FHIR CI-Build
FinancialThis is the Continuous Integration Build of FHIR (will be incorrect/inconsistent at times).
See the Directory of published versions
| Financial Management Work Group | Maturity Level: N/A | Standards Status: Informative | Compartments: Patient, Practitioner |
Raw Turtle (+ also see Turtle/RDF Format Specification)
StructureDefinition for claimresponse
@prefix fhir: <http://hl7.org/fhir/> .
@prefix rdfs: <http://www.w3.org/2000/01/rdf-schema#> .
# - resource -------------------------------------------------------------------
[] a fhir:StructureDefinition ;
fhir:id [ fhir:v "ClaimResponse"] ;
fhir:meta [
fhir:lastUpdated [ fhir:v "2024-11-06T19:10:34.820+00:00" ]
] ;
fhir:text [
fhir:status [ fhir:v "generated" ]
] ;
fhir:extension ( [
fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status" ] ;
fhir:value [ fhir:v "trial-use" ]
] [
fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/structuredefinition-wg" ] ;
fhir:value [ fhir:v "fm" ]
] [
fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/structuredefinition-fmm" ] ;
fhir:value [ fhir:v "2" ]
] [
fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/structuredefinition-security-category" ] ;
fhir:value [ fhir:v "patient" ]
] ) ;
fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/ClaimResponse"], [ fhir:v "http://hl7.org/fhir/StructureDefinition/ClaimResponse"] ;
fhir:version [ fhir:v "6.0.0-ballot2"], [ fhir:v "6.0.0-ballot2"] ;
fhir:name [ fhir:v "ClaimResponse"], [ fhir:v "ClaimResponse"] ;
fhir:status [ fhir:v "draft"], [ fhir:v "draft"] ;
fhir:experimental [ fhir:v "false"], [ fhir:v "false"] ;
fhir:date [ fhir:v "2024-11-06T19:10:34+00:00"], [ fhir:v "2024-11-06T19:10:34+00:00"] ;
fhir:publisher [ fhir:v "HL7 International / Financial Management"], [ fhir:v "HL7 International / Financial Management"] ;
fhir:contact ( [
fhir:telecom ( [
fhir:system [ fhir:v "url" ] ;
fhir:value [ fhir:v "http://www.hl7.org/Special/committees/fiwg" ]
] )
] [
fhir:telecom ( [
fhir:system [ fhir:v "url" ] ;
fhir:value [ fhir:v "http://www.hl7.org/Special/committees/fm" ]
] )
] [
fhir:telecom ( [
fhir:system [ fhir:v "url" ] ;
fhir:value [ fhir:v "http://www.hl7.org/Special/committees/fiwg" ]
] )
] [
fhir:telecom ( [
fhir:system [ fhir:v "url" ] ;
fhir:value [ fhir:v "http://www.hl7.org/Special/committees/fm" ]
] )
] ) ;
fhir:description [ fhir:v "This resource provides the adjudication details from the processing of a Claim resource."], [ fhir:v "This resource provides the adjudication details from the processing of a Claim resource."] ;
fhir:jurisdiction ( [
fhir:coding ( [
fhir:system [ fhir:v "http://unstats.un.org/unsd/methods/m49/m49.htm" ] ;
fhir:code [ fhir:v "001" ] ;
fhir:display [ fhir:v "World" ]
] )
] [
fhir:coding ( [
fhir:system [ fhir:v "http://unstats.un.org/unsd/methods/m49/m49.htm" ] ;
fhir:code [ fhir:v "001" ] ;
fhir:display [ fhir:v "World" ]
] )
] ) ;
fhir:fhirVersion [ fhir:v "6.0.0-ballot2"] ;
fhir:mapping ( [
fhir:identity [ fhir:v "workflow" ] ;
fhir:uri [ fhir:v "http://hl7.org/fhir/workflow" ] ;
fhir:name [ fhir:v "Workflow Pattern" ]
] [
fhir:identity [ fhir:v "w5" ] ;
fhir:uri [ fhir:v "http://hl7.org/fhir/fivews" ] ;
fhir:name [ fhir:v "FiveWs Pattern Mapping" ]
] [
fhir:identity [ fhir:v "rim" ] ;
fhir:uri [ fhir:v "http://hl7.org/v3" ] ;
fhir:name [ fhir:v "RIM Mapping" ]
] ) ;
fhir:kind [ fhir:v "resource"] ;
fhir:abstract [ fhir:v "false"] ;
fhir:type [ fhir:v "ClaimResponse"] ;
fhir:baseDefinition [ fhir:v "http://hl7.org/fhir/StructureDefinition/DomainResource"] ;
fhir:derivation [ fhir:v "specialization"] ;
fhir:snapshot [
fhir:element ( [
fhir:id [ fhir:v "ClaimResponse" ] ;
fhir:path [ fhir:v "ClaimResponse" ] ;
fhir:short [ fhir:v "Response to a claim predetermination or preauthorization" ] ;
fhir:definition [ fhir:v "This resource provides the adjudication details from the processing of a Claim resource." ] ;
fhir:alias ( [ fhir:v "Remittance Advice" ] ) ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "*" ] ;
fhir:base [
fhir:path [ fhir:v "ClaimResponse" ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "*" ]
] ;
fhir:constraint ( [
fhir:key [ fhir:v "dom-2" ] ;
fhir:severity [ fhir:v "error" ] ;
fhir:human [ fhir:v "If the resource is contained in another resource, it SHALL NOT contain nested Resources" ] ;
fhir:expression [ fhir:v "contained.contained.empty()" ] ;
fhir:source [ fhir:v "http://hl7.org/fhir/StructureDefinition/DomainResource" ]
] [
fhir:key [ fhir:v "dom-3" ] ;
fhir:severity [ fhir:v "error" ] ;
fhir:human [ fhir:v "If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource" ] ;
fhir:expression [ fhir:v "contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().ofType(canonical) | %resource.descendants().ofType(uri) | %resource.descendants().ofType(url))) or descendants().where(reference = '#').exists() or descendants().where(ofType(canonical) = '#').exists() or descendants().where(ofType(canonical) = '#').exists()).not()).trace('unmatched', id).empty()" ] ;
fhir:source [ fhir:v "http://hl7.org/fhir/StructureDefinition/DomainResource" ]
] [
fhir:key [ fhir:v "dom-4" ] ;
fhir:severity [ fhir:v "error" ] ;
fhir:human [ fhir:v "If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated" ] ;
fhir:expression [ fhir:v "contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()" ] ;
fhir:source [ fhir:v "http://hl7.org/fhir/StructureDefinition/DomainResource" ]
] [
fhir:key [ fhir:v "dom-5" ] ;
fhir:severity [ fhir:v "error" ] ;
fhir:human [ fhir:v "If a resource is contained in another resource, it SHALL NOT have a security label" ] ;
fhir:expression [ fhir:v "contained.meta.security.empty()" ] ;
fhir:source [ fhir:v "http://hl7.org/fhir/StructureDefinition/DomainResource" ]
] [
fhir:extension ( [
fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/elementdefinition-bestpractice" ] ;
fhir:value [ fhir:v "true" ]
] [
fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/elementdefinition-bestpractice-explanation" ] ;
fhir:value [ fhir:v "When a resource has no narrative, only systems that fully understand the data can display the resource to a human safely. Including a human readable representation in the resource makes for a much more robust eco-system and cheaper handling of resources by intermediary systems. Some ecosystems restrict distribution of resources to only those systems that do fully understand the resources, and as a consequence implementers may believe that the narrative is superfluous. However experience shows that such eco-systems often open up to new participants over time." ]
] ) ;
fhir:key [ fhir:v "dom-6" ] ;
fhir:severity [ fhir:v "warning" ] ;
fhir:human [ fhir:v "A resource should have narrative for robust management" ] ;
fhir:expression [ fhir:v "text.`div`.exists()" ] ;
fhir:source [ fhir:v "http://hl7.org/fhir/StructureDefinition/DomainResource" ]
] ) ;
fhir:mustSupport [ fhir:v "false" ] ;
fhir:isModifier [ fhir:v "false" ] ;
fhir:isSummary [ fhir:v "false" ] ;
fhir:mapping ( [
fhir:identity [ fhir:v "rim" ] ;
fhir:map [ fhir:v "Entity, Role, or Act" ]
] [
fhir:identity [ fhir:v "workflow" ] ;
fhir:map [ fhir:v "Event" ]
] [
fhir:identity [ fhir:v "w5" ] ;
fhir:map [ fhir:v "financial.billing" ]
] )
] [
fhir:id [ fhir:v "ClaimResponse.id" ] ;
fhir:path [ fhir:v "ClaimResponse.id" ] ;
fhir:short [ fhir:v "Logical id of this artifact" ] ;
fhir:definition [ fhir:v "The logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes." ] ;
fhir:comment [ fhir:v "Within the context of the FHIR RESTful interactions, the resource has an id except for cases like the create and conditional update. Otherwise, the use of the resouce id depends on the given use case." ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "1" ] ;
fhir:base [
fhir:path [ fhir:v "Resource.id" ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "1" ]
] ;
fhir:type ( [
fhir:extension ( [
fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type" ] ;
fhir:value [ fhir:v "id" ]
] ) ;
fhir:code [ fhir:v "http://hl7.org/fhirpath/System.String" ]
] ) ;
fhir:mustSupport [ fhir:v "false" ] ;
fhir:isModifier [ fhir:v "false" ] ;
fhir:isSummary [ fhir:v "true" ]
] [
fhir:id [ fhir:v "ClaimResponse.meta" ] ;
fhir:path [ fhir:v "ClaimResponse.meta" ] ;
fhir:short [ fhir:v "Metadata about the resource" ] ;
fhir:definition [ fhir:v "The metadata about the resource. This is content that is maintained by the infrastructure. Changes to the content might not always be associated with version changes to the resource." ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "1" ] ;
fhir:base [
fhir:path [ fhir:v "Resource.meta" ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "1" ]
] ;
fhir:type ( [
fhir:code [ fhir:v "Meta" ]
] ) ;
fhir:constraint ( [
fhir:key [ fhir:v "ele-1" ] ;
fhir:severity [ fhir:v "error" ] ;
fhir:human [ fhir:v "All FHIR elements must have a @value or children" ] ;
fhir:expression [ fhir:v "hasValue() or (children().count() > id.count())" ] ;
fhir:source [ fhir:v "http://hl7.org/fhir/StructureDefinition/Element" ]
] ) ;
fhir:mustSupport [ fhir:v "false" ] ;
fhir:isModifier [ fhir:v "false" ] ;
fhir:isSummary [ fhir:v "true" ]
] [
fhir:id [ fhir:v "ClaimResponse.implicitRules" ] ;
fhir:path [ fhir:v "ClaimResponse.implicitRules" ] ;
fhir:short [ fhir:v "A set of rules under which this content was created" ] ;
fhir:definition [ fhir:v "A reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content. Often, this is a reference to an implementation guide that defines the special rules along with other profiles etc." ] ;
fhir:comment [ fhir:v "Asserting this rule set restricts the content to be only understood by a limited set of trading partners. This inherently limits the usefulness of the data in the long term. However, the existing health eco-system is highly fractured, and not yet ready to define, collect, and exchange data in a generally computable sense. Wherever possible, implementers and/or specification writers should avoid using this element. Often, when used, the URL is a reference to an implementation guide that defines these special rules as part of its narrative along with other profiles, value sets, etc." ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "1" ] ;
fhir:base [
fhir:path [ fhir:v "Resource.implicitRules" ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "1" ]
] ;
fhir:type ( [
fhir:code [ fhir:v "uri" ]
] ) ;
fhir:constraint ( [
fhir:key [ fhir:v "ele-1" ] ;
fhir:severity [ fhir:v "error" ] ;
fhir:human [ fhir:v "All FHIR elements must have a @value or children" ] ;
fhir:expression [ fhir:v "hasValue() or (children().count() > id.count())" ] ;
fhir:source [ fhir:v "http://hl7.org/fhir/StructureDefinition/Element" ]
] ) ;
fhir:mustSupport [ fhir:v "false" ] ;
fhir:isModifier [ fhir:v "true" ] ;
fhir:isModifierReason [ fhir:v "This element is labeled as a modifier because the implicit rules may provide additional knowledge about the resource that modifies its meaning or interpretation" ] ;
fhir:isSummary [ fhir:v "true" ]
] [
fhir:id [ fhir:v "ClaimResponse.language" ] ;
fhir:path [ fhir:v "ClaimResponse.language" ] ;
fhir:short [ fhir:v "Language of the resource content" ] ;
fhir:definition [ fhir:v "The base language in which the resource is written." ] ;
fhir:comment [ fhir:v "Language is provided to support indexing and accessibility (typically, services such as text to speech use the language tag). The html language tag in the narrative applies to the narrative. The language tag on the resource may be used to specify the language of other presentations generated from the data in the resource. Not all the content has to be in the base language. The Resource.language should not be assumed to apply to the narrative automatically. If a language is specified, it should it also be specified on the div element in the html (see rules in HTML5 for information about the relationship between xml:lang and the html lang attribute)." ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "1" ] ;
fhir:base [
fhir:path [ fhir:v "Resource.language" ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "1" ]
] ;
fhir:type ( [
fhir:code [ fhir:v "code" ]
] ) ;
fhir:constraint ( [
fhir:key [ fhir:v "ele-1" ] ;
fhir:severity [ fhir:v "error" ] ;
fhir:human [ fhir:v "All FHIR elements must have a @value or children" ] ;
fhir:expression [ fhir:v "hasValue() or (children().count() > id.count())" ] ;
fhir:source [ fhir:v "http://hl7.org/fhir/StructureDefinition/Element" ]
] ) ;
fhir:mustSupport [ fhir:v "false" ] ;
fhir:isModifier [ fhir:v "false" ] ;
fhir:isSummary [ fhir:v "false" ] ;
fhir:binding [
fhir:extension ( [
fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName" ] ;
fhir:value [ fhir:v "Language" ]
] [
fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/elementdefinition-isCommonBinding" ] ;
fhir:value [ fhir:v "true" ]
] ) ;
fhir:strength [ fhir:v "required" ] ;
fhir:description [ fhir:v "IETF language tag for a human language" ] ;
fhir:valueSet [ fhir:v "http://hl7.org/fhir/ValueSet/all-languages|6.0.0-ballot2" ] ;
fhir:additional ( [
fhir:purpose [ fhir:v "starter" ] ;
fhir:valueSet [ fhir:v "http://hl7.org/fhir/ValueSet/languages" ]
] )
]
] [
fhir:id [ fhir:v "ClaimResponse.text" ] ;
fhir:path [ fhir:v "ClaimResponse.text" ] ;
fhir:short [ fhir:v "Text summary of the resource, for human interpretation" ] ;
fhir:definition [ fhir:v "A human-readable narrative that contains a summary of the resource and can be used to represent the content of the resource to a human. The narrative need not encode all the structured data, but is required to contain sufficient detail to make it \"clinically safe\" for a human to just read the narrative. Resource definitions may define what content should be represented in the narrative to ensure clinical safety." ] ;
fhir:comment [ fhir:v "Contained resources do not have a narrative. Resources that are not contained SHOULD have a narrative. In some cases, a resource may only have text with little or no additional discrete data (as long as all minOccurs=1 elements are satisfied). This may be necessary for data from legacy systems where information is captured as a \"text blob\" or where text is additionally entered raw or narrated and encoded information is added later." ] ;
fhir:alias ( [ fhir:v "narrative" ] [ fhir:v "html" ] [ fhir:v "xhtml" ] [ fhir:v "display" ] ) ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "1" ] ;
fhir:base [
fhir:path [ fhir:v "DomainResource.text" ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "1" ]
] ;
fhir:type ( [
fhir:code [ fhir:v "Narrative" ]
] ) ;
fhir:condition ( [ fhir:v "dom-6" ] ) ;
fhir:constraint ( [
fhir:key [ fhir:v "ele-1" ] ;
fhir:severity [ fhir:v "error" ] ;
fhir:human [ fhir:v "All FHIR elements must have a @value or children" ] ;
fhir:expression [ fhir:v "hasValue() or (children().count() > id.count())" ] ;
fhir:source [ fhir:v "http://hl7.org/fhir/StructureDefinition/Element" ]
] ) ;
fhir:mustSupport [ fhir:v "false" ] ;
fhir:isModifier [ fhir:v "false" ] ;
fhir:isSummary [ fhir:v "false" ] ;
fhir:mapping ( [
fhir:identity [ fhir:v "rim" ] ;
fhir:map [ fhir:v "Act.text?" ]
] )
] [
fhir:id [ fhir:v "ClaimResponse.contained" ] ;
fhir:path [ fhir:v "ClaimResponse.contained" ] ;
fhir:short [ fhir:v "Contained, inline Resources" ] ;
fhir:definition [ fhir:v "These resources do not have an independent existence apart from the resource that contains them - they cannot be identified independently, nor can they have their own independent transaction scope. This is allowed to be a Parameters resource if and only if it is referenced by a resource that provides context/meaning." ] ;
fhir:comment [ fhir:v "This should never be done when the content can be identified properly, as once identification is lost, it is extremely difficult (and context dependent) to restore it again. Contained resources may have profiles and tags in their meta elements, but SHALL NOT have security labels." ] ;
fhir:alias ( [ fhir:v "inline resources" ] [ fhir:v "anonymous resources" ] [ fhir:v "contained resources" ] ) ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "*" ] ;
fhir:base [
fhir:path [ fhir:v "DomainResource.contained" ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "*" ]
] ;
fhir:type ( [
fhir:code [ fhir:v "Resource" ]
] ) ;
fhir:condition ( [ fhir:v "dom-2" ] [ fhir:v "dom-4" ] [ fhir:v "dom-3" ] [ fhir:v "dom-5" ] ) ;
fhir:mustSupport [ fhir:v "false" ] ;
fhir:isModifier [ fhir:v "false" ] ;
fhir:isSummary [ fhir:v "false" ] ;
fhir:mapping ( [
fhir:identity [ fhir:v "rim" ] ;
fhir:map [ fhir:v "N/A" ]
] )
] [
fhir:id [ fhir:v "ClaimResponse.extension" ] ;
fhir:path [ fhir:v "ClaimResponse.extension" ] ;
fhir:short [ fhir:v "Additional content defined by implementations" ] ;
fhir:definition [ fhir:v "May be used to represent additional information that is not part of the basic definition of the resource. To make the use of extensions safe and managable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension." ] ;
fhir:comment [ fhir:v "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone." ] ;
fhir:alias ( [ fhir:v "extensions" ] [ fhir:v "user content" ] ) ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "*" ] ;
fhir:base [
fhir:path [ fhir:v "DomainResource.extension" ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "*" ]
] ;
fhir:type ( [
fhir:code [ fhir:v "Extension" ]
] ) ;
fhir:constraint ( [
fhir:key [ fhir:v "ele-1" ] ;
fhir:severity [ fhir:v "error" ] ;
fhir:human [ fhir:v "All FHIR elements must have a @value or children" ] ;
fhir:expression [ fhir:v "hasValue() or (children().count() > id.count())" ] ;
fhir:source [ fhir:v "http://hl7.org/fhir/StructureDefinition/Element" ]
] ) ;
fhir:mustSupport [ fhir:v "false" ] ;
fhir:isModifier [ fhir:v "false" ] ;
fhir:isSummary [ fhir:v "false" ] ;
fhir:mapping ( [
fhir:identity [ fhir:v "rim" ] ;
fhir:map [ fhir:v "N/A" ]
] )
] [
fhir:id [ fhir:v "ClaimResponse.modifierExtension" ] ;
fhir:path [ fhir:v "ClaimResponse.modifierExtension" ] ;
fhir:short [ fhir:v "Extensions that cannot be ignored" ] ;
fhir:definition [ fhir:v "May be used to represent additional information that is not part of the basic definition of the resource and that modifies the understanding of the element that contains it and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and managable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.\n\nModifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself)." ] ;
fhir:comment [ fhir:v "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone." ] ;
fhir:requirements [ fhir:v "Modifier extensions allow for extensions that *cannot* be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the [definition of modifier extensions](extensibility.html#modifierExtension)." ] ;
fhir:alias ( [ fhir:v "extensions" ] [ fhir:v "user content" ] ) ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "*" ] ;
fhir:base [
fhir:path [ fhir:v "DomainResource.modifierExtension" ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "*" ]
] ;
fhir:type ( [
fhir:code [ fhir:v "Extension" ]
] ) ;
fhir:constraint ( [
fhir:key [ fhir:v "ele-1" ] ;
fhir:severity [ fhir:v "error" ] ;
fhir:human [ fhir:v "All FHIR elements must have a @value or children" ] ;
fhir:expression [ fhir:v "hasValue() or (children().count() > id.count())" ] ;
fhir:source [ fhir:v "http://hl7.org/fhir/StructureDefinition/Element" ]
] ) ;
fhir:mustSupport [ fhir:v "false" ] ;
fhir:isModifier [ fhir:v "true" ] ;
fhir:isModifierReason [ fhir:v "Modifier extensions are expected to modify the meaning or interpretation of the resource that contains them" ] ;
fhir:isSummary [ fhir:v "true" ] ;
fhir:mapping ( [
fhir:identity [ fhir:v "rim" ] ;
fhir:map [ fhir:v "N/A" ]
] )
] [
fhir:id [ fhir:v "ClaimResponse.identifier" ] ;
fhir:path [ fhir:v "ClaimResponse.identifier" ] ;
fhir:short [ fhir:v "Business Identifier for a claim response" ] ;
fhir:definition [ fhir:v "A unique identifier assigned to this claim response." ] ;
fhir:requirements [ fhir:v "Allows claim responses to be distinguished and referenced." ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "*" ] ;
fhir:base [
fhir:path [ fhir:v "ClaimResponse.identifier" ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "*" ]
] ;
fhir:type ( [
fhir:code [ fhir:v "Identifier" ]
] ) ;
fhir:constraint ( [
fhir:key [ fhir:v "ele-1" ] ;
fhir:severity [ fhir:v "error" ] ;
fhir:human [ fhir:v "All FHIR elements must have a @value or children" ] ;
fhir:expression [ fhir:v "hasValue() or (children().count() > id.count())" ] ;
fhir:source [ fhir:v "http://hl7.org/fhir/StructureDefinition/Element" ]
] ) ;
fhir:mustSupport [ fhir:v "false" ] ;
fhir:isModifier [ fhir:v "false" ] ;
fhir:isSummary [ fhir:v "false" ] ;
fhir:mapping ( [
fhir:identity [ fhir:v "workflow" ] ;
fhir:map [ fhir:v "Event.identifier" ]
] [
fhir:identity [ fhir:v "w5" ] ;
fhir:map [ fhir:v "FiveWs.identifier" ]
] )
] [
fhir:id [ fhir:v "ClaimResponse.traceNumber" ] ;
fhir:path [ fhir:v "ClaimResponse.traceNumber" ] ;
fhir:short [ fhir:v "Number for tracking" ] ;
fhir:definition [ fhir:v "Trace number for tracking purposes. May be defined at the jurisdiction level or between trading partners." ] ;
fhir:requirements [ fhir:v "Allows partners to uniquely identify components for tracking." ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "*" ] ;
fhir:base [
fhir:path [ fhir:v "ClaimResponse.traceNumber" ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "*" ]
] ;
fhir:type ( [
fhir:code [ fhir:v "Identifier" ]
] ) ;
fhir:constraint ( [
fhir:key [ fhir:v "ele-1" ] ;
fhir:severity [ fhir:v "error" ] ;
fhir:human [ fhir:v "All FHIR elements must have a @value or children" ] ;
fhir:expression [ fhir:v "hasValue() or (children().count() > id.count())" ] ;
fhir:source [ fhir:v "http://hl7.org/fhir/StructureDefinition/Element" ]
] ) ;
fhir:mustSupport [ fhir:v "false" ] ;
fhir:isModifier [ fhir:v "false" ] ;
fhir:isSummary [ fhir:v "false" ]
] [
fhir:id [ fhir:v "ClaimResponse.status" ] ;
fhir:path [ fhir:v "ClaimResponse.status" ] ;
fhir:short [ fhir:v "active | cancelled | draft | entered-in-error" ] ;
fhir:definition [ fhir:v "The status of the resource instance." ] ;
fhir:comment [ fhir:v "This element is labeled as a modifier because the status contains codes that mark the resource as not currently valid." ] ;
fhir:requirements [ fhir:v "Need to track the status of the resource as 'draft' resources may undergo further edits while 'active' resources are immutable and may only have their status changed to 'cancelled'." ] ;
fhir:min [ fhir:v "1" ] ;
fhir:max [ fhir:v "1" ] ;
fhir:base [
fhir:path [ fhir:v "ClaimResponse.status" ] ;
fhir:min [ fhir:v "1" ] ;
fhir:max [ fhir:v "1" ]
] ;
fhir:type ( [
fhir:code [ fhir:v "code" ]
] ) ;
fhir:constraint ( [
fhir:key [ fhir:v "ele-1" ] ;
fhir:severity [ fhir:v "error" ] ;
fhir:human [ fhir:v "All FHIR elements must have a @value or children" ] ;
fhir:expression [ fhir:v "hasValue() or (children().count() > id.count())" ] ;
fhir:source [ fhir:v "http://hl7.org/fhir/StructureDefinition/Element" ]
] ) ;
fhir:mustSupport [ fhir:v "false" ] ;
fhir:isModifier [ fhir:v "true" ] ;
fhir:isModifierReason [ fhir:v "This element is labeled as a modifier because it is a status element that contains status entered-in-error which means that the resource should not be treated as valid" ] ;
fhir:isSummary [ fhir:v "true" ] ;
fhir:binding [
fhir:extension ( [
fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName" ] ;
fhir:value [ fhir:v "ClaimResponseStatus" ]
] ) ;
fhir:strength [ fhir:v "required" ] ;
fhir:description [ fhir:v "A code specifying the state of the resource instance." ] ;
fhir:valueSet [ fhir:v "http://hl7.org/fhir/ValueSet/fm-status|6.0.0-ballot2" ]
] ;
fhir:mapping ( [
fhir:identity [ fhir:v "workflow" ] ;
fhir:map [ fhir:v "Event.status" ]
] [
fhir:identity [ fhir:v "w5" ] ;
fhir:map [ fhir:v "FiveWs.status" ]
] )
] [
fhir:id [ fhir:v "ClaimResponse.type" ] ;
fhir:path [ fhir:v "ClaimResponse.type" ] ;
fhir:short [ fhir:v "More granular claim type" ] ;
fhir:definition [ fhir:v "A finer grained suite of claim type codes which may convey additional information such as Inpatient vs Outpatient and/or a specialty service." ] ;
fhir:comment [ fhir:v "This may contain the local bill type codes, for example the US UB-04 bill type code or the CMS bill type." ] ;
fhir:requirements [ fhir:v "Some jurisdictions need a finer grained claim type for routing and adjudication." ] ;
fhir:min [ fhir:v "1" ] ;
fhir:max [ fhir:v "1" ] ;
fhir:base [
fhir:path [ fhir:v "ClaimResponse.type" ] ;
fhir:min [ fhir:v "1" ] ;
fhir:max [ fhir:v "1" ]
] ;
fhir:type ( [
fhir:code [ fhir:v "CodeableConcept" ]
] ) ;
fhir:constraint ( [
fhir:key [ fhir:v "ele-1" ] ;
fhir:severity [ fhir:v "error" ] ;
fhir:human [ fhir:v "All FHIR elements must have a @value or children" ] ;
fhir:expression [ fhir:v "hasValue() or (children().count() > id.count())" ] ;
fhir:source [ fhir:v "http://hl7.org/fhir/StructureDefinition/Element" ]
] ) ;
fhir:mustSupport [ fhir:v "false" ] ;
fhir:isModifier [ fhir:v "false" ] ;
fhir:isSummary [ fhir:v "true" ] ;
fhir:binding [
fhir:extension ( [
fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName" ] ;
fhir:value [ fhir:v "ClaimType" ]
] ) ;
fhir:strength [ fhir:v "extensible" ] ;
fhir:description [ fhir:v "The type or discipline-style of the claim." ] ;
fhir:valueSet [ fhir:v "http://hl7.org/fhir/ValueSet/claim-type" ]
] ;
fhir:mapping ( [
fhir:identity [ fhir:v "w5" ] ;
fhir:map [ fhir:v "FiveWs.class" ]
] )
] [
fhir:id [ fhir:v "ClaimResponse.subType" ] ;
fhir:path [ fhir:v "ClaimResponse.subType" ] ;
fhir:short [ fhir:v "More granular claim type" ] ;
fhir:definition [ fhir:v "A finer grained suite of claim type codes which may convey additional information such as Inpatient vs Outpatient and/or a specialty service." ] ;
fhir:comment [ fhir:v "This may contain the local bill type codes, for example the US UB-04 bill type code or the CMS bill type." ] ;
fhir:requirements [ fhir:v "Some jurisdictions need a finer grained claim type for routing and adjudication." ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "1" ] ;
fhir:base [
fhir:path [ fhir:v "ClaimResponse.subType" ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "1" ]
] ;
fhir:type ( [
fhir:code [ fhir:v "CodeableConcept" ]
] ) ;
fhir:constraint ( [
fhir:key [ fhir:v "ele-1" ] ;
fhir:severity [ fhir:v "error" ] ;
fhir:human [ fhir:v "All FHIR elements must have a @value or children" ] ;
fhir:expression [ fhir:v "hasValue() or (children().count() > id.count())" ] ;
fhir:source [ fhir:v "http://hl7.org/fhir/StructureDefinition/Element" ]
] ) ;
fhir:mustSupport [ fhir:v "false" ] ;
fhir:isModifier [ fhir:v "false" ] ;
fhir:isSummary [ fhir:v "false" ] ;
fhir:binding [
fhir:extension ( [
fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName" ] ;
fhir:value [ fhir:v "ClaimSubType" ]
] ) ;
fhir:strength [ fhir:v "example" ] ;
fhir:description [ fhir:v "A more granular claim typecode." ] ;
fhir:valueSet [ fhir:v "http://hl7.org/fhir/ValueSet/claim-subtype" ]
] ;
fhir:mapping ( [
fhir:identity [ fhir:v "w5" ] ;
fhir:map [ fhir:v "FiveWs.class" ]
] )
] [
fhir:id [ fhir:v "ClaimResponse.use" ] ;
fhir:path [ fhir:v "ClaimResponse.use" ] ;
fhir:short [ fhir:v "claim | preauthorization | predetermination" ] ;
fhir:definition [ fhir:v "A code to indicate whether the nature of the request is: Claim - A request to an Insurer to adjudicate the supplied charges for health care goods and services under the identified policy and to pay the determined Benefit amount, if any; Preauthorization - A request to an Insurer to adjudicate the supplied proposed future charges for health care goods and services under the identified policy and to approve the services and provide the expected benefit amounts and potentially to reserve funds to pay the benefits when Claims for the indicated services are later submitted; or, Pre-determination - A request to an Insurer to adjudicate the supplied 'what if' charges for health care goods and services under the identified policy and report back what the Benefit payable would be had the services actually been provided." ] ;
fhir:requirements [ fhir:v "This element is required to understand the nature of the request for adjudication." ] ;
fhir:min [ fhir:v "1" ] ;
fhir:max [ fhir:v "1" ] ;
fhir:base [
fhir:path [ fhir:v "ClaimResponse.use" ] ;
fhir:min [ fhir:v "1" ] ;
fhir:max [ fhir:v "1" ]
] ;
fhir:type ( [
fhir:code [ fhir:v "code" ]
] ) ;
fhir:constraint ( [
fhir:key [ fhir:v "ele-1" ] ;
fhir:severity [ fhir:v "error" ] ;
fhir:human [ fhir:v "All FHIR elements must have a @value or children" ] ;
fhir:expression [ fhir:v "hasValue() or (children().count() > id.count())" ] ;
fhir:source [ fhir:v "http://hl7.org/fhir/StructureDefinition/Element" ]
] ) ;
fhir:mustSupport [ fhir:v "false" ] ;
fhir:isModifier [ fhir:v "false" ] ;
fhir:isSummary [ fhir:v "true" ] ;
fhir:binding [
fhir:extension ( [
fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName" ] ;
fhir:value [ fhir:v "Use" ]
] ) ;
fhir:strength [ fhir:v "required" ] ;
fhir:description [ fhir:v "Claim, preauthorization, predetermination." ] ;
fhir:valueSet [ fhir:v "http://hl7.org/fhir/ValueSet/claim-use|6.0.0-ballot2" ]
] ;
fhir:mapping ( [
fhir:identity [ fhir:v "w5" ] ;
fhir:map [ fhir:v "FiveWs.class" ]
] )
] [
fhir:id [ fhir:v "ClaimResponse.patient" ] ;
fhir:path [ fhir:v "ClaimResponse.patient" ] ;
fhir:short [ fhir:v "The recipient of the products and services" ] ;
fhir:definition [ fhir:v "The party to whom the professional services and/or products have been supplied or are being considered and for whom actual for facast reimbursement is sought." ] ;
fhir:requirements [ fhir:v "The patient must be supplied to the insurer so that confirmation of coverage and service hstory may be considered as part of the authorization and/or adjudiction." ] ;
fhir:min [ fhir:v "1" ] ;
fhir:max [ fhir:v "1" ] ;
fhir:base [
fhir:path [ fhir:v "ClaimResponse.patient" ] ;
fhir:min [ fhir:v "1" ] ;
fhir:max [ fhir:v "1" ]
] ;
fhir:type ( [
fhir:code [ fhir:v "Reference" ] ;
fhir:targetProfile ( [ fhir:v "http://hl7.org/fhir/StructureDefinition/Patient" ] )
] ) ;
fhir:constraint ( [
fhir:key [ fhir:v "ele-1" ] ;
fhir:severity [ fhir:v "error" ] ;
fhir:human [ fhir:v "All FHIR elements must have a @value or children" ] ;
fhir:expression [ fhir:v "hasValue() or (children().count() > id.count())" ] ;
fhir:source [ fhir:v "http://hl7.org/fhir/StructureDefinition/Element" ]
] ) ;
fhir:mustSupport [ fhir:v "false" ] ;
fhir:isModifier [ fhir:v "false" ] ;
fhir:isSummary [ fhir:v "true" ] ;
fhir:mapping ( [
fhir:identity [ fhir:v "w5" ] ;
fhir:map [ fhir:v "FiveWs.subject[x]" ]
] )
] [
fhir:id [ fhir:v "ClaimResponse.created" ] ;
fhir:path [ fhir:v "ClaimResponse.created" ] ;
fhir:short [ fhir:v "Response creation date" ] ;
fhir:definition [ fhir:v "The date this resource was created." ] ;
fhir:requirements [ fhir:v "Need to record a timestamp for use by both the recipient and the issuer." ] ;
fhir:min [ fhir:v "1" ] ;
fhir:max [ fhir:v "1" ] ;
fhir:base [
fhir:path [ fhir:v "ClaimResponse.created" ] ;
fhir:min [ fhir:v "1" ] ;
fhir:max [ fhir:v "1" ]
] ;
fhir:type ( [
fhir:code [ fhir:v "dateTime" ]
] ) ;
fhir:constraint ( [
fhir:key [ fhir:v "ele-1" ] ;
fhir:severity [ fhir:v "error" ] ;
fhir:human [ fhir:v "All FHIR elements must have a @value or children" ] ;
fhir:expression [ fhir:v "hasValue() or (children().count() > id.count())" ] ;
fhir:source [ fhir:v "http://hl7.org/fhir/StructureDefinition/Element" ]
] ) ;
fhir:mustSupport [ fhir:v "false" ] ;
fhir:isModifier [ fhir:v "false" ] ;
fhir:isSummary [ fhir:v "true" ] ;
fhir:mapping ( [
fhir:identity [ fhir:v "workflow" ] ;
fhir:map [ fhir:v "Event.occurrence[x]" ]
] [
fhir:identity [ fhir:v "w5" ] ;
fhir:map [ fhir:v "FiveWs.recorded" ]
] )
] [
fhir:id [ fhir:v "ClaimResponse.insurer" ] ;
fhir:path [ fhir:v "ClaimResponse.insurer" ] ;
fhir:short [ fhir:v "Party responsible for reimbursement" ] ;
fhir:definition [ fhir:v "The party responsible for authorization, adjudication and reimbursement." ] ;
fhir:requirements [ fhir:v "To be a valid claim, preauthorization or predetermination there must be a party who is responsible for adjudicating the contents against a policy which provides benefits for the patient." ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "1" ] ;
fhir:base [
fhir:path [ fhir:v "ClaimResponse.insurer" ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "1" ]
] ;
fhir:type ( [
fhir:code [ fhir:v "Reference" ] ;
fhir:targetProfile ( [ fhir:v "http://hl7.org/fhir/StructureDefinition/Organization" ] )
] ) ;
fhir:constraint ( [
fhir:key [ fhir:v "ele-1" ] ;
fhir:severity [ fhir:v "error" ] ;
fhir:human [ fhir:v "All FHIR elements must have a @value or children" ] ;
fhir:expression [ fhir:v "hasValue() or (children().count() > id.count())" ] ;
fhir:source [ fhir:v "http://hl7.org/fhir/StructureDefinition/Element" ]
] ) ;
fhir:mustSupport [ fhir:v "false" ] ;
fhir:isModifier [ fhir:v "false" ] ;
fhir:isSummary [ fhir:v "true" ] ;
fhir:mapping ( [
fhir:identity [ fhir:v "workflow" ] ;
fhir:map [ fhir:v "Event.performer" ]
] )
] [
fhir:id [ fhir:v "ClaimResponse.requestor" ] ;
fhir:path [ fhir:v "ClaimResponse.requestor" ] ;
fhir:short [ fhir:v "Party responsible for the claim" ] ;
fhir:definition [ fhir:v "The provider which is responsible for the claim, predetermination or preauthorization." ] ;
fhir:comment [ fhir:v "Typically this field would be 1..1 where this party is accountable for the data content within the claim but is not necessarily the facility, provider group or practitioner who provided the products and services listed within this claim resource. This field is the Billing Provider, for example, a facility, provider group, lab or practitioner.." ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "1" ] ;
fhir:base [
fhir:path [ fhir:v "ClaimResponse.requestor" ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "1" ]
] ;
fhir:type ( [
fhir:code [ fhir:v "Reference" ] ;
fhir:targetProfile ( [ fhir:v "http://hl7.org/fhir/StructureDefinition/Practitioner" ] [ fhir:v "http://hl7.org/fhir/StructureDefinition/PractitionerRole" ] [ fhir:v "http://hl7.org/fhir/StructureDefinition/Organization" ] )
] ) ;
fhir:constraint ( [
fhir:key [ fhir:v "ele-1" ] ;
fhir:severity [ fhir:v "error" ] ;
fhir:human [ fhir:v "All FHIR elements must have a @value or children" ] ;
fhir:expression [ fhir:v "hasValue() or (children().count() > id.count())" ] ;
fhir:source [ fhir:v "http://hl7.org/fhir/StructureDefinition/Element" ]
] ) ;
fhir:mustSupport [ fhir:v "false" ] ;
fhir:isModifier [ fhir:v "false" ] ;
fhir:isSummary [ fhir:v "false" ] ;
fhir:mapping ( [
fhir:identity [ fhir:v "w5" ] ;
fhir:map [ fhir:v "FiveWs.source" ]
] )
] [
fhir:id [ fhir:v "ClaimResponse.request" ] ;
fhir:path [ fhir:v "ClaimResponse.request" ] ;
fhir:short [ fhir:v "Id of resource triggering adjudication" ] ;
fhir:definition [ fhir:v "Original request resource reference." ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "1" ] ;
fhir:base [
fhir:path [ fhir:v "ClaimResponse.request" ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "1" ]
] ;
fhir:type ( [
fhir:code [ fhir:v "Reference" ] ;
fhir:targetProfile ( [ fhir:v "http://hl7.org/fhir/StructureDefinition/Claim" ] )
] ) ;
fhir:constraint ( [
fhir:key [ fhir:v "ele-1" ] ;
fhir:severity [ fhir:v "error" ] ;
fhir:human [ fhir:v "All FHIR elements must have a @value or children" ] ;
fhir:expression [ fhir:v "hasValue() or (children().count() > id.count())" ] ;
fhir:source [ fhir:v "http://hl7.org/fhir/StructureDefinition/Element" ]
] ) ;
fhir:mustSupport [ fhir:v "false" ] ;
fhir:isModifier [ fhir:v "false" ] ;
fhir:isSummary [ fhir:v "true" ] ;
fhir:mapping ( [
fhir:identity [ fhir:v "workflow" ] ;
fhir:map [ fhir:v "Event.basedOn" ]
] [
fhir:identity [ fhir:v "w5" ] ;
fhir:map [ fhir:v "FiveWs.why[x]" ]
] )
] [
fhir:id [ fhir:v "ClaimResponse.outcome" ] ;
fhir:path [ fhir:v "ClaimResponse.outcome" ] ;
fhir:short [ fhir:v "queued | complete | error | partial" ] ;
fhir:definition [ fhir:v "The outcome of the claim, predetermination, or preauthorization processing." ] ;
fhir:comment [ fhir:v "The resource may be used to indicate that the Claim/Preauthorization/Pre-determination has been received but processing has not begun (queued); that it has been processed and one or more errors have been detected (error); no errors were detected and some of the adjudication processing has been performed (partial); or all of the adjudication processing has completed without errors (complete)." ] ;
fhir:requirements [ fhir:v "To advise the requestor of an overall processing outcome." ] ;
fhir:min [ fhir:v "1" ] ;
fhir:max [ fhir:v "1" ] ;
fhir:base [
fhir:path [ fhir:v "ClaimResponse.outcome" ] ;
fhir:min [ fhir:v "1" ] ;
fhir:max [ fhir:v "1" ]
] ;
fhir:type ( [
fhir:code [ fhir:v "code" ]
] ) ;
fhir:constraint ( [
fhir:key [ fhir:v "ele-1" ] ;
fhir:severity [ fhir:v "error" ] ;
fhir:human [ fhir:v "All FHIR elements must have a @value or children" ] ;
fhir:expression [ fhir:v "hasValue() or (children().count() > id.count())" ] ;
fhir:source [ fhir:v "http://hl7.org/fhir/StructureDefinition/Element" ]
] ) ;
fhir:mustSupport [ fhir:v "false" ] ;
fhir:isModifier [ fhir:v "false" ] ;
fhir:isSummary [ fhir:v "true" ] ;
fhir:binding [
fhir:extension ( [
fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName" ] ;
fhir:value [ fhir:v "RemittanceOutcome" ]
] ) ;
fhir:strength [ fhir:v "required" ] ;
fhir:description [ fhir:v "The result of the claim processing." ] ;
fhir:valueSet [ fhir:v "http://hl7.org/fhir/ValueSet/claim-outcome|6.0.0-ballot2" ]
]
] [
fhir:id [ fhir:v "ClaimResponse.decision" ] ;
fhir:path [ fhir:v "ClaimResponse.decision" ] ;
fhir:short [ fhir:v "Result of the adjudication" ] ;
fhir:definition [ fhir:v "The result of the claim, predetermination, or preauthorization adjudication." ] ;
fhir:comment [ fhir:v "The element is used to indicate the current state of the adjudication overall for the claim resource, for example: the request has been held (pended) for adjudication processing, for manual review or other reasons; that it has been processed and will be paid, or the outstanding paid, as submitted (approved); that no amount will be paid (denied); or that some amount between zero and the submitted amount will be paid (partial)." ] ;
fhir:requirements [ fhir:v "To advise the requestor of the result of the adjudication process." ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "1" ] ;
fhir:base [
fhir:path [ fhir:v "ClaimResponse.decision" ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "1" ]
] ;
fhir:type ( [
fhir:code [ fhir:v "CodeableConcept" ]
] ) ;
fhir:constraint ( [
fhir:key [ fhir:v "ele-1" ] ;
fhir:severity [ fhir:v "error" ] ;
fhir:human [ fhir:v "All FHIR elements must have a @value or children" ] ;
fhir:expression [ fhir:v "hasValue() or (children().count() > id.count())" ] ;
fhir:source [ fhir:v "http://hl7.org/fhir/StructureDefinition/Element" ]
] ) ;
fhir:mustSupport [ fhir:v "false" ] ;
fhir:isModifier [ fhir:v "false" ] ;
fhir:isSummary [ fhir:v "true" ] ;
fhir:binding [
fhir:extension ( [
fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName" ] ;
fhir:value [ fhir:v "AdjudicationDecision" ]
] ) ;
fhir:strength [ fhir:v "example" ] ;
fhir:description [ fhir:v "The overall result of the claim adjudication." ] ;
fhir:valueSet [ fhir:v "http://hl7.org/fhir/ValueSet/claim-decision" ]
]
] [
fhir:id [ fhir:v "ClaimResponse.disposition" ] ;
fhir:path [ fhir:v "ClaimResponse.disposition" ] ;
fhir:short [ fhir:v "Disposition Message" ] ;
fhir:definition [ fhir:v "A human readable description of the status of the adjudication." ] ;
fhir:requirements [ fhir:v "Provided for user display." ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "1" ] ;
fhir:base [
fhir:path [ fhir:v "ClaimResponse.disposition" ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "1" ]
] ;
fhir:type ( [
fhir:code [ fhir:v "string" ]
] ) ;
fhir:constraint ( [
fhir:key [ fhir:v "ele-1" ] ;
fhir:severity [ fhir:v "error" ] ;
fhir:human [ fhir:v "All FHIR elements must have a @value or children" ] ;
fhir:expression [ fhir:v "hasValue() or (children().count() > id.count())" ] ;
fhir:source [ fhir:v "http://hl7.org/fhir/StructureDefinition/Element" ]
] ) ;
fhir:mustSupport [ fhir:v "false" ] ;
fhir:isModifier [ fhir:v "false" ] ;
fhir:isSummary [ fhir:v "false" ] ;
fhir:mapping ( [
fhir:identity [ fhir:v "workflow" ] ;
fhir:map [ fhir:v "Event.note" ]
] )
] [
fhir:id [ fhir:v "ClaimResponse.preAuthRef" ] ;
fhir:path [ fhir:v "ClaimResponse.preAuthRef" ] ;
fhir:short [ fhir:v "Preauthorization reference" ] ;
fhir:definition [ fhir:v "Reference from the Insurer which is used in later communications which refers to this adjudication." ] ;
fhir:comment [ fhir:v "This value is only present on preauthorization adjudications." ] ;
fhir:requirements [ fhir:v "On subsequent claims, the insurer may require the provider to quote this value." ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "1" ] ;
fhir:base [
fhir:path [ fhir:v "ClaimResponse.preAuthRef" ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "1" ]
] ;
fhir:type ( [
fhir:code [ fhir:v "string" ]
] ) ;
fhir:constraint ( [
fhir:key [ fhir:v "ele-1" ] ;
fhir:severity [ fhir:v "error" ] ;
fhir:human [ fhir:v "All FHIR elements must have a @value or children" ] ;
fhir:expression [ fhir:v "hasValue() or (children().count() > id.count())" ] ;
fhir:source [ fhir:v "http://hl7.org/fhir/StructureDefinition/Element" ]
] ) ;
fhir:mustSupport [ fhir:v "false" ] ;
fhir:isModifier [ fhir:v "false" ] ;
fhir:isSummary [ fhir:v "false" ]
] [
fhir:id [ fhir:v "ClaimResponse.preAuthPeriod" ] ;
fhir:path [ fhir:v "ClaimResponse.preAuthPeriod" ] ;
fhir:short [ fhir:v "Preauthorization reference effective period" ] ;
fhir:definition [ fhir:v "The time frame during which this authorization is effective." ] ;
fhir:requirements [ fhir:v "To convey to the provider when the authorized products and services must be supplied for the authorized adjudication to apply." ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "1" ] ;
fhir:base [
fhir:path [ fhir:v "ClaimResponse.preAuthPeriod" ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "1" ]
] ;
fhir:type ( [
fhir:code [ fhir:v "Period" ]
] ) ;
fhir:constraint ( [
fhir:key [ fhir:v "ele-1" ] ;
fhir:severity [ fhir:v "error" ] ;
fhir:human [ fhir:v "All FHIR elements must have a @value or children" ] ;
fhir:expression [ fhir:v "hasValue() or (children().count() > id.count())" ] ;
fhir:source [ fhir:v "http://hl7.org/fhir/StructureDefinition/Element" ]
] ) ;
fhir:mustSupport [ fhir:v "false" ] ;
fhir:isModifier [ fhir:v "false" ] ;
fhir:isSummary [ fhir:v "false" ]
] [
fhir:id [ fhir:v "ClaimResponse.event" ] ;
fhir:path [ fhir:v "ClaimResponse.event" ] ;
fhir:short [ fhir:v "Event information" ] ;
fhir:definition [ fhir:v "Information code for an event with a corresponding date or period." ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "*" ] ;
fhir:base [
fhir:path [ fhir:v "ClaimResponse.event" ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "*" ]
] ;
fhir:type ( [
fhir:code [ fhir:v "BackboneElement" ]
] ) ;
fhir:constraint ( [
fhir:key [ fhir:v "ele-1" ] ;
fhir:severity [ fhir:v "error" ] ;
fhir:human [ fhir:v "All FHIR elements must have a @value or children" ] ;
fhir:expression [ fhir:v "hasValue() or (children().count() > id.count())" ] ;
fhir:source [ fhir:v "http://hl7.org/fhir/StructureDefinition/Element" ]
] ) ;
fhir:mustSupport [ fhir:v "false" ] ;
fhir:isModifier [ fhir:v "false" ] ;
fhir:isSummary [ fhir:v "false" ]
] [
fhir:id [ fhir:v "ClaimResponse.event.id" ] ;
fhir:path [ fhir:v "ClaimResponse.event.id" ] ;
fhir:representation ( [ fhir:v "xmlAttr" ] ) ;
fhir:short [ fhir:v "Unique id for inter-element referencing" ] ;
fhir:definition [ fhir:v "Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces." ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "1" ] ;
fhir:base [
fhir:path [ fhir:v "Element.id" ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "1" ]
] ;
fhir:type ( [
fhir:extension ( [
fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type" ] ;
fhir:value [ fhir:v "string" ]
] ) ;
fhir:code [ fhir:v "http://hl7.org/fhirpath/System.String" ]
] ) ;
fhir:condition ( [ fhir:v "ele-1" ] ) ;
fhir:isModifier [ fhir:v "false" ] ;
fhir:isSummary [ fhir:v "false" ] ;
fhir:mapping ( [
fhir:identity [ fhir:v "rim" ] ;
fhir:map [ fhir:v "n/a" ]
] )
] [
fhir:id [ fhir:v "ClaimResponse.event.extension" ] ;
fhir:path [ fhir:v "ClaimResponse.event.extension" ] ;
fhir:short [ fhir:v "Additional content defined by implementations" ] ;
fhir:definition [ fhir:v "May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and managable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension." ] ;
fhir:comment [ fhir:v "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone." ] ;
fhir:alias ( [ fhir:v "extensions" ] [ fhir:v "user content" ] ) ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "*" ] ;
fhir:base [
fhir:path [ fhir:v "Element.extension" ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "*" ]
] ;
fhir:type ( [
fhir:code [ fhir:v "Extension" ]
] ) ;
fhir:constraint ( [
fhir:key [ fhir:v "ele-1" ] ;
fhir:severity [ fhir:v "error" ] ;
fhir:human [ fhir:v "All FHIR elements must have a @value or children" ] ;
fhir:expression [ fhir:v "hasValue() or (children().count() > id.count())" ] ;
fhir:source [ fhir:v "http://hl7.org/fhir/StructureDefinition/Element" ]
] ) ;
fhir:isModifier [ fhir:v "false" ] ;
fhir:isSummary [ fhir:v "false" ] ;
fhir:mapping ( [
fhir:identity [ fhir:v "rim" ] ;
fhir:map [ fhir:v "n/a" ]
] )
] [
fhir:id [ fhir:v "ClaimResponse.event.modifierExtension" ] ;
fhir:path [ fhir:v "ClaimResponse.event.modifierExtension" ] ;
fhir:short [ fhir:v "Extensions that cannot be ignored even if unrecognized" ] ;
fhir:definition [ fhir:v "May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and managable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.\n\nModifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself)." ] ;
fhir:comment [ fhir:v "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone." ] ;
fhir:requirements [ fhir:v "Modifier extensions allow for extensions that *cannot* be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the [definition of modifier extensions](extensibility.html#modifierExtension)." ] ;
fhir:alias ( [ fhir:v "extensions" ] [ fhir:v "user content" ] [ fhir:v "modifiers" ] ) ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "*" ] ;
fhir:base [
fhir:path [ fhir:v "BackboneElement.modifierExtension" ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "*" ]
] ;
fhir:type ( [
fhir:code [ fhir:v "Extension" ]
] ) ;
fhir:constraint ( [
fhir:key [ fhir:v "ele-1" ] ;
fhir:severity [ fhir:v "error" ] ;
fhir:human [ fhir:v "All FHIR elements must have a @value or children" ] ;
fhir:expression [ fhir:v "hasValue() or (children().count() > id.count())" ] ;
fhir:source [ fhir:v "http://hl7.org/fhir/StructureDefinition/Element" ]
] ) ;
fhir:isModifier [ fhir:v "true" ] ;
fhir:isModifierReason [ fhir:v "Modifier extensions are expected to modify the meaning or interpretation of the element that contains them" ] ;
fhir:isSummary [ fhir:v "true" ] ;
fhir:mapping ( [
fhir:identity [ fhir:v "rim" ] ;
fhir:map [ fhir:v "N/A" ]
] )
] [
fhir:id [ fhir:v "ClaimResponse.event.type" ] ;
fhir:path [ fhir:v "ClaimResponse.event.type" ] ;
fhir:short [ fhir:v "Specific event" ] ;
fhir:definition [ fhir:v "A coded event such as when a service is expected or a card printed." ] ;
fhir:min [ fhir:v "1" ] ;
fhir:max [ fhir:v "1" ] ;
fhir:base [
fhir:path [ fhir:v "ClaimResponse.event.type" ] ;
fhir:min [ fhir:v "1" ] ;
fhir:max [ fhir:v "1" ]
] ;
fhir:type ( [
fhir:code [ fhir:v "CodeableConcept" ]
] ) ;
fhir:constraint ( [
fhir:key [ fhir:v "ele-1" ] ;
fhir:severity [ fhir:v "error" ] ;
fhir:human [ fhir:v "All FHIR elements must have a @value or children" ] ;
fhir:expression [ fhir:v "hasValue() or (children().count() > id.count())" ] ;
fhir:source [ fhir:v "http://hl7.org/fhir/StructureDefinition/Element" ]
] ) ;
fhir:mustSupport [ fhir:v "false" ] ;
fhir:isModifier [ fhir:v "false" ] ;
fhir:isSummary [ fhir:v "false" ] ;
fhir:binding [
fhir:extension ( [
fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName" ] ;
fhir:value [ fhir:v "DatesType" ]
] ) ;
fhir:strength [ fhir:v "example" ] ;
fhir:valueSet [ fhir:v "http://hl7.org/fhir/ValueSet/datestype" ]
]
] [
fhir:id [ fhir:v "ClaimResponse.event.when[x]" ] ;
fhir:path [ fhir:v "ClaimResponse.event.when[x]" ] ;
fhir:short [ fhir:v "Occurance date or period" ] ;
fhir:definition [ fhir:v "A date or period in the past or future indicating when the event occurred or is expectd to occur." ] ;
fhir:min [ fhir:v "1" ] ;
fhir:max [ fhir:v "1" ] ;
fhir:base [
fhir:path [ fhir:v "ClaimResponse.event.when[x]" ] ;
fhir:min [ fhir:v "1" ] ;
fhir:max [ fhir:v "1" ]
] ;
fhir:type ( [
fhir:code [ fhir:v "dateTime" ]
] [
fhir:code [ fhir:v "Period" ]
] ) ;
fhir:constraint ( [
fhir:key [ fhir:v "ele-1" ] ;
fhir:severity [ fhir:v "error" ] ;
fhir:human [ fhir:v "All FHIR elements must have a @value or children" ] ;
fhir:expression [ fhir:v "hasValue() or (children().count() > id.count())" ] ;
fhir:source [ fhir:v "http://hl7.org/fhir/StructureDefinition/Element" ]
] ) ;
fhir:mustSupport [ fhir:v "false" ] ;
fhir:isModifier [ fhir:v "false" ] ;
fhir:isSummary [ fhir:v "false" ]
] [
fhir:id [ fhir:v "ClaimResponse.payeeType" ] ;
fhir:path [ fhir:v "ClaimResponse.payeeType" ] ;
fhir:short [ fhir:v "Party to be paid any benefits payable" ] ;
fhir:definition [ fhir:v "Type of Party to be reimbursed: subscriber, provider, other." ] ;
fhir:requirements [ fhir:v "Need to know who should receive payment with the most common situations being the Provider (assignment of benefits) or the Subscriber." ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "1" ] ;
fhir:base [
fhir:path [ fhir:v "ClaimResponse.payeeType" ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "1" ]
] ;
fhir:type ( [
fhir:code [ fhir:v "CodeableConcept" ]
] ) ;
fhir:constraint ( [
fhir:key [ fhir:v "ele-1" ] ;
fhir:severity [ fhir:v "error" ] ;
fhir:human [ fhir:v "All FHIR elements must have a @value or children" ] ;
fhir:expression [ fhir:v "hasValue() or (children().count() > id.count())" ] ;
fhir:source [ fhir:v "http://hl7.org/fhir/StructureDefinition/Element" ]
] ) ;
fhir:mustSupport [ fhir:v "false" ] ;
fhir:isModifier [ fhir:v "false" ] ;
fhir:isSummary [ fhir:v "false" ] ;
fhir:binding [
fhir:extension ( [
fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName" ] ;
fhir:value [ fhir:v "PayeeType" ]
] [
fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/elementdefinition-isCommonBinding" ] ;
fhir:value [ fhir:v "true" ]
] ) ;
fhir:strength [ fhir:v "example" ] ;
fhir:description [ fhir:v "A code for the party to be reimbursed." ] ;
fhir:valueSet [ fhir:v "http://hl7.org/fhir/ValueSet/payeetype" ]
]
] [
fhir:id [ fhir:v "ClaimResponse.encounter" ] ;
fhir:path [ fhir:v "ClaimResponse.encounter" ] ;
fhir:short [ fhir:v "Encounters associated with the listed treatments" ] ;
fhir:definition [ fhir:v "Healthcare encounters related to this claim." ] ;
fhir:comment [ fhir:v "This will typically be the encounter the event occurred within, but some activities may be initiated prior to or after the official completion of an encounter but still be tied to the context of the encounter." ] ;
fhir:requirements [ fhir:v "Used in some jurisdictions to link clinical events to claim items." ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "*" ] ;
fhir:base [
fhir:path [ fhir:v "ClaimResponse.encounter" ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "*" ]
] ;
fhir:type ( [
fhir:code [ fhir:v "Reference" ] ;
fhir:targetProfile ( [ fhir:v "http://hl7.org/fhir/StructureDefinition/Encounter" ] )
] ) ;
fhir:constraint ( [
fhir:key [ fhir:v "ele-1" ] ;
fhir:severity [ fhir:v "error" ] ;
fhir:human [ fhir:v "All FHIR elements must have a @value or children" ] ;
fhir:expression [ fhir:v "hasValue() or (children().count() > id.count())" ] ;
fhir:source [ fhir:v "http://hl7.org/fhir/StructureDefinition/Element" ]
] ) ;
fhir:mustSupport [ fhir:v "false" ] ;
fhir:isModifier [ fhir:v "false" ] ;
fhir:isSummary [ fhir:v "false" ]
] [
fhir:id [ fhir:v "ClaimResponse.diagnosisRelatedGroup" ] ;
fhir:path [ fhir:v "ClaimResponse.diagnosisRelatedGroup" ] ;
fhir:short [ fhir:v "Package billing code" ] ;
fhir:definition [ fhir:v "A package billing code or bundle code used to group products and services to a particular health condition (such as heart attack) which is based on a predetermined grouping code system." ] ;
fhir:comment [ fhir:v "For example DRG (Diagnosis Related Group) or a bundled billing code. A patient may have a diagnosis of a Myocardial Infarction and a DRG for HeartAttack would be assigned. The Claim item (and possible subsequent claims) would refer to the DRG for those line items that were for services related to the heart attack event." ] ;
fhir:requirements [ fhir:v "Required to relate the current diagnosis to a package billing code that is then referenced on the individual claim items which are specific to the health condition covered by the package code." ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "1" ] ;
fhir:base [
fhir:path [ fhir:v "ClaimResponse.diagnosisRelatedGroup" ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "1" ]
] ;
fhir:type ( [
fhir:code [ fhir:v "CodeableConcept" ]
] ) ;
fhir:constraint ( [
fhir:key [ fhir:v "ele-1" ] ;
fhir:severity [ fhir:v "error" ] ;
fhir:human [ fhir:v "All FHIR elements must have a @value or children" ] ;
fhir:expression [ fhir:v "hasValue() or (children().count() > id.count())" ] ;
fhir:source [ fhir:v "http://hl7.org/fhir/StructureDefinition/Element" ]
] ) ;
fhir:mustSupport [ fhir:v "false" ] ;
fhir:isModifier [ fhir:v "false" ] ;
fhir:isSummary [ fhir:v "false" ] ;
fhir:binding [
fhir:extension ( [
fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName" ] ;
fhir:value [ fhir:v "DiagnosisRelatedGroup" ]
] ) ;
fhir:strength [ fhir:v "example" ] ;
fhir:valueSet [ fhir:v "http://hl7.org/fhir/ValueSet/ex-diagnosisrelatedgroup" ]
]
] [
fhir:id [ fhir:v "ClaimResponse.item" ] ;
fhir:extension ( [
fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/structuredefinition-explicit-type-name" ] ;
fhir:value [ fhir:v "Item" ]
] ) ;
fhir:path [ fhir:v "ClaimResponse.item" ] ;
fhir:short [ fhir:v "Adjudication for claim line items" ] ;
fhir:definition [ fhir:v "A claim line. Either a simple (a product or service) or a 'group' of details which can also be a simple items or groups of sub-details." ] ;
fhir:requirements [ fhir:v "The adjudication for items provided on the claim." ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "*" ] ;
fhir:base [
fhir:path [ fhir:v "ClaimResponse.item" ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "*" ]
] ;
fhir:type ( [
fhir:code [ fhir:v "BackboneElement" ]
] ) ;
fhir:constraint ( [
fhir:key [ fhir:v "ele-1" ] ;
fhir:severity [ fhir:v "error" ] ;
fhir:human [ fhir:v "All FHIR elements must have a @value or children" ] ;
fhir:expression [ fhir:v "hasValue() or (children().count() > id.count())" ] ;
fhir:source [ fhir:v "http://hl7.org/fhir/StructureDefinition/Element" ]
] ) ;
fhir:mustSupport [ fhir:v "false" ] ;
fhir:isModifier [ fhir:v "false" ] ;
fhir:isSummary [ fhir:v "false" ]
] [
fhir:id [ fhir:v "ClaimResponse.item.id" ] ;
fhir:path [ fhir:v "ClaimResponse.item.id" ] ;
fhir:representation ( [ fhir:v "xmlAttr" ] ) ;
fhir:short [ fhir:v "Unique id for inter-element referencing" ] ;
fhir:definition [ fhir:v "Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces." ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "1" ] ;
fhir:base [
fhir:path [ fhir:v "Element.id" ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "1" ]
] ;
fhir:type ( [
fhir:extension ( [
fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type" ] ;
fhir:value [ fhir:v "string" ]
] ) ;
fhir:code [ fhir:v "http://hl7.org/fhirpath/System.String" ]
] ) ;
fhir:condition ( [ fhir:v "ele-1" ] ) ;
fhir:isModifier [ fhir:v "false" ] ;
fhir:isSummary [ fhir:v "false" ] ;
fhir:mapping ( [
fhir:identity [ fhir:v "rim" ] ;
fhir:map [ fhir:v "n/a" ]
] )
] [
fhir:id [ fhir:v "ClaimResponse.item.extension" ] ;
fhir:path [ fhir:v "ClaimResponse.item.extension" ] ;
fhir:short [ fhir:v "Additional content defined by implementations" ] ;
fhir:definition [ fhir:v "May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and managable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension." ] ;
fhir:comment [ fhir:v "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone." ] ;
fhir:alias ( [ fhir:v "extensions" ] [ fhir:v "user content" ] ) ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "*" ] ;
fhir:base [
fhir:path [ fhir:v "Element.extension" ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "*" ]
] ;
fhir:type ( [
fhir:code [ fhir:v "Extension" ]
] ) ;
fhir:constraint ( [
fhir:key [ fhir:v "ele-1" ] ;
fhir:severity [ fhir:v "error" ] ;
fhir:human [ fhir:v "All FHIR elements must have a @value or children" ] ;
fhir:expression [ fhir:v "hasValue() or (children().count() > id.count())" ] ;
fhir:source [ fhir:v "http://hl7.org/fhir/StructureDefinition/Element" ]
] ) ;
fhir:isModifier [ fhir:v "false" ] ;
fhir:isSummary [ fhir:v "false" ] ;
fhir:mapping ( [
fhir:identity [ fhir:v "rim" ] ;
fhir:map [ fhir:v "n/a" ]
] )
] [
fhir:id [ fhir:v "ClaimResponse.item.modifierExtension" ] ;
fhir:path [ fhir:v "ClaimResponse.item.modifierExtension" ] ;
fhir:short [ fhir:v "Extensions that cannot be ignored even if unrecognized" ] ;
fhir:definition [ fhir:v "May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and managable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.\n\nModifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself)." ] ;
fhir:comment [ fhir:v "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone." ] ;
fhir:requirements [ fhir:v "Modifier extensions allow for extensions that *cannot* be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the [definition of modifier extensions](extensibility.html#modifierExtension)." ] ;
fhir:alias ( [ fhir:v "extensions" ] [ fhir:v "user content" ] [ fhir:v "modifiers" ] ) ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "*" ] ;
fhir:base [
fhir:path [ fhir:v "BackboneElement.modifierExtension" ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "*" ]
] ;
fhir:type ( [
fhir:code [ fhir:v "Extension" ]
] ) ;
fhir:constraint ( [
fhir:key [ fhir:v "ele-1" ] ;
fhir:severity [ fhir:v "error" ] ;
fhir:human [ fhir:v "All FHIR elements must have a @value or children" ] ;
fhir:expression [ fhir:v "hasValue() or (children().count() > id.count())" ] ;
fhir:source [ fhir:v "http://hl7.org/fhir/StructureDefinition/Element" ]
] ) ;
fhir:isModifier [ fhir:v "true" ] ;
fhir:isModifierReason [ fhir:v "Modifier extensions are expected to modify the meaning or interpretation of the element that contains them" ] ;
fhir:isSummary [ fhir:v "true" ] ;
fhir:mapping ( [
fhir:identity [ fhir:v "rim" ] ;
fhir:map [ fhir:v "N/A" ]
] )
] [
fhir:id [ fhir:v "ClaimResponse.item.itemSequence" ] ;
fhir:path [ fhir:v "ClaimResponse.item.itemSequence" ] ;
fhir:short [ fhir:v "Claim item instance identifier" ] ;
fhir:definition [ fhir:v "A number to uniquely reference the claim item entries." ] ;
fhir:requirements [ fhir:v "Necessary to provide a mechanism to link the adjudication result to the submitted claim item." ] ;
fhir:min [ fhir:v "1" ] ;
fhir:max [ fhir:v "1" ] ;
fhir:base [
fhir:path [ fhir:v "ClaimResponse.item.itemSequence" ] ;
fhir:min [ fhir:v "1" ] ;
fhir:max [ fhir:v "1" ]
] ;
fhir:type ( [
fhir:code [ fhir:v "positiveInt" ]
] ) ;
fhir:constraint ( [
fhir:key [ fhir:v "ele-1" ] ;
fhir:severity [ fhir:v "error" ] ;
fhir:human [ fhir:v "All FHIR elements must have a @value or children" ] ;
fhir:expression [ fhir:v "hasValue() or (children().count() > id.count())" ] ;
fhir:source [ fhir:v "http://hl7.org/fhir/StructureDefinition/Element" ]
] ) ;
fhir:mustSupport [ fhir:v "false" ] ;
fhir:isModifier [ fhir:v "false" ] ;
fhir:isSummary [ fhir:v "false" ]
] [
fhir:id [ fhir:v "ClaimResponse.item.traceNumber" ] ;
fhir:path [ fhir:v "ClaimResponse.item.traceNumber" ] ;
fhir:short [ fhir:v "Number for tracking" ] ;
fhir:definition [ fhir:v "Trace number for tracking purposes. May be defined at the jurisdiction level or between trading partners." ] ;
fhir:requirements [ fhir:v "Allows partners to uniquely identify components for tracking." ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "*" ] ;
fhir:base [
fhir:path [ fhir:v "ClaimResponse.item.traceNumber" ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "*" ]
] ;
fhir:type ( [
fhir:code [ fhir:v "Identifier" ]
] ) ;
fhir:constraint ( [
fhir:key [ fhir:v "ele-1" ] ;
fhir:severity [ fhir:v "error" ] ;
fhir:human [ fhir:v "All FHIR elements must have a @value or children" ] ;
fhir:expression [ fhir:v "hasValue() or (children().count() > id.count())" ] ;
fhir:source [ fhir:v "http://hl7.org/fhir/StructureDefinition/Element" ]
] ) ;
fhir:mustSupport [ fhir:v "false" ] ;
fhir:isModifier [ fhir:v "false" ] ;
fhir:isSummary [ fhir:v "false" ]
] [
fhir:id [ fhir:v "ClaimResponse.item.noteNumber" ] ;
fhir:path [ fhir:v "ClaimResponse.item.noteNumber" ] ;
fhir:short [ fhir:v "Applicable note numbers" ] ;
fhir:definition [ fhir:v "The numbers associated with notes below which apply to the adjudication of this item." ] ;
fhir:requirements [ fhir:v "Provides a condensed manner for associating human readable descriptive explanations for adjudications on the line item." ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "*" ] ;
fhir:base [
fhir:path [ fhir:v "ClaimResponse.item.noteNumber" ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "*" ]
] ;
fhir:type ( [
fhir:code [ fhir:v "positiveInt" ]
] ) ;
fhir:constraint ( [
fhir:key [ fhir:v "ele-1" ] ;
fhir:severity [ fhir:v "error" ] ;
fhir:human [ fhir:v "All FHIR elements must have a @value or children" ] ;
fhir:expression [ fhir:v "hasValue() or (children().count() > id.count())" ] ;
fhir:source [ fhir:v "http://hl7.org/fhir/StructureDefinition/Element" ]
] ) ;
fhir:mustSupport [ fhir:v "false" ] ;
fhir:isModifier [ fhir:v "false" ] ;
fhir:isSummary [ fhir:v "false" ]
] [
fhir:id [ fhir:v "ClaimResponse.item.reviewOutcome" ] ;
fhir:extension ( [
fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/structuredefinition-explicit-type-name" ] ;
fhir:value [ fhir:v "ReviewOutcome" ]
] ) ;
fhir:path [ fhir:v "ClaimResponse.item.reviewOutcome" ] ;
fhir:short [ fhir:v "Adjudication results" ] ;
fhir:definition [ fhir:v "The high-level results of the adjudication if adjudication has been performed." ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "1" ] ;
fhir:base [
fhir:path [ fhir:v "ClaimResponse.item.reviewOutcome" ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "1" ]
] ;
fhir:type ( [
fhir:code [ fhir:v "BackboneElement" ]
] ) ;
fhir:constraint ( [
fhir:key [ fhir:v "ele-1" ] ;
fhir:severity [ fhir:v "error" ] ;
fhir:human [ fhir:v "All FHIR elements must have a @value or children" ] ;
fhir:expression [ fhir:v "hasValue() or (children().count() > id.count())" ] ;
fhir:source [ fhir:v "http://hl7.org/fhir/StructureDefinition/Element" ]
] ) ;
fhir:mustSupport [ fhir:v "false" ] ;
fhir:isModifier [ fhir:v "false" ] ;
fhir:isSummary [ fhir:v "false" ]
] [
fhir:id [ fhir:v "ClaimResponse.item.reviewOutcome.id" ] ;
fhir:path [ fhir:v "ClaimResponse.item.reviewOutcome.id" ] ;
fhir:representation ( [ fhir:v "xmlAttr" ] ) ;
fhir:short [ fhir:v "Unique id for inter-element referencing" ] ;
fhir:definition [ fhir:v "Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces." ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "1" ] ;
fhir:base [
fhir:path [ fhir:v "Element.id" ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "1" ]
] ;
fhir:type ( [
fhir:extension ( [
fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type" ] ;
fhir:value [ fhir:v "string" ]
] ) ;
fhir:code [ fhir:v "http://hl7.org/fhirpath/System.String" ]
] ) ;
fhir:condition ( [ fhir:v "ele-1" ] ) ;
fhir:isModifier [ fhir:v "false" ] ;
fhir:isSummary [ fhir:v "false" ] ;
fhir:mapping ( [
fhir:identity [ fhir:v "rim" ] ;
fhir:map [ fhir:v "n/a" ]
] )
] [
fhir:id [ fhir:v "ClaimResponse.item.reviewOutcome.extension" ] ;
fhir:path [ fhir:v "ClaimResponse.item.reviewOutcome.extension" ] ;
fhir:short [ fhir:v "Additional content defined by implementations" ] ;
fhir:definition [ fhir:v "May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and managable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension." ] ;
fhir:comment [ fhir:v "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone." ] ;
fhir:alias ( [ fhir:v "extensions" ] [ fhir:v "user content" ] ) ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "*" ] ;
fhir:base [
fhir:path [ fhir:v "Element.extension" ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "*" ]
] ;
fhir:type ( [
fhir:code [ fhir:v "Extension" ]
] ) ;
fhir:constraint ( [
fhir:key [ fhir:v "ele-1" ] ;
fhir:severity [ fhir:v "error" ] ;
fhir:human [ fhir:v "All FHIR elements must have a @value or children" ] ;
fhir:expression [ fhir:v "hasValue() or (children().count() > id.count())" ] ;
fhir:source [ fhir:v "http://hl7.org/fhir/StructureDefinition/Element" ]
] ) ;
fhir:isModifier [ fhir:v "false" ] ;
fhir:isSummary [ fhir:v "false" ] ;
fhir:mapping ( [
fhir:identity [ fhir:v "rim" ] ;
fhir:map [ fhir:v "n/a" ]
] )
] [
fhir:id [ fhir:v "ClaimResponse.item.reviewOutcome.modifierExtension" ] ;
fhir:path [ fhir:v "ClaimResponse.item.reviewOutcome.modifierExtension" ] ;
fhir:short [ fhir:v "Extensions that cannot be ignored even if unrecognized" ] ;
fhir:definition [ fhir:v "May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and managable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.\n\nModifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself)." ] ;
fhir:comment [ fhir:v "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone." ] ;
fhir:requirements [ fhir:v "Modifier extensions allow for extensions that *cannot* be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the [definition of modifier extensions](extensibility.html#modifierExtension)." ] ;
fhir:alias ( [ fhir:v "extensions" ] [ fhir:v "user content" ] [ fhir:v "modifiers" ] ) ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "*" ] ;
fhir:base [
fhir:path [ fhir:v "BackboneElement.modifierExtension" ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "*" ]
] ;
fhir:type ( [
fhir:code [ fhir:v "Extension" ]
] ) ;
fhir:constraint ( [
fhir:key [ fhir:v "ele-1" ] ;
fhir:severity [ fhir:v "error" ] ;
fhir:human [ fhir:v "All FHIR elements must have a @value or children" ] ;
fhir:expression [ fhir:v "hasValue() or (children().count() > id.count())" ] ;
fhir:source [ fhir:v "http://hl7.org/fhir/StructureDefinition/Element" ]
] ) ;
fhir:isModifier [ fhir:v "true" ] ;
fhir:isModifierReason [ fhir:v "Modifier extensions are expected to modify the meaning or interpretation of the element that contains them" ] ;
fhir:isSummary [ fhir:v "true" ] ;
fhir:mapping ( [
fhir:identity [ fhir:v "rim" ] ;
fhir:map [ fhir:v "N/A" ]
] )
] [
fhir:id [ fhir:v "ClaimResponse.item.reviewOutcome.decision" ] ;
fhir:path [ fhir:v "ClaimResponse.item.reviewOutcome.decision" ] ;
fhir:short [ fhir:v "Result of the adjudication" ] ;
fhir:definition [ fhir:v "The result of the claim, predetermination, or preauthorization adjudication." ] ;
fhir:comment [ fhir:v "The element is used to indicate the current state of the adjudication overall for the claim resource, for example: the request has been held (pended) for adjudication processing, for manual review or other reasons; that it has been processed and will be paid, or the outstanding paid, as submitted (approved); that no amount will be paid (denied); or that some amount between zero and the submitted amount will be paid (partial)." ] ;
fhir:requirements [ fhir:v "To advise the requestor of the result of the adjudication process." ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "1" ] ;
fhir:base [
fhir:path [ fhir:v "ClaimResponse.item.reviewOutcome.decision" ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "1" ]
] ;
fhir:type ( [
fhir:code [ fhir:v "CodeableConcept" ]
] ) ;
fhir:constraint ( [
fhir:key [ fhir:v "ele-1" ] ;
fhir:severity [ fhir:v "error" ] ;
fhir:human [ fhir:v "All FHIR elements must have a @value or children" ] ;
fhir:expression [ fhir:v "hasValue() or (children().count() > id.count())" ] ;
fhir:source [ fhir:v "http://hl7.org/fhir/StructureDefinition/Element" ]
] ) ;
fhir:mustSupport [ fhir:v "false" ] ;
fhir:isModifier [ fhir:v "false" ] ;
fhir:isSummary [ fhir:v "false" ] ;
fhir:binding [
fhir:extension ( [
fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName" ] ;
fhir:value [ fhir:v "AdjudicationDecision" ]
] ) ;
fhir:strength [ fhir:v "example" ] ;
fhir:valueSet [ fhir:v "http://hl7.org/fhir/ValueSet/claim-decision" ]
]
] [
fhir:id [ fhir:v "ClaimResponse.item.reviewOutcome.reason" ] ;
fhir:path [ fhir:v "ClaimResponse.item.reviewOutcome.reason" ] ;
fhir:short [ fhir:v "Reason for result of the adjudication" ] ;
fhir:definition [ fhir:v "The reasons for the result of the claim, predetermination, or preauthorization adjudication." ] ;
fhir:requirements [ fhir:v "To advise the requestor of the contributors to the result of the adjudication process." ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "*" ] ;
fhir:base [
fhir:path [ fhir:v "ClaimResponse.item.reviewOutcome.reason" ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "*" ]
] ;
fhir:type ( [
fhir:code [ fhir:v "CodeableConcept" ]
] ) ;
fhir:constraint ( [
fhir:key [ fhir:v "ele-1" ] ;
fhir:severity [ fhir:v "error" ] ;
fhir:human [ fhir:v "All FHIR elements must have a @value or children" ] ;
fhir:expression [ fhir:v "hasValue() or (children().count() > id.count())" ] ;
fhir:source [ fhir:v "http://hl7.org/fhir/StructureDefinition/Element" ]
] ) ;
fhir:mustSupport [ fhir:v "false" ] ;
fhir:isModifier [ fhir:v "false" ] ;
fhir:isSummary [ fhir:v "false" ] ;
fhir:binding [
fhir:extension ( [
fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName" ] ;
fhir:value [ fhir:v "AdjudicationDecisionReason" ]
] ) ;
fhir:strength [ fhir:v "example" ] ;
fhir:valueSet [ fhir:v "http://hl7.org/fhir/ValueSet/claim-decision-reason" ]
]
] [
fhir:id [ fhir:v "ClaimResponse.item.reviewOutcome.preAuthRef" ] ;
fhir:path [ fhir:v "ClaimResponse.item.reviewOutcome.preAuthRef" ] ;
fhir:short [ fhir:v "Preauthorization reference" ] ;
fhir:definition [ fhir:v "Reference from the Insurer which is used in later communications which refers to this adjudication." ] ;
fhir:comment [ fhir:v "This value is only present on preauthorization adjudications." ] ;
fhir:requirements [ fhir:v "On subsequent claims, the insurer may require the provider to quote this value." ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "1" ] ;
fhir:base [
fhir:path [ fhir:v "ClaimResponse.item.reviewOutcome.preAuthRef" ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "1" ]
] ;
fhir:type ( [
fhir:code [ fhir:v "string" ]
] ) ;
fhir:constraint ( [
fhir:key [ fhir:v "ele-1" ] ;
fhir:severity [ fhir:v "error" ] ;
fhir:human [ fhir:v "All FHIR elements must have a @value or children" ] ;
fhir:expression [ fhir:v "hasValue() or (children().count() > id.count())" ] ;
fhir:source [ fhir:v "http://hl7.org/fhir/StructureDefinition/Element" ]
] ) ;
fhir:mustSupport [ fhir:v "false" ] ;
fhir:isModifier [ fhir:v "false" ] ;
fhir:isSummary [ fhir:v "false" ]
] [
fhir:id [ fhir:v "ClaimResponse.item.reviewOutcome.preAuthPeriod" ] ;
fhir:path [ fhir:v "ClaimResponse.item.reviewOutcome.preAuthPeriod" ] ;
fhir:short [ fhir:v "Preauthorization reference effective period" ] ;
fhir:definition [ fhir:v "The time frame during which this authorization is effective." ] ;
fhir:requirements [ fhir:v "To convey to the provider when the authorized products and services must be supplied for the authorized adjudication to apply." ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "1" ] ;
fhir:base [
fhir:path [ fhir:v "ClaimResponse.item.reviewOutcome.preAuthPeriod" ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "1" ]
] ;
fhir:type ( [
fhir:code [ fhir:v "Period" ]
] ) ;
fhir:constraint ( [
fhir:key [ fhir:v "ele-1" ] ;
fhir:severity [ fhir:v "error" ] ;
fhir:human [ fhir:v "All FHIR elements must have a @value or children" ] ;
fhir:expression [ fhir:v "hasValue() or (children().count() > id.count())" ] ;
fhir:source [ fhir:v "http://hl7.org/fhir/StructureDefinition/Element" ]
] ) ;
fhir:mustSupport [ fhir:v "false" ] ;
fhir:isModifier [ fhir:v "false" ] ;
fhir:isSummary [ fhir:v "false" ]
] [
fhir:id [ fhir:v "ClaimResponse.item.adjudication" ] ;
fhir:extension ( [
fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/structuredefinition-explicit-type-name" ] ;
fhir:value [ fhir:v "Adjudication" ]
] ) ;
fhir:path [ fhir:v "ClaimResponse.item.adjudication" ] ;
fhir:short [ fhir:v "Adjudication details" ] ;
fhir:definition [ fhir:v "If this item is a group then the values here are a summary of the adjudication of the detail items. If this item is a simple product or service then this is the result of the adjudication of this item." ] ;
fhir:requirements [ fhir:v "The adjudication results conveys the insurer's assessment of the item provided in the claim under the terms of the patient's insurance coverage." ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "*" ] ;
fhir:base [
fhir:path [ fhir:v "ClaimResponse.item.adjudication" ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "*" ]
] ;
fhir:type ( [
fhir:code [ fhir:v "BackboneElement" ]
] ) ;
fhir:constraint ( [
fhir:key [ fhir:v "ele-1" ] ;
fhir:severity [ fhir:v "error" ] ;
fhir:human [ fhir:v "All FHIR elements must have a @value or children" ] ;
fhir:expression [ fhir:v "hasValue() or (children().count() > id.count())" ] ;
fhir:source [ fhir:v "http://hl7.org/fhir/StructureDefinition/Element" ]
] ) ;
fhir:mustSupport [ fhir:v "false" ] ;
fhir:isModifier [ fhir:v "false" ] ;
fhir:isSummary [ fhir:v "false" ]
] [
fhir:id [ fhir:v "ClaimResponse.item.adjudication.id" ] ;
fhir:path [ fhir:v "ClaimResponse.item.adjudication.id" ] ;
fhir:representation ( [ fhir:v "xmlAttr" ] ) ;
fhir:short [ fhir:v "Unique id for inter-element referencing" ] ;
fhir:definition [ fhir:v "Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces." ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "1" ] ;
fhir:base [
fhir:path [ fhir:v "Element.id" ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "1" ]
] ;
fhir:type ( [
fhir:extension ( [
fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type" ] ;
fhir:value [ fhir:v "string" ]
] ) ;
fhir:code [ fhir:v "http://hl7.org/fhirpath/System.String" ]
] ) ;
fhir:condition ( [ fhir:v "ele-1" ] ) ;
fhir:isModifier [ fhir:v "false" ] ;
fhir:isSummary [ fhir:v "false" ] ;
fhir:mapping ( [
fhir:identity [ fhir:v "rim" ] ;
fhir:map [ fhir:v "n/a" ]
] )
] [
fhir:id [ fhir:v "ClaimResponse.item.adjudication.extension" ] ;
fhir:path [ fhir:v "ClaimResponse.item.adjudication.extension" ] ;
fhir:short [ fhir:v "Additional content defined by implementations" ] ;
fhir:definition [ fhir:v "May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and managable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension." ] ;
fhir:comment [ fhir:v "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone." ] ;
fhir:alias ( [ fhir:v "extensions" ] [ fhir:v "user content" ] ) ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "*" ] ;
fhir:base [
fhir:path [ fhir:v "Element.extension" ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "*" ]
] ;
fhir:type ( [
fhir:code [ fhir:v "Extension" ]
] ) ;
fhir:constraint ( [
fhir:key [ fhir:v "ele-1" ] ;
fhir:severity [ fhir:v "error" ] ;
fhir:human [ fhir:v "All FHIR elements must have a @value or children" ] ;
fhir:expression [ fhir:v "hasValue() or (children().count() > id.count())" ] ;
fhir:source [ fhir:v "http://hl7.org/fhir/StructureDefinition/Element" ]
] ) ;
fhir:isModifier [ fhir:v "false" ] ;
fhir:isSummary [ fhir:v "false" ] ;
fhir:mapping ( [
fhir:identity [ fhir:v "rim" ] ;
fhir:map [ fhir:v "n/a" ]
] )
] [
fhir:id [ fhir:v "ClaimResponse.item.adjudication.modifierExtension" ] ;
fhir:path [ fhir:v "ClaimResponse.item.adjudication.modifierExtension" ] ;
fhir:short [ fhir:v "Extensions that cannot be ignored even if unrecognized" ] ;
fhir:definition [ fhir:v "May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and managable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.\n\nModifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself)." ] ;
fhir:comment [ fhir:v "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone." ] ;
fhir:requirements [ fhir:v "Modifier extensions allow for extensions that *cannot* be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the [definition of modifier extensions](extensibility.html#modifierExtension)." ] ;
fhir:alias ( [ fhir:v "extensions" ] [ fhir:v "user content" ] [ fhir:v "modifiers" ] ) ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "*" ] ;
fhir:base [
fhir:path [ fhir:v "BackboneElement.modifierExtension" ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "*" ]
] ;
fhir:type ( [
fhir:code [ fhir:v "Extension" ]
] ) ;
fhir:constraint ( [
fhir:key [ fhir:v "ele-1" ] ;
fhir:severity [ fhir:v "error" ] ;
fhir:human [ fhir:v "All FHIR elements must have a @value or children" ] ;
fhir:expression [ fhir:v "hasValue() or (children().count() > id.count())" ] ;
fhir:source [ fhir:v "http://hl7.org/fhir/StructureDefinition/Element" ]
] ) ;
fhir:isModifier [ fhir:v "true" ] ;
fhir:isModifierReason [ fhir:v "Modifier extensions are expected to modify the meaning or interpretation of the element that contains them" ] ;
fhir:isSummary [ fhir:v "true" ] ;
fhir:mapping ( [
fhir:identity [ fhir:v "rim" ] ;
fhir:map [ fhir:v "N/A" ]
] )
] [
fhir:id [ fhir:v "ClaimResponse.item.adjudication.category" ] ;
fhir:path [ fhir:v "ClaimResponse.item.adjudication.category" ] ;
fhir:short [ fhir:v "Type of adjudication information" ] ;
fhir:definition [ fhir:v "A code to indicate the information type of this adjudication record. Information types may include the value submitted, maximum values or percentages allowed or payable under the plan, amounts that: the patient is responsible for in aggregate or pertaining to this item; amounts paid by other coverages; and, the benefit payable for this item." ] ;
fhir:comment [ fhir:v "For example codes indicating: Co-Pay, deductible, eligible, benefit, tax, etc." ] ;
fhir:requirements [ fhir:v "Needed to enable understanding of the context of the other information in the adjudication." ] ;
fhir:min [ fhir:v "1" ] ;
fhir:max [ fhir:v "1" ] ;
fhir:base [
fhir:path [ fhir:v "ClaimResponse.item.adjudication.category" ] ;
fhir:min [ fhir:v "1" ] ;
fhir:max [ fhir:v "1" ]
] ;
fhir:type ( [
fhir:code [ fhir:v "CodeableConcept" ]
] ) ;
fhir:constraint ( [
fhir:key [ fhir:v "ele-1" ] ;
fhir:severity [ fhir:v "error" ] ;
fhir:human [ fhir:v "All FHIR elements must have a @value or children" ] ;
fhir:expression [ fhir:v "hasValue() or (children().count() > id.count())" ] ;
fhir:source [ fhir:v "http://hl7.org/fhir/StructureDefinition/Element" ]
] ) ;
fhir:mustSupport [ fhir:v "false" ] ;
fhir:isModifier [ fhir:v "false" ] ;
fhir:isSummary [ fhir:v "false" ] ;
fhir:binding [
fhir:extension ( [
fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName" ] ;
fhir:value [ fhir:v "Adjudication" ]
] ) ;
fhir:strength [ fhir:v "example" ] ;
fhir:description [ fhir:v "The adjudication codes." ] ;
fhir:valueSet [ fhir:v "http://hl7.org/fhir/ValueSet/adjudication" ]
]
] [
fhir:id [ fhir:v "ClaimResponse.item.adjudication.reason" ] ;
fhir:path [ fhir:v "ClaimResponse.item.adjudication.reason" ] ;
fhir:short [ fhir:v "Explanation of adjudication outcome" ] ;
fhir:definition [ fhir:v "A code supporting the understanding of the adjudication result and explaining variance from expected amount." ] ;
fhir:comment [ fhir:v "For example may indicate that the funds for this benefit type have been exhausted." ] ;
fhir:requirements [ fhir:v "To support understanding of variance from adjudication expectations." ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "1" ] ;
fhir:base [
fhir:path [ fhir:v "ClaimResponse.item.adjudication.reason" ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "1" ]
] ;
fhir:type ( [
fhir:code [ fhir:v "CodeableConcept" ]
] ) ;
fhir:constraint ( [
fhir:key [ fhir:v "ele-1" ] ;
fhir:severity [ fhir:v "error" ] ;
fhir:human [ fhir:v "All FHIR elements must have a @value or children" ] ;
fhir:expression [ fhir:v "hasValue() or (children().count() > id.count())" ] ;
fhir:source [ fhir:v "http://hl7.org/fhir/StructureDefinition/Element" ]
] ) ;
fhir:mustSupport [ fhir:v "false" ] ;
fhir:isModifier [ fhir:v "false" ] ;
fhir:isSummary [ fhir:v "false" ] ;
fhir:binding [
fhir:extension ( [
fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName" ] ;
fhir:value [ fhir:v "AdjudicationReason" ]
] ) ;
fhir:strength [ fhir:v "example" ] ;
fhir:description [ fhir:v "The adjudication reason codes." ] ;
fhir:valueSet [ fhir:v "http://hl7.org/fhir/ValueSet/adjudication-reason" ]
]
] [
fhir:id [ fhir:v "ClaimResponse.item.adjudication.amount" ] ;
fhir:path [ fhir:v "ClaimResponse.item.adjudication.amount" ] ;
fhir:short [ fhir:v "Monetary amount" ] ;
fhir:definition [ fhir:v "Monetary amount associated with the category." ] ;
fhir:comment [ fhir:v "For example: amount submitted, eligible amount, co-payment, and benefit payable." ] ;
fhir:requirements [ fhir:v "Most adjudication categories convey a monetary amount." ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "1" ] ;
fhir:base [
fhir:path [ fhir:v "ClaimResponse.item.adjudication.amount" ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "1" ]
] ;
fhir:type ( [
fhir:code [ fhir:v "Money" ]
] ) ;
fhir:constraint ( [
fhir:key [ fhir:v "ele-1" ] ;
fhir:severity [ fhir:v "error" ] ;
fhir:human [ fhir:v "All FHIR elements must have a @value or children" ] ;
fhir:expression [ fhir:v "hasValue() or (children().count() > id.count())" ] ;
fhir:source [ fhir:v "http://hl7.org/fhir/StructureDefinition/Element" ]
] ) ;
fhir:mustSupport [ fhir:v "false" ] ;
fhir:isModifier [ fhir:v "false" ] ;
fhir:isSummary [ fhir:v "false" ]
] [
fhir:id [ fhir:v "ClaimResponse.item.adjudication.quantity" ] ;
fhir:path [ fhir:v "ClaimResponse.item.adjudication.quantity" ] ;
fhir:short [ fhir:v "Non-monetary value" ] ;
fhir:definition [ fhir:v "A non-monetary value associated with the category. Mutually exclusive to the amount element above." ] ;
fhir:comment [ fhir:v "For example: eligible percentage or co-payment percentage." ] ;
fhir:requirements [ fhir:v "Some adjudication categories convey a percentage or a fixed value." ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "1" ] ;
fhir:base [
fhir:path [ fhir:v "ClaimResponse.item.adjudication.quantity" ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "1" ]
] ;
fhir:type ( [
fhir:code [ fhir:v "Quantity" ]
] ) ;
fhir:constraint ( [
fhir:key [ fhir:v "ele-1" ] ;
fhir:severity [ fhir:v "error" ] ;
fhir:human [ fhir:v "All FHIR elements must have a @value or children" ] ;
fhir:expression [ fhir:v "hasValue() or (children().count() > id.count())" ] ;
fhir:source [ fhir:v "http://hl7.org/fhir/StructureDefinition/Element" ]
] ) ;
fhir:mustSupport [ fhir:v "false" ] ;
fhir:isModifier [ fhir:v "false" ] ;
fhir:isSummary [ fhir:v "false" ]
] [
fhir:id [ fhir:v "ClaimResponse.item.detail" ] ;
fhir:extension ( [
fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/structuredefinition-explicit-type-name" ] ;
fhir:value [ fhir:v "ItemDetail" ]
] ) ;
fhir:path [ fhir:v "ClaimResponse.item.detail" ] ;
fhir:short [ fhir:v "Adjudication for claim details" ] ;
fhir:definition [ fhir:v "A claim detail. Either a simple (a product or service) or a 'group' of sub-details which are simple items." ] ;
fhir:requirements [ fhir:v "The adjudication for details provided on the claim." ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "*" ] ;
fhir:base [
fhir:path [ fhir:v "ClaimResponse.item.detail" ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "*" ]
] ;
fhir:type ( [
fhir:code [ fhir:v "BackboneElement" ]
] ) ;
fhir:constraint ( [
fhir:key [ fhir:v "ele-1" ] ;
fhir:severity [ fhir:v "error" ] ;
fhir:human [ fhir:v "All FHIR elements must have a @value or children" ] ;
fhir:expression [ fhir:v "hasValue() or (children().count() > id.count())" ] ;
fhir:source [ fhir:v "http://hl7.org/fhir/StructureDefinition/Element" ]
] ) ;
fhir:mustSupport [ fhir:v "false" ] ;
fhir:isModifier [ fhir:v "false" ] ;
fhir:isSummary [ fhir:v "false" ]
] [
fhir:id [ fhir:v "ClaimResponse.item.detail.id" ] ;
fhir:path [ fhir:v "ClaimResponse.item.detail.id" ] ;
fhir:representation ( [ fhir:v "xmlAttr" ] ) ;
fhir:short [ fhir:v "Unique id for inter-element referencing" ] ;
fhir:definition [ fhir:v "Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces." ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "1" ] ;
fhir:base [
fhir:path [ fhir:v "Element.id" ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "1" ]
] ;
fhir:type ( [
fhir:extension ( [
fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type" ] ;
fhir:value [ fhir:v "string" ]
] ) ;
fhir:code [ fhir:v "http://hl7.org/fhirpath/System.String" ]
] ) ;
fhir:condition ( [ fhir:v "ele-1" ] ) ;
fhir:isModifier [ fhir:v "false" ] ;
fhir:isSummary [ fhir:v "false" ] ;
fhir:mapping ( [
fhir:identity [ fhir:v "rim" ] ;
fhir:map [ fhir:v "n/a" ]
] )
] [
fhir:id [ fhir:v "ClaimResponse.item.detail.extension" ] ;
fhir:path [ fhir:v "ClaimResponse.item.detail.extension" ] ;
fhir:short [ fhir:v "Additional content defined by implementations" ] ;
fhir:definition [ fhir:v "May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and managable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension." ] ;
fhir:comment [ fhir:v "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone." ] ;
fhir:alias ( [ fhir:v "extensions" ] [ fhir:v "user content" ] ) ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "*" ] ;
fhir:base [
fhir:path [ fhir:v "Element.extension" ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "*" ]
] ;
fhir:type ( [
fhir:code [ fhir:v "Extension" ]
] ) ;
fhir:constraint ( [
fhir:key [ fhir:v "ele-1" ] ;
fhir:severity [ fhir:v "error" ] ;
fhir:human [ fhir:v "All FHIR elements must have a @value or children" ] ;
fhir:expression [ fhir:v "hasValue() or (children().count() > id.count())" ] ;
fhir:source [ fhir:v "http://hl7.org/fhir/StructureDefinition/Element" ]
] ) ;
fhir:isModifier [ fhir:v "false" ] ;
fhir:isSummary [ fhir:v "false" ] ;
fhir:mapping ( [
fhir:identity [ fhir:v "rim" ] ;
fhir:map [ fhir:v "n/a" ]
] )
] [
fhir:id [ fhir:v "ClaimResponse.item.detail.modifierExtension" ] ;
fhir:path [ fhir:v "ClaimResponse.item.detail.modifierExtension" ] ;
fhir:short [ fhir:v "Extensions that cannot be ignored even if unrecognized" ] ;
fhir:definition [ fhir:v "May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and managable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.\n\nModifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself)." ] ;
fhir:comment [ fhir:v "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone." ] ;
fhir:requirements [ fhir:v "Modifier extensions allow for extensions that *cannot* be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the [definition of modifier extensions](extensibility.html#modifierExtension)." ] ;
fhir:alias ( [ fhir:v "extensions" ] [ fhir:v "user content" ] [ fhir:v "modifiers" ] ) ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "*" ] ;
fhir:base [
fhir:path [ fhir:v "BackboneElement.modifierExtension" ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "*" ]
] ;
fhir:type ( [
fhir:code [ fhir:v "Extension" ]
] ) ;
fhir:constraint ( [
fhir:key [ fhir:v "ele-1" ] ;
fhir:severity [ fhir:v "error" ] ;
fhir:human [ fhir:v "All FHIR elements must have a @value or children" ] ;
fhir:expression [ fhir:v "hasValue() or (children().count() > id.count())" ] ;
fhir:source [ fhir:v "http://hl7.org/fhir/StructureDefinition/Element" ]
] ) ;
fhir:isModifier [ fhir:v "true" ] ;
fhir:isModifierReason [ fhir:v "Modifier extensions are expected to modify the meaning or interpretation of the element that contains them" ] ;
fhir:isSummary [ fhir:v "true" ] ;
fhir:mapping ( [
fhir:identity [ fhir:v "rim" ] ;
fhir:map [ fhir:v "N/A" ]
] )
] [
fhir:id [ fhir:v "ClaimResponse.item.detail.detailSequence" ] ;
fhir:path [ fhir:v "ClaimResponse.item.detail.detailSequence" ] ;
fhir:short [ fhir:v "Claim detail instance identifier" ] ;
fhir:definition [ fhir:v "A number to uniquely reference the claim detail entry." ] ;
fhir:requirements [ fhir:v "Necessary to provide a mechanism to link the adjudication result to the submitted claim detail." ] ;
fhir:min [ fhir:v "1" ] ;
fhir:max [ fhir:v "1" ] ;
fhir:base [
fhir:path [ fhir:v "ClaimResponse.item.detail.detailSequence" ] ;
fhir:min [ fhir:v "1" ] ;
fhir:max [ fhir:v "1" ]
] ;
fhir:type ( [
fhir:code [ fhir:v "positiveInt" ]
] ) ;
fhir:constraint ( [
fhir:key [ fhir:v "ele-1" ] ;
fhir:severity [ fhir:v "error" ] ;
fhir:human [ fhir:v "All FHIR elements must have a @value or children" ] ;
fhir:expression [ fhir:v "hasValue() or (children().count() > id.count())" ] ;
fhir:source [ fhir:v "http://hl7.org/fhir/StructureDefinition/Element" ]
] ) ;
fhir:mustSupport [ fhir:v "false" ] ;
fhir:isModifier [ fhir:v "false" ] ;
fhir:isSummary [ fhir:v "false" ]
] [
fhir:id [ fhir:v "ClaimResponse.item.detail.traceNumber" ] ;
fhir:path [ fhir:v "ClaimResponse.item.detail.traceNumber" ] ;
fhir:short [ fhir:v "Number for tracking" ] ;
fhir:definition [ fhir:v "Trace number for tracking purposes. May be defined at the jurisdiction level or between trading partners." ] ;
fhir:requirements [ fhir:v "Allows partners to uniquely identify components for tracking." ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "*" ] ;
fhir:base [
fhir:path [ fhir:v "ClaimResponse.item.detail.traceNumber" ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "*" ]
] ;
fhir:type ( [
fhir:code [ fhir:v "Identifier" ]
] ) ;
fhir:constraint ( [
fhir:key [ fhir:v "ele-1" ] ;
fhir:severity [ fhir:v "error" ] ;
fhir:human [ fhir:v "All FHIR elements must have a @value or children" ] ;
fhir:expression [ fhir:v "hasValue() or (children().count() > id.count())" ] ;
fhir:source [ fhir:v "http://hl7.org/fhir/StructureDefinition/Element" ]
] ) ;
fhir:mustSupport [ fhir:v "false" ] ;
fhir:isModifier [ fhir:v "false" ] ;
fhir:isSummary [ fhir:v "false" ]
] [
fhir:id [ fhir:v "ClaimResponse.item.detail.noteNumber" ] ;
fhir:path [ fhir:v "ClaimResponse.item.detail.noteNumber" ] ;
fhir:short [ fhir:v "Applicable note numbers" ] ;
fhir:definition [ fhir:v "The numbers associated with notes below which apply to the adjudication of this item." ] ;
fhir:requirements [ fhir:v "Provides a condensed manner for associating human readable descriptive explanations for adjudications on the line item." ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "*" ] ;
fhir:base [
fhir:path [ fhir:v "ClaimResponse.item.detail.noteNumber" ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "*" ]
] ;
fhir:type ( [
fhir:code [ fhir:v "positiveInt" ]
] ) ;
fhir:constraint ( [
fhir:key [ fhir:v "ele-1" ] ;
fhir:severity [ fhir:v "error" ] ;
fhir:human [ fhir:v "All FHIR elements must have a @value or children" ] ;
fhir:expression [ fhir:v "hasValue() or (children().count() > id.count())" ] ;
fhir:source [ fhir:v "http://hl7.org/fhir/StructureDefinition/Element" ]
] ) ;
fhir:mustSupport [ fhir:v "false" ] ;
fhir:isModifier [ fhir:v "false" ] ;
fhir:isSummary [ fhir:v "false" ]
] [
fhir:id [ fhir:v "ClaimResponse.item.detail.reviewOutcome" ] ;
fhir:path [ fhir:v "ClaimResponse.item.detail.reviewOutcome" ] ;
fhir:short [ fhir:v "Detail level adjudication results" ] ;
fhir:definition [ fhir:v "The high-level results of the adjudication if adjudication has been performed." ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "1" ] ;
fhir:base [
fhir:path [ fhir:v "ClaimResponse.item.detail.reviewOutcome" ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "1" ]
] ;
fhir:contentReference [ fhir:v "#ClaimResponse.item.reviewOutcome" ] ;
fhir:constraint ( [
fhir:key [ fhir:v "ele-1" ] ;
fhir:severity [ fhir:v "error" ] ;
fhir:human [ fhir:v "All FHIR elements must have a @value or children" ] ;
fhir:expression [ fhir:v "hasValue() or (children().count() > id.count())" ] ;
fhir:source [ fhir:v "http://hl7.org/fhir/StructureDefinition/Element" ]
] ) ;
fhir:mustSupport [ fhir:v "false" ] ;
fhir:isModifier [ fhir:v "false" ] ;
fhir:isSummary [ fhir:v "false" ]
] [
fhir:id [ fhir:v "ClaimResponse.item.detail.adjudication" ] ;
fhir:path [ fhir:v "ClaimResponse.item.detail.adjudication" ] ;
fhir:short [ fhir:v "Detail level adjudication details" ] ;
fhir:definition [ fhir:v "The adjudication results." ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "*" ] ;
fhir:base [
fhir:path [ fhir:v "ClaimResponse.item.detail.adjudication" ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "*" ]
] ;
fhir:contentReference [ fhir:v "#ClaimResponse.item.adjudication" ] ;
fhir:constraint ( [
fhir:key [ fhir:v "ele-1" ] ;
fhir:severity [ fhir:v "error" ] ;
fhir:human [ fhir:v "All FHIR elements must have a @value or children" ] ;
fhir:expression [ fhir:v "hasValue() or (children().count() > id.count())" ] ;
fhir:source [ fhir:v "http://hl7.org/fhir/StructureDefinition/Element" ]
] ) ;
fhir:mustSupport [ fhir:v "false" ] ;
fhir:isModifier [ fhir:v "false" ] ;
fhir:isSummary [ fhir:v "false" ]
] [
fhir:id [ fhir:v "ClaimResponse.item.detail.subDetail" ] ;
fhir:extension ( [
fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/structuredefinition-explicit-type-name" ] ;
fhir:value [ fhir:v "SubDetail" ]
] ) ;
fhir:path [ fhir:v "ClaimResponse.item.detail.subDetail" ] ;
fhir:short [ fhir:v "Adjudication for claim sub-details" ] ;
fhir:definition [ fhir:v "A sub-detail adjudication of a simple product or service." ] ;
fhir:requirements [ fhir:v "The adjudication for sub-details provided on the claim." ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "*" ] ;
fhir:base [
fhir:path [ fhir:v "ClaimResponse.item.detail.subDetail" ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "*" ]
] ;
fhir:type ( [
fhir:code [ fhir:v "BackboneElement" ]
] ) ;
fhir:constraint ( [
fhir:key [ fhir:v "ele-1" ] ;
fhir:severity [ fhir:v "error" ] ;
fhir:human [ fhir:v "All FHIR elements must have a @value or children" ] ;
fhir:expression [ fhir:v "hasValue() or (children().count() > id.count())" ] ;
fhir:source [ fhir:v "http://hl7.org/fhir/StructureDefinition/Element" ]
] ) ;
fhir:mustSupport [ fhir:v "false" ] ;
fhir:isModifier [ fhir:v "false" ] ;
fhir:isSummary [ fhir:v "false" ]
] [
fhir:id [ fhir:v "ClaimResponse.item.detail.subDetail.id" ] ;
fhir:path [ fhir:v "ClaimResponse.item.detail.subDetail.id" ] ;
fhir:representation ( [ fhir:v "xmlAttr" ] ) ;
fhir:short [ fhir:v "Unique id for inter-element referencing" ] ;
fhir:definition [ fhir:v "Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces." ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "1" ] ;
fhir:base [
fhir:path [ fhir:v "Element.id" ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "1" ]
] ;
fhir:type ( [
fhir:extension ( [
fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type" ] ;
fhir:value [ fhir:v "string" ]
] ) ;
fhir:code [ fhir:v "http://hl7.org/fhirpath/System.String" ]
] ) ;
fhir:condition ( [ fhir:v "ele-1" ] ) ;
fhir:isModifier [ fhir:v "false" ] ;
fhir:isSummary [ fhir:v "false" ] ;
fhir:mapping ( [
fhir:identity [ fhir:v "rim" ] ;
fhir:map [ fhir:v "n/a" ]
] )
] [
fhir:id [ fhir:v "ClaimResponse.item.detail.subDetail.extension" ] ;
fhir:path [ fhir:v "ClaimResponse.item.detail.subDetail.extension" ] ;
fhir:short [ fhir:v "Additional content defined by implementations" ] ;
fhir:definition [ fhir:v "May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and managable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension." ] ;
fhir:comment [ fhir:v "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone." ] ;
fhir:alias ( [ fhir:v "extensions" ] [ fhir:v "user content" ] ) ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "*" ] ;
fhir:base [
fhir:path [ fhir:v "Element.extension" ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "*" ]
] ;
fhir:type ( [
fhir:code [ fhir:v "Extension" ]
] ) ;
fhir:constraint ( [
fhir:key [ fhir:v "ele-1" ] ;
fhir:severity [ fhir:v "error" ] ;
fhir:human [ fhir:v "All FHIR elements must have a @value or children" ] ;
fhir:expression [ fhir:v "hasValue() or (children().count() > id.count())" ] ;
fhir:source [ fhir:v "http://hl7.org/fhir/StructureDefinition/Element" ]
] ) ;
fhir:isModifier [ fhir:v "false" ] ;
fhir:isSummary [ fhir:v "false" ] ;
fhir:mapping ( [
fhir:identity [ fhir:v "rim" ] ;
fhir:map [ fhir:v "n/a" ]
] )
] [
fhir:id [ fhir:v "ClaimResponse.item.detail.subDetail.modifierExtension" ] ;
fhir:path [ fhir:v "ClaimResponse.item.detail.subDetail.modifierExtension" ] ;
fhir:short [ fhir:v "Extensions that cannot be ignored even if unrecognized" ] ;
fhir:definition [ fhir:v "May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and managable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.\n\nModifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself)." ] ;
fhir:comment [ fhir:v "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone." ] ;
fhir:requirements [ fhir:v "Modifier extensions allow for extensions that *cannot* be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the [definition of modifier extensions](extensibility.html#modifierExtension)." ] ;
fhir:alias ( [ fhir:v "extensions" ] [ fhir:v "user content" ] [ fhir:v "modifiers" ] ) ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "*" ] ;
fhir:base [
fhir:path [ fhir:v "BackboneElement.modifierExtension" ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "*" ]
] ;
fhir:type ( [
fhir:code [ fhir:v "Extension" ]
] ) ;
fhir:constraint ( [
fhir:key [ fhir:v "ele-1" ] ;
fhir:severity [ fhir:v "error" ] ;
fhir:human [ fhir:v "All FHIR elements must have a @value or children" ] ;
fhir:expression [ fhir:v "hasValue() or (children().count() > id.count())" ] ;
fhir:source [ fhir:v "http://hl7.org/fhir/StructureDefinition/Element" ]
] ) ;
fhir:isModifier [ fhir:v "true" ] ;
fhir:isModifierReason [ fhir:v "Modifier extensions are expected to modify the meaning or interpretation of the element that contains them" ] ;
fhir:isSummary [ fhir:v "true" ] ;
fhir:mapping ( [
fhir:identity [ fhir:v "rim" ] ;
fhir:map [ fhir:v "N/A" ]
] )
] [
fhir:id [ fhir:v "ClaimResponse.item.detail.subDetail.subDetailSequence" ] ;
fhir:path [ fhir:v "ClaimResponse.item.detail.subDetail.subDetailSequence" ] ;
fhir:short [ fhir:v "Claim sub-detail instance identifier" ] ;
fhir:definition [ fhir:v "A number to uniquely reference the claim sub-detail entry." ] ;
fhir:requirements [ fhir:v "Necessary to provide a mechanism to link the adjudication result to the submitted claim sub-detail." ] ;
fhir:min [ fhir:v "1" ] ;
fhir:max [ fhir:v "1" ] ;
fhir:base [
fhir:path [ fhir:v "ClaimResponse.item.detail.subDetail.subDetailSequence" ] ;
fhir:min [ fhir:v "1" ] ;
fhir:max [ fhir:v "1" ]
] ;
fhir:type ( [
fhir:code [ fhir:v "positiveInt" ]
] ) ;
fhir:constraint ( [
fhir:key [ fhir:v "ele-1" ] ;
fhir:severity [ fhir:v "error" ] ;
fhir:human [ fhir:v "All FHIR elements must have a @value or children" ] ;
fhir:expression [ fhir:v "hasValue() or (children().count() > id.count())" ] ;
fhir:source [ fhir:v "http://hl7.org/fhir/StructureDefinition/Element" ]
] ) ;
fhir:mustSupport [ fhir:v "false" ] ;
fhir:isModifier [ fhir:v "false" ] ;
fhir:isSummary [ fhir:v "false" ]
] [
fhir:id [ fhir:v "ClaimResponse.item.detail.subDetail.traceNumber" ] ;
fhir:path [ fhir:v "ClaimResponse.item.detail.subDetail.traceNumber" ] ;
fhir:short [ fhir:v "Number for tracking" ] ;
fhir:definition [ fhir:v "Trace number for tracking purposes. May be defined at the jurisdiction level or between trading partners." ] ;
fhir:requirements [ fhir:v "Allows partners to uniquely identify components for tracking." ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "*" ] ;
fhir:base [
fhir:path [ fhir:v "ClaimResponse.item.detail.subDetail.traceNumber" ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "*" ]
] ;
fhir:type ( [
fhir:code [ fhir:v "Identifier" ]
] ) ;
fhir:constraint ( [
fhir:key [ fhir:v "ele-1" ] ;
fhir:severity [ fhir:v "error" ] ;
fhir:human [ fhir:v "All FHIR elements must have a @value or children" ] ;
fhir:expression [ fhir:v "hasValue() or (children().count() > id.count())" ] ;
fhir:source [ fhir:v "http://hl7.org/fhir/StructureDefinition/Element" ]
] ) ;
fhir:mustSupport [ fhir:v "false" ] ;
fhir:isModifier [ fhir:v "false" ] ;
fhir:isSummary [ fhir:v "false" ]
] [
fhir:id [ fhir:v "ClaimResponse.item.detail.subDetail.noteNumber" ] ;
fhir:path [ fhir:v "ClaimResponse.item.detail.subDetail.noteNumber" ] ;
fhir:short [ fhir:v "Applicable note numbers" ] ;
fhir:definition [ fhir:v "The numbers associated with notes below which apply to the adjudication of this item." ] ;
fhir:requirements [ fhir:v "Provides a condensed manner for associating human readable descriptive explanations for adjudications on the line item." ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "*" ] ;
fhir:base [
fhir:path [ fhir:v "ClaimResponse.item.detail.subDetail.noteNumber" ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "*" ]
] ;
fhir:type ( [
fhir:code [ fhir:v "positiveInt" ]
] ) ;
fhir:constraint ( [
fhir:key [ fhir:v "ele-1" ] ;
fhir:severity [ fhir:v "error" ] ;
fhir:human [ fhir:v "All FHIR elements must have a @value or children" ] ;
fhir:expression [ fhir:v "hasValue() or (children().count() > id.count())" ] ;
fhir:source [ fhir:v "http://hl7.org/fhir/StructureDefinition/Element" ]
] ) ;
fhir:mustSupport [ fhir:v "false" ] ;
fhir:isModifier [ fhir:v "false" ] ;
fhir:isSummary [ fhir:v "false" ]
] [
fhir:id [ fhir:v "ClaimResponse.item.detail.subDetail.reviewOutcome" ] ;
fhir:path [ fhir:v "ClaimResponse.item.detail.subDetail.reviewOutcome" ] ;
fhir:short [ fhir:v "Subdetail level adjudication results" ] ;
fhir:definition [ fhir:v "The high-level results of the adjudication if adjudication has been performed." ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "1" ] ;
fhir:base [
fhir:path [ fhir:v "ClaimResponse.item.detail.subDetail.reviewOutcome" ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "1" ]
] ;
fhir:contentReference [ fhir:v "#ClaimResponse.item.reviewOutcome" ] ;
fhir:constraint ( [
fhir:key [ fhir:v "ele-1" ] ;
fhir:severity [ fhir:v "error" ] ;
fhir:human [ fhir:v "All FHIR elements must have a @value or children" ] ;
fhir:expression [ fhir:v "hasValue() or (children().count() > id.count())" ] ;
fhir:source [ fhir:v "http://hl7.org/fhir/StructureDefinition/Element" ]
] ) ;
fhir:mustSupport [ fhir:v "false" ] ;
fhir:isModifier [ fhir:v "false" ] ;
fhir:isSummary [ fhir:v "false" ]
] [
fhir:id [ fhir:v "ClaimResponse.item.detail.subDetail.adjudication" ] ;
fhir:path [ fhir:v "ClaimResponse.item.detail.subDetail.adjudication" ] ;
fhir:short [ fhir:v "Subdetail level adjudication details" ] ;
fhir:definition [ fhir:v "The adjudication results." ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "*" ] ;
fhir:base [
fhir:path [ fhir:v "ClaimResponse.item.detail.subDetail.adjudication" ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "*" ]
] ;
fhir:contentReference [ fhir:v "#ClaimResponse.item.adjudication" ] ;
fhir:constraint ( [
fhir:key [ fhir:v "ele-1" ] ;
fhir:severity [ fhir:v "error" ] ;
fhir:human [ fhir:v "All FHIR elements must have a @value or children" ] ;
fhir:expression [ fhir:v "hasValue() or (children().count() > id.count())" ] ;
fhir:source [ fhir:v "http://hl7.org/fhir/StructureDefinition/Element" ]
] ) ;
fhir:mustSupport [ fhir:v "false" ] ;
fhir:isModifier [ fhir:v "false" ] ;
fhir:isSummary [ fhir:v "false" ]
] [
fhir:id [ fhir:v "ClaimResponse.addItem" ] ;
fhir:extension ( [
fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/structuredefinition-explicit-type-name" ] ;
fhir:value [ fhir:v "AddedItem" ]
] ) ;
fhir:path [ fhir:v "ClaimResponse.addItem" ] ;
fhir:short [ fhir:v "Insurer added line items" ] ;
fhir:definition [ fhir:v "The first-tier service adjudications for payor added product or service lines." ] ;
fhir:requirements [ fhir:v "Insurers may redefine the provided product or service or may package and/or decompose groups of products and services. The addItems allows the insurer to provide their line item list with linkage to the submitted items/details/sub-details. In a preauthorization the insurer may use the addItem structure to provide additional information on authorized products and services." ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "*" ] ;
fhir:base [
fhir:path [ fhir:v "ClaimResponse.addItem" ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "*" ]
] ;
fhir:type ( [
fhir:code [ fhir:v "BackboneElement" ]
] ) ;
fhir:constraint ( [
fhir:key [ fhir:v "ele-1" ] ;
fhir:severity [ fhir:v "error" ] ;
fhir:human [ fhir:v "All FHIR elements must have a @value or children" ] ;
fhir:expression [ fhir:v "hasValue() or (children().count() > id.count())" ] ;
fhir:source [ fhir:v "http://hl7.org/fhir/StructureDefinition/Element" ]
] ) ;
fhir:mustSupport [ fhir:v "false" ] ;
fhir:isModifier [ fhir:v "false" ] ;
fhir:isSummary [ fhir:v "false" ]
] [
fhir:id [ fhir:v "ClaimResponse.addItem.id" ] ;
fhir:path [ fhir:v "ClaimResponse.addItem.id" ] ;
fhir:representation ( [ fhir:v "xmlAttr" ] ) ;
fhir:short [ fhir:v "Unique id for inter-element referencing" ] ;
fhir:definition [ fhir:v "Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces." ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "1" ] ;
fhir:base [
fhir:path [ fhir:v "Element.id" ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "1" ]
] ;
fhir:type ( [
fhir:extension ( [
fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type" ] ;
fhir:value [ fhir:v "string" ]
] ) ;
fhir:code [ fhir:v "http://hl7.org/fhirpath/System.String" ]
] ) ;
fhir:condition ( [ fhir:v "ele-1" ] ) ;
fhir:isModifier [ fhir:v "false" ] ;
fhir:isSummary [ fhir:v "false" ] ;
fhir:mapping ( [
fhir:identity [ fhir:v "rim" ] ;
fhir:map [ fhir:v "n/a" ]
] )
] [
fhir:id [ fhir:v "ClaimResponse.addItem.extension" ] ;
fhir:path [ fhir:v "ClaimResponse.addItem.extension" ] ;
fhir:short [ fhir:v "Additional content defined by implementations" ] ;
fhir:definition [ fhir:v "May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and managable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension." ] ;
fhir:comment [ fhir:v "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone." ] ;
fhir:alias ( [ fhir:v "extensions" ] [ fhir:v "user content" ] ) ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "*" ] ;
fhir:base [
fhir:path [ fhir:v "Element.extension" ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "*" ]
] ;
fhir:type ( [
fhir:code [ fhir:v "Extension" ]
] ) ;
fhir:constraint ( [
fhir:key [ fhir:v "ele-1" ] ;
fhir:severity [ fhir:v "error" ] ;
fhir:human [ fhir:v "All FHIR elements must have a @value or children" ] ;
fhir:expression [ fhir:v "hasValue() or (children().count() > id.count())" ] ;
fhir:source [ fhir:v "http://hl7.org/fhir/StructureDefinition/Element" ]
] ) ;
fhir:isModifier [ fhir:v "false" ] ;
fhir:isSummary [ fhir:v "false" ] ;
fhir:mapping ( [
fhir:identity [ fhir:v "rim" ] ;
fhir:map [ fhir:v "n/a" ]
] )
] [
fhir:id [ fhir:v "ClaimResponse.addItem.modifierExtension" ] ;
fhir:path [ fhir:v "ClaimResponse.addItem.modifierExtension" ] ;
fhir:short [ fhir:v "Extensions that cannot be ignored even if unrecognized" ] ;
fhir:definition [ fhir:v "May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and managable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.\n\nModifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself)." ] ;
fhir:comment [ fhir:v "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone." ] ;
fhir:requirements [ fhir:v "Modifier extensions allow for extensions that *cannot* be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the [definition of modifier extensions](extensibility.html#modifierExtension)." ] ;
fhir:alias ( [ fhir:v "extensions" ] [ fhir:v "user content" ] [ fhir:v "modifiers" ] ) ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "*" ] ;
fhir:base [
fhir:path [ fhir:v "BackboneElement.modifierExtension" ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "*" ]
] ;
fhir:type ( [
fhir:code [ fhir:v "Extension" ]
] ) ;
fhir:constraint ( [
fhir:key [ fhir:v "ele-1" ] ;
fhir:severity [ fhir:v "error" ] ;
fhir:human [ fhir:v "All FHIR elements must have a @value or children" ] ;
fhir:expression [ fhir:v "hasValue() or (children().count() > id.count())" ] ;
fhir:source [ fhir:v "http://hl7.org/fhir/StructureDefinition/Element" ]
] ) ;
fhir:isModifier [ fhir:v "true" ] ;
fhir:isModifierReason [ fhir:v "Modifier extensions are expected to modify the meaning or interpretation of the element that contains them" ] ;
fhir:isSummary [ fhir:v "true" ] ;
fhir:mapping ( [
fhir:identity [ fhir:v "rim" ] ;
fhir:map [ fhir:v "N/A" ]
] )
] [
fhir:id [ fhir:v "ClaimResponse.addItem.itemSequence" ] ;
fhir:path [ fhir:v "ClaimResponse.addItem.itemSequence" ] ;
fhir:short [ fhir:v "Item sequence number" ] ;
fhir:definition [ fhir:v "Claim items which this service line is intended to replace." ] ;
fhir:requirements [ fhir:v "Provides references to the claim items." ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "*" ] ;
fhir:base [
fhir:path [ fhir:v "ClaimResponse.addItem.itemSequence" ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "*" ]
] ;
fhir:type ( [
fhir:code [ fhir:v "positiveInt" ]
] ) ;
fhir:constraint ( [
fhir:key [ fhir:v "ele-1" ] ;
fhir:severity [ fhir:v "error" ] ;
fhir:human [ fhir:v "All FHIR elements must have a @value or children" ] ;
fhir:expression [ fhir:v "hasValue() or (children().count() > id.count())" ] ;
fhir:source [ fhir:v "http://hl7.org/fhir/StructureDefinition/Element" ]
] ) ;
fhir:mustSupport [ fhir:v "false" ] ;
fhir:isModifier [ fhir:v "false" ] ;
fhir:isSummary [ fhir:v "false" ]
] [
fhir:id [ fhir:v "ClaimResponse.addItem.detailSequence" ] ;
fhir:path [ fhir:v "ClaimResponse.addItem.detailSequence" ] ;
fhir:short [ fhir:v "Detail sequence number" ] ;
fhir:definition [ fhir:v "The sequence number of the details within the claim item which this line is intended to replace." ] ;
fhir:requirements [ fhir:v "Provides references to the claim details within the claim item." ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "*" ] ;
fhir:base [
fhir:path [ fhir:v "ClaimResponse.addItem.detailSequence" ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "*" ]
] ;
fhir:type ( [
fhir:code [ fhir:v "positiveInt" ]
] ) ;
fhir:constraint ( [
fhir:key [ fhir:v "ele-1" ] ;
fhir:severity [ fhir:v "error" ] ;
fhir:human [ fhir:v "All FHIR elements must have a @value or children" ] ;
fhir:expression [ fhir:v "hasValue() or (children().count() > id.count())" ] ;
fhir:source [ fhir:v "http://hl7.org/fhir/StructureDefinition/Element" ]
] ) ;
fhir:mustSupport [ fhir:v "false" ] ;
fhir:isModifier [ fhir:v "false" ] ;
fhir:isSummary [ fhir:v "false" ]
] [
fhir:id [ fhir:v "ClaimResponse.addItem.subdetailSequence" ] ;
fhir:path [ fhir:v "ClaimResponse.addItem.subdetailSequence" ] ;
fhir:short [ fhir:v "Subdetail sequence number" ] ;
fhir:definition [ fhir:v "The sequence number of the sub-details within the details within the claim item which this line is intended to replace." ] ;
fhir:requirements [ fhir:v "Provides references to the claim sub-details within the claim detail." ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "*" ] ;
fhir:base [
fhir:path [ fhir:v "ClaimResponse.addItem.subdetailSequence" ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "*" ]
] ;
fhir:type ( [
fhir:code [ fhir:v "positiveInt" ]
] ) ;
fhir:constraint ( [
fhir:key [ fhir:v "ele-1" ] ;
fhir:severity [ fhir:v "error" ] ;
fhir:human [ fhir:v "All FHIR elements must have a @value or children" ] ;
fhir:expression [ fhir:v "hasValue() or (children().count() > id.count())" ] ;
fhir:source [ fhir:v "http://hl7.org/fhir/StructureDefinition/Element" ]
] ) ;
fhir:mustSupport [ fhir:v "false" ] ;
fhir:isModifier [ fhir:v "false" ] ;
fhir:isSummary [ fhir:v "false" ]
] [
fhir:id [ fhir:v "ClaimResponse.addItem.traceNumber" ] ;
fhir:path [ fhir:v "ClaimResponse.addItem.traceNumber" ] ;
fhir:short [ fhir:v "Number for tracking" ] ;
fhir:definition [ fhir:v "Trace number for tracking purposes. May be defined at the jurisdiction level or between trading partners." ] ;
fhir:requirements [ fhir:v "Allows partners to uniquely identify components for tracking." ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "*" ] ;
fhir:base [
fhir:path [ fhir:v "ClaimResponse.addItem.traceNumber" ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "*" ]
] ;
fhir:type ( [
fhir:code [ fhir:v "Identifier" ]
] ) ;
fhir:constraint ( [
fhir:key [ fhir:v "ele-1" ] ;
fhir:severity [ fhir:v "error" ] ;
fhir:human [ fhir:v "All FHIR elements must have a @value or children" ] ;
fhir:expression [ fhir:v "hasValue() or (children().count() > id.count())" ] ;
fhir:source [ fhir:v "http://hl7.org/fhir/StructureDefinition/Element" ]
] ) ;
fhir:mustSupport [ fhir:v "false" ] ;
fhir:isModifier [ fhir:v "false" ] ;
fhir:isSummary [ fhir:v "false" ]
] [
fhir:id [ fhir:v "ClaimResponse.addItem.provider" ] ;
fhir:path [ fhir:v "ClaimResponse.addItem.provider" ] ;
fhir:short [ fhir:v "Authorized providers" ] ;
fhir:definition [ fhir:v "The providers who are authorized for the services rendered to the patient." ] ;
fhir:requirements [ fhir:v "Insurer may provide authorization specifically to a restricted set of providers rather than an open authorization." ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "*" ] ;
fhir:base [
fhir:path [ fhir:v "ClaimResponse.addItem.provider" ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "*" ]
] ;
fhir:type ( [
fhir:code [ fhir:v "Reference" ] ;
fhir:targetProfile ( [ fhir:v "http://hl7.org/fhir/StructureDefinition/Practitioner" ] [ fhir:v "http://hl7.org/fhir/StructureDefinition/PractitionerRole" ] [ fhir:v "http://hl7.org/fhir/StructureDefinition/Organization" ] )
] ) ;
fhir:constraint ( [
fhir:key [ fhir:v "ele-1" ] ;
fhir:severity [ fhir:v "error" ] ;
fhir:human [ fhir:v "All FHIR elements must have a @value or children" ] ;
fhir:expression [ fhir:v "hasValue() or (children().count() > id.count())" ] ;
fhir:source [ fhir:v "http://hl7.org/fhir/StructureDefinition/Element" ]
] ) ;
fhir:mustSupport [ fhir:v "false" ] ;
fhir:isModifier [ fhir:v "false" ] ;
fhir:isSummary [ fhir:v "false" ] ;
fhir:mapping ( [
fhir:identity [ fhir:v "w5" ] ;
fhir:map [ fhir:v "FiveWs.source" ]
] )
] [
fhir:id [ fhir:v "ClaimResponse.addItem.revenue" ] ;
fhir:path [ fhir:v "ClaimResponse.addItem.revenue" ] ;
fhir:short [ fhir:v "Revenue or cost center code" ] ;
fhir:definition [ fhir:v "The type of revenue or cost center providing the product and/or service." ] ;
fhir:requirements [ fhir:v "Needed in the processing of institutional claims." ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "1" ] ;
fhir:base [
fhir:path [ fhir:v "ClaimResponse.addItem.revenue" ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "1" ]
] ;
fhir:type ( [
fhir:code [ fhir:v "CodeableConcept" ]
] ) ;
fhir:constraint ( [
fhir:key [ fhir:v "ele-1" ] ;
fhir:severity [ fhir:v "error" ] ;
fhir:human [ fhir:v "All FHIR elements must have a @value or children" ] ;
fhir:expression [ fhir:v "hasValue() or (children().count() > id.count())" ] ;
fhir:source [ fhir:v "http://hl7.org/fhir/StructureDefinition/Element" ]
] ) ;
fhir:mustSupport [ fhir:v "false" ] ;
fhir:isModifier [ fhir:v "false" ] ;
fhir:isSummary [ fhir:v "false" ] ;
fhir:binding [
fhir:extension ( [
fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName" ] ;
fhir:value [ fhir:v "RevenueCenter" ]
] ) ;
fhir:strength [ fhir:v "example" ] ;
fhir:description [ fhir:v "Codes for the revenue or cost centers supplying the service and/or products." ] ;
fhir:valueSet [ fhir:v "http://hl7.org/fhir/ValueSet/ex-revenue-center" ]
]
] [
fhir:id [ fhir:v "ClaimResponse.addItem.productOrService" ] ;
fhir:path [ fhir:v "ClaimResponse.addItem.productOrService" ] ;
fhir:short [ fhir:v "Billing, service, product, or drug code" ] ;
fhir:definition [ fhir:v "When the value is a group code then this item collects a set of related item details, otherwise this contains the product, service, drug or other billing code for the item. This element may be the start of a range of .productOrService codes used in conjunction with .productOrServiceEnd or it may be a solo element where .productOrServiceEnd is not used." ] ;
fhir:comment [ fhir:v "If this is an actual service or product line, i.e. not a Group, then use code to indicate the Professional Service or Product supplied (e.g. CTP, HCPCS, USCLS, ICD10, NCPDP, DIN, RxNorm, ACHI, CCI). If a grouping item then use a group code to indicate the type of thing being grouped e.g. 'glasses' or 'compound'." ] ;
fhir:requirements [ fhir:v "Necessary to state what was provided or done." ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "1" ] ;
fhir:base [
fhir:path [ fhir:v "ClaimResponse.addItem.productOrService" ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "1" ]
] ;
fhir:type ( [
fhir:code [ fhir:v "CodeableConcept" ]
] ) ;
fhir:constraint ( [
fhir:key [ fhir:v "ele-1" ] ;
fhir:severity [ fhir:v "error" ] ;
fhir:human [ fhir:v "All FHIR elements must have a @value or children" ] ;
fhir:expression [ fhir:v "hasValue() or (children().count() > id.count())" ] ;
fhir:source [ fhir:v "http://hl7.org/fhir/StructureDefinition/Element" ]
] ) ;
fhir:mustSupport [ fhir:v "false" ] ;
fhir:isModifier [ fhir:v "false" ] ;
fhir:isSummary [ fhir:v "false" ] ;
fhir:binding [
fhir:extension ( [
fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName" ] ;
fhir:value [ fhir:v "ServiceProduct" ]
] ) ;
fhir:strength [ fhir:v "example" ] ;
fhir:description [ fhir:v "Allowable service and product codes." ] ;
fhir:valueSet [ fhir:v "http://hl7.org/fhir/ValueSet/service-uscls" ]
]
] [
fhir:id [ fhir:v "ClaimResponse.addItem.productOrServiceEnd" ] ;
fhir:path [ fhir:v "ClaimResponse.addItem.productOrServiceEnd" ] ;
fhir:short [ fhir:v "End of a range of codes" ] ;
fhir:definition [ fhir:v "This contains the end of a range of product, service, drug or other billing codes for the item. This element is not used when the .productOrService is a group code. This value may only be present when a .productOfService code has been provided to convey the start of the range. Typically this value may be used only with preauthorizations and not with claims." ] ;
fhir:alias ( [ fhir:v "End of a range of Drug Code; Bill Code; Service Cod" ] ) ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "1" ] ;
fhir:base [
fhir:path [ fhir:v "ClaimResponse.addItem.productOrServiceEnd" ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "1" ]
] ;
fhir:type ( [
fhir:code [ fhir:v "CodeableConcept" ]
] ) ;
fhir:constraint ( [
fhir:key [ fhir:v "ele-1" ] ;
fhir:severity [ fhir:v "error" ] ;
fhir:human [ fhir:v "All FHIR elements must have a @value or children" ] ;
fhir:expression [ fhir:v "hasValue() or (children().count() > id.count())" ] ;
fhir:source [ fhir:v "http://hl7.org/fhir/StructureDefinition/Element" ]
] ) ;
fhir:mustSupport [ fhir:v "false" ] ;
fhir:isModifier [ fhir:v "false" ] ;
fhir:isSummary [ fhir:v "false" ] ;
fhir:binding [
fhir:extension ( [
fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName" ] ;
fhir:value [ fhir:v "ServiceProduct" ]
] ) ;
fhir:strength [ fhir:v "example" ] ;
fhir:valueSet [ fhir:v "http://hl7.org/fhir/ValueSet/service-uscls" ]
]
] [
fhir:id [ fhir:v "ClaimResponse.addItem.request" ] ;
fhir:path [ fhir:v "ClaimResponse.addItem.request" ] ;
fhir:short [ fhir:v "Request or Referral for Service" ] ;
fhir:definition [ fhir:v "Request or Referral for Goods or Service to be rendered." ] ;
fhir:requirements [ fhir:v "May identify the service to be provided or provider authorization for the service." ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "*" ] ;
fhir:base [
fhir:path [ fhir:v "ClaimResponse.addItem.request" ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "*" ]
] ;
fhir:type ( [
fhir:code [ fhir:v "Reference" ] ;
fhir:targetProfile ( [ fhir:v "http://hl7.org/fhir/StructureDefinition/DeviceRequest" ] [ fhir:v "http://hl7.org/fhir/StructureDefinition/MedicationRequest" ] [ fhir:v "http://hl7.org/fhir/StructureDefinition/NutritionOrder" ] [ fhir:v "http://hl7.org/fhir/StructureDefinition/ServiceRequest" ] [ fhir:v "http://hl7.org/fhir/StructureDefinition/SupplyRequest" ] [ fhir:v "http://hl7.org/fhir/StructureDefinition/VisionPrescription" ] )
] ) ;
fhir:constraint ( [
fhir:key [ fhir:v "ele-1" ] ;
fhir:severity [ fhir:v "error" ] ;
fhir:human [ fhir:v "All FHIR elements must have a @value or children" ] ;
fhir:expression [ fhir:v "hasValue() or (children().count() > id.count())" ] ;
fhir:source [ fhir:v "http://hl7.org/fhir/StructureDefinition/Element" ]
] ) ;
fhir:mustSupport [ fhir:v "false" ] ;
fhir:isModifier [ fhir:v "false" ] ;
fhir:isSummary [ fhir:v "false" ]
] [
fhir:id [ fhir:v "ClaimResponse.addItem.modifier" ] ;
fhir:path [ fhir:v "ClaimResponse.addItem.modifier" ] ;
fhir:short [ fhir:v "Service/Product billing modifiers" ] ;
fhir:definition [ fhir:v "Item typification or modifiers codes to convey additional context for the product or service." ] ;
fhir:comment [ fhir:v "For example in Oral whether the treatment is cosmetic or associated with TMJ, or for Medical whether the treatment was outside the clinic or outside of office hours." ] ;
fhir:requirements [ fhir:v "To support inclusion of the item for adjudication or to charge an elevated fee." ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "*" ] ;
fhir:base [
fhir:path [ fhir:v "ClaimResponse.addItem.modifier" ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "*" ]
] ;
fhir:type ( [
fhir:code [ fhir:v "CodeableConcept" ]
] ) ;
fhir:constraint ( [
fhir:key [ fhir:v "ele-1" ] ;
fhir:severity [ fhir:v "error" ] ;
fhir:human [ fhir:v "All FHIR elements must have a @value or children" ] ;
fhir:expression [ fhir:v "hasValue() or (children().count() > id.count())" ] ;
fhir:source [ fhir:v "http://hl7.org/fhir/StructureDefinition/Element" ]
] ) ;
fhir:mustSupport [ fhir:v "false" ] ;
fhir:isModifier [ fhir:v "false" ] ;
fhir:isSummary [ fhir:v "false" ] ;
fhir:binding [
fhir:extension ( [
fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName" ] ;
fhir:value [ fhir:v "Modifiers" ]
] ) ;
fhir:strength [ fhir:v "example" ] ;
fhir:description [ fhir:v "Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen." ] ;
fhir:valueSet [ fhir:v "http://hl7.org/fhir/ValueSet/claim-modifiers" ]
] ;
fhir:mapping ( [
fhir:identity [ fhir:v "rim" ] ;
fhir:map [ fhir:v "24.C, 24.D mods" ]
] )
] [
fhir:id [ fhir:v "ClaimResponse.addItem.programCode" ] ;
fhir:path [ fhir:v "ClaimResponse.addItem.programCode" ] ;
fhir:short [ fhir:v "Program the product or service is provided under" ] ;
fhir:definition [ fhir:v "Identifies the program under which this may be recovered." ] ;
fhir:comment [ fhir:v "For example: Neonatal program, child dental program or drug users recovery program." ] ;
fhir:requirements [ fhir:v "Commonly used in in the identification of publicly provided program focused on population segments or disease classifications." ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "*" ] ;
fhir:base [
fhir:path [ fhir:v "ClaimResponse.addItem.programCode" ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "*" ]
] ;
fhir:type ( [
fhir:code [ fhir:v "CodeableConcept" ]
] ) ;
fhir:constraint ( [
fhir:key [ fhir:v "ele-1" ] ;
fhir:severity [ fhir:v "error" ] ;
fhir:human [ fhir:v "All FHIR elements must have a @value or children" ] ;
fhir:expression [ fhir:v "hasValue() or (children().count() > id.count())" ] ;
fhir:source [ fhir:v "http://hl7.org/fhir/StructureDefinition/Element" ]
] ) ;
fhir:mustSupport [ fhir:v "false" ] ;
fhir:isModifier [ fhir:v "false" ] ;
fhir:isSummary [ fhir:v "false" ] ;
fhir:binding [
fhir:extension ( [
fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName" ] ;
fhir:value [ fhir:v "ProgramCode" ]
] ) ;
fhir:strength [ fhir:v "example" ] ;
fhir:description [ fhir:v "Program specific reason codes." ] ;
fhir:valueSet [ fhir:v "http://hl7.org/fhir/ValueSet/ex-program-code" ]
] ;
fhir:mapping ( [
fhir:identity [ fhir:v "rim" ] ;
fhir:map [ fhir:v "24.H" ]
] )
] [
fhir:id [ fhir:v "ClaimResponse.addItem.serviced[x]" ] ;
fhir:path [ fhir:v "ClaimResponse.addItem.serviced[x]" ] ;
fhir:short [ fhir:v "Date or dates of service or product delivery" ] ;
fhir:definition [ fhir:v "The date or dates when the service or product was supplied, performed or completed." ] ;
fhir:requirements [ fhir:v "Needed to determine whether the service or product was provided during the term of the insurance coverage." ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "1" ] ;
fhir:base [
fhir:path [ fhir:v "ClaimResponse.addItem.serviced[x]" ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "1" ]
] ;
fhir:type ( [
fhir:code [ fhir:v "date" ]
] [
fhir:code [ fhir:v "Period" ]
] ) ;
fhir:constraint ( [
fhir:key [ fhir:v "ele-1" ] ;
fhir:severity [ fhir:v "error" ] ;
fhir:human [ fhir:v "All FHIR elements must have a @value or children" ] ;
fhir:expression [ fhir:v "hasValue() or (children().count() > id.count())" ] ;
fhir:source [ fhir:v "http://hl7.org/fhir/StructureDefinition/Element" ]
] ) ;
fhir:mustSupport [ fhir:v "false" ] ;
fhir:isModifier [ fhir:v "false" ] ;
fhir:isSummary [ fhir:v "false" ] ;
fhir:mapping ( [
fhir:identity [ fhir:v "w5" ] ;
fhir:map [ fhir:v "FiveWs.done[x]" ]
] [
fhir:identity [ fhir:v "rim" ] ;
fhir:map [ fhir:v "24.A" ]
] )
] [
fhir:id [ fhir:v "ClaimResponse.addItem.location[x]" ] ;
fhir:path [ fhir:v "ClaimResponse.addItem.location[x]" ] ;
fhir:short [ fhir:v "Place of service or where product was supplied" ] ;
fhir:definition [ fhir:v "Where the product or service was provided." ] ;
fhir:requirements [ fhir:v "The location can alter whether the item was acceptable for insurance purposes or impact the determination of the benefit amount." ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "1" ] ;
fhir:base [
fhir:path [ fhir:v "ClaimResponse.addItem.location[x]" ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "1" ]
] ;
fhir:type ( [
fhir:code [ fhir:v "CodeableConcept" ]
] [
fhir:code [ fhir:v "Address" ]
] [
fhir:code [ fhir:v "Reference" ] ;
fhir:targetProfile ( [ fhir:v "http://hl7.org/fhir/StructureDefinition/Location" ] )
] ) ;
fhir:constraint ( [
fhir:key [ fhir:v "ele-1" ] ;
fhir:severity [ fhir:v "error" ] ;
fhir:human [ fhir:v "All FHIR elements must have a @value or children" ] ;
fhir:expression [ fhir:v "hasValue() or (children().count() > id.count())" ] ;
fhir:source [ fhir:v "http://hl7.org/fhir/StructureDefinition/Element" ]
] ) ;
fhir:mustSupport [ fhir:v "false" ] ;
fhir:isModifier [ fhir:v "false" ] ;
fhir:isSummary [ fhir:v "false" ] ;
fhir:binding [
fhir:extension ( [
fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName" ] ;
fhir:value [ fhir:v "ServicePlace" ]
] ) ;
fhir:strength [ fhir:v "example" ] ;
fhir:description [ fhir:v "Place of service: pharmacy, school, prison, etc." ] ;
fhir:valueSet [ fhir:v "http://hl7.org/fhir/ValueSet/service-place" ]
] ;
fhir:mapping ( [
fhir:identity [ fhir:v "w5" ] ;
fhir:map [ fhir:v "FiveWs.where[x]" ]
] [
fhir:identity [ fhir:v "rim" ] ;
fhir:map [ fhir:v "24.B" ]
] )
] [
fhir:id [ fhir:v "ClaimResponse.addItem.quantity" ] ;
fhir:path [ fhir:v "ClaimResponse.addItem.quantity" ] ;
fhir:short [ fhir:v "Count of products or services" ] ;
fhir:definition [ fhir:v "The number of repetitions of a service or product." ] ;
fhir:requirements [ fhir:v "Required when the product or service code does not convey the quantity provided." ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "1" ] ;
fhir:base [
fhir:path [ fhir:v "ClaimResponse.addItem.quantity" ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "1" ]
] ;
fhir:type ( [
fhir:code [ fhir:v "Quantity" ] ;
fhir:profile ( [ fhir:v "http://hl7.org/fhir/StructureDefinition/SimpleQuantity" ] )
] ) ;
fhir:constraint ( [
fhir:key [ fhir:v "ele-1" ] ;
fhir:severity [ fhir:v "error" ] ;
fhir:human [ fhir:v "All FHIR elements must have a @value or children" ] ;
fhir:expression [ fhir:v "hasValue() or (children().count() > id.count())" ] ;
fhir:source [ fhir:v "http://hl7.org/fhir/StructureDefinition/Element" ]
] ) ;
fhir:mustSupport [ fhir:v "false" ] ;
fhir:isModifier [ fhir:v "false" ] ;
fhir:isSummary [ fhir:v "false" ] ;
fhir:mapping ( [
fhir:identity [ fhir:v "rim" ] ;
fhir:map [ fhir:v "24.G" ]
] )
] [
fhir:id [ fhir:v "ClaimResponse.addItem.unitPrice" ] ;
fhir:path [ fhir:v "ClaimResponse.addItem.unitPrice" ] ;
fhir:short [ fhir:v "Fee, charge or cost per item" ] ;
fhir:definition [ fhir:v "If the item is not a group then this is the fee for the product or service, otherwise this is the total of the fees for the details of the group." ] ;
fhir:requirements [ fhir:v "The amount charged to the patient by the provider for a single unit." ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "1" ] ;
fhir:base [
fhir:path [ fhir:v "ClaimResponse.addItem.unitPrice" ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "1" ]
] ;
fhir:type ( [
fhir:code [ fhir:v "Money" ]
] ) ;
fhir:constraint ( [
fhir:key [ fhir:v "ele-1" ] ;
fhir:severity [ fhir:v "error" ] ;
fhir:human [ fhir:v "All FHIR elements must have a @value or children" ] ;
fhir:expression [ fhir:v "hasValue() or (children().count() > id.count())" ] ;
fhir:source [ fhir:v "http://hl7.org/fhir/StructureDefinition/Element" ]
] ) ;
fhir:mustSupport [ fhir:v "false" ] ;
fhir:isModifier [ fhir:v "false" ] ;
fhir:isSummary [ fhir:v "false" ]
] [
fhir:id [ fhir:v "ClaimResponse.addItem.factor" ] ;
fhir:path [ fhir:v "ClaimResponse.addItem.factor" ] ;
fhir:short [ fhir:v "Price scaling factor" ] ;
fhir:definition [ fhir:v "A real number that represents a multiplier used in determining the overall value of services delivered and/or goods received. The concept of a Factor allows for a discount or surcharge multiplier to be applied to a monetary amount." ] ;
fhir:comment [ fhir:v "To show a 10% senior's discount, the value entered is: 0.90 (1.00 - 0.10)." ] ;
fhir:requirements [ fhir:v "When discounts are provided to a patient (example: Senior's discount) then this must be documented for adjudication." ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "1" ] ;
fhir:base [
fhir:path [ fhir:v "ClaimResponse.addItem.factor" ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "1" ]
] ;
fhir:type ( [
fhir:code [ fhir:v "decimal" ]
] ) ;
fhir:constraint ( [
fhir:key [ fhir:v "ele-1" ] ;
fhir:severity [ fhir:v "error" ] ;
fhir:human [ fhir:v "All FHIR elements must have a @value or children" ] ;
fhir:expression [ fhir:v "hasValue() or (children().count() > id.count())" ] ;
fhir:source [ fhir:v "http://hl7.org/fhir/StructureDefinition/Element" ]
] ) ;
fhir:mustSupport [ fhir:v "false" ] ;
fhir:isModifier [ fhir:v "false" ] ;
fhir:isSummary [ fhir:v "false" ]
] [
fhir:id [ fhir:v "ClaimResponse.addItem.tax" ] ;
fhir:path [ fhir:v "ClaimResponse.addItem.tax" ] ;
fhir:short [ fhir:v "Total tax" ] ;
fhir:definition [ fhir:v "The total of taxes applicable for this product or service." ] ;
fhir:requirements [ fhir:v "Required when taxes are not embedded in the unit price or provided as a separate service." ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "1" ] ;
fhir:base [
fhir:path [ fhir:v "ClaimResponse.addItem.tax" ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "1" ]
] ;
fhir:type ( [
fhir:code [ fhir:v "Money" ]
] ) ;
fhir:constraint ( [
fhir:key [ fhir:v "ele-1" ] ;
fhir:severity [ fhir:v "error" ] ;
fhir:human [ fhir:v "All FHIR elements must have a @value or children" ] ;
fhir:expression [ fhir:v "hasValue() or (children().count() > id.count())" ] ;
fhir:source [ fhir:v "http://hl7.org/fhir/StructureDefinition/Element" ]
] ) ;
fhir:mustSupport [ fhir:v "false" ] ;
fhir:isModifier [ fhir:v "false" ] ;
fhir:isSummary [ fhir:v "false" ]
] [
fhir:id [ fhir:v "ClaimResponse.addItem.net" ] ;
fhir:path [ fhir:v "ClaimResponse.addItem.net" ] ;
fhir:short [ fhir:v "Total item cost" ] ;
fhir:definition [ fhir:v "The total amount claimed for the group (if a grouper) or the addItem. Net = unit price * quantity * factor." ] ;
fhir:comment [ fhir:v "For example, the formula: quantity * unitPrice * factor = net. Quantity and factor are assumed to be 1 if not supplied." ] ;
fhir:requirements [ fhir:v "Provides the total amount claimed for the group (if a grouper) or the line item." ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "1" ] ;
fhir:base [
fhir:path [ fhir:v "ClaimResponse.addItem.net" ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "1" ]
] ;
fhir:type ( [
fhir:code [ fhir:v "Money" ]
] ) ;
fhir:constraint ( [
fhir:key [ fhir:v "ele-1" ] ;
fhir:severity [ fhir:v "error" ] ;
fhir:human [ fhir:v "All FHIR elements must have a @value or children" ] ;
fhir:expression [ fhir:v "hasValue() or (children().count() > id.count())" ] ;
fhir:source [ fhir:v "http://hl7.org/fhir/StructureDefinition/Element" ]
] ) ;
fhir:mustSupport [ fhir:v "false" ] ;
fhir:isModifier [ fhir:v "false" ] ;
fhir:isSummary [ fhir:v "false" ] ;
fhir:mapping ( [
fhir:identity [ fhir:v "rim" ] ;
fhir:map [ fhir:v "24.F" ]
] )
] [
fhir:id [ fhir:v "ClaimResponse.addItem.bodySite" ] ;
fhir:extension ( [
fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/structuredefinition-explicit-type-name" ] ;
fhir:value [ fhir:v "BodySite" ]
] ) ;
fhir:path [ fhir:v "ClaimResponse.addItem.bodySite" ] ;
fhir:short [ fhir:v "Anatomical location" ] ;
fhir:definition [ fhir:v "Physical location where the service is performed or applies." ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "*" ] ;
fhir:base [
fhir:path [ fhir:v "ClaimResponse.addItem.bodySite" ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "*" ]
] ;
fhir:type ( [
fhir:code [ fhir:v "BackboneElement" ]
] ) ;
fhir:constraint ( [
fhir:key [ fhir:v "ele-1" ] ;
fhir:severity [ fhir:v "error" ] ;
fhir:human [ fhir:v "All FHIR elements must have a @value or children" ] ;
fhir:expression [ fhir:v "hasValue() or (children().count() > id.count())" ] ;
fhir:source [ fhir:v "http://hl7.org/fhir/StructureDefinition/Element" ]
] ) ;
fhir:mustSupport [ fhir:v "false" ] ;
fhir:isModifier [ fhir:v "false" ] ;
fhir:isSummary [ fhir:v "false" ]
] [
fhir:id [ fhir:v "ClaimResponse.addItem.bodySite.id" ] ;
fhir:path [ fhir:v "ClaimResponse.addItem.bodySite.id" ] ;
fhir:representation ( [ fhir:v "xmlAttr" ] ) ;
fhir:short [ fhir:v "Unique id for inter-element referencing" ] ;
fhir:definition [ fhir:v "Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces." ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "1" ] ;
fhir:base [
fhir:path [ fhir:v "Element.id" ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "1" ]
] ;
fhir:type ( [
fhir:extension ( [
fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type" ] ;
fhir:value [ fhir:v "string" ]
] ) ;
fhir:code [ fhir:v "http://hl7.org/fhirpath/System.String" ]
] ) ;
fhir:condition ( [ fhir:v "ele-1" ] ) ;
fhir:isModifier [ fhir:v "false" ] ;
fhir:isSummary [ fhir:v "false" ] ;
fhir:mapping ( [
fhir:identity [ fhir:v "rim" ] ;
fhir:map [ fhir:v "n/a" ]
] )
] [
fhir:id [ fhir:v "ClaimResponse.addItem.bodySite.extension" ] ;
fhir:path [ fhir:v "ClaimResponse.addItem.bodySite.extension" ] ;
fhir:short [ fhir:v "Additional content defined by implementations" ] ;
fhir:definition [ fhir:v "May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and managable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension." ] ;
fhir:comment [ fhir:v "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone." ] ;
fhir:alias ( [ fhir:v "extensions" ] [ fhir:v "user content" ] ) ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "*" ] ;
fhir:base [
fhir:path [ fhir:v "Element.extension" ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "*" ]
] ;
fhir:type ( [
fhir:code [ fhir:v "Extension" ]
] ) ;
fhir:constraint ( [
fhir:key [ fhir:v "ele-1" ] ;
fhir:severity [ fhir:v "error" ] ;
fhir:human [ fhir:v "All FHIR elements must have a @value or children" ] ;
fhir:expression [ fhir:v "hasValue() or (children().count() > id.count())" ] ;
fhir:source [ fhir:v "http://hl7.org/fhir/StructureDefinition/Element" ]
] ) ;
fhir:isModifier [ fhir:v "false" ] ;
fhir:isSummary [ fhir:v "false" ] ;
fhir:mapping ( [
fhir:identity [ fhir:v "rim" ] ;
fhir:map [ fhir:v "n/a" ]
] )
] [
fhir:id [ fhir:v "ClaimResponse.addItem.bodySite.modifierExtension" ] ;
fhir:path [ fhir:v "ClaimResponse.addItem.bodySite.modifierExtension" ] ;
fhir:short [ fhir:v "Extensions that cannot be ignored even if unrecognized" ] ;
fhir:definition [ fhir:v "May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and managable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.\n\nModifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself)." ] ;
fhir:comment [ fhir:v "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone." ] ;
fhir:requirements [ fhir:v "Modifier extensions allow for extensions that *cannot* be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the [definition of modifier extensions](extensibility.html#modifierExtension)." ] ;
fhir:alias ( [ fhir:v "extensions" ] [ fhir:v "user content" ] [ fhir:v "modifiers" ] ) ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "*" ] ;
fhir:base [
fhir:path [ fhir:v "BackboneElement.modifierExtension" ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "*" ]
] ;
fhir:type ( [
fhir:code [ fhir:v "Extension" ]
] ) ;
fhir:constraint ( [
fhir:key [ fhir:v "ele-1" ] ;
fhir:severity [ fhir:v "error" ] ;
fhir:human [ fhir:v "All FHIR elements must have a @value or children" ] ;
fhir:expression [ fhir:v "hasValue() or (children().count() > id.count())" ] ;
fhir:source [ fhir:v "http://hl7.org/fhir/StructureDefinition/Element" ]
] ) ;
fhir:isModifier [ fhir:v "true" ] ;
fhir:isModifierReason [ fhir:v "Modifier extensions are expected to modify the meaning or interpretation of the element that contains them" ] ;
fhir:isSummary [ fhir:v "true" ] ;
fhir:mapping ( [
fhir:identity [ fhir:v "rim" ] ;
fhir:map [ fhir:v "N/A" ]
] )
] [
fhir:id [ fhir:v "ClaimResponse.addItem.bodySite.site" ] ;
fhir:path [ fhir:v "ClaimResponse.addItem.bodySite.site" ] ;
fhir:short [ fhir:v "Location" ] ;
fhir:definition [ fhir:v "Physical service site on the patient (limb, tooth, etc.)." ] ;
fhir:comment [ fhir:v "For example: Providing a tooth code allows an insurer to identify a provider performing a filling on a tooth that was previously removed." ] ;
fhir:requirements [ fhir:v "Allows insurer to validate specific procedures." ] ;
fhir:min [ fhir:v "1" ] ;
fhir:max [ fhir:v "*" ] ;
fhir:base [
fhir:path [ fhir:v "ClaimResponse.addItem.bodySite.site" ] ;
fhir:min [ fhir:v "1" ] ;
fhir:max [ fhir:v "*" ]
] ;
fhir:type ( [
fhir:code [ fhir:v "CodeableReference" ] ;
fhir:targetProfile ( [ fhir:v "http://hl7.org/fhir/StructureDefinition/BodyStructure" ] )
] ) ;
fhir:constraint ( [
fhir:key [ fhir:v "ele-1" ] ;
fhir:severity [ fhir:v "error" ] ;
fhir:human [ fhir:v "All FHIR elements must have a @value or children" ] ;
fhir:expression [ fhir:v "hasValue() or (children().count() > id.count())" ] ;
fhir:source [ fhir:v "http://hl7.org/fhir/StructureDefinition/Element" ]
] ) ;
fhir:mustSupport [ fhir:v "false" ] ;
fhir:isModifier [ fhir:v "false" ] ;
fhir:isSummary [ fhir:v "false" ] ;
fhir:binding [
fhir:extension ( [
fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName" ] ;
fhir:value [ fhir:v "OralSites" ]
] ) ;
fhir:strength [ fhir:v "example" ] ;
fhir:valueSet [ fhir:v "http://hl7.org/fhir/ValueSet/tooth" ]
]
] [
fhir:id [ fhir:v "ClaimResponse.addItem.bodySite.subSite" ] ;
fhir:path [ fhir:v "ClaimResponse.addItem.bodySite.subSite" ] ;
fhir:short [ fhir:v "Sub-location" ] ;
fhir:definition [ fhir:v "A region or surface of the bodySite, e.g. limb region or tooth surface(s)." ] ;
fhir:requirements [ fhir:v "Allows insurer to validate specific procedures." ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "*" ] ;
fhir:base [
fhir:path [ fhir:v "ClaimResponse.addItem.bodySite.subSite" ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "*" ]
] ;
fhir:type ( [
fhir:code [ fhir:v "CodeableConcept" ]
] ) ;
fhir:constraint ( [
fhir:key [ fhir:v "ele-1" ] ;
fhir:severity [ fhir:v "error" ] ;
fhir:human [ fhir:v "All FHIR elements must have a @value or children" ] ;
fhir:expression [ fhir:v "hasValue() or (children().count() > id.count())" ] ;
fhir:source [ fhir:v "http://hl7.org/fhir/StructureDefinition/Element" ]
] ) ;
fhir:mustSupport [ fhir:v "false" ] ;
fhir:isModifier [ fhir:v "false" ] ;
fhir:isSummary [ fhir:v "false" ] ;
fhir:binding [
fhir:extension ( [
fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName" ] ;
fhir:value [ fhir:v "Surface" ]
] ) ;
fhir:strength [ fhir:v "example" ] ;
fhir:valueSet [ fhir:v "http://hl7.org/fhir/ValueSet/surface" ]
]
] [
fhir:id [ fhir:v "ClaimResponse.addItem.noteNumber" ] ;
fhir:path [ fhir:v "ClaimResponse.addItem.noteNumber" ] ;
fhir:short [ fhir:v "Applicable note numbers" ] ;
fhir:definition [ fhir:v "The numbers associated with notes below which apply to the adjudication of this item." ] ;
fhir:requirements [ fhir:v "Provides a condensed manner for associating human readable descriptive explanations for adjudications on the line item." ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "*" ] ;
fhir:base [
fhir:path [ fhir:v "ClaimResponse.addItem.noteNumber" ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "*" ]
] ;
fhir:type ( [
fhir:code [ fhir:v "positiveInt" ]
] ) ;
fhir:constraint ( [
fhir:key [ fhir:v "ele-1" ] ;
fhir:severity [ fhir:v "error" ] ;
fhir:human [ fhir:v "All FHIR elements must have a @value or children" ] ;
fhir:expression [ fhir:v "hasValue() or (children().count() > id.count())" ] ;
fhir:source [ fhir:v "http://hl7.org/fhir/StructureDefinition/Element" ]
] ) ;
fhir:mustSupport [ fhir:v "false" ] ;
fhir:isModifier [ fhir:v "false" ] ;
fhir:isSummary [ fhir:v "false" ]
] [
fhir:id [ fhir:v "ClaimResponse.addItem.reviewOutcome" ] ;
fhir:path [ fhir:v "ClaimResponse.addItem.reviewOutcome" ] ;
fhir:short [ fhir:v "Added items adjudication results" ] ;
fhir:definition [ fhir:v "The high-level results of the adjudication if adjudication has been performed." ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "1" ] ;
fhir:base [
fhir:path [ fhir:v "ClaimResponse.addItem.reviewOutcome" ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "1" ]
] ;
fhir:contentReference [ fhir:v "#ClaimResponse.item.reviewOutcome" ] ;
fhir:constraint ( [
fhir:key [ fhir:v "ele-1" ] ;
fhir:severity [ fhir:v "error" ] ;
fhir:human [ fhir:v "All FHIR elements must have a @value or children" ] ;
fhir:expression [ fhir:v "hasValue() or (children().count() > id.count())" ] ;
fhir:source [ fhir:v "http://hl7.org/fhir/StructureDefinition/Element" ]
] ) ;
fhir:mustSupport [ fhir:v "false" ] ;
fhir:isModifier [ fhir:v "false" ] ;
fhir:isSummary [ fhir:v "false" ]
] [
fhir:id [ fhir:v "ClaimResponse.addItem.adjudication" ] ;
fhir:path [ fhir:v "ClaimResponse.addItem.adjudication" ] ;
fhir:short [ fhir:v "Added items adjudication" ] ;
fhir:definition [ fhir:v "The adjudication results." ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "*" ] ;
fhir:base [
fhir:path [ fhir:v "ClaimResponse.addItem.adjudication" ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "*" ]
] ;
fhir:contentReference [ fhir:v "#ClaimResponse.item.adjudication" ] ;
fhir:constraint ( [
fhir:key [ fhir:v "ele-1" ] ;
fhir:severity [ fhir:v "error" ] ;
fhir:human [ fhir:v "All FHIR elements must have a @value or children" ] ;
fhir:expression [ fhir:v "hasValue() or (children().count() > id.count())" ] ;
fhir:source [ fhir:v "http://hl7.org/fhir/StructureDefinition/Element" ]
] ) ;
fhir:mustSupport [ fhir:v "false" ] ;
fhir:isModifier [ fhir:v "false" ] ;
fhir:isSummary [ fhir:v "false" ]
] [
fhir:id [ fhir:v "ClaimResponse.addItem.detail" ] ;
fhir:extension ( [
fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/structuredefinition-explicit-type-name" ] ;
fhir:value [ fhir:v "AddedItemDetail" ]
] ) ;
fhir:path [ fhir:v "ClaimResponse.addItem.detail" ] ;
fhir:short [ fhir:v "Insurer added line details" ] ;
fhir:definition [ fhir:v "The second-tier service adjudications for payor added services." ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "*" ] ;
fhir:base [
fhir:path [ fhir:v "ClaimResponse.addItem.detail" ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "*" ]
] ;
fhir:type ( [
fhir:code [ fhir:v "BackboneElement" ]
] ) ;
fhir:constraint ( [
fhir:key [ fhir:v "ele-1" ] ;
fhir:severity [ fhir:v "error" ] ;
fhir:human [ fhir:v "All FHIR elements must have a @value or children" ] ;
fhir:expression [ fhir:v "hasValue() or (children().count() > id.count())" ] ;
fhir:source [ fhir:v "http://hl7.org/fhir/StructureDefinition/Element" ]
] ) ;
fhir:mustSupport [ fhir:v "false" ] ;
fhir:isModifier [ fhir:v "false" ] ;
fhir:isSummary [ fhir:v "false" ]
] [
fhir:id [ fhir:v "ClaimResponse.addItem.detail.id" ] ;
fhir:path [ fhir:v "ClaimResponse.addItem.detail.id" ] ;
fhir:representation ( [ fhir:v "xmlAttr" ] ) ;
fhir:short [ fhir:v "Unique id for inter-element referencing" ] ;
fhir:definition [ fhir:v "Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces." ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "1" ] ;
fhir:base [
fhir:path [ fhir:v "Element.id" ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "1" ]
] ;
fhir:type ( [
fhir:extension ( [
fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type" ] ;
fhir:value [ fhir:v "string" ]
] ) ;
fhir:code [ fhir:v "http://hl7.org/fhirpath/System.String" ]
] ) ;
fhir:condition ( [ fhir:v "ele-1" ] ) ;
fhir:isModifier [ fhir:v "false" ] ;
fhir:isSummary [ fhir:v "false" ] ;
fhir:mapping ( [
fhir:identity [ fhir:v "rim" ] ;
fhir:map [ fhir:v "n/a" ]
] )
] [
fhir:id [ fhir:v "ClaimResponse.addItem.detail.extension" ] ;
fhir:path [ fhir:v "ClaimResponse.addItem.detail.extension" ] ;
fhir:short [ fhir:v "Additional content defined by implementations" ] ;
fhir:definition [ fhir:v "May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and managable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension." ] ;
fhir:comment [ fhir:v "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone." ] ;
fhir:alias ( [ fhir:v "extensions" ] [ fhir:v "user content" ] ) ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "*" ] ;
fhir:base [
fhir:path [ fhir:v "Element.extension" ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "*" ]
] ;
fhir:type ( [
fhir:code [ fhir:v "Extension" ]
] ) ;
fhir:constraint ( [
fhir:key [ fhir:v "ele-1" ] ;
fhir:severity [ fhir:v "error" ] ;
fhir:human [ fhir:v "All FHIR elements must have a @value or children" ] ;
fhir:expression [ fhir:v "hasValue() or (children().count() > id.count())" ] ;
fhir:source [ fhir:v "http://hl7.org/fhir/StructureDefinition/Element" ]
] ) ;
fhir:isModifier [ fhir:v "false" ] ;
fhir:isSummary [ fhir:v "false" ] ;
fhir:mapping ( [
fhir:identity [ fhir:v "rim" ] ;
fhir:map [ fhir:v "n/a" ]
] )
] [
fhir:id [ fhir:v "ClaimResponse.addItem.detail.modifierExtension" ] ;
fhir:path [ fhir:v "ClaimResponse.addItem.detail.modifierExtension" ] ;
fhir:short [ fhir:v "Extensions that cannot be ignored even if unrecognized" ] ;
fhir:definition [ fhir:v "May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and managable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.\n\nModifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself)." ] ;
fhir:comment [ fhir:v "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone." ] ;
fhir:requirements [ fhir:v "Modifier extensions allow for extensions that *cannot* be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the [definition of modifier extensions](extensibility.html#modifierExtension)." ] ;
fhir:alias ( [ fhir:v "extensions" ] [ fhir:v "user content" ] [ fhir:v "modifiers" ] ) ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "*" ] ;
fhir:base [
fhir:path [ fhir:v "BackboneElement.modifierExtension" ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "*" ]
] ;
fhir:type ( [
fhir:code [ fhir:v "Extension" ]
] ) ;
fhir:constraint ( [
fhir:key [ fhir:v "ele-1" ] ;
fhir:severity [ fhir:v "error" ] ;
fhir:human [ fhir:v "All FHIR elements must have a @value or children" ] ;
fhir:expression [ fhir:v "hasValue() or (children().count() > id.count())" ] ;
fhir:source [ fhir:v "http://hl7.org/fhir/StructureDefinition/Element" ]
] ) ;
fhir:isModifier [ fhir:v "true" ] ;
fhir:isModifierReason [ fhir:v "Modifier extensions are expected to modify the meaning or interpretation of the element that contains them" ] ;
fhir:isSummary [ fhir:v "true" ] ;
fhir:mapping ( [
fhir:identity [ fhir:v "rim" ] ;
fhir:map [ fhir:v "N/A" ]
] )
] [
fhir:id [ fhir:v "ClaimResponse.addItem.detail.traceNumber" ] ;
fhir:path [ fhir:v "ClaimResponse.addItem.detail.traceNumber" ] ;
fhir:short [ fhir:v "Number for tracking" ] ;
fhir:definition [ fhir:v "Trace number for tracking purposes. May be defined at the jurisdiction level or between trading partners." ] ;
fhir:requirements [ fhir:v "Allows partners to uniquely identify components for tracking." ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "*" ] ;
fhir:base [
fhir:path [ fhir:v "ClaimResponse.addItem.detail.traceNumber" ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "*" ]
] ;
fhir:type ( [
fhir:code [ fhir:v "Identifier" ]
] ) ;
fhir:constraint ( [
fhir:key [ fhir:v "ele-1" ] ;
fhir:severity [ fhir:v "error" ] ;
fhir:human [ fhir:v "All FHIR elements must have a @value or children" ] ;
fhir:expression [ fhir:v "hasValue() or (children().count() > id.count())" ] ;
fhir:source [ fhir:v "http://hl7.org/fhir/StructureDefinition/Element" ]
] ) ;
fhir:mustSupport [ fhir:v "false" ] ;
fhir:isModifier [ fhir:v "false" ] ;
fhir:isSummary [ fhir:v "false" ]
] [
fhir:id [ fhir:v "ClaimResponse.addItem.detail.revenue" ] ;
fhir:path [ fhir:v "ClaimResponse.addItem.detail.revenue" ] ;
fhir:short [ fhir:v "Revenue or cost center code" ] ;
fhir:definition [ fhir:v "The type of revenue or cost center providing the product and/or service." ] ;
fhir:requirements [ fhir:v "Needed in the processing of institutional claims." ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "1" ] ;
fhir:base [
fhir:path [ fhir:v "ClaimResponse.addItem.detail.revenue" ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "1" ]
] ;
fhir:type ( [
fhir:code [ fhir:v "CodeableConcept" ]
] ) ;
fhir:constraint ( [
fhir:key [ fhir:v "ele-1" ] ;
fhir:severity [ fhir:v "error" ] ;
fhir:human [ fhir:v "All FHIR elements must have a @value or children" ] ;
fhir:expression [ fhir:v "hasValue() or (children().count() > id.count())" ] ;
fhir:source [ fhir:v "http://hl7.org/fhir/StructureDefinition/Element" ]
] ) ;
fhir:mustSupport [ fhir:v "false" ] ;
fhir:isModifier [ fhir:v "false" ] ;
fhir:isSummary [ fhir:v "false" ] ;
fhir:binding [
fhir:extension ( [
fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName" ] ;
fhir:value [ fhir:v "RevenueCenter" ]
] ) ;
fhir:strength [ fhir:v "example" ] ;
fhir:description [ fhir:v "Codes for the revenue or cost centers supplying the service and/or products." ] ;
fhir:valueSet [ fhir:v "http://hl7.org/fhir/ValueSet/ex-revenue-center" ]
]
] [
fhir:id [ fhir:v "ClaimResponse.addItem.detail.productOrService" ] ;
fhir:path [ fhir:v "ClaimResponse.addItem.detail.productOrService" ] ;
fhir:short [ fhir:v "Billing, service, product, or drug code" ] ;
fhir:definition [ fhir:v "When the value is a group code then this item collects a set of related item details, otherwise this contains the product, service, drug or other billing code for the item. This element may be the start of a range of .productOrService codes used in conjunction with .productOrServiceEnd or it may be a solo element where .productOrServiceEnd is not used." ] ;
fhir:comment [ fhir:v "If this is an actual service or product line, i.e. not a Group, then use code to indicate the Professional Service or Product supplied (e.g. CTP, HCPCS, USCLS, ICD10, NCPDP, DIN, RxNorm, ACHI, CCI). If a grouping item then use a group code to indicate the type of thing being grouped e.g. 'glasses' or 'compound'." ] ;
fhir:requirements [ fhir:v "Necessary to state what was provided or done." ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "1" ] ;
fhir:base [
fhir:path [ fhir:v "ClaimResponse.addItem.detail.productOrService" ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "1" ]
] ;
fhir:type ( [
fhir:code [ fhir:v "CodeableConcept" ]
] ) ;
fhir:constraint ( [
fhir:key [ fhir:v "ele-1" ] ;
fhir:severity [ fhir:v "error" ] ;
fhir:human [ fhir:v "All FHIR elements must have a @value or children" ] ;
fhir:expression [ fhir:v "hasValue() or (children().count() > id.count())" ] ;
fhir:source [ fhir:v "http://hl7.org/fhir/StructureDefinition/Element" ]
] ) ;
fhir:mustSupport [ fhir:v "false" ] ;
fhir:isModifier [ fhir:v "false" ] ;
fhir:isSummary [ fhir:v "false" ] ;
fhir:binding [
fhir:extension ( [
fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName" ] ;
fhir:value [ fhir:v "ServiceProduct" ]
] ) ;
fhir:strength [ fhir:v "example" ] ;
fhir:description [ fhir:v "Allowable service and product codes." ] ;
fhir:valueSet [ fhir:v "http://hl7.org/fhir/ValueSet/service-uscls" ]
]
] [
fhir:id [ fhir:v "ClaimResponse.addItem.detail.productOrServiceEnd" ] ;
fhir:path [ fhir:v "ClaimResponse.addItem.detail.productOrServiceEnd" ] ;
fhir:short [ fhir:v "End of a range of codes" ] ;
fhir:definition [ fhir:v "This contains the end of a range of product, service, drug or other billing codes for the item. This element is not used when the .productOrService is a group code. This value may only be present when a .productOfService code has been provided to convey the start of the range. Typically this value may be used only with preauthorizations and not with claims." ] ;
fhir:alias ( [ fhir:v "End of a range of Drug Code; Bill Code; Service Cod" ] ) ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "1" ] ;
fhir:base [
fhir:path [ fhir:v "ClaimResponse.addItem.detail.productOrServiceEnd" ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "1" ]
] ;
fhir:type ( [
fhir:code [ fhir:v "CodeableConcept" ]
] ) ;
fhir:constraint ( [
fhir:key [ fhir:v "ele-1" ] ;
fhir:severity [ fhir:v "error" ] ;
fhir:human [ fhir:v "All FHIR elements must have a @value or children" ] ;
fhir:expression [ fhir:v "hasValue() or (children().count() > id.count())" ] ;
fhir:source [ fhir:v "http://hl7.org/fhir/StructureDefinition/Element" ]
] ) ;
fhir:mustSupport [ fhir:v "false" ] ;
fhir:isModifier [ fhir:v "false" ] ;
fhir:isSummary [ fhir:v "false" ] ;
fhir:binding [
fhir:extension ( [
fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName" ] ;
fhir:value [ fhir:v "ServiceProduct" ]
] ) ;
fhir:strength [ fhir:v "example" ] ;
fhir:valueSet [ fhir:v "http://hl7.org/fhir/ValueSet/service-uscls" ]
]
] [
fhir:id [ fhir:v "ClaimResponse.addItem.detail.modifier" ] ;
fhir:path [ fhir:v "ClaimResponse.addItem.detail.modifier" ] ;
fhir:short [ fhir:v "Service/Product billing modifiers" ] ;
fhir:definition [ fhir:v "Item typification or modifiers codes to convey additional context for the product or service." ] ;
fhir:comment [ fhir:v "For example in Oral whether the treatment is cosmetic or associated with TMJ, or for Medical whether the treatment was outside the clinic or outside of office hours." ] ;
fhir:requirements [ fhir:v "To support inclusion of the item for adjudication or to charge an elevated fee." ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "*" ] ;
fhir:base [
fhir:path [ fhir:v "ClaimResponse.addItem.detail.modifier" ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "*" ]
] ;
fhir:type ( [
fhir:code [ fhir:v "CodeableConcept" ]
] ) ;
fhir:constraint ( [
fhir:key [ fhir:v "ele-1" ] ;
fhir:severity [ fhir:v "error" ] ;
fhir:human [ fhir:v "All FHIR elements must have a @value or children" ] ;
fhir:expression [ fhir:v "hasValue() or (children().count() > id.count())" ] ;
fhir:source [ fhir:v "http://hl7.org/fhir/StructureDefinition/Element" ]
] ) ;
fhir:mustSupport [ fhir:v "false" ] ;
fhir:isModifier [ fhir:v "false" ] ;
fhir:isSummary [ fhir:v "false" ] ;
fhir:binding [
fhir:extension ( [
fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName" ] ;
fhir:value [ fhir:v "Modifiers" ]
] ) ;
fhir:strength [ fhir:v "example" ] ;
fhir:description [ fhir:v "Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen." ] ;
fhir:valueSet [ fhir:v "http://hl7.org/fhir/ValueSet/claim-modifiers" ]
] ;
fhir:mapping ( [
fhir:identity [ fhir:v "rim" ] ;
fhir:map [ fhir:v "24.C, 24.D mods" ]
] )
] [
fhir:id [ fhir:v "ClaimResponse.addItem.detail.quantity" ] ;
fhir:path [ fhir:v "ClaimResponse.addItem.detail.quantity" ] ;
fhir:short [ fhir:v "Count of products or services" ] ;
fhir:definition [ fhir:v "The number of repetitions of a service or product." ] ;
fhir:requirements [ fhir:v "Required when the product or service code does not convey the quantity provided." ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "1" ] ;
fhir:base [
fhir:path [ fhir:v "ClaimResponse.addItem.detail.quantity" ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "1" ]
] ;
fhir:type ( [
fhir:code [ fhir:v "Quantity" ] ;
fhir:profile ( [ fhir:v "http://hl7.org/fhir/StructureDefinition/SimpleQuantity" ] )
] ) ;
fhir:constraint ( [
fhir:key [ fhir:v "ele-1" ] ;
fhir:severity [ fhir:v "error" ] ;
fhir:human [ fhir:v "All FHIR elements must have a @value or children" ] ;
fhir:expression [ fhir:v "hasValue() or (children().count() > id.count())" ] ;
fhir:source [ fhir:v "http://hl7.org/fhir/StructureDefinition/Element" ]
] ) ;
fhir:mustSupport [ fhir:v "false" ] ;
fhir:isModifier [ fhir:v "false" ] ;
fhir:isSummary [ fhir:v "false" ] ;
fhir:mapping ( [
fhir:identity [ fhir:v "rim" ] ;
fhir:map [ fhir:v "24.G" ]
] )
] [
fhir:id [ fhir:v "ClaimResponse.addItem.detail.unitPrice" ] ;
fhir:path [ fhir:v "ClaimResponse.addItem.detail.unitPrice" ] ;
fhir:short [ fhir:v "Fee, charge or cost per item" ] ;
fhir:definition [ fhir:v "If the item is not a group then this is the fee for the product or service, otherwise this is the total of the fees for the details of the group." ] ;
fhir:requirements [ fhir:v "The amount charged to the patient by the provider for a single unit." ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "1" ] ;
fhir:base [
fhir:path [ fhir:v "ClaimResponse.addItem.detail.unitPrice" ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "1" ]
] ;
fhir:type ( [
fhir:code [ fhir:v "Money" ]
] ) ;
fhir:constraint ( [
fhir:key [ fhir:v "ele-1" ] ;
fhir:severity [ fhir:v "error" ] ;
fhir:human [ fhir:v "All FHIR elements must have a @value or children" ] ;
fhir:expression [ fhir:v "hasValue() or (children().count() > id.count())" ] ;
fhir:source [ fhir:v "http://hl7.org/fhir/StructureDefinition/Element" ]
] ) ;
fhir:mustSupport [ fhir:v "false" ] ;
fhir:isModifier [ fhir:v "false" ] ;
fhir:isSummary [ fhir:v "false" ]
] [
fhir:id [ fhir:v "ClaimResponse.addItem.detail.factor" ] ;
fhir:path [ fhir:v "ClaimResponse.addItem.detail.factor" ] ;
fhir:short [ fhir:v "Price scaling factor" ] ;
fhir:definition [ fhir:v "A real number that represents a multiplier used in determining the overall value of services delivered and/or goods received. The concept of a Factor allows for a discount or surcharge multiplier to be applied to a monetary amount." ] ;
fhir:comment [ fhir:v "To show a 10% senior's discount, the value entered is: 0.90 (1.00 - 0.10)." ] ;
fhir:requirements [ fhir:v "When discounts are provided to a patient (example: Senior's discount) then this must be documented for adjudication." ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "1" ] ;
fhir:base [
fhir:path [ fhir:v "ClaimResponse.addItem.detail.factor" ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "1" ]
] ;
fhir:type ( [
fhir:code [ fhir:v "decimal" ]
] ) ;
fhir:constraint ( [
fhir:key [ fhir:v "ele-1" ] ;
fhir:severity [ fhir:v "error" ] ;
fhir:human [ fhir:v "All FHIR elements must have a @value or children" ] ;
fhir:expression [ fhir:v "hasValue() or (children().count() > id.count())" ] ;
fhir:source [ fhir:v "http://hl7.org/fhir/StructureDefinition/Element" ]
] ) ;
fhir:mustSupport [ fhir:v "false" ] ;
fhir:isModifier [ fhir:v "false" ] ;
fhir:isSummary [ fhir:v "false" ]
] [
fhir:id [ fhir:v "ClaimResponse.addItem.detail.tax" ] ;
fhir:path [ fhir:v "ClaimResponse.addItem.detail.tax" ] ;
fhir:short [ fhir:v "Total tax" ] ;
fhir:definition [ fhir:v "The total of taxes applicable for this product or service." ] ;
fhir:requirements [ fhir:v "Required when taxes are not embedded in the unit price or provided as a separate service." ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "1" ] ;
fhir:base [
fhir:path [ fhir:v "ClaimResponse.addItem.detail.tax" ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "1" ]
] ;
fhir:type ( [
fhir:code [ fhir:v "Money" ]
] ) ;
fhir:constraint ( [
fhir:key [ fhir:v "ele-1" ] ;
fhir:severity [ fhir:v "error" ] ;
fhir:human [ fhir:v "All FHIR elements must have a @value or children" ] ;
fhir:expression [ fhir:v "hasValue() or (children().count() > id.count())" ] ;
fhir:source [ fhir:v "http://hl7.org/fhir/StructureDefinition/Element" ]
] ) ;
fhir:mustSupport [ fhir:v "false" ] ;
fhir:isModifier [ fhir:v "false" ] ;
fhir:isSummary [ fhir:v "false" ]
] [
fhir:id [ fhir:v "ClaimResponse.addItem.detail.net" ] ;
fhir:path [ fhir:v "ClaimResponse.addItem.detail.net" ] ;
fhir:short [ fhir:v "Total item cost" ] ;
fhir:definition [ fhir:v "The total amount claimed for the group (if a grouper) or the addItem.detail. Net = unit price * quantity * factor." ] ;
fhir:comment [ fhir:v "For example, the formula: quantity * unitPrice * factor = net. Quantity and factor are assumed to be 1 if not supplied." ] ;
fhir:requirements [ fhir:v "Provides the total amount claimed for the group (if a grouper) or the line item." ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "1" ] ;
fhir:base [
fhir:path [ fhir:v "ClaimResponse.addItem.detail.net" ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "1" ]
] ;
fhir:type ( [
fhir:code [ fhir:v "Money" ]
] ) ;
fhir:constraint ( [
fhir:key [ fhir:v "ele-1" ] ;
fhir:severity [ fhir:v "error" ] ;
fhir:human [ fhir:v "All FHIR elements must have a @value or children" ] ;
fhir:expression [ fhir:v "hasValue() or (children().count() > id.count())" ] ;
fhir:source [ fhir:v "http://hl7.org/fhir/StructureDefinition/Element" ]
] ) ;
fhir:mustSupport [ fhir:v "false" ] ;
fhir:isModifier [ fhir:v "false" ] ;
fhir:isSummary [ fhir:v "false" ] ;
fhir:mapping ( [
fhir:identity [ fhir:v "rim" ] ;
fhir:map [ fhir:v "24.F" ]
] )
] [
fhir:id [ fhir:v "ClaimResponse.addItem.detail.noteNumber" ] ;
fhir:path [ fhir:v "ClaimResponse.addItem.detail.noteNumber" ] ;
fhir:short [ fhir:v "Applicable note numbers" ] ;
fhir:definition [ fhir:v "The numbers associated with notes below which apply to the adjudication of this item." ] ;
fhir:requirements [ fhir:v "Provides a condensed manner for associating human readable descriptive explanations for adjudications on the line item." ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "*" ] ;
fhir:base [
fhir:path [ fhir:v "ClaimResponse.addItem.detail.noteNumber" ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "*" ]
] ;
fhir:type ( [
fhir:code [ fhir:v "positiveInt" ]
] ) ;
fhir:constraint ( [
fhir:key [ fhir:v "ele-1" ] ;
fhir:severity [ fhir:v "error" ] ;
fhir:human [ fhir:v "All FHIR elements must have a @value or children" ] ;
fhir:expression [ fhir:v "hasValue() or (children().count() > id.count())" ] ;
fhir:source [ fhir:v "http://hl7.org/fhir/StructureDefinition/Element" ]
] ) ;
fhir:mustSupport [ fhir:v "false" ] ;
fhir:isModifier [ fhir:v "false" ] ;
fhir:isSummary [ fhir:v "false" ]
] [
fhir:id [ fhir:v "ClaimResponse.addItem.detail.reviewOutcome" ] ;
fhir:path [ fhir:v "ClaimResponse.addItem.detail.reviewOutcome" ] ;
fhir:short [ fhir:v "Added items detail level adjudication results" ] ;
fhir:definition [ fhir:v "The high-level results of the adjudication if adjudication has been performed." ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "1" ] ;
fhir:base [
fhir:path [ fhir:v "ClaimResponse.addItem.detail.reviewOutcome" ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "1" ]
] ;
fhir:contentReference [ fhir:v "#ClaimResponse.item.reviewOutcome" ] ;
fhir:constraint ( [
fhir:key [ fhir:v "ele-1" ] ;
fhir:severity [ fhir:v "error" ] ;
fhir:human [ fhir:v "All FHIR elements must have a @value or children" ] ;
fhir:expression [ fhir:v "hasValue() or (children().count() > id.count())" ] ;
fhir:source [ fhir:v "http://hl7.org/fhir/StructureDefinition/Element" ]
] ) ;
fhir:mustSupport [ fhir:v "false" ] ;
fhir:isModifier [ fhir:v "false" ] ;
fhir:isSummary [ fhir:v "false" ]
] [
fhir:id [ fhir:v "ClaimResponse.addItem.detail.adjudication" ] ;
fhir:path [ fhir:v "ClaimResponse.addItem.detail.adjudication" ] ;
fhir:short [ fhir:v "Added items detail adjudication" ] ;
fhir:definition [ fhir:v "The adjudication results." ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "*" ] ;
fhir:base [
fhir:path [ fhir:v "ClaimResponse.addItem.detail.adjudication" ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "*" ]
] ;
fhir:contentReference [ fhir:v "#ClaimResponse.item.adjudication" ] ;
fhir:constraint ( [
fhir:key [ fhir:v "ele-1" ] ;
fhir:severity [ fhir:v "error" ] ;
fhir:human [ fhir:v "All FHIR elements must have a @value or children" ] ;
fhir:expression [ fhir:v "hasValue() or (children().count() > id.count())" ] ;
fhir:source [ fhir:v "http://hl7.org/fhir/StructureDefinition/Element" ]
] ) ;
fhir:mustSupport [ fhir:v "false" ] ;
fhir:isModifier [ fhir:v "false" ] ;
fhir:isSummary [ fhir:v "false" ]
] [
fhir:id [ fhir:v "ClaimResponse.addItem.detail.subDetail" ] ;
fhir:extension ( [
fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/structuredefinition-explicit-type-name" ] ;
fhir:value [ fhir:v "AddedItemSubDetail" ]
] ) ;
fhir:path [ fhir:v "ClaimResponse.addItem.detail.subDetail" ] ;
fhir:short [ fhir:v "Insurer added line items" ] ;
fhir:definition [ fhir:v "The third-tier service adjudications for payor added services." ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "*" ] ;
fhir:base [
fhir:path [ fhir:v "ClaimResponse.addItem.detail.subDetail" ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "*" ]
] ;
fhir:type ( [
fhir:code [ fhir:v "BackboneElement" ]
] ) ;
fhir:constraint ( [
fhir:key [ fhir:v "ele-1" ] ;
fhir:severity [ fhir:v "error" ] ;
fhir:human [ fhir:v "All FHIR elements must have a @value or children" ] ;
fhir:expression [ fhir:v "hasValue() or (children().count() > id.count())" ] ;
fhir:source [ fhir:v "http://hl7.org/fhir/StructureDefinition/Element" ]
] ) ;
fhir:mustSupport [ fhir:v "false" ] ;
fhir:isModifier [ fhir:v "false" ] ;
fhir:isSummary [ fhir:v "false" ]
] [
fhir:id [ fhir:v "ClaimResponse.addItem.detail.subDetail.id" ] ;
fhir:path [ fhir:v "ClaimResponse.addItem.detail.subDetail.id" ] ;
fhir:representation ( [ fhir:v "xmlAttr" ] ) ;
fhir:short [ fhir:v "Unique id for inter-element referencing" ] ;
fhir:definition [ fhir:v "Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces." ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "1" ] ;
fhir:base [
fhir:path [ fhir:v "Element.id" ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "1" ]
] ;
fhir:type ( [
fhir:extension ( [
fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type" ] ;
fhir:value [ fhir:v "string" ]
] ) ;
fhir:code [ fhir:v "http://hl7.org/fhirpath/System.String" ]
] ) ;
fhir:condition ( [ fhir:v "ele-1" ] ) ;
fhir:isModifier [ fhir:v "false" ] ;
fhir:isSummary [ fhir:v "false" ] ;
fhir:mapping ( [
fhir:identity [ fhir:v "rim" ] ;
fhir:map [ fhir:v "n/a" ]
] )
] [
fhir:id [ fhir:v "ClaimResponse.addItem.detail.subDetail.extension" ] ;
fhir:path [ fhir:v "ClaimResponse.addItem.detail.subDetail.extension" ] ;
fhir:short [ fhir:v "Additional content defined by implementations" ] ;
fhir:definition [ fhir:v "May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and managable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension." ] ;
fhir:comment [ fhir:v "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone." ] ;
fhir:alias ( [ fhir:v "extensions" ] [ fhir:v "user content" ] ) ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "*" ] ;
fhir:base [
fhir:path [ fhir:v "Element.extension" ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "*" ]
] ;
fhir:type ( [
fhir:code [ fhir:v "Extension" ]
] ) ;
fhir:constraint ( [
fhir:key [ fhir:v "ele-1" ] ;
fhir:severity [ fhir:v "error" ] ;
fhir:human [ fhir:v "All FHIR elements must have a @value or children" ] ;
fhir:expression [ fhir:v "hasValue() or (children().count() > id.count())" ] ;
fhir:source [ fhir:v "http://hl7.org/fhir/StructureDefinition/Element" ]
] ) ;
fhir:isModifier [ fhir:v "false" ] ;
fhir:isSummary [ fhir:v "false" ] ;
fhir:mapping ( [
fhir:identity [ fhir:v "rim" ] ;
fhir:map [ fhir:v "n/a" ]
] )
] [
fhir:id [ fhir:v "ClaimResponse.addItem.detail.subDetail.modifierExtension" ] ;
fhir:path [ fhir:v "ClaimResponse.addItem.detail.subDetail.modifierExtension" ] ;
fhir:short [ fhir:v "Extensions that cannot be ignored even if unrecognized" ] ;
fhir:definition [ fhir:v "May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and managable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.\n\nModifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself)." ] ;
fhir:comment [ fhir:v "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone." ] ;
fhir:requirements [ fhir:v "Modifier extensions allow for extensions that *cannot* be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the [definition of modifier extensions](extensibility.html#modifierExtension)." ] ;
fhir:alias ( [ fhir:v "extensions" ] [ fhir:v "user content" ] [ fhir:v "modifiers" ] ) ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "*" ] ;
fhir:base [
fhir:path [ fhir:v "BackboneElement.modifierExtension" ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "*" ]
] ;
fhir:type ( [
fhir:code [ fhir:v "Extension" ]
] ) ;
fhir:constraint ( [
fhir:key [ fhir:v "ele-1" ] ;
fhir:severity [ fhir:v "error" ] ;
fhir:human [ fhir:v "All FHIR elements must have a @value or children" ] ;
fhir:expression [ fhir:v "hasValue() or (children().count() > id.count())" ] ;
fhir:source [ fhir:v "http://hl7.org/fhir/StructureDefinition/Element" ]
] ) ;
fhir:isModifier [ fhir:v "true" ] ;
fhir:isModifierReason [ fhir:v "Modifier extensions are expected to modify the meaning or interpretation of the element that contains them" ] ;
fhir:isSummary [ fhir:v "true" ] ;
fhir:mapping ( [
fhir:identity [ fhir:v "rim" ] ;
fhir:map [ fhir:v "N/A" ]
] )
] [
fhir:id [ fhir:v "ClaimResponse.addItem.detail.subDetail.traceNumber" ] ;
fhir:path [ fhir:v "ClaimResponse.addItem.detail.subDetail.traceNumber" ] ;
fhir:short [ fhir:v "Number for tracking" ] ;
fhir:definition [ fhir:v "Trace number for tracking purposes. May be defined at the jurisdiction level or between trading partners." ] ;
fhir:requirements [ fhir:v "Allows partners to uniquely identify components for tracking." ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "*" ] ;
fhir:base [
fhir:path [ fhir:v "ClaimResponse.addItem.detail.subDetail.traceNumber" ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "*" ]
] ;
fhir:type ( [
fhir:code [ fhir:v "Identifier" ]
] ) ;
fhir:constraint ( [
fhir:key [ fhir:v "ele-1" ] ;
fhir:severity [ fhir:v "error" ] ;
fhir:human [ fhir:v "All FHIR elements must have a @value or children" ] ;
fhir:expression [ fhir:v "hasValue() or (children().count() > id.count())" ] ;
fhir:source [ fhir:v "http://hl7.org/fhir/StructureDefinition/Element" ]
] ) ;
fhir:mustSupport [ fhir:v "false" ] ;
fhir:isModifier [ fhir:v "false" ] ;
fhir:isSummary [ fhir:v "false" ]
] [
fhir:id [ fhir:v "ClaimResponse.addItem.detail.subDetail.revenue" ] ;
fhir:path [ fhir:v "ClaimResponse.addItem.detail.subDetail.revenue" ] ;
fhir:short [ fhir:v "Revenue or cost center code" ] ;
fhir:definition [ fhir:v "The type of revenue or cost center providing the product and/or service." ] ;
fhir:requirements [ fhir:v "Needed in the processing of institutional claims." ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "1" ] ;
fhir:base [
fhir:path [ fhir:v "ClaimResponse.addItem.detail.subDetail.revenue" ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "1" ]
] ;
fhir:type ( [
fhir:code [ fhir:v "CodeableConcept" ]
] ) ;
fhir:constraint ( [
fhir:key [ fhir:v "ele-1" ] ;
fhir:severity [ fhir:v "error" ] ;
fhir:human [ fhir:v "All FHIR elements must have a @value or children" ] ;
fhir:expression [ fhir:v "hasValue() or (children().count() > id.count())" ] ;
fhir:source [ fhir:v "http://hl7.org/fhir/StructureDefinition/Element" ]
] ) ;
fhir:mustSupport [ fhir:v "false" ] ;
fhir:isModifier [ fhir:v "false" ] ;
fhir:isSummary [ fhir:v "false" ] ;
fhir:binding [
fhir:extension ( [
fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName" ] ;
fhir:value [ fhir:v "RevenueCenter" ]
] ) ;
fhir:strength [ fhir:v "example" ] ;
fhir:description [ fhir:v "Codes for the revenue or cost centers supplying the service and/or products." ] ;
fhir:valueSet [ fhir:v "http://hl7.org/fhir/ValueSet/ex-revenue-center" ]
]
] [
fhir:id [ fhir:v "ClaimResponse.addItem.detail.subDetail.productOrService" ] ;
fhir:path [ fhir:v "ClaimResponse.addItem.detail.subDetail.productOrService" ] ;
fhir:short [ fhir:v "Billing, service, product, or drug code" ] ;
fhir:definition [ fhir:v "When the value is a group code then this item collects a set of related item details, otherwise this contains the product, service, drug or other billing code for the item. This element may be the start of a range of .productOrService codes used in conjunction with .productOrServiceEnd or it may be a solo element where .productOrServiceEnd is not used." ] ;
fhir:comment [ fhir:v "If this is an actual service or product line, i.e. not a Group, then use code to indicate the Professional Service or Product supplied (e.g. CTP, HCPCS, USCLS, ICD10, NCPDP, DIN, RxNorm, ACHI, CCI). If a grouping item then use a group code to indicate the type of thing being grouped e.g. 'glasses' or 'compound'." ] ;
fhir:requirements [ fhir:v "Necessary to state what was provided or done." ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "1" ] ;
fhir:base [
fhir:path [ fhir:v "ClaimResponse.addItem.detail.subDetail.productOrService" ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "1" ]
] ;
fhir:type ( [
fhir:code [ fhir:v "CodeableConcept" ]
] ) ;
fhir:constraint ( [
fhir:key [ fhir:v "ele-1" ] ;
fhir:severity [ fhir:v "error" ] ;
fhir:human [ fhir:v "All FHIR elements must have a @value or children" ] ;
fhir:expression [ fhir:v "hasValue() or (children().count() > id.count())" ] ;
fhir:source [ fhir:v "http://hl7.org/fhir/StructureDefinition/Element" ]
] ) ;
fhir:mustSupport [ fhir:v "false" ] ;
fhir:isModifier [ fhir:v "false" ] ;
fhir:isSummary [ fhir:v "false" ] ;
fhir:binding [
fhir:extension ( [
fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName" ] ;
fhir:value [ fhir:v "ServiceProduct" ]
] ) ;
fhir:strength [ fhir:v "example" ] ;
fhir:description [ fhir:v "Allowable service and product codes." ] ;
fhir:valueSet [ fhir:v "http://hl7.org/fhir/ValueSet/service-uscls" ]
]
] [
fhir:id [ fhir:v "ClaimResponse.addItem.detail.subDetail.productOrServiceEnd" ] ;
fhir:path [ fhir:v "ClaimResponse.addItem.detail.subDetail.productOrServiceEnd" ] ;
fhir:short [ fhir:v "End of a range of codes" ] ;
fhir:definition [ fhir:v "This contains the end of a range of product, service, drug or other billing codes for the item. This element is not used when the .productOrService is a group code. This value may only be present when a .productOfService code has been provided to convey the start of the range. Typically this value may be used only with preauthorizations and not with claims." ] ;
fhir:alias ( [ fhir:v "End of a range of Drug Code; Bill Code; Service Cod" ] ) ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "1" ] ;
fhir:base [
fhir:path [ fhir:v "ClaimResponse.addItem.detail.subDetail.productOrServiceEnd" ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "1" ]
] ;
fhir:type ( [
fhir:code [ fhir:v "CodeableConcept" ]
] ) ;
fhir:constraint ( [
fhir:key [ fhir:v "ele-1" ] ;
fhir:severity [ fhir:v "error" ] ;
fhir:human [ fhir:v "All FHIR elements must have a @value or children" ] ;
fhir:expression [ fhir:v "hasValue() or (children().count() > id.count())" ] ;
fhir:source [ fhir:v "http://hl7.org/fhir/StructureDefinition/Element" ]
] ) ;
fhir:mustSupport [ fhir:v "false" ] ;
fhir:isModifier [ fhir:v "false" ] ;
fhir:isSummary [ fhir:v "false" ] ;
fhir:binding [
fhir:extension ( [
fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName" ] ;
fhir:value [ fhir:v "ServiceProduct" ]
] ) ;
fhir:strength [ fhir:v "example" ] ;
fhir:valueSet [ fhir:v "http://hl7.org/fhir/ValueSet/service-uscls" ]
]
] [
fhir:id [ fhir:v "ClaimResponse.addItem.detail.subDetail.modifier" ] ;
fhir:path [ fhir:v "ClaimResponse.addItem.detail.subDetail.modifier" ] ;
fhir:short [ fhir:v "Service/Product billing modifiers" ] ;
fhir:definition [ fhir:v "Item typification or modifiers codes to convey additional context for the product or service." ] ;
fhir:comment [ fhir:v "For example in Oral whether the treatment is cosmetic or associated with TMJ, or for Medical whether the treatment was outside the clinic or outside of office hours." ] ;
fhir:requirements [ fhir:v "To support inclusion of the item for adjudication or to charge an elevated fee." ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "*" ] ;
fhir:base [
fhir:path [ fhir:v "ClaimResponse.addItem.detail.subDetail.modifier" ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "*" ]
] ;
fhir:type ( [
fhir:code [ fhir:v "CodeableConcept" ]
] ) ;
fhir:constraint ( [
fhir:key [ fhir:v "ele-1" ] ;
fhir:severity [ fhir:v "error" ] ;
fhir:human [ fhir:v "All FHIR elements must have a @value or children" ] ;
fhir:expression [ fhir:v "hasValue() or (children().count() > id.count())" ] ;
fhir:source [ fhir:v "http://hl7.org/fhir/StructureDefinition/Element" ]
] ) ;
fhir:mustSupport [ fhir:v "false" ] ;
fhir:isModifier [ fhir:v "false" ] ;
fhir:isSummary [ fhir:v "false" ] ;
fhir:binding [
fhir:extension ( [
fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName" ] ;
fhir:value [ fhir:v "Modifiers" ]
] ) ;
fhir:strength [ fhir:v "example" ] ;
fhir:description [ fhir:v "Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen." ] ;
fhir:valueSet [ fhir:v "http://hl7.org/fhir/ValueSet/claim-modifiers" ]
] ;
fhir:mapping ( [
fhir:identity [ fhir:v "rim" ] ;
fhir:map [ fhir:v "24.C, 24.D mods" ]
] )
] [
fhir:id [ fhir:v "ClaimResponse.addItem.detail.subDetail.quantity" ] ;
fhir:path [ fhir:v "ClaimResponse.addItem.detail.subDetail.quantity" ] ;
fhir:short [ fhir:v "Count of products or services" ] ;
fhir:definition [ fhir:v "The number of repetitions of a service or product." ] ;
fhir:requirements [ fhir:v "Required when the product or service code does not convey the quantity provided." ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "1" ] ;
fhir:base [
fhir:path [ fhir:v "ClaimResponse.addItem.detail.subDetail.quantity" ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "1" ]
] ;
fhir:type ( [
fhir:code [ fhir:v "Quantity" ] ;
fhir:profile ( [ fhir:v "http://hl7.org/fhir/StructureDefinition/SimpleQuantity" ] )
] ) ;
fhir:constraint ( [
fhir:key [ fhir:v "ele-1" ] ;
fhir:severity [ fhir:v "error" ] ;
fhir:human [ fhir:v "All FHIR elements must have a @value or children" ] ;
fhir:expression [ fhir:v "hasValue() or (children().count() > id.count())" ] ;
fhir:source [ fhir:v "http://hl7.org/fhir/StructureDefinition/Element" ]
] ) ;
fhir:mustSupport [ fhir:v "false" ] ;
fhir:isModifier [ fhir:v "false" ] ;
fhir:isSummary [ fhir:v "false" ] ;
fhir:mapping ( [
fhir:identity [ fhir:v "rim" ] ;
fhir:map [ fhir:v "24.G" ]
] )
] [
fhir:id [ fhir:v "ClaimResponse.addItem.detail.subDetail.unitPrice" ] ;
fhir:path [ fhir:v "ClaimResponse.addItem.detail.subDetail.unitPrice" ] ;
fhir:short [ fhir:v "Fee, charge or cost per item" ] ;
fhir:definition [ fhir:v "If the item is not a group then this is the fee for the product or service, otherwise this is the total of the fees for the details of the group." ] ;
fhir:requirements [ fhir:v "The amount charged to the patient by the provider for a single unit." ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "1" ] ;
fhir:base [
fhir:path [ fhir:v "ClaimResponse.addItem.detail.subDetail.unitPrice" ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "1" ]
] ;
fhir:type ( [
fhir:code [ fhir:v "Money" ]
] ) ;
fhir:constraint ( [
fhir:key [ fhir:v "ele-1" ] ;
fhir:severity [ fhir:v "error" ] ;
fhir:human [ fhir:v "All FHIR elements must have a @value or children" ] ;
fhir:expression [ fhir:v "hasValue() or (children().count() > id.count())" ] ;
fhir:source [ fhir:v "http://hl7.org/fhir/StructureDefinition/Element" ]
] ) ;
fhir:mustSupport [ fhir:v "false" ] ;
fhir:isModifier [ fhir:v "false" ] ;
fhir:isSummary [ fhir:v "false" ]
] [
fhir:id [ fhir:v "ClaimResponse.addItem.detail.subDetail.factor" ] ;
fhir:path [ fhir:v "ClaimResponse.addItem.detail.subDetail.factor" ] ;
fhir:short [ fhir:v "Price scaling factor" ] ;
fhir:definition [ fhir:v "A real number that represents a multiplier used in determining the overall value of services delivered and/or goods received. The concept of a Factor allows for a discount or surcharge multiplier to be applied to a monetary amount." ] ;
fhir:comment [ fhir:v "To show a 10% senior's discount, the value entered is: 0.90 (1.00 - 0.10)." ] ;
fhir:requirements [ fhir:v "When discounts are provided to a patient (example: Senior's discount) then this must be documented for adjudication." ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "1" ] ;
fhir:base [
fhir:path [ fhir:v "ClaimResponse.addItem.detail.subDetail.factor" ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "1" ]
] ;
fhir:type ( [
fhir:code [ fhir:v "decimal" ]
] ) ;
fhir:constraint ( [
fhir:key [ fhir:v "ele-1" ] ;
fhir:severity [ fhir:v "error" ] ;
fhir:human [ fhir:v "All FHIR elements must have a @value or children" ] ;
fhir:expression [ fhir:v "hasValue() or (children().count() > id.count())" ] ;
fhir:source [ fhir:v "http://hl7.org/fhir/StructureDefinition/Element" ]
] ) ;
fhir:mustSupport [ fhir:v "false" ] ;
fhir:isModifier [ fhir:v "false" ] ;
fhir:isSummary [ fhir:v "false" ]
] [
fhir:id [ fhir:v "ClaimResponse.addItem.detail.subDetail.tax" ] ;
fhir:path [ fhir:v "ClaimResponse.addItem.detail.subDetail.tax" ] ;
fhir:short [ fhir:v "Total tax" ] ;
fhir:definition [ fhir:v "The total of taxes applicable for this product or service." ] ;
fhir:requirements [ fhir:v "Required when taxes are not embedded in the unit price or provided as a separate service." ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "1" ] ;
fhir:base [
fhir:path [ fhir:v "ClaimResponse.addItem.detail.subDetail.tax" ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "1" ]
] ;
fhir:type ( [
fhir:code [ fhir:v "Money" ]
] ) ;
fhir:constraint ( [
fhir:key [ fhir:v "ele-1" ] ;
fhir:severity [ fhir:v "error" ] ;
fhir:human [ fhir:v "All FHIR elements must have a @value or children" ] ;
fhir:expression [ fhir:v "hasValue() or (children().count() > id.count())" ] ;
fhir:source [ fhir:v "http://hl7.org/fhir/StructureDefinition/Element" ]
] ) ;
fhir:mustSupport [ fhir:v "false" ] ;
fhir:isModifier [ fhir:v "false" ] ;
fhir:isSummary [ fhir:v "false" ]
] [
fhir:id [ fhir:v "ClaimResponse.addItem.detail.subDetail.net" ] ;
fhir:path [ fhir:v "ClaimResponse.addItem.detail.subDetail.net" ] ;
fhir:short [ fhir:v "Total item cost" ] ;
fhir:definition [ fhir:v "The total amount claimed for the addItem.detail.subDetail. Net = unit price * quantity * factor." ] ;
fhir:comment [ fhir:v "For example, the formula: quantity * unitPrice * factor = net. Quantity and factor are assumed to be 1 if not supplied." ] ;
fhir:requirements [ fhir:v "Provides the total amount claimed for the group (if a grouper) or the line item." ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "1" ] ;
fhir:base [
fhir:path [ fhir:v "ClaimResponse.addItem.detail.subDetail.net" ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "1" ]
] ;
fhir:type ( [
fhir:code [ fhir:v "Money" ]
] ) ;
fhir:constraint ( [
fhir:key [ fhir:v "ele-1" ] ;
fhir:severity [ fhir:v "error" ] ;
fhir:human [ fhir:v "All FHIR elements must have a @value or children" ] ;
fhir:expression [ fhir:v "hasValue() or (children().count() > id.count())" ] ;
fhir:source [ fhir:v "http://hl7.org/fhir/StructureDefinition/Element" ]
] ) ;
fhir:mustSupport [ fhir:v "false" ] ;
fhir:isModifier [ fhir:v "false" ] ;
fhir:isSummary [ fhir:v "false" ] ;
fhir:mapping ( [
fhir:identity [ fhir:v "rim" ] ;
fhir:map [ fhir:v "24.F" ]
] )
] [
fhir:id [ fhir:v "ClaimResponse.addItem.detail.subDetail.noteNumber" ] ;
fhir:path [ fhir:v "ClaimResponse.addItem.detail.subDetail.noteNumber" ] ;
fhir:short [ fhir:v "Applicable note numbers" ] ;
fhir:definition [ fhir:v "The numbers associated with notes below which apply to the adjudication of this item." ] ;
fhir:requirements [ fhir:v "Provides a condensed manner for associating human readable descriptive explanations for adjudications on the line item." ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "*" ] ;
fhir:base [
fhir:path [ fhir:v "ClaimResponse.addItem.detail.subDetail.noteNumber" ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "*" ]
] ;
fhir:type ( [
fhir:code [ fhir:v "positiveInt" ]
] ) ;
fhir:constraint ( [
fhir:key [ fhir:v "ele-1" ] ;
fhir:severity [ fhir:v "error" ] ;
fhir:human [ fhir:v "All FHIR elements must have a @value or children" ] ;
fhir:expression [ fhir:v "hasValue() or (children().count() > id.count())" ] ;
fhir:source [ fhir:v "http://hl7.org/fhir/StructureDefinition/Element" ]
] ) ;
fhir:mustSupport [ fhir:v "false" ] ;
fhir:isModifier [ fhir:v "false" ] ;
fhir:isSummary [ fhir:v "false" ]
] [
fhir:id [ fhir:v "ClaimResponse.addItem.detail.subDetail.reviewOutcome" ] ;
fhir:path [ fhir:v "ClaimResponse.addItem.detail.subDetail.reviewOutcome" ] ;
fhir:short [ fhir:v "Added items subdetail level adjudication results" ] ;
fhir:definition [ fhir:v "The high-level results of the adjudication if adjudication has been performed." ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "1" ] ;
fhir:base [
fhir:path [ fhir:v "ClaimResponse.addItem.detail.subDetail.reviewOutcome" ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "1" ]
] ;
fhir:contentReference [ fhir:v "#ClaimResponse.item.reviewOutcome" ] ;
fhir:constraint ( [
fhir:key [ fhir:v "ele-1" ] ;
fhir:severity [ fhir:v "error" ] ;
fhir:human [ fhir:v "All FHIR elements must have a @value or children" ] ;
fhir:expression [ fhir:v "hasValue() or (children().count() > id.count())" ] ;
fhir:source [ fhir:v "http://hl7.org/fhir/StructureDefinition/Element" ]
] ) ;
fhir:mustSupport [ fhir:v "false" ] ;
fhir:isModifier [ fhir:v "false" ] ;
fhir:isSummary [ fhir:v "false" ]
] [
fhir:id [ fhir:v "ClaimResponse.addItem.detail.subDetail.adjudication" ] ;
fhir:path [ fhir:v "ClaimResponse.addItem.detail.subDetail.adjudication" ] ;
fhir:short [ fhir:v "Added items subdetail adjudication" ] ;
fhir:definition [ fhir:v "The adjudication results." ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "*" ] ;
fhir:base [
fhir:path [ fhir:v "ClaimResponse.addItem.detail.subDetail.adjudication" ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "*" ]
] ;
fhir:contentReference [ fhir:v "#ClaimResponse.item.adjudication" ] ;
fhir:constraint ( [
fhir:key [ fhir:v "ele-1" ] ;
fhir:severity [ fhir:v "error" ] ;
fhir:human [ fhir:v "All FHIR elements must have a @value or children" ] ;
fhir:expression [ fhir:v "hasValue() or (children().count() > id.count())" ] ;
fhir:source [ fhir:v "http://hl7.org/fhir/StructureDefinition/Element" ]
] ) ;
fhir:mustSupport [ fhir:v "false" ] ;
fhir:isModifier [ fhir:v "false" ] ;
fhir:isSummary [ fhir:v "false" ]
] [
fhir:id [ fhir:v "ClaimResponse.adjudication" ] ;
fhir:path [ fhir:v "ClaimResponse.adjudication" ] ;
fhir:short [ fhir:v "Header-level adjudication" ] ;
fhir:definition [ fhir:v "The adjudication results which are presented at the header level rather than at the line-item or add-item levels." ] ;
fhir:requirements [ fhir:v "Some insurers will receive line-items but provide the adjudication only at a summary or header-level." ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "*" ] ;
fhir:base [
fhir:path [ fhir:v "ClaimResponse.adjudication" ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "*" ]
] ;
fhir:contentReference [ fhir:v "#ClaimResponse.item.adjudication" ] ;
fhir:constraint ( [
fhir:key [ fhir:v "ele-1" ] ;
fhir:severity [ fhir:v "error" ] ;
fhir:human [ fhir:v "All FHIR elements must have a @value or children" ] ;
fhir:expression [ fhir:v "hasValue() or (children().count() > id.count())" ] ;
fhir:source [ fhir:v "http://hl7.org/fhir/StructureDefinition/Element" ]
] ) ;
fhir:mustSupport [ fhir:v "false" ] ;
fhir:isModifier [ fhir:v "false" ] ;
fhir:isSummary [ fhir:v "false" ]
] [
fhir:id [ fhir:v "ClaimResponse.total" ] ;
fhir:extension ( [
fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/structuredefinition-explicit-type-name" ] ;
fhir:value [ fhir:v "Total" ]
] ) ;
fhir:path [ fhir:v "ClaimResponse.total" ] ;
fhir:short [ fhir:v "Adjudication totals" ] ;
fhir:definition [ fhir:v "Categorized monetary totals for the adjudication." ] ;
fhir:comment [ fhir:v "Totals for amounts submitted, co-pays, benefits payable etc." ] ;
fhir:requirements [ fhir:v "To provide the requestor with financial totals by category for the adjudication." ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "*" ] ;
fhir:base [
fhir:path [ fhir:v "ClaimResponse.total" ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "*" ]
] ;
fhir:type ( [
fhir:code [ fhir:v "BackboneElement" ]
] ) ;
fhir:constraint ( [
fhir:key [ fhir:v "ele-1" ] ;
fhir:severity [ fhir:v "error" ] ;
fhir:human [ fhir:v "All FHIR elements must have a @value or children" ] ;
fhir:expression [ fhir:v "hasValue() or (children().count() > id.count())" ] ;
fhir:source [ fhir:v "http://hl7.org/fhir/StructureDefinition/Element" ]
] ) ;
fhir:mustSupport [ fhir:v "false" ] ;
fhir:isModifier [ fhir:v "false" ] ;
fhir:isSummary [ fhir:v "true" ]
] [
fhir:id [ fhir:v "ClaimResponse.total.id" ] ;
fhir:path [ fhir:v "ClaimResponse.total.id" ] ;
fhir:representation ( [ fhir:v "xmlAttr" ] ) ;
fhir:short [ fhir:v "Unique id for inter-element referencing" ] ;
fhir:definition [ fhir:v "Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces." ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "1" ] ;
fhir:base [
fhir:path [ fhir:v "Element.id" ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "1" ]
] ;
fhir:type ( [
fhir:extension ( [
fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type" ] ;
fhir:value [ fhir:v "string" ]
] ) ;
fhir:code [ fhir:v "http://hl7.org/fhirpath/System.String" ]
] ) ;
fhir:condition ( [ fhir:v "ele-1" ] ) ;
fhir:isModifier [ fhir:v "false" ] ;
fhir:isSummary [ fhir:v "false" ] ;
fhir:mapping ( [
fhir:identity [ fhir:v "rim" ] ;
fhir:map [ fhir:v "n/a" ]
] )
] [
fhir:id [ fhir:v "ClaimResponse.total.extension" ] ;
fhir:path [ fhir:v "ClaimResponse.total.extension" ] ;
fhir:short [ fhir:v "Additional content defined by implementations" ] ;
fhir:definition [ fhir:v "May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and managable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension." ] ;
fhir:comment [ fhir:v "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone." ] ;
fhir:alias ( [ fhir:v "extensions" ] [ fhir:v "user content" ] ) ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "*" ] ;
fhir:base [
fhir:path [ fhir:v "Element.extension" ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "*" ]
] ;
fhir:type ( [
fhir:code [ fhir:v "Extension" ]
] ) ;
fhir:constraint ( [
fhir:key [ fhir:v "ele-1" ] ;
fhir:severity [ fhir:v "error" ] ;
fhir:human [ fhir:v "All FHIR elements must have a @value or children" ] ;
fhir:expression [ fhir:v "hasValue() or (children().count() > id.count())" ] ;
fhir:source [ fhir:v "http://hl7.org/fhir/StructureDefinition/Element" ]
] ) ;
fhir:isModifier [ fhir:v "false" ] ;
fhir:isSummary [ fhir:v "false" ] ;
fhir:mapping ( [
fhir:identity [ fhir:v "rim" ] ;
fhir:map [ fhir:v "n/a" ]
] )
] [
fhir:id [ fhir:v "ClaimResponse.total.modifierExtension" ] ;
fhir:path [ fhir:v "ClaimResponse.total.modifierExtension" ] ;
fhir:short [ fhir:v "Extensions that cannot be ignored even if unrecognized" ] ;
fhir:definition [ fhir:v "May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and managable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.\n\nModifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself)." ] ;
fhir:comment [ fhir:v "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone." ] ;
fhir:requirements [ fhir:v "Modifier extensions allow for extensions that *cannot* be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the [definition of modifier extensions](extensibility.html#modifierExtension)." ] ;
fhir:alias ( [ fhir:v "extensions" ] [ fhir:v "user content" ] [ fhir:v "modifiers" ] ) ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "*" ] ;
fhir:base [
fhir:path [ fhir:v "BackboneElement.modifierExtension" ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "*" ]
] ;
fhir:type ( [
fhir:code [ fhir:v "Extension" ]
] ) ;
fhir:constraint ( [
fhir:key [ fhir:v "ele-1" ] ;
fhir:severity [ fhir:v "error" ] ;
fhir:human [ fhir:v "All FHIR elements must have a @value or children" ] ;
fhir:expression [ fhir:v "hasValue() or (children().count() > id.count())" ] ;
fhir:source [ fhir:v "http://hl7.org/fhir/StructureDefinition/Element" ]
] ) ;
fhir:isModifier [ fhir:v "true" ] ;
fhir:isModifierReason [ fhir:v "Modifier extensions are expected to modify the meaning or interpretation of the element that contains them" ] ;
fhir:isSummary [ fhir:v "true" ] ;
fhir:mapping ( [
fhir:identity [ fhir:v "rim" ] ;
fhir:map [ fhir:v "N/A" ]
] )
] [
fhir:id [ fhir:v "ClaimResponse.total.category" ] ;
fhir:path [ fhir:v "ClaimResponse.total.category" ] ;
fhir:short [ fhir:v "Type of adjudication information" ] ;
fhir:definition [ fhir:v "A code to indicate the information type of this adjudication record. Information types may include: the value submitted, maximum values or percentages allowed or payable under the plan, amounts that the patient is responsible for in aggregate or pertaining to this item, amounts paid by other coverages, and the benefit payable for this item." ] ;
fhir:comment [ fhir:v "For example codes indicating: Co-Pay, deductible, eligible, benefit, tax, etc." ] ;
fhir:requirements [ fhir:v "Needed to convey the type of total provided." ] ;
fhir:min [ fhir:v "1" ] ;
fhir:max [ fhir:v "1" ] ;
fhir:base [
fhir:path [ fhir:v "ClaimResponse.total.category" ] ;
fhir:min [ fhir:v "1" ] ;
fhir:max [ fhir:v "1" ]
] ;
fhir:type ( [
fhir:code [ fhir:v "CodeableConcept" ]
] ) ;
fhir:constraint ( [
fhir:key [ fhir:v "ele-1" ] ;
fhir:severity [ fhir:v "error" ] ;
fhir:human [ fhir:v "All FHIR elements must have a @value or children" ] ;
fhir:expression [ fhir:v "hasValue() or (children().count() > id.count())" ] ;
fhir:source [ fhir:v "http://hl7.org/fhir/StructureDefinition/Element" ]
] ) ;
fhir:mustSupport [ fhir:v "false" ] ;
fhir:isModifier [ fhir:v "false" ] ;
fhir:isSummary [ fhir:v "true" ] ;
fhir:binding [
fhir:extension ( [
fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName" ] ;
fhir:value [ fhir:v "Adjudication" ]
] ) ;
fhir:strength [ fhir:v "example" ] ;
fhir:description [ fhir:v "The adjudication codes." ] ;
fhir:valueSet [ fhir:v "http://hl7.org/fhir/ValueSet/adjudication" ]
]
] [
fhir:id [ fhir:v "ClaimResponse.total.amount" ] ;
fhir:path [ fhir:v "ClaimResponse.total.amount" ] ;
fhir:short [ fhir:v "Financial total for the category" ] ;
fhir:definition [ fhir:v "Monetary total amount associated with the category." ] ;
fhir:requirements [ fhir:v "Needed to convey the total monetary amount." ] ;
fhir:min [ fhir:v "1" ] ;
fhir:max [ fhir:v "1" ] ;
fhir:base [
fhir:path [ fhir:v "ClaimResponse.total.amount" ] ;
fhir:min [ fhir:v "1" ] ;
fhir:max [ fhir:v "1" ]
] ;
fhir:type ( [
fhir:code [ fhir:v "Money" ]
] ) ;
fhir:constraint ( [
fhir:key [ fhir:v "ele-1" ] ;
fhir:severity [ fhir:v "error" ] ;
fhir:human [ fhir:v "All FHIR elements must have a @value or children" ] ;
fhir:expression [ fhir:v "hasValue() or (children().count() > id.count())" ] ;
fhir:source [ fhir:v "http://hl7.org/fhir/StructureDefinition/Element" ]
] ) ;
fhir:mustSupport [ fhir:v "false" ] ;
fhir:isModifier [ fhir:v "false" ] ;
fhir:isSummary [ fhir:v "true" ]
] [
fhir:id [ fhir:v "ClaimResponse.payment" ] ;
fhir:extension ( [
fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/structuredefinition-explicit-type-name" ] ;
fhir:value [ fhir:v "Payment" ]
] ) ;
fhir:path [ fhir:v "ClaimResponse.payment" ] ;
fhir:short [ fhir:v "Payment Details" ] ;
fhir:definition [ fhir:v "Payment details for the adjudication of the claim." ] ;
fhir:requirements [ fhir:v "Needed to convey references to the financial instrument that has been used if payment has been made." ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "1" ] ;
fhir:base [
fhir:path [ fhir:v "ClaimResponse.payment" ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "1" ]
] ;
fhir:type ( [
fhir:code [ fhir:v "BackboneElement" ]
] ) ;
fhir:constraint ( [
fhir:key [ fhir:v "ele-1" ] ;
fhir:severity [ fhir:v "error" ] ;
fhir:human [ fhir:v "All FHIR elements must have a @value or children" ] ;
fhir:expression [ fhir:v "hasValue() or (children().count() > id.count())" ] ;
fhir:source [ fhir:v "http://hl7.org/fhir/StructureDefinition/Element" ]
] ) ;
fhir:mustSupport [ fhir:v "false" ] ;
fhir:isModifier [ fhir:v "false" ] ;
fhir:isSummary [ fhir:v "false" ]
] [
fhir:id [ fhir:v "ClaimResponse.payment.id" ] ;
fhir:path [ fhir:v "ClaimResponse.payment.id" ] ;
fhir:representation ( [ fhir:v "xmlAttr" ] ) ;
fhir:short [ fhir:v "Unique id for inter-element referencing" ] ;
fhir:definition [ fhir:v "Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces." ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "1" ] ;
fhir:base [
fhir:path [ fhir:v "Element.id" ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "1" ]
] ;
fhir:type ( [
fhir:extension ( [
fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type" ] ;
fhir:value [ fhir:v "string" ]
] ) ;
fhir:code [ fhir:v "http://hl7.org/fhirpath/System.String" ]
] ) ;
fhir:condition ( [ fhir:v "ele-1" ] ) ;
fhir:isModifier [ fhir:v "false" ] ;
fhir:isSummary [ fhir:v "false" ] ;
fhir:mapping ( [
fhir:identity [ fhir:v "rim" ] ;
fhir:map [ fhir:v "n/a" ]
] )
] [
fhir:id [ fhir:v "ClaimResponse.payment.extension" ] ;
fhir:path [ fhir:v "ClaimResponse.payment.extension" ] ;
fhir:short [ fhir:v "Additional content defined by implementations" ] ;
fhir:definition [ fhir:v "May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and managable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension." ] ;
fhir:comment [ fhir:v "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone." ] ;
fhir:alias ( [ fhir:v "extensions" ] [ fhir:v "user content" ] ) ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "*" ] ;
fhir:base [
fhir:path [ fhir:v "Element.extension" ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "*" ]
] ;
fhir:type ( [
fhir:code [ fhir:v "Extension" ]
] ) ;
fhir:constraint ( [
fhir:key [ fhir:v "ele-1" ] ;
fhir:severity [ fhir:v "error" ] ;
fhir:human [ fhir:v "All FHIR elements must have a @value or children" ] ;
fhir:expression [ fhir:v "hasValue() or (children().count() > id.count())" ] ;
fhir:source [ fhir:v "http://hl7.org/fhir/StructureDefinition/Element" ]
] ) ;
fhir:isModifier [ fhir:v "false" ] ;
fhir:isSummary [ fhir:v "false" ] ;
fhir:mapping ( [
fhir:identity [ fhir:v "rim" ] ;
fhir:map [ fhir:v "n/a" ]
] )
] [
fhir:id [ fhir:v "ClaimResponse.payment.modifierExtension" ] ;
fhir:path [ fhir:v "ClaimResponse.payment.modifierExtension" ] ;
fhir:short [ fhir:v "Extensions that cannot be ignored even if unrecognized" ] ;
fhir:definition [ fhir:v "May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and managable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.\n\nModifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself)." ] ;
fhir:comment [ fhir:v "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone." ] ;
fhir:requirements [ fhir:v "Modifier extensions allow for extensions that *cannot* be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the [definition of modifier extensions](extensibility.html#modifierExtension)." ] ;
fhir:alias ( [ fhir:v "extensions" ] [ fhir:v "user content" ] [ fhir:v "modifiers" ] ) ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "*" ] ;
fhir:base [
fhir:path [ fhir:v "BackboneElement.modifierExtension" ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "*" ]
] ;
fhir:type ( [
fhir:code [ fhir:v "Extension" ]
] ) ;
fhir:constraint ( [
fhir:key [ fhir:v "ele-1" ] ;
fhir:severity [ fhir:v "error" ] ;
fhir:human [ fhir:v "All FHIR elements must have a @value or children" ] ;
fhir:expression [ fhir:v "hasValue() or (children().count() > id.count())" ] ;
fhir:source [ fhir:v "http://hl7.org/fhir/StructureDefinition/Element" ]
] ) ;
fhir:isModifier [ fhir:v "true" ] ;
fhir:isModifierReason [ fhir:v "Modifier extensions are expected to modify the meaning or interpretation of the element that contains them" ] ;
fhir:isSummary [ fhir:v "true" ] ;
fhir:mapping ( [
fhir:identity [ fhir:v "rim" ] ;
fhir:map [ fhir:v "N/A" ]
] )
] [
fhir:id [ fhir:v "ClaimResponse.payment.type" ] ;
fhir:path [ fhir:v "ClaimResponse.payment.type" ] ;
fhir:short [ fhir:v "Partial or complete payment" ] ;
fhir:definition [ fhir:v "Whether this represents partial or complete payment of the benefits payable." ] ;
fhir:requirements [ fhir:v "To advise the requestor when the insurer believes all payments to have been completed." ] ;
fhir:min [ fhir:v "1" ] ;
fhir:max [ fhir:v "1" ] ;
fhir:base [
fhir:path [ fhir:v "ClaimResponse.payment.type" ] ;
fhir:min [ fhir:v "1" ] ;
fhir:max [ fhir:v "1" ]
] ;
fhir:type ( [
fhir:code [ fhir:v "CodeableConcept" ]
] ) ;
fhir:constraint ( [
fhir:key [ fhir:v "ele-1" ] ;
fhir:severity [ fhir:v "error" ] ;
fhir:human [ fhir:v "All FHIR elements must have a @value or children" ] ;
fhir:expression [ fhir:v "hasValue() or (children().count() > id.count())" ] ;
fhir:source [ fhir:v "http://hl7.org/fhir/StructureDefinition/Element" ]
] ) ;
fhir:mustSupport [ fhir:v "false" ] ;
fhir:isModifier [ fhir:v "false" ] ;
fhir:isSummary [ fhir:v "false" ] ;
fhir:binding [
fhir:extension ( [
fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName" ] ;
fhir:value [ fhir:v "PaymentType" ]
] ) ;
fhir:strength [ fhir:v "example" ] ;
fhir:description [ fhir:v "The type (partial, complete) of the payment." ] ;
fhir:valueSet [ fhir:v "http://hl7.org/fhir/ValueSet/ex-paymenttype" ]
]
] [
fhir:id [ fhir:v "ClaimResponse.payment.adjustment" ] ;
fhir:path [ fhir:v "ClaimResponse.payment.adjustment" ] ;
fhir:short [ fhir:v "Payment adjustment for non-claim issues" ] ;
fhir:definition [ fhir:v "Total amount of all adjustments to this payment included in this transaction which are not related to this claim's adjudication." ] ;
fhir:comment [ fhir:v "Insurers will deduct amounts owing from the provider (adjustment), such as a prior overpayment, from the amount owing to the provider (benefits payable) when payment is made to the provider." ] ;
fhir:requirements [ fhir:v "To advise the requestor of adjustments applied to the payment." ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "1" ] ;
fhir:base [
fhir:path [ fhir:v "ClaimResponse.payment.adjustment" ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "1" ]
] ;
fhir:type ( [
fhir:code [ fhir:v "Money" ]
] ) ;
fhir:constraint ( [
fhir:key [ fhir:v "ele-1" ] ;
fhir:severity [ fhir:v "error" ] ;
fhir:human [ fhir:v "All FHIR elements must have a @value or children" ] ;
fhir:expression [ fhir:v "hasValue() or (children().count() > id.count())" ] ;
fhir:source [ fhir:v "http://hl7.org/fhir/StructureDefinition/Element" ]
] ) ;
fhir:mustSupport [ fhir:v "false" ] ;
fhir:isModifier [ fhir:v "false" ] ;
fhir:isSummary [ fhir:v "false" ]
] [
fhir:id [ fhir:v "ClaimResponse.payment.adjustmentReason" ] ;
fhir:path [ fhir:v "ClaimResponse.payment.adjustmentReason" ] ;
fhir:short [ fhir:v "Explanation for the adjustment" ] ;
fhir:definition [ fhir:v "Reason for the payment adjustment." ] ;
fhir:requirements [ fhir:v "Needed to clarify the monetary adjustment." ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "1" ] ;
fhir:base [
fhir:path [ fhir:v "ClaimResponse.payment.adjustmentReason" ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "1" ]
] ;
fhir:type ( [
fhir:code [ fhir:v "CodeableConcept" ]
] ) ;
fhir:constraint ( [
fhir:key [ fhir:v "ele-1" ] ;
fhir:severity [ fhir:v "error" ] ;
fhir:human [ fhir:v "All FHIR elements must have a @value or children" ] ;
fhir:expression [ fhir:v "hasValue() or (children().count() > id.count())" ] ;
fhir:source [ fhir:v "http://hl7.org/fhir/StructureDefinition/Element" ]
] ) ;
fhir:mustSupport [ fhir:v "false" ] ;
fhir:isModifier [ fhir:v "false" ] ;
fhir:isSummary [ fhir:v "false" ] ;
fhir:binding [
fhir:extension ( [
fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName" ] ;
fhir:value [ fhir:v "PaymentAdjustmentReason" ]
] ) ;
fhir:strength [ fhir:v "example" ] ;
fhir:description [ fhir:v "Payment Adjustment reason codes." ] ;
fhir:valueSet [ fhir:v "http://hl7.org/fhir/ValueSet/payment-adjustment-reason" ]
]
] [
fhir:id [ fhir:v "ClaimResponse.payment.date" ] ;
fhir:path [ fhir:v "ClaimResponse.payment.date" ] ;
fhir:short [ fhir:v "Expected date of payment" ] ;
fhir:definition [ fhir:v "Estimated date the payment will be issued or the actual issue date of payment." ] ;
fhir:requirements [ fhir:v "To advise the payee when payment can be expected." ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "1" ] ;
fhir:base [
fhir:path [ fhir:v "ClaimResponse.payment.date" ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "1" ]
] ;
fhir:type ( [
fhir:code [ fhir:v "date" ]
] ) ;
fhir:constraint ( [
fhir:key [ fhir:v "ele-1" ] ;
fhir:severity [ fhir:v "error" ] ;
fhir:human [ fhir:v "All FHIR elements must have a @value or children" ] ;
fhir:expression [ fhir:v "hasValue() or (children().count() > id.count())" ] ;
fhir:source [ fhir:v "http://hl7.org/fhir/StructureDefinition/Element" ]
] ) ;
fhir:mustSupport [ fhir:v "false" ] ;
fhir:isModifier [ fhir:v "false" ] ;
fhir:isSummary [ fhir:v "false" ]
] [
fhir:id [ fhir:v "ClaimResponse.payment.amount" ] ;
fhir:path [ fhir:v "ClaimResponse.payment.amount" ] ;
fhir:short [ fhir:v "Payable amount after adjustment" ] ;
fhir:definition [ fhir:v "Benefits payable less any payment adjustment." ] ;
fhir:requirements [ fhir:v "Needed to provide the actual payment amount." ] ;
fhir:min [ fhir:v "1" ] ;
fhir:max [ fhir:v "1" ] ;
fhir:base [
fhir:path [ fhir:v "ClaimResponse.payment.amount" ] ;
fhir:min [ fhir:v "1" ] ;
fhir:max [ fhir:v "1" ]
] ;
fhir:type ( [
fhir:code [ fhir:v "Money" ]
] ) ;
fhir:constraint ( [
fhir:key [ fhir:v "ele-1" ] ;
fhir:severity [ fhir:v "error" ] ;
fhir:human [ fhir:v "All FHIR elements must have a @value or children" ] ;
fhir:expression [ fhir:v "hasValue() or (children().count() > id.count())" ] ;
fhir:source [ fhir:v "http://hl7.org/fhir/StructureDefinition/Element" ]
] ) ;
fhir:mustSupport [ fhir:v "false" ] ;
fhir:isModifier [ fhir:v "false" ] ;
fhir:isSummary [ fhir:v "false" ]
] [
fhir:id [ fhir:v "ClaimResponse.payment.identifier" ] ;
fhir:path [ fhir:v "ClaimResponse.payment.identifier" ] ;
fhir:short [ fhir:v "Business identifier for the payment" ] ;
fhir:definition [ fhir:v "Issuer's unique identifier for the payment instrument." ] ;
fhir:comment [ fhir:v "For example: EFT number or check number." ] ;
fhir:requirements [ fhir:v "Enable the receiver to reconcile when payment received." ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "1" ] ;
fhir:base [
fhir:path [ fhir:v "ClaimResponse.payment.identifier" ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "1" ]
] ;
fhir:type ( [
fhir:code [ fhir:v "Identifier" ]
] ) ;
fhir:constraint ( [
fhir:key [ fhir:v "ele-1" ] ;
fhir:severity [ fhir:v "error" ] ;
fhir:human [ fhir:v "All FHIR elements must have a @value or children" ] ;
fhir:expression [ fhir:v "hasValue() or (children().count() > id.count())" ] ;
fhir:source [ fhir:v "http://hl7.org/fhir/StructureDefinition/Element" ]
] ) ;
fhir:mustSupport [ fhir:v "false" ] ;
fhir:isModifier [ fhir:v "false" ] ;
fhir:isSummary [ fhir:v "false" ]
] [
fhir:id [ fhir:v "ClaimResponse.fundsReserve" ] ;
fhir:path [ fhir:v "ClaimResponse.fundsReserve" ] ;
fhir:short [ fhir:v "Funds reserved status" ] ;
fhir:definition [ fhir:v "A code, used only on a response to a preauthorization, to indicate whether the benefits payable have been reserved and for whom." ] ;
fhir:comment [ fhir:v "Fund would be release by a future claim quoting the preAuthRef of this response. Examples of values include: provider, patient, none." ] ;
fhir:requirements [ fhir:v "Needed to advise the submitting provider on whether the rquest for reservation of funds has been honored." ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "1" ] ;
fhir:base [
fhir:path [ fhir:v "ClaimResponse.fundsReserve" ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "1" ]
] ;
fhir:type ( [
fhir:code [ fhir:v "CodeableConcept" ]
] ) ;
fhir:constraint ( [
fhir:key [ fhir:v "ele-1" ] ;
fhir:severity [ fhir:v "error" ] ;
fhir:human [ fhir:v "All FHIR elements must have a @value or children" ] ;
fhir:expression [ fhir:v "hasValue() or (children().count() > id.count())" ] ;
fhir:source [ fhir:v "http://hl7.org/fhir/StructureDefinition/Element" ]
] ) ;
fhir:mustSupport [ fhir:v "false" ] ;
fhir:isModifier [ fhir:v "false" ] ;
fhir:isSummary [ fhir:v "false" ] ;
fhir:binding [
fhir:extension ( [
fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName" ] ;
fhir:value [ fhir:v "FundsReserve" ]
] [
fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/elementdefinition-isCommonBinding" ] ;
fhir:value [ fhir:v "true" ]
] ) ;
fhir:strength [ fhir:v "example" ] ;
fhir:description [ fhir:v "For whom funds are to be reserved: (Patient, Provider, None)." ] ;
fhir:valueSet [ fhir:v "http://hl7.org/fhir/ValueSet/fundsreserve" ]
]
] [
fhir:id [ fhir:v "ClaimResponse.formCode" ] ;
fhir:path [ fhir:v "ClaimResponse.formCode" ] ;
fhir:short [ fhir:v "Printed form identifier" ] ;
fhir:definition [ fhir:v "A code for the form to be used for printing the content." ] ;
fhir:comment [ fhir:v "May be needed to identify specific jurisdictional forms." ] ;
fhir:requirements [ fhir:v "Needed to specify the specific form used for producing output for this response." ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "1" ] ;
fhir:base [
fhir:path [ fhir:v "ClaimResponse.formCode" ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "1" ]
] ;
fhir:type ( [
fhir:code [ fhir:v "CodeableConcept" ]
] ) ;
fhir:constraint ( [
fhir:key [ fhir:v "ele-1" ] ;
fhir:severity [ fhir:v "error" ] ;
fhir:human [ fhir:v "All FHIR elements must have a @value or children" ] ;
fhir:expression [ fhir:v "hasValue() or (children().count() > id.count())" ] ;
fhir:source [ fhir:v "http://hl7.org/fhir/StructureDefinition/Element" ]
] ) ;
fhir:mustSupport [ fhir:v "false" ] ;
fhir:isModifier [ fhir:v "false" ] ;
fhir:isSummary [ fhir:v "false" ] ;
fhir:binding [
fhir:extension ( [
fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName" ] ;
fhir:value [ fhir:v "Forms" ]
] [
fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/elementdefinition-isCommonBinding" ] ;
fhir:value [ fhir:v "true" ]
] ) ;
fhir:strength [ fhir:v "example" ] ;
fhir:description [ fhir:v "The forms codes." ] ;
fhir:valueSet [ fhir:v "http://hl7.org/fhir/ValueSet/forms" ]
]
] [
fhir:id [ fhir:v "ClaimResponse.form" ] ;
fhir:path [ fhir:v "ClaimResponse.form" ] ;
fhir:short [ fhir:v "Printed reference or actual form" ] ;
fhir:definition [ fhir:v "The actual form, by reference or inclusion, for printing the content or an EOB." ] ;
fhir:comment [ fhir:v "Needed to permit insurers to include the actual form." ] ;
fhir:requirements [ fhir:v "Needed to include the specific form used for producing output for this response." ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "1" ] ;
fhir:base [
fhir:path [ fhir:v "ClaimResponse.form" ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "1" ]
] ;
fhir:type ( [
fhir:code [ fhir:v "Attachment" ]
] ) ;
fhir:constraint ( [
fhir:key [ fhir:v "ele-1" ] ;
fhir:severity [ fhir:v "error" ] ;
fhir:human [ fhir:v "All FHIR elements must have a @value or children" ] ;
fhir:expression [ fhir:v "hasValue() or (children().count() > id.count())" ] ;
fhir:source [ fhir:v "http://hl7.org/fhir/StructureDefinition/Element" ]
] ) ;
fhir:mustSupport [ fhir:v "false" ] ;
fhir:isModifier [ fhir:v "false" ] ;
fhir:isSummary [ fhir:v "false" ]
] [
fhir:id [ fhir:v "ClaimResponse.processNote" ] ;
fhir:extension ( [
fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/structuredefinition-explicit-type-name" ] ;
fhir:value [ fhir:v "Note" ]
] ) ;
fhir:path [ fhir:v "ClaimResponse.processNote" ] ;
fhir:short [ fhir:v "Note concerning adjudication" ] ;
fhir:definition [ fhir:v "A note that describes or explains adjudication results in a human readable form." ] ;
fhir:requirements [ fhir:v "Provides the insurer specific textual explanations associated with the processing." ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "*" ] ;
fhir:base [
fhir:path [ fhir:v "ClaimResponse.processNote" ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "*" ]
] ;
fhir:type ( [
fhir:code [ fhir:v "BackboneElement" ]
] ) ;
fhir:constraint ( [
fhir:key [ fhir:v "ele-1" ] ;
fhir:severity [ fhir:v "error" ] ;
fhir:human [ fhir:v "All FHIR elements must have a @value or children" ] ;
fhir:expression [ fhir:v "hasValue() or (children().count() > id.count())" ] ;
fhir:source [ fhir:v "http://hl7.org/fhir/StructureDefinition/Element" ]
] ) ;
fhir:mustSupport [ fhir:v "false" ] ;
fhir:isModifier [ fhir:v "false" ] ;
fhir:isSummary [ fhir:v "false" ]
] [
fhir:id [ fhir:v "ClaimResponse.processNote.id" ] ;
fhir:path [ fhir:v "ClaimResponse.processNote.id" ] ;
fhir:representation ( [ fhir:v "xmlAttr" ] ) ;
fhir:short [ fhir:v "Unique id for inter-element referencing" ] ;
fhir:definition [ fhir:v "Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces." ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "1" ] ;
fhir:base [
fhir:path [ fhir:v "Element.id" ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "1" ]
] ;
fhir:type ( [
fhir:extension ( [
fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type" ] ;
fhir:value [ fhir:v "string" ]
] ) ;
fhir:code [ fhir:v "http://hl7.org/fhirpath/System.String" ]
] ) ;
fhir:condition ( [ fhir:v "ele-1" ] ) ;
fhir:isModifier [ fhir:v "false" ] ;
fhir:isSummary [ fhir:v "false" ] ;
fhir:mapping ( [
fhir:identity [ fhir:v "rim" ] ;
fhir:map [ fhir:v "n/a" ]
] )
] [
fhir:id [ fhir:v "ClaimResponse.processNote.extension" ] ;
fhir:path [ fhir:v "ClaimResponse.processNote.extension" ] ;
fhir:short [ fhir:v "Additional content defined by implementations" ] ;
fhir:definition [ fhir:v "May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and managable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension." ] ;
fhir:comment [ fhir:v "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone." ] ;
fhir:alias ( [ fhir:v "extensions" ] [ fhir:v "user content" ] ) ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "*" ] ;
fhir:base [
fhir:path [ fhir:v "Element.extension" ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "*" ]
] ;
fhir:type ( [
fhir:code [ fhir:v "Extension" ]
] ) ;
fhir:constraint ( [
fhir:key [ fhir:v "ele-1" ] ;
fhir:severity [ fhir:v "error" ] ;
fhir:human [ fhir:v "All FHIR elements must have a @value or children" ] ;
fhir:expression [ fhir:v "hasValue() or (children().count() > id.count())" ] ;
fhir:source [ fhir:v "http://hl7.org/fhir/StructureDefinition/Element" ]
] ) ;
fhir:isModifier [ fhir:v "false" ] ;
fhir:isSummary [ fhir:v "false" ] ;
fhir:mapping ( [
fhir:identity [ fhir:v "rim" ] ;
fhir:map [ fhir:v "n/a" ]
] )
] [
fhir:id [ fhir:v "ClaimResponse.processNote.modifierExtension" ] ;
fhir:path [ fhir:v "ClaimResponse.processNote.modifierExtension" ] ;
fhir:short [ fhir:v "Extensions that cannot be ignored even if unrecognized" ] ;
fhir:definition [ fhir:v "May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and managable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.\n\nModifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself)." ] ;
fhir:comment [ fhir:v "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone." ] ;
fhir:requirements [ fhir:v "Modifier extensions allow for extensions that *cannot* be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the [definition of modifier extensions](extensibility.html#modifierExtension)." ] ;
fhir:alias ( [ fhir:v "extensions" ] [ fhir:v "user content" ] [ fhir:v "modifiers" ] ) ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "*" ] ;
fhir:base [
fhir:path [ fhir:v "BackboneElement.modifierExtension" ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "*" ]
] ;
fhir:type ( [
fhir:code [ fhir:v "Extension" ]
] ) ;
fhir:constraint ( [
fhir:key [ fhir:v "ele-1" ] ;
fhir:severity [ fhir:v "error" ] ;
fhir:human [ fhir:v "All FHIR elements must have a @value or children" ] ;
fhir:expression [ fhir:v "hasValue() or (children().count() > id.count())" ] ;
fhir:source [ fhir:v "http://hl7.org/fhir/StructureDefinition/Element" ]
] ) ;
fhir:isModifier [ fhir:v "true" ] ;
fhir:isModifierReason [ fhir:v "Modifier extensions are expected to modify the meaning or interpretation of the element that contains them" ] ;
fhir:isSummary [ fhir:v "true" ] ;
fhir:mapping ( [
fhir:identity [ fhir:v "rim" ] ;
fhir:map [ fhir:v "N/A" ]
] )
] [
fhir:id [ fhir:v "ClaimResponse.processNote.number" ] ;
fhir:path [ fhir:v "ClaimResponse.processNote.number" ] ;
fhir:short [ fhir:v "Note instance identifier" ] ;
fhir:definition [ fhir:v "A number to uniquely identify a note entry." ] ;
fhir:requirements [ fhir:v "Necessary to provide a mechanism to link from adjudications." ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "1" ] ;
fhir:base [
fhir:path [ fhir:v "ClaimResponse.processNote.number" ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "1" ]
] ;
fhir:type ( [
fhir:code [ fhir:v "positiveInt" ]
] ) ;
fhir:constraint ( [
fhir:key [ fhir:v "ele-1" ] ;
fhir:severity [ fhir:v "error" ] ;
fhir:human [ fhir:v "All FHIR elements must have a @value or children" ] ;
fhir:expression [ fhir:v "hasValue() or (children().count() > id.count())" ] ;
fhir:source [ fhir:v "http://hl7.org/fhir/StructureDefinition/Element" ]
] ) ;
fhir:mustSupport [ fhir:v "false" ] ;
fhir:isModifier [ fhir:v "false" ] ;
fhir:isSummary [ fhir:v "false" ]
] [
fhir:id [ fhir:v "ClaimResponse.processNote.type" ] ;
fhir:path [ fhir:v "ClaimResponse.processNote.type" ] ;
fhir:short [ fhir:v "Note purpose" ] ;
fhir:definition [ fhir:v "The business purpose of the note text." ] ;
fhir:requirements [ fhir:v "To convey the expectation for when the text is used." ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "1" ] ;
fhir:base [
fhir:path [ fhir:v "ClaimResponse.processNote.type" ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "1" ]
] ;
fhir:type ( [
fhir:code [ fhir:v "CodeableConcept" ]
] ) ;
fhir:constraint ( [
fhir:key [ fhir:v "ele-1" ] ;
fhir:severity [ fhir:v "error" ] ;
fhir:human [ fhir:v "All FHIR elements must have a @value or children" ] ;
fhir:expression [ fhir:v "hasValue() or (children().count() > id.count())" ] ;
fhir:source [ fhir:v "http://hl7.org/fhir/StructureDefinition/Element" ]
] ) ;
fhir:mustSupport [ fhir:v "false" ] ;
fhir:isModifier [ fhir:v "false" ] ;
fhir:isSummary [ fhir:v "false" ] ;
fhir:binding [
fhir:extension ( [
fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName" ] ;
fhir:value [ fhir:v "NoteType" ]
] [
fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/elementdefinition-isCommonBinding" ] ;
fhir:value [ fhir:v "true" ]
] ) ;
fhir:strength [ fhir:v "extensible" ] ;
fhir:description [ fhir:v "The presentation types of notes." ] ;
fhir:valueSet [ fhir:v "http://hl7.org/fhir/ValueSet/note-type" ]
]
] [
fhir:id [ fhir:v "ClaimResponse.processNote.text" ] ;
fhir:path [ fhir:v "ClaimResponse.processNote.text" ] ;
fhir:short [ fhir:v "Note explanatory text" ] ;
fhir:definition [ fhir:v "The explanation or description associated with the processing." ] ;
fhir:requirements [ fhir:v "Required to provide human readable explanation." ] ;
fhir:min [ fhir:v "1" ] ;
fhir:max [ fhir:v "1" ] ;
fhir:base [
fhir:path [ fhir:v "ClaimResponse.processNote.text" ] ;
fhir:min [ fhir:v "1" ] ;
fhir:max [ fhir:v "1" ]
] ;
fhir:type ( [
fhir:code [ fhir:v "string" ]
] ) ;
fhir:constraint ( [
fhir:key [ fhir:v "ele-1" ] ;
fhir:severity [ fhir:v "error" ] ;
fhir:human [ fhir:v "All FHIR elements must have a @value or children" ] ;
fhir:expression [ fhir:v "hasValue() or (children().count() > id.count())" ] ;
fhir:source [ fhir:v "http://hl7.org/fhir/StructureDefinition/Element" ]
] ) ;
fhir:mustSupport [ fhir:v "false" ] ;
fhir:isModifier [ fhir:v "false" ] ;
fhir:isSummary [ fhir:v "false" ]
] [
fhir:id [ fhir:v "ClaimResponse.processNote.language" ] ;
fhir:path [ fhir:v "ClaimResponse.processNote.language" ] ;
fhir:short [ fhir:v "Language of the text" ] ;
fhir:definition [ fhir:v "A code to define the language used in the text of the note." ] ;
fhir:comment [ fhir:v "Only required if the language is different from the resource language." ] ;
fhir:requirements [ fhir:v "Note text may vary from the resource defined language." ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "1" ] ;
fhir:base [
fhir:path [ fhir:v "ClaimResponse.processNote.language" ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "1" ]
] ;
fhir:type ( [
fhir:code [ fhir:v "CodeableConcept" ]
] ) ;
fhir:constraint ( [
fhir:key [ fhir:v "ele-1" ] ;
fhir:severity [ fhir:v "error" ] ;
fhir:human [ fhir:v "All FHIR elements must have a @value or children" ] ;
fhir:expression [ fhir:v "hasValue() or (children().count() > id.count())" ] ;
fhir:source [ fhir:v "http://hl7.org/fhir/StructureDefinition/Element" ]
] ) ;
fhir:mustSupport [ fhir:v "false" ] ;
fhir:isModifier [ fhir:v "false" ] ;
fhir:isSummary [ fhir:v "false" ] ;
fhir:binding [
fhir:extension ( [
fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName" ] ;
fhir:value [ fhir:v "Language" ]
] [
fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/elementdefinition-isCommonBinding" ] ;
fhir:value [ fhir:v "true" ]
] ) ;
fhir:strength [ fhir:v "required" ] ;
fhir:description [ fhir:v "IETF language tag for a human language" ] ;
fhir:valueSet [ fhir:v "http://hl7.org/fhir/ValueSet/all-languages|6.0.0-ballot2" ] ;
fhir:additional ( [
fhir:purpose [ fhir:v "starter" ] ;
fhir:valueSet [ fhir:v "http://hl7.org/fhir/ValueSet/languages" ]
] )
]
] [
fhir:id [ fhir:v "ClaimResponse.communicationRequest" ] ;
fhir:path [ fhir:v "ClaimResponse.communicationRequest" ] ;
fhir:short [ fhir:v "Request for additional information" ] ;
fhir:definition [ fhir:v "Request for additional supporting or authorizing information." ] ;
fhir:comment [ fhir:v "For example: professional reports, documents, images, clinical resources, or accident reports." ] ;
fhir:requirements [ fhir:v "Need to communicate insurer request for additional information required to support the adjudication." ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "*" ] ;
fhir:base [
fhir:path [ fhir:v "ClaimResponse.communicationRequest" ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "*" ]
] ;
fhir:type ( [
fhir:code [ fhir:v "Reference" ] ;
fhir:targetProfile ( [ fhir:v "http://hl7.org/fhir/StructureDefinition/CommunicationRequest" ] )
] ) ;
fhir:constraint ( [
fhir:key [ fhir:v "ele-1" ] ;
fhir:severity [ fhir:v "error" ] ;
fhir:human [ fhir:v "All FHIR elements must have a @value or children" ] ;
fhir:expression [ fhir:v "hasValue() or (children().count() > id.count())" ] ;
fhir:source [ fhir:v "http://hl7.org/fhir/StructureDefinition/Element" ]
] ) ;
fhir:mustSupport [ fhir:v "false" ] ;
fhir:isModifier [ fhir:v "false" ] ;
fhir:isSummary [ fhir:v "false" ]
] [
fhir:id [ fhir:v "ClaimResponse.insurance" ] ;
fhir:extension ( [
fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/structuredefinition-explicit-type-name" ] ;
fhir:value [ fhir:v "Insurance" ]
] ) ;
fhir:path [ fhir:v "ClaimResponse.insurance" ] ;
fhir:short [ fhir:v "Patient insurance information" ] ;
fhir:definition [ fhir:v "Financial instruments for reimbursement for the health care products and services specified on the claim." ] ;
fhir:comment [ fhir:v "All insurance coverages for the patient which may be applicable for reimbursement, of the products and services listed in the claim, are typically provided in the claim to allow insurers to confirm the ordering of the insurance coverages relative to local 'coordination of benefit' rules. One coverage (and only one) with 'focal=true' is to be used in the adjudication of this claim. Coverages appearing before the focal Coverage in the list, and where 'subrogation=false', should provide a reference to the ClaimResponse containing the adjudication results of the prior claim." ] ;
fhir:requirements [ fhir:v "At least one insurer is required for a claim to be a claim." ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "*" ] ;
fhir:base [
fhir:path [ fhir:v "ClaimResponse.insurance" ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "*" ]
] ;
fhir:type ( [
fhir:code [ fhir:v "BackboneElement" ]
] ) ;
fhir:constraint ( [
fhir:key [ fhir:v "ele-1" ] ;
fhir:severity [ fhir:v "error" ] ;
fhir:human [ fhir:v "All FHIR elements must have a @value or children" ] ;
fhir:expression [ fhir:v "hasValue() or (children().count() > id.count())" ] ;
fhir:source [ fhir:v "http://hl7.org/fhir/StructureDefinition/Element" ]
] ) ;
fhir:mustSupport [ fhir:v "false" ] ;
fhir:isModifier [ fhir:v "false" ] ;
fhir:isSummary [ fhir:v "false" ] ;
fhir:mapping ( [
fhir:identity [ fhir:v "rim" ] ;
fhir:map [ fhir:v "Coverage" ]
] )
] [
fhir:id [ fhir:v "ClaimResponse.insurance.id" ] ;
fhir:path [ fhir:v "ClaimResponse.insurance.id" ] ;
fhir:representation ( [ fhir:v "xmlAttr" ] ) ;
fhir:short [ fhir:v "Unique id for inter-element referencing" ] ;
fhir:definition [ fhir:v "Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces." ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "1" ] ;
fhir:base [
fhir:path [ fhir:v "Element.id" ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "1" ]
] ;
fhir:type ( [
fhir:extension ( [
fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type" ] ;
fhir:value [ fhir:v "string" ]
] ) ;
fhir:code [ fhir:v "http://hl7.org/fhirpath/System.String" ]
] ) ;
fhir:condition ( [ fhir:v "ele-1" ] ) ;
fhir:isModifier [ fhir:v "false" ] ;
fhir:isSummary [ fhir:v "false" ] ;
fhir:mapping ( [
fhir:identity [ fhir:v "rim" ] ;
fhir:map [ fhir:v "n/a" ]
] )
] [
fhir:id [ fhir:v "ClaimResponse.insurance.extension" ] ;
fhir:path [ fhir:v "ClaimResponse.insurance.extension" ] ;
fhir:short [ fhir:v "Additional content defined by implementations" ] ;
fhir:definition [ fhir:v "May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and managable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension." ] ;
fhir:comment [ fhir:v "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone." ] ;
fhir:alias ( [ fhir:v "extensions" ] [ fhir:v "user content" ] ) ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "*" ] ;
fhir:base [
fhir:path [ fhir:v "Element.extension" ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "*" ]
] ;
fhir:type ( [
fhir:code [ fhir:v "Extension" ]
] ) ;
fhir:constraint ( [
fhir:key [ fhir:v "ele-1" ] ;
fhir:severity [ fhir:v "error" ] ;
fhir:human [ fhir:v "All FHIR elements must have a @value or children" ] ;
fhir:expression [ fhir:v "hasValue() or (children().count() > id.count())" ] ;
fhir:source [ fhir:v "http://hl7.org/fhir/StructureDefinition/Element" ]
] ) ;
fhir:isModifier [ fhir:v "false" ] ;
fhir:isSummary [ fhir:v "false" ] ;
fhir:mapping ( [
fhir:identity [ fhir:v "rim" ] ;
fhir:map [ fhir:v "n/a" ]
] )
] [
fhir:id [ fhir:v "ClaimResponse.insurance.modifierExtension" ] ;
fhir:path [ fhir:v "ClaimResponse.insurance.modifierExtension" ] ;
fhir:short [ fhir:v "Extensions that cannot be ignored even if unrecognized" ] ;
fhir:definition [ fhir:v "May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and managable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.\n\nModifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself)." ] ;
fhir:comment [ fhir:v "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone." ] ;
fhir:requirements [ fhir:v "Modifier extensions allow for extensions that *cannot* be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the [definition of modifier extensions](extensibility.html#modifierExtension)." ] ;
fhir:alias ( [ fhir:v "extensions" ] [ fhir:v "user content" ] [ fhir:v "modifiers" ] ) ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "*" ] ;
fhir:base [
fhir:path [ fhir:v "BackboneElement.modifierExtension" ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "*" ]
] ;
fhir:type ( [
fhir:code [ fhir:v "Extension" ]
] ) ;
fhir:constraint ( [
fhir:key [ fhir:v "ele-1" ] ;
fhir:severity [ fhir:v "error" ] ;
fhir:human [ fhir:v "All FHIR elements must have a @value or children" ] ;
fhir:expression [ fhir:v "hasValue() or (children().count() > id.count())" ] ;
fhir:source [ fhir:v "http://hl7.org/fhir/StructureDefinition/Element" ]
] ) ;
fhir:isModifier [ fhir:v "true" ] ;
fhir:isModifierReason [ fhir:v "Modifier extensions are expected to modify the meaning or interpretation of the element that contains them" ] ;
fhir:isSummary [ fhir:v "true" ] ;
fhir:mapping ( [
fhir:identity [ fhir:v "rim" ] ;
fhir:map [ fhir:v "N/A" ]
] )
] [
fhir:id [ fhir:v "ClaimResponse.insurance.sequence" ] ;
fhir:path [ fhir:v "ClaimResponse.insurance.sequence" ] ;
fhir:short [ fhir:v "Insurance instance identifier" ] ;
fhir:definition [ fhir:v "A number to uniquely identify insurance entries and provide a sequence of coverages to convey coordination of benefit order." ] ;
fhir:requirements [ fhir:v "To maintain order of the coverages." ] ;
fhir:min [ fhir:v "1" ] ;
fhir:max [ fhir:v "1" ] ;
fhir:base [
fhir:path [ fhir:v "ClaimResponse.insurance.sequence" ] ;
fhir:min [ fhir:v "1" ] ;
fhir:max [ fhir:v "1" ]
] ;
fhir:type ( [
fhir:code [ fhir:v "positiveInt" ]
] ) ;
fhir:constraint ( [
fhir:key [ fhir:v "ele-1" ] ;
fhir:severity [ fhir:v "error" ] ;
fhir:human [ fhir:v "All FHIR elements must have a @value or children" ] ;
fhir:expression [ fhir:v "hasValue() or (children().count() > id.count())" ] ;
fhir:source [ fhir:v "http://hl7.org/fhir/StructureDefinition/Element" ]
] ) ;
fhir:mustSupport [ fhir:v "false" ] ;
fhir:isModifier [ fhir:v "false" ] ;
fhir:isSummary [ fhir:v "false" ]
] [
fhir:id [ fhir:v "ClaimResponse.insurance.focal" ] ;
fhir:path [ fhir:v "ClaimResponse.insurance.focal" ] ;
fhir:short [ fhir:v "Coverage to be used for adjudication" ] ;
fhir:definition [ fhir:v "A flag to indicate that this Coverage is to be used for adjudication of this claim when set to true." ] ;
fhir:comment [ fhir:v "A patient may (will) have multiple insurance policies which provide reimbursement for healthcare services and products. For example a person may also be covered by their spouse's policy and both appear in the list (and may be from the same insurer). This flag will be set to true for only one of the listed policies and that policy will be used for adjudicating this claim. Other claims would be created to request adjudication against the other listed policies." ] ;
fhir:requirements [ fhir:v "To identify which coverage in the list is being used to adjudicate this claim." ] ;
fhir:min [ fhir:v "1" ] ;
fhir:max [ fhir:v "1" ] ;
fhir:base [
fhir:path [ fhir:v "ClaimResponse.insurance.focal" ] ;
fhir:min [ fhir:v "1" ] ;
fhir:max [ fhir:v "1" ]
] ;
fhir:type ( [
fhir:code [ fhir:v "boolean" ]
] ) ;
fhir:constraint ( [
fhir:key [ fhir:v "ele-1" ] ;
fhir:severity [ fhir:v "error" ] ;
fhir:human [ fhir:v "All FHIR elements must have a @value or children" ] ;
fhir:expression [ fhir:v "hasValue() or (children().count() > id.count())" ] ;
fhir:source [ fhir:v "http://hl7.org/fhir/StructureDefinition/Element" ]
] ) ;
fhir:mustSupport [ fhir:v "false" ] ;
fhir:isModifier [ fhir:v "false" ] ;
fhir:isSummary [ fhir:v "false" ]
] [
fhir:id [ fhir:v "ClaimResponse.insurance.coverage" ] ;
fhir:path [ fhir:v "ClaimResponse.insurance.coverage" ] ;
fhir:short [ fhir:v "Insurance information" ] ;
fhir:definition [ fhir:v "Reference to the insurance card level information contained in the Coverage resource. The coverage issuing insurer will use these details to locate the patient's actual coverage within the insurer's information system." ] ;
fhir:requirements [ fhir:v "Required to allow the adjudicator to locate the correct policy and history within their information system." ] ;
fhir:min [ fhir:v "1" ] ;
fhir:max [ fhir:v "1" ] ;
fhir:base [
fhir:path [ fhir:v "ClaimResponse.insurance.coverage" ] ;
fhir:min [ fhir:v "1" ] ;
fhir:max [ fhir:v "1" ]
] ;
fhir:type ( [
fhir:code [ fhir:v "Reference" ] ;
fhir:targetProfile ( [ fhir:v "http://hl7.org/fhir/StructureDefinition/Coverage" ] )
] ) ;
fhir:constraint ( [
fhir:key [ fhir:v "ele-1" ] ;
fhir:severity [ fhir:v "error" ] ;
fhir:human [ fhir:v "All FHIR elements must have a @value or children" ] ;
fhir:expression [ fhir:v "hasValue() or (children().count() > id.count())" ] ;
fhir:source [ fhir:v "http://hl7.org/fhir/StructureDefinition/Element" ]
] ) ;
fhir:mustSupport [ fhir:v "false" ] ;
fhir:isModifier [ fhir:v "false" ] ;
fhir:isSummary [ fhir:v "false" ]
] [
fhir:id [ fhir:v "ClaimResponse.insurance.businessArrangement" ] ;
fhir:path [ fhir:v "ClaimResponse.insurance.businessArrangement" ] ;
fhir:short [ fhir:v "Additional provider contract number" ] ;
fhir:definition [ fhir:v "A business agreement number established between the provider and the insurer for special business processing purposes." ] ;
fhir:requirements [ fhir:v "Providers may have multiple business arrangements with a given insurer and must supply the specific contract number for adjudication." ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "1" ] ;
fhir:base [
fhir:path [ fhir:v "ClaimResponse.insurance.businessArrangement" ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "1" ]
] ;
fhir:type ( [
fhir:code [ fhir:v "string" ]
] ) ;
fhir:constraint ( [
fhir:key [ fhir:v "ele-1" ] ;
fhir:severity [ fhir:v "error" ] ;
fhir:human [ fhir:v "All FHIR elements must have a @value or children" ] ;
fhir:expression [ fhir:v "hasValue() or (children().count() > id.count())" ] ;
fhir:source [ fhir:v "http://hl7.org/fhir/StructureDefinition/Element" ]
] ) ;
fhir:mustSupport [ fhir:v "false" ] ;
fhir:isModifier [ fhir:v "false" ] ;
fhir:isSummary [ fhir:v "false" ]
] [
fhir:id [ fhir:v "ClaimResponse.insurance.claimResponse" ] ;
fhir:path [ fhir:v "ClaimResponse.insurance.claimResponse" ] ;
fhir:short [ fhir:v "Adjudication results" ] ;
fhir:definition [ fhir:v "The result of the adjudication of the line items for the Coverage specified in this insurance." ] ;
fhir:comment [ fhir:v "Must not be specified when 'focal=true' for this insurance." ] ;
fhir:requirements [ fhir:v "An insurer need the adjudication results from prior insurers to determine the outstanding balance remaining by item for the items in the curent claim." ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "1" ] ;
fhir:base [
fhir:path [ fhir:v "ClaimResponse.insurance.claimResponse" ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "1" ]
] ;
fhir:type ( [
fhir:extension ( [
fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/structuredefinition-hierarchy" ] ;
fhir:value [ fhir:v "false" ]
] ) ;
fhir:code [ fhir:v "Reference" ] ;
fhir:targetProfile ( [ fhir:v "http://hl7.org/fhir/StructureDefinition/ClaimResponse" ] )
] ) ;
fhir:constraint ( [
fhir:key [ fhir:v "ele-1" ] ;
fhir:severity [ fhir:v "error" ] ;
fhir:human [ fhir:v "All FHIR elements must have a @value or children" ] ;
fhir:expression [ fhir:v "hasValue() or (children().count() > id.count())" ] ;
fhir:source [ fhir:v "http://hl7.org/fhir/StructureDefinition/Element" ]
] ) ;
fhir:mustSupport [ fhir:v "false" ] ;
fhir:isModifier [ fhir:v "false" ] ;
fhir:isSummary [ fhir:v "false" ]
] [
fhir:id [ fhir:v "ClaimResponse.error" ] ;
fhir:extension ( [
fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/structuredefinition-explicit-type-name" ] ;
fhir:value [ fhir:v "Error" ]
] ) ;
fhir:path [ fhir:v "ClaimResponse.error" ] ;
fhir:short [ fhir:v "Processing errors" ] ;
fhir:definition [ fhir:v "Errors encountered during the processing of the adjudication." ] ;
fhir:comment [ fhir:v "If the request contains errors then an error element should be provided and no adjudication related sections (item, addItem, or payment) should be present." ] ;
fhir:requirements [ fhir:v "Need to communicate processing issues to the requestor." ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "*" ] ;
fhir:base [
fhir:path [ fhir:v "ClaimResponse.error" ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "*" ]
] ;
fhir:type ( [
fhir:code [ fhir:v "BackboneElement" ]
] ) ;
fhir:constraint ( [
fhir:key [ fhir:v "ele-1" ] ;
fhir:severity [ fhir:v "error" ] ;
fhir:human [ fhir:v "All FHIR elements must have a @value or children" ] ;
fhir:expression [ fhir:v "hasValue() or (children().count() > id.count())" ] ;
fhir:source [ fhir:v "http://hl7.org/fhir/StructureDefinition/Element" ]
] ) ;
fhir:mustSupport [ fhir:v "false" ] ;
fhir:isModifier [ fhir:v "false" ] ;
fhir:isSummary [ fhir:v "false" ]
] [
fhir:id [ fhir:v "ClaimResponse.error.id" ] ;
fhir:path [ fhir:v "ClaimResponse.error.id" ] ;
fhir:representation ( [ fhir:v "xmlAttr" ] ) ;
fhir:short [ fhir:v "Unique id for inter-element referencing" ] ;
fhir:definition [ fhir:v "Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces." ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "1" ] ;
fhir:base [
fhir:path [ fhir:v "Element.id" ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "1" ]
] ;
fhir:type ( [
fhir:extension ( [
fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type" ] ;
fhir:value [ fhir:v "string" ]
] ) ;
fhir:code [ fhir:v "http://hl7.org/fhirpath/System.String" ]
] ) ;
fhir:condition ( [ fhir:v "ele-1" ] ) ;
fhir:isModifier [ fhir:v "false" ] ;
fhir:isSummary [ fhir:v "false" ] ;
fhir:mapping ( [
fhir:identity [ fhir:v "rim" ] ;
fhir:map [ fhir:v "n/a" ]
] )
] [
fhir:id [ fhir:v "ClaimResponse.error.extension" ] ;
fhir:path [ fhir:v "ClaimResponse.error.extension" ] ;
fhir:short [ fhir:v "Additional content defined by implementations" ] ;
fhir:definition [ fhir:v "May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and managable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension." ] ;
fhir:comment [ fhir:v "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone." ] ;
fhir:alias ( [ fhir:v "extensions" ] [ fhir:v "user content" ] ) ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "*" ] ;
fhir:base [
fhir:path [ fhir:v "Element.extension" ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "*" ]
] ;
fhir:type ( [
fhir:code [ fhir:v "Extension" ]
] ) ;
fhir:constraint ( [
fhir:key [ fhir:v "ele-1" ] ;
fhir:severity [ fhir:v "error" ] ;
fhir:human [ fhir:v "All FHIR elements must have a @value or children" ] ;
fhir:expression [ fhir:v "hasValue() or (children().count() > id.count())" ] ;
fhir:source [ fhir:v "http://hl7.org/fhir/StructureDefinition/Element" ]
] ) ;
fhir:isModifier [ fhir:v "false" ] ;
fhir:isSummary [ fhir:v "false" ] ;
fhir:mapping ( [
fhir:identity [ fhir:v "rim" ] ;
fhir:map [ fhir:v "n/a" ]
] )
] [
fhir:id [ fhir:v "ClaimResponse.error.modifierExtension" ] ;
fhir:path [ fhir:v "ClaimResponse.error.modifierExtension" ] ;
fhir:short [ fhir:v "Extensions that cannot be ignored even if unrecognized" ] ;
fhir:definition [ fhir:v "May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and managable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.\n\nModifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself)." ] ;
fhir:comment [ fhir:v "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone." ] ;
fhir:requirements [ fhir:v "Modifier extensions allow for extensions that *cannot* be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the [definition of modifier extensions](extensibility.html#modifierExtension)." ] ;
fhir:alias ( [ fhir:v "extensions" ] [ fhir:v "user content" ] [ fhir:v "modifiers" ] ) ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "*" ] ;
fhir:base [
fhir:path [ fhir:v "BackboneElement.modifierExtension" ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "*" ]
] ;
fhir:type ( [
fhir:code [ fhir:v "Extension" ]
] ) ;
fhir:constraint ( [
fhir:key [ fhir:v "ele-1" ] ;
fhir:severity [ fhir:v "error" ] ;
fhir:human [ fhir:v "All FHIR elements must have a @value or children" ] ;
fhir:expression [ fhir:v "hasValue() or (children().count() > id.count())" ] ;
fhir:source [ fhir:v "http://hl7.org/fhir/StructureDefinition/Element" ]
] ) ;
fhir:isModifier [ fhir:v "true" ] ;
fhir:isModifierReason [ fhir:v "Modifier extensions are expected to modify the meaning or interpretation of the element that contains them" ] ;
fhir:isSummary [ fhir:v "true" ] ;
fhir:mapping ( [
fhir:identity [ fhir:v "rim" ] ;
fhir:map [ fhir:v "N/A" ]
] )
] [
fhir:id [ fhir:v "ClaimResponse.error.itemSequence" ] ;
fhir:path [ fhir:v "ClaimResponse.error.itemSequence" ] ;
fhir:short [ fhir:v "Item sequence number" ] ;
fhir:definition [ fhir:v "The sequence number of the line item submitted which contains the error. This value is omitted when the error occurs outside of the item structure." ] ;
fhir:requirements [ fhir:v "Provides references to the claim items." ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "1" ] ;
fhir:base [
fhir:path [ fhir:v "ClaimResponse.error.itemSequence" ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "1" ]
] ;
fhir:type ( [
fhir:code [ fhir:v "positiveInt" ]
] ) ;
fhir:constraint ( [
fhir:key [ fhir:v "ele-1" ] ;
fhir:severity [ fhir:v "error" ] ;
fhir:human [ fhir:v "All FHIR elements must have a @value or children" ] ;
fhir:expression [ fhir:v "hasValue() or (children().count() > id.count())" ] ;
fhir:source [ fhir:v "http://hl7.org/fhir/StructureDefinition/Element" ]
] ) ;
fhir:mustSupport [ fhir:v "false" ] ;
fhir:isModifier [ fhir:v "false" ] ;
fhir:isSummary [ fhir:v "false" ]
] [
fhir:id [ fhir:v "ClaimResponse.error.detailSequence" ] ;
fhir:path [ fhir:v "ClaimResponse.error.detailSequence" ] ;
fhir:short [ fhir:v "Detail sequence number" ] ;
fhir:definition [ fhir:v "The sequence number of the detail within the line item submitted which contains the error. This value is omitted when the error occurs outside of the item structure." ] ;
fhir:requirements [ fhir:v "Provides references to the claim details within the claim item." ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "1" ] ;
fhir:base [
fhir:path [ fhir:v "ClaimResponse.error.detailSequence" ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "1" ]
] ;
fhir:type ( [
fhir:code [ fhir:v "positiveInt" ]
] ) ;
fhir:constraint ( [
fhir:key [ fhir:v "ele-1" ] ;
fhir:severity [ fhir:v "error" ] ;
fhir:human [ fhir:v "All FHIR elements must have a @value or children" ] ;
fhir:expression [ fhir:v "hasValue() or (children().count() > id.count())" ] ;
fhir:source [ fhir:v "http://hl7.org/fhir/StructureDefinition/Element" ]
] ) ;
fhir:mustSupport [ fhir:v "false" ] ;
fhir:isModifier [ fhir:v "false" ] ;
fhir:isSummary [ fhir:v "false" ]
] [
fhir:id [ fhir:v "ClaimResponse.error.subDetailSequence" ] ;
fhir:path [ fhir:v "ClaimResponse.error.subDetailSequence" ] ;
fhir:short [ fhir:v "Subdetail sequence number" ] ;
fhir:definition [ fhir:v "The sequence number of the sub-detail within the detail within the line item submitted which contains the error. This value is omitted when the error occurs outside of the item structure." ] ;
fhir:requirements [ fhir:v "Provides references to the claim sub-details within the claim detail." ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "1" ] ;
fhir:base [
fhir:path [ fhir:v "ClaimResponse.error.subDetailSequence" ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "1" ]
] ;
fhir:type ( [
fhir:code [ fhir:v "positiveInt" ]
] ) ;
fhir:constraint ( [
fhir:key [ fhir:v "ele-1" ] ;
fhir:severity [ fhir:v "error" ] ;
fhir:human [ fhir:v "All FHIR elements must have a @value or children" ] ;
fhir:expression [ fhir:v "hasValue() or (children().count() > id.count())" ] ;
fhir:source [ fhir:v "http://hl7.org/fhir/StructureDefinition/Element" ]
] ) ;
fhir:mustSupport [ fhir:v "false" ] ;
fhir:isModifier [ fhir:v "false" ] ;
fhir:isSummary [ fhir:v "false" ]
] [
fhir:id [ fhir:v "ClaimResponse.error.code" ] ;
fhir:path [ fhir:v "ClaimResponse.error.code" ] ;
fhir:short [ fhir:v "Error code detailing processing issues" ] ;
fhir:definition [ fhir:v "An error code, from a specified code system, which details why the claim could not be adjudicated." ] ;
fhir:requirements [ fhir:v "Required to convey processing errors." ] ;
fhir:min [ fhir:v "1" ] ;
fhir:max [ fhir:v "1" ] ;
fhir:base [
fhir:path [ fhir:v "ClaimResponse.error.code" ] ;
fhir:min [ fhir:v "1" ] ;
fhir:max [ fhir:v "1" ]
] ;
fhir:type ( [
fhir:code [ fhir:v "CodeableConcept" ]
] ) ;
fhir:constraint ( [
fhir:key [ fhir:v "ele-1" ] ;
fhir:severity [ fhir:v "error" ] ;
fhir:human [ fhir:v "All FHIR elements must have a @value or children" ] ;
fhir:expression [ fhir:v "hasValue() or (children().count() > id.count())" ] ;
fhir:source [ fhir:v "http://hl7.org/fhir/StructureDefinition/Element" ]
] ) ;
fhir:mustSupport [ fhir:v "false" ] ;
fhir:isModifier [ fhir:v "false" ] ;
fhir:isSummary [ fhir:v "true" ] ;
fhir:binding [
fhir:extension ( [
fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName" ] ;
fhir:value [ fhir:v "AdjudicationError" ]
] [
fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/elementdefinition-isCommonBinding" ] ;
fhir:value [ fhir:v "true" ]
] ) ;
fhir:strength [ fhir:v "example" ] ;
fhir:description [ fhir:v "The adjudication error codes." ] ;
fhir:valueSet [ fhir:v "http://hl7.org/fhir/ValueSet/adjudication-error" ]
]
] [
fhir:id [ fhir:v "ClaimResponse.error.expression" ] ;
fhir:path [ fhir:v "ClaimResponse.error.expression" ] ;
fhir:short [ fhir:v "FHIRPath of element(s) related to issue" ] ;
fhir:definition [ fhir:v "A [simple subset of FHIRPath](fhirpath.html#simple) limited to element names, repetition indicators and the default child accessor that identifies one of the elements in the resource that caused this issue to be raised." ] ;
fhir:comment [ fhir:v "The root of the FHIRPath is the resource or bundle that generated OperationOutcome. Each FHIRPath SHALL resolve to a single node." ] ;
fhir:requirements [ fhir:v "Allows systems to highlight or otherwise guide users to elements implicated in issues to allow them to be fixed more easily." ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "*" ] ;
fhir:base [
fhir:path [ fhir:v "ClaimResponse.error.expression" ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "*" ]
] ;
fhir:type ( [
fhir:code [ fhir:v "string" ]
] ) ;
fhir:constraint ( [
fhir:key [ fhir:v "ele-1" ] ;
fhir:severity [ fhir:v "error" ] ;
fhir:human [ fhir:v "All FHIR elements must have a @value or children" ] ;
fhir:expression [ fhir:v "hasValue() or (children().count() > id.count())" ] ;
fhir:source [ fhir:v "http://hl7.org/fhir/StructureDefinition/Element" ]
] ) ;
fhir:mustSupport [ fhir:v "false" ] ;
fhir:isModifier [ fhir:v "false" ] ;
fhir:isSummary [ fhir:v "true" ]
] )
] ;
fhir:differential [
fhir:element ( [
fhir:id [ fhir:v "ClaimResponse" ] ;
fhir:path [ fhir:v "ClaimResponse" ] ;
fhir:short [ fhir:v "Response to a claim predetermination or preauthorization" ] ;
fhir:definition [ fhir:v "This resource provides the adjudication details from the processing of a Claim resource." ] ;
fhir:alias ( [ fhir:v "Remittance Advice" ] ) ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "*" ] ;
fhir:mustSupport [ fhir:v "false" ] ;
fhir:isModifier [ fhir:v "false" ] ;
fhir:mapping ( [
fhir:identity [ fhir:v "workflow" ] ;
fhir:map [ fhir:v "Event" ]
] [
fhir:identity [ fhir:v "w5" ] ;
fhir:map [ fhir:v "financial.billing" ]
] )
] [
fhir:id [ fhir:v "ClaimResponse.identifier" ] ;
fhir:path [ fhir:v "ClaimResponse.identifier" ] ;
fhir:short [ fhir:v "Business Identifier for a claim response" ] ;
fhir:definition [ fhir:v "A unique identifier assigned to this claim response." ] ;
fhir:requirements [ fhir:v "Allows claim responses to be distinguished and referenced." ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "*" ] ;
fhir:type ( [
fhir:code [ fhir:v "Identifier" ]
] ) ;
fhir:mustSupport [ fhir:v "false" ] ;
fhir:isModifier [ fhir:v "false" ] ;
fhir:isSummary [ fhir:v "false" ] ;
fhir:mapping ( [
fhir:identity [ fhir:v "workflow" ] ;
fhir:map [ fhir:v "Event.identifier" ]
] [
fhir:identity [ fhir:v "w5" ] ;
fhir:map [ fhir:v "FiveWs.identifier" ]
] )
] [
fhir:id [ fhir:v "ClaimResponse.traceNumber" ] ;
fhir:path [ fhir:v "ClaimResponse.traceNumber" ] ;
fhir:short [ fhir:v "Number for tracking" ] ;
fhir:definition [ fhir:v "Trace number for tracking purposes. May be defined at the jurisdiction level or between trading partners." ] ;
fhir:requirements [ fhir:v "Allows partners to uniquely identify components for tracking." ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "*" ] ;
fhir:type ( [
fhir:code [ fhir:v "Identifier" ]
] ) ;
fhir:mustSupport [ fhir:v "false" ] ;
fhir:isModifier [ fhir:v "false" ] ;
fhir:isSummary [ fhir:v "false" ]
] [
fhir:id [ fhir:v "ClaimResponse.status" ] ;
fhir:path [ fhir:v "ClaimResponse.status" ] ;
fhir:short [ fhir:v "active | cancelled | draft | entered-in-error" ] ;
fhir:definition [ fhir:v "The status of the resource instance." ] ;
fhir:comment [ fhir:v "This element is labeled as a modifier because the status contains codes that mark the resource as not currently valid." ] ;
fhir:requirements [ fhir:v "Need to track the status of the resource as 'draft' resources may undergo further edits while 'active' resources are immutable and may only have their status changed to 'cancelled'." ] ;
fhir:min [ fhir:v "1" ] ;
fhir:max [ fhir:v "1" ] ;
fhir:type ( [
fhir:code [ fhir:v "code" ]
] ) ;
fhir:mustSupport [ fhir:v "false" ] ;
fhir:isModifier [ fhir:v "true" ] ;
fhir:isModifierReason [ fhir:v "This element is labeled as a modifier because it is a status element that contains status entered-in-error which means that the resource should not be treated as valid" ] ;
fhir:isSummary [ fhir:v "true" ] ;
fhir:binding [
fhir:extension ( [
fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName" ] ;
fhir:value [ fhir:v "ClaimResponseStatus" ]
] ) ;
fhir:strength [ fhir:v "required" ] ;
fhir:description [ fhir:v "A code specifying the state of the resource instance." ] ;
fhir:valueSet [ fhir:v "http://hl7.org/fhir/ValueSet/fm-status|6.0.0-ballot2" ]
] ;
fhir:mapping ( [
fhir:identity [ fhir:v "workflow" ] ;
fhir:map [ fhir:v "Event.status" ]
] [
fhir:identity [ fhir:v "w5" ] ;
fhir:map [ fhir:v "FiveWs.status" ]
] )
] [
fhir:id [ fhir:v "ClaimResponse.type" ] ;
fhir:path [ fhir:v "ClaimResponse.type" ] ;
fhir:short [ fhir:v "More granular claim type" ] ;
fhir:definition [ fhir:v "A finer grained suite of claim type codes which may convey additional information such as Inpatient vs Outpatient and/or a specialty service." ] ;
fhir:comment [ fhir:v "This may contain the local bill type codes, for example the US UB-04 bill type code or the CMS bill type." ] ;
fhir:requirements [ fhir:v "Some jurisdictions need a finer grained claim type for routing and adjudication." ] ;
fhir:min [ fhir:v "1" ] ;
fhir:max [ fhir:v "1" ] ;
fhir:type ( [
fhir:code [ fhir:v "CodeableConcept" ]
] ) ;
fhir:mustSupport [ fhir:v "false" ] ;
fhir:isModifier [ fhir:v "false" ] ;
fhir:isSummary [ fhir:v "true" ] ;
fhir:binding [
fhir:extension ( [
fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName" ] ;
fhir:value [ fhir:v "ClaimType" ]
] ) ;
fhir:strength [ fhir:v "extensible" ] ;
fhir:description [ fhir:v "The type or discipline-style of the claim." ] ;
fhir:valueSet [ fhir:v "http://hl7.org/fhir/ValueSet/claim-type" ]
] ;
fhir:mapping ( [
fhir:identity [ fhir:v "w5" ] ;
fhir:map [ fhir:v "FiveWs.class" ]
] )
] [
fhir:id [ fhir:v "ClaimResponse.subType" ] ;
fhir:path [ fhir:v "ClaimResponse.subType" ] ;
fhir:short [ fhir:v "More granular claim type" ] ;
fhir:definition [ fhir:v "A finer grained suite of claim type codes which may convey additional information such as Inpatient vs Outpatient and/or a specialty service." ] ;
fhir:comment [ fhir:v "This may contain the local bill type codes, for example the US UB-04 bill type code or the CMS bill type." ] ;
fhir:requirements [ fhir:v "Some jurisdictions need a finer grained claim type for routing and adjudication." ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "1" ] ;
fhir:type ( [
fhir:code [ fhir:v "CodeableConcept" ]
] ) ;
fhir:mustSupport [ fhir:v "false" ] ;
fhir:isModifier [ fhir:v "false" ] ;
fhir:isSummary [ fhir:v "false" ] ;
fhir:binding [
fhir:extension ( [
fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName" ] ;
fhir:value [ fhir:v "ClaimSubType" ]
] ) ;
fhir:strength [ fhir:v "example" ] ;
fhir:description [ fhir:v "A more granular claim typecode." ] ;
fhir:valueSet [ fhir:v "http://hl7.org/fhir/ValueSet/claim-subtype" ]
] ;
fhir:mapping ( [
fhir:identity [ fhir:v "w5" ] ;
fhir:map [ fhir:v "FiveWs.class" ]
] )
] [
fhir:id [ fhir:v "ClaimResponse.use" ] ;
fhir:path [ fhir:v "ClaimResponse.use" ] ;
fhir:short [ fhir:v "claim | preauthorization | predetermination" ] ;
fhir:definition [ fhir:v "A code to indicate whether the nature of the request is: Claim - A request to an Insurer to adjudicate the supplied charges for health care goods and services under the identified policy and to pay the determined Benefit amount, if any; Preauthorization - A request to an Insurer to adjudicate the supplied proposed future charges for health care goods and services under the identified policy and to approve the services and provide the expected benefit amounts and potentially to reserve funds to pay the benefits when Claims for the indicated services are later submitted; or, Pre-determination - A request to an Insurer to adjudicate the supplied 'what if' charges for health care goods and services under the identified policy and report back what the Benefit payable would be had the services actually been provided." ] ;
fhir:requirements [ fhir:v "This element is required to understand the nature of the request for adjudication." ] ;
fhir:min [ fhir:v "1" ] ;
fhir:max [ fhir:v "1" ] ;
fhir:type ( [
fhir:code [ fhir:v "code" ]
] ) ;
fhir:mustSupport [ fhir:v "false" ] ;
fhir:isModifier [ fhir:v "false" ] ;
fhir:isSummary [ fhir:v "true" ] ;
fhir:binding [
fhir:extension ( [
fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName" ] ;
fhir:value [ fhir:v "Use" ]
] ) ;
fhir:strength [ fhir:v "required" ] ;
fhir:description [ fhir:v "Claim, preauthorization, predetermination." ] ;
fhir:valueSet [ fhir:v "http://hl7.org/fhir/ValueSet/claim-use|6.0.0-ballot2" ]
] ;
fhir:mapping ( [
fhir:identity [ fhir:v "w5" ] ;
fhir:map [ fhir:v "FiveWs.class" ]
] )
] [
fhir:id [ fhir:v "ClaimResponse.patient" ] ;
fhir:path [ fhir:v "ClaimResponse.patient" ] ;
fhir:short [ fhir:v "The recipient of the products and services" ] ;
fhir:definition [ fhir:v "The party to whom the professional services and/or products have been supplied or are being considered and for whom actual for facast reimbursement is sought." ] ;
fhir:requirements [ fhir:v "The patient must be supplied to the insurer so that confirmation of coverage and service hstory may be considered as part of the authorization and/or adjudiction." ] ;
fhir:min [ fhir:v "1" ] ;
fhir:max [ fhir:v "1" ] ;
fhir:type ( [
fhir:code [ fhir:v "Reference" ] ;
fhir:targetProfile ( [ fhir:v "http://hl7.org/fhir/StructureDefinition/Patient" ] )
] ) ;
fhir:mustSupport [ fhir:v "false" ] ;
fhir:isModifier [ fhir:v "false" ] ;
fhir:isSummary [ fhir:v "true" ] ;
fhir:mapping ( [
fhir:identity [ fhir:v "w5" ] ;
fhir:map [ fhir:v "FiveWs.subject[x]" ]
] )
] [
fhir:id [ fhir:v "ClaimResponse.created" ] ;
fhir:path [ fhir:v "ClaimResponse.created" ] ;
fhir:short [ fhir:v "Response creation date" ] ;
fhir:definition [ fhir:v "The date this resource was created." ] ;
fhir:requirements [ fhir:v "Need to record a timestamp for use by both the recipient and the issuer." ] ;
fhir:min [ fhir:v "1" ] ;
fhir:max [ fhir:v "1" ] ;
fhir:type ( [
fhir:code [ fhir:v "dateTime" ]
] ) ;
fhir:mustSupport [ fhir:v "false" ] ;
fhir:isModifier [ fhir:v "false" ] ;
fhir:isSummary [ fhir:v "true" ] ;
fhir:mapping ( [
fhir:identity [ fhir:v "workflow" ] ;
fhir:map [ fhir:v "Event.occurrence[x]" ]
] [
fhir:identity [ fhir:v "w5" ] ;
fhir:map [ fhir:v "FiveWs.recorded" ]
] )
] [
fhir:id [ fhir:v "ClaimResponse.insurer" ] ;
fhir:path [ fhir:v "ClaimResponse.insurer" ] ;
fhir:short [ fhir:v "Party responsible for reimbursement" ] ;
fhir:definition [ fhir:v "The party responsible for authorization, adjudication and reimbursement." ] ;
fhir:requirements [ fhir:v "To be a valid claim, preauthorization or predetermination there must be a party who is responsible for adjudicating the contents against a policy which provides benefits for the patient." ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "1" ] ;
fhir:type ( [
fhir:code [ fhir:v "Reference" ] ;
fhir:targetProfile ( [ fhir:v "http://hl7.org/fhir/StructureDefinition/Organization" ] )
] ) ;
fhir:mustSupport [ fhir:v "false" ] ;
fhir:isModifier [ fhir:v "false" ] ;
fhir:isSummary [ fhir:v "true" ] ;
fhir:mapping ( [
fhir:identity [ fhir:v "workflow" ] ;
fhir:map [ fhir:v "Event.performer" ]
] )
] [
fhir:id [ fhir:v "ClaimResponse.requestor" ] ;
fhir:path [ fhir:v "ClaimResponse.requestor" ] ;
fhir:short [ fhir:v "Party responsible for the claim" ] ;
fhir:definition [ fhir:v "The provider which is responsible for the claim, predetermination or preauthorization." ] ;
fhir:comment [ fhir:v "Typically this field would be 1..1 where this party is accountable for the data content within the claim but is not necessarily the facility, provider group or practitioner who provided the products and services listed within this claim resource. This field is the Billing Provider, for example, a facility, provider group, lab or practitioner.." ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "1" ] ;
fhir:type ( [
fhir:code [ fhir:v "Reference" ] ;
fhir:targetProfile ( [ fhir:v "http://hl7.org/fhir/StructureDefinition/Practitioner" ] [ fhir:v "http://hl7.org/fhir/StructureDefinition/PractitionerRole" ] [ fhir:v "http://hl7.org/fhir/StructureDefinition/Organization" ] )
] ) ;
fhir:mustSupport [ fhir:v "false" ] ;
fhir:isModifier [ fhir:v "false" ] ;
fhir:isSummary [ fhir:v "false" ] ;
fhir:mapping ( [
fhir:identity [ fhir:v "w5" ] ;
fhir:map [ fhir:v "FiveWs.source" ]
] )
] [
fhir:id [ fhir:v "ClaimResponse.request" ] ;
fhir:path [ fhir:v "ClaimResponse.request" ] ;
fhir:short [ fhir:v "Id of resource triggering adjudication" ] ;
fhir:definition [ fhir:v "Original request resource reference." ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "1" ] ;
fhir:type ( [
fhir:code [ fhir:v "Reference" ] ;
fhir:targetProfile ( [ fhir:v "http://hl7.org/fhir/StructureDefinition/Claim" ] )
] ) ;
fhir:mustSupport [ fhir:v "false" ] ;
fhir:isModifier [ fhir:v "false" ] ;
fhir:isSummary [ fhir:v "true" ] ;
fhir:mapping ( [
fhir:identity [ fhir:v "workflow" ] ;
fhir:map [ fhir:v "Event.basedOn" ]
] [
fhir:identity [ fhir:v "w5" ] ;
fhir:map [ fhir:v "FiveWs.why[x]" ]
] )
] [
fhir:id [ fhir:v "ClaimResponse.outcome" ] ;
fhir:path [ fhir:v "ClaimResponse.outcome" ] ;
fhir:short [ fhir:v "queued | complete | error | partial" ] ;
fhir:definition [ fhir:v "The outcome of the claim, predetermination, or preauthorization processing." ] ;
fhir:comment [ fhir:v "The resource may be used to indicate that the Claim/Preauthorization/Pre-determination has been received but processing has not begun (queued); that it has been processed and one or more errors have been detected (error); no errors were detected and some of the adjudication processing has been performed (partial); or all of the adjudication processing has completed without errors (complete)." ] ;
fhir:requirements [ fhir:v "To advise the requestor of an overall processing outcome." ] ;
fhir:min [ fhir:v "1" ] ;
fhir:max [ fhir:v "1" ] ;
fhir:type ( [
fhir:code [ fhir:v "code" ]
] ) ;
fhir:mustSupport [ fhir:v "false" ] ;
fhir:isModifier [ fhir:v "false" ] ;
fhir:isSummary [ fhir:v "true" ] ;
fhir:binding [
fhir:extension ( [
fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName" ] ;
fhir:value [ fhir:v "RemittanceOutcome" ]
] ) ;
fhir:strength [ fhir:v "required" ] ;
fhir:description [ fhir:v "The result of the claim processing." ] ;
fhir:valueSet [ fhir:v "http://hl7.org/fhir/ValueSet/claim-outcome|6.0.0-ballot2" ]
]
] [
fhir:id [ fhir:v "ClaimResponse.decision" ] ;
fhir:path [ fhir:v "ClaimResponse.decision" ] ;
fhir:short [ fhir:v "Result of the adjudication" ] ;
fhir:definition [ fhir:v "The result of the claim, predetermination, or preauthorization adjudication." ] ;
fhir:comment [ fhir:v "The element is used to indicate the current state of the adjudication overall for the claim resource, for example: the request has been held (pended) for adjudication processing, for manual review or other reasons; that it has been processed and will be paid, or the outstanding paid, as submitted (approved); that no amount will be paid (denied); or that some amount between zero and the submitted amount will be paid (partial)." ] ;
fhir:requirements [ fhir:v "To advise the requestor of the result of the adjudication process." ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "1" ] ;
fhir:type ( [
fhir:code [ fhir:v "CodeableConcept" ]
] ) ;
fhir:mustSupport [ fhir:v "false" ] ;
fhir:isModifier [ fhir:v "false" ] ;
fhir:isSummary [ fhir:v "true" ] ;
fhir:binding [
fhir:extension ( [
fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName" ] ;
fhir:value [ fhir:v "AdjudicationDecision" ]
] ) ;
fhir:strength [ fhir:v "example" ] ;
fhir:description [ fhir:v "The overall result of the claim adjudication." ] ;
fhir:valueSet [ fhir:v "http://hl7.org/fhir/ValueSet/claim-decision" ]
]
] [
fhir:id [ fhir:v "ClaimResponse.disposition" ] ;
fhir:path [ fhir:v "ClaimResponse.disposition" ] ;
fhir:short [ fhir:v "Disposition Message" ] ;
fhir:definition [ fhir:v "A human readable description of the status of the adjudication." ] ;
fhir:requirements [ fhir:v "Provided for user display." ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "1" ] ;
fhir:type ( [
fhir:code [ fhir:v "string" ]
] ) ;
fhir:mustSupport [ fhir:v "false" ] ;
fhir:isModifier [ fhir:v "false" ] ;
fhir:isSummary [ fhir:v "false" ] ;
fhir:mapping ( [
fhir:identity [ fhir:v "workflow" ] ;
fhir:map [ fhir:v "Event.note" ]
] )
] [
fhir:id [ fhir:v "ClaimResponse.preAuthRef" ] ;
fhir:path [ fhir:v "ClaimResponse.preAuthRef" ] ;
fhir:short [ fhir:v "Preauthorization reference" ] ;
fhir:definition [ fhir:v "Reference from the Insurer which is used in later communications which refers to this adjudication." ] ;
fhir:comment [ fhir:v "This value is only present on preauthorization adjudications." ] ;
fhir:requirements [ fhir:v "On subsequent claims, the insurer may require the provider to quote this value." ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "1" ] ;
fhir:type ( [
fhir:code [ fhir:v "string" ]
] ) ;
fhir:mustSupport [ fhir:v "false" ] ;
fhir:isModifier [ fhir:v "false" ] ;
fhir:isSummary [ fhir:v "false" ]
] [
fhir:id [ fhir:v "ClaimResponse.preAuthPeriod" ] ;
fhir:path [ fhir:v "ClaimResponse.preAuthPeriod" ] ;
fhir:short [ fhir:v "Preauthorization reference effective period" ] ;
fhir:definition [ fhir:v "The time frame during which this authorization is effective." ] ;
fhir:requirements [ fhir:v "To convey to the provider when the authorized products and services must be supplied for the authorized adjudication to apply." ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "1" ] ;
fhir:type ( [
fhir:code [ fhir:v "Period" ]
] ) ;
fhir:mustSupport [ fhir:v "false" ] ;
fhir:isModifier [ fhir:v "false" ] ;
fhir:isSummary [ fhir:v "false" ]
] [
fhir:id [ fhir:v "ClaimResponse.event" ] ;
fhir:path [ fhir:v "ClaimResponse.event" ] ;
fhir:short [ fhir:v "Event information" ] ;
fhir:definition [ fhir:v "Information code for an event with a corresponding date or period." ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "*" ] ;
fhir:type ( [
fhir:code [ fhir:v "BackboneElement" ]
] ) ;
fhir:mustSupport [ fhir:v "false" ] ;
fhir:isModifier [ fhir:v "false" ] ;
fhir:isSummary [ fhir:v "false" ]
] [
fhir:id [ fhir:v "ClaimResponse.event.type" ] ;
fhir:path [ fhir:v "ClaimResponse.event.type" ] ;
fhir:short [ fhir:v "Specific event" ] ;
fhir:definition [ fhir:v "A coded event such as when a service is expected or a card printed." ] ;
fhir:min [ fhir:v "1" ] ;
fhir:max [ fhir:v "1" ] ;
fhir:type ( [
fhir:code [ fhir:v "CodeableConcept" ]
] ) ;
fhir:mustSupport [ fhir:v "false" ] ;
fhir:isModifier [ fhir:v "false" ] ;
fhir:isSummary [ fhir:v "false" ] ;
fhir:binding [
fhir:extension ( [
fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName" ] ;
fhir:value [ fhir:v "DatesType" ]
] ) ;
fhir:strength [ fhir:v "example" ] ;
fhir:valueSet [ fhir:v "http://hl7.org/fhir/ValueSet/datestype" ]
]
] [
fhir:id [ fhir:v "ClaimResponse.event.when[x]" ] ;
fhir:path [ fhir:v "ClaimResponse.event.when[x]" ] ;
fhir:short [ fhir:v "Occurance date or period" ] ;
fhir:definition [ fhir:v "A date or period in the past or future indicating when the event occurred or is expectd to occur." ] ;
fhir:min [ fhir:v "1" ] ;
fhir:max [ fhir:v "1" ] ;
fhir:type ( [
fhir:code [ fhir:v "dateTime" ]
] [
fhir:code [ fhir:v "Period" ]
] ) ;
fhir:mustSupport [ fhir:v "false" ] ;
fhir:isModifier [ fhir:v "false" ] ;
fhir:isSummary [ fhir:v "false" ]
] [
fhir:id [ fhir:v "ClaimResponse.payeeType" ] ;
fhir:path [ fhir:v "ClaimResponse.payeeType" ] ;
fhir:short [ fhir:v "Party to be paid any benefits payable" ] ;
fhir:definition [ fhir:v "Type of Party to be reimbursed: subscriber, provider, other." ] ;
fhir:requirements [ fhir:v "Need to know who should receive payment with the most common situations being the Provider (assignment of benefits) or the Subscriber." ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "1" ] ;
fhir:type ( [
fhir:code [ fhir:v "CodeableConcept" ]
] ) ;
fhir:mustSupport [ fhir:v "false" ] ;
fhir:isModifier [ fhir:v "false" ] ;
fhir:isSummary [ fhir:v "false" ] ;
fhir:binding [
fhir:extension ( [
fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName" ] ;
fhir:value [ fhir:v "PayeeType" ]
] [
fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/elementdefinition-isCommonBinding" ] ;
fhir:value [ fhir:v "true" ]
] ) ;
fhir:strength [ fhir:v "example" ] ;
fhir:description [ fhir:v "A code for the party to be reimbursed." ] ;
fhir:valueSet [ fhir:v "http://hl7.org/fhir/ValueSet/payeetype" ]
]
] [
fhir:id [ fhir:v "ClaimResponse.encounter" ] ;
fhir:path [ fhir:v "ClaimResponse.encounter" ] ;
fhir:short [ fhir:v "Encounters associated with the listed treatments" ] ;
fhir:definition [ fhir:v "Healthcare encounters related to this claim." ] ;
fhir:comment [ fhir:v "This will typically be the encounter the event occurred within, but some activities may be initiated prior to or after the official completion of an encounter but still be tied to the context of the encounter." ] ;
fhir:requirements [ fhir:v "Used in some jurisdictions to link clinical events to claim items." ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "*" ] ;
fhir:type ( [
fhir:code [ fhir:v "Reference" ] ;
fhir:targetProfile ( [ fhir:v "http://hl7.org/fhir/StructureDefinition/Encounter" ] )
] ) ;
fhir:mustSupport [ fhir:v "false" ] ;
fhir:isModifier [ fhir:v "false" ] ;
fhir:isSummary [ fhir:v "false" ]
] [
fhir:id [ fhir:v "ClaimResponse.diagnosisRelatedGroup" ] ;
fhir:path [ fhir:v "ClaimResponse.diagnosisRelatedGroup" ] ;
fhir:short [ fhir:v "Package billing code" ] ;
fhir:definition [ fhir:v "A package billing code or bundle code used to group products and services to a particular health condition (such as heart attack) which is based on a predetermined grouping code system." ] ;
fhir:comment [ fhir:v "For example DRG (Diagnosis Related Group) or a bundled billing code. A patient may have a diagnosis of a Myocardial Infarction and a DRG for HeartAttack would be assigned. The Claim item (and possible subsequent claims) would refer to the DRG for those line items that were for services related to the heart attack event." ] ;
fhir:requirements [ fhir:v "Required to relate the current diagnosis to a package billing code that is then referenced on the individual claim items which are specific to the health condition covered by the package code." ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "1" ] ;
fhir:type ( [
fhir:code [ fhir:v "CodeableConcept" ]
] ) ;
fhir:mustSupport [ fhir:v "false" ] ;
fhir:isModifier [ fhir:v "false" ] ;
fhir:isSummary [ fhir:v "false" ] ;
fhir:binding [
fhir:extension ( [
fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName" ] ;
fhir:value [ fhir:v "DiagnosisRelatedGroup" ]
] ) ;
fhir:strength [ fhir:v "example" ] ;
fhir:valueSet [ fhir:v "http://hl7.org/fhir/ValueSet/ex-diagnosisrelatedgroup" ]
]
] [
fhir:id [ fhir:v "ClaimResponse.item" ] ;
fhir:extension ( [
fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/structuredefinition-explicit-type-name" ] ;
fhir:value [ fhir:v "Item" ]
] ) ;
fhir:path [ fhir:v "ClaimResponse.item" ] ;
fhir:short [ fhir:v "Adjudication for claim line items" ] ;
fhir:definition [ fhir:v "A claim line. Either a simple (a product or service) or a 'group' of details which can also be a simple items or groups of sub-details." ] ;
fhir:requirements [ fhir:v "The adjudication for items provided on the claim." ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "*" ] ;
fhir:type ( [
fhir:code [ fhir:v "BackboneElement" ]
] ) ;
fhir:mustSupport [ fhir:v "false" ] ;
fhir:isModifier [ fhir:v "false" ] ;
fhir:isSummary [ fhir:v "false" ]
] [
fhir:id [ fhir:v "ClaimResponse.item.itemSequence" ] ;
fhir:path [ fhir:v "ClaimResponse.item.itemSequence" ] ;
fhir:short [ fhir:v "Claim item instance identifier" ] ;
fhir:definition [ fhir:v "A number to uniquely reference the claim item entries." ] ;
fhir:requirements [ fhir:v "Necessary to provide a mechanism to link the adjudication result to the submitted claim item." ] ;
fhir:min [ fhir:v "1" ] ;
fhir:max [ fhir:v "1" ] ;
fhir:type ( [
fhir:code [ fhir:v "positiveInt" ]
] ) ;
fhir:mustSupport [ fhir:v "false" ] ;
fhir:isModifier [ fhir:v "false" ] ;
fhir:isSummary [ fhir:v "false" ]
] [
fhir:id [ fhir:v "ClaimResponse.item.traceNumber" ] ;
fhir:path [ fhir:v "ClaimResponse.item.traceNumber" ] ;
fhir:short [ fhir:v "Number for tracking" ] ;
fhir:definition [ fhir:v "Trace number for tracking purposes. May be defined at the jurisdiction level or between trading partners." ] ;
fhir:requirements [ fhir:v "Allows partners to uniquely identify components for tracking." ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "*" ] ;
fhir:type ( [
fhir:code [ fhir:v "Identifier" ]
] ) ;
fhir:mustSupport [ fhir:v "false" ] ;
fhir:isModifier [ fhir:v "false" ] ;
fhir:isSummary [ fhir:v "false" ]
] [
fhir:id [ fhir:v "ClaimResponse.item.noteNumber" ] ;
fhir:path [ fhir:v "ClaimResponse.item.noteNumber" ] ;
fhir:short [ fhir:v "Applicable note numbers" ] ;
fhir:definition [ fhir:v "The numbers associated with notes below which apply to the adjudication of this item." ] ;
fhir:requirements [ fhir:v "Provides a condensed manner for associating human readable descriptive explanations for adjudications on the line item." ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "*" ] ;
fhir:type ( [
fhir:code [ fhir:v "positiveInt" ]
] ) ;
fhir:mustSupport [ fhir:v "false" ] ;
fhir:isModifier [ fhir:v "false" ] ;
fhir:isSummary [ fhir:v "false" ]
] [
fhir:id [ fhir:v "ClaimResponse.item.reviewOutcome" ] ;
fhir:extension ( [
fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/structuredefinition-explicit-type-name" ] ;
fhir:value [ fhir:v "ReviewOutcome" ]
] ) ;
fhir:path [ fhir:v "ClaimResponse.item.reviewOutcome" ] ;
fhir:short [ fhir:v "Adjudication results" ] ;
fhir:definition [ fhir:v "The high-level results of the adjudication if adjudication has been performed." ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "1" ] ;
fhir:type ( [
fhir:code [ fhir:v "BackboneElement" ]
] ) ;
fhir:mustSupport [ fhir:v "false" ] ;
fhir:isModifier [ fhir:v "false" ] ;
fhir:isSummary [ fhir:v "false" ]
] [
fhir:id [ fhir:v "ClaimResponse.item.reviewOutcome.decision" ] ;
fhir:path [ fhir:v "ClaimResponse.item.reviewOutcome.decision" ] ;
fhir:short [ fhir:v "Result of the adjudication" ] ;
fhir:definition [ fhir:v "The result of the claim, predetermination, or preauthorization adjudication." ] ;
fhir:comment [ fhir:v "The element is used to indicate the current state of the adjudication overall for the claim resource, for example: the request has been held (pended) for adjudication processing, for manual review or other reasons; that it has been processed and will be paid, or the outstanding paid, as submitted (approved); that no amount will be paid (denied); or that some amount between zero and the submitted amount will be paid (partial)." ] ;
fhir:requirements [ fhir:v "To advise the requestor of the result of the adjudication process." ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "1" ] ;
fhir:type ( [
fhir:code [ fhir:v "CodeableConcept" ]
] ) ;
fhir:mustSupport [ fhir:v "false" ] ;
fhir:isModifier [ fhir:v "false" ] ;
fhir:isSummary [ fhir:v "false" ] ;
fhir:binding [
fhir:extension ( [
fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName" ] ;
fhir:value [ fhir:v "AdjudicationDecision" ]
] ) ;
fhir:strength [ fhir:v "example" ] ;
fhir:valueSet [ fhir:v "http://hl7.org/fhir/ValueSet/claim-decision" ]
]
] [
fhir:id [ fhir:v "ClaimResponse.item.reviewOutcome.reason" ] ;
fhir:path [ fhir:v "ClaimResponse.item.reviewOutcome.reason" ] ;
fhir:short [ fhir:v "Reason for result of the adjudication" ] ;
fhir:definition [ fhir:v "The reasons for the result of the claim, predetermination, or preauthorization adjudication." ] ;
fhir:requirements [ fhir:v "To advise the requestor of the contributors to the result of the adjudication process." ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "*" ] ;
fhir:type ( [
fhir:code [ fhir:v "CodeableConcept" ]
] ) ;
fhir:mustSupport [ fhir:v "false" ] ;
fhir:isModifier [ fhir:v "false" ] ;
fhir:isSummary [ fhir:v "false" ] ;
fhir:binding [
fhir:extension ( [
fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName" ] ;
fhir:value [ fhir:v "AdjudicationDecisionReason" ]
] ) ;
fhir:strength [ fhir:v "example" ] ;
fhir:valueSet [ fhir:v "http://hl7.org/fhir/ValueSet/claim-decision-reason" ]
]
] [
fhir:id [ fhir:v "ClaimResponse.item.reviewOutcome.preAuthRef" ] ;
fhir:path [ fhir:v "ClaimResponse.item.reviewOutcome.preAuthRef" ] ;
fhir:short [ fhir:v "Preauthorization reference" ] ;
fhir:definition [ fhir:v "Reference from the Insurer which is used in later communications which refers to this adjudication." ] ;
fhir:comment [ fhir:v "This value is only present on preauthorization adjudications." ] ;
fhir:requirements [ fhir:v "On subsequent claims, the insurer may require the provider to quote this value." ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "1" ] ;
fhir:type ( [
fhir:code [ fhir:v "string" ]
] ) ;
fhir:mustSupport [ fhir:v "false" ] ;
fhir:isModifier [ fhir:v "false" ] ;
fhir:isSummary [ fhir:v "false" ]
] [
fhir:id [ fhir:v "ClaimResponse.item.reviewOutcome.preAuthPeriod" ] ;
fhir:path [ fhir:v "ClaimResponse.item.reviewOutcome.preAuthPeriod" ] ;
fhir:short [ fhir:v "Preauthorization reference effective period" ] ;
fhir:definition [ fhir:v "The time frame during which this authorization is effective." ] ;
fhir:requirements [ fhir:v "To convey to the provider when the authorized products and services must be supplied for the authorized adjudication to apply." ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "1" ] ;
fhir:type ( [
fhir:code [ fhir:v "Period" ]
] ) ;
fhir:mustSupport [ fhir:v "false" ] ;
fhir:isModifier [ fhir:v "false" ] ;
fhir:isSummary [ fhir:v "false" ]
] [
fhir:id [ fhir:v "ClaimResponse.item.adjudication" ] ;
fhir:extension ( [
fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/structuredefinition-explicit-type-name" ] ;
fhir:value [ fhir:v "Adjudication" ]
] ) ;
fhir:path [ fhir:v "ClaimResponse.item.adjudication" ] ;
fhir:short [ fhir:v "Adjudication details" ] ;
fhir:definition [ fhir:v "If this item is a group then the values here are a summary of the adjudication of the detail items. If this item is a simple product or service then this is the result of the adjudication of this item." ] ;
fhir:requirements [ fhir:v "The adjudication results conveys the insurer's assessment of the item provided in the claim under the terms of the patient's insurance coverage." ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "*" ] ;
fhir:type ( [
fhir:code [ fhir:v "BackboneElement" ]
] ) ;
fhir:mustSupport [ fhir:v "false" ] ;
fhir:isModifier [ fhir:v "false" ] ;
fhir:isSummary [ fhir:v "false" ]
] [
fhir:id [ fhir:v "ClaimResponse.item.adjudication.category" ] ;
fhir:path [ fhir:v "ClaimResponse.item.adjudication.category" ] ;
fhir:short [ fhir:v "Type of adjudication information" ] ;
fhir:definition [ fhir:v "A code to indicate the information type of this adjudication record. Information types may include the value submitted, maximum values or percentages allowed or payable under the plan, amounts that: the patient is responsible for in aggregate or pertaining to this item; amounts paid by other coverages; and, the benefit payable for this item." ] ;
fhir:comment [ fhir:v "For example codes indicating: Co-Pay, deductible, eligible, benefit, tax, etc." ] ;
fhir:requirements [ fhir:v "Needed to enable understanding of the context of the other information in the adjudication." ] ;
fhir:min [ fhir:v "1" ] ;
fhir:max [ fhir:v "1" ] ;
fhir:type ( [
fhir:code [ fhir:v "CodeableConcept" ]
] ) ;
fhir:mustSupport [ fhir:v "false" ] ;
fhir:isModifier [ fhir:v "false" ] ;
fhir:isSummary [ fhir:v "false" ] ;
fhir:binding [
fhir:extension ( [
fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName" ] ;
fhir:value [ fhir:v "Adjudication" ]
] ) ;
fhir:strength [ fhir:v "example" ] ;
fhir:description [ fhir:v "The adjudication codes." ] ;
fhir:valueSet [ fhir:v "http://hl7.org/fhir/ValueSet/adjudication" ]
]
] [
fhir:id [ fhir:v "ClaimResponse.item.adjudication.reason" ] ;
fhir:path [ fhir:v "ClaimResponse.item.adjudication.reason" ] ;
fhir:short [ fhir:v "Explanation of adjudication outcome" ] ;
fhir:definition [ fhir:v "A code supporting the understanding of the adjudication result and explaining variance from expected amount." ] ;
fhir:comment [ fhir:v "For example may indicate that the funds for this benefit type have been exhausted." ] ;
fhir:requirements [ fhir:v "To support understanding of variance from adjudication expectations." ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "1" ] ;
fhir:type ( [
fhir:code [ fhir:v "CodeableConcept" ]
] ) ;
fhir:mustSupport [ fhir:v "false" ] ;
fhir:isModifier [ fhir:v "false" ] ;
fhir:isSummary [ fhir:v "false" ] ;
fhir:binding [
fhir:extension ( [
fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName" ] ;
fhir:value [ fhir:v "AdjudicationReason" ]
] ) ;
fhir:strength [ fhir:v "example" ] ;
fhir:description [ fhir:v "The adjudication reason codes." ] ;
fhir:valueSet [ fhir:v "http://hl7.org/fhir/ValueSet/adjudication-reason" ]
]
] [
fhir:id [ fhir:v "ClaimResponse.item.adjudication.amount" ] ;
fhir:path [ fhir:v "ClaimResponse.item.adjudication.amount" ] ;
fhir:short [ fhir:v "Monetary amount" ] ;
fhir:definition [ fhir:v "Monetary amount associated with the category." ] ;
fhir:comment [ fhir:v "For example: amount submitted, eligible amount, co-payment, and benefit payable." ] ;
fhir:requirements [ fhir:v "Most adjudication categories convey a monetary amount." ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "1" ] ;
fhir:type ( [
fhir:code [ fhir:v "Money" ]
] ) ;
fhir:mustSupport [ fhir:v "false" ] ;
fhir:isModifier [ fhir:v "false" ] ;
fhir:isSummary [ fhir:v "false" ]
] [
fhir:id [ fhir:v "ClaimResponse.item.adjudication.quantity" ] ;
fhir:path [ fhir:v "ClaimResponse.item.adjudication.quantity" ] ;
fhir:short [ fhir:v "Non-monetary value" ] ;
fhir:definition [ fhir:v "A non-monetary value associated with the category. Mutually exclusive to the amount element above." ] ;
fhir:comment [ fhir:v "For example: eligible percentage or co-payment percentage." ] ;
fhir:requirements [ fhir:v "Some adjudication categories convey a percentage or a fixed value." ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "1" ] ;
fhir:type ( [
fhir:code [ fhir:v "Quantity" ]
] ) ;
fhir:mustSupport [ fhir:v "false" ] ;
fhir:isModifier [ fhir:v "false" ] ;
fhir:isSummary [ fhir:v "false" ]
] [
fhir:id [ fhir:v "ClaimResponse.item.detail" ] ;
fhir:extension ( [
fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/structuredefinition-explicit-type-name" ] ;
fhir:value [ fhir:v "ItemDetail" ]
] ) ;
fhir:path [ fhir:v "ClaimResponse.item.detail" ] ;
fhir:short [ fhir:v "Adjudication for claim details" ] ;
fhir:definition [ fhir:v "A claim detail. Either a simple (a product or service) or a 'group' of sub-details which are simple items." ] ;
fhir:requirements [ fhir:v "The adjudication for details provided on the claim." ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "*" ] ;
fhir:type ( [
fhir:code [ fhir:v "BackboneElement" ]
] ) ;
fhir:mustSupport [ fhir:v "false" ] ;
fhir:isModifier [ fhir:v "false" ] ;
fhir:isSummary [ fhir:v "false" ]
] [
fhir:id [ fhir:v "ClaimResponse.item.detail.detailSequence" ] ;
fhir:path [ fhir:v "ClaimResponse.item.detail.detailSequence" ] ;
fhir:short [ fhir:v "Claim detail instance identifier" ] ;
fhir:definition [ fhir:v "A number to uniquely reference the claim detail entry." ] ;
fhir:requirements [ fhir:v "Necessary to provide a mechanism to link the adjudication result to the submitted claim detail." ] ;
fhir:min [ fhir:v "1" ] ;
fhir:max [ fhir:v "1" ] ;
fhir:type ( [
fhir:code [ fhir:v "positiveInt" ]
] ) ;
fhir:mustSupport [ fhir:v "false" ] ;
fhir:isModifier [ fhir:v "false" ] ;
fhir:isSummary [ fhir:v "false" ]
] [
fhir:id [ fhir:v "ClaimResponse.item.detail.traceNumber" ] ;
fhir:path [ fhir:v "ClaimResponse.item.detail.traceNumber" ] ;
fhir:short [ fhir:v "Number for tracking" ] ;
fhir:definition [ fhir:v "Trace number for tracking purposes. May be defined at the jurisdiction level or between trading partners." ] ;
fhir:requirements [ fhir:v "Allows partners to uniquely identify components for tracking." ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "*" ] ;
fhir:type ( [
fhir:code [ fhir:v "Identifier" ]
] ) ;
fhir:mustSupport [ fhir:v "false" ] ;
fhir:isModifier [ fhir:v "false" ] ;
fhir:isSummary [ fhir:v "false" ]
] [
fhir:id [ fhir:v "ClaimResponse.item.detail.noteNumber" ] ;
fhir:path [ fhir:v "ClaimResponse.item.detail.noteNumber" ] ;
fhir:short [ fhir:v "Applicable note numbers" ] ;
fhir:definition [ fhir:v "The numbers associated with notes below which apply to the adjudication of this item." ] ;
fhir:requirements [ fhir:v "Provides a condensed manner for associating human readable descriptive explanations for adjudications on the line item." ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "*" ] ;
fhir:type ( [
fhir:code [ fhir:v "positiveInt" ]
] ) ;
fhir:mustSupport [ fhir:v "false" ] ;
fhir:isModifier [ fhir:v "false" ] ;
fhir:isSummary [ fhir:v "false" ]
] [
fhir:id [ fhir:v "ClaimResponse.item.detail.reviewOutcome" ] ;
fhir:path [ fhir:v "ClaimResponse.item.detail.reviewOutcome" ] ;
fhir:short [ fhir:v "Detail level adjudication results" ] ;
fhir:definition [ fhir:v "The high-level results of the adjudication if adjudication has been performed." ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "1" ] ;
fhir:contentReference [ fhir:v "#ClaimResponse.item.reviewOutcome" ] ;
fhir:mustSupport [ fhir:v "false" ] ;
fhir:isModifier [ fhir:v "false" ] ;
fhir:isSummary [ fhir:v "false" ]
] [
fhir:id [ fhir:v "ClaimResponse.item.detail.adjudication" ] ;
fhir:path [ fhir:v "ClaimResponse.item.detail.adjudication" ] ;
fhir:short [ fhir:v "Detail level adjudication details" ] ;
fhir:definition [ fhir:v "The adjudication results." ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "*" ] ;
fhir:contentReference [ fhir:v "#ClaimResponse.item.adjudication" ] ;
fhir:mustSupport [ fhir:v "false" ] ;
fhir:isModifier [ fhir:v "false" ] ;
fhir:isSummary [ fhir:v "false" ]
] [
fhir:id [ fhir:v "ClaimResponse.item.detail.subDetail" ] ;
fhir:extension ( [
fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/structuredefinition-explicit-type-name" ] ;
fhir:value [ fhir:v "SubDetail" ]
] ) ;
fhir:path [ fhir:v "ClaimResponse.item.detail.subDetail" ] ;
fhir:short [ fhir:v "Adjudication for claim sub-details" ] ;
fhir:definition [ fhir:v "A sub-detail adjudication of a simple product or service." ] ;
fhir:requirements [ fhir:v "The adjudication for sub-details provided on the claim." ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "*" ] ;
fhir:type ( [
fhir:code [ fhir:v "BackboneElement" ]
] ) ;
fhir:mustSupport [ fhir:v "false" ] ;
fhir:isModifier [ fhir:v "false" ] ;
fhir:isSummary [ fhir:v "false" ]
] [
fhir:id [ fhir:v "ClaimResponse.item.detail.subDetail.subDetailSequence" ] ;
fhir:path [ fhir:v "ClaimResponse.item.detail.subDetail.subDetailSequence" ] ;
fhir:short [ fhir:v "Claim sub-detail instance identifier" ] ;
fhir:definition [ fhir:v "A number to uniquely reference the claim sub-detail entry." ] ;
fhir:requirements [ fhir:v "Necessary to provide a mechanism to link the adjudication result to the submitted claim sub-detail." ] ;
fhir:min [ fhir:v "1" ] ;
fhir:max [ fhir:v "1" ] ;
fhir:type ( [
fhir:code [ fhir:v "positiveInt" ]
] ) ;
fhir:mustSupport [ fhir:v "false" ] ;
fhir:isModifier [ fhir:v "false" ] ;
fhir:isSummary [ fhir:v "false" ]
] [
fhir:id [ fhir:v "ClaimResponse.item.detail.subDetail.traceNumber" ] ;
fhir:path [ fhir:v "ClaimResponse.item.detail.subDetail.traceNumber" ] ;
fhir:short [ fhir:v "Number for tracking" ] ;
fhir:definition [ fhir:v "Trace number for tracking purposes. May be defined at the jurisdiction level or between trading partners." ] ;
fhir:requirements [ fhir:v "Allows partners to uniquely identify components for tracking." ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "*" ] ;
fhir:type ( [
fhir:code [ fhir:v "Identifier" ]
] ) ;
fhir:mustSupport [ fhir:v "false" ] ;
fhir:isModifier [ fhir:v "false" ] ;
fhir:isSummary [ fhir:v "false" ]
] [
fhir:id [ fhir:v "ClaimResponse.item.detail.subDetail.noteNumber" ] ;
fhir:path [ fhir:v "ClaimResponse.item.detail.subDetail.noteNumber" ] ;
fhir:short [ fhir:v "Applicable note numbers" ] ;
fhir:definition [ fhir:v "The numbers associated with notes below which apply to the adjudication of this item." ] ;
fhir:requirements [ fhir:v "Provides a condensed manner for associating human readable descriptive explanations for adjudications on the line item." ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "*" ] ;
fhir:type ( [
fhir:code [ fhir:v "positiveInt" ]
] ) ;
fhir:mustSupport [ fhir:v "false" ] ;
fhir:isModifier [ fhir:v "false" ] ;
fhir:isSummary [ fhir:v "false" ]
] [
fhir:id [ fhir:v "ClaimResponse.item.detail.subDetail.reviewOutcome" ] ;
fhir:path [ fhir:v "ClaimResponse.item.detail.subDetail.reviewOutcome" ] ;
fhir:short [ fhir:v "Subdetail level adjudication results" ] ;
fhir:definition [ fhir:v "The high-level results of the adjudication if adjudication has been performed." ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "1" ] ;
fhir:contentReference [ fhir:v "#ClaimResponse.item.reviewOutcome" ] ;
fhir:mustSupport [ fhir:v "false" ] ;
fhir:isModifier [ fhir:v "false" ] ;
fhir:isSummary [ fhir:v "false" ]
] [
fhir:id [ fhir:v "ClaimResponse.item.detail.subDetail.adjudication" ] ;
fhir:path [ fhir:v "ClaimResponse.item.detail.subDetail.adjudication" ] ;
fhir:short [ fhir:v "Subdetail level adjudication details" ] ;
fhir:definition [ fhir:v "The adjudication results." ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "*" ] ;
fhir:contentReference [ fhir:v "#ClaimResponse.item.adjudication" ] ;
fhir:mustSupport [ fhir:v "false" ] ;
fhir:isModifier [ fhir:v "false" ] ;
fhir:isSummary [ fhir:v "false" ]
] [
fhir:id [ fhir:v "ClaimResponse.addItem" ] ;
fhir:extension ( [
fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/structuredefinition-explicit-type-name" ] ;
fhir:value [ fhir:v "AddedItem" ]
] ) ;
fhir:path [ fhir:v "ClaimResponse.addItem" ] ;
fhir:short [ fhir:v "Insurer added line items" ] ;
fhir:definition [ fhir:v "The first-tier service adjudications for payor added product or service lines." ] ;
fhir:requirements [ fhir:v "Insurers may redefine the provided product or service or may package and/or decompose groups of products and services. The addItems allows the insurer to provide their line item list with linkage to the submitted items/details/sub-details. In a preauthorization the insurer may use the addItem structure to provide additional information on authorized products and services." ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "*" ] ;
fhir:type ( [
fhir:code [ fhir:v "BackboneElement" ]
] ) ;
fhir:mustSupport [ fhir:v "false" ] ;
fhir:isModifier [ fhir:v "false" ] ;
fhir:isSummary [ fhir:v "false" ]
] [
fhir:id [ fhir:v "ClaimResponse.addItem.itemSequence" ] ;
fhir:path [ fhir:v "ClaimResponse.addItem.itemSequence" ] ;
fhir:short [ fhir:v "Item sequence number" ] ;
fhir:definition [ fhir:v "Claim items which this service line is intended to replace." ] ;
fhir:requirements [ fhir:v "Provides references to the claim items." ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "*" ] ;
fhir:type ( [
fhir:code [ fhir:v "positiveInt" ]
] ) ;
fhir:mustSupport [ fhir:v "false" ] ;
fhir:isModifier [ fhir:v "false" ] ;
fhir:isSummary [ fhir:v "false" ]
] [
fhir:id [ fhir:v "ClaimResponse.addItem.detailSequence" ] ;
fhir:path [ fhir:v "ClaimResponse.addItem.detailSequence" ] ;
fhir:short [ fhir:v "Detail sequence number" ] ;
fhir:definition [ fhir:v "The sequence number of the details within the claim item which this line is intended to replace." ] ;
fhir:requirements [ fhir:v "Provides references to the claim details within the claim item." ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "*" ] ;
fhir:type ( [
fhir:code [ fhir:v "positiveInt" ]
] ) ;
fhir:mustSupport [ fhir:v "false" ] ;
fhir:isModifier [ fhir:v "false" ] ;
fhir:isSummary [ fhir:v "false" ]
] [
fhir:id [ fhir:v "ClaimResponse.addItem.subdetailSequence" ] ;
fhir:path [ fhir:v "ClaimResponse.addItem.subdetailSequence" ] ;
fhir:short [ fhir:v "Subdetail sequence number" ] ;
fhir:definition [ fhir:v "The sequence number of the sub-details within the details within the claim item which this line is intended to replace." ] ;
fhir:requirements [ fhir:v "Provides references to the claim sub-details within the claim detail." ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "*" ] ;
fhir:type ( [
fhir:code [ fhir:v "positiveInt" ]
] ) ;
fhir:mustSupport [ fhir:v "false" ] ;
fhir:isModifier [ fhir:v "false" ] ;
fhir:isSummary [ fhir:v "false" ]
] [
fhir:id [ fhir:v "ClaimResponse.addItem.traceNumber" ] ;
fhir:path [ fhir:v "ClaimResponse.addItem.traceNumber" ] ;
fhir:short [ fhir:v "Number for tracking" ] ;
fhir:definition [ fhir:v "Trace number for tracking purposes. May be defined at the jurisdiction level or between trading partners." ] ;
fhir:requirements [ fhir:v "Allows partners to uniquely identify components for tracking." ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "*" ] ;
fhir:type ( [
fhir:code [ fhir:v "Identifier" ]
] ) ;
fhir:mustSupport [ fhir:v "false" ] ;
fhir:isModifier [ fhir:v "false" ] ;
fhir:isSummary [ fhir:v "false" ]
] [
fhir:id [ fhir:v "ClaimResponse.addItem.provider" ] ;
fhir:path [ fhir:v "ClaimResponse.addItem.provider" ] ;
fhir:short [ fhir:v "Authorized providers" ] ;
fhir:definition [ fhir:v "The providers who are authorized for the services rendered to the patient." ] ;
fhir:requirements [ fhir:v "Insurer may provide authorization specifically to a restricted set of providers rather than an open authorization." ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "*" ] ;
fhir:type ( [
fhir:code [ fhir:v "Reference" ] ;
fhir:targetProfile ( [ fhir:v "http://hl7.org/fhir/StructureDefinition/Practitioner" ] [ fhir:v "http://hl7.org/fhir/StructureDefinition/PractitionerRole" ] [ fhir:v "http://hl7.org/fhir/StructureDefinition/Organization" ] )
] ) ;
fhir:mustSupport [ fhir:v "false" ] ;
fhir:isModifier [ fhir:v "false" ] ;
fhir:isSummary [ fhir:v "false" ] ;
fhir:mapping ( [
fhir:identity [ fhir:v "w5" ] ;
fhir:map [ fhir:v "FiveWs.source" ]
] )
] [
fhir:id [ fhir:v "ClaimResponse.addItem.revenue" ] ;
fhir:path [ fhir:v "ClaimResponse.addItem.revenue" ] ;
fhir:short [ fhir:v "Revenue or cost center code" ] ;
fhir:definition [ fhir:v "The type of revenue or cost center providing the product and/or service." ] ;
fhir:requirements [ fhir:v "Needed in the processing of institutional claims." ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "1" ] ;
fhir:type ( [
fhir:code [ fhir:v "CodeableConcept" ]
] ) ;
fhir:mustSupport [ fhir:v "false" ] ;
fhir:isModifier [ fhir:v "false" ] ;
fhir:isSummary [ fhir:v "false" ] ;
fhir:binding [
fhir:extension ( [
fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName" ] ;
fhir:value [ fhir:v "RevenueCenter" ]
] ) ;
fhir:strength [ fhir:v "example" ] ;
fhir:description [ fhir:v "Codes for the revenue or cost centers supplying the service and/or products." ] ;
fhir:valueSet [ fhir:v "http://hl7.org/fhir/ValueSet/ex-revenue-center" ]
]
] [
fhir:id [ fhir:v "ClaimResponse.addItem.productOrService" ] ;
fhir:path [ fhir:v "ClaimResponse.addItem.productOrService" ] ;
fhir:short [ fhir:v "Billing, service, product, or drug code" ] ;
fhir:definition [ fhir:v "When the value is a group code then this item collects a set of related item details, otherwise this contains the product, service, drug or other billing code for the item. This element may be the start of a range of .productOrService codes used in conjunction with .productOrServiceEnd or it may be a solo element where .productOrServiceEnd is not used." ] ;
fhir:comment [ fhir:v "If this is an actual service or product line, i.e. not a Group, then use code to indicate the Professional Service or Product supplied (e.g. CTP, HCPCS, USCLS, ICD10, NCPDP, DIN, RxNorm, ACHI, CCI). If a grouping item then use a group code to indicate the type of thing being grouped e.g. 'glasses' or 'compound'." ] ;
fhir:requirements [ fhir:v "Necessary to state what was provided or done." ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "1" ] ;
fhir:type ( [
fhir:code [ fhir:v "CodeableConcept" ]
] ) ;
fhir:mustSupport [ fhir:v "false" ] ;
fhir:isModifier [ fhir:v "false" ] ;
fhir:isSummary [ fhir:v "false" ] ;
fhir:binding [
fhir:extension ( [
fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName" ] ;
fhir:value [ fhir:v "ServiceProduct" ]
] ) ;
fhir:strength [ fhir:v "example" ] ;
fhir:description [ fhir:v "Allowable service and product codes." ] ;
fhir:valueSet [ fhir:v "http://hl7.org/fhir/ValueSet/service-uscls" ]
]
] [
fhir:id [ fhir:v "ClaimResponse.addItem.productOrServiceEnd" ] ;
fhir:path [ fhir:v "ClaimResponse.addItem.productOrServiceEnd" ] ;
fhir:short [ fhir:v "End of a range of codes" ] ;
fhir:definition [ fhir:v "This contains the end of a range of product, service, drug or other billing codes for the item. This element is not used when the .productOrService is a group code. This value may only be present when a .productOfService code has been provided to convey the start of the range. Typically this value may be used only with preauthorizations and not with claims." ] ;
fhir:alias ( [ fhir:v "End of a range of Drug Code; Bill Code; Service Cod" ] ) ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "1" ] ;
fhir:type ( [
fhir:code [ fhir:v "CodeableConcept" ]
] ) ;
fhir:mustSupport [ fhir:v "false" ] ;
fhir:isModifier [ fhir:v "false" ] ;
fhir:isSummary [ fhir:v "false" ] ;
fhir:binding [
fhir:extension ( [
fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName" ] ;
fhir:value [ fhir:v "ServiceProduct" ]
] ) ;
fhir:strength [ fhir:v "example" ] ;
fhir:valueSet [ fhir:v "http://hl7.org/fhir/ValueSet/service-uscls" ]
]
] [
fhir:id [ fhir:v "ClaimResponse.addItem.request" ] ;
fhir:path [ fhir:v "ClaimResponse.addItem.request" ] ;
fhir:short [ fhir:v "Request or Referral for Service" ] ;
fhir:definition [ fhir:v "Request or Referral for Goods or Service to be rendered." ] ;
fhir:requirements [ fhir:v "May identify the service to be provided or provider authorization for the service." ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "*" ] ;
fhir:type ( [
fhir:code [ fhir:v "Reference" ] ;
fhir:targetProfile ( [ fhir:v "http://hl7.org/fhir/StructureDefinition/DeviceRequest" ] [ fhir:v "http://hl7.org/fhir/StructureDefinition/MedicationRequest" ] [ fhir:v "http://hl7.org/fhir/StructureDefinition/NutritionOrder" ] [ fhir:v "http://hl7.org/fhir/StructureDefinition/ServiceRequest" ] [ fhir:v "http://hl7.org/fhir/StructureDefinition/SupplyRequest" ] [ fhir:v "http://hl7.org/fhir/StructureDefinition/VisionPrescription" ] )
] ) ;
fhir:mustSupport [ fhir:v "false" ] ;
fhir:isModifier [ fhir:v "false" ] ;
fhir:isSummary [ fhir:v "false" ]
] [
fhir:id [ fhir:v "ClaimResponse.addItem.modifier" ] ;
fhir:path [ fhir:v "ClaimResponse.addItem.modifier" ] ;
fhir:short [ fhir:v "Service/Product billing modifiers" ] ;
fhir:definition [ fhir:v "Item typification or modifiers codes to convey additional context for the product or service." ] ;
fhir:comment [ fhir:v "For example in Oral whether the treatment is cosmetic or associated with TMJ, or for Medical whether the treatment was outside the clinic or outside of office hours." ] ;
fhir:requirements [ fhir:v "To support inclusion of the item for adjudication or to charge an elevated fee." ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "*" ] ;
fhir:type ( [
fhir:code [ fhir:v "CodeableConcept" ]
] ) ;
fhir:mustSupport [ fhir:v "false" ] ;
fhir:isModifier [ fhir:v "false" ] ;
fhir:isSummary [ fhir:v "false" ] ;
fhir:binding [
fhir:extension ( [
fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName" ] ;
fhir:value [ fhir:v "Modifiers" ]
] ) ;
fhir:strength [ fhir:v "example" ] ;
fhir:description [ fhir:v "Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen." ] ;
fhir:valueSet [ fhir:v "http://hl7.org/fhir/ValueSet/claim-modifiers" ]
] ;
fhir:mapping ( [
fhir:identity [ fhir:v "rim" ] ;
fhir:map [ fhir:v "24.C, 24.D mods" ]
] )
] [
fhir:id [ fhir:v "ClaimResponse.addItem.programCode" ] ;
fhir:path [ fhir:v "ClaimResponse.addItem.programCode" ] ;
fhir:short [ fhir:v "Program the product or service is provided under" ] ;
fhir:definition [ fhir:v "Identifies the program under which this may be recovered." ] ;
fhir:comment [ fhir:v "For example: Neonatal program, child dental program or drug users recovery program." ] ;
fhir:requirements [ fhir:v "Commonly used in in the identification of publicly provided program focused on population segments or disease classifications." ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "*" ] ;
fhir:type ( [
fhir:code [ fhir:v "CodeableConcept" ]
] ) ;
fhir:mustSupport [ fhir:v "false" ] ;
fhir:isModifier [ fhir:v "false" ] ;
fhir:isSummary [ fhir:v "false" ] ;
fhir:binding [
fhir:extension ( [
fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName" ] ;
fhir:value [ fhir:v "ProgramCode" ]
] ) ;
fhir:strength [ fhir:v "example" ] ;
fhir:description [ fhir:v "Program specific reason codes." ] ;
fhir:valueSet [ fhir:v "http://hl7.org/fhir/ValueSet/ex-program-code" ]
] ;
fhir:mapping ( [
fhir:identity [ fhir:v "rim" ] ;
fhir:map [ fhir:v "24.H" ]
] )
] [
fhir:id [ fhir:v "ClaimResponse.addItem.serviced[x]" ] ;
fhir:path [ fhir:v "ClaimResponse.addItem.serviced[x]" ] ;
fhir:short [ fhir:v "Date or dates of service or product delivery" ] ;
fhir:definition [ fhir:v "The date or dates when the service or product was supplied, performed or completed." ] ;
fhir:requirements [ fhir:v "Needed to determine whether the service or product was provided during the term of the insurance coverage." ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "1" ] ;
fhir:type ( [
fhir:code [ fhir:v "date" ]
] [
fhir:code [ fhir:v "Period" ]
] ) ;
fhir:mustSupport [ fhir:v "false" ] ;
fhir:isModifier [ fhir:v "false" ] ;
fhir:isSummary [ fhir:v "false" ] ;
fhir:mapping ( [
fhir:identity [ fhir:v "w5" ] ;
fhir:map [ fhir:v "FiveWs.done[x]" ]
] [
fhir:identity [ fhir:v "rim" ] ;
fhir:map [ fhir:v "24.A" ]
] )
] [
fhir:id [ fhir:v "ClaimResponse.addItem.location[x]" ] ;
fhir:path [ fhir:v "ClaimResponse.addItem.location[x]" ] ;
fhir:short [ fhir:v "Place of service or where product was supplied" ] ;
fhir:definition [ fhir:v "Where the product or service was provided." ] ;
fhir:requirements [ fhir:v "The location can alter whether the item was acceptable for insurance purposes or impact the determination of the benefit amount." ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "1" ] ;
fhir:type ( [
fhir:code [ fhir:v "CodeableConcept" ]
] [
fhir:code [ fhir:v "Address" ]
] [
fhir:code [ fhir:v "Reference" ] ;
fhir:targetProfile ( [ fhir:v "http://hl7.org/fhir/StructureDefinition/Location" ] )
] ) ;
fhir:mustSupport [ fhir:v "false" ] ;
fhir:isModifier [ fhir:v "false" ] ;
fhir:isSummary [ fhir:v "false" ] ;
fhir:binding [
fhir:extension ( [
fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName" ] ;
fhir:value [ fhir:v "ServicePlace" ]
] ) ;
fhir:strength [ fhir:v "example" ] ;
fhir:description [ fhir:v "Place of service: pharmacy, school, prison, etc." ] ;
fhir:valueSet [ fhir:v "http://hl7.org/fhir/ValueSet/service-place" ]
] ;
fhir:mapping ( [
fhir:identity [ fhir:v "w5" ] ;
fhir:map [ fhir:v "FiveWs.where[x]" ]
] [
fhir:identity [ fhir:v "rim" ] ;
fhir:map [ fhir:v "24.B" ]
] )
] [
fhir:id [ fhir:v "ClaimResponse.addItem.quantity" ] ;
fhir:path [ fhir:v "ClaimResponse.addItem.quantity" ] ;
fhir:short [ fhir:v "Count of products or services" ] ;
fhir:definition [ fhir:v "The number of repetitions of a service or product." ] ;
fhir:requirements [ fhir:v "Required when the product or service code does not convey the quantity provided." ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "1" ] ;
fhir:type ( [
fhir:code [ fhir:v "Quantity" ] ;
fhir:profile ( [ fhir:v "http://hl7.org/fhir/StructureDefinition/SimpleQuantity" ] )
] ) ;
fhir:mustSupport [ fhir:v "false" ] ;
fhir:isModifier [ fhir:v "false" ] ;
fhir:isSummary [ fhir:v "false" ] ;
fhir:mapping ( [
fhir:identity [ fhir:v "rim" ] ;
fhir:map [ fhir:v "24.G" ]
] )
] [
fhir:id [ fhir:v "ClaimResponse.addItem.unitPrice" ] ;
fhir:path [ fhir:v "ClaimResponse.addItem.unitPrice" ] ;
fhir:short [ fhir:v "Fee, charge or cost per item" ] ;
fhir:definition [ fhir:v "If the item is not a group then this is the fee for the product or service, otherwise this is the total of the fees for the details of the group." ] ;
fhir:requirements [ fhir:v "The amount charged to the patient by the provider for a single unit." ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "1" ] ;
fhir:type ( [
fhir:code [ fhir:v "Money" ]
] ) ;
fhir:mustSupport [ fhir:v "false" ] ;
fhir:isModifier [ fhir:v "false" ] ;
fhir:isSummary [ fhir:v "false" ]
] [
fhir:id [ fhir:v "ClaimResponse.addItem.factor" ] ;
fhir:path [ fhir:v "ClaimResponse.addItem.factor" ] ;
fhir:short [ fhir:v "Price scaling factor" ] ;
fhir:definition [ fhir:v "A real number that represents a multiplier used in determining the overall value of services delivered and/or goods received. The concept of a Factor allows for a discount or surcharge multiplier to be applied to a monetary amount." ] ;
fhir:comment [ fhir:v "To show a 10% senior's discount, the value entered is: 0.90 (1.00 - 0.10)." ] ;
fhir:requirements [ fhir:v "When discounts are provided to a patient (example: Senior's discount) then this must be documented for adjudication." ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "1" ] ;
fhir:type ( [
fhir:code [ fhir:v "decimal" ]
] ) ;
fhir:mustSupport [ fhir:v "false" ] ;
fhir:isModifier [ fhir:v "false" ] ;
fhir:isSummary [ fhir:v "false" ]
] [
fhir:id [ fhir:v "ClaimResponse.addItem.tax" ] ;
fhir:path [ fhir:v "ClaimResponse.addItem.tax" ] ;
fhir:short [ fhir:v "Total tax" ] ;
fhir:definition [ fhir:v "The total of taxes applicable for this product or service." ] ;
fhir:requirements [ fhir:v "Required when taxes are not embedded in the unit price or provided as a separate service." ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "1" ] ;
fhir:type ( [
fhir:code [ fhir:v "Money" ]
] ) ;
fhir:mustSupport [ fhir:v "false" ] ;
fhir:isModifier [ fhir:v "false" ] ;
fhir:isSummary [ fhir:v "false" ]
] [
fhir:id [ fhir:v "ClaimResponse.addItem.net" ] ;
fhir:path [ fhir:v "ClaimResponse.addItem.net" ] ;
fhir:short [ fhir:v "Total item cost" ] ;
fhir:definition [ fhir:v "The total amount claimed for the group (if a grouper) or the addItem. Net = unit price * quantity * factor." ] ;
fhir:comment [ fhir:v "For example, the formula: quantity * unitPrice * factor = net. Quantity and factor are assumed to be 1 if not supplied." ] ;
fhir:requirements [ fhir:v "Provides the total amount claimed for the group (if a grouper) or the line item." ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "1" ] ;
fhir:type ( [
fhir:code [ fhir:v "Money" ]
] ) ;
fhir:mustSupport [ fhir:v "false" ] ;
fhir:isModifier [ fhir:v "false" ] ;
fhir:isSummary [ fhir:v "false" ] ;
fhir:mapping ( [
fhir:identity [ fhir:v "rim" ] ;
fhir:map [ fhir:v "24.F" ]
] )
] [
fhir:id [ fhir:v "ClaimResponse.addItem.bodySite" ] ;
fhir:extension ( [
fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/structuredefinition-explicit-type-name" ] ;
fhir:value [ fhir:v "BodySite" ]
] ) ;
fhir:path [ fhir:v "ClaimResponse.addItem.bodySite" ] ;
fhir:short [ fhir:v "Anatomical location" ] ;
fhir:definition [ fhir:v "Physical location where the service is performed or applies." ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "*" ] ;
fhir:type ( [
fhir:code [ fhir:v "BackboneElement" ]
] ) ;
fhir:mustSupport [ fhir:v "false" ] ;
fhir:isModifier [ fhir:v "false" ] ;
fhir:isSummary [ fhir:v "false" ]
] [
fhir:id [ fhir:v "ClaimResponse.addItem.bodySite.site" ] ;
fhir:path [ fhir:v "ClaimResponse.addItem.bodySite.site" ] ;
fhir:short [ fhir:v "Location" ] ;
fhir:definition [ fhir:v "Physical service site on the patient (limb, tooth, etc.)." ] ;
fhir:comment [ fhir:v "For example: Providing a tooth code allows an insurer to identify a provider performing a filling on a tooth that was previously removed." ] ;
fhir:requirements [ fhir:v "Allows insurer to validate specific procedures." ] ;
fhir:min [ fhir:v "1" ] ;
fhir:max [ fhir:v "*" ] ;
fhir:type ( [
fhir:code [ fhir:v "CodeableReference" ] ;
fhir:targetProfile ( [ fhir:v "http://hl7.org/fhir/StructureDefinition/BodyStructure" ] )
] ) ;
fhir:mustSupport [ fhir:v "false" ] ;
fhir:isModifier [ fhir:v "false" ] ;
fhir:isSummary [ fhir:v "false" ] ;
fhir:binding [
fhir:extension ( [
fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName" ] ;
fhir:value [ fhir:v "OralSites" ]
] ) ;
fhir:strength [ fhir:v "example" ] ;
fhir:valueSet [ fhir:v "http://hl7.org/fhir/ValueSet/tooth" ]
]
] [
fhir:id [ fhir:v "ClaimResponse.addItem.bodySite.subSite" ] ;
fhir:path [ fhir:v "ClaimResponse.addItem.bodySite.subSite" ] ;
fhir:short [ fhir:v "Sub-location" ] ;
fhir:definition [ fhir:v "A region or surface of the bodySite, e.g. limb region or tooth surface(s)." ] ;
fhir:requirements [ fhir:v "Allows insurer to validate specific procedures." ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "*" ] ;
fhir:type ( [
fhir:code [ fhir:v "CodeableConcept" ]
] ) ;
fhir:mustSupport [ fhir:v "false" ] ;
fhir:isModifier [ fhir:v "false" ] ;
fhir:isSummary [ fhir:v "false" ] ;
fhir:binding [
fhir:extension ( [
fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName" ] ;
fhir:value [ fhir:v "Surface" ]
] ) ;
fhir:strength [ fhir:v "example" ] ;
fhir:valueSet [ fhir:v "http://hl7.org/fhir/ValueSet/surface" ]
]
] [
fhir:id [ fhir:v "ClaimResponse.addItem.noteNumber" ] ;
fhir:path [ fhir:v "ClaimResponse.addItem.noteNumber" ] ;
fhir:short [ fhir:v "Applicable note numbers" ] ;
fhir:definition [ fhir:v "The numbers associated with notes below which apply to the adjudication of this item." ] ;
fhir:requirements [ fhir:v "Provides a condensed manner for associating human readable descriptive explanations for adjudications on the line item." ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "*" ] ;
fhir:type ( [
fhir:code [ fhir:v "positiveInt" ]
] ) ;
fhir:mustSupport [ fhir:v "false" ] ;
fhir:isModifier [ fhir:v "false" ] ;
fhir:isSummary [ fhir:v "false" ]
] [
fhir:id [ fhir:v "ClaimResponse.addItem.reviewOutcome" ] ;
fhir:path [ fhir:v "ClaimResponse.addItem.reviewOutcome" ] ;
fhir:short [ fhir:v "Added items adjudication results" ] ;
fhir:definition [ fhir:v "The high-level results of the adjudication if adjudication has been performed." ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "1" ] ;
fhir:contentReference [ fhir:v "#ClaimResponse.item.reviewOutcome" ] ;
fhir:mustSupport [ fhir:v "false" ] ;
fhir:isModifier [ fhir:v "false" ] ;
fhir:isSummary [ fhir:v "false" ]
] [
fhir:id [ fhir:v "ClaimResponse.addItem.adjudication" ] ;
fhir:path [ fhir:v "ClaimResponse.addItem.adjudication" ] ;
fhir:short [ fhir:v "Added items adjudication" ] ;
fhir:definition [ fhir:v "The adjudication results." ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "*" ] ;
fhir:contentReference [ fhir:v "#ClaimResponse.item.adjudication" ] ;
fhir:mustSupport [ fhir:v "false" ] ;
fhir:isModifier [ fhir:v "false" ] ;
fhir:isSummary [ fhir:v "false" ]
] [
fhir:id [ fhir:v "ClaimResponse.addItem.detail" ] ;
fhir:extension ( [
fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/structuredefinition-explicit-type-name" ] ;
fhir:value [ fhir:v "AddedItemDetail" ]
] ) ;
fhir:path [ fhir:v "ClaimResponse.addItem.detail" ] ;
fhir:short [ fhir:v "Insurer added line details" ] ;
fhir:definition [ fhir:v "The second-tier service adjudications for payor added services." ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "*" ] ;
fhir:type ( [
fhir:code [ fhir:v "BackboneElement" ]
] ) ;
fhir:mustSupport [ fhir:v "false" ] ;
fhir:isModifier [ fhir:v "false" ] ;
fhir:isSummary [ fhir:v "false" ]
] [
fhir:id [ fhir:v "ClaimResponse.addItem.detail.traceNumber" ] ;
fhir:path [ fhir:v "ClaimResponse.addItem.detail.traceNumber" ] ;
fhir:short [ fhir:v "Number for tracking" ] ;
fhir:definition [ fhir:v "Trace number for tracking purposes. May be defined at the jurisdiction level or between trading partners." ] ;
fhir:requirements [ fhir:v "Allows partners to uniquely identify components for tracking." ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "*" ] ;
fhir:type ( [
fhir:code [ fhir:v "Identifier" ]
] ) ;
fhir:mustSupport [ fhir:v "false" ] ;
fhir:isModifier [ fhir:v "false" ] ;
fhir:isSummary [ fhir:v "false" ]
] [
fhir:id [ fhir:v "ClaimResponse.addItem.detail.revenue" ] ;
fhir:path [ fhir:v "ClaimResponse.addItem.detail.revenue" ] ;
fhir:short [ fhir:v "Revenue or cost center code" ] ;
fhir:definition [ fhir:v "The type of revenue or cost center providing the product and/or service." ] ;
fhir:requirements [ fhir:v "Needed in the processing of institutional claims." ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "1" ] ;
fhir:type ( [
fhir:code [ fhir:v "CodeableConcept" ]
] ) ;
fhir:mustSupport [ fhir:v "false" ] ;
fhir:isModifier [ fhir:v "false" ] ;
fhir:isSummary [ fhir:v "false" ] ;
fhir:binding [
fhir:extension ( [
fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName" ] ;
fhir:value [ fhir:v "RevenueCenter" ]
] ) ;
fhir:strength [ fhir:v "example" ] ;
fhir:description [ fhir:v "Codes for the revenue or cost centers supplying the service and/or products." ] ;
fhir:valueSet [ fhir:v "http://hl7.org/fhir/ValueSet/ex-revenue-center" ]
]
] [
fhir:id [ fhir:v "ClaimResponse.addItem.detail.productOrService" ] ;
fhir:path [ fhir:v "ClaimResponse.addItem.detail.productOrService" ] ;
fhir:short [ fhir:v "Billing, service, product, or drug code" ] ;
fhir:definition [ fhir:v "When the value is a group code then this item collects a set of related item details, otherwise this contains the product, service, drug or other billing code for the item. This element may be the start of a range of .productOrService codes used in conjunction with .productOrServiceEnd or it may be a solo element where .productOrServiceEnd is not used." ] ;
fhir:comment [ fhir:v "If this is an actual service or product line, i.e. not a Group, then use code to indicate the Professional Service or Product supplied (e.g. CTP, HCPCS, USCLS, ICD10, NCPDP, DIN, RxNorm, ACHI, CCI). If a grouping item then use a group code to indicate the type of thing being grouped e.g. 'glasses' or 'compound'." ] ;
fhir:requirements [ fhir:v "Necessary to state what was provided or done." ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "1" ] ;
fhir:type ( [
fhir:code [ fhir:v "CodeableConcept" ]
] ) ;
fhir:mustSupport [ fhir:v "false" ] ;
fhir:isModifier [ fhir:v "false" ] ;
fhir:isSummary [ fhir:v "false" ] ;
fhir:binding [
fhir:extension ( [
fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName" ] ;
fhir:value [ fhir:v "ServiceProduct" ]
] ) ;
fhir:strength [ fhir:v "example" ] ;
fhir:description [ fhir:v "Allowable service and product codes." ] ;
fhir:valueSet [ fhir:v "http://hl7.org/fhir/ValueSet/service-uscls" ]
]
] [
fhir:id [ fhir:v "ClaimResponse.addItem.detail.productOrServiceEnd" ] ;
fhir:path [ fhir:v "ClaimResponse.addItem.detail.productOrServiceEnd" ] ;
fhir:short [ fhir:v "End of a range of codes" ] ;
fhir:definition [ fhir:v "This contains the end of a range of product, service, drug or other billing codes for the item. This element is not used when the .productOrService is a group code. This value may only be present when a .productOfService code has been provided to convey the start of the range. Typically this value may be used only with preauthorizations and not with claims." ] ;
fhir:alias ( [ fhir:v "End of a range of Drug Code; Bill Code; Service Cod" ] ) ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "1" ] ;
fhir:type ( [
fhir:code [ fhir:v "CodeableConcept" ]
] ) ;
fhir:mustSupport [ fhir:v "false" ] ;
fhir:isModifier [ fhir:v "false" ] ;
fhir:isSummary [ fhir:v "false" ] ;
fhir:binding [
fhir:extension ( [
fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName" ] ;
fhir:value [ fhir:v "ServiceProduct" ]
] ) ;
fhir:strength [ fhir:v "example" ] ;
fhir:valueSet [ fhir:v "http://hl7.org/fhir/ValueSet/service-uscls" ]
]
] [
fhir:id [ fhir:v "ClaimResponse.addItem.detail.modifier" ] ;
fhir:path [ fhir:v "ClaimResponse.addItem.detail.modifier" ] ;
fhir:short [ fhir:v "Service/Product billing modifiers" ] ;
fhir:definition [ fhir:v "Item typification or modifiers codes to convey additional context for the product or service." ] ;
fhir:comment [ fhir:v "For example in Oral whether the treatment is cosmetic or associated with TMJ, or for Medical whether the treatment was outside the clinic or outside of office hours." ] ;
fhir:requirements [ fhir:v "To support inclusion of the item for adjudication or to charge an elevated fee." ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "*" ] ;
fhir:type ( [
fhir:code [ fhir:v "CodeableConcept" ]
] ) ;
fhir:mustSupport [ fhir:v "false" ] ;
fhir:isModifier [ fhir:v "false" ] ;
fhir:isSummary [ fhir:v "false" ] ;
fhir:binding [
fhir:extension ( [
fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName" ] ;
fhir:value [ fhir:v "Modifiers" ]
] ) ;
fhir:strength [ fhir:v "example" ] ;
fhir:description [ fhir:v "Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen." ] ;
fhir:valueSet [ fhir:v "http://hl7.org/fhir/ValueSet/claim-modifiers" ]
] ;
fhir:mapping ( [
fhir:identity [ fhir:v "rim" ] ;
fhir:map [ fhir:v "24.C, 24.D mods" ]
] )
] [
fhir:id [ fhir:v "ClaimResponse.addItem.detail.quantity" ] ;
fhir:path [ fhir:v "ClaimResponse.addItem.detail.quantity" ] ;
fhir:short [ fhir:v "Count of products or services" ] ;
fhir:definition [ fhir:v "The number of repetitions of a service or product." ] ;
fhir:requirements [ fhir:v "Required when the product or service code does not convey the quantity provided." ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "1" ] ;
fhir:type ( [
fhir:code [ fhir:v "Quantity" ] ;
fhir:profile ( [ fhir:v "http://hl7.org/fhir/StructureDefinition/SimpleQuantity" ] )
] ) ;
fhir:mustSupport [ fhir:v "false" ] ;
fhir:isModifier [ fhir:v "false" ] ;
fhir:isSummary [ fhir:v "false" ] ;
fhir:mapping ( [
fhir:identity [ fhir:v "rim" ] ;
fhir:map [ fhir:v "24.G" ]
] )
] [
fhir:id [ fhir:v "ClaimResponse.addItem.detail.unitPrice" ] ;
fhir:path [ fhir:v "ClaimResponse.addItem.detail.unitPrice" ] ;
fhir:short [ fhir:v "Fee, charge or cost per item" ] ;
fhir:definition [ fhir:v "If the item is not a group then this is the fee for the product or service, otherwise this is the total of the fees for the details of the group." ] ;
fhir:requirements [ fhir:v "The amount charged to the patient by the provider for a single unit." ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "1" ] ;
fhir:type ( [
fhir:code [ fhir:v "Money" ]
] ) ;
fhir:mustSupport [ fhir:v "false" ] ;
fhir:isModifier [ fhir:v "false" ] ;
fhir:isSummary [ fhir:v "false" ]
] [
fhir:id [ fhir:v "ClaimResponse.addItem.detail.factor" ] ;
fhir:path [ fhir:v "ClaimResponse.addItem.detail.factor" ] ;
fhir:short [ fhir:v "Price scaling factor" ] ;
fhir:definition [ fhir:v "A real number that represents a multiplier used in determining the overall value of services delivered and/or goods received. The concept of a Factor allows for a discount or surcharge multiplier to be applied to a monetary amount." ] ;
fhir:comment [ fhir:v "To show a 10% senior's discount, the value entered is: 0.90 (1.00 - 0.10)." ] ;
fhir:requirements [ fhir:v "When discounts are provided to a patient (example: Senior's discount) then this must be documented for adjudication." ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "1" ] ;
fhir:type ( [
fhir:code [ fhir:v "decimal" ]
] ) ;
fhir:mustSupport [ fhir:v "false" ] ;
fhir:isModifier [ fhir:v "false" ] ;
fhir:isSummary [ fhir:v "false" ]
] [
fhir:id [ fhir:v "ClaimResponse.addItem.detail.tax" ] ;
fhir:path [ fhir:v "ClaimResponse.addItem.detail.tax" ] ;
fhir:short [ fhir:v "Total tax" ] ;
fhir:definition [ fhir:v "The total of taxes applicable for this product or service." ] ;
fhir:requirements [ fhir:v "Required when taxes are not embedded in the unit price or provided as a separate service." ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "1" ] ;
fhir:type ( [
fhir:code [ fhir:v "Money" ]
] ) ;
fhir:mustSupport [ fhir:v "false" ] ;
fhir:isModifier [ fhir:v "false" ] ;
fhir:isSummary [ fhir:v "false" ]
] [
fhir:id [ fhir:v "ClaimResponse.addItem.detail.net" ] ;
fhir:path [ fhir:v "ClaimResponse.addItem.detail.net" ] ;
fhir:short [ fhir:v "Total item cost" ] ;
fhir:definition [ fhir:v "The total amount claimed for the group (if a grouper) or the addItem.detail. Net = unit price * quantity * factor." ] ;
fhir:comment [ fhir:v "For example, the formula: quantity * unitPrice * factor = net. Quantity and factor are assumed to be 1 if not supplied." ] ;
fhir:requirements [ fhir:v "Provides the total amount claimed for the group (if a grouper) or the line item." ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "1" ] ;
fhir:type ( [
fhir:code [ fhir:v "Money" ]
] ) ;
fhir:mustSupport [ fhir:v "false" ] ;
fhir:isModifier [ fhir:v "false" ] ;
fhir:isSummary [ fhir:v "false" ] ;
fhir:mapping ( [
fhir:identity [ fhir:v "rim" ] ;
fhir:map [ fhir:v "24.F" ]
] )
] [
fhir:id [ fhir:v "ClaimResponse.addItem.detail.noteNumber" ] ;
fhir:path [ fhir:v "ClaimResponse.addItem.detail.noteNumber" ] ;
fhir:short [ fhir:v "Applicable note numbers" ] ;
fhir:definition [ fhir:v "The numbers associated with notes below which apply to the adjudication of this item." ] ;
fhir:requirements [ fhir:v "Provides a condensed manner for associating human readable descriptive explanations for adjudications on the line item." ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "*" ] ;
fhir:type ( [
fhir:code [ fhir:v "positiveInt" ]
] ) ;
fhir:mustSupport [ fhir:v "false" ] ;
fhir:isModifier [ fhir:v "false" ] ;
fhir:isSummary [ fhir:v "false" ]
] [
fhir:id [ fhir:v "ClaimResponse.addItem.detail.reviewOutcome" ] ;
fhir:path [ fhir:v "ClaimResponse.addItem.detail.reviewOutcome" ] ;
fhir:short [ fhir:v "Added items detail level adjudication results" ] ;
fhir:definition [ fhir:v "The high-level results of the adjudication if adjudication has been performed." ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "1" ] ;
fhir:contentReference [ fhir:v "#ClaimResponse.item.reviewOutcome" ] ;
fhir:mustSupport [ fhir:v "false" ] ;
fhir:isModifier [ fhir:v "false" ] ;
fhir:isSummary [ fhir:v "false" ]
] [
fhir:id [ fhir:v "ClaimResponse.addItem.detail.adjudication" ] ;
fhir:path [ fhir:v "ClaimResponse.addItem.detail.adjudication" ] ;
fhir:short [ fhir:v "Added items detail adjudication" ] ;
fhir:definition [ fhir:v "The adjudication results." ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "*" ] ;
fhir:contentReference [ fhir:v "#ClaimResponse.item.adjudication" ] ;
fhir:mustSupport [ fhir:v "false" ] ;
fhir:isModifier [ fhir:v "false" ] ;
fhir:isSummary [ fhir:v "false" ]
] [
fhir:id [ fhir:v "ClaimResponse.addItem.detail.subDetail" ] ;
fhir:extension ( [
fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/structuredefinition-explicit-type-name" ] ;
fhir:value [ fhir:v "AddedItemSubDetail" ]
] ) ;
fhir:path [ fhir:v "ClaimResponse.addItem.detail.subDetail" ] ;
fhir:short [ fhir:v "Insurer added line items" ] ;
fhir:definition [ fhir:v "The third-tier service adjudications for payor added services." ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "*" ] ;
fhir:type ( [
fhir:code [ fhir:v "BackboneElement" ]
] ) ;
fhir:mustSupport [ fhir:v "false" ] ;
fhir:isModifier [ fhir:v "false" ] ;
fhir:isSummary [ fhir:v "false" ]
] [
fhir:id [ fhir:v "ClaimResponse.addItem.detail.subDetail.traceNumber" ] ;
fhir:path [ fhir:v "ClaimResponse.addItem.detail.subDetail.traceNumber" ] ;
fhir:short [ fhir:v "Number for tracking" ] ;
fhir:definition [ fhir:v "Trace number for tracking purposes. May be defined at the jurisdiction level or between trading partners." ] ;
fhir:requirements [ fhir:v "Allows partners to uniquely identify components for tracking." ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "*" ] ;
fhir:type ( [
fhir:code [ fhir:v "Identifier" ]
] ) ;
fhir:mustSupport [ fhir:v "false" ] ;
fhir:isModifier [ fhir:v "false" ] ;
fhir:isSummary [ fhir:v "false" ]
] [
fhir:id [ fhir:v "ClaimResponse.addItem.detail.subDetail.revenue" ] ;
fhir:path [ fhir:v "ClaimResponse.addItem.detail.subDetail.revenue" ] ;
fhir:short [ fhir:v "Revenue or cost center code" ] ;
fhir:definition [ fhir:v "The type of revenue or cost center providing the product and/or service." ] ;
fhir:requirements [ fhir:v "Needed in the processing of institutional claims." ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "1" ] ;
fhir:type ( [
fhir:code [ fhir:v "CodeableConcept" ]
] ) ;
fhir:mustSupport [ fhir:v "false" ] ;
fhir:isModifier [ fhir:v "false" ] ;
fhir:isSummary [ fhir:v "false" ] ;
fhir:binding [
fhir:extension ( [
fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName" ] ;
fhir:value [ fhir:v "RevenueCenter" ]
] ) ;
fhir:strength [ fhir:v "example" ] ;
fhir:description [ fhir:v "Codes for the revenue or cost centers supplying the service and/or products." ] ;
fhir:valueSet [ fhir:v "http://hl7.org/fhir/ValueSet/ex-revenue-center" ]
]
] [
fhir:id [ fhir:v "ClaimResponse.addItem.detail.subDetail.productOrService" ] ;
fhir:path [ fhir:v "ClaimResponse.addItem.detail.subDetail.productOrService" ] ;
fhir:short [ fhir:v "Billing, service, product, or drug code" ] ;
fhir:definition [ fhir:v "When the value is a group code then this item collects a set of related item details, otherwise this contains the product, service, drug or other billing code for the item. This element may be the start of a range of .productOrService codes used in conjunction with .productOrServiceEnd or it may be a solo element where .productOrServiceEnd is not used." ] ;
fhir:comment [ fhir:v "If this is an actual service or product line, i.e. not a Group, then use code to indicate the Professional Service or Product supplied (e.g. CTP, HCPCS, USCLS, ICD10, NCPDP, DIN, RxNorm, ACHI, CCI). If a grouping item then use a group code to indicate the type of thing being grouped e.g. 'glasses' or 'compound'." ] ;
fhir:requirements [ fhir:v "Necessary to state what was provided or done." ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "1" ] ;
fhir:type ( [
fhir:code [ fhir:v "CodeableConcept" ]
] ) ;
fhir:mustSupport [ fhir:v "false" ] ;
fhir:isModifier [ fhir:v "false" ] ;
fhir:isSummary [ fhir:v "false" ] ;
fhir:binding [
fhir:extension ( [
fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName" ] ;
fhir:value [ fhir:v "ServiceProduct" ]
] ) ;
fhir:strength [ fhir:v "example" ] ;
fhir:description [ fhir:v "Allowable service and product codes." ] ;
fhir:valueSet [ fhir:v "http://hl7.org/fhir/ValueSet/service-uscls" ]
]
] [
fhir:id [ fhir:v "ClaimResponse.addItem.detail.subDetail.productOrServiceEnd" ] ;
fhir:path [ fhir:v "ClaimResponse.addItem.detail.subDetail.productOrServiceEnd" ] ;
fhir:short [ fhir:v "End of a range of codes" ] ;
fhir:definition [ fhir:v "This contains the end of a range of product, service, drug or other billing codes for the item. This element is not used when the .productOrService is a group code. This value may only be present when a .productOfService code has been provided to convey the start of the range. Typically this value may be used only with preauthorizations and not with claims." ] ;
fhir:alias ( [ fhir:v "End of a range of Drug Code; Bill Code; Service Cod" ] ) ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "1" ] ;
fhir:type ( [
fhir:code [ fhir:v "CodeableConcept" ]
] ) ;
fhir:mustSupport [ fhir:v "false" ] ;
fhir:isModifier [ fhir:v "false" ] ;
fhir:isSummary [ fhir:v "false" ] ;
fhir:binding [
fhir:extension ( [
fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName" ] ;
fhir:value [ fhir:v "ServiceProduct" ]
] ) ;
fhir:strength [ fhir:v "example" ] ;
fhir:valueSet [ fhir:v "http://hl7.org/fhir/ValueSet/service-uscls" ]
]
] [
fhir:id [ fhir:v "ClaimResponse.addItem.detail.subDetail.modifier" ] ;
fhir:path [ fhir:v "ClaimResponse.addItem.detail.subDetail.modifier" ] ;
fhir:short [ fhir:v "Service/Product billing modifiers" ] ;
fhir:definition [ fhir:v "Item typification or modifiers codes to convey additional context for the product or service." ] ;
fhir:comment [ fhir:v "For example in Oral whether the treatment is cosmetic or associated with TMJ, or for Medical whether the treatment was outside the clinic or outside of office hours." ] ;
fhir:requirements [ fhir:v "To support inclusion of the item for adjudication or to charge an elevated fee." ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "*" ] ;
fhir:type ( [
fhir:code [ fhir:v "CodeableConcept" ]
] ) ;
fhir:mustSupport [ fhir:v "false" ] ;
fhir:isModifier [ fhir:v "false" ] ;
fhir:isSummary [ fhir:v "false" ] ;
fhir:binding [
fhir:extension ( [
fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName" ] ;
fhir:value [ fhir:v "Modifiers" ]
] ) ;
fhir:strength [ fhir:v "example" ] ;
fhir:description [ fhir:v "Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen." ] ;
fhir:valueSet [ fhir:v "http://hl7.org/fhir/ValueSet/claim-modifiers" ]
] ;
fhir:mapping ( [
fhir:identity [ fhir:v "rim" ] ;
fhir:map [ fhir:v "24.C, 24.D mods" ]
] )
] [
fhir:id [ fhir:v "ClaimResponse.addItem.detail.subDetail.quantity" ] ;
fhir:path [ fhir:v "ClaimResponse.addItem.detail.subDetail.quantity" ] ;
fhir:short [ fhir:v "Count of products or services" ] ;
fhir:definition [ fhir:v "The number of repetitions of a service or product." ] ;
fhir:requirements [ fhir:v "Required when the product or service code does not convey the quantity provided." ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "1" ] ;
fhir:type ( [
fhir:code [ fhir:v "Quantity" ] ;
fhir:profile ( [ fhir:v "http://hl7.org/fhir/StructureDefinition/SimpleQuantity" ] )
] ) ;
fhir:mustSupport [ fhir:v "false" ] ;
fhir:isModifier [ fhir:v "false" ] ;
fhir:isSummary [ fhir:v "false" ] ;
fhir:mapping ( [
fhir:identity [ fhir:v "rim" ] ;
fhir:map [ fhir:v "24.G" ]
] )
] [
fhir:id [ fhir:v "ClaimResponse.addItem.detail.subDetail.unitPrice" ] ;
fhir:path [ fhir:v "ClaimResponse.addItem.detail.subDetail.unitPrice" ] ;
fhir:short [ fhir:v "Fee, charge or cost per item" ] ;
fhir:definition [ fhir:v "If the item is not a group then this is the fee for the product or service, otherwise this is the total of the fees for the details of the group." ] ;
fhir:requirements [ fhir:v "The amount charged to the patient by the provider for a single unit." ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "1" ] ;
fhir:type ( [
fhir:code [ fhir:v "Money" ]
] ) ;
fhir:mustSupport [ fhir:v "false" ] ;
fhir:isModifier [ fhir:v "false" ] ;
fhir:isSummary [ fhir:v "false" ]
] [
fhir:id [ fhir:v "ClaimResponse.addItem.detail.subDetail.factor" ] ;
fhir:path [ fhir:v "ClaimResponse.addItem.detail.subDetail.factor" ] ;
fhir:short [ fhir:v "Price scaling factor" ] ;
fhir:definition [ fhir:v "A real number that represents a multiplier used in determining the overall value of services delivered and/or goods received. The concept of a Factor allows for a discount or surcharge multiplier to be applied to a monetary amount." ] ;
fhir:comment [ fhir:v "To show a 10% senior's discount, the value entered is: 0.90 (1.00 - 0.10)." ] ;
fhir:requirements [ fhir:v "When discounts are provided to a patient (example: Senior's discount) then this must be documented for adjudication." ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "1" ] ;
fhir:type ( [
fhir:code [ fhir:v "decimal" ]
] ) ;
fhir:mustSupport [ fhir:v "false" ] ;
fhir:isModifier [ fhir:v "false" ] ;
fhir:isSummary [ fhir:v "false" ]
] [
fhir:id [ fhir:v "ClaimResponse.addItem.detail.subDetail.tax" ] ;
fhir:path [ fhir:v "ClaimResponse.addItem.detail.subDetail.tax" ] ;
fhir:short [ fhir:v "Total tax" ] ;
fhir:definition [ fhir:v "The total of taxes applicable for this product or service." ] ;
fhir:requirements [ fhir:v "Required when taxes are not embedded in the unit price or provided as a separate service." ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "1" ] ;
fhir:type ( [
fhir:code [ fhir:v "Money" ]
] ) ;
fhir:mustSupport [ fhir:v "false" ] ;
fhir:isModifier [ fhir:v "false" ] ;
fhir:isSummary [ fhir:v "false" ]
] [
fhir:id [ fhir:v "ClaimResponse.addItem.detail.subDetail.net" ] ;
fhir:path [ fhir:v "ClaimResponse.addItem.detail.subDetail.net" ] ;
fhir:short [ fhir:v "Total item cost" ] ;
fhir:definition [ fhir:v "The total amount claimed for the addItem.detail.subDetail. Net = unit price * quantity * factor." ] ;
fhir:comment [ fhir:v "For example, the formula: quantity * unitPrice * factor = net. Quantity and factor are assumed to be 1 if not supplied." ] ;
fhir:requirements [ fhir:v "Provides the total amount claimed for the group (if a grouper) or the line item." ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "1" ] ;
fhir:type ( [
fhir:code [ fhir:v "Money" ]
] ) ;
fhir:mustSupport [ fhir:v "false" ] ;
fhir:isModifier [ fhir:v "false" ] ;
fhir:isSummary [ fhir:v "false" ] ;
fhir:mapping ( [
fhir:identity [ fhir:v "rim" ] ;
fhir:map [ fhir:v "24.F" ]
] )
] [
fhir:id [ fhir:v "ClaimResponse.addItem.detail.subDetail.noteNumber" ] ;
fhir:path [ fhir:v "ClaimResponse.addItem.detail.subDetail.noteNumber" ] ;
fhir:short [ fhir:v "Applicable note numbers" ] ;
fhir:definition [ fhir:v "The numbers associated with notes below which apply to the adjudication of this item." ] ;
fhir:requirements [ fhir:v "Provides a condensed manner for associating human readable descriptive explanations for adjudications on the line item." ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "*" ] ;
fhir:type ( [
fhir:code [ fhir:v "positiveInt" ]
] ) ;
fhir:mustSupport [ fhir:v "false" ] ;
fhir:isModifier [ fhir:v "false" ] ;
fhir:isSummary [ fhir:v "false" ]
] [
fhir:id [ fhir:v "ClaimResponse.addItem.detail.subDetail.reviewOutcome" ] ;
fhir:path [ fhir:v "ClaimResponse.addItem.detail.subDetail.reviewOutcome" ] ;
fhir:short [ fhir:v "Added items subdetail level adjudication results" ] ;
fhir:definition [ fhir:v "The high-level results of the adjudication if adjudication has been performed." ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "1" ] ;
fhir:contentReference [ fhir:v "#ClaimResponse.item.reviewOutcome" ] ;
fhir:mustSupport [ fhir:v "false" ] ;
fhir:isModifier [ fhir:v "false" ] ;
fhir:isSummary [ fhir:v "false" ]
] [
fhir:id [ fhir:v "ClaimResponse.addItem.detail.subDetail.adjudication" ] ;
fhir:path [ fhir:v "ClaimResponse.addItem.detail.subDetail.adjudication" ] ;
fhir:short [ fhir:v "Added items subdetail adjudication" ] ;
fhir:definition [ fhir:v "The adjudication results." ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "*" ] ;
fhir:contentReference [ fhir:v "#ClaimResponse.item.adjudication" ] ;
fhir:mustSupport [ fhir:v "false" ] ;
fhir:isModifier [ fhir:v "false" ] ;
fhir:isSummary [ fhir:v "false" ]
] [
fhir:id [ fhir:v "ClaimResponse.adjudication" ] ;
fhir:path [ fhir:v "ClaimResponse.adjudication" ] ;
fhir:short [ fhir:v "Header-level adjudication" ] ;
fhir:definition [ fhir:v "The adjudication results which are presented at the header level rather than at the line-item or add-item levels." ] ;
fhir:requirements [ fhir:v "Some insurers will receive line-items but provide the adjudication only at a summary or header-level." ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "*" ] ;
fhir:contentReference [ fhir:v "#ClaimResponse.item.adjudication" ] ;
fhir:mustSupport [ fhir:v "false" ] ;
fhir:isModifier [ fhir:v "false" ] ;
fhir:isSummary [ fhir:v "false" ]
] [
fhir:id [ fhir:v "ClaimResponse.total" ] ;
fhir:extension ( [
fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/structuredefinition-explicit-type-name" ] ;
fhir:value [ fhir:v "Total" ]
] ) ;
fhir:path [ fhir:v "ClaimResponse.total" ] ;
fhir:short [ fhir:v "Adjudication totals" ] ;
fhir:definition [ fhir:v "Categorized monetary totals for the adjudication." ] ;
fhir:comment [ fhir:v "Totals for amounts submitted, co-pays, benefits payable etc." ] ;
fhir:requirements [ fhir:v "To provide the requestor with financial totals by category for the adjudication." ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "*" ] ;
fhir:type ( [
fhir:code [ fhir:v "BackboneElement" ]
] ) ;
fhir:mustSupport [ fhir:v "false" ] ;
fhir:isModifier [ fhir:v "false" ] ;
fhir:isSummary [ fhir:v "true" ]
] [
fhir:id [ fhir:v "ClaimResponse.total.category" ] ;
fhir:path [ fhir:v "ClaimResponse.total.category" ] ;
fhir:short [ fhir:v "Type of adjudication information" ] ;
fhir:definition [ fhir:v "A code to indicate the information type of this adjudication record. Information types may include: the value submitted, maximum values or percentages allowed or payable under the plan, amounts that the patient is responsible for in aggregate or pertaining to this item, amounts paid by other coverages, and the benefit payable for this item." ] ;
fhir:comment [ fhir:v "For example codes indicating: Co-Pay, deductible, eligible, benefit, tax, etc." ] ;
fhir:requirements [ fhir:v "Needed to convey the type of total provided." ] ;
fhir:min [ fhir:v "1" ] ;
fhir:max [ fhir:v "1" ] ;
fhir:type ( [
fhir:code [ fhir:v "CodeableConcept" ]
] ) ;
fhir:mustSupport [ fhir:v "false" ] ;
fhir:isModifier [ fhir:v "false" ] ;
fhir:isSummary [ fhir:v "true" ] ;
fhir:binding [
fhir:extension ( [
fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName" ] ;
fhir:value [ fhir:v "Adjudication" ]
] ) ;
fhir:strength [ fhir:v "example" ] ;
fhir:description [ fhir:v "The adjudication codes." ] ;
fhir:valueSet [ fhir:v "http://hl7.org/fhir/ValueSet/adjudication" ]
]
] [
fhir:id [ fhir:v "ClaimResponse.total.amount" ] ;
fhir:path [ fhir:v "ClaimResponse.total.amount" ] ;
fhir:short [ fhir:v "Financial total for the category" ] ;
fhir:definition [ fhir:v "Monetary total amount associated with the category." ] ;
fhir:requirements [ fhir:v "Needed to convey the total monetary amount." ] ;
fhir:min [ fhir:v "1" ] ;
fhir:max [ fhir:v "1" ] ;
fhir:type ( [
fhir:code [ fhir:v "Money" ]
] ) ;
fhir:mustSupport [ fhir:v "false" ] ;
fhir:isModifier [ fhir:v "false" ] ;
fhir:isSummary [ fhir:v "true" ]
] [
fhir:id [ fhir:v "ClaimResponse.payment" ] ;
fhir:extension ( [
fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/structuredefinition-explicit-type-name" ] ;
fhir:value [ fhir:v "Payment" ]
] ) ;
fhir:path [ fhir:v "ClaimResponse.payment" ] ;
fhir:short [ fhir:v "Payment Details" ] ;
fhir:definition [ fhir:v "Payment details for the adjudication of the claim." ] ;
fhir:requirements [ fhir:v "Needed to convey references to the financial instrument that has been used if payment has been made." ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "1" ] ;
fhir:type ( [
fhir:code [ fhir:v "BackboneElement" ]
] ) ;
fhir:mustSupport [ fhir:v "false" ] ;
fhir:isModifier [ fhir:v "false" ] ;
fhir:isSummary [ fhir:v "false" ]
] [
fhir:id [ fhir:v "ClaimResponse.payment.type" ] ;
fhir:path [ fhir:v "ClaimResponse.payment.type" ] ;
fhir:short [ fhir:v "Partial or complete payment" ] ;
fhir:definition [ fhir:v "Whether this represents partial or complete payment of the benefits payable." ] ;
fhir:requirements [ fhir:v "To advise the requestor when the insurer believes all payments to have been completed." ] ;
fhir:min [ fhir:v "1" ] ;
fhir:max [ fhir:v "1" ] ;
fhir:type ( [
fhir:code [ fhir:v "CodeableConcept" ]
] ) ;
fhir:mustSupport [ fhir:v "false" ] ;
fhir:isModifier [ fhir:v "false" ] ;
fhir:isSummary [ fhir:v "false" ] ;
fhir:binding [
fhir:extension ( [
fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName" ] ;
fhir:value [ fhir:v "PaymentType" ]
] ) ;
fhir:strength [ fhir:v "example" ] ;
fhir:description [ fhir:v "The type (partial, complete) of the payment." ] ;
fhir:valueSet [ fhir:v "http://hl7.org/fhir/ValueSet/ex-paymenttype" ]
]
] [
fhir:id [ fhir:v "ClaimResponse.payment.adjustment" ] ;
fhir:path [ fhir:v "ClaimResponse.payment.adjustment" ] ;
fhir:short [ fhir:v "Payment adjustment for non-claim issues" ] ;
fhir:definition [ fhir:v "Total amount of all adjustments to this payment included in this transaction which are not related to this claim's adjudication." ] ;
fhir:comment [ fhir:v "Insurers will deduct amounts owing from the provider (adjustment), such as a prior overpayment, from the amount owing to the provider (benefits payable) when payment is made to the provider." ] ;
fhir:requirements [ fhir:v "To advise the requestor of adjustments applied to the payment." ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "1" ] ;
fhir:type ( [
fhir:code [ fhir:v "Money" ]
] ) ;
fhir:mustSupport [ fhir:v "false" ] ;
fhir:isModifier [ fhir:v "false" ] ;
fhir:isSummary [ fhir:v "false" ]
] [
fhir:id [ fhir:v "ClaimResponse.payment.adjustmentReason" ] ;
fhir:path [ fhir:v "ClaimResponse.payment.adjustmentReason" ] ;
fhir:short [ fhir:v "Explanation for the adjustment" ] ;
fhir:definition [ fhir:v "Reason for the payment adjustment." ] ;
fhir:requirements [ fhir:v "Needed to clarify the monetary adjustment." ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "1" ] ;
fhir:type ( [
fhir:code [ fhir:v "CodeableConcept" ]
] ) ;
fhir:mustSupport [ fhir:v "false" ] ;
fhir:isModifier [ fhir:v "false" ] ;
fhir:isSummary [ fhir:v "false" ] ;
fhir:binding [
fhir:extension ( [
fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName" ] ;
fhir:value [ fhir:v "PaymentAdjustmentReason" ]
] ) ;
fhir:strength [ fhir:v "example" ] ;
fhir:description [ fhir:v "Payment Adjustment reason codes." ] ;
fhir:valueSet [ fhir:v "http://hl7.org/fhir/ValueSet/payment-adjustment-reason" ]
]
] [
fhir:id [ fhir:v "ClaimResponse.payment.date" ] ;
fhir:path [ fhir:v "ClaimResponse.payment.date" ] ;
fhir:short [ fhir:v "Expected date of payment" ] ;
fhir:definition [ fhir:v "Estimated date the payment will be issued or the actual issue date of payment." ] ;
fhir:requirements [ fhir:v "To advise the payee when payment can be expected." ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "1" ] ;
fhir:type ( [
fhir:code [ fhir:v "date" ]
] ) ;
fhir:mustSupport [ fhir:v "false" ] ;
fhir:isModifier [ fhir:v "false" ] ;
fhir:isSummary [ fhir:v "false" ]
] [
fhir:id [ fhir:v "ClaimResponse.payment.amount" ] ;
fhir:path [ fhir:v "ClaimResponse.payment.amount" ] ;
fhir:short [ fhir:v "Payable amount after adjustment" ] ;
fhir:definition [ fhir:v "Benefits payable less any payment adjustment." ] ;
fhir:requirements [ fhir:v "Needed to provide the actual payment amount." ] ;
fhir:min [ fhir:v "1" ] ;
fhir:max [ fhir:v "1" ] ;
fhir:type ( [
fhir:code [ fhir:v "Money" ]
] ) ;
fhir:mustSupport [ fhir:v "false" ] ;
fhir:isModifier [ fhir:v "false" ] ;
fhir:isSummary [ fhir:v "false" ]
] [
fhir:id [ fhir:v "ClaimResponse.payment.identifier" ] ;
fhir:path [ fhir:v "ClaimResponse.payment.identifier" ] ;
fhir:short [ fhir:v "Business identifier for the payment" ] ;
fhir:definition [ fhir:v "Issuer's unique identifier for the payment instrument." ] ;
fhir:comment [ fhir:v "For example: EFT number or check number." ] ;
fhir:requirements [ fhir:v "Enable the receiver to reconcile when payment received." ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "1" ] ;
fhir:type ( [
fhir:code [ fhir:v "Identifier" ]
] ) ;
fhir:mustSupport [ fhir:v "false" ] ;
fhir:isModifier [ fhir:v "false" ] ;
fhir:isSummary [ fhir:v "false" ]
] [
fhir:id [ fhir:v "ClaimResponse.fundsReserve" ] ;
fhir:path [ fhir:v "ClaimResponse.fundsReserve" ] ;
fhir:short [ fhir:v "Funds reserved status" ] ;
fhir:definition [ fhir:v "A code, used only on a response to a preauthorization, to indicate whether the benefits payable have been reserved and for whom." ] ;
fhir:comment [ fhir:v "Fund would be release by a future claim quoting the preAuthRef of this response. Examples of values include: provider, patient, none." ] ;
fhir:requirements [ fhir:v "Needed to advise the submitting provider on whether the rquest for reservation of funds has been honored." ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "1" ] ;
fhir:type ( [
fhir:code [ fhir:v "CodeableConcept" ]
] ) ;
fhir:mustSupport [ fhir:v "false" ] ;
fhir:isModifier [ fhir:v "false" ] ;
fhir:isSummary [ fhir:v "false" ] ;
fhir:binding [
fhir:extension ( [
fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName" ] ;
fhir:value [ fhir:v "FundsReserve" ]
] [
fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/elementdefinition-isCommonBinding" ] ;
fhir:value [ fhir:v "true" ]
] ) ;
fhir:strength [ fhir:v "example" ] ;
fhir:description [ fhir:v "For whom funds are to be reserved: (Patient, Provider, None)." ] ;
fhir:valueSet [ fhir:v "http://hl7.org/fhir/ValueSet/fundsreserve" ]
]
] [
fhir:id [ fhir:v "ClaimResponse.formCode" ] ;
fhir:path [ fhir:v "ClaimResponse.formCode" ] ;
fhir:short [ fhir:v "Printed form identifier" ] ;
fhir:definition [ fhir:v "A code for the form to be used for printing the content." ] ;
fhir:comment [ fhir:v "May be needed to identify specific jurisdictional forms." ] ;
fhir:requirements [ fhir:v "Needed to specify the specific form used for producing output for this response." ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "1" ] ;
fhir:type ( [
fhir:code [ fhir:v "CodeableConcept" ]
] ) ;
fhir:mustSupport [ fhir:v "false" ] ;
fhir:isModifier [ fhir:v "false" ] ;
fhir:isSummary [ fhir:v "false" ] ;
fhir:binding [
fhir:extension ( [
fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName" ] ;
fhir:value [ fhir:v "Forms" ]
] [
fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/elementdefinition-isCommonBinding" ] ;
fhir:value [ fhir:v "true" ]
] ) ;
fhir:strength [ fhir:v "example" ] ;
fhir:description [ fhir:v "The forms codes." ] ;
fhir:valueSet [ fhir:v "http://hl7.org/fhir/ValueSet/forms" ]
]
] [
fhir:id [ fhir:v "ClaimResponse.form" ] ;
fhir:path [ fhir:v "ClaimResponse.form" ] ;
fhir:short [ fhir:v "Printed reference or actual form" ] ;
fhir:definition [ fhir:v "The actual form, by reference or inclusion, for printing the content or an EOB." ] ;
fhir:comment [ fhir:v "Needed to permit insurers to include the actual form." ] ;
fhir:requirements [ fhir:v "Needed to include the specific form used for producing output for this response." ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "1" ] ;
fhir:type ( [
fhir:code [ fhir:v "Attachment" ]
] ) ;
fhir:mustSupport [ fhir:v "false" ] ;
fhir:isModifier [ fhir:v "false" ] ;
fhir:isSummary [ fhir:v "false" ]
] [
fhir:id [ fhir:v "ClaimResponse.processNote" ] ;
fhir:extension ( [
fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/structuredefinition-explicit-type-name" ] ;
fhir:value [ fhir:v "Note" ]
] ) ;
fhir:path [ fhir:v "ClaimResponse.processNote" ] ;
fhir:short [ fhir:v "Note concerning adjudication" ] ;
fhir:definition [ fhir:v "A note that describes or explains adjudication results in a human readable form." ] ;
fhir:requirements [ fhir:v "Provides the insurer specific textual explanations associated with the processing." ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "*" ] ;
fhir:type ( [
fhir:code [ fhir:v "BackboneElement" ]
] ) ;
fhir:mustSupport [ fhir:v "false" ] ;
fhir:isModifier [ fhir:v "false" ] ;
fhir:isSummary [ fhir:v "false" ]
] [
fhir:id [ fhir:v "ClaimResponse.processNote.number" ] ;
fhir:path [ fhir:v "ClaimResponse.processNote.number" ] ;
fhir:short [ fhir:v "Note instance identifier" ] ;
fhir:definition [ fhir:v "A number to uniquely identify a note entry." ] ;
fhir:requirements [ fhir:v "Necessary to provide a mechanism to link from adjudications." ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "1" ] ;
fhir:type ( [
fhir:code [ fhir:v "positiveInt" ]
] ) ;
fhir:mustSupport [ fhir:v "false" ] ;
fhir:isModifier [ fhir:v "false" ] ;
fhir:isSummary [ fhir:v "false" ]
] [
fhir:id [ fhir:v "ClaimResponse.processNote.type" ] ;
fhir:path [ fhir:v "ClaimResponse.processNote.type" ] ;
fhir:short [ fhir:v "Note purpose" ] ;
fhir:definition [ fhir:v "The business purpose of the note text." ] ;
fhir:requirements [ fhir:v "To convey the expectation for when the text is used." ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "1" ] ;
fhir:type ( [
fhir:code [ fhir:v "CodeableConcept" ]
] ) ;
fhir:mustSupport [ fhir:v "false" ] ;
fhir:isModifier [ fhir:v "false" ] ;
fhir:isSummary [ fhir:v "false" ] ;
fhir:binding [
fhir:extension ( [
fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName" ] ;
fhir:value [ fhir:v "NoteType" ]
] [
fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/elementdefinition-isCommonBinding" ] ;
fhir:value [ fhir:v "true" ]
] ) ;
fhir:strength [ fhir:v "extensible" ] ;
fhir:description [ fhir:v "The presentation types of notes." ] ;
fhir:valueSet [ fhir:v "http://hl7.org/fhir/ValueSet/note-type" ]
]
] [
fhir:id [ fhir:v "ClaimResponse.processNote.text" ] ;
fhir:path [ fhir:v "ClaimResponse.processNote.text" ] ;
fhir:short [ fhir:v "Note explanatory text" ] ;
fhir:definition [ fhir:v "The explanation or description associated with the processing." ] ;
fhir:requirements [ fhir:v "Required to provide human readable explanation." ] ;
fhir:min [ fhir:v "1" ] ;
fhir:max [ fhir:v "1" ] ;
fhir:type ( [
fhir:code [ fhir:v "string" ]
] ) ;
fhir:mustSupport [ fhir:v "false" ] ;
fhir:isModifier [ fhir:v "false" ] ;
fhir:isSummary [ fhir:v "false" ]
] [
fhir:id [ fhir:v "ClaimResponse.processNote.language" ] ;
fhir:path [ fhir:v "ClaimResponse.processNote.language" ] ;
fhir:short [ fhir:v "Language of the text" ] ;
fhir:definition [ fhir:v "A code to define the language used in the text of the note." ] ;
fhir:comment [ fhir:v "Only required if the language is different from the resource language." ] ;
fhir:requirements [ fhir:v "Note text may vary from the resource defined language." ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "1" ] ;
fhir:type ( [
fhir:code [ fhir:v "CodeableConcept" ]
] ) ;
fhir:mustSupport [ fhir:v "false" ] ;
fhir:isModifier [ fhir:v "false" ] ;
fhir:isSummary [ fhir:v "false" ] ;
fhir:binding [
fhir:extension ( [
fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName" ] ;
fhir:value [ fhir:v "Language" ]
] [
fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/elementdefinition-isCommonBinding" ] ;
fhir:value [ fhir:v "true" ]
] ) ;
fhir:strength [ fhir:v "required" ] ;
fhir:description [ fhir:v "IETF language tag for a human language" ] ;
fhir:valueSet [ fhir:v "http://hl7.org/fhir/ValueSet/all-languages|6.0.0-ballot2" ] ;
fhir:additional ( [
fhir:purpose [ fhir:v "starter" ] ;
fhir:valueSet [ fhir:v "http://hl7.org/fhir/ValueSet/languages" ]
] )
]
] [
fhir:id [ fhir:v "ClaimResponse.communicationRequest" ] ;
fhir:path [ fhir:v "ClaimResponse.communicationRequest" ] ;
fhir:short [ fhir:v "Request for additional information" ] ;
fhir:definition [ fhir:v "Request for additional supporting or authorizing information." ] ;
fhir:comment [ fhir:v "For example: professional reports, documents, images, clinical resources, or accident reports." ] ;
fhir:requirements [ fhir:v "Need to communicate insurer request for additional information required to support the adjudication." ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "*" ] ;
fhir:type ( [
fhir:code [ fhir:v "Reference" ] ;
fhir:targetProfile ( [ fhir:v "http://hl7.org/fhir/StructureDefinition/CommunicationRequest" ] )
] ) ;
fhir:mustSupport [ fhir:v "false" ] ;
fhir:isModifier [ fhir:v "false" ] ;
fhir:isSummary [ fhir:v "false" ]
] [
fhir:id [ fhir:v "ClaimResponse.insurance" ] ;
fhir:extension ( [
fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/structuredefinition-explicit-type-name" ] ;
fhir:value [ fhir:v "Insurance" ]
] ) ;
fhir:path [ fhir:v "ClaimResponse.insurance" ] ;
fhir:short [ fhir:v "Patient insurance information" ] ;
fhir:definition [ fhir:v "Financial instruments for reimbursement for the health care products and services specified on the claim." ] ;
fhir:comment [ fhir:v "All insurance coverages for the patient which may be applicable for reimbursement, of the products and services listed in the claim, are typically provided in the claim to allow insurers to confirm the ordering of the insurance coverages relative to local 'coordination of benefit' rules. One coverage (and only one) with 'focal=true' is to be used in the adjudication of this claim. Coverages appearing before the focal Coverage in the list, and where 'subrogation=false', should provide a reference to the ClaimResponse containing the adjudication results of the prior claim." ] ;
fhir:requirements [ fhir:v "At least one insurer is required for a claim to be a claim." ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "*" ] ;
fhir:type ( [
fhir:code [ fhir:v "BackboneElement" ]
] ) ;
fhir:mustSupport [ fhir:v "false" ] ;
fhir:isModifier [ fhir:v "false" ] ;
fhir:isSummary [ fhir:v "false" ] ;
fhir:mapping ( [
fhir:identity [ fhir:v "rim" ] ;
fhir:map [ fhir:v "Coverage" ]
] )
] [
fhir:id [ fhir:v "ClaimResponse.insurance.sequence" ] ;
fhir:path [ fhir:v "ClaimResponse.insurance.sequence" ] ;
fhir:short [ fhir:v "Insurance instance identifier" ] ;
fhir:definition [ fhir:v "A number to uniquely identify insurance entries and provide a sequence of coverages to convey coordination of benefit order." ] ;
fhir:requirements [ fhir:v "To maintain order of the coverages." ] ;
fhir:min [ fhir:v "1" ] ;
fhir:max [ fhir:v "1" ] ;
fhir:type ( [
fhir:code [ fhir:v "positiveInt" ]
] ) ;
fhir:mustSupport [ fhir:v "false" ] ;
fhir:isModifier [ fhir:v "false" ] ;
fhir:isSummary [ fhir:v "false" ]
] [
fhir:id [ fhir:v "ClaimResponse.insurance.focal" ] ;
fhir:path [ fhir:v "ClaimResponse.insurance.focal" ] ;
fhir:short [ fhir:v "Coverage to be used for adjudication" ] ;
fhir:definition [ fhir:v "A flag to indicate that this Coverage is to be used for adjudication of this claim when set to true." ] ;
fhir:comment [ fhir:v "A patient may (will) have multiple insurance policies which provide reimbursement for healthcare services and products. For example a person may also be covered by their spouse's policy and both appear in the list (and may be from the same insurer). This flag will be set to true for only one of the listed policies and that policy will be used for adjudicating this claim. Other claims would be created to request adjudication against the other listed policies." ] ;
fhir:requirements [ fhir:v "To identify which coverage in the list is being used to adjudicate this claim." ] ;
fhir:min [ fhir:v "1" ] ;
fhir:max [ fhir:v "1" ] ;
fhir:type ( [
fhir:code [ fhir:v "boolean" ]
] ) ;
fhir:mustSupport [ fhir:v "false" ] ;
fhir:isModifier [ fhir:v "false" ] ;
fhir:isSummary [ fhir:v "false" ]
] [
fhir:id [ fhir:v "ClaimResponse.insurance.coverage" ] ;
fhir:path [ fhir:v "ClaimResponse.insurance.coverage" ] ;
fhir:short [ fhir:v "Insurance information" ] ;
fhir:definition [ fhir:v "Reference to the insurance card level information contained in the Coverage resource. The coverage issuing insurer will use these details to locate the patient's actual coverage within the insurer's information system." ] ;
fhir:requirements [ fhir:v "Required to allow the adjudicator to locate the correct policy and history within their information system." ] ;
fhir:min [ fhir:v "1" ] ;
fhir:max [ fhir:v "1" ] ;
fhir:type ( [
fhir:code [ fhir:v "Reference" ] ;
fhir:targetProfile ( [ fhir:v "http://hl7.org/fhir/StructureDefinition/Coverage" ] )
] ) ;
fhir:mustSupport [ fhir:v "false" ] ;
fhir:isModifier [ fhir:v "false" ] ;
fhir:isSummary [ fhir:v "false" ]
] [
fhir:id [ fhir:v "ClaimResponse.insurance.businessArrangement" ] ;
fhir:path [ fhir:v "ClaimResponse.insurance.businessArrangement" ] ;
fhir:short [ fhir:v "Additional provider contract number" ] ;
fhir:definition [ fhir:v "A business agreement number established between the provider and the insurer for special business processing purposes." ] ;
fhir:requirements [ fhir:v "Providers may have multiple business arrangements with a given insurer and must supply the specific contract number for adjudication." ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "1" ] ;
fhir:type ( [
fhir:code [ fhir:v "string" ]
] ) ;
fhir:mustSupport [ fhir:v "false" ] ;
fhir:isModifier [ fhir:v "false" ] ;
fhir:isSummary [ fhir:v "false" ]
] [
fhir:id [ fhir:v "ClaimResponse.insurance.claimResponse" ] ;
fhir:path [ fhir:v "ClaimResponse.insurance.claimResponse" ] ;
fhir:short [ fhir:v "Adjudication results" ] ;
fhir:definition [ fhir:v "The result of the adjudication of the line items for the Coverage specified in this insurance." ] ;
fhir:comment [ fhir:v "Must not be specified when 'focal=true' for this insurance." ] ;
fhir:requirements [ fhir:v "An insurer need the adjudication results from prior insurers to determine the outstanding balance remaining by item for the items in the curent claim." ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "1" ] ;
fhir:type ( [
fhir:extension ( [
fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/structuredefinition-hierarchy" ] ;
fhir:value [ fhir:v "false" ]
] ) ;
fhir:code [ fhir:v "Reference" ] ;
fhir:targetProfile ( [ fhir:v "http://hl7.org/fhir/StructureDefinition/ClaimResponse" ] )
] ) ;
fhir:mustSupport [ fhir:v "false" ] ;
fhir:isModifier [ fhir:v "false" ] ;
fhir:isSummary [ fhir:v "false" ]
] [
fhir:id [ fhir:v "ClaimResponse.error" ] ;
fhir:extension ( [
fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/structuredefinition-explicit-type-name" ] ;
fhir:value [ fhir:v "Error" ]
] ) ;
fhir:path [ fhir:v "ClaimResponse.error" ] ;
fhir:short [ fhir:v "Processing errors" ] ;
fhir:definition [ fhir:v "Errors encountered during the processing of the adjudication." ] ;
fhir:comment [ fhir:v "If the request contains errors then an error element should be provided and no adjudication related sections (item, addItem, or payment) should be present." ] ;
fhir:requirements [ fhir:v "Need to communicate processing issues to the requestor." ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "*" ] ;
fhir:type ( [
fhir:code [ fhir:v "BackboneElement" ]
] ) ;
fhir:mustSupport [ fhir:v "false" ] ;
fhir:isModifier [ fhir:v "false" ] ;
fhir:isSummary [ fhir:v "false" ]
] [
fhir:id [ fhir:v "ClaimResponse.error.itemSequence" ] ;
fhir:path [ fhir:v "ClaimResponse.error.itemSequence" ] ;
fhir:short [ fhir:v "Item sequence number" ] ;
fhir:definition [ fhir:v "The sequence number of the line item submitted which contains the error. This value is omitted when the error occurs outside of the item structure." ] ;
fhir:requirements [ fhir:v "Provides references to the claim items." ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "1" ] ;
fhir:type ( [
fhir:code [ fhir:v "positiveInt" ]
] ) ;
fhir:mustSupport [ fhir:v "false" ] ;
fhir:isModifier [ fhir:v "false" ] ;
fhir:isSummary [ fhir:v "false" ]
] [
fhir:id [ fhir:v "ClaimResponse.error.detailSequence" ] ;
fhir:path [ fhir:v "ClaimResponse.error.detailSequence" ] ;
fhir:short [ fhir:v "Detail sequence number" ] ;
fhir:definition [ fhir:v "The sequence number of the detail within the line item submitted which contains the error. This value is omitted when the error occurs outside of the item structure." ] ;
fhir:requirements [ fhir:v "Provides references to the claim details within the claim item." ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "1" ] ;
fhir:type ( [
fhir:code [ fhir:v "positiveInt" ]
] ) ;
fhir:mustSupport [ fhir:v "false" ] ;
fhir:isModifier [ fhir:v "false" ] ;
fhir:isSummary [ fhir:v "false" ]
] [
fhir:id [ fhir:v "ClaimResponse.error.subDetailSequence" ] ;
fhir:path [ fhir:v "ClaimResponse.error.subDetailSequence" ] ;
fhir:short [ fhir:v "Subdetail sequence number" ] ;
fhir:definition [ fhir:v "The sequence number of the sub-detail within the detail within the line item submitted which contains the error. This value is omitted when the error occurs outside of the item structure." ] ;
fhir:requirements [ fhir:v "Provides references to the claim sub-details within the claim detail." ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "1" ] ;
fhir:type ( [
fhir:code [ fhir:v "positiveInt" ]
] ) ;
fhir:mustSupport [ fhir:v "false" ] ;
fhir:isModifier [ fhir:v "false" ] ;
fhir:isSummary [ fhir:v "false" ]
] [
fhir:id [ fhir:v "ClaimResponse.error.code" ] ;
fhir:path [ fhir:v "ClaimResponse.error.code" ] ;
fhir:short [ fhir:v "Error code detailing processing issues" ] ;
fhir:definition [ fhir:v "An error code, from a specified code system, which details why the claim could not be adjudicated." ] ;
fhir:requirements [ fhir:v "Required to convey processing errors." ] ;
fhir:min [ fhir:v "1" ] ;
fhir:max [ fhir:v "1" ] ;
fhir:type ( [
fhir:code [ fhir:v "CodeableConcept" ]
] ) ;
fhir:mustSupport [ fhir:v "false" ] ;
fhir:isModifier [ fhir:v "false" ] ;
fhir:isSummary [ fhir:v "true" ] ;
fhir:binding [
fhir:extension ( [
fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName" ] ;
fhir:value [ fhir:v "AdjudicationError" ]
] [
fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/elementdefinition-isCommonBinding" ] ;
fhir:value [ fhir:v "true" ]
] ) ;
fhir:strength [ fhir:v "example" ] ;
fhir:description [ fhir:v "The adjudication error codes." ] ;
fhir:valueSet [ fhir:v "http://hl7.org/fhir/ValueSet/adjudication-error" ]
]
] [
fhir:id [ fhir:v "ClaimResponse.error.expression" ] ;
fhir:path [ fhir:v "ClaimResponse.error.expression" ] ;
fhir:short [ fhir:v "FHIRPath of element(s) related to issue" ] ;
fhir:definition [ fhir:v "A [simple subset of FHIRPath](fhirpath.html#simple) limited to element names, repetition indicators and the default child accessor that identifies one of the elements in the resource that caused this issue to be raised." ] ;
fhir:comment [ fhir:v "The root of the FHIRPath is the resource or bundle that generated OperationOutcome. Each FHIRPath SHALL resolve to a single node." ] ;
fhir:requirements [ fhir:v "Allows systems to highlight or otherwise guide users to elements implicated in issues to allow them to be fixed more easily." ] ;
fhir:min [ fhir:v "0" ] ;
fhir:max [ fhir:v "*" ] ;
fhir:type ( [
fhir:code [ fhir:v "string" ]
] ) ;
fhir:mustSupport [ fhir:v "false" ] ;
fhir:isModifier [ fhir:v "false" ] ;
fhir:isSummary [ fhir:v "true" ]
] )
] .
# -------------------------------------------------------------------------------------
Usage note: every effort has been made to ensure that the examples are correct and useful, but they are not a normative part of the specification.
FHIR ®© HL7.org 2011+. FHIR R6 hl7.fhir.core#6.0.0-ballot2 generated on Wed, Nov 6, 2024 19:16+0000.
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