Belgian MyCareNet Profiles, published by eHealth Platform. This guide is not an authorized publication; it is the continuous build for version 2.1.0 built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/hl7-be/mycarenet/ and changes regularly. See the Directory of published versions
Official URL: https://www.ehealth.fgov.be/standards/fhir/mycarenet/StructureDefinition/be-eagreementclaimresponse | Version: 2.1.0 | |||
Active as of 2025-01-22 | Computable Name: BeMyCareNetEagreementClaimResponse |
Claimresponse profile for use in the different eAgreement flows from MyCareNet.
Usage:
Description of Profiles, Differentials, Snapshots and how the different presentations work.
Name | Flags | Card. | Type | Description & Constraints![]() |
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C | 0..* | ClaimResponse | Response to a claim predetermination or preauthorization dom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources dom-3: 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 dom-4: If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated dom-5: If a resource is contained in another resource, it SHALL NOT have a security label dom-6: A resource should have narrative for robust management be-rule-eagreementclaimresponse-1: preAuthPeriod start and end SHALL be YYYY-MM-DD be-rule-eagreementclaimresponse-2: Created SHALL be YYYY-MM-DDThh:mm:ss+zz:zz |
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SΣ | 1..1 | id | Logical id of this artifact |
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SΣ | 1..1 | Meta | Metadata about the resource ele-1: All FHIR elements must have a @value or children |
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Σ | 1..1 | canonical(StructureDefinition) | Profiles this resource claims to conform to ele-1: All FHIR elements must have a @value or children |
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?!Σ | 0..1 | uri | A set of rules under which this content was created ele-1: All FHIR elements must have a @value or children |
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?! | 0..* | Extension | Extensions that cannot be ignored ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both |
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?!SΣ | 1..1 | code | active | cancelled | draft | entered-in-error Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance. ele-1: All FHIR elements must have a @value or children |
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SΣ | 1..1 | CodeableConcept | More granular claim type Binding: ClaimTypeCodes (extensible): The type or discipline-style of the claim. ele-1: All FHIR elements must have a @value or children |
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Σ | 1..1 | Coding | Code defined by a terminology system ele-1: All FHIR elements must have a @value or children |
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Σ | 1..1 | uri | Identity of the terminology system ele-1: All FHIR elements must have a @value or children |
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Σ | 1..1 | code | Symbol in syntax defined by the system ele-1: All FHIR elements must have a @value or children |
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S | 1..1 | CodeableConcept | More granular claim type Binding: ExampleClaimSubTypeCodes (example): A more granular claim typecode. ele-1: All FHIR elements must have a @value or children |
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Σ | 1..1 | Coding | Code defined by a terminology system ele-1: All FHIR elements must have a @value or children |
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Σ | 1..1 | uri | Identity of the terminology system ele-1: All FHIR elements must have a @value or children Required Pattern: https://www.ehealth.fgov.be/standards/fhir/mycarenet/CodeSystem/agreement-types |
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Σ | 1..1 | code | Symbol in syntax defined by the system ele-1: All FHIR elements must have a @value or children |
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SΣ | 1..1 | code | claim | preauthorization | predetermination Binding: Use (required): Claim, preauthorization, predetermination. ele-1: All FHIR elements must have a @value or children |
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SΣ | 1..1 | Reference(BePatient) | The recipient of the products and services ele-1: All FHIR elements must have a @value or children |
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SΣ | 1..1 | dateTime | Response creation date ele-1: All FHIR elements must have a @value or children |
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SΣ | 1..1 | Reference(BeOrganization) | Party responsible for reimbursement ele-1: All FHIR elements must have a @value or children |
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S | 1..1 | Reference(BeOrganization | BePractitioner | BePractitionerRole) | Party responsible for the claim ele-1: All FHIR elements must have a @value or children |
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ΣC | 1..1 | string | Literal reference, Relative, internal or absolute URL ele-1: All FHIR elements must have a @value or children |
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SΣ | 1..1 | code | queued | complete | error | partial Binding: ClaimProcessingCodes (required): The result of the claim processing. ele-1: All FHIR elements must have a @value or children |
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S | 1..1 | string | Preauthorization reference ele-1: All FHIR elements must have a @value or children |
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S | 0..1 | Period | Preauthorization reference effective period ele-1: All FHIR elements must have a @value or children |
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ΣC | 1..1 | dateTime | Starting time with inclusive boundary ele-1: All FHIR elements must have a @value or children |
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0..* | BackboneElement | Adjudication for claim line items ele-1: All FHIR elements must have a @value or children | |
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?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both |
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1..1 | positiveInt | Claim item instance identifier ele-1: All FHIR elements must have a @value or children | |
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S | 1..1 | BackboneElement | Adjudication details ele-1: All FHIR elements must have a @value or children |
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?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both |
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1..1 | CodeableConcept | Type of adjudication information Binding: AdjudicationValueCodes (example): The adjudication codes. ele-1: All FHIR elements must have a @value or children | |
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Σ | 1..1 | Coding | Code defined by a terminology system ele-1: All FHIR elements must have a @value or children |
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Σ | 1..1 | uri | Identity of the terminology system ele-1: All FHIR elements must have a @value or children Required Pattern: https://www.ehealth.fgov.be/standards/fhir/mycarenet/CodeSystem/decision-values |
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Σ | 1..1 | code | Symbol in syntax defined by the system ele-1: All FHIR elements must have a @value or children |
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S | 0..* | BackboneElement | Insurer added line items ele-1: All FHIR elements must have a @value or children |
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?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both |
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S | 1..1 | positiveInt | Item sequence number ele-1: All FHIR elements must have a @value or children |
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1..1 | CodeableConcept | Billing, service, product, or drug code Binding: ValueSet product or service (extensible) ele-1: All FHIR elements must have a @value or children | |
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Σ | 1..1 | Coding | Code defined by a terminology system ele-1: All FHIR elements must have a @value or children |
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Σ | 1..1 | uri | Identity of the terminology system ele-1: All FHIR elements must have a @value or children |
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Σ | 1..1 | code | Symbol in syntax defined by the system ele-1: All FHIR elements must have a @value or children |
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S | 1..* | See adjudication (ClaimResponse) | Added items adjudication ele-1: All FHIR elements must have a @value or children |
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Path | Conformance | ValueSet | URI |
ClaimResponse.status | required | FinancialResourceStatusCodeshttp://hl7.org/fhir/ValueSet/fm-status|4.0.1 from the FHIR Standard | |
ClaimResponse.type | extensible | ClaimTypeCodeshttp://hl7.org/fhir/ValueSet/claim-type from the FHIR Standard | |
ClaimResponse.subType | example | ExampleClaimSubTypeCodeshttp://hl7.org/fhir/ValueSet/claim-subtype from the FHIR Standard | |
ClaimResponse.use | required | Usehttp://hl7.org/fhir/ValueSet/claim-use|4.0.1 from the FHIR Standard | |
ClaimResponse.outcome | required | ClaimProcessingCodeshttp://hl7.org/fhir/ValueSet/remittance-outcome|4.0.1 from the FHIR Standard | |
ClaimResponse.item.adjudication.category | example | AdjudicationValueCodeshttp://hl7.org/fhir/ValueSet/adjudication from the FHIR Standard | |
ClaimResponse.addItem.productOrService | extensible | BeProductOrServiceNihdiEAgreementhttps://www.ehealth.fgov.be/standards/fhir/mycarenet/ValueSet/eagreementproductorservice from this IG |
Id | Grade | Path(s) | Details | Requirements |
be-rule-eagreementclaimresponse-1 | error | ClaimResponse | preAuthPeriod start and end SHALL be YYYY-MM-DD : (ClaimResponse.preAuthPeriod.exists() implies ClaimResponse.preAuthPeriod.start.toString().length()=10) and (ClaimResponse.preAuthPeriod.end.exists() implies ClaimResponse.preAuthPeriod.end.toString().length()=10) | |
be-rule-eagreementclaimresponse-2 | error | ClaimResponse | Created SHALL be YYYY-MM-DDThh:mm:ss+zz:zz : ClaimResponse.created.toString().length()=25 | |
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
Name | Flags | Card. | Type | Description & Constraints![]() |
---|---|---|---|---|
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C | 0..* | ClaimResponse | Response to a claim predetermination or preauthorization be-rule-eagreementclaimresponse-1: preAuthPeriod start and end SHALL be YYYY-MM-DD be-rule-eagreementclaimresponse-2: Created SHALL be YYYY-MM-DDThh:mm:ss+zz:zz |
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S | 1..1 | id | Logical id of this artifact |
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S | 1..1 | Meta | Metadata about the resource |
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1..1 | canonical(StructureDefinition) | Profiles this resource claims to conform to | |
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S | 1..1 | code | active | cancelled | draft | entered-in-error |
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S | 1..1 | CodeableConcept | More granular claim type |
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1..1 | Coding | Code defined by a terminology system | |
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1..1 | uri | Identity of the terminology system | |
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1..1 | code | Symbol in syntax defined by the system | |
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S | 1..1 | CodeableConcept | More granular claim type |
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1..1 | Coding | Code defined by a terminology system | |
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1..1 | uri | Identity of the terminology system Required Pattern: https://www.ehealth.fgov.be/standards/fhir/mycarenet/CodeSystem/agreement-types | |
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1..1 | code | Symbol in syntax defined by the system | |
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S | 1..1 | code | claim | preauthorization | predetermination |
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S | 1..1 | Reference(BePatient) | The recipient of the products and services |
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S | 1..1 | dateTime | Response creation date |
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S | 1..1 | Reference(BeOrganization) | Party responsible for reimbursement |
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S | 1..1 | Reference(BeOrganization | BePractitioner | BePractitionerRole) | Party responsible for the claim |
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1..1 | string | Literal reference, Relative, internal or absolute URL | |
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S | 1..1 | code | queued | complete | error | partial |
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S | 1..1 | string | Preauthorization reference |
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S | 0..1 | Period | Preauthorization reference effective period |
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1..1 | dateTime | Starting time with inclusive boundary | |
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S | 1..1 | BackboneElement | Adjudication details |
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1..1 | Coding | Code defined by a terminology system | |
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1..1 | uri | Identity of the terminology system Required Pattern: https://www.ehealth.fgov.be/standards/fhir/mycarenet/CodeSystem/decision-values | |
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1..1 | code | Symbol in syntax defined by the system | |
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1..1 | Coding | Code defined by a terminology system Binding: ValueSet adjudication reason (extensible) | |
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1..1 | uri | Identity of the terminology system | |
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1..1 | code | Symbol in syntax defined by the system | |
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S | 0..* | BackboneElement | Insurer added line items |
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S | 1..1 | positiveInt | Item sequence number |
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1..1 | CodeableConcept | Billing, service, product, or drug code Binding: ValueSet product or service (extensible) | |
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1..1 | Coding | Code defined by a terminology system | |
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1..1 | uri | Identity of the terminology system | |
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1..1 | code | Symbol in syntax defined by the system | |
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S | 1..* | Added items adjudication | |
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Path | Conformance | ValueSet | URI |
ClaimResponse.item.adjudication.reason.coding | extensible | BeEAgreementAdjudicationReasonhttps://www.ehealth.fgov.be/standards/fhir/mycarenet/ValueSet/eagreementadjudicationreason from this IG | |
ClaimResponse.addItem.productOrService | extensible | BeProductOrServiceNihdiEAgreementhttps://www.ehealth.fgov.be/standards/fhir/mycarenet/ValueSet/eagreementproductorservice from this IG |
Id | Grade | Path(s) | Details | Requirements |
be-rule-eagreementclaimresponse-1 | error | ClaimResponse | preAuthPeriod start and end SHALL be YYYY-MM-DD : (ClaimResponse.preAuthPeriod.exists() implies ClaimResponse.preAuthPeriod.start.toString().length()=10) and (ClaimResponse.preAuthPeriod.end.exists() implies ClaimResponse.preAuthPeriod.end.toString().length()=10) | |
be-rule-eagreementclaimresponse-2 | error | ClaimResponse | Created SHALL be YYYY-MM-DDThh:mm:ss+zz:zz : ClaimResponse.created.toString().length()=25 |
Name | Flags | Card. | Type | Description & Constraints![]() | ||||
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C | 0..* | ClaimResponse | Response to a claim predetermination or preauthorization be-rule-eagreementclaimresponse-1: preAuthPeriod start and end SHALL be YYYY-MM-DD be-rule-eagreementclaimresponse-2: Created SHALL be YYYY-MM-DDThh:mm:ss+zz:zz | ||||
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SΣ | 1..1 | id | Logical id of this artifact | ||||
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SΣ | 1..1 | Meta | Metadata about the resource | ||||
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0..1 | string | Unique id for inter-element referencing | |||||
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0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | |||||
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Σ | 0..1 | id | Version specific identifier | ||||
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Σ | 0..1 | instant | When the resource version last changed | ||||
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Σ | 0..1 | uri | Identifies where the resource comes from | ||||
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Σ | 1..1 | canonical(StructureDefinition) | Profiles this resource claims to conform to | ||||
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Σ | 0..* | Coding | Security Labels applied to this resource Binding: All Security Labels (extensible): Security Labels from the Healthcare Privacy and Security Classification System. | ||||
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Σ | 0..* | Coding | Tags applied to this resource Binding: CommonTags (example): Codes that represent various types of tags, commonly workflow-related; e.g. "Needs review by Dr. Jones". | ||||
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?!Σ | 0..1 | uri | A set of rules under which this content was created | ||||
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0..1 | code | Language of the resource content Binding: CommonLanguages (preferred): A human language.
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0..1 | Narrative | Text summary of the resource, for human interpretation | |||||
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0..* | Resource | Contained, inline Resources | |||||
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0..* | Extension | Additional content defined by implementations | |||||
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?! | 0..* | Extension | Extensions that cannot be ignored | ||||
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0..* | Identifier | Business Identifier for a claim response | |||||
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?!SΣ | 1..1 | code | active | cancelled | draft | entered-in-error Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance. | ||||
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SΣ | 1..1 | CodeableConcept | More granular claim type Binding: ClaimTypeCodes (extensible): The type or discipline-style of the claim. | ||||
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0..1 | string | Unique id for inter-element referencing | |||||
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0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | |||||
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Σ | 1..1 | Coding | Code defined by a terminology system | ||||
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0..1 | string | Unique id for inter-element referencing | |||||
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0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | |||||
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Σ | 1..1 | uri | Identity of the terminology system | ||||
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Σ | 0..1 | string | Version of the system - if relevant | ||||
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Σ | 1..1 | code | Symbol in syntax defined by the system | ||||
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Σ | 0..1 | string | Representation defined by the system | ||||
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Σ | 0..1 | boolean | If this coding was chosen directly by the user | ||||
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Σ | 0..1 | string | Plain text representation of the concept | ||||
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S | 1..1 | CodeableConcept | More granular claim type Binding: ExampleClaimSubTypeCodes (example): A more granular claim typecode. | ||||
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0..1 | string | Unique id for inter-element referencing | |||||
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0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | |||||
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Σ | 1..1 | Coding | Code defined by a terminology system | ||||
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0..1 | string | Unique id for inter-element referencing | |||||
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0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | |||||
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Σ | 1..1 | uri | Identity of the terminology system Required Pattern: https://www.ehealth.fgov.be/standards/fhir/mycarenet/CodeSystem/agreement-types | ||||
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Σ | 0..1 | string | Version of the system - if relevant | ||||
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Σ | 1..1 | code | Symbol in syntax defined by the system | ||||
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Σ | 0..1 | string | Representation defined by the system | ||||
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Σ | 0..1 | boolean | If this coding was chosen directly by the user | ||||
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Σ | 0..1 | string | Plain text representation of the concept | ||||
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SΣ | 1..1 | code | claim | preauthorization | predetermination Binding: Use (required): Claim, preauthorization, predetermination. | ||||
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SΣ | 1..1 | Reference(BePatient) | The recipient of the products and services | ||||
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SΣ | 1..1 | dateTime | Response creation date | ||||
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SΣ | 1..1 | Reference(BeOrganization) | Party responsible for reimbursement | ||||
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S | 1..1 | Reference(BeOrganization | BePractitioner | BePractitionerRole) | Party responsible for the claim | ||||
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0..1 | string | Unique id for inter-element referencing | |||||
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0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | |||||
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ΣC | 1..1 | string | Literal reference, Relative, internal or absolute URL | ||||
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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). | ||||
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Σ | 0..1 | Identifier | Logical reference, when literal reference is not known | ||||
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Σ | 0..1 | string | Text alternative for the resource | ||||
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Σ | 0..1 | Reference(Claim) | Id of resource triggering adjudication | ||||
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SΣ | 1..1 | code | queued | complete | error | partial Binding: ClaimProcessingCodes (required): The result of the claim processing. | ||||
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0..1 | string | Disposition Message | |||||
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S | 1..1 | string | Preauthorization reference | ||||
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S | 0..1 | Period | Preauthorization reference effective period | ||||
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0..1 | string | Unique id for inter-element referencing | |||||
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0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | |||||
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ΣC | 1..1 | dateTime | Starting time with inclusive boundary | ||||
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ΣC | 0..1 | dateTime | End time with inclusive boundary, if not ongoing | ||||
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0..1 | CodeableConcept | Party to be paid any benefits payable Binding: Claim Payee Type Codes (example): A code for the party to be reimbursed. | |||||
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0..* | BackboneElement | Adjudication for claim line items | |||||
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0..1 | string | Unique id for inter-element referencing | |||||
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0..* | Extension | Additional content defined by implementations | |||||
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?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
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1..1 | positiveInt | Claim item instance identifier | |||||
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0..* | positiveInt | Applicable note numbers | |||||
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S | 1..1 | BackboneElement | Adjudication details | ||||
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0..1 | string | Unique id for inter-element referencing | |||||
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0..* | Extension | Additional content defined by implementations | |||||
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?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
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1..1 | CodeableConcept | Type of adjudication information Binding: AdjudicationValueCodes (example): The adjudication codes. | |||||
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0..1 | string | Unique id for inter-element referencing | |||||
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0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | |||||
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Σ | 1..1 | Coding | Code defined by a terminology system | ||||
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0..1 | string | Unique id for inter-element referencing | |||||
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0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | |||||
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Σ | 1..1 | uri | Identity of the terminology system Required Pattern: https://www.ehealth.fgov.be/standards/fhir/mycarenet/CodeSystem/decision-values | ||||
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Σ | 0..1 | string | Version of the system - if relevant | ||||
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Σ | 1..1 | code | Symbol in syntax defined by the system | ||||
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Σ | 0..1 | string | Representation defined by the system | ||||
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Σ | 0..1 | boolean | If this coding was chosen directly by the user | ||||
![]() ![]() ![]() ![]() ![]() ![]() |
Σ | 0..1 | string | Plain text representation of the concept | ||||
![]() ![]() ![]() ![]() ![]() |
0..1 | CodeableConcept | Explanation of adjudication outcome Binding: AdjudicationReasonCodes (example): The adjudication reason codes. | |||||
![]() ![]() ![]() ![]() ![]() ![]() |
0..1 | string | Unique id for inter-element referencing | |||||
![]() ![]() ![]() ![]() ![]() ![]() |
0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | |||||
![]() ![]() ![]() ![]() ![]() ![]() |
Σ | 1..1 | Coding | Code defined by a terminology system Binding: ValueSet adjudication reason (extensible) | ||||
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0..1 | string | Unique id for inter-element referencing | |||||
![]() ![]() ![]() ![]() ![]() ![]() ![]() |
0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | |||||
![]() ![]() ![]() ![]() ![]() ![]() ![]() |
Σ | 1..1 | uri | Identity of the terminology system | ||||
![]() ![]() ![]() ![]() ![]() ![]() ![]() |
Σ | 0..1 | string | Version of the system - if relevant | ||||
![]() ![]() ![]() ![]() ![]() ![]() ![]() |
Σ | 1..1 | code | Symbol in syntax defined by the system | ||||
![]() ![]() ![]() ![]() ![]() ![]() ![]() |
Σ | 0..1 | string | Representation defined by the system | ||||
![]() ![]() ![]() ![]() ![]() ![]() ![]() |
Σ | 0..1 | boolean | If this coding was chosen directly by the user | ||||
![]() ![]() ![]() ![]() ![]() ![]() |
Σ | 0..1 | string | Plain text representation of the concept | ||||
![]() ![]() ![]() ![]() ![]() |
0..1 | Money | Monetary amount | |||||
![]() ![]() ![]() ![]() ![]() |
0..1 | decimal | Non-monetary value | |||||
![]() ![]() ![]() ![]() |
0..* | BackboneElement | Adjudication for claim details | |||||
![]() ![]() ![]() ![]() ![]() |
0..1 | string | Unique id for inter-element referencing | |||||
![]() ![]() ![]() ![]() ![]() |
0..* | Extension | Additional content defined by implementations | |||||
![]() ![]() ![]() ![]() ![]() |
?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
![]() ![]() ![]() ![]() ![]() |
1..1 | positiveInt | Claim detail instance identifier | |||||
![]() ![]() ![]() ![]() ![]() |
0..* | positiveInt | Applicable note numbers | |||||
![]() ![]() ![]() ![]() ![]() |
1..* | See adjudication (ClaimResponse) | Detail level adjudication details | |||||
![]() ![]() ![]() ![]() ![]() |
0..* | BackboneElement | Adjudication for claim sub-details | |||||
![]() ![]() ![]() ![]() ![]() ![]() |
0..1 | string | Unique id for inter-element referencing | |||||
![]() ![]() ![]() ![]() ![]() ![]() |
0..* | Extension | Additional content defined by implementations | |||||
![]() ![]() ![]() ![]() ![]() ![]() |
?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
![]() ![]() ![]() ![]() ![]() ![]() |
1..1 | positiveInt | Claim sub-detail instance identifier | |||||
![]() ![]() ![]() ![]() ![]() ![]() |
0..* | positiveInt | Applicable note numbers | |||||
![]() ![]() ![]() ![]() ![]() ![]() |
0..* | See adjudication (ClaimResponse) | Subdetail level adjudication details | |||||
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S | 0..* | BackboneElement | Insurer added line items | ||||
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0..1 | string | Unique id for inter-element referencing | |||||
![]() ![]() ![]() ![]() |
0..* | Extension | Additional content defined by implementations | |||||
![]() ![]() ![]() ![]() |
?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
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S | 1..1 | positiveInt | Item sequence number | ||||
![]() ![]() ![]() ![]() |
0..* | positiveInt | Detail sequence number | |||||
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0..* | positiveInt | Subdetail sequence number | |||||
![]() ![]() ![]() ![]() |
0..* | Reference(Practitioner | PractitionerRole | Organization) | Authorized providers | |||||
![]() ![]() ![]() ![]() |
1..1 | CodeableConcept | Billing, service, product, or drug code Binding: ValueSet product or service (extensible) | |||||
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0..1 | string | Unique id for inter-element referencing | |||||
![]() ![]() ![]() ![]() ![]() |
0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | |||||
![]() ![]() ![]() ![]() ![]() |
Σ | 1..1 | Coding | Code defined by a terminology system | ||||
![]() ![]() ![]() ![]() ![]() ![]() |
0..1 | string | Unique id for inter-element referencing | |||||
![]() ![]() ![]() ![]() ![]() ![]() |
0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | |||||
![]() ![]() ![]() ![]() ![]() ![]() |
Σ | 1..1 | uri | Identity of the terminology system | ||||
![]() ![]() ![]() ![]() ![]() ![]() |
Σ | 0..1 | string | Version of the system - if relevant | ||||
![]() ![]() ![]() ![]() ![]() ![]() |
Σ | 1..1 | code | Symbol in syntax defined by the system | ||||
![]() ![]() ![]() ![]() ![]() ![]() |
Σ | 0..1 | string | Representation defined by the system | ||||
![]() ![]() ![]() ![]() ![]() ![]() |
Σ | 0..1 | boolean | If this coding was chosen directly by the user | ||||
![]() ![]() ![]() ![]() ![]() |
Σ | 0..1 | string | Plain text representation of the concept | ||||
![]() ![]() ![]() ![]() |
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. | |||||
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0..* | CodeableConcept | Program the product or service is provided under Binding: ExampleProgramReasonCodes (example): Program specific reason codes. | |||||
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0..1 | Date or dates of service or product delivery | ||||||
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date | |||||||
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Period | |||||||
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0..1 | Place of service or where product was supplied Binding: ExampleServicePlaceCodes (example): Place of service: pharmacy, school, prison, etc. | ||||||
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CodeableConcept | |||||||
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Address | |||||||
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Reference(Location) | |||||||
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0..1 | SimpleQuantity | Count of products or services | |||||
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0..1 | Money | Fee, charge or cost per item | |||||
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0..1 | decimal | Price scaling factor | |||||
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0..1 | Money | Total item cost | |||||
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0..1 | CodeableConcept | Anatomical location Binding: OralSiteCodes (example): The code for the teeth, quadrant, sextant and arch. | |||||
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0..* | CodeableConcept | Anatomical sub-location Binding: SurfaceCodes (example): The code for the tooth surface and surface combinations. | |||||
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0..* | positiveInt | Applicable note numbers | |||||
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S | 1..* | See adjudication (ClaimResponse) | Added items adjudication | ||||
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0..* | BackboneElement | Insurer added line details | |||||
![]() ![]() ![]() ![]() ![]() |
0..1 | string | Unique id for inter-element referencing | |||||
![]() ![]() ![]() ![]() ![]() |
0..* | Extension | Additional content defined by implementations | |||||
![]() ![]() ![]() ![]() ![]() |
?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
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1..1 | CodeableConcept | Billing, service, product, or drug code Binding: USCLSCodes (example): Allowable service and product codes. | |||||
![]() ![]() ![]() ![]() ![]() |
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. | |||||
![]() ![]() ![]() ![]() ![]() |
0..1 | SimpleQuantity | Count of products or services | |||||
![]() ![]() ![]() ![]() ![]() |
0..1 | Money | Fee, charge or cost per item | |||||
![]() ![]() ![]() ![]() ![]() |
0..1 | decimal | Price scaling factor | |||||
![]() ![]() ![]() ![]() ![]() |
0..1 | Money | Total item cost | |||||
![]() ![]() ![]() ![]() ![]() |
0..* | positiveInt | Applicable note numbers | |||||
![]() ![]() ![]() ![]() ![]() |
1..* | See adjudication (ClaimResponse) | Added items detail adjudication | |||||
![]() ![]() ![]() ![]() ![]() |
0..* | BackboneElement | Insurer added line items | |||||
![]() ![]() ![]() ![]() ![]() ![]() |
0..1 | string | Unique id for inter-element referencing | |||||
![]() ![]() ![]() ![]() ![]() ![]() |
0..* | Extension | Additional content defined by implementations | |||||
![]() ![]() ![]() ![]() ![]() ![]() |
?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
![]() ![]() ![]() ![]() ![]() ![]() |
1..1 | CodeableConcept | Billing, service, product, or drug code Binding: USCLSCodes (example): Allowable service and product codes. | |||||
![]() ![]() ![]() ![]() ![]() ![]() |
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. | |||||
![]() ![]() ![]() ![]() ![]() ![]() |
0..1 | SimpleQuantity | Count of products or services | |||||
![]() ![]() ![]() ![]() ![]() ![]() |
0..1 | Money | Fee, charge or cost per item | |||||
![]() ![]() ![]() ![]() ![]() ![]() |
0..1 | decimal | Price scaling factor | |||||
![]() ![]() ![]() ![]() ![]() ![]() |
0..1 | Money | Total item cost | |||||
![]() ![]() ![]() ![]() ![]() ![]() |
0..* | positiveInt | Applicable note numbers | |||||
![]() ![]() ![]() ![]() ![]() ![]() |
1..* | See adjudication (ClaimResponse) | Added items detail adjudication | |||||
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0..* | See adjudication (ClaimResponse) | Header-level adjudication | |||||
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Σ | 0..* | BackboneElement | Adjudication totals | ||||
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0..1 | string | Unique id for inter-element referencing | |||||
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0..* | Extension | Additional content defined by implementations | |||||
![]() ![]() ![]() ![]() |
?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
![]() ![]() ![]() ![]() |
Σ | 1..1 | CodeableConcept | Type of adjudication information Binding: AdjudicationValueCodes (example): The adjudication codes. | ||||
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Σ | 1..1 | Money | Financial total for the category | ||||
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0..1 | BackboneElement | Payment Details | |||||
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0..1 | string | Unique id for inter-element referencing | |||||
![]() ![]() ![]() ![]() |
0..* | Extension | Additional content defined by implementations | |||||
![]() ![]() ![]() ![]() |
?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
![]() ![]() ![]() ![]() |
1..1 | CodeableConcept | Partial or complete payment Binding: ExamplePaymentTypeCodes (example): The type (partial, complete) of the payment. | |||||
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0..1 | Money | Payment adjustment for non-claim issues | |||||
![]() ![]() ![]() ![]() |
0..1 | CodeableConcept | Explanation for the adjustment Binding: PaymentAdjustmentReasonCodes (example): Payment Adjustment reason codes. | |||||
![]() ![]() ![]() ![]() |
0..1 | date | Expected date of payment | |||||
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1..1 | Money | Payable amount after adjustment | |||||
![]() ![]() ![]() ![]() |
0..1 | Identifier | Business identifier for the payment | |||||
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0..1 | CodeableConcept | Funds reserved status Binding: Funds Reservation Codes (example): For whom funds are to be reserved: (Patient, Provider, None). | |||||
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0..1 | CodeableConcept | Printed form identifier Binding: Form Codes (example): The forms codes. | |||||
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0..1 | Attachment | Printed reference or actual form | |||||
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0..* | BackboneElement | Note concerning adjudication | |||||
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0..1 | string | Unique id for inter-element referencing | |||||
![]() ![]() ![]() ![]() |
0..* | Extension | Additional content defined by implementations | |||||
![]() ![]() ![]() ![]() |
?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
![]() ![]() ![]() ![]() |
0..1 | positiveInt | Note instance identifier | |||||
![]() ![]() ![]() ![]() |
0..1 | code | display | print | printoper Binding: NoteType (required): The presentation types of notes. | |||||
![]() ![]() ![]() ![]() |
1..1 | string | Note explanatory text | |||||
![]() ![]() ![]() ![]() |
0..1 | CodeableConcept | Language of the text Binding: CommonLanguages (preferred): A human language.
| |||||
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0..* | Reference(CommunicationRequest) | Request for additional information | |||||
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0..* | BackboneElement | Patient insurance information | |||||
![]() ![]() ![]() ![]() |
0..1 | string | Unique id for inter-element referencing | |||||
![]() ![]() ![]() ![]() |
0..* | Extension | Additional content defined by implementations | |||||
![]() ![]() ![]() ![]() |
?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
![]() ![]() ![]() ![]() |
1..1 | positiveInt | Insurance instance identifier | |||||
![]() ![]() ![]() ![]() |
1..1 | boolean | Coverage to be used for adjudication | |||||
![]() ![]() ![]() ![]() |
1..1 | Reference(Coverage) | Insurance information | |||||
![]() ![]() ![]() ![]() |
0..1 | string | Additional provider contract number | |||||
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0..1 | Reference(ClaimResponse) | Adjudication results | |||||
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0..* | BackboneElement | Processing errors | |||||
![]() ![]() ![]() ![]() |
0..1 | string | Unique id for inter-element referencing | |||||
![]() ![]() ![]() ![]() |
0..* | Extension | Additional content defined by implementations | |||||
![]() ![]() ![]() ![]() |
?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
![]() ![]() ![]() ![]() |
0..1 | positiveInt | Item sequence number | |||||
![]() ![]() ![]() ![]() |
0..1 | positiveInt | Detail sequence number | |||||
![]() ![]() ![]() ![]() |
0..1 | positiveInt | Subdetail sequence number | |||||
![]() ![]() ![]() ![]() |
1..1 | CodeableConcept | Error code detailing processing issues Binding: Adjudication Error Codes (example): The adjudication error codes. | |||||
![]() |
Path | Conformance | ValueSet | URI | |||
ClaimResponse.meta.security | extensible | All Security Labelshttp://hl7.org/fhir/ValueSet/security-labels from the FHIR Standard | ||||
ClaimResponse.meta.tag | example | CommonTagshttp://hl7.org/fhir/ValueSet/common-tags from the FHIR Standard | ||||
ClaimResponse.language | preferred | CommonLanguageshttp://hl7.org/fhir/ValueSet/languages from the FHIR Standard
| ||||
ClaimResponse.status | required | FinancialResourceStatusCodeshttp://hl7.org/fhir/ValueSet/fm-status|4.0.1 from the FHIR Standard | ||||
ClaimResponse.type | extensible | ClaimTypeCodeshttp://hl7.org/fhir/ValueSet/claim-type from the FHIR Standard | ||||
ClaimResponse.subType | example | ExampleClaimSubTypeCodeshttp://hl7.org/fhir/ValueSet/claim-subtype from the FHIR Standard | ||||
ClaimResponse.use | required | Usehttp://hl7.org/fhir/ValueSet/claim-use|4.0.1 from the FHIR Standard | ||||
ClaimResponse.requestor.type | extensible | ResourceTypehttp://hl7.org/fhir/ValueSet/resource-types from the FHIR Standard | ||||
ClaimResponse.outcome | required | ClaimProcessingCodeshttp://hl7.org/fhir/ValueSet/remittance-outcome|4.0.1 from the FHIR Standard | ||||
ClaimResponse.payeeType | example | Claim Payee Type Codeshttp://hl7.org/fhir/ValueSet/payeetype from the FHIR Standard | ||||
ClaimResponse.item.adjudication.category | example | AdjudicationValueCodeshttp://hl7.org/fhir/ValueSet/adjudication from the FHIR Standard | ||||
ClaimResponse.item.adjudication.reason | example | AdjudicationReasonCodeshttp://hl7.org/fhir/ValueSet/adjudication-reason from the FHIR Standard | ||||
ClaimResponse.item.adjudication.reason.coding | extensible | BeEAgreementAdjudicationReasonhttps://www.ehealth.fgov.be/standards/fhir/mycarenet/ValueSet/eagreementadjudicationreason from this IG | ||||
ClaimResponse.addItem.productOrService | extensible | BeProductOrServiceNihdiEAgreementhttps://www.ehealth.fgov.be/standards/fhir/mycarenet/ValueSet/eagreementproductorservice from this IG | ||||
ClaimResponse.addItem.modifier | example | ModifierTypeCodeshttp://hl7.org/fhir/ValueSet/claim-modifiers from the FHIR Standard | ||||
ClaimResponse.addItem.programCode | example | ExampleProgramReasonCodeshttp://hl7.org/fhir/ValueSet/ex-program-code from the FHIR Standard | ||||
ClaimResponse.addItem.location[x] | example | ExampleServicePlaceCodeshttp://hl7.org/fhir/ValueSet/service-place from the FHIR Standard | ||||
ClaimResponse.addItem.bodySite | example | OralSiteCodeshttp://hl7.org/fhir/ValueSet/tooth from the FHIR Standard | ||||
ClaimResponse.addItem.subSite | example | SurfaceCodeshttp://hl7.org/fhir/ValueSet/surface from the FHIR Standard | ||||
ClaimResponse.addItem.detail.productOrService | example | USCLSCodeshttp://hl7.org/fhir/ValueSet/service-uscls from the FHIR Standard | ||||
ClaimResponse.addItem.detail.modifier | example | ModifierTypeCodeshttp://hl7.org/fhir/ValueSet/claim-modifiers from the FHIR Standard | ||||
ClaimResponse.addItem.detail.subDetail.productOrService | example | USCLSCodeshttp://hl7.org/fhir/ValueSet/service-uscls from the FHIR Standard | ||||
ClaimResponse.addItem.detail.subDetail.modifier | example | ModifierTypeCodeshttp://hl7.org/fhir/ValueSet/claim-modifiers from the FHIR Standard | ||||
ClaimResponse.total.category | example | AdjudicationValueCodeshttp://hl7.org/fhir/ValueSet/adjudication from the FHIR Standard | ||||
ClaimResponse.payment.type | example | ExamplePaymentTypeCodeshttp://hl7.org/fhir/ValueSet/ex-paymenttype from the FHIR Standard | ||||
ClaimResponse.payment.adjustmentReason | example | PaymentAdjustmentReasonCodeshttp://hl7.org/fhir/ValueSet/payment-adjustment-reason from the FHIR Standard | ||||
ClaimResponse.fundsReserve | example | Funds Reservation Codeshttp://hl7.org/fhir/ValueSet/fundsreserve from the FHIR Standard | ||||
ClaimResponse.formCode | example | Form Codeshttp://hl7.org/fhir/ValueSet/forms from the FHIR Standard | ||||
ClaimResponse.processNote.type | required | NoteTypehttp://hl7.org/fhir/ValueSet/note-type|4.0.1 from the FHIR Standard | ||||
ClaimResponse.processNote.language | preferred | CommonLanguageshttp://hl7.org/fhir/ValueSet/languages from the FHIR Standard
| ||||
ClaimResponse.error.code | example | Adjudication Error Codeshttp://hl7.org/fhir/ValueSet/adjudication-error from the FHIR Standard |
Id | Grade | Path(s) | Details | Requirements |
be-rule-eagreementclaimresponse-1 | error | ClaimResponse | preAuthPeriod start and end SHALL be YYYY-MM-DD : (ClaimResponse.preAuthPeriod.exists() implies ClaimResponse.preAuthPeriod.start.toString().length()=10) and (ClaimResponse.preAuthPeriod.end.exists() implies ClaimResponse.preAuthPeriod.end.toString().length()=10) | |
be-rule-eagreementclaimresponse-2 | error | ClaimResponse | Created SHALL be YYYY-MM-DDThh:mm:ss+zz:zz : ClaimResponse.created.toString().length()=25 | |
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: 13 elements(11 nested mandatory elements)
Must-Support: 17 elements
Structures
This structure refers to these other structures:
Key Elements View
Name | Flags | Card. | Type | Description & Constraints![]() |
---|---|---|---|---|
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C | 0..* | ClaimResponse | Response to a claim predetermination or preauthorization dom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources dom-3: 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 dom-4: If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated dom-5: If a resource is contained in another resource, it SHALL NOT have a security label dom-6: A resource should have narrative for robust management be-rule-eagreementclaimresponse-1: preAuthPeriod start and end SHALL be YYYY-MM-DD be-rule-eagreementclaimresponse-2: Created SHALL be YYYY-MM-DDThh:mm:ss+zz:zz |
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SΣ | 1..1 | id | Logical id of this artifact |
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SΣ | 1..1 | Meta | Metadata about the resource ele-1: All FHIR elements must have a @value or children |
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Σ | 1..1 | canonical(StructureDefinition) | Profiles this resource claims to conform to ele-1: All FHIR elements must have a @value or children |
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?!Σ | 0..1 | uri | A set of rules under which this content was created ele-1: All FHIR elements must have a @value or children |
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?! | 0..* | Extension | Extensions that cannot be ignored ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both |
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?!SΣ | 1..1 | code | active | cancelled | draft | entered-in-error Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance. ele-1: All FHIR elements must have a @value or children |
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SΣ | 1..1 | CodeableConcept | More granular claim type Binding: ClaimTypeCodes (extensible): The type or discipline-style of the claim. ele-1: All FHIR elements must have a @value or children |
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Σ | 1..1 | Coding | Code defined by a terminology system ele-1: All FHIR elements must have a @value or children |
![]() ![]() ![]() ![]() ![]() |
Σ | 1..1 | uri | Identity of the terminology system ele-1: All FHIR elements must have a @value or children |
![]() ![]() ![]() ![]() ![]() |
Σ | 1..1 | code | Symbol in syntax defined by the system ele-1: All FHIR elements must have a @value or children |
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S | 1..1 | CodeableConcept | More granular claim type Binding: ExampleClaimSubTypeCodes (example): A more granular claim typecode. ele-1: All FHIR elements must have a @value or children |
![]() ![]() ![]() ![]() |
Σ | 1..1 | Coding | Code defined by a terminology system ele-1: All FHIR elements must have a @value or children |
![]() ![]() ![]() ![]() ![]() |
Σ | 1..1 | uri | Identity of the terminology system ele-1: All FHIR elements must have a @value or children Required Pattern: https://www.ehealth.fgov.be/standards/fhir/mycarenet/CodeSystem/agreement-types |
![]() ![]() ![]() ![]() ![]() |
Σ | 1..1 | code | Symbol in syntax defined by the system ele-1: All FHIR elements must have a @value or children |
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SΣ | 1..1 | code | claim | preauthorization | predetermination Binding: Use (required): Claim, preauthorization, predetermination. ele-1: All FHIR elements must have a @value or children |
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SΣ | 1..1 | Reference(BePatient) | The recipient of the products and services ele-1: All FHIR elements must have a @value or children |
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SΣ | 1..1 | dateTime | Response creation date ele-1: All FHIR elements must have a @value or children |
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SΣ | 1..1 | Reference(BeOrganization) | Party responsible for reimbursement ele-1: All FHIR elements must have a @value or children |
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S | 1..1 | Reference(BeOrganization | BePractitioner | BePractitionerRole) | Party responsible for the claim ele-1: All FHIR elements must have a @value or children |
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ΣC | 1..1 | string | Literal reference, Relative, internal or absolute URL ele-1: All FHIR elements must have a @value or children |
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SΣ | 1..1 | code | queued | complete | error | partial Binding: ClaimProcessingCodes (required): The result of the claim processing. ele-1: All FHIR elements must have a @value or children |
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S | 1..1 | string | Preauthorization reference ele-1: All FHIR elements must have a @value or children |
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S | 0..1 | Period | Preauthorization reference effective period ele-1: All FHIR elements must have a @value or children |
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ΣC | 1..1 | dateTime | Starting time with inclusive boundary ele-1: All FHIR elements must have a @value or children |
![]() ![]() ![]() |
0..* | BackboneElement | Adjudication for claim line items ele-1: All FHIR elements must have a @value or children | |
![]() ![]() ![]() ![]() |
?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both |
![]() ![]() ![]() ![]() |
1..1 | positiveInt | Claim item instance identifier ele-1: All FHIR elements must have a @value or children | |
![]() ![]() ![]() ![]() |
S | 1..1 | BackboneElement | Adjudication details ele-1: All FHIR elements must have a @value or children |
![]() ![]() ![]() ![]() ![]() |
?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both |
![]() ![]() ![]() ![]() ![]() |
1..1 | CodeableConcept | Type of adjudication information Binding: AdjudicationValueCodes (example): The adjudication codes. ele-1: All FHIR elements must have a @value or children | |
![]() ![]() ![]() ![]() ![]() ![]() |
Σ | 1..1 | Coding | Code defined by a terminology system ele-1: All FHIR elements must have a @value or children |
![]() ![]() ![]() ![]() ![]() ![]() ![]() |
Σ | 1..1 | uri | Identity of the terminology system ele-1: All FHIR elements must have a @value or children Required Pattern: https://www.ehealth.fgov.be/standards/fhir/mycarenet/CodeSystem/decision-values |
![]() ![]() ![]() ![]() ![]() ![]() ![]() |
Σ | 1..1 | code | Symbol in syntax defined by the system ele-1: All FHIR elements must have a @value or children |
![]() ![]() ![]() |
S | 0..* | BackboneElement | Insurer added line items ele-1: All FHIR elements must have a @value or children |
![]() ![]() ![]() ![]() |
?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both |
![]() ![]() ![]() ![]() |
S | 1..1 | positiveInt | Item sequence number ele-1: All FHIR elements must have a @value or children |
![]() ![]() ![]() ![]() |
1..1 | CodeableConcept | Billing, service, product, or drug code Binding: ValueSet product or service (extensible) ele-1: All FHIR elements must have a @value or children | |
![]() ![]() ![]() ![]() ![]() |
Σ | 1..1 | Coding | Code defined by a terminology system ele-1: All FHIR elements must have a @value or children |
![]() ![]() ![]() ![]() ![]() ![]() |
Σ | 1..1 | uri | Identity of the terminology system ele-1: All FHIR elements must have a @value or children |
![]() ![]() ![]() ![]() ![]() ![]() |
Σ | 1..1 | code | Symbol in syntax defined by the system ele-1: All FHIR elements must have a @value or children |
![]() ![]() ![]() ![]() |
S | 1..* | See adjudication (ClaimResponse) | Added items adjudication ele-1: All FHIR elements must have a @value or children |
![]() |
Path | Conformance | ValueSet | URI |
ClaimResponse.status | required | FinancialResourceStatusCodeshttp://hl7.org/fhir/ValueSet/fm-status|4.0.1 from the FHIR Standard | |
ClaimResponse.type | extensible | ClaimTypeCodeshttp://hl7.org/fhir/ValueSet/claim-type from the FHIR Standard | |
ClaimResponse.subType | example | ExampleClaimSubTypeCodeshttp://hl7.org/fhir/ValueSet/claim-subtype from the FHIR Standard | |
ClaimResponse.use | required | Usehttp://hl7.org/fhir/ValueSet/claim-use|4.0.1 from the FHIR Standard | |
ClaimResponse.outcome | required | ClaimProcessingCodeshttp://hl7.org/fhir/ValueSet/remittance-outcome|4.0.1 from the FHIR Standard | |
ClaimResponse.item.adjudication.category | example | AdjudicationValueCodeshttp://hl7.org/fhir/ValueSet/adjudication from the FHIR Standard | |
ClaimResponse.addItem.productOrService | extensible | BeProductOrServiceNihdiEAgreementhttps://www.ehealth.fgov.be/standards/fhir/mycarenet/ValueSet/eagreementproductorservice from this IG |
Id | Grade | Path(s) | Details | Requirements |
be-rule-eagreementclaimresponse-1 | error | ClaimResponse | preAuthPeriod start and end SHALL be YYYY-MM-DD : (ClaimResponse.preAuthPeriod.exists() implies ClaimResponse.preAuthPeriod.start.toString().length()=10) and (ClaimResponse.preAuthPeriod.end.exists() implies ClaimResponse.preAuthPeriod.end.toString().length()=10) | |
be-rule-eagreementclaimresponse-2 | error | ClaimResponse | Created SHALL be YYYY-MM-DDThh:mm:ss+zz:zz : ClaimResponse.created.toString().length()=25 | |
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() |
Differential View
This structure is derived from ClaimResponse
Name | Flags | Card. | Type | Description & Constraints![]() |
---|---|---|---|---|
![]() ![]() |
C | 0..* | ClaimResponse | Response to a claim predetermination or preauthorization be-rule-eagreementclaimresponse-1: preAuthPeriod start and end SHALL be YYYY-MM-DD be-rule-eagreementclaimresponse-2: Created SHALL be YYYY-MM-DDThh:mm:ss+zz:zz |
![]() ![]() ![]() |
S | 1..1 | id | Logical id of this artifact |
![]() ![]() ![]() |
S | 1..1 | Meta | Metadata about the resource |
![]() ![]() ![]() ![]() |
1..1 | canonical(StructureDefinition) | Profiles this resource claims to conform to | |
![]() ![]() ![]() |
S | 1..1 | code | active | cancelled | draft | entered-in-error |
![]() ![]() ![]() |
S | 1..1 | CodeableConcept | More granular claim type |
![]() ![]() ![]() ![]() |
1..1 | Coding | Code defined by a terminology system | |
![]() ![]() ![]() ![]() ![]() |
1..1 | uri | Identity of the terminology system | |
![]() ![]() ![]() ![]() ![]() |
1..1 | code | Symbol in syntax defined by the system | |
![]() ![]() ![]() |
S | 1..1 | CodeableConcept | More granular claim type |
![]() ![]() ![]() ![]() |
1..1 | Coding | Code defined by a terminology system | |
![]() ![]() ![]() ![]() ![]() |
1..1 | uri | Identity of the terminology system Required Pattern: https://www.ehealth.fgov.be/standards/fhir/mycarenet/CodeSystem/agreement-types | |
![]() ![]() ![]() ![]() ![]() |
1..1 | code | Symbol in syntax defined by the system | |
![]() ![]() ![]() |
S | 1..1 | code | claim | preauthorization | predetermination |
![]() ![]() ![]() |
S | 1..1 | Reference(BePatient) | The recipient of the products and services |
![]() ![]() ![]() |
S | 1..1 | dateTime | Response creation date |
![]() ![]() ![]() |
S | 1..1 | Reference(BeOrganization) | Party responsible for reimbursement |
![]() ![]() ![]() |
S | 1..1 | Reference(BeOrganization | BePractitioner | BePractitionerRole) | Party responsible for the claim |
![]() ![]() ![]() ![]() |
1..1 | string | Literal reference, Relative, internal or absolute URL | |
![]() ![]() ![]() |
S | 1..1 | code | queued | complete | error | partial |
![]() ![]() ![]() |
S | 1..1 | string | Preauthorization reference |
![]() ![]() ![]() |
S | 0..1 | Period | Preauthorization reference effective period |
![]() ![]() ![]() ![]() |
1..1 | dateTime | Starting time with inclusive boundary | |
![]() ![]() ![]() |
||||
![]() ![]() ![]() ![]() |
S | 1..1 | BackboneElement | Adjudication details |
![]() ![]() ![]() ![]() ![]() |
||||
![]() ![]() ![]() ![]() ![]() ![]() |
1..1 | Coding | Code defined by a terminology system | |
![]() ![]() ![]() ![]() ![]() ![]() ![]() |
1..1 | uri | Identity of the terminology system Required Pattern: https://www.ehealth.fgov.be/standards/fhir/mycarenet/CodeSystem/decision-values | |
![]() ![]() ![]() ![]() ![]() ![]() ![]() |
1..1 | code | Symbol in syntax defined by the system | |
![]() ![]() ![]() ![]() ![]() |
||||
![]() ![]() ![]() ![]() ![]() ![]() |
1..1 | Coding | Code defined by a terminology system Binding: ValueSet adjudication reason (extensible) | |
![]() ![]() ![]() ![]() ![]() ![]() ![]() |
1..1 | uri | Identity of the terminology system | |
![]() ![]() ![]() ![]() ![]() ![]() ![]() |
1..1 | code | Symbol in syntax defined by the system | |
![]() ![]() ![]() |
S | 0..* | BackboneElement | Insurer added line items |
![]() ![]() ![]() ![]() |
S | 1..1 | positiveInt | Item sequence number |
![]() ![]() ![]() ![]() |
1..1 | CodeableConcept | Billing, service, product, or drug code Binding: ValueSet product or service (extensible) | |
![]() ![]() ![]() ![]() ![]() |
1..1 | Coding | Code defined by a terminology system | |
![]() ![]() ![]() ![]() ![]() ![]() |
1..1 | uri | Identity of the terminology system | |
![]() ![]() ![]() ![]() ![]() ![]() |
1..1 | code | Symbol in syntax defined by the system | |
![]() ![]() ![]() ![]() |
S | 1..* | Added items adjudication | |
![]() |
Path | Conformance | ValueSet | URI |
ClaimResponse.item.adjudication.reason.coding | extensible | BeEAgreementAdjudicationReasonhttps://www.ehealth.fgov.be/standards/fhir/mycarenet/ValueSet/eagreementadjudicationreason from this IG | |
ClaimResponse.addItem.productOrService | extensible | BeProductOrServiceNihdiEAgreementhttps://www.ehealth.fgov.be/standards/fhir/mycarenet/ValueSet/eagreementproductorservice from this IG |
Id | Grade | Path(s) | Details | Requirements |
be-rule-eagreementclaimresponse-1 | error | ClaimResponse | preAuthPeriod start and end SHALL be YYYY-MM-DD : (ClaimResponse.preAuthPeriod.exists() implies ClaimResponse.preAuthPeriod.start.toString().length()=10) and (ClaimResponse.preAuthPeriod.end.exists() implies ClaimResponse.preAuthPeriod.end.toString().length()=10) | |
be-rule-eagreementclaimresponse-2 | error | ClaimResponse | Created SHALL be YYYY-MM-DDThh:mm:ss+zz:zz : ClaimResponse.created.toString().length()=25 |
Snapshot View
Name | Flags | Card. | Type | Description & Constraints![]() | ||||
---|---|---|---|---|---|---|---|---|
![]() ![]() |
C | 0..* | ClaimResponse | Response to a claim predetermination or preauthorization be-rule-eagreementclaimresponse-1: preAuthPeriod start and end SHALL be YYYY-MM-DD be-rule-eagreementclaimresponse-2: Created SHALL be YYYY-MM-DDThh:mm:ss+zz:zz | ||||
![]() ![]() ![]() |
SΣ | 1..1 | id | Logical id of this artifact | ||||
![]() ![]() ![]() |
SΣ | 1..1 | Meta | Metadata about the resource | ||||
![]() ![]() ![]() ![]() |
0..1 | string | Unique id for inter-element referencing | |||||
![]() ![]() ![]() ![]() |
0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | |||||
![]() ![]() ![]() ![]() |
Σ | 0..1 | id | Version specific identifier | ||||
![]() ![]() ![]() ![]() |
Σ | 0..1 | instant | When the resource version last changed | ||||
![]() ![]() ![]() ![]() |
Σ | 0..1 | uri | Identifies where the resource comes from | ||||
![]() ![]() ![]() ![]() |
Σ | 1..1 | canonical(StructureDefinition) | Profiles this resource claims to conform to | ||||
![]() ![]() ![]() ![]() |
Σ | 0..* | Coding | Security Labels applied to this resource Binding: All Security Labels (extensible): Security Labels from the Healthcare Privacy and Security Classification System. | ||||
![]() ![]() ![]() ![]() |
Σ | 0..* | Coding | Tags applied to this resource Binding: CommonTags (example): Codes that represent various types of tags, commonly workflow-related; e.g. "Needs review by Dr. Jones". | ||||
![]() ![]() ![]() |
?!Σ | 0..1 | uri | A set of rules under which this content was created | ||||
![]() ![]() ![]() |
0..1 | code | Language of the resource content Binding: CommonLanguages (preferred): A human language.
| |||||
![]() ![]() ![]() |
0..1 | Narrative | Text summary of the resource, for human interpretation | |||||
![]() ![]() ![]() |
0..* | Resource | Contained, inline Resources | |||||
![]() ![]() ![]() |
0..* | Extension | Additional content defined by implementations | |||||
![]() ![]() ![]() |
?! | 0..* | Extension | Extensions that cannot be ignored | ||||
![]() ![]() ![]() |
0..* | Identifier | Business Identifier for a claim response | |||||
![]() ![]() ![]() |
?!SΣ | 1..1 | code | active | cancelled | draft | entered-in-error Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance. | ||||
![]() ![]() ![]() |
SΣ | 1..1 | CodeableConcept | More granular claim type Binding: ClaimTypeCodes (extensible): The type or discipline-style of the claim. | ||||
![]() ![]() ![]() ![]() |
0..1 | string | Unique id for inter-element referencing | |||||
![]() ![]() ![]() ![]() |
0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | |||||
![]() ![]() ![]() ![]() |
Σ | 1..1 | Coding | Code defined by a terminology system | ||||
![]() ![]() ![]() ![]() ![]() |
0..1 | string | Unique id for inter-element referencing | |||||
![]() ![]() ![]() ![]() ![]() |
0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | |||||
![]() ![]() ![]() ![]() ![]() |
Σ | 1..1 | uri | Identity of the terminology system | ||||
![]() ![]() ![]() ![]() ![]() |
Σ | 0..1 | string | Version of the system - if relevant | ||||
![]() ![]() ![]() ![]() ![]() |
Σ | 1..1 | code | Symbol in syntax defined by the system | ||||
![]() ![]() ![]() ![]() ![]() |
Σ | 0..1 | string | Representation defined by the system | ||||
![]() ![]() ![]() ![]() ![]() |
Σ | 0..1 | boolean | If this coding was chosen directly by the user | ||||
![]() ![]() ![]() ![]() |
Σ | 0..1 | string | Plain text representation of the concept | ||||
![]() ![]() ![]() |
S | 1..1 | CodeableConcept | More granular claim type Binding: ExampleClaimSubTypeCodes (example): A more granular claim typecode. | ||||
![]() ![]() ![]() ![]() |
0..1 | string | Unique id for inter-element referencing | |||||
![]() ![]() ![]() ![]() |
0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | |||||
![]() ![]() ![]() ![]() |
Σ | 1..1 | Coding | Code defined by a terminology system | ||||
![]() ![]() ![]() ![]() ![]() |
0..1 | string | Unique id for inter-element referencing | |||||
![]() ![]() ![]() ![]() ![]() |
0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | |||||
![]() ![]() ![]() ![]() ![]() |
Σ | 1..1 | uri | Identity of the terminology system Required Pattern: https://www.ehealth.fgov.be/standards/fhir/mycarenet/CodeSystem/agreement-types | ||||
![]() ![]() ![]() ![]() ![]() |
Σ | 0..1 | string | Version of the system - if relevant | ||||
![]() ![]() ![]() ![]() ![]() |
Σ | 1..1 | code | Symbol in syntax defined by the system | ||||
![]() ![]() ![]() ![]() ![]() |
Σ | 0..1 | string | Representation defined by the system | ||||
![]() ![]() ![]() ![]() ![]() |
Σ | 0..1 | boolean | If this coding was chosen directly by the user | ||||
![]() ![]() ![]() ![]() |
Σ | 0..1 | string | Plain text representation of the concept | ||||
![]() ![]() ![]() |
SΣ | 1..1 | code | claim | preauthorization | predetermination Binding: Use (required): Claim, preauthorization, predetermination. | ||||
![]() ![]() ![]() |
SΣ | 1..1 | Reference(BePatient) | The recipient of the products and services | ||||
![]() ![]() ![]() |
SΣ | 1..1 | dateTime | Response creation date | ||||
![]() ![]() ![]() |
SΣ | 1..1 | Reference(BeOrganization) | Party responsible for reimbursement | ||||
![]() ![]() ![]() |
S | 1..1 | Reference(BeOrganization | BePractitioner | BePractitionerRole) | Party responsible for the claim | ||||
![]() ![]() ![]() ![]() |
0..1 | string | Unique id for inter-element referencing | |||||
![]() ![]() ![]() ![]() |
0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | |||||
![]() ![]() ![]() ![]() |
ΣC | 1..1 | string | Literal reference, Relative, internal or absolute URL | ||||
![]() ![]() ![]() ![]() |
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). | ||||
![]() ![]() ![]() ![]() |
Σ | 0..1 | Identifier | Logical reference, when literal reference is not known | ||||
![]() ![]() ![]() ![]() |
Σ | 0..1 | string | Text alternative for the resource | ||||
![]() ![]() ![]() |
Σ | 0..1 | Reference(Claim) | Id of resource triggering adjudication | ||||
![]() ![]() ![]() |
SΣ | 1..1 | code | queued | complete | error | partial Binding: ClaimProcessingCodes (required): The result of the claim processing. | ||||
![]() ![]() ![]() |
0..1 | string | Disposition Message | |||||
![]() ![]() ![]() |
S | 1..1 | string | Preauthorization reference | ||||
![]() ![]() ![]() |
S | 0..1 | Period | Preauthorization reference effective period | ||||
![]() ![]() ![]() ![]() |
0..1 | string | Unique id for inter-element referencing | |||||
![]() ![]() ![]() ![]() |
0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | |||||
![]() ![]() ![]() ![]() |
ΣC | 1..1 | dateTime | Starting time with inclusive boundary | ||||
![]() ![]() ![]() ![]() |
ΣC | 0..1 | dateTime | End time with inclusive boundary, if not ongoing | ||||
![]() ![]() ![]() |
0..1 | CodeableConcept | Party to be paid any benefits payable Binding: Claim Payee Type Codes (example): A code for the party to be reimbursed. | |||||
![]() ![]() ![]() |
0..* | BackboneElement | Adjudication for claim line items | |||||
![]() ![]() ![]() ![]() |
0..1 | string | Unique id for inter-element referencing | |||||
![]() ![]() ![]() ![]() |
0..* | Extension | Additional content defined by implementations | |||||
![]() ![]() ![]() ![]() |
?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
![]() ![]() ![]() ![]() |
1..1 | positiveInt | Claim item instance identifier | |||||
![]() ![]() ![]() ![]() |
0..* | positiveInt | Applicable note numbers | |||||
![]() ![]() ![]() ![]() |
S | 1..1 | BackboneElement | Adjudication details | ||||
![]() ![]() ![]() ![]() ![]() |
0..1 | string | Unique id for inter-element referencing | |||||
![]() ![]() ![]() ![]() ![]() |
0..* | Extension | Additional content defined by implementations | |||||
![]() ![]() ![]() ![]() ![]() |
?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
![]() ![]() ![]() ![]() ![]() |
1..1 | CodeableConcept | Type of adjudication information Binding: AdjudicationValueCodes (example): The adjudication codes. | |||||
![]() ![]() ![]() ![]() ![]() ![]() |
0..1 | string | Unique id for inter-element referencing | |||||
![]() ![]() ![]() ![]() ![]() ![]() |
0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | |||||
![]() ![]() ![]() ![]() ![]() ![]() |
Σ | 1..1 | Coding | Code defined by a terminology system | ||||
![]() ![]() ![]() ![]() ![]() ![]() ![]() |
0..1 | string | Unique id for inter-element referencing | |||||
![]() ![]() ![]() ![]() ![]() ![]() ![]() |
0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | |||||
![]() ![]() ![]() ![]() ![]() ![]() ![]() |
Σ | 1..1 | uri | Identity of the terminology system Required Pattern: https://www.ehealth.fgov.be/standards/fhir/mycarenet/CodeSystem/decision-values | ||||
![]() ![]() ![]() ![]() ![]() ![]() ![]() |
Σ | 0..1 | string | Version of the system - if relevant | ||||
![]() ![]() ![]() ![]() ![]() ![]() ![]() |
Σ | 1..1 | code | Symbol in syntax defined by the system | ||||
![]() ![]() ![]() ![]() ![]() ![]() ![]() |
Σ | 0..1 | string | Representation defined by the system | ||||
![]() ![]() ![]() ![]() ![]() ![]() ![]() |
Σ | 0..1 | boolean | If this coding was chosen directly by the user | ||||
![]() ![]() ![]() ![]() ![]() ![]() |
Σ | 0..1 | string | Plain text representation of the concept | ||||
![]() ![]() ![]() ![]() ![]() |
0..1 | CodeableConcept | Explanation of adjudication outcome Binding: AdjudicationReasonCodes (example): The adjudication reason codes. | |||||
![]() ![]() ![]() ![]() ![]() ![]() |
0..1 | string | Unique id for inter-element referencing | |||||
![]() ![]() ![]() ![]() ![]() ![]() |
0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | |||||
![]() ![]() ![]() ![]() ![]() ![]() |
Σ | 1..1 | Coding | Code defined by a terminology system Binding: ValueSet adjudication reason (extensible) | ||||
![]() ![]() ![]() ![]() ![]() ![]() ![]() |
0..1 | string | Unique id for inter-element referencing | |||||
![]() ![]() ![]() ![]() ![]() ![]() ![]() |
0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | |||||
![]() ![]() ![]() ![]() ![]() ![]() ![]() |
Σ | 1..1 | uri | Identity of the terminology system | ||||
![]() ![]() ![]() ![]() ![]() ![]() ![]() |
Σ | 0..1 | string | Version of the system - if relevant | ||||
![]() ![]() ![]() ![]() ![]() ![]() ![]() |
Σ | 1..1 | code | Symbol in syntax defined by the system | ||||
![]() ![]() ![]() ![]() ![]() ![]() ![]() |
Σ | 0..1 | string | Representation defined by the system | ||||
![]() ![]() ![]() ![]() ![]() ![]() ![]() |
Σ | 0..1 | boolean | If this coding was chosen directly by the user | ||||
![]() ![]() ![]() ![]() ![]() ![]() |
Σ | 0..1 | string | Plain text representation of the concept | ||||
![]() ![]() ![]() ![]() ![]() |
0..1 | Money | Monetary amount | |||||
![]() ![]() ![]() ![]() ![]() |
0..1 | decimal | Non-monetary value | |||||
![]() ![]() ![]() ![]() |
0..* | BackboneElement | Adjudication for claim details | |||||
![]() ![]() ![]() ![]() ![]() |
0..1 | string | Unique id for inter-element referencing | |||||
![]() ![]() ![]() ![]() ![]() |
0..* | Extension | Additional content defined by implementations | |||||
![]() ![]() ![]() ![]() ![]() |
?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
![]() ![]() ![]() ![]() ![]() |
1..1 | positiveInt | Claim detail instance identifier | |||||
![]() ![]() ![]() ![]() ![]() |
0..* | positiveInt | Applicable note numbers | |||||
![]() ![]() ![]() ![]() ![]() |
1..* | See adjudication (ClaimResponse) | Detail level adjudication details | |||||
![]() ![]() ![]() ![]() ![]() |
0..* | BackboneElement | Adjudication for claim sub-details | |||||
![]() ![]() ![]() ![]() ![]() ![]() |
0..1 | string | Unique id for inter-element referencing | |||||
![]() ![]() ![]() ![]() ![]() ![]() |
0..* | Extension | Additional content defined by implementations | |||||
![]() ![]() ![]() ![]() ![]() ![]() |
?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
![]() ![]() ![]() ![]() ![]() ![]() |
1..1 | positiveInt | Claim sub-detail instance identifier | |||||
![]() ![]() ![]() ![]() ![]() ![]() |
0..* | positiveInt | Applicable note numbers | |||||
![]() ![]() ![]() ![]() ![]() ![]() |
0..* | See adjudication (ClaimResponse) | Subdetail level adjudication details | |||||
![]() ![]() ![]() |
S | 0..* | BackboneElement | Insurer added line items | ||||
![]() ![]() ![]() ![]() |
0..1 | string | Unique id for inter-element referencing | |||||
![]() ![]() ![]() ![]() |
0..* | Extension | Additional content defined by implementations | |||||
![]() ![]() ![]() ![]() |
?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
![]() ![]() ![]() ![]() |
S | 1..1 | positiveInt | Item sequence number | ||||
![]() ![]() ![]() ![]() |
0..* | positiveInt | Detail sequence number | |||||
![]() ![]() ![]() ![]() |
0..* | positiveInt | Subdetail sequence number | |||||
![]() ![]() ![]() ![]() |
0..* | Reference(Practitioner | PractitionerRole | Organization) | Authorized providers | |||||
![]() ![]() ![]() ![]() |
1..1 | CodeableConcept | Billing, service, product, or drug code Binding: ValueSet product or service (extensible) | |||||
![]() ![]() ![]() ![]() ![]() |
0..1 | string | Unique id for inter-element referencing | |||||
![]() ![]() ![]() ![]() ![]() |
0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | |||||
![]() ![]() ![]() ![]() ![]() |
Σ | 1..1 | Coding | Code defined by a terminology system | ||||
![]() ![]() ![]() ![]() ![]() ![]() |
0..1 | string | Unique id for inter-element referencing | |||||
![]() ![]() ![]() ![]() ![]() ![]() |
0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | |||||
![]() ![]() ![]() ![]() ![]() ![]() |
Σ | 1..1 | uri | Identity of the terminology system | ||||
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Σ | 0..1 | string | Version of the system - if relevant | ||||
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Σ | 1..1 | code | Symbol in syntax defined by the system | ||||
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Σ | 0..1 | string | Representation defined by the system | ||||
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Σ | 0..1 | boolean | If this coding was chosen directly by the user | ||||
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Σ | 0..1 | string | Plain text representation of the concept | ||||
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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. | |||||
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0..* | CodeableConcept | Program the product or service is provided under Binding: ExampleProgramReasonCodes (example): Program specific reason codes. | |||||
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0..1 | Date or dates of service or product delivery | ||||||
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date | |||||||
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Period | |||||||
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0..1 | Place of service or where product was supplied Binding: ExampleServicePlaceCodes (example): Place of service: pharmacy, school, prison, etc. | ||||||
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CodeableConcept | |||||||
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Address | |||||||
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Reference(Location) | |||||||
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0..1 | SimpleQuantity | Count of products or services | |||||
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0..1 | Money | Fee, charge or cost per item | |||||
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0..1 | decimal | Price scaling factor | |||||
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0..1 | Money | Total item cost | |||||
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0..1 | CodeableConcept | Anatomical location Binding: OralSiteCodes (example): The code for the teeth, quadrant, sextant and arch. | |||||
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0..* | CodeableConcept | Anatomical sub-location Binding: SurfaceCodes (example): The code for the tooth surface and surface combinations. | |||||
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0..* | positiveInt | Applicable note numbers | |||||
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S | 1..* | See adjudication (ClaimResponse) | Added items adjudication | ||||
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0..* | BackboneElement | Insurer added line details | |||||
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0..1 | string | Unique id for inter-element referencing | |||||
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0..* | Extension | Additional content defined by implementations | |||||
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?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
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1..1 | CodeableConcept | Billing, service, product, or drug code Binding: USCLSCodes (example): Allowable service and product codes. | |||||
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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. | |||||
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0..1 | SimpleQuantity | Count of products or services | |||||
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0..1 | Money | Fee, charge or cost per item | |||||
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0..1 | decimal | Price scaling factor | |||||
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0..1 | Money | Total item cost | |||||
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0..* | positiveInt | Applicable note numbers | |||||
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1..* | See adjudication (ClaimResponse) | Added items detail adjudication | |||||
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0..* | BackboneElement | Insurer added line items | |||||
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0..1 | string | Unique id for inter-element referencing | |||||
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0..* | Extension | Additional content defined by implementations | |||||
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?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
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1..1 | CodeableConcept | Billing, service, product, or drug code Binding: USCLSCodes (example): Allowable service and product codes. | |||||
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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. | |||||
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0..1 | SimpleQuantity | Count of products or services | |||||
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0..1 | Money | Fee, charge or cost per item | |||||
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0..1 | decimal | Price scaling factor | |||||
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0..1 | Money | Total item cost | |||||
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0..* | positiveInt | Applicable note numbers | |||||
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1..* | See adjudication (ClaimResponse) | Added items detail adjudication | |||||
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0..* | See adjudication (ClaimResponse) | Header-level adjudication | |||||
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Σ | 0..* | BackboneElement | Adjudication totals | ||||
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0..1 | string | Unique id for inter-element referencing | |||||
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0..* | Extension | Additional content defined by implementations | |||||
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?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
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Σ | 1..1 | CodeableConcept | Type of adjudication information Binding: AdjudicationValueCodes (example): The adjudication codes. | ||||
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Σ | 1..1 | Money | Financial total for the category | ||||
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0..1 | BackboneElement | Payment Details | |||||
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0..1 | string | Unique id for inter-element referencing | |||||
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0..* | Extension | Additional content defined by implementations | |||||
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?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
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1..1 | CodeableConcept | Partial or complete payment Binding: ExamplePaymentTypeCodes (example): The type (partial, complete) of the payment. | |||||
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0..1 | Money | Payment adjustment for non-claim issues | |||||
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0..1 | CodeableConcept | Explanation for the adjustment Binding: PaymentAdjustmentReasonCodes (example): Payment Adjustment reason codes. | |||||
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0..1 | date | Expected date of payment | |||||
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1..1 | Money | Payable amount after adjustment | |||||
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0..1 | Identifier | Business identifier for the payment | |||||
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0..1 | CodeableConcept | Funds reserved status Binding: Funds Reservation Codes (example): For whom funds are to be reserved: (Patient, Provider, None). | |||||
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0..1 | CodeableConcept | Printed form identifier Binding: Form Codes (example): The forms codes. | |||||
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0..1 | Attachment | Printed reference or actual form | |||||
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0..* | BackboneElement | Note concerning adjudication | |||||
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0..1 | string | Unique id for inter-element referencing | |||||
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0..* | Extension | Additional content defined by implementations | |||||
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?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
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0..1 | positiveInt | Note instance identifier | |||||
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0..1 | code | display | print | printoper Binding: NoteType (required): The presentation types of notes. | |||||
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1..1 | string | Note explanatory text | |||||
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0..1 | CodeableConcept | Language of the text Binding: CommonLanguages (preferred): A human language.
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0..* | Reference(CommunicationRequest) | Request for additional information | |||||
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0..* | BackboneElement | Patient insurance information | |||||
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0..1 | string | Unique id for inter-element referencing | |||||
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0..* | Extension | Additional content defined by implementations | |||||
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?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
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1..1 | positiveInt | Insurance instance identifier | |||||
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1..1 | boolean | Coverage to be used for adjudication | |||||
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1..1 | Reference(Coverage) | Insurance information | |||||
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0..1 | string | Additional provider contract number | |||||
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0..1 | Reference(ClaimResponse) | Adjudication results | |||||
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0..* | BackboneElement | Processing errors | |||||
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0..1 | string | Unique id for inter-element referencing | |||||
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0..* | Extension | Additional content defined by implementations | |||||
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?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
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0..1 | positiveInt | Item sequence number | |||||
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0..1 | positiveInt | Detail sequence number | |||||
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0..1 | positiveInt | Subdetail sequence number | |||||
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1..1 | CodeableConcept | Error code detailing processing issues Binding: Adjudication Error Codes (example): The adjudication error codes. | |||||
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Path | Conformance | ValueSet | URI | |||
ClaimResponse.meta.security | extensible | All Security Labelshttp://hl7.org/fhir/ValueSet/security-labels from the FHIR Standard | ||||
ClaimResponse.meta.tag | example | CommonTagshttp://hl7.org/fhir/ValueSet/common-tags from the FHIR Standard | ||||
ClaimResponse.language | preferred | CommonLanguageshttp://hl7.org/fhir/ValueSet/languages from the FHIR Standard
| ||||
ClaimResponse.status | required | FinancialResourceStatusCodeshttp://hl7.org/fhir/ValueSet/fm-status|4.0.1 from the FHIR Standard | ||||
ClaimResponse.type | extensible | ClaimTypeCodeshttp://hl7.org/fhir/ValueSet/claim-type from the FHIR Standard | ||||
ClaimResponse.subType | example | ExampleClaimSubTypeCodeshttp://hl7.org/fhir/ValueSet/claim-subtype from the FHIR Standard | ||||
ClaimResponse.use | required | Usehttp://hl7.org/fhir/ValueSet/claim-use|4.0.1 from the FHIR Standard | ||||
ClaimResponse.requestor.type | extensible | ResourceTypehttp://hl7.org/fhir/ValueSet/resource-types from the FHIR Standard | ||||
ClaimResponse.outcome | required | ClaimProcessingCodeshttp://hl7.org/fhir/ValueSet/remittance-outcome|4.0.1 from the FHIR Standard | ||||
ClaimResponse.payeeType | example | Claim Payee Type Codeshttp://hl7.org/fhir/ValueSet/payeetype from the FHIR Standard | ||||
ClaimResponse.item.adjudication.category | example | AdjudicationValueCodeshttp://hl7.org/fhir/ValueSet/adjudication from the FHIR Standard | ||||
ClaimResponse.item.adjudication.reason | example | AdjudicationReasonCodeshttp://hl7.org/fhir/ValueSet/adjudication-reason from the FHIR Standard | ||||
ClaimResponse.item.adjudication.reason.coding | extensible | BeEAgreementAdjudicationReasonhttps://www.ehealth.fgov.be/standards/fhir/mycarenet/ValueSet/eagreementadjudicationreason from this IG | ||||
ClaimResponse.addItem.productOrService | extensible | BeProductOrServiceNihdiEAgreementhttps://www.ehealth.fgov.be/standards/fhir/mycarenet/ValueSet/eagreementproductorservice from this IG | ||||
ClaimResponse.addItem.modifier | example | ModifierTypeCodeshttp://hl7.org/fhir/ValueSet/claim-modifiers from the FHIR Standard | ||||
ClaimResponse.addItem.programCode | example | ExampleProgramReasonCodeshttp://hl7.org/fhir/ValueSet/ex-program-code from the FHIR Standard | ||||
ClaimResponse.addItem.location[x] | example | ExampleServicePlaceCodeshttp://hl7.org/fhir/ValueSet/service-place from the FHIR Standard | ||||
ClaimResponse.addItem.bodySite | example | OralSiteCodeshttp://hl7.org/fhir/ValueSet/tooth from the FHIR Standard | ||||
ClaimResponse.addItem.subSite | example | SurfaceCodeshttp://hl7.org/fhir/ValueSet/surface from the FHIR Standard | ||||
ClaimResponse.addItem.detail.productOrService | example | USCLSCodeshttp://hl7.org/fhir/ValueSet/service-uscls from the FHIR Standard | ||||
ClaimResponse.addItem.detail.modifier | example | ModifierTypeCodeshttp://hl7.org/fhir/ValueSet/claim-modifiers from the FHIR Standard | ||||
ClaimResponse.addItem.detail.subDetail.productOrService | example | USCLSCodeshttp://hl7.org/fhir/ValueSet/service-uscls from the FHIR Standard | ||||
ClaimResponse.addItem.detail.subDetail.modifier | example | ModifierTypeCodeshttp://hl7.org/fhir/ValueSet/claim-modifiers from the FHIR Standard | ||||
ClaimResponse.total.category | example | AdjudicationValueCodeshttp://hl7.org/fhir/ValueSet/adjudication from the FHIR Standard | ||||
ClaimResponse.payment.type | example | ExamplePaymentTypeCodeshttp://hl7.org/fhir/ValueSet/ex-paymenttype from the FHIR Standard | ||||
ClaimResponse.payment.adjustmentReason | example | PaymentAdjustmentReasonCodeshttp://hl7.org/fhir/ValueSet/payment-adjustment-reason from the FHIR Standard | ||||
ClaimResponse.fundsReserve | example | Funds Reservation Codeshttp://hl7.org/fhir/ValueSet/fundsreserve from the FHIR Standard | ||||
ClaimResponse.formCode | example | Form Codeshttp://hl7.org/fhir/ValueSet/forms from the FHIR Standard | ||||
ClaimResponse.processNote.type | required | NoteTypehttp://hl7.org/fhir/ValueSet/note-type|4.0.1 from the FHIR Standard | ||||
ClaimResponse.processNote.language | preferred | CommonLanguageshttp://hl7.org/fhir/ValueSet/languages from the FHIR Standard
| ||||
ClaimResponse.error.code | example | Adjudication Error Codeshttp://hl7.org/fhir/ValueSet/adjudication-error from the FHIR Standard |
Id | Grade | Path(s) | Details | Requirements |
be-rule-eagreementclaimresponse-1 | error | ClaimResponse | preAuthPeriod start and end SHALL be YYYY-MM-DD : (ClaimResponse.preAuthPeriod.exists() implies ClaimResponse.preAuthPeriod.start.toString().length()=10) and (ClaimResponse.preAuthPeriod.end.exists() implies ClaimResponse.preAuthPeriod.end.toString().length()=10) | |
be-rule-eagreementclaimresponse-2 | error | ClaimResponse | Created SHALL be YYYY-MM-DDThh:mm:ss+zz:zz : ClaimResponse.created.toString().length()=25 | |
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: 13 elements(11 nested mandatory elements)
Must-Support: 17 elements
Structures
This structure refers to these other structures:
Other representations of profile: CSV, Excel, Schematron
IG © 2022+ eHealth Platform. Package hl7.fhir.be.mycarenet#2.1.0 based on FHIR 4.0.1. Generated 2025-01-22
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