Left: | FAIS ClaimResponse Profile (https://profiles.ihe.net/ITI/FAIS/StructureDefinition/IHE.FAIS.ClaimResponse) |
Right: | FAIS ClaimResponse Profile (https://profiles.ihe.net/ITI/FAIS/StructureDefinition/IHE.FAIS.ClaimResponse) |
Error | StructureDefinition.version | Values for version differ: '1.0.0' vs '1.0.1-current' |
Information | StructureDefinition.date | Values for date differ: '2024-11-13T10:50:55-06:00' vs '2024-11-22T13:00:48+00:00' |
Name | Value | Comments | |
---|---|---|---|
![]() | false | ||
![]() | http://hl7.org/fhir/StructureDefinition/ClaimResponse | ||
![]() | |||
![]() | 2024-11-13T10:50:55-06:00 | 2024-11-22T13:00:48+00:00 |
|
![]() | The FAIS ClaimResponse profile to be used as the response to the [FAIS Claim $submit](OperationDefinition-IHE.FAIS.Claim.Submit.html) | ||
![]() | |||
![]() | 4.0.1 | ||
![]() | |||
![]() ![]() | http://unstats.un.org/unsd/methods/m49/m49.htm#001 | ||
![]() | resource | ||
![]() | FAISClaimResponse | ||
![]() | IHE IT Infrastructure Technical Committee | ||
![]() | |||
![]() | active | ||
![]() | FAIS ClaimResponse Profile | ||
![]() | ClaimResponse | ||
![]() | https://profiles.ihe.net/ITI/FAIS/StructureDefinition/IHE.FAIS.ClaimResponse | ||
![]() | 1.0.0 | 1.0.1-current |
|
Name | L Flags | L Card. | L Type | L Description & Constraints | R Flags | R Card. | R Type | R Description & Constraints | Comments![]() | ||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
![]() ![]() | 0..* | ClaimResponse | Response to a claim predetermination or preauthorization | 0..* | ClaimResponse | Response to a claim predetermination or preauthorization | |||||||||||
![]() ![]() ![]() | Σ | 0..1 | id | Logical id of this artifact | Σ | 0..1 | id | Logical id of this artifact | |||||||||
![]() ![]() ![]() | Σ | 0..1 | Meta | Metadata about the resource | Σ | 0..1 | Meta | Metadata about the resource | |||||||||
![]() ![]() ![]() | ?!Σ | 0..0 | ?!Σ | 0..0 | |||||||||||||
![]() ![]() ![]() | 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.
| |||||||||||
![]() ![]() ![]() | 0..1 | Narrative | Text summary of the resource, for human interpretation | 0..1 | Narrative | Text summary of the resource, for human interpretation | |||||||||||
![]() ![]() ![]() | 0..* | Resource | Contained, inline Resources | 0..* | Resource | Contained, inline Resources | |||||||||||
![]() ![]() ![]() | 0..* | Extension | Additional content defined by implementations | 0..* | Extension | Additional content defined by implementations | |||||||||||
![]() ![]() ![]() | ?! | 0..0 | ?! | 0..0 | |||||||||||||
![]() ![]() ![]() | 0..* | Identifier | Business Identifier for a claim response | 0..* | Identifier | Business Identifier for a claim response | |||||||||||
![]() ![]() ![]() | ?!Σ | 1..1 | code | active | cancelled | draft | entered-in-error Binding: ?? (required): A code specifying the state of the resource instance. | ?!Σ | 1..1 | code | active | cancelled | draft | entered-in-error Binding: ?? (required): A code specifying the state of the resource instance. | |||||||||
![]() ![]() ![]() | 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. | |||||||||
![]() ![]() ![]() | 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. | |||||||||||
![]() ![]() ![]() | Σ | 1..1 | code | claim | preauthorization | predetermination Binding: ?? (required): Claim, preauthorization, predetermination. | Σ | 1..1 | code | claim | preauthorization | predetermination Binding: ?? (required): Claim, preauthorization, predetermination. | |||||||||
![]() ![]() ![]() | Σ | 1..1 | Reference(Patient) | The recipient of the products and services | Σ | 1..1 | Reference(Patient) | The recipient of the products and services | |||||||||
![]() ![]() ![]() | Σ | 1..1 | dateTime | Response creation date | Σ | 1..1 | dateTime | Response creation date | |||||||||
![]() ![]() ![]() | Σ | 1..1 | Reference(Organization) | Party responsible for reimbursement | Σ | 1..1 | Reference(Organization) | Party responsible for reimbursement | |||||||||
![]() ![]() ![]() | 0..1 | Reference(Practitioner | PractitionerRole | Organization) | Party responsible for the claim | 0..1 | Reference(Practitioner | PractitionerRole | Organization) | Party responsible for the claim | |||||||||||
![]() ![]() ![]() | Σ | 1..1 | Reference(FAIS Claim Profile) | Id of resource triggering adjudication | Σ | 1..1 | Reference(FAIS Claim Profile) | Id of resource triggering adjudication | |||||||||
![]() ![]() ![]() | Σ | 1..1 | code | queued | complete | error | partial Binding: ?? (required): The result of the claim processing. | Σ | 1..1 | code | queued | complete | error | partial Binding: ?? (required): The result of the claim processing. | |||||||||
![]() ![]() ![]() | 0..1 | string | Disposition Message | 0..1 | string | Disposition Message | |||||||||||
![]() ![]() ![]() | 0..1 | string | Preauthorization reference | 0..1 | string | Preauthorization reference | |||||||||||
![]() ![]() ![]() | 0..1 | Period | Preauthorization reference effective period | 0..1 | Period | Preauthorization reference effective period | |||||||||||
![]() ![]() ![]() | 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. | |||||||||||
![]() ![]() ![]() | 0..* | BackboneElement | Adjudication for claim line items | 0..* | BackboneElement | Adjudication for claim line items | |||||||||||
![]() ![]() ![]() ![]() | 0..1 | string | Unique id for inter-element referencing | 0..1 | string | Unique id for inter-element referencing | |||||||||||
![]() ![]() ![]() ![]() | 0..* | Extension | Additional content defined by implementations | 0..* | Extension | Additional content defined by implementations | |||||||||||
![]() ![]() ![]() ![]() | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | |||||||||
![]() ![]() ![]() ![]() | 1..1 | positiveInt | Claim item instance identifier | 1..1 | positiveInt | Claim item instance identifier | |||||||||||
![]() ![]() ![]() ![]() | 0..* | positiveInt | Applicable note numbers | 0..* | positiveInt | Applicable note numbers | |||||||||||
![]() ![]() ![]() ![]() | 1..* | BackboneElement | Adjudication details | 1..* | BackboneElement | Adjudication details | |||||||||||
![]() ![]() ![]() ![]() ![]() | 0..1 | string | Unique id for inter-element referencing | 0..1 | string | Unique id for inter-element referencing | |||||||||||
![]() ![]() ![]() ![]() ![]() | 0..* | Extension | Additional content defined by implementations | 0..* | Extension | Additional content defined by implementations | |||||||||||
![]() ![]() ![]() ![]() ![]() | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | |||||||||
![]() ![]() ![]() ![]() ![]() | 1..1 | CodeableConcept | Type of adjudication information Binding: ?? (example): The adjudication codes. | 1..1 | CodeableConcept | Type of adjudication information Binding: ?? (example): The adjudication codes. | |||||||||||
![]() ![]() ![]() ![]() ![]() | 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. | |||||||||||
![]() ![]() ![]() ![]() ![]() | 0..1 | Money | Monetary amount | 0..1 | Money | Monetary amount | |||||||||||
![]() ![]() ![]() ![]() ![]() | 0..1 | decimal | Non-monetary value | 0..1 | decimal | Non-monetary value | |||||||||||
![]() ![]() ![]() ![]() | 0..* | BackboneElement | Adjudication for claim details | 0..* | BackboneElement | Adjudication for claim details | |||||||||||
![]() ![]() ![]() ![]() ![]() | 0..1 | string | Unique id for inter-element referencing | 0..1 | string | Unique id for inter-element referencing | |||||||||||
![]() ![]() ![]() ![]() ![]() | 0..* | Extension | Additional content defined by implementations | 0..* | Extension | Additional content defined by implementations | |||||||||||
![]() ![]() ![]() ![]() ![]() | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | |||||||||
![]() ![]() ![]() ![]() ![]() | 1..1 | positiveInt | Claim detail instance identifier | 1..1 | positiveInt | Claim detail instance identifier | |||||||||||
![]() ![]() ![]() ![]() ![]() | 0..* | positiveInt | Applicable note numbers | 0..* | positiveInt | Applicable note numbers | |||||||||||
![]() ![]() ![]() ![]() ![]() | 1..* | See adjudication (ClaimResponse) | Detail level adjudication details | 1..* | See adjudication (ClaimResponse) | Detail level adjudication details | |||||||||||
![]() ![]() ![]() ![]() ![]() | 0..* | BackboneElement | Adjudication for claim sub-details | 0..* | BackboneElement | Adjudication for claim sub-details | |||||||||||
![]() ![]() ![]() ![]() ![]() ![]() | 0..1 | string | Unique id for inter-element referencing | 0..1 | string | Unique id for inter-element referencing | |||||||||||
![]() ![]() ![]() ![]() ![]() ![]() | 0..* | Extension | Additional content defined by implementations | 0..* | Extension | Additional content defined by implementations | |||||||||||
![]() ![]() ![]() ![]() ![]() ![]() | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | |||||||||
![]() ![]() ![]() ![]() ![]() ![]() | 1..1 | positiveInt | Claim sub-detail instance identifier | 1..1 | positiveInt | Claim sub-detail instance identifier | |||||||||||
![]() ![]() ![]() ![]() ![]() ![]() | 0..* | positiveInt | Applicable note numbers | 0..* | positiveInt | Applicable note numbers | |||||||||||
![]() ![]() ![]() ![]() ![]() ![]() | 0..* | See adjudication (ClaimResponse) | Subdetail level adjudication details | 0..* | See adjudication (ClaimResponse) | Subdetail level adjudication details | |||||||||||
![]() ![]() ![]() | 0..* | BackboneElement | Insurer added line items | 0..* | BackboneElement | Insurer added line items | |||||||||||
![]() ![]() ![]() ![]() | 0..1 | string | Unique id for inter-element referencing | 0..1 | string | Unique id for inter-element referencing | |||||||||||
![]() ![]() ![]() ![]() | 0..* | Extension | Additional content defined by implementations | 0..* | Extension | Additional content defined by implementations | |||||||||||
![]() ![]() ![]() ![]() | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | |||||||||
![]() ![]() ![]() ![]() | 0..* | positiveInt | Item sequence number | 0..* | positiveInt | Item sequence number | |||||||||||
![]() ![]() ![]() ![]() | 0..* | positiveInt | Detail sequence number | 0..* | positiveInt | Detail sequence number | |||||||||||
![]() ![]() ![]() ![]() | 0..* | positiveInt | Subdetail sequence number | 0..* | positiveInt | Subdetail sequence number | |||||||||||
![]() ![]() ![]() ![]() | 0..* | Reference(Practitioner | PractitionerRole | Organization) | Authorized providers | 0..* | Reference(Practitioner | PractitionerRole | Organization) | Authorized providers | |||||||||||
![]() ![]() ![]() ![]() | 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. | |||||||||||
![]() ![]() ![]() ![]() | 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. | |||||||||||
![]() ![]() ![]() ![]() | 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. | |||||||||||
![]() ![]() ![]() ![]() | 0..1 | date, Period | Date or dates of service or product delivery | 0..1 | date, Period | Date or dates of service or product delivery | |||||||||||
![]() ![]() ![]() ![]() | 0..1 | CodeableConcept, Address, Reference(Location) | Place of service or where product was supplied Binding: ?? (example): Place of service: pharmacy, school, prison, etc. | 0..1 | CodeableConcept, Address, Reference(Location) | Place of service or where product was supplied Binding: ?? (example): Place of service: pharmacy, school, prison, etc. | |||||||||||
![]() ![]() ![]() ![]() | 0..1 | ?? | Count of products or services | 0..1 | ?? | Count of products or services | |||||||||||
![]() ![]() ![]() ![]() | 0..1 | Money | Fee, charge or cost per item | 0..1 | Money | Fee, charge or cost per item | |||||||||||
![]() ![]() ![]() ![]() | 0..1 | decimal | Price scaling factor | 0..1 | decimal | Price scaling factor | |||||||||||
![]() ![]() ![]() ![]() | 0..1 | Money | Total item cost | 0..1 | Money | Total item cost | |||||||||||
![]() ![]() ![]() ![]() | 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. | |||||||||||
![]() ![]() ![]() ![]() | 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. | |||||||||||
![]() ![]() ![]() ![]() | 0..* | positiveInt | Applicable note numbers | 0..* | positiveInt | Applicable note numbers | |||||||||||
![]() ![]() ![]() ![]() | 1..* | See adjudication (ClaimResponse) | Added items adjudication | 1..* | See adjudication (ClaimResponse) | Added items adjudication | |||||||||||
![]() ![]() ![]() ![]() | 0..* | BackboneElement | Insurer added line details | 0..* | BackboneElement | Insurer added line details | |||||||||||
![]() ![]() ![]() ![]() ![]() | 0..1 | string | Unique id for inter-element referencing | 0..1 | string | Unique id for inter-element referencing | |||||||||||
![]() ![]() ![]() ![]() ![]() | 0..* | Extension | Additional content defined by implementations | 0..* | Extension | Additional content defined by implementations | |||||||||||
![]() ![]() ![]() ![]() ![]() | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | |||||||||
![]() ![]() ![]() ![]() ![]() | 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. | |||||||||||
![]() ![]() ![]() ![]() ![]() | 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. | |||||||||||
![]() ![]() ![]() ![]() ![]() | 0..1 | ?? | Count of products or services | 0..1 | ?? | Count of products or services | |||||||||||
![]() ![]() ![]() ![]() ![]() | 0..1 | Money | Fee, charge or cost per item | 0..1 | Money | Fee, charge or cost per item | |||||||||||
![]() ![]() ![]() ![]() ![]() | 0..1 | decimal | Price scaling factor | 0..1 | decimal | Price scaling factor | |||||||||||
![]() ![]() ![]() ![]() ![]() | 0..1 | Money | Total item cost | 0..1 | Money | Total item cost | |||||||||||
![]() ![]() ![]() ![]() ![]() | 0..* | positiveInt | Applicable note numbers | 0..* | positiveInt | Applicable note numbers | |||||||||||
![]() ![]() ![]() ![]() ![]() | 1..* | See adjudication (ClaimResponse) | Added items detail adjudication | 1..* | See adjudication (ClaimResponse) | Added items detail adjudication | |||||||||||
![]() ![]() ![]() ![]() ![]() | 0..* | BackboneElement | Insurer added line items | 0..* | BackboneElement | Insurer added line items | |||||||||||
![]() ![]() ![]() ![]() ![]() ![]() | 0..1 | string | Unique id for inter-element referencing | 0..1 | string | Unique id for inter-element referencing | |||||||||||
![]() ![]() ![]() ![]() ![]() ![]() | 0..* | Extension | Additional content defined by implementations | 0..* | Extension | Additional content defined by implementations | |||||||||||
![]() ![]() ![]() ![]() ![]() ![]() | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | |||||||||
![]() ![]() ![]() ![]() ![]() ![]() | 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. | |||||||||||
![]() ![]() ![]() ![]() ![]() ![]() | 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. | |||||||||||
![]() ![]() ![]() ![]() ![]() ![]() | 0..1 | ?? | Count of products or services | 0..1 | ?? | Count of products or services | |||||||||||
![]() ![]() ![]() ![]() ![]() ![]() | 0..1 | Money | Fee, charge or cost per item | 0..1 | Money | Fee, charge or cost per item | |||||||||||
![]() ![]() ![]() ![]() ![]() ![]() | 0..1 | decimal | Price scaling factor | 0..1 | decimal | Price scaling factor | |||||||||||
![]() ![]() ![]() ![]() ![]() ![]() | 0..1 | Money | Total item cost | 0..1 | Money | Total item cost | |||||||||||
![]() ![]() ![]() ![]() ![]() ![]() | 0..* | positiveInt | Applicable note numbers | 0..* | positiveInt | Applicable note numbers | |||||||||||
![]() ![]() ![]() ![]() ![]() ![]() | 1..* | See adjudication (ClaimResponse) | Added items detail adjudication | 1..* | See adjudication (ClaimResponse) | Added items detail adjudication | |||||||||||
![]() ![]() ![]() | 0..* | See adjudication (ClaimResponse) | Header-level adjudication | 0..* | See adjudication (ClaimResponse) | Header-level adjudication | |||||||||||
![]() ![]() ![]() | Σ | 0..* | BackboneElement | Adjudication totals | Σ | 0..* | BackboneElement | Adjudication totals | |||||||||
![]() ![]() ![]() ![]() | 0..1 | string | Unique id for inter-element referencing | 0..1 | string | Unique id for inter-element referencing | |||||||||||
![]() ![]() ![]() ![]() | 0..* | Extension | Additional content defined by implementations | 0..* | Extension | Additional content defined by implementations | |||||||||||
![]() ![]() ![]() ![]() | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | |||||||||
![]() ![]() ![]() ![]() | 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. | |||||||||
![]() ![]() ![]() ![]() | Σ | 1..1 | Money | Financial total for the category | Σ | 1..1 | Money | Financial total for the category | |||||||||
![]() ![]() ![]() | 0..1 | BackboneElement | Payment Details | 0..1 | BackboneElement | Payment Details | |||||||||||
![]() ![]() ![]() ![]() | 0..1 | string | Unique id for inter-element referencing | 0..1 | string | Unique id for inter-element referencing | |||||||||||
![]() ![]() ![]() ![]() | 0..* | Extension | Additional content defined by implementations | 0..* | Extension | Additional content defined by implementations | |||||||||||
![]() ![]() ![]() ![]() | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | |||||||||
![]() ![]() ![]() ![]() | 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. | |||||||||||
![]() ![]() ![]() ![]() | 0..1 | Money | Payment adjustment for non-claim issues | 0..1 | Money | Payment adjustment for non-claim issues | |||||||||||
![]() ![]() ![]() ![]() | 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. | |||||||||||
![]() ![]() ![]() ![]() | 0..1 | date | Expected date of payment | 0..1 | date | Expected date of payment | |||||||||||
![]() ![]() ![]() ![]() | 1..1 | Money | Payable amount after adjustment | 1..1 | Money | Payable amount after adjustment | |||||||||||
![]() ![]() ![]() ![]() | 0..1 | Identifier | Business identifier for the payment | 0..1 | Identifier | Business identifier for the payment | |||||||||||
![]() ![]() ![]() | 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). | |||||||||||
![]() ![]() ![]() | 0..1 | CodeableConcept | Printed form identifier Binding: ?? (example): The forms codes. | 0..1 | CodeableConcept | Printed form identifier Binding: ?? (example): The forms codes. | |||||||||||
![]() ![]() ![]() | 0..1 | Attachment | Printed reference or actual form | 0..1 | Attachment | Printed reference or actual form | |||||||||||
![]() ![]() ![]() | 0..* | BackboneElement | Note concerning adjudication | 0..* | BackboneElement | Note concerning adjudication | |||||||||||
![]() ![]() ![]() ![]() | 0..1 | string | Unique id for inter-element referencing | 0..1 | string | Unique id for inter-element referencing | |||||||||||
![]() ![]() ![]() ![]() | 0..* | Extension | Additional content defined by implementations | 0..* | Extension | Additional content defined by implementations | |||||||||||
![]() ![]() ![]() ![]() | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | |||||||||
![]() ![]() ![]() ![]() | 0..1 | positiveInt | Note instance identifier | 0..1 | positiveInt | Note instance identifier | |||||||||||
![]() ![]() ![]() ![]() | 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. | |||||||||||
![]() ![]() ![]() ![]() | 1..1 | string | Note explanatory text | 1..1 | string | Note explanatory text | |||||||||||
![]() ![]() ![]() ![]() | 0..1 | CodeableConcept | Language of the text Binding: ?? (preferred): A human language.
| 0..1 | CodeableConcept | Language of the text Binding: ?? (preferred): A human language.
| |||||||||||
![]() ![]() ![]() | 0..* | Reference(CommunicationRequest) | Request for additional information | 0..* | Reference(CommunicationRequest) | Request for additional information | |||||||||||
![]() ![]() ![]() | 0..* | BackboneElement | Patient insurance information | 0..* | BackboneElement | Patient insurance information | |||||||||||
![]() ![]() ![]() ![]() | 0..1 | string | Unique id for inter-element referencing | 0..1 | string | Unique id for inter-element referencing | |||||||||||
![]() ![]() ![]() ![]() | 0..* | Extension | Additional content defined by implementations | 0..* | Extension | Additional content defined by implementations | |||||||||||
![]() ![]() ![]() ![]() | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | |||||||||
![]() ![]() ![]() ![]() | 1..1 | positiveInt | Insurance instance identifier | 1..1 | positiveInt | Insurance instance identifier | |||||||||||
![]() ![]() ![]() ![]() | 1..1 | boolean | Coverage to be used for adjudication | 1..1 | boolean | Coverage to be used for adjudication | |||||||||||
![]() ![]() ![]() ![]() | 1..1 | Reference(Coverage) | Insurance information | 1..1 | Reference(Coverage) | Insurance information | |||||||||||
![]() ![]() ![]() ![]() | 0..1 | string | Additional provider contract number | 0..1 | string | Additional provider contract number | |||||||||||
![]() ![]() ![]() ![]() | 0..1 | Reference(ClaimResponse) | Adjudication results | 0..1 | Reference(ClaimResponse) | Adjudication results | |||||||||||
![]() ![]() ![]() | 0..* | BackboneElement | Processing errors | 0..* | BackboneElement | Processing errors | |||||||||||
![]() ![]() ![]() ![]() | 0..1 | string | Unique id for inter-element referencing | 0..1 | string | Unique id for inter-element referencing | |||||||||||
![]() ![]() ![]() ![]() | 0..* | Extension | Additional content defined by implementations | 0..* | Extension | Additional content defined by implementations | |||||||||||
![]() ![]() ![]() ![]() | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | |||||||||
![]() ![]() ![]() ![]() | 0..1 | positiveInt | Item sequence number | 0..1 | positiveInt | Item sequence number | |||||||||||
![]() ![]() ![]() ![]() | 0..1 | positiveInt | Detail sequence number | 0..1 | positiveInt | Detail sequence number | |||||||||||
![]() ![]() ![]() ![]() | 0..1 | positiveInt | Subdetail sequence number | 0..1 | positiveInt | Subdetail sequence number | |||||||||||
![]() ![]() ![]() ![]() | 1..1 | CodeableConcept | Error code detailing processing issues Binding: ?? (example): The adjudication error codes. | 1..1 | CodeableConcept | Error code detailing processing issues Binding: ?? (example): The adjudication error codes. | |||||||||||
![]() |