SIL HIE Implementation Guide, published by Kathurima Kimathi. This guide is not an authorized publication; it is the continuous build for version 0.1.0 built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/savannahghi/hie-fhir-ig-profile/ and changes regularly. See the Directory of published versions

• Content
• Detailed Descriptions
• Mappings
• Examples
• XML
• JSON
• TTL

Resource Profile: HIE ClaimResponse

R4B ClaimResponse constrained for HIE payer adjudication exchanges. Focus on request linkage, parties, outcome, adjudication details, totals, and payment.

Usages:

• Refer to this Profile: HIE ClaimResponse and HIE MedicationRequest
• Examples for this Profile: ClaimResponse/HIEClaimResponse-example

You can also check for usages in the FHIR IG Statistics

Formal Views of Profile Content

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

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

Name	Flags	Card.	Type	Description & Constraints    Filter: Bindings Constraints Obligations
ClaimResponse		0..*	ClaimResponse	Response to a claim predetermination or preauthorization
ClaimResponse.implicitRules	?! This element is a modifier element. Σ This element is included in summaries.	0..1	uri	A set of rules under which this content was created
ClaimResponse.modifierExtension	?! This element is a modifier element.	0..*	Extension	Extensions that cannot be ignored
ClaimResponse.identifier	S This element must be supported.	1..*	Identifier	Business Identifier for a claim response
ClaimResponse.identifier.use	?! This element is a modifier element. Σ This element is included in summaries.	1..1	code	usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required)
ClaimResponse.identifier.type	Σ This element is included in summaries. C	1..1	HIECodeableConcept	Description of identifier Binding: Identifier Type Codes (extensible) Constraints: cc-text-or-code
ClaimResponse.identifier.system	Σ This element is included in summaries.	1..1	uri	The namespace for the identifier value Example General: http://www.acme.com/identifiers/patient
ClaimResponse.identifier.value	S This element must be supported. Σ This element is included in summaries.	1..1	string	The value that is unique Example General: 123456
ClaimResponse.identifier.assigner	S This element must be supported. Σ This element is included in summaries.	0..1	HIEReference(HIE Organization)	Organization that issued id (may be just text)
ClaimResponse.status	?! This element is a modifier element. S This element must be supported. Σ This element is included in summaries.	1..1	code	active | cancelled | draft | entered-in-error Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance.
ClaimResponse.type	Σ This element is included in summaries. C	1..1	HIECodeableConcept	More granular claim type Binding: ClaimTypeCodes (extensible): The type or discipline-style of the claim. Constraints: cc-text-or-code
ClaimResponse.use	S This element must be supported. Σ This element is included in summaries.	1..1	code	claim | preauthorization | predetermination Binding: Use (required): Claim, preauthorization, predetermination.
ClaimResponse.patient	S This element must be supported. Σ This element is included in summaries.	1..1	HIEReference(HIE Patient)	The recipient of the products and services
ClaimResponse.created	S This element must be supported. Σ This element is included in summaries.	1..1	dateTime	Response creation date
ClaimResponse.insurer	S This element must be supported. Σ This element is included in summaries.	1..1	HIEReference(HIE Organization)	Party responsible for reimbursement
ClaimResponse.requestor		1..1	HIEReference(HIE Practitioner | PractitionerRole | HIE Organization)	Party responsible for the claim
ClaimResponse.request	S This element must be supported. Σ This element is included in summaries.	1..1	HIEReference(HIE Claim)	Id of resource triggering adjudication
ClaimResponse.outcome	S This element must be supported. Σ This element is included in summaries.	1..1	code	queued | complete | error | partial Binding: RemittanceOutcome (required): The result of the claim processing.
ClaimResponse.payeeType	C	0..1	HIECodeableConcept	Party to be paid any benefits payable Binding: Claim Payee Type Codes (example): A code for the party to be reimbursed. Constraints: cc-text-or-code
ClaimResponse.item	S This element must be supported.	1..*	BackboneElement	Adjudication for claim line items
ClaimResponse.item.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
ClaimResponse.item.itemSequence		1..1	positiveInt	Claim item instance identifier
ClaimResponse.item.adjudication		1..*	BackboneElement	Adjudication details
ClaimResponse.item.adjudication.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
ClaimResponse.item.adjudication.category	C	1..1	HIECodeableConcept	Type of adjudication information Binding: AdjudicationValueCodes (example): The adjudication codes. Constraints: cc-text-or-code
ClaimResponse.item.adjudication.reason	C	0..1	HIECodeableConcept	Explanation of adjudication outcome Binding: AdjudicationReasonCodes (example): The adjudication reason codes. Constraints: cc-text-or-code
ClaimResponse.item.adjudication.amount		1..1	Money	Monetary amount
ClaimResponse.item.detail		1..*	BackboneElement	Adjudication for claim details
ClaimResponse.item.detail.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
ClaimResponse.item.detail.detailSequence		1..1	positiveInt	Claim detail instance identifier
ClaimResponse.item.detail.adjudication		1..*	BackboneElement	Detail level adjudication details
ClaimResponse.item.detail.adjudication.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
ClaimResponse.item.detail.adjudication.category	C	1..1	HIECodeableConcept	Type of adjudication information Binding: AdjudicationValueCodes (example): The adjudication codes. Constraints: cc-text-or-code
ClaimResponse.item.detail.adjudication.reason	C	0..1	HIECodeableConcept	Explanation of adjudication outcome Binding: AdjudicationReasonCodes (example): The adjudication reason codes. Constraints: cc-text-or-code
ClaimResponse.total	S This element must be supported. Σ This element is included in summaries.	1..*	BackboneElement	Adjudication totals
ClaimResponse.total.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
ClaimResponse.total.category	Σ This element is included in summaries. C	1..1	HIECodeableConcept	Type of adjudication information Binding: AdjudicationValueCodes (example): The adjudication codes. Constraints: cc-text-or-code
ClaimResponse.total.amount	Σ This element is included in summaries.	1..1	Money	Financial total for the category
ClaimResponse.payment		1..1	BackboneElement	Payment Details
ClaimResponse.payment.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
ClaimResponse.payment.type	C	1..1	HIECodeableConcept	Partial or complete payment Binding: ExamplePaymentTypeCodes (example): The type (partial, complete) of the payment. Constraints: cc-text-or-code
ClaimResponse.payment.adjustmentReason	C	0..1	HIECodeableConcept	Explanation for the adjustment Binding: PaymentAdjustmentReasonCodes (example): Payment Adjustment reason codes. Constraints: cc-text-or-code
ClaimResponse.payment.amount		1..1	Money	Payable amount after adjustment
ClaimResponse.fundsReserve	C	0..1	HIECodeableConcept	Funds reserved status Binding: Funds Reservation Codes (example): For whom funds are to be reserved: (Patient, Provider, None). Constraints: cc-text-or-code
ClaimResponse.formCode	C	0..1	HIECodeableConcept	Printed form identifier Binding: Form Codes (example): The forms codes. Constraints: cc-text-or-code
ClaimResponse.communicationRequest		0..*	HIEReference(CommunicationRequest)	Request for additional information
ClaimResponse.insurance		1..*	BackboneElement	Patient insurance information
ClaimResponse.insurance.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
ClaimResponse.insurance.sequence		1..1	positiveInt	Insurance instance identifier
ClaimResponse.insurance.focal		1..1	boolean	Coverage to be used for adjudication
ClaimResponse.insurance.coverage		1..1	HIEReference(Coverage)	Insurance information
ClaimResponse.insurance.claimResponse		0..1	HIEReference(HIE ClaimResponse)	Adjudication results
Documentation for this format

Terminology Bindings

Path	Status	Usage	ValueSet	Version	Source
ClaimResponse.identifier.​use	Base	required	IdentifierUse	📦4.3.0	FHIR Std.
ClaimResponse.identifier.​type	Base	extensible	IdentifierType	📦4.3.0	FHIR Std.
ClaimResponse.status	Base	required	Financial Resource Status Codes	📍4.3.0	FHIR Std.
ClaimResponse.type	Base	extensible	Claim Type Codes	📍4.3.0	FHIR Std.
ClaimResponse.use	Base	required	Use	📍4.3.0	FHIR Std.
ClaimResponse.outcome	Base	required	RemittanceOutcome	📍4.3.0	FHIR Std.
ClaimResponse.payeeType	Base	example	PayeeType	📍4.3.0	FHIR Std.
ClaimResponse.item.adjudication.​category	Base	example	Adjudication Value Codes	📍4.3.0	FHIR Std.
ClaimResponse.item.adjudication.​reason	Base	example	Adjudication Reason Codes	📍4.3.0	FHIR Std.
ClaimResponse.item.detail.​adjudication.category	Base	example	Adjudication Value Codes	📍4.3.0	FHIR Std.
ClaimResponse.item.detail.​adjudication.reason	Base	example	Adjudication Reason Codes	📍4.3.0	FHIR Std.
ClaimResponse.total.​category	Base	example	Adjudication Value Codes	📍4.3.0	FHIR Std.
ClaimResponse.payment.​type	Base	example	Example Payment Type Codes	📍4.3.0	FHIR Std.
ClaimResponse.payment.​adjustmentReason	Base	example	Payment Adjustment Reason Codes	📍4.3.0	FHIR Std.
ClaimResponse.fundsReserve	Base	example	FundsReserve	📍4.3.0	FHIR Std.
ClaimResponse.formCode	Base	example	Forms	📍4.3.0	FHIR Std.

Constraints

Id	Grade	Path(s)	Description	Expression
cc-text-or-code	warning	ClaimResponse.identifier.type, ClaimResponse.type, ClaimResponse.payeeType, ClaimResponse.item.adjudication.category, ClaimResponse.item.adjudication.reason, ClaimResponse.item.detail.adjudication.category, ClaimResponse.item.detail.adjudication.reason, ClaimResponse.total.category, ClaimResponse.payment.type, ClaimResponse.payment.adjustmentReason, ClaimResponse.fundsReserve, ClaimResponse.formCode	Text is optional, coding is required	coding.exists()
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.exists() and ('#'+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(uri) = '#').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    Filter: Bindings Constraints Obligations
ClaimResponse		0..*	ClaimResponse	Response to a claim predetermination or preauthorization
ClaimResponse.identifier	S This element must be supported.	1..*	Identifier	Business Identifier for a claim response
ClaimResponse.identifier.use		1..1	code	usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required)
ClaimResponse.identifier.type		1..1	HIECodeableConcept	Description of identifier Binding: Identifier Type Codes (extensible)
ClaimResponse.identifier.system		1..1	uri	The namespace for the identifier value
ClaimResponse.identifier.value	S This element must be supported.	1..1	string	The value that is unique
ClaimResponse.identifier.assigner	S This element must be supported.	0..1	HIEReference(HIE Organization)	Organization that issued id (may be just text)
ClaimResponse.status	S This element must be supported.	1..1	code	active | cancelled | draft | entered-in-error
ClaimResponse.type		1..1	HIECodeableConcept	More granular claim type
ClaimResponse.use	S This element must be supported.	1..1	code	claim | preauthorization | predetermination
ClaimResponse.patient	S This element must be supported.	1..1	HIEReference(HIE Patient)	The recipient of the products and services
ClaimResponse.created	S This element must be supported.	1..1	dateTime	Response creation date
ClaimResponse.insurer	S This element must be supported.	1..1	HIEReference(HIE Organization)	Party responsible for reimbursement
ClaimResponse.requestor		1..1	HIEReference(HIE Practitioner | PractitionerRole | HIE Organization)	Party responsible for the claim
ClaimResponse.request	S This element must be supported.	1..1	HIEReference(HIE Claim)	Id of resource triggering adjudication
ClaimResponse.outcome	S This element must be supported.	1..1	code	queued | complete | error | partial
ClaimResponse.payeeType		0..1	HIECodeableConcept	Party to be paid any benefits payable
ClaimResponse.item	S This element must be supported.	1..*	BackboneElement	Adjudication for claim line items
ClaimResponse.item.adjudication
ClaimResponse.item.adjudication.category		1..1	HIECodeableConcept	Type of adjudication information
ClaimResponse.item.adjudication.reason		0..1	HIECodeableConcept	Explanation of adjudication outcome
ClaimResponse.item.adjudication.amount		1..1	Money	Monetary amount
ClaimResponse.item.detail		1..*	BackboneElement	Adjudication for claim details
ClaimResponse.item.detail.adjudication		1..*	BackboneElement	Detail level adjudication details
ClaimResponse.item.detail.adjudication.category		1..1	HIECodeableConcept	Type of adjudication information
ClaimResponse.item.detail.adjudication.reason		0..1	HIECodeableConcept	Explanation of adjudication outcome
ClaimResponse.item.detail.subDetail
ClaimResponse.item.detail.subDetail.adjudication		1..*	BackboneElement	Subdetail level adjudication details
ClaimResponse.item.detail.subDetail.adjudication.category		1..1	HIECodeableConcept	Type of adjudication information
ClaimResponse.item.detail.subDetail.adjudication.reason		0..1	HIECodeableConcept	Explanation of adjudication outcome
ClaimResponse.addItem
ClaimResponse.addItem.provider		0..*	HIEReference(HIE Practitioner | PractitionerRole | HIE Organization)	Authorized providers
ClaimResponse.addItem.productOrService		1..1	HIECodeableConcept	Billing, service, product, or drug code
ClaimResponse.addItem.modifier		0..*	HIECodeableConcept	Service/Product billing modifiers
ClaimResponse.addItem.programCode		0..*	HIECodeableConcept	Program the product or service is provided under
ClaimResponse.addItem.bodySite		0..1	HIECodeableConcept	Anatomical location
ClaimResponse.addItem.subSite		0..*	HIECodeableConcept	Anatomical sub-location
ClaimResponse.addItem.adjudication		1..*	BackboneElement	Added items adjudication
ClaimResponse.addItem.adjudication.category		1..1	HIECodeableConcept	Type of adjudication information
ClaimResponse.addItem.adjudication.reason		0..1	HIECodeableConcept	Explanation of adjudication outcome
ClaimResponse.addItem.detail
ClaimResponse.addItem.detail.productOrService		1..1	HIECodeableConcept	Billing, service, product, or drug code
ClaimResponse.addItem.detail.modifier		0..*	HIECodeableConcept	Service/Product billing modifiers
ClaimResponse.addItem.detail.adjudication		1..*	BackboneElement	Added items detail adjudication
ClaimResponse.addItem.detail.adjudication.category		1..1	HIECodeableConcept	Type of adjudication information
ClaimResponse.addItem.detail.adjudication.reason		0..1	HIECodeableConcept	Explanation of adjudication outcome
ClaimResponse.addItem.detail.subDetail
ClaimResponse.addItem.detail.subDetail.productOrService		1..1	HIECodeableConcept	Billing, service, product, or drug code
ClaimResponse.addItem.detail.subDetail.modifier		0..*	HIECodeableConcept	Service/Product billing modifiers
ClaimResponse.addItem.detail.subDetail.adjudication		1..*	BackboneElement	Added items detail adjudication
ClaimResponse.addItem.detail.subDetail.adjudication.category		1..1	HIECodeableConcept	Type of adjudication information
ClaimResponse.addItem.detail.subDetail.adjudication.reason		0..1	HIECodeableConcept	Explanation of adjudication outcome
ClaimResponse.total	S This element must be supported.	1..*	BackboneElement	Adjudication totals
ClaimResponse.total.category		1..1	HIECodeableConcept	Type of adjudication information
ClaimResponse.payment		1..1	BackboneElement	Payment Details
ClaimResponse.payment.type		1..1	HIECodeableConcept	Partial or complete payment
ClaimResponse.payment.adjustmentReason		0..1	HIECodeableConcept	Explanation for the adjustment
ClaimResponse.fundsReserve		0..1	HIECodeableConcept	Funds reserved status
ClaimResponse.formCode		0..1	HIECodeableConcept	Printed form identifier
ClaimResponse.processNote
ClaimResponse.processNote.language		0..1	HIECodeableConcept	Language of the text
ClaimResponse.communicationRequest		0..*	HIEReference(CommunicationRequest)	Request for additional information
ClaimResponse.insurance		1..*	BackboneElement	Patient insurance information
ClaimResponse.insurance.coverage		1..1	HIEReference(Coverage)	Insurance information
ClaimResponse.insurance.claimResponse		0..1	HIEReference(HIE ClaimResponse)	Adjudication results
Documentation for this format

Terminology Bindings (Differential)

Path	Status	Usage	ValueSet	Version	Source
ClaimResponse.identifier.​use	Base	required	IdentifierUse	📦4.3.0	FHIR Std.
ClaimResponse.identifier.​type	Base	extensible	IdentifierType	📦4.3.0	FHIR Std.

Name	Flags	Card.	Type	Description & Constraints    Filter: Bindings Constraints Obligations
ClaimResponse		0..*	ClaimResponse	Response to a claim predetermination or preauthorization
ClaimResponse.id	Σ This element is included in summaries.	0..1	id	Logical id of this artifact
ClaimResponse.meta	Σ This element is included in summaries.	0..1	Meta	Metadata about the resource
ClaimResponse.implicitRules	?! This element is a modifier element. Σ This element is included in summaries.	0..1	uri	A set of rules under which this content was created
ClaimResponse.language		0..1	code	Language of the resource content Binding: CommonLanguages (preferred): IETF language tag Additional Bindings Purpose AllLanguages Max Binding
ClaimResponse.text		0..1	Narrative	Text summary of the resource, for human interpretation This profile does not constrain the narrative in regard to content, language, or traceability to data elements
ClaimResponse.contained		0..*	Resource	Contained, inline Resources Constraints: dom-r4b
ClaimResponse.extension		0..*	Extension	Additional content defined by implementations
ClaimResponse.modifierExtension	?! This element is a modifier element.	0..*	Extension	Extensions that cannot be ignored
ClaimResponse.identifier	S This element must be supported.	1..*	Identifier	Business Identifier for a claim response
ClaimResponse.identifier.id		0..1	id	Unique id for inter-element referencing
ClaimResponse.identifier.extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
ClaimResponse.identifier.use	?! This element is a modifier element. Σ This element is included in summaries.	1..1	code	usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required)
ClaimResponse.identifier.type	Σ This element is included in summaries. C	1..1	HIECodeableConcept	Description of identifier Binding: Identifier Type Codes (extensible) Constraints: cc-text-or-code
ClaimResponse.identifier.system	Σ This element is included in summaries.	1..1	uri	The namespace for the identifier value Example General: http://www.acme.com/identifiers/patient
ClaimResponse.identifier.value	S This element must be supported. Σ This element is included in summaries.	1..1	string	The value that is unique Example General: 123456
ClaimResponse.identifier.period	Σ This element is included in summaries.	0..1	Period	Time period when id is/was valid for use
ClaimResponse.identifier.assigner	S This element must be supported. Σ This element is included in summaries.	0..1	HIEReference(HIE Organization)	Organization that issued id (may be just text)
ClaimResponse.status	?! This element is a modifier element. S This element must be supported. Σ This element is included in summaries.	1..1	code	active | cancelled | draft | entered-in-error Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance.
ClaimResponse.type	Σ This element is included in summaries. C	1..1	HIECodeableConcept	More granular claim type Binding: ClaimTypeCodes (extensible): The type or discipline-style of the claim. Constraints: cc-text-or-code
ClaimResponse.subType		0..1	CodeableConcept	More granular claim type Binding: ExampleClaimSubTypeCodes (example): A more granular claim typecode.
ClaimResponse.use	S This element must be supported. Σ This element is included in summaries.	1..1	code	claim | preauthorization | predetermination Binding: Use (required): Claim, preauthorization, predetermination.
ClaimResponse.patient	S This element must be supported. Σ This element is included in summaries.	1..1	HIEReference(HIE Patient)	The recipient of the products and services
ClaimResponse.created	S This element must be supported. Σ This element is included in summaries.	1..1	dateTime	Response creation date
ClaimResponse.insurer	S This element must be supported. Σ This element is included in summaries.	1..1	HIEReference(HIE Organization)	Party responsible for reimbursement
ClaimResponse.requestor		1..1	HIEReference(HIE Practitioner | PractitionerRole | HIE Organization)	Party responsible for the claim
ClaimResponse.request	S This element must be supported. Σ This element is included in summaries.	1..1	HIEReference(HIE Claim)	Id of resource triggering adjudication
ClaimResponse.outcome	S This element must be supported. Σ This element is included in summaries.	1..1	code	queued | complete | error | partial Binding: RemittanceOutcome (required): The result of the claim processing.
ClaimResponse.disposition		0..1	string	Disposition Message
ClaimResponse.preAuthRef		0..1	string	Preauthorization reference
ClaimResponse.preAuthPeriod		0..1	Period	Preauthorization reference effective period
ClaimResponse.payeeType	C	0..1	HIECodeableConcept	Party to be paid any benefits payable Binding: Claim Payee Type Codes (example): A code for the party to be reimbursed. Constraints: cc-text-or-code
ClaimResponse.item	S This element must be supported.	1..*	BackboneElement	Adjudication for claim line items
ClaimResponse.item.id		0..1	string	Unique id for inter-element referencing
ClaimResponse.item.extension		0..*	Extension	Additional content defined by implementations
ClaimResponse.item.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
ClaimResponse.item.itemSequence		1..1	positiveInt	Claim item instance identifier
ClaimResponse.item.noteNumber		0..*	positiveInt	Applicable note numbers
ClaimResponse.item.adjudication		1..*	BackboneElement	Adjudication details
ClaimResponse.item.adjudication.id		0..1	string	Unique id for inter-element referencing
ClaimResponse.item.adjudication.extension		0..*	Extension	Additional content defined by implementations
ClaimResponse.item.adjudication.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
ClaimResponse.item.adjudication.category	C	1..1	HIECodeableConcept	Type of adjudication information Binding: AdjudicationValueCodes (example): The adjudication codes. Constraints: cc-text-or-code
ClaimResponse.item.adjudication.reason	C	0..1	HIECodeableConcept	Explanation of adjudication outcome Binding: AdjudicationReasonCodes (example): The adjudication reason codes. Constraints: cc-text-or-code
ClaimResponse.item.adjudication.amount		1..1	Money	Monetary amount
ClaimResponse.item.adjudication.value		0..1	decimal	Non-monetary value
ClaimResponse.item.detail		1..*	BackboneElement	Adjudication for claim details
ClaimResponse.item.detail.id		0..1	string	Unique id for inter-element referencing
ClaimResponse.item.detail.extension		0..*	Extension	Additional content defined by implementations
ClaimResponse.item.detail.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
ClaimResponse.item.detail.detailSequence		1..1	positiveInt	Claim detail instance identifier
ClaimResponse.item.detail.noteNumber		0..*	positiveInt	Applicable note numbers
ClaimResponse.item.detail.adjudication		1..*	BackboneElement	Detail level adjudication details
ClaimResponse.item.detail.adjudication.id		0..1	string	Unique id for inter-element referencing
ClaimResponse.item.detail.adjudication.extension		0..*	Extension	Additional content defined by implementations
ClaimResponse.item.detail.adjudication.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
ClaimResponse.item.detail.adjudication.category	C	1..1	HIECodeableConcept	Type of adjudication information Binding: AdjudicationValueCodes (example): The adjudication codes. Constraints: cc-text-or-code
ClaimResponse.item.detail.adjudication.reason	C	0..1	HIECodeableConcept	Explanation of adjudication outcome Binding: AdjudicationReasonCodes (example): The adjudication reason codes. Constraints: cc-text-or-code
ClaimResponse.item.detail.adjudication.amount		0..1	Money	Monetary amount
ClaimResponse.item.detail.adjudication.value		0..1	decimal	Non-monetary value
ClaimResponse.item.detail.subDetail		0..*	BackboneElement	Adjudication for claim sub-details
ClaimResponse.item.detail.subDetail.id		0..1	string	Unique id for inter-element referencing
ClaimResponse.item.detail.subDetail.extension		0..*	Extension	Additional content defined by implementations
ClaimResponse.item.detail.subDetail.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
ClaimResponse.item.detail.subDetail.subDetailSequence		1..1	positiveInt	Claim sub-detail instance identifier
ClaimResponse.item.detail.subDetail.noteNumber		0..*	positiveInt	Applicable note numbers
ClaimResponse.item.detail.subDetail.adjudication		1..*	BackboneElement	Subdetail level adjudication details
ClaimResponse.item.detail.subDetail.adjudication.id		0..1	string	Unique id for inter-element referencing
ClaimResponse.item.detail.subDetail.adjudication.extension		0..*	Extension	Additional content defined by implementations
ClaimResponse.item.detail.subDetail.adjudication.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
ClaimResponse.item.detail.subDetail.adjudication.category	C	1..1	HIECodeableConcept	Type of adjudication information Binding: AdjudicationValueCodes (example): The adjudication codes. Constraints: cc-text-or-code
ClaimResponse.item.detail.subDetail.adjudication.reason	C	0..1	HIECodeableConcept	Explanation of adjudication outcome Binding: AdjudicationReasonCodes (example): The adjudication reason codes. Constraints: cc-text-or-code
ClaimResponse.item.detail.subDetail.adjudication.amount		0..1	Money	Monetary amount
ClaimResponse.item.detail.subDetail.adjudication.value		0..1	decimal	Non-monetary value
ClaimResponse.addItem		0..*	BackboneElement	Insurer added line items
ClaimResponse.addItem.id		0..1	string	Unique id for inter-element referencing
ClaimResponse.addItem.extension		0..*	Extension	Additional content defined by implementations
ClaimResponse.addItem.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
ClaimResponse.addItem.itemSequence		0..*	positiveInt	Item sequence number
ClaimResponse.addItem.detailSequence		0..*	positiveInt	Detail sequence number
ClaimResponse.addItem.subdetailSequence		0..*	positiveInt	Subdetail sequence number
ClaimResponse.addItem.provider		0..*	HIEReference(HIE Practitioner | PractitionerRole | HIE Organization)	Authorized providers
ClaimResponse.addItem.productOrService	C	1..1	HIECodeableConcept	Billing, service, product, or drug code Binding: USCLSCodes (example): Allowable service and product codes. Constraints: cc-text-or-code
ClaimResponse.addItem.modifier	C	0..*	HIECodeableConcept	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. Constraints: cc-text-or-code
ClaimResponse.addItem.programCode	C	0..*	HIECodeableConcept	Program the product or service is provided under Binding: ExampleProgramReasonCodes (example): Program specific reason codes. Constraints: cc-text-or-code
ClaimResponse.addItem.serviced[x]		0..1		Date or dates of service or product delivery
ClaimResponse.addItem.serviced[x].servicedDate			date
ClaimResponse.addItem.serviced[x].servicedPeriod			Period
ClaimResponse.addItem.location[x]		0..1		Place of service or where product was supplied Binding: ExampleServicePlaceCodes (example): Place of service: pharmacy, school, prison, etc.
ClaimResponse.addItem.location[x].locationCodeableConcept			CodeableConcept
ClaimResponse.addItem.location[x].locationAddress			Address
ClaimResponse.addItem.location[x].locationReference			Reference(Location)
ClaimResponse.addItem.quantity	C	0..1	SimpleQuantity(4.3.0)	Count of products or services Constraints: sqty-1
ClaimResponse.addItem.unitPrice		0..1	Money	Fee, charge or cost per item
ClaimResponse.addItem.factor		0..1	decimal	Price scaling factor
ClaimResponse.addItem.net		0..1	Money	Total item cost
ClaimResponse.addItem.bodySite	C	0..1	HIECodeableConcept	Anatomical location Binding: OralSiteCodes (example): The code for the teeth, quadrant, sextant and arch. Constraints: cc-text-or-code
ClaimResponse.addItem.subSite	C	0..*	HIECodeableConcept	Anatomical sub-location Binding: SurfaceCodes (example): The code for the tooth surface and surface combinations. Constraints: cc-text-or-code
ClaimResponse.addItem.noteNumber		0..*	positiveInt	Applicable note numbers
ClaimResponse.addItem.adjudication		1..*	BackboneElement	Added items adjudication
ClaimResponse.addItem.adjudication.id		0..1	string	Unique id for inter-element referencing
ClaimResponse.addItem.adjudication.extension		0..*	Extension	Additional content defined by implementations
ClaimResponse.addItem.adjudication.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
ClaimResponse.addItem.adjudication.category	C	1..1	HIECodeableConcept	Type of adjudication information Binding: AdjudicationValueCodes (example): The adjudication codes. Constraints: cc-text-or-code
ClaimResponse.addItem.adjudication.reason	C	0..1	HIECodeableConcept	Explanation of adjudication outcome Binding: AdjudicationReasonCodes (example): The adjudication reason codes. Constraints: cc-text-or-code
ClaimResponse.addItem.adjudication.amount		0..1	Money	Monetary amount
ClaimResponse.addItem.adjudication.value		0..1	decimal	Non-monetary value
ClaimResponse.addItem.detail		0..*	BackboneElement	Insurer added line details
ClaimResponse.addItem.detail.id		0..1	string	Unique id for inter-element referencing
ClaimResponse.addItem.detail.extension		0..*	Extension	Additional content defined by implementations
ClaimResponse.addItem.detail.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
ClaimResponse.addItem.detail.productOrService	C	1..1	HIECodeableConcept	Billing, service, product, or drug code Binding: USCLSCodes (example): Allowable service and product codes. Constraints: cc-text-or-code
ClaimResponse.addItem.detail.modifier	C	0..*	HIECodeableConcept	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. Constraints: cc-text-or-code
ClaimResponse.addItem.detail.quantity	C	0..1	SimpleQuantity(4.3.0)	Count of products or services Constraints: sqty-1
ClaimResponse.addItem.detail.unitPrice		0..1	Money	Fee, charge or cost per item
ClaimResponse.addItem.detail.factor		0..1	decimal	Price scaling factor
ClaimResponse.addItem.detail.net		0..1	Money	Total item cost
ClaimResponse.addItem.detail.noteNumber		0..*	positiveInt	Applicable note numbers
ClaimResponse.addItem.detail.adjudication		1..*	BackboneElement	Added items detail adjudication
ClaimResponse.addItem.detail.adjudication.id		0..1	string	Unique id for inter-element referencing
ClaimResponse.addItem.detail.adjudication.extension		0..*	Extension	Additional content defined by implementations
ClaimResponse.addItem.detail.adjudication.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
ClaimResponse.addItem.detail.adjudication.category	C	1..1	HIECodeableConcept	Type of adjudication information Binding: AdjudicationValueCodes (example): The adjudication codes. Constraints: cc-text-or-code
ClaimResponse.addItem.detail.adjudication.reason	C	0..1	HIECodeableConcept	Explanation of adjudication outcome Binding: AdjudicationReasonCodes (example): The adjudication reason codes. Constraints: cc-text-or-code
ClaimResponse.addItem.detail.adjudication.amount		0..1	Money	Monetary amount
ClaimResponse.addItem.detail.adjudication.value		0..1	decimal	Non-monetary value
ClaimResponse.addItem.detail.subDetail		0..*	BackboneElement	Insurer added line items
ClaimResponse.addItem.detail.subDetail.id		0..1	string	Unique id for inter-element referencing
ClaimResponse.addItem.detail.subDetail.extension		0..*	Extension	Additional content defined by implementations
ClaimResponse.addItem.detail.subDetail.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
ClaimResponse.addItem.detail.subDetail.productOrService	C	1..1	HIECodeableConcept	Billing, service, product, or drug code Binding: USCLSCodes (example): Allowable service and product codes. Constraints: cc-text-or-code
ClaimResponse.addItem.detail.subDetail.modifier	C	0..*	HIECodeableConcept	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. Constraints: cc-text-or-code
ClaimResponse.addItem.detail.subDetail.quantity	C	0..1	SimpleQuantity(4.3.0)	Count of products or services Constraints: sqty-1
ClaimResponse.addItem.detail.subDetail.unitPrice		0..1	Money	Fee, charge or cost per item
ClaimResponse.addItem.detail.subDetail.factor		0..1	decimal	Price scaling factor
ClaimResponse.addItem.detail.subDetail.net		0..1	Money	Total item cost
ClaimResponse.addItem.detail.subDetail.noteNumber		0..*	positiveInt	Applicable note numbers
ClaimResponse.addItem.detail.subDetail.adjudication		1..*	BackboneElement	Added items detail adjudication
ClaimResponse.addItem.detail.subDetail.adjudication.id		0..1	string	Unique id for inter-element referencing
ClaimResponse.addItem.detail.subDetail.adjudication.extension		0..*	Extension	Additional content defined by implementations
ClaimResponse.addItem.detail.subDetail.adjudication.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
ClaimResponse.addItem.detail.subDetail.adjudication.category	C	1..1	HIECodeableConcept	Type of adjudication information Binding: AdjudicationValueCodes (example): The adjudication codes. Constraints: cc-text-or-code
ClaimResponse.addItem.detail.subDetail.adjudication.reason	C	0..1	HIECodeableConcept	Explanation of adjudication outcome Binding: AdjudicationReasonCodes (example): The adjudication reason codes. Constraints: cc-text-or-code
ClaimResponse.addItem.detail.subDetail.adjudication.amount		0..1	Money	Monetary amount
ClaimResponse.addItem.detail.subDetail.adjudication.value		0..1	decimal	Non-monetary value
ClaimResponse.adjudication		0..*	See adjudication (ClaimResponse)	Header-level adjudication
ClaimResponse.total	S This element must be supported. Σ This element is included in summaries.	1..*	BackboneElement	Adjudication totals
ClaimResponse.total.id		0..1	string	Unique id for inter-element referencing
ClaimResponse.total.extension		0..*	Extension	Additional content defined by implementations
ClaimResponse.total.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
ClaimResponse.total.category	Σ This element is included in summaries. C	1..1	HIECodeableConcept	Type of adjudication information Binding: AdjudicationValueCodes (example): The adjudication codes. Constraints: cc-text-or-code
ClaimResponse.total.amount	Σ This element is included in summaries.	1..1	Money	Financial total for the category
ClaimResponse.payment		1..1	BackboneElement	Payment Details
ClaimResponse.payment.id		0..1	string	Unique id for inter-element referencing
ClaimResponse.payment.extension		0..*	Extension	Additional content defined by implementations
ClaimResponse.payment.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
ClaimResponse.payment.type	C	1..1	HIECodeableConcept	Partial or complete payment Binding: ExamplePaymentTypeCodes (example): The type (partial, complete) of the payment. Constraints: cc-text-or-code
ClaimResponse.payment.adjustment		0..1	Money	Payment adjustment for non-claim issues
ClaimResponse.payment.adjustmentReason	C	0..1	HIECodeableConcept	Explanation for the adjustment Binding: PaymentAdjustmentReasonCodes (example): Payment Adjustment reason codes. Constraints: cc-text-or-code
ClaimResponse.payment.date		0..1	date	Expected date of payment
ClaimResponse.payment.amount		1..1	Money	Payable amount after adjustment
ClaimResponse.payment.identifier		0..1	Identifier	Business identifier for the payment
ClaimResponse.fundsReserve	C	0..1	HIECodeableConcept	Funds reserved status Binding: Funds Reservation Codes (example): For whom funds are to be reserved: (Patient, Provider, None). Constraints: cc-text-or-code
ClaimResponse.formCode	C	0..1	HIECodeableConcept	Printed form identifier Binding: Form Codes (example): The forms codes. Constraints: cc-text-or-code
ClaimResponse.form		0..1	Attachment	Printed reference or actual form
ClaimResponse.processNote		0..*	BackboneElement	Note concerning adjudication
ClaimResponse.processNote.id		0..1	string	Unique id for inter-element referencing
ClaimResponse.processNote.extension		0..*	Extension	Additional content defined by implementations
ClaimResponse.processNote.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
ClaimResponse.processNote.number		0..1	positiveInt	Note instance identifier
ClaimResponse.processNote.type		0..1	code	display | print | printoper Binding: NoteType (required): The presentation types of notes.
ClaimResponse.processNote.text		1..1	string	Note explanatory text
ClaimResponse.processNote.language	C	0..1	HIECodeableConcept	Language of the text Binding: CommonLanguages (preferred): IETF language tag Additional Bindings Purpose AllLanguages Max Binding Constraints: cc-text-or-code
ClaimResponse.communicationRequest		0..*	HIEReference(CommunicationRequest)	Request for additional information
ClaimResponse.insurance		1..*	BackboneElement	Patient insurance information
ClaimResponse.insurance.id		0..1	string	Unique id for inter-element referencing
ClaimResponse.insurance.extension		0..*	Extension	Additional content defined by implementations
ClaimResponse.insurance.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
ClaimResponse.insurance.sequence		1..1	positiveInt	Insurance instance identifier
ClaimResponse.insurance.focal		1..1	boolean	Coverage to be used for adjudication
ClaimResponse.insurance.coverage		1..1	HIEReference(Coverage)	Insurance information
ClaimResponse.insurance.businessArrangement		0..1	string	Additional provider contract number
ClaimResponse.insurance.claimResponse		0..1	HIEReference(HIE ClaimResponse)	Adjudication results
ClaimResponse.error		0..*	BackboneElement	Processing errors
ClaimResponse.error.id		0..1	string	Unique id for inter-element referencing
ClaimResponse.error.extension		0..*	Extension	Additional content defined by implementations
ClaimResponse.error.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
ClaimResponse.error.itemSequence		0..1	positiveInt	Item sequence number
ClaimResponse.error.detailSequence		0..1	positiveInt	Detail sequence number
ClaimResponse.error.subDetailSequence		0..1	positiveInt	Subdetail sequence number
ClaimResponse.error.code		1..1	CodeableConcept	Error code detailing processing issues Binding: Adjudication Error Codes (example): The adjudication error codes.
Documentation for this format

Terminology Bindings

Path	Status	Usage	ValueSet	Version	Source
ClaimResponse.language	Base	preferred	Common Languages	📍4.3.0	FHIR Std.
ClaimResponse.identifier.​use	Base	required	IdentifierUse	📦4.3.0	FHIR Std.
ClaimResponse.identifier.​type	Base	extensible	IdentifierType	📦4.3.0	FHIR Std.
ClaimResponse.status	Base	required	Financial Resource Status Codes	📍4.3.0	FHIR Std.
ClaimResponse.type	Base	extensible	Claim Type Codes	📍4.3.0	FHIR Std.
ClaimResponse.subType	Base	example	Example Claim SubType Codes	📍4.3.0	FHIR Std.
ClaimResponse.use	Base	required	Use	📍4.3.0	FHIR Std.
ClaimResponse.outcome	Base	required	RemittanceOutcome	📍4.3.0	FHIR Std.
ClaimResponse.payeeType	Base	example	PayeeType	📍4.3.0	FHIR Std.
ClaimResponse.item.adjudication.​category	Base	example	Adjudication Value Codes	📍4.3.0	FHIR Std.
ClaimResponse.item.adjudication.​reason	Base	example	Adjudication Reason Codes	📍4.3.0	FHIR Std.
ClaimResponse.item.detail.​adjudication.category	Base	example	Adjudication Value Codes	📍4.3.0	FHIR Std.
ClaimResponse.item.detail.​adjudication.reason	Base	example	Adjudication Reason Codes	📍4.3.0	FHIR Std.
ClaimResponse.item.detail.​subDetail.adjudication.​category	Base	example	Adjudication Value Codes	📍4.3.0	FHIR Std.
ClaimResponse.item.detail.​subDetail.adjudication.​reason	Base	example	Adjudication Reason Codes	📍4.3.0	FHIR Std.
ClaimResponse.addItem.​productOrService	Base	example	USCLS Codes	📍4.3.0	FHIR Std.
ClaimResponse.addItem.​modifier	Base	example	Modifier type Codes	📍4.3.0	FHIR Std.
ClaimResponse.addItem.​programCode	Base	example	Example Program Reason Codes	📍4.3.0	FHIR Std.
ClaimResponse.addItem.​location[x]	Base	example	Example Service Place Codes	📍4.3.0	FHIR Std.
ClaimResponse.addItem.​bodySite	Base	example	Oral Site Codes	📍4.3.0	FHIR Std.
ClaimResponse.addItem.​subSite	Base	example	Surface Codes	📍4.3.0	FHIR Std.
ClaimResponse.addItem.​adjudication.category	Base	example	Adjudication Value Codes	📍4.3.0	FHIR Std.
ClaimResponse.addItem.​adjudication.reason	Base	example	Adjudication Reason Codes	📍4.3.0	FHIR Std.
ClaimResponse.addItem.​detail.productOrService	Base	example	USCLS Codes	📍4.3.0	FHIR Std.
ClaimResponse.addItem.​detail.modifier	Base	example	Modifier type Codes	📍4.3.0	FHIR Std.
ClaimResponse.addItem.​detail.adjudication.​category	Base	example	Adjudication Value Codes	📍4.3.0	FHIR Std.
ClaimResponse.addItem.​detail.adjudication.​reason	Base	example	Adjudication Reason Codes	📍4.3.0	FHIR Std.
ClaimResponse.addItem.​detail.subDetail.productOrService	Base	example	USCLS Codes	📍4.3.0	FHIR Std.
ClaimResponse.addItem.​detail.subDetail.modifier	Base	example	Modifier type Codes	📍4.3.0	FHIR Std.
ClaimResponse.addItem.​detail.subDetail.adjudication.​category	Base	example	Adjudication Value Codes	📍4.3.0	FHIR Std.
ClaimResponse.addItem.​detail.subDetail.adjudication.​reason	Base	example	Adjudication Reason Codes	📍4.3.0	FHIR Std.
ClaimResponse.total.​category	Base	example	Adjudication Value Codes	📍4.3.0	FHIR Std.
ClaimResponse.payment.​type	Base	example	Example Payment Type Codes	📍4.3.0	FHIR Std.
ClaimResponse.payment.​adjustmentReason	Base	example	Payment Adjustment Reason Codes	📍4.3.0	FHIR Std.
ClaimResponse.fundsReserve	Base	example	FundsReserve	📍4.3.0	FHIR Std.
ClaimResponse.formCode	Base	example	Forms	📍4.3.0	FHIR Std.
ClaimResponse.processNote.​type	Base	required	NoteType	📍4.3.0	FHIR Std.
ClaimResponse.processNote.​language	Base	preferred	Common Languages	📍4.3.0	FHIR Std.
ClaimResponse.error.​code	Base	example	AdjudicationError	📍4.3.0	FHIR Std.

Constraints

Id	Grade	Path(s)	Description	Expression
cc-text-or-code	warning	ClaimResponse.identifier.type, ClaimResponse.type, ClaimResponse.payeeType, ClaimResponse.item.adjudication.category, ClaimResponse.item.adjudication.reason, ClaimResponse.item.detail.adjudication.category, ClaimResponse.item.detail.adjudication.reason, ClaimResponse.item.detail.subDetail.adjudication.category, ClaimResponse.item.detail.subDetail.adjudication.reason, ClaimResponse.addItem.productOrService, ClaimResponse.addItem.modifier, ClaimResponse.addItem.programCode, ClaimResponse.addItem.bodySite, ClaimResponse.addItem.subSite, ClaimResponse.addItem.adjudication.category, ClaimResponse.addItem.adjudication.reason, ClaimResponse.addItem.detail.productOrService, ClaimResponse.addItem.detail.modifier, ClaimResponse.addItem.detail.adjudication.category, ClaimResponse.addItem.detail.adjudication.reason, ClaimResponse.addItem.detail.subDetail.productOrService, ClaimResponse.addItem.detail.subDetail.modifier, ClaimResponse.addItem.detail.subDetail.adjudication.category, ClaimResponse.addItem.detail.subDetail.adjudication.reason, ClaimResponse.total.category, ClaimResponse.payment.type, ClaimResponse.payment.adjustmentReason, ClaimResponse.fundsReserve, ClaimResponse.formCode, ClaimResponse.processNote.language	Text is optional, coding is required	coding.exists()
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.exists() and ('#'+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(uri) = '#').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()
dom-r4b	warning	ClaimResponse.contained	Containing new R4B resources within R4 resources may cause interoperability issues if instances are shared with R4 systems	($this is Citation or $this is Evidence or $this is EvidenceReport or $this is EvidenceVariable or $this is MedicinalProductDefinition or $this is PackagedProductDefinition or $this is AdministrableProductDefinition or $this is Ingredient or $this is ClinicalUseDefinition or $this is RegulatedAuthorization or $this is SubstanceDefinition or $this is SubscriptionStatus or $this is SubscriptionTopic) implies (%resource is Citation or %resource is Evidence or %resource is EvidenceReport or %resource is EvidenceVariable or %resource is MedicinalProductDefinition or %resource is PackagedProductDefinition or %resource is AdministrableProductDefinition or %resource is Ingredient or %resource is ClinicalUseDefinition or %resource is RegulatedAuthorization or %resource is SubstanceDefinition or %resource is SubscriptionStatus or %resource is SubscriptionTopic)
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()
sqty-1	error	ClaimResponse.addItem.quantity, ClaimResponse.addItem.detail.quantity, ClaimResponse.addItem.detail.subDetail.quantity	The comparator is not used on a SimpleQuantity	comparator.empty()

This structure is derived from ClaimResponse

Summary

Mandatory: 13 elements(1 nested mandatory element)
Must-Support: 12 elements

Structures

This structure refers to these other structures:

• HIE CodeableConcept (https://nshr.dha.go.ke/fhir/StructureDefinition/codeable-concept)
• HIE Reference (https://nshr.dha.go.ke/fhir/StructureDefinition/reference)
• HIE Organization (https://nshr.dha.go.ke/fhir/StructureDefinition/organization)
• HIE Patient (https://nshr.dha.go.ke/fhir/StructureDefinition/patient)
• HIE Practitioner (https://nshr.dha.go.ke/fhir/StructureDefinition/practitioner)
• HIE Claim (https://nshr.dha.go.ke/fhir/StructureDefinition/claim)
• HIE ClaimResponse (https://nshr.dha.go.ke/fhir/StructureDefinition/claimresponse)

Key Elements View

Name	Flags	Card.	Type	Description & Constraints    Filter: Bindings Constraints Obligations
ClaimResponse		0..*	ClaimResponse	Response to a claim predetermination or preauthorization
ClaimResponse.implicitRules	?! This element is a modifier element. Σ This element is included in summaries.	0..1	uri	A set of rules under which this content was created
ClaimResponse.modifierExtension	?! This element is a modifier element.	0..*	Extension	Extensions that cannot be ignored
ClaimResponse.identifier	S This element must be supported.	1..*	Identifier	Business Identifier for a claim response
ClaimResponse.identifier.use	?! This element is a modifier element. Σ This element is included in summaries.	1..1	code	usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required)
ClaimResponse.identifier.type	Σ This element is included in summaries. C	1..1	HIECodeableConcept	Description of identifier Binding: Identifier Type Codes (extensible) Constraints: cc-text-or-code
ClaimResponse.identifier.system	Σ This element is included in summaries.	1..1	uri	The namespace for the identifier value Example General: http://www.acme.com/identifiers/patient
ClaimResponse.identifier.value	S This element must be supported. Σ This element is included in summaries.	1..1	string	The value that is unique Example General: 123456
ClaimResponse.identifier.assigner	S This element must be supported. Σ This element is included in summaries.	0..1	HIEReference(HIE Organization)	Organization that issued id (may be just text)
ClaimResponse.status	?! This element is a modifier element. S This element must be supported. Σ This element is included in summaries.	1..1	code	active | cancelled | draft | entered-in-error Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance.
ClaimResponse.type	Σ This element is included in summaries. C	1..1	HIECodeableConcept	More granular claim type Binding: ClaimTypeCodes (extensible): The type or discipline-style of the claim. Constraints: cc-text-or-code
ClaimResponse.use	S This element must be supported. Σ This element is included in summaries.	1..1	code	claim | preauthorization | predetermination Binding: Use (required): Claim, preauthorization, predetermination.
ClaimResponse.patient	S This element must be supported. Σ This element is included in summaries.	1..1	HIEReference(HIE Patient)	The recipient of the products and services
ClaimResponse.created	S This element must be supported. Σ This element is included in summaries.	1..1	dateTime	Response creation date
ClaimResponse.insurer	S This element must be supported. Σ This element is included in summaries.	1..1	HIEReference(HIE Organization)	Party responsible for reimbursement
ClaimResponse.requestor		1..1	HIEReference(HIE Practitioner | PractitionerRole | HIE Organization)	Party responsible for the claim
ClaimResponse.request	S This element must be supported. Σ This element is included in summaries.	1..1	HIEReference(HIE Claim)	Id of resource triggering adjudication
ClaimResponse.outcome	S This element must be supported. Σ This element is included in summaries.	1..1	code	queued | complete | error | partial Binding: RemittanceOutcome (required): The result of the claim processing.
ClaimResponse.payeeType	C	0..1	HIECodeableConcept	Party to be paid any benefits payable Binding: Claim Payee Type Codes (example): A code for the party to be reimbursed. Constraints: cc-text-or-code
ClaimResponse.item	S This element must be supported.	1..*	BackboneElement	Adjudication for claim line items
ClaimResponse.item.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
ClaimResponse.item.itemSequence		1..1	positiveInt	Claim item instance identifier
ClaimResponse.item.adjudication		1..*	BackboneElement	Adjudication details
ClaimResponse.item.adjudication.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
ClaimResponse.item.adjudication.category	C	1..1	HIECodeableConcept	Type of adjudication information Binding: AdjudicationValueCodes (example): The adjudication codes. Constraints: cc-text-or-code
ClaimResponse.item.adjudication.reason	C	0..1	HIECodeableConcept	Explanation of adjudication outcome Binding: AdjudicationReasonCodes (example): The adjudication reason codes. Constraints: cc-text-or-code
ClaimResponse.item.adjudication.amount		1..1	Money	Monetary amount
ClaimResponse.item.detail		1..*	BackboneElement	Adjudication for claim details
ClaimResponse.item.detail.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
ClaimResponse.item.detail.detailSequence		1..1	positiveInt	Claim detail instance identifier
ClaimResponse.item.detail.adjudication		1..*	BackboneElement	Detail level adjudication details
ClaimResponse.item.detail.adjudication.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
ClaimResponse.item.detail.adjudication.category	C	1..1	HIECodeableConcept	Type of adjudication information Binding: AdjudicationValueCodes (example): The adjudication codes. Constraints: cc-text-or-code
ClaimResponse.item.detail.adjudication.reason	C	0..1	HIECodeableConcept	Explanation of adjudication outcome Binding: AdjudicationReasonCodes (example): The adjudication reason codes. Constraints: cc-text-or-code
ClaimResponse.total	S This element must be supported. Σ This element is included in summaries.	1..*	BackboneElement	Adjudication totals
ClaimResponse.total.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
ClaimResponse.total.category	Σ This element is included in summaries. C	1..1	HIECodeableConcept	Type of adjudication information Binding: AdjudicationValueCodes (example): The adjudication codes. Constraints: cc-text-or-code
ClaimResponse.total.amount	Σ This element is included in summaries.	1..1	Money	Financial total for the category
ClaimResponse.payment		1..1	BackboneElement	Payment Details
ClaimResponse.payment.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
ClaimResponse.payment.type	C	1..1	HIECodeableConcept	Partial or complete payment Binding: ExamplePaymentTypeCodes (example): The type (partial, complete) of the payment. Constraints: cc-text-or-code
ClaimResponse.payment.adjustmentReason	C	0..1	HIECodeableConcept	Explanation for the adjustment Binding: PaymentAdjustmentReasonCodes (example): Payment Adjustment reason codes. Constraints: cc-text-or-code
ClaimResponse.payment.amount		1..1	Money	Payable amount after adjustment
ClaimResponse.fundsReserve	C	0..1	HIECodeableConcept	Funds reserved status Binding: Funds Reservation Codes (example): For whom funds are to be reserved: (Patient, Provider, None). Constraints: cc-text-or-code
ClaimResponse.formCode	C	0..1	HIECodeableConcept	Printed form identifier Binding: Form Codes (example): The forms codes. Constraints: cc-text-or-code
ClaimResponse.communicationRequest		0..*	HIEReference(CommunicationRequest)	Request for additional information
ClaimResponse.insurance		1..*	BackboneElement	Patient insurance information
ClaimResponse.insurance.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
ClaimResponse.insurance.sequence		1..1	positiveInt	Insurance instance identifier
ClaimResponse.insurance.focal		1..1	boolean	Coverage to be used for adjudication
ClaimResponse.insurance.coverage		1..1	HIEReference(Coverage)	Insurance information
ClaimResponse.insurance.claimResponse		0..1	HIEReference(HIE ClaimResponse)	Adjudication results
Documentation for this format

Terminology Bindings

Path	Status	Usage	ValueSet	Version	Source
ClaimResponse.identifier.​use	Base	required	IdentifierUse	📦4.3.0	FHIR Std.
ClaimResponse.identifier.​type	Base	extensible	IdentifierType	📦4.3.0	FHIR Std.
ClaimResponse.status	Base	required	Financial Resource Status Codes	📍4.3.0	FHIR Std.
ClaimResponse.type	Base	extensible	Claim Type Codes	📍4.3.0	FHIR Std.
ClaimResponse.use	Base	required	Use	📍4.3.0	FHIR Std.
ClaimResponse.outcome	Base	required	RemittanceOutcome	📍4.3.0	FHIR Std.
ClaimResponse.payeeType	Base	example	PayeeType	📍4.3.0	FHIR Std.
ClaimResponse.item.adjudication.​category	Base	example	Adjudication Value Codes	📍4.3.0	FHIR Std.
ClaimResponse.item.adjudication.​reason	Base	example	Adjudication Reason Codes	📍4.3.0	FHIR Std.
ClaimResponse.item.detail.​adjudication.category	Base	example	Adjudication Value Codes	📍4.3.0	FHIR Std.
ClaimResponse.item.detail.​adjudication.reason	Base	example	Adjudication Reason Codes	📍4.3.0	FHIR Std.
ClaimResponse.total.​category	Base	example	Adjudication Value Codes	📍4.3.0	FHIR Std.
ClaimResponse.payment.​type	Base	example	Example Payment Type Codes	📍4.3.0	FHIR Std.
ClaimResponse.payment.​adjustmentReason	Base	example	Payment Adjustment Reason Codes	📍4.3.0	FHIR Std.
ClaimResponse.fundsReserve	Base	example	FundsReserve	📍4.3.0	FHIR Std.
ClaimResponse.formCode	Base	example	Forms	📍4.3.0	FHIR Std.

Constraints

Id	Grade	Path(s)	Description	Expression
cc-text-or-code	warning	ClaimResponse.identifier.type, ClaimResponse.type, ClaimResponse.payeeType, ClaimResponse.item.adjudication.category, ClaimResponse.item.adjudication.reason, ClaimResponse.item.detail.adjudication.category, ClaimResponse.item.detail.adjudication.reason, ClaimResponse.total.category, ClaimResponse.payment.type, ClaimResponse.payment.adjustmentReason, ClaimResponse.fundsReserve, ClaimResponse.formCode	Text is optional, coding is required	coding.exists()
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.exists() and ('#'+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(uri) = '#').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    Filter: Bindings Constraints Obligations
ClaimResponse		0..*	ClaimResponse	Response to a claim predetermination or preauthorization
ClaimResponse.identifier	S This element must be supported.	1..*	Identifier	Business Identifier for a claim response
ClaimResponse.identifier.use		1..1	code	usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required)
ClaimResponse.identifier.type		1..1	HIECodeableConcept	Description of identifier Binding: Identifier Type Codes (extensible)
ClaimResponse.identifier.system		1..1	uri	The namespace for the identifier value
ClaimResponse.identifier.value	S This element must be supported.	1..1	string	The value that is unique
ClaimResponse.identifier.assigner	S This element must be supported.	0..1	HIEReference(HIE Organization)	Organization that issued id (may be just text)
ClaimResponse.status	S This element must be supported.	1..1	code	active | cancelled | draft | entered-in-error
ClaimResponse.type		1..1	HIECodeableConcept	More granular claim type
ClaimResponse.use	S This element must be supported.	1..1	code	claim | preauthorization | predetermination
ClaimResponse.patient	S This element must be supported.	1..1	HIEReference(HIE Patient)	The recipient of the products and services
ClaimResponse.created	S This element must be supported.	1..1	dateTime	Response creation date
ClaimResponse.insurer	S This element must be supported.	1..1	HIEReference(HIE Organization)	Party responsible for reimbursement
ClaimResponse.requestor		1..1	HIEReference(HIE Practitioner | PractitionerRole | HIE Organization)	Party responsible for the claim
ClaimResponse.request	S This element must be supported.	1..1	HIEReference(HIE Claim)	Id of resource triggering adjudication
ClaimResponse.outcome	S This element must be supported.	1..1	code	queued | complete | error | partial
ClaimResponse.payeeType		0..1	HIECodeableConcept	Party to be paid any benefits payable
ClaimResponse.item	S This element must be supported.	1..*	BackboneElement	Adjudication for claim line items
ClaimResponse.item.adjudication
ClaimResponse.item.adjudication.category		1..1	HIECodeableConcept	Type of adjudication information
ClaimResponse.item.adjudication.reason		0..1	HIECodeableConcept	Explanation of adjudication outcome
ClaimResponse.item.adjudication.amount		1..1	Money	Monetary amount
ClaimResponse.item.detail		1..*	BackboneElement	Adjudication for claim details
ClaimResponse.item.detail.adjudication		1..*	BackboneElement	Detail level adjudication details
ClaimResponse.item.detail.adjudication.category		1..1	HIECodeableConcept	Type of adjudication information
ClaimResponse.item.detail.adjudication.reason		0..1	HIECodeableConcept	Explanation of adjudication outcome
ClaimResponse.item.detail.subDetail
ClaimResponse.item.detail.subDetail.adjudication		1..*	BackboneElement	Subdetail level adjudication details
ClaimResponse.item.detail.subDetail.adjudication.category		1..1	HIECodeableConcept	Type of adjudication information
ClaimResponse.item.detail.subDetail.adjudication.reason		0..1	HIECodeableConcept	Explanation of adjudication outcome
ClaimResponse.addItem
ClaimResponse.addItem.provider		0..*	HIEReference(HIE Practitioner | PractitionerRole | HIE Organization)	Authorized providers
ClaimResponse.addItem.productOrService		1..1	HIECodeableConcept	Billing, service, product, or drug code
ClaimResponse.addItem.modifier		0..*	HIECodeableConcept	Service/Product billing modifiers
ClaimResponse.addItem.programCode		0..*	HIECodeableConcept	Program the product or service is provided under
ClaimResponse.addItem.bodySite		0..1	HIECodeableConcept	Anatomical location
ClaimResponse.addItem.subSite		0..*	HIECodeableConcept	Anatomical sub-location
ClaimResponse.addItem.adjudication		1..*	BackboneElement	Added items adjudication
ClaimResponse.addItem.adjudication.category		1..1	HIECodeableConcept	Type of adjudication information
ClaimResponse.addItem.adjudication.reason		0..1	HIECodeableConcept	Explanation of adjudication outcome
ClaimResponse.addItem.detail
ClaimResponse.addItem.detail.productOrService		1..1	HIECodeableConcept	Billing, service, product, or drug code
ClaimResponse.addItem.detail.modifier		0..*	HIECodeableConcept	Service/Product billing modifiers
ClaimResponse.addItem.detail.adjudication		1..*	BackboneElement	Added items detail adjudication
ClaimResponse.addItem.detail.adjudication.category		1..1	HIECodeableConcept	Type of adjudication information
ClaimResponse.addItem.detail.adjudication.reason		0..1	HIECodeableConcept	Explanation of adjudication outcome
ClaimResponse.addItem.detail.subDetail
ClaimResponse.addItem.detail.subDetail.productOrService		1..1	HIECodeableConcept	Billing, service, product, or drug code
ClaimResponse.addItem.detail.subDetail.modifier		0..*	HIECodeableConcept	Service/Product billing modifiers
ClaimResponse.addItem.detail.subDetail.adjudication		1..*	BackboneElement	Added items detail adjudication
ClaimResponse.addItem.detail.subDetail.adjudication.category		1..1	HIECodeableConcept	Type of adjudication information
ClaimResponse.addItem.detail.subDetail.adjudication.reason		0..1	HIECodeableConcept	Explanation of adjudication outcome
ClaimResponse.total	S This element must be supported.	1..*	BackboneElement	Adjudication totals
ClaimResponse.total.category		1..1	HIECodeableConcept	Type of adjudication information
ClaimResponse.payment		1..1	BackboneElement	Payment Details
ClaimResponse.payment.type		1..1	HIECodeableConcept	Partial or complete payment
ClaimResponse.payment.adjustmentReason		0..1	HIECodeableConcept	Explanation for the adjustment
ClaimResponse.fundsReserve		0..1	HIECodeableConcept	Funds reserved status
ClaimResponse.formCode		0..1	HIECodeableConcept	Printed form identifier
ClaimResponse.processNote
ClaimResponse.processNote.language		0..1	HIECodeableConcept	Language of the text
ClaimResponse.communicationRequest		0..*	HIEReference(CommunicationRequest)	Request for additional information
ClaimResponse.insurance		1..*	BackboneElement	Patient insurance information
ClaimResponse.insurance.coverage		1..1	HIEReference(Coverage)	Insurance information
ClaimResponse.insurance.claimResponse		0..1	HIEReference(HIE ClaimResponse)	Adjudication results
Documentation for this format

Terminology Bindings (Differential)

Path	Status	Usage	ValueSet	Version	Source
ClaimResponse.identifier.​use	Base	required	IdentifierUse	📦4.3.0	FHIR Std.
ClaimResponse.identifier.​type	Base	extensible	IdentifierType	📦4.3.0	FHIR Std.

Snapshot View

Name	Flags	Card.	Type	Description & Constraints    Filter: Bindings Constraints Obligations
ClaimResponse		0..*	ClaimResponse	Response to a claim predetermination or preauthorization
ClaimResponse.id	Σ This element is included in summaries.	0..1	id	Logical id of this artifact
ClaimResponse.meta	Σ This element is included in summaries.	0..1	Meta	Metadata about the resource
ClaimResponse.implicitRules	?! This element is a modifier element. Σ This element is included in summaries.	0..1	uri	A set of rules under which this content was created
ClaimResponse.language		0..1	code	Language of the resource content Binding: CommonLanguages (preferred): IETF language tag Additional Bindings Purpose AllLanguages Max Binding
ClaimResponse.text		0..1	Narrative	Text summary of the resource, for human interpretation This profile does not constrain the narrative in regard to content, language, or traceability to data elements
ClaimResponse.contained		0..*	Resource	Contained, inline Resources Constraints: dom-r4b
ClaimResponse.extension		0..*	Extension	Additional content defined by implementations
ClaimResponse.modifierExtension	?! This element is a modifier element.	0..*	Extension	Extensions that cannot be ignored
ClaimResponse.identifier	S This element must be supported.	1..*	Identifier	Business Identifier for a claim response
ClaimResponse.identifier.id		0..1	id	Unique id for inter-element referencing
ClaimResponse.identifier.extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
ClaimResponse.identifier.use	?! This element is a modifier element. Σ This element is included in summaries.	1..1	code	usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required)
ClaimResponse.identifier.type	Σ This element is included in summaries. C	1..1	HIECodeableConcept	Description of identifier Binding: Identifier Type Codes (extensible) Constraints: cc-text-or-code
ClaimResponse.identifier.system	Σ This element is included in summaries.	1..1	uri	The namespace for the identifier value Example General: http://www.acme.com/identifiers/patient
ClaimResponse.identifier.value	S This element must be supported. Σ This element is included in summaries.	1..1	string	The value that is unique Example General: 123456
ClaimResponse.identifier.period	Σ This element is included in summaries.	0..1	Period	Time period when id is/was valid for use
ClaimResponse.identifier.assigner	S This element must be supported. Σ This element is included in summaries.	0..1	HIEReference(HIE Organization)	Organization that issued id (may be just text)
ClaimResponse.status	?! This element is a modifier element. S This element must be supported. Σ This element is included in summaries.	1..1	code	active | cancelled | draft | entered-in-error Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance.
ClaimResponse.type	Σ This element is included in summaries. C	1..1	HIECodeableConcept	More granular claim type Binding: ClaimTypeCodes (extensible): The type or discipline-style of the claim. Constraints: cc-text-or-code
ClaimResponse.subType		0..1	CodeableConcept	More granular claim type Binding: ExampleClaimSubTypeCodes (example): A more granular claim typecode.
ClaimResponse.use	S This element must be supported. Σ This element is included in summaries.	1..1	code	claim | preauthorization | predetermination Binding: Use (required): Claim, preauthorization, predetermination.
ClaimResponse.patient	S This element must be supported. Σ This element is included in summaries.	1..1	HIEReference(HIE Patient)	The recipient of the products and services
ClaimResponse.created	S This element must be supported. Σ This element is included in summaries.	1..1	dateTime	Response creation date
ClaimResponse.insurer	S This element must be supported. Σ This element is included in summaries.	1..1	HIEReference(HIE Organization)	Party responsible for reimbursement
ClaimResponse.requestor		1..1	HIEReference(HIE Practitioner | PractitionerRole | HIE Organization)	Party responsible for the claim
ClaimResponse.request	S This element must be supported. Σ This element is included in summaries.	1..1	HIEReference(HIE Claim)	Id of resource triggering adjudication
ClaimResponse.outcome	S This element must be supported. Σ This element is included in summaries.	1..1	code	queued | complete | error | partial Binding: RemittanceOutcome (required): The result of the claim processing.
ClaimResponse.disposition		0..1	string	Disposition Message
ClaimResponse.preAuthRef		0..1	string	Preauthorization reference
ClaimResponse.preAuthPeriod		0..1	Period	Preauthorization reference effective period
ClaimResponse.payeeType	C	0..1	HIECodeableConcept	Party to be paid any benefits payable Binding: Claim Payee Type Codes (example): A code for the party to be reimbursed. Constraints: cc-text-or-code
ClaimResponse.item	S This element must be supported.	1..*	BackboneElement	Adjudication for claim line items
ClaimResponse.item.id		0..1	string	Unique id for inter-element referencing
ClaimResponse.item.extension		0..*	Extension	Additional content defined by implementations
ClaimResponse.item.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
ClaimResponse.item.itemSequence		1..1	positiveInt	Claim item instance identifier
ClaimResponse.item.noteNumber		0..*	positiveInt	Applicable note numbers
ClaimResponse.item.adjudication		1..*	BackboneElement	Adjudication details
ClaimResponse.item.adjudication.id		0..1	string	Unique id for inter-element referencing
ClaimResponse.item.adjudication.extension		0..*	Extension	Additional content defined by implementations
ClaimResponse.item.adjudication.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
ClaimResponse.item.adjudication.category	C	1..1	HIECodeableConcept	Type of adjudication information Binding: AdjudicationValueCodes (example): The adjudication codes. Constraints: cc-text-or-code
ClaimResponse.item.adjudication.reason	C	0..1	HIECodeableConcept	Explanation of adjudication outcome Binding: AdjudicationReasonCodes (example): The adjudication reason codes. Constraints: cc-text-or-code
ClaimResponse.item.adjudication.amount		1..1	Money	Monetary amount
ClaimResponse.item.adjudication.value		0..1	decimal	Non-monetary value
ClaimResponse.item.detail		1..*	BackboneElement	Adjudication for claim details
ClaimResponse.item.detail.id		0..1	string	Unique id for inter-element referencing
ClaimResponse.item.detail.extension		0..*	Extension	Additional content defined by implementations
ClaimResponse.item.detail.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
ClaimResponse.item.detail.detailSequence		1..1	positiveInt	Claim detail instance identifier
ClaimResponse.item.detail.noteNumber		0..*	positiveInt	Applicable note numbers
ClaimResponse.item.detail.adjudication		1..*	BackboneElement	Detail level adjudication details
ClaimResponse.item.detail.adjudication.id		0..1	string	Unique id for inter-element referencing
ClaimResponse.item.detail.adjudication.extension		0..*	Extension	Additional content defined by implementations
ClaimResponse.item.detail.adjudication.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
ClaimResponse.item.detail.adjudication.category	C	1..1	HIECodeableConcept	Type of adjudication information Binding: AdjudicationValueCodes (example): The adjudication codes. Constraints: cc-text-or-code
ClaimResponse.item.detail.adjudication.reason	C	0..1	HIECodeableConcept	Explanation of adjudication outcome Binding: AdjudicationReasonCodes (example): The adjudication reason codes. Constraints: cc-text-or-code
ClaimResponse.item.detail.adjudication.amount		0..1	Money	Monetary amount
ClaimResponse.item.detail.adjudication.value		0..1	decimal	Non-monetary value
ClaimResponse.item.detail.subDetail		0..*	BackboneElement	Adjudication for claim sub-details
ClaimResponse.item.detail.subDetail.id		0..1	string	Unique id for inter-element referencing
ClaimResponse.item.detail.subDetail.extension		0..*	Extension	Additional content defined by implementations
ClaimResponse.item.detail.subDetail.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
ClaimResponse.item.detail.subDetail.subDetailSequence		1..1	positiveInt	Claim sub-detail instance identifier
ClaimResponse.item.detail.subDetail.noteNumber		0..*	positiveInt	Applicable note numbers
ClaimResponse.item.detail.subDetail.adjudication		1..*	BackboneElement	Subdetail level adjudication details
ClaimResponse.item.detail.subDetail.adjudication.id		0..1	string	Unique id for inter-element referencing
ClaimResponse.item.detail.subDetail.adjudication.extension		0..*	Extension	Additional content defined by implementations
ClaimResponse.item.detail.subDetail.adjudication.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
ClaimResponse.item.detail.subDetail.adjudication.category	C	1..1	HIECodeableConcept	Type of adjudication information Binding: AdjudicationValueCodes (example): The adjudication codes. Constraints: cc-text-or-code
ClaimResponse.item.detail.subDetail.adjudication.reason	C	0..1	HIECodeableConcept	Explanation of adjudication outcome Binding: AdjudicationReasonCodes (example): The adjudication reason codes. Constraints: cc-text-or-code
ClaimResponse.item.detail.subDetail.adjudication.amount		0..1	Money	Monetary amount
ClaimResponse.item.detail.subDetail.adjudication.value		0..1	decimal	Non-monetary value
ClaimResponse.addItem		0..*	BackboneElement	Insurer added line items
ClaimResponse.addItem.id		0..1	string	Unique id for inter-element referencing
ClaimResponse.addItem.extension		0..*	Extension	Additional content defined by implementations
ClaimResponse.addItem.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
ClaimResponse.addItem.itemSequence		0..*	positiveInt	Item sequence number
ClaimResponse.addItem.detailSequence		0..*	positiveInt	Detail sequence number
ClaimResponse.addItem.subdetailSequence		0..*	positiveInt	Subdetail sequence number
ClaimResponse.addItem.provider		0..*	HIEReference(HIE Practitioner | PractitionerRole | HIE Organization)	Authorized providers
ClaimResponse.addItem.productOrService	C	1..1	HIECodeableConcept	Billing, service, product, or drug code Binding: USCLSCodes (example): Allowable service and product codes. Constraints: cc-text-or-code
ClaimResponse.addItem.modifier	C	0..*	HIECodeableConcept	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. Constraints: cc-text-or-code
ClaimResponse.addItem.programCode	C	0..*	HIECodeableConcept	Program the product or service is provided under Binding: ExampleProgramReasonCodes (example): Program specific reason codes. Constraints: cc-text-or-code
ClaimResponse.addItem.serviced[x]		0..1		Date or dates of service or product delivery
ClaimResponse.addItem.serviced[x].servicedDate			date
ClaimResponse.addItem.serviced[x].servicedPeriod			Period
ClaimResponse.addItem.location[x]		0..1		Place of service or where product was supplied Binding: ExampleServicePlaceCodes (example): Place of service: pharmacy, school, prison, etc.
ClaimResponse.addItem.location[x].locationCodeableConcept			CodeableConcept
ClaimResponse.addItem.location[x].locationAddress			Address
ClaimResponse.addItem.location[x].locationReference			Reference(Location)
ClaimResponse.addItem.quantity	C	0..1	SimpleQuantity(4.3.0)	Count of products or services Constraints: sqty-1
ClaimResponse.addItem.unitPrice		0..1	Money	Fee, charge or cost per item
ClaimResponse.addItem.factor		0..1	decimal	Price scaling factor
ClaimResponse.addItem.net		0..1	Money	Total item cost
ClaimResponse.addItem.bodySite	C	0..1	HIECodeableConcept	Anatomical location Binding: OralSiteCodes (example): The code for the teeth, quadrant, sextant and arch. Constraints: cc-text-or-code
ClaimResponse.addItem.subSite	C	0..*	HIECodeableConcept	Anatomical sub-location Binding: SurfaceCodes (example): The code for the tooth surface and surface combinations. Constraints: cc-text-or-code
ClaimResponse.addItem.noteNumber		0..*	positiveInt	Applicable note numbers
ClaimResponse.addItem.adjudication		1..*	BackboneElement	Added items adjudication
ClaimResponse.addItem.adjudication.id		0..1	string	Unique id for inter-element referencing
ClaimResponse.addItem.adjudication.extension		0..*	Extension	Additional content defined by implementations
ClaimResponse.addItem.adjudication.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
ClaimResponse.addItem.adjudication.category	C	1..1	HIECodeableConcept	Type of adjudication information Binding: AdjudicationValueCodes (example): The adjudication codes. Constraints: cc-text-or-code
ClaimResponse.addItem.adjudication.reason	C	0..1	HIECodeableConcept	Explanation of adjudication outcome Binding: AdjudicationReasonCodes (example): The adjudication reason codes. Constraints: cc-text-or-code
ClaimResponse.addItem.adjudication.amount		0..1	Money	Monetary amount
ClaimResponse.addItem.adjudication.value		0..1	decimal	Non-monetary value
ClaimResponse.addItem.detail		0..*	BackboneElement	Insurer added line details
ClaimResponse.addItem.detail.id		0..1	string	Unique id for inter-element referencing
ClaimResponse.addItem.detail.extension		0..*	Extension	Additional content defined by implementations
ClaimResponse.addItem.detail.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
ClaimResponse.addItem.detail.productOrService	C	1..1	HIECodeableConcept	Billing, service, product, or drug code Binding: USCLSCodes (example): Allowable service and product codes. Constraints: cc-text-or-code
ClaimResponse.addItem.detail.modifier	C	0..*	HIECodeableConcept	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. Constraints: cc-text-or-code
ClaimResponse.addItem.detail.quantity	C	0..1	SimpleQuantity(4.3.0)	Count of products or services Constraints: sqty-1
ClaimResponse.addItem.detail.unitPrice		0..1	Money	Fee, charge or cost per item
ClaimResponse.addItem.detail.factor		0..1	decimal	Price scaling factor
ClaimResponse.addItem.detail.net		0..1	Money	Total item cost
ClaimResponse.addItem.detail.noteNumber		0..*	positiveInt	Applicable note numbers
ClaimResponse.addItem.detail.adjudication		1..*	BackboneElement	Added items detail adjudication
ClaimResponse.addItem.detail.adjudication.id		0..1	string	Unique id for inter-element referencing
ClaimResponse.addItem.detail.adjudication.extension		0..*	Extension	Additional content defined by implementations
ClaimResponse.addItem.detail.adjudication.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
ClaimResponse.addItem.detail.adjudication.category	C	1..1	HIECodeableConcept	Type of adjudication information Binding: AdjudicationValueCodes (example): The adjudication codes. Constraints: cc-text-or-code
ClaimResponse.addItem.detail.adjudication.reason	C	0..1	HIECodeableConcept	Explanation of adjudication outcome Binding: AdjudicationReasonCodes (example): The adjudication reason codes. Constraints: cc-text-or-code
ClaimResponse.addItem.detail.adjudication.amount		0..1	Money	Monetary amount
ClaimResponse.addItem.detail.adjudication.value		0..1	decimal	Non-monetary value
ClaimResponse.addItem.detail.subDetail		0..*	BackboneElement	Insurer added line items
ClaimResponse.addItem.detail.subDetail.id		0..1	string	Unique id for inter-element referencing
ClaimResponse.addItem.detail.subDetail.extension		0..*	Extension	Additional content defined by implementations
ClaimResponse.addItem.detail.subDetail.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
ClaimResponse.addItem.detail.subDetail.productOrService	C	1..1	HIECodeableConcept	Billing, service, product, or drug code Binding: USCLSCodes (example): Allowable service and product codes. Constraints: cc-text-or-code
ClaimResponse.addItem.detail.subDetail.modifier	C	0..*	HIECodeableConcept	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. Constraints: cc-text-or-code
ClaimResponse.addItem.detail.subDetail.quantity	C	0..1	SimpleQuantity(4.3.0)	Count of products or services Constraints: sqty-1
ClaimResponse.addItem.detail.subDetail.unitPrice		0..1	Money	Fee, charge or cost per item
ClaimResponse.addItem.detail.subDetail.factor		0..1	decimal	Price scaling factor
ClaimResponse.addItem.detail.subDetail.net		0..1	Money	Total item cost
ClaimResponse.addItem.detail.subDetail.noteNumber		0..*	positiveInt	Applicable note numbers
ClaimResponse.addItem.detail.subDetail.adjudication		1..*	BackboneElement	Added items detail adjudication
ClaimResponse.addItem.detail.subDetail.adjudication.id		0..1	string	Unique id for inter-element referencing
ClaimResponse.addItem.detail.subDetail.adjudication.extension		0..*	Extension	Additional content defined by implementations
ClaimResponse.addItem.detail.subDetail.adjudication.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
ClaimResponse.addItem.detail.subDetail.adjudication.category	C	1..1	HIECodeableConcept	Type of adjudication information Binding: AdjudicationValueCodes (example): The adjudication codes. Constraints: cc-text-or-code
ClaimResponse.addItem.detail.subDetail.adjudication.reason	C	0..1	HIECodeableConcept	Explanation of adjudication outcome Binding: AdjudicationReasonCodes (example): The adjudication reason codes. Constraints: cc-text-or-code
ClaimResponse.addItem.detail.subDetail.adjudication.amount		0..1	Money	Monetary amount
ClaimResponse.addItem.detail.subDetail.adjudication.value		0..1	decimal	Non-monetary value
ClaimResponse.adjudication		0..*	See adjudication (ClaimResponse)	Header-level adjudication
ClaimResponse.total	S This element must be supported. Σ This element is included in summaries.	1..*	BackboneElement	Adjudication totals
ClaimResponse.total.id		0..1	string	Unique id for inter-element referencing
ClaimResponse.total.extension		0..*	Extension	Additional content defined by implementations
ClaimResponse.total.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
ClaimResponse.total.category	Σ This element is included in summaries. C	1..1	HIECodeableConcept	Type of adjudication information Binding: AdjudicationValueCodes (example): The adjudication codes. Constraints: cc-text-or-code
ClaimResponse.total.amount	Σ This element is included in summaries.	1..1	Money	Financial total for the category
ClaimResponse.payment		1..1	BackboneElement	Payment Details
ClaimResponse.payment.id		0..1	string	Unique id for inter-element referencing
ClaimResponse.payment.extension		0..*	Extension	Additional content defined by implementations
ClaimResponse.payment.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
ClaimResponse.payment.type	C	1..1	HIECodeableConcept	Partial or complete payment Binding: ExamplePaymentTypeCodes (example): The type (partial, complete) of the payment. Constraints: cc-text-or-code
ClaimResponse.payment.adjustment		0..1	Money	Payment adjustment for non-claim issues
ClaimResponse.payment.adjustmentReason	C	0..1	HIECodeableConcept	Explanation for the adjustment Binding: PaymentAdjustmentReasonCodes (example): Payment Adjustment reason codes. Constraints: cc-text-or-code
ClaimResponse.payment.date		0..1	date	Expected date of payment
ClaimResponse.payment.amount		1..1	Money	Payable amount after adjustment
ClaimResponse.payment.identifier		0..1	Identifier	Business identifier for the payment
ClaimResponse.fundsReserve	C	0..1	HIECodeableConcept	Funds reserved status Binding: Funds Reservation Codes (example): For whom funds are to be reserved: (Patient, Provider, None). Constraints: cc-text-or-code
ClaimResponse.formCode	C	0..1	HIECodeableConcept	Printed form identifier Binding: Form Codes (example): The forms codes. Constraints: cc-text-or-code
ClaimResponse.form		0..1	Attachment	Printed reference or actual form
ClaimResponse.processNote		0..*	BackboneElement	Note concerning adjudication
ClaimResponse.processNote.id		0..1	string	Unique id for inter-element referencing
ClaimResponse.processNote.extension		0..*	Extension	Additional content defined by implementations
ClaimResponse.processNote.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
ClaimResponse.processNote.number		0..1	positiveInt	Note instance identifier
ClaimResponse.processNote.type		0..1	code	display | print | printoper Binding: NoteType (required): The presentation types of notes.
ClaimResponse.processNote.text		1..1	string	Note explanatory text
ClaimResponse.processNote.language	C	0..1	HIECodeableConcept	Language of the text Binding: CommonLanguages (preferred): IETF language tag Additional Bindings Purpose AllLanguages Max Binding Constraints: cc-text-or-code
ClaimResponse.communicationRequest		0..*	HIEReference(CommunicationRequest)	Request for additional information
ClaimResponse.insurance		1..*	BackboneElement	Patient insurance information
ClaimResponse.insurance.id		0..1	string	Unique id for inter-element referencing
ClaimResponse.insurance.extension		0..*	Extension	Additional content defined by implementations
ClaimResponse.insurance.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
ClaimResponse.insurance.sequence		1..1	positiveInt	Insurance instance identifier
ClaimResponse.insurance.focal		1..1	boolean	Coverage to be used for adjudication
ClaimResponse.insurance.coverage		1..1	HIEReference(Coverage)	Insurance information
ClaimResponse.insurance.businessArrangement		0..1	string	Additional provider contract number
ClaimResponse.insurance.claimResponse		0..1	HIEReference(HIE ClaimResponse)	Adjudication results
ClaimResponse.error		0..*	BackboneElement	Processing errors
ClaimResponse.error.id		0..1	string	Unique id for inter-element referencing
ClaimResponse.error.extension		0..*	Extension	Additional content defined by implementations
ClaimResponse.error.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
ClaimResponse.error.itemSequence		0..1	positiveInt	Item sequence number
ClaimResponse.error.detailSequence		0..1	positiveInt	Detail sequence number
ClaimResponse.error.subDetailSequence		0..1	positiveInt	Subdetail sequence number
ClaimResponse.error.code		1..1	CodeableConcept	Error code detailing processing issues Binding: Adjudication Error Codes (example): The adjudication error codes.
Documentation for this format

Terminology Bindings

Path	Status	Usage	ValueSet	Version	Source
ClaimResponse.language	Base	preferred	Common Languages	📍4.3.0	FHIR Std.
ClaimResponse.identifier.​use	Base	required	IdentifierUse	📦4.3.0	FHIR Std.
ClaimResponse.identifier.​type	Base	extensible	IdentifierType	📦4.3.0	FHIR Std.
ClaimResponse.status	Base	required	Financial Resource Status Codes	📍4.3.0	FHIR Std.
ClaimResponse.type	Base	extensible	Claim Type Codes	📍4.3.0	FHIR Std.
ClaimResponse.subType	Base	example	Example Claim SubType Codes	📍4.3.0	FHIR Std.
ClaimResponse.use	Base	required	Use	📍4.3.0	FHIR Std.
ClaimResponse.outcome	Base	required	RemittanceOutcome	📍4.3.0	FHIR Std.
ClaimResponse.payeeType	Base	example	PayeeType	📍4.3.0	FHIR Std.
ClaimResponse.item.adjudication.​category	Base	example	Adjudication Value Codes	📍4.3.0	FHIR Std.
ClaimResponse.item.adjudication.​reason	Base	example	Adjudication Reason Codes	📍4.3.0	FHIR Std.
ClaimResponse.item.detail.​adjudication.category	Base	example	Adjudication Value Codes	📍4.3.0	FHIR Std.
ClaimResponse.item.detail.​adjudication.reason	Base	example	Adjudication Reason Codes	📍4.3.0	FHIR Std.
ClaimResponse.item.detail.​subDetail.adjudication.​category	Base	example	Adjudication Value Codes	📍4.3.0	FHIR Std.
ClaimResponse.item.detail.​subDetail.adjudication.​reason	Base	example	Adjudication Reason Codes	📍4.3.0	FHIR Std.
ClaimResponse.addItem.​productOrService	Base	example	USCLS Codes	📍4.3.0	FHIR Std.
ClaimResponse.addItem.​modifier	Base	example	Modifier type Codes	📍4.3.0	FHIR Std.
ClaimResponse.addItem.​programCode	Base	example	Example Program Reason Codes	📍4.3.0	FHIR Std.
ClaimResponse.addItem.​location[x]	Base	example	Example Service Place Codes	📍4.3.0	FHIR Std.
ClaimResponse.addItem.​bodySite	Base	example	Oral Site Codes	📍4.3.0	FHIR Std.
ClaimResponse.addItem.​subSite	Base	example	Surface Codes	📍4.3.0	FHIR Std.
ClaimResponse.addItem.​adjudication.category	Base	example	Adjudication Value Codes	📍4.3.0	FHIR Std.
ClaimResponse.addItem.​adjudication.reason	Base	example	Adjudication Reason Codes	📍4.3.0	FHIR Std.
ClaimResponse.addItem.​detail.productOrService	Base	example	USCLS Codes	📍4.3.0	FHIR Std.
ClaimResponse.addItem.​detail.modifier	Base	example	Modifier type Codes	📍4.3.0	FHIR Std.
ClaimResponse.addItem.​detail.adjudication.​category	Base	example	Adjudication Value Codes	📍4.3.0	FHIR Std.
ClaimResponse.addItem.​detail.adjudication.​reason	Base	example	Adjudication Reason Codes	📍4.3.0	FHIR Std.
ClaimResponse.addItem.​detail.subDetail.productOrService	Base	example	USCLS Codes	📍4.3.0	FHIR Std.
ClaimResponse.addItem.​detail.subDetail.modifier	Base	example	Modifier type Codes	📍4.3.0	FHIR Std.
ClaimResponse.addItem.​detail.subDetail.adjudication.​category	Base	example	Adjudication Value Codes	📍4.3.0	FHIR Std.
ClaimResponse.addItem.​detail.subDetail.adjudication.​reason	Base	example	Adjudication Reason Codes	📍4.3.0	FHIR Std.
ClaimResponse.total.​category	Base	example	Adjudication Value Codes	📍4.3.0	FHIR Std.
ClaimResponse.payment.​type	Base	example	Example Payment Type Codes	📍4.3.0	FHIR Std.
ClaimResponse.payment.​adjustmentReason	Base	example	Payment Adjustment Reason Codes	📍4.3.0	FHIR Std.
ClaimResponse.fundsReserve	Base	example	FundsReserve	📍4.3.0	FHIR Std.
ClaimResponse.formCode	Base	example	Forms	📍4.3.0	FHIR Std.
ClaimResponse.processNote.​type	Base	required	NoteType	📍4.3.0	FHIR Std.
ClaimResponse.processNote.​language	Base	preferred	Common Languages	📍4.3.0	FHIR Std.
ClaimResponse.error.​code	Base	example	AdjudicationError	📍4.3.0	FHIR Std.

Constraints

Id	Grade	Path(s)	Description	Expression
cc-text-or-code	warning	ClaimResponse.identifier.type, ClaimResponse.type, ClaimResponse.payeeType, ClaimResponse.item.adjudication.category, ClaimResponse.item.adjudication.reason, ClaimResponse.item.detail.adjudication.category, ClaimResponse.item.detail.adjudication.reason, ClaimResponse.item.detail.subDetail.adjudication.category, ClaimResponse.item.detail.subDetail.adjudication.reason, ClaimResponse.addItem.productOrService, ClaimResponse.addItem.modifier, ClaimResponse.addItem.programCode, ClaimResponse.addItem.bodySite, ClaimResponse.addItem.subSite, ClaimResponse.addItem.adjudication.category, ClaimResponse.addItem.adjudication.reason, ClaimResponse.addItem.detail.productOrService, ClaimResponse.addItem.detail.modifier, ClaimResponse.addItem.detail.adjudication.category, ClaimResponse.addItem.detail.adjudication.reason, ClaimResponse.addItem.detail.subDetail.productOrService, ClaimResponse.addItem.detail.subDetail.modifier, ClaimResponse.addItem.detail.subDetail.adjudication.category, ClaimResponse.addItem.detail.subDetail.adjudication.reason, ClaimResponse.total.category, ClaimResponse.payment.type, ClaimResponse.payment.adjustmentReason, ClaimResponse.fundsReserve, ClaimResponse.formCode, ClaimResponse.processNote.language	Text is optional, coding is required	coding.exists()
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.exists() and ('#'+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(uri) = '#').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()
dom-r4b	warning	ClaimResponse.contained	Containing new R4B resources within R4 resources may cause interoperability issues if instances are shared with R4 systems	($this is Citation or $this is Evidence or $this is EvidenceReport or $this is EvidenceVariable or $this is MedicinalProductDefinition or $this is PackagedProductDefinition or $this is AdministrableProductDefinition or $this is Ingredient or $this is ClinicalUseDefinition or $this is RegulatedAuthorization or $this is SubstanceDefinition or $this is SubscriptionStatus or $this is SubscriptionTopic) implies (%resource is Citation or %resource is Evidence or %resource is EvidenceReport or %resource is EvidenceVariable or %resource is MedicinalProductDefinition or %resource is PackagedProductDefinition or %resource is AdministrableProductDefinition or %resource is Ingredient or %resource is ClinicalUseDefinition or %resource is RegulatedAuthorization or %resource is SubstanceDefinition or %resource is SubscriptionStatus or %resource is SubscriptionTopic)
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()
sqty-1	error	ClaimResponse.addItem.quantity, ClaimResponse.addItem.detail.quantity, ClaimResponse.addItem.detail.subDetail.quantity	The comparator is not used on a SimpleQuantity	comparator.empty()

This structure is derived from ClaimResponse

Summary

Mandatory: 13 elements(1 nested mandatory element)
Must-Support: 12 elements

Structures

This structure refers to these other structures:

• HIE CodeableConcept (https://nshr.dha.go.ke/fhir/StructureDefinition/codeable-concept)
• HIE Reference (https://nshr.dha.go.ke/fhir/StructureDefinition/reference)
• HIE Organization (https://nshr.dha.go.ke/fhir/StructureDefinition/organization)
• HIE Patient (https://nshr.dha.go.ke/fhir/StructureDefinition/patient)
• HIE Practitioner (https://nshr.dha.go.ke/fhir/StructureDefinition/practitioner)
• HIE Claim (https://nshr.dha.go.ke/fhir/StructureDefinition/claim)
• HIE ClaimResponse (https://nshr.dha.go.ke/fhir/StructureDefinition/claimresponse)