Uzbekistan Digital Health Platform
0.11.1 - ci-build Uzbekistan flag

Uzbekistan Digital Health Platform, published by Ministry of Health of the Republic of Uzbekistan. This guide is not an authorized publication; it is the continuous build for version 0.11.1 built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/uzinfocom-org/digital-health-ig/ and changes regularly. See the Directory of published versions

Resource Profile: UZ Core ClaimResponse ( Experimental )

Official URL: https://dhp.uz/fhir/core/StructureDefinition/uz-core-claim-response Version: 0.11.1
Active as of 2026-06-22 Computable Name: UZCoreClaimResponse

Uzbekistan Core ClaimResponse profile, used to represent claim adjudication and reimbursement responses

Usages:

You can also check for usages in the FHIR IG Statistics

Formal Views of Profile Content

Description Differentials, Snapshots, and other representations.

NameFlagsCard.TypeDescription & Constraints    Filter: doco
ClaimResponse 0..* ClaimResponse(5.0.0) Response to a claim predetermination or preauthorization
ClaimResponse.implicitRules This element is a modifier element. This element is included in summaries. 0..1 uri A set of rules under which this content was created
ClaimResponse.contained 0..* Resource Contained, inline Resources
ClaimResponse.Slices for extension 0..* Extension Extension
Slice: Unordered, Open by value:url
Constraints: ext-1

Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them
ClaimResponse.Slices for extension.extension:cancellationReason This element must be supported. 0..1 CodeableConcept Reason for cancellation
URL: https://dhp.uz/fhir/core/StructureDefinition/claim-response-cancellation-reason
Binding: CancellationReasonVS (0.11.1) (required)
Constraints: ext-1
ClaimResponse.modifierExtension This element is a modifier element. This element is included in summaries. 0..* Extension Extensions that cannot be ignored
Constraints: ext-1
ClaimResponse.identifier This element must be supported. 0..* Identifier Business identifier for the claim response
ClaimResponse.status This element is a modifier element. This element must be supported. This element is included in summaries. 1..1 code Current status of the claim response
Binding: FMStatusVS (0.11.1) (required)
ClaimResponse.type This element must be supported. This element is included in summaries. 1..1 CodeableConcept Category or discipline of the claim
Binding: ClaimTypeVS (0.11.1) (required)
ClaimResponse.use This element must be supported. This element is included in summaries. 1..1 code Purpose of the claim response
Binding: ClaimUseVS (0.11.1) (required)
ClaimResponse.patient This element must be supported. This element is included in summaries. 1..1 Reference(UZ Core Patient(0.11.1)) Patient associated with the claim
ClaimResponse.created This element must be supported. This element is included in summaries. 1..1 dateTime Date the claim response was created
ClaimResponse.insurer This element must be supported. This element is included in summaries. 0..1 Reference(UZ Core Organization(0.11.1)) Organization responsible for reimbursement
ClaimResponse.request This element must be supported. This element is included in summaries. 0..1 Reference(UZ Core Claim(0.11.1)) Reference to the original claim
ClaimResponse.outcome This element must be supported. This element is included in summaries. 1..1 code Processing outcome of the claim
Binding: ClaimResponseOutcomeVS (0.11.1) (required)
ClaimResponse.decision This element must be supported. This element is included in summaries. 0..1 CodeableConcept Adjudication decision
Binding: ClaimResponseDecisionVS (0.11.1) (required)
ClaimResponse.preAuthRef This element must be supported. 0..1 string Reference to a prior authorization
ClaimResponse.preAuthPeriod This element must be supported. 0..1 Period Validity period of the prior authorization
ClaimResponse.preAuthPeriod.start This element is included in summaries. C 0..1 dateTime Authorization start date
ClaimResponse.preAuthPeriod.end This element is included in summaries. C 0..1 dateTime Authorization end date
ClaimResponse.total This element must be supported. This element is included in summaries. 0..* BackboneElement Summary adjudication amounts
ClaimResponse.total.modifierExtension This element is a modifier element. This element is included in summaries. 0..* Extension Extensions that cannot be ignored even if unrecognized
Constraints: ext-1
ClaimResponse.total.category This element is included in summaries. 1..1 CodeableConcept Type of adjudication information
Binding: ClaimResponseCategoryVS (0.11.1) (required)
ClaimResponse.total.amount This element is included in summaries. 1..1 Money Total amount for the category

doco Documentation for this format

Terminology Bindings

Path Status Usage ValueSet Version Source
ClaimResponse.status Base required Financial Management Status Value set 📍0.11.1 This IG
ClaimResponse.type Base required Claim Type VS 📍0.11.1 This IG
ClaimResponse.use Base required Claim Use Value set 📍0.11.1 This IG
ClaimResponse.outcome Base required Claim Response Outcome VS 📍0.11.1 This IG
ClaimResponse.decision Base required Claim Response Decision VS 📍0.11.1 This IG
ClaimResponse.total.​category Base required Claim Response Category VS 📍0.11.1 This IG

Constraints

Id Grade Path(s) Description Expression

This structure is derived from ClaimResponse

NameFlagsCard.TypeDescription & Constraints    Filter: doco
ClaimResponse 0..* ClaimResponse(5.0.0) Response to a claim predetermination or preauthorization
ClaimResponse.Slices for extension 0..* Extension Extension
Slice: Unordered, Open by value:url
Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them
ClaimResponse.Slices for extension.extension:cancellationReason This element must be supported. 0..1 CodeableConcept Reason for cancellation
URL: https://dhp.uz/fhir/core/StructureDefinition/claim-response-cancellation-reason
Binding: CancellationReasonVS (0.11.1) (required)
ClaimResponse.identifier This element must be supported. 0..* Identifier Business identifier for the claim response
ClaimResponse.status This element must be supported. 1..1 code Current status of the claim response
Binding: FMStatusVS (0.11.1) (required)
ClaimResponse.use This element must be supported. 1..1 code Purpose of the claim response
Binding: ClaimUseVS (0.11.1) (required)
ClaimResponse.patient This element must be supported. 1..1 Reference(UZ Core Patient(0.11.1)) Patient associated with the claim
ClaimResponse.created This element must be supported. 1..1 dateTime Date the claim response was created
ClaimResponse.insurer This element must be supported. 0..1 Reference(UZ Core Organization(0.11.1)) Organization responsible for reimbursement
ClaimResponse.request This element must be supported. 0..1 Reference(UZ Core Claim(0.11.1)) Reference to the original claim
ClaimResponse.outcome This element must be supported. 1..1 code Processing outcome of the claim
Binding: ClaimResponseOutcomeVS (0.11.1) (required)
ClaimResponse.decision This element must be supported. 0..1 CodeableConcept Adjudication decision
Binding: ClaimResponseDecisionVS (0.11.1) (required)
ClaimResponse.preAuthRef This element must be supported. 0..1 string Reference to a prior authorization
ClaimResponse.preAuthPeriod This element must be supported. 0..1 Period Validity period of the prior authorization
ClaimResponse.preAuthPeriod.start 0..1 dateTime Authorization start date
ClaimResponse.preAuthPeriod.end 0..1 dateTime Authorization end date
ClaimResponse.total This element must be supported. 0..* BackboneElement Summary adjudication amounts
ClaimResponse.total.category 1..1 CodeableConcept Type of adjudication information
Binding: ClaimResponseCategoryVS (0.11.1) (required)
ClaimResponse.total.amount 1..1 Money Total amount for the category

doco Documentation for this format

Terminology Bindings (Differential)

Path Status Usage ValueSet Version Source
ClaimResponse.status Base required Financial Management Status Value set 📍0.11.1 This IG
ClaimResponse.type Base required Claim Type VS 📍0.11.1 This IG
ClaimResponse.use Base required Claim Use Value set 📍0.11.1 This IG
ClaimResponse.outcome Base required Claim Response Outcome VS 📍0.11.1 This IG
ClaimResponse.decision Base required Claim Response Decision VS 📍0.11.1 This IG
ClaimResponse.total.​category Base required Claim Response Category VS 📍0.11.1 This IG
NameFlagsCard.TypeDescription & Constraints    Filter: doco
ClaimResponse 0..* ClaimResponse(5.0.0) Response to a claim predetermination or preauthorization
ClaimResponse.id This element is included in summaries. 0..1 id Logical id of this artifact
ClaimResponse.meta This element is included in summaries. 0..1 Meta Metadata about the resource
ClaimResponse.implicitRules This element is a modifier element. 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: AllLanguages (required): IETF language tag for a human language
Additional BindingsPurpose
CommonLanguages Starter
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
ClaimResponse.Slices for extension 0..* Extension Extension
Slice: Unordered, Open by value:url
Constraints: ext-1

Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them
ClaimResponse.Slices for extension.extension:cancellationReason This element must be supported. 0..1 CodeableConcept Reason for cancellation
URL: https://dhp.uz/fhir/core/StructureDefinition/claim-response-cancellation-reason
Binding: CancellationReasonVS (0.11.1) (required)
Constraints: ext-1
ClaimResponse.modifierExtension This element is a modifier element. This element is included in summaries. 0..* Extension Extensions that cannot be ignored
Constraints: ext-1
ClaimResponse.identifier This element must be supported. 0..* Identifier Business identifier for the claim response
ClaimResponse.traceNumber 0..* Identifier Number for tracking
ClaimResponse.status This element is a modifier element. This element must be supported. This element is included in summaries. 1..1 code Current status of the claim response
Binding: FMStatusVS (0.11.1) (required)
ClaimResponse.type This element must be supported. This element is included in summaries. 1..1 CodeableConcept Category or discipline of the claim
Binding: ClaimTypeVS (0.11.1) (required)
ClaimResponse.subType 0..1 CodeableConcept More granular claim type
Binding: ExampleClaimSubTypeCodes (example): A more granular claim typecode.
ClaimResponse.use This element must be supported. This element is included in summaries. 1..1 code Purpose of the claim response
Binding: ClaimUseVS (0.11.1) (required)
ClaimResponse.patient This element must be supported. This element is included in summaries. 1..1 Reference(UZ Core Patient(0.11.1)) Patient associated with the claim
ClaimResponse.created This element must be supported. This element is included in summaries. 1..1 dateTime Date the claim response was created
ClaimResponse.insurer This element must be supported. This element is included in summaries. 0..1 Reference(UZ Core Organization(0.11.1)) Organization responsible for reimbursement
ClaimResponse.requestor 0..1 Reference(Practitioner | PractitionerRole | Organization) Party responsible for the claim
ClaimResponse.request This element must be supported. This element is included in summaries. 0..1 Reference(UZ Core Claim(0.11.1)) Reference to the original claim
ClaimResponse.outcome This element must be supported. This element is included in summaries. 1..1 code Processing outcome of the claim
Binding: ClaimResponseOutcomeVS (0.11.1) (required)
ClaimResponse.decision This element must be supported. This element is included in summaries. 0..1 CodeableConcept Adjudication decision
Binding: ClaimResponseDecisionVS (0.11.1) (required)
ClaimResponse.disposition 0..1 string Disposition Message
ClaimResponse.preAuthRef This element must be supported. 0..1 string Reference to a prior authorization
ClaimResponse.preAuthPeriod This element must be supported. 0..1 Period Validity period of the prior authorization
ClaimResponse.preAuthPeriod.id 0..1 id Unique id for inter-element referencing
ClaimResponse.preAuthPeriod.extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
Constraints: ext-1
ClaimResponse.preAuthPeriod.start This element is included in summaries. C 0..1 dateTime Authorization start date
ClaimResponse.preAuthPeriod.end This element is included in summaries. C 0..1 dateTime Authorization end date
ClaimResponse.event 0..* BackboneElement Event information
ClaimResponse.event.id 0..1 string Unique id for inter-element referencing
ClaimResponse.event.extension 0..* Extension Additional content defined by implementations
Constraints: ext-1
ClaimResponse.event.modifierExtension This element is a modifier element. This element is included in summaries. 0..* Extension Extensions that cannot be ignored even if unrecognized
Constraints: ext-1
ClaimResponse.event.type 1..1 CodeableConcept Specific event
Binding: DatesTypeCodes (example)
ClaimResponse.event.when[x] 1..1 Occurance date or period
ClaimResponse.event.when[x].whenDateTime dateTime
ClaimResponse.event.when[x].whenPeriod Period
ClaimResponse.payeeType 0..1 CodeableConcept Party to be paid any benefits payable
Binding: ClaimPayeeTypeCodes (example): A code for the party to be reimbursed.
ClaimResponse.encounter 0..* Reference(Encounter) Encounters associated with the listed treatments
ClaimResponse.diagnosisRelatedGroup 0..1 CodeableConcept Package billing code
Binding: ExampleDiagnosisRelatedGroupCodes (example)
ClaimResponse.item 0..* 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
Constraints: ext-1
ClaimResponse.item.modifierExtension This element is a modifier element. This element is included in summaries. 0..* Extension Extensions that cannot be ignored even if unrecognized
Constraints: ext-1
ClaimResponse.item.itemSequence 1..1 positiveInt Claim item instance identifier
ClaimResponse.item.traceNumber 0..* Identifier Number for tracking
ClaimResponse.item.noteNumber 0..* positiveInt Applicable note numbers
ClaimResponse.item.reviewOutcome 0..1 BackboneElement Adjudication results
ClaimResponse.item.reviewOutcome.id 0..1 string Unique id for inter-element referencing
ClaimResponse.item.reviewOutcome.extension 0..* Extension Additional content defined by implementations
Constraints: ext-1
ClaimResponse.item.reviewOutcome.modifierExtension This element is a modifier element. This element is included in summaries. 0..* Extension Extensions that cannot be ignored even if unrecognized
Constraints: ext-1
ClaimResponse.item.reviewOutcome.decision 0..1 CodeableConcept Result of the adjudication
Binding: ClaimAdjudicationDecisionsCodes (example)
ClaimResponse.item.reviewOutcome.reason 0..* CodeableConcept Reason for result of the adjudication
Binding: ClaimAdjudicationDecisionReasonCodes (example)
ClaimResponse.item.reviewOutcome.preAuthRef 0..1 string Preauthorization reference
ClaimResponse.item.reviewOutcome.preAuthPeriod 0..1 Period Preauthorization reference effective period
ClaimResponse.item.adjudication 0..* 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
Constraints: ext-1
ClaimResponse.item.adjudication.modifierExtension This element is a modifier element. This element is included in summaries. 0..* Extension Extensions that cannot be ignored even if unrecognized
Constraints: ext-1
ClaimResponse.item.adjudication.category 1..1 CodeableConcept Type of adjudication information
Binding: AdjudicationValueCodes (example): The adjudication codes.
ClaimResponse.item.adjudication.reason 0..1 CodeableConcept Explanation of adjudication outcome
Binding: AdjudicationReasonCodes (example): The adjudication reason codes.
ClaimResponse.item.adjudication.amount 0..1 Money Monetary amount
ClaimResponse.item.adjudication.quantity 0..1 Quantity Non-monetary value
ClaimResponse.item.detail 0..* 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
Constraints: ext-1
ClaimResponse.item.detail.modifierExtension This element is a modifier element. This element is included in summaries. 0..* Extension Extensions that cannot be ignored even if unrecognized
Constraints: ext-1
ClaimResponse.item.detail.detailSequence 1..1 positiveInt Claim detail instance identifier
ClaimResponse.item.detail.traceNumber 0..* Identifier Number for tracking
ClaimResponse.item.detail.noteNumber 0..* positiveInt Applicable note numbers
ClaimResponse.item.detail.reviewOutcome 0..1 See reviewOutcome (ClaimResponse) Detail level adjudication results
ClaimResponse.item.detail.adjudication 0..* See adjudication (ClaimResponse) Detail level adjudication details
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
Constraints: ext-1
ClaimResponse.item.detail.subDetail.modifierExtension This element is a modifier element. This element is included in summaries. 0..* Extension Extensions that cannot be ignored even if unrecognized
Constraints: ext-1
ClaimResponse.item.detail.subDetail.subDetailSequence 1..1 positiveInt Claim sub-detail instance identifier
ClaimResponse.item.detail.subDetail.traceNumber 0..* Identifier Number for tracking
ClaimResponse.item.detail.subDetail.noteNumber 0..* positiveInt Applicable note numbers
ClaimResponse.item.detail.subDetail.reviewOutcome 0..1 See reviewOutcome (ClaimResponse) Subdetail level adjudication results
ClaimResponse.item.detail.subDetail.adjudication 0..* See adjudication (ClaimResponse) Subdetail level adjudication details
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
Constraints: ext-1
ClaimResponse.addItem.modifierExtension This element is a modifier element. This element is included in summaries. 0..* Extension Extensions that cannot be ignored even if unrecognized
Constraints: ext-1
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.traceNumber 0..* Identifier Number for tracking
ClaimResponse.addItem.provider 0..* Reference(Practitioner | PractitionerRole | Organization) Authorized providers
ClaimResponse.addItem.revenue 0..1 CodeableConcept Revenue or cost center code
Binding: ExampleRevenueCenterCodes (example): Codes for the revenue or cost centers supplying the service and/or products.
ClaimResponse.addItem.productOrService 0..1 CodeableConcept Billing, service, product, or drug code
Binding: USCLSCodes (example): Allowable service and product codes.
ClaimResponse.addItem.productOrServiceEnd 0..1 CodeableConcept End of a range of codes
Binding: USCLSCodes (example)
ClaimResponse.addItem.request 0..* Reference(DeviceRequest | MedicationRequest | NutritionOrder | ServiceRequest | SupplyRequest | VisionPrescription) Request or Referral for Service
ClaimResponse.addItem.modifier 0..* CodeableConcept Service/Product billing modifiers
Binding: ModifierTypeCodes (example): Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen.
ClaimResponse.addItem.programCode 0..* CodeableConcept Program the product or service is provided under
Binding: ExampleProgramReasonCodes (example): Program specific reason codes.
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(5.0.0) 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.tax 0..1 Money Total tax
ClaimResponse.addItem.net 0..1 Money Total item cost
ClaimResponse.addItem.bodySite 0..* BackboneElement Anatomical location
ClaimResponse.addItem.bodySite.id 0..1 string Unique id for inter-element referencing
ClaimResponse.addItem.bodySite.extension 0..* Extension Additional content defined by implementations
Constraints: ext-1
ClaimResponse.addItem.bodySite.modifierExtension This element is a modifier element. This element is included in summaries. 0..* Extension Extensions that cannot be ignored even if unrecognized
Constraints: ext-1
ClaimResponse.addItem.bodySite.site 1..* CodeableReference(BodyStructure) Location
Binding: OralSiteCodes (example)
ClaimResponse.addItem.bodySite.subSite 0..* CodeableConcept Sub-location
Binding: SurfaceCodes (example)
ClaimResponse.addItem.noteNumber 0..* positiveInt Applicable note numbers
ClaimResponse.addItem.reviewOutcome 0..1 See reviewOutcome (ClaimResponse) Added items adjudication results
ClaimResponse.addItem.adjudication 0..* See adjudication (ClaimResponse) Added items adjudication
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
Constraints: ext-1
ClaimResponse.addItem.detail.modifierExtension This element is a modifier element. This element is included in summaries. 0..* Extension Extensions that cannot be ignored even if unrecognized
Constraints: ext-1
ClaimResponse.addItem.detail.traceNumber 0..* Identifier Number for tracking
ClaimResponse.addItem.detail.revenue 0..1 CodeableConcept Revenue or cost center code
Binding: ExampleRevenueCenterCodes (example): Codes for the revenue or cost centers supplying the service and/or products.
ClaimResponse.addItem.detail.productOrService 0..1 CodeableConcept Billing, service, product, or drug code
Binding: USCLSCodes (example): Allowable service and product codes.
ClaimResponse.addItem.detail.productOrServiceEnd 0..1 CodeableConcept End of a range of codes
Binding: USCLSCodes (example)
ClaimResponse.addItem.detail.modifier 0..* CodeableConcept Service/Product billing modifiers
Binding: ModifierTypeCodes (example): Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen.
ClaimResponse.addItem.detail.quantity C 0..1 SimpleQuantity(5.0.0) 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.tax 0..1 Money Total tax
ClaimResponse.addItem.detail.net 0..1 Money Total item cost
ClaimResponse.addItem.detail.noteNumber 0..* positiveInt Applicable note numbers
ClaimResponse.addItem.detail.reviewOutcome 0..1 See reviewOutcome (ClaimResponse) Added items detail level adjudication results
ClaimResponse.addItem.detail.adjudication 0..* See adjudication (ClaimResponse) Added items detail adjudication
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
Constraints: ext-1
ClaimResponse.addItem.detail.subDetail.modifierExtension This element is a modifier element. This element is included in summaries. 0..* Extension Extensions that cannot be ignored even if unrecognized
Constraints: ext-1
ClaimResponse.addItem.detail.subDetail.traceNumber 0..* Identifier Number for tracking
ClaimResponse.addItem.detail.subDetail.revenue 0..1 CodeableConcept Revenue or cost center code
Binding: ExampleRevenueCenterCodes (example): Codes for the revenue or cost centers supplying the service and/or products.
ClaimResponse.addItem.detail.subDetail.productOrService 0..1 CodeableConcept Billing, service, product, or drug code
Binding: USCLSCodes (example): Allowable service and product codes.
ClaimResponse.addItem.detail.subDetail.productOrServiceEnd 0..1 CodeableConcept End of a range of codes
Binding: USCLSCodes (example)
ClaimResponse.addItem.detail.subDetail.modifier 0..* CodeableConcept Service/Product billing modifiers
Binding: ModifierTypeCodes (example): Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen.
ClaimResponse.addItem.detail.subDetail.quantity C 0..1 SimpleQuantity(5.0.0) 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.tax 0..1 Money Total tax
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.reviewOutcome 0..1 See reviewOutcome (ClaimResponse) Added items subdetail level adjudication results
ClaimResponse.addItem.detail.subDetail.adjudication 0..* See adjudication (ClaimResponse) Added items subdetail adjudication
ClaimResponse.adjudication 0..* See adjudication (ClaimResponse) Header-level adjudication
ClaimResponse.total This element must be supported. This element is included in summaries. 0..* BackboneElement Summary adjudication amounts
ClaimResponse.total.id 0..1 string Unique id for inter-element referencing
ClaimResponse.total.extension 0..* Extension Additional content defined by implementations
Constraints: ext-1
ClaimResponse.total.modifierExtension This element is a modifier element. This element is included in summaries. 0..* Extension Extensions that cannot be ignored even if unrecognized
Constraints: ext-1
ClaimResponse.total.category This element is included in summaries. 1..1 CodeableConcept Type of adjudication information
Binding: ClaimResponseCategoryVS (0.11.1) (required)
ClaimResponse.total.amount This element is included in summaries. 1..1 Money Total amount for the category
ClaimResponse.payment 0..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
Constraints: ext-1
ClaimResponse.payment.modifierExtension This element is a modifier element. This element is included in summaries. 0..* Extension Extensions that cannot be ignored even if unrecognized
Constraints: ext-1
ClaimResponse.payment.type 1..1 CodeableConcept Partial or complete payment
Binding: ExamplePaymentTypeCodes (example): The type (partial, complete) of the payment.
ClaimResponse.payment.adjustment 0..1 Money Payment adjustment for non-claim issues
ClaimResponse.payment.adjustmentReason 0..1 CodeableConcept Explanation for the adjustment
Binding: PaymentAdjustmentReasonCodes (example): Payment Adjustment reason codes.
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 0..1 CodeableConcept Funds reserved status
Binding: FundsReservationCodes (example): For whom funds are to be reserved: (Patient, Provider, None).
ClaimResponse.formCode 0..1 CodeableConcept Printed form identifier
Binding: FormCodes (example): The forms codes.
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
Constraints: ext-1
ClaimResponse.processNote.modifierExtension This element is a modifier element. This element is included in summaries. 0..* Extension Extensions that cannot be ignored even if unrecognized
Constraints: ext-1
ClaimResponse.processNote.number 0..1 positiveInt Note instance identifier
ClaimResponse.processNote.type 0..1 CodeableConcept Note purpose
Binding: NoteType (extensible): The presentation types of notes.
ClaimResponse.processNote.text 1..1 string Note explanatory text
ClaimResponse.processNote.language 0..1 CodeableConcept Language of the text
Binding: AllLanguages (required): IETF language tag for a human language
Additional BindingsPurpose
CommonLanguages Starter
ClaimResponse.communicationRequest 0..* Reference(CommunicationRequest) Request for additional information
ClaimResponse.insurance 0..* 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
Constraints: ext-1
ClaimResponse.insurance.modifierExtension This element is a modifier element. This element is included in summaries. 0..* Extension Extensions that cannot be ignored even if unrecognized
Constraints: ext-1
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 Reference(Coverage) Insurance information
ClaimResponse.insurance.businessArrangement 0..1 string Additional provider contract number
ClaimResponse.insurance.claimResponse 0..1 Reference(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
Constraints: ext-1
ClaimResponse.error.modifierExtension This element is a modifier element. This element is included in summaries. 0..* Extension Extensions that cannot be ignored even if unrecognized
Constraints: ext-1
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 This element is included in summaries. 1..1 CodeableConcept Error code detailing processing issues
Binding: AdjudicationErrorCodes (example): The adjudication error codes.
ClaimResponse.error.expression This element is included in summaries. 0..* string FHIRPath of element(s) related to issue

doco Documentation for this format

Terminology Bindings

Path Status Usage ValueSet Version Source
ClaimResponse.language Base required All Languages 📍5.0.0 FHIR Std.
ClaimResponse.status Base required Financial Management Status Value set 📍0.11.1 This IG
ClaimResponse.type Base required Claim Type VS 📍0.11.1 This IG
ClaimResponse.subType Base example Example Claim SubType Codes 📍5.0.0 FHIR Std.
ClaimResponse.use Base required Claim Use Value set 📍0.11.1 This IG
ClaimResponse.outcome Base required Claim Response Outcome VS 📍0.11.1 This IG
ClaimResponse.decision Base required Claim Response Decision VS 📍0.11.1 This IG
ClaimResponse.event.​type Base example Dates Type Codes 📍5.0.0 FHIR Std.
ClaimResponse.payeeType Base example Claim Payee Type Codes 📍5.0.0 FHIR Std.
ClaimResponse.diagnosisRelatedGroup Base example Example Diagnosis Related Group Codes 📍5.0.0 FHIR Std.
ClaimResponse.item.reviewOutcome.​decision Base example Claim Adjudication Decision Codes 📍5.0.0 FHIR Std.
ClaimResponse.item.reviewOutcome.​reason Base example Claim Adjudication Decision Reason Codes 📍5.0.0 FHIR Std.
ClaimResponse.item.adjudication.​category Base example Adjudication Value Codes 📍5.0.0 FHIR Std.
ClaimResponse.item.adjudication.​reason Base example Adjudication Reason Codes 📍5.0.0 FHIR Std.
ClaimResponse.addItem.​revenue Base example Example Revenue Center Codes 📍5.0.0 FHIR Std.
ClaimResponse.addItem.​productOrService Base example USCLS Codes 📍5.0.0 FHIR Std.
ClaimResponse.addItem.​productOrServiceEnd Base example USCLS Codes 📍5.0.0 FHIR Std.
ClaimResponse.addItem.​modifier Base example Modifier type Codes 📍5.0.0 FHIR Std.
ClaimResponse.addItem.​programCode Base example Example Program Reason Codes 📍5.0.0 FHIR Std.
ClaimResponse.addItem.​location[x] Base example Example Service Place Codes 📍5.0.0 FHIR Std.
ClaimResponse.addItem.​bodySite.site Base example Oral Site Codes 📍5.0.0 FHIR Std.
ClaimResponse.addItem.​bodySite.subSite Base example Surface Codes 📍5.0.0 FHIR Std.
ClaimResponse.addItem.​detail.revenue Base example Example Revenue Center Codes 📍5.0.0 FHIR Std.
ClaimResponse.addItem.​detail.productOrService Base example USCLS Codes 📍5.0.0 FHIR Std.
ClaimResponse.addItem.​detail.productOrServiceEnd Base example USCLS Codes 📍5.0.0 FHIR Std.
ClaimResponse.addItem.​detail.modifier Base example Modifier type Codes 📍5.0.0 FHIR Std.
ClaimResponse.addItem.​detail.subDetail.revenue Base example Example Revenue Center Codes 📍5.0.0 FHIR Std.
ClaimResponse.addItem.​detail.subDetail.productOrService Base example USCLS Codes 📍5.0.0 FHIR Std.
ClaimResponse.addItem.​detail.subDetail.productOrServiceEnd Base example USCLS Codes 📍5.0.0 FHIR Std.
ClaimResponse.addItem.​detail.subDetail.modifier Base example Modifier type Codes 📍5.0.0 FHIR Std.
ClaimResponse.total.​category Base required Claim Response Category VS 📍0.11.1 This IG
ClaimResponse.payment.​type Base example Example Payment Type Codes 📍5.0.0 FHIR Std.
ClaimResponse.payment.​adjustmentReason Base example Payment Adjustment Reason Codes 📍5.0.0 FHIR Std.
ClaimResponse.fundsReserve Base example Funds Reservation Codes 📍5.0.0 FHIR Std.
ClaimResponse.formCode Base example Form Codes 📍5.0.0 FHIR Std.
ClaimResponse.processNote.​type Base extensible NoteType 📍5.0.0 FHIR Std.
ClaimResponse.processNote.​language Base required All Languages 📍5.0.0 FHIR Std.
ClaimResponse.error.​code Base example Adjudication Error Codes 📍5.0.0 FHIR Std.

Constraints

Id Grade Path(s) Description Expression

Key Elements View

NameFlagsCard.TypeDescription & Constraints    Filter: doco
ClaimResponse 0..* ClaimResponse(5.0.0) Response to a claim predetermination or preauthorization
ClaimResponse.implicitRules This element is a modifier element. This element is included in summaries. 0..1 uri A set of rules under which this content was created
ClaimResponse.contained 0..* Resource Contained, inline Resources
ClaimResponse.Slices for extension 0..* Extension Extension
Slice: Unordered, Open by value:url
Constraints: ext-1

Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them
ClaimResponse.Slices for extension.extension:cancellationReason This element must be supported. 0..1 CodeableConcept Reason for cancellation
URL: https://dhp.uz/fhir/core/StructureDefinition/claim-response-cancellation-reason
Binding: CancellationReasonVS (0.11.1) (required)
Constraints: ext-1
ClaimResponse.modifierExtension This element is a modifier element. This element is included in summaries. 0..* Extension Extensions that cannot be ignored
Constraints: ext-1
ClaimResponse.identifier This element must be supported. 0..* Identifier Business identifier for the claim response
ClaimResponse.status This element is a modifier element. This element must be supported. This element is included in summaries. 1..1 code Current status of the claim response
Binding: FMStatusVS (0.11.1) (required)
ClaimResponse.type This element must be supported. This element is included in summaries. 1..1 CodeableConcept Category or discipline of the claim
Binding: ClaimTypeVS (0.11.1) (required)
ClaimResponse.use This element must be supported. This element is included in summaries. 1..1 code Purpose of the claim response
Binding: ClaimUseVS (0.11.1) (required)
ClaimResponse.patient This element must be supported. This element is included in summaries. 1..1 Reference(UZ Core Patient(0.11.1)) Patient associated with the claim
ClaimResponse.created This element must be supported. This element is included in summaries. 1..1 dateTime Date the claim response was created
ClaimResponse.insurer This element must be supported. This element is included in summaries. 0..1 Reference(UZ Core Organization(0.11.1)) Organization responsible for reimbursement
ClaimResponse.request This element must be supported. This element is included in summaries. 0..1 Reference(UZ Core Claim(0.11.1)) Reference to the original claim
ClaimResponse.outcome This element must be supported. This element is included in summaries. 1..1 code Processing outcome of the claim
Binding: ClaimResponseOutcomeVS (0.11.1) (required)
ClaimResponse.decision This element must be supported. This element is included in summaries. 0..1 CodeableConcept Adjudication decision
Binding: ClaimResponseDecisionVS (0.11.1) (required)
ClaimResponse.preAuthRef This element must be supported. 0..1 string Reference to a prior authorization
ClaimResponse.preAuthPeriod This element must be supported. 0..1 Period Validity period of the prior authorization
ClaimResponse.preAuthPeriod.start This element is included in summaries. C 0..1 dateTime Authorization start date
ClaimResponse.preAuthPeriod.end This element is included in summaries. C 0..1 dateTime Authorization end date
ClaimResponse.total This element must be supported. This element is included in summaries. 0..* BackboneElement Summary adjudication amounts
ClaimResponse.total.modifierExtension This element is a modifier element. This element is included in summaries. 0..* Extension Extensions that cannot be ignored even if unrecognized
Constraints: ext-1
ClaimResponse.total.category This element is included in summaries. 1..1 CodeableConcept Type of adjudication information
Binding: ClaimResponseCategoryVS (0.11.1) (required)
ClaimResponse.total.amount This element is included in summaries. 1..1 Money Total amount for the category

doco Documentation for this format

Terminology Bindings

Path Status Usage ValueSet Version Source
ClaimResponse.status Base required Financial Management Status Value set 📍0.11.1 This IG
ClaimResponse.type Base required Claim Type VS 📍0.11.1 This IG
ClaimResponse.use Base required Claim Use Value set 📍0.11.1 This IG
ClaimResponse.outcome Base required Claim Response Outcome VS 📍0.11.1 This IG
ClaimResponse.decision Base required Claim Response Decision VS 📍0.11.1 This IG
ClaimResponse.total.​category Base required Claim Response Category VS 📍0.11.1 This IG

Constraints

Id Grade Path(s) Description Expression

Differential View

This structure is derived from ClaimResponse

NameFlagsCard.TypeDescription & Constraints    Filter: doco
ClaimResponse 0..* ClaimResponse(5.0.0) Response to a claim predetermination or preauthorization
ClaimResponse.Slices for extension 0..* Extension Extension
Slice: Unordered, Open by value:url
Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them
ClaimResponse.Slices for extension.extension:cancellationReason This element must be supported. 0..1 CodeableConcept Reason for cancellation
URL: https://dhp.uz/fhir/core/StructureDefinition/claim-response-cancellation-reason
Binding: CancellationReasonVS (0.11.1) (required)
ClaimResponse.identifier This element must be supported. 0..* Identifier Business identifier for the claim response
ClaimResponse.status This element must be supported. 1..1 code Current status of the claim response
Binding: FMStatusVS (0.11.1) (required)
ClaimResponse.type This element must be supported. 1..1 CodeableConcept Category or discipline of the claim
Binding: ClaimTypeVS (0.11.1) (required)
ClaimResponse.use This element must be supported. 1..1 code Purpose of the claim response
Binding: ClaimUseVS (0.11.1) (required)
ClaimResponse.patient This element must be supported. 1..1 Reference(UZ Core Patient(0.11.1)) Patient associated with the claim
ClaimResponse.created This element must be supported. 1..1 dateTime Date the claim response was created
ClaimResponse.insurer This element must be supported. 0..1 Reference(UZ Core Organization(0.11.1)) Organization responsible for reimbursement
ClaimResponse.request This element must be supported. 0..1 Reference(UZ Core Claim(0.11.1)) Reference to the original claim
ClaimResponse.outcome This element must be supported. 1..1 code Processing outcome of the claim
Binding: ClaimResponseOutcomeVS (0.11.1) (required)
ClaimResponse.decision This element must be supported. 0..1 CodeableConcept Adjudication decision
Binding: ClaimResponseDecisionVS (0.11.1) (required)
ClaimResponse.preAuthRef This element must be supported. 0..1 string Reference to a prior authorization
ClaimResponse.preAuthPeriod This element must be supported. 0..1 Period Validity period of the prior authorization
ClaimResponse.preAuthPeriod.start 0..1 dateTime Authorization start date
ClaimResponse.preAuthPeriod.end 0..1 dateTime Authorization end date
ClaimResponse.total This element must be supported. 0..* BackboneElement Summary adjudication amounts
ClaimResponse.total.category 1..1 CodeableConcept Type of adjudication information
Binding: ClaimResponseCategoryVS (0.11.1) (required)
ClaimResponse.total.amount 1..1 Money Total amount for the category

doco Documentation for this format

Terminology Bindings (Differential)

Path Status Usage ValueSet Version Source
ClaimResponse.status Base required Financial Management Status Value set 📍0.11.1 This IG
ClaimResponse.type Base required Claim Type VS 📍0.11.1 This IG
ClaimResponse.use Base required Claim Use Value set 📍0.11.1 This IG
ClaimResponse.outcome Base required Claim Response Outcome VS 📍0.11.1 This IG
ClaimResponse.decision Base required Claim Response Decision VS 📍0.11.1 This IG
ClaimResponse.total.​category Base required Claim Response Category VS 📍0.11.1 This IG

Snapshot ViewView

NameFlagsCard.TypeDescription & Constraints    Filter: doco
ClaimResponse 0..* ClaimResponse(5.0.0) Response to a claim predetermination or preauthorization
ClaimResponse.id This element is included in summaries. 0..1 id Logical id of this artifact
ClaimResponse.meta This element is included in summaries. 0..1 Meta Metadata about the resource
ClaimResponse.implicitRules This element is a modifier element. 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: AllLanguages (required): IETF language tag for a human language
Additional BindingsPurpose
CommonLanguages Starter
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
ClaimResponse.Slices for extension 0..* Extension Extension
Slice: Unordered, Open by value:url
Constraints: ext-1

Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them
ClaimResponse.Slices for extension.extension:cancellationReason This element must be supported. 0..1 CodeableConcept Reason for cancellation
URL: https://dhp.uz/fhir/core/StructureDefinition/claim-response-cancellation-reason
Binding: CancellationReasonVS (0.11.1) (required)
Constraints: ext-1
ClaimResponse.modifierExtension This element is a modifier element. This element is included in summaries. 0..* Extension Extensions that cannot be ignored
Constraints: ext-1
ClaimResponse.identifier This element must be supported. 0..* Identifier Business identifier for the claim response
ClaimResponse.traceNumber 0..* Identifier Number for tracking
ClaimResponse.status This element is a modifier element. This element must be supported. This element is included in summaries. 1..1 code Current status of the claim response
Binding: FMStatusVS (0.11.1) (required)
ClaimResponse.type This element must be supported. This element is included in summaries. 1..1 CodeableConcept Category or discipline of the claim
Binding: ClaimTypeVS (0.11.1) (required)
ClaimResponse.subType 0..1 CodeableConcept More granular claim type
Binding: ExampleClaimSubTypeCodes (example): A more granular claim typecode.
ClaimResponse.use This element must be supported. This element is included in summaries. 1..1 code Purpose of the claim response
Binding: ClaimUseVS (0.11.1) (required)
ClaimResponse.patient This element must be supported. This element is included in summaries. 1..1 Reference(UZ Core Patient(0.11.1)) Patient associated with the claim
ClaimResponse.created This element must be supported. This element is included in summaries. 1..1 dateTime Date the claim response was created
ClaimResponse.insurer This element must be supported. This element is included in summaries. 0..1 Reference(UZ Core Organization(0.11.1)) Organization responsible for reimbursement
ClaimResponse.requestor 0..1 Reference(Practitioner | PractitionerRole | Organization) Party responsible for the claim
ClaimResponse.request This element must be supported. This element is included in summaries. 0..1 Reference(UZ Core Claim(0.11.1)) Reference to the original claim
ClaimResponse.outcome This element must be supported. This element is included in summaries. 1..1 code Processing outcome of the claim
Binding: ClaimResponseOutcomeVS (0.11.1) (required)
ClaimResponse.decision This element must be supported. This element is included in summaries. 0..1 CodeableConcept Adjudication decision
Binding: ClaimResponseDecisionVS (0.11.1) (required)
ClaimResponse.disposition 0..1 string Disposition Message
ClaimResponse.preAuthRef This element must be supported. 0..1 string Reference to a prior authorization
ClaimResponse.preAuthPeriod This element must be supported. 0..1 Period Validity period of the prior authorization
ClaimResponse.preAuthPeriod.id 0..1 id Unique id for inter-element referencing
ClaimResponse.preAuthPeriod.extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
Constraints: ext-1
ClaimResponse.preAuthPeriod.start This element is included in summaries. C 0..1 dateTime Authorization start date
ClaimResponse.preAuthPeriod.end This element is included in summaries. C 0..1 dateTime Authorization end date
ClaimResponse.event 0..* BackboneElement Event information
ClaimResponse.event.id 0..1 string Unique id for inter-element referencing
ClaimResponse.event.extension 0..* Extension Additional content defined by implementations
Constraints: ext-1
ClaimResponse.event.modifierExtension This element is a modifier element. This element is included in summaries. 0..* Extension Extensions that cannot be ignored even if unrecognized
Constraints: ext-1
ClaimResponse.event.type 1..1 CodeableConcept Specific event
Binding: DatesTypeCodes (example)
ClaimResponse.event.when[x] 1..1 Occurance date or period
ClaimResponse.event.when[x].whenDateTime dateTime
ClaimResponse.event.when[x].whenPeriod Period
ClaimResponse.payeeType 0..1 CodeableConcept Party to be paid any benefits payable
Binding: ClaimPayeeTypeCodes (example): A code for the party to be reimbursed.
ClaimResponse.encounter 0..* Reference(Encounter) Encounters associated with the listed treatments
ClaimResponse.diagnosisRelatedGroup 0..1 CodeableConcept Package billing code
Binding: ExampleDiagnosisRelatedGroupCodes (example)
ClaimResponse.item 0..* 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
Constraints: ext-1
ClaimResponse.item.modifierExtension This element is a modifier element. This element is included in summaries. 0..* Extension Extensions that cannot be ignored even if unrecognized
Constraints: ext-1
ClaimResponse.item.itemSequence 1..1 positiveInt Claim item instance identifier
ClaimResponse.item.traceNumber 0..* Identifier Number for tracking
ClaimResponse.item.noteNumber 0..* positiveInt Applicable note numbers
ClaimResponse.item.reviewOutcome 0..1 BackboneElement Adjudication results
ClaimResponse.item.reviewOutcome.id 0..1 string Unique id for inter-element referencing
ClaimResponse.item.reviewOutcome.extension 0..* Extension Additional content defined by implementations
Constraints: ext-1
ClaimResponse.item.reviewOutcome.modifierExtension This element is a modifier element. This element is included in summaries. 0..* Extension Extensions that cannot be ignored even if unrecognized
Constraints: ext-1
ClaimResponse.item.reviewOutcome.decision 0..1 CodeableConcept Result of the adjudication
Binding: ClaimAdjudicationDecisionsCodes (example)
ClaimResponse.item.reviewOutcome.reason 0..* CodeableConcept Reason for result of the adjudication
Binding: ClaimAdjudicationDecisionReasonCodes (example)
ClaimResponse.item.reviewOutcome.preAuthRef 0..1 string Preauthorization reference
ClaimResponse.item.reviewOutcome.preAuthPeriod 0..1 Period Preauthorization reference effective period
ClaimResponse.item.adjudication 0..* 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
Constraints: ext-1
ClaimResponse.item.adjudication.modifierExtension This element is a modifier element. This element is included in summaries. 0..* Extension Extensions that cannot be ignored even if unrecognized
Constraints: ext-1
ClaimResponse.item.adjudication.category 1..1 CodeableConcept Type of adjudication information
Binding: AdjudicationValueCodes (example): The adjudication codes.
ClaimResponse.item.adjudication.reason 0..1 CodeableConcept Explanation of adjudication outcome
Binding: AdjudicationReasonCodes (example): The adjudication reason codes.
ClaimResponse.item.adjudication.amount 0..1 Money Monetary amount
ClaimResponse.item.adjudication.quantity 0..1 Quantity Non-monetary value
ClaimResponse.item.detail 0..* 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
Constraints: ext-1
ClaimResponse.item.detail.modifierExtension This element is a modifier element. This element is included in summaries. 0..* Extension Extensions that cannot be ignored even if unrecognized
Constraints: ext-1
ClaimResponse.item.detail.detailSequence 1..1 positiveInt Claim detail instance identifier
ClaimResponse.item.detail.traceNumber 0..* Identifier Number for tracking
ClaimResponse.item.detail.noteNumber 0..* positiveInt Applicable note numbers
ClaimResponse.item.detail.reviewOutcome 0..1 See reviewOutcome (ClaimResponse) Detail level adjudication results
ClaimResponse.item.detail.adjudication 0..* See adjudication (ClaimResponse) Detail level adjudication details
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
Constraints: ext-1
ClaimResponse.item.detail.subDetail.modifierExtension This element is a modifier element. This element is included in summaries. 0..* Extension Extensions that cannot be ignored even if unrecognized
Constraints: ext-1
ClaimResponse.item.detail.subDetail.subDetailSequence 1..1 positiveInt Claim sub-detail instance identifier
ClaimResponse.item.detail.subDetail.traceNumber 0..* Identifier Number for tracking
ClaimResponse.item.detail.subDetail.noteNumber 0..* positiveInt Applicable note numbers
ClaimResponse.item.detail.subDetail.reviewOutcome 0..1 See reviewOutcome (ClaimResponse) Subdetail level adjudication results
ClaimResponse.item.detail.subDetail.adjudication 0..* See adjudication (ClaimResponse) Subdetail level adjudication details
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
Constraints: ext-1
ClaimResponse.addItem.modifierExtension This element is a modifier element. This element is included in summaries. 0..* Extension Extensions that cannot be ignored even if unrecognized
Constraints: ext-1
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.traceNumber 0..* Identifier Number for tracking
ClaimResponse.addItem.provider 0..* Reference(Practitioner | PractitionerRole | Organization) Authorized providers
ClaimResponse.addItem.revenue 0..1 CodeableConcept Revenue or cost center code
Binding: ExampleRevenueCenterCodes (example): Codes for the revenue or cost centers supplying the service and/or products.
ClaimResponse.addItem.productOrService 0..1 CodeableConcept Billing, service, product, or drug code
Binding: USCLSCodes (example): Allowable service and product codes.
ClaimResponse.addItem.productOrServiceEnd 0..1 CodeableConcept End of a range of codes
Binding: USCLSCodes (example)
ClaimResponse.addItem.request 0..* Reference(DeviceRequest | MedicationRequest | NutritionOrder | ServiceRequest | SupplyRequest | VisionPrescription) Request or Referral for Service
ClaimResponse.addItem.modifier 0..* CodeableConcept Service/Product billing modifiers
Binding: ModifierTypeCodes (example): Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen.
ClaimResponse.addItem.programCode 0..* CodeableConcept Program the product or service is provided under
Binding: ExampleProgramReasonCodes (example): Program specific reason codes.
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(5.0.0) 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.tax 0..1 Money Total tax
ClaimResponse.addItem.net 0..1 Money Total item cost
ClaimResponse.addItem.bodySite 0..* BackboneElement Anatomical location
ClaimResponse.addItem.bodySite.id 0..1 string Unique id for inter-element referencing
ClaimResponse.addItem.bodySite.extension 0..* Extension Additional content defined by implementations
Constraints: ext-1
ClaimResponse.addItem.bodySite.modifierExtension This element is a modifier element. This element is included in summaries. 0..* Extension Extensions that cannot be ignored even if unrecognized
Constraints: ext-1
ClaimResponse.addItem.bodySite.site 1..* CodeableReference(BodyStructure) Location
Binding: OralSiteCodes (example)
ClaimResponse.addItem.bodySite.subSite 0..* CodeableConcept Sub-location
Binding: SurfaceCodes (example)
ClaimResponse.addItem.noteNumber 0..* positiveInt Applicable note numbers
ClaimResponse.addItem.reviewOutcome 0..1 See reviewOutcome (ClaimResponse) Added items adjudication results
ClaimResponse.addItem.adjudication 0..* See adjudication (ClaimResponse) Added items adjudication
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
Constraints: ext-1
ClaimResponse.addItem.detail.modifierExtension This element is a modifier element. This element is included in summaries. 0..* Extension Extensions that cannot be ignored even if unrecognized
Constraints: ext-1
ClaimResponse.addItem.detail.traceNumber 0..* Identifier Number for tracking
ClaimResponse.addItem.detail.revenue 0..1 CodeableConcept Revenue or cost center code
Binding: ExampleRevenueCenterCodes (example): Codes for the revenue or cost centers supplying the service and/or products.
ClaimResponse.addItem.detail.productOrService 0..1 CodeableConcept Billing, service, product, or drug code
Binding: USCLSCodes (example): Allowable service and product codes.
ClaimResponse.addItem.detail.productOrServiceEnd 0..1 CodeableConcept End of a range of codes
Binding: USCLSCodes (example)
ClaimResponse.addItem.detail.modifier 0..* CodeableConcept Service/Product billing modifiers
Binding: ModifierTypeCodes (example): Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen.
ClaimResponse.addItem.detail.quantity C 0..1 SimpleQuantity(5.0.0) 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.tax 0..1 Money Total tax
ClaimResponse.addItem.detail.net 0..1 Money Total item cost
ClaimResponse.addItem.detail.noteNumber 0..* positiveInt Applicable note numbers
ClaimResponse.addItem.detail.reviewOutcome 0..1 See reviewOutcome (ClaimResponse) Added items detail level adjudication results
ClaimResponse.addItem.detail.adjudication 0..* See adjudication (ClaimResponse) Added items detail adjudication
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
Constraints: ext-1
ClaimResponse.addItem.detail.subDetail.modifierExtension This element is a modifier element. This element is included in summaries. 0..* Extension Extensions that cannot be ignored even if unrecognized
Constraints: ext-1
ClaimResponse.addItem.detail.subDetail.traceNumber 0..* Identifier Number for tracking
ClaimResponse.addItem.detail.subDetail.revenue 0..1 CodeableConcept Revenue or cost center code
Binding: ExampleRevenueCenterCodes (example): Codes for the revenue or cost centers supplying the service and/or products.
ClaimResponse.addItem.detail.subDetail.productOrService 0..1 CodeableConcept Billing, service, product, or drug code
Binding: USCLSCodes (example): Allowable service and product codes.
ClaimResponse.addItem.detail.subDetail.productOrServiceEnd 0..1 CodeableConcept End of a range of codes
Binding: USCLSCodes (example)
ClaimResponse.addItem.detail.subDetail.modifier 0..* CodeableConcept Service/Product billing modifiers
Binding: ModifierTypeCodes (example): Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen.
ClaimResponse.addItem.detail.subDetail.quantity C 0..1 SimpleQuantity(5.0.0) 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.tax 0..1 Money Total tax
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.reviewOutcome 0..1 See reviewOutcome (ClaimResponse) Added items subdetail level adjudication results
ClaimResponse.addItem.detail.subDetail.adjudication 0..* See adjudication (ClaimResponse) Added items subdetail adjudication
ClaimResponse.adjudication 0..* See adjudication (ClaimResponse) Header-level adjudication
ClaimResponse.total This element must be supported. This element is included in summaries. 0..* BackboneElement Summary adjudication amounts
ClaimResponse.total.id 0..1 string Unique id for inter-element referencing
ClaimResponse.total.extension 0..* Extension Additional content defined by implementations
Constraints: ext-1
ClaimResponse.total.modifierExtension This element is a modifier element. This element is included in summaries. 0..* Extension Extensions that cannot be ignored even if unrecognized
Constraints: ext-1
ClaimResponse.total.category This element is included in summaries. 1..1 CodeableConcept Type of adjudication information
Binding: ClaimResponseCategoryVS (0.11.1) (required)
ClaimResponse.total.amount This element is included in summaries. 1..1 Money Total amount for the category
ClaimResponse.payment 0..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
Constraints: ext-1
ClaimResponse.payment.modifierExtension This element is a modifier element. This element is included in summaries. 0..* Extension Extensions that cannot be ignored even if unrecognized
Constraints: ext-1
ClaimResponse.payment.type 1..1 CodeableConcept Partial or complete payment
Binding: ExamplePaymentTypeCodes (example): The type (partial, complete) of the payment.
ClaimResponse.payment.adjustment 0..1 Money Payment adjustment for non-claim issues
ClaimResponse.payment.adjustmentReason 0..1 CodeableConcept Explanation for the adjustment
Binding: PaymentAdjustmentReasonCodes (example): Payment Adjustment reason codes.
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 0..1 CodeableConcept Funds reserved status
Binding: FundsReservationCodes (example): For whom funds are to be reserved: (Patient, Provider, None).
ClaimResponse.formCode 0..1 CodeableConcept Printed form identifier
Binding: FormCodes (example): The forms codes.
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
Constraints: ext-1
ClaimResponse.processNote.modifierExtension This element is a modifier element. This element is included in summaries. 0..* Extension Extensions that cannot be ignored even if unrecognized
Constraints: ext-1
ClaimResponse.processNote.number 0..1 positiveInt Note instance identifier
ClaimResponse.processNote.type 0..1 CodeableConcept Note purpose
Binding: NoteType (extensible): The presentation types of notes.
ClaimResponse.processNote.text 1..1 string Note explanatory text
ClaimResponse.processNote.language 0..1 CodeableConcept Language of the text
Binding: AllLanguages (required): IETF language tag for a human language
Additional BindingsPurpose
CommonLanguages Starter
ClaimResponse.communicationRequest 0..* Reference(CommunicationRequest) Request for additional information
ClaimResponse.insurance 0..* 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
Constraints: ext-1
ClaimResponse.insurance.modifierExtension This element is a modifier element. This element is included in summaries. 0..* Extension Extensions that cannot be ignored even if unrecognized
Constraints: ext-1
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 Reference(Coverage) Insurance information
ClaimResponse.insurance.businessArrangement 0..1 string Additional provider contract number
ClaimResponse.insurance.claimResponse 0..1 Reference(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
Constraints: ext-1
ClaimResponse.error.modifierExtension This element is a modifier element. This element is included in summaries. 0..* Extension Extensions that cannot be ignored even if unrecognized
Constraints: ext-1
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 This element is included in summaries. 1..1 CodeableConcept Error code detailing processing issues
Binding: AdjudicationErrorCodes (example): The adjudication error codes.
ClaimResponse.error.expression This element is included in summaries. 0..* string FHIRPath of element(s) related to issue

doco Documentation for this format

Terminology Bindings

Path Status Usage ValueSet Version Source
ClaimResponse.language Base required All Languages 📍5.0.0 FHIR Std.
ClaimResponse.status Base required Financial Management Status Value set 📍0.11.1 This IG
ClaimResponse.type Base required Claim Type VS 📍0.11.1 This IG
ClaimResponse.subType Base example Example Claim SubType Codes 📍5.0.0 FHIR Std.
ClaimResponse.use Base required Claim Use Value set 📍0.11.1 This IG
ClaimResponse.outcome Base required Claim Response Outcome VS 📍0.11.1 This IG
ClaimResponse.decision Base required Claim Response Decision VS 📍0.11.1 This IG
ClaimResponse.event.​type Base example Dates Type Codes 📍5.0.0 FHIR Std.
ClaimResponse.payeeType Base example Claim Payee Type Codes 📍5.0.0 FHIR Std.
ClaimResponse.diagnosisRelatedGroup Base example Example Diagnosis Related Group Codes 📍5.0.0 FHIR Std.
ClaimResponse.item.reviewOutcome.​decision Base example Claim Adjudication Decision Codes 📍5.0.0 FHIR Std.
ClaimResponse.item.reviewOutcome.​reason Base example Claim Adjudication Decision Reason Codes 📍5.0.0 FHIR Std.
ClaimResponse.item.adjudication.​category Base example Adjudication Value Codes 📍5.0.0 FHIR Std.
ClaimResponse.item.adjudication.​reason Base example Adjudication Reason Codes 📍5.0.0 FHIR Std.
ClaimResponse.addItem.​revenue Base example Example Revenue Center Codes 📍5.0.0 FHIR Std.
ClaimResponse.addItem.​productOrService Base example USCLS Codes 📍5.0.0 FHIR Std.
ClaimResponse.addItem.​productOrServiceEnd Base example USCLS Codes 📍5.0.0 FHIR Std.
ClaimResponse.addItem.​modifier Base example Modifier type Codes 📍5.0.0 FHIR Std.
ClaimResponse.addItem.​programCode Base example Example Program Reason Codes 📍5.0.0 FHIR Std.
ClaimResponse.addItem.​location[x] Base example Example Service Place Codes 📍5.0.0 FHIR Std.
ClaimResponse.addItem.​bodySite.site Base example Oral Site Codes 📍5.0.0 FHIR Std.
ClaimResponse.addItem.​bodySite.subSite Base example Surface Codes 📍5.0.0 FHIR Std.
ClaimResponse.addItem.​detail.revenue Base example Example Revenue Center Codes 📍5.0.0 FHIR Std.
ClaimResponse.addItem.​detail.productOrService Base example USCLS Codes 📍5.0.0 FHIR Std.
ClaimResponse.addItem.​detail.productOrServiceEnd Base example USCLS Codes 📍5.0.0 FHIR Std.
ClaimResponse.addItem.​detail.modifier Base example Modifier type Codes 📍5.0.0 FHIR Std.
ClaimResponse.addItem.​detail.subDetail.revenue Base example Example Revenue Center Codes 📍5.0.0 FHIR Std.
ClaimResponse.addItem.​detail.subDetail.productOrService Base example USCLS Codes 📍5.0.0 FHIR Std.
ClaimResponse.addItem.​detail.subDetail.productOrServiceEnd Base example USCLS Codes 📍5.0.0 FHIR Std.
ClaimResponse.addItem.​detail.subDetail.modifier Base example Modifier type Codes 📍5.0.0 FHIR Std.
ClaimResponse.total.​category Base required Claim Response Category VS 📍0.11.1 This IG
ClaimResponse.payment.​type Base example Example Payment Type Codes 📍5.0.0 FHIR Std.
ClaimResponse.payment.​adjustmentReason Base example Payment Adjustment Reason Codes 📍5.0.0 FHIR Std.
ClaimResponse.fundsReserve Base example Funds Reservation Codes 📍5.0.0 FHIR Std.
ClaimResponse.formCode Base example Form Codes 📍5.0.0 FHIR Std.
ClaimResponse.processNote.​type Base extensible NoteType 📍5.0.0 FHIR Std.
ClaimResponse.processNote.​language Base required All Languages 📍5.0.0 FHIR Std.
ClaimResponse.error.​code Base example Adjudication Error Codes 📍5.0.0 FHIR Std.

Constraints

Id Grade Path(s) Description Expression

 

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