Kenya eClaims FHIR Implementation Guide
0.1.0 - ci-build Kenya flag

Kenya eClaims FHIR Implementation Guide, published by Digital Health Agency of Kenya. This guide is not an authorized publication; it is the continuous build for version 0.1.0 built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/IntelliSOFT-Consulting/Kenya-eClaims-FHIR-IG/ and changes regularly. See the Directory of published versions

Resource Profile: Kenya eClaims ClaimResponse Profile

Official URL: https://nshr-uat.sha.go.ke/fhir/StructureDefinition/ke-eclaims-claimresponse Version: 0.1.0
Draft as of 2026-06-03 Computable Name: EClaimsClaimResponse

Profile for the response to a Claim or Preauthorization, including specific adjudication states and expiry logic.

Usages:

You can also check for usages in the FHIR IG Statistics

Formal Views of Profile Content

Description of Profiles, Differentials, Snapshots and how the different presentations work.

NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
.. ClaimResponse 0..* ClaimResponse Response to a claim predetermination or preauthorization
... implicitRules ?!Σ 0..1 uri A set of rules under which this content was created
... Slices for extension 1..* Extension Extension
Slice: Unordered, Open by value:url
.... extension:claimState S 1..1 CodeableConcept Claim Workflow State
URL: https://nshr-uat.sha.go.ke/fhir/StructureDefinition/eclaim-state-extension
.... extension:claimExpiry S 0..1 CodeableConcept Preauthorization Expiry Date
URL: https://nshr-uat.sha.go.ke/fhir/StructureDefinition/eclaim-expiry-extension
... modifierExtension ?! 0..* Extension Extensions that cannot be ignored
... type SΣ 1..1 CodeableConcept More granular claim type
Binding: ClaimTypeCodes (extensible): The type or discipline-style of the claim.
... subType S 0..1 CodeableConcept More granular claim type
Binding: ExampleClaimSubTypeCodes (required)
.... coding SΣ 1..* Coding Code defined by a terminology system
..... system SΣ 1..1 uri Identity of the terminology system
..... code SΣ 1..1 code Symbol in syntax defined by the system
..... display SΣ 1..1 string Representation defined by the system
.... text SΣ 0..1 string Plain text representation of the concept
... use SΣ 1..1 code claim | preauthorization | predetermination
Binding: Use (required): Claim, preauthorization, predetermination.
... patient Σ 1..1 Reference(Patient) The recipient of the products and services
... created SΣ 1..1 dateTime Response creation date
... insurer SΣ 1..1 Reference(Organization) Party responsible for reimbursement
... request SΣ 1..1 Reference(Claim) Id of resource triggering adjudication
... outcome SΣ 1..1 code queued | complete | error | partial
Binding: ClaimProcessingCodes (required)
... payeeType S 0..1 CodeableConcept Party to be paid any benefits payable
Binding: ClaimResponse Payee Type ValueSet (required)
.... coding SΣ 1..* Coding Code defined by a terminology system
..... system SΣ 1..1 uri Identity of the terminology system
..... code SΣ 1..1 code Symbol in syntax defined by the system
..... display SΣ 1..1 string Representation defined by the system
.... text SΣ 0..1 string Plain text representation of the concept
... item S 1..* BackboneElement Adjudication for claim line items
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... itemSequence S 1..1 positiveInt Claim item instance identifier
.... adjudication S 1..* BackboneElement Adjudication details
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... category S 1..1 CodeableConcept Type of adjudication information
Binding: AdjudicationValueCodes (required)
...... coding SΣ 1..* Coding Code defined by a terminology system
....... system SΣ 1..1 uri Identity of the terminology system
....... code SΣ 1..1 code Symbol in syntax defined by the system
....... display SΣ 1..1 string Representation defined by the system
...... text SΣ 0..1 string Plain text representation of the concept
..... reason S 0..1 CodeableConcept Explanation of adjudication outcome
Binding: AdjudicationReasonCodes (required)
...... coding SΣ 1..* Coding Code defined by a terminology system
....... system SΣ 1..1 uri Identity of the terminology system
....... code SΣ 1..1 code Symbol in syntax defined by the system
....... display SΣ 1..1 string Representation defined by the system
...... text SΣ 0..1 string Plain text representation of the concept
..... amount S 0..1 Money Monetary amount
... addItem S 0..* BackboneElement Insurer added line items
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... productOrService S 1..1 CodeableConcept Billing, service, product, or drug code
Binding: Kenya Social Health Authority Interventions ValueSet (required)
..... coding SΣ 1..* Coding Code defined by a terminology system
...... system SΣ 1..1 uri Identity of the terminology system
...... code SΣ 1..1 code Symbol in syntax defined by the system
...... display SΣ 1..1 string Representation defined by the system
..... text SΣ 0..1 string Plain text representation of the concept
.... modifier S 0..1 CodeableConcept Service/Product billing modifiers
Binding: ModifierTypeCodes (required)
..... coding SΣ 1..* Coding Code defined by a terminology system
...... system SΣ 1..1 uri Identity of the terminology system
...... code SΣ 1..1 code Symbol in syntax defined by the system
...... display SΣ 1..1 string Representation defined by the system
..... text SΣ 0..1 string Plain text representation of the concept
.... programCode S 0..1 CodeableConcept Program the product or service is provided under
Binding: ExampleProgramReasonCodes (required)
..... coding SΣ 1..* Coding Code defined by a terminology system
...... system SΣ 1..1 uri Identity of the terminology system
...... code SΣ 1..1 code Symbol in syntax defined by the system
...... display SΣ 1..1 string Representation defined by the system
..... text SΣ 0..1 string Plain text representation of the concept
.... location[x] 0..1 Place of service or where product was supplied
Binding: ExampleServicePlaceCodes (required)
..... locationCodeableConcept CodeableConcept
..... locationAddress Address
..... locationReference Reference(Location)
.... bodySite S 0..1 CodeableConcept Anatomical location
Binding: Kenya Institutional Body Site ValueSet (required)
..... coding SΣ 1..* Coding Code defined by a terminology system
...... system SΣ 1..1 uri Identity of the terminology system
...... code SΣ 1..1 code Symbol in syntax defined by the system
...... display SΣ 1..1 string Representation defined by the system
..... text SΣ 0..1 string Plain text representation of the concept
.... subSite S 0..1 CodeableConcept Anatomical sub-location
Binding: Kenya Subsite ValueSet (required)
..... coding SΣ 1..* Coding Code defined by a terminology system
...... system SΣ 1..1 uri Identity of the terminology system
...... code SΣ 1..1 code Symbol in syntax defined by the system
...... display SΣ 1..1 string Representation defined by the system
..... text SΣ 0..1 string Plain text representation of the concept
.... adjudication 1..* See adjudication (ClaimResponse) Added items adjudication
.... detail S 0..* BackboneElement Insurer added line details
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... productOrService S 1..1 CodeableConcept Billing, service, product, or drug code
Binding: Kenya Social Health Authority Interventions ValueSet (required)
...... coding SΣ 1..* Coding Code defined by a terminology system
....... system SΣ 1..1 uri Identity of the terminology system
....... code SΣ 1..1 code Symbol in syntax defined by the system
....... display SΣ 1..1 string Representation defined by the system
...... text SΣ 0..1 string Plain text representation of the concept
..... modifier S 0..1 CodeableConcept Service/Product billing modifiers
Binding: ModifierTypeCodes (required)
...... coding SΣ 1..* Coding Code defined by a terminology system
....... system SΣ 1..1 uri Identity of the terminology system
....... code SΣ 1..1 code Symbol in syntax defined by the system
....... display SΣ 1..1 string Representation defined by the system
...... text SΣ 0..1 string Plain text representation of the concept
..... adjudication 1..* See adjudication (ClaimResponse) Added items detail adjudication
..... subDetail S 0..* BackboneElement Insurer added line items
...... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
...... productOrService S 1..1 CodeableConcept Billing, service, product, or drug code
Binding: Kenya Social Health Authority Interventions ValueSet (required)
....... coding SΣ 1..* Coding Code defined by a terminology system
........ system SΣ 1..1 uri Identity of the terminology system
........ code SΣ 1..1 code Symbol in syntax defined by the system
........ display SΣ 1..1 string Representation defined by the system
....... text SΣ 0..1 string Plain text representation of the concept
...... modifier S 0..1 CodeableConcept Service/Product billing modifiers
Binding: ModifierTypeCodes (required)
....... coding SΣ 1..* Coding Code defined by a terminology system
........ system SΣ 1..1 uri Identity of the terminology system
........ code SΣ 1..1 code Symbol in syntax defined by the system
........ display SΣ 1..1 string Representation defined by the system
....... text SΣ 0..1 string Plain text representation of the concept
...... adjudication 1..* See adjudication (ClaimResponse) Added items detail adjudication
... total SΣ 0..* BackboneElement Adjudication totals
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... category SΣ 1..1 CodeableConcept Type of adjudication information
Binding: AdjudicationValueCodes (required)
..... coding SΣ 1..* Coding Code defined by a terminology system
...... system SΣ 1..1 uri Identity of the terminology system
...... code SΣ 1..1 code Symbol in syntax defined by the system
...... display SΣ 1..1 string Representation defined by the system
..... text SΣ 0..1 string Plain text representation of the concept
.... amount SΣ 1..1 Money Financial total for the category
..... currency SΣ 1..1 code ISO 4217 Currency Code
Binding: Currencies (required): A code indicating the currency, taken from ISO 4217.
... payment S 0..1 BackboneElement Payment Details
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... type S 1..1 CodeableConcept Partial or complete payment
Binding: ExamplePaymentTypeCodes (required)
..... coding SΣ 1..* Coding Code defined by a terminology system
...... system SΣ 1..1 uri Identity of the terminology system
...... code SΣ 1..1 code Symbol in syntax defined by the system
...... display SΣ 1..1 string Representation defined by the system
..... text SΣ 0..1 string Plain text representation of the concept
.... adjustmentReason S 0..1 CodeableConcept Explanation for the adjustment
Binding: PaymentAdjustmentReasonCodes (required)
..... coding SΣ 1..* Coding Code defined by a terminology system
...... system SΣ 1..1 uri Identity of the terminology system
...... code SΣ 1..1 code Symbol in syntax defined by the system
...... display SΣ 1..1 string Representation defined by the system
..... text SΣ 0..1 string Plain text representation of the concept
.... amount 1..1 Money Payable amount after adjustment
... fundsReserve S 0..1 CodeableConcept Funds reserved status
Binding: ClaimResponse Funds Reserve ValueSet (required)
.... coding SΣ 1..* Coding Code defined by a terminology system
..... system SΣ 1..1 uri Identity of the terminology system
..... code SΣ 1..1 code Symbol in syntax defined by the system
..... display SΣ 1..1 string Representation defined by the system
.... text SΣ 0..1 string Plain text representation of the concept
... formCode S 0..1 CodeableConcept Printed form identifier
Binding: ClaimResponse Forms ValueSet (required)
.... coding SΣ 1..* Coding Code defined by a terminology system
..... system SΣ 1..1 uri Identity of the terminology system
..... code SΣ 1..1 code Symbol in syntax defined by the system
..... display SΣ 1..1 string Representation defined by the system
.... text SΣ 0..1 string Plain text representation of the concept
... processNote S 0..* BackboneElement Note concerning adjudication
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... number S 0..1 positiveInt Note instance identifier
.... type S 0..1 code display | print | printoper
Binding: NoteType (required): The presentation types of notes.
.... text S 1..1 string Note explanatory text
... error S 0..* BackboneElement Processing errors
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... code S 1..1 CodeableConcept Error code detailing processing issues
Binding: ClaimResponse Adjudication Error ValueSet (required)
..... coding SΣ 1..* Coding Code defined by a terminology system
...... system SΣ 1..1 uri Identity of the terminology system
...... code SΣ 1..1 code Symbol in syntax defined by the system
...... display SΣ 1..1 string Representation defined by the system
..... text SΣ 0..1 string Plain text representation of the concept

doco Documentation for this format

Terminology Bindings

Path Status Usage ValueSet Version Source
ClaimResponse.status Base required Financial Resource Status Codes 📍4.0.1 FHIR Std.
ClaimResponse.type Base extensible Claim Type Codes 📍4.0.1 FHIR Std.
ClaimResponse.subType Base required Example Claim SubType Codes 📦4.0.1 FHIR Std.
ClaimResponse.use Base required Use 📍4.0.1 FHIR Std.
ClaimResponse.outcome Base required Claim Processing Codes 📦4.0.1 FHIR Std.
ClaimResponse.payeeType Base required ClaimResponse Payee Type ValueSet 📦0.1.0 This IG
ClaimResponse.item.adjudication.​category Base required Adjudication Value Codes 📦4.0.1 FHIR Std.
ClaimResponse.item.adjudication.​reason Base required Adjudication Reason Codes 📦4.0.1 FHIR Std.
ClaimResponse.addItem.​productOrService Base required Kenya Social Health Authority Interventions ValueSet 📦0.1.0 This IG
ClaimResponse.addItem.​modifier Base required Modifier type Codes 📦4.0.1 FHIR Std.
ClaimResponse.addItem.​programCode Base required Example Program Reason Codes 📦4.0.1 FHIR Std.
ClaimResponse.addItem.​location[x] Base required Example Service Place Codes 📦4.0.1 FHIR Std.
ClaimResponse.addItem.​bodySite Base required Kenya Institutional Body Site ValueSet 📦0.1.0 This IG
ClaimResponse.addItem.​subSite Base required Kenya Subsite ValueSet 📦0.1.0 This IG
ClaimResponse.addItem.​detail.productOrService Base required Kenya Social Health Authority Interventions ValueSet 📦0.1.0 This IG
ClaimResponse.addItem.​detail.modifier Base required Modifier type Codes 📦4.0.1 FHIR Std.
ClaimResponse.addItem.​detail.subDetail.productOrService Base required Kenya Social Health Authority Interventions ValueSet 📦0.1.0 This IG
ClaimResponse.addItem.​detail.subDetail.modifier Base required Modifier type Codes 📦4.0.1 FHIR Std.
ClaimResponse.total.​category Base required Adjudication Value Codes 📦4.0.1 FHIR Std.
ClaimResponse.total.​amount.currency Base required CurrencyCode 📍4.0.1 FHIR Std.
ClaimResponse.payment.​type Base required Example Payment Type Codes 📦4.0.1 FHIR Std.
ClaimResponse.payment.​adjustmentReason Base required Payment Adjustment Reason Codes 📦4.0.1 FHIR Std.
ClaimResponse.fundsReserve Base required ClaimResponse Funds Reserve ValueSet 📦0.1.0 This IG
ClaimResponse.formCode Base required ClaimResponse Forms ValueSet 📦0.1.0 This IG
ClaimResponse.processNote.​type Base required NoteType 📍4.0.1 FHIR Std.
ClaimResponse.error.​code Base required ClaimResponse Adjudication Error ValueSet 📦0.1.0 This IG

Constraints

Id Grade Path(s) Description Expression
dom-2 error ClaimResponse If the resource is contained in another resource, it SHALL NOT contain nested Resources contained.contained.empty()
dom-3 error ClaimResponse 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 contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
dom-4 error ClaimResponse If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
dom-5 error ClaimResponse If a resource is contained in another resource, it SHALL NOT have a security label contained.meta.security.empty()
dom-6 best practice ClaimResponse A resource should have narrative for robust management text.`div`.exists()
ele-1 error **ALL** elements All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
ext-1 error **ALL** extensions Must have either extensions or value[x], not both extension.exists() != value.exists()

This structure is derived from ClaimResponse

NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
.. ClaimResponse 0..* ClaimResponse Response to a claim predetermination or preauthorization
... Slices for extension 1..* Extension Extension
Slice: Unordered, Open by value:url
.... extension:claimState S 1..1 CodeableConcept Claim Workflow State
URL: https://nshr-uat.sha.go.ke/fhir/StructureDefinition/eclaim-state-extension
.... extension:claimExpiry S 0..1 CodeableConcept Preauthorization Expiry Date
URL: https://nshr-uat.sha.go.ke/fhir/StructureDefinition/eclaim-expiry-extension
... status S 1..1 code active | cancelled | draft | entered-in-error
Fixed Value: active
... type S 1..1 CodeableConcept More granular claim type
.... coding S 1..* Coding Code defined by a terminology system
..... system S 1..1 uri Identity of the terminology system
..... code S 1..1 code Symbol in syntax defined by the system
..... display S 1..1 string Representation defined by the system
.... text S 0..1 string Plain text representation of the concept
... use S 1..1 code claim | preauthorization | predetermination
... created S 1..1 dateTime Response creation date
... insurer S 1..1 Reference(Organization) Party responsible for reimbursement
... request S 1..1 Reference(Claim) Id of resource triggering adjudication
... outcome S 1..1 code queued | complete | error | partial
Binding: ClaimProcessingCodes (required)
... payeeType S 0..1 CodeableConcept Party to be paid any benefits payable
Binding: ClaimResponse Payee Type ValueSet (required)
.... coding S 1..* Coding Code defined by a terminology system
..... system S 1..1 uri Identity of the terminology system
..... code S 1..1 code Symbol in syntax defined by the system
..... display S 1..1 string Representation defined by the system
.... text S 0..1 string Plain text representation of the concept
... item S 1..* BackboneElement Adjudication for claim line items
.... itemSequence S 1..1 positiveInt Claim item instance identifier
.... adjudication S 1..* BackboneElement Adjudication details
..... category S 1..1 CodeableConcept Type of adjudication information
Binding: AdjudicationValueCodes (required)
...... coding S 1..* Coding Code defined by a terminology system
....... system S 1..1 uri Identity of the terminology system
....... code S 1..1 code Symbol in syntax defined by the system
....... display S 1..1 string Representation defined by the system
...... text S 0..1 string Plain text representation of the concept
..... reason S 0..1 CodeableConcept Explanation of adjudication outcome
Binding: AdjudicationReasonCodes (required)
...... coding S 1..* Coding Code defined by a terminology system
....... system S 1..1 uri Identity of the terminology system
....... code S 1..1 code Symbol in syntax defined by the system
....... display S 1..1 string Representation defined by the system
...... text S 0..1 string Plain text representation of the concept
..... amount S 0..1 Money Monetary amount
... addItem S 0..* BackboneElement Insurer added line items
.... productOrService S 1..1 CodeableConcept Billing, service, product, or drug code
Binding: Kenya Social Health Authority Interventions ValueSet (required)
..... coding S 1..* Coding Code defined by a terminology system
...... system S 1..1 uri Identity of the terminology system
...... code S 1..1 code Symbol in syntax defined by the system
...... display S 1..1 string Representation defined by the system
..... text S 0..1 string Plain text representation of the concept
.... modifier S 0..1 CodeableConcept Service/Product billing modifiers
Binding: ModifierTypeCodes (required)
..... coding S 1..* Coding Code defined by a terminology system
...... system S 1..1 uri Identity of the terminology system
...... code S 1..1 code Symbol in syntax defined by the system
...... display S 1..1 string Representation defined by the system
..... text S 0..1 string Plain text representation of the concept
.... programCode S 0..1 CodeableConcept Program the product or service is provided under
Binding: ExampleProgramReasonCodes (required)
..... coding S 1..* Coding Code defined by a terminology system
...... system S 1..1 uri Identity of the terminology system
...... code S 1..1 code Symbol in syntax defined by the system
...... display S 1..1 string Representation defined by the system
..... text S 0..1 string Plain text representation of the concept
.... location[x] 0..1 CodeableConcept, Address, Reference(Location) Place of service or where product was supplied
Binding: ExampleServicePlaceCodes (required)
.... bodySite S 0..1 CodeableConcept Anatomical location
Binding: Kenya Institutional Body Site ValueSet (required)
..... coding S 1..* Coding Code defined by a terminology system
...... system S 1..1 uri Identity of the terminology system
...... code S 1..1 code Symbol in syntax defined by the system
...... display S 1..1 string Representation defined by the system
..... text S 0..1 string Plain text representation of the concept
.... subSite S 0..1 CodeableConcept Anatomical sub-location
Binding: Kenya Subsite ValueSet (required)
..... coding S 1..* Coding Code defined by a terminology system
...... system S 1..1 uri Identity of the terminology system
...... code S 1..1 code Symbol in syntax defined by the system
...... display S 1..1 string Representation defined by the system
..... text S 0..1 string Plain text representation of the concept
.... detail S 0..* BackboneElement Insurer added line details
..... productOrService S 1..1 CodeableConcept Billing, service, product, or drug code
Binding: Kenya Social Health Authority Interventions ValueSet (required)
...... coding S 1..* Coding Code defined by a terminology system
....... system S 1..1 uri Identity of the terminology system
....... code S 1..1 code Symbol in syntax defined by the system
....... display S 1..1 string Representation defined by the system
...... text S 0..1 string Plain text representation of the concept
..... modifier S 0..1 CodeableConcept Service/Product billing modifiers
Binding: ModifierTypeCodes (required)
...... coding S 1..* Coding Code defined by a terminology system
....... system S 1..1 uri Identity of the terminology system
....... code S 1..1 code Symbol in syntax defined by the system
....... display S 1..1 string Representation defined by the system
...... text S 0..1 string Plain text representation of the concept
..... subDetail S 0..* BackboneElement Insurer added line items
...... productOrService S 1..1 CodeableConcept Billing, service, product, or drug code
Binding: Kenya Social Health Authority Interventions ValueSet (required)
....... coding S 1..* Coding Code defined by a terminology system
........ system S 1..1 uri Identity of the terminology system
........ code S 1..1 code Symbol in syntax defined by the system
........ display S 1..1 string Representation defined by the system
....... text S 0..1 string Plain text representation of the concept
...... modifier S 0..1 CodeableConcept Service/Product billing modifiers
Binding: ModifierTypeCodes (required)
....... coding S 1..* Coding Code defined by a terminology system
........ system S 1..1 uri Identity of the terminology system
........ code S 1..1 code Symbol in syntax defined by the system
........ display S 1..1 string Representation defined by the system
....... text S 0..1 string Plain text representation of the concept
... total S 0..* BackboneElement Adjudication totals
.... category S 1..1 CodeableConcept Type of adjudication information
Binding: AdjudicationValueCodes (required)
..... coding S 1..* Coding Code defined by a terminology system
...... system S 1..1 uri Identity of the terminology system
...... code S 1..1 code Symbol in syntax defined by the system
...... display S 1..1 string Representation defined by the system
..... text S 0..1 string Plain text representation of the concept
.... amount S 1..1 Money Financial total for the category
..... currency S 1..1 code ISO 4217 Currency Code
... payment S 0..1 BackboneElement Payment Details
.... type S 1..1 CodeableConcept Partial or complete payment
Binding: ExamplePaymentTypeCodes (required)
..... coding S 1..* Coding Code defined by a terminology system
...... system S 1..1 uri Identity of the terminology system
...... code S 1..1 code Symbol in syntax defined by the system
...... display S 1..1 string Representation defined by the system
..... text S 0..1 string Plain text representation of the concept
.... adjustmentReason S 0..1 CodeableConcept Explanation for the adjustment
Binding: PaymentAdjustmentReasonCodes (required)
..... coding S 1..* Coding Code defined by a terminology system
...... system S 1..1 uri Identity of the terminology system
...... code S 1..1 code Symbol in syntax defined by the system
...... display S 1..1 string Representation defined by the system
..... text S 0..1 string Plain text representation of the concept
... fundsReserve S 0..1 CodeableConcept Funds reserved status
Binding: ClaimResponse Funds Reserve ValueSet (required)
.... coding S 1..* Coding Code defined by a terminology system
..... system S 1..1 uri Identity of the terminology system
..... code S 1..1 code Symbol in syntax defined by the system
..... display S 1..1 string Representation defined by the system
.... text S 0..1 string Plain text representation of the concept
... formCode S 0..1 CodeableConcept Printed form identifier
Binding: ClaimResponse Forms ValueSet (required)
.... coding S 1..* Coding Code defined by a terminology system
..... system S 1..1 uri Identity of the terminology system
..... code S 1..1 code Symbol in syntax defined by the system
..... display S 1..1 string Representation defined by the system
.... text S 0..1 string Plain text representation of the concept
... processNote S 0..* BackboneElement Note concerning adjudication
.... number S 0..1 positiveInt Note instance identifier
.... type S 0..1 code display | print | printoper
.... text S 1..1 string Note explanatory text
... error S 0..* BackboneElement Processing errors
.... code S 1..1 CodeableConcept Error code detailing processing issues
Binding: ClaimResponse Adjudication Error ValueSet (required)
..... coding S 1..* Coding Code defined by a terminology system
...... system S 1..1 uri Identity of the terminology system
...... code S 1..1 code Symbol in syntax defined by the system
...... display S 1..1 string Representation defined by the system
..... text S 0..1 string Plain text representation of the concept

doco Documentation for this format

Terminology Bindings (Differential)

Path Status Usage ValueSet Version Source
ClaimResponse.subType Base required Example Claim SubType Codes 📦4.0.1 FHIR Std.
ClaimResponse.outcome Base required Claim Processing Codes 📦4.0.1 FHIR Std.
ClaimResponse.payeeType Base required ClaimResponse Payee Type ValueSet 📦0.1.0 This IG
ClaimResponse.item.adjudication.​category Base required Adjudication Value Codes 📦4.0.1 FHIR Std.
ClaimResponse.item.adjudication.​reason Base required Adjudication Reason Codes 📦4.0.1 FHIR Std.
ClaimResponse.addItem.​productOrService Base required Kenya Social Health Authority Interventions ValueSet 📦0.1.0 This IG
ClaimResponse.addItem.​modifier Base required Modifier type Codes 📦4.0.1 FHIR Std.
ClaimResponse.addItem.​programCode Base required Example Program Reason Codes 📦4.0.1 FHIR Std.
ClaimResponse.addItem.​location[x] Base required Example Service Place Codes 📦4.0.1 FHIR Std.
ClaimResponse.addItem.​bodySite Base required Kenya Institutional Body Site ValueSet 📦0.1.0 This IG
ClaimResponse.addItem.​subSite Base required Kenya Subsite ValueSet 📦0.1.0 This IG
ClaimResponse.addItem.​detail.productOrService Base required Kenya Social Health Authority Interventions ValueSet 📦0.1.0 This IG
ClaimResponse.addItem.​detail.modifier Base required Modifier type Codes 📦4.0.1 FHIR Std.
ClaimResponse.addItem.​detail.subDetail.productOrService Base required Kenya Social Health Authority Interventions ValueSet 📦0.1.0 This IG
ClaimResponse.addItem.​detail.subDetail.modifier Base required Modifier type Codes 📦4.0.1 FHIR Std.
ClaimResponse.total.​category Base required Adjudication Value Codes 📦4.0.1 FHIR Std.
ClaimResponse.payment.​type Base required Example Payment Type Codes 📦4.0.1 FHIR Std.
ClaimResponse.payment.​adjustmentReason Base required Payment Adjustment Reason Codes 📦4.0.1 FHIR Std.
ClaimResponse.fundsReserve Base required ClaimResponse Funds Reserve ValueSet 📦0.1.0 This IG
ClaimResponse.formCode Base required ClaimResponse Forms ValueSet 📦0.1.0 This IG
ClaimResponse.error.​code Base required ClaimResponse Adjudication Error ValueSet 📦0.1.0 This IG
NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
.. ClaimResponse 0..* ClaimResponse Response to a claim predetermination or preauthorization
... id Σ 0..1 id Logical id of this artifact
... meta Σ 0..1 Meta Metadata about the resource
... implicitRules ?!Σ 0..1 uri A set of rules under which this content was created
... language 0..1 code Language of the resource content
Binding: CommonLanguages (preferred): A human language.
Additional BindingsPurpose
AllLanguages Max Binding
... text 0..1 Narrative Text summary of the resource, for human interpretation
This profile does not constrain the narrative in regard to content, language, or traceability to data elements
... contained 0..* Resource Contained, inline Resources
... Slices for extension 1..* Extension Extension
Slice: Unordered, Open by value:url
.... extension:claimState S 1..1 CodeableConcept Claim Workflow State
URL: https://nshr-uat.sha.go.ke/fhir/StructureDefinition/eclaim-state-extension
.... extension:claimExpiry S 0..1 CodeableConcept Preauthorization Expiry Date
URL: https://nshr-uat.sha.go.ke/fhir/StructureDefinition/eclaim-expiry-extension
... modifierExtension ?! 0..* Extension Extensions that cannot be ignored
... identifier 0..* Identifier Business Identifier for a claim response
... status ?!SΣ 1..1 code active | cancelled | draft | entered-in-error
Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance.
Fixed Value: active
... type SΣ 1..1 CodeableConcept More granular claim type
Binding: ClaimTypeCodes (extensible): The type or discipline-style of the claim.
... subType S 0..1 CodeableConcept More granular claim type
Binding: ExampleClaimSubTypeCodes (required)
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
.... coding SΣ 1..* Coding Code defined by a terminology system
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
..... system SΣ 1..1 uri Identity of the terminology system
..... version Σ 0..1 string Version of the system - if relevant
..... code SΣ 1..1 code Symbol in syntax defined by the system
..... display SΣ 1..1 string Representation defined by the system
..... userSelected Σ 0..1 boolean If this coding was chosen directly by the user
.... text SΣ 0..1 string Plain text representation of the concept
... use SΣ 1..1 code claim | preauthorization | predetermination
Binding: Use (required): Claim, preauthorization, predetermination.
... patient Σ 1..1 Reference(Patient) The recipient of the products and services
... created SΣ 1..1 dateTime Response creation date
... insurer SΣ 1..1 Reference(Organization) Party responsible for reimbursement
... requestor 0..1 Reference(Practitioner | PractitionerRole | Organization) Party responsible for the claim
... request SΣ 1..1 Reference(Claim) Id of resource triggering adjudication
... outcome SΣ 1..1 code queued | complete | error | partial
Binding: ClaimProcessingCodes (required)
... disposition 0..1 string Disposition Message
... preAuthRef 0..1 string Preauthorization reference
... preAuthPeriod 0..1 Period Preauthorization reference effective period
... payeeType S 0..1 CodeableConcept Party to be paid any benefits payable
Binding: ClaimResponse Payee Type ValueSet (required)
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
.... coding SΣ 1..* Coding Code defined by a terminology system
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
..... system SΣ 1..1 uri Identity of the terminology system
..... version Σ 0..1 string Version of the system - if relevant
..... code SΣ 1..1 code Symbol in syntax defined by the system
..... display SΣ 1..1 string Representation defined by the system
..... userSelected Σ 0..1 boolean If this coding was chosen directly by the user
.... text SΣ 0..1 string Plain text representation of the concept
... item S 1..* BackboneElement Adjudication for claim line items
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... itemSequence S 1..1 positiveInt Claim item instance identifier
.... noteNumber 0..* positiveInt Applicable note numbers
.... adjudication S 1..* BackboneElement Adjudication details
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... category S 1..1 CodeableConcept Type of adjudication information
Binding: AdjudicationValueCodes (required)
...... id 0..1 string Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
...... coding SΣ 1..* Coding Code defined by a terminology system
....... id 0..1 string Unique id for inter-element referencing
....... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
....... system SΣ 1..1 uri Identity of the terminology system
....... version Σ 0..1 string Version of the system - if relevant
....... code SΣ 1..1 code Symbol in syntax defined by the system
....... display SΣ 1..1 string Representation defined by the system
....... userSelected Σ 0..1 boolean If this coding was chosen directly by the user
...... text SΣ 0..1 string Plain text representation of the concept
..... reason S 0..1 CodeableConcept Explanation of adjudication outcome
Binding: AdjudicationReasonCodes (required)
...... id 0..1 string Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
...... coding SΣ 1..* Coding Code defined by a terminology system
....... id 0..1 string Unique id for inter-element referencing
....... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
....... system SΣ 1..1 uri Identity of the terminology system
....... version Σ 0..1 string Version of the system - if relevant
....... code SΣ 1..1 code Symbol in syntax defined by the system
....... display SΣ 1..1 string Representation defined by the system
....... userSelected Σ 0..1 boolean If this coding was chosen directly by the user
...... text SΣ 0..1 string Plain text representation of the concept
..... amount S 0..1 Money Monetary amount
..... value 0..1 decimal Non-monetary value
.... detail 0..* BackboneElement Adjudication for claim details
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... detailSequence 1..1 positiveInt Claim detail instance identifier
..... noteNumber 0..* positiveInt Applicable note numbers
..... adjudication 1..* See adjudication (ClaimResponse) Detail level adjudication details
..... subDetail 0..* BackboneElement Adjudication for claim sub-details
...... id 0..1 string Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
...... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
...... subDetailSequence 1..1 positiveInt Claim sub-detail instance identifier
...... noteNumber 0..* positiveInt Applicable note numbers
...... adjudication 0..* See adjudication (ClaimResponse) Subdetail level adjudication details
... addItem S 0..* BackboneElement Insurer added line items
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... itemSequence 0..* positiveInt Item sequence number
.... detailSequence 0..* positiveInt Detail sequence number
.... subdetailSequence 0..* positiveInt Subdetail sequence number
.... provider 0..* Reference(Practitioner | PractitionerRole | Organization) Authorized providers
.... productOrService S 1..1 CodeableConcept Billing, service, product, or drug code
Binding: Kenya Social Health Authority Interventions ValueSet (required)
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
..... coding SΣ 1..* Coding Code defined by a terminology system
...... id 0..1 string Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
...... system SΣ 1..1 uri Identity of the terminology system
...... version Σ 0..1 string Version of the system - if relevant
...... code SΣ 1..1 code Symbol in syntax defined by the system
...... display SΣ 1..1 string Representation defined by the system
...... userSelected Σ 0..1 boolean If this coding was chosen directly by the user
..... text SΣ 0..1 string Plain text representation of the concept
.... modifier S 0..1 CodeableConcept Service/Product billing modifiers
Binding: ModifierTypeCodes (required)
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
..... coding SΣ 1..* Coding Code defined by a terminology system
...... id 0..1 string Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
...... system SΣ 1..1 uri Identity of the terminology system
...... version Σ 0..1 string Version of the system - if relevant
...... code SΣ 1..1 code Symbol in syntax defined by the system
...... display SΣ 1..1 string Representation defined by the system
...... userSelected Σ 0..1 boolean If this coding was chosen directly by the user
..... text SΣ 0..1 string Plain text representation of the concept
.... programCode S 0..1 CodeableConcept Program the product or service is provided under
Binding: ExampleProgramReasonCodes (required)
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
..... coding SΣ 1..* Coding Code defined by a terminology system
...... id 0..1 string Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
...... system SΣ 1..1 uri Identity of the terminology system
...... version Σ 0..1 string Version of the system - if relevant
...... code SΣ 1..1 code Symbol in syntax defined by the system
...... display SΣ 1..1 string Representation defined by the system
...... userSelected Σ 0..1 boolean If this coding was chosen directly by the user
..... text SΣ 0..1 string Plain text representation of the concept
.... serviced[x] 0..1 Date or dates of service or product delivery
..... servicedDate date
..... servicedPeriod Period
.... location[x] 0..1 Place of service or where product was supplied
Binding: ExampleServicePlaceCodes (required)
..... locationCodeableConcept CodeableConcept
..... locationAddress Address
..... locationReference Reference(Location)
.... quantity 0..1 SimpleQuantity(4.0.1) Count of products or services
.... unitPrice 0..1 Money Fee, charge or cost per item
.... factor 0..1 decimal Price scaling factor
.... net 0..1 Money Total item cost
.... bodySite S 0..1 CodeableConcept Anatomical location
Binding: Kenya Institutional Body Site ValueSet (required)
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
..... coding SΣ 1..* Coding Code defined by a terminology system
...... id 0..1 string Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
...... system SΣ 1..1 uri Identity of the terminology system
...... version Σ 0..1 string Version of the system - if relevant
...... code SΣ 1..1 code Symbol in syntax defined by the system
...... display SΣ 1..1 string Representation defined by the system
...... userSelected Σ 0..1 boolean If this coding was chosen directly by the user
..... text SΣ 0..1 string Plain text representation of the concept
.... subSite S 0..1 CodeableConcept Anatomical sub-location
Binding: Kenya Subsite ValueSet (required)
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
..... coding SΣ 1..* Coding Code defined by a terminology system
...... id 0..1 string Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
...... system SΣ 1..1 uri Identity of the terminology system
...... version Σ 0..1 string Version of the system - if relevant
...... code SΣ 1..1 code Symbol in syntax defined by the system
...... display SΣ 1..1 string Representation defined by the system
...... userSelected Σ 0..1 boolean If this coding was chosen directly by the user
..... text SΣ 0..1 string Plain text representation of the concept
.... noteNumber 0..* positiveInt Applicable note numbers
.... adjudication 1..* See adjudication (ClaimResponse) Added items adjudication
.... detail S 0..* BackboneElement Insurer added line details
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... productOrService S 1..1 CodeableConcept Billing, service, product, or drug code
Binding: Kenya Social Health Authority Interventions ValueSet (required)
...... id 0..1 string Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
...... coding SΣ 1..* Coding Code defined by a terminology system
....... id 0..1 string Unique id for inter-element referencing
....... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
....... system SΣ 1..1 uri Identity of the terminology system
....... version Σ 0..1 string Version of the system - if relevant
....... code SΣ 1..1 code Symbol in syntax defined by the system
....... display SΣ 1..1 string Representation defined by the system
....... userSelected Σ 0..1 boolean If this coding was chosen directly by the user
...... text SΣ 0..1 string Plain text representation of the concept
..... modifier S 0..1 CodeableConcept Service/Product billing modifiers
Binding: ModifierTypeCodes (required)
...... id 0..1 string Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
...... coding SΣ 1..* Coding Code defined by a terminology system
....... id 0..1 string Unique id for inter-element referencing
....... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
....... system SΣ 1..1 uri Identity of the terminology system
....... version Σ 0..1 string Version of the system - if relevant
....... code SΣ 1..1 code Symbol in syntax defined by the system
....... display SΣ 1..1 string Representation defined by the system
....... userSelected Σ 0..1 boolean If this coding was chosen directly by the user
...... text SΣ 0..1 string Plain text representation of the concept
..... quantity 0..1 SimpleQuantity(4.0.1) Count of products or services
..... unitPrice 0..1 Money Fee, charge or cost per item
..... factor 0..1 decimal Price scaling factor
..... net 0..1 Money Total item cost
..... noteNumber 0..* positiveInt Applicable note numbers
..... adjudication 1..* See adjudication (ClaimResponse) Added items detail adjudication
..... subDetail S 0..* BackboneElement Insurer added line items
...... id 0..1 string Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
...... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
...... productOrService S 1..1 CodeableConcept Billing, service, product, or drug code
Binding: Kenya Social Health Authority Interventions ValueSet (required)
....... id 0..1 string Unique id for inter-element referencing
....... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
....... coding SΣ 1..* Coding Code defined by a terminology system
........ id 0..1 string Unique id for inter-element referencing
........ extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
........ system SΣ 1..1 uri Identity of the terminology system
........ version Σ 0..1 string Version of the system - if relevant
........ code SΣ 1..1 code Symbol in syntax defined by the system
........ display SΣ 1..1 string Representation defined by the system
........ userSelected Σ 0..1 boolean If this coding was chosen directly by the user
....... text SΣ 0..1 string Plain text representation of the concept
...... modifier S 0..1 CodeableConcept Service/Product billing modifiers
Binding: ModifierTypeCodes (required)
....... id 0..1 string Unique id for inter-element referencing
....... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
....... coding SΣ 1..* Coding Code defined by a terminology system
........ id 0..1 string Unique id for inter-element referencing
........ extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
........ system SΣ 1..1 uri Identity of the terminology system
........ version Σ 0..1 string Version of the system - if relevant
........ code SΣ 1..1 code Symbol in syntax defined by the system
........ display SΣ 1..1 string Representation defined by the system
........ userSelected Σ 0..1 boolean If this coding was chosen directly by the user
....... text SΣ 0..1 string Plain text representation of the concept
...... quantity 0..1 SimpleQuantity(4.0.1) Count of products or services
...... unitPrice 0..1 Money Fee, charge or cost per item
...... factor 0..1 decimal Price scaling factor
...... net 0..1 Money Total item cost
...... noteNumber 0..* positiveInt Applicable note numbers
...... adjudication 1..* See adjudication (ClaimResponse) Added items detail adjudication
... adjudication 0..* See adjudication (ClaimResponse) Header-level adjudication
... total SΣ 0..* BackboneElement Adjudication totals
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... category SΣ 1..1 CodeableConcept Type of adjudication information
Binding: AdjudicationValueCodes (required)
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
..... coding SΣ 1..* Coding Code defined by a terminology system
...... id 0..1 string Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
...... system SΣ 1..1 uri Identity of the terminology system
...... version Σ 0..1 string Version of the system - if relevant
...... code SΣ 1..1 code Symbol in syntax defined by the system
...... display SΣ 1..1 string Representation defined by the system
...... userSelected Σ 0..1 boolean If this coding was chosen directly by the user
..... text SΣ 0..1 string Plain text representation of the concept
.... amount SΣ 1..1 Money Financial total for the category
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
..... value Σ 0..1 decimal Numerical value (with implicit precision)
..... currency SΣ 1..1 code ISO 4217 Currency Code
Binding: Currencies (required): A code indicating the currency, taken from ISO 4217.
... payment S 0..1 BackboneElement Payment Details
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... type S 1..1 CodeableConcept Partial or complete payment
Binding: ExamplePaymentTypeCodes (required)
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
..... coding SΣ 1..* Coding Code defined by a terminology system
...... id 0..1 string Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
...... system SΣ 1..1 uri Identity of the terminology system
...... version Σ 0..1 string Version of the system - if relevant
...... code SΣ 1..1 code Symbol in syntax defined by the system
...... display SΣ 1..1 string Representation defined by the system
...... userSelected Σ 0..1 boolean If this coding was chosen directly by the user
..... text SΣ 0..1 string Plain text representation of the concept
.... adjustment 0..1 Money Payment adjustment for non-claim issues
.... adjustmentReason S 0..1 CodeableConcept Explanation for the adjustment
Binding: PaymentAdjustmentReasonCodes (required)
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
..... coding SΣ 1..* Coding Code defined by a terminology system
...... id 0..1 string Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
...... system SΣ 1..1 uri Identity of the terminology system
...... version Σ 0..1 string Version of the system - if relevant
...... code SΣ 1..1 code Symbol in syntax defined by the system
...... display SΣ 1..1 string Representation defined by the system
...... userSelected Σ 0..1 boolean If this coding was chosen directly by the user
..... text SΣ 0..1 string Plain text representation of the concept
.... date 0..1 date Expected date of payment
.... amount 1..1 Money Payable amount after adjustment
.... identifier 0..1 Identifier Business identifier for the payment
... fundsReserve S 0..1 CodeableConcept Funds reserved status
Binding: ClaimResponse Funds Reserve ValueSet (required)
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
.... coding SΣ 1..* Coding Code defined by a terminology system
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
..... system SΣ 1..1 uri Identity of the terminology system
..... version Σ 0..1 string Version of the system - if relevant
..... code SΣ 1..1 code Symbol in syntax defined by the system
..... display SΣ 1..1 string Representation defined by the system
..... userSelected Σ 0..1 boolean If this coding was chosen directly by the user
.... text SΣ 0..1 string Plain text representation of the concept
... formCode S 0..1 CodeableConcept Printed form identifier
Binding: ClaimResponse Forms ValueSet (required)
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
.... coding SΣ 1..* Coding Code defined by a terminology system
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
..... system SΣ 1..1 uri Identity of the terminology system
..... version Σ 0..1 string Version of the system - if relevant
..... code SΣ 1..1 code Symbol in syntax defined by the system
..... display SΣ 1..1 string Representation defined by the system
..... userSelected Σ 0..1 boolean If this coding was chosen directly by the user
.... text SΣ 0..1 string Plain text representation of the concept
... form 0..1 Attachment Printed reference or actual form
... processNote S 0..* BackboneElement Note concerning adjudication
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... number S 0..1 positiveInt Note instance identifier
.... type S 0..1 code display | print | printoper
Binding: NoteType (required): The presentation types of notes.
.... text S 1..1 string Note explanatory text
.... language 0..1 CodeableConcept Language of the text
Binding: CommonLanguages (preferred): A human language.
Additional BindingsPurpose
AllLanguages Max Binding
... communicationRequest 0..* Reference(CommunicationRequest) Request for additional information
... insurance 0..* BackboneElement Patient insurance information
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... sequence 1..1 positiveInt Insurance instance identifier
.... focal 1..1 boolean Coverage to be used for adjudication
.... coverage 1..1 Reference(Coverage) Insurance information
.... businessArrangement 0..1 string Additional provider contract number
.... claimResponse 0..1 Reference(ClaimResponse) Adjudication results
... error S 0..* BackboneElement Processing errors
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... itemSequence 0..1 positiveInt Item sequence number
.... detailSequence 0..1 positiveInt Detail sequence number
.... subDetailSequence 0..1 positiveInt Subdetail sequence number
.... code S 1..1 CodeableConcept Error code detailing processing issues
Binding: ClaimResponse Adjudication Error ValueSet (required)
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
..... coding SΣ 1..* Coding Code defined by a terminology system
...... id 0..1 string Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
...... system SΣ 1..1 uri Identity of the terminology system
...... version Σ 0..1 string Version of the system - if relevant
...... code SΣ 1..1 code Symbol in syntax defined by the system
...... display SΣ 1..1 string Representation defined by the system
...... userSelected Σ 0..1 boolean If this coding was chosen directly by the user
..... text SΣ 0..1 string Plain text representation of the concept

doco Documentation for this format

Terminology Bindings

Path Status Usage ValueSet Version Source
ClaimResponse.language Base preferred Common Languages 📍4.0.1 FHIR Std.
ClaimResponse.status Base required Financial Resource Status Codes 📍4.0.1 FHIR Std.
ClaimResponse.type Base extensible Claim Type Codes 📍4.0.1 FHIR Std.
ClaimResponse.subType Base required Example Claim SubType Codes 📦4.0.1 FHIR Std.
ClaimResponse.use Base required Use 📍4.0.1 FHIR Std.
ClaimResponse.outcome Base required Claim Processing Codes 📦4.0.1 FHIR Std.
ClaimResponse.payeeType Base required ClaimResponse Payee Type ValueSet 📦0.1.0 This IG
ClaimResponse.item.adjudication.​category Base required Adjudication Value Codes 📦4.0.1 FHIR Std.
ClaimResponse.item.adjudication.​reason Base required Adjudication Reason Codes 📦4.0.1 FHIR Std.
ClaimResponse.addItem.​productOrService Base required Kenya Social Health Authority Interventions ValueSet 📦0.1.0 This IG
ClaimResponse.addItem.​modifier Base required Modifier type Codes 📦4.0.1 FHIR Std.
ClaimResponse.addItem.​programCode Base required Example Program Reason Codes 📦4.0.1 FHIR Std.
ClaimResponse.addItem.​location[x] Base required Example Service Place Codes 📦4.0.1 FHIR Std.
ClaimResponse.addItem.​bodySite Base required Kenya Institutional Body Site ValueSet 📦0.1.0 This IG
ClaimResponse.addItem.​subSite Base required Kenya Subsite ValueSet 📦0.1.0 This IG
ClaimResponse.addItem.​detail.productOrService Base required Kenya Social Health Authority Interventions ValueSet 📦0.1.0 This IG
ClaimResponse.addItem.​detail.modifier Base required Modifier type Codes 📦4.0.1 FHIR Std.
ClaimResponse.addItem.​detail.subDetail.productOrService Base required Kenya Social Health Authority Interventions ValueSet 📦0.1.0 This IG
ClaimResponse.addItem.​detail.subDetail.modifier Base required Modifier type Codes 📦4.0.1 FHIR Std.
ClaimResponse.total.​category Base required Adjudication Value Codes 📦4.0.1 FHIR Std.
ClaimResponse.total.​amount.currency Base required CurrencyCode 📍4.0.1 FHIR Std.
ClaimResponse.payment.​type Base required Example Payment Type Codes 📦4.0.1 FHIR Std.
ClaimResponse.payment.​adjustmentReason Base required Payment Adjustment Reason Codes 📦4.0.1 FHIR Std.
ClaimResponse.fundsReserve Base required ClaimResponse Funds Reserve ValueSet 📦0.1.0 This IG
ClaimResponse.formCode Base required ClaimResponse Forms ValueSet 📦0.1.0 This IG
ClaimResponse.processNote.​type Base required NoteType 📍4.0.1 FHIR Std.
ClaimResponse.processNote.​language Base preferred Common Languages 📍4.0.1 FHIR Std.
ClaimResponse.error.​code Base required ClaimResponse Adjudication Error ValueSet 📦0.1.0 This IG

Constraints

Id Grade Path(s) Description Expression
dom-2 error ClaimResponse If the resource is contained in another resource, it SHALL NOT contain nested Resources contained.contained.empty()
dom-3 error ClaimResponse 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 contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
dom-4 error ClaimResponse If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
dom-5 error ClaimResponse If a resource is contained in another resource, it SHALL NOT have a security label contained.meta.security.empty()
dom-6 best practice ClaimResponse A resource should have narrative for robust management text.`div`.exists()
ele-1 error **ALL** elements All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
ext-1 error **ALL** extensions Must have either extensions or value[x], not both extension.exists() != value.exists()

This structure is derived from ClaimResponse

Summary

Mandatory: 8 elements(73 nested mandatory elements)
Must-Support: 139 elements
Fixed: 1 element

Extensions

This structure refers to these extensions:

Key Elements View

NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
.. ClaimResponse 0..* ClaimResponse Response to a claim predetermination or preauthorization
... implicitRules ?!Σ 0..1 uri A set of rules under which this content was created
... Slices for extension 1..* Extension Extension
Slice: Unordered, Open by value:url
.... extension:claimState S 1..1 CodeableConcept Claim Workflow State
URL: https://nshr-uat.sha.go.ke/fhir/StructureDefinition/eclaim-state-extension
.... extension:claimExpiry S 0..1 CodeableConcept Preauthorization Expiry Date
URL: https://nshr-uat.sha.go.ke/fhir/StructureDefinition/eclaim-expiry-extension
... modifierExtension ?! 0..* Extension Extensions that cannot be ignored
... type SΣ 1..1 CodeableConcept More granular claim type
Binding: ClaimTypeCodes (extensible): The type or discipline-style of the claim.
... subType S 0..1 CodeableConcept More granular claim type
Binding: ExampleClaimSubTypeCodes (required)
.... coding SΣ 1..* Coding Code defined by a terminology system
..... system SΣ 1..1 uri Identity of the terminology system
..... code SΣ 1..1 code Symbol in syntax defined by the system
..... display SΣ 1..1 string Representation defined by the system
.... text SΣ 0..1 string Plain text representation of the concept
... use SΣ 1..1 code claim | preauthorization | predetermination
Binding: Use (required): Claim, preauthorization, predetermination.
... patient Σ 1..1 Reference(Patient) The recipient of the products and services
... created SΣ 1..1 dateTime Response creation date
... insurer SΣ 1..1 Reference(Organization) Party responsible for reimbursement
... request SΣ 1..1 Reference(Claim) Id of resource triggering adjudication
... outcome SΣ 1..1 code queued | complete | error | partial
Binding: ClaimProcessingCodes (required)
... payeeType S 0..1 CodeableConcept Party to be paid any benefits payable
Binding: ClaimResponse Payee Type ValueSet (required)
.... coding SΣ 1..* Coding Code defined by a terminology system
..... system SΣ 1..1 uri Identity of the terminology system
..... code SΣ 1..1 code Symbol in syntax defined by the system
..... display SΣ 1..1 string Representation defined by the system
.... text SΣ 0..1 string Plain text representation of the concept
... item S 1..* BackboneElement Adjudication for claim line items
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... itemSequence S 1..1 positiveInt Claim item instance identifier
.... adjudication S 1..* BackboneElement Adjudication details
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... category S 1..1 CodeableConcept Type of adjudication information
Binding: AdjudicationValueCodes (required)
...... coding SΣ 1..* Coding Code defined by a terminology system
....... system SΣ 1..1 uri Identity of the terminology system
....... code SΣ 1..1 code Symbol in syntax defined by the system
....... display SΣ 1..1 string Representation defined by the system
...... text SΣ 0..1 string Plain text representation of the concept
..... reason S 0..1 CodeableConcept Explanation of adjudication outcome
Binding: AdjudicationReasonCodes (required)
...... coding SΣ 1..* Coding Code defined by a terminology system
....... system SΣ 1..1 uri Identity of the terminology system
....... code SΣ 1..1 code Symbol in syntax defined by the system
....... display SΣ 1..1 string Representation defined by the system
...... text SΣ 0..1 string Plain text representation of the concept
..... amount S 0..1 Money Monetary amount
... addItem S 0..* BackboneElement Insurer added line items
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... productOrService S 1..1 CodeableConcept Billing, service, product, or drug code
Binding: Kenya Social Health Authority Interventions ValueSet (required)
..... coding SΣ 1..* Coding Code defined by a terminology system
...... system SΣ 1..1 uri Identity of the terminology system
...... code SΣ 1..1 code Symbol in syntax defined by the system
...... display SΣ 1..1 string Representation defined by the system
..... text SΣ 0..1 string Plain text representation of the concept
.... modifier S 0..1 CodeableConcept Service/Product billing modifiers
Binding: ModifierTypeCodes (required)
..... coding SΣ 1..* Coding Code defined by a terminology system
...... system SΣ 1..1 uri Identity of the terminology system
...... code SΣ 1..1 code Symbol in syntax defined by the system
...... display SΣ 1..1 string Representation defined by the system
..... text SΣ 0..1 string Plain text representation of the concept
.... programCode S 0..1 CodeableConcept Program the product or service is provided under
Binding: ExampleProgramReasonCodes (required)
..... coding SΣ 1..* Coding Code defined by a terminology system
...... system SΣ 1..1 uri Identity of the terminology system
...... code SΣ 1..1 code Symbol in syntax defined by the system
...... display SΣ 1..1 string Representation defined by the system
..... text SΣ 0..1 string Plain text representation of the concept
.... location[x] 0..1 Place of service or where product was supplied
Binding: ExampleServicePlaceCodes (required)
..... locationCodeableConcept CodeableConcept
..... locationAddress Address
..... locationReference Reference(Location)
.... bodySite S 0..1 CodeableConcept Anatomical location
Binding: Kenya Institutional Body Site ValueSet (required)
..... coding SΣ 1..* Coding Code defined by a terminology system
...... system SΣ 1..1 uri Identity of the terminology system
...... code SΣ 1..1 code Symbol in syntax defined by the system
...... display SΣ 1..1 string Representation defined by the system
..... text SΣ 0..1 string Plain text representation of the concept
.... subSite S 0..1 CodeableConcept Anatomical sub-location
Binding: Kenya Subsite ValueSet (required)
..... coding SΣ 1..* Coding Code defined by a terminology system
...... system SΣ 1..1 uri Identity of the terminology system
...... code SΣ 1..1 code Symbol in syntax defined by the system
...... display SΣ 1..1 string Representation defined by the system
..... text SΣ 0..1 string Plain text representation of the concept
.... adjudication 1..* See adjudication (ClaimResponse) Added items adjudication
.... detail S 0..* BackboneElement Insurer added line details
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... productOrService S 1..1 CodeableConcept Billing, service, product, or drug code
Binding: Kenya Social Health Authority Interventions ValueSet (required)
...... coding SΣ 1..* Coding Code defined by a terminology system
....... system SΣ 1..1 uri Identity of the terminology system
....... code SΣ 1..1 code Symbol in syntax defined by the system
....... display SΣ 1..1 string Representation defined by the system
...... text SΣ 0..1 string Plain text representation of the concept
..... modifier S 0..1 CodeableConcept Service/Product billing modifiers
Binding: ModifierTypeCodes (required)
...... coding SΣ 1..* Coding Code defined by a terminology system
....... system SΣ 1..1 uri Identity of the terminology system
....... code SΣ 1..1 code Symbol in syntax defined by the system
....... display SΣ 1..1 string Representation defined by the system
...... text SΣ 0..1 string Plain text representation of the concept
..... adjudication 1..* See adjudication (ClaimResponse) Added items detail adjudication
..... subDetail S 0..* BackboneElement Insurer added line items
...... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
...... productOrService S 1..1 CodeableConcept Billing, service, product, or drug code
Binding: Kenya Social Health Authority Interventions ValueSet (required)
....... coding SΣ 1..* Coding Code defined by a terminology system
........ system SΣ 1..1 uri Identity of the terminology system
........ code SΣ 1..1 code Symbol in syntax defined by the system
........ display SΣ 1..1 string Representation defined by the system
....... text SΣ 0..1 string Plain text representation of the concept
...... modifier S 0..1 CodeableConcept Service/Product billing modifiers
Binding: ModifierTypeCodes (required)
....... coding SΣ 1..* Coding Code defined by a terminology system
........ system SΣ 1..1 uri Identity of the terminology system
........ code SΣ 1..1 code Symbol in syntax defined by the system
........ display SΣ 1..1 string Representation defined by the system
....... text SΣ 0..1 string Plain text representation of the concept
...... adjudication 1..* See adjudication (ClaimResponse) Added items detail adjudication
... total SΣ 0..* BackboneElement Adjudication totals
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... category SΣ 1..1 CodeableConcept Type of adjudication information
Binding: AdjudicationValueCodes (required)
..... coding SΣ 1..* Coding Code defined by a terminology system
...... system SΣ 1..1 uri Identity of the terminology system
...... code SΣ 1..1 code Symbol in syntax defined by the system
...... display SΣ 1..1 string Representation defined by the system
..... text SΣ 0..1 string Plain text representation of the concept
.... amount SΣ 1..1 Money Financial total for the category
..... currency SΣ 1..1 code ISO 4217 Currency Code
Binding: Currencies (required): A code indicating the currency, taken from ISO 4217.
... payment S 0..1 BackboneElement Payment Details
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... type S 1..1 CodeableConcept Partial or complete payment
Binding: ExamplePaymentTypeCodes (required)
..... coding SΣ 1..* Coding Code defined by a terminology system
...... system SΣ 1..1 uri Identity of the terminology system
...... code SΣ 1..1 code Symbol in syntax defined by the system
...... display SΣ 1..1 string Representation defined by the system
..... text SΣ 0..1 string Plain text representation of the concept
.... adjustmentReason S 0..1 CodeableConcept Explanation for the adjustment
Binding: PaymentAdjustmentReasonCodes (required)
..... coding SΣ 1..* Coding Code defined by a terminology system
...... system SΣ 1..1 uri Identity of the terminology system
...... code SΣ 1..1 code Symbol in syntax defined by the system
...... display SΣ 1..1 string Representation defined by the system
..... text SΣ 0..1 string Plain text representation of the concept
.... amount 1..1 Money Payable amount after adjustment
... fundsReserve S 0..1 CodeableConcept Funds reserved status
Binding: ClaimResponse Funds Reserve ValueSet (required)
.... coding SΣ 1..* Coding Code defined by a terminology system
..... system SΣ 1..1 uri Identity of the terminology system
..... code SΣ 1..1 code Symbol in syntax defined by the system
..... display SΣ 1..1 string Representation defined by the system
.... text SΣ 0..1 string Plain text representation of the concept
... formCode S 0..1 CodeableConcept Printed form identifier
Binding: ClaimResponse Forms ValueSet (required)
.... coding SΣ 1..* Coding Code defined by a terminology system
..... system SΣ 1..1 uri Identity of the terminology system
..... code SΣ 1..1 code Symbol in syntax defined by the system
..... display SΣ 1..1 string Representation defined by the system
.... text SΣ 0..1 string Plain text representation of the concept
... processNote S 0..* BackboneElement Note concerning adjudication
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... number S 0..1 positiveInt Note instance identifier
.... type S 0..1 code display | print | printoper
Binding: NoteType (required): The presentation types of notes.
.... text S 1..1 string Note explanatory text
... error S 0..* BackboneElement Processing errors
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... code S 1..1 CodeableConcept Error code detailing processing issues
Binding: ClaimResponse Adjudication Error ValueSet (required)
..... coding SΣ 1..* Coding Code defined by a terminology system
...... system SΣ 1..1 uri Identity of the terminology system
...... code SΣ 1..1 code Symbol in syntax defined by the system
...... display SΣ 1..1 string Representation defined by the system
..... text SΣ 0..1 string Plain text representation of the concept

doco Documentation for this format

Terminology Bindings

Path Status Usage ValueSet Version Source
ClaimResponse.status Base required Financial Resource Status Codes 📍4.0.1 FHIR Std.
ClaimResponse.type Base extensible Claim Type Codes 📍4.0.1 FHIR Std.
ClaimResponse.subType Base required Example Claim SubType Codes 📦4.0.1 FHIR Std.
ClaimResponse.use Base required Use 📍4.0.1 FHIR Std.
ClaimResponse.outcome Base required Claim Processing Codes 📦4.0.1 FHIR Std.
ClaimResponse.payeeType Base required ClaimResponse Payee Type ValueSet 📦0.1.0 This IG
ClaimResponse.item.adjudication.​category Base required Adjudication Value Codes 📦4.0.1 FHIR Std.
ClaimResponse.item.adjudication.​reason Base required Adjudication Reason Codes 📦4.0.1 FHIR Std.
ClaimResponse.addItem.​productOrService Base required Kenya Social Health Authority Interventions ValueSet 📦0.1.0 This IG
ClaimResponse.addItem.​modifier Base required Modifier type Codes 📦4.0.1 FHIR Std.
ClaimResponse.addItem.​programCode Base required Example Program Reason Codes 📦4.0.1 FHIR Std.
ClaimResponse.addItem.​location[x] Base required Example Service Place Codes 📦4.0.1 FHIR Std.
ClaimResponse.addItem.​bodySite Base required Kenya Institutional Body Site ValueSet 📦0.1.0 This IG
ClaimResponse.addItem.​subSite Base required Kenya Subsite ValueSet 📦0.1.0 This IG
ClaimResponse.addItem.​detail.productOrService Base required Kenya Social Health Authority Interventions ValueSet 📦0.1.0 This IG
ClaimResponse.addItem.​detail.modifier Base required Modifier type Codes 📦4.0.1 FHIR Std.
ClaimResponse.addItem.​detail.subDetail.productOrService Base required Kenya Social Health Authority Interventions ValueSet 📦0.1.0 This IG
ClaimResponse.addItem.​detail.subDetail.modifier Base required Modifier type Codes 📦4.0.1 FHIR Std.
ClaimResponse.total.​category Base required Adjudication Value Codes 📦4.0.1 FHIR Std.
ClaimResponse.total.​amount.currency Base required CurrencyCode 📍4.0.1 FHIR Std.
ClaimResponse.payment.​type Base required Example Payment Type Codes 📦4.0.1 FHIR Std.
ClaimResponse.payment.​adjustmentReason Base required Payment Adjustment Reason Codes 📦4.0.1 FHIR Std.
ClaimResponse.fundsReserve Base required ClaimResponse Funds Reserve ValueSet 📦0.1.0 This IG
ClaimResponse.formCode Base required ClaimResponse Forms ValueSet 📦0.1.0 This IG
ClaimResponse.processNote.​type Base required NoteType 📍4.0.1 FHIR Std.
ClaimResponse.error.​code Base required ClaimResponse Adjudication Error ValueSet 📦0.1.0 This IG

Constraints

Id Grade Path(s) Description Expression
dom-2 error ClaimResponse If the resource is contained in another resource, it SHALL NOT contain nested Resources contained.contained.empty()
dom-3 error ClaimResponse 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 contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
dom-4 error ClaimResponse If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
dom-5 error ClaimResponse If a resource is contained in another resource, it SHALL NOT have a security label contained.meta.security.empty()
dom-6 best practice ClaimResponse A resource should have narrative for robust management text.`div`.exists()
ele-1 error **ALL** elements All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
ext-1 error **ALL** extensions Must have either extensions or value[x], not both extension.exists() != value.exists()

Differential View

This structure is derived from ClaimResponse

NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
.. ClaimResponse 0..* ClaimResponse Response to a claim predetermination or preauthorization
... Slices for extension 1..* Extension Extension
Slice: Unordered, Open by value:url
.... extension:claimState S 1..1 CodeableConcept Claim Workflow State
URL: https://nshr-uat.sha.go.ke/fhir/StructureDefinition/eclaim-state-extension
.... extension:claimExpiry S 0..1 CodeableConcept Preauthorization Expiry Date
URL: https://nshr-uat.sha.go.ke/fhir/StructureDefinition/eclaim-expiry-extension
... status S 1..1 code active | cancelled | draft | entered-in-error
Fixed Value: active
... type S 1..1 CodeableConcept More granular claim type
.... coding S 1..* Coding Code defined by a terminology system
..... system S 1..1 uri Identity of the terminology system
..... code S 1..1 code Symbol in syntax defined by the system
..... display S 1..1 string Representation defined by the system
.... text S 0..1 string Plain text representation of the concept
... use S 1..1 code claim | preauthorization | predetermination
... created S 1..1 dateTime Response creation date
... insurer S 1..1 Reference(Organization) Party responsible for reimbursement
... request S 1..1 Reference(Claim) Id of resource triggering adjudication
... outcome S 1..1 code queued | complete | error | partial
Binding: ClaimProcessingCodes (required)
... payeeType S 0..1 CodeableConcept Party to be paid any benefits payable
Binding: ClaimResponse Payee Type ValueSet (required)
.... coding S 1..* Coding Code defined by a terminology system
..... system S 1..1 uri Identity of the terminology system
..... code S 1..1 code Symbol in syntax defined by the system
..... display S 1..1 string Representation defined by the system
.... text S 0..1 string Plain text representation of the concept
... item S 1..* BackboneElement Adjudication for claim line items
.... itemSequence S 1..1 positiveInt Claim item instance identifier
.... adjudication S 1..* BackboneElement Adjudication details
..... category S 1..1 CodeableConcept Type of adjudication information
Binding: AdjudicationValueCodes (required)
...... coding S 1..* Coding Code defined by a terminology system
....... system S 1..1 uri Identity of the terminology system
....... code S 1..1 code Symbol in syntax defined by the system
....... display S 1..1 string Representation defined by the system
...... text S 0..1 string Plain text representation of the concept
..... reason S 0..1 CodeableConcept Explanation of adjudication outcome
Binding: AdjudicationReasonCodes (required)
...... coding S 1..* Coding Code defined by a terminology system
....... system S 1..1 uri Identity of the terminology system
....... code S 1..1 code Symbol in syntax defined by the system
....... display S 1..1 string Representation defined by the system
...... text S 0..1 string Plain text representation of the concept
..... amount S 0..1 Money Monetary amount
... addItem S 0..* BackboneElement Insurer added line items
.... productOrService S 1..1 CodeableConcept Billing, service, product, or drug code
Binding: Kenya Social Health Authority Interventions ValueSet (required)
..... coding S 1..* Coding Code defined by a terminology system
...... system S 1..1 uri Identity of the terminology system
...... code S 1..1 code Symbol in syntax defined by the system
...... display S 1..1 string Representation defined by the system
..... text S 0..1 string Plain text representation of the concept
.... modifier S 0..1 CodeableConcept Service/Product billing modifiers
Binding: ModifierTypeCodes (required)
..... coding S 1..* Coding Code defined by a terminology system
...... system S 1..1 uri Identity of the terminology system
...... code S 1..1 code Symbol in syntax defined by the system
...... display S 1..1 string Representation defined by the system
..... text S 0..1 string Plain text representation of the concept
.... programCode S 0..1 CodeableConcept Program the product or service is provided under
Binding: ExampleProgramReasonCodes (required)
..... coding S 1..* Coding Code defined by a terminology system
...... system S 1..1 uri Identity of the terminology system
...... code S 1..1 code Symbol in syntax defined by the system
...... display S 1..1 string Representation defined by the system
..... text S 0..1 string Plain text representation of the concept
.... location[x] 0..1 CodeableConcept, Address, Reference(Location) Place of service or where product was supplied
Binding: ExampleServicePlaceCodes (required)
.... bodySite S 0..1 CodeableConcept Anatomical location
Binding: Kenya Institutional Body Site ValueSet (required)
..... coding S 1..* Coding Code defined by a terminology system
...... system S 1..1 uri Identity of the terminology system
...... code S 1..1 code Symbol in syntax defined by the system
...... display S 1..1 string Representation defined by the system
..... text S 0..1 string Plain text representation of the concept
.... subSite S 0..1 CodeableConcept Anatomical sub-location
Binding: Kenya Subsite ValueSet (required)
..... coding S 1..* Coding Code defined by a terminology system
...... system S 1..1 uri Identity of the terminology system
...... code S 1..1 code Symbol in syntax defined by the system
...... display S 1..1 string Representation defined by the system
..... text S 0..1 string Plain text representation of the concept
.... detail S 0..* BackboneElement Insurer added line details
..... productOrService S 1..1 CodeableConcept Billing, service, product, or drug code
Binding: Kenya Social Health Authority Interventions ValueSet (required)
...... coding S 1..* Coding Code defined by a terminology system
....... system S 1..1 uri Identity of the terminology system
....... code S 1..1 code Symbol in syntax defined by the system
....... display S 1..1 string Representation defined by the system
...... text S 0..1 string Plain text representation of the concept
..... modifier S 0..1 CodeableConcept Service/Product billing modifiers
Binding: ModifierTypeCodes (required)
...... coding S 1..* Coding Code defined by a terminology system
....... system S 1..1 uri Identity of the terminology system
....... code S 1..1 code Symbol in syntax defined by the system
....... display S 1..1 string Representation defined by the system
...... text S 0..1 string Plain text representation of the concept
..... subDetail S 0..* BackboneElement Insurer added line items
...... productOrService S 1..1 CodeableConcept Billing, service, product, or drug code
Binding: Kenya Social Health Authority Interventions ValueSet (required)
....... coding S 1..* Coding Code defined by a terminology system
........ system S 1..1 uri Identity of the terminology system
........ code S 1..1 code Symbol in syntax defined by the system
........ display S 1..1 string Representation defined by the system
....... text S 0..1 string Plain text representation of the concept
...... modifier S 0..1 CodeableConcept Service/Product billing modifiers
Binding: ModifierTypeCodes (required)
....... coding S 1..* Coding Code defined by a terminology system
........ system S 1..1 uri Identity of the terminology system
........ code S 1..1 code Symbol in syntax defined by the system
........ display S 1..1 string Representation defined by the system
....... text S 0..1 string Plain text representation of the concept
... total S 0..* BackboneElement Adjudication totals
.... category S 1..1 CodeableConcept Type of adjudication information
Binding: AdjudicationValueCodes (required)
..... coding S 1..* Coding Code defined by a terminology system
...... system S 1..1 uri Identity of the terminology system
...... code S 1..1 code Symbol in syntax defined by the system
...... display S 1..1 string Representation defined by the system
..... text S 0..1 string Plain text representation of the concept
.... amount S 1..1 Money Financial total for the category
..... currency S 1..1 code ISO 4217 Currency Code
... payment S 0..1 BackboneElement Payment Details
.... type S 1..1 CodeableConcept Partial or complete payment
Binding: ExamplePaymentTypeCodes (required)
..... coding S 1..* Coding Code defined by a terminology system
...... system S 1..1 uri Identity of the terminology system
...... code S 1..1 code Symbol in syntax defined by the system
...... display S 1..1 string Representation defined by the system
..... text S 0..1 string Plain text representation of the concept
.... adjustmentReason S 0..1 CodeableConcept Explanation for the adjustment
Binding: PaymentAdjustmentReasonCodes (required)
..... coding S 1..* Coding Code defined by a terminology system
...... system S 1..1 uri Identity of the terminology system
...... code S 1..1 code Symbol in syntax defined by the system
...... display S 1..1 string Representation defined by the system
..... text S 0..1 string Plain text representation of the concept
... fundsReserve S 0..1 CodeableConcept Funds reserved status
Binding: ClaimResponse Funds Reserve ValueSet (required)
.... coding S 1..* Coding Code defined by a terminology system
..... system S 1..1 uri Identity of the terminology system
..... code S 1..1 code Symbol in syntax defined by the system
..... display S 1..1 string Representation defined by the system
.... text S 0..1 string Plain text representation of the concept
... formCode S 0..1 CodeableConcept Printed form identifier
Binding: ClaimResponse Forms ValueSet (required)
.... coding S 1..* Coding Code defined by a terminology system
..... system S 1..1 uri Identity of the terminology system
..... code S 1..1 code Symbol in syntax defined by the system
..... display S 1..1 string Representation defined by the system
.... text S 0..1 string Plain text representation of the concept
... processNote S 0..* BackboneElement Note concerning adjudication
.... number S 0..1 positiveInt Note instance identifier
.... type S 0..1 code display | print | printoper
.... text S 1..1 string Note explanatory text
... error S 0..* BackboneElement Processing errors
.... code S 1..1 CodeableConcept Error code detailing processing issues
Binding: ClaimResponse Adjudication Error ValueSet (required)
..... coding S 1..* Coding Code defined by a terminology system
...... system S 1..1 uri Identity of the terminology system
...... code S 1..1 code Symbol in syntax defined by the system
...... display S 1..1 string Representation defined by the system
..... text S 0..1 string Plain text representation of the concept

doco Documentation for this format

Terminology Bindings (Differential)

Path Status Usage ValueSet Version Source
ClaimResponse.subType Base required Example Claim SubType Codes 📦4.0.1 FHIR Std.
ClaimResponse.outcome Base required Claim Processing Codes 📦4.0.1 FHIR Std.
ClaimResponse.payeeType Base required ClaimResponse Payee Type ValueSet 📦0.1.0 This IG
ClaimResponse.item.adjudication.​category Base required Adjudication Value Codes 📦4.0.1 FHIR Std.
ClaimResponse.item.adjudication.​reason Base required Adjudication Reason Codes 📦4.0.1 FHIR Std.
ClaimResponse.addItem.​productOrService Base required Kenya Social Health Authority Interventions ValueSet 📦0.1.0 This IG
ClaimResponse.addItem.​modifier Base required Modifier type Codes 📦4.0.1 FHIR Std.
ClaimResponse.addItem.​programCode Base required Example Program Reason Codes 📦4.0.1 FHIR Std.
ClaimResponse.addItem.​location[x] Base required Example Service Place Codes 📦4.0.1 FHIR Std.
ClaimResponse.addItem.​bodySite Base required Kenya Institutional Body Site ValueSet 📦0.1.0 This IG
ClaimResponse.addItem.​subSite Base required Kenya Subsite ValueSet 📦0.1.0 This IG
ClaimResponse.addItem.​detail.productOrService Base required Kenya Social Health Authority Interventions ValueSet 📦0.1.0 This IG
ClaimResponse.addItem.​detail.modifier Base required Modifier type Codes 📦4.0.1 FHIR Std.
ClaimResponse.addItem.​detail.subDetail.productOrService Base required Kenya Social Health Authority Interventions ValueSet 📦0.1.0 This IG
ClaimResponse.addItem.​detail.subDetail.modifier Base required Modifier type Codes 📦4.0.1 FHIR Std.
ClaimResponse.total.​category Base required Adjudication Value Codes 📦4.0.1 FHIR Std.
ClaimResponse.payment.​type Base required Example Payment Type Codes 📦4.0.1 FHIR Std.
ClaimResponse.payment.​adjustmentReason Base required Payment Adjustment Reason Codes 📦4.0.1 FHIR Std.
ClaimResponse.fundsReserve Base required ClaimResponse Funds Reserve ValueSet 📦0.1.0 This IG
ClaimResponse.formCode Base required ClaimResponse Forms ValueSet 📦0.1.0 This IG
ClaimResponse.error.​code Base required ClaimResponse Adjudication Error ValueSet 📦0.1.0 This IG

Snapshot View

NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
.. ClaimResponse 0..* ClaimResponse Response to a claim predetermination or preauthorization
... id Σ 0..1 id Logical id of this artifact
... meta Σ 0..1 Meta Metadata about the resource
... implicitRules ?!Σ 0..1 uri A set of rules under which this content was created
... language 0..1 code Language of the resource content
Binding: CommonLanguages (preferred): A human language.
Additional BindingsPurpose
AllLanguages Max Binding
... text 0..1 Narrative Text summary of the resource, for human interpretation
This profile does not constrain the narrative in regard to content, language, or traceability to data elements
... contained 0..* Resource Contained, inline Resources
... Slices for extension 1..* Extension Extension
Slice: Unordered, Open by value:url
.... extension:claimState S 1..1 CodeableConcept Claim Workflow State
URL: https://nshr-uat.sha.go.ke/fhir/StructureDefinition/eclaim-state-extension
.... extension:claimExpiry S 0..1 CodeableConcept Preauthorization Expiry Date
URL: https://nshr-uat.sha.go.ke/fhir/StructureDefinition/eclaim-expiry-extension
... modifierExtension ?! 0..* Extension Extensions that cannot be ignored
... identifier 0..* Identifier Business Identifier for a claim response
... status ?!SΣ 1..1 code active | cancelled | draft | entered-in-error
Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance.
Fixed Value: active
... type SΣ 1..1 CodeableConcept More granular claim type
Binding: ClaimTypeCodes (extensible): The type or discipline-style of the claim.
... subType S 0..1 CodeableConcept More granular claim type
Binding: ExampleClaimSubTypeCodes (required)
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
.... coding SΣ 1..* Coding Code defined by a terminology system
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
..... system SΣ 1..1 uri Identity of the terminology system
..... version Σ 0..1 string Version of the system - if relevant
..... code SΣ 1..1 code Symbol in syntax defined by the system
..... display SΣ 1..1 string Representation defined by the system
..... userSelected Σ 0..1 boolean If this coding was chosen directly by the user
.... text SΣ 0..1 string Plain text representation of the concept
... use SΣ 1..1 code claim | preauthorization | predetermination
Binding: Use (required): Claim, preauthorization, predetermination.
... patient Σ 1..1 Reference(Patient) The recipient of the products and services
... created SΣ 1..1 dateTime Response creation date
... insurer SΣ 1..1 Reference(Organization) Party responsible for reimbursement
... requestor 0..1 Reference(Practitioner | PractitionerRole | Organization) Party responsible for the claim
... request SΣ 1..1 Reference(Claim) Id of resource triggering adjudication
... outcome SΣ 1..1 code queued | complete | error | partial
Binding: ClaimProcessingCodes (required)
... disposition 0..1 string Disposition Message
... preAuthRef 0..1 string Preauthorization reference
... preAuthPeriod 0..1 Period Preauthorization reference effective period
... payeeType S 0..1 CodeableConcept Party to be paid any benefits payable
Binding: ClaimResponse Payee Type ValueSet (required)
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
.... coding SΣ 1..* Coding Code defined by a terminology system
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
..... system SΣ 1..1 uri Identity of the terminology system
..... version Σ 0..1 string Version of the system - if relevant
..... code SΣ 1..1 code Symbol in syntax defined by the system
..... display SΣ 1..1 string Representation defined by the system
..... userSelected Σ 0..1 boolean If this coding was chosen directly by the user
.... text SΣ 0..1 string Plain text representation of the concept
... item S 1..* BackboneElement Adjudication for claim line items
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... itemSequence S 1..1 positiveInt Claim item instance identifier
.... noteNumber 0..* positiveInt Applicable note numbers
.... adjudication S 1..* BackboneElement Adjudication details
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... category S 1..1 CodeableConcept Type of adjudication information
Binding: AdjudicationValueCodes (required)
...... id 0..1 string Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
...... coding SΣ 1..* Coding Code defined by a terminology system
....... id 0..1 string Unique id for inter-element referencing
....... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
....... system SΣ 1..1 uri Identity of the terminology system
....... version Σ 0..1 string Version of the system - if relevant
....... code SΣ 1..1 code Symbol in syntax defined by the system
....... display SΣ 1..1 string Representation defined by the system
....... userSelected Σ 0..1 boolean If this coding was chosen directly by the user
...... text SΣ 0..1 string Plain text representation of the concept
..... reason S 0..1 CodeableConcept Explanation of adjudication outcome
Binding: AdjudicationReasonCodes (required)
...... id 0..1 string Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
...... coding SΣ 1..* Coding Code defined by a terminology system
....... id 0..1 string Unique id for inter-element referencing
....... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
....... system SΣ 1..1 uri Identity of the terminology system
....... version Σ 0..1 string Version of the system - if relevant
....... code SΣ 1..1 code Symbol in syntax defined by the system
....... display SΣ 1..1 string Representation defined by the system
....... userSelected Σ 0..1 boolean If this coding was chosen directly by the user
...... text SΣ 0..1 string Plain text representation of the concept
..... amount S 0..1 Money Monetary amount
..... value 0..1 decimal Non-monetary value
.... detail 0..* BackboneElement Adjudication for claim details
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... detailSequence 1..1 positiveInt Claim detail instance identifier
..... noteNumber 0..* positiveInt Applicable note numbers
..... adjudication 1..* See adjudication (ClaimResponse) Detail level adjudication details
..... subDetail 0..* BackboneElement Adjudication for claim sub-details
...... id 0..1 string Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
...... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
...... subDetailSequence 1..1 positiveInt Claim sub-detail instance identifier
...... noteNumber 0..* positiveInt Applicable note numbers
...... adjudication 0..* See adjudication (ClaimResponse) Subdetail level adjudication details
... addItem S 0..* BackboneElement Insurer added line items
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... itemSequence 0..* positiveInt Item sequence number
.... detailSequence 0..* positiveInt Detail sequence number
.... subdetailSequence 0..* positiveInt Subdetail sequence number
.... provider 0..* Reference(Practitioner | PractitionerRole | Organization) Authorized providers
.... productOrService S 1..1 CodeableConcept Billing, service, product, or drug code
Binding: Kenya Social Health Authority Interventions ValueSet (required)
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
..... coding SΣ 1..* Coding Code defined by a terminology system
...... id 0..1 string Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
...... system SΣ 1..1 uri Identity of the terminology system
...... version Σ 0..1 string Version of the system - if relevant
...... code SΣ 1..1 code Symbol in syntax defined by the system
...... display SΣ 1..1 string Representation defined by the system
...... userSelected Σ 0..1 boolean If this coding was chosen directly by the user
..... text SΣ 0..1 string Plain text representation of the concept
.... modifier S 0..1 CodeableConcept Service/Product billing modifiers
Binding: ModifierTypeCodes (required)
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
..... coding SΣ 1..* Coding Code defined by a terminology system
...... id 0..1 string Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
...... system SΣ 1..1 uri Identity of the terminology system
...... version Σ 0..1 string Version of the system - if relevant
...... code SΣ 1..1 code Symbol in syntax defined by the system
...... display SΣ 1..1 string Representation defined by the system
...... userSelected Σ 0..1 boolean If this coding was chosen directly by the user
..... text SΣ 0..1 string Plain text representation of the concept
.... programCode S 0..1 CodeableConcept Program the product or service is provided under
Binding: ExampleProgramReasonCodes (required)
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
..... coding SΣ 1..* Coding Code defined by a terminology system
...... id 0..1 string Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
...... system SΣ 1..1 uri Identity of the terminology system
...... version Σ 0..1 string Version of the system - if relevant
...... code SΣ 1..1 code Symbol in syntax defined by the system
...... display SΣ 1..1 string Representation defined by the system
...... userSelected Σ 0..1 boolean If this coding was chosen directly by the user
..... text SΣ 0..1 string Plain text representation of the concept
.... serviced[x] 0..1 Date or dates of service or product delivery
..... servicedDate date
..... servicedPeriod Period
.... location[x] 0..1 Place of service or where product was supplied
Binding: ExampleServicePlaceCodes (required)
..... locationCodeableConcept CodeableConcept
..... locationAddress Address
..... locationReference Reference(Location)
.... quantity 0..1 SimpleQuantity(4.0.1) Count of products or services
.... unitPrice 0..1 Money Fee, charge or cost per item
.... factor 0..1 decimal Price scaling factor
.... net 0..1 Money Total item cost
.... bodySite S 0..1 CodeableConcept Anatomical location
Binding: Kenya Institutional Body Site ValueSet (required)
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
..... coding SΣ 1..* Coding Code defined by a terminology system
...... id 0..1 string Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
...... system SΣ 1..1 uri Identity of the terminology system
...... version Σ 0..1 string Version of the system - if relevant
...... code SΣ 1..1 code Symbol in syntax defined by the system
...... display SΣ 1..1 string Representation defined by the system
...... userSelected Σ 0..1 boolean If this coding was chosen directly by the user
..... text SΣ 0..1 string Plain text representation of the concept
.... subSite S 0..1 CodeableConcept Anatomical sub-location
Binding: Kenya Subsite ValueSet (required)
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
..... coding SΣ 1..* Coding Code defined by a terminology system
...... id 0..1 string Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
...... system SΣ 1..1 uri Identity of the terminology system
...... version Σ 0..1 string Version of the system - if relevant
...... code SΣ 1..1 code Symbol in syntax defined by the system
...... display SΣ 1..1 string Representation defined by the system
...... userSelected Σ 0..1 boolean If this coding was chosen directly by the user
..... text SΣ 0..1 string Plain text representation of the concept
.... noteNumber 0..* positiveInt Applicable note numbers
.... adjudication 1..* See adjudication (ClaimResponse) Added items adjudication
.... detail S 0..* BackboneElement Insurer added line details
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... productOrService S 1..1 CodeableConcept Billing, service, product, or drug code
Binding: Kenya Social Health Authority Interventions ValueSet (required)
...... id 0..1 string Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
...... coding SΣ 1..* Coding Code defined by a terminology system
....... id 0..1 string Unique id for inter-element referencing
....... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
....... system SΣ 1..1 uri Identity of the terminology system
....... version Σ 0..1 string Version of the system - if relevant
....... code SΣ 1..1 code Symbol in syntax defined by the system
....... display SΣ 1..1 string Representation defined by the system
....... userSelected Σ 0..1 boolean If this coding was chosen directly by the user
...... text SΣ 0..1 string Plain text representation of the concept
..... modifier S 0..1 CodeableConcept Service/Product billing modifiers
Binding: ModifierTypeCodes (required)
...... id 0..1 string Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
...... coding SΣ 1..* Coding Code defined by a terminology system
....... id 0..1 string Unique id for inter-element referencing
....... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
....... system SΣ 1..1 uri Identity of the terminology system
....... version Σ 0..1 string Version of the system - if relevant
....... code SΣ 1..1 code Symbol in syntax defined by the system
....... display SΣ 1..1 string Representation defined by the system
....... userSelected Σ 0..1 boolean If this coding was chosen directly by the user
...... text SΣ 0..1 string Plain text representation of the concept
..... quantity 0..1 SimpleQuantity(4.0.1) Count of products or services
..... unitPrice 0..1 Money Fee, charge or cost per item
..... factor 0..1 decimal Price scaling factor
..... net 0..1 Money Total item cost
..... noteNumber 0..* positiveInt Applicable note numbers
..... adjudication 1..* See adjudication (ClaimResponse) Added items detail adjudication
..... subDetail S 0..* BackboneElement Insurer added line items
...... id 0..1 string Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
...... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
...... productOrService S 1..1 CodeableConcept Billing, service, product, or drug code
Binding: Kenya Social Health Authority Interventions ValueSet (required)
....... id 0..1 string Unique id for inter-element referencing
....... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
....... coding SΣ 1..* Coding Code defined by a terminology system
........ id 0..1 string Unique id for inter-element referencing
........ extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
........ system SΣ 1..1 uri Identity of the terminology system
........ version Σ 0..1 string Version of the system - if relevant
........ code SΣ 1..1 code Symbol in syntax defined by the system
........ display SΣ 1..1 string Representation defined by the system
........ userSelected Σ 0..1 boolean If this coding was chosen directly by the user
....... text SΣ 0..1 string Plain text representation of the concept
...... modifier S 0..1 CodeableConcept Service/Product billing modifiers
Binding: ModifierTypeCodes (required)
....... id 0..1 string Unique id for inter-element referencing
....... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
....... coding SΣ 1..* Coding Code defined by a terminology system
........ id 0..1 string Unique id for inter-element referencing
........ extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
........ system SΣ 1..1 uri Identity of the terminology system
........ version Σ 0..1 string Version of the system - if relevant
........ code SΣ 1..1 code Symbol in syntax defined by the system
........ display SΣ 1..1 string Representation defined by the system
........ userSelected Σ 0..1 boolean If this coding was chosen directly by the user
....... text SΣ 0..1 string Plain text representation of the concept
...... quantity 0..1 SimpleQuantity(4.0.1) Count of products or services
...... unitPrice 0..1 Money Fee, charge or cost per item
...... factor 0..1 decimal Price scaling factor
...... net 0..1 Money Total item cost
...... noteNumber 0..* positiveInt Applicable note numbers
...... adjudication 1..* See adjudication (ClaimResponse) Added items detail adjudication
... adjudication 0..* See adjudication (ClaimResponse) Header-level adjudication
... total SΣ 0..* BackboneElement Adjudication totals
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... category SΣ 1..1 CodeableConcept Type of adjudication information
Binding: AdjudicationValueCodes (required)
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
..... coding SΣ 1..* Coding Code defined by a terminology system
...... id 0..1 string Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
...... system SΣ 1..1 uri Identity of the terminology system
...... version Σ 0..1 string Version of the system - if relevant
...... code SΣ 1..1 code Symbol in syntax defined by the system
...... display SΣ 1..1 string Representation defined by the system
...... userSelected Σ 0..1 boolean If this coding was chosen directly by the user
..... text SΣ 0..1 string Plain text representation of the concept
.... amount SΣ 1..1 Money Financial total for the category
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
..... value Σ 0..1 decimal Numerical value (with implicit precision)
..... currency SΣ 1..1 code ISO 4217 Currency Code
Binding: Currencies (required): A code indicating the currency, taken from ISO 4217.
... payment S 0..1 BackboneElement Payment Details
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... type S 1..1 CodeableConcept Partial or complete payment
Binding: ExamplePaymentTypeCodes (required)
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
..... coding SΣ 1..* Coding Code defined by a terminology system
...... id 0..1 string Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
...... system SΣ 1..1 uri Identity of the terminology system
...... version Σ 0..1 string Version of the system - if relevant
...... code SΣ 1..1 code Symbol in syntax defined by the system
...... display SΣ 1..1 string Representation defined by the system
...... userSelected Σ 0..1 boolean If this coding was chosen directly by the user
..... text SΣ 0..1 string Plain text representation of the concept
.... adjustment 0..1 Money Payment adjustment for non-claim issues
.... adjustmentReason S 0..1 CodeableConcept Explanation for the adjustment
Binding: PaymentAdjustmentReasonCodes (required)
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
..... coding SΣ 1..* Coding Code defined by a terminology system
...... id 0..1 string Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
...... system SΣ 1..1 uri Identity of the terminology system
...... version Σ 0..1 string Version of the system - if relevant
...... code SΣ 1..1 code Symbol in syntax defined by the system
...... display SΣ 1..1 string Representation defined by the system
...... userSelected Σ 0..1 boolean If this coding was chosen directly by the user
..... text SΣ 0..1 string Plain text representation of the concept
.... date 0..1 date Expected date of payment
.... amount 1..1 Money Payable amount after adjustment
.... identifier 0..1 Identifier Business identifier for the payment
... fundsReserve S 0..1 CodeableConcept Funds reserved status
Binding: ClaimResponse Funds Reserve ValueSet (required)
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
.... coding SΣ 1..* Coding Code defined by a terminology system
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
..... system SΣ 1..1 uri Identity of the terminology system
..... version Σ 0..1 string Version of the system - if relevant
..... code SΣ 1..1 code Symbol in syntax defined by the system
..... display SΣ 1..1 string Representation defined by the system
..... userSelected Σ 0..1 boolean If this coding was chosen directly by the user
.... text SΣ 0..1 string Plain text representation of the concept
... formCode S 0..1 CodeableConcept Printed form identifier
Binding: ClaimResponse Forms ValueSet (required)
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
.... coding SΣ 1..* Coding Code defined by a terminology system
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
..... system SΣ 1..1 uri Identity of the terminology system
..... version Σ 0..1 string Version of the system - if relevant
..... code SΣ 1..1 code Symbol in syntax defined by the system
..... display SΣ 1..1 string Representation defined by the system
..... userSelected Σ 0..1 boolean If this coding was chosen directly by the user
.... text SΣ 0..1 string Plain text representation of the concept
... form 0..1 Attachment Printed reference or actual form
... processNote S 0..* BackboneElement Note concerning adjudication
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... number S 0..1 positiveInt Note instance identifier
.... type S 0..1 code display | print | printoper
Binding: NoteType (required): The presentation types of notes.
.... text S 1..1 string Note explanatory text
.... language 0..1 CodeableConcept Language of the text
Binding: CommonLanguages (preferred): A human language.
Additional BindingsPurpose
AllLanguages Max Binding
... communicationRequest 0..* Reference(CommunicationRequest) Request for additional information
... insurance 0..* BackboneElement Patient insurance information
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... sequence 1..1 positiveInt Insurance instance identifier
.... focal 1..1 boolean Coverage to be used for adjudication
.... coverage 1..1 Reference(Coverage) Insurance information
.... businessArrangement 0..1 string Additional provider contract number
.... claimResponse 0..1 Reference(ClaimResponse) Adjudication results
... error S 0..* BackboneElement Processing errors
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... itemSequence 0..1 positiveInt Item sequence number
.... detailSequence 0..1 positiveInt Detail sequence number
.... subDetailSequence 0..1 positiveInt Subdetail sequence number
.... code S 1..1 CodeableConcept Error code detailing processing issues
Binding: ClaimResponse Adjudication Error ValueSet (required)
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
..... coding SΣ 1..* Coding Code defined by a terminology system
...... id 0..1 string Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
...... system SΣ 1..1 uri Identity of the terminology system
...... version Σ 0..1 string Version of the system - if relevant
...... code SΣ 1..1 code Symbol in syntax defined by the system
...... display SΣ 1..1 string Representation defined by the system
...... userSelected Σ 0..1 boolean If this coding was chosen directly by the user
..... text SΣ 0..1 string Plain text representation of the concept

doco Documentation for this format

Terminology Bindings

Path Status Usage ValueSet Version Source
ClaimResponse.language Base preferred Common Languages 📍4.0.1 FHIR Std.
ClaimResponse.status Base required Financial Resource Status Codes 📍4.0.1 FHIR Std.
ClaimResponse.type Base extensible Claim Type Codes 📍4.0.1 FHIR Std.
ClaimResponse.subType Base required Example Claim SubType Codes 📦4.0.1 FHIR Std.
ClaimResponse.use Base required Use 📍4.0.1 FHIR Std.
ClaimResponse.outcome Base required Claim Processing Codes 📦4.0.1 FHIR Std.
ClaimResponse.payeeType Base required ClaimResponse Payee Type ValueSet 📦0.1.0 This IG
ClaimResponse.item.adjudication.​category Base required Adjudication Value Codes 📦4.0.1 FHIR Std.
ClaimResponse.item.adjudication.​reason Base required Adjudication Reason Codes 📦4.0.1 FHIR Std.
ClaimResponse.addItem.​productOrService Base required Kenya Social Health Authority Interventions ValueSet 📦0.1.0 This IG
ClaimResponse.addItem.​modifier Base required Modifier type Codes 📦4.0.1 FHIR Std.
ClaimResponse.addItem.​programCode Base required Example Program Reason Codes 📦4.0.1 FHIR Std.
ClaimResponse.addItem.​location[x] Base required Example Service Place Codes 📦4.0.1 FHIR Std.
ClaimResponse.addItem.​bodySite Base required Kenya Institutional Body Site ValueSet 📦0.1.0 This IG
ClaimResponse.addItem.​subSite Base required Kenya Subsite ValueSet 📦0.1.0 This IG
ClaimResponse.addItem.​detail.productOrService Base required Kenya Social Health Authority Interventions ValueSet 📦0.1.0 This IG
ClaimResponse.addItem.​detail.modifier Base required Modifier type Codes 📦4.0.1 FHIR Std.
ClaimResponse.addItem.​detail.subDetail.productOrService Base required Kenya Social Health Authority Interventions ValueSet 📦0.1.0 This IG
ClaimResponse.addItem.​detail.subDetail.modifier Base required Modifier type Codes 📦4.0.1 FHIR Std.
ClaimResponse.total.​category Base required Adjudication Value Codes 📦4.0.1 FHIR Std.
ClaimResponse.total.​amount.currency Base required CurrencyCode 📍4.0.1 FHIR Std.
ClaimResponse.payment.​type Base required Example Payment Type Codes 📦4.0.1 FHIR Std.
ClaimResponse.payment.​adjustmentReason Base required Payment Adjustment Reason Codes 📦4.0.1 FHIR Std.
ClaimResponse.fundsReserve Base required ClaimResponse Funds Reserve ValueSet 📦0.1.0 This IG
ClaimResponse.formCode Base required ClaimResponse Forms ValueSet 📦0.1.0 This IG
ClaimResponse.processNote.​type Base required NoteType 📍4.0.1 FHIR Std.
ClaimResponse.processNote.​language Base preferred Common Languages 📍4.0.1 FHIR Std.
ClaimResponse.error.​code Base required ClaimResponse Adjudication Error ValueSet 📦0.1.0 This IG

Constraints

Id Grade Path(s) Description Expression
dom-2 error ClaimResponse If the resource is contained in another resource, it SHALL NOT contain nested Resources contained.contained.empty()
dom-3 error ClaimResponse 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 contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
dom-4 error ClaimResponse If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
dom-5 error ClaimResponse If a resource is contained in another resource, it SHALL NOT have a security label contained.meta.security.empty()
dom-6 best practice ClaimResponse A resource should have narrative for robust management text.`div`.exists()
ele-1 error **ALL** elements All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
ext-1 error **ALL** extensions Must have either extensions or value[x], not both extension.exists() != value.exists()

This structure is derived from ClaimResponse

Summary

Mandatory: 8 elements(73 nested mandatory elements)
Must-Support: 139 elements
Fixed: 1 element

Extensions

This structure refers to these extensions:

 

Other representations of profile: CSV, Excel, Schematron