Belgian MyCareNet eTariff Profiles, published by eHealth Platform. This guide is not an authorized publication; it is the continuous build for version 1.0.0 built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/hl7-be/etariff/ and changes regularly. See the Directory of published versions

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• Detailed Descriptions
• Mappings
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Resource Profile: MyCareNet Etariff Claim Response BE profile

Claimresponse profile for use in the different Etariff flows from MyCareNet.

Usage:

• Use this Resource Profile: MyCareNet eTariff Response Bundle BE profile

Formal Views of Profile Content

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

• Differential Table
• Key Elements Table
• Snapshot Table
• Statistics/References
• All

This structure is derived from ClaimResponse

Name	Flags	Card.	Type	Description & Constraints
ClaimResponse		0..*	ClaimResponse	Response to a claim predetermination or preauthorization
id	S	1..1	id	Logical id of this artifact
status	S	1..1	code	active | cancelled | draft | entered-in-error
type	S	1..1	CodeableConcept	More granular claim type
coding	S	1..1	Coding	Code defined by a terminology system
system	S	1..1	uri	Identity of the terminology system
code	S	1..1	code	Symbol in syntax defined by the system
subType	S	1..1	CodeableConcept	More granular claim type Binding: eTariff types (extensible)
coding	S	1..1	Coding	Code defined by a terminology system
system	S	1..1	uri	Identity of the terminology system
code	S	1..1	code	Symbol in syntax defined by the system
use	S	1..1	code	claim | preauthorization | predetermination Required Pattern: predetermination
patient	S	1..1	Reference(BePatient)	The recipient of the products and services
created	S	1..1	dateTime	Response creation date
insurer	S	1..1	Reference(BeOrganization)	Party responsible for reimbursement
requestor	S	1..1	Reference(BeOrganization | BePractitionerRole)	Party responsible for the claim
reference		1..1	string	Literal reference, Relative, internal or absolute URL
outcome	S	1..1	code	queued | complete | error | partial
addItem	S	1..*	BackboneElement	Insurer added line items
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
reimbursement	S	0..1	(Complex)	Extension URL: https://www.ehealth.fgov.be/standards/fhir/mycarenet/StructureDefinition/be-ext-mycarenet-item-reimbursement
value[x]
value	S	1..1	decimal	Numerical value (with implicit precision)
currency	S	1..1	code	ISO 4217 Currency Code
patientFee	S	0..1	(Complex)	Extension URL: https://www.ehealth.fgov.be/standards/fhir/mycarenet/StructureDefinition/be-ext-mycarenet-item-patientfee
value[x]
value	S	1..1	decimal	Numerical value (with implicit precision)
currency	S	1..1	code	ISO 4217 Currency Code
commitment	S	0..1	string	Optional Extensions Element URL: https://www.ehealth.fgov.be/standards/fhir/etariff/StructureDefinition/be-ext-etariff-item-commitment
itemSequence	S	1..1	positiveInt	Item sequence number
provider	S	1..1	Reference(BePractitionerRole)	Authorized providers
productOrService	S	1..1	CodeableConcept	Billing, service, product, or drug code
coding	S	1..1	Coding	Code defined by a terminology system
system	S	1..1	uri	Identity of the terminology system Required Pattern: https://www.ehealth.fgov.be/standards/fhir/core/NamingSystem/be-ns-nihdi-nomenclature
code	S	1..1	code	Symbol in syntax defined by the system
Slices for serviced[x]		0..1	date, Period	Date or dates of service or product delivery Slice: Unordered, Open by type:$this
serviced[x]:servicedDate	S	0..1	date	Date or dates of service or product delivery
quantity	S	0..1	SimpleQuantity	Count of products or services
value	S	1..1	decimal	Numerical value (with implicit precision)
unitPrice	S	0..1	Money	Fee, charge or cost per item
value	S	1..1	decimal	Numerical value (with implicit precision)
currency	S	1..1	code	ISO 4217 Currency Code
net	S	0..1	Money	Total item cost
value	S	1..1	decimal	Numerical value (with implicit precision)
currency	S	1..1	code	ISO 4217 Currency Code
adjudication	S	1..1	BackboneElement	Added items adjudication
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
refusalId	S	0..1	(Complex)	Optional Extensions Element URL: https://www.ehealth.fgov.be/standards/fhir/etariff/StructureDefinition/be-ext-etariff-adjudication-refusalserviceidentifier
Slices for value[x]				Content/Rules for all slices
value[x]:valueCodeableConcept		1..1	CodeableConcept	Value of extension
coding	S	1..1	Coding	Code defined by a terminology system
system	S	1..1	uri	Identity of the terminology system
code	S	1..1	code	Symbol in syntax defined by the system
refusalDate	S	0..1	date	Optional Extensions Element URL: https://www.ehealth.fgov.be/standards/fhir/etariff/StructureDefinition/be-ext-etariff-adjudication-refusalservicedate
category	S	1..1	CodeableConcept	Type of adjudication information Binding: Mycarenet Decision Values (extensible)
coding	S	1..1	Coding	Code defined by a terminology system
system	S	1..1	uri	Identity of the terminology system
code	S	1..1	code	Symbol in syntax defined by the system
reason		0..1	CodeableConcept	Explanation of adjudication outcome Binding: BeVSRefusalValues (extensible)
insurance	S	1..1	BackboneElement	Patient insurance information
coverage	S	1..1	Reference(MyCareNet Coverage BE profile)	Insurance information
Documentation for this format

Terminology Bindings (Differential)

Path	Conformance	ValueSet	URI
ClaimResponse.subType	extensible	BeVSEtariffTypes (a valid code from eTariff types) https://www.ehealth.fgov.be/standards/fhir/etariff/ValueSet/be-vs-etarifftypes from this IG
ClaimResponse.addItem.adjudication.category	extensible	BeVSDecisionValues https://www.ehealth.fgov.be/standards/fhir/mycarenet/ValueSet/be-vs-decision-values
ClaimResponse.addItem.adjudication.reason	extensible	BeVSRefusalValues (a valid code from refusal values) https://www.ehealth.fgov.be/standards/fhir/etariff/ValueSet/be-vs-refusal-values from this IG

Name	Flags	Card.	Type	Description & Constraints
ClaimResponse		0..*	ClaimResponse	Response to a claim predetermination or preauthorization
id	SΣ	1..1	id	Logical id of this artifact
implicitRules	?!Σ	0..1	uri	A set of rules under which this content was created
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored
status	?!SΣ	1..1	code	active | cancelled | draft | entered-in-error Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance.
type	SΣ	1..1	CodeableConcept	More granular claim type Binding: ClaimTypeCodes (extensible): The type or discipline-style of the claim.
coding	SΣ	1..1	Coding	Code defined by a terminology system
system	SΣ	1..1	uri	Identity of the terminology system
code	SΣ	1..1	code	Symbol in syntax defined by the system
subType	S	1..1	CodeableConcept	More granular claim type Binding: eTariff types (extensible)
coding	SΣ	1..1	Coding	Code defined by a terminology system
system	SΣ	1..1	uri	Identity of the terminology system
code	SΣ	1..1	code	Symbol in syntax defined by the system
use	SΣ	1..1	code	claim | preauthorization | predetermination Binding: Use (required): Claim, preauthorization, predetermination. Required Pattern: predetermination
patient	SΣ	1..1	Reference(BePatient)	The recipient of the products and services
created	SΣ	1..1	dateTime	Response creation date
insurer	SΣ	1..1	Reference(BeOrganization)	Party responsible for reimbursement
requestor	S	1..1	Reference(BeOrganization | BePractitionerRole)	Party responsible for the claim
reference	ΣC	1..1	string	Literal reference, Relative, internal or absolute URL
outcome	SΣ	1..1	code	queued | complete | error | partial Binding: ClaimProcessingCodes (required): The result of the claim processing.
addItem	S	1..*	BackboneElement	Insurer added line items
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
reimbursement	S	0..1	(Complex)	Extension URL: https://www.ehealth.fgov.be/standards/fhir/mycarenet/StructureDefinition/be-ext-mycarenet-item-reimbursement
extension		0..0
url		1..1	uri	"https://www.ehealth.fgov.be/standards/fhir/mycarenet/StructureDefinition/be-ext-mycarenet-item-reimbursement"
value[x]	S	1..1	Money	Value of extension
value	SΣ	1..1	decimal	Numerical value (with implicit precision)
currency	SΣ	1..1	code	ISO 4217 Currency Code Binding: Currencies (required): A code indicating the currency, taken from ISO 4217.
patientFee	S	0..1	(Complex)	Extension URL: https://www.ehealth.fgov.be/standards/fhir/mycarenet/StructureDefinition/be-ext-mycarenet-item-patientfee
extension		0..0
url		1..1	uri	"https://www.ehealth.fgov.be/standards/fhir/mycarenet/StructureDefinition/be-ext-mycarenet-item-patientfee"
value[x]	S	1..1	Money	Value of extension
value	SΣ	1..1	decimal	Numerical value (with implicit precision)
currency	SΣ	1..1	code	ISO 4217 Currency Code Binding: Currencies (required): A code indicating the currency, taken from ISO 4217.
commitment	S	0..1	string	Optional Extensions Element URL: https://www.ehealth.fgov.be/standards/fhir/etariff/StructureDefinition/be-ext-etariff-item-commitment
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
itemSequence	S	1..1	positiveInt	Item sequence number
provider	S	1..1	Reference(BePractitionerRole)	Authorized providers
productOrService	S	1..1	CodeableConcept	Billing, service, product, or drug code Binding: USCLSCodes (example): Allowable service and product codes.
coding	SΣ	1..1	Coding	Code defined by a terminology system
system	SΣ	1..1	uri	Identity of the terminology system Required Pattern: https://www.ehealth.fgov.be/standards/fhir/core/NamingSystem/be-ns-nihdi-nomenclature
code	SΣ	1..1	code	Symbol in syntax defined by the system
Slices for serviced[x]		0..1		Date or dates of service or product delivery Slice: Unordered, Open by type:$this
servicedDate			date
servicedPeriod			Period
serviced[x]:servicedDate	S	0..1	date	Date or dates of service or product delivery
quantity	S	0..1	SimpleQuantity	Count of products or services
value	SΣ	1..1	decimal	Numerical value (with implicit precision)
unitPrice	S	0..1	Money	Fee, charge or cost per item
value	SΣ	1..1	decimal	Numerical value (with implicit precision)
currency	SΣ	1..1	code	ISO 4217 Currency Code Binding: Currencies (required): A code indicating the currency, taken from ISO 4217.
net	S	0..1	Money	Total item cost
value	SΣ	1..1	decimal	Numerical value (with implicit precision)
currency	SΣ	1..1	code	ISO 4217 Currency Code Binding: Currencies (required): A code indicating the currency, taken from ISO 4217.
adjudication	S	1..1	BackboneElement	Added items adjudication
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
refusalId	S	0..1	(Complex)	Optional Extensions Element URL: https://www.ehealth.fgov.be/standards/fhir/etariff/StructureDefinition/be-ext-etariff-adjudication-refusalserviceidentifier
extension		0..0
url		1..1	uri	"https://www.ehealth.fgov.be/standards/fhir/etariff/StructureDefinition/be-ext-etariff-adjudication-refusalserviceidentifier"
Slices for value[x]		1..1	CodeableConcept	Value of extension Slice: Unordered, Closed by type:$this
value[x]:valueCodeableConcept	S	1..1	CodeableConcept	Value of extension
coding	SΣ	1..1	Coding	Code defined by a terminology system
system	SΣ	1..1	uri	Identity of the terminology system Required Pattern: https://www.ehealth.fgov.be/standards/fhir/core/NamingSystem/be-ns-nihdi-nomenclature
code	SΣ	1..1	code	Symbol in syntax defined by the system
refusalDate	S	0..1	date	Optional Extensions Element URL: https://www.ehealth.fgov.be/standards/fhir/etariff/StructureDefinition/be-ext-etariff-adjudication-refusalservicedate
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
category	S	1..1	CodeableConcept	Type of adjudication information Binding: Mycarenet Decision Values (extensible)
coding	SΣ	1..1	Coding	Code defined by a terminology system
system	SΣ	1..1	uri	Identity of the terminology system
code	SΣ	1..1	code	Symbol in syntax defined by the system
reason		0..1	CodeableConcept	Explanation of adjudication outcome Binding: BeVSRefusalValues (extensible)
insurance	S	1..1	BackboneElement	Patient insurance information
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
sequence		1..1	positiveInt	Insurance instance identifier
focal		1..1	boolean	Coverage to be used for adjudication
coverage	S	1..1	Reference(MyCareNet Coverage BE profile)	Insurance information
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet / Code	URI
ClaimResponse.status	required	FinancialResourceStatusCodes http://hl7.org/fhir/ValueSet/fm-status|4.0.1 from the FHIR Standard
ClaimResponse.type	extensible	ClaimTypeCodes http://hl7.org/fhir/ValueSet/claim-type from the FHIR Standard
ClaimResponse.subType	extensible	BeVSEtariffTypes (a valid code from eTariff types) https://www.ehealth.fgov.be/standards/fhir/etariff/ValueSet/be-vs-etarifftypes from this IG
ClaimResponse.use	required	Pattern: predetermination http://hl7.org/fhir/ValueSet/claim-use|4.0.1 from the FHIR Standard
ClaimResponse.outcome	required	ClaimProcessingCodes http://hl7.org/fhir/ValueSet/remittance-outcome|4.0.1 from the FHIR Standard
ClaimResponse.addItem.extension:reimbursement.value[x].currency	required	Currencies (a valid code from urn:iso:std:iso:4217) http://hl7.org/fhir/ValueSet/currencies|4.0.1 from the FHIR Standard
ClaimResponse.addItem.extension:patientFee.value[x].currency	required	Currencies (a valid code from urn:iso:std:iso:4217) http://hl7.org/fhir/ValueSet/currencies|4.0.1 from the FHIR Standard
ClaimResponse.addItem.productOrService	example	USCLSCodes http://hl7.org/fhir/ValueSet/service-uscls from the FHIR Standard
ClaimResponse.addItem.unitPrice.currency	required	Currencies (a valid code from urn:iso:std:iso:4217) http://hl7.org/fhir/ValueSet/currencies|4.0.1 from the FHIR Standard
ClaimResponse.addItem.net.currency	required	Currencies (a valid code from urn:iso:std:iso:4217) http://hl7.org/fhir/ValueSet/currencies|4.0.1 from the FHIR Standard
ClaimResponse.addItem.adjudication.category	extensible	BeVSDecisionValues https://www.ehealth.fgov.be/standards/fhir/mycarenet/ValueSet/be-vs-decision-values
ClaimResponse.addItem.adjudication.reason	extensible	BeVSRefusalValues (a valid code from refusal values) https://www.ehealth.fgov.be/standards/fhir/etariff/ValueSet/be-vs-refusal-values from this IG

Constraints

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

Name	Flags	Card.	Type	Description & Constraints
ClaimResponse		0..*	ClaimResponse	Response to a claim predetermination or preauthorization
id	SΣ	1..1	id	Logical id of this artifact
meta	Σ	0..1	Meta	Metadata about the resource
implicitRules	?!Σ	0..1	uri	A set of rules under which this content was created
language		0..1	code	Language of the resource content Binding: CommonLanguages (preferred): A human language. Additional Bindings Purpose AllLanguages Max Binding
text		0..1	Narrative	Text summary of the resource, for human interpretation
contained		0..*	Resource	Contained, inline Resources
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored
identifier		0..*	Identifier	Business Identifier for a claim response
status	?!SΣ	1..1	code	active | cancelled | draft | entered-in-error Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance.
type	SΣ	1..1	CodeableConcept	More granular claim type Binding: ClaimTypeCodes (extensible): The type or discipline-style of the claim.
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
coding	SΣ	1..1	Coding	Code defined by a terminology system
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
system	SΣ	1..1	uri	Identity of the terminology system
version	Σ	0..1	string	Version of the system - if relevant
code	SΣ	1..1	code	Symbol in syntax defined by the system
display	Σ	0..1	string	Representation defined by the system
userSelected	Σ	0..1	boolean	If this coding was chosen directly by the user
text	Σ	0..1	string	Plain text representation of the concept
subType	S	1..1	CodeableConcept	More granular claim type Binding: eTariff types (extensible)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
coding	SΣ	1..1	Coding	Code defined by a terminology system
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
system	SΣ	1..1	uri	Identity of the terminology system
version	Σ	0..1	string	Version of the system - if relevant
code	SΣ	1..1	code	Symbol in syntax defined by the system
display	Σ	0..1	string	Representation defined by the system
userSelected	Σ	0..1	boolean	If this coding was chosen directly by the user
text	Σ	0..1	string	Plain text representation of the concept
use	SΣ	1..1	code	claim | preauthorization | predetermination Binding: Use (required): Claim, preauthorization, predetermination. Required Pattern: predetermination
patient	SΣ	1..1	Reference(BePatient)	The recipient of the products and services
created	SΣ	1..1	dateTime	Response creation date
insurer	SΣ	1..1	Reference(BeOrganization)	Party responsible for reimbursement
requestor	S	1..1	Reference(BeOrganization | BePractitionerRole)	Party responsible for the claim
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
reference	ΣC	1..1	string	Literal reference, Relative, internal or absolute URL
type	Σ	0..1	uri	Type the reference refers to (e.g. "Patient") Binding: ResourceType (extensible): Aa resource (or, for logical models, the URI of the logical model).
identifier	Σ	0..1	Identifier	Logical reference, when literal reference is not known
display	Σ	0..1	string	Text alternative for the resource
request	Σ	0..1	Reference(Claim)	Id of resource triggering adjudication
outcome	SΣ	1..1	code	queued | complete | error | partial Binding: ClaimProcessingCodes (required): The result of the claim processing.
disposition		0..1	string	Disposition Message
preAuthRef		0..1	string	Preauthorization reference
preAuthPeriod		0..1	Period	Preauthorization reference effective period
payeeType		0..1	CodeableConcept	Party to be paid any benefits payable Binding: Claim Payee Type Codes (example): A code for the party to be reimbursed.
item		0..*	BackboneElement	Adjudication for claim line items
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
itemSequence		1..1	positiveInt	Claim item instance identifier
noteNumber		0..*	positiveInt	Applicable note numbers
adjudication		1..*	BackboneElement	Adjudication details
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
category		1..1	CodeableConcept	Type of adjudication information Binding: AdjudicationValueCodes (example): The adjudication codes.
reason		0..1	CodeableConcept	Explanation of adjudication outcome Binding: AdjudicationReasonCodes (example): The adjudication reason codes.
amount		0..1	Money	Monetary amount
value		0..1	decimal	Non-monetary value
detail		0..*	BackboneElement	Adjudication for claim details
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
detailSequence		1..1	positiveInt	Claim detail instance identifier
noteNumber		0..*	positiveInt	Applicable note numbers
adjudication		1..*	See adjudication (ClaimResponse)	Detail level adjudication details
subDetail		0..*	BackboneElement	Adjudication for claim sub-details
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
subDetailSequence		1..1	positiveInt	Claim sub-detail instance identifier
noteNumber		0..*	positiveInt	Applicable note numbers
adjudication		0..*	See adjudication (ClaimResponse)	Subdetail level adjudication details
addItem	S	1..*	BackboneElement	Insurer added line items
id		0..1	string	Unique id for inter-element referencing
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
reimbursement	S	0..1	(Complex)	Extension URL: https://www.ehealth.fgov.be/standards/fhir/mycarenet/StructureDefinition/be-ext-mycarenet-item-reimbursement
id		0..1	string	Unique id for inter-element referencing
extension		0..0
url		1..1	uri	"https://www.ehealth.fgov.be/standards/fhir/mycarenet/StructureDefinition/be-ext-mycarenet-item-reimbursement"
value[x]	S	1..1	Money	Value of extension
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
value	SΣ	1..1	decimal	Numerical value (with implicit precision)
currency	SΣ	1..1	code	ISO 4217 Currency Code Binding: Currencies (required): A code indicating the currency, taken from ISO 4217.
patientFee	S	0..1	(Complex)	Extension URL: https://www.ehealth.fgov.be/standards/fhir/mycarenet/StructureDefinition/be-ext-mycarenet-item-patientfee
id		0..1	string	Unique id for inter-element referencing
extension		0..0
url		1..1	uri	"https://www.ehealth.fgov.be/standards/fhir/mycarenet/StructureDefinition/be-ext-mycarenet-item-patientfee"
value[x]	S	1..1	Money	Value of extension
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
value	SΣ	1..1	decimal	Numerical value (with implicit precision)
currency	SΣ	1..1	code	ISO 4217 Currency Code Binding: Currencies (required): A code indicating the currency, taken from ISO 4217.
commitment	S	0..1	string	Optional Extensions Element URL: https://www.ehealth.fgov.be/standards/fhir/etariff/StructureDefinition/be-ext-etariff-item-commitment
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
itemSequence	S	1..1	positiveInt	Item sequence number
detailSequence		0..*	positiveInt	Detail sequence number
subdetailSequence		0..*	positiveInt	Subdetail sequence number
provider	S	1..1	Reference(BePractitionerRole)	Authorized providers
productOrService	S	1..1	CodeableConcept	Billing, service, product, or drug code Binding: USCLSCodes (example): Allowable service and product codes.
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
coding	SΣ	1..1	Coding	Code defined by a terminology system
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
system	SΣ	1..1	uri	Identity of the terminology system Required Pattern: https://www.ehealth.fgov.be/standards/fhir/core/NamingSystem/be-ns-nihdi-nomenclature
version	Σ	0..1	string	Version of the system - if relevant
code	SΣ	1..1	code	Symbol in syntax defined by the system
display	Σ	0..1	string	Representation defined by the system
userSelected	Σ	0..1	boolean	If this coding was chosen directly by the user
text	Σ	0..1	string	Plain text representation of the concept
modifier		0..*	CodeableConcept	Service/Product billing modifiers Binding: ModifierTypeCodes (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: ExampleProgramReasonCodes (example): Program specific reason codes.
Slices for serviced[x]		0..1		Date or dates of service or product delivery Slice: Unordered, Open by type:$this
servicedDate			date
servicedPeriod			Period
serviced[x]:servicedDate	S	0..1	date	Date or dates of service or product delivery
location[x]		0..1		Place of service or where product was supplied Binding: ExampleServicePlaceCodes (example): Place of service: pharmacy, school, prison, etc.
locationCodeableConcept			CodeableConcept
locationAddress			Address
locationReference			Reference(Location)
quantity	S	0..1	SimpleQuantity	Count of products or services
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
value	SΣ	1..1	decimal	Numerical value (with implicit precision)
unit	Σ	0..1	string	Unit representation
system	ΣC	0..1	uri	System that defines coded unit form
code	Σ	0..1	code	Coded form of the unit
unitPrice	S	0..1	Money	Fee, charge or cost per item
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
value	SΣ	1..1	decimal	Numerical value (with implicit precision)
currency	SΣ	1..1	code	ISO 4217 Currency Code Binding: Currencies (required): A code indicating the currency, taken from ISO 4217.
factor		0..1	decimal	Price scaling factor
net	S	0..1	Money	Total item cost
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
value	SΣ	1..1	decimal	Numerical value (with implicit precision)
currency	SΣ	1..1	code	ISO 4217 Currency Code Binding: Currencies (required): A code indicating the currency, taken from ISO 4217.
bodySite		0..1	CodeableConcept	Anatomical location Binding: OralSiteCodes (example): The code for the teeth, quadrant, sextant and arch.
subSite		0..*	CodeableConcept	Anatomical sub-location Binding: SurfaceCodes (example): The code for the tooth surface and surface combinations.
noteNumber		0..*	positiveInt	Applicable note numbers
adjudication	S	1..1	BackboneElement	Added items adjudication
id		0..1	string	Unique id for inter-element referencing
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
refusalId	S	0..1	(Complex)	Optional Extensions Element URL: https://www.ehealth.fgov.be/standards/fhir/etariff/StructureDefinition/be-ext-etariff-adjudication-refusalserviceidentifier
id		0..1	string	Unique id for inter-element referencing
extension		0..0
url		1..1	uri	"https://www.ehealth.fgov.be/standards/fhir/etariff/StructureDefinition/be-ext-etariff-adjudication-refusalserviceidentifier"
Slices for value[x]		1..1	CodeableConcept	Value of extension Slice: Unordered, Closed by type:$this
value[x]:valueCodeableConcept	S	1..1	CodeableConcept	Value of extension
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
coding	SΣ	1..1	Coding	Code defined by a terminology system
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
system	SΣ	1..1	uri	Identity of the terminology system Required Pattern: https://www.ehealth.fgov.be/standards/fhir/core/NamingSystem/be-ns-nihdi-nomenclature
version	Σ	0..1	string	Version of the system - if relevant
code	SΣ	1..1	code	Symbol in syntax defined by the system
display	Σ	0..1	string	Representation defined by the system
userSelected	Σ	0..1	boolean	If this coding was chosen directly by the user
text	Σ	0..1	string	Plain text representation of the concept
refusalDate	S	0..1	date	Optional Extensions Element URL: https://www.ehealth.fgov.be/standards/fhir/etariff/StructureDefinition/be-ext-etariff-adjudication-refusalservicedate
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
category	S	1..1	CodeableConcept	Type of adjudication information Binding: Mycarenet Decision Values (extensible)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
coding	SΣ	1..1	Coding	Code defined by a terminology system
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
system	SΣ	1..1	uri	Identity of the terminology system
version	Σ	0..1	string	Version of the system - if relevant
code	SΣ	1..1	code	Symbol in syntax defined by the system
display	Σ	0..1	string	Representation defined by the system
userSelected	Σ	0..1	boolean	If this coding was chosen directly by the user
text	Σ	0..1	string	Plain text representation of the concept
reason		0..1	CodeableConcept	Explanation of adjudication outcome Binding: BeVSRefusalValues (extensible)
amount		0..1	Money	Monetary amount
value		0..1	decimal	Non-monetary value
detail		0..*	BackboneElement	Insurer added line details
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
productOrService		1..1	CodeableConcept	Billing, service, product, or drug code Binding: USCLSCodes (example): Allowable service and product codes.
modifier		0..*	CodeableConcept	Service/Product billing modifiers Binding: ModifierTypeCodes (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	SimpleQuantity	Count of products or services
unitPrice		0..1	Money	Fee, charge or cost per item
factor		0..1	decimal	Price scaling factor
net		0..1	Money	Total item cost
noteNumber		0..*	positiveInt	Applicable note numbers
adjudication		1..*	See adjudication (ClaimResponse)	Added items detail adjudication
subDetail		0..*	BackboneElement	Insurer added line items
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
productOrService		1..1	CodeableConcept	Billing, service, product, or drug code Binding: USCLSCodes (example): Allowable service and product codes.
modifier		0..*	CodeableConcept	Service/Product billing modifiers Binding: ModifierTypeCodes (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	SimpleQuantity	Count of products or services
unitPrice		0..1	Money	Fee, charge or cost per item
factor		0..1	decimal	Price scaling factor
net		0..1	Money	Total item cost
noteNumber		0..*	positiveInt	Applicable note numbers
adjudication		1..*	See adjudication (ClaimResponse)	Added items detail adjudication
adjudication		0..*	See adjudication (ClaimResponse)	Header-level adjudication
total	Σ	0..*	BackboneElement	Adjudication totals
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
category	Σ	1..1	CodeableConcept	Type of adjudication information Binding: AdjudicationValueCodes (example): The adjudication codes.
amount	Σ	1..1	Money	Financial total for the category
payment		0..1	BackboneElement	Payment Details
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
type		1..1	CodeableConcept	Partial or complete payment Binding: ExamplePaymentTypeCodes (example): The type (partial, complete) of the payment.
adjustment		0..1	Money	Payment adjustment for non-claim issues
adjustmentReason		0..1	CodeableConcept	Explanation for the adjustment Binding: PaymentAdjustmentReasonCodes (example): Payment Adjustment reason codes.
date		0..1	date	Expected date of payment
amount		1..1	Money	Payable amount after adjustment
identifier		0..1	Identifier	Business identifier for the payment
fundsReserve		0..1	CodeableConcept	Funds reserved status Binding: Funds Reservation Codes (example): For whom funds are to be reserved: (Patient, Provider, None).
formCode		0..1	CodeableConcept	Printed form identifier Binding: Form Codes (example): The forms codes.
form		0..1	Attachment	Printed reference or actual form
processNote		0..*	BackboneElement	Note concerning adjudication
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
number		0..1	positiveInt	Note instance identifier
type		0..1	code	display | print | printoper Binding: NoteType (required): The presentation types of notes.
text		1..1	string	Note explanatory text
language		0..1	CodeableConcept	Language of the text Binding: CommonLanguages (preferred): A human language. Additional Bindings Purpose AllLanguages Max Binding
communicationRequest		0..*	Reference(CommunicationRequest)	Request for additional information
insurance	S	1..1	BackboneElement	Patient insurance information
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
sequence		1..1	positiveInt	Insurance instance identifier
focal		1..1	boolean	Coverage to be used for adjudication
coverage	S	1..1	Reference(MyCareNet Coverage BE profile)	Insurance information
businessArrangement		0..1	string	Additional provider contract number
claimResponse		0..1	Reference(ClaimResponse)	Adjudication results
error		0..*	BackboneElement	Processing errors
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
itemSequence		0..1	positiveInt	Item sequence number
detailSequence		0..1	positiveInt	Detail sequence number
subDetailSequence		0..1	positiveInt	Subdetail sequence number
code		1..1	CodeableConcept	Error code detailing processing issues Binding: Adjudication Error Codes (example): The adjudication error codes.
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet / Code	URI
ClaimResponse.language	preferred	CommonLanguages Additional Bindings Purpose AllLanguages Max Binding http://hl7.org/fhir/ValueSet/languages from the FHIR Standard
ClaimResponse.status	required	FinancialResourceStatusCodes http://hl7.org/fhir/ValueSet/fm-status|4.0.1 from the FHIR Standard
ClaimResponse.type	extensible	ClaimTypeCodes http://hl7.org/fhir/ValueSet/claim-type from the FHIR Standard
ClaimResponse.subType	extensible	BeVSEtariffTypes (a valid code from eTariff types) https://www.ehealth.fgov.be/standards/fhir/etariff/ValueSet/be-vs-etarifftypes from this IG
ClaimResponse.use	required	Pattern: predetermination http://hl7.org/fhir/ValueSet/claim-use|4.0.1 from the FHIR Standard
ClaimResponse.requestor.type	extensible	ResourceType http://hl7.org/fhir/ValueSet/resource-types from the FHIR Standard
ClaimResponse.outcome	required	ClaimProcessingCodes http://hl7.org/fhir/ValueSet/remittance-outcome|4.0.1 from the FHIR Standard
ClaimResponse.payeeType	example	Claim Payee Type Codes http://hl7.org/fhir/ValueSet/payeetype from the FHIR Standard
ClaimResponse.item.adjudication.category	example	AdjudicationValueCodes http://hl7.org/fhir/ValueSet/adjudication from the FHIR Standard
ClaimResponse.item.adjudication.reason	example	AdjudicationReasonCodes http://hl7.org/fhir/ValueSet/adjudication-reason from the FHIR Standard
ClaimResponse.addItem.extension:reimbursement.value[x].currency	required	Currencies (a valid code from urn:iso:std:iso:4217) http://hl7.org/fhir/ValueSet/currencies|4.0.1 from the FHIR Standard
ClaimResponse.addItem.extension:patientFee.value[x].currency	required	Currencies (a valid code from urn:iso:std:iso:4217) http://hl7.org/fhir/ValueSet/currencies|4.0.1 from the FHIR Standard
ClaimResponse.addItem.productOrService	example	USCLSCodes http://hl7.org/fhir/ValueSet/service-uscls from the FHIR Standard
ClaimResponse.addItem.modifier	example	ModifierTypeCodes http://hl7.org/fhir/ValueSet/claim-modifiers from the FHIR Standard
ClaimResponse.addItem.programCode	example	ExampleProgramReasonCodes http://hl7.org/fhir/ValueSet/ex-program-code from the FHIR Standard
ClaimResponse.addItem.location[x]	example	ExampleServicePlaceCodes http://hl7.org/fhir/ValueSet/service-place from the FHIR Standard
ClaimResponse.addItem.unitPrice.currency	required	Currencies (a valid code from urn:iso:std:iso:4217) http://hl7.org/fhir/ValueSet/currencies|4.0.1 from the FHIR Standard
ClaimResponse.addItem.net.currency	required	Currencies (a valid code from urn:iso:std:iso:4217) http://hl7.org/fhir/ValueSet/currencies|4.0.1 from the FHIR Standard
ClaimResponse.addItem.bodySite	example	OralSiteCodes http://hl7.org/fhir/ValueSet/tooth from the FHIR Standard
ClaimResponse.addItem.subSite	example	SurfaceCodes http://hl7.org/fhir/ValueSet/surface from the FHIR Standard
ClaimResponse.addItem.adjudication.category	extensible	BeVSDecisionValues https://www.ehealth.fgov.be/standards/fhir/mycarenet/ValueSet/be-vs-decision-values
ClaimResponse.addItem.adjudication.reason	extensible	BeVSRefusalValues (a valid code from refusal values) https://www.ehealth.fgov.be/standards/fhir/etariff/ValueSet/be-vs-refusal-values from this IG
ClaimResponse.addItem.detail.productOrService	example	USCLSCodes http://hl7.org/fhir/ValueSet/service-uscls from the FHIR Standard
ClaimResponse.addItem.detail.modifier	example	ModifierTypeCodes http://hl7.org/fhir/ValueSet/claim-modifiers from the FHIR Standard
ClaimResponse.addItem.detail.subDetail.productOrService	example	USCLSCodes http://hl7.org/fhir/ValueSet/service-uscls from the FHIR Standard
ClaimResponse.addItem.detail.subDetail.modifier	example	ModifierTypeCodes http://hl7.org/fhir/ValueSet/claim-modifiers from the FHIR Standard
ClaimResponse.total.category	example	AdjudicationValueCodes http://hl7.org/fhir/ValueSet/adjudication from the FHIR Standard
ClaimResponse.payment.type	example	ExamplePaymentTypeCodes http://hl7.org/fhir/ValueSet/ex-paymenttype from the FHIR Standard
ClaimResponse.payment.adjustmentReason	example	PaymentAdjustmentReasonCodes http://hl7.org/fhir/ValueSet/payment-adjustment-reason from the FHIR Standard
ClaimResponse.fundsReserve	example	Funds Reservation Codes http://hl7.org/fhir/ValueSet/fundsreserve from the FHIR Standard
ClaimResponse.formCode	example	Form Codes http://hl7.org/fhir/ValueSet/forms from the FHIR Standard
ClaimResponse.processNote.type	required	NoteType http://hl7.org/fhir/ValueSet/note-type|4.0.1 from the FHIR Standard
ClaimResponse.processNote.language	preferred	CommonLanguages Additional Bindings Purpose AllLanguages Max Binding http://hl7.org/fhir/ValueSet/languages from the FHIR Standard
ClaimResponse.error.code	example	Adjudication Error Codes http://hl7.org/fhir/ValueSet/adjudication-error from the FHIR Standard

Constraints

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

This structure is derived from ClaimResponse

Summary

Mandatory: 20 elements(12 nested mandatory elements)
Must-Support: 51 elements

Structures

This structure refers to these other structures:

• BePatient (https://www.ehealth.fgov.be/standards/fhir/core/StructureDefinition/be-patient)
• BeOrganization (https://www.ehealth.fgov.be/standards/fhir/core/StructureDefinition/be-organization)
• BePractitionerRole (https://www.ehealth.fgov.be/standards/fhir/core/StructureDefinition/be-practitionerrole)
• MyCareNet Coverage BE profile (https://www.ehealth.fgov.be/standards/fhir/mycarenet/StructureDefinition/be-mycarenet-coverage)

Extensions

This structure refers to these extensions:

• https://www.ehealth.fgov.be/standards/fhir/mycarenet/StructureDefinition/be-ext-mycarenet-item-reimbursement
• https://www.ehealth.fgov.be/standards/fhir/mycarenet/StructureDefinition/be-ext-mycarenet-item-patientfee
• https://www.ehealth.fgov.be/standards/fhir/etariff/StructureDefinition/be-ext-etariff-item-commitment
• https://www.ehealth.fgov.be/standards/fhir/etariff/StructureDefinition/be-ext-etariff-adjudication-refusalserviceidentifier
• https://www.ehealth.fgov.be/standards/fhir/etariff/StructureDefinition/be-ext-etariff-adjudication-refusalservicedate

Slices

This structure defines the following Slices:

• The element 1 is sliced based on the value of ClaimResponse.addItem.serviced[x]

Differential View

This structure is derived from ClaimResponse

Name	Flags	Card.	Type	Description & Constraints
ClaimResponse		0..*	ClaimResponse	Response to a claim predetermination or preauthorization
id	S	1..1	id	Logical id of this artifact
status	S	1..1	code	active | cancelled | draft | entered-in-error
type	S	1..1	CodeableConcept	More granular claim type
coding	S	1..1	Coding	Code defined by a terminology system
system	S	1..1	uri	Identity of the terminology system
code	S	1..1	code	Symbol in syntax defined by the system
subType	S	1..1	CodeableConcept	More granular claim type Binding: eTariff types (extensible)
coding	S	1..1	Coding	Code defined by a terminology system
system	S	1..1	uri	Identity of the terminology system
code	S	1..1	code	Symbol in syntax defined by the system
use	S	1..1	code	claim | preauthorization | predetermination Required Pattern: predetermination
patient	S	1..1	Reference(BePatient)	The recipient of the products and services
created	S	1..1	dateTime	Response creation date
insurer	S	1..1	Reference(BeOrganization)	Party responsible for reimbursement
requestor	S	1..1	Reference(BeOrganization | BePractitionerRole)	Party responsible for the claim
reference		1..1	string	Literal reference, Relative, internal or absolute URL
outcome	S	1..1	code	queued | complete | error | partial
addItem	S	1..*	BackboneElement	Insurer added line items
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
reimbursement	S	0..1	(Complex)	Extension URL: https://www.ehealth.fgov.be/standards/fhir/mycarenet/StructureDefinition/be-ext-mycarenet-item-reimbursement
value[x]
value	S	1..1	decimal	Numerical value (with implicit precision)
currency	S	1..1	code	ISO 4217 Currency Code
patientFee	S	0..1	(Complex)	Extension URL: https://www.ehealth.fgov.be/standards/fhir/mycarenet/StructureDefinition/be-ext-mycarenet-item-patientfee
value[x]
value	S	1..1	decimal	Numerical value (with implicit precision)
currency	S	1..1	code	ISO 4217 Currency Code
commitment	S	0..1	string	Optional Extensions Element URL: https://www.ehealth.fgov.be/standards/fhir/etariff/StructureDefinition/be-ext-etariff-item-commitment
itemSequence	S	1..1	positiveInt	Item sequence number
provider	S	1..1	Reference(BePractitionerRole)	Authorized providers
productOrService	S	1..1	CodeableConcept	Billing, service, product, or drug code
coding	S	1..1	Coding	Code defined by a terminology system
system	S	1..1	uri	Identity of the terminology system Required Pattern: https://www.ehealth.fgov.be/standards/fhir/core/NamingSystem/be-ns-nihdi-nomenclature
code	S	1..1	code	Symbol in syntax defined by the system
Slices for serviced[x]		0..1	date, Period	Date or dates of service or product delivery Slice: Unordered, Open by type:$this
serviced[x]:servicedDate	S	0..1	date	Date or dates of service or product delivery
quantity	S	0..1	SimpleQuantity	Count of products or services
value	S	1..1	decimal	Numerical value (with implicit precision)
unitPrice	S	0..1	Money	Fee, charge or cost per item
value	S	1..1	decimal	Numerical value (with implicit precision)
currency	S	1..1	code	ISO 4217 Currency Code
net	S	0..1	Money	Total item cost
value	S	1..1	decimal	Numerical value (with implicit precision)
currency	S	1..1	code	ISO 4217 Currency Code
adjudication	S	1..1	BackboneElement	Added items adjudication
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
refusalId	S	0..1	(Complex)	Optional Extensions Element URL: https://www.ehealth.fgov.be/standards/fhir/etariff/StructureDefinition/be-ext-etariff-adjudication-refusalserviceidentifier
Slices for value[x]				Content/Rules for all slices
value[x]:valueCodeableConcept		1..1	CodeableConcept	Value of extension
coding	S	1..1	Coding	Code defined by a terminology system
system	S	1..1	uri	Identity of the terminology system
code	S	1..1	code	Symbol in syntax defined by the system
refusalDate	S	0..1	date	Optional Extensions Element URL: https://www.ehealth.fgov.be/standards/fhir/etariff/StructureDefinition/be-ext-etariff-adjudication-refusalservicedate
category	S	1..1	CodeableConcept	Type of adjudication information Binding: Mycarenet Decision Values (extensible)
coding	S	1..1	Coding	Code defined by a terminology system
system	S	1..1	uri	Identity of the terminology system
code	S	1..1	code	Symbol in syntax defined by the system
reason		0..1	CodeableConcept	Explanation of adjudication outcome Binding: BeVSRefusalValues (extensible)
insurance	S	1..1	BackboneElement	Patient insurance information
coverage	S	1..1	Reference(MyCareNet Coverage BE profile)	Insurance information
Documentation for this format

Terminology Bindings (Differential)

Path	Conformance	ValueSet	URI
ClaimResponse.subType	extensible	BeVSEtariffTypes (a valid code from eTariff types) https://www.ehealth.fgov.be/standards/fhir/etariff/ValueSet/be-vs-etarifftypes from this IG
ClaimResponse.addItem.adjudication.category	extensible	BeVSDecisionValues https://www.ehealth.fgov.be/standards/fhir/mycarenet/ValueSet/be-vs-decision-values
ClaimResponse.addItem.adjudication.reason	extensible	BeVSRefusalValues (a valid code from refusal values) https://www.ehealth.fgov.be/standards/fhir/etariff/ValueSet/be-vs-refusal-values from this IG

Key Elements View

Name	Flags	Card.	Type	Description & Constraints
ClaimResponse		0..*	ClaimResponse	Response to a claim predetermination or preauthorization
id	SΣ	1..1	id	Logical id of this artifact
implicitRules	?!Σ	0..1	uri	A set of rules under which this content was created
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored
status	?!SΣ	1..1	code	active | cancelled | draft | entered-in-error Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance.
type	SΣ	1..1	CodeableConcept	More granular claim type Binding: ClaimTypeCodes (extensible): The type or discipline-style of the claim.
coding	SΣ	1..1	Coding	Code defined by a terminology system
system	SΣ	1..1	uri	Identity of the terminology system
code	SΣ	1..1	code	Symbol in syntax defined by the system
subType	S	1..1	CodeableConcept	More granular claim type Binding: eTariff types (extensible)
coding	SΣ	1..1	Coding	Code defined by a terminology system
system	SΣ	1..1	uri	Identity of the terminology system
code	SΣ	1..1	code	Symbol in syntax defined by the system
use	SΣ	1..1	code	claim | preauthorization | predetermination Binding: Use (required): Claim, preauthorization, predetermination. Required Pattern: predetermination
patient	SΣ	1..1	Reference(BePatient)	The recipient of the products and services
created	SΣ	1..1	dateTime	Response creation date
insurer	SΣ	1..1	Reference(BeOrganization)	Party responsible for reimbursement
requestor	S	1..1	Reference(BeOrganization | BePractitionerRole)	Party responsible for the claim
reference	ΣC	1..1	string	Literal reference, Relative, internal or absolute URL
outcome	SΣ	1..1	code	queued | complete | error | partial Binding: ClaimProcessingCodes (required): The result of the claim processing.
addItem	S	1..*	BackboneElement	Insurer added line items
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
reimbursement	S	0..1	(Complex)	Extension URL: https://www.ehealth.fgov.be/standards/fhir/mycarenet/StructureDefinition/be-ext-mycarenet-item-reimbursement
extension		0..0
url		1..1	uri	"https://www.ehealth.fgov.be/standards/fhir/mycarenet/StructureDefinition/be-ext-mycarenet-item-reimbursement"
value[x]	S	1..1	Money	Value of extension
value	SΣ	1..1	decimal	Numerical value (with implicit precision)
currency	SΣ	1..1	code	ISO 4217 Currency Code Binding: Currencies (required): A code indicating the currency, taken from ISO 4217.
patientFee	S	0..1	(Complex)	Extension URL: https://www.ehealth.fgov.be/standards/fhir/mycarenet/StructureDefinition/be-ext-mycarenet-item-patientfee
extension		0..0
url		1..1	uri	"https://www.ehealth.fgov.be/standards/fhir/mycarenet/StructureDefinition/be-ext-mycarenet-item-patientfee"
value[x]	S	1..1	Money	Value of extension
value	SΣ	1..1	decimal	Numerical value (with implicit precision)
currency	SΣ	1..1	code	ISO 4217 Currency Code Binding: Currencies (required): A code indicating the currency, taken from ISO 4217.
commitment	S	0..1	string	Optional Extensions Element URL: https://www.ehealth.fgov.be/standards/fhir/etariff/StructureDefinition/be-ext-etariff-item-commitment
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
itemSequence	S	1..1	positiveInt	Item sequence number
provider	S	1..1	Reference(BePractitionerRole)	Authorized providers
productOrService	S	1..1	CodeableConcept	Billing, service, product, or drug code Binding: USCLSCodes (example): Allowable service and product codes.
coding	SΣ	1..1	Coding	Code defined by a terminology system
system	SΣ	1..1	uri	Identity of the terminology system Required Pattern: https://www.ehealth.fgov.be/standards/fhir/core/NamingSystem/be-ns-nihdi-nomenclature
code	SΣ	1..1	code	Symbol in syntax defined by the system
Slices for serviced[x]		0..1		Date or dates of service or product delivery Slice: Unordered, Open by type:$this
servicedDate			date
servicedPeriod			Period
serviced[x]:servicedDate	S	0..1	date	Date or dates of service or product delivery
quantity	S	0..1	SimpleQuantity	Count of products or services
value	SΣ	1..1	decimal	Numerical value (with implicit precision)
unitPrice	S	0..1	Money	Fee, charge or cost per item
value	SΣ	1..1	decimal	Numerical value (with implicit precision)
currency	SΣ	1..1	code	ISO 4217 Currency Code Binding: Currencies (required): A code indicating the currency, taken from ISO 4217.
net	S	0..1	Money	Total item cost
value	SΣ	1..1	decimal	Numerical value (with implicit precision)
currency	SΣ	1..1	code	ISO 4217 Currency Code Binding: Currencies (required): A code indicating the currency, taken from ISO 4217.
adjudication	S	1..1	BackboneElement	Added items adjudication
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
refusalId	S	0..1	(Complex)	Optional Extensions Element URL: https://www.ehealth.fgov.be/standards/fhir/etariff/StructureDefinition/be-ext-etariff-adjudication-refusalserviceidentifier
extension		0..0
url		1..1	uri	"https://www.ehealth.fgov.be/standards/fhir/etariff/StructureDefinition/be-ext-etariff-adjudication-refusalserviceidentifier"
Slices for value[x]		1..1	CodeableConcept	Value of extension Slice: Unordered, Closed by type:$this
value[x]:valueCodeableConcept	S	1..1	CodeableConcept	Value of extension
coding	SΣ	1..1	Coding	Code defined by a terminology system
system	SΣ	1..1	uri	Identity of the terminology system Required Pattern: https://www.ehealth.fgov.be/standards/fhir/core/NamingSystem/be-ns-nihdi-nomenclature
code	SΣ	1..1	code	Symbol in syntax defined by the system
refusalDate	S	0..1	date	Optional Extensions Element URL: https://www.ehealth.fgov.be/standards/fhir/etariff/StructureDefinition/be-ext-etariff-adjudication-refusalservicedate
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
category	S	1..1	CodeableConcept	Type of adjudication information Binding: Mycarenet Decision Values (extensible)
coding	SΣ	1..1	Coding	Code defined by a terminology system
system	SΣ	1..1	uri	Identity of the terminology system
code	SΣ	1..1	code	Symbol in syntax defined by the system
reason		0..1	CodeableConcept	Explanation of adjudication outcome Binding: BeVSRefusalValues (extensible)
insurance	S	1..1	BackboneElement	Patient insurance information
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
sequence		1..1	positiveInt	Insurance instance identifier
focal		1..1	boolean	Coverage to be used for adjudication
coverage	S	1..1	Reference(MyCareNet Coverage BE profile)	Insurance information
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet / Code	URI
ClaimResponse.status	required	FinancialResourceStatusCodes http://hl7.org/fhir/ValueSet/fm-status|4.0.1 from the FHIR Standard
ClaimResponse.type	extensible	ClaimTypeCodes http://hl7.org/fhir/ValueSet/claim-type from the FHIR Standard
ClaimResponse.subType	extensible	BeVSEtariffTypes (a valid code from eTariff types) https://www.ehealth.fgov.be/standards/fhir/etariff/ValueSet/be-vs-etarifftypes from this IG
ClaimResponse.use	required	Pattern: predetermination http://hl7.org/fhir/ValueSet/claim-use|4.0.1 from the FHIR Standard
ClaimResponse.outcome	required	ClaimProcessingCodes http://hl7.org/fhir/ValueSet/remittance-outcome|4.0.1 from the FHIR Standard
ClaimResponse.addItem.extension:reimbursement.value[x].currency	required	Currencies (a valid code from urn:iso:std:iso:4217) http://hl7.org/fhir/ValueSet/currencies|4.0.1 from the FHIR Standard
ClaimResponse.addItem.extension:patientFee.value[x].currency	required	Currencies (a valid code from urn:iso:std:iso:4217) http://hl7.org/fhir/ValueSet/currencies|4.0.1 from the FHIR Standard
ClaimResponse.addItem.productOrService	example	USCLSCodes http://hl7.org/fhir/ValueSet/service-uscls from the FHIR Standard
ClaimResponse.addItem.unitPrice.currency	required	Currencies (a valid code from urn:iso:std:iso:4217) http://hl7.org/fhir/ValueSet/currencies|4.0.1 from the FHIR Standard
ClaimResponse.addItem.net.currency	required	Currencies (a valid code from urn:iso:std:iso:4217) http://hl7.org/fhir/ValueSet/currencies|4.0.1 from the FHIR Standard
ClaimResponse.addItem.adjudication.category	extensible	BeVSDecisionValues https://www.ehealth.fgov.be/standards/fhir/mycarenet/ValueSet/be-vs-decision-values
ClaimResponse.addItem.adjudication.reason	extensible	BeVSRefusalValues (a valid code from refusal values) https://www.ehealth.fgov.be/standards/fhir/etariff/ValueSet/be-vs-refusal-values from this IG

Constraints

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

Snapshot View

Name	Flags	Card.	Type	Description & Constraints
ClaimResponse		0..*	ClaimResponse	Response to a claim predetermination or preauthorization
id	SΣ	1..1	id	Logical id of this artifact
meta	Σ	0..1	Meta	Metadata about the resource
implicitRules	?!Σ	0..1	uri	A set of rules under which this content was created
language		0..1	code	Language of the resource content Binding: CommonLanguages (preferred): A human language. Additional Bindings Purpose AllLanguages Max Binding
text		0..1	Narrative	Text summary of the resource, for human interpretation
contained		0..*	Resource	Contained, inline Resources
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored
identifier		0..*	Identifier	Business Identifier for a claim response
status	?!SΣ	1..1	code	active | cancelled | draft | entered-in-error Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance.
type	SΣ	1..1	CodeableConcept	More granular claim type Binding: ClaimTypeCodes (extensible): The type or discipline-style of the claim.
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
coding	SΣ	1..1	Coding	Code defined by a terminology system
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
system	SΣ	1..1	uri	Identity of the terminology system
version	Σ	0..1	string	Version of the system - if relevant
code	SΣ	1..1	code	Symbol in syntax defined by the system
display	Σ	0..1	string	Representation defined by the system
userSelected	Σ	0..1	boolean	If this coding was chosen directly by the user
text	Σ	0..1	string	Plain text representation of the concept
subType	S	1..1	CodeableConcept	More granular claim type Binding: eTariff types (extensible)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
coding	SΣ	1..1	Coding	Code defined by a terminology system
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
system	SΣ	1..1	uri	Identity of the terminology system
version	Σ	0..1	string	Version of the system - if relevant
code	SΣ	1..1	code	Symbol in syntax defined by the system
display	Σ	0..1	string	Representation defined by the system
userSelected	Σ	0..1	boolean	If this coding was chosen directly by the user
text	Σ	0..1	string	Plain text representation of the concept
use	SΣ	1..1	code	claim | preauthorization | predetermination Binding: Use (required): Claim, preauthorization, predetermination. Required Pattern: predetermination
patient	SΣ	1..1	Reference(BePatient)	The recipient of the products and services
created	SΣ	1..1	dateTime	Response creation date
insurer	SΣ	1..1	Reference(BeOrganization)	Party responsible for reimbursement
requestor	S	1..1	Reference(BeOrganization | BePractitionerRole)	Party responsible for the claim
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
reference	ΣC	1..1	string	Literal reference, Relative, internal or absolute URL
type	Σ	0..1	uri	Type the reference refers to (e.g. "Patient") Binding: ResourceType (extensible): Aa resource (or, for logical models, the URI of the logical model).
identifier	Σ	0..1	Identifier	Logical reference, when literal reference is not known
display	Σ	0..1	string	Text alternative for the resource
request	Σ	0..1	Reference(Claim)	Id of resource triggering adjudication
outcome	SΣ	1..1	code	queued | complete | error | partial Binding: ClaimProcessingCodes (required): The result of the claim processing.
disposition		0..1	string	Disposition Message
preAuthRef		0..1	string	Preauthorization reference
preAuthPeriod		0..1	Period	Preauthorization reference effective period
payeeType		0..1	CodeableConcept	Party to be paid any benefits payable Binding: Claim Payee Type Codes (example): A code for the party to be reimbursed.
item		0..*	BackboneElement	Adjudication for claim line items
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
itemSequence		1..1	positiveInt	Claim item instance identifier
noteNumber		0..*	positiveInt	Applicable note numbers
adjudication		1..*	BackboneElement	Adjudication details
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
category		1..1	CodeableConcept	Type of adjudication information Binding: AdjudicationValueCodes (example): The adjudication codes.
reason		0..1	CodeableConcept	Explanation of adjudication outcome Binding: AdjudicationReasonCodes (example): The adjudication reason codes.
amount		0..1	Money	Monetary amount
value		0..1	decimal	Non-monetary value
detail		0..*	BackboneElement	Adjudication for claim details
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
detailSequence		1..1	positiveInt	Claim detail instance identifier
noteNumber		0..*	positiveInt	Applicable note numbers
adjudication		1..*	See adjudication (ClaimResponse)	Detail level adjudication details
subDetail		0..*	BackboneElement	Adjudication for claim sub-details
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
subDetailSequence		1..1	positiveInt	Claim sub-detail instance identifier
noteNumber		0..*	positiveInt	Applicable note numbers
adjudication		0..*	See adjudication (ClaimResponse)	Subdetail level adjudication details
addItem	S	1..*	BackboneElement	Insurer added line items
id		0..1	string	Unique id for inter-element referencing
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
reimbursement	S	0..1	(Complex)	Extension URL: https://www.ehealth.fgov.be/standards/fhir/mycarenet/StructureDefinition/be-ext-mycarenet-item-reimbursement
id		0..1	string	Unique id for inter-element referencing
extension		0..0
url		1..1	uri	"https://www.ehealth.fgov.be/standards/fhir/mycarenet/StructureDefinition/be-ext-mycarenet-item-reimbursement"
value[x]	S	1..1	Money	Value of extension
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
value	SΣ	1..1	decimal	Numerical value (with implicit precision)
currency	SΣ	1..1	code	ISO 4217 Currency Code Binding: Currencies (required): A code indicating the currency, taken from ISO 4217.
patientFee	S	0..1	(Complex)	Extension URL: https://www.ehealth.fgov.be/standards/fhir/mycarenet/StructureDefinition/be-ext-mycarenet-item-patientfee
id		0..1	string	Unique id for inter-element referencing
extension		0..0
url		1..1	uri	"https://www.ehealth.fgov.be/standards/fhir/mycarenet/StructureDefinition/be-ext-mycarenet-item-patientfee"
value[x]	S	1..1	Money	Value of extension
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
value	SΣ	1..1	decimal	Numerical value (with implicit precision)
currency	SΣ	1..1	code	ISO 4217 Currency Code Binding: Currencies (required): A code indicating the currency, taken from ISO 4217.
commitment	S	0..1	string	Optional Extensions Element URL: https://www.ehealth.fgov.be/standards/fhir/etariff/StructureDefinition/be-ext-etariff-item-commitment
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
itemSequence	S	1..1	positiveInt	Item sequence number
detailSequence		0..*	positiveInt	Detail sequence number
subdetailSequence		0..*	positiveInt	Subdetail sequence number
provider	S	1..1	Reference(BePractitionerRole)	Authorized providers
productOrService	S	1..1	CodeableConcept	Billing, service, product, or drug code Binding: USCLSCodes (example): Allowable service and product codes.
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
coding	SΣ	1..1	Coding	Code defined by a terminology system
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
system	SΣ	1..1	uri	Identity of the terminology system Required Pattern: https://www.ehealth.fgov.be/standards/fhir/core/NamingSystem/be-ns-nihdi-nomenclature
version	Σ	0..1	string	Version of the system - if relevant
code	SΣ	1..1	code	Symbol in syntax defined by the system
display	Σ	0..1	string	Representation defined by the system
userSelected	Σ	0..1	boolean	If this coding was chosen directly by the user
text	Σ	0..1	string	Plain text representation of the concept
modifier		0..*	CodeableConcept	Service/Product billing modifiers Binding: ModifierTypeCodes (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: ExampleProgramReasonCodes (example): Program specific reason codes.
Slices for serviced[x]		0..1		Date or dates of service or product delivery Slice: Unordered, Open by type:$this
servicedDate			date
servicedPeriod			Period
serviced[x]:servicedDate	S	0..1	date	Date or dates of service or product delivery
location[x]		0..1		Place of service or where product was supplied Binding: ExampleServicePlaceCodes (example): Place of service: pharmacy, school, prison, etc.
locationCodeableConcept			CodeableConcept
locationAddress			Address
locationReference			Reference(Location)
quantity	S	0..1	SimpleQuantity	Count of products or services
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
value	SΣ	1..1	decimal	Numerical value (with implicit precision)
unit	Σ	0..1	string	Unit representation
system	ΣC	0..1	uri	System that defines coded unit form
code	Σ	0..1	code	Coded form of the unit
unitPrice	S	0..1	Money	Fee, charge or cost per item
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
value	SΣ	1..1	decimal	Numerical value (with implicit precision)
currency	SΣ	1..1	code	ISO 4217 Currency Code Binding: Currencies (required): A code indicating the currency, taken from ISO 4217.
factor		0..1	decimal	Price scaling factor
net	S	0..1	Money	Total item cost
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
value	SΣ	1..1	decimal	Numerical value (with implicit precision)
currency	SΣ	1..1	code	ISO 4217 Currency Code Binding: Currencies (required): A code indicating the currency, taken from ISO 4217.
bodySite		0..1	CodeableConcept	Anatomical location Binding: OralSiteCodes (example): The code for the teeth, quadrant, sextant and arch.
subSite		0..*	CodeableConcept	Anatomical sub-location Binding: SurfaceCodes (example): The code for the tooth surface and surface combinations.
noteNumber		0..*	positiveInt	Applicable note numbers
adjudication	S	1..1	BackboneElement	Added items adjudication
id		0..1	string	Unique id for inter-element referencing
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
refusalId	S	0..1	(Complex)	Optional Extensions Element URL: https://www.ehealth.fgov.be/standards/fhir/etariff/StructureDefinition/be-ext-etariff-adjudication-refusalserviceidentifier
id		0..1	string	Unique id for inter-element referencing
extension		0..0
url		1..1	uri	"https://www.ehealth.fgov.be/standards/fhir/etariff/StructureDefinition/be-ext-etariff-adjudication-refusalserviceidentifier"
Slices for value[x]		1..1	CodeableConcept	Value of extension Slice: Unordered, Closed by type:$this
value[x]:valueCodeableConcept	S	1..1	CodeableConcept	Value of extension
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
coding	SΣ	1..1	Coding	Code defined by a terminology system
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
system	SΣ	1..1	uri	Identity of the terminology system Required Pattern: https://www.ehealth.fgov.be/standards/fhir/core/NamingSystem/be-ns-nihdi-nomenclature
version	Σ	0..1	string	Version of the system - if relevant
code	SΣ	1..1	code	Symbol in syntax defined by the system
display	Σ	0..1	string	Representation defined by the system
userSelected	Σ	0..1	boolean	If this coding was chosen directly by the user
text	Σ	0..1	string	Plain text representation of the concept
refusalDate	S	0..1	date	Optional Extensions Element URL: https://www.ehealth.fgov.be/standards/fhir/etariff/StructureDefinition/be-ext-etariff-adjudication-refusalservicedate
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
category	S	1..1	CodeableConcept	Type of adjudication information Binding: Mycarenet Decision Values (extensible)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
coding	SΣ	1..1	Coding	Code defined by a terminology system
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
system	SΣ	1..1	uri	Identity of the terminology system
version	Σ	0..1	string	Version of the system - if relevant
code	SΣ	1..1	code	Symbol in syntax defined by the system
display	Σ	0..1	string	Representation defined by the system
userSelected	Σ	0..1	boolean	If this coding was chosen directly by the user
text	Σ	0..1	string	Plain text representation of the concept
reason		0..1	CodeableConcept	Explanation of adjudication outcome Binding: BeVSRefusalValues (extensible)
amount		0..1	Money	Monetary amount
value		0..1	decimal	Non-monetary value
detail		0..*	BackboneElement	Insurer added line details
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
productOrService		1..1	CodeableConcept	Billing, service, product, or drug code Binding: USCLSCodes (example): Allowable service and product codes.
modifier		0..*	CodeableConcept	Service/Product billing modifiers Binding: ModifierTypeCodes (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	SimpleQuantity	Count of products or services
unitPrice		0..1	Money	Fee, charge or cost per item
factor		0..1	decimal	Price scaling factor
net		0..1	Money	Total item cost
noteNumber		0..*	positiveInt	Applicable note numbers
adjudication		1..*	See adjudication (ClaimResponse)	Added items detail adjudication
subDetail		0..*	BackboneElement	Insurer added line items
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
productOrService		1..1	CodeableConcept	Billing, service, product, or drug code Binding: USCLSCodes (example): Allowable service and product codes.
modifier		0..*	CodeableConcept	Service/Product billing modifiers Binding: ModifierTypeCodes (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	SimpleQuantity	Count of products or services
unitPrice		0..1	Money	Fee, charge or cost per item
factor		0..1	decimal	Price scaling factor
net		0..1	Money	Total item cost
noteNumber		0..*	positiveInt	Applicable note numbers
adjudication		1..*	See adjudication (ClaimResponse)	Added items detail adjudication
adjudication		0..*	See adjudication (ClaimResponse)	Header-level adjudication
total	Σ	0..*	BackboneElement	Adjudication totals
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
category	Σ	1..1	CodeableConcept	Type of adjudication information Binding: AdjudicationValueCodes (example): The adjudication codes.
amount	Σ	1..1	Money	Financial total for the category
payment		0..1	BackboneElement	Payment Details
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
type		1..1	CodeableConcept	Partial or complete payment Binding: ExamplePaymentTypeCodes (example): The type (partial, complete) of the payment.
adjustment		0..1	Money	Payment adjustment for non-claim issues
adjustmentReason		0..1	CodeableConcept	Explanation for the adjustment Binding: PaymentAdjustmentReasonCodes (example): Payment Adjustment reason codes.
date		0..1	date	Expected date of payment
amount		1..1	Money	Payable amount after adjustment
identifier		0..1	Identifier	Business identifier for the payment
fundsReserve		0..1	CodeableConcept	Funds reserved status Binding: Funds Reservation Codes (example): For whom funds are to be reserved: (Patient, Provider, None).
formCode		0..1	CodeableConcept	Printed form identifier Binding: Form Codes (example): The forms codes.
form		0..1	Attachment	Printed reference or actual form
processNote		0..*	BackboneElement	Note concerning adjudication
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
number		0..1	positiveInt	Note instance identifier
type		0..1	code	display | print | printoper Binding: NoteType (required): The presentation types of notes.
text		1..1	string	Note explanatory text
language		0..1	CodeableConcept	Language of the text Binding: CommonLanguages (preferred): A human language. Additional Bindings Purpose AllLanguages Max Binding
communicationRequest		0..*	Reference(CommunicationRequest)	Request for additional information
insurance	S	1..1	BackboneElement	Patient insurance information
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
sequence		1..1	positiveInt	Insurance instance identifier
focal		1..1	boolean	Coverage to be used for adjudication
coverage	S	1..1	Reference(MyCareNet Coverage BE profile)	Insurance information
businessArrangement		0..1	string	Additional provider contract number
claimResponse		0..1	Reference(ClaimResponse)	Adjudication results
error		0..*	BackboneElement	Processing errors
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
itemSequence		0..1	positiveInt	Item sequence number
detailSequence		0..1	positiveInt	Detail sequence number
subDetailSequence		0..1	positiveInt	Subdetail sequence number
code		1..1	CodeableConcept	Error code detailing processing issues Binding: Adjudication Error Codes (example): The adjudication error codes.
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet / Code	URI
ClaimResponse.language	preferred	CommonLanguages Additional Bindings Purpose AllLanguages Max Binding http://hl7.org/fhir/ValueSet/languages from the FHIR Standard
ClaimResponse.status	required	FinancialResourceStatusCodes http://hl7.org/fhir/ValueSet/fm-status|4.0.1 from the FHIR Standard
ClaimResponse.type	extensible	ClaimTypeCodes http://hl7.org/fhir/ValueSet/claim-type from the FHIR Standard
ClaimResponse.subType	extensible	BeVSEtariffTypes (a valid code from eTariff types) https://www.ehealth.fgov.be/standards/fhir/etariff/ValueSet/be-vs-etarifftypes from this IG
ClaimResponse.use	required	Pattern: predetermination http://hl7.org/fhir/ValueSet/claim-use|4.0.1 from the FHIR Standard
ClaimResponse.requestor.type	extensible	ResourceType http://hl7.org/fhir/ValueSet/resource-types from the FHIR Standard
ClaimResponse.outcome	required	ClaimProcessingCodes http://hl7.org/fhir/ValueSet/remittance-outcome|4.0.1 from the FHIR Standard
ClaimResponse.payeeType	example	Claim Payee Type Codes http://hl7.org/fhir/ValueSet/payeetype from the FHIR Standard
ClaimResponse.item.adjudication.category	example	AdjudicationValueCodes http://hl7.org/fhir/ValueSet/adjudication from the FHIR Standard
ClaimResponse.item.adjudication.reason	example	AdjudicationReasonCodes http://hl7.org/fhir/ValueSet/adjudication-reason from the FHIR Standard
ClaimResponse.addItem.extension:reimbursement.value[x].currency	required	Currencies (a valid code from urn:iso:std:iso:4217) http://hl7.org/fhir/ValueSet/currencies|4.0.1 from the FHIR Standard
ClaimResponse.addItem.extension:patientFee.value[x].currency	required	Currencies (a valid code from urn:iso:std:iso:4217) http://hl7.org/fhir/ValueSet/currencies|4.0.1 from the FHIR Standard
ClaimResponse.addItem.productOrService	example	USCLSCodes http://hl7.org/fhir/ValueSet/service-uscls from the FHIR Standard
ClaimResponse.addItem.modifier	example	ModifierTypeCodes http://hl7.org/fhir/ValueSet/claim-modifiers from the FHIR Standard
ClaimResponse.addItem.programCode	example	ExampleProgramReasonCodes http://hl7.org/fhir/ValueSet/ex-program-code from the FHIR Standard
ClaimResponse.addItem.location[x]	example	ExampleServicePlaceCodes http://hl7.org/fhir/ValueSet/service-place from the FHIR Standard
ClaimResponse.addItem.unitPrice.currency	required	Currencies (a valid code from urn:iso:std:iso:4217) http://hl7.org/fhir/ValueSet/currencies|4.0.1 from the FHIR Standard
ClaimResponse.addItem.net.currency	required	Currencies (a valid code from urn:iso:std:iso:4217) http://hl7.org/fhir/ValueSet/currencies|4.0.1 from the FHIR Standard
ClaimResponse.addItem.bodySite	example	OralSiteCodes http://hl7.org/fhir/ValueSet/tooth from the FHIR Standard
ClaimResponse.addItem.subSite	example	SurfaceCodes http://hl7.org/fhir/ValueSet/surface from the FHIR Standard
ClaimResponse.addItem.adjudication.category	extensible	BeVSDecisionValues https://www.ehealth.fgov.be/standards/fhir/mycarenet/ValueSet/be-vs-decision-values
ClaimResponse.addItem.adjudication.reason	extensible	BeVSRefusalValues (a valid code from refusal values) https://www.ehealth.fgov.be/standards/fhir/etariff/ValueSet/be-vs-refusal-values from this IG
ClaimResponse.addItem.detail.productOrService	example	USCLSCodes http://hl7.org/fhir/ValueSet/service-uscls from the FHIR Standard
ClaimResponse.addItem.detail.modifier	example	ModifierTypeCodes http://hl7.org/fhir/ValueSet/claim-modifiers from the FHIR Standard
ClaimResponse.addItem.detail.subDetail.productOrService	example	USCLSCodes http://hl7.org/fhir/ValueSet/service-uscls from the FHIR Standard
ClaimResponse.addItem.detail.subDetail.modifier	example	ModifierTypeCodes http://hl7.org/fhir/ValueSet/claim-modifiers from the FHIR Standard
ClaimResponse.total.category	example	AdjudicationValueCodes http://hl7.org/fhir/ValueSet/adjudication from the FHIR Standard
ClaimResponse.payment.type	example	ExamplePaymentTypeCodes http://hl7.org/fhir/ValueSet/ex-paymenttype from the FHIR Standard
ClaimResponse.payment.adjustmentReason	example	PaymentAdjustmentReasonCodes http://hl7.org/fhir/ValueSet/payment-adjustment-reason from the FHIR Standard
ClaimResponse.fundsReserve	example	Funds Reservation Codes http://hl7.org/fhir/ValueSet/fundsreserve from the FHIR Standard
ClaimResponse.formCode	example	Form Codes http://hl7.org/fhir/ValueSet/forms from the FHIR Standard
ClaimResponse.processNote.type	required	NoteType http://hl7.org/fhir/ValueSet/note-type|4.0.1 from the FHIR Standard
ClaimResponse.processNote.language	preferred	CommonLanguages Additional Bindings Purpose AllLanguages Max Binding http://hl7.org/fhir/ValueSet/languages from the FHIR Standard
ClaimResponse.error.code	example	Adjudication Error Codes http://hl7.org/fhir/ValueSet/adjudication-error from the FHIR Standard

Constraints

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

This structure is derived from ClaimResponse

Summary

Mandatory: 20 elements(12 nested mandatory elements)
Must-Support: 51 elements

Structures

This structure refers to these other structures:

• BePatient (https://www.ehealth.fgov.be/standards/fhir/core/StructureDefinition/be-patient)
• BeOrganization (https://www.ehealth.fgov.be/standards/fhir/core/StructureDefinition/be-organization)
• BePractitionerRole (https://www.ehealth.fgov.be/standards/fhir/core/StructureDefinition/be-practitionerrole)
• MyCareNet Coverage BE profile (https://www.ehealth.fgov.be/standards/fhir/mycarenet/StructureDefinition/be-mycarenet-coverage)

Extensions

This structure refers to these extensions:

• https://www.ehealth.fgov.be/standards/fhir/mycarenet/StructureDefinition/be-ext-mycarenet-item-reimbursement
• https://www.ehealth.fgov.be/standards/fhir/mycarenet/StructureDefinition/be-ext-mycarenet-item-patientfee
• https://www.ehealth.fgov.be/standards/fhir/etariff/StructureDefinition/be-ext-etariff-item-commitment
• https://www.ehealth.fgov.be/standards/fhir/etariff/StructureDefinition/be-ext-etariff-adjudication-refusalserviceidentifier
• https://www.ehealth.fgov.be/standards/fhir/etariff/StructureDefinition/be-ext-etariff-adjudication-refusalservicedate

Slices

This structure defines the following Slices:

• The element 1 is sliced based on the value of ClaimResponse.addItem.serviced[x]