STU 3 Candidate

This page is part of the FHIR Specification (v1.4.0: STU 3 Ballot 3). The current version which supercedes this version is 5.0.0. For a full list of available versions, see the Directory of published versions . Page versions: R5 R4B R4 R3 R2

7.2.6 Resource ClaimResponse - Mappings

Mappings for the claimresponse resource.

7.2.6.1 Mappings for RIM (http://hl7.org/v3)

ClaimResponse
    identifier
    request[x]
    ruleset
    originalRuleset
    created
    organization[x]
    requestProvider[x]
    requestOrganization[x]
    outcome
    disposition
    payeeType
    item
        sequenceLinkId
        noteNumber
        adjudication
            category
            reason
            amount
            value
        detail
            sequenceLinkId
            adjudication
                category
                reason
                amount
                value
            subDetail
                sequenceLinkId
                adjudication
                    category
                    reason
                    amount
                    value
    addItem
        sequenceLinkId
        service
        fee
        noteNumberLinkId
        adjudication
            category
            reason
            amount
            value
        detail
            service
            fee
            adjudication
                category
                reason
                amount
                value
    error
        sequenceLinkId
        detailSequenceLinkId
        subdetailSequenceLinkId
        code
    totalCost
    unallocDeductable
    totalBenefit
    paymentAdjustment
    paymentAdjustmentReason
    paymentDate
    paymentAmount
    paymentRef
    reserved
    form
    note
        number
        type
        text
    coverageCoverage
        sequence
        focal
        coverage[x]
        businessArrangement
        preAuthRef
        claimResponse

7.2.6.2 Mappings for Canadian Dental Association eclaims standard (http://www.cda-adc.ca/en/services/cdanet/)

ClaimResponse
    identifier
    request[x]A02|G01
    ruleset
    originalRuleset
    created
    organization[x]
    requestProvider[x]B01
    requestOrganization[x]
    outcome
    disposition
    payeeType
    item
        sequenceLinkIdF07
        noteNumber
        adjudication
            category
            reason
            amount
            value
        detail
            sequenceLinkIdF07
            adjudication
                category
                reason
                amount
                value
            subDetail
                sequenceLinkIdF07
                adjudication
                    category
                    reason
                    amount
                    value
    addItem
        sequenceLinkId
        service
        fee
        noteNumberLinkId
        adjudication
            category
            reason
            amount
            value
        detail
            service
            fee
            adjudication
                category
                reason
                amount
                value
    error
        sequenceLinkId
        detailSequenceLinkId
        subdetailSequenceLinkId
        code
    totalCost
    unallocDeductable
    totalBenefit
    paymentAdjustment
    paymentAdjustmentReason
    paymentDate
    paymentAmount
    paymentRef
    reserved
    formG42
    note
        number
        type
        textG32
    coverage
        sequence
        focal
        coverage[x]
        businessArrangement
        preAuthRefF03
        claimResponseEOB