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).
Name | Flags | Card. | Type | Description & Constraints | ||||
---|---|---|---|---|---|---|---|---|
ExplanationOfBenefit | C | 0..* | 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 | Σ | 0..1 | Meta | Metadata about the resource ele-1: All FHIR elements must have a @value or children | ||||
extension | 0..* | Extension | Additional 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 | Σ | 0..1 | id | Version specific identifier ele-1: All FHIR elements must have a @value or children | ||||
lastUpdated | Σ | 0..1 | instant | When the resource version last changed ele-1: All FHIR elements must have a @value or children | ||||
source | Σ | 0..1 | uri | Identifies where the resource comes from ele-1: All FHIR elements must have a @value or children | ||||
profile | Σ | 1..* | canonical(StructureDefinition) | Profiles this resource claims to conform to ele-1: All FHIR elements must have a @value or children | ||||
security | Σ | 0..* | Coding | Security 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 | Σ | 0..* | Coding | Tags 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 | ?!Σ | 0..1 | uri | A set of rules under which this content was created ele-1: All FHIR elements must have a @value or children | ||||
language | 0..1 | code | Language of the resource content Binding: ?? (preferred): A human language.
ele-1: All FHIR elements must have a @value or children | |||||
text | 0..1 | Narrative | Text summary of the resource, for human interpretation ele-1: All FHIR elements must have a @value or children | |||||
contained | 0..* | Resource | Contained, inline Resources | |||||
extension | 0..* | Extension | Extension ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both | |||||
modifierExtension | ?! | 0..* | Extension | Extensions 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..* | Identifier | Business Identifier for the resource ele-1: All FHIR elements must have a @value or children | |||||
status | ?!SΣ | 1..1 | code | active | 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 | SΣ | 1..1 | CodeableConcept | Category 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..1 | CodeableConcept | More granular claim type Binding: ?? (example): A more granular claim typecode. ele-1: All FHIR elements must have a @value or children | |||||
use | SΣ | 1..1 | code | claim | preauthorization | predetermination Binding: ?? (required): Complete, proposed, exploratory, other. ele-1: All FHIR elements must have a @value or children | ||||
patient | SΣ | 1..1 | Reference(US Core Patient Profile(7.0.0)) | The recipient of the products and services ele-1: All FHIR elements must have a @value or children | ||||
billablePeriod | Σ | 0..1 | Period | Relevant time frame for the claim ele-1: All FHIR elements must have a @value or children | ||||
created | Σ | 1..1 | dateTime | Response creation date ele-1: All FHIR elements must have a @value or children | ||||
enterer | S | 0..1 | Reference(US Core Practitioner Profile(7.0.0) | US Core PractitionerRole Profile(7.0.0)) | Author of the claim ele-1: All FHIR elements must have a @value or children | ||||
insurer | SΣ | 1..1 | Reference(US Core Organization Profile(7.0.0)) | Party responsible for reimbursement ele-1: All FHIR elements must have a @value or children | ||||
provider | SΣ | 1..1 | Reference(US Core Practitioner Profile(7.0.0) | US Core PractitionerRole Profile(7.0.0) | US Core Organization Profile(7.0.0)) | Party responsible for the claim ele-1: All FHIR elements must have a @value or children | ||||
priority | 0..1 | CodeableConcept | Desired processing urgency Binding: ?? (required) ele-1: All FHIR elements must have a @value or children | |||||
fundsReserveRequested | 0..1 | CodeableConcept | For 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..1 | CodeableConcept | Funds 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..* | BackboneElement | Prior or corollary claims ele-1: All FHIR elements must have a @value or children | |||||
extension | 0..* | Extension | Additional 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 | ?!Σ | 0..* | Extension | Extensions 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..1 | Reference(Claim) | Reference to the related claim ele-1: All FHIR elements must have a @value or children | |||||
relationship | 0..1 | CodeableConcept | How 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..1 | Identifier | File or case reference ele-1: All FHIR elements must have a @value or children | |||||
prescription | 0..1 | Reference(MedicationRequest | VisionPrescription) | Prescription authorizing services or products ele-1: All FHIR elements must have a @value or children | |||||
originalPrescription | 0..1 | Reference(MedicationRequest) | Original prescription if superceded by fulfiller ele-1: All FHIR elements must have a @value or children | |||||
payee | 0..1 | BackboneElement | Recipient of benefits payable ele-1: All FHIR elements must have a @value or children | |||||
extension | 0..* | Extension | Additional 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 | ?!Σ | 0..* | Extension | Extensions 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..1 | CodeableConcept | Category 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..1 | Reference(Practitioner | PractitionerRole | Organization | Patient | RelatedPerson) | Recipient reference ele-1: All FHIR elements must have a @value or children | |||||
referral | 0..1 | Reference(ServiceRequest) | Treatment Referral ele-1: All FHIR elements must have a @value or children | |||||
facility | S | 0..1 | Reference(US Core Location Profile(7.0.0)) | Servicing Facility ele-1: All FHIR elements must have a @value or children | ||||
claim | 0..1 | Reference(Claim) | Claim reference ele-1: All FHIR elements must have a @value or children | |||||
claimResponse | 0..1 | Reference(ClaimResponse) | Claim response reference ele-1: All FHIR elements must have a @value or children | |||||
outcome | Σ | 1..1 | code | queued | complete | error | partial Binding: ?? (required): The result of the claim processing. ele-1: All FHIR elements must have a @value or children | ||||
disposition | 0..1 | string | Disposition Message ele-1: All FHIR elements must have a @value or children | |||||
preAuthRef | 0..* | string | Preauthorization reference ele-1: All FHIR elements must have a @value or children | |||||
preAuthRefPeriod | S | 0..1 | Period | Preauthorization in-effect period ele-1: All FHIR elements must have a @value or children | ||||
careTeam | 0..* | BackboneElement | Care Team members ele-1: All FHIR elements must have a @value or children | |||||
extension | 0..* | Extension | Additional 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 | ?!Σ | 0..* | Extension | Extensions 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..1 | positiveInt | Order of care team ele-1: All FHIR elements must have a @value or children | |||||
provider | S | 1..1 | Reference(US Core Practitioner Profile(7.0.0) | US Core PractitionerRole Profile(7.0.0) | US Core Organization Profile(7.0.0)) | Practitioner or organization ele-1: All FHIR elements must have a @value or children | ||||
responsible | 0..1 | boolean | Indicator of the lead practitioner ele-1: All FHIR elements must have a @value or children | |||||
role | 0..1 | CodeableConcept | Function 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..1 | CodeableConcept | Practitioner credential or specialization Binding: ?? (example): Provider professional qualifications. ele-1: All FHIR elements must have a @value or children | |||||
supportingInfo | 0..* | BackboneElement | Supporting information ele-1: All FHIR elements must have a @value or children | |||||
extension | 0..* | Extension | Additional 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 | ?!Σ | 0..* | Extension | Extensions 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..1 | positiveInt | Information instance identifier ele-1: All FHIR elements must have a @value or children | |||||
category | 1..1 | CodeableConcept | Classification 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..1 | CodeableConcept | Type 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..1 | When it occurred ele-1: All FHIR elements must have a @value or children | ||||||
timingDate | date | |||||||
timingPeriod | Period | |||||||
value[x] | 0..1 | Data to be provided ele-1: All FHIR elements must have a @value or children | ||||||
valueBoolean | boolean | |||||||
valueString | string | |||||||
valueQuantity | Quantity | |||||||
valueAttachment | Attachment | |||||||
valueReference | Reference(Resource) | |||||||
reason | 0..1 | Coding | Explanation for the information Binding: ?? (example): Reason codes for the missing teeth. ele-1: All FHIR elements must have a @value or children | |||||
diagnosis | 0..* | BackboneElement | Pertinent diagnosis information ele-1: All FHIR elements must have a @value or children | |||||
extension | 0..* | Extension | Additional 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 | ?!Σ | 0..* | Extension | Extensions 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..1 | positiveInt | Diagnosis instance identifier ele-1: All FHIR elements must have a @value or children | |||||
diagnosis[x] | 1..1 | Nature of illness or problem Binding: ?? (example): ICD10 Diagnostic codes. ele-1: All FHIR elements must have a @value or children | ||||||
diagnosisCodeableConcept | CodeableConcept | |||||||
diagnosisReference | Reference(Condition) | |||||||
type | 0..* | CodeableConcept | Timing 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..1 | CodeableConcept | Present on admission Binding: ?? (example): Present on admission. ele-1: All FHIR elements must have a @value or children | |||||
packageCode | 0..1 | CodeableConcept | Package billing code Binding: ?? (example): The DRG codes associated with the diagnosis. ele-1: All FHIR elements must have a @value or children | |||||
procedure | 0..* | BackboneElement | Clinical procedures performed ele-1: All FHIR elements must have a @value or children | |||||
extension | 0..* | Extension | Additional 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 | ?!Σ | 0..* | Extension | Extensions 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..1 | positiveInt | Procedure instance identifier ele-1: All FHIR elements must have a @value or children | |||||
type | 0..* | CodeableConcept | Category of Procedure Binding: ?? (example): Example procedure type codes. ele-1: All FHIR elements must have a @value or children | |||||
date | 0..1 | dateTime | When the procedure was performed ele-1: All FHIR elements must have a @value or children | |||||
procedure[x] | 1..1 | Specific clinical procedure Binding: ?? (example): ICD10 Procedure codes. ele-1: All FHIR elements must have a @value or children | ||||||
procedureCodeableConcept | CodeableConcept | |||||||
procedureReference | Reference(Procedure) | |||||||
udi | 0..* | Reference(Device) | Unique device identifier ele-1: All FHIR elements must have a @value or children | |||||
precedence | 0..1 | positiveInt | Precedence (primary, secondary, etc.) ele-1: All FHIR elements must have a @value or children | |||||
insurance | Σ | 1..* | BackboneElement | Patient insurance information ele-1: All FHIR elements must have a @value or children | ||||
extension | 0..* | Extension | Additional 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 | ?!Σ | 0..* | Extension | Extensions 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 | Σ | 1..1 | boolean | Coverage to be used for adjudication ele-1: All FHIR elements must have a @value or children | ||||
coverage | Σ | 1..1 | Reference(HRex Coverage Profile(1.1.0-ballot)) | Insurance information ele-1: All FHIR elements must have a @value or children | ||||
preAuthRef | 0..* | string | Prior authorization reference number ele-1: All FHIR elements must have a @value or children | |||||
accident | 0..1 | BackboneElement | Details of the event ele-1: All FHIR elements must have a @value or children | |||||
extension | 0..* | Extension | Additional 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 | ?!Σ | 0..* | Extension | Extensions 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..1 | date | When the incident occurred ele-1: All FHIR elements must have a @value or children | |||||
type | 0..1 | CodeableConcept | The 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..1 | Where the event occurred ele-1: All FHIR elements must have a @value or children | ||||||
locationAddress | Address | |||||||
locationReference | Reference(Location) | |||||||
item | 0..* | BackboneElement | Product or service provided ele-1: All FHIR elements must have a @value or children | |||||
extension | 0..* | Extension | Extension ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both | |||||
modifierExtension | ?!Σ | 0..* | Extension | Extensions 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..1 | positiveInt | Item instance identifier ele-1: All FHIR elements must have a @value or children | |||||
careTeamSequence | 0..* | positiveInt | Applicable care team members ele-1: All FHIR elements must have a @value or children | |||||
diagnosisSequence | 0..* | positiveInt | Applicable diagnoses ele-1: All FHIR elements must have a @value or children | |||||
procedureSequence | 0..* | positiveInt | Applicable procedures ele-1: All FHIR elements must have a @value or children | |||||
informationSequence | 0..* | positiveInt | Applicable exception and supporting information ele-1: All FHIR elements must have a @value or children | |||||
revenue | 0..1 | CodeableConcept | Revenue 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 | S | 0..1 | CodeableConcept | Benefit 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..1 | CodeableConcept | Billing, service, product, or drug code Binding: ?? (required) ele-1: All FHIR elements must have a @value or children | |||||
modifier | 0..* | CodeableConcept | Product 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..* | CodeableConcept | Program 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..1 | Date or dates of service or product delivery ele-1: All FHIR elements must have a @value or children | ||||||
servicedDate | date | |||||||
servicedPeriod | Period | |||||||
location[x] | 0..1 | Place 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 | ||||||
locationCodeableConcept | CodeableConcept | |||||||
locationAddress | Address | |||||||
locationReference | Reference(Location) | |||||||
quantity | 0..1 | ??, ?? | Count of products or services ele-1: All FHIR elements must have a @value or children | |||||
unitPrice | 0..1 | Money | Fee, charge or cost per item ele-1: All FHIR elements must have a @value or children | |||||
factor | 0..1 | decimal | Price scaling factor ele-1: All FHIR elements must have a @value or children | |||||
net | 0..1 | Money | Total 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..1 | CodeableConcept | Anatomical 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..* | CodeableConcept | Anatomical 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(7.0.0)) | Encounters related to this billed item ele-1: All FHIR elements must have a @value or children | |||||
noteNumber | 0..* | positiveInt | Applicable note numbers ele-1: All FHIR elements must have a @value or children | |||||
adjudication | 0..* | BackboneElement | Adjudication details ele-1: All FHIR elements must have a @value or children | |||||
extension | 0..* | Extension | Extension ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both | |||||
modifierExtension | ?!Σ | 0..* | Extension | Extensions 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..1 | CodeableConcept | Type of adjudication information Binding: ?? (required) ele-1: All FHIR elements must have a @value or children | |||||
reason | 0..1 | CodeableConcept | Explanation of adjudication outcome Binding: ?? (example): Adjudication reason codes. ele-1: All FHIR elements must have a @value or children | |||||
amount | 0..1 | Money | Monetary amount ele-1: All FHIR elements must have a @value or children | |||||
value | 0..1 | decimal | Non-monitary value ele-1: All FHIR elements must have a @value or children | |||||
detail | 0..* | BackboneElement | Additional items ele-1: All FHIR elements must have a @value or children | |||||
extension | 0..* | Extension | Additional 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 | ?!Σ | 0..* | Extension | Extensions 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..1 | positiveInt | Product or service provided ele-1: All FHIR elements must have a @value or children | |||||
revenue | 0..1 | CodeableConcept | Revenue 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..1 | CodeableConcept | Benefit 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..1 | CodeableConcept | Billing, 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..* | CodeableConcept | Service/Product billing modifiers Binding: ?? (example): Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen. ele-1: All FHIR elements must have a @value or children | |||||
programCode | 0..* | CodeableConcept | Program 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..1 | Money | Fee, charge or cost per item ele-1: All FHIR elements must have a @value or children | |||||
factor | 0..1 | decimal | Price scaling factor ele-1: All FHIR elements must have a @value or children | |||||
net | 0..1 | Money | Total 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..* | positiveInt | Applicable 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..* | BackboneElement | Additional items ele-1: All FHIR elements must have a @value or children | |||||
extension | 0..* | Extension | Additional 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 | ?!Σ | 0..* | Extension | Extensions 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..1 | positiveInt | Product or service provided ele-1: All FHIR elements must have a @value or children | |||||
revenue | 0..1 | CodeableConcept | Revenue 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..1 | CodeableConcept | Benefit 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..1 | CodeableConcept | Billing, 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..* | CodeableConcept | Service/Product billing modifiers Binding: ?? (example): Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen. ele-1: All FHIR elements must have a @value or children | |||||
programCode | 0..* | CodeableConcept | Program 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..1 | Money | Fee, charge or cost per item ele-1: All FHIR elements must have a @value or children | |||||
factor | 0..1 | decimal | Price scaling factor ele-1: All FHIR elements must have a @value or children | |||||
net | 0..1 | Money | Total 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..* | positiveInt | Applicable 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..* | BackboneElement | Insurer added line items ele-1: All FHIR elements must have a @value or children | |||||
extension | 0..* | Extension | Additional 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 | ?!Σ | 0..* | Extension | Extensions 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..* | positiveInt | Item sequence number ele-1: All FHIR elements must have a @value or children | |||||
detailSequence | 0..* | positiveInt | Detail sequence number ele-1: All FHIR elements must have a @value or children | |||||
subDetailSequence | 0..* | positiveInt | Subdetail sequence number ele-1: All FHIR elements must have a @value or children | |||||
provider | 0..* | Reference(US Core Practitioner Profile(7.0.0) | US Core PractitionerRole Profile(7.0.0) | US Core Organization Profile(7.0.0)) | Authorized providers ele-1: All FHIR elements must have a @value or children | |||||
productOrService | 1..1 | CodeableConcept | Billing, 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..* | CodeableConcept | Service/Product billing modifiers Binding: ?? (example): Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen. ele-1: All FHIR elements must have a @value or children | |||||
programCode | 0..* | CodeableConcept | Program 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..1 | Date or dates of service or product delivery ele-1: All FHIR elements must have a @value or children | ||||||
servicedDate | date | |||||||
servicedPeriod | Period | |||||||
location[x] | 0..1 | Place 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 | ||||||
locationCodeableConcept | CodeableConcept | |||||||
locationAddress | Address | |||||||
locationReference | Reference(Location) | |||||||
quantity | 0..1 | ??, ?? | Count of products or services ele-1: All FHIR elements must have a @value or children | |||||
unitPrice | 0..1 | Money | Fee, charge or cost per item ele-1: All FHIR elements must have a @value or children | |||||
factor | 0..1 | decimal | Price scaling factor ele-1: All FHIR elements must have a @value or children | |||||
net | 0..1 | Money | Total item cost ele-1: All FHIR elements must have a @value or children | |||||
bodySite | 0..1 | CodeableConcept | Anatomical 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..* | CodeableConcept | Anatomical 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..* | positiveInt | Applicable 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..* | BackboneElement | Insurer added line items ele-1: All FHIR elements must have a @value or children | |||||
extension | 0..* | Extension | Additional 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 | ?!Σ | 0..* | Extension | Extensions 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..1 | CodeableConcept | Billing, 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..* | CodeableConcept | Service/Product billing modifiers Binding: ?? (example): Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen. 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..1 | Money | Fee, charge or cost per item ele-1: All FHIR elements must have a @value or children | |||||
factor | 0..1 | decimal | Price scaling factor ele-1: All FHIR elements must have a @value or children | |||||
net | 0..1 | Money | Total item cost ele-1: All FHIR elements must have a @value or children | |||||
noteNumber | 0..* | positiveInt | Applicable 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..* | BackboneElement | Insurer added line items ele-1: All FHIR elements must have a @value or children | |||||
extension | 0..* | Extension | Additional 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 | ?!Σ | 0..* | Extension | Extensions 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..1 | CodeableConcept | Billing, 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..* | CodeableConcept | Service/Product billing modifiers Binding: ?? (example): Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen. 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..1 | Money | Fee, charge or cost per item ele-1: All FHIR elements must have a @value or children | |||||
factor | 0..1 | decimal | Price scaling factor ele-1: All FHIR elements must have a @value or children | |||||
net | 0..1 | Money | Total item cost ele-1: All FHIR elements must have a @value or children | |||||
noteNumber | 0..* | positiveInt | Applicable 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 | S | 0..* | BackboneElement | Header-level adjudication ele-1: All FHIR elements must have a @value or children | ||||
extension | 0..* | Extension | Extension ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both | |||||
modifierExtension | ?!Σ | 0..* | Extension | Extensions 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 | S | 1..1 | CodeableConcept | Type of adjudication information Binding: ?? (required) ele-1: All FHIR elements must have a @value or children | ||||
reason | 0..1 | CodeableConcept | Explanation of adjudication outcome Binding: ?? (example): Adjudication reason codes. ele-1: All FHIR elements must have a @value or children | |||||
amount | 0..1 | Money | Monetary amount ele-1: All FHIR elements must have a @value or children | |||||
value | 0..1 | decimal | Non-monitary value ele-1: All FHIR elements must have a @value or children | |||||
total | Σ | 0..* | BackboneElement | Adjudication totals ele-1: All FHIR elements must have a @value or children | ||||
extension | 0..* | Extension | Extension ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both | |||||
modifierExtension | ?!Σ | 0..* | Extension | Extensions 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 | SΣ | 1..1 | CodeableConcept | Prior Authorization utilization codes Binding: ?? (extensible) ele-1: All FHIR elements must have a @value or children | ||||
amount | Σ | 1..1 | Money | Financial total for the category ele-1: All FHIR elements must have a @value or children | ||||
payment | 0..1 | BackboneElement | Payment Details ele-1: All FHIR elements must have a @value or children | |||||
extension | 0..* | Extension | Additional 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 | ?!Σ | 0..* | Extension | Extensions 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..1 | CodeableConcept | Partial 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..1 | Money | Payment adjustment for non-claim issues ele-1: All FHIR elements must have a @value or children | |||||
adjustmentReason | 0..1 | CodeableConcept | Explanation for the variance Binding: ?? (example): Payment Adjustment reason codes. ele-1: All FHIR elements must have a @value or children | |||||
date | 0..1 | date | Expected date of payment ele-1: All FHIR elements must have a @value or children | |||||
amount | 0..1 | Money | Payable amount after adjustment ele-1: All FHIR elements must have a @value or children | |||||
identifier | 0..1 | Identifier | Business identifier for the payment ele-1: All FHIR elements must have a @value or children | |||||
formCode | 0..1 | CodeableConcept | Printed form identifier Binding: ?? (example): The forms codes. ele-1: All FHIR elements must have a @value or children | |||||
form | 0..1 | Attachment | Printed reference or actual form ele-1: All FHIR elements must have a @value or children | |||||
processNote | 0..* | BackboneElement | Note concerning adjudication ele-1: All FHIR elements must have a @value or children | |||||
extension | 0..* | Extension | Additional 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 | ?!Σ | 0..* | Extension | Extensions 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..1 | positiveInt | Note instance identifier ele-1: All FHIR elements must have a @value or children | |||||
type | 0..1 | code | display | print | printoper Binding: ?? (required): The presentation types of notes. ele-1: All FHIR elements must have a @value or children | |||||
text | 0..1 | string | Note explanatory text ele-1: All FHIR elements must have a @value or children | |||||
language | 0..1 | CodeableConcept | Language of the text Binding: ?? (preferred): A human language.
ele-1: All FHIR elements must have a @value or children | |||||
benefitPeriod | 0..1 | Period | When the benefits are applicable ele-1: All FHIR elements must have a @value or children | |||||
benefitBalance | 0..* | BackboneElement | Balance by Benefit Category ele-1: All FHIR elements must have a @value or children | |||||
extension | 0..* | Extension | Additional 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 | ?!Σ | 0..* | Extension | Extensions 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..1 | CodeableConcept | Benefit 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..1 | boolean | Excluded from the plan ele-1: All FHIR elements must have a @value or children | |||||
name | 0..1 | string | Short name for the benefit ele-1: All FHIR elements must have a @value or children | |||||
description | 0..1 | string | Description of the benefit or services covered ele-1: All FHIR elements must have a @value or children | |||||
network | 0..1 | CodeableConcept | In 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..1 | CodeableConcept | Individual or family Binding: ?? (example): Unit covered/serviced - individual or family. ele-1: All FHIR elements must have a @value or children | |||||
term | 0..1 | CodeableConcept | Annual or lifetime Binding: ?? (example): Coverage unit - annual, lifetime. ele-1: All FHIR elements must have a @value or children | |||||
financial | 0..* | BackboneElement | Benefit Summary ele-1: All FHIR elements must have a @value or children | |||||
extension | 0..* | Extension | Additional 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 | ?!Σ | 0..* | Extension | Extensions 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..1 | CodeableConcept | Benefit classification Binding: ?? (example): Deductable, visits, co-pay, etc. ele-1: All FHIR elements must have a @value or children | |||||
allowed[x] | 0..1 | Benefits allowed ele-1: All FHIR elements must have a @value or children | ||||||
allowedUnsignedInt | unsignedInt | |||||||
allowedString | string | |||||||
allowedMoney | Money | |||||||
used[x] | 0..1 | Benefits used ele-1: All FHIR elements must have a @value or children | ||||||
usedUnsignedInt | unsignedInt | |||||||
usedMoney | Money | |||||||
Documentation for this format |