Intersection of http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-claiminquiryresponse and http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-claiminquiryresponse

This is the set of resources that conform to both PAS Claim Inquiry Response (http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-claiminquiryresponse) and PAS Claim Inquiry Response (http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-claiminquiryresponse).

Structure

NameFlagsCard.TypeDescription & Constraints    Filter: doco
ClaimResponse 0..*Response to a preauthorization query
ClaimResponse.meta This element is included in summaries. 0..1MetaMetadata about the resource
ClaimResponse.implicitRules This element is a modifier element. This element is included in summaries. 0..1uriA set of rules under which this content was created
ClaimResponse.language 0..1codeLanguage of the resource content
Binding: ?? (preferred): A human language.
Additional BindingsPurpose
??Max Binding
ClaimResponse.text 0..1NarrativeText summary of the resource, for human interpretation
This profile does not constrain the narrative in regard to content, language, or traceability to data elements
ClaimResponse.contained 0..*ResourceContained, inline Resources
ClaimResponse.extension 0..*Extensionleft: Additional content defined by implementations; right: Extension
ClaimResponse.modifierExtension This element is a modifier element. 0..*ExtensionExtensions that cannot be ignored
ClaimResponse.identifier This element must be supported. 0..*?? The snapshot does not say whether the constraints on the root of this type profile have been applied to this element, so assume they have not. Check the type profile directly as well, ?? The snapshot does not say whether the constraints on the root of this type profile have been applied to this element, so assume they have not. Check the type profile directly as wellleft: An identifier intended for computation; right: Business Identifier for a claim response
ClaimResponse.identifier.extension 0..*ExtensionAdditional content defined by implementations
ClaimResponse.identifier.use This element is a modifier element. This element is included in summaries. 0..1codeusual | official | temp | secondary | old (If known)
Binding: ?? (required): Identifies the purpose for this identifier, if known .
ClaimResponse.identifier.type This element is included in summaries. 0..1CodeableConceptDescription of identifier
Binding: ?? (extensible): A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.
ClaimResponse.identifier.system This element must be supported. This element is included in summaries. 1..1uriShould use a scheme of 'urn:trnorg:<TRN03>'
Example General: http://www.acme.com/identifiers/patient
ClaimResponse.identifier.value This element must be supported. This element is included in summaries. 1..1stringThe value that is unique
Example General: 123456
ClaimResponse.identifier.period This element is included in summaries. 0..1PeriodTime period when id is/was valid for use
ClaimResponse.identifier.assigner This element is included in summaries. 0..1Reference(Organization)Organization that issued id (may be just text)
ClaimResponse.status This element is a modifier element. This element must be supported. This element is included in summaries. 1..1codeactive | cancelled | draft | entered-in-error
Binding: ?? (required): A code specifying the state of the resource instance.
ClaimResponse.type This element is included in summaries. 1..1CodeableConceptMore granular claim type
Binding: ?? (extensible): The type or discipline-style of the claim.
ClaimResponse.subType 0..1CodeableConceptMore granular claim type
Binding: ?? (example): A more granular claim typecode.
ClaimResponse.use This element is included in summaries. 1..1codeclaim | preauthorization | predetermination
Binding: ?? (required): Claim, preauthorization, predetermination.
ClaimResponse.patient This element must be supported. This element is included in summaries. 1..1Reference(PAS Beneficiary Patient | #sd-49-profile-beneficiary-profile-beneficiary)The recipient of the products and services
ClaimResponse.created This element must be supported. This element is included in summaries. 1..1dateTimeResponse creation date
ClaimResponse.insurer This element must be supported. This element is included in summaries. 1..1Reference(PAS Insurer Organization | #sd-69-profile-insurer-profile-insurer)Party responsible for reimbursement
ClaimResponse.requestor This element must be supported. 0..1Reference(PAS Requestor Organization | PAS PractitionerRole | #sd-70-profile-requestor-profile-requestor)Party responsible for the claim
ClaimResponse.request This element must be supported. This element is included in summaries. 1..1Id of resource triggering adjudication
ClaimResponse.outcome This element must be supported. This element is included in summaries. 1..1codeleft: queued | complete | error | partial; right: complete | error | partial
Binding: ?? (required): The result of the claim processing.
ClaimResponse.disposition 0..1stringDisposition Message
ClaimResponse.preAuthRef 0..1stringPreauthorization reference
ClaimResponse.preAuthPeriod This element must be supported. 0..1PeriodPreauthorization reference effective period
ClaimResponse.payeeType 0..1CodeableConceptParty to be paid any benefits payable
Binding: ?? (example): A code for the party to be reimbursed.
ClaimResponse.item This element must be supported. 0..*BackboneElementAdjudication for claim line items
ClaimResponse.item.extension 0..*ExtensionExtension
ClaimResponse.item.modifierExtension This element is a modifier element. This element is included in summaries. 0..*ExtensionExtensions that cannot be ignored even if unrecognized
ClaimResponse.item.itemSequence This element must be supported. 1..1positiveIntleft: Claim item instance identifier; right: Sequence numbers SHALL stay the same across all instances of the Prior Authorization, eg the Claim, ClaimResponse, ClaimUpdate, ClaimUpdateResponse
ClaimResponse.item.noteNumber This element must be supported. 0..*positiveIntApplicable note numbers
ClaimResponse.item.adjudication This element must be supported. 1..*BackboneElementAdjudication details
ClaimResponse.item.adjudication.extension 0..*ExtensionExtension
ClaimResponse.item.adjudication.modifierExtension This element is a modifier element. This element is included in summaries. 0..*ExtensionExtensions that cannot be ignored even if unrecognized
ClaimResponse.item.adjudication.category 1..1CodeableConceptThis code is fixed to 'submitted' to indicate that the adjudication result is on what was submitted.
Binding: ?? (example): The adjudication codes.
ClaimResponse.item.adjudication.reason 0..1CodeableConceptExplanation of adjudication outcome
Binding: ?? (example): The adjudication reason codes.
ClaimResponse.item.adjudication.amount 0..1MoneyMonetary amount
ClaimResponse.item.adjudication.value 0..1decimalNon-monetary value
ClaimResponse.item.detail 0..*BackboneElementAdjudication for claim details
ClaimResponse.item.detail.extension 0..*ExtensionAdditional content defined by implementations
ClaimResponse.item.detail.modifierExtension This element is a modifier element. This element is included in summaries. 0..*ExtensionExtensions that cannot be ignored even if unrecognized
ClaimResponse.item.detail.detailSequence 1..1positiveIntClaim detail instance identifier
ClaimResponse.item.detail.noteNumber 0..*positiveIntApplicable note numbers
ClaimResponse.item.detail.adjudication 1..*Detail level adjudication details
ClaimResponse.item.detail.subDetail 0..*BackboneElementAdjudication for claim sub-details
ClaimResponse.item.detail.subDetail.extension 0..*ExtensionAdditional content defined by implementations
ClaimResponse.item.detail.subDetail.modifierExtension This element is a modifier element. This element is included in summaries. 0..*ExtensionExtensions that cannot be ignored even if unrecognized
ClaimResponse.item.detail.subDetail.subDetailSequence 1..1positiveIntClaim sub-detail instance identifier
ClaimResponse.item.detail.subDetail.noteNumber 0..*positiveIntApplicable note numbers
ClaimResponse.item.detail.subDetail.adjudication 0..*Subdetail level adjudication details
ClaimResponse.addItem This element must be supported. 0..*BackboneElementInsurer added line items
ClaimResponse.addItem.extension 0..*ExtensionExtension
ClaimResponse.addItem.modifierExtension This element is a modifier element. This element is included in summaries. 0..*ExtensionExtensions that cannot be ignored even if unrecognized
ClaimResponse.addItem.itemSequence This element must be supported. 1..1positiveIntItem sequence number
ClaimResponse.addItem.detailSequence 0..*positiveIntDetail sequence number
ClaimResponse.addItem.subdetailSequence 0..*positiveIntSubdetail sequence number
ClaimResponse.addItem.provider This element must be supported. 0..*Reference(PAS Practitioner | PAS Organization Base Profile | #sd-106-profile-practitioner-profile-practitioner)Authorized providers
ClaimResponse.addItem.provider.extension 0..*ExtensionAdditional content defined by implementations
ClaimResponse.addItem.provider.reference This element is included in summaries. 0..1stringLiteral reference, Relative, internal or absolute URL
ClaimResponse.addItem.provider.type This element is included in summaries. 0..1uriType the reference refers to (e.g. "Patient")
Binding: ?? (extensible): Aa resource (or, for logical models, the URI of the logical model).
ClaimResponse.addItem.provider.identifier This element is included in summaries. 0..1IdentifierLogical reference, when literal reference is not known
ClaimResponse.addItem.provider.display This element is included in summaries. 0..1stringText alternative for the resource
ClaimResponse.addItem.productOrService This element must be supported. 1..1CodeableConceptBilling, service, product, or drug code
Binding: ?? (required)
ClaimResponse.addItem.modifier This element must be supported. 0..*CodeableConceptService/Product billing modifiers
Binding: ?? (required)
ClaimResponse.addItem.programCode 0..*CodeableConceptProgram the product or service is provided under
Binding: ?? (example): Program specific reason codes.
ClaimResponse.addItem.serviced[x] This element must be supported. 0..1Date or dates of service or product delivery
ClaimResponse.addItem.serviced[x].servicedDatedate
ClaimResponse.addItem.serviced[x].servicedPeriodPeriod
ClaimResponse.addItem.location[x] This element must be supported. 0..1Place of service or where product was supplied
Binding: ?? (example): Place of service: pharmacy, school, prison, etc.
ClaimResponse.addItem.location[x].locationCodeableConceptCodeableConcept
ClaimResponse.addItem.location[x].locationAddressAddress
ClaimResponse.addItem.location[x].locationReferenceReference(Location)
ClaimResponse.addItem.quantity This element must be supported. C0..1?? The snapshot does not say whether the constraints on the root of this type profile have been applied to this element, so assume they have not. Check the type profile directly as well, ?? The snapshot does not say whether the constraints on the root of this type profile have been applied to this element, so assume they have not. Check the type profile directly as wellleft: A fixed quantity (no comparator); right: Count of products or services
Constraints: qty-3, sqty-1
ClaimResponse.addItem.unitPrice This element must be supported. 0..1MoneyFee, charge or cost per item
ClaimResponse.addItem.factor 0..1decimalPrice scaling factor
ClaimResponse.addItem.net 0..1MoneyTotal item cost
ClaimResponse.addItem.bodySite 0..1CodeableConceptAnatomical location
Binding: ?? (example): The code for the teeth, quadrant, sextant and arch.
ClaimResponse.addItem.subSite 0..*CodeableConceptAnatomical sub-location
Binding: ?? (example): The code for the tooth surface and surface combinations.
ClaimResponse.addItem.noteNumber 0..*positiveIntApplicable note numbers
ClaimResponse.addItem.adjudication This element must be supported. 1..*BackboneElementAdded items adjudication
ClaimResponse.addItem.adjudication.extension 0..*ExtensionExtension
ClaimResponse.addItem.adjudication.modifierExtension This element is a modifier element. This element is included in summaries. 0..*ExtensionExtensions that cannot be ignored even if unrecognized
ClaimResponse.addItem.adjudication.category 1..1CodeableConceptThis code is fixed to 'submitted' to indicate that the adjudication result is on what was submitted.
Binding: ?? (example): The adjudication codes.
ClaimResponse.addItem.adjudication.reason 0..1CodeableConceptExplanation of adjudication outcome
Binding: ?? (example): The adjudication reason codes.
ClaimResponse.addItem.adjudication.amount 0..1MoneyMonetary amount
ClaimResponse.addItem.adjudication.value 0..1decimalNon-monetary value
ClaimResponse.addItem.detail 0..*BackboneElementInsurer added line details
ClaimResponse.addItem.detail.extension 0..*ExtensionAdditional content defined by implementations
ClaimResponse.addItem.detail.modifierExtension This element is a modifier element. This element is included in summaries. 0..*ExtensionExtensions that cannot be ignored even if unrecognized
ClaimResponse.addItem.detail.productOrService 1..1CodeableConceptBilling, service, product, or drug code
Binding: ?? (example): Allowable service and product codes.
ClaimResponse.addItem.detail.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.
ClaimResponse.addItem.detail.quantity 0..1?? The snapshot does not say whether the constraints on the root of this type profile have been applied to this element, so assume they have not. Check the type profile directly as well, ?? The snapshot does not say whether the constraints on the root of this type profile have been applied to this element, so assume they have not. Check the type profile directly as wellCount of products or services
ClaimResponse.addItem.detail.unitPrice 0..1MoneyFee, charge or cost per item
ClaimResponse.addItem.detail.factor 0..1decimalPrice scaling factor
ClaimResponse.addItem.detail.net 0..1MoneyTotal item cost
ClaimResponse.addItem.detail.noteNumber 0..*positiveIntApplicable note numbers
ClaimResponse.addItem.detail.adjudication 1..*Added items detail adjudication
ClaimResponse.addItem.detail.subDetail 0..*BackboneElementInsurer added line items
ClaimResponse.addItem.detail.subDetail.extension 0..*ExtensionAdditional content defined by implementations
ClaimResponse.addItem.detail.subDetail.modifierExtension This element is a modifier element. This element is included in summaries. 0..*ExtensionExtensions that cannot be ignored even if unrecognized
ClaimResponse.addItem.detail.subDetail.productOrService 1..1CodeableConceptBilling, service, product, or drug code
Binding: ?? (example): Allowable service and product codes.
ClaimResponse.addItem.detail.subDetail.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.
ClaimResponse.addItem.detail.subDetail.quantity 0..1?? The snapshot does not say whether the constraints on the root of this type profile have been applied to this element, so assume they have not. Check the type profile directly as well, ?? The snapshot does not say whether the constraints on the root of this type profile have been applied to this element, so assume they have not. Check the type profile directly as wellCount of products or services
ClaimResponse.addItem.detail.subDetail.unitPrice 0..1MoneyFee, charge or cost per item
ClaimResponse.addItem.detail.subDetail.factor 0..1decimalPrice scaling factor
ClaimResponse.addItem.detail.subDetail.net 0..1MoneyTotal item cost
ClaimResponse.addItem.detail.subDetail.noteNumber 0..*positiveIntApplicable note numbers
ClaimResponse.addItem.detail.subDetail.adjudication 1..*Added items detail adjudication
ClaimResponse.adjudication This element must be supported. 0..*BackboneElementHeader-level adjudication
ClaimResponse.adjudication.extension 0..*ExtensionExtension
ClaimResponse.adjudication.modifierExtension This element is a modifier element. This element is included in summaries. 0..*ExtensionExtensions that cannot be ignored even if unrecognized
ClaimResponse.adjudication.category 1..1CodeableConceptThis code is fixed to 'submitted' to indicate that the adjudication result is on what was submitted.
Binding: ?? (example): The adjudication codes.
ClaimResponse.adjudication.reason 0..1CodeableConceptExplanation of adjudication outcome
Binding: ?? (example): The adjudication reason codes.
ClaimResponse.adjudication.amount 0..1MoneyMonetary amount
ClaimResponse.adjudication.value 0..1decimalNon-monetary value
ClaimResponse.total This element is included in summaries. 0..*BackboneElementAdjudication totals
ClaimResponse.total.extension 0..*ExtensionAdditional content defined by implementations
ClaimResponse.total.modifierExtension This element is a modifier element. This element is included in summaries. 0..*ExtensionExtensions that cannot be ignored even if unrecognized
ClaimResponse.total.category This element is included in summaries. 1..1CodeableConceptType of adjudication information
Binding: ?? (example): The adjudication codes.
ClaimResponse.total.amount This element is included in summaries. 1..1MoneyFinancial total for the category
ClaimResponse.payment 0..1BackboneElementPayment Details
ClaimResponse.payment.extension 0..*ExtensionAdditional content defined by implementations
ClaimResponse.payment.modifierExtension This element is a modifier element. This element is included in summaries. 0..*ExtensionExtensions that cannot be ignored even if unrecognized
ClaimResponse.payment.type 1..1CodeableConceptPartial or complete payment
Binding: ?? (example): The type (partial, complete) of the payment.
ClaimResponse.payment.adjustment 0..1MoneyPayment adjustment for non-claim issues
ClaimResponse.payment.adjustmentReason 0..1CodeableConceptExplanation for the adjustment
Binding: ?? (example): Payment Adjustment reason codes.
ClaimResponse.payment.date 0..1dateExpected date of payment
ClaimResponse.payment.amount 1..1MoneyPayable amount after adjustment
ClaimResponse.payment.identifier 0..1IdentifierBusiness identifier for the payment
ClaimResponse.fundsReserve 0..1CodeableConceptFunds reserved status
Binding: ?? (example): For whom funds are to be reserved: (Patient, Provider, None).
ClaimResponse.formCode 0..1CodeableConceptPrinted form identifier
Binding: ?? (example): The forms codes.
ClaimResponse.form 0..1AttachmentPrinted reference or actual form
ClaimResponse.processNote This element must be supported. 0..*BackboneElementNote concerning adjudication
ClaimResponse.processNote.extension 0..*ExtensionAdditional content defined by implementations
ClaimResponse.processNote.modifierExtension This element is a modifier element. This element is included in summaries. 0..*ExtensionExtensions that cannot be ignored even if unrecognized
ClaimResponse.processNote.number This element must be supported. 1..1positiveIntNote instance identifier
ClaimResponse.processNote.type 0..1codedisplay | print | printoper
Binding: ?? (required): The presentation types of notes.
ClaimResponse.processNote.text This element must be supported. 1..1stringNote explanatory text
ClaimResponse.processNote.language 0..1CodeableConceptLanguage of the text
Binding: ?? (preferred): A human language.
Additional BindingsPurpose
??Max Binding
ClaimResponse.communicationRequest 0..*Reference(CommunicationRequest)Request for additional information
ClaimResponse.insurance 0..*BackboneElementPatient insurance information
ClaimResponse.insurance.extension 0..*ExtensionAdditional content defined by implementations
ClaimResponse.insurance.modifierExtension This element is a modifier element. This element is included in summaries. 0..*ExtensionExtensions that cannot be ignored even if unrecognized
ClaimResponse.insurance.sequence 1..1positiveIntInsurance instance identifier
ClaimResponse.insurance.focal 1..1booleanCoverage to be used for adjudication
ClaimResponse.insurance.coverage 1..1Reference(Coverage)Insurance information
ClaimResponse.insurance.businessArrangement 0..1stringAdditional provider contract number
ClaimResponse.insurance.claimResponse 0..1Reference(ClaimResponse)Adjudication results
ClaimResponse.error This element must be supported. 0..*BackboneElementProcessing errors
ClaimResponse.error.extension 0..*ExtensionExtension
ClaimResponse.error.modifierExtension This element is a modifier element. This element is included in summaries. 0..*ExtensionExtensions that cannot be ignored even if unrecognized
ClaimResponse.error.itemSequence 0..1positiveIntItem sequence number
ClaimResponse.error.detailSequence 0..1positiveIntDetail sequence number
ClaimResponse.error.subDetailSequence 0..1positiveIntSubdetail sequence number
ClaimResponse.error.code This element must be supported. 1..1CodeableConceptError code detailing processing issues
Binding: ?? (required)

doco Documentation for this format