Left: | PAS Claim Response Base (http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-claimresponse-base) |
Right: | PAS Claim Response Base (http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-claimresponse-base) |
Error | StructureDefinition.version | Values for version differ: '2.0.1' vs '2.1.0' |
Information | StructureDefinition.date | Values for date differ: '2023-12-01T20:58:53+00:00' vs '2024-12-20T19:33:39+00:00' |
Information | StructureDefinition.short | Values for short differ: 'Response to a claim predetermination or preauthorization' vs 'Response to a preauthorization' |
Information | ClaimResponse.request | Element minimum cardinalities differ: '0' vs '1' |
Warning | ClaimResponse.item.itemSequence | Elements differ in definition for mustSupport: 'false' vs 'true' |
Warning | ClaimResponse.addItem | Elements differ in definition for mustSupport: 'false' vs 'true' |
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 element. 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' |
Warning | ClaimResponse.addItem.itemSequence | Elements differ in definition for mustSupport: 'false' vs 'true' |
Information | ClaimResponse.addItem.itemSequence | Element minimum cardinalities differ: '0' vs '1' |
Information | ClaimResponse.addItem.itemSequence | Element maximum cardinalities differ: '2147483647' vs '1' |
Warning | ClaimResponse.addItem.provider | Elements differ in definition for mustSupport: 'false' vs 'true' |
Warning | ClaimResponse.addItem.productOrService | Elements differ in definition for mustSupport: 'false' vs 'true' |
Warning | ClaimResponse.addItem.modifier | Elements differ in definition for mustSupport: 'false' vs 'true' |
Warning | ClaimResponse.addItem.serviced[x] | Elements differ in definition for mustSupport: 'false' vs 'true' |
Warning | ClaimResponse.addItem.location[x] | Elements differ in definition for mustSupport: 'false' vs 'true' |
Information | StructureDefinition.short | Values for short differ: 'Count of products or services' vs 'A fixed quantity (no comparator)' |
Information | StructureDefinition.definition | Values for definition differ: 'The number of repetitions of a service or product.' vs 'The comparator is not used on a SimpleQuantity' |
Warning | ClaimResponse.addItem.quantity | Elements differ in definition for mustSupport: 'false' vs 'true' |
Warning | ClaimResponse.addItem.unitPrice | Elements differ in definition for mustSupport: 'false' vs 'true' |
Warning | ClaimResponse.addItem.adjudication | Elements differ in definition for mustSupport: 'false' vs 'true' |
Error | ClaimResponse.addItem.adjudication | Type Mismatch: vs BackboneElement |
Warning | ClaimResponse.adjudication | Elements differ in definition for mustSupport: 'false' vs 'true' |
Error | ClaimResponse.adjudication | Type Mismatch: vs BackboneElement |
Name | Value | Comments | |
---|---|---|---|
abstract | true | ||
baseDefinition | http://hl7.org/fhir/StructureDefinition/ClaimResponse | ||
copyright | |||
date | 2023-12-01T20:58:53+00:00 | 2024-12-20T19:33:39+00:00 |
|
description | PAS constraints on ClaimResponse resource that are common to both the request and the inquiry. | ||
experimental | |||
fhirVersion | 4.0.1 | ||
jurisdiction | |||
jurisdiction[0] | urn:iso:std:iso:3166#US | ||
kind | resource | ||
name | PASClaimResponseBase | ||
publisher | HL7 International / Financial Management | ||
purpose | |||
status | active | ||
title | PAS Claim Response Base | ||
type | ClaimResponse | ||
url | http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-claimresponse-base | ||
version | 2.0.1 | 2.1.0 |
|
Name | L Flags | L Card. | L Type | L Description & Constraints | R Flags | R Card. | R Type | R Description & Constraints | Comments | ||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
ClaimResponse | 0..* | ClaimResponse | This is an abstractprofile. Childprofiles: PASClaimInquiryResponse, PASClaimResponse Response to a claim predetermination or preauthorization | 0..* | ClaimResponse | This is an abstractprofile. Childprofiles: PASClaimInquiryResponse, PASClaimResponse 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.
| 0..1 | code | Language of the resource content Binding: ?? (preferred): A human language.
| |||||||||||
text | 0..1 | Narrative | Text summary of the resource, for human interpretation | 0..1 | Narrative | Text summary of the resource, for human interpretation | |||||||||||
contained | 0..* | Resource | Contained, inline Resources | 0..* | Resource | Contained, inline Resources | |||||||||||
extension | 0..* | Extension | Additional content defined by implementations | 0..* | Extension | Additional content defined by implementations | |||||||||||
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..* | ?? | An identifier intended for computation | |||||||||
id | 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 |
| |||||||||||||
use | ?!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. |
| ||||||||||||
system | SΣ | 1..1 | uri | Should use a scheme of 'urn:trnorg:<TRN03>' Example General: http://www.acme.com/identifiers/patient |
| ||||||||||||
value | SΣ | 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 |
| ||||||||||||
assigner | Σ | 0..1 | Reference(Organization) | Organization that issued id (may be just text) |
| ||||||||||||
status | ?!SΣ | 1..1 | code | active | cancelled | draft | entered-in-error Binding: ?? (required): A code specifying the state of the resource instance. Required Pattern: active | ?!SΣ | 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 | SΣ | 1..1 | Reference(PAS Beneficiary Patient) | The recipient of the products and services | SΣ | 1..1 | Reference(PAS Beneficiary Patient) | The recipient of the products and services | |||||||||
created | SΣ | 1..1 | dateTime | Response creation date | SΣ | 1..1 | dateTime | Response creation date | |||||||||
insurer | SΣ | 1..1 | Reference(PAS Insurer Organization) | Party responsible for reimbursement | SΣ | 1..1 | Reference(PAS Insurer Organization) | 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 | PAS PractitionerRole) | Party responsible for the claim | |||||||||
request | SΣ | 0..1 | Reference(PAS Claim) | Id of resource triggering adjudication | SΣ | 1..1 | Reference(PAS Claim) | Id of resource triggering adjudication |
| ||||||||
outcome | SΣ | 1..1 | code | queued | complete | error | partial Binding: ?? (required): The result of the claim processing. | SΣ | 1..1 | code | queued | complete | error | partial Binding: ?? (required): The result of the claim processing. | |||||||||
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 | 1..1 | positiveInt | Claim item instance identifier | S | 1..1 | positiveInt | Claim item instance identifier |
| |||||||||
noteNumber | 0..* | positiveInt | Applicable note numbers | 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 | |||||||||||
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 | |||||||||||
addItem | 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 | |||||||||||
extension | 0..* | Extension | Additional content defined by implementations | 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..* | 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 | 0..* | Reference(Practitioner | PractitionerRole | Organization) | Authorized providers | S | 0..* | Reference(PAS Practitioner | PAS Organization Base Profile) | Authorized providers |
| |||||||||
id | 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 |
| |||||||||||||
reference | ΣC | 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). |
| ||||||||||||
identifier | Σ | 0..1 | Identifier | Logical reference, when literal reference is not known |
| ||||||||||||
display | Σ | 0..1 | string | Text alternative for the resource |
| ||||||||||||
productOrService | 1..1 | CodeableConcept | Billing, service, product, or drug code Binding: ?? (example): Allowable service and product codes. | S | 1..1 | CodeableConcept | Billing, service, product, or drug code Binding: ?? (required) |
| |||||||||
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. | 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] | 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] | 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 | 0..1 | ?? | Count of products or services | SC | 0..1 | ?? | A fixed quantity (no comparator) qty-3: If a code for the unit is present, the system SHALL also be present sqty-1: The comparator is not used on a SimpleQuantity |
| |||||||||
unitPrice | 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 | 1..* | See adjudication (ClaimResponse) | Added items adjudication | S | 1..* | BackboneElement | Added items adjudication |
| |||||||||
id | 0..1 | string | Unique id for inter-element referencing |
| |||||||||||||
Slices for extension | 0..* | Extension | Extension Slice: Unordered, Open by value:url |
| |||||||||||||
modifierExtension | ?!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"}]} |
| |||||||||||||
reason | 0..1 | CodeableConcept | Explanation of adjudication outcome Binding: ?? (example): The adjudication reason codes. |
| |||||||||||||
amount | 0..1 | Money | Monetary amount |
| |||||||||||||
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 | |||||||||||
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 | |||||||||||
adjudication | 0..* | See adjudication (ClaimResponse) | Header-level adjudication | S | 0..* | BackboneElement | Header-level adjudication |
| |||||||||
id | 0..1 | string | Unique id for inter-element referencing |
| |||||||||||||
Slices for extension | 0..* | Extension | Extension Slice: Unordered, Open by value:url |
| |||||||||||||
modifierExtension | ?!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"}]} |
| |||||||||||||
reason | 0..1 | CodeableConcept | Explanation of adjudication outcome Binding: ?? (example): The adjudication reason codes. |
| |||||||||||||
amount | 0..1 | Money | Monetary amount |
| |||||||||||||
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 | 0..* | BackboneElement | Note concerning adjudication | 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 | 0..1 | positiveInt | Note instance identifier | 0..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 | 1..1 | string | Note explanatory text | 1..1 | string | Note explanatory text | |||||||||||
language | 0..1 | CodeableConcept | Language of the text Binding: ?? (preferred): A human language.
| 0..1 | CodeableConcept | Language of the text Binding: ?? (preferred): A human language.
| |||||||||||
communicationRequest | 0..* | Reference(CommunicationRequest) | Request for additional information | 0..* | Reference(CommunicationRequest) | 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 |