This resource provides the adjudication details from the processing of a Claim resource. This resource provides the adjudication details from the processing of a Claim resource. If the element is present, it must have either a @value, an @id, or extensions A unique identifier assigned to this claim response. Trace number for tracking purposes. May be defined at the jurisdiction level or between trading partners. The status of the resource instance. Used to indicate why the status has changed. A finer grained suite of claim type codes which may convey additional information such as Inpatient vs Outpatient and/or a specialty service. A finer grained suite of claim type codes which may convey additional information such as Inpatient vs Outpatient and/or a specialty service. 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. The party/group to whom the professional services and/or products have been supplied or are being considered and for whom actual for facast reimbursement is sought. The date this resource was created. The party responsible for authorization, adjudication and reimbursement. The provider which is responsible for the claim, predetermination or preauthorization. Original request resource reference. The outcome of the claim, predetermination, or preauthorization processing. The result of the claim, predetermination, or preauthorization adjudication. A human readable description of the status of the adjudication. Reference from the Insurer which is used in later communications which refers to this adjudication. The time frame during which this authorization is effective. Information code for an event with a corresponding date or period. Type of Party to be reimbursed: subscriber, billing provider, other. Healthcare encounters related to this claim. 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. Additional information codes regarding exceptions, special considerations, the condition, situation, prior or concurrent issues. 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. The first-tier service adjudications for payer added product or service lines. The adjudication results which are presented at the header level rather than at the line-item or add-item levels. Categorized monetary totals for the adjudication. Payment details for the adjudication of the claim. A code, used only on a response to a preauthorization, to indicate whether the benefits payable have been reserved and for whom. A code for the form to be used for printing the content. The actual form, by reference or inclusion, for printing the content or an EOB. A note that describes or explains adjudication results in a human readable form. Request for additional supporting or authorizing information. Financial instruments for reimbursement for the health care products and services specified on the claim. Errors encountered during the processing of the adjudication. This resource provides the adjudication details from the processing of a Claim resource. A coded event such as when a service is expected or a card printed. A date or period in the past or future indicating when the event occurred or is expectd to occur. This resource provides the adjudication details from the processing of a Claim resource. A number to uniquely identify supporting information entries. The general class of the information supplied: information; exception; accident, employment; onset, etc. System and code pertaining to the specific information regarding special conditions relating to the setting, treatment or patient for which care is sought. The date when or period to which this information refers. Additional data or information such as resources, documents, images etc. including references to the data or the actual inclusion of the data. Provides the reason in the situation where a reason code is required in addition to the content. This resource provides the adjudication details from the processing of a Claim resource. A number to uniquely reference the claim item entries. Trace number for tracking purposes. May be defined at the jurisdiction level or between trading partners. Exceptions, special conditions and supporting information applicable for this service or product. The numbers associated with notes below which apply to the adjudication of this item. The high-level results of the adjudication if adjudication has been performed. 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. A claim detail. Either a simple (a product or service) or a 'group' of sub-details which are simple items. This resource provides the adjudication details from the processing of a Claim resource. The result of the claim, predetermination, or preauthorization adjudication. The reasons for the result of the claim, predetermination, or preauthorization adjudication. Reference from the Insurer which is used in later communications which refers to this adjudication. The time frame during which this authorization is effective. This resource provides the adjudication details from the processing of a Claim resource. 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. A code supporting the understanding of the adjudication result and explaining variance from expected amount. Monetary amount associated with the category. A non-monetary value associated with the category. Mutually exclusive to the amount element above. The date and time the adjudication decision occured. This resource provides the adjudication details from the processing of a Claim resource. A number to uniquely reference the claim detail entry. Trace number for tracking purposes. May be defined at the jurisdiction level or between trading partners. The numbers associated with notes below which apply to the adjudication of this item. The high-level results of the adjudication if adjudication has been performed. The adjudication results. A sub-detail adjudication of a simple product or service. This resource provides the adjudication details from the processing of a Claim resource. A number to uniquely reference the claim sub-detail entry. Trace number for tracking purposes. May be defined at the jurisdiction level or between trading partners. The numbers associated with notes below which apply to the adjudication of this item. The high-level results of the adjudication if adjudication has been performed. The adjudication results. This resource provides the adjudication details from the processing of a Claim resource. Claim items which this service line is intended to replace. The sequence number of the details within the claim item which this line is intended to replace. The sequence number of the sub-details within the details within the claim item which this line is intended to replace. Trace number for tracking purposes. May be defined at the jurisdiction level or between trading partners. 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. Exceptions, special conditions and supporting information applicable for this service or product. The providers who are authorized for the services rendered to the patient. The type of revenue or cost center providing the product and/or service. Code to identify the general type of benefits under which products and services are provided. 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. 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. Request or Referral for Goods or Service to be rendered. Item typification or modifiers codes to convey additional context for the product or service. Identifies the program under which this may be recovered. The date or dates when the service or product was supplied, performed or completed. Where the product or service was provided. The number of repetitions of a service or product. 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. 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. The total of taxes applicable for this product or service. The total amount claimed for the group (if a grouper) or the addItem. Net = unit price * quantity * factor. Physical location where the service is performed or applies. The numbers associated with notes below which apply to the adjudication of this item. The high-level results of the adjudication if adjudication has been performed. The adjudication results. The second-tier service adjudications for payer added services. This resource provides the adjudication details from the processing of a Claim resource. Physical service site on the patient (limb, tooth, etc.). A region or surface of the bodySite, e.g. limb region or tooth surface(s). This resource provides the adjudication details from the processing of a Claim resource. Trace number for tracking purposes. May be defined at the jurisdiction level or between trading partners. The type of revenue or cost center providing the product and/or service. 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. 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. Item typification or modifiers codes to convey additional context for the product or service. The number of repetitions of a service or product. 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. 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. The total of taxes applicable for this product or service. The total amount claimed for the group (if a grouper) or the addItem.detail. Net = unit price * quantity * factor. The numbers associated with notes below which apply to the adjudication of this item. The high-level results of the adjudication if adjudication has been performed. The adjudication results. The third-tier service adjudications for payer added services. This resource provides the adjudication details from the processing of a Claim resource. Trace number for tracking purposes. May be defined at the jurisdiction level or between trading partners. The type of revenue or cost center providing the product and/or service. 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. 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. Item typification or modifiers codes to convey additional context for the product or service. The number of repetitions of a service or product. 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. 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. The total of taxes applicable for this product or service. The total amount claimed for the addItem.detail.subDetail. Net = unit price * quantity * factor. The numbers associated with notes below which apply to the adjudication of this item. The high-level results of the adjudication if adjudication has been performed. The adjudication results. This resource provides the adjudication details from the processing of a Claim resource. 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. Monetary total amount associated with the category. This resource provides the adjudication details from the processing of a Claim resource. Whether this represents partial or complete payment of the benefits payable. Total amount of all adjustments to this payment included in this transaction which are not related to this claim's adjudication. Reason for the payment adjustment. Estimated date the payment will be issued or the actual issue date of payment. Benefits payable less any payment adjustment. Issuer's unique identifier for the payment instrument. This resource provides the adjudication details from the processing of a Claim resource. A code to indicate the business purpose of the note. A number to uniquely identify a note entry. The business purpose of the note text. The explanation or description associated with the processing. A code to define the language used in the text of the note. This resource provides the adjudication details from the processing of a Claim resource. A number to uniquely identify insurance entries and provide a sequence of coverages to convey coordination of benefit order. A flag to indicate that this Coverage is to be used for adjudication of this claim when set to true. 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. A business agreement number established between the provider and the insurer for special business processing purposes. The result of the adjudication of the line items for the Coverage specified in this insurance. This resource provides the adjudication details from the processing of a Claim resource. 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. 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. 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. An error code, from a specified code system, which details why the claim could not be adjudicated. 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. Queued Processing Complete Error Partial Processing If the element is present, it must have either a @value, an @id, or extensions