臺灣健保事前審查實作指引
1.2.3 - ci-build

臺灣健保事前審查實作指引, published by 衛生福利部中央健康保險署. This guide is not an authorized publication; it is the continuous build for version 1.2.3 built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/TWNHIFHIR/pas/ and changes regularly. See the Directory of published versions

Resource Profile: ClaimResponseSelfAssessmentTWPAS - Mappings

Active as of 2026-05-27

Mappings for the ClaimResponse-self-assessment-twpas resource profile.

Mappings to Structures in this Implementation Guide

NameMapping to TWPAS ClaimResponse Self AssessmentMapping to TWPAS ClaimResponse Self Assessmentdoco
.. ClaimResponse
      ... id
          ... meta
              .... id
                  .... extension
                      .... versionId
                          .... lastUpdated
                              .... source
                                  .... profile
                                      .... security
                                          .... tag
                                              ... implicitRules
                                                  ... language
                                                      ... text
                                                          ... contained
                                                              ... Slices for extension
                                                              .... extension:requestor
                                                              ... modifierExtension
                                                                  ... identifier
                                                                      ... status
                                                                          ... type
                                                                              ... subType
                                                                                  ... use
                                                                                      ... patient
                                                                                          ... created
                                                                                          ... insurer
                                                                                              ... requestor
                                                                                                  ... request
                                                                                                      ... outcome
                                                                                                          ... disposition
                                                                                                            ... preAuthRef
                                                                                                                ... preAuthPeriod
                                                                                                                    ... payeeType
                                                                                                                        ... item
                                                                                                                            .... id
                                                                                                                                .... extension
                                                                                                                                    .... modifierExtension
                                                                                                                                        .... itemSequence
                                                                                                                                            .... noteNumber
                                                                                                                                                .... adjudication
                                                                                                                                                    ..... id
                                                                                                                                                        ..... extension
                                                                                                                                                            ..... modifierExtension
                                                                                                                                                                ..... category
                                                                                                                                                                    ...... id
                                                                                                                                                                        ...... extension
                                                                                                                                                                            ...... coding
                                                                                                                                                                                ....... id
                                                                                                                                                                                    ....... extension
                                                                                                                                                                                        ....... system
                                                                                                                                                                                            ....... version
                                                                                                                                                                                                ....... code
                                                                                                                                                                                                    ....... display
                                                                                                                                                                                                        ....... userSelected
                                                                                                                                                                                                            ...... text
                                                                                                                                                                                                                ..... reason
                                                                                                                                                                                                                ..... amount
                                                                                                                                                                                                                    ..... value
                                                                                                                                                                                                                    .... detail
                                                                                                                                                                                                                        ..... id
                                                                                                                                                                                                                            ..... extension
                                                                                                                                                                                                                                ..... modifierExtension
                                                                                                                                                                                                                                    ..... detailSequence
                                                                                                                                                                                                                                        ..... noteNumber
                                                                                                                                                                                                                                            ..... adjudication
                                                                                                                                                                                                                                                ..... subDetail
                                                                                                                                                                                                                                                    ...... id
                                                                                                                                                                                                                                                        ...... extension
                                                                                                                                                                                                                                                            ...... modifierExtension
                                                                                                                                                                                                                                                                ...... subDetailSequence
                                                                                                                                                                                                                                                                    ...... noteNumber
                                                                                                                                                                                                                                                                        ...... adjudication
                                                                                                                                                                                                                                                                            ... addItem
                                                                                                                                                                                                                                                                                .... id
                                                                                                                                                                                                                                                                                    .... extension
                                                                                                                                                                                                                                                                                        .... modifierExtension
                                                                                                                                                                                                                                                                                            .... itemSequence
                                                                                                                                                                                                                                                                                                .... detailSequence
                                                                                                                                                                                                                                                                                                    .... subdetailSequence
                                                                                                                                                                                                                                                                                                        .... provider
                                                                                                                                                                                                                                                                                                            .... productOrService
                                                                                                                                                                                                                                                                                                                .... modifier
                                                                                                                                                                                                                                                                                                                    .... programCode
                                                                                                                                                                                                                                                                                                                        .... serviced[x]
                                                                                                                                                                                                                                                                                                                            .... location[x]
                                                                                                                                                                                                                                                                                                                                .... quantity
                                                                                                                                                                                                                                                                                                                                    .... unitPrice
                                                                                                                                                                                                                                                                                                                                        .... factor
                                                                                                                                                                                                                                                                                                                                            .... net
                                                                                                                                                                                                                                                                                                                                                .... bodySite
                                                                                                                                                                                                                                                                                                                                                    .... subSite
                                                                                                                                                                                                                                                                                                                                                        .... noteNumber
                                                                                                                                                                                                                                                                                                                                                            .... adjudication
                                                                                                                                                                                                                                                                                                                                                                .... 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
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                .... extension
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    .... 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
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        .... id
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        n/a
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        .... extension
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        n/a
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        .... versionId
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        .... lastUpdated
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        .... source
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        .... profile
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        .... security
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        .... tag
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        ... implicitRules
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        ... language
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        ... text
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        Act.text?
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        ... contained
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        N/A
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        ... Slices for extension
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        .... extension:requestor
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        ... modifierExtension
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        N/A
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        ... identifier
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        Event.identifier
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        FiveWs.identifier
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        ... 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
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        .... extension
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        n/a
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        .... modifierExtension
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        N/A
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        .... itemSequence
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        .... noteNumber
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        .... adjudication
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        ..... id
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        n/a
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        ..... extension
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        n/a
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        ..... modifierExtension
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        N/A
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        ..... category
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        ...... id
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        n/a
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        ...... extension
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        n/a
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        ...... coding
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        • union(.
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        • ./translation)
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        ....... id
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        n/a
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        ....... extension
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        n/a
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        ....... system
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        ./codeSystem
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        ....... version
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        ./codeSystemVersion
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        ....... code
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        ./code
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        ....... display
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        CV.displayName
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        ....... userSelected
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        CD.codingRationale
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        ...... text
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        ./originalText[mediaType/code="text/plain"]/data
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        ..... 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
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        .... extension
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        n/a
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        .... 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
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        .... 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
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        .... extension
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        n/a
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        .... modifierExtension
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        N/A
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        .... itemSequence
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        .... detailSequence
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        .... subDetailSequence
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        .... code

                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        doco Documentation for this format