NameFlagsCard.TypeDescription & Constraintsdoco
.. ClaimResponse TUDomainResourceClaimResponse resource
Elements defined in Ancestors: id, meta, implicitRules, language, text, contained, extension, modifierExtension
... identifier 0..*IdentifierResponse number
... status ?!Σ0..1codeactive | cancelled | draft | entered-in-error
Financial Resource Status Codes (Required)
... type 0..1CodeableConceptType or discipline
Claim Type Codes (Extensible)
... subType 0..1CodeableConceptFiner grained claim type information
Example Claim SubType Codes (Example)
... use Σ0..1codeclaim | preauthorization | predetermination
Use (Required)
... patient 0..1Reference(Patient)The subject of the Products and Services
... created 0..1dateTimeCreation date
... insurer 0..1Reference(Organization)Insurance issuing organization
... requestProvider 0..1Reference(Practitioner | PractitionerRole | Organization)Responsible practitioner
... request 0..1Reference(Claim)Id of resource triggering adjudication
... outcome 0..1codequeued | complete | error | partial
Claim Processing Codes (Required)
... disposition 0..1stringDisposition Message
... preAuthRef 0..1stringPre-Authorization/Determination Reference
... payeeType 0..1CodeableConceptParty to be paid any benefits payable
PayeeType (Example)
... item 0..*BackboneElementLine items
.... itemSequence 1..1positiveIntService instance
.... noteNumber 0..*positiveIntList of note numbers which apply
.... adjudication 0..*BackboneElementAdjudication details
..... category 1..1CodeableConceptAdjudication category such as co-pay, eligible, benefit, etc.
Adjudication Value Codes (Example)
..... reason 0..1CodeableConceptExplanation of Adjudication outcome
Adjudication Reason Codes (Example)
..... amount 0..1MoneyMonetary amount
..... value 0..1decimalNon-monetary value
.... detail 0..*BackboneElementDetail line items
..... detailSequence 1..1positiveIntService instance
..... noteNumber 0..*positiveIntList of note numbers which apply
..... adjudication 0..*see adjudicationDetail level adjudication details
..... subDetail 0..*BackboneElementSubdetail line items
...... subDetailSequence 1..1positiveIntService instance
...... noteNumber 0..*positiveIntList of note numbers which apply
...... adjudication 0..*see adjudicationSubdetail level adjudication details
... addItem 0..*BackboneElementInsurer added line items
.... itemSequence 0..*positiveIntService instances
.... detailSequence 0..*positiveIntDetail sequence number
.... subdetailSequence 0..*positiveIntSubdetail sequence number
.... provider 0..*Reference(Practitioner | PractitionerRole | Organization)Authorized providers
.... billcode 0..1CodeableConceptGroup, Service or Product
USCLS Codes (Example)
.... modifier 0..*CodeableConceptService/Product billing modifiers
Modifier type Codes (Example)
.... programCode 0..*CodeableConceptProgram specific reason for item inclusion
Example Program Reason Codes (Example)
.... serviced[x] 0..1Date or dates of Service
..... servicedDatedate
..... servicedPeriodPeriod
.... location[x] 0..1Place of service
Example Service Place Codes (Example)
..... locationCodeableConceptCodeableConcept
..... locationAddressAddress
..... locationReferenceReference(Location)
.... quantity 0..1SimpleQuantityCount of Products or Services
.... unitPrice 0..1MoneyFee, charge or cost per point
.... factor 0..1decimalPrice scaling factor
.... net 0..1MoneyTotal item cost
.... bodySite 0..1CodeableConceptService Location
Oral Site Codes (Example)
.... subSite 0..*CodeableConceptService Sub-location
Surface Codes (Example)
.... noteNumber 0..*positiveIntList of note numbers which apply
.... adjudication 0..*see adjudicationAdded items adjudication
.... detail 0..*BackboneElementInsurer added line items
..... billcode 0..1CodeableConceptGroup, Service or Product
USCLS Codes (Example)
..... modifier 0..*CodeableConceptService/Product billing modifiers
Modifier type Codes (Example)
..... quantity 0..1SimpleQuantityCount of Products or Services
..... unitPrice 0..1MoneyFee, charge or cost per point
..... factor 0..1decimalPrice scaling factor
..... net 0..1MoneyTotal item cost
..... noteNumber 0..*positiveIntList of note numbers which apply
..... adjudication 0..*see adjudicationAdded items detail adjudication
..... subDetail 0..*BackboneElementInsurer added line items
...... billcode 0..1CodeableConceptGroup, Service or Product
USCLS Codes (Example)
...... modifier 0..*CodeableConceptService/Product billing modifiers
Modifier type Codes (Example)
...... quantity 0..1SimpleQuantityCount of Products or Services
...... unitPrice 0..1MoneyFee, charge or cost per point
...... factor 0..1decimalPrice scaling factor
...... net 0..1MoneyTotal item cost
...... noteNumber 0..*positiveIntList of note numbers which apply
...... adjudication 0..*see adjudicationAdded items detail adjudication
... error 0..*BackboneElementProcessing errors
.... itemSequence 0..1positiveIntItem sequence number
.... detailSequence 0..1positiveIntDetail sequence number
.... subDetailSequence 0..1positiveIntSubdetail sequence number
.... code 1..1CodeableConceptError code detailing processing issues
AdjudicationError (Example)
... total 0..*BackboneElementAdjudication totals
.... category 1..1CodeableConceptAdjudication category such as submitted, co-pay, eligible, benefit, etc.
Adjudication Value Codes (Example)
.... amount 1..1MoneyMonetary amount
... payment 0..1BackboneElementPayment Details
.... type 0..1CodeableConceptPartial or Complete
Example Payment Type Codes (Example)
.... adjustment 0..1MoneyPayment adjustment for non-Claim issues
.... adjustmentReason 0..1CodeableConceptExplanation for the non-claim adjustment
Payment Adjustment Reason Codes (Example)
.... date 0..1dateExpected data of Payment
.... amount 0..1MoneyPayable amount after adjustment
.... identifier 0..1IdentifierIdentifier of the payment instrument
... reserved 0..1CodingFunds reserved status
FundsReserve (Example)
... form 0..1CodeableConceptPrinted Form Identifier
Forms (Example)
... processNote 0..*BackboneElementProcessing notes
.... number 0..1positiveIntSequence Number for this note
.... type 0..1codedisplay | print | printoper
NoteType (Required)
.... text 0..1stringNote explanatory text
.... language 0..1CodeableConceptLanguage if different from the resource
Language (Preferred but limited to All Languages)
... communicationRequest 0..*Reference(CommunicationRequest)Request for additional information
... insurance 0..*BackboneElementInsurance or medical plan
.... sequence 1..1positiveIntService instance identifier
.... focal 1..1booleanIs the focal Coverage
.... coverage 1..1Reference(Coverage)Insurance information
.... businessArrangement 0..1stringBusiness agreement
.... claimResponse 0..1Reference(ClaimResponse)Adjudication results

doco Documentation for this format