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

Left: | PAS Claim Response (http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-claimresponse)
Right: | PAS Claim Response (http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-claimresponse)

### Messages

Error | StructureDefinition.version | Values for version differ: '2.1.0' vs '2.2.0-ballot'
Information | StructureDefinition.date | Values for date differ: '2024-12-20T21:11:16+00:00' vs '2026-01-30T16:26:59+00:00'
Error | StructureDefinition.baseDefinition | Values for baseDefinition differ: 'http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-claimresponse-base' vs 'http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-claimresponse-base|2.2.0-ballot'
Information | ClaimResponse.language | Example/preferred bindings differ at ClaimResponse.language using binding from PASClaimResponse
Information | StructureDefinition.short | Values for short differ: 'Additional content defined by implementations' vs 'Extension'
Information | StructureDefinition.definition | Values for definition differ: 'May be used to represent additional information that is not part of the basic definition of the resource. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.' vs 'An Extension'
Information | StructureDefinition.short | Values for short differ: 'An identifier intended for computation' vs 'Business Identifier for a claim response'
Information | StructureDefinition.definition | Values for definition differ: 'An identifier - identifies some entity uniquely and unambiguously. Typically this is used for business identifiers.' vs 'A unique identifier assigned to this claim response.'
Error | ClaimResponse.request | 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|2.2.0-ballot]])
Information | StructureDefinition.short | Values for short differ: 'queued | complete | error | partial' vs 'complete | error | partial'
Information | StructureDefinition.short | Values for short differ: 'Claim item instance identifier' vs 'Sequence numbers SHALL stay the same across all instances of the Prior Authorization, eg the Claim, ClaimResponse, ClaimUpdate, ClaimUpdateResponse'
Information | StructureDefinition.short | Values for short differ: 'A fixed quantity (no comparator)' vs 'Count of products or services'
Information | StructureDefinition.definition | Values for definition differ: 'The comparator is not used on a SimpleQuantity' vs 'The number of repetitions of a service or product.'
Information | ClaimResponse.processNote.language | Example/preferred bindings differ at ClaimResponse.processNote.language using binding from PASClaimResponse

### 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|2.2.0-ballot | Values Differ
copyright |  |
date | 2024-12-20T21:11:16+00:00 | 2026-01-30T16:26:59+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[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 | 2.2.0-ballot | 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(2.2.0-ballot) | Response to a preauthorization |
id | Σ | 0..1 | id | Logical id of this artifact | Σ | 0..1 | id | Logical id of this artifact |
meta | Σ | 0..1 | Meta | Metadata about the resource | Σ | 0..1 | Meta | Metadata about the resource |
implicitRules | ?!Σ | 0..1 | uri | A set of rules under which this content was created | ?!Σ | 0..1 | uri | A set of rules under which this content was created |
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
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 |
contained |  | 0..* | Resource | Contained, inline Resources |  | 0..* | Resource | Contained, inline Resources |
extension |  | 0..* | Extension | Additional content defined by implementations |  | 0..* | Extension | Extension Slice: Unordered, Open by value:url |
modifierExtension | ?! | 0..* | Extension | Extensions that cannot be ignored | ?! | 0..* | Extension | Extensions that cannot be ignored |
identifier | S | 0..* | ?? | An identifier intended for computation | S | 0..* | ?? | Business Identifier for a claim response |
id |  | 0..1 | string | Unique id for inter-element referencing |  | 0..1 | string | Unique id for inter-element referencing |
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 |
use | ?!Σ | 0..1 | code | usual | official | temp | secondary | old (If known) Binding: ?? (required): Identifies the purpose for this identifier, if known . | ?!Σ | 0..1 | code | usual | official | temp | secondary | old (If known) Binding: ?? (required): Identifies the purpose for this identifier, if known . |
type | Σ | 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 | 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. |
system | S Σ | 1..1 | uri | Should use a scheme of 'urn:trnorg:<TRN03>' Example General: http://www.acme.com/identifiers/patient | S Σ | 1..1 | uri | Should use a scheme of 'urn:trnorg:<TRN03>' Example General: http://www.acme.com/identifiers/patient |
value | S Σ | 1..1 | string | The value that is unique Example General: 123456 | S Σ | 1..1 | string | The value that is unique Example General: 123456 |
period | Σ | 0..1 | Period | Time period when id is/was valid for use | Σ | 0..1 | Period | Time period when id is/was valid for use |
assigner | Σ | 0..1 | Reference(Organization) | Organization that issued id (may be just text) | Σ | 0..1 | Reference(Organization) | Organization that issued id (may be just text) |
status | ?!S Σ | 1..1 | code | active | cancelled | draft | entered-in-error Binding: ?? (required): A code specifying the state of the resource instance. Required Pattern: active | ?!S Σ | 1..1 | code | active | cancelled | draft | entered-in-error Binding: ?? (required): A code specifying the state of the resource instance. Required Pattern: active |
type | Σ | 1..1 | CodeableConcept | More granular claim type Binding: ?? (extensible): The type or discipline-style of the claim. | Σ | 1..1 | CodeableConcept | More granular claim type Binding: ?? (extensible): The type or discipline-style of the claim. |
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. |
use | Σ | 1..1 | code | claim | preauthorization | predetermination Binding: ?? (required): Claim, preauthorization, predetermination. Required Pattern: preauthorization | Σ | 1..1 | code | claim | preauthorization | predetermination Binding: ?? (required): Claim, preauthorization, predetermination. Required Pattern: preauthorization |
patient | S Σ | 1..1 | Reference(PAS Beneficiary Patient) | The recipient of the products and services | S Σ | 1..1 | Reference(PAS Beneficiary Patient(2.2.0-ballot)) | The recipient of the products and services |
created | S Σ | 1..1 | dateTime | Response creation date | S Σ | 1..1 | dateTime | Response creation date |
insurer | S Σ | 1..1 | Reference(PAS Insurer Organization) | Party responsible for reimbursement | S Σ | 1..1 | Reference(PAS Insurer Organization(2.2.0-ballot)) | Party responsible for reimbursement |
requestor | S | 0..1 | Reference(PAS Requestor Organization | PAS PractitionerRole) | Party responsible for the claim | S | 0..1 | Reference(PAS Requestor Organization(2.2.0-ballot) | PAS PractitionerRole(2.2.0-ballot)) | Party responsible for the claim |
request | S Σ | 1..1 | Reference(PAS Claim) | Id of resource triggering adjudication | S Σ | 1..1 | Reference(PAS Claim(2.2.0-ballot)) | 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|2.2.0-ballot]])
id |  |  |  |  |  | 0..1 | string | Unique id for inter-element referencing | Added this element
Slices for extension |  |  |  |  |  | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | Added this element
reference |  |  |  |  | Σ C | 0..1 | string | Literal reference, Relative, internal or absolute URL | Added this element
type |  |  |  |  | Σ | 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
identifier |  |  |  |  | Σ | 0..1 | Identifier | Logical reference, when literal reference is not known | Added this element
display |  |  |  |  | Σ | 0..1 | string | Text alternative for the resource | Added this element
outcome | S Σ | 1..1 | code | queued | complete | error | partial Binding: ?? (required): The result of the claim processing. | S Σ | 1..1 | code | complete | error | partial Binding: ?? (required) |
disposition |  | 0..1 | string | Disposition Message |  | 0..1 | string | Disposition Message |
preAuthRef |  | 0..1 | string | Preauthorization reference |  | 0..1 | string | Preauthorization reference |
preAuthPeriod | S | 0..1 | Period | Preauthorization reference effective period | S | 0..1 | Period | Preauthorization reference effective period |
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. |
item | S | 0..* | BackboneElement | Adjudication for claim line items | S | 0..* | BackboneElement | Adjudication for claim line items |
id |  | 0..1 | string | Unique id for inter-element referencing |  | 0..1 | string | Unique id for inter-element referencing |
Slices for extension |  | 0..* | Extension | Extension Slice: Unordered, Open by value:url |  | 0..* | Extension | Extension Slice: Unordered, Open by value:url |
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
itemSequence | S | 1..1 | positiveInt | Claim item instance identifier | S | 1..1 | positiveInt | Sequence numbers SHALL stay the same across all instances of the Prior Authorization, eg the Claim, ClaimResponse, ClaimUpdate, ClaimUpdateResponse |
noteNumber | S | 0..* | positiveInt | Applicable note numbers | S | 0..* | positiveInt | Applicable note numbers |
adjudication | S | 1..* | BackboneElement | Adjudication details | S | 1..* | BackboneElement | Adjudication details |
id |  | 0..1 | string | Unique id for inter-element referencing |  | 0..1 | string | Unique id for inter-element referencing |
Slices for extension |  | 0..* | Extension | Extension Slice: Unordered, Open by value:url |  | 0..* | Extension | Extension Slice: Unordered, Open by value:url |
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
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"}]} |
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. |
amount |  | 0..1 | Money | Monetary amount |  | 0..1 | Money | Monetary amount |
value |  | 0..1 | decimal | Non-monetary value |  | 0..1 | decimal | Non-monetary value |
detail |  | 0..* | BackboneElement | Adjudication for claim details |  | 0..* | BackboneElement | Adjudication for claim details |
id |  | 0..1 | string | Unique id for inter-element referencing |  | 0..1 | string | Unique id for inter-element referencing |
extension |  | 0..* | Extension | Additional content defined by implementations |  | 0..* | Extension | Additional content defined by implementations |
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
detailSequence |  | 1..1 | positiveInt | Claim detail instance identifier |  | 1..1 | positiveInt | Claim detail instance identifier |
noteNumber |  | 0..* | positiveInt | Applicable note numbers |  | 0..* | positiveInt | Applicable note numbers |
adjudication |  | 1..* | See adjudication (ClaimResponse) | Detail level adjudication details |  | 1..* | See adjudication (ClaimResponse) | Detail level adjudication details |
id |  | 0..1 | string | Unique id for inter-element referencing |  | 0..1 | string | Unique id for inter-element referencing |
Slices for extension |  | 0..* | Extension | Extension Slice: Unordered, Open by value:url |  | 0..* | Extension | Extension Slice: Unordered, Open by value:url |
extension | S | 0..1 | (Complex) | The details of the review action that is necessary for the authorization. URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-reviewAction | S | 0..1 | (Complex) | The details of the review action that is necessary for the authorization. URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-reviewAction |
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
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"}]} |
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. |
amount |  | 0..1 | Money | Monetary amount |  | 0..1 | Money | Monetary amount |
value |  | 0..1 | decimal | Non-monetary value |  | 0..1 | decimal | Non-monetary value |
subDetail |  | 0..* | BackboneElement | Adjudication for claim sub-details |  | 0..* | BackboneElement | Adjudication for claim sub-details |
id |  | 0..1 | string | Unique id for inter-element referencing |  | 0..1 | string | Unique id for inter-element referencing |
extension |  | 0..* | Extension | Additional content defined by implementations |  | 0..* | Extension | Additional content defined by implementations |
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
subDetailSequence |  | 1..1 | positiveInt | Claim sub-detail instance identifier |  | 1..1 | positiveInt | Claim sub-detail instance identifier |
noteNumber |  | 0..* | positiveInt | Applicable note numbers |  | 0..* | positiveInt | Applicable note numbers |
adjudication |  | 0..* | See adjudication (ClaimResponse) | Subdetail level adjudication details |  | 0..* | See adjudication (ClaimResponse) | Subdetail level adjudication details |
id |  | 0..1 | string | Unique id for inter-element referencing |  | 0..1 | string | Unique id for inter-element referencing |
Slices for extension |  | 0..* | Extension | Extension Slice: Unordered, Open by value:url |  | 0..* | Extension | Extension Slice: Unordered, Open by value:url |
extension | S | 0..1 | (Complex) | The details of the review action that is necessary for the authorization. URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-reviewAction | S | 0..1 | (Complex) | The details of the review action that is necessary for the authorization. URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-reviewAction |
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
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"}]} |
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. |
amount |  | 0..1 | Money | Monetary amount |  | 0..1 | Money | Monetary amount |
value |  | 0..1 | decimal | Non-monetary value |  | 0..1 | decimal | Non-monetary value |
addItem | S | 0..* | BackboneElement | Insurer added line items | S | 0..* | BackboneElement | Insurer added line items |
id |  | 0..1 | string | Unique id for inter-element referencing |  | 0..1 | string | Unique id for inter-element referencing |
Slices for extension |  | 0..* | Extension | Extension Slice: Unordered, Open by value:url |  | 0..* | Extension | Extension Slice: Unordered, Open by value:url |
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
itemSequence | S | 1..1 | positiveInt | Item sequence number | S | 1..1 | positiveInt | Item sequence number |
detailSequence |  | 0..* | positiveInt | Detail sequence number |  | 0..* | positiveInt | Detail sequence number |
subdetailSequence |  | 0..* | positiveInt | Subdetail sequence number |  | 0..* | positiveInt | Subdetail sequence number |
provider | S | 0..* | Reference(PAS Practitioner | PAS Organization Base Profile) | Authorized providers | S | 0..* | Reference(PAS Practitioner(2.2.0-ballot) | PAS Organization Base Profile(2.2.0-ballot)) | Authorized providers |
id |  | 0..1 | string | Unique id for inter-element referencing |  | 0..1 | string | Unique id for inter-element referencing |
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 |
reference | Σ C | 0..1 | string | Literal reference, Relative, internal or absolute URL | Σ C | 0..1 | string | Literal reference, Relative, internal or absolute URL |
type | Σ | 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 | 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). |
identifier | Σ | 0..1 | Identifier | Logical reference, when literal reference is not known | Σ | 0..1 | Identifier | Logical reference, when literal reference is not known |
display | Σ | 0..1 | string | Text alternative for the resource | Σ | 0..1 | string | Text alternative for the resource |
productOrService | S | 1..1 | CodeableConcept | Billing, service, product, or drug code Binding: ?? (required) | S | 1..1 | CodeableConcept | Billing, service, product, or drug code Binding: ?? (required) |
modifier | S | 0..* | CodeableConcept | Service/Product billing modifiers Binding: ?? (required) | S | 0..* | CodeableConcept | Service/Product billing modifiers Binding: ?? (required) |
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. |
serviced[x] | S | 0..1 | date, Period | Date or dates of service or product delivery | S | 0..1 | date, Period | Date or dates of service or product delivery |
location[x] | S | 0..1 | CodeableConcept, Address, Reference(Location) | Place of service or where product was supplied Binding: ?? (example): Place of service: pharmacy, school, prison, etc. | S | 0..1 | CodeableConcept, Address, Reference(Location) | Place of service or where product was supplied Binding: ?? (example): Place of service: pharmacy, school, prison, etc. |
quantity | S C | 0..1 | ?? | A fixed quantity (no comparator) | S | 0..1 | ?? | Count of products or services |
unitPrice | S | 0..1 | Money | Fee, charge or cost per item | S | 0..1 | Money | Fee, charge or cost per item |
factor |  | 0..1 | decimal | Price scaling factor |  | 0..1 | decimal | Price scaling factor |
net |  | 0..1 | Money | Total item cost |  | 0..1 | Money | Total item cost |
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. |
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. |
noteNumber |  | 0..* | positiveInt | Applicable note numbers |  | 0..* | positiveInt | Applicable note numbers |
adjudication | S | 1..* | BackboneElement | Added items adjudication | S | 1..* | BackboneElement | Added items adjudication |
id |  | 0..1 | string | Unique id for inter-element referencing |  | 0..1 | string | Unique id for inter-element referencing |
Slices for extension |  | 0..* | Extension | Extension Slice: Unordered, Open by value:url |  | 0..* | Extension | Extension Slice: Unordered, Open by value:url |
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
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"}]} |
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. |
amount |  | 0..1 | Money | Monetary amount |  | 0..1 | Money | Monetary amount |
value |  | 0..1 | decimal | Non-monetary value |  | 0..1 | decimal | Non-monetary value |
detail |  | 0..* | BackboneElement | Insurer added line details |  | 0..* | BackboneElement | Insurer added line details |
id |  | 0..1 | string | Unique id for inter-element referencing |  | 0..1 | string | Unique id for inter-element referencing |
extension |  | 0..* | Extension | Additional content defined by implementations |  | 0..* | Extension | Additional content defined by implementations |
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
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. |
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. |
quantity |  | 0..1 | ?? | Count of products or services |  | 0..1 | ?? | Count of products or services |
unitPrice |  | 0..1 | Money | Fee, charge or cost per item |  | 0..1 | Money | Fee, charge or cost per item |
factor |  | 0..1 | decimal | Price scaling factor |  | 0..1 | decimal | Price scaling factor |
net |  | 0..1 | Money | Total item cost |  | 0..1 | Money | Total item cost |
noteNumber |  | 0..* | positiveInt | Applicable note numbers |  | 0..* | positiveInt | Applicable note numbers |
adjudication |  | 1..* | See adjudication (ClaimResponse) | Added items detail adjudication |  | 1..* | See adjudication (ClaimResponse) | Added items detail adjudication |
id |  | 0..1 | string | Unique id for inter-element referencing |  | 0..1 | string | Unique id for inter-element referencing |
Slices for extension |  | 0..* | Extension | Extension Slice: Unordered, Open by value:url |  | 0..* | Extension | Extension Slice: Unordered, Open by value:url |
extension | S | 0..1 | (Complex) | The details of the review action that is necessary for the authorization. URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-reviewAction | S | 0..1 | (Complex) | The details of the review action that is necessary for the authorization. URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-reviewAction |
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
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"}]} |
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. |
amount |  | 0..1 | Money | Monetary amount |  | 0..1 | Money | Monetary amount |
value |  | 0..1 | decimal | Non-monetary value |  | 0..1 | decimal | Non-monetary value |
subDetail |  | 0..* | BackboneElement | Insurer added line items |  | 0..* | BackboneElement | Insurer added line items |
id |  | 0..1 | string | Unique id for inter-element referencing |  | 0..1 | string | Unique id for inter-element referencing |
extension |  | 0..* | Extension | Additional content defined by implementations |  | 0..* | Extension | Additional content defined by implementations |
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
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. |
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. |
quantity |  | 0..1 | ?? | Count of products or services |  | 0..1 | ?? | Count of products or services |
unitPrice |  | 0..1 | Money | Fee, charge or cost per item |  | 0..1 | Money | Fee, charge or cost per item |
factor |  | 0..1 | decimal | Price scaling factor |  | 0..1 | decimal | Price scaling factor |
net |  | 0..1 | Money | Total item cost |  | 0..1 | Money | Total item cost |
noteNumber |  | 0..* | positiveInt | Applicable note numbers |  | 0..* | positiveInt | Applicable note numbers |
adjudication |  | 1..* | See adjudication (ClaimResponse) | Added items detail adjudication |  | 1..* | See adjudication (ClaimResponse) | Added items detail adjudication |
id |  | 0..1 | string | Unique id for inter-element referencing |  | 0..1 | string | Unique id for inter-element referencing |
Slices for extension |  | 0..* | Extension | Extension Slice: Unordered, Open by value:url |  | 0..* | Extension | Extension Slice: Unordered, Open by value:url |
extension | S | 0..1 | (Complex) | The details of the review action that is necessary for the authorization. URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-reviewAction | S | 0..1 | (Complex) | The details of the review action that is necessary for the authorization. URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-reviewAction |
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
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"}]} |
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. |
amount |  | 0..1 | Money | Monetary amount |  | 0..1 | Money | Monetary amount |
value |  | 0..1 | decimal | Non-monetary value |  | 0..1 | decimal | Non-monetary value |
adjudication | S | 0..* | BackboneElement | Header-level adjudication | S | 0..* | BackboneElement | Header-level adjudication |
id |  | 0..1 | string | Unique id for inter-element referencing |  | 0..1 | string | Unique id for inter-element referencing |
Slices for extension |  | 0..* | Extension | Extension Slice: Unordered, Open by value:url |  | 0..* | Extension | Extension Slice: Unordered, Open by value:url |
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
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"}]} |
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. |
amount |  | 0..1 | Money | Monetary amount |  | 0..1 | Money | Monetary amount |
value |  | 0..1 | decimal | Non-monetary value |  | 0..1 | decimal | Non-monetary value |
total | Σ | 0..* | BackboneElement | Adjudication totals | Σ | 0..* | BackboneElement | Adjudication totals |
id |  | 0..1 | string | Unique id for inter-element referencing |  | 0..1 | string | Unique id for inter-element referencing |
extension |  | 0..* | Extension | Additional content defined by implementations |  | 0..* | Extension | Additional content defined by implementations |
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
category | Σ | 1..1 | CodeableConcept | Type of adjudication information Binding: ?? (example): The adjudication codes. | Σ | 1..1 | CodeableConcept | Type of adjudication information Binding: ?? (example): The adjudication codes. |
amount | Σ | 1..1 | Money | Financial total for the category | Σ | 1..1 | Money | Financial total for the category |
payment |  | 0..1 | BackboneElement | Payment Details |  | 0..1 | BackboneElement | Payment Details |
id |  | 0..1 | string | Unique id for inter-element referencing |  | 0..1 | string | Unique id for inter-element referencing |
extension |  | 0..* | Extension | Additional content defined by implementations |  | 0..* | Extension | Additional content defined by implementations |
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
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. |
adjustment |  | 0..1 | Money | Payment adjustment for non-claim issues |  | 0..1 | Money | Payment adjustment for non-claim issues |
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. |
date |  | 0..1 | date | Expected date of payment |  | 0..1 | date | Expected date of payment |
amount |  | 1..1 | Money | Payable amount after adjustment |  | 1..1 | Money | Payable amount after adjustment |
identifier |  | 0..1 | Identifier | Business identifier for the payment |  | 0..1 | Identifier | Business identifier for the payment |
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). |
formCode |  | 0..1 | CodeableConcept | Printed form identifier Binding: ?? (example): The forms codes. |  | 0..1 | CodeableConcept | Printed form identifier Binding: ?? (example): The forms codes. |
form |  | 0..1 | Attachment | Printed reference or actual form |  | 0..1 | Attachment | Printed reference or actual form |
processNote | S | 0..* | BackboneElement | Note concerning adjudication | S | 0..* | BackboneElement | Note concerning adjudication |
id |  | 0..1 | string | Unique id for inter-element referencing |  | 0..1 | string | Unique id for inter-element referencing |
extension |  | 0..* | Extension | Additional content defined by implementations |  | 0..* | Extension | Additional content defined by implementations |
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
number | S | 1..1 | positiveInt | Note instance identifier | S | 1..1 | positiveInt | Note instance identifier |
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. |
text | S | 1..1 | string | Note explanatory text | S | 1..1 | string | Note explanatory text |
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
communicationRequest | S | 0..* | Reference(PAS CommunicationRequest) | Request for additional information | S | 0..* | Reference(PAS CommunicationRequest(2.2.0-ballot)) | Request for additional information |
insurance |  | 0..* | BackboneElement | Patient insurance information |  | 0..* | BackboneElement | Patient insurance information |
id |  | 0..1 | string | Unique id for inter-element referencing |  | 0..1 | string | Unique id for inter-element referencing |
extension |  | 0..* | Extension | Additional content defined by implementations |  | 0..* | Extension | Additional content defined by implementations |
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
sequence |  | 1..1 | positiveInt | Insurance instance identifier |  | 1..1 | positiveInt | Insurance instance identifier |
focal |  | 1..1 | boolean | Coverage to be used for adjudication |  | 1..1 | boolean | Coverage to be used for adjudication |
coverage |  | 1..1 | Reference(Coverage) | Insurance information |  | 1..1 | Reference(Coverage) | Insurance information |
businessArrangement |  | 0..1 | string | Additional provider contract number |  | 0..1 | string | Additional provider contract number |
claimResponse |  | 0..1 | Reference(ClaimResponse) | Adjudication results |  | 0..1 | Reference(ClaimResponse) | Adjudication results |
error | S | 0..* | BackboneElement | Processing errors | S | 0..* | BackboneElement | Processing errors |
id |  | 0..1 | string | Unique id for inter-element referencing |  | 0..1 | string | Unique id for inter-element referencing |
Slices for extension |  | 0..* | Extension | Extension Slice: Unordered, Open by value:url |  | 0..* | Extension | Extension Slice: Unordered, Open by value:url |
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
itemSequence |  | 0..1 | positiveInt | Item sequence number |  | 0..1 | positiveInt | Item sequence number |
detailSequence |  | 0..1 | positiveInt | Detail sequence number |  | 0..1 | positiveInt | Detail sequence number |
subDetailSequence |  | 0..1 | positiveInt | Subdetail sequence number |  | 0..1 | positiveInt | Subdetail sequence number |
code | S | 1..1 | CodeableConcept | Error code detailing processing issues Binding: ?? (required) | S | 1..1 | CodeableConcept | Error code detailing processing issues Binding: ?? (required) |
Documentation for this format