Consumer Real-Time Pharmacy Benefit Check FHIR IG
2.0.0-ballot - STU 2 Ballot United States of America flag

Consumer Real-Time Pharmacy Benefit Check FHIR IG, published by HL7 International / Pharmacy. This guide is not an authorized publication; it is the continuous build for version 2.0.0-ballot built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/HL7/carin-rtpbc/ and changes regularly. See the Directory of published versions

Resource Profile: RTPBC Non-PHI Response Using ClaimResponse

Official URL: http://hl7.org/fhir/us/carin-rtpbc/StructureDefinition/rtpbc-response-claimresponse-non-phi Version: 2.0.0-ballot
Standards status: Trial-use Active as of 2026-02-17 Maturity Level: 2 Computable Name: RtpbcResponseClaimResponseNonPHI

This profile omits persoanlly-identifiable content in an RTPBC response. To be used by data sources that can provide benefit or price information without receiving patient details.

Usages:

You can also check for usages in the FHIR IG Statistics

Formal Views of Profile Content

Description Differentials, Snapshots, and other representations.

NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
.. ClaimResponse 0..* ClaimResponse Response to a claim predetermination or preauthorization
... id SΣ 0..1 id Unique ClaimResponse Resource Identifier
... implicitRules ?!Σ 0..1 uri A set of rules under which this content was created
... modifierExtension ?! 0..* Extension Extensions that cannot be ignored
.... use ?!Σ 0..1 code usual | official | temp | secondary | old (If known)
Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .
.... value SΣ 1..1 string Unique RTPBC response ID
Example General: 123456
... status ?!SΣ 1..1 code Response status
Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance.
Fixed Value: active
... type SΣ 1..1 CodeableConcept Requested Service Type
Binding: ClaimTypeCodes (extensible): The type or discipline-style of the claim.
.... coding SΣ 1..1 Coding Code defined by a terminology system
..... system SΣ 1..1 uri Identity of the terminology system
Fixed Value: http://terminology.hl7.org/CodeSystem/claim-type
..... code SΣ 1..1 code Symbol in syntax defined by the system
Fixed Value: pharmacy
..... display SΣ 1..1 string Representation defined by the system
Fixed Value: Pharmacy
... use SΣ 1..1 code Processing Mode
Binding: Use (required): Claim, preauthorization, predetermination.
Fixed Value: predetermination
... patient Σ 1..1 Reference(Patient) Patient information (masked)
.... Slices for extension S 1..* Extension Extension
Slice: Unordered, Open by value:url
..... extension:data-masked S 1..1 (Complex) unknown | asked | temp | notasked | masked | unsupported | astext | error
URL: http://hl7.org/fhir/StructureDefinition/data-absent-reason
...... extension 0..0 Extension
Slice: Unordered, Open by value:url
...... url 1..1 uri "http://hl7.org/fhir/StructureDefinition/data-absent-reason"
...... value[x] 1..1 code Value of extension
Binding: DataAbsentReason (required)
Fixed Value: masked
.... identifier Σ 0..1 Identifier Unique, non-personally identifiable code
... created Σ 1..1 dateTime Response creation date
... insurer Σ 1..1 Reference(Organization) Insurer (masked)
.... Slices for extension S 1..* Extension Extension
Slice: Unordered, Open by value:url
..... extension:data-masked S 1..1 (Complex) unknown | asked | temp | notasked | masked | unsupported | astext | error
URL: http://hl7.org/fhir/StructureDefinition/data-absent-reason
...... extension 0..0 Extension
Slice: Unordered, Open by value:url
...... url 1..1 uri "http://hl7.org/fhir/StructureDefinition/data-absent-reason"
...... value[x] 1..1 code Value of extension
Binding: DataAbsentReason (required)
Fixed Value: masked
... request SΣ 1..1 Reference(Claim) Submitter's RTPBC Request ID
.... identifier SΣ 1..1 Identifier Logical reference, when literal reference is not known
..... use ?!Σ 0..1 code usual | official | temp | secondary | old (If known)
Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .
..... value SΣ 1..1 string RTPBC Request ID
Example General: 123456
... outcome SΣ 1..1 code Processing Outcome
Binding: ClaimProcessingCodes (required): The result of the claim processing.
... disposition S 0..1 string Completed Note
... item S 0..* BackboneElement Requested Product and Pharmacy
.... Slices for extension 0..* Extension Extension
Slice: Unordered, Open by value:url
..... extension:benefitRestriction S 0..* Coding Benefit Restriction (Extension)
URL: http://hl7.org/fhir/us/carin-rtpbc/StructureDefinition/rtpbc-benefitRestriction
Binding: RTPBC Benefit Restriction Value Set (extensible)
..... extension:formularyStatus S 0..1 Coding Formulary Status (Extension)
URL: http://hl7.org/fhir/us/carin-rtpbc/StructureDefinition/rtpbc-formularyStatus
Binding: RTPBC Formulary Status Value Set (extensible)
..... extension:preferenceLevel S 0..1 positiveInt Preference Level (Extension)
URL: http://hl7.org/fhir/us/carin-rtpbc/StructureDefinition/rtpbc-preferenceLevel
..... extension:nextAvailableFillDate S 0..1 date Next Available Fill Date (Extension)
URL: http://hl7.org/fhir/us/carin-rtpbc/StructureDefinition/rtpbc-nextAvailableFillDate
..... extension:relatedCoverage S 0..* Reference(RTPBC Coverage | RTPBC Coverage - Non-PHI) Related Coverage (Extension)
URL: http://hl7.org/fhir/us/carin-rtpbc/StructureDefinition/rtpbc-relatedCoverage
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... itemSequence S 1..1 positiveInt Claim item instance identifier
.... noteNumber S 0..* positiveInt Determination Note Number
.... adjudication S 1..* BackboneElement Requested Product and Pharmacy Determination
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... category S 1..1 CodeableConcept Patient Pay Component
Binding: RTPBC Patient Pay Type Value Set (required): RTPBC Patient Pay Categories
..... amount S 1..1 Money Patient Pay Component Amount
...... value SΣ 1..1 decimal Patient Pay Amount Value
...... currency SΣ 1..1 code Patient Pay Amount Currency
Binding: Currencies (required): Currencies
... addItem S 0..* BackboneElement Insurer added line items
.... Slices for extension 1..* Extension Extension
Slice: Unordered, Open by value:url
..... extension:isAlternative S 1..1 boolean Is Alternative (Extension)
URL: http://hl7.org/fhir/us/carin-rtpbc/StructureDefinition/rtpbc-isAlternative
..... extension:benefitRestriction S 0..* Coding Benefit Restriction (Extension)
URL: http://hl7.org/fhir/us/carin-rtpbc/StructureDefinition/rtpbc-benefitRestriction
Binding: RTPBC Benefit Restriction Value Set (extensible)
..... extension:formularyStatus S 0..* Coding Formulary Status (Extension)
URL: http://hl7.org/fhir/us/carin-rtpbc/StructureDefinition/rtpbc-formularyStatus
Binding: RTPBC Formulary Status Value Set (extensible)
..... extension:preferenceLevel S 0..* positiveInt Preference Level (Extension)
URL: http://hl7.org/fhir/us/carin-rtpbc/StructureDefinition/rtpbc-preferenceLevel
..... extension:nextAvailableFillDate S 0..* date Next Available Fill Date (Extension)
URL: http://hl7.org/fhir/us/carin-rtpbc/StructureDefinition/rtpbc-nextAvailableFillDate
..... extension:relatedCoverage S 0..* Reference(RTPBC Coverage | RTPBC Coverage - Non-PHI) Related Coverage (Extension)
URL: http://hl7.org/fhir/us/carin-rtpbc/StructureDefinition/rtpbc-relatedCoverage
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... itemSequence S 1..* positiveInt Associated request Item Sequence
.... provider S 0..* Reference(RTPBC Pharmacy Organization) Priced Pharmacy
..... reference SΣC 1..1 string Reference to Priced Pharmacy
.... productOrService S 1..1 CodeableConcept Product
Binding: RTPBC Prescribable Product Code Value Set (extensible): RTPBC prescribable product codes (NDC11 and RxNorm)
..... coding SΣ 1..* Coding Code defined by a terminology system
...... system SΣ 1..1 uri Identity of the terminology system
...... code SΣ 1..1 code Symbol in syntax defined by the system
...... display SΣ 1..1 string Product Description
.... quantity S 1..1 SimpleQuantity(4.0.1) Priced Quantity
..... value SΣ 1..1 decimal Quantity in Billing Units
..... unit SΣ 1..1 string Billing unit of measure
Binding: RTPBC Billing Unit Value Set (extensible): Billing quantity unit of measure
.... noteNumber S 0..* positiveInt Determination Note Number
.... adjudication S 1..* BackboneElement Alternative Product and Pharmacy Determination
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... category S 1..1 CodeableConcept Patient Pay Component
Binding: RTPBC Patient Pay Type Value Set (required): RTPBC Patient Pay Categories
..... amount S 1..1 Money Patient Pay Component Amount
...... value SΣ 1..1 decimal Patient Pay Amount Value
...... currency SΣ 1..1 code Patient Pay Amount Currency
Binding: Currencies (required): Currencies
... processNote S 0..* BackboneElement Determination Note
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... number S 1..1 positiveInt Determination Note Number
.... text S 1..1 string Determination Note Text
... error S 0..* BackboneElement Error Information
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... code S 1..1 CodeableConcept Reject Reason
Binding: RTPBC Error Code Value Set (preferred): RTPBC Error Codes
..... coding SΣ 1..* Coding Code defined by a terminology system
...... system SΣ 1..1 uri Identity of the terminology system
...... code SΣ 1..1 code Reject Code
...... display SΣ 1..1 string Representation defined by the system
..... text SΣ 0..1 string Reject Message

doco Documentation for this format

Terminology Bindings

Path Status Usage ValueSet Version Source
ClaimResponse.identifier.​use Base required IdentifierUse 📍4.0.1 FHIR Std.
ClaimResponse.status Base required Financial Resource Status Codes 📍4.0.1 FHIR Std.
ClaimResponse.type Base extensible Claim Type Codes 📍4.0.1 FHIR Std.
ClaimResponse.use Base required Use 📍4.0.1 FHIR Std.
ClaimResponse.patient.​extension:data-masked.​value[x] Base required DataAbsentReason 📦4.0.1 FHIR Std.
ClaimResponse.insurer.​extension:data-masked.​value[x] Base required DataAbsentReason 📦4.0.1 FHIR Std.
ClaimResponse.request.​identifier.use Base required IdentifierUse 📍4.0.1 FHIR Std.
ClaimResponse.outcome Base required Claim Processing Codes 📍4.0.1 FHIR Std.
ClaimResponse.item.adjudication.​category Base required RTPBC Patient Pay Type Value Set 📦2.0.0-ballot This IG
ClaimResponse.item.adjudication.​amount.currency Base required CurrencyCode 📦4.0.1 FHIR Std.
ClaimResponse.addItem.​productOrService Base extensible RTPBC Prescribable Product Code Value Set 📦2.0.0-ballot This IG
ClaimResponse.addItem.​quantity.unit Base extensible RTPBC Billing Unit Value Set 📦2.0.0-ballot This IG
ClaimResponse.addItem.​adjudication.category Base required RTPBC Patient Pay Type Value Set 📦2.0.0-ballot This IG
ClaimResponse.addItem.​adjudication.amount.​currency Base required CurrencyCode 📦4.0.1 FHIR Std.
ClaimResponse.error.​code Base preferred RTPBC Error Code Value Set 📦2.0.0-ballot This IG

Constraints

Id Grade Path(s) Description Expression
dom-2 error ClaimResponse If the resource is contained in another resource, it SHALL NOT contain nested Resources contained.contained.empty()
dom-3 error ClaimResponse 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 contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
dom-4 error ClaimResponse If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
dom-5 error ClaimResponse If a resource is contained in another resource, it SHALL NOT have a security label contained.meta.security.empty()
dom-6 best practice ClaimResponse A resource should have narrative for robust management text.`div`.exists()
ele-1 error **ALL** elements All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
ext-1 error **ALL** extensions Must have either extensions or value[x], not both extension.exists() != value.exists()

NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
.. ClaimResponse ClaimResponse
... id S 0..1 id Unique ClaimResponse Resource Identifier
... identifier S 1..* Identifier RTPBC Response Identifier
.... value S 1..1 string Unique RTPBC response ID
... status S 1..1 code Response status
Fixed Value: active
.... coding S 1..1 Coding Code defined by a terminology system
..... system S 1..1 uri Identity of the terminology system
Fixed Value: http://terminology.hl7.org/CodeSystem/claim-type
..... code S 1..1 code Symbol in syntax defined by the system
Fixed Value: pharmacy
..... display S 1..1 string Representation defined by the system
Fixed Value: Pharmacy
... use S 1..1 code Processing Mode
Fixed Value: predetermination
... patient 1..1 Reference(Patient) Patient information (masked)
.... extension S 1..* Extension Extension
.... Slices for extension Content/Rules for all slices
..... extension:data-masked S 1..1 (Complex) unknown | asked | temp | notasked | masked | unsupported | astext | error
URL: http://hl7.org/fhir/StructureDefinition/data-absent-reason
...... value[x] 1..1 code Value of extension
Fixed Value: masked
.... reference 0..0 Literal reference, Relative, internal or absolute URL
.... type 0..0 Type the reference refers to (e.g. "Patient")
.... identifier 0..1 Identifier Unique, non-personally identifiable code
.... display 0..0 Text alternative for the resource
... insurer 1..1 Reference(Organization) Insurer (masked)
.... extension S 1..* Extension Extension
.... Slices for extension Content/Rules for all slices
..... extension:data-masked S 1..1 (Complex) unknown | asked | temp | notasked | masked | unsupported | astext | error
URL: http://hl7.org/fhir/StructureDefinition/data-absent-reason
...... value[x] 1..1 code Value of extension
Fixed Value: masked
... request S 1..1 Reference(Claim) Submitter's RTPBC Request ID
.... identifier S 1..1 Identifier Logical reference, when literal reference is not known
..... value S 1..1 string RTPBC Request ID
... outcome S 1..1 code Processing Outcome
... disposition S 0..1 string Completed Note
... item S 0..* BackboneElement Requested Product and Pharmacy
.... Slices for extension 0..* Extension Extension
Slice: Unordered, Open by value:url
..... extension:benefitRestriction S 0..* Coding Benefit Restriction (Extension)
URL: http://hl7.org/fhir/us/carin-rtpbc/StructureDefinition/rtpbc-benefitRestriction
Binding: RTPBC Benefit Restriction Value Set (extensible)
..... extension:formularyStatus S 0..1 Coding Formulary Status (Extension)
URL: http://hl7.org/fhir/us/carin-rtpbc/StructureDefinition/rtpbc-formularyStatus
Binding: RTPBC Formulary Status Value Set (extensible)
..... extension:preferenceLevel S 0..1 positiveInt Preference Level (Extension)
URL: http://hl7.org/fhir/us/carin-rtpbc/StructureDefinition/rtpbc-preferenceLevel
..... extension:nextAvailableFillDate S 0..1 date Next Available Fill Date (Extension)
URL: http://hl7.org/fhir/us/carin-rtpbc/StructureDefinition/rtpbc-nextAvailableFillDate
..... extension:relatedCoverage S 0..* Reference(RTPBC Coverage | RTPBC Coverage - Non-PHI) Related Coverage (Extension)
URL: http://hl7.org/fhir/us/carin-rtpbc/StructureDefinition/rtpbc-relatedCoverage
.... itemSequence S 1..1 positiveInt Claim item instance identifier
.... noteNumber S 0..* positiveInt Determination Note Number
.... adjudication S 1..* BackboneElement Requested Product and Pharmacy Determination
..... category S 1..1 CodeableConcept Patient Pay Component
Binding: RTPBC Patient Pay Type Value Set (required): RTPBC Patient Pay Categories
..... amount S 1..1 Money Patient Pay Component Amount
...... value S 1..1 decimal Patient Pay Amount Value
...... currency S 1..1 code Patient Pay Amount Currency
Binding: Currencies (required): Currencies
... addItem S 0..* BackboneElement Insurer added line items
.... Slices for extension 1..* Extension Extension
Slice: Unordered, Open by value:url
..... extension:isAlternative S 1..1 boolean Is Alternative (Extension)
URL: http://hl7.org/fhir/us/carin-rtpbc/StructureDefinition/rtpbc-isAlternative
..... extension:benefitRestriction S 0..* Coding Benefit Restriction (Extension)
URL: http://hl7.org/fhir/us/carin-rtpbc/StructureDefinition/rtpbc-benefitRestriction
Binding: RTPBC Benefit Restriction Value Set (extensible)
..... extension:formularyStatus S 0..* Coding Formulary Status (Extension)
URL: http://hl7.org/fhir/us/carin-rtpbc/StructureDefinition/rtpbc-formularyStatus
Binding: RTPBC Formulary Status Value Set (extensible)
..... extension:preferenceLevel S 0..* positiveInt Preference Level (Extension)
URL: http://hl7.org/fhir/us/carin-rtpbc/StructureDefinition/rtpbc-preferenceLevel
..... extension:nextAvailableFillDate S 0..* date Next Available Fill Date (Extension)
URL: http://hl7.org/fhir/us/carin-rtpbc/StructureDefinition/rtpbc-nextAvailableFillDate
..... extension:relatedCoverage S 0..* Reference(RTPBC Coverage | RTPBC Coverage - Non-PHI) Related Coverage (Extension)
URL: http://hl7.org/fhir/us/carin-rtpbc/StructureDefinition/rtpbc-relatedCoverage
.... itemSequence S 1..* positiveInt Associated request Item Sequence
.... provider S 0..* Reference(RTPBC Pharmacy Organization) Priced Pharmacy
..... reference S 1..1 string Reference to Priced Pharmacy
.... productOrService S 1..1 CodeableConcept Product
Binding: RTPBC Prescribable Product Code Value Set (extensible): RTPBC prescribable product codes (NDC11 and RxNorm)
..... coding S 1..* Coding Code defined by a terminology system
...... system S 1..1 uri Identity of the terminology system
...... code S 1..1 code Symbol in syntax defined by the system
...... display S 1..1 string Product Description
.... quantity S 1..1 SimpleQuantity(4.0.1) Priced Quantity
..... value S 1..1 decimal Quantity in Billing Units
..... unit S 1..1 string Billing unit of measure
Binding: RTPBC Billing Unit Value Set (extensible): Billing quantity unit of measure
.... noteNumber S 0..* positiveInt Determination Note Number
.... adjudication S 1..* BackboneElement Alternative Product and Pharmacy Determination
..... category S 1..1 CodeableConcept Patient Pay Component
Binding: RTPBC Patient Pay Type Value Set (required): RTPBC Patient Pay Categories
..... amount S 1..1 Money Patient Pay Component Amount
...... value S 1..1 decimal Patient Pay Amount Value
...... currency S 1..1 code Patient Pay Amount Currency
Binding: Currencies (required): Currencies
... processNote S 0..* BackboneElement Determination Note
.... number S 1..1 positiveInt Determination Note Number
.... text S 1..1 string Determination Note Text
... error S 0..* BackboneElement Error Information
.... code S 1..1 CodeableConcept Reject Reason
Binding: RTPBC Error Code Value Set (preferred): RTPBC Error Codes
..... coding S 1..* Coding Code defined by a terminology system
...... system S 1..1 uri Identity of the terminology system
...... code S 1..1 code Reject Code
...... display S 1..1 string Representation defined by the system
..... text S 0..1 string Reject Message

doco Documentation for this format

Terminology Bindings (Differential)

Path Status Usage ValueSet Version Source
ClaimResponse.item.adjudication.​category Base required RTPBC Patient Pay Type Value Set 📦2.0.0-ballot This IG
ClaimResponse.item.adjudication.​amount.currency Base required CurrencyCode 📦4.0.1 FHIR Std.
ClaimResponse.addItem.​productOrService Base extensible RTPBC Prescribable Product Code Value Set 📦2.0.0-ballot This IG
ClaimResponse.addItem.​quantity.unit Base extensible RTPBC Billing Unit Value Set 📦2.0.0-ballot This IG
ClaimResponse.addItem.​adjudication.category Base required RTPBC Patient Pay Type Value Set 📦2.0.0-ballot This IG
ClaimResponse.addItem.​adjudication.amount.​currency Base required CurrencyCode 📦4.0.1 FHIR Std.
ClaimResponse.error.​code Base preferred RTPBC Error Code Value Set 📦2.0.0-ballot This IG
NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
.. ClaimResponse 0..* ClaimResponse Response to a claim predetermination or preauthorization
... id SΣ 0..1 id Unique ClaimResponse Resource Identifier
... meta Σ 0..1 Meta Metadata about the resource
... implicitRules ?!Σ 0..1 uri A set of rules under which this content was created
... language 0..1 code Language of the resource content
Binding: CommonLanguages (preferred): A human language.
Additional BindingsPurpose
AllLanguages Max Binding
... text 0..1 Narrative Text summary of the resource, for human interpretation
This profile does not constrain the narrative in regard to content, language, or traceability to data elements
... contained 0..* Resource Contained, inline Resources
... extension 0..* Extension Additional content defined by implementations
... modifierExtension ?! 0..* Extension Extensions that cannot be ignored
... identifier S 1..* Identifier RTPBC Response Identifier
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
.... use ?!Σ 0..1 code usual | official | temp | secondary | old (If known)
Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .
.... type Σ 0..1 CodeableConcept Description of identifier
Binding: Identifier Type Codes (extensible): A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.
.... system Σ 0..1 uri The namespace for the identifier value
Example General: http://www.acme.com/identifiers/patient
.... value SΣ 1..1 string Unique RTPBC response ID
Example General: 123456
.... period Σ 0..1 Period Time period when id is/was valid for use
.... assigner Σ 0..1 Reference(Organization) Organization that issued id (may be just text)
... status ?!SΣ 1..1 code Response status
Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance.
Fixed Value: active
... type SΣ 1..1 CodeableConcept Requested Service Type
Binding: ClaimTypeCodes (extensible): The type or discipline-style of the claim.
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
.... coding SΣ 1..1 Coding Code defined by a terminology system
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
..... system SΣ 1..1 uri Identity of the terminology system
Fixed Value: http://terminology.hl7.org/CodeSystem/claim-type
..... version Σ 0..1 string Version of the system - if relevant
..... code SΣ 1..1 code Symbol in syntax defined by the system
Fixed Value: pharmacy
..... display SΣ 1..1 string Representation defined by the system
Fixed Value: Pharmacy
..... userSelected Σ 0..1 boolean If this coding was chosen directly by the user
.... text Σ 0..1 string Plain text representation of the concept
... subType 0..1 CodeableConcept More granular claim type
Binding: ExampleClaimSubTypeCodes (example): A more granular claim typecode.
... use SΣ 1..1 code Processing Mode
Binding: Use (required): Claim, preauthorization, predetermination.
Fixed Value: predetermination
... patient Σ 1..1 Reference(Patient) Patient information (masked)
.... id 0..1 string Unique id for inter-element referencing
.... Slices for extension S 1..* Extension Extension
Slice: Unordered, Open by value:url
..... extension:data-masked S 1..1 (Complex) unknown | asked | temp | notasked | masked | unsupported | astext | error
URL: http://hl7.org/fhir/StructureDefinition/data-absent-reason
...... id 0..1 id Unique id for inter-element referencing
...... extension 0..0 Extension
Slice: Unordered, Open by value:url
...... url 1..1 uri "http://hl7.org/fhir/StructureDefinition/data-absent-reason"
...... value[x] 1..1 code Value of extension
Binding: DataAbsentReason (required)
Fixed Value: masked
.... identifier Σ 0..1 Identifier Unique, non-personally identifiable code
... created Σ 1..1 dateTime Response creation date
... insurer Σ 1..1 Reference(Organization) Insurer (masked)
.... id 0..1 string Unique id for inter-element referencing
.... Slices for extension S 1..* Extension Extension
Slice: Unordered, Open by value:url
..... extension:data-masked S 1..1 (Complex) unknown | asked | temp | notasked | masked | unsupported | astext | error
URL: http://hl7.org/fhir/StructureDefinition/data-absent-reason
...... id 0..1 id Unique id for inter-element referencing
...... extension 0..0 Extension
Slice: Unordered, Open by value:url
...... url 1..1 uri "http://hl7.org/fhir/StructureDefinition/data-absent-reason"
...... value[x] 1..1 code Value of extension
Binding: DataAbsentReason (required)
Fixed Value: masked
.... reference ΣC 0..1 string Literal reference, Relative, internal or absolute URL
.... type Σ 0..1 uri Type the reference refers to (e.g. "Patient")
Binding: ResourceType (extensible): Aa resource (or, for logical models, the URI of the logical model).
.... identifier Σ 0..1 Identifier Logical reference, when literal reference is not known
.... display Σ 0..1 string Text alternative for the resource
... requestor 0..1 Reference(Practitioner | PractitionerRole | Organization) Party responsible for the claim
... request SΣ 1..1 Reference(Claim) Submitter's RTPBC Request ID
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
.... reference ΣC 0..1 string Literal reference, Relative, internal or absolute URL
.... type Σ 0..1 uri Type the reference refers to (e.g. "Patient")
Binding: ResourceType (extensible): Aa resource (or, for logical models, the URI of the logical model).
.... identifier SΣ 1..1 Identifier Logical reference, when literal reference is not known
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
..... use ?!Σ 0..1 code usual | official | temp | secondary | old (If known)
Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .
..... type Σ 0..1 CodeableConcept Description of identifier
Binding: Identifier Type Codes (extensible): A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.
..... system Σ 0..1 uri The namespace for the identifier value
Example General: http://www.acme.com/identifiers/patient
..... value SΣ 1..1 string RTPBC Request ID
Example General: 123456
..... period Σ 0..1 Period Time period when id is/was valid for use
..... assigner Σ 0..1 Reference(Organization) Organization that issued id (may be just text)
.... display Σ 0..1 string Text alternative for the resource
... outcome SΣ 1..1 code Processing Outcome
Binding: ClaimProcessingCodes (required): The result of the claim processing.
... disposition S 0..1 string Completed Note
... preAuthRef 0..1 string Preauthorization reference
... preAuthPeriod 0..1 Period Preauthorization reference effective period
... payeeType 0..1 CodeableConcept Party to be paid any benefits payable
Binding: Claim Payee Type Codes (example): A code for the party to be reimbursed.
... item S 0..* BackboneElement Requested Product and Pharmacy
.... id 0..1 string Unique id for inter-element referencing
.... Slices for extension 0..* Extension Extension
Slice: Unordered, Open by value:url
..... extension:benefitRestriction S 0..* Coding Benefit Restriction (Extension)
URL: http://hl7.org/fhir/us/carin-rtpbc/StructureDefinition/rtpbc-benefitRestriction
Binding: RTPBC Benefit Restriction Value Set (extensible)
..... extension:formularyStatus S 0..1 Coding Formulary Status (Extension)
URL: http://hl7.org/fhir/us/carin-rtpbc/StructureDefinition/rtpbc-formularyStatus
Binding: RTPBC Formulary Status Value Set (extensible)
..... extension:preferenceLevel S 0..1 positiveInt Preference Level (Extension)
URL: http://hl7.org/fhir/us/carin-rtpbc/StructureDefinition/rtpbc-preferenceLevel
..... extension:nextAvailableFillDate S 0..1 date Next Available Fill Date (Extension)
URL: http://hl7.org/fhir/us/carin-rtpbc/StructureDefinition/rtpbc-nextAvailableFillDate
..... extension:relatedCoverage S 0..* Reference(RTPBC Coverage | RTPBC Coverage - Non-PHI) Related Coverage (Extension)
URL: http://hl7.org/fhir/us/carin-rtpbc/StructureDefinition/rtpbc-relatedCoverage
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... itemSequence S 1..1 positiveInt Claim item instance identifier
.... noteNumber S 0..* positiveInt Determination Note Number
.... adjudication S 1..* BackboneElement Requested Product and Pharmacy Determination
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... category S 1..1 CodeableConcept Patient Pay Component
Binding: RTPBC Patient Pay Type Value Set (required): RTPBC Patient Pay Categories
..... reason 0..1 CodeableConcept Explanation of adjudication outcome
Binding: AdjudicationReasonCodes (example): The adjudication reason codes.
..... amount S 1..1 Money Patient Pay Component Amount
...... id 0..1 string Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
...... value SΣ 1..1 decimal Patient Pay Amount Value
...... currency SΣ 1..1 code Patient Pay Amount Currency
Binding: Currencies (required): Currencies
..... value 0..1 decimal Non-monetary value
.... detail 0..* BackboneElement Adjudication for claim details
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... detailSequence 1..1 positiveInt Claim detail instance identifier
..... noteNumber 0..* positiveInt Applicable note numbers
..... adjudication 1..* See adjudication (ClaimResponse) Detail level adjudication details
..... subDetail 0..* BackboneElement Adjudication for claim sub-details
...... id 0..1 string Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
...... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
...... subDetailSequence 1..1 positiveInt Claim sub-detail instance identifier
...... noteNumber 0..* positiveInt Applicable note numbers
...... adjudication 0..* See adjudication (ClaimResponse) Subdetail level adjudication details
... addItem S 0..* BackboneElement Insurer added line items
.... id 0..1 string Unique id for inter-element referencing
.... Slices for extension 1..* Extension Extension
Slice: Unordered, Open by value:url
..... extension:isAlternative S 1..1 boolean Is Alternative (Extension)
URL: http://hl7.org/fhir/us/carin-rtpbc/StructureDefinition/rtpbc-isAlternative
..... extension:benefitRestriction S 0..* Coding Benefit Restriction (Extension)
URL: http://hl7.org/fhir/us/carin-rtpbc/StructureDefinition/rtpbc-benefitRestriction
Binding: RTPBC Benefit Restriction Value Set (extensible)
..... extension:formularyStatus S 0..* Coding Formulary Status (Extension)
URL: http://hl7.org/fhir/us/carin-rtpbc/StructureDefinition/rtpbc-formularyStatus
Binding: RTPBC Formulary Status Value Set (extensible)
..... extension:preferenceLevel S 0..* positiveInt Preference Level (Extension)
URL: http://hl7.org/fhir/us/carin-rtpbc/StructureDefinition/rtpbc-preferenceLevel
..... extension:nextAvailableFillDate S 0..* date Next Available Fill Date (Extension)
URL: http://hl7.org/fhir/us/carin-rtpbc/StructureDefinition/rtpbc-nextAvailableFillDate
..... extension:relatedCoverage S 0..* Reference(RTPBC Coverage | RTPBC Coverage - Non-PHI) Related Coverage (Extension)
URL: http://hl7.org/fhir/us/carin-rtpbc/StructureDefinition/rtpbc-relatedCoverage
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... itemSequence S 1..* positiveInt Associated request Item Sequence
.... detailSequence 0..* positiveInt Detail sequence number
.... subdetailSequence 0..* positiveInt Subdetail sequence number
.... provider S 0..* Reference(RTPBC Pharmacy Organization) Priced Pharmacy
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
..... reference SΣC 1..1 string Reference to Priced Pharmacy
..... type Σ 0..1 uri Type the reference refers to (e.g. "Patient")
Binding: ResourceType (extensible): Aa resource (or, for logical models, the URI of the logical model).
..... identifier Σ 0..1 Identifier Logical reference, when literal reference is not known
..... display Σ 0..1 string Text alternative for the resource
.... productOrService S 1..1 CodeableConcept Product
Binding: RTPBC Prescribable Product Code Value Set (extensible): RTPBC prescribable product codes (NDC11 and RxNorm)
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
..... coding SΣ 1..* Coding Code defined by a terminology system
...... id 0..1 string Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
...... system SΣ 1..1 uri Identity of the terminology system
...... version Σ 0..1 string Version of the system - if relevant
...... code SΣ 1..1 code Symbol in syntax defined by the system
...... display SΣ 1..1 string Product Description
...... userSelected Σ 0..1 boolean If this coding was chosen directly by the user
..... text Σ 0..1 string Plain text representation of the concept
.... modifier 0..* CodeableConcept Service/Product billing modifiers
Binding: ModifierTypeCodes (example): Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen.
.... programCode 0..* CodeableConcept Program the product or service is provided under
Binding: ExampleProgramReasonCodes (example): Program specific reason codes.
.... serviced[x] 0..1 Date or dates of service or product delivery
..... servicedDate date
..... servicedPeriod Period
.... location[x] 0..1 Place of service or where product was supplied
Binding: ExampleServicePlaceCodes (example): Place of service: pharmacy, school, prison, etc.
..... locationCodeableConcept CodeableConcept
..... locationAddress Address
..... locationReference Reference(Location)
.... quantity S 1..1 SimpleQuantity(4.0.1) Priced Quantity
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
..... value SΣ 1..1 decimal Quantity in Billing Units
..... unit SΣ 1..1 string Billing unit of measure
Binding: RTPBC Billing Unit Value Set (extensible): Billing quantity unit of measure
..... system ΣC 0..1 uri System that defines coded unit form
..... code Σ 0..1 code Coded form of the unit
.... unitPrice 0..1 Money Fee, charge or cost per item
.... factor 0..1 decimal Price scaling factor
.... net 0..1 Money Total item cost
.... bodySite 0..1 CodeableConcept Anatomical location
Binding: OralSiteCodes (example): The code for the teeth, quadrant, sextant and arch.
.... subSite 0..* CodeableConcept Anatomical sub-location
Binding: SurfaceCodes (example): The code for the tooth surface and surface combinations.
.... noteNumber S 0..* positiveInt Determination Note Number
.... adjudication S 1..* BackboneElement Alternative Product and Pharmacy Determination
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... category S 1..1 CodeableConcept Patient Pay Component
Binding: RTPBC Patient Pay Type Value Set (required): RTPBC Patient Pay Categories
..... reason 0..1 CodeableConcept Explanation of adjudication outcome
Binding: AdjudicationReasonCodes (example): The adjudication reason codes.
..... amount S 1..1 Money Patient Pay Component Amount
...... id 0..1 string Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
...... value SΣ 1..1 decimal Patient Pay Amount Value
...... currency SΣ 1..1 code Patient Pay Amount Currency
Binding: Currencies (required): Currencies
..... value 0..1 decimal Non-monetary value
.... detail 0..* BackboneElement Insurer added line details
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... productOrService 1..1 CodeableConcept Billing, service, product, or drug code
Binding: USCLSCodes (example): Allowable service and product codes.
..... modifier 0..* CodeableConcept Service/Product billing modifiers
Binding: ModifierTypeCodes (example): Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen.
..... quantity 0..1 SimpleQuantity(4.0.1) Count of products or services
..... unitPrice 0..1 Money Fee, charge or cost per item
..... factor 0..1 decimal Price scaling factor
..... net 0..1 Money Total item cost
..... noteNumber 0..* positiveInt Applicable note numbers
..... adjudication 1..* See adjudication (ClaimResponse) Added items detail adjudication
..... subDetail 0..* BackboneElement Insurer added line items
...... id 0..1 string Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
...... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
...... productOrService 1..1 CodeableConcept Billing, service, product, or drug code
Binding: USCLSCodes (example): Allowable service and product codes.
...... modifier 0..* CodeableConcept Service/Product billing modifiers
Binding: ModifierTypeCodes (example): Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen.
...... quantity 0..1 SimpleQuantity(4.0.1) Count of products or services
...... unitPrice 0..1 Money Fee, charge or cost per item
...... factor 0..1 decimal Price scaling factor
...... net 0..1 Money Total item cost
...... noteNumber 0..* positiveInt Applicable note numbers
...... adjudication 1..* See adjudication (ClaimResponse) Added items detail adjudication
... adjudication 0..* See adjudication (ClaimResponse) Header-level adjudication
... total Σ 0..* BackboneElement Adjudication totals
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... category Σ 1..1 CodeableConcept Type of adjudication information
Binding: AdjudicationValueCodes (example): The adjudication codes.
.... amount Σ 1..1 Money Financial total for the category
... payment 0..1 BackboneElement Payment Details
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... type 1..1 CodeableConcept Partial or complete payment
Binding: ExamplePaymentTypeCodes (example): The type (partial, complete) of the payment.
.... adjustment 0..1 Money Payment adjustment for non-claim issues
.... adjustmentReason 0..1 CodeableConcept Explanation for the adjustment
Binding: PaymentAdjustmentReasonCodes (example): Payment Adjustment reason codes.
.... date 0..1 date Expected date of payment
.... amount 1..1 Money Payable amount after adjustment
.... identifier 0..1 Identifier Business identifier for the payment
... fundsReserve 0..1 CodeableConcept Funds reserved status
Binding: Funds Reservation Codes (example): For whom funds are to be reserved: (Patient, Provider, None).
... formCode 0..1 CodeableConcept Printed form identifier
Binding: Form Codes (example): The forms codes.
... form 0..1 Attachment Printed reference or actual form
... processNote S 0..* BackboneElement Determination Note
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... number S 1..1 positiveInt Determination Note Number
.... type 0..1 code display | print | printoper
Binding: NoteType (required): The presentation types of notes.
.... text S 1..1 string Determination Note Text
.... language 0..1 CodeableConcept Language of the text
Binding: CommonLanguages (preferred): A human language.
Additional BindingsPurpose
AllLanguages Max Binding
... communicationRequest 0..* Reference(CommunicationRequest) Request for additional information
... insurance 0..* BackboneElement Patient insurance information
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... sequence 1..1 positiveInt Insurance instance identifier
.... focal 1..1 boolean Coverage to be used for adjudication
.... coverage 1..1 Reference(Coverage) Insurance information
.... businessArrangement 0..1 string Additional provider contract number
.... claimResponse 0..1 Reference(ClaimResponse) Adjudication results
... error S 0..* BackboneElement Error Information
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... itemSequence 0..1 positiveInt Item sequence number
.... detailSequence 0..1 positiveInt Detail sequence number
.... subDetailSequence 0..1 positiveInt Subdetail sequence number
.... code S 1..1 CodeableConcept Reject Reason
Binding: RTPBC Error Code Value Set (preferred): RTPBC Error Codes
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
..... coding SΣ 1..* Coding Code defined by a terminology system
...... id 0..1 string Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
...... system SΣ 1..1 uri Identity of the terminology system
...... version Σ 0..1 string Version of the system - if relevant
...... code SΣ 1..1 code Reject Code
...... display SΣ 1..1 string Representation defined by the system
...... userSelected Σ 0..1 boolean If this coding was chosen directly by the user
..... text SΣ 0..1 string Reject Message

doco Documentation for this format

Terminology Bindings

Path Status Usage ValueSet Version Source
ClaimResponse.language Base preferred Common Languages 📍4.0.1 FHIR Std.
ClaimResponse.identifier.​use Base required IdentifierUse 📍4.0.1 FHIR Std.
ClaimResponse.identifier.​type Base extensible IdentifierType 📍4.0.1 FHIR Std.
ClaimResponse.status Base required Financial Resource Status Codes 📍4.0.1 FHIR Std.
ClaimResponse.type Base extensible Claim Type Codes 📍4.0.1 FHIR Std.
ClaimResponse.subType Base example Example Claim SubType Codes 📍4.0.1 FHIR Std.
ClaimResponse.use Base required Use 📍4.0.1 FHIR Std.
ClaimResponse.patient.​extension:data-masked.​value[x] Base required DataAbsentReason 📦4.0.1 FHIR Std.
ClaimResponse.insurer.​extension:data-masked.​value[x] Base required DataAbsentReason 📦4.0.1 FHIR Std.
ClaimResponse.insurer.​type Base extensible ResourceType 📍4.0.1 FHIR Std.
ClaimResponse.request.​type Base extensible ResourceType 📍4.0.1 FHIR Std.
ClaimResponse.request.​identifier.use Base required IdentifierUse 📍4.0.1 FHIR Std.
ClaimResponse.request.​identifier.type Base extensible IdentifierType 📍4.0.1 FHIR Std.
ClaimResponse.outcome Base required Claim Processing Codes 📍4.0.1 FHIR Std.
ClaimResponse.payeeType Base example PayeeType 📍4.0.1 FHIR Std.
ClaimResponse.item.adjudication.​category Base required RTPBC Patient Pay Type Value Set 📦2.0.0-ballot This IG
ClaimResponse.item.adjudication.​reason Base example Adjudication Reason Codes 📍4.0.1 FHIR Std.
ClaimResponse.item.adjudication.​amount.currency Base required CurrencyCode 📦4.0.1 FHIR Std.
ClaimResponse.addItem.​provider.type Base extensible ResourceType 📍4.0.1 FHIR Std.
ClaimResponse.addItem.​productOrService Base extensible RTPBC Prescribable Product Code Value Set 📦2.0.0-ballot This IG
ClaimResponse.addItem.​modifier Base example Modifier type Codes 📍4.0.1 FHIR Std.
ClaimResponse.addItem.​programCode Base example Example Program Reason Codes 📍4.0.1 FHIR Std.
ClaimResponse.addItem.​location[x] Base example Example Service Place Codes 📍4.0.1 FHIR Std.
ClaimResponse.addItem.​quantity.unit Base extensible RTPBC Billing Unit Value Set 📦2.0.0-ballot This IG
ClaimResponse.addItem.​bodySite Base example Oral Site Codes 📍4.0.1 FHIR Std.
ClaimResponse.addItem.​subSite Base example Surface Codes 📍4.0.1 FHIR Std.
ClaimResponse.addItem.​adjudication.category Base required RTPBC Patient Pay Type Value Set 📦2.0.0-ballot This IG
ClaimResponse.addItem.​adjudication.reason Base example Adjudication Reason Codes 📍4.0.1 FHIR Std.
ClaimResponse.addItem.​adjudication.amount.​currency Base required CurrencyCode 📦4.0.1 FHIR Std.
ClaimResponse.addItem.​detail.productOrService Base example USCLS Codes 📍4.0.1 FHIR Std.
ClaimResponse.addItem.​detail.modifier Base example Modifier type Codes 📍4.0.1 FHIR Std.
ClaimResponse.addItem.​detail.subDetail.productOrService Base example USCLS Codes 📍4.0.1 FHIR Std.
ClaimResponse.addItem.​detail.subDetail.modifier Base example Modifier type Codes 📍4.0.1 FHIR Std.
ClaimResponse.total.​category Base example Adjudication Value Codes 📍4.0.1 FHIR Std.
ClaimResponse.payment.​type Base example Example Payment Type Codes 📍4.0.1 FHIR Std.
ClaimResponse.payment.​adjustmentReason Base example Payment Adjustment Reason Codes 📍4.0.1 FHIR Std.
ClaimResponse.fundsReserve Base example FundsReserve 📍4.0.1 FHIR Std.
ClaimResponse.formCode Base example Forms 📍4.0.1 FHIR Std.
ClaimResponse.processNote.​type Base required NoteType 📍4.0.1 FHIR Std.
ClaimResponse.processNote.​language Base preferred Common Languages 📍4.0.1 FHIR Std.
ClaimResponse.error.​code Base preferred RTPBC Error Code Value Set 📦2.0.0-ballot This IG

Constraints

Id Grade Path(s) Description Expression
dom-2 error ClaimResponse If the resource is contained in another resource, it SHALL NOT contain nested Resources contained.contained.empty()
dom-3 error ClaimResponse 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 contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
dom-4 error ClaimResponse If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
dom-5 error ClaimResponse If a resource is contained in another resource, it SHALL NOT have a security label contained.meta.security.empty()
dom-6 best practice ClaimResponse A resource should have narrative for robust management text.`div`.exists()
ele-1 error **ALL** elements All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
ext-1 error **ALL** extensions Must have either extensions or value[x], not both extension.exists() != value.exists()

Key Elements View

NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
.. ClaimResponse 0..* ClaimResponse Response to a claim predetermination or preauthorization
... id SΣ 0..1 id Unique ClaimResponse Resource Identifier
... implicitRules ?!Σ 0..1 uri A set of rules under which this content was created
... modifierExtension ?! 0..* Extension Extensions that cannot be ignored
.... use ?!Σ 0..1 code usual | official | temp | secondary | old (If known)
Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .
.... value SΣ 1..1 string Unique RTPBC response ID
Example General: 123456
... status ?!SΣ 1..1 code Response status
Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance.
Fixed Value: active
... type SΣ 1..1 CodeableConcept Requested Service Type
Binding: ClaimTypeCodes (extensible): The type or discipline-style of the claim.
.... coding SΣ 1..1 Coding Code defined by a terminology system
..... system SΣ 1..1 uri Identity of the terminology system
Fixed Value: http://terminology.hl7.org/CodeSystem/claim-type
..... code SΣ 1..1 code Symbol in syntax defined by the system
Fixed Value: pharmacy
..... display SΣ 1..1 string Representation defined by the system
Fixed Value: Pharmacy
... use SΣ 1..1 code Processing Mode
Binding: Use (required): Claim, preauthorization, predetermination.
Fixed Value: predetermination
... patient Σ 1..1 Reference(Patient) Patient information (masked)
.... Slices for extension S 1..* Extension Extension
Slice: Unordered, Open by value:url
..... extension:data-masked S 1..1 (Complex) unknown | asked | temp | notasked | masked | unsupported | astext | error
URL: http://hl7.org/fhir/StructureDefinition/data-absent-reason
...... extension 0..0 Extension
Slice: Unordered, Open by value:url
...... url 1..1 uri "http://hl7.org/fhir/StructureDefinition/data-absent-reason"
...... value[x] 1..1 code Value of extension
Binding: DataAbsentReason (required)
Fixed Value: masked
.... identifier Σ 0..1 Identifier Unique, non-personally identifiable code
... created Σ 1..1 dateTime Response creation date
... insurer Σ 1..1 Reference(Organization) Insurer (masked)
.... Slices for extension S 1..* Extension Extension
Slice: Unordered, Open by value:url
..... extension:data-masked S 1..1 (Complex) unknown | asked | temp | notasked | masked | unsupported | astext | error
URL: http://hl7.org/fhir/StructureDefinition/data-absent-reason
...... extension 0..0 Extension
Slice: Unordered, Open by value:url
...... url 1..1 uri "http://hl7.org/fhir/StructureDefinition/data-absent-reason"
...... value[x] 1..1 code Value of extension
Binding: DataAbsentReason (required)
Fixed Value: masked
... request SΣ 1..1 Reference(Claim) Submitter's RTPBC Request ID
.... identifier SΣ 1..1 Identifier Logical reference, when literal reference is not known
..... use ?!Σ 0..1 code usual | official | temp | secondary | old (If known)
Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .
..... value SΣ 1..1 string RTPBC Request ID
Example General: 123456
... outcome SΣ 1..1 code Processing Outcome
Binding: ClaimProcessingCodes (required): The result of the claim processing.
... disposition S 0..1 string Completed Note
... item S 0..* BackboneElement Requested Product and Pharmacy
.... Slices for extension 0..* Extension Extension
Slice: Unordered, Open by value:url
..... extension:benefitRestriction S 0..* Coding Benefit Restriction (Extension)
URL: http://hl7.org/fhir/us/carin-rtpbc/StructureDefinition/rtpbc-benefitRestriction
Binding: RTPBC Benefit Restriction Value Set (extensible)
..... extension:formularyStatus S 0..1 Coding Formulary Status (Extension)
URL: http://hl7.org/fhir/us/carin-rtpbc/StructureDefinition/rtpbc-formularyStatus
Binding: RTPBC Formulary Status Value Set (extensible)
..... extension:preferenceLevel S 0..1 positiveInt Preference Level (Extension)
URL: http://hl7.org/fhir/us/carin-rtpbc/StructureDefinition/rtpbc-preferenceLevel
..... extension:nextAvailableFillDate S 0..1 date Next Available Fill Date (Extension)
URL: http://hl7.org/fhir/us/carin-rtpbc/StructureDefinition/rtpbc-nextAvailableFillDate
..... extension:relatedCoverage S 0..* Reference(RTPBC Coverage | RTPBC Coverage - Non-PHI) Related Coverage (Extension)
URL: http://hl7.org/fhir/us/carin-rtpbc/StructureDefinition/rtpbc-relatedCoverage
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... itemSequence S 1..1 positiveInt Claim item instance identifier
.... noteNumber S 0..* positiveInt Determination Note Number
.... adjudication S 1..* BackboneElement Requested Product and Pharmacy Determination
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... category S 1..1 CodeableConcept Patient Pay Component
Binding: RTPBC Patient Pay Type Value Set (required): RTPBC Patient Pay Categories
..... amount S 1..1 Money Patient Pay Component Amount
...... value SΣ 1..1 decimal Patient Pay Amount Value
...... currency SΣ 1..1 code Patient Pay Amount Currency
Binding: Currencies (required): Currencies
... addItem S 0..* BackboneElement Insurer added line items
.... Slices for extension 1..* Extension Extension
Slice: Unordered, Open by value:url
..... extension:isAlternative S 1..1 boolean Is Alternative (Extension)
URL: http://hl7.org/fhir/us/carin-rtpbc/StructureDefinition/rtpbc-isAlternative
..... extension:benefitRestriction S 0..* Coding Benefit Restriction (Extension)
URL: http://hl7.org/fhir/us/carin-rtpbc/StructureDefinition/rtpbc-benefitRestriction
Binding: RTPBC Benefit Restriction Value Set (extensible)
..... extension:formularyStatus S 0..* Coding Formulary Status (Extension)
URL: http://hl7.org/fhir/us/carin-rtpbc/StructureDefinition/rtpbc-formularyStatus
Binding: RTPBC Formulary Status Value Set (extensible)
..... extension:preferenceLevel S 0..* positiveInt Preference Level (Extension)
URL: http://hl7.org/fhir/us/carin-rtpbc/StructureDefinition/rtpbc-preferenceLevel
..... extension:nextAvailableFillDate S 0..* date Next Available Fill Date (Extension)
URL: http://hl7.org/fhir/us/carin-rtpbc/StructureDefinition/rtpbc-nextAvailableFillDate
..... extension:relatedCoverage S 0..* Reference(RTPBC Coverage | RTPBC Coverage - Non-PHI) Related Coverage (Extension)
URL: http://hl7.org/fhir/us/carin-rtpbc/StructureDefinition/rtpbc-relatedCoverage
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... itemSequence S 1..* positiveInt Associated request Item Sequence
.... provider S 0..* Reference(RTPBC Pharmacy Organization) Priced Pharmacy
..... reference SΣC 1..1 string Reference to Priced Pharmacy
.... productOrService S 1..1 CodeableConcept Product
Binding: RTPBC Prescribable Product Code Value Set (extensible): RTPBC prescribable product codes (NDC11 and RxNorm)
..... coding SΣ 1..* Coding Code defined by a terminology system
...... system SΣ 1..1 uri Identity of the terminology system
...... code SΣ 1..1 code Symbol in syntax defined by the system
...... display SΣ 1..1 string Product Description
.... quantity S 1..1 SimpleQuantity(4.0.1) Priced Quantity
..... value SΣ 1..1 decimal Quantity in Billing Units
..... unit SΣ 1..1 string Billing unit of measure
Binding: RTPBC Billing Unit Value Set (extensible): Billing quantity unit of measure
.... noteNumber S 0..* positiveInt Determination Note Number
.... adjudication S 1..* BackboneElement Alternative Product and Pharmacy Determination
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... category S 1..1 CodeableConcept Patient Pay Component
Binding: RTPBC Patient Pay Type Value Set (required): RTPBC Patient Pay Categories
..... amount S 1..1 Money Patient Pay Component Amount
...... value SΣ 1..1 decimal Patient Pay Amount Value
...... currency SΣ 1..1 code Patient Pay Amount Currency
Binding: Currencies (required): Currencies
... processNote S 0..* BackboneElement Determination Note
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... number S 1..1 positiveInt Determination Note Number
.... text S 1..1 string Determination Note Text
... error S 0..* BackboneElement Error Information
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... code S 1..1 CodeableConcept Reject Reason
Binding: RTPBC Error Code Value Set (preferred): RTPBC Error Codes
..... coding SΣ 1..* Coding Code defined by a terminology system
...... system SΣ 1..1 uri Identity of the terminology system
...... code SΣ 1..1 code Reject Code
...... display SΣ 1..1 string Representation defined by the system
..... text SΣ 0..1 string Reject Message

doco Documentation for this format

Terminology Bindings

Path Status Usage ValueSet Version Source
ClaimResponse.identifier.​use Base required IdentifierUse 📍4.0.1 FHIR Std.
ClaimResponse.status Base required Financial Resource Status Codes 📍4.0.1 FHIR Std.
ClaimResponse.type Base extensible Claim Type Codes 📍4.0.1 FHIR Std.
ClaimResponse.use Base required Use 📍4.0.1 FHIR Std.
ClaimResponse.patient.​extension:data-masked.​value[x] Base required DataAbsentReason 📦4.0.1 FHIR Std.
ClaimResponse.insurer.​extension:data-masked.​value[x] Base required DataAbsentReason 📦4.0.1 FHIR Std.
ClaimResponse.request.​identifier.use Base required IdentifierUse 📍4.0.1 FHIR Std.
ClaimResponse.outcome Base required Claim Processing Codes 📍4.0.1 FHIR Std.
ClaimResponse.item.adjudication.​category Base required RTPBC Patient Pay Type Value Set 📦2.0.0-ballot This IG
ClaimResponse.item.adjudication.​amount.currency Base required CurrencyCode 📦4.0.1 FHIR Std.
ClaimResponse.addItem.​productOrService Base extensible RTPBC Prescribable Product Code Value Set 📦2.0.0-ballot This IG
ClaimResponse.addItem.​quantity.unit Base extensible RTPBC Billing Unit Value Set 📦2.0.0-ballot This IG
ClaimResponse.addItem.​adjudication.category Base required RTPBC Patient Pay Type Value Set 📦2.0.0-ballot This IG
ClaimResponse.addItem.​adjudication.amount.​currency Base required CurrencyCode 📦4.0.1 FHIR Std.
ClaimResponse.error.​code Base preferred RTPBC Error Code Value Set 📦2.0.0-ballot This IG

Constraints

Id Grade Path(s) Description Expression
dom-2 error ClaimResponse If the resource is contained in another resource, it SHALL NOT contain nested Resources contained.contained.empty()
dom-3 error ClaimResponse 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 contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
dom-4 error ClaimResponse If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
dom-5 error ClaimResponse If a resource is contained in another resource, it SHALL NOT have a security label contained.meta.security.empty()
dom-6 best practice ClaimResponse A resource should have narrative for robust management text.`div`.exists()
ele-1 error **ALL** elements All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
ext-1 error **ALL** extensions Must have either extensions or value[x], not both extension.exists() != value.exists()

Differential View

NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
.. ClaimResponse ClaimResponse
... id S 0..1 id Unique ClaimResponse Resource Identifier
... identifier S 1..* Identifier RTPBC Response Identifier
.... value S 1..1 string Unique RTPBC response ID
... status S 1..1 code Response status
Fixed Value: active
.... coding S 1..1 Coding Code defined by a terminology system
..... system S 1..1 uri Identity of the terminology system
Fixed Value: http://terminology.hl7.org/CodeSystem/claim-type
..... code S 1..1 code Symbol in syntax defined by the system
Fixed Value: pharmacy
..... display S 1..1 string Representation defined by the system
Fixed Value: Pharmacy
... use S 1..1 code Processing Mode
Fixed Value: predetermination
... patient 1..1 Reference(Patient) Patient information (masked)
.... extension S 1..* Extension Extension
.... Slices for extension Content/Rules for all slices
..... extension:data-masked S 1..1 (Complex) unknown | asked | temp | notasked | masked | unsupported | astext | error
URL: http://hl7.org/fhir/StructureDefinition/data-absent-reason
...... value[x] 1..1 code Value of extension
Fixed Value: masked
.... reference 0..0 Literal reference, Relative, internal or absolute URL
.... type 0..0 Type the reference refers to (e.g. "Patient")
.... identifier 0..1 Identifier Unique, non-personally identifiable code
.... display 0..0 Text alternative for the resource
... insurer 1..1 Reference(Organization) Insurer (masked)
.... extension S 1..* Extension Extension
.... Slices for extension Content/Rules for all slices
..... extension:data-masked S 1..1 (Complex) unknown | asked | temp | notasked | masked | unsupported | astext | error
URL: http://hl7.org/fhir/StructureDefinition/data-absent-reason
...... value[x] 1..1 code Value of extension
Fixed Value: masked
... request S 1..1 Reference(Claim) Submitter's RTPBC Request ID
.... identifier S 1..1 Identifier Logical reference, when literal reference is not known
..... value S 1..1 string RTPBC Request ID
... outcome S 1..1 code Processing Outcome
... disposition S 0..1 string Completed Note
... item S 0..* BackboneElement Requested Product and Pharmacy
.... Slices for extension 0..* Extension Extension
Slice: Unordered, Open by value:url
..... extension:benefitRestriction S 0..* Coding Benefit Restriction (Extension)
URL: http://hl7.org/fhir/us/carin-rtpbc/StructureDefinition/rtpbc-benefitRestriction
Binding: RTPBC Benefit Restriction Value Set (extensible)
..... extension:formularyStatus S 0..1 Coding Formulary Status (Extension)
URL: http://hl7.org/fhir/us/carin-rtpbc/StructureDefinition/rtpbc-formularyStatus
Binding: RTPBC Formulary Status Value Set (extensible)
..... extension:preferenceLevel S 0..1 positiveInt Preference Level (Extension)
URL: http://hl7.org/fhir/us/carin-rtpbc/StructureDefinition/rtpbc-preferenceLevel
..... extension:nextAvailableFillDate S 0..1 date Next Available Fill Date (Extension)
URL: http://hl7.org/fhir/us/carin-rtpbc/StructureDefinition/rtpbc-nextAvailableFillDate
..... extension:relatedCoverage S 0..* Reference(RTPBC Coverage | RTPBC Coverage - Non-PHI) Related Coverage (Extension)
URL: http://hl7.org/fhir/us/carin-rtpbc/StructureDefinition/rtpbc-relatedCoverage
.... itemSequence S 1..1 positiveInt Claim item instance identifier
.... noteNumber S 0..* positiveInt Determination Note Number
.... adjudication S 1..* BackboneElement Requested Product and Pharmacy Determination
..... category S 1..1 CodeableConcept Patient Pay Component
Binding: RTPBC Patient Pay Type Value Set (required): RTPBC Patient Pay Categories
..... amount S 1..1 Money Patient Pay Component Amount
...... value S 1..1 decimal Patient Pay Amount Value
...... currency S 1..1 code Patient Pay Amount Currency
Binding: Currencies (required): Currencies
... addItem S 0..* BackboneElement Insurer added line items
.... Slices for extension 1..* Extension Extension
Slice: Unordered, Open by value:url
..... extension:isAlternative S 1..1 boolean Is Alternative (Extension)
URL: http://hl7.org/fhir/us/carin-rtpbc/StructureDefinition/rtpbc-isAlternative
..... extension:benefitRestriction S 0..* Coding Benefit Restriction (Extension)
URL: http://hl7.org/fhir/us/carin-rtpbc/StructureDefinition/rtpbc-benefitRestriction
Binding: RTPBC Benefit Restriction Value Set (extensible)
..... extension:formularyStatus S 0..* Coding Formulary Status (Extension)
URL: http://hl7.org/fhir/us/carin-rtpbc/StructureDefinition/rtpbc-formularyStatus
Binding: RTPBC Formulary Status Value Set (extensible)
..... extension:preferenceLevel S 0..* positiveInt Preference Level (Extension)
URL: http://hl7.org/fhir/us/carin-rtpbc/StructureDefinition/rtpbc-preferenceLevel
..... extension:nextAvailableFillDate S 0..* date Next Available Fill Date (Extension)
URL: http://hl7.org/fhir/us/carin-rtpbc/StructureDefinition/rtpbc-nextAvailableFillDate
..... extension:relatedCoverage S 0..* Reference(RTPBC Coverage | RTPBC Coverage - Non-PHI) Related Coverage (Extension)
URL: http://hl7.org/fhir/us/carin-rtpbc/StructureDefinition/rtpbc-relatedCoverage
.... itemSequence S 1..* positiveInt Associated request Item Sequence
.... provider S 0..* Reference(RTPBC Pharmacy Organization) Priced Pharmacy
..... reference S 1..1 string Reference to Priced Pharmacy
.... productOrService S 1..1 CodeableConcept Product
Binding: RTPBC Prescribable Product Code Value Set (extensible): RTPBC prescribable product codes (NDC11 and RxNorm)
..... coding S 1..* Coding Code defined by a terminology system
...... system S 1..1 uri Identity of the terminology system
...... code S 1..1 code Symbol in syntax defined by the system
...... display S 1..1 string Product Description
.... quantity S 1..1 SimpleQuantity(4.0.1) Priced Quantity
..... value S 1..1 decimal Quantity in Billing Units
..... unit S 1..1 string Billing unit of measure
Binding: RTPBC Billing Unit Value Set (extensible): Billing quantity unit of measure
.... noteNumber S 0..* positiveInt Determination Note Number
.... adjudication S 1..* BackboneElement Alternative Product and Pharmacy Determination
..... category S 1..1 CodeableConcept Patient Pay Component
Binding: RTPBC Patient Pay Type Value Set (required): RTPBC Patient Pay Categories
..... amount S 1..1 Money Patient Pay Component Amount
...... value S 1..1 decimal Patient Pay Amount Value
...... currency S 1..1 code Patient Pay Amount Currency
Binding: Currencies (required): Currencies
... processNote S 0..* BackboneElement Determination Note
.... number S 1..1 positiveInt Determination Note Number
.... text S 1..1 string Determination Note Text
... error S 0..* BackboneElement Error Information
.... code S 1..1 CodeableConcept Reject Reason
Binding: RTPBC Error Code Value Set (preferred): RTPBC Error Codes
..... coding S 1..* Coding Code defined by a terminology system
...... system S 1..1 uri Identity of the terminology system
...... code S 1..1 code Reject Code
...... display S 1..1 string Representation defined by the system
..... text S 0..1 string Reject Message

doco Documentation for this format

Terminology Bindings (Differential)

Path Status Usage ValueSet Version Source
ClaimResponse.item.adjudication.​category Base required RTPBC Patient Pay Type Value Set 📦2.0.0-ballot This IG
ClaimResponse.item.adjudication.​amount.currency Base required CurrencyCode 📦4.0.1 FHIR Std.
ClaimResponse.addItem.​productOrService Base extensible RTPBC Prescribable Product Code Value Set 📦2.0.0-ballot This IG
ClaimResponse.addItem.​quantity.unit Base extensible RTPBC Billing Unit Value Set 📦2.0.0-ballot This IG
ClaimResponse.addItem.​adjudication.category Base required RTPBC Patient Pay Type Value Set 📦2.0.0-ballot This IG
ClaimResponse.addItem.​adjudication.amount.​currency Base required CurrencyCode 📦4.0.1 FHIR Std.
ClaimResponse.error.​code Base preferred RTPBC Error Code Value Set 📦2.0.0-ballot This IG

Snapshot ViewView

NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
.. ClaimResponse 0..* ClaimResponse Response to a claim predetermination or preauthorization
... id SΣ 0..1 id Unique ClaimResponse Resource Identifier
... meta Σ 0..1 Meta Metadata about the resource
... implicitRules ?!Σ 0..1 uri A set of rules under which this content was created
... language 0..1 code Language of the resource content
Binding: CommonLanguages (preferred): A human language.
Additional BindingsPurpose
AllLanguages Max Binding
... text 0..1 Narrative Text summary of the resource, for human interpretation
This profile does not constrain the narrative in regard to content, language, or traceability to data elements
... contained 0..* Resource Contained, inline Resources
... extension 0..* Extension Additional content defined by implementations
... modifierExtension ?! 0..* Extension Extensions that cannot be ignored
... identifier S 1..* Identifier RTPBC Response Identifier
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
.... use ?!Σ 0..1 code usual | official | temp | secondary | old (If known)
Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .
.... type Σ 0..1 CodeableConcept Description of identifier
Binding: Identifier Type Codes (extensible): A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.
.... system Σ 0..1 uri The namespace for the identifier value
Example General: http://www.acme.com/identifiers/patient
.... value SΣ 1..1 string Unique RTPBC response ID
Example General: 123456
.... period Σ 0..1 Period Time period when id is/was valid for use
.... assigner Σ 0..1 Reference(Organization) Organization that issued id (may be just text)
... status ?!SΣ 1..1 code Response status
Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance.
Fixed Value: active
... type SΣ 1..1 CodeableConcept Requested Service Type
Binding: ClaimTypeCodes (extensible): The type or discipline-style of the claim.
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
.... coding SΣ 1..1 Coding Code defined by a terminology system
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
..... system SΣ 1..1 uri Identity of the terminology system
Fixed Value: http://terminology.hl7.org/CodeSystem/claim-type
..... version Σ 0..1 string Version of the system - if relevant
..... code SΣ 1..1 code Symbol in syntax defined by the system
Fixed Value: pharmacy
..... display SΣ 1..1 string Representation defined by the system
Fixed Value: Pharmacy
..... userSelected Σ 0..1 boolean If this coding was chosen directly by the user
.... text Σ 0..1 string Plain text representation of the concept
... subType 0..1 CodeableConcept More granular claim type
Binding: ExampleClaimSubTypeCodes (example): A more granular claim typecode.
... use SΣ 1..1 code Processing Mode
Binding: Use (required): Claim, preauthorization, predetermination.
Fixed Value: predetermination
... patient Σ 1..1 Reference(Patient) Patient information (masked)
.... id 0..1 string Unique id for inter-element referencing
.... Slices for extension S 1..* Extension Extension
Slice: Unordered, Open by value:url
..... extension:data-masked S 1..1 (Complex) unknown | asked | temp | notasked | masked | unsupported | astext | error
URL: http://hl7.org/fhir/StructureDefinition/data-absent-reason
...... id 0..1 id Unique id for inter-element referencing
...... extension 0..0 Extension
Slice: Unordered, Open by value:url
...... url 1..1 uri "http://hl7.org/fhir/StructureDefinition/data-absent-reason"
...... value[x] 1..1 code Value of extension
Binding: DataAbsentReason (required)
Fixed Value: masked
.... identifier Σ 0..1 Identifier Unique, non-personally identifiable code
... created Σ 1..1 dateTime Response creation date
... insurer Σ 1..1 Reference(Organization) Insurer (masked)
.... id 0..1 string Unique id for inter-element referencing
.... Slices for extension S 1..* Extension Extension
Slice: Unordered, Open by value:url
..... extension:data-masked S 1..1 (Complex) unknown | asked | temp | notasked | masked | unsupported | astext | error
URL: http://hl7.org/fhir/StructureDefinition/data-absent-reason
...... id 0..1 id Unique id for inter-element referencing
...... extension 0..0 Extension
Slice: Unordered, Open by value:url
...... url 1..1 uri "http://hl7.org/fhir/StructureDefinition/data-absent-reason"
...... value[x] 1..1 code Value of extension
Binding: DataAbsentReason (required)
Fixed Value: masked
.... reference ΣC 0..1 string Literal reference, Relative, internal or absolute URL
.... type Σ 0..1 uri Type the reference refers to (e.g. "Patient")
Binding: ResourceType (extensible): Aa resource (or, for logical models, the URI of the logical model).
.... identifier Σ 0..1 Identifier Logical reference, when literal reference is not known
.... display Σ 0..1 string Text alternative for the resource
... requestor 0..1 Reference(Practitioner | PractitionerRole | Organization) Party responsible for the claim
... request SΣ 1..1 Reference(Claim) Submitter's RTPBC Request ID
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
.... reference ΣC 0..1 string Literal reference, Relative, internal or absolute URL
.... type Σ 0..1 uri Type the reference refers to (e.g. "Patient")
Binding: ResourceType (extensible): Aa resource (or, for logical models, the URI of the logical model).
.... identifier SΣ 1..1 Identifier Logical reference, when literal reference is not known
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
..... use ?!Σ 0..1 code usual | official | temp | secondary | old (If known)
Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .
..... type Σ 0..1 CodeableConcept Description of identifier
Binding: Identifier Type Codes (extensible): A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.
..... system Σ 0..1 uri The namespace for the identifier value
Example General: http://www.acme.com/identifiers/patient
..... value SΣ 1..1 string RTPBC Request ID
Example General: 123456
..... period Σ 0..1 Period Time period when id is/was valid for use
..... assigner Σ 0..1 Reference(Organization) Organization that issued id (may be just text)
.... display Σ 0..1 string Text alternative for the resource
... outcome SΣ 1..1 code Processing Outcome
Binding: ClaimProcessingCodes (required): The result of the claim processing.
... disposition S 0..1 string Completed Note
... preAuthRef 0..1 string Preauthorization reference
... preAuthPeriod 0..1 Period Preauthorization reference effective period
... payeeType 0..1 CodeableConcept Party to be paid any benefits payable
Binding: Claim Payee Type Codes (example): A code for the party to be reimbursed.
... item S 0..* BackboneElement Requested Product and Pharmacy
.... id 0..1 string Unique id for inter-element referencing
.... Slices for extension 0..* Extension Extension
Slice: Unordered, Open by value:url
..... extension:benefitRestriction S 0..* Coding Benefit Restriction (Extension)
URL: http://hl7.org/fhir/us/carin-rtpbc/StructureDefinition/rtpbc-benefitRestriction
Binding: RTPBC Benefit Restriction Value Set (extensible)
..... extension:formularyStatus S 0..1 Coding Formulary Status (Extension)
URL: http://hl7.org/fhir/us/carin-rtpbc/StructureDefinition/rtpbc-formularyStatus
Binding: RTPBC Formulary Status Value Set (extensible)
..... extension:preferenceLevel S 0..1 positiveInt Preference Level (Extension)
URL: http://hl7.org/fhir/us/carin-rtpbc/StructureDefinition/rtpbc-preferenceLevel
..... extension:nextAvailableFillDate S 0..1 date Next Available Fill Date (Extension)
URL: http://hl7.org/fhir/us/carin-rtpbc/StructureDefinition/rtpbc-nextAvailableFillDate
..... extension:relatedCoverage S 0..* Reference(RTPBC Coverage | RTPBC Coverage - Non-PHI) Related Coverage (Extension)
URL: http://hl7.org/fhir/us/carin-rtpbc/StructureDefinition/rtpbc-relatedCoverage
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... itemSequence S 1..1 positiveInt Claim item instance identifier
.... noteNumber S 0..* positiveInt Determination Note Number
.... adjudication S 1..* BackboneElement Requested Product and Pharmacy Determination
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... category S 1..1 CodeableConcept Patient Pay Component
Binding: RTPBC Patient Pay Type Value Set (required): RTPBC Patient Pay Categories
..... reason 0..1 CodeableConcept Explanation of adjudication outcome
Binding: AdjudicationReasonCodes (example): The adjudication reason codes.
..... amount S 1..1 Money Patient Pay Component Amount
...... id 0..1 string Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
...... value SΣ 1..1 decimal Patient Pay Amount Value
...... currency SΣ 1..1 code Patient Pay Amount Currency
Binding: Currencies (required): Currencies
..... value 0..1 decimal Non-monetary value
.... detail 0..* BackboneElement Adjudication for claim details
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... detailSequence 1..1 positiveInt Claim detail instance identifier
..... noteNumber 0..* positiveInt Applicable note numbers
..... adjudication 1..* See adjudication (ClaimResponse) Detail level adjudication details
..... subDetail 0..* BackboneElement Adjudication for claim sub-details
...... id 0..1 string Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
...... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
...... subDetailSequence 1..1 positiveInt Claim sub-detail instance identifier
...... noteNumber 0..* positiveInt Applicable note numbers
...... adjudication 0..* See adjudication (ClaimResponse) Subdetail level adjudication details
... addItem S 0..* BackboneElement Insurer added line items
.... id 0..1 string Unique id for inter-element referencing
.... Slices for extension 1..* Extension Extension
Slice: Unordered, Open by value:url
..... extension:isAlternative S 1..1 boolean Is Alternative (Extension)
URL: http://hl7.org/fhir/us/carin-rtpbc/StructureDefinition/rtpbc-isAlternative
..... extension:benefitRestriction S 0..* Coding Benefit Restriction (Extension)
URL: http://hl7.org/fhir/us/carin-rtpbc/StructureDefinition/rtpbc-benefitRestriction
Binding: RTPBC Benefit Restriction Value Set (extensible)
..... extension:formularyStatus S 0..* Coding Formulary Status (Extension)
URL: http://hl7.org/fhir/us/carin-rtpbc/StructureDefinition/rtpbc-formularyStatus
Binding: RTPBC Formulary Status Value Set (extensible)
..... extension:preferenceLevel S 0..* positiveInt Preference Level (Extension)
URL: http://hl7.org/fhir/us/carin-rtpbc/StructureDefinition/rtpbc-preferenceLevel
..... extension:nextAvailableFillDate S 0..* date Next Available Fill Date (Extension)
URL: http://hl7.org/fhir/us/carin-rtpbc/StructureDefinition/rtpbc-nextAvailableFillDate
..... extension:relatedCoverage S 0..* Reference(RTPBC Coverage | RTPBC Coverage - Non-PHI) Related Coverage (Extension)
URL: http://hl7.org/fhir/us/carin-rtpbc/StructureDefinition/rtpbc-relatedCoverage
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... itemSequence S 1..* positiveInt Associated request Item Sequence
.... detailSequence 0..* positiveInt Detail sequence number
.... subdetailSequence 0..* positiveInt Subdetail sequence number
.... provider S 0..* Reference(RTPBC Pharmacy Organization) Priced Pharmacy
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
..... reference SΣC 1..1 string Reference to Priced Pharmacy
..... type Σ 0..1 uri Type the reference refers to (e.g. "Patient")
Binding: ResourceType (extensible): Aa resource (or, for logical models, the URI of the logical model).
..... identifier Σ 0..1 Identifier Logical reference, when literal reference is not known
..... display Σ 0..1 string Text alternative for the resource
.... productOrService S 1..1 CodeableConcept Product
Binding: RTPBC Prescribable Product Code Value Set (extensible): RTPBC prescribable product codes (NDC11 and RxNorm)
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
..... coding SΣ 1..* Coding Code defined by a terminology system
...... id 0..1 string Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
...... system SΣ 1..1 uri Identity of the terminology system
...... version Σ 0..1 string Version of the system - if relevant
...... code SΣ 1..1 code Symbol in syntax defined by the system
...... display SΣ 1..1 string Product Description
...... userSelected Σ 0..1 boolean If this coding was chosen directly by the user
..... text Σ 0..1 string Plain text representation of the concept
.... modifier 0..* CodeableConcept Service/Product billing modifiers
Binding: ModifierTypeCodes (example): Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen.
.... programCode 0..* CodeableConcept Program the product or service is provided under
Binding: ExampleProgramReasonCodes (example): Program specific reason codes.
.... serviced[x] 0..1 Date or dates of service or product delivery
..... servicedDate date
..... servicedPeriod Period
.... location[x] 0..1 Place of service or where product was supplied
Binding: ExampleServicePlaceCodes (example): Place of service: pharmacy, school, prison, etc.
..... locationCodeableConcept CodeableConcept
..... locationAddress Address
..... locationReference Reference(Location)
.... quantity S 1..1 SimpleQuantity(4.0.1) Priced Quantity
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
..... value SΣ 1..1 decimal Quantity in Billing Units
..... unit SΣ 1..1 string Billing unit of measure
Binding: RTPBC Billing Unit Value Set (extensible): Billing quantity unit of measure
..... system ΣC 0..1 uri System that defines coded unit form
..... code Σ 0..1 code Coded form of the unit
.... unitPrice 0..1 Money Fee, charge or cost per item
.... factor 0..1 decimal Price scaling factor
.... net 0..1 Money Total item cost
.... bodySite 0..1 CodeableConcept Anatomical location
Binding: OralSiteCodes (example): The code for the teeth, quadrant, sextant and arch.
.... subSite 0..* CodeableConcept Anatomical sub-location
Binding: SurfaceCodes (example): The code for the tooth surface and surface combinations.
.... noteNumber S 0..* positiveInt Determination Note Number
.... adjudication S 1..* BackboneElement Alternative Product and Pharmacy Determination
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... category S 1..1 CodeableConcept Patient Pay Component
Binding: RTPBC Patient Pay Type Value Set (required): RTPBC Patient Pay Categories
..... reason 0..1 CodeableConcept Explanation of adjudication outcome
Binding: AdjudicationReasonCodes (example): The adjudication reason codes.
..... amount S 1..1 Money Patient Pay Component Amount
...... id 0..1 string Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
...... value SΣ 1..1 decimal Patient Pay Amount Value
...... currency SΣ 1..1 code Patient Pay Amount Currency
Binding: Currencies (required): Currencies
..... value 0..1 decimal Non-monetary value
.... detail 0..* BackboneElement Insurer added line details
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... productOrService 1..1 CodeableConcept Billing, service, product, or drug code
Binding: USCLSCodes (example): Allowable service and product codes.
..... modifier 0..* CodeableConcept Service/Product billing modifiers
Binding: ModifierTypeCodes (example): Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen.
..... quantity 0..1 SimpleQuantity(4.0.1) Count of products or services
..... unitPrice 0..1 Money Fee, charge or cost per item
..... factor 0..1 decimal Price scaling factor
..... net 0..1 Money Total item cost
..... noteNumber 0..* positiveInt Applicable note numbers
..... adjudication 1..* See adjudication (ClaimResponse) Added items detail adjudication
..... subDetail 0..* BackboneElement Insurer added line items
...... id 0..1 string Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
...... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
...... productOrService 1..1 CodeableConcept Billing, service, product, or drug code
Binding: USCLSCodes (example): Allowable service and product codes.
...... modifier 0..* CodeableConcept Service/Product billing modifiers
Binding: ModifierTypeCodes (example): Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen.
...... quantity 0..1 SimpleQuantity(4.0.1) Count of products or services
...... unitPrice 0..1 Money Fee, charge or cost per item
...... factor 0..1 decimal Price scaling factor
...... net 0..1 Money Total item cost
...... noteNumber 0..* positiveInt Applicable note numbers
...... adjudication 1..* See adjudication (ClaimResponse) Added items detail adjudication
... adjudication 0..* See adjudication (ClaimResponse) Header-level adjudication
... total Σ 0..* BackboneElement Adjudication totals
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... category Σ 1..1 CodeableConcept Type of adjudication information
Binding: AdjudicationValueCodes (example): The adjudication codes.
.... amount Σ 1..1 Money Financial total for the category
... payment 0..1 BackboneElement Payment Details
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... type 1..1 CodeableConcept Partial or complete payment
Binding: ExamplePaymentTypeCodes (example): The type (partial, complete) of the payment.
.... adjustment 0..1 Money Payment adjustment for non-claim issues
.... adjustmentReason 0..1 CodeableConcept Explanation for the adjustment
Binding: PaymentAdjustmentReasonCodes (example): Payment Adjustment reason codes.
.... date 0..1 date Expected date of payment
.... amount 1..1 Money Payable amount after adjustment
.... identifier 0..1 Identifier Business identifier for the payment
... fundsReserve 0..1 CodeableConcept Funds reserved status
Binding: Funds Reservation Codes (example): For whom funds are to be reserved: (Patient, Provider, None).
... formCode 0..1 CodeableConcept Printed form identifier
Binding: Form Codes (example): The forms codes.
... form 0..1 Attachment Printed reference or actual form
... processNote S 0..* BackboneElement Determination Note
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... number S 1..1 positiveInt Determination Note Number
.... type 0..1 code display | print | printoper
Binding: NoteType (required): The presentation types of notes.
.... text S 1..1 string Determination Note Text
.... language 0..1 CodeableConcept Language of the text
Binding: CommonLanguages (preferred): A human language.
Additional BindingsPurpose
AllLanguages Max Binding
... communicationRequest 0..* Reference(CommunicationRequest) Request for additional information
... insurance 0..* BackboneElement Patient insurance information
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... sequence 1..1 positiveInt Insurance instance identifier
.... focal 1..1 boolean Coverage to be used for adjudication
.... coverage 1..1 Reference(Coverage) Insurance information
.... businessArrangement 0..1 string Additional provider contract number
.... claimResponse 0..1 Reference(ClaimResponse) Adjudication results
... error S 0..* BackboneElement Error Information
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... itemSequence 0..1 positiveInt Item sequence number
.... detailSequence 0..1 positiveInt Detail sequence number
.... subDetailSequence 0..1 positiveInt Subdetail sequence number
.... code S 1..1 CodeableConcept Reject Reason
Binding: RTPBC Error Code Value Set (preferred): RTPBC Error Codes
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
..... coding SΣ 1..* Coding Code defined by a terminology system
...... id 0..1 string Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
...... system SΣ 1..1 uri Identity of the terminology system
...... version Σ 0..1 string Version of the system - if relevant
...... code SΣ 1..1 code Reject Code
...... display SΣ 1..1 string Representation defined by the system
...... userSelected Σ 0..1 boolean If this coding was chosen directly by the user
..... text SΣ 0..1 string Reject Message

doco Documentation for this format

Terminology Bindings

Path Status Usage ValueSet Version Source
ClaimResponse.language Base preferred Common Languages 📍4.0.1 FHIR Std.
ClaimResponse.identifier.​use Base required IdentifierUse 📍4.0.1 FHIR Std.
ClaimResponse.identifier.​type Base extensible IdentifierType 📍4.0.1 FHIR Std.
ClaimResponse.status Base required Financial Resource Status Codes 📍4.0.1 FHIR Std.
ClaimResponse.type Base extensible Claim Type Codes 📍4.0.1 FHIR Std.
ClaimResponse.subType Base example Example Claim SubType Codes 📍4.0.1 FHIR Std.
ClaimResponse.use Base required Use 📍4.0.1 FHIR Std.
ClaimResponse.patient.​extension:data-masked.​value[x] Base required DataAbsentReason 📦4.0.1 FHIR Std.
ClaimResponse.insurer.​extension:data-masked.​value[x] Base required DataAbsentReason 📦4.0.1 FHIR Std.
ClaimResponse.insurer.​type Base extensible ResourceType 📍4.0.1 FHIR Std.
ClaimResponse.request.​type Base extensible ResourceType 📍4.0.1 FHIR Std.
ClaimResponse.request.​identifier.use Base required IdentifierUse 📍4.0.1 FHIR Std.
ClaimResponse.request.​identifier.type Base extensible IdentifierType 📍4.0.1 FHIR Std.
ClaimResponse.outcome Base required Claim Processing Codes 📍4.0.1 FHIR Std.
ClaimResponse.payeeType Base example PayeeType 📍4.0.1 FHIR Std.
ClaimResponse.item.adjudication.​category Base required RTPBC Patient Pay Type Value Set 📦2.0.0-ballot This IG
ClaimResponse.item.adjudication.​reason Base example Adjudication Reason Codes 📍4.0.1 FHIR Std.
ClaimResponse.item.adjudication.​amount.currency Base required CurrencyCode 📦4.0.1 FHIR Std.
ClaimResponse.addItem.​provider.type Base extensible ResourceType 📍4.0.1 FHIR Std.
ClaimResponse.addItem.​productOrService Base extensible RTPBC Prescribable Product Code Value Set 📦2.0.0-ballot This IG
ClaimResponse.addItem.​modifier Base example Modifier type Codes 📍4.0.1 FHIR Std.
ClaimResponse.addItem.​programCode Base example Example Program Reason Codes 📍4.0.1 FHIR Std.
ClaimResponse.addItem.​location[x] Base example Example Service Place Codes 📍4.0.1 FHIR Std.
ClaimResponse.addItem.​quantity.unit Base extensible RTPBC Billing Unit Value Set 📦2.0.0-ballot This IG
ClaimResponse.addItem.​bodySite Base example Oral Site Codes 📍4.0.1 FHIR Std.
ClaimResponse.addItem.​subSite Base example Surface Codes 📍4.0.1 FHIR Std.
ClaimResponse.addItem.​adjudication.category Base required RTPBC Patient Pay Type Value Set 📦2.0.0-ballot This IG
ClaimResponse.addItem.​adjudication.reason Base example Adjudication Reason Codes 📍4.0.1 FHIR Std.
ClaimResponse.addItem.​adjudication.amount.​currency Base required CurrencyCode 📦4.0.1 FHIR Std.
ClaimResponse.addItem.​detail.productOrService Base example USCLS Codes 📍4.0.1 FHIR Std.
ClaimResponse.addItem.​detail.modifier Base example Modifier type Codes 📍4.0.1 FHIR Std.
ClaimResponse.addItem.​detail.subDetail.productOrService Base example USCLS Codes 📍4.0.1 FHIR Std.
ClaimResponse.addItem.​detail.subDetail.modifier Base example Modifier type Codes 📍4.0.1 FHIR Std.
ClaimResponse.total.​category Base example Adjudication Value Codes 📍4.0.1 FHIR Std.
ClaimResponse.payment.​type Base example Example Payment Type Codes 📍4.0.1 FHIR Std.
ClaimResponse.payment.​adjustmentReason Base example Payment Adjustment Reason Codes 📍4.0.1 FHIR Std.
ClaimResponse.fundsReserve Base example FundsReserve 📍4.0.1 FHIR Std.
ClaimResponse.formCode Base example Forms 📍4.0.1 FHIR Std.
ClaimResponse.processNote.​type Base required NoteType 📍4.0.1 FHIR Std.
ClaimResponse.processNote.​language Base preferred Common Languages 📍4.0.1 FHIR Std.
ClaimResponse.error.​code Base preferred RTPBC Error Code Value Set 📦2.0.0-ballot This IG

Constraints

Id Grade Path(s) Description Expression
dom-2 error ClaimResponse If the resource is contained in another resource, it SHALL NOT contain nested Resources contained.contained.empty()
dom-3 error ClaimResponse 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 contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
dom-4 error ClaimResponse If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
dom-5 error ClaimResponse If a resource is contained in another resource, it SHALL NOT have a security label contained.meta.security.empty()
dom-6 best practice ClaimResponse A resource should have narrative for robust management text.`div`.exists()
ele-1 error **ALL** elements All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
ext-1 error **ALL** extensions Must have either extensions or value[x], not both extension.exists() != value.exists()

 

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