Intersection 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 both 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).

Structure

Name	Flags	Card.	Type	Description & Constraints
ClaimResponse		0..*		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. Additional Bindings Purpose ?? Max Binding 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 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	1..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	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	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(PAS Practitioner | PAS Organization Base Profile | #sd-profile-practitioner-profile-practitioner)	Authorized providers ele-1: All FHIR elements must have a @value or children
productOrService	S	1..1	CodeableConcept	Billing, service, product, or drug code Binding: ?? (required) ele-1: All FHIR elements must have a @value or children
modifier	S	0..*	CodeableConcept	Service/Product billing modifiers Binding: ?? (required) 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 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	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..*		Header-level adjudication 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. Additional Bindings Purpose ?? Max Binding 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