Profile Comparison between http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-claimresponse vs http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-claimresponse

Messages

Metadata

Name	Value		Comments
abstract	false
baseDefinition	http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-claimresponse-base	http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-claimresponse-base|2.2.1	Values Differ
copyright
date	2024-12-20T21:11:16+00:00	2026-10-09T18:42:41+00:00	Values Differ
description	PAS constraints on Claim resource mandating support for elements relevant to the response of a prior authorization request
experimental
fhirVersion	4.0.1
jurisdiction
jurisdiction / jurisdiction[0]	urn:iso:std:iso:3166#US
kind	resource
name	PASClaimResponse
publisher	HL7 International / Financial Management
purpose
status	active
title	PAS Claim Response
type	ClaimResponse
url	http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-claimresponse
version	2.1.0	2.2.1	Values Differ

Structure

Name	L Flags	L Card.	L Type	L Description & Constraints	R Flags	R Card.	R Type	R Description & Constraints	Comments
ClaimResponse		0..*	PASClaimResponseBase	Response to a preauthorization		0..*	PASClaimResponseBase(2.2.1)	Response to a preauthorization
ClaimResponse.id	Σ This element is included in summaries.	0..1	id	Logical id of this artifact	Σ This element is included in summaries.	0..1	id	Logical id of this artifact
ClaimResponse.meta	Σ This element is included in summaries.	0..1	Meta	Metadata about the resource	Σ This element is included in summaries.	0..1	Meta	Metadata about the resource
ClaimResponse.implicitRules	?! This element is a modifier element. Σ This element is included in summaries.	0..1	uri	A set of rules under which this content was created	?! This element is a modifier element. Σ This element is included in summaries.	0..1	uri	A set of rules under which this content was created
ClaimResponse.language		0..1	code	Language of the resource content Binding: ?? (preferred): A human language. Additional Bindings Purpose ?? Max Binding		0..1	code	Language of the resource content Binding: ?? (preferred): A human language. Additional Bindings Purpose ?? Max Binding	Example/preferred bindings differ at ClaimResponse.language using binding from PASClaimResponse
ClaimResponse.text		0..1	Narrative	Text summary of the resource, for human interpretation This profile does not constrain the narrative in regard to content, language, or traceability to data elements		0..1	Narrative	Text summary of the resource, for human interpretation This profile does not constrain the narrative in regard to content, language, or traceability to data elements
ClaimResponse.contained		0..*	Resource	Contained, inline Resources		0..*	Resource	Contained, inline Resources
ClaimResponse.extension		0..*	Extension	Additional content defined by implementations		0..*	Extension	Extension Slice: Unordered, Open by value:url
ClaimResponse.modifierExtension	?! This element is a modifier element.	0..*	Extension	Extensions that cannot be ignored	?! This element is a modifier element.	0..*	Extension	Extensions that cannot be ignored
ClaimResponse.identifier	S This element must be supported.	0..*	??	An identifier intended for computation	S This element must be supported.	0..*	??	Business Identifier for a claim response
ClaimResponse.identifier.id		0..1	string	Unique id for inter-element referencing		0..1	string	Unique id for inter-element referencing
ClaimResponse.identifier.Slices for extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
ClaimResponse.identifier.use	?! This element is a modifier element. Σ This element is included in summaries.	0..1	code	usual | official | temp | secondary | old (If known) Binding: ?? (required): Identifies the purpose for this identifier, if known .	?! This element is a modifier element. Σ This element is included in summaries.	0..1	code	usual | official | temp | secondary | old (If known) Binding: ?? (required): Identifies the purpose for this identifier, if known .
ClaimResponse.identifier.type	Σ This element is included in summaries.	0..1	CodeableConcept	Description of identifier Binding: ?? (extensible): A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.	Σ This element is included in summaries.	0..1	CodeableConcept	Description 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	S This element must be supported. Σ This element is included in summaries.	1..1	uri	Should use a scheme of 'urn:trnorg:<TRN03>' Example General: http://www.acme.com/identifiers/patient	S This element must be supported. Σ This element is included in summaries.	1..1	uri	Should use a scheme of 'urn:trnorg:<TRN03>' Example General: http://www.acme.com/identifiers/patient
ClaimResponse.identifier.value	S This element must be supported. Σ This element is included in summaries.	1..1	string	The value that is unique Example General: 123456	S This element must be supported. Σ This element is included in summaries.	1..1	string	The value that is unique Example General: 123456
ClaimResponse.identifier.period	Σ This element is included in summaries.	0..1	Period	Time period when id is/was valid for use	Σ This element is included in summaries.	0..1	Period	Time period when id is/was valid for use
ClaimResponse.identifier.assigner	Σ This element is included in summaries.	0..1	Reference(Organization)	Organization that issued id (may be just text)	Σ This element is included in summaries.	0..1	Reference(Organization)	Organization that issued id (may be just text)
ClaimResponse.status	?! This element is a modifier element. S This element must be supported. Σ This element is included in summaries.	1..1	code	active | cancelled | draft | entered-in-error Binding: ?? (required): A code specifying the state of the resource instance. Required Pattern: active	?! This element is a modifier element. S This element must be supported. Σ This element is included in summaries.	1..1	code	active | cancelled | draft | entered-in-error Binding: ?? (required): A code specifying the state of the resource instance. Required Pattern: active
ClaimResponse.type	Σ This element is included in summaries.	1..1	CodeableConcept	More granular claim type Binding: ?? (extensible): The type or discipline-style of the claim.	Σ This element is included in summaries.	1..1	CodeableConcept	More granular claim type Binding: ?? (extensible): The type or discipline-style of the claim.
ClaimResponse.subType		0..1	CodeableConcept	More granular claim type Binding: ?? (example): A more granular claim typecode.		0..1	CodeableConcept	More granular claim type Binding: ?? (example): A more granular claim typecode.
ClaimResponse.use	Σ This element is included in summaries.	1..1	code	claim | preauthorization | predetermination Binding: ?? (required): Claim, preauthorization, predetermination. Required Pattern: preauthorization	Σ This element is included in summaries.	1..1	code	claim | preauthorization | predetermination Binding: ?? (required): Claim, preauthorization, predetermination. Required Pattern: preauthorization
ClaimResponse.patient	S This element must be supported. Σ This element is included in summaries.	1..1	Reference(PAS Beneficiary Patient)	The recipient of the products and services	S This element must be supported. Σ This element is included in summaries.	1..1	Reference(PAS Beneficiary Patient(2.2.1))	The recipient of the products and services
ClaimResponse.created	S This element must be supported. Σ This element is included in summaries.	1..1	dateTime	Response creation date	S This element must be supported. Σ This element is included in summaries.	1..1	dateTime	Response creation date
ClaimResponse.insurer	S This element must be supported. Σ This element is included in summaries.	1..1	Reference(PAS Insurer Organization)	Party responsible for reimbursement	S This element must be supported. Σ This element is included in summaries.	1..1	Reference(PAS Insurer Organization(2.2.1))	Party responsible for reimbursement
ClaimResponse.requestor	S This element must be supported.	0..1	Reference(PAS Requestor Organization | PAS PractitionerRole)	Party responsible for the claim	S This element must be supported.	0..1	Reference(PAS Requestor Organization(2.2.1) | PAS PractitionerRole(2.2.1))	Party responsible for the claim
ClaimResponse.request	S This element must be supported. Σ This element is included in summaries.	1..1	Reference(PAS Claim)	Id of resource triggering adjudication	S This element must be supported. Σ This element is included in summaries.	1..1	Reference(PAS Claim(2.2.1))	Id of resource triggering adjudication	Type Mismatch: Reference([CanonicalType[http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-claim]]) vs Reference([CanonicalType[http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-claim|2.2.1]])
ClaimResponse.request.id						0..1	string	Unique id for inter-element referencing	Added this element
ClaimResponse.request.Slices for extension						0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url	Added this element
ClaimResponse.request.reference					Σ This element is included in summaries. C	0..1	string	Literal reference, Relative, internal or absolute URL	Added this element
ClaimResponse.request.type					Σ This element is included in summaries.	0..1	uri	Type the reference refers to (e.g. "Patient") Binding: ?? (extensible): Aa resource (or, for logical models, the URI of the logical model).	Added this element
ClaimResponse.request.identifier					Σ This element is included in summaries.	0..1	Identifier	Logical reference, when literal reference is not known	Added this element
ClaimResponse.request.display					Σ This element is included in summaries.	0..1	string	Text alternative for the resource	Added this element
ClaimResponse.outcome	S This element must be supported. Σ This element is included in summaries.	1..1	code	queued | complete | error | partial Binding: ?? (required): The result of the claim processing.	S This element must be supported. Σ This element is included in summaries.	1..1	code	complete | error | partial Binding: ?? (required)
ClaimResponse.disposition		0..1	string	Disposition Message		0..1	string	Disposition Message
ClaimResponse.preAuthRef		0..1	string	Preauthorization reference		0..1	string	Preauthorization reference
ClaimResponse.preAuthPeriod	S This element must be supported.	0..1	Period	Preauthorization reference effective period	S This element must be supported.	0..1	Period	Preauthorization reference effective period
ClaimResponse.payeeType		0..1	CodeableConcept	Party to be paid any benefits payable Binding: ?? (example): A code for the party to be reimbursed.		0..1	CodeableConcept	Party to be paid any benefits payable Binding: ?? (example): A code for the party to be reimbursed.
ClaimResponse.item	S This element must be supported.	0..*	BackboneElement	Adjudication for claim line items	S This element must be supported.	0..*	BackboneElement	Adjudication for claim line items
ClaimResponse.item.id		0..1	string	Unique id for inter-element referencing		0..1	string	Unique id for inter-element referencing
ClaimResponse.item.Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url		0..*	Extension	Extension Slice: Unordered, Open by value:url Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them
ClaimResponse.item.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
ClaimResponse.item.itemSequence	S This element must be supported.	1..1	positiveInt	Claim item instance identifier	S This element must be supported.	1..1	positiveInt	Sequence numbers SHALL stay the same across all instances of the Prior Authorization, eg the Claim, ClaimResponse, ClaimUpdate, ClaimUpdateResponse
ClaimResponse.item.noteNumber	S This element must be supported.	0..*	positiveInt	Applicable note numbers	S This element must be supported.	0..*	positiveInt	Applicable note numbers
ClaimResponse.item.adjudication	S This element must be supported.	1..*	BackboneElement	Adjudication details	S This element must be supported.	1..*	BackboneElement	Adjudication details
ClaimResponse.item.adjudication.id		0..1	string	Unique id for inter-element referencing		0..1	string	Unique id for inter-element referencing
ClaimResponse.item.adjudication.Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url		0..*	Extension	Extension Slice: Unordered, Open by value:url Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them
ClaimResponse.item.adjudication.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
ClaimResponse.item.adjudication.category		1..1	CodeableConcept	This code is fixed to 'submitted' to indicate that the adjudication result is on what was submitted. Binding: ?? (example): The adjudication codes. Required Pattern: {"coding":[{"system":"http://terminology.hl7.org/CodeSystem/adjudication","code":"submitted"}]}		1..1	CodeableConcept	This code is fixed to 'submitted' to indicate that the adjudication result is on what was submitted. Binding: ?? (example): The adjudication codes. Required Pattern: {"coding":[{"system":"http://terminology.hl7.org/CodeSystem/adjudication","code":"submitted"}]}
ClaimResponse.item.adjudication.reason		0..1	CodeableConcept	Explanation of adjudication outcome Binding: ?? (example): The adjudication reason codes.		0..1	CodeableConcept	Explanation of adjudication outcome Binding: ?? (example): The adjudication reason codes.
ClaimResponse.item.adjudication.amount		0..1	Money	Monetary amount		0..1	Money	Monetary amount
ClaimResponse.item.adjudication.value		0..1	decimal	Non-monetary value		0..1	decimal	Non-monetary value
ClaimResponse.item.detail		0..*	BackboneElement	Adjudication for claim details		0..*	BackboneElement	Adjudication for claim details
ClaimResponse.item.detail.id		0..1	string	Unique id for inter-element referencing		0..1	string	Unique id for inter-element referencing
ClaimResponse.item.detail.extension		0..*	Extension	Additional content defined by implementations		0..*	Extension	Additional content defined by implementations
ClaimResponse.item.detail.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
ClaimResponse.item.detail.detailSequence		1..1	positiveInt	Claim detail instance identifier		1..1	positiveInt	Claim detail instance identifier
ClaimResponse.item.detail.noteNumber		0..*	positiveInt	Applicable note numbers		0..*	positiveInt	Applicable note numbers
ClaimResponse.item.detail.adjudication		1..*	See adjudication (ClaimResponse)	Detail level adjudication details		1..*	See adjudication (ClaimResponse)	Detail level adjudication details
ClaimResponse.item.detail.subDetail		0..*	BackboneElement	Adjudication for claim sub-details		0..*	BackboneElement	Adjudication for claim sub-details
ClaimResponse.item.detail.subDetail.id		0..1	string	Unique id for inter-element referencing		0..1	string	Unique id for inter-element referencing
ClaimResponse.item.detail.subDetail.extension		0..*	Extension	Additional content defined by implementations		0..*	Extension	Additional content defined by implementations
ClaimResponse.item.detail.subDetail.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
ClaimResponse.item.detail.subDetail.subDetailSequence		1..1	positiveInt	Claim sub-detail instance identifier		1..1	positiveInt	Claim sub-detail instance identifier
ClaimResponse.item.detail.subDetail.noteNumber		0..*	positiveInt	Applicable note numbers		0..*	positiveInt	Applicable note numbers
ClaimResponse.item.detail.subDetail.adjudication		0..*	See adjudication (ClaimResponse)	Subdetail level adjudication details		0..*	See adjudication (ClaimResponse)	Subdetail level adjudication details
ClaimResponse.addItem	S This element must be supported.	0..*	BackboneElement	Insurer added line items	S This element must be supported.	0..*	BackboneElement	Insurer added line items
ClaimResponse.addItem.id		0..1	string	Unique id for inter-element referencing		0..1	string	Unique id for inter-element referencing
ClaimResponse.addItem.Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url		0..*	Extension	Extension Slice: Unordered, Open by value:url Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them
ClaimResponse.addItem.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
ClaimResponse.addItem.itemSequence	S This element must be supported.	1..1	positiveInt	Item sequence number	S This element must be supported.	1..1	positiveInt	Item sequence number
ClaimResponse.addItem.detailSequence		0..*	positiveInt	Detail sequence number		0..*	positiveInt	Detail sequence number
ClaimResponse.addItem.subdetailSequence		0..*	positiveInt	Subdetail sequence number		0..*	positiveInt	Subdetail sequence number
ClaimResponse.addItem.provider	S This element must be supported.	0..*	Reference(PAS Practitioner | PAS Organization Base Profile)	Authorized providers	S This element must be supported.	0..*	Reference(PAS Practitioner(2.2.1) | PAS Organization Base Profile(2.2.1))	Authorized providers
ClaimResponse.addItem.provider.id		0..1	string	Unique id for inter-element referencing		0..1	string	Unique id for inter-element referencing
ClaimResponse.addItem.provider.Slices for extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
ClaimResponse.addItem.provider.reference	Σ This element is included in summaries. C	0..1	string	Literal reference, Relative, internal or absolute URL	Σ This element is included in summaries. C	0..1	string	Literal reference, Relative, internal or absolute URL
ClaimResponse.addItem.provider.type	Σ This element is included in summaries.	0..1	uri	Type the reference refers to (e.g. "Patient") Binding: ?? (extensible): Aa resource (or, for logical models, the URI of the logical model).	Σ This element is included in summaries.	0..1	uri	Type 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	Σ This element is included in summaries.	0..1	Identifier	Logical reference, when literal reference is not known	Σ This element is included in summaries.	0..1	Identifier	Logical reference, when literal reference is not known
ClaimResponse.addItem.provider.display	Σ This element is included in summaries.	0..1	string	Text alternative for the resource	Σ This element is included in summaries.	0..1	string	Text alternative for the resource
ClaimResponse.addItem.productOrService	S This element must be supported.	1..1	CodeableConcept	Billing, service, product, or drug code Binding: ?? (required)	S This element must be supported.	1..1	CodeableConcept	Billing, service, product, or drug code Binding: ?? (required)
ClaimResponse.addItem.modifier	S This element must be supported.	0..*	CodeableConcept	Service/Product billing modifiers Binding: ?? (required)	S This element must be supported.	0..*	CodeableConcept	Service/Product billing modifiers Binding: ?? (required)
ClaimResponse.addItem.programCode		0..*	CodeableConcept	Program the product or service is provided under Binding: ?? (example): Program specific reason codes.		0..*	CodeableConcept	Program the product or service is provided under Binding: ?? (example): Program specific reason codes.
ClaimResponse.addItem.serviced[x]	S This element must be supported.	0..1	date, Period	Date or dates of service or product delivery	S This element must be supported.	0..1	date, Period	Date or dates of service or product delivery
ClaimResponse.addItem.location[x]	S This element must be supported.	0..1	CodeableConcept, Address, Reference(Location)	Place of service or where product was supplied Binding: ?? (example): Place of service: pharmacy, school, prison, etc.	S This element must be supported.	0..1	CodeableConcept, Address, Reference(Location)	Place of service or where product was supplied Binding: ?? (example): Place of service: pharmacy, school, prison, etc.
ClaimResponse.addItem.quantity	S This element must be supported. C	0..1	??	A fixed quantity (no comparator)	S This element must be supported. C	0..1	??	Count of products or services
ClaimResponse.addItem.unitPrice	S This element must be supported.	0..1	Money	Fee, charge or cost per item	S This element must be supported.	0..1	Money	Fee, charge or cost per item
ClaimResponse.addItem.factor		0..1	decimal	Price scaling factor		0..1	decimal	Price scaling factor
ClaimResponse.addItem.net		0..1	Money	Total item cost		0..1	Money	Total item cost
ClaimResponse.addItem.bodySite		0..1	CodeableConcept	Anatomical location Binding: ?? (example): The code for the teeth, quadrant, sextant and arch.		0..1	CodeableConcept	Anatomical location Binding: ?? (example): The code for the teeth, quadrant, sextant and arch.
ClaimResponse.addItem.subSite		0..*	CodeableConcept	Anatomical sub-location Binding: ?? (example): The code for the tooth surface and surface combinations.		0..*	CodeableConcept	Anatomical sub-location Binding: ?? (example): The code for the tooth surface and surface combinations.
ClaimResponse.addItem.noteNumber		0..*	positiveInt	Applicable note numbers		0..*	positiveInt	Applicable note numbers
ClaimResponse.addItem.adjudication	S This element must be supported.	1..*	BackboneElement	Added items adjudication	S This element must be supported.	1..*	BackboneElement	Added items adjudication
ClaimResponse.addItem.adjudication.id		0..1	string	Unique id for inter-element referencing		0..1	string	Unique id for inter-element referencing
ClaimResponse.addItem.adjudication.Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url		0..*	Extension	Extension Slice: Unordered, Open by value:url Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them
ClaimResponse.addItem.adjudication.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
ClaimResponse.addItem.adjudication.category		1..1	CodeableConcept	This code is fixed to 'submitted' to indicate that the adjudication result is on what was submitted. Binding: ?? (example): The adjudication codes. Required Pattern: {"coding":[{"system":"http://terminology.hl7.org/CodeSystem/adjudication","code":"submitted"}]}		1..1	CodeableConcept	This code is fixed to 'submitted' to indicate that the adjudication result is on what was submitted. Binding: ?? (example): The adjudication codes. Required Pattern: {"coding":[{"system":"http://terminology.hl7.org/CodeSystem/adjudication","code":"submitted"}]}
ClaimResponse.addItem.adjudication.reason		0..1	CodeableConcept	Explanation of adjudication outcome Binding: ?? (example): The adjudication reason codes.		0..1	CodeableConcept	Explanation of adjudication outcome Binding: ?? (example): The adjudication reason codes.
ClaimResponse.addItem.adjudication.amount		0..1	Money	Monetary amount		0..1	Money	Monetary amount
ClaimResponse.addItem.adjudication.value		0..1	decimal	Non-monetary value		0..1	decimal	Non-monetary value
ClaimResponse.addItem.detail		0..*	BackboneElement	Insurer added line details		0..*	BackboneElement	Insurer added line details
ClaimResponse.addItem.detail.id		0..1	string	Unique id for inter-element referencing		0..1	string	Unique id for inter-element referencing
ClaimResponse.addItem.detail.extension		0..*	Extension	Additional content defined by implementations		0..*	Extension	Additional content defined by implementations
ClaimResponse.addItem.detail.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
ClaimResponse.addItem.detail.productOrService		1..1	CodeableConcept	Billing, service, product, or drug code Binding: ?? (example): Allowable service and product codes.		1..1	CodeableConcept	Billing, service, product, or drug code Binding: ?? (example): Allowable service and product codes.
ClaimResponse.addItem.detail.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.		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.
ClaimResponse.addItem.detail.quantity		0..1	??	Count of products or services	C	0..1	??	Count of products or services
ClaimResponse.addItem.detail.unitPrice		0..1	Money	Fee, charge or cost per item		0..1	Money	Fee, charge or cost per item
ClaimResponse.addItem.detail.factor		0..1	decimal	Price scaling factor		0..1	decimal	Price scaling factor
ClaimResponse.addItem.detail.net		0..1	Money	Total item cost		0..1	Money	Total item cost
ClaimResponse.addItem.detail.noteNumber		0..*	positiveInt	Applicable note numbers		0..*	positiveInt	Applicable note numbers
ClaimResponse.addItem.detail.adjudication		1..*	See adjudication (ClaimResponse)	Added items detail adjudication		1..*	See adjudication (ClaimResponse)	Added items detail adjudication
ClaimResponse.addItem.detail.subDetail		0..*	BackboneElement	Insurer added line items		0..*	BackboneElement	Insurer added line items
ClaimResponse.addItem.detail.subDetail.id		0..1	string	Unique id for inter-element referencing		0..1	string	Unique id for inter-element referencing
ClaimResponse.addItem.detail.subDetail.extension		0..*	Extension	Additional content defined by implementations		0..*	Extension	Additional content defined by implementations
ClaimResponse.addItem.detail.subDetail.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
ClaimResponse.addItem.detail.subDetail.productOrService		1..1	CodeableConcept	Billing, service, product, or drug code Binding: ?? (example): Allowable service and product codes.		1..1	CodeableConcept	Billing, service, product, or drug code Binding: ?? (example): Allowable service and product codes.
ClaimResponse.addItem.detail.subDetail.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.		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.
ClaimResponse.addItem.detail.subDetail.quantity		0..1	??	Count of products or services	C	0..1	??	Count of products or services
ClaimResponse.addItem.detail.subDetail.unitPrice		0..1	Money	Fee, charge or cost per item		0..1	Money	Fee, charge or cost per item
ClaimResponse.addItem.detail.subDetail.factor		0..1	decimal	Price scaling factor		0..1	decimal	Price scaling factor
ClaimResponse.addItem.detail.subDetail.net		0..1	Money	Total item cost		0..1	Money	Total item cost
ClaimResponse.addItem.detail.subDetail.noteNumber		0..*	positiveInt	Applicable note numbers		0..*	positiveInt	Applicable note numbers
ClaimResponse.addItem.detail.subDetail.adjudication		1..*	See adjudication (ClaimResponse)	Added items detail adjudication		1..*	See adjudication (ClaimResponse)	Added items detail adjudication
ClaimResponse.adjudication	S This element must be supported.	0..*	BackboneElement	Header-level adjudication	S This element must be supported.	0..*	BackboneElement	Header-level adjudication
ClaimResponse.adjudication.id		0..1	string	Unique id for inter-element referencing		0..1	string	Unique id for inter-element referencing
ClaimResponse.adjudication.Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url		0..*	Extension	Extension Slice: Unordered, Open by value:url Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them
ClaimResponse.adjudication.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
ClaimResponse.adjudication.category		1..1	CodeableConcept	This code is fixed to 'submitted' to indicate that the adjudication result is on what was submitted. Binding: ?? (example): The adjudication codes. Required Pattern: {"coding":[{"system":"http://terminology.hl7.org/CodeSystem/adjudication","code":"submitted"}]}		1..1	CodeableConcept	This code is fixed to 'submitted' to indicate that the adjudication result is on what was submitted. Binding: ?? (example): The adjudication codes. Required Pattern: {"coding":[{"system":"http://terminology.hl7.org/CodeSystem/adjudication","code":"submitted"}]}
ClaimResponse.adjudication.reason		0..1	CodeableConcept	Explanation of adjudication outcome Binding: ?? (example): The adjudication reason codes.		0..1	CodeableConcept	Explanation of adjudication outcome Binding: ?? (example): The adjudication reason codes.
ClaimResponse.adjudication.amount		0..1	Money	Monetary amount		0..1	Money	Monetary amount
ClaimResponse.adjudication.value		0..1	decimal	Non-monetary value		0..1	decimal	Non-monetary value
ClaimResponse.total	Σ This element is included in summaries.	0..*	BackboneElement	Adjudication totals	Σ This element is included in summaries.	0..*	BackboneElement	Adjudication totals
ClaimResponse.total.id		0..1	string	Unique id for inter-element referencing		0..1	string	Unique id for inter-element referencing
ClaimResponse.total.extension		0..*	Extension	Additional content defined by implementations		0..*	Extension	Additional content defined by implementations
ClaimResponse.total.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
ClaimResponse.total.category	Σ This element is included in summaries.	1..1	CodeableConcept	Type of adjudication information Binding: ?? (example): The adjudication codes.	Σ This element is included in summaries.	1..1	CodeableConcept	Type of adjudication information Binding: ?? (example): The adjudication codes.
ClaimResponse.total.amount	Σ This element is included in summaries.	1..1	Money	Financial total for the category	Σ This element is included in summaries.	1..1	Money	Financial total for the category
ClaimResponse.payment		0..1	BackboneElement	Payment Details		0..1	BackboneElement	Payment Details
ClaimResponse.payment.id		0..1	string	Unique id for inter-element referencing		0..1	string	Unique id for inter-element referencing
ClaimResponse.payment.extension		0..*	Extension	Additional content defined by implementations		0..*	Extension	Additional content defined by implementations
ClaimResponse.payment.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
ClaimResponse.payment.type		1..1	CodeableConcept	Partial or complete payment Binding: ?? (example): The type (partial, complete) of the payment.		1..1	CodeableConcept	Partial or complete payment Binding: ?? (example): The type (partial, complete) of the payment.
ClaimResponse.payment.adjustment		0..1	Money	Payment adjustment for non-claim issues		0..1	Money	Payment adjustment for non-claim issues
ClaimResponse.payment.adjustmentReason		0..1	CodeableConcept	Explanation for the adjustment Binding: ?? (example): Payment Adjustment reason codes.		0..1	CodeableConcept	Explanation for the adjustment Binding: ?? (example): Payment Adjustment reason codes.
ClaimResponse.payment.date		0..1	date	Expected date of payment		0..1	date	Expected date of payment
ClaimResponse.payment.amount		1..1	Money	Payable amount after adjustment		1..1	Money	Payable amount after adjustment
ClaimResponse.payment.identifier		0..1	Identifier	Business identifier for the payment		0..1	Identifier	Business identifier for the payment
ClaimResponse.fundsReserve		0..1	CodeableConcept	Funds reserved status Binding: ?? (example): For whom funds are to be reserved: (Patient, Provider, None).		0..1	CodeableConcept	Funds reserved status Binding: ?? (example): For whom funds are to be reserved: (Patient, Provider, None).
ClaimResponse.formCode		0..1	CodeableConcept	Printed form identifier Binding: ?? (example): The forms codes.		0..1	CodeableConcept	Printed form identifier Binding: ?? (example): The forms codes.
ClaimResponse.form		0..1	Attachment	Printed reference or actual form		0..1	Attachment	Printed reference or actual form
ClaimResponse.processNote	S This element must be supported.	0..*	BackboneElement	Note concerning adjudication	S This element must be supported.	0..*	BackboneElement	Note concerning adjudication
ClaimResponse.processNote.id		0..1	string	Unique id for inter-element referencing		0..1	string	Unique id for inter-element referencing
ClaimResponse.processNote.extension		0..*	Extension	Additional content defined by implementations		0..*	Extension	Additional content defined by implementations
ClaimResponse.processNote.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
ClaimResponse.processNote.number	S This element must be supported.	1..1	positiveInt	Note instance identifier	S This element must be supported.	1..1	positiveInt	Note instance identifier
ClaimResponse.processNote.type		0..1	code	display | print | printoper Binding: ?? (required): The presentation types of notes.		0..1	code	display | print | printoper Binding: ?? (required): The presentation types of notes.
ClaimResponse.processNote.text	S This element must be supported.	1..1	string	Note explanatory text	S This element must be supported.	1..1	string	Note explanatory text
ClaimResponse.processNote.language		0..1	CodeableConcept	Language of the text Binding: ?? (preferred): A human language. Additional Bindings Purpose ?? Max Binding		0..1	CodeableConcept	Language of the text Binding: ?? (preferred): A human language. Additional Bindings Purpose ?? Max Binding	Example/preferred bindings differ at ClaimResponse.processNote.language using binding from PASClaimResponse
ClaimResponse.communicationRequest	S This element must be supported.	0..*	Reference(PAS CommunicationRequest)	Request for additional information	S This element must be supported.	0..*	Reference(PAS CommunicationRequest(2.2.1))	Request for additional information
ClaimResponse.insurance		0..*	BackboneElement	Patient insurance information		0..*	BackboneElement	Patient insurance information
ClaimResponse.insurance.id		0..1	string	Unique id for inter-element referencing		0..1	string	Unique id for inter-element referencing
ClaimResponse.insurance.extension		0..*	Extension	Additional content defined by implementations		0..*	Extension	Additional content defined by implementations
ClaimResponse.insurance.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
ClaimResponse.insurance.sequence		1..1	positiveInt	Insurance instance identifier		1..1	positiveInt	Insurance instance identifier
ClaimResponse.insurance.focal		1..1	boolean	Coverage to be used for adjudication		1..1	boolean	Coverage to be used for adjudication
ClaimResponse.insurance.coverage		1..1	Reference(Coverage)	Insurance information		1..1	Reference(Coverage)	Insurance information
ClaimResponse.insurance.businessArrangement		0..1	string	Additional provider contract number		0..1	string	Additional provider contract number
ClaimResponse.insurance.claimResponse		0..1	Reference(ClaimResponse)	Adjudication results		0..1	Reference(ClaimResponse)	Adjudication results
ClaimResponse.error	S This element must be supported.	0..*	BackboneElement	Processing errors	S This element must be supported.	0..*	BackboneElement	Processing errors
ClaimResponse.error.id		0..1	string	Unique id for inter-element referencing		0..1	string	Unique id for inter-element referencing
ClaimResponse.error.Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url		0..*	Extension	Extension Slice: Unordered, Open by value:url Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them
ClaimResponse.error.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
ClaimResponse.error.itemSequence		0..1	positiveInt	Item sequence number		0..1	positiveInt	Item sequence number
ClaimResponse.error.detailSequence		0..1	positiveInt	Detail sequence number		0..1	positiveInt	Detail sequence number
ClaimResponse.error.subDetailSequence		0..1	positiveInt	Subdetail sequence number		0..1	positiveInt	Subdetail sequence number
ClaimResponse.error.code	S This element must be supported.	1..1	CodeableConcept	Error code detailing processing issues Binding: ?? (required)	S This element must be supported.	1..1	CodeableConcept	Error code detailing processing issues Binding: ?? (required)
Documentation for this format