abstractbaseDefinitioncopyrightdate- Values Differ
descriptionexperimentalfhirVersionjurisdiction
jurisdiction[0]- Added the item 'null#null'
kindnamepublisherpurposestatustitletypeurlversion- Values Differ
| Left: | 事前審查回覆-ClaimResponse TWPAS (https://nhicore.nhi.gov.tw/pas/StructureDefinition/ClaimResponse-twpas) |
| Right: | 事前審查回覆-ClaimResponse TWPAS (https://nhicore.nhi.gov.tw/pas/StructureDefinition/ClaimResponse-twpas) |
| Error | StructureDefinition.version | Values for version differ: '1.2.7' vs '1.2.8' |
| Information | StructureDefinition.date | Values for date differ: '2026-09-24T22:23:31+08:00' vs '2026-10-14T06:35:06+00:00' |
| Information | StructureDefinition.jurisdiction | Added the item 'null#null' |
| 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 |
|
| description | 此事前審查回覆-ClaimResponse TWPAS Profile說明本IG如何進一步定義FHIR的ClaimResponse Resource以呈現事前審查回覆之內容 | ||
| experimental | |||
| fhirVersion | 4.0.1 | ||
| jurisdiction | |||
| jurisdiction[0] | null#null |
| |
| kind | resource | ||
| name | ClaimResponseTWPAS | ||
| publisher | 衛生福利部中央健康保險署 | ||
| purpose | |||
| status | active | ||
| title | 事前審查回覆-ClaimResponse TWPAS | ||
| type | ClaimResponse | ||
| url | https://nhicore.nhi.gov.tw/pas/StructureDefinition/ClaimResponse-twpas | ||
| version | 1.2.7 | 1.2.8 |
|
| Name | L Flags | L Card. | L Type | L Description & Constraints | R Flags | R Card. | R Type | R Description & Constraints | Comments | ||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
 ClaimResponse | 0..* | ClaimResponse | Response to a claim predetermination or preauthorization | 0..* | ClaimResponse | Response to a claim predetermination or preauthorization | |||||||||||
 id | 0..1 | id | Logical id of this artifact | 0..1 | id | Logical id of this artifact | |||||||||||
 meta | 1..1 | Meta | Metadata about the resource | 1..1 | Meta | Metadata about the resource | |||||||||||
 id | 0..1 | string | Unique id for inter-element referencing | 0..1 | string | Unique id for inter-element referencing | |||||||||||
 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 | |||||||||||
| versionId | 0..1 | id | Version specific identifier | 0..1 | id | Version specific identifier | |||||||||||
| lastUpdated | 0..1 | instant | When the resource version last changed | 0..1 | instant | When the resource version last changed | |||||||||||
| source | 0..1 | uri | Identifies where the resource comes from | 0..1 | uri | Identifies where the resource comes from | |||||||||||
| profile | 1..1 | canonical(StructureDefinition) | Profiles this resource claims to conform to Required Pattern: https://nhicore.nhi.gov.tw/pas/StructureDefinition/ClaimResponse-twpas | 1..1 | canonical(StructureDefinition) | Profiles this resource claims to conform to Required Pattern: https://nhicore.nhi.gov.tw/pas/StructureDefinition/ClaimResponse-twpas | |||||||||||
| security | 0..* | Coding | Security Labels applied to this resource Binding: ?? (extensible): Security Labels from the Healthcare Privacy and Security Classification System. | 0..* | Coding | Security Labels applied to this resource Binding: ?? (extensible): Security Labels from the Healthcare Privacy and Security Classification System. | |||||||||||
| tag | 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". | 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". | |||||||||||
| implicitRules | 0..1 | uri | A set of rules under which this content was created | 0..1 | uri | A set of rules under which this content was created | |||||||||||
| language | 0..1 | code | Language of the resource content Binding: ?? (preferred): A human language.
| 0..1 | code | Language of the resource content Binding: ?? (preferred): A human language.
| |||||||||||
| 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 | |||||||||||
| contained | 0..* | Resource | Contained, inline Resources | 0..* | Resource | Contained, inline Resources | |||||||||||
| extension | 0..* | Extension | Additional content defined by implementations | 0..* | Extension | Additional content defined by implementations | |||||||||||
 modifierExtension | 0..* | Extension | Extensions that cannot be ignored | 0..* | Extension | Extensions that cannot be ignored | |||||||||||
| identifier | 0..* | Identifier | 受理編號。供案件追蹤與識別使用，醫院上傳時無須填寫。 | 0..* | Identifier | 受理編號。供案件追蹤與識別使用，醫院上傳時無須填寫。 | |||||||||||
| id | 0..1 | string | Unique id for inter-element referencing | 0..1 | string | Unique id for inter-element referencing | |||||||||||
| 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 | |||||||||||
| use | 0..1 | code | usual | official | temp | secondary | old (If known) Binding: ?? (required): Identifies the purpose for this identifier, if known . Required Pattern: official | 0..1 | code | usual | official | temp | secondary | old (If known) Binding: ?? (required): Identifies the purpose for this identifier, if known . Required Pattern: official | |||||||||||
| type | 0..1 | CodeableConcept | Description of identifier Binding: ?? (extensible): A coded type for an identifier that can be used to determine which identifier to use for a specific purpose. | 0..1 | CodeableConcept | Description of identifier Binding: ?? (extensible): A coded type for an identifier that can be used to determine which identifier to use for a specific purpose. | |||||||||||
| system | 0..1 | uri | The namespace for the identifier value Example General: http://www.acme.com/identifiers/patient | 0..1 | uri | The namespace for the identifier value Example General: http://www.acme.com/identifiers/patient | |||||||||||
| value | 0..1 | string | The value that is unique Example General: 123456 | 0..1 | string | The value that is unique Example General: 123456 | |||||||||||
| period | 0..1 | Period | Time period when id is/was valid for use | 0..1 | Period | Time period when id is/was valid for use | |||||||||||
| assigner | 0..1 | Reference(Organization) | Organization that issued id (may be just text) | 0..1 | Reference(Organization) | Organization that issued id (may be just text) | |||||||||||
| status | 1..1 | code | active | cancelled | draft | entered-in-error Binding: ?? (required): A code specifying the state of the resource instance. Required Pattern: active | 1..1 | code | active | cancelled | draft | entered-in-error Binding: ?? (required): A code specifying the state of the resource instance. Required Pattern: active | |||||||||||
| type | 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"}]} | 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"}]} | |||||||||||
| 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. | |||||||||||
| use | 1..1 | code | claim | preauthorization | predetermination Binding: ?? (required): Claim, preauthorization, predetermination. Required Pattern: preauthorization | 1..1 | code | claim | preauthorization | predetermination Binding: ?? (required): Claim, preauthorization, predetermination. Required Pattern: preauthorization | |||||||||||
| patient | 1..1 | Reference(病人資訊-Patient TWPAS) | The recipient of the products and services | 1..1 | Reference(病人資訊-Patient TWPAS) | The recipient of the products and services | |||||||||||
| created | 1..1 | dateTime | 核定日期或受理日期，即為案件受理狀態(disposition)之異動日期，依據其狀態不同而有不同日期，例如案件受理狀態為已受理，此日期則為受理日期；若為審畢結果則為核定日期。 | 1..1 | dateTime | 核定日期或受理日期，即為案件受理狀態(disposition)之異動日期，依據其狀態不同而有不同日期，例如案件受理狀態為已受理，此日期則為受理日期；若為審畢結果則為核定日期。 | |||||||||||
| insurer | 1..1 | Reference(TW Core Organization Government) | Party responsible for reimbursement | 1..1 | Reference(TW Core Organization Government) | Party responsible for reimbursement | |||||||||||
| requestor | 1..1 | Reference(醫事機構-Organization TWPAS) | Party responsible for the claim | 1..1 | Reference(醫事機構-Organization TWPAS) | Party responsible for the claim | |||||||||||
| request | 1..1 | Reference(癌藥事前審查-Claim TWPAS) | Id of resource triggering adjudication | 1..1 | Reference(癌藥事前審查-Claim TWPAS) | Id of resource triggering adjudication | |||||||||||
| outcome | 1..1 | code | queued | complete | error | partial Binding: ?? (required): The result of the claim processing. | 1..1 | code | queued | complete | error | partial Binding: ?? (required): The result of the claim processing. | |||||||||||
| disposition | 1..1 | string | 案件受理狀態。待處理 | 處理中 | 處理中(等待附件檔) | 處理中(檔案檢核中) | 處理中(等待檢查申報資料) | 資料檢核失敗 | 檔案傳送失敗 | 附件檔轉檔失敗 | 影像檔轉檔失敗 | 電子病歷檔轉檔失敗 | 申請檔案檢核失敗 | 申請檔案未備齊 | 已受理 | 審查中 | 審畢結果 Binding: ?? (required) | 1..1 | string | 案件受理狀態。待處理 | 處理中 | 處理中(等待附件檔) | 處理中(檔案檢核中) | 處理中(等待檢查申報資料) | 資料檢核失敗 | 檔案傳送失敗 | 附件檔轉檔失敗 | 影像檔轉檔失敗 | 電子病歷檔轉檔失敗 | 申請檔案檢核失敗 | 申請檔案未備齊 | 已受理 | 審查中 | 審畢結果 Binding: ?? (required) | |||||||||||
| preAuthRef | 0..1 | string | Preauthorization reference | 0..1 | string | Preauthorization reference | |||||||||||
| preAuthPeriod | 0..1 | Period | Preauthorization reference effective period | 0..1 | Period | Preauthorization reference effective period | |||||||||||
| 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. | |||||||||||
| item | 1..1 | BackboneElement | Adjudication for claim line items | 1..1 | BackboneElement | Adjudication for claim line items | |||||||||||
| id | 0..1 | string | Unique id for inter-element referencing | 0..1 | string | Unique id for inter-element referencing | |||||||||||
| extension | 0..* | Extension | Additional content defined by implementations | 0..* | Extension | Additional content defined by implementations | |||||||||||
| modifierExtension | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | |||||||||||
| itemSequence | 1..1 | positiveInt | Claim item instance identifier | 1..1 | positiveInt | Claim item instance identifier | |||||||||||
| noteNumber | 0..* | positiveInt | Applicable note numbers | 0..* | positiveInt | Applicable note numbers | |||||||||||
| adjudication | 1..1 | BackboneElement | Adjudication details | 1..1 | BackboneElement | Adjudication details | |||||||||||
| id | 0..1 | string | Unique id for inter-element referencing | 0..1 | string | Unique id for inter-element referencing | |||||||||||
| extension | 0..* | Extension | Additional content defined by implementations | 0..* | Extension | Additional content defined by implementations | |||||||||||
| modifierExtension | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | |||||||||||
| 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. | |||||||||||
| id | 0..1 | string | Unique id for inter-element referencing | 0..1 | string | Unique id for inter-element referencing | |||||||||||
| 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 | |||||||||||
| coding | 0..* | Coding | Code defined by a terminology system | 0..* | Coding | Code defined by a terminology system | |||||||||||
| id | 0..1 | string | Unique id for inter-element referencing | 0..1 | string | Unique id for inter-element referencing | |||||||||||
| 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 | |||||||||||
| system | 0..1 | uri | Identity of the terminology system Example General: http://terminology.hl7.org/CodeSystem/adjudication | 0..1 | uri | Identity of the terminology system Example General: http://terminology.hl7.org/CodeSystem/adjudication | |||||||||||
| version | 0..1 | string | Version of the system - if relevant | 0..1 | string | Version of the system - if relevant | |||||||||||
| code | 0..1 | code | Symbol in syntax defined by the system Example General: submitted | 0..1 | code | Symbol in syntax defined by the system Example General: submitted | |||||||||||
| display | 0..1 | string | Representation defined by the system | 0..1 | string | Representation defined by the system | |||||||||||
| userSelected | 0..1 | boolean | If this coding was chosen directly by the user | 0..1 | boolean | If this coding was chosen directly by the user | |||||||||||
| text | 0..1 | string | Plain text representation of the concept | 0..1 | string | Plain text representation of the concept | |||||||||||
| reason | 1..1 | CodeableConcept | 受理審查案件核定註記。1:同意 | 2:不予同意 | 3:部份同意 | 4:補件 | 5:退件 Binding: ?? (required) | 1..1 | CodeableConcept | 受理審查案件核定註記。1:同意 | 2:不予同意 | 3:部份同意 | 4:補件 | 5:退件 Binding: ?? (required) | |||||||||||
| id | 0..1 | string | Unique id for inter-element referencing | 0..1 | string | Unique id for inter-element referencing | |||||||||||
| 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 | |||||||||||
| coding | 0..* | Coding | Code defined by a terminology system | 0..* | Coding | Code defined by a terminology system | |||||||||||
| text | 0..1 | string | 核定意見 | 0..1 | string | 核定意見 | |||||||||||
| amount | 0..1 | Money | Monetary amount | 0..1 | Money | Monetary amount | |||||||||||
| value | 0..1 | decimal | Non-monetary value | 0..1 | decimal | Non-monetary value | |||||||||||
 detail | 1..* | BackboneElement | Adjudication for claim details | 1..* | BackboneElement | Adjudication for claim details | |||||||||||
 id | 0..1 | string | Unique id for inter-element referencing | 0..1 | string | Unique id for inter-element referencing | |||||||||||
| extension | 0..* | Extension | Additional content defined by implementations | 0..* | Extension | Additional content defined by implementations | |||||||||||
| modifierExtension | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | |||||||||||
| detailSequence | 1..1 | positiveInt | 請填寫對應的Claim.item.sequence | 1..1 | positiveInt | 請填寫對應的Claim.item.sequence | |||||||||||
| noteNumber | 0..* | positiveInt | Applicable note numbers | 0..* | positiveInt | Applicable note numbers | |||||||||||
| adjudication | 1..* | BackboneElement | Detail level adjudication details | 1..* | BackboneElement | Detail level adjudication details | |||||||||||
| id | 0..1 | string | Unique id for inter-element referencing | 0..1 | string | Unique id for inter-element referencing | |||||||||||
| extension | 0..* | Extension | Additional content defined by implementations | 0..* | Extension | Additional content defined by implementations | |||||||||||
| modifierExtension | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | |||||||||||
| 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. | |||||||||||
| id | 0..1 | string | Unique id for inter-element referencing | 0..1 | string | Unique id for inter-element referencing | |||||||||||
| 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 | |||||||||||
| coding | 0..* | Coding | Code defined by a terminology system | 0..* | Coding | Code defined by a terminology system | |||||||||||
| id | 0..1 | string | Unique id for inter-element referencing | 0..1 | string | Unique id for inter-element referencing | |||||||||||
| 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 | |||||||||||
| system | 0..1 | uri | Identity of the terminology system Example General: http://terminology.hl7.org/CodeSystem/adjudication | 0..1 | uri | Identity of the terminology system Example General: http://terminology.hl7.org/CodeSystem/adjudication | |||||||||||
| version | 0..1 | string | Version of the system - if relevant | 0..1 | string | Version of the system - if relevant | |||||||||||
| code | 0..1 | code | Symbol in syntax defined by the system Example General: submitted | 0..1 | code | Symbol in syntax defined by the system Example General: submitted | |||||||||||
| display | 0..1 | string | Representation defined by the system | 0..1 | string | Representation defined by the system | |||||||||||
| userSelected | 0..1 | boolean | If this coding was chosen directly by the user | 0..1 | boolean | If this coding was chosen directly by the user | |||||||||||
| text | 0..1 | string | Plain text representation of the concept | 0..1 | string | Plain text representation of the concept | |||||||||||
| reason | 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) | 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) | |||||||||||
| amount | 0..1 | Money | Monetary amount | 0..1 | Money | Monetary amount | |||||||||||
| value | 1..1 | decimal | 個別醫令核定數量 | 1..1 | decimal | 個別醫令核定數量 | |||||||||||
| subDetail | 0..* | BackboneElement | Adjudication for claim sub-details | 0..* | BackboneElement | Adjudication for claim sub-details | |||||||||||
| id | 0..1 | string | Unique id for inter-element referencing | 0..1 | string | Unique id for inter-element referencing | |||||||||||
| extension | 0..* | Extension | Additional content defined by implementations | 0..* | Extension | Additional content defined by implementations | |||||||||||
| modifierExtension | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | |||||||||||
| subDetailSequence | 1..1 | positiveInt | Claim sub-detail instance identifier | 1..1 | positiveInt | Claim sub-detail instance identifier | |||||||||||
| noteNumber | 0..* | positiveInt | Applicable note numbers | 0..* | positiveInt | Applicable note numbers | |||||||||||
 adjudication | 0..* | See adjudication (ClaimResponse) | Subdetail level adjudication details | 0..* | See adjudication (ClaimResponse) | Subdetail level adjudication details | |||||||||||
| addItem | 0..* | BackboneElement | Insurer added line items | 0..* | BackboneElement | Insurer added line items | |||||||||||
| id | 0..1 | string | Unique id for inter-element referencing | 0..1 | string | Unique id for inter-element referencing | |||||||||||
| extension | 0..* | Extension | Additional content defined by implementations | 0..* | Extension | Additional content defined by implementations | |||||||||||
| modifierExtension | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | |||||||||||
| itemSequence | 0..* | positiveInt | Item sequence number | 0..* | positiveInt | Item sequence number | |||||||||||
| detailSequence | 0..* | positiveInt | Detail sequence number | 0..* | positiveInt | Detail sequence number | |||||||||||
| subdetailSequence | 0..* | positiveInt | Subdetail sequence number | 0..* | positiveInt | Subdetail sequence number | |||||||||||
| provider | 0..* | Reference(Practitioner | PractitionerRole | Organization) | Authorized providers | 0..* | Reference(Practitioner | PractitionerRole | Organization) | Authorized providers | |||||||||||
| 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. | |||||||||||
| 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. | |||||||||||
| 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. | |||||||||||
| 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 | |||||||||||
| 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. | |||||||||||
| quantity | 0..1 | ??  | Count of products or services | C | 0..1 | ?? | Count of products or services | ||||||||||
| unitPrice | 0..1 | Money | Fee, charge or cost per item | 0..1 | Money | Fee, charge or cost per item | |||||||||||
| factor | 0..1 | decimal | Price scaling factor | 0..1 | decimal | Price scaling factor | |||||||||||
| net | 0..1 | Money | Total item cost | 0..1 | Money | Total item cost | |||||||||||
| 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. | |||||||||||
| 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. | |||||||||||
| noteNumber | 0..* | positiveInt | Applicable note numbers | 0..* | positiveInt | Applicable note numbers | |||||||||||
| adjudication | 1..* | See adjudication (ClaimResponse) | Added items adjudication | 1..* | See adjudication (ClaimResponse) | Added items adjudication | |||||||||||
| detail | 0..* | BackboneElement | Insurer added line details | 0..* | BackboneElement | Insurer added line details | |||||||||||
| id | 0..1 | string | Unique id for inter-element referencing | 0..1 | string | Unique id for inter-element referencing | |||||||||||
| extension | 0..* | Extension | Additional content defined by implementations | 0..* | Extension | Additional content defined by implementations | |||||||||||
| modifierExtension | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | |||||||||||
| 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. | |||||||||||
| 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. | |||||||||||
| quantity | 0..1 | ?? | Count of products or services | C | 0..1 | ?? | Count of products or services | ||||||||||
| unitPrice | 0..1 | Money | Fee, charge or cost per item | 0..1 | Money | Fee, charge or cost per item | |||||||||||
| factor | 0..1 | decimal | Price scaling factor | 0..1 | decimal | Price scaling factor | |||||||||||
| net | 0..1 | Money | Total item cost | 0..1 | Money | Total item cost | |||||||||||
| noteNumber | 0..* | positiveInt | Applicable note numbers | 0..* | positiveInt | Applicable note numbers | |||||||||||
| adjudication | 1..* | See adjudication (ClaimResponse) | Added items detail adjudication | 1..* | See adjudication (ClaimResponse) | Added items detail adjudication | |||||||||||
| subDetail | 0..* | BackboneElement | Insurer added line items | 0..* | BackboneElement | Insurer added line items | |||||||||||
| id | 0..1 | string | Unique id for inter-element referencing | 0..1 | string | Unique id for inter-element referencing | |||||||||||
| extension | 0..* | Extension | Additional content defined by implementations | 0..* | Extension | Additional content defined by implementations | |||||||||||
| modifierExtension | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | |||||||||||
| 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. | |||||||||||
| 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. | |||||||||||
| quantity | 0..1 | ?? | Count of products or services | C | 0..1 | ?? | Count of products or services | ||||||||||
| unitPrice | 0..1 | Money | Fee, charge or cost per item | 0..1 | Money | Fee, charge or cost per item | |||||||||||
| factor | 0..1 | decimal | Price scaling factor | 0..1 | decimal | Price scaling factor | |||||||||||
| net | 0..1 | Money | Total item cost | 0..1 | Money | Total item cost | |||||||||||
| noteNumber | 0..* | positiveInt | Applicable note numbers | 0..* | positiveInt | Applicable note numbers | |||||||||||
| adjudication | 1..* | See adjudication (ClaimResponse) | Added items detail adjudication | 1..* | See adjudication (ClaimResponse) | Added items detail adjudication | |||||||||||
| adjudication | 0..* | See adjudication (ClaimResponse) | Header-level adjudication | 0..* | See adjudication (ClaimResponse) | Header-level adjudication | |||||||||||
| total | 0..* | BackboneElement | Adjudication totals | 0..* | BackboneElement | Adjudication totals | |||||||||||
| id | 0..1 | string | Unique id for inter-element referencing | 0..1 | string | Unique id for inter-element referencing | |||||||||||
| extension | 0..* | Extension | Additional content defined by implementations | 0..* | Extension | Additional content defined by implementations | |||||||||||
| modifierExtension | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | |||||||||||
| category | 1..1 | CodeableConcept | Type of adjudication information Binding: ?? (example): The adjudication codes. | 1..1 | CodeableConcept | Type of adjudication information Binding: ?? (example): The adjudication codes. | |||||||||||
| amount | 1..1 | Money | Financial total for the category | 1..1 | Money | Financial total for the category | |||||||||||
| payment | 0..1 | BackboneElement | Payment Details | 0..1 | BackboneElement | Payment Details | |||||||||||
| id | 0..1 | string | Unique id for inter-element referencing | 0..1 | string | Unique id for inter-element referencing | |||||||||||
| extension | 0..* | Extension | Additional content defined by implementations | 0..* | Extension | Additional content defined by implementations | |||||||||||
| modifierExtension | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | |||||||||||
| 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. | |||||||||||
| adjustment | 0..1 | Money | Payment adjustment for non-claim issues | 0..1 | Money | Payment adjustment for non-claim issues | |||||||||||
| 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. | |||||||||||
| date | 0..1 | date | Expected date of payment | 0..1 | date | Expected date of payment | |||||||||||
| amount | 1..1 | Money | Payable amount after adjustment | 1..1 | Money | Payable amount after adjustment | |||||||||||
| identifier | 0..1 | Identifier | Business identifier for the payment | 0..1 | Identifier | Business identifier for the payment | |||||||||||
| 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). | |||||||||||
| formCode | 0..1 | CodeableConcept | Printed form identifier Binding: ?? (example): The forms codes. | 0..1 | CodeableConcept | Printed form identifier Binding: ?? (example): The forms codes. | |||||||||||
| form | 0..1 | Attachment | Printed reference or actual form | 0..1 | Attachment | Printed reference or actual form | |||||||||||
| processNote | 0..* | BackboneElement | Note concerning adjudication | 0..* | BackboneElement | Note concerning adjudication | |||||||||||
| id | 0..1 | string | Unique id for inter-element referencing | 0..1 | string | Unique id for inter-element referencing | |||||||||||
| extension | 0..* | Extension | Additional content defined by implementations | 0..* | Extension | Additional content defined by implementations | |||||||||||
| modifierExtension | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | |||||||||||
| number | 0..1 | positiveInt | Note instance identifier | 0..1 | positiveInt | Note instance identifier | |||||||||||
| 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. | |||||||||||
| text | 1..1 | string | Note explanatory text | 1..1 | string | Note explanatory text | |||||||||||
| language | 0..1 | CodeableConcept | Language of the text Binding: ?? (preferred): A human language.
| 0..1 | CodeableConcept | Language of the text Binding: ?? (preferred): A human language.
| |||||||||||
| communicationRequest | 0..* | Reference(CommunicationRequest) | Request for additional information | 0..* | Reference(CommunicationRequest) | Request for additional information | |||||||||||
| insurance | 0..* | BackboneElement | Patient insurance information | 0..* | BackboneElement | Patient insurance information | |||||||||||
| id | 0..1 | string | Unique id for inter-element referencing | 0..1 | string | Unique id for inter-element referencing | |||||||||||
| extension | 0..* | Extension | Additional content defined by implementations | 0..* | Extension | Additional content defined by implementations | |||||||||||
| modifierExtension | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | |||||||||||
| sequence | 1..1 | positiveInt | Insurance instance identifier | 1..1 | positiveInt | Insurance instance identifier | |||||||||||
| focal | 1..1 | boolean | Coverage to be used for adjudication | 1..1 | boolean | Coverage to be used for adjudication | |||||||||||
| coverage | 1..1 | Reference(Coverage) | Insurance information | 1..1 | Reference(Coverage) | Insurance information | |||||||||||
| businessArrangement | 0..1 | string | Additional provider contract number | 0..1 | string | Additional provider contract number | |||||||||||
| claimResponse | 0..1 | Reference(ClaimResponse) | Adjudication results | 0..1 | Reference(ClaimResponse) | Adjudication results | |||||||||||
| error | 0..* | BackboneElement | Processing errors | 0..* | BackboneElement | Processing errors | |||||||||||
| id | 0..1 | string | Unique id for inter-element referencing | 0..1 | string | Unique id for inter-element referencing | |||||||||||
| extension | 0..* | Extension | Additional content defined by implementations | 0..* | Extension | Additional content defined by implementations | |||||||||||
| modifierExtension | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | |||||||||||
| itemSequence | 0..1 | positiveInt | Item sequence number | 0..1 | positiveInt | Item sequence number | |||||||||||
| detailSequence | 0..1 | positiveInt | Detail sequence number | 0..1 | positiveInt | Detail sequence number | |||||||||||
| subDetailSequence | 0..1 | positiveInt | Subdetail sequence number | 0..1 | positiveInt | Subdetail sequence number | |||||||||||
| 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 | |||||||||||||||||