臺灣長期照顧實作指引(TW LTC IG)
1.0.0 - STU 1.0.0

臺灣長期照顧實作指引(TW LTC IG), published by 經濟部產業發展署. This guide is not an authorized publication; it is the continuous build for version 1.0.0 built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/Lorex/TWLongTermCare_IG_Build/ and changes regularly. See the Directory of published versions

Resource Profile: LTCClaimResponseFeeAudit - Mappings

Draft as of 2026-07-29

Mappings for the LTCClaimResponseFeeAudit resource profile.

Mappings to Structures in this Implementation Guide

Name長照支付審查－分案審核明細邏輯模型對應doco
.. ClaimResponse
... id
    ... meta
      ... implicitRules
        ... language
          ... text
            ... contained
              ... Slices for extension
                .... extension:docUrl
                  .... extension:auditSummary
                    ... modifierExtension
                      ... Slices for identifier
                        .... identifier:caseNo
                          ..... id
                            ..... extension
                              ..... use
                                ..... type
                                  ..... system
                                    ..... value
                                      ..... period
                                        ..... assigner
                                          .... identifier:docVer
                                            ..... id
                                              ..... extension
                                                ..... use
                                                  ..... type
                                                    ..... system
                                                      ..... value
                                                        ..... period
                                                          ..... assigner
                                                            .... identifier:accNum
                                                              ..... id
                                                                ..... extension
                                                                  ..... use
                                                                    ..... type
                                                                      ..... system
                                                                        ..... value
                                                                          ..... period
                                                                            ..... assigner
                                                                              .... identifier:yyyymm
                                                                                ..... id
                                                                                  ..... extension
                                                                                    ..... use
                                                                                      ..... type
                                                                                        ..... system
                                                                                          ..... value
                                                                                            ..... period
                                                                                              ..... assigner
                                                                                                ... status
                                                                                                  ... type
                                                                                                    ... subType
                                                                                                      ... use
                                                                                                        ... patient
                                                                                                          ... created
                                                                                                          ... insurer
                                                                                                          ... requestor
                                                                                                            ... request
                                                                                                              ... outcome
                                                                                                                ... disposition
                                                                                                                ... preAuthRef
                                                                                                                  ... preAuthPeriod
                                                                                                                    ... payeeType
                                                                                                                      ... item
                                                                                                                      .... id
                                                                                                                        .... Slices for extension
                                                                                                                          ..... extension:recordRef
                                                                                                                            .... modifierExtension
                                                                                                                              .... itemSequence
                                                                                                                                .... noteNumber
                                                                                                                                  .... adjudication
                                                                                                                                    ..... id
                                                                                                                                      ..... extension
                                                                                                                                        ..... modifierExtension
                                                                                                                                          ..... category
                                                                                                                                            ..... reason
                                                                                                                                              ..... amount
                                                                                                                                              ..... value
                                                                                                                                                .... detail
                                                                                                                                                  ..... id
                                                                                                                                                    ..... extension
                                                                                                                                                      ..... modifierExtension
                                                                                                                                                        ..... detailSequence
                                                                                                                                                          ..... noteNumber
                                                                                                                                                            ..... adjudication
                                                                                                                                                              ..... subDetail
                                                                                                                                                                ...... id
                                                                                                                                                                  ...... extension
                                                                                                                                                                    ...... modifierExtension
                                                                                                                                                                      ...... subDetailSequence
                                                                                                                                                                        ...... noteNumber
                                                                                                                                                                          ...... adjudication
                                                                                                                                                                            ... addItem
                                                                                                                                                                            .... id
                                                                                                                                                                              .... Slices for extension
                                                                                                                                                                                ..... extension:recordRef
                                                                                                                                                                                  .... modifierExtension
                                                                                                                                                                                    .... itemSequence
                                                                                                                                                                                      .... detailSequence
                                                                                                                                                                                        .... subdetailSequence
                                                                                                                                                                                          .... provider
                                                                                                                                                                                            .... productOrService
                                                                                                                                                                                            .... modifier
                                                                                                                                                                                              .... programCode
                                                                                                                                                                                                .... serviced[x]
                                                                                                                                                                                                  .... location[x]
                                                                                                                                                                                                    .... quantity
                                                                                                                                                                                                      .... unitPrice
                                                                                                                                                                                                        .... factor
                                                                                                                                                                                                          .... net
                                                                                                                                                                                                            .... bodySite
                                                                                                                                                                                                              .... subSite
                                                                                                                                                                                                                .... noteNumber
                                                                                                                                                                                                                  .... adjudication
                                                                                                                                                                                                                    ..... id
                                                                                                                                                                                                                      ..... extension
                                                                                                                                                                                                                        ..... modifierExtension
                                                                                                                                                                                                                          ..... category
                                                                                                                                                                                                                            ..... reason
                                                                                                                                                                                                                              ..... amount
                                                                                                                                                                                                                              ..... value
                                                                                                                                                                                                                                .... detail
                                                                                                                                                                                                                                  ..... id
                                                                                                                                                                                                                                    ..... extension
                                                                                                                                                                                                                                      ..... modifierExtension
                                                                                                                                                                                                                                        ..... productOrService
                                                                                                                                                                                                                                          ..... modifier
                                                                                                                                                                                                                                            ..... quantity
                                                                                                                                                                                                                                              ..... unitPrice
                                                                                                                                                                                                                                                ..... factor
                                                                                                                                                                                                                                                  ..... net
                                                                                                                                                                                                                                                    ..... noteNumber
                                                                                                                                                                                                                                                      ..... adjudication
                                                                                                                                                                                                                                                        ..... subDetail
                                                                                                                                                                                                                                                          ...... id
                                                                                                                                                                                                                                                            ...... extension
                                                                                                                                                                                                                                                              ...... modifierExtension
                                                                                                                                                                                                                                                                ...... productOrService
                                                                                                                                                                                                                                                                  ...... modifier
                                                                                                                                                                                                                                                                    ...... quantity
                                                                                                                                                                                                                                                                      ...... unitPrice
                                                                                                                                                                                                                                                                        ...... factor
                                                                                                                                                                                                                                                                          ...... net
                                                                                                                                                                                                                                                                            ...... noteNumber
                                                                                                                                                                                                                                                                              ...... adjudication
                                                                                                                                                                                                                                                                                ... adjudication
                                                                                                                                                                                                                                                                                  ... total
                                                                                                                                                                                                                                                                                    .... id
                                                                                                                                                                                                                                                                                      .... extension
                                                                                                                                                                                                                                                                                        .... modifierExtension
                                                                                                                                                                                                                                                                                          .... category
                                                                                                                                                                                                                                                                                            .... amount
                                                                                                                                                                                                                                                                                            ... payment
                                                                                                                                                                                                                                                                                              .... id
                                                                                                                                                                                                                                                                                                .... extension
                                                                                                                                                                                                                                                                                                  .... modifierExtension
                                                                                                                                                                                                                                                                                                    .... type
                                                                                                                                                                                                                                                                                                      .... adjustment
                                                                                                                                                                                                                                                                                                        .... adjustmentReason
                                                                                                                                                                                                                                                                                                          .... date
                                                                                                                                                                                                                                                                                                            .... amount
                                                                                                                                                                                                                                                                                                              .... identifier
                                                                                                                                                                                                                                                                                                                ... fundsReserve
                                                                                                                                                                                                                                                                                                                  ... formCode
                                                                                                                                                                                                                                                                                                                    ... form
                                                                                                                                                                                                                                                                                                                      ... processNote
                                                                                                                                                                                                                                                                                                                        .... id
                                                                                                                                                                                                                                                                                                                          .... extension
                                                                                                                                                                                                                                                                                                                            .... modifierExtension
                                                                                                                                                                                                                                                                                                                              .... number
                                                                                                                                                                                                                                                                                                                                .... type
                                                                                                                                                                                                                                                                                                                                  .... text
                                                                                                                                                                                                                                                                                                                                  .... language
                                                                                                                                                                                                                                                                                                                                    ... communicationRequest
                                                                                                                                                                                                                                                                                                                                      ... insurance
                                                                                                                                                                                                                                                                                                                                        .... id
                                                                                                                                                                                                                                                                                                                                          .... extension
                                                                                                                                                                                                                                                                                                                                            .... modifierExtension
                                                                                                                                                                                                                                                                                                                                              .... sequence
                                                                                                                                                                                                                                                                                                                                                .... focal
                                                                                                                                                                                                                                                                                                                                                  .... coverage
                                                                                                                                                                                                                                                                                                                                                    .... businessArrangement
                                                                                                                                                                                                                                                                                                                                                      .... claimResponse
                                                                                                                                                                                                                                                                                                                                                        ... error
                                                                                                                                                                                                                                                                                                                                                        .... id
                                                                                                                                                                                                                                                                                                                                                          .... Slices for extension
                                                                                                                                                                                                                                                                                                                                                            ..... extension:recordRef
                                                                                                                                                                                                                                                                                                                                                              .... modifierExtension
                                                                                                                                                                                                                                                                                                                                                                .... itemSequence
                                                                                                                                                                                                                                                                                                                                                                  .... detailSequence
                                                                                                                                                                                                                                                                                                                                                                    .... subDetailSequence
                                                                                                                                                                                                                                                                                                                                                                      .... code

                                                                                                                                                                                                                                                                                                                                                                        doco Documentation for this format

                                                                                                                                                                                                                                                                                                                                                                        Mappings to other Structures

                                                                                                                                                                                                                                                                                                                                                                        No Mappings Found

                                                                                                                                                                                                                                                                                                                                                                        Other Mappings

                                                                                                                                                                                                                                                                                                                                                                        NameWorkflow PatternFiveWs Pattern MappingRIM Mappingdoco
                                                                                                                                                                                                                                                                                                                                                                        .. ClaimResponse
                                                                                                                                                                                                                                                                                                                                                                        Event
                                                                                                                                                                                                                                                                                                                                                                        • Entity. Role
                                                                                                                                                                                                                                                                                                                                                                        • or Act
                                                                                                                                                                                                                                                                                                                                                                        ... id
                                                                                                                                                                                                                                                                                                                                                                        ... meta
                                                                                                                                                                                                                                                                                                                                                                        ... implicitRules
                                                                                                                                                                                                                                                                                                                                                                        ... language
                                                                                                                                                                                                                                                                                                                                                                        ... text
                                                                                                                                                                                                                                                                                                                                                                        Act.text?
                                                                                                                                                                                                                                                                                                                                                                        ... contained
                                                                                                                                                                                                                                                                                                                                                                        N/A
                                                                                                                                                                                                                                                                                                                                                                        ... Slices for extension
                                                                                                                                                                                                                                                                                                                                                                        .... extension:docUrl
                                                                                                                                                                                                                                                                                                                                                                        .... extension:auditSummary
                                                                                                                                                                                                                                                                                                                                                                        ... modifierExtension
                                                                                                                                                                                                                                                                                                                                                                        N/A
                                                                                                                                                                                                                                                                                                                                                                        ... Slices for identifier
                                                                                                                                                                                                                                                                                                                                                                        Event.identifier
                                                                                                                                                                                                                                                                                                                                                                        FiveWs.identifier
                                                                                                                                                                                                                                                                                                                                                                        .... identifier:caseNo
                                                                                                                                                                                                                                                                                                                                                                        Event.identifier
                                                                                                                                                                                                                                                                                                                                                                        FiveWs.identifier
                                                                                                                                                                                                                                                                                                                                                                        ..... id
                                                                                                                                                                                                                                                                                                                                                                        n/a
                                                                                                                                                                                                                                                                                                                                                                        ..... extension
                                                                                                                                                                                                                                                                                                                                                                        n/a
                                                                                                                                                                                                                                                                                                                                                                        ..... use
                                                                                                                                                                                                                                                                                                                                                                        Role.code or implied by context
                                                                                                                                                                                                                                                                                                                                                                        ..... type
                                                                                                                                                                                                                                                                                                                                                                        Role.code or implied by context
                                                                                                                                                                                                                                                                                                                                                                        ..... system
                                                                                                                                                                                                                                                                                                                                                                        II.root or Role.id.root
                                                                                                                                                                                                                                                                                                                                                                        ..... value
                                                                                                                                                                                                                                                                                                                                                                        II.extension or II.root if system indicates OID or GUID (Or Role.id.extension or root)
                                                                                                                                                                                                                                                                                                                                                                        ..... period
                                                                                                                                                                                                                                                                                                                                                                        Role.effectiveTime or implied by context
                                                                                                                                                                                                                                                                                                                                                                        ..... assigner
                                                                                                                                                                                                                                                                                                                                                                        II.assigningAuthorityName but note that this is an improper use by the definition of the field. Also Role.scoper
                                                                                                                                                                                                                                                                                                                                                                        .... identifier:docVer
                                                                                                                                                                                                                                                                                                                                                                        Event.identifier
                                                                                                                                                                                                                                                                                                                                                                        FiveWs.identifier
                                                                                                                                                                                                                                                                                                                                                                        ..... id
                                                                                                                                                                                                                                                                                                                                                                        n/a
                                                                                                                                                                                                                                                                                                                                                                        ..... extension
                                                                                                                                                                                                                                                                                                                                                                        n/a
                                                                                                                                                                                                                                                                                                                                                                        ..... use
                                                                                                                                                                                                                                                                                                                                                                        Role.code or implied by context
                                                                                                                                                                                                                                                                                                                                                                        ..... type
                                                                                                                                                                                                                                                                                                                                                                        Role.code or implied by context
                                                                                                                                                                                                                                                                                                                                                                        ..... system
                                                                                                                                                                                                                                                                                                                                                                        II.root or Role.id.root
                                                                                                                                                                                                                                                                                                                                                                        ..... value
                                                                                                                                                                                                                                                                                                                                                                        II.extension or II.root if system indicates OID or GUID (Or Role.id.extension or root)
                                                                                                                                                                                                                                                                                                                                                                        ..... period
                                                                                                                                                                                                                                                                                                                                                                        Role.effectiveTime or implied by context
                                                                                                                                                                                                                                                                                                                                                                        ..... assigner
                                                                                                                                                                                                                                                                                                                                                                        II.assigningAuthorityName but note that this is an improper use by the definition of the field. Also Role.scoper
                                                                                                                                                                                                                                                                                                                                                                        .... identifier:accNum
                                                                                                                                                                                                                                                                                                                                                                        Event.identifier
                                                                                                                                                                                                                                                                                                                                                                        FiveWs.identifier
                                                                                                                                                                                                                                                                                                                                                                        ..... id
                                                                                                                                                                                                                                                                                                                                                                        n/a
                                                                                                                                                                                                                                                                                                                                                                        ..... extension
                                                                                                                                                                                                                                                                                                                                                                        n/a
                                                                                                                                                                                                                                                                                                                                                                        ..... use
                                                                                                                                                                                                                                                                                                                                                                        Role.code or implied by context
                                                                                                                                                                                                                                                                                                                                                                        ..... type
                                                                                                                                                                                                                                                                                                                                                                        Role.code or implied by context
                                                                                                                                                                                                                                                                                                                                                                        ..... system
                                                                                                                                                                                                                                                                                                                                                                        II.root or Role.id.root
                                                                                                                                                                                                                                                                                                                                                                        ..... value
                                                                                                                                                                                                                                                                                                                                                                        II.extension or II.root if system indicates OID or GUID (Or Role.id.extension or root)
                                                                                                                                                                                                                                                                                                                                                                        ..... period
                                                                                                                                                                                                                                                                                                                                                                        Role.effectiveTime or implied by context
                                                                                                                                                                                                                                                                                                                                                                        ..... assigner
                                                                                                                                                                                                                                                                                                                                                                        II.assigningAuthorityName but note that this is an improper use by the definition of the field. Also Role.scoper
                                                                                                                                                                                                                                                                                                                                                                        .... identifier:yyyymm
                                                                                                                                                                                                                                                                                                                                                                        Event.identifier
                                                                                                                                                                                                                                                                                                                                                                        FiveWs.identifier
                                                                                                                                                                                                                                                                                                                                                                        ..... id
                                                                                                                                                                                                                                                                                                                                                                        n/a
                                                                                                                                                                                                                                                                                                                                                                        ..... extension
                                                                                                                                                                                                                                                                                                                                                                        n/a
                                                                                                                                                                                                                                                                                                                                                                        ..... use
                                                                                                                                                                                                                                                                                                                                                                        Role.code or implied by context
                                                                                                                                                                                                                                                                                                                                                                        ..... type
                                                                                                                                                                                                                                                                                                                                                                        Role.code or implied by context
                                                                                                                                                                                                                                                                                                                                                                        ..... system
                                                                                                                                                                                                                                                                                                                                                                        II.root or Role.id.root
                                                                                                                                                                                                                                                                                                                                                                        ..... value
                                                                                                                                                                                                                                                                                                                                                                        II.extension or II.root if system indicates OID or GUID (Or Role.id.extension or root)
                                                                                                                                                                                                                                                                                                                                                                        ..... period
                                                                                                                                                                                                                                                                                                                                                                        Role.effectiveTime or implied by context
                                                                                                                                                                                                                                                                                                                                                                        ..... assigner
                                                                                                                                                                                                                                                                                                                                                                        II.assigningAuthorityName but note that this is an improper use by the definition of the field. Also Role.scoper
                                                                                                                                                                                                                                                                                                                                                                        ... status
                                                                                                                                                                                                                                                                                                                                                                        Event.status
                                                                                                                                                                                                                                                                                                                                                                        FiveWs.status
                                                                                                                                                                                                                                                                                                                                                                        ... type
                                                                                                                                                                                                                                                                                                                                                                        FiveWs.class
                                                                                                                                                                                                                                                                                                                                                                        ... subType
                                                                                                                                                                                                                                                                                                                                                                        FiveWs.class
                                                                                                                                                                                                                                                                                                                                                                        ... use
                                                                                                                                                                                                                                                                                                                                                                        FiveWs.class
                                                                                                                                                                                                                                                                                                                                                                        ... patient
                                                                                                                                                                                                                                                                                                                                                                        FiveWs.subject
                                                                                                                                                                                                                                                                                                                                                                        ... created
                                                                                                                                                                                                                                                                                                                                                                        Event.occurrence[x]
                                                                                                                                                                                                                                                                                                                                                                        FiveWs.recorded
                                                                                                                                                                                                                                                                                                                                                                        ... insurer
                                                                                                                                                                                                                                                                                                                                                                        Event.performer
                                                                                                                                                                                                                                                                                                                                                                        ... requestor
                                                                                                                                                                                                                                                                                                                                                                        FiveWs.source
                                                                                                                                                                                                                                                                                                                                                                        ... request
                                                                                                                                                                                                                                                                                                                                                                        Event.basedOn
                                                                                                                                                                                                                                                                                                                                                                        FiveWs.why[x]
                                                                                                                                                                                                                                                                                                                                                                        ... outcome
                                                                                                                                                                                                                                                                                                                                                                        ... disposition
                                                                                                                                                                                                                                                                                                                                                                        Event.note
                                                                                                                                                                                                                                                                                                                                                                        ... preAuthRef
                                                                                                                                                                                                                                                                                                                                                                        ... preAuthPeriod
                                                                                                                                                                                                                                                                                                                                                                        ... payeeType
                                                                                                                                                                                                                                                                                                                                                                        ... item
                                                                                                                                                                                                                                                                                                                                                                        .... id
                                                                                                                                                                                                                                                                                                                                                                        n/a
                                                                                                                                                                                                                                                                                                                                                                        .... Slices for extension
                                                                                                                                                                                                                                                                                                                                                                        ..... extension:recordRef
                                                                                                                                                                                                                                                                                                                                                                        .... modifierExtension
                                                                                                                                                                                                                                                                                                                                                                        N/A
                                                                                                                                                                                                                                                                                                                                                                        .... itemSequence
                                                                                                                                                                                                                                                                                                                                                                        .... noteNumber
                                                                                                                                                                                                                                                                                                                                                                        .... adjudication
                                                                                                                                                                                                                                                                                                                                                                        ..... id
                                                                                                                                                                                                                                                                                                                                                                        n/a
                                                                                                                                                                                                                                                                                                                                                                        ..... extension
                                                                                                                                                                                                                                                                                                                                                                        n/a
                                                                                                                                                                                                                                                                                                                                                                        ..... modifierExtension
                                                                                                                                                                                                                                                                                                                                                                        N/A
                                                                                                                                                                                                                                                                                                                                                                        ..... category
                                                                                                                                                                                                                                                                                                                                                                        ..... reason
                                                                                                                                                                                                                                                                                                                                                                        ..... amount
                                                                                                                                                                                                                                                                                                                                                                        ..... value
                                                                                                                                                                                                                                                                                                                                                                        .... detail
                                                                                                                                                                                                                                                                                                                                                                        ..... id
                                                                                                                                                                                                                                                                                                                                                                        n/a
                                                                                                                                                                                                                                                                                                                                                                        ..... extension
                                                                                                                                                                                                                                                                                                                                                                        n/a
                                                                                                                                                                                                                                                                                                                                                                        ..... modifierExtension
                                                                                                                                                                                                                                                                                                                                                                        N/A
                                                                                                                                                                                                                                                                                                                                                                        ..... detailSequence
                                                                                                                                                                                                                                                                                                                                                                        ..... noteNumber
                                                                                                                                                                                                                                                                                                                                                                        ..... adjudication
                                                                                                                                                                                                                                                                                                                                                                        ..... subDetail
                                                                                                                                                                                                                                                                                                                                                                        ...... id
                                                                                                                                                                                                                                                                                                                                                                        n/a
                                                                                                                                                                                                                                                                                                                                                                        ...... extension
                                                                                                                                                                                                                                                                                                                                                                        n/a
                                                                                                                                                                                                                                                                                                                                                                        ...... modifierExtension
                                                                                                                                                                                                                                                                                                                                                                        N/A
                                                                                                                                                                                                                                                                                                                                                                        ...... subDetailSequence
                                                                                                                                                                                                                                                                                                                                                                        ...... noteNumber
                                                                                                                                                                                                                                                                                                                                                                        ...... adjudication
                                                                                                                                                                                                                                                                                                                                                                        ... addItem
                                                                                                                                                                                                                                                                                                                                                                        .... id
                                                                                                                                                                                                                                                                                                                                                                        n/a
                                                                                                                                                                                                                                                                                                                                                                        .... Slices for extension
                                                                                                                                                                                                                                                                                                                                                                        ..... extension:recordRef
                                                                                                                                                                                                                                                                                                                                                                        .... modifierExtension
                                                                                                                                                                                                                                                                                                                                                                        N/A
                                                                                                                                                                                                                                                                                                                                                                        .... itemSequence
                                                                                                                                                                                                                                                                                                                                                                        .... detailSequence
                                                                                                                                                                                                                                                                                                                                                                        .... subdetailSequence
                                                                                                                                                                                                                                                                                                                                                                        .... provider
                                                                                                                                                                                                                                                                                                                                                                        FiveWs.source
                                                                                                                                                                                                                                                                                                                                                                        .... productOrService
                                                                                                                                                                                                                                                                                                                                                                        .... modifier
                                                                                                                                                                                                                                                                                                                                                                        • 24.C
                                                                                                                                                                                                                                                                                                                                                                        • 24.D mods
                                                                                                                                                                                                                                                                                                                                                                        .... programCode
                                                                                                                                                                                                                                                                                                                                                                        24.H
                                                                                                                                                                                                                                                                                                                                                                        .... serviced[x]
                                                                                                                                                                                                                                                                                                                                                                        FiveWs.done[x]
                                                                                                                                                                                                                                                                                                                                                                        24.A
                                                                                                                                                                                                                                                                                                                                                                        .... location[x]
                                                                                                                                                                                                                                                                                                                                                                        FiveWs.where[x]
                                                                                                                                                                                                                                                                                                                                                                        24.B
                                                                                                                                                                                                                                                                                                                                                                        .... quantity
                                                                                                                                                                                                                                                                                                                                                                        24.G
                                                                                                                                                                                                                                                                                                                                                                        .... unitPrice
                                                                                                                                                                                                                                                                                                                                                                        .... factor
                                                                                                                                                                                                                                                                                                                                                                        .... net
                                                                                                                                                                                                                                                                                                                                                                        24.F
                                                                                                                                                                                                                                                                                                                                                                        .... bodySite
                                                                                                                                                                                                                                                                                                                                                                        .... subSite
                                                                                                                                                                                                                                                                                                                                                                        .... noteNumber
                                                                                                                                                                                                                                                                                                                                                                        .... adjudication
                                                                                                                                                                                                                                                                                                                                                                        ..... id
                                                                                                                                                                                                                                                                                                                                                                        n/a
                                                                                                                                                                                                                                                                                                                                                                        ..... extension
                                                                                                                                                                                                                                                                                                                                                                        n/a
                                                                                                                                                                                                                                                                                                                                                                        ..... modifierExtension
                                                                                                                                                                                                                                                                                                                                                                        N/A
                                                                                                                                                                                                                                                                                                                                                                        ..... category
                                                                                                                                                                                                                                                                                                                                                                        ..... reason
                                                                                                                                                                                                                                                                                                                                                                        ..... amount
                                                                                                                                                                                                                                                                                                                                                                        ..... value
                                                                                                                                                                                                                                                                                                                                                                        .... detail
                                                                                                                                                                                                                                                                                                                                                                        ..... id
                                                                                                                                                                                                                                                                                                                                                                        n/a
                                                                                                                                                                                                                                                                                                                                                                        ..... extension
                                                                                                                                                                                                                                                                                                                                                                        n/a
                                                                                                                                                                                                                                                                                                                                                                        ..... modifierExtension
                                                                                                                                                                                                                                                                                                                                                                        N/A
                                                                                                                                                                                                                                                                                                                                                                        ..... productOrService
                                                                                                                                                                                                                                                                                                                                                                        ..... modifier
                                                                                                                                                                                                                                                                                                                                                                        • 24.C
                                                                                                                                                                                                                                                                                                                                                                        • 24.D mods
                                                                                                                                                                                                                                                                                                                                                                        ..... quantity
                                                                                                                                                                                                                                                                                                                                                                        24.G
                                                                                                                                                                                                                                                                                                                                                                        ..... unitPrice
                                                                                                                                                                                                                                                                                                                                                                        ..... factor
                                                                                                                                                                                                                                                                                                                                                                        ..... net
                                                                                                                                                                                                                                                                                                                                                                        24.F
                                                                                                                                                                                                                                                                                                                                                                        ..... noteNumber
                                                                                                                                                                                                                                                                                                                                                                        ..... adjudication
                                                                                                                                                                                                                                                                                                                                                                        ..... subDetail
                                                                                                                                                                                                                                                                                                                                                                        ...... id
                                                                                                                                                                                                                                                                                                                                                                        n/a
                                                                                                                                                                                                                                                                                                                                                                        ...... extension
                                                                                                                                                                                                                                                                                                                                                                        n/a
                                                                                                                                                                                                                                                                                                                                                                        ...... modifierExtension
                                                                                                                                                                                                                                                                                                                                                                        N/A
                                                                                                                                                                                                                                                                                                                                                                        ...... productOrService
                                                                                                                                                                                                                                                                                                                                                                        ...... modifier
                                                                                                                                                                                                                                                                                                                                                                        • 24.C
                                                                                                                                                                                                                                                                                                                                                                        • 24.D mods
                                                                                                                                                                                                                                                                                                                                                                        ...... quantity
                                                                                                                                                                                                                                                                                                                                                                        24.G
                                                                                                                                                                                                                                                                                                                                                                        ...... unitPrice
                                                                                                                                                                                                                                                                                                                                                                        ...... factor
                                                                                                                                                                                                                                                                                                                                                                        ...... net
                                                                                                                                                                                                                                                                                                                                                                        24.F
                                                                                                                                                                                                                                                                                                                                                                        ...... noteNumber
                                                                                                                                                                                                                                                                                                                                                                        ...... adjudication
                                                                                                                                                                                                                                                                                                                                                                        ... adjudication
                                                                                                                                                                                                                                                                                                                                                                        ... total
                                                                                                                                                                                                                                                                                                                                                                        .... id
                                                                                                                                                                                                                                                                                                                                                                        n/a
                                                                                                                                                                                                                                                                                                                                                                        .... extension
                                                                                                                                                                                                                                                                                                                                                                        n/a
                                                                                                                                                                                                                                                                                                                                                                        .... modifierExtension
                                                                                                                                                                                                                                                                                                                                                                        N/A
                                                                                                                                                                                                                                                                                                                                                                        .... category
                                                                                                                                                                                                                                                                                                                                                                        .... amount
                                                                                                                                                                                                                                                                                                                                                                        ... payment
                                                                                                                                                                                                                                                                                                                                                                        .... id
                                                                                                                                                                                                                                                                                                                                                                        n/a
                                                                                                                                                                                                                                                                                                                                                                        .... extension
                                                                                                                                                                                                                                                                                                                                                                        n/a
                                                                                                                                                                                                                                                                                                                                                                        .... modifierExtension
                                                                                                                                                                                                                                                                                                                                                                        N/A
                                                                                                                                                                                                                                                                                                                                                                        .... type
                                                                                                                                                                                                                                                                                                                                                                        .... adjustment
                                                                                                                                                                                                                                                                                                                                                                        .... adjustmentReason
                                                                                                                                                                                                                                                                                                                                                                        .... date
                                                                                                                                                                                                                                                                                                                                                                        .... amount
                                                                                                                                                                                                                                                                                                                                                                        .... identifier
                                                                                                                                                                                                                                                                                                                                                                        ... fundsReserve
                                                                                                                                                                                                                                                                                                                                                                        ... formCode
                                                                                                                                                                                                                                                                                                                                                                        ... form
                                                                                                                                                                                                                                                                                                                                                                        ... processNote
                                                                                                                                                                                                                                                                                                                                                                        .... id
                                                                                                                                                                                                                                                                                                                                                                        n/a
                                                                                                                                                                                                                                                                                                                                                                        .... extension
                                                                                                                                                                                                                                                                                                                                                                        n/a
                                                                                                                                                                                                                                                                                                                                                                        .... modifierExtension
                                                                                                                                                                                                                                                                                                                                                                        N/A
                                                                                                                                                                                                                                                                                                                                                                        .... number
                                                                                                                                                                                                                                                                                                                                                                        .... type
                                                                                                                                                                                                                                                                                                                                                                        .... text
                                                                                                                                                                                                                                                                                                                                                                        .... language
                                                                                                                                                                                                                                                                                                                                                                        ... communicationRequest
                                                                                                                                                                                                                                                                                                                                                                        ... insurance
                                                                                                                                                                                                                                                                                                                                                                        Coverage
                                                                                                                                                                                                                                                                                                                                                                        .... id
                                                                                                                                                                                                                                                                                                                                                                        n/a
                                                                                                                                                                                                                                                                                                                                                                        .... extension
                                                                                                                                                                                                                                                                                                                                                                        n/a
                                                                                                                                                                                                                                                                                                                                                                        .... modifierExtension
                                                                                                                                                                                                                                                                                                                                                                        N/A
                                                                                                                                                                                                                                                                                                                                                                        .... sequence
                                                                                                                                                                                                                                                                                                                                                                        .... focal
                                                                                                                                                                                                                                                                                                                                                                        .... coverage
                                                                                                                                                                                                                                                                                                                                                                        .... businessArrangement
                                                                                                                                                                                                                                                                                                                                                                        .... claimResponse
                                                                                                                                                                                                                                                                                                                                                                        ... error
                                                                                                                                                                                                                                                                                                                                                                        .... id
                                                                                                                                                                                                                                                                                                                                                                        n/a
                                                                                                                                                                                                                                                                                                                                                                        .... Slices for extension
                                                                                                                                                                                                                                                                                                                                                                        ..... extension:recordRef
                                                                                                                                                                                                                                                                                                                                                                        .... modifierExtension
                                                                                                                                                                                                                                                                                                                                                                        N/A
                                                                                                                                                                                                                                                                                                                                                                        .... itemSequence
                                                                                                                                                                                                                                                                                                                                                                        .... detailSequence
                                                                                                                                                                                                                                                                                                                                                                        .... subDetailSequence
                                                                                                                                                                                                                                                                                                                                                                        .... code

                                                                                                                                                                                                                                                                                                                                                                        doco Documentation for this format