Union of http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-claimresponse-base and http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-claimresponse-base

This is the set of resources that conform to either of the profiles PAS Claim Response Base (http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-claimresponse-base) and PAS Claim Response Base (http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-claimresponse-base). E.g. what you have to deal with if you get resources conforming to one of them

Structure

Name	Flags	Card.	Type	Description & Constraints
ClaimResponse		0..*		left: Response to a claim predetermination or preauthorization; right: Response to a preauthorization dom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources dom-3: If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource dom-4: If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated dom-5: If a resource is contained in another resource, it SHALL NOT have a security label dom-6: A resource should have narrative for robust management
meta	Σ	0..1	Meta	Metadata about the resource ele-1: All FHIR elements must have a @value or children
implicitRules	?!Σ	0..1	uri	A set of rules under which this content was created ele-1: All FHIR elements must have a @value or children
language		0..1	code	Language of the resource content Binding: ?? (preferred): A human language. ele-1: All FHIR elements must have a @value or children
text		0..1	Narrative	Text summary of the resource, for human interpretation ele-1: All FHIR elements must have a @value or children
contained		0..*	Resource	Contained, inline Resources
extension		0..*	Extension	Additional content defined by implementations ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
identifier	S	0..*	??	An identifier intended for computation ele-1: All FHIR elements must have a @value or children
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
use	?!Σ	0..1	code	usual | official | temp | secondary | old (If known) Binding: ?? (required): Identifies the purpose for this identifier, if known . ele-1: All FHIR elements must have a @value or children
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. ele-1: All FHIR elements must have a @value or children
system	SΣ	1..1	uri	Should use a scheme of 'urn:trnorg:<TRN03>' ele-1: All FHIR elements must have a @value or children Example General: http://www.acme.com/identifiers/patient
value	SΣ	1..1	string	The value that is unique ele-1: All FHIR elements must have a @value or children Example General: 123456
period	Σ	0..1	Period	Time period when id is/was valid for use ele-1: All FHIR elements must have a @value or children
assigner	Σ	0..1	Reference(Organization)	Organization that issued id (may be just text) ele-1: All FHIR elements must have a @value or children
status	?!SΣ	1..1	code	active | cancelled | draft | entered-in-error Binding: ?? (required): A code specifying the state of the resource instance. ele-1: All FHIR elements must have a @value or children
type	Σ	1..1	CodeableConcept	More granular claim type Binding: ?? (extensible): The type or discipline-style of the claim. ele-1: All FHIR elements must have a @value or children
subType		0..1	CodeableConcept	More granular claim type Binding: ?? (example): A more granular claim typecode. ele-1: All FHIR elements must have a @value or children
use	Σ	1..1	code	claim | preauthorization | predetermination Binding: ?? (required): Claim, preauthorization, predetermination. ele-1: All FHIR elements must have a @value or children
patient	SΣ	1..1	Reference(PAS Beneficiary Patient | #sd-profile-beneficiary-profile-beneficiary)	The recipient of the products and services ele-1: All FHIR elements must have a @value or children
created	SΣ	1..1	dateTime	Response creation date ele-1: All FHIR elements must have a @value or children
insurer	SΣ	1..1	Reference(PAS Insurer Organization | #sd-profile-insurer-profile-insurer)	Party responsible for reimbursement ele-1: All FHIR elements must have a @value or children
requestor	S	0..1	Reference(PAS Requestor Organization | PAS PractitionerRole | #sd-profile-requestor-profile-requestor)	Party responsible for the claim ele-1: All FHIR elements must have a @value or children
request	SΣ	0..1	Reference(PAS Claim | #sd-profile-claim-profile-claim)	Id of resource triggering adjudication ele-1: All FHIR elements must have a @value or children
outcome	SΣ	1..1	code	queued | complete | error | partial Binding: ?? (required): The result of the claim processing. ele-1: All FHIR elements must have a @value or children
disposition		0..1	string	Disposition Message ele-1: All FHIR elements must have a @value or children
preAuthRef		0..1	string	Preauthorization reference ele-1: All FHIR elements must have a @value or children
preAuthPeriod	S	0..1	Period	Preauthorization reference effective period ele-1: All FHIR elements must have a @value or children
payeeType		0..1	CodeableConcept	Party to be paid any benefits payable Binding: ?? (example): A code for the party to be reimbursed. ele-1: All FHIR elements must have a @value or children
item	S	0..*	BackboneElement	Adjudication for claim line items ele-1: All FHIR elements must have a @value or children
extension		0..*	Extension	Extension ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
itemSequence	S	1..1	positiveInt	Claim item instance identifier ele-1: All FHIR elements must have a @value or children
noteNumber		0..*	positiveInt	Applicable note numbers ele-1: All FHIR elements must have a @value or children
adjudication	S	1..*	BackboneElement	Adjudication details ele-1: All FHIR elements must have a @value or children
extension		0..*	Extension	Extension ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
category		1..1	CodeableConcept	This code is fixed to 'submitted' to indicate that the adjudication result is on what was submitted. Binding: ?? (example): The adjudication codes. ele-1: All FHIR elements must have a @value or children
reason		0..1	CodeableConcept	Explanation of adjudication outcome Binding: ?? (example): The adjudication reason codes. ele-1: All FHIR elements must have a @value or children
amount		0..1	Money	Monetary amount ele-1: All FHIR elements must have a @value or children
value		0..1	decimal	Non-monetary value ele-1: All FHIR elements must have a @value or children
detail		0..*	BackboneElement	Adjudication for claim details ele-1: All FHIR elements must have a @value or children
extension		0..*	Extension	Additional content defined by implementations ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
detailSequence		1..1	positiveInt	Claim detail instance identifier ele-1: All FHIR elements must have a @value or children
noteNumber		0..*	positiveInt	Applicable note numbers ele-1: All FHIR elements must have a @value or children
adjudication		1..*		Detail level adjudication details ele-1: All FHIR elements must have a @value or children
subDetail		0..*	BackboneElement	Adjudication for claim sub-details ele-1: All FHIR elements must have a @value or children
extension		0..*	Extension	Additional content defined by implementations ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
subDetailSequence		1..1	positiveInt	Claim sub-detail instance identifier ele-1: All FHIR elements must have a @value or children
noteNumber		0..*	positiveInt	Applicable note numbers ele-1: All FHIR elements must have a @value or children
adjudication		0..*		Subdetail level adjudication details ele-1: All FHIR elements must have a @value or children
addItem	S	0..*	BackboneElement	Insurer added line items ele-1: All FHIR elements must have a @value or children
extension		0..*	Extension	left: Additional content defined by implementations; right: Extension ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
itemSequence	S	0..*	positiveInt	Item sequence number ele-1: All FHIR elements must have a @value or children
detailSequence		0..*	positiveInt	Detail sequence number ele-1: All FHIR elements must have a @value or children
subdetailSequence		0..*	positiveInt	Subdetail sequence number ele-1: All FHIR elements must have a @value or children
provider	S	0..*	Reference(Practitioner | PractitionerRole | Organization)	Authorized providers ele-1: All FHIR elements must have a @value or children
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
reference	ΣC	0..1	string	Literal reference, Relative, internal or absolute URL ele-1: All FHIR elements must have a @value or children
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). ele-1: All FHIR elements must have a @value or children
identifier	Σ	0..1	Identifier	Logical reference, when literal reference is not known ele-1: All FHIR elements must have a @value or children
display	Σ	0..1	string	Text alternative for the resource ele-1: All FHIR elements must have a @value or children
productOrService	S	1..1	CodeableConcept	Billing, service, product, or drug code Binding: ?? (required): Allowable service and product codes. ele-1: All FHIR elements must have a @value or children
modifier	S	0..*	CodeableConcept	Service/Product billing modifiers Binding: ?? (required): Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen. ele-1: All FHIR elements must have a @value or children
programCode		0..*	CodeableConcept	Program the product or service is provided under Binding: ?? (example): Program specific reason codes. ele-1: All FHIR elements must have a @value or children
serviced[x]	S	0..1		Date or dates of service or product delivery ele-1: All FHIR elements must have a @value or children
servicedDate			date
servicedPeriod			Period
location[x]	S	0..1		Place of service or where product was supplied Binding: ?? (example): Place of service: pharmacy, school, prison, etc. ele-1: All FHIR elements must have a @value or children
locationCodeableConcept			CodeableConcept
locationAddress			Address
locationReference			Reference(Location)
quantity	S	0..1	??	left: Count of products or services; right: A fixed quantity (no comparator) ele-1: All FHIR elements must have a @value or children
unitPrice	S	0..1	Money	Fee, charge or cost per item ele-1: All FHIR elements must have a @value or children
factor		0..1	decimal	Price scaling factor ele-1: All FHIR elements must have a @value or children
net		0..1	Money	Total item cost ele-1: All FHIR elements must have a @value or children
bodySite		0..1	CodeableConcept	Anatomical location Binding: ?? (example): The code for the teeth, quadrant, sextant and arch. ele-1: All FHIR elements must have a @value or children
subSite		0..*	CodeableConcept	Anatomical sub-location Binding: ?? (example): The code for the tooth surface and surface combinations. ele-1: All FHIR elements must have a @value or children
noteNumber		0..*	positiveInt	Applicable note numbers ele-1: All FHIR elements must have a @value or children
adjudication	S	1..*	BackboneElement	Added items adjudication ele-1: All FHIR elements must have a @value or children
extension		0..*	Extension	Extension Slice: Unordered, Open by value:url ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
category		1..1	CodeableConcept	This code is fixed to 'submitted' to indicate that the adjudication result is on what was submitted. Binding: ?? (example): The adjudication codes. ele-1: All FHIR elements must have a @value or children Required Pattern: At least the following
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (complex)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
system		1..1	uri	Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/adjudication
version		0..1	string	Version of the system - if relevant
code		1..1	code	Symbol in syntax defined by the system Fixed Value: submitted
display		0..1	string	Representation defined by the system
userSelected		0..1	boolean	If this coding was chosen directly by the user
text		0..1	string	Plain text representation of the concept
reason		0..1	CodeableConcept	Explanation of adjudication outcome Binding: ?? (example): The adjudication reason codes. ele-1: All FHIR elements must have a @value or children
amount		0..1	Money	Monetary amount ele-1: All FHIR elements must have a @value or children
value		0..1	decimal	Non-monetary value ele-1: All FHIR elements must have a @value or children
detail		0..*	BackboneElement	Insurer added line details ele-1: All FHIR elements must have a @value or children
extension		0..*	Extension	Additional content defined by implementations ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
productOrService		1..1	CodeableConcept	Billing, service, product, or drug code Binding: ?? (example): Allowable service and product codes. ele-1: All FHIR elements must have a @value or children
modifier		0..*	CodeableConcept	Service/Product billing modifiers Binding: ?? (example): Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen. ele-1: All FHIR elements must have a @value or children
quantity		0..1	??	Count of products or services ele-1: All FHIR elements must have a @value or children
unitPrice		0..1	Money	Fee, charge or cost per item ele-1: All FHIR elements must have a @value or children
factor		0..1	decimal	Price scaling factor ele-1: All FHIR elements must have a @value or children
net		0..1	Money	Total item cost ele-1: All FHIR elements must have a @value or children
noteNumber		0..*	positiveInt	Applicable note numbers ele-1: All FHIR elements must have a @value or children
adjudication		1..*		Added items detail adjudication ele-1: All FHIR elements must have a @value or children
subDetail		0..*	BackboneElement	Insurer added line items ele-1: All FHIR elements must have a @value or children
extension		0..*	Extension	Additional content defined by implementations ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
productOrService		1..1	CodeableConcept	Billing, service, product, or drug code Binding: ?? (example): Allowable service and product codes. ele-1: All FHIR elements must have a @value or children
modifier		0..*	CodeableConcept	Service/Product billing modifiers Binding: ?? (example): Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen. ele-1: All FHIR elements must have a @value or children
quantity		0..1	??	Count of products or services ele-1: All FHIR elements must have a @value or children
unitPrice		0..1	Money	Fee, charge or cost per item ele-1: All FHIR elements must have a @value or children
factor		0..1	decimal	Price scaling factor ele-1: All FHIR elements must have a @value or children
net		0..1	Money	Total item cost ele-1: All FHIR elements must have a @value or children
noteNumber		0..*	positiveInt	Applicable note numbers ele-1: All FHIR elements must have a @value or children
adjudication		1..*		Added items detail adjudication ele-1: All FHIR elements must have a @value or children
adjudication	S	0..*	BackboneElement	Header-level adjudication ele-1: All FHIR elements must have a @value or children
extension		0..*	Extension	Extension Slice: Unordered, Open by value:url ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
category		1..1	CodeableConcept	This code is fixed to 'submitted' to indicate that the adjudication result is on what was submitted. Binding: ?? (example): The adjudication codes. ele-1: All FHIR elements must have a @value or children Required Pattern: At least the following
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (complex)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
system		1..1	uri	Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/adjudication
version		0..1	string	Version of the system - if relevant
code		1..1	code	Symbol in syntax defined by the system Fixed Value: submitted
display		0..1	string	Representation defined by the system
userSelected		0..1	boolean	If this coding was chosen directly by the user
text		0..1	string	Plain text representation of the concept
reason		0..1	CodeableConcept	Explanation of adjudication outcome Binding: ?? (example): The adjudication reason codes. ele-1: All FHIR elements must have a @value or children
amount		0..1	Money	Monetary amount ele-1: All FHIR elements must have a @value or children
value		0..1	decimal	Non-monetary value ele-1: All FHIR elements must have a @value or children
total	Σ	0..*	BackboneElement	Adjudication totals ele-1: All FHIR elements must have a @value or children
extension		0..*	Extension	Additional content defined by implementations ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
category	Σ	1..1	CodeableConcept	Type of adjudication information Binding: ?? (example): The adjudication codes. ele-1: All FHIR elements must have a @value or children
amount	Σ	1..1	Money	Financial total for the category ele-1: All FHIR elements must have a @value or children
payment		0..1	BackboneElement	Payment Details ele-1: All FHIR elements must have a @value or children
extension		0..*	Extension	Additional content defined by implementations ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
type		1..1	CodeableConcept	Partial or complete payment Binding: ?? (example): The type (partial, complete) of the payment. ele-1: All FHIR elements must have a @value or children
adjustment		0..1	Money	Payment adjustment for non-claim issues ele-1: All FHIR elements must have a @value or children
adjustmentReason		0..1	CodeableConcept	Explanation for the adjustment Binding: ?? (example): Payment Adjustment reason codes. ele-1: All FHIR elements must have a @value or children
date		0..1	date	Expected date of payment ele-1: All FHIR elements must have a @value or children
amount		1..1	Money	Payable amount after adjustment ele-1: All FHIR elements must have a @value or children
identifier		0..1	Identifier	Business identifier for the payment ele-1: All FHIR elements must have a @value or children
fundsReserve		0..1	CodeableConcept	Funds reserved status Binding: ?? (example): For whom funds are to be reserved: (Patient, Provider, None). ele-1: All FHIR elements must have a @value or children
formCode		0..1	CodeableConcept	Printed form identifier Binding: ?? (example): The forms codes. ele-1: All FHIR elements must have a @value or children
form		0..1	Attachment	Printed reference or actual form ele-1: All FHIR elements must have a @value or children
processNote		0..*	BackboneElement	Note concerning adjudication ele-1: All FHIR elements must have a @value or children
extension		0..*	Extension	Additional content defined by implementations ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
number		0..1	positiveInt	Note instance identifier ele-1: All FHIR elements must have a @value or children
type		0..1	code	display | print | printoper Binding: ?? (required): The presentation types of notes. ele-1: All FHIR elements must have a @value or children
text		1..1	string	Note explanatory text ele-1: All FHIR elements must have a @value or children
language		0..1	CodeableConcept	Language of the text Binding: ?? (preferred): A human language. ele-1: All FHIR elements must have a @value or children
communicationRequest		0..*	Reference(CommunicationRequest)	Request for additional information ele-1: All FHIR elements must have a @value or children
insurance		0..*	BackboneElement	Patient insurance information ele-1: All FHIR elements must have a @value or children
extension		0..*	Extension	Additional content defined by implementations ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
sequence		1..1	positiveInt	Insurance instance identifier ele-1: All FHIR elements must have a @value or children
focal		1..1	boolean	Coverage to be used for adjudication ele-1: All FHIR elements must have a @value or children
coverage		1..1	Reference(Coverage)	Insurance information ele-1: All FHIR elements must have a @value or children
businessArrangement		0..1	string	Additional provider contract number ele-1: All FHIR elements must have a @value or children
claimResponse		0..1	Reference(ClaimResponse)	Adjudication results ele-1: All FHIR elements must have a @value or children
error	S	0..*	BackboneElement	Processing errors ele-1: All FHIR elements must have a @value or children
extension		0..*	Extension	Extension ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
itemSequence		0..1	positiveInt	Item sequence number ele-1: All FHIR elements must have a @value or children
detailSequence		0..1	positiveInt	Detail sequence number ele-1: All FHIR elements must have a @value or children
subDetailSequence		0..1	positiveInt	Subdetail sequence number ele-1: All FHIR elements must have a @value or children
code	S	1..1	CodeableConcept	Error code detailing processing issues Binding: ?? (required) ele-1: All FHIR elements must have a @value or children
Documentation for this format