STU3 Candidate

This page is part of the FHIR Specification (v1.8.0: STU 3 Draft). 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

13.2.6 Resource ClaimResponse - Mappings

Mappings:

RIM Mapping

Canadian Dental Association eclaims standard

Mappings for the claimresponse resource.

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

ClaimResponse
    identifier
    status
    created
    insurer
    requestProvider
    requestOrganization
    request
    outcome
    disposition
    payeeType
    item
        sequenceLinkId
        noteNumber
        adjudication
            category
            reason
            amount
            value
        detail
            sequenceLinkId
            noteNumber
            adjudication
            subDetail
                sequenceLinkId
                noteNumber
                adjudication
    addItem
        sequenceLinkId
        revenue
        category
        service
        modifier24.C, 24.D mods
        fee
        noteNumber
        adjudication
        detail
            revenue
            category
            service
            modifier24.C, 24.D mods
            fee
            noteNumber
            adjudication
    error
        sequenceLinkId
        detailSequenceLinkId
        subdetailSequenceLinkId
        code
    totalCost
    unallocDeductable
    totalBenefit
    payment
        type
        adjustment
        adjustmentReason
        date
        amount
        identifier
    reserved
    form
    note
        number
        type
        text
        language
    communicationRequest
    insuranceCoverage
        sequence
        focal
        coverage
        businessArrangement
        preAuthRef
        claimResponse

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

ClaimResponse
    identifier
    status
    created
    insurer
    requestProviderB01
    requestOrganization
    requestA02|G01
    outcome
    disposition
    payeeType
    item
        sequenceLinkIdF07
        noteNumber
        adjudication
            category
            reason
            amount
            value
        detail
            sequenceLinkIdF07
            noteNumber
            adjudication
            subDetail
                sequenceLinkIdF07
                noteNumber
                adjudication
    addItem
        sequenceLinkId
        revenue
        category
        service
        modifier
        fee
        noteNumber
        adjudication
        detail
            revenue
            category
            service
            modifier
            fee
            noteNumber
            adjudication
    error
        sequenceLinkId
        detailSequenceLinkId
        subdetailSequenceLinkId
        code
    totalCost
    unallocDeductable
    totalBenefit
    payment
        type
        adjustment
        adjustmentReason
        date
        amount
        identifier
    reserved
    formG42
    note
        number
        type
        textG32
        language
    communicationRequest
    insurance
        sequence
        focal
        coverage
        businessArrangement
        preAuthRefF03
        claimResponseEOB