Intersection of http://hl7.org/fhir/us/davinci-pdex/StructureDefinition/pdex-priorauthorization and http://hl7.org/fhir/us/davinci-pdex/StructureDefinition/pdex-priorauthorization

This is the set of resources that conform to both PDex Prior Authorization (http://hl7.org/fhir/us/davinci-pdex/StructureDefinition/pdex-priorauthorization) and PDex Prior Authorization (http://hl7.org/fhir/us/davinci-pdex/StructureDefinition/pdex-priorauthorization).

Structure

NameFlagsCard.TypeDescription & Constraintsdoco
.. ExplanationOfBenefit C0..*Explanation of Benefit resource
dom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources
dom-3: 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
dom-4: If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated
dom-5: If a resource is contained in another resource, it SHALL NOT have a security label
dom-6: A resource should have narrative for robust management
adjudication-has-amount-type-slice: If Adjudication is present, it must have at least one adjudicationamounttype slice
... meta Σ0..1MetaMetadata about the resource
ele-1: All FHIR elements must have a @value or children
.... extension 0..*ExtensionAdditional content defined by implementations
ele-1: All FHIR elements must have a @value or children
ext-1: Must have either extensions or value[x], not both
.... versionId Σ0..1idVersion specific identifier
ele-1: All FHIR elements must have a @value or children
.... lastUpdated Σ0..1instantWhen the resource version last changed
ele-1: All FHIR elements must have a @value or children
.... source Σ0..1uriIdentifies where the resource comes from
ele-1: All FHIR elements must have a @value or children
.... profile Σ1..*canonical(StructureDefinition)Profiles this resource claims to conform to
ele-1: All FHIR elements must have a @value or children
.... security Σ0..*CodingSecurity Labels applied to this resource
Binding: ?? (extensible): Security Labels from the Healthcare Privacy and Security Classification System.


ele-1: All FHIR elements must have a @value or children
.... tag Σ0..*CodingTags applied to this resource
Binding: ?? (example): Codes that represent various types of tags, commonly workflow-related; e.g. "Needs review by Dr. Jones".


ele-1: All FHIR elements must have a @value or children
... implicitRules ?!Σ0..1uriA set of rules under which this content was created
ele-1: All FHIR elements must have a @value or children
... language 0..1codeLanguage of the resource content
Binding: ?? (preferred): A human language.

Additional BindingsPurpose
??Max Binding

ele-1: All FHIR elements must have a @value or children
... text 0..1NarrativeText summary of the resource, for human interpretation
ele-1: All FHIR elements must have a @value or children
... contained 0..*ResourceContained, inline Resources
... extension 0..*ExtensionExtension
ele-1: All FHIR elements must have a @value or children
ext-1: Must have either extensions or value[x], not both
... modifierExtension ?!0..*ExtensionExtensions that cannot be ignored
ele-1: All FHIR elements must have a @value or children
ext-1: Must have either extensions or value[x], not both
... identifier 0..*IdentifierBusiness Identifier for the resource
ele-1: All FHIR elements must have a @value or children
... status ?!SΣ1..1codeactive | cancelled | draft | entered-in-error
Binding: ?? (required): A code specifying the state of the resource instance.


ele-1: All FHIR elements must have a @value or children
... type SΣ1..1CodeableConceptCategory or discipline
Binding: ?? (extensible): The type or discipline-style of the claim.


ele-1: All FHIR elements must have a @value or children
... subType 0..1CodeableConceptMore granular claim type
Binding: ?? (example): A more granular claim typecode.


ele-1: All FHIR elements must have a @value or children
... use SΣ1..1codeclaim | preauthorization | predetermination
Binding: ?? (required): Complete, proposed, exploratory, other.


ele-1: All FHIR elements must have a @value or children
... patient SΣ1..1Reference(US Core Patient Profile | #sd-us-core-patient-us-core-patient)The recipient of the products and services
ele-1: All FHIR elements must have a @value or children
... billablePeriod Σ0..1PeriodRelevant time frame for the claim
ele-1: All FHIR elements must have a @value or children
... created Σ1..1dateTimeResponse creation date
ele-1: All FHIR elements must have a @value or children
... enterer S0..1Reference(US Core Practitioner Profile | US Core PractitionerRole Profile | #sd-us-core-practitioner-us-core-practitioner)Author of the claim
ele-1: All FHIR elements must have a @value or children
... insurer SΣ1..1Reference(US Core Organization Profile | #sd-us-core-organization-us-core-organization)Party responsible for reimbursement
ele-1: All FHIR elements must have a @value or children
... provider SΣ1..1Reference(US Core Practitioner Profile | US Core PractitionerRole Profile | US Core Organization Profile | #sd-us-core-practitioner-us-core-practitioner)Party responsible for the claim
ele-1: All FHIR elements must have a @value or children
... priority 0..1CodeableConceptDesired processing urgency
Binding: ?? (required)
ele-1: All FHIR elements must have a @value or children
... fundsReserveRequested 0..1CodeableConceptFor whom to reserve funds
Binding: ?? (example): For whom funds are to be reserved: (Patient, Provider, None).


ele-1: All FHIR elements must have a @value or children
... fundsReserve 0..1CodeableConceptFunds reserved status
Binding: ?? (example): For whom funds are to be reserved: (Patient, Provider, None).


ele-1: All FHIR elements must have a @value or children
... related 0..*BackboneElementPrior or corollary claims
ele-1: All FHIR elements must have a @value or children
.... extension 0..*ExtensionAdditional content defined by implementations
ele-1: All FHIR elements must have a @value or children
ext-1: Must have either extensions or value[x], not both
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
ele-1: All FHIR elements must have a @value or children
ext-1: Must have either extensions or value[x], not both
.... claim 0..1Reference(Claim)Reference to the related claim
ele-1: All FHIR elements must have a @value or children
.... relationship 0..1CodeableConceptHow the reference claim is related
Binding: ?? (example): Relationship of this claim to a related Claim.


ele-1: All FHIR elements must have a @value or children
.... reference 0..1IdentifierFile or case reference
ele-1: All FHIR elements must have a @value or children
... prescription 0..1Reference(MedicationRequest | VisionPrescription)Prescription authorizing services or products
ele-1: All FHIR elements must have a @value or children
... originalPrescription 0..1Reference(MedicationRequest)Original prescription if superceded by fulfiller
ele-1: All FHIR elements must have a @value or children
... payee 0..1BackboneElementRecipient of benefits payable
ele-1: All FHIR elements must have a @value or children
.... extension 0..*ExtensionAdditional content defined by implementations
ele-1: All FHIR elements must have a @value or children
ext-1: Must have either extensions or value[x], not both
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
ele-1: All FHIR elements must have a @value or children
ext-1: Must have either extensions or value[x], not both
.... type 0..1CodeableConceptCategory of recipient
Binding: ?? (example): A code for the party to be reimbursed.


ele-1: All FHIR elements must have a @value or children
.... party 0..1Reference(Practitioner | PractitionerRole | Organization | Patient | RelatedPerson)Recipient reference
ele-1: All FHIR elements must have a @value or children
... referral 0..1Reference(ServiceRequest)Treatment Referral
ele-1: All FHIR elements must have a @value or children
... facility S0..1Reference(US Core Location Profile | #sd-us-core-location-us-core-location)Servicing Facility
ele-1: All FHIR elements must have a @value or children
... claim 0..1Reference(Claim)Claim reference
ele-1: All FHIR elements must have a @value or children
... claimResponse 0..1Reference(ClaimResponse)Claim response reference
ele-1: All FHIR elements must have a @value or children
... outcome Σ1..1codequeued | complete | error | partial
Binding: ?? (required): The result of the claim processing.


ele-1: All FHIR elements must have a @value or children
... disposition 0..1stringDisposition Message
ele-1: All FHIR elements must have a @value or children
... preAuthRef 0..*stringPreauthorization reference
ele-1: All FHIR elements must have a @value or children
... preAuthRefPeriod S0..1PeriodPreauthorization in-effect period
ele-1: All FHIR elements must have a @value or children
... careTeam 0..*BackboneElementCare Team members
ele-1: All FHIR elements must have a @value or children
.... extension 0..*ExtensionAdditional content defined by implementations
ele-1: All FHIR elements must have a @value or children
ext-1: Must have either extensions or value[x], not both
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
ele-1: All FHIR elements must have a @value or children
ext-1: Must have either extensions or value[x], not both
.... sequence 1..1positiveIntOrder of care team
ele-1: All FHIR elements must have a @value or children
.... provider S1..1Reference(US Core Practitioner Profile | US Core PractitionerRole Profile | US Core Organization Profile | #sd-us-core-practitioner-us-core-practitioner)Practitioner or organization
ele-1: All FHIR elements must have a @value or children
.... responsible 0..1booleanIndicator of the lead practitioner
ele-1: All FHIR elements must have a @value or children
.... role 0..1CodeableConceptFunction within the team
Binding: ?? (example): The role codes for the care team members.


ele-1: All FHIR elements must have a @value or children
.... qualification 0..1CodeableConceptPractitioner credential or specialization
Binding: ?? (example): Provider professional qualifications.


ele-1: All FHIR elements must have a @value or children
... supportingInfo 0..*BackboneElementSupporting information
ele-1: All FHIR elements must have a @value or children
.... extension 0..*ExtensionAdditional content defined by implementations
ele-1: All FHIR elements must have a @value or children
ext-1: Must have either extensions or value[x], not both
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
ele-1: All FHIR elements must have a @value or children
ext-1: Must have either extensions or value[x], not both
.... sequence 1..1positiveIntInformation instance identifier
ele-1: All FHIR elements must have a @value or children
.... category 1..1CodeableConceptClassification of the supplied information
Binding: ?? (example): The valuset used for additional information category codes.


ele-1: All FHIR elements must have a @value or children
.... code 0..1CodeableConceptType of information
Binding: ?? (example): The valuset used for additional information codes.


ele-1: All FHIR elements must have a @value or children
.... timing[x] 0..1When it occurred
ele-1: All FHIR elements must have a @value or children
..... timingDatedate
..... timingPeriodPeriod
.... value[x] 0..1Data to be provided
ele-1: All FHIR elements must have a @value or children
..... valueBooleanboolean
..... valueStringstring
..... valueQuantityQuantity
..... valueAttachmentAttachment
..... valueReferenceReference(Resource)
.... reason 0..1CodingExplanation for the information
Binding: ?? (example): Reason codes for the missing teeth.


ele-1: All FHIR elements must have a @value or children
... diagnosis 0..*BackboneElementPertinent diagnosis information
ele-1: All FHIR elements must have a @value or children
.... extension 0..*ExtensionAdditional content defined by implementations
ele-1: All FHIR elements must have a @value or children
ext-1: Must have either extensions or value[x], not both
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
ele-1: All FHIR elements must have a @value or children
ext-1: Must have either extensions or value[x], not both
.... sequence 1..1positiveIntDiagnosis instance identifier
ele-1: All FHIR elements must have a @value or children
.... diagnosis[x] 1..1Nature of illness or problem
Binding: ?? (example): ICD10 Diagnostic codes.


ele-1: All FHIR elements must have a @value or children
..... diagnosisCodeableConceptCodeableConcept
..... diagnosisReferenceReference(Condition)
.... type 0..*CodeableConceptTiming or nature of the diagnosis
Binding: ?? (example): The type of the diagnosis: admitting, principal, discharge.


ele-1: All FHIR elements must have a @value or children
.... onAdmission 0..1CodeableConceptPresent on admission
Binding: ?? (example): Present on admission.


ele-1: All FHIR elements must have a @value or children
.... packageCode 0..1CodeableConceptPackage billing code
Binding: ?? (example): The DRG codes associated with the diagnosis.


ele-1: All FHIR elements must have a @value or children
... procedure 0..*BackboneElementClinical procedures performed
ele-1: All FHIR elements must have a @value or children
.... extension 0..*ExtensionAdditional content defined by implementations
ele-1: All FHIR elements must have a @value or children
ext-1: Must have either extensions or value[x], not both
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
ele-1: All FHIR elements must have a @value or children
ext-1: Must have either extensions or value[x], not both
.... sequence 1..1positiveIntProcedure instance identifier
ele-1: All FHIR elements must have a @value or children
.... type 0..*CodeableConceptCategory of Procedure
Binding: ?? (example): Example procedure type codes.


ele-1: All FHIR elements must have a @value or children
.... date 0..1dateTimeWhen the procedure was performed
ele-1: All FHIR elements must have a @value or children
.... procedure[x] 1..1Specific clinical procedure
Binding: ?? (example): ICD10 Procedure codes.


ele-1: All FHIR elements must have a @value or children
..... procedureCodeableConceptCodeableConcept
..... procedureReferenceReference(Procedure)
.... udi 0..*Reference(Device)Unique device identifier
ele-1: All FHIR elements must have a @value or children
... precedence 0..1positiveIntPrecedence (primary, secondary, etc.)
ele-1: All FHIR elements must have a @value or children
... insurance Σ1..*BackboneElementPatient insurance information
ele-1: All FHIR elements must have a @value or children
.... extension 0..*ExtensionAdditional content defined by implementations
ele-1: All FHIR elements must have a @value or children
ext-1: Must have either extensions or value[x], not both
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
ele-1: All FHIR elements must have a @value or children
ext-1: Must have either extensions or value[x], not both
.... focal Σ1..1booleanCoverage to be used for adjudication
ele-1: All FHIR elements must have a @value or children
.... coverage Σ1..1Reference(HRex Coverage Profile | #sd-hrex-coverage-hrex-coverage)Insurance information
ele-1: All FHIR elements must have a @value or children
.... preAuthRef 0..*stringPrior authorization reference number
ele-1: All FHIR elements must have a @value or children
... accident 0..1BackboneElementDetails of the event
ele-1: All FHIR elements must have a @value or children
.... extension 0..*ExtensionAdditional content defined by implementations
ele-1: All FHIR elements must have a @value or children
ext-1: Must have either extensions or value[x], not both
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
ele-1: All FHIR elements must have a @value or children
ext-1: Must have either extensions or value[x], not both
.... date 0..1dateWhen the incident occurred
ele-1: All FHIR elements must have a @value or children
.... type 0..1CodeableConceptThe nature of the accident
Binding: ?? (extensible): Type of accident: work place, auto, etc.


ele-1: All FHIR elements must have a @value or children
.... location[x] 0..1Where the event occurred
ele-1: All FHIR elements must have a @value or children
..... locationAddressAddress
..... locationReferenceReference(Location)
... item 0..*BackboneElementProduct or service provided
ele-1: All FHIR elements must have a @value or children
.... extension 0..*ExtensionExtension
ele-1: All FHIR elements must have a @value or children
ext-1: Must have either extensions or value[x], not both
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
ele-1: All FHIR elements must have a @value or children
ext-1: Must have either extensions or value[x], not both
.... sequence 1..1positiveIntItem instance identifier
ele-1: All FHIR elements must have a @value or children
.... careTeamSequence 0..*positiveIntApplicable care team members
ele-1: All FHIR elements must have a @value or children
.... diagnosisSequence 0..*positiveIntApplicable diagnoses
ele-1: All FHIR elements must have a @value or children
.... procedureSequence 0..*positiveIntApplicable procedures
ele-1: All FHIR elements must have a @value or children
.... informationSequence 0..*positiveIntApplicable exception and supporting information
ele-1: All FHIR elements must have a @value or children
.... revenue 0..1CodeableConceptRevenue or cost center code
Binding: ?? (example): Codes for the revenue or cost centers supplying the service and/or products.


ele-1: All FHIR elements must have a @value or children
.... category S0..1CodeableConceptBenefit classification
Binding: ?? (required): Codes identifying business groupings for health care services or benefits. These codes are listed within an X12 implementation guide (TR3) and maintained by X12. All X12 work products are copyrighted. See their website for licensing terms and conditions.


ele-1: All FHIR elements must have a @value or children
.... productOrService 1..1CodeableConceptBilling, service, product, or drug code
Binding: ?? (required)
ele-1: All FHIR elements must have a @value or children
.... modifier 0..*CodeableConceptProduct or service billing modifiers
Binding: ?? (example): Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen.


ele-1: All FHIR elements must have a @value or children
.... programCode 0..*CodeableConceptProgram the product or service is provided under
Binding: ?? (example): Program specific reason codes.


ele-1: All FHIR elements must have a @value or children
.... serviced[x] 0..1Date or dates of service or product delivery
ele-1: All FHIR elements must have a @value or children
..... servicedDatedate
..... servicedPeriodPeriod
.... location[x] 0..1Place of service or where product was supplied
Binding: ?? (example): Place where the service is rendered.


ele-1: All FHIR elements must have a @value or children
..... locationCodeableConceptCodeableConcept
..... locationAddressAddress
..... locationReferenceReference(Location)
.... quantity 0..1??, ??Count of products or services
ele-1: All FHIR elements must have a @value or children
.... unitPrice 0..1MoneyFee, charge or cost per item
ele-1: All FHIR elements must have a @value or children
.... factor 0..1decimalPrice scaling factor
ele-1: All FHIR elements must have a @value or children
.... net 0..1MoneyTotal item cost
ele-1: All FHIR elements must have a @value or children
.... udi 0..*Reference(Device)Unique device identifier
ele-1: All FHIR elements must have a @value or children
.... bodySite 0..1CodeableConceptAnatomical location
Binding: ?? (example): The code for the teeth, quadrant, sextant and arch.


ele-1: All FHIR elements must have a @value or children
.... subSite 0..*CodeableConceptAnatomical sub-location
Binding: ?? (example): The code for the tooth surface and surface combinations.


ele-1: All FHIR elements must have a @value or children
.... encounter 0..*Reference(US Core Encounter Profile | #sd-us-core-encounter-us-core-encounter)Encounters related to this billed item
ele-1: All FHIR elements must have a @value or children
.... noteNumber 0..*positiveIntApplicable note numbers
ele-1: All FHIR elements must have a @value or children
.... adjudication 0..*BackboneElementAdjudication details
ele-1: All FHIR elements must have a @value or children
..... extension 0..*ExtensionExtension
ele-1: All FHIR elements must have a @value or children
ext-1: Must have either extensions or value[x], not both
..... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
ele-1: All FHIR elements must have a @value or children
ext-1: Must have either extensions or value[x], not both
..... category 1..1CodeableConceptType of adjudication information
Binding: ?? (required)
ele-1: All FHIR elements must have a @value or children
..... reason 0..1CodeableConceptExplanation of adjudication outcome
Binding: ?? (example): Adjudication reason codes.


ele-1: All FHIR elements must have a @value or children
..... amount 0..1MoneyMonetary amount
ele-1: All FHIR elements must have a @value or children
..... value 0..1decimalNon-monitary value
ele-1: All FHIR elements must have a @value or children
.... detail 0..*BackboneElementAdditional items
ele-1: All FHIR elements must have a @value or children
..... extension 0..*ExtensionAdditional content defined by implementations
ele-1: All FHIR elements must have a @value or children
ext-1: Must have either extensions or value[x], not both
..... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
ele-1: All FHIR elements must have a @value or children
ext-1: Must have either extensions or value[x], not both
..... sequence 1..1positiveIntProduct or service provided
ele-1: All FHIR elements must have a @value or children
..... revenue 0..1CodeableConceptRevenue or cost center code
Binding: ?? (example): Codes for the revenue or cost centers supplying the service and/or products.


ele-1: All FHIR elements must have a @value or children
..... category 0..1CodeableConceptBenefit classification
Binding: ?? (example): Benefit categories such as: oral, medical, vision, oral-basic etc.


ele-1: All FHIR elements must have a @value or children
..... productOrService 1..1CodeableConceptBilling, service, product, or drug code
Binding: ?? (example): Allowable service and product codes.


ele-1: All FHIR elements must have a @value or children
..... modifier 0..*CodeableConceptService/Product billing modifiers
Binding: ?? (example): Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen.


ele-1: All FHIR elements must have a @value or children
..... programCode 0..*CodeableConceptProgram the product or service is provided under
Binding: ?? (example): Program specific reason codes.


ele-1: All FHIR elements must have a @value or children
..... quantity 0..1??, ??Count of products or services
ele-1: All FHIR elements must have a @value or children
..... unitPrice 0..1MoneyFee, charge or cost per item
ele-1: All FHIR elements must have a @value or children
..... factor 0..1decimalPrice scaling factor
ele-1: All FHIR elements must have a @value or children
..... net 0..1MoneyTotal item cost
ele-1: All FHIR elements must have a @value or children
..... udi 0..*Reference(Device)Unique device identifier
ele-1: All FHIR elements must have a @value or children
..... noteNumber 0..*positiveIntApplicable note numbers
ele-1: All FHIR elements must have a @value or children
..... adjudication 0..*Detail level adjudication details
ele-1: All FHIR elements must have a @value or children
..... subDetail 0..*BackboneElementAdditional items
ele-1: All FHIR elements must have a @value or children
...... extension 0..*ExtensionAdditional content defined by implementations
ele-1: All FHIR elements must have a @value or children
ext-1: Must have either extensions or value[x], not both
...... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
ele-1: All FHIR elements must have a @value or children
ext-1: Must have either extensions or value[x], not both
...... sequence 1..1positiveIntProduct or service provided
ele-1: All FHIR elements must have a @value or children
...... revenue 0..1CodeableConceptRevenue or cost center code
Binding: ?? (example): Codes for the revenue or cost centers supplying the service and/or products.


ele-1: All FHIR elements must have a @value or children
...... category 0..1CodeableConceptBenefit classification
Binding: ?? (example): Benefit categories such as: oral, medical, vision, oral-basic etc.


ele-1: All FHIR elements must have a @value or children
...... productOrService 1..1CodeableConceptBilling, service, product, or drug code
Binding: ?? (example): Allowable service and product codes.


ele-1: All FHIR elements must have a @value or children
...... modifier 0..*CodeableConceptService/Product billing modifiers
Binding: ?? (example): Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen.


ele-1: All FHIR elements must have a @value or children
...... programCode 0..*CodeableConceptProgram the product or service is provided under
Binding: ?? (example): Program specific reason codes.


ele-1: All FHIR elements must have a @value or children
...... quantity 0..1??, ??Count of products or services
ele-1: All FHIR elements must have a @value or children
...... unitPrice 0..1MoneyFee, charge or cost per item
ele-1: All FHIR elements must have a @value or children
...... factor 0..1decimalPrice scaling factor
ele-1: All FHIR elements must have a @value or children
...... net 0..1MoneyTotal item cost
ele-1: All FHIR elements must have a @value or children
...... udi 0..*Reference(Device)Unique device identifier
ele-1: All FHIR elements must have a @value or children
...... noteNumber 0..*positiveIntApplicable note numbers
ele-1: All FHIR elements must have a @value or children
...... adjudication 0..*Subdetail level adjudication details
ele-1: All FHIR elements must have a @value or children
... addItem 0..*BackboneElementInsurer added line items
ele-1: All FHIR elements must have a @value or children
.... extension 0..*ExtensionAdditional content defined by implementations
ele-1: All FHIR elements must have a @value or children
ext-1: Must have either extensions or value[x], not both
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
ele-1: All FHIR elements must have a @value or children
ext-1: Must have either extensions or value[x], not both
.... itemSequence 0..*positiveIntItem sequence number
ele-1: All FHIR elements must have a @value or children
.... detailSequence 0..*positiveIntDetail sequence number
ele-1: All FHIR elements must have a @value or children
.... subDetailSequence 0..*positiveIntSubdetail sequence number
ele-1: All FHIR elements must have a @value or children
.... provider 0..*Reference(US Core Practitioner Profile | US Core PractitionerRole Profile | US Core Organization Profile | #sd-us-core-practitioner-us-core-practitioner)Authorized providers
ele-1: All FHIR elements must have a @value or children
.... productOrService 1..1CodeableConceptBilling, service, product, or drug code
Binding: ?? (example): Allowable service and product codes.


ele-1: All FHIR elements must have a @value or children
.... modifier 0..*CodeableConceptService/Product billing modifiers
Binding: ?? (example): Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen.


ele-1: All FHIR elements must have a @value or children
.... programCode 0..*CodeableConceptProgram the product or service is provided under
Binding: ?? (example): Program specific reason codes.


ele-1: All FHIR elements must have a @value or children
.... serviced[x] 0..1Date or dates of service or product delivery
ele-1: All FHIR elements must have a @value or children
..... servicedDatedate
..... servicedPeriodPeriod
.... location[x] 0..1Place of service or where product was supplied
Binding: ?? (example): Place where the service is rendered.


ele-1: All FHIR elements must have a @value or children
..... locationCodeableConceptCodeableConcept
..... locationAddressAddress
..... locationReferenceReference(Location)
.... quantity 0..1??, ??Count of products or services
ele-1: All FHIR elements must have a @value or children
.... unitPrice 0..1MoneyFee, charge or cost per item
ele-1: All FHIR elements must have a @value or children
.... factor 0..1decimalPrice scaling factor
ele-1: All FHIR elements must have a @value or children
.... net 0..1MoneyTotal item cost
ele-1: All FHIR elements must have a @value or children
.... bodySite 0..1CodeableConceptAnatomical location
Binding: ?? (example): The code for the teeth, quadrant, sextant and arch.


ele-1: All FHIR elements must have a @value or children
.... subSite 0..*CodeableConceptAnatomical sub-location
Binding: ?? (example): The code for the tooth surface and surface combinations.


ele-1: All FHIR elements must have a @value or children
.... noteNumber 0..*positiveIntApplicable note numbers
ele-1: All FHIR elements must have a @value or children
.... adjudication 0..*Added items adjudication
ele-1: All FHIR elements must have a @value or children
.... detail 0..*BackboneElementInsurer added line items
ele-1: All FHIR elements must have a @value or children
..... extension 0..*ExtensionAdditional content defined by implementations
ele-1: All FHIR elements must have a @value or children
ext-1: Must have either extensions or value[x], not both
..... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
ele-1: All FHIR elements must have a @value or children
ext-1: Must have either extensions or value[x], not both
..... productOrService 1..1CodeableConceptBilling, service, product, or drug code
Binding: ?? (example): Allowable service and product codes.


ele-1: All FHIR elements must have a @value or children
..... modifier 0..*CodeableConceptService/Product billing modifiers
Binding: ?? (example): Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen.


ele-1: All FHIR elements must have a @value or children
..... quantity 0..1??, ??Count of products or services
ele-1: All FHIR elements must have a @value or children
..... unitPrice 0..1MoneyFee, charge or cost per item
ele-1: All FHIR elements must have a @value or children
..... factor 0..1decimalPrice scaling factor
ele-1: All FHIR elements must have a @value or children
..... net 0..1MoneyTotal item cost
ele-1: All FHIR elements must have a @value or children
..... noteNumber 0..*positiveIntApplicable note numbers
ele-1: All FHIR elements must have a @value or children
..... adjudication 0..*Added items adjudication
ele-1: All FHIR elements must have a @value or children
..... subDetail 0..*BackboneElementInsurer added line items
ele-1: All FHIR elements must have a @value or children
...... extension 0..*ExtensionAdditional content defined by implementations
ele-1: All FHIR elements must have a @value or children
ext-1: Must have either extensions or value[x], not both
...... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
ele-1: All FHIR elements must have a @value or children
ext-1: Must have either extensions or value[x], not both
...... productOrService 1..1CodeableConceptBilling, service, product, or drug code
Binding: ?? (example): Allowable service and product codes.


ele-1: All FHIR elements must have a @value or children
...... modifier 0..*CodeableConceptService/Product billing modifiers
Binding: ?? (example): Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen.


ele-1: All FHIR elements must have a @value or children
...... quantity 0..1??, ??Count of products or services
ele-1: All FHIR elements must have a @value or children
...... unitPrice 0..1MoneyFee, charge or cost per item
ele-1: All FHIR elements must have a @value or children
...... factor 0..1decimalPrice scaling factor
ele-1: All FHIR elements must have a @value or children
...... net 0..1MoneyTotal item cost
ele-1: All FHIR elements must have a @value or children
...... noteNumber 0..*positiveIntApplicable note numbers
ele-1: All FHIR elements must have a @value or children
...... adjudication 0..*Added items adjudication
ele-1: All FHIR elements must have a @value or children
... adjudication S0..*BackboneElementHeader-level adjudication
ele-1: All FHIR elements must have a @value or children
.... extension 0..*ExtensionExtension
ele-1: All FHIR elements must have a @value or children
ext-1: Must have either extensions or value[x], not both
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
ele-1: All FHIR elements must have a @value or children
ext-1: Must have either extensions or value[x], not both
.... category S1..1CodeableConceptType of adjudication information
Binding: ?? (required)
ele-1: All FHIR elements must have a @value or children
.... reason 0..1CodeableConceptExplanation of adjudication outcome
Binding: ?? (example): Adjudication reason codes.


ele-1: All FHIR elements must have a @value or children
.... amount 0..1MoneyMonetary amount
ele-1: All FHIR elements must have a @value or children
.... value 0..1decimalNon-monitary value
ele-1: All FHIR elements must have a @value or children
... total Σ0..*BackboneElementAdjudication totals
ele-1: All FHIR elements must have a @value or children
.... extension 0..*ExtensionExtension
ele-1: All FHIR elements must have a @value or children
ext-1: Must have either extensions or value[x], not both
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
ele-1: All FHIR elements must have a @value or children
ext-1: Must have either extensions or value[x], not both
.... category SΣ1..1CodeableConceptPrior Authorization utilization codes
Binding: ?? (extensible)
ele-1: All FHIR elements must have a @value or children
.... amount Σ1..1MoneyFinancial total for the category
ele-1: All FHIR elements must have a @value or children
... payment 0..1BackboneElementPayment Details
ele-1: All FHIR elements must have a @value or children
.... extension 0..*ExtensionAdditional content defined by implementations
ele-1: All FHIR elements must have a @value or children
ext-1: Must have either extensions or value[x], not both
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
ele-1: All FHIR elements must have a @value or children
ext-1: Must have either extensions or value[x], not both
.... type 0..1CodeableConceptPartial or complete payment
Binding: ?? (example): The type (partial, complete) of the payment.


ele-1: All FHIR elements must have a @value or children
.... adjustment 0..1MoneyPayment adjustment for non-claim issues
ele-1: All FHIR elements must have a @value or children
.... adjustmentReason 0..1CodeableConceptExplanation for the variance
Binding: ?? (example): Payment Adjustment reason codes.


ele-1: All FHIR elements must have a @value or children
.... date 0..1dateExpected date of payment
ele-1: All FHIR elements must have a @value or children
.... amount 0..1MoneyPayable amount after adjustment
ele-1: All FHIR elements must have a @value or children
.... identifier 0..1IdentifierBusiness identifier for the payment
ele-1: All FHIR elements must have a @value or children
... formCode 0..1CodeableConceptPrinted form identifier
Binding: ?? (example): The forms codes.


ele-1: All FHIR elements must have a @value or children
... form 0..1AttachmentPrinted reference or actual form
ele-1: All FHIR elements must have a @value or children
... processNote 0..*BackboneElementNote concerning adjudication
ele-1: All FHIR elements must have a @value or children
.... extension 0..*ExtensionAdditional content defined by implementations
ele-1: All FHIR elements must have a @value or children
ext-1: Must have either extensions or value[x], not both
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
ele-1: All FHIR elements must have a @value or children
ext-1: Must have either extensions or value[x], not both
.... number 0..1positiveIntNote instance identifier
ele-1: All FHIR elements must have a @value or children
.... type 0..1codedisplay | print | printoper
Binding: ?? (required): The presentation types of notes.


ele-1: All FHIR elements must have a @value or children
.... text 0..1stringNote explanatory text
ele-1: All FHIR elements must have a @value or children
.... language 0..1CodeableConceptLanguage of the text
Binding: ?? (preferred): A human language.

Additional BindingsPurpose
??Max Binding

ele-1: All FHIR elements must have a @value or children
... benefitPeriod 0..1PeriodWhen the benefits are applicable
ele-1: All FHIR elements must have a @value or children
... benefitBalance 0..*BackboneElementBalance by Benefit Category
ele-1: All FHIR elements must have a @value or children
.... extension 0..*ExtensionAdditional content defined by implementations
ele-1: All FHIR elements must have a @value or children
ext-1: Must have either extensions or value[x], not both
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
ele-1: All FHIR elements must have a @value or children
ext-1: Must have either extensions or value[x], not both
.... category 1..1CodeableConceptBenefit classification
Binding: ?? (example): Benefit categories such as: oral, medical, vision, oral-basic etc.


ele-1: All FHIR elements must have a @value or children
.... excluded 0..1booleanExcluded from the plan
ele-1: All FHIR elements must have a @value or children
.... name 0..1stringShort name for the benefit
ele-1: All FHIR elements must have a @value or children
.... description 0..1stringDescription of the benefit or services covered
ele-1: All FHIR elements must have a @value or children
.... network 0..1CodeableConceptIn or out of network
Binding: ?? (example): Code to classify in or out of network services.


ele-1: All FHIR elements must have a @value or children
.... unit 0..1CodeableConceptIndividual or family
Binding: ?? (example): Unit covered/serviced - individual or family.


ele-1: All FHIR elements must have a @value or children
.... term 0..1CodeableConceptAnnual or lifetime
Binding: ?? (example): Coverage unit - annual, lifetime.


ele-1: All FHIR elements must have a @value or children
.... financial 0..*BackboneElementBenefit Summary
ele-1: All FHIR elements must have a @value or children
..... extension 0..*ExtensionAdditional content defined by implementations
ele-1: All FHIR elements must have a @value or children
ext-1: Must have either extensions or value[x], not both
..... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
ele-1: All FHIR elements must have a @value or children
ext-1: Must have either extensions or value[x], not both
..... type 1..1CodeableConceptBenefit classification
Binding: ?? (example): Deductable, visits, co-pay, etc.


ele-1: All FHIR elements must have a @value or children
..... allowed[x] 0..1Benefits allowed
ele-1: All FHIR elements must have a @value or children
...... allowedUnsignedIntunsignedInt
...... allowedStringstring
...... allowedMoneyMoney
..... used[x] 0..1Benefits used
ele-1: All FHIR elements must have a @value or children
...... usedUnsignedIntunsignedInt
...... usedMoneyMoney

doco Documentation for this format