Profile Comparison between https://nhicore.nhi.gov.tw/pas/StructureDefinition/ClaimResponse-self-assessment-twpas vs https://nhicore.nhi.gov.tw/pas/StructureDefinition/ClaimResponse-self-assessment-twpas

Messages

Metadata

Name	Value		Comments
abstract	false
baseDefinition	http://hl7.org/fhir/StructureDefinition/ClaimResponse
copyright
date	2026-09-24T22:23:31+08:00	2026-10-14T06:35:06+00:00	Values Differ
description	此自主審查-ClaimResponse TWPAS Profile說明本IG如何進一步定義FHIR的ClaimResponse Resource以呈現自主審查之內容。 現行開放自主事前審查項目僅有心臟及肝臟移植，若醫院要自主事前審查需向健保署申請，通過後，健保署會於署內系統維護，具有此資格之院所才可填報自主審查。	此自主審查-ClaimResponse TWPAS Profile說明本IG如何進一步定義FHIR的ClaimResponse Resource以呈現自主審查之內容。 現行開放自主事前審查項目僅有心臟及肝臟移植，若醫院要自主事前審查需向健保署申請，通過後，健保署會於署內系統維護，具有此資格之院所才可填報自主審查。	Values Differ
experimental
fhirVersion	4.0.1
jurisdiction
jurisdiction / jurisdiction[0]		null#null	Added the item 'null#null'
kind	resource
name	ClaimResponseSelfAssessmentTWPAS
publisher	衛生福利部中央健康保險署
purpose
status	active
title	自主審查-ClaimResponse Self Assessment TWPAS
type	ClaimResponse
url	https://nhicore.nhi.gov.tw/pas/StructureDefinition/ClaimResponse-self-assessment-twpas
version	1.2.7	1.2.8	Values Differ

Structure

Name	L Flags	L Card.	L Type	L Description & Constraints	R Flags	R Card.	R Type	R Description & Constraints	Comments
ClaimResponse	C	0..*	ClaimResponse	Response to a claim predetermination or preauthorization Constraints: acceptanceStatus	C	0..*	ClaimResponse	Response to a claim predetermination or preauthorization Constraints: acceptanceStatus
ClaimResponse.id	Σ This element is included in summaries.	0..1	id	Logical id of this artifact	Σ This element is included in summaries.	0..1	id	Logical id of this artifact
ClaimResponse.meta	Σ This element is included in summaries.	1..1	Meta	Metadata about the resource	Σ This element is included in summaries.	1..1	Meta	Metadata about the resource
ClaimResponse.meta.id		0..1	string	Unique id for inter-element referencing		0..1	string	Unique id for inter-element referencing
ClaimResponse.meta.Slices for extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
ClaimResponse.meta.versionId	Σ This element is included in summaries.	0..1	id	Version specific identifier	Σ This element is included in summaries.	0..1	id	Version specific identifier
ClaimResponse.meta.lastUpdated	Σ This element is included in summaries.	0..1	instant	When the resource version last changed	Σ This element is included in summaries.	0..1	instant	When the resource version last changed
ClaimResponse.meta.source	Σ This element is included in summaries.	0..1	uri	Identifies where the resource comes from	Σ This element is included in summaries.	0..1	uri	Identifies where the resource comes from
ClaimResponse.meta.profile	Σ This element is included in summaries.	1..1	canonical(StructureDefinition)	Profiles this resource claims to conform to Required Pattern: https://nhicore.nhi.gov.tw/pas/StructureDefinition/ClaimResponse-self-assessment-twpas	Σ This element is included in summaries.	1..1	canonical(StructureDefinition)	Profiles this resource claims to conform to Required Pattern: https://nhicore.nhi.gov.tw/pas/StructureDefinition/ClaimResponse-self-assessment-twpas
ClaimResponse.meta.security	Σ This element is included in summaries.	0..*	Coding	Security Labels applied to this resource Binding: ?? (extensible): Security Labels from the Healthcare Privacy and Security Classification System.	Σ This element is included in summaries.	0..*	Coding	Security Labels applied to this resource Binding: ?? (extensible): Security Labels from the Healthcare Privacy and Security Classification System.
ClaimResponse.meta.tag	Σ This element is included in summaries.	0..*	Coding	Tags applied to this resource Binding: ?? (example): Codes that represent various types of tags, commonly workflow-related; e.g. "Needs review by Dr. Jones".	Σ This element is included in summaries.	0..*	Coding	Tags applied to this resource Binding: ?? (example): Codes that represent various types of tags, commonly workflow-related; e.g. "Needs review by Dr. Jones".
ClaimResponse.implicitRules	?! This element is a modifier element. Σ This element is included in summaries.	0..1	uri	A set of rules under which this content was created	?! This element is a modifier element. Σ This element is included in summaries.	0..1	uri	A set of rules under which this content was created
ClaimResponse.language		0..1	code	Language of the resource content Binding: ?? (preferred): A human language. Additional Bindings Purpose ?? Max Binding		0..1	code	Language of the resource content Binding: ?? (preferred): A human language. Additional Bindings Purpose ?? Max Binding
ClaimResponse.text		0..1	Narrative	Text summary of the resource, for human interpretation This profile does not constrain the narrative in regard to content, language, or traceability to data elements		0..1	Narrative	Text summary of the resource, for human interpretation This profile does not constrain the narrative in regard to content, language, or traceability to data elements
ClaimResponse.contained		0..*	Resource	Contained, inline Resources		0..*	Resource	Contained, inline Resources
ClaimResponse.Slices for extension		1..*	Extension	Extension Slice: Unordered, Open by value:url Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them		1..*	Extension	Extension Slice: Unordered, Open by value:url Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them
ClaimResponse.modifierExtension	?! This element is a modifier element.	0..*	Extension	Extensions that cannot be ignored	?! This element is a modifier element.	0..*	Extension	Extensions that cannot be ignored
ClaimResponse.identifier		0..*	Identifier	Business Identifier for a claim response		0..*	Identifier	Business Identifier for a claim response
ClaimResponse.status	?! This element is a modifier element. Σ This element is included in summaries.	1..1	code	active | cancelled | draft | entered-in-error Binding: ?? (required): A code specifying the state of the resource instance. Required Pattern: active	?! This element is a modifier element. Σ This element is included in summaries.	1..1	code	active | cancelled | draft | entered-in-error Binding: ?? (required): A code specifying the state of the resource instance. Required Pattern: active
ClaimResponse.type	Σ This element is included in summaries.	1..1	CodeableConcept	More granular claim type Binding: ?? (extensible): The type or discipline-style of the claim. Required Pattern: {"coding":[{"system":"http://terminology.hl7.org/CodeSystem/claim-type","code":"institutional"}]}	Σ This element is included in summaries.	1..1	CodeableConcept	More granular claim type Binding: ?? (extensible): The type or discipline-style of the claim. Required Pattern: {"coding":[{"system":"http://terminology.hl7.org/CodeSystem/claim-type","code":"institutional"}]}
ClaimResponse.subType		0..1	CodeableConcept	More granular claim type Binding: ?? (example): A more granular claim typecode.		0..1	CodeableConcept	More granular claim type Binding: ?? (example): A more granular claim typecode.
ClaimResponse.use	Σ This element is included in summaries.	1..1	code	claim | preauthorization | predetermination Binding: ?? (required): Claim, preauthorization, predetermination. Required Pattern: preauthorization	Σ This element is included in summaries.	1..1	code	claim | preauthorization | predetermination Binding: ?? (required): Claim, preauthorization, predetermination. Required Pattern: preauthorization
ClaimResponse.patient	Σ This element is included in summaries.	1..1	Reference(病人資訊-Patient TWPAS)	The recipient of the products and services	Σ This element is included in summaries.	1..1	Reference(病人資訊-Patient TWPAS)	The recipient of the products and services
ClaimResponse.created	S This element must be supported. Σ This element is included in summaries.	1..1	dateTime	核定日期。若申請案件類別為3時須填寫。YYYY-MM-DD，西元年月日。	S This element must be supported. Σ This element is included in summaries.	1..1	dateTime	核定日期。若申請案件類別為3時須填寫。YYYY-MM-DD，西元年月日。
ClaimResponse.insurer	Σ This element is included in summaries.	1..1	Reference(TW Core Organization Government)	Party responsible for reimbursement	Σ This element is included in summaries.	1..1	Reference(TW Core Organization Government)	Party responsible for reimbursement
ClaimResponse.requestor		0..1	Reference(Practitioner | PractitionerRole | Organization)	Party responsible for the claim		0..1	Reference(Practitioner | PractitionerRole | Organization)	Party responsible for the claim
ClaimResponse.request	Σ This element is included in summaries.	0..1	Reference(Claim)	Id of resource triggering adjudication	Σ This element is included in summaries.	0..1	Reference(Claim)	Id of resource triggering adjudication
ClaimResponse.outcome	Σ This element is included in summaries.	1..1	code	queued | complete | error | partial Binding: ?? (required): The result of the claim processing.	Σ This element is included in summaries.	1..1	code	queued | complete | error | partial Binding: ?? (required): The result of the claim processing.
ClaimResponse.disposition	S This element must be supported.	0..1	string	核定意見	S This element must be supported.	0..1	string	核定意見
ClaimResponse.preAuthRef		0..1	string	Preauthorization reference		0..1	string	Preauthorization reference
ClaimResponse.preAuthPeriod		0..1	Period	Preauthorization reference effective period		0..1	Period	Preauthorization reference effective period
ClaimResponse.payeeType		0..1	CodeableConcept	Party to be paid any benefits payable Binding: ?? (example): A code for the party to be reimbursed.		0..1	CodeableConcept	Party to be paid any benefits payable Binding: ?? (example): A code for the party to be reimbursed.
ClaimResponse.item		1..*	BackboneElement	Adjudication for claim line items		1..*	BackboneElement	Adjudication for claim line items
ClaimResponse.item.id		0..1	string	Unique id for inter-element referencing		0..1	string	Unique id for inter-element referencing
ClaimResponse.item.extension		0..*	Extension	Additional content defined by implementations		0..*	Extension	Additional content defined by implementations
ClaimResponse.item.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
ClaimResponse.item.itemSequence		1..1	positiveInt	請填寫對應的Claim.item.sequence		1..1	positiveInt	請填寫對應的Claim.item.sequence
ClaimResponse.item.noteNumber		0..*	positiveInt	Applicable note numbers		0..*	positiveInt	Applicable note numbers
ClaimResponse.item.adjudication		1..1	BackboneElement	Adjudication details		1..1	BackboneElement	Adjudication details
ClaimResponse.item.adjudication.id		0..1	string	Unique id for inter-element referencing		0..1	string	Unique id for inter-element referencing
ClaimResponse.item.adjudication.extension		0..*	Extension	Additional content defined by implementations		0..*	Extension	Additional content defined by implementations
ClaimResponse.item.adjudication.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
ClaimResponse.item.adjudication.category		1..1	CodeableConcept	【因FHIR設計而需必填】 Binding: ?? (example): The adjudication codes.		1..1	CodeableConcept	【因FHIR設計而需必填】 Binding: ?? (example): The adjudication codes.
ClaimResponse.item.adjudication.category.id		0..1	string	Unique id for inter-element referencing		0..1	string	Unique id for inter-element referencing
ClaimResponse.item.adjudication.category.Slices for extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
ClaimResponse.item.adjudication.category.coding	Σ This element is included in summaries.	0..*	Coding	Code defined by a terminology system	Σ This element is included in summaries.	0..*	Coding	Code defined by a terminology system
ClaimResponse.item.adjudication.category.coding.id		0..1	string	Unique id for inter-element referencing		0..1	string	Unique id for inter-element referencing
ClaimResponse.item.adjudication.category.coding.Slices for extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
ClaimResponse.item.adjudication.category.coding.system	Σ This element is included in summaries.	0..1	uri	Identity of the terminology system Example General: http://terminology.hl7.org/CodeSystem/adjudication	Σ This element is included in summaries.	0..1	uri	Identity of the terminology system Example General: http://terminology.hl7.org/CodeSystem/adjudication
ClaimResponse.item.adjudication.category.coding.version	Σ This element is included in summaries.	0..1	string	Version of the system - if relevant	Σ This element is included in summaries.	0..1	string	Version of the system - if relevant
ClaimResponse.item.adjudication.category.coding.code	Σ This element is included in summaries.	0..1	code	Symbol in syntax defined by the system Example General: submitted	Σ This element is included in summaries.	0..1	code	Symbol in syntax defined by the system Example General: submitted
ClaimResponse.item.adjudication.category.coding.display	Σ This element is included in summaries.	0..1	string	Representation defined by the system	Σ This element is included in summaries.	0..1	string	Representation defined by the system
ClaimResponse.item.adjudication.category.coding.userSelected	Σ This element is included in summaries.	0..1	boolean	If this coding was chosen directly by the user	Σ This element is included in summaries.	0..1	boolean	If this coding was chosen directly by the user
ClaimResponse.item.adjudication.category.text	Σ This element is included in summaries.	0..1	string	Plain text representation of the concept	Σ This element is included in summaries.	0..1	string	Plain text representation of the concept
ClaimResponse.item.adjudication.reason	S This element must be supported.	1..1	CodeableConcept	個別醫令核定註記。0:審核中 | 1:同意 | 2:不予同意 | 3:部份同意 | 4:補件 | 5:退件 | 6:不予同意:對應手術亦不支付 | 7:改核:如審查核定意見 Binding: ?? (required)	S This element must be supported.	1..1	CodeableConcept	個別醫令核定註記。0:審核中 | 1:同意 | 2:不予同意 | 3:部份同意 | 4:補件 | 5:退件 | 6:不予同意:對應手術亦不支付 | 7:改核:如審查核定意見 Binding: ?? (required)
ClaimResponse.item.adjudication.amount		0..1	Money	Monetary amount		0..1	Money	Monetary amount
ClaimResponse.item.adjudication.value	S This element must be supported.	1..1	decimal	個別審查結果數量，若申請案件類別為3時須填寫。	S This element must be supported.	1..1	decimal	個別審查結果數量，若申請案件類別為3時須填寫。
ClaimResponse.item.detail		0..*	BackboneElement	Adjudication for claim details		0..*	BackboneElement	Adjudication for claim details
ClaimResponse.item.detail.id		0..1	string	Unique id for inter-element referencing		0..1	string	Unique id for inter-element referencing
ClaimResponse.item.detail.extension		0..*	Extension	Additional content defined by implementations		0..*	Extension	Additional content defined by implementations
ClaimResponse.item.detail.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
ClaimResponse.item.detail.detailSequence		1..1	positiveInt	Claim detail instance identifier		1..1	positiveInt	Claim detail instance identifier
ClaimResponse.item.detail.noteNumber		0..*	positiveInt	Applicable note numbers		0..*	positiveInt	Applicable note numbers
ClaimResponse.item.detail.adjudication		1..*	See adjudication (ClaimResponse)	Detail level adjudication details		1..*	See adjudication (ClaimResponse)	Detail level adjudication details
ClaimResponse.item.detail.subDetail		0..*	BackboneElement	Adjudication for claim sub-details		0..*	BackboneElement	Adjudication for claim sub-details
ClaimResponse.item.detail.subDetail.id		0..1	string	Unique id for inter-element referencing		0..1	string	Unique id for inter-element referencing
ClaimResponse.item.detail.subDetail.extension		0..*	Extension	Additional content defined by implementations		0..*	Extension	Additional content defined by implementations
ClaimResponse.item.detail.subDetail.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
ClaimResponse.item.detail.subDetail.subDetailSequence		1..1	positiveInt	Claim sub-detail instance identifier		1..1	positiveInt	Claim sub-detail instance identifier
ClaimResponse.item.detail.subDetail.noteNumber		0..*	positiveInt	Applicable note numbers		0..*	positiveInt	Applicable note numbers
ClaimResponse.item.detail.subDetail.adjudication		0..*	See adjudication (ClaimResponse)	Subdetail level adjudication details		0..*	See adjudication (ClaimResponse)	Subdetail level adjudication details
ClaimResponse.addItem		0..*	BackboneElement	Insurer added line items		0..*	BackboneElement	Insurer added line items
ClaimResponse.addItem.id		0..1	string	Unique id for inter-element referencing		0..1	string	Unique id for inter-element referencing
ClaimResponse.addItem.extension		0..*	Extension	Additional content defined by implementations		0..*	Extension	Additional content defined by implementations
ClaimResponse.addItem.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
ClaimResponse.addItem.itemSequence		0..*	positiveInt	Item sequence number		0..*	positiveInt	Item sequence number
ClaimResponse.addItem.detailSequence		0..*	positiveInt	Detail sequence number		0..*	positiveInt	Detail sequence number
ClaimResponse.addItem.subdetailSequence		0..*	positiveInt	Subdetail sequence number		0..*	positiveInt	Subdetail sequence number
ClaimResponse.addItem.provider		0..*	Reference(Practitioner | PractitionerRole | Organization)	Authorized providers		0..*	Reference(Practitioner | PractitionerRole | Organization)	Authorized providers
ClaimResponse.addItem.productOrService		1..1	CodeableConcept	Billing, service, product, or drug code Binding: ?? (example): Allowable service and product codes.		1..1	CodeableConcept	Billing, service, product, or drug code Binding: ?? (example): Allowable service and product codes.
ClaimResponse.addItem.modifier		0..*	CodeableConcept	Service/Product billing modifiers Binding: ?? (example): Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen.		0..*	CodeableConcept	Service/Product billing modifiers Binding: ?? (example): Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen.
ClaimResponse.addItem.programCode		0..*	CodeableConcept	Program the product or service is provided under Binding: ?? (example): Program specific reason codes.		0..*	CodeableConcept	Program the product or service is provided under Binding: ?? (example): Program specific reason codes.
ClaimResponse.addItem.serviced[x]		0..1	date, Period	Date or dates of service or product delivery		0..1	date, Period	Date or dates of service or product delivery
ClaimResponse.addItem.location[x]		0..1	CodeableConcept, Address, Reference(Location)	Place of service or where product was supplied Binding: ?? (example): Place of service: pharmacy, school, prison, etc.		0..1	CodeableConcept, Address, Reference(Location)	Place of service or where product was supplied Binding: ?? (example): Place of service: pharmacy, school, prison, etc.
ClaimResponse.addItem.quantity		0..1	??	Count of products or services	C	0..1	??	Count of products or services
ClaimResponse.addItem.unitPrice		0..1	Money	Fee, charge or cost per item		0..1	Money	Fee, charge or cost per item
ClaimResponse.addItem.factor		0..1	decimal	Price scaling factor		0..1	decimal	Price scaling factor
ClaimResponse.addItem.net		0..1	Money	Total item cost		0..1	Money	Total item cost
ClaimResponse.addItem.bodySite		0..1	CodeableConcept	Anatomical location Binding: ?? (example): The code for the teeth, quadrant, sextant and arch.		0..1	CodeableConcept	Anatomical location Binding: ?? (example): The code for the teeth, quadrant, sextant and arch.
ClaimResponse.addItem.subSite		0..*	CodeableConcept	Anatomical sub-location Binding: ?? (example): The code for the tooth surface and surface combinations.		0..*	CodeableConcept	Anatomical sub-location Binding: ?? (example): The code for the tooth surface and surface combinations.
ClaimResponse.addItem.noteNumber		0..*	positiveInt	Applicable note numbers		0..*	positiveInt	Applicable note numbers
ClaimResponse.addItem.adjudication		1..*	See adjudication (ClaimResponse)	Added items adjudication		1..*	See adjudication (ClaimResponse)	Added items adjudication
ClaimResponse.addItem.detail		0..*	BackboneElement	Insurer added line details		0..*	BackboneElement	Insurer added line details
ClaimResponse.addItem.detail.id		0..1	string	Unique id for inter-element referencing		0..1	string	Unique id for inter-element referencing
ClaimResponse.addItem.detail.extension		0..*	Extension	Additional content defined by implementations		0..*	Extension	Additional content defined by implementations
ClaimResponse.addItem.detail.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
ClaimResponse.addItem.detail.productOrService		1..1	CodeableConcept	Billing, service, product, or drug code Binding: ?? (example): Allowable service and product codes.		1..1	CodeableConcept	Billing, service, product, or drug code Binding: ?? (example): Allowable service and product codes.
ClaimResponse.addItem.detail.modifier		0..*	CodeableConcept	Service/Product billing modifiers Binding: ?? (example): Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen.		0..*	CodeableConcept	Service/Product billing modifiers Binding: ?? (example): Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen.
ClaimResponse.addItem.detail.quantity		0..1	??	Count of products or services	C	0..1	??	Count of products or services
ClaimResponse.addItem.detail.unitPrice		0..1	Money	Fee, charge or cost per item		0..1	Money	Fee, charge or cost per item
ClaimResponse.addItem.detail.factor		0..1	decimal	Price scaling factor		0..1	decimal	Price scaling factor
ClaimResponse.addItem.detail.net		0..1	Money	Total item cost		0..1	Money	Total item cost
ClaimResponse.addItem.detail.noteNumber		0..*	positiveInt	Applicable note numbers		0..*	positiveInt	Applicable note numbers
ClaimResponse.addItem.detail.adjudication		1..*	See adjudication (ClaimResponse)	Added items detail adjudication		1..*	See adjudication (ClaimResponse)	Added items detail adjudication
ClaimResponse.addItem.detail.subDetail		0..*	BackboneElement	Insurer added line items		0..*	BackboneElement	Insurer added line items
ClaimResponse.addItem.detail.subDetail.id		0..1	string	Unique id for inter-element referencing		0..1	string	Unique id for inter-element referencing
ClaimResponse.addItem.detail.subDetail.extension		0..*	Extension	Additional content defined by implementations		0..*	Extension	Additional content defined by implementations
ClaimResponse.addItem.detail.subDetail.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
ClaimResponse.addItem.detail.subDetail.productOrService		1..1	CodeableConcept	Billing, service, product, or drug code Binding: ?? (example): Allowable service and product codes.		1..1	CodeableConcept	Billing, service, product, or drug code Binding: ?? (example): Allowable service and product codes.
ClaimResponse.addItem.detail.subDetail.modifier		0..*	CodeableConcept	Service/Product billing modifiers Binding: ?? (example): Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen.		0..*	CodeableConcept	Service/Product billing modifiers Binding: ?? (example): Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen.
ClaimResponse.addItem.detail.subDetail.quantity		0..1	??	Count of products or services	C	0..1	??	Count of products or services
ClaimResponse.addItem.detail.subDetail.unitPrice		0..1	Money	Fee, charge or cost per item		0..1	Money	Fee, charge or cost per item
ClaimResponse.addItem.detail.subDetail.factor		0..1	decimal	Price scaling factor		0..1	decimal	Price scaling factor
ClaimResponse.addItem.detail.subDetail.net		0..1	Money	Total item cost		0..1	Money	Total item cost
ClaimResponse.addItem.detail.subDetail.noteNumber		0..*	positiveInt	Applicable note numbers		0..*	positiveInt	Applicable note numbers
ClaimResponse.addItem.detail.subDetail.adjudication		1..*	See adjudication (ClaimResponse)	Added items detail adjudication		1..*	See adjudication (ClaimResponse)	Added items detail adjudication
ClaimResponse.adjudication		0..*	See adjudication (ClaimResponse)	Header-level adjudication		0..*	See adjudication (ClaimResponse)	Header-level adjudication
ClaimResponse.total	Σ This element is included in summaries.	0..*	BackboneElement	Adjudication totals	Σ This element is included in summaries.	0..*	BackboneElement	Adjudication totals
ClaimResponse.total.id		0..1	string	Unique id for inter-element referencing		0..1	string	Unique id for inter-element referencing
ClaimResponse.total.extension		0..*	Extension	Additional content defined by implementations		0..*	Extension	Additional content defined by implementations
ClaimResponse.total.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
ClaimResponse.total.category	Σ This element is included in summaries.	1..1	CodeableConcept	Type of adjudication information Binding: ?? (example): The adjudication codes.	Σ This element is included in summaries.	1..1	CodeableConcept	Type of adjudication information Binding: ?? (example): The adjudication codes.
ClaimResponse.total.amount	Σ This element is included in summaries.	1..1	Money	Financial total for the category	Σ This element is included in summaries.	1..1	Money	Financial total for the category
ClaimResponse.payment		0..1	BackboneElement	Payment Details		0..1	BackboneElement	Payment Details
ClaimResponse.payment.id		0..1	string	Unique id for inter-element referencing		0..1	string	Unique id for inter-element referencing
ClaimResponse.payment.extension		0..*	Extension	Additional content defined by implementations		0..*	Extension	Additional content defined by implementations
ClaimResponse.payment.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
ClaimResponse.payment.type		1..1	CodeableConcept	Partial or complete payment Binding: ?? (example): The type (partial, complete) of the payment.		1..1	CodeableConcept	Partial or complete payment Binding: ?? (example): The type (partial, complete) of the payment.
ClaimResponse.payment.adjustment		0..1	Money	Payment adjustment for non-claim issues		0..1	Money	Payment adjustment for non-claim issues
ClaimResponse.payment.adjustmentReason		0..1	CodeableConcept	Explanation for the adjustment Binding: ?? (example): Payment Adjustment reason codes.		0..1	CodeableConcept	Explanation for the adjustment Binding: ?? (example): Payment Adjustment reason codes.
ClaimResponse.payment.date		0..1	date	Expected date of payment		0..1	date	Expected date of payment
ClaimResponse.payment.amount		1..1	Money	Payable amount after adjustment		1..1	Money	Payable amount after adjustment
ClaimResponse.payment.identifier		0..1	Identifier	Business identifier for the payment		0..1	Identifier	Business identifier for the payment
ClaimResponse.fundsReserve		0..1	CodeableConcept	Funds reserved status Binding: ?? (example): For whom funds are to be reserved: (Patient, Provider, None).		0..1	CodeableConcept	Funds reserved status Binding: ?? (example): For whom funds are to be reserved: (Patient, Provider, None).
ClaimResponse.formCode		0..1	CodeableConcept	Printed form identifier Binding: ?? (example): The forms codes.		0..1	CodeableConcept	Printed form identifier Binding: ?? (example): The forms codes.
ClaimResponse.form		0..1	Attachment	Printed reference or actual form		0..1	Attachment	Printed reference or actual form
ClaimResponse.processNote		0..*	BackboneElement	Note concerning adjudication		0..*	BackboneElement	Note concerning adjudication
ClaimResponse.processNote.id		0..1	string	Unique id for inter-element referencing		0..1	string	Unique id for inter-element referencing
ClaimResponse.processNote.extension		0..*	Extension	Additional content defined by implementations		0..*	Extension	Additional content defined by implementations
ClaimResponse.processNote.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
ClaimResponse.processNote.number		0..1	positiveInt	Note instance identifier		0..1	positiveInt	Note instance identifier
ClaimResponse.processNote.type		0..1	code	display | print | printoper Binding: ?? (required): The presentation types of notes.		0..1	code	display | print | printoper Binding: ?? (required): The presentation types of notes.
ClaimResponse.processNote.text		1..1	string	Note explanatory text		1..1	string	Note explanatory text
ClaimResponse.processNote.language		0..1	CodeableConcept	Language of the text Binding: ?? (preferred): A human language. Additional Bindings Purpose ?? Max Binding		0..1	CodeableConcept	Language of the text Binding: ?? (preferred): A human language. Additional Bindings Purpose ?? Max Binding
ClaimResponse.communicationRequest		0..*	Reference(CommunicationRequest)	Request for additional information		0..*	Reference(CommunicationRequest)	Request for additional information
ClaimResponse.insurance		0..*	BackboneElement	Patient insurance information		0..*	BackboneElement	Patient insurance information
ClaimResponse.insurance.id		0..1	string	Unique id for inter-element referencing		0..1	string	Unique id for inter-element referencing
ClaimResponse.insurance.extension		0..*	Extension	Additional content defined by implementations		0..*	Extension	Additional content defined by implementations
ClaimResponse.insurance.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
ClaimResponse.insurance.sequence		1..1	positiveInt	Insurance instance identifier		1..1	positiveInt	Insurance instance identifier
ClaimResponse.insurance.focal		1..1	boolean	Coverage to be used for adjudication		1..1	boolean	Coverage to be used for adjudication
ClaimResponse.insurance.coverage		1..1	Reference(Coverage)	Insurance information		1..1	Reference(Coverage)	Insurance information
ClaimResponse.insurance.businessArrangement		0..1	string	Additional provider contract number		0..1	string	Additional provider contract number
ClaimResponse.insurance.claimResponse		0..1	Reference(ClaimResponse)	Adjudication results		0..1	Reference(ClaimResponse)	Adjudication results
ClaimResponse.error		0..*	BackboneElement	Processing errors		0..*	BackboneElement	Processing errors
ClaimResponse.error.id		0..1	string	Unique id for inter-element referencing		0..1	string	Unique id for inter-element referencing
ClaimResponse.error.extension		0..*	Extension	Additional content defined by implementations		0..*	Extension	Additional content defined by implementations
ClaimResponse.error.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
ClaimResponse.error.itemSequence		0..1	positiveInt	Item sequence number		0..1	positiveInt	Item sequence number
ClaimResponse.error.detailSequence		0..1	positiveInt	Detail sequence number		0..1	positiveInt	Detail sequence number
ClaimResponse.error.subDetailSequence		0..1	positiveInt	Subdetail sequence number		0..1	positiveInt	Subdetail sequence number
ClaimResponse.error.code		1..1	CodeableConcept	Error code detailing processing issues Binding: ?? (example): The adjudication error codes.		1..1	CodeableConcept	Error code detailing processing issues Binding: ?? (example): The adjudication error codes.
Documentation for this format