example): The adjudication codes. Required Pattern: {"coding":[{"system":"http://terminology.hl7.org/CodeSystem/adjudication","code":"submitted"}]} |
reason |  | 0..1 | CodeableConcept | Explanation of adjudication outcome Binding: ?? (example): The adjudication reason codes. |  | 0..1 | CodeableConcept | Explanation of adjudication outcome Binding: ?? (example): The adjudication reason codes. |
amount |  | 0..1 | Money | (QI) Monetary amount |  | 0..1 | Money | (QI) Monetary amount |
value |  | 0..1 | decimal | Non-monetary value |  | 0..1 | decimal | Non-monetary value |
subDetail |  | 0..* | BackboneElement | Adjudication for claim sub-details |  | 0..* | BackboneElement | Adjudication for claim sub-details |
id |  | 0..1 | string | Unique id for inter-element referencing |  | 0..1 | string | Unique id for inter-element referencing |
extension |  | 0..* | Extension | Additional content defined by implementations |  | 0..* | Extension | Additional content defined by implementations |
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
subDetailSequence |  | 1..1 | positiveInt | Claim sub-detail instance identifier |  | 1..1 | positiveInt | Claim sub-detail instance identifier |
noteNumber |  | 0..* | positiveInt | Applicable note numbers |  | 0..* | positiveInt | Applicable note numbers |
adjudication |  | 0..* | See adjudication (ClaimResponse) | Subdetail level adjudication details |  | 0..* | See adjudication (ClaimResponse) | Subdetail level adjudication details |
id |  | 0..1 | string | Unique id for inter-element referencing |  | 0..1 | string | Unique id for inter-element referencing |
extension |  | 0..* | Extension | Additional content defined by implementations |  | 0..* | Extension | Additional content defined by implementations |
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
category |  | 1..1 | CodeableConcept | (QI) This code is fixed to 'submitted' to indicate that the adjudication result is on what was submitted. Binding: ?? (example): The adjudication codes. Required Pattern: {"coding":[{"system":"http://terminology.hl7.org/CodeSystem/adjudication","code":"submitted"}]} |  | 1..1 | CodeableConcept | (QI) This code is fixed to 'submitted' to indicate that the adjudication result is on what was submitted. Binding: ?? (example): The adjudication codes. Required Pattern: {"coding":[{"system":"http://terminology.hl7.org/CodeSystem/adjudication","code":"submitted"}]} |
reason |  | 0..1 | CodeableConcept | Explanation of adjudication outcome Binding: ?? (example): The adjudication reason codes. |  | 0..1 | CodeableConcept | Explanation of adjudication outcome Binding: ?? (example): The adjudication reason codes. |
amount |  | 0..1 | Money | (QI) Monetary amount |  | 0..1 | Money | (QI) Monetary amount |
value |  | 0..1 | decimal | Non-monetary value |  | 0..1 | decimal | Non-monetary value |
addItem |  | 0..* | BackboneElement | Insurer added line items |  | 0..* | BackboneElement | Insurer added line items |
id |  | 0..1 | string | Unique id for inter-element referencing |  | 0..1 | string | Unique id for inter-element referencing |
extension |  | 0..* | Extension | Additional content defined by implementations |  | 0..* | Extension | Additional content defined by implementations |
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
itemSequence |  | 0..* | positiveInt | Item sequence number |  | 0..* | positiveInt | Item sequence number |
detailSequence |  | 0..* | positiveInt | Detail sequence number |  | 0..* | positiveInt | Detail sequence number |
subdetailSequence |  | 0..* | positiveInt | Subdetail sequence number |  | 0..* | positiveInt | Subdetail sequence number |
provider |  | 0..* | Reference(Practitioner | PractitionerRole | Organization) | Authorized providers |  | 0..* | Reference(Practitioner | PractitionerRole | Organization) | Authorized providers |
productOrService |  | 1..1 | CodeableConcept | Billing, service, product, or drug code Binding: ?? (example): Allowable service and product codes. |  | 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. |  | 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. |  | 0..* | CodeableConcept | Program the product or service is provided under Binding: ?? (example): Program specific reason codes. |
serviced[x] |  | 0..1 | date, Period | Date or dates of service or product delivery |  | 0..1 | date, Period | Date or dates of service or product delivery |
location[x] |  | 0..1 | CodeableConcept, Address, Reference(Location) | Place of service or where product was supplied Binding: ?? (example): Place of service: pharmacy, school, prison, etc. |  | 0..1 | CodeableConcept, Address, Reference(Location) | Place of service or where product was supplied Binding: ?? (example): Place of service: pharmacy, school, prison, etc. |
quantity |  | 0..1 | ?? | Count of products or services |  | 0..1 | ?? | Count of products or services |
unitPrice |  | 0..1 | Money | Fee, charge or cost per item |  | 0..1 | Money | Fee, charge or cost per item |
factor |  | 0..1 | decimal | Price scaling factor |  | 0..1 | decimal | Price scaling factor |
net |  | 0..1 | Money | Total item cost |  | 0..1 | Money | Total item cost |
bodySite |  | 0..1 | CodeableConcept | Anatomical location Binding: ?? (example): The code for the teeth, quadrant, sextant and arch. |  | 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. |  | 0..* | CodeableConcept | Anatomical sub-location Binding: ?? (example): The code for the tooth surface and surface combinations. |
noteNumber |  | 0..* | positiveInt | Applicable note numbers |  | 0..* | positiveInt | Applicable note numbers |
adjudication |  | 1..* | See adjudication (ClaimResponse) | Added items adjudication |  | 1..* | See adjudication (ClaimResponse) | Added items adjudication |
id |  | 0..1 | string | Unique id for inter-element referencing |  | 0..1 | string | Unique id for inter-element referencing |
extension |  | 0..* | Extension | Additional content defined by implementations |  | 0..* | Extension | Additional content defined by implementations |
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
category |  | 1..1 | CodeableConcept | (QI) This code is fixed to 'submitted' to indicate that the adjudication result is on what was submitted. Binding: ?? (example): The adjudication codes. Required Pattern: {"coding":[{"system":"http://terminology.hl7.org/CodeSystem/adjudication","code":"submitted"}]} |  | 1..1 | CodeableConcept | (QI) This code is fixed to 'submitted' to indicate that the adjudication result is on what was submitted. Binding: ?? (example): The adjudication codes. Required Pattern: {"coding":[{"system":"http://terminology.hl7.org/CodeSystem/adjudication","code":"submitted"}]} |
reason |  | 0..1 | CodeableConcept | Explanation of adjudication outcome Binding: ?? (example): The adjudication reason codes. |  | 0..1 | CodeableConcept | Explanation of adjudication outcome Binding: ?? (example): The adjudication reason codes. |
amount |  | 0..1 | Money | (QI) Monetary amount |  | 0..1 | Money | (QI) Monetary amount |
value |  | 0..1 | decimal | Non-monetary value |  | 0..1 | decimal | Non-monetary value |
detail |  | 0..* | BackboneElement | Insurer added line details |  | 0..* | BackboneElement | Insurer added line details |
id |  | 0..1 | string | Unique id for inter-element referencing |  | 0..1 | string | Unique id for inter-element referencing |
extension |  | 0..* | Extension | Additional content defined by implementations |  | 0..* | Extension | Additional content defined by implementations |
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ?!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. |  | 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. |  | 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 |  | 0..1 | ?? | Count of products or services |
unitPrice |  | 0..1 | Money | Fee, charge or cost per item |  | 0..1 | Money | Fee, charge or cost per item |
factor |  | 0..1 | decimal | Price scaling factor |  | 0..1 | decimal | Price scaling factor |
net |  | 0..1 | Money | Total item cost |  | 0..1 | Money | Total item cost |
noteNumber |  | 0..* | positiveInt | Applicable note numbers |  | 0..* | positiveInt | Applicable note numbers |
adjudication |  | 1..* | See adjudication (ClaimResponse) | Added items detail adjudication |  | 1..* | See adjudication (ClaimResponse) | Added items detail adjudication |
id |  | 0..1 | string | Unique id for inter-element referencing |  | 0..1 | string | Unique id for inter-element referencing |
extension |  | 0..* | Extension | Additional content defined by implementations |  | 0..* | Extension | Additional content defined by implementations |
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
category |  | 1..1 | CodeableConcept | (QI) This code is fixed to 'submitted' to indicate that the adjudication result is on what was submitted. Binding: ?? (example): The adjudication codes. Required Pattern: {"coding":[{"system":"http://terminology.hl7.org/CodeSystem/adjudication","code":"submitted"}]} |  | 1..1 | CodeableConcept | (QI) This code is fixed to 'submitted' to indicate that the adjudication result is on what was submitted. Binding: ?? (example): The adjudication codes. Required Pattern: {"coding":[{"system":"http://terminology.hl7.org/CodeSystem/adjudication","code":"submitted"}]} |
reason |  | 0..1 | CodeableConcept | Explanation of adjudication outcome Binding: ?? (example): The adjudication reason codes. |  | 0..1 | CodeableConcept | Explanation of adjudication outcome Binding: ?? (example): The adjudication reason codes. |
amount |  | 0..1 | Money | (QI) Monetary amount |  | 0..1 | Money | (QI) Monetary amount |
value |  | 0..1 | decimal | Non-monetary value |  | 0..1 | decimal | Non-monetary value |
subDetail |  | 0..* | BackboneElement | Insurer added line items |  | 0..* | BackboneElement | Insurer added line items |
id |  | 0..1 | string | Unique id for inter-element referencing |  | 0..1 | string | Unique id for inter-element referencing |
extension |  | 0..* | Extension | Additional content defined by implementations |  | 0..* | Extension | Additional content defined by implementations |
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ?!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. |  | 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. |  | 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 |  | 0..1 | ?? | Count of products or services |
unitPrice |  | 0..1 | Money | Fee, charge or cost per item |  | 0..1 | Money | Fee, charge or cost per item |
factor |  | 0..1 | decimal | Price scaling factor |  | 0..1 | decimal | Price scaling factor |
net |  | 0..1 | Money | Total item cost |  | 0..1 | Money | Total item cost |
noteNumber |  | 0..* | positiveInt | Applicable note numbers |  | 0..* | positiveInt | Applicable note numbers |
adjudication |  | 1..* | See adjudication (ClaimResponse) | Added items detail adjudication |  | 1..* | See adjudication (ClaimResponse) | Added items detail adjudication |
id |  | 0..1 | string | Unique id for inter-element referencing |  | 0..1 | string | Unique id for inter-element referencing |
extension |  | 0..* | Extension | Additional content defined by implementations |  | 0..* | Extension | Additional content defined by implementations |
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
category |  | 1..1 | CodeableConcept | (QI) This code is fixed to 'submitted' to indicate that the adjudication result is on what was submitted. Binding: ?? (example): The adjudication codes. Required Pattern: {"coding":[{"system":"http://terminology.hl7.org/CodeSystem/adjudication","code":"submitted"}]} |  | 1..1 | CodeableConcept | (QI) This code is fixed to 'submitted' to indicate that the adjudication result is on what was submitted. Binding: ?? (example): The adjudication codes. Required Pattern: {"coding":[{"system":"http://terminology.hl7.org/CodeSystem/adjudication","code":"submitted"}]} |
reason |  | 0..1 | CodeableConcept | Explanation of adjudication outcome Binding: ?? (example): The adjudication reason codes. |  | 0..1 | CodeableConcept | Explanation of adjudication outcome Binding: ?? (example): The adjudication reason codes. |
amount |  | 0..1 | Money | (QI) Monetary amount |  | 0..1 | Money | (QI) Monetary amount |
value |  | 0..1 | decimal | Non-monetary value |  | 0..1 | decimal | Non-monetary value |
adjudication |  | 0..* | See adjudication (ClaimResponse) | Header-level adjudication |  | 0..* | See adjudication (ClaimResponse) | Header-level adjudication |
id |  | 0..1 | string | Unique id for inter-element referencing |  | 0..1 | string | Unique id for inter-element referencing |
extension |  | 0..* | Extension | Additional content defined by implementations |  | 0..* | Extension | Additional content defined by implementations |
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
category |  | 1..1 | CodeableConcept | (QI) This code is fixed to 'submitted' to indicate that the adjudication result is on what was submitted. Binding: ?? (example): The adjudication codes. Required Pattern: {"coding":[{"system":"http://terminology.hl7.org/CodeSystem/adjudication","code":"submitted"}]} |  | 1..1 | CodeableConcept | (QI) This code is fixed to 'submitted' to indicate that the adjudication result is on what was submitted. Binding: ?? (example): The adjudication codes. Required Pattern: {"coding":[{"system":"http://terminology.hl7.org/CodeSystem/adjudication","code":"submitted"}]} |
reason |  | 0..1 | CodeableConcept | Explanation of adjudication outcome Binding: ?? (example): The adjudication reason codes. |  | 0..1 | CodeableConcept | Explanation of adjudication outcome Binding: ?? (example): The adjudication reason codes. |
amount |  | 0..1 | Money | (QI) Monetary amount |  | 0..1 | Money | (QI) Monetary amount |
value |  | 0..1 | decimal | Non-monetary value |  | 0..1 | decimal | Non-monetary value |
total | Σ | 0..* | BackboneElement | Adjudication totals | Σ | 0..* | BackboneElement | Adjudication totals |
id |  | 0..1 | string | Unique id for inter-element referencing |  | 0..1 | string | Unique id for inter-element referencing |
extension |  | 0..* | Extension | Additional content defined by implementations |  | 0..* | Extension | Additional content defined by implementations |
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ?!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. | Σ | 1..1 | CodeableConcept | Type of adjudication information Binding: ?? (example): The adjudication codes. |
amount | Σ | 1..1 | Money | Financial total for the category | Σ | 1..1 | Money | Financial total for the category |
payment |  | 0..1 | BackboneElement | Payment Details |  | 0..1 | BackboneElement | Payment Details |
id |  | 0..1 | string | Unique id for inter-element referencing |  | 0..1 | string | Unique id for inter-element referencing |
extension |  | 0..* | Extension | Additional content defined by implementations |  | 0..* | Extension | Additional content defined by implementations |
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ?!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. |  | 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 |  | 0..1 | Money | Payment adjustment for non-claim issues |
adjustmentReason |  | 0..1 | CodeableConcept | Explanation for the adjustment Binding: ?? (example): Payment Adjustment reason codes. |  | 0..1 | CodeableConcept | Explanation for the adjustment Binding: ?? (example): Payment Adjustment reason codes. |
date |  | 0..1 | date | Expected date of payment |  | 0..1 | date | Expected date of payment |
amount |  | 1..1 | Money | Payable amount after adjustment |  | 1..1 | Money | Payable amount after adjustment |
identifier |  | 0..1 | Identifier | Business identifier for the payment |  | 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). |  | 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. |  | 0..1 | CodeableConcept | Printed form identifier Binding: ?? (example): The forms codes. |
form |  | 0..1 | Attachment | Printed reference or actual form |  | 0..1 | Attachment | Printed reference or actual form |
processNote |  | 0..* | BackboneElement | Note concerning adjudication |  | 0..* | BackboneElement | Note concerning adjudication |
id |  | 0..1 | string | Unique id for inter-element referencing |  | 0..1 | string | Unique id for inter-element referencing |
extension |  | 0..* | Extension | Additional content defined by implementations |  | 0..* | Extension | Additional content defined by implementations |
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
number |  | 0..1 | positiveInt | Note instance identifier |  | 0..1 | positiveInt | Note instance identifier |
type |  | 0..1 | code | display | print | printoper Binding: ?? (required): The presentation types of notes. |  | 0..1 | code | display | print | printoper Binding: ?? (required): The presentation types of notes. |
text |  | 1..1 | string | Note explanatory text |  | 1..1 | string | Note explanatory text |
language |  | 0..1 | CodeableConcept | Language of the text Binding: ?? (preferred): A human language.
Additional Bindings | Purpose
?? | Max Binding
|  | 0..1 | CodeableConcept | Language of the text Binding: ?? (preferred): A human language.
Additional Bindings | Purpose
?? | Max Binding
| Example/preferred bindings differ at ClaimResponse.processNote.language using binding from QICoreClaimResponse
communicationRequest |  | 0..* | Reference(CommunicationRequest) | Request for additional information |  | 0..* | Reference(CommunicationRequest) | Request for additional information |
insurance |  | 0..* | BackboneElement | Patient insurance information |  | 0..* | BackboneElement | Patient insurance information |
id |  | 0..1 | string | Unique id for inter-element referencing |  | 0..1 | string | Unique id for inter-element referencing |
extension |  | 0..* | Extension | Additional content defined by implementations |  | 0..* | Extension | Additional content defined by implementations |
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
sequence |  | 1..1 | positiveInt | Insurance instance identifier |  | 1..1 | positiveInt | Insurance instance identifier |
focal |  | 1..1 | boolean | Coverage to be used for adjudication |  | 1..1 | boolean | Coverage to be used for adjudication |
coverage |  | 1..1 | Reference(Coverage) | Insurance information |  | 1..1 | Reference(Coverage) | Insurance information |
businessArrangement |  | 0..1 | string | Additional provider contract number |  | 0..1 | string | Additional provider contract number |
claimResponse |  | 0..1 | Reference(ClaimResponse) | Adjudication results |  | 0..1 | Reference(ClaimResponse) | Adjudication results |
error |  | 0..* | BackboneElement | Processing errors |  | 0..* | BackboneElement | Processing errors |
id |  | 0..1 | string | Unique id for inter-element referencing |  | 0..1 | string | Unique id for inter-element referencing |
extension |  | 0..* | Extension | Additional content defined by implementations |  | 0..* | Extension | Additional content defined by implementations |
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
itemSequence |  | 0..1 | positiveInt | Item sequence number |  | 0..1 | positiveInt | Item sequence number |
detailSequence |  | 0..1 | positiveInt | Detail sequence number |  | 0..1 | positiveInt | Detail sequence number |
subDetailSequence |  | 0..1 | positiveInt | Subdetail sequence number |  | 0..1 | positiveInt | Subdetail sequence number |
code |  | 1..1 | CodeableConcept | Error code detailing processing issues Binding: ?? (example): The adjudication error codes. |  | 1..1 | CodeableConcept | Error code detailing processing issues Binding: ?? (example): The adjudication error codes. |
Documentation for this format