abstractbaseDefinitioncopyrightdate- Values Differ
descriptionexperimentalfhirVersionjurisdiction
jurisdiction[0]kindnamepublisher- Added the item 'eHealth Platform'
purposestatustitletypeurlversion- Values Differ
| Left: | MyCareNet eAgreement Claim Response BE profile (https://www.ehealth.fgov.be/standards/fhir/mycarenet/StructureDefinition/be-eagreementclaimresponse) |
| Right: | MyCareNet eAgreement Claim Response BE profile (https://www.ehealth.fgov.be/standards/fhir/mycarenet/StructureDefinition/be-eagreementclaimresponse) |
| Error | StructureDefinition.version | Values for version differ: '2.0.0' vs '2.1.0' |
| Information | StructureDefinition.date | Values for date differ: '2022-09-08T11:51:10+02:00' vs '2025-01-22T08:18:17+00:00' |
| Name | Value | Comments | |
|---|---|---|---|
| abstract | false | ||
| baseDefinition | http://hl7.org/fhir/StructureDefinition/ClaimResponse | ||
| copyright | |||
| date | 2022-09-08T11:51:10+02:00 | 2025-01-22T08:18:17+00:00 |
|
| description | Claimresponse profile for use in the different eAgreement flows from MyCareNet. | ||
| experimental | |||
| fhirVersion | 4.0.1 | ||
| jurisdiction | |||
| jurisdiction[0] | urn:iso:std:iso:3166#BE | ||
| kind | resource | ||
| name | BeMyCareNetEagreementClaimResponse | ||
| publisher | eHealth Platform |
| |
| purpose | |||
| status | active | ||
| title | MyCareNet eAgreement Claim Response BE profile | ||
| type | ClaimResponse | ||
| url | https://www.ehealth.fgov.be/standards/fhir/mycarenet/StructureDefinition/be-eagreementclaimresponse | ||
| version | 2.0.0 | 2.1.0 |
|
| Name | L Flags | L Card. | L Type | L Description & Constraints | R Flags | R Card. | R Type | R Description & Constraints | Comments | ||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
 ClaimResponse | C | 0..* | ClaimResponse | Response to a claim predetermination or preauthorization 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 | 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 | |||||||||
 id | SΣ | 1..1 | string | Logical id of this artifact | SΣ | 1..1 | id | Logical id of this artifact | |||||||||
 meta | SΣ | 1..1 | Meta | Metadata about the resource | SΣ | 1..1 | Meta | Metadata about the resource | |||||||||
 id | 0..1 | string | Unique id for inter-element referencing | 0..1 | string | Unique id for inter-element referencing | |||||||||||
 Slices for extension | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | |||||||||||
| versionId | Σ | 0..1 | id | Version specific identifier | Σ | 0..1 | id | Version specific identifier | |||||||||
| lastUpdated | Σ | 0..1 | instant | When the resource version last changed | Σ | 0..1 | instant | When the resource version last changed | |||||||||
| source | Σ | 0..1 | uri | Identifies where the resource comes from | Σ | 0..1 | uri | Identifies where the resource comes from | |||||||||
| profile | Σ | 1..1 | canonical(StructureDefinition) | Profiles this resource claims to conform to | Σ | 1..1 | canonical(StructureDefinition) | Profiles this resource claims to conform to | |||||||||
| security | Σ | 0..* | Coding | Security Labels applied to this resource Binding: ?? (extensible): Security Labels from the Healthcare Privacy and Security Classification System. | Σ | 0..* | Coding | Security Labels applied to this resource Binding: ?? (extensible): Security Labels from the Healthcare Privacy and Security Classification System. | |||||||||
| tag | Σ | 0..* | Coding | Tags applied to this resource Binding: ?? (example): Codes that represent various types of tags, commonly workflow-related; e.g. "Needs review by Dr. Jones". | Σ | 0..* | Coding | Tags applied to this resource Binding: ?? (example): Codes that represent various types of tags, commonly workflow-related; e.g. "Needs review by Dr. Jones". | |||||||||
| implicitRules | ?!Σ | 0..1 | uri | A set of rules under which this content was created | ?!Σ | 0..1 | uri | A set of rules under which this content was created | |||||||||
| language | 0..1 | code | Language of the resource content Binding: ?? (preferred): A human language.
| 0..1 | code | Language of the resource content Binding: ?? (preferred): A human language.
| |||||||||||
| text | 0..1 | Narrative | Text summary of the resource, for human interpretation | 0..1 | Narrative | Text summary of the resource, for human interpretation | |||||||||||
| contained | 0..* | Resource | Contained, inline Resources | 0..* | Resource | Contained, inline Resources | |||||||||||
| extension | 0..* | Extension | Additional content defined by implementations | 0..* | Extension | Additional content defined by implementations | |||||||||||
 modifierExtension | ?! | 0..* | Extension | Extensions that cannot be ignored | ?! | 0..* | Extension | Extensions that cannot be ignored | |||||||||
| identifier | 0..* | Identifier | Business Identifier for a claim response | 0..* | Identifier | Business Identifier for a claim response | |||||||||||
| status | ?!SΣ | 1..1 | code | active | cancelled | draft | entered-in-error Binding: ?? (required): A code specifying the state of the resource instance. | ?!SΣ | 1..1 | code | active | cancelled | draft | entered-in-error Binding: ?? (required): A code specifying the state of the resource instance. | |||||||||
| type | SΣ | 1..1 | CodeableConcept | More granular claim type Binding: ?? (extensible): The type or discipline-style of the claim. | SΣ | 1..1 | CodeableConcept | More granular claim type Binding: ?? (extensible): The type or discipline-style of the claim. | |||||||||
| id | 0..1 | string | Unique id for inter-element referencing | 0..1 | string | Unique id for inter-element referencing | |||||||||||
| Slices for extension | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | |||||||||||
| coding | Σ | 1..1 | Coding | Code defined by a terminology system | Σ | 1..1 | Coding | Code defined by a terminology system | |||||||||
| id | 0..1 | string | Unique id for inter-element referencing | 0..1 | string | Unique id for inter-element referencing | |||||||||||
| Slices for extension | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | |||||||||||
| system | Σ | 1..1 | uri | Identity of the terminology system | Σ | 1..1 | uri | Identity of the terminology system | |||||||||
| version | Σ | 0..1 | string | Version of the system - if relevant | Σ | 0..1 | string | Version of the system - if relevant | |||||||||
| code | Σ | 1..1 | code | Symbol in syntax defined by the system | Σ | 1..1 | code | Symbol in syntax defined by the system | |||||||||
| display | Σ | 0..1 | string | Representation defined by the system | Σ | 0..1 | string | Representation defined by the system | |||||||||
| userSelected | Σ | 0..1 | boolean | If this coding was chosen directly by the user | Σ | 0..1 | boolean | If this coding was chosen directly by the user | |||||||||
| text | Σ | 0..1 | string | Plain text representation of the concept | Σ | 0..1 | string | Plain text representation of the concept | |||||||||
| subType | S | 1..1 | CodeableConcept | More granular claim type Binding: ?? (example): A more granular claim typecode. | S | 1..1 | CodeableConcept | More granular claim type Binding: ?? (example): A more granular claim typecode. | |||||||||
| id | 0..1 | string | Unique id for inter-element referencing | 0..1 | string | Unique id for inter-element referencing | |||||||||||
| Slices for extension | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | |||||||||||
| coding | Σ | 1..1 | Coding | Code defined by a terminology system | Σ | 1..1 | Coding | Code defined by a terminology system | |||||||||
| id | 0..1 | string | Unique id for inter-element referencing | 0..1 | string | Unique id for inter-element referencing | |||||||||||
| Slices for extension | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | |||||||||||
| system | Σ | 1..1 | uri | Identity of the terminology system Required Pattern: https://www.ehealth.fgov.be/standards/fhir/mycarenet/CodeSystem/agreement-types | Σ | 1..1 | uri | Identity of the terminology system Required Pattern: https://www.ehealth.fgov.be/standards/fhir/mycarenet/CodeSystem/agreement-types | |||||||||
| version | Σ | 0..1 | string | Version of the system - if relevant | Σ | 0..1 | string | Version of the system - if relevant | |||||||||
| code | Σ | 1..1 | code | Symbol in syntax defined by the system | Σ | 1..1 | code | Symbol in syntax defined by the system | |||||||||
| display | Σ | 0..1 | string | Representation defined by the system | Σ | 0..1 | string | Representation defined by the system | |||||||||
| userSelected | Σ | 0..1 | boolean | If this coding was chosen directly by the user | Σ | 0..1 | boolean | If this coding was chosen directly by the user | |||||||||
| text | Σ | 0..1 | string | Plain text representation of the concept | Σ | 0..1 | string | Plain text representation of the concept | |||||||||
| use | SΣ | 1..1 | code | claim | preauthorization | predetermination Binding: ?? (required): Claim, preauthorization, predetermination. | SΣ | 1..1 | code | claim | preauthorization | predetermination Binding: ?? (required): Claim, preauthorization, predetermination. | |||||||||
| patient | SΣ | 1..1 | Reference(Patient core BE profile) | The recipient of the products and services | SΣ | 1..1 | Reference(BePatient) | The recipient of the products and services | |||||||||
| created | SΣ | 1..1 | dateTime | Response creation date | SΣ | 1..1 | dateTime | Response creation date | |||||||||
| insurer | SΣ | 1..1 | Reference(Organisation core BE profile) | Party responsible for reimbursement | SΣ | 1..1 | Reference(BeOrganization) | Party responsible for reimbursement | |||||||||
| requestor | S | 1..1 | Reference(Organisation core BE profile | Practitioner core BE profile | Practitioner role core BE profile) | Party responsible for the claim | S | 1..1 | Reference(BeOrganization | BePractitioner | BePractitionerRole) | Party responsible for the claim | |||||||||
| id | 0..1 | string | Unique id for inter-element referencing | 0..1 | string | Unique id for inter-element referencing | |||||||||||
| Slices for extension | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | |||||||||||
| reference | ΣC | 1..1 | string | Literal reference, Relative, internal or absolute URL | ΣC | 1..1 | string | Literal reference, Relative, internal or absolute URL | |||||||||
| type | Σ | 0..1 | uri | Type the reference refers to (e.g. "Patient") Binding: ?? (extensible): Aa resource (or, for logical models, the URI of the logical model). | Σ | 0..1 | uri | Type the reference refers to (e.g. "Patient") Binding: ?? (extensible): Aa resource (or, for logical models, the URI of the logical model). | |||||||||
| identifier | Σ | 0..1 | Identifier | Logical reference, when literal reference is not known | Σ | 0..1 | Identifier | Logical reference, when literal reference is not known | |||||||||
| display | Σ | 0..1 | string | Text alternative for the resource | Σ | 0..1 | string | Text alternative for the resource | |||||||||
| request | Σ | 0..1 | Reference(Claim) | Id of resource triggering adjudication | Σ | 0..1 | Reference(Claim) | Id of resource triggering adjudication | |||||||||
| outcome | SΣ | 1..1 | code | queued | complete | error | partial Binding: ?? (required): The result of the claim processing. | SΣ | 1..1 | code | queued | complete | error | partial Binding: ?? (required): The result of the claim processing. | |||||||||
| disposition | 0..1 | string | Disposition Message | 0..1 | string | Disposition Message | |||||||||||
| preAuthRef | S | 1..1 | string | Preauthorization reference | S | 1..1 | string | Preauthorization reference | |||||||||
| preAuthPeriod | S | 0..1 | Period | Preauthorization reference effective period | S | 0..1 | Period | Preauthorization reference effective period | |||||||||
| id | 0..1 | string | Unique id for inter-element referencing | 0..1 | string | Unique id for inter-element referencing | |||||||||||
| Slices for extension | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | |||||||||||
| start | ΣC | 1..1 | dateTime | Starting time with inclusive boundary | ΣC | 1..1 | dateTime | Starting time with inclusive boundary | |||||||||
| end | ΣC | 0..1 | dateTime | End time with inclusive boundary, if not ongoing | ΣC | 0..1 | dateTime | End time with inclusive boundary, if not ongoing | |||||||||
| payeeType | 0..1 | CodeableConcept | Party to be paid any benefits payable Binding: ?? (example): A code for the party to be reimbursed. | 0..1 | CodeableConcept | Party to be paid any benefits payable Binding: ?? (example): A code for the party to be reimbursed. | |||||||||||
| item | 0..* | BackboneElement | Adjudication for claim line items | 0..* | BackboneElement | Adjudication for claim line items | |||||||||||
| id | 0..1 | string | Unique id for inter-element referencing | 0..1 | string | Unique id for inter-element referencing | |||||||||||
| extension | 0..* | Extension | Additional content defined by implementations | 0..* | Extension | Additional content defined by implementations | |||||||||||
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | |||||||||
| itemSequence | 1..1 | positiveInt | Claim item instance identifier | 1..1 | positiveInt | Claim item instance identifier | |||||||||||
| noteNumber | 0..* | positiveInt | Applicable note numbers | 0..* | positiveInt | Applicable note numbers | |||||||||||
| adjudication | S | 1..1 | BackboneElement | Adjudication details | S | 1..1 | BackboneElement | Adjudication details | |||||||||
| id | 0..1 | string | Unique id for inter-element referencing | 0..1 | string | Unique id for inter-element referencing | |||||||||||
| extension | 0..* | Extension | Additional content defined by implementations | 0..* | Extension | Additional content defined by implementations | |||||||||||
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | |||||||||
| category | 1..1 | CodeableConcept | Type of adjudication information Binding: ?? (example): The adjudication codes. | 1..1 | CodeableConcept | Type of adjudication information Binding: ?? (example): The adjudication codes. | |||||||||||
| id | 0..1 | string | Unique id for inter-element referencing | 0..1 | string | Unique id for inter-element referencing | |||||||||||
| Slices for extension | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | |||||||||||
| coding | Σ | 1..1 | Coding | Code defined by a terminology system | Σ | 1..1 | Coding | Code defined by a terminology system | |||||||||
| id | 0..1 | string | Unique id for inter-element referencing | 0..1 | string | Unique id for inter-element referencing | |||||||||||
| Slices for extension | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | |||||||||||
| system | Σ | 1..1 | uri | Identity of the terminology system Required Pattern: https://www.ehealth.fgov.be/standards/fhir/mycarenet/CodeSystem/decision-values | Σ | 1..1 | uri | Identity of the terminology system Required Pattern: https://www.ehealth.fgov.be/standards/fhir/mycarenet/CodeSystem/decision-values | |||||||||
| version | Σ | 0..1 | string | Version of the system - if relevant | Σ | 0..1 | string | Version of the system - if relevant | |||||||||
| code | Σ | 1..1 | code | Symbol in syntax defined by the system | Σ | 1..1 | code | Symbol in syntax defined by the system | |||||||||
| display | Σ | 0..1 | string | Representation defined by the system | Σ | 0..1 | string | Representation defined by the system | |||||||||
| userSelected | Σ | 0..1 | boolean | If this coding was chosen directly by the user | Σ | 0..1 | boolean | If this coding was chosen directly by the user | |||||||||
| text | Σ | 0..1 | string | Plain text representation of the concept | Σ | 0..1 | string | Plain text representation of the concept | |||||||||
| reason | 0..1 | CodeableConcept | Explanation of adjudication outcome Binding: ?? (example): The adjudication reason codes. | 0..1 | CodeableConcept | Explanation of adjudication outcome Binding: ?? (example): The adjudication reason codes. | |||||||||||
| id | 0..1 | string | Unique id for inter-element referencing | 0..1 | string | Unique id for inter-element referencing | |||||||||||
| Slices for extension | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | |||||||||||
| coding | Σ | 1..1 | Coding | Code defined by a terminology system Binding: ?? (extensible) | Σ | 1..1 | Coding | Code defined by a terminology system Binding: ?? (extensible) | |||||||||
| id | 0..1 | string | Unique id for inter-element referencing | 0..1 | string | Unique id for inter-element referencing | |||||||||||
| Slices for extension | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | |||||||||||
| system | Σ | 1..1 | uri | Identity of the terminology system | Σ | 1..1 | uri | Identity of the terminology system | |||||||||
| version | Σ | 0..1 | string | Version of the system - if relevant | Σ | 0..1 | string | Version of the system - if relevant | |||||||||
| code | Σ | 1..1 | code | Symbol in syntax defined by the system | Σ | 1..1 | code | Symbol in syntax defined by the system | |||||||||
| display | Σ | 0..1 | string | Representation defined by the system | Σ | 0..1 | string | Representation defined by the system | |||||||||
| userSelected | Σ | 0..1 | boolean | If this coding was chosen directly by the user | Σ | 0..1 | boolean | If this coding was chosen directly by the user | |||||||||
| text | Σ | 0..1 | string | Plain text representation of the concept | Σ | 0..1 | string | Plain text representation of the concept | |||||||||
| amount | 0..1 | Money | Monetary amount | 0..1 | Money | Monetary amount | |||||||||||
| value | 0..1 | decimal | Non-monetary value | 0..1 | decimal | Non-monetary value | |||||||||||
 detail | 0..* | BackboneElement | Adjudication for claim details | 0..* | BackboneElement | Adjudication for claim details | |||||||||||
 id | 0..1 | string | Unique id for inter-element referencing | 0..1 | string | Unique id for inter-element referencing | |||||||||||
| extension | 0..* | Extension | Additional content defined by implementations | 0..* | Extension | Additional content defined by implementations | |||||||||||
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | |||||||||
| detailSequence | 1..1 | positiveInt | Claim detail instance identifier | 1..1 | positiveInt | Claim detail instance identifier | |||||||||||
| noteNumber | 0..* | positiveInt | Applicable note numbers | 0..* | positiveInt | Applicable note numbers | |||||||||||
 adjudication | 1..* | See adjudication (ClaimResponse) | Detail level adjudication details | 1..* | See adjudication (ClaimResponse) | Detail level adjudication details | |||||||||||
| subDetail | 0..* | BackboneElement | Adjudication for claim sub-details | 0..* | BackboneElement | Adjudication for claim sub-details | |||||||||||
| id | 0..1 | string | Unique id for inter-element referencing | 0..1 | string | Unique id for inter-element referencing | |||||||||||
| extension | 0..* | Extension | Additional content defined by implementations | 0..* | Extension | Additional content defined by implementations | |||||||||||
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | |||||||||
| subDetailSequence | 1..1 | positiveInt | Claim sub-detail instance identifier | 1..1 | positiveInt | Claim sub-detail instance identifier | |||||||||||
| noteNumber | 0..* | positiveInt | Applicable note numbers | 0..* | positiveInt | Applicable note numbers | |||||||||||
| adjudication | 0..* | See adjudication (ClaimResponse) | Subdetail level adjudication details | 0..* | See adjudication (ClaimResponse) | Subdetail level adjudication details | |||||||||||
| addItem | S | 0..* | BackboneElement | Insurer added line items | S | 0..* | BackboneElement | Insurer added line items | |||||||||
| id | 0..1 | string | Unique id for inter-element referencing | 0..1 | string | Unique id for inter-element referencing | |||||||||||
| extension | 0..* | Extension | Additional content defined by implementations | 0..* | Extension | Additional content defined by implementations | |||||||||||
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | |||||||||
| itemSequence | S | 1..1 | positiveInt | Item sequence number | S | 1..1 | positiveInt | Item sequence number | |||||||||
| detailSequence | 0..* | positiveInt | Detail sequence number | 0..* | positiveInt | Detail sequence number | |||||||||||
| subdetailSequence | 0..* | positiveInt | Subdetail sequence number | 0..* | positiveInt | Subdetail sequence number | |||||||||||
| provider | 0..* | Reference(Practitioner | PractitionerRole | Organization) | Authorized providers | 0..* | Reference(Practitioner | PractitionerRole | Organization) | Authorized providers | |||||||||||
| productOrService | 1..1 | CodeableConcept | Billing, service, product, or drug code Binding: ?? (extensible) | 1..1 | CodeableConcept | Billing, service, product, or drug code Binding: ?? (extensible) | |||||||||||
| id | 0..1 | string | Unique id for inter-element referencing | 0..1 | string | Unique id for inter-element referencing | |||||||||||
| Slices for extension | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | |||||||||||
| coding | Σ | 1..1 | Coding | Code defined by a terminology system | Σ | 1..1 | Coding | Code defined by a terminology system | |||||||||
| id | 0..1 | string | Unique id for inter-element referencing | 0..1 | string | Unique id for inter-element referencing | |||||||||||
| Slices for extension | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | |||||||||||
| system | Σ | 1..1 | uri | Identity of the terminology system | Σ | 1..1 | uri | Identity of the terminology system | |||||||||
| version | Σ | 0..1 | string | Version of the system - if relevant | Σ | 0..1 | string | Version of the system - if relevant | |||||||||
| code | Σ | 1..1 | code | Symbol in syntax defined by the system | Σ | 1..1 | code | Symbol in syntax defined by the system | |||||||||
| display | Σ | 0..1 | string | Representation defined by the system | Σ | 0..1 | string | Representation defined by the system | |||||||||
| userSelected | Σ | 0..1 | boolean | If this coding was chosen directly by the user | Σ | 0..1 | boolean | If this coding was chosen directly by the user | |||||||||
| text | Σ | 0..1 | string | Plain text representation of the concept | Σ | 0..1 | string | Plain text representation of the concept | |||||||||
| modifier | 0..* | CodeableConcept | Service/Product billing modifiers Binding: ?? (example): Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen. | 0..* | CodeableConcept | Service/Product billing modifiers Binding: ?? (example): Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen. | |||||||||||
| programCode | 0..* | CodeableConcept | Program the product or service is provided under Binding: ?? (example): Program specific reason codes. | 0..* | CodeableConcept | Program the product or service is provided under Binding: ?? (example): Program specific reason codes. | |||||||||||
| serviced[x] | 0..1 | date, Period | Date or dates of service or product delivery | 0..1 | date, Period | Date or dates of service or product delivery | |||||||||||
| location[x] | 0..1 | CodeableConcept, Address, Reference(Location) | Place of service or where product was supplied Binding: ?? (example): Place of service: pharmacy, school, prison, etc. | 0..1 | CodeableConcept, Address, Reference(Location) | Place of service or where product was supplied Binding: ?? (example): Place of service: pharmacy, school, prison, etc. | |||||||||||
| quantity | 0..1 | ?? | Count of products or services | 0..1 | ?? | Count of products or services | |||||||||||
| unitPrice | 0..1 | Money | Fee, charge or cost per item | 0..1 | Money | Fee, charge or cost per item | |||||||||||
| factor | 0..1 | decimal | Price scaling factor | 0..1 | decimal | Price scaling factor | |||||||||||
| net | 0..1 | Money | Total item cost | 0..1 | Money | Total item cost | |||||||||||
| bodySite | 0..1 | CodeableConcept | Anatomical location Binding: ?? (example): The code for the teeth, quadrant, sextant and arch. | 0..1 | CodeableConcept | Anatomical location Binding: ?? (example): The code for the teeth, quadrant, sextant and arch. | |||||||||||
| subSite | 0..* | CodeableConcept | Anatomical sub-location Binding: ?? (example): The code for the tooth surface and surface combinations. | 0..* | CodeableConcept | Anatomical sub-location Binding: ?? (example): The code for the tooth surface and surface combinations. | |||||||||||
| noteNumber | 0..* | positiveInt | Applicable note numbers | 0..* | positiveInt | Applicable note numbers | |||||||||||
| adjudication | S | 1..* | See adjudication (ClaimResponse) | Added items adjudication | S | 1..* | See adjudication (ClaimResponse) | Added items adjudication | |||||||||
| detail | 0..* | BackboneElement | Insurer added line details | 0..* | BackboneElement | Insurer added line details | |||||||||||
| id | 0..1 | string | Unique id for inter-element referencing | 0..1 | string | Unique id for inter-element referencing | |||||||||||
| extension | 0..* | Extension | Additional content defined by implementations | 0..* | Extension | Additional content defined by implementations | |||||||||||
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | |||||||||
| productOrService | 1..1 | CodeableConcept | Billing, service, product, or drug code Binding: ?? (example): Allowable service and product codes. | 1..1 | CodeableConcept | Billing, service, product, or drug code Binding: ?? (example): Allowable service and product codes. | |||||||||||
| modifier | 0..* | CodeableConcept | Service/Product billing modifiers Binding: ?? (example): Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen. | 0..* | CodeableConcept | Service/Product billing modifiers Binding: ?? (example): Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen. | |||||||||||
| quantity | 0..1 | ?? | Count of products or services | 0..1 | ?? | Count of products or services | |||||||||||
| unitPrice | 0..1 | Money | Fee, charge or cost per item | 0..1 | Money | Fee, charge or cost per item | |||||||||||
| factor | 0..1 | decimal | Price scaling factor | 0..1 | decimal | Price scaling factor | |||||||||||
| net | 0..1 | Money | Total item cost | 0..1 | Money | Total item cost | |||||||||||
| noteNumber | 0..* | positiveInt | Applicable note numbers | 0..* | positiveInt | Applicable note numbers | |||||||||||
| adjudication | 1..* | See adjudication (ClaimResponse) | Added items detail adjudication | 1..* | See adjudication (ClaimResponse) | Added items detail adjudication | |||||||||||
| subDetail | 0..* | BackboneElement | Insurer added line items | 0..* | BackboneElement | Insurer added line items | |||||||||||
| id | 0..1 | string | Unique id for inter-element referencing | 0..1 | string | Unique id for inter-element referencing | |||||||||||
| extension | 0..* | Extension | Additional content defined by implementations | 0..* | Extension | Additional content defined by implementations | |||||||||||
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | |||||||||
| productOrService | 1..1 | CodeableConcept | Billing, service, product, or drug code Binding: ?? (example): Allowable service and product codes. | 1..1 | CodeableConcept | Billing, service, product, or drug code Binding: ?? (example): Allowable service and product codes. | |||||||||||
| modifier | 0..* | CodeableConcept | Service/Product billing modifiers Binding: ?? (example): Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen. | 0..* | CodeableConcept | Service/Product billing modifiers Binding: ?? (example): Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen. | |||||||||||
| quantity | 0..1 | ?? | Count of products or services | 0..1 | ?? | Count of products or services | |||||||||||
| unitPrice | 0..1 | Money | Fee, charge or cost per item | 0..1 | Money | Fee, charge or cost per item | |||||||||||
| factor | 0..1 | decimal | Price scaling factor | 0..1 | decimal | Price scaling factor | |||||||||||
| net | 0..1 | Money | Total item cost | 0..1 | Money | Total item cost | |||||||||||
| noteNumber | 0..* | positiveInt | Applicable note numbers | 0..* | positiveInt | Applicable note numbers | |||||||||||
| adjudication | 1..* | See adjudication (ClaimResponse) | Added items detail adjudication | 1..* | See adjudication (ClaimResponse) | Added items detail adjudication | |||||||||||
| adjudication | 0..* | See adjudication (ClaimResponse) | Header-level adjudication | 0..* | See adjudication (ClaimResponse) | Header-level adjudication | |||||||||||
| total | Σ | 0..* | BackboneElement | Adjudication totals | Σ | 0..* | BackboneElement | Adjudication totals | |||||||||
| id | 0..1 | string | Unique id for inter-element referencing | 0..1 | string | Unique id for inter-element referencing | |||||||||||
| extension | 0..* | Extension | Additional content defined by implementations | 0..* | Extension | Additional content defined by implementations | |||||||||||
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | |||||||||
| category | Σ | 1..1 | CodeableConcept | Type of adjudication information Binding: ?? (example): The adjudication codes. | Σ | 1..1 | CodeableConcept | Type of adjudication information Binding: ?? (example): The adjudication codes. | |||||||||
| amount | Σ | 1..1 | Money | Financial total for the category | Σ | 1..1 | Money | Financial total for the category | |||||||||
| payment | 0..1 | BackboneElement | Payment Details | 0..1 | BackboneElement | Payment Details | |||||||||||
| id | 0..1 | string | Unique id for inter-element referencing | 0..1 | string | Unique id for inter-element referencing | |||||||||||
| extension | 0..* | Extension | Additional content defined by implementations | 0..* | Extension | Additional content defined by implementations | |||||||||||
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | |||||||||
| type | 1..1 | CodeableConcept | Partial or complete payment Binding: ?? (example): The type (partial, complete) of the payment. | 1..1 | CodeableConcept | Partial or complete payment Binding: ?? (example): The type (partial, complete) of the payment. | |||||||||||
| adjustment | 0..1 | Money | Payment adjustment for non-claim issues | 0..1 | Money | Payment adjustment for non-claim issues | |||||||||||
| adjustmentReason | 0..1 | CodeableConcept | Explanation for the adjustment Binding: ?? (example): Payment Adjustment reason codes. | 0..1 | CodeableConcept | Explanation for the adjustment Binding: ?? (example): Payment Adjustment reason codes. | |||||||||||
| date | 0..1 | date | Expected date of payment | 0..1 | date | Expected date of payment | |||||||||||
| amount | 1..1 | Money | Payable amount after adjustment | 1..1 | Money | Payable amount after adjustment | |||||||||||
| identifier | 0..1 | Identifier | Business identifier for the payment | 0..1 | Identifier | Business identifier for the payment | |||||||||||
| fundsReserve | 0..1 | CodeableConcept | Funds reserved status Binding: ?? (example): For whom funds are to be reserved: (Patient, Provider, None). | 0..1 | CodeableConcept | Funds reserved status Binding: ?? (example): For whom funds are to be reserved: (Patient, Provider, None). | |||||||||||
| formCode | 0..1 | CodeableConcept | Printed form identifier Binding: ?? (example): The forms codes. | 0..1 | CodeableConcept | Printed form identifier Binding: ?? (example): The forms codes. | |||||||||||
| form | 0..1 | Attachment | Printed reference or actual form | 0..1 | Attachment | Printed reference or actual form | |||||||||||
| processNote | 0..* | BackboneElement | Note concerning adjudication | 0..* | BackboneElement | Note concerning adjudication | |||||||||||
| id | 0..1 | string | Unique id for inter-element referencing | 0..1 | string | Unique id for inter-element referencing | |||||||||||
| extension | 0..* | Extension | Additional content defined by implementations | 0..* | Extension | Additional content defined by implementations | |||||||||||
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | |||||||||
| number | 0..1 | positiveInt | Note instance identifier | 0..1 | positiveInt | Note instance identifier | |||||||||||
| type | 0..1 | code | display | print | printoper Binding: ?? (required): The presentation types of notes. | 0..1 | code | display | print | printoper Binding: ?? (required): The presentation types of notes. | |||||||||||
| text | 1..1 | string | Note explanatory text | 1..1 | string | Note explanatory text | |||||||||||
| language | 0..1 | CodeableConcept | Language of the text Binding: ?? (preferred): A human language.
| 0..1 | CodeableConcept | Language of the text Binding: ?? (preferred): A human language.
| |||||||||||
| communicationRequest | 0..* | Reference(CommunicationRequest) | Request for additional information | 0..* | Reference(CommunicationRequest) | Request for additional information | |||||||||||
| insurance | 0..* | BackboneElement | Patient insurance information | 0..* | BackboneElement | Patient insurance information | |||||||||||
| id | 0..1 | string | Unique id for inter-element referencing | 0..1 | string | Unique id for inter-element referencing | |||||||||||
| extension | 0..* | Extension | Additional content defined by implementations | 0..* | Extension | Additional content defined by implementations | |||||||||||
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | |||||||||
| sequence | 1..1 | positiveInt | Insurance instance identifier | 1..1 | positiveInt | Insurance instance identifier | |||||||||||
| focal | 1..1 | boolean | Coverage to be used for adjudication | 1..1 | boolean | Coverage to be used for adjudication | |||||||||||
| coverage | 1..1 | Reference(Coverage) | Insurance information | 1..1 | Reference(Coverage) | Insurance information | |||||||||||
| businessArrangement | 0..1 | string | Additional provider contract number | 0..1 | string | Additional provider contract number | |||||||||||
| claimResponse | 0..1 | Reference(ClaimResponse) | Adjudication results | 0..1 | Reference(ClaimResponse) | Adjudication results | |||||||||||
| error | 0..* | BackboneElement | Processing errors | 0..* | BackboneElement | Processing errors | |||||||||||
| id | 0..1 | string | Unique id for inter-element referencing | 0..1 | string | Unique id for inter-element referencing | |||||||||||
| extension | 0..* | Extension | Additional content defined by implementations | 0..* | Extension | Additional content defined by implementations | |||||||||||
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | |||||||||
| itemSequence | 0..1 | positiveInt | Item sequence number | 0..1 | positiveInt | Item sequence number | |||||||||||
| detailSequence | 0..1 | positiveInt | Detail sequence number | 0..1 | positiveInt | Detail sequence number | |||||||||||
| subDetailSequence | 0..1 | positiveInt | Subdetail sequence number | 0..1 | positiveInt | Subdetail sequence number | |||||||||||
| code | 1..1 | CodeableConcept | Error code detailing processing issues Binding: ?? (example): The adjudication error codes. | 1..1 | CodeableConcept | Error code detailing processing issues Binding: ?? (example): The adjudication error codes. | |||||||||||
| Documentation for this format | |||||||||||||||||