R4 Ballot #2 (Mixed Normative/Trial use)
FinancialThis page is part of the FHIR Specification (v3.5.0: R4 Ballot #2). 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
| Financial Management Work Group | Maturity Level: N/A | Ballot Status: Informative | Compartments: Patient, Practitioner |
This is a representation of the json schema for ClaimResponse, which is just a part of the full JSON Schema.
{
"$schema": "http://json-schema.org/draft-06/schema#",
"id": "http://hl7.org/fhir/json-schema/ClaimResponse",
"$ref": "#/definitions/ClaimResponse",
"description": "see http://hl7.org/fhir/json.html#schema for information about the FHIR Json Schemas",
"definitions": {
"ClaimResponse": {
"description": "This resource provides the adjudication details from the processing of a Claim resource.",
"properties": {
"resourceType": {
"description": "This is a ClaimResponse resource",
"const": "ClaimResponse"
},
"id": {
"description": "The logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes.",
"$ref": "id.schema.json#/definitions/id"
},
"meta": {
"description": "The metadata about the resource. This is content that is maintained by the infrastructure. Changes to the content might not always be associated with version changes to the resource.",
"$ref": "Meta.schema.json#/definitions/Meta"
},
"implicitRules": {
"description": "A reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content. Often, this is a reference to an implementation guide that defines the special rules along with other profiles etc.",
"$ref": "#/definitions/uri"
},
"_implicitRules": {
"description": "Extensions for implicitRules",
"$ref": "Element.schema.json#/definitions/Element"
},
"language": {
"description": "The base language in which the resource is written.",
"$ref": "#/definitions/code"
},
"_language": {
"description": "Extensions for language",
"$ref": "Element.schema.json#/definitions/Element"
},
"text": {
"description": "A human-readable narrative that contains a summary of the resource and can be used to represent the content of the resource to a human. The narrative need not encode all the structured data, but is required to contain sufficient detail to make it \"clinically safe\" for a human to just read the narrative. Resource definitions may define what content should be represented in the narrative to ensure clinical safety.",
"$ref": "Narrative.schema.json#/definitions/Narrative"
},
"contained": {
"description": "These resources do not have an independent existence apart from the resource that contains them - they cannot be identified independently, and nor can they have their own independent transaction scope.",
"items": {
"$ref": "ResourceList.schema.json#/definitions/ResourceList"
},
"type": "array"
},
"extension": {
"description": "May be used to represent additional information that is not part of the basic definition of the resource. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.",
"items": {
"$ref": "Extension.schema.json#/definitions/Extension"
},
"type": "array"
},
"modifierExtension": {
"description": "May be used to represent additional information that is not part of the basic definition of the resource, and that modifies the understanding of the element that contains it. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.\n\nModifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).",
"items": {
"$ref": "Extension.schema.json#/definitions/Extension"
},
"type": "array"
},
"identifier": {
"description": "The response business identifier.",
"items": {
"$ref": "Identifier.schema.json#/definitions/Identifier"
},
"type": "array"
},
"status": {
"description": "The status of the resource instance.",
"$ref": "#/definitions/code"
},
"_status": {
"description": "Extensions for status",
"$ref": "Element.schema.json#/definitions/Element"
},
"type": {
"description": "The category of claim, e.g, oral, pharmacy, vision, institutional, professional.",
"$ref": "CodeableConcept.schema.json#/definitions/CodeableConcept"
},
"subType": {
"description": "A finer grained suite of claim subtype codes which may convey Inpatient vs Outpatient and/or a specialty service. In the US the CMS Bill Type.",
"$ref": "CodeableConcept.schema.json#/definitions/CodeableConcept"
},
"use": {
"description": "A claim, a list of completed goods and services; a preauthorization, a list or proposed goods and services; or a predetermination, a set of goods and services being considered, for which insurer adjudication is sought.",
"$ref": "#/definitions/code"
},
"_use": {
"description": "Extensions for use",
"$ref": "Element.schema.json#/definitions/Element"
},
"patient": {
"description": "Patient Resource.",
"$ref": "Reference.schema.json#/definitions/Reference"
},
"created": {
"description": "The date when this resource was created.",
"$ref": "#/definitions/dateTime"
},
"_created": {
"description": "Extensions for created",
"$ref": "Element.schema.json#/definitions/Element"
},
"insurer": {
"description": "The Insurer who produced this adjudicated response.",
"$ref": "Reference.schema.json#/definitions/Reference"
},
"requestProvider": {
"description": "The practitioner who is responsible for the services rendered to the patient.",
"$ref": "Reference.schema.json#/definitions/Reference"
},
"request": {
"description": "Original request resource reference.",
"$ref": "Reference.schema.json#/definitions/Reference"
},
"outcome": {
"description": "Transaction: error, complete, partial processing.",
"$ref": "#/definitions/code"
},
"_outcome": {
"description": "Extensions for outcome",
"$ref": "Element.schema.json#/definitions/Element"
},
"disposition": {
"description": "A description of the status of the adjudication.",
"$ref": "#/definitions/string"
},
"_disposition": {
"description": "Extensions for disposition",
"$ref": "Element.schema.json#/definitions/Element"
},
"preAuthRef": {
"description": "A list of references from the Insurer to which these services pertain.",
"$ref": "#/definitions/string"
},
"_preAuthRef": {
"description": "Extensions for preAuthRef",
"$ref": "Element.schema.json#/definitions/Element"
},
"payeeType": {
"description": "Party to be reimbursed: Subscriber, provider, other.",
"$ref": "CodeableConcept.schema.json#/definitions/CodeableConcept"
},
"item": {
"description": "The first-tier service adjudications for submitted services.",
"items": {
"$ref": "#/definitions/ClaimResponse_Item"
},
"type": "array"
},
"addItem": {
"description": "The first-tier service adjudications for payor added services.",
"items": {
"$ref": "#/definitions/ClaimResponse_AddItem"
},
"type": "array"
},
"error": {
"description": "Mutually exclusive with Services Provided (Item).",
"items": {
"$ref": "#/definitions/ClaimResponse_Error"
},
"type": "array"
},
"total": {
"description": "Totals for amounts submitted, co-pays, benefits payable etc.",
"items": {
"$ref": "#/definitions/ClaimResponse_Total"
},
"type": "array"
},
"payment": {
"description": "Payment details for the claim if the claim has been paid.",
"$ref": "#/definitions/ClaimResponse_Payment"
},
"reserved": {
"description": "Status of funds reservation (For provider, for Patient, None).",
"$ref": "Coding.schema.json#/definitions/Coding"
},
"form": {
"description": "The form to be used for printing the content.",
"$ref": "CodeableConcept.schema.json#/definitions/CodeableConcept"
},
"processNote": {
"description": "Note text.",
"items": {
"$ref": "#/definitions/ClaimResponse_ProcessNote"
},
"type": "array"
},
"communicationRequest": {
"description": "Request for additional supporting or authorizing information, such as: documents, images or resources.",
"items": {
"$ref": "Reference.schema.json#/definitions/Reference"
},
"type": "array"
},
"insurance": {
"description": "Financial instrument by which payment information for health care.",
"items": {
"$ref": "#/definitions/ClaimResponse_Insurance"
},
"type": "array"
}
},
"additionalProperties": false,
"required": [
"resourceType"
]
},
"ClaimResponse_Item": {
"description": "This resource provides the adjudication details from the processing of a Claim resource.",
"properties": {
"id": {
"description": "Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.",
"$ref": "string.schema.json#/definitions/string"
},
"extension": {
"description": "May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.",
"items": {
"$ref": "Extension.schema.json#/definitions/Extension"
},
"type": "array"
},
"modifierExtension": {
"description": "May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.\n\nModifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).",
"items": {
"$ref": "Extension.schema.json#/definitions/Extension"
},
"type": "array"
},
"itemSequence": {
"description": "A service line number.",
"$ref": "#/definitions/positiveInt"
},
"_itemSequence": {
"description": "Extensions for itemSequence",
"$ref": "Element.schema.json#/definitions/Element"
},
"noteNumber": {
"description": "A list of note references to the notes provided below.",
"items": {
"$ref": "#/definitions/positiveInt"
},
"type": "array"
},
"_noteNumber": {
"description": "Extensions for noteNumber",
"items": {
"$ref": "Element.schema.json#/definitions/Element"
},
"type": "array"
},
"adjudication": {
"description": "The adjudication results.",
"items": {
"$ref": "#/definitions/ClaimResponse_Adjudication"
},
"type": "array"
},
"detail": {
"description": "The second-tier service adjudications for submitted services.",
"items": {
"$ref": "#/definitions/ClaimResponse_Detail"
},
"type": "array"
}
},
"additionalProperties": false
},
"ClaimResponse_Adjudication": {
"description": "This resource provides the adjudication details from the processing of a Claim resource.",
"properties": {
"id": {
"description": "Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.",
"$ref": "string.schema.json#/definitions/string"
},
"extension": {
"description": "May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.",
"items": {
"$ref": "Extension.schema.json#/definitions/Extension"
},
"type": "array"
},
"modifierExtension": {
"description": "May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.\n\nModifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).",
"items": {
"$ref": "Extension.schema.json#/definitions/Extension"
},
"type": "array"
},
"category": {
"description": "Code indicating: Co-Pay, deductible, eligible, benefit, tax, etc.",
"$ref": "CodeableConcept.schema.json#/definitions/CodeableConcept"
},
"reason": {
"description": "Adjudication reason such as limit reached.",
"$ref": "CodeableConcept.schema.json#/definitions/CodeableConcept"
},
"amount": {
"description": "Monetary amount associated with the code.",
"$ref": "Money.schema.json#/definitions/Money"
},
"value": {
"description": "A non-monetary value for example a percentage. Mutually exclusive to the amount element above.",
"$ref": "#/definitions/decimal"
},
"_value": {
"description": "Extensions for value",
"$ref": "Element.schema.json#/definitions/Element"
}
},
"additionalProperties": false,
"required": [
"category"
]
},
"ClaimResponse_Detail": {
"description": "This resource provides the adjudication details from the processing of a Claim resource.",
"properties": {
"id": {
"description": "Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.",
"$ref": "string.schema.json#/definitions/string"
},
"extension": {
"description": "May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.",
"items": {
"$ref": "Extension.schema.json#/definitions/Extension"
},
"type": "array"
},
"modifierExtension": {
"description": "May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.\n\nModifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).",
"items": {
"$ref": "Extension.schema.json#/definitions/Extension"
},
"type": "array"
},
"detailSequence": {
"description": "A service line number.",
"$ref": "#/definitions/positiveInt"
},
"_detailSequence": {
"description": "Extensions for detailSequence",
"$ref": "Element.schema.json#/definitions/Element"
},
"noteNumber": {
"description": "A list of note references to the notes provided below.",
"items": {
"$ref": "#/definitions/positiveInt"
},
"type": "array"
},
"_noteNumber": {
"description": "Extensions for noteNumber",
"items": {
"$ref": "Element.schema.json#/definitions/Element"
},
"type": "array"
},
"adjudication": {
"description": "The adjudication results.",
"items": {
"$ref": "#/definitions/ClaimResponse_Adjudication"
},
"type": "array"
},
"subDetail": {
"description": "The third-tier service adjudications for submitted services.",
"items": {
"$ref": "#/definitions/ClaimResponse_SubDetail"
},
"type": "array"
}
},
"additionalProperties": false
},
"ClaimResponse_SubDetail": {
"description": "This resource provides the adjudication details from the processing of a Claim resource.",
"properties": {
"id": {
"description": "Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.",
"$ref": "string.schema.json#/definitions/string"
},
"extension": {
"description": "May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.",
"items": {
"$ref": "Extension.schema.json#/definitions/Extension"
},
"type": "array"
},
"modifierExtension": {
"description": "May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.\n\nModifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).",
"items": {
"$ref": "Extension.schema.json#/definitions/Extension"
},
"type": "array"
},
"subDetailSequence": {
"description": "A service line number.",
"$ref": "#/definitions/positiveInt"
},
"_subDetailSequence": {
"description": "Extensions for subDetailSequence",
"$ref": "Element.schema.json#/definitions/Element"
},
"noteNumber": {
"description": "A list of note references to the notes provided below.",
"items": {
"$ref": "#/definitions/positiveInt"
},
"type": "array"
},
"_noteNumber": {
"description": "Extensions for noteNumber",
"items": {
"$ref": "Element.schema.json#/definitions/Element"
},
"type": "array"
},
"adjudication": {
"description": "The adjudication results.",
"items": {
"$ref": "#/definitions/ClaimResponse_Adjudication"
},
"type": "array"
}
},
"additionalProperties": false
},
"ClaimResponse_AddItem": {
"description": "This resource provides the adjudication details from the processing of a Claim resource.",
"properties": {
"id": {
"description": "Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.",
"$ref": "string.schema.json#/definitions/string"
},
"extension": {
"description": "May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.",
"items": {
"$ref": "Extension.schema.json#/definitions/Extension"
},
"type": "array"
},
"modifierExtension": {
"description": "May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.\n\nModifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).",
"items": {
"$ref": "Extension.schema.json#/definitions/Extension"
},
"type": "array"
},
"itemSequence": {
"description": "List of input service items which this service line is intended to replace.",
"items": {
"$ref": "#/definitions/positiveInt"
},
"type": "array"
},
"_itemSequence": {
"description": "Extensions for itemSequence",
"items": {
"$ref": "Element.schema.json#/definitions/Element"
},
"type": "array"
},
"detailSequence": {
"description": "The sequence number of the addition within the line item submitted which contains the error. This value is omitted when the error is not related to an Addition.",
"items": {
"$ref": "#/definitions/positiveInt"
},
"type": "array"
},
"_detailSequence": {
"description": "Extensions for detailSequence",
"items": {
"$ref": "Element.schema.json#/definitions/Element"
},
"type": "array"
},
"subdetailSequence": {
"description": "The sequence number of the addition within the line item submitted which contains the error. This value is omitted when the error is not related to an Addition.",
"items": {
"$ref": "#/definitions/positiveInt"
},
"type": "array"
},
"_subdetailSequence": {
"description": "Extensions for subdetailSequence",
"items": {
"$ref": "Element.schema.json#/definitions/Element"
},
"type": "array"
},
"provider": {
"description": "The providers who are authorized for the services rendered to the patient.",
"items": {
"$ref": "Reference.schema.json#/definitions/Reference"
},
"type": "array"
},
"billcode": {
"description": "A code to indicate the Professional Service or Product supplied.",
"$ref": "CodeableConcept.schema.json#/definitions/CodeableConcept"
},
"modifier": {
"description": "Item typification or modifiers codes, e.g. for Oral whether the treatment is cosmetic or associated with TMJ, or for medical whether the treatment was outside the clinic or out of office hours.",
"items": {
"$ref": "CodeableConcept.schema.json#/definitions/CodeableConcept"
},
"type": "array"
},
"programCode": {
"description": "For programs which require reason codes for the inclusion or covering of this billed item under the program or sub-program.",
"items": {
"$ref": "CodeableConcept.schema.json#/definitions/CodeableConcept"
},
"type": "array"
},
"servicedDate": {
"description": "The date or dates when the service or product was supplied, performed or completed.",
"pattern": "^([0-9]([0-9]([0-9][1-9]|[1-9]0)|[1-9]00)|[1-9]000)(-(0[1-9]|1[0-2])(-(0[1-9]|[1-2][0-9]|3[0-1]))?)?$",
"type": "string"
},
"_servicedDate": {
"description": "Extensions for servicedDate",
"$ref": "Element.schema.json#/definitions/Element"
},
"servicedPeriod": {
"description": "The date or dates when the service or product was supplied, performed or completed.",
"$ref": "Period.schema.json#/definitions/Period"
},
"locationCodeableConcept": {
"description": "Where the service was provided.",
"$ref": "CodeableConcept.schema.json#/definitions/CodeableConcept"
},
"locationAddress": {
"description": "Where the service was provided.",
"$ref": "Address.schema.json#/definitions/Address"
},
"locationReference": {
"description": "Where the service was provided.",
"$ref": "Reference.schema.json#/definitions/Reference"
},
"quantity": {
"description": "The number of repetitions of a service or product.",
"$ref": "Quantity.schema.json#/definitions/Quantity"
},
"unitPrice": {
"description": "If the item is a node then this is the fee for the product or service, otherwise this is the total of the fees for the children of the group.",
"$ref": "Money.schema.json#/definitions/Money"
},
"factor": {
"description": "A real number that represents a multiplier used in determining the overall value of services delivered and/or goods received. The concept of a Factor allows for a discount or surcharge multiplier to be applied to a monetary amount.",
"$ref": "#/definitions/decimal"
},
"_factor": {
"description": "Extensions for factor",
"$ref": "Element.schema.json#/definitions/Element"
},
"net": {
"description": "The quantity times the unit price for an additional service or product or charge. For example, the formula: unit Quantity * unit Price (Cost per Point) * factor Number * points \u003d net Amount. Quantity, factor and points are assumed to be 1 if not supplied.",
"$ref": "Money.schema.json#/definitions/Money"
},
"bodySite": {
"description": "Physical service site on the patient (limb, tooth, etc.).",
"$ref": "CodeableConcept.schema.json#/definitions/CodeableConcept"
},
"subSite": {
"description": "A region or surface of the site, e.g. limb region or tooth surface(s).",
"items": {
"$ref": "CodeableConcept.schema.json#/definitions/CodeableConcept"
},
"type": "array"
},
"noteNumber": {
"description": "A list of note references to the notes provided below.",
"items": {
"$ref": "#/definitions/positiveInt"
},
"type": "array"
},
"_noteNumber": {
"description": "Extensions for noteNumber",
"items": {
"$ref": "Element.schema.json#/definitions/Element"
},
"type": "array"
},
"adjudication": {
"description": "The adjudication results.",
"items": {
"$ref": "#/definitions/ClaimResponse_Adjudication"
},
"type": "array"
},
"detail": {
"description": "The second-tier service adjudications for payor added services.",
"items": {
"$ref": "#/definitions/ClaimResponse_Detail1"
},
"type": "array"
}
},
"additionalProperties": false
},
"ClaimResponse_Detail1": {
"description": "This resource provides the adjudication details from the processing of a Claim resource.",
"properties": {
"id": {
"description": "Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.",
"$ref": "string.schema.json#/definitions/string"
},
"extension": {
"description": "May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.",
"items": {
"$ref": "Extension.schema.json#/definitions/Extension"
},
"type": "array"
},
"modifierExtension": {
"description": "May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.\n\nModifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).",
"items": {
"$ref": "Extension.schema.json#/definitions/Extension"
},
"type": "array"
},
"billcode": {
"description": "A code to indicate the Professional Service or Product supplied.",
"$ref": "CodeableConcept.schema.json#/definitions/CodeableConcept"
},
"modifier": {
"description": "Item typification or modifiers codes, e.g. for Oral whether the treatment is cosmetic or associated with TMJ, or for medical whether the treatment was outside the clinic or out of office hours.",
"items": {
"$ref": "CodeableConcept.schema.json#/definitions/CodeableConcept"
},
"type": "array"
},
"quantity": {
"description": "The number of repetitions of a service or product.",
"$ref": "Quantity.schema.json#/definitions/Quantity"
},
"unitPrice": {
"description": "If the item is a node then this is the fee for the product or service, otherwise this is the total of the fees for the children of the group.",
"$ref": "Money.schema.json#/definitions/Money"
},
"factor": {
"description": "A real number that represents a multiplier used in determining the overall value of services delivered and/or goods received. The concept of a Factor allows for a discount or surcharge multiplier to be applied to a monetary amount.",
"$ref": "#/definitions/decimal"
},
"_factor": {
"description": "Extensions for factor",
"$ref": "Element.schema.json#/definitions/Element"
},
"net": {
"description": "The quantity times the unit price for an additional service or product or charge. For example, the formula: unit Quantity * unit Price (Cost per Point) * factor Number * points \u003d net Amount. Quantity, factor and points are assumed to be 1 if not supplied.",
"$ref": "Money.schema.json#/definitions/Money"
},
"noteNumber": {
"description": "A list of note references to the notes provided below.",
"items": {
"$ref": "#/definitions/positiveInt"
},
"type": "array"
},
"_noteNumber": {
"description": "Extensions for noteNumber",
"items": {
"$ref": "Element.schema.json#/definitions/Element"
},
"type": "array"
},
"adjudication": {
"description": "The adjudication results.",
"items": {
"$ref": "#/definitions/ClaimResponse_Adjudication"
},
"type": "array"
},
"subDetail": {
"description": "The third-tier service adjudications for payor added services.",
"items": {
"$ref": "#/definitions/ClaimResponse_SubDetail1"
},
"type": "array"
}
},
"additionalProperties": false
},
"ClaimResponse_SubDetail1": {
"description": "This resource provides the adjudication details from the processing of a Claim resource.",
"properties": {
"id": {
"description": "Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.",
"$ref": "string.schema.json#/definitions/string"
},
"extension": {
"description": "May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.",
"items": {
"$ref": "Extension.schema.json#/definitions/Extension"
},
"type": "array"
},
"modifierExtension": {
"description": "May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.\n\nModifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).",
"items": {
"$ref": "Extension.schema.json#/definitions/Extension"
},
"type": "array"
},
"billcode": {
"description": "A code to indicate the Professional Service or Product supplied.",
"$ref": "CodeableConcept.schema.json#/definitions/CodeableConcept"
},
"modifier": {
"description": "Item typification or modifiers codes, e.g. for Oral whether the treatment is cosmetic or associated with TMJ, or for medical whether the treatment was outside the clinic or out of office hours.",
"items": {
"$ref": "CodeableConcept.schema.json#/definitions/CodeableConcept"
},
"type": "array"
},
"quantity": {
"description": "The number of repetitions of a service or product.",
"$ref": "Quantity.schema.json#/definitions/Quantity"
},
"unitPrice": {
"description": "If the item is a node then this is the fee for the product or service, otherwise this is the total of the fees for the children of the group.",
"$ref": "Money.schema.json#/definitions/Money"
},
"factor": {
"description": "A real number that represents a multiplier used in determining the overall value of services delivered and/or goods received. The concept of a Factor allows for a discount or surcharge multiplier to be applied to a monetary amount.",
"$ref": "#/definitions/decimal"
},
"_factor": {
"description": "Extensions for factor",
"$ref": "Element.schema.json#/definitions/Element"
},
"net": {
"description": "The quantity times the unit price for an additional service or product or charge. For example, the formula: unit Quantity * unit Price (Cost per Point) * factor Number * points \u003d net Amount. Quantity, factor and points are assumed to be 1 if not supplied.",
"$ref": "Money.schema.json#/definitions/Money"
},
"noteNumber": {
"description": "A list of note references to the notes provided below.",
"items": {
"$ref": "#/definitions/positiveInt"
},
"type": "array"
},
"_noteNumber": {
"description": "Extensions for noteNumber",
"items": {
"$ref": "Element.schema.json#/definitions/Element"
},
"type": "array"
},
"adjudication": {
"description": "The adjudication results.",
"items": {
"$ref": "#/definitions/ClaimResponse_Adjudication"
},
"type": "array"
}
},
"additionalProperties": false
},
"ClaimResponse_Error": {
"description": "This resource provides the adjudication details from the processing of a Claim resource.",
"properties": {
"id": {
"description": "Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.",
"$ref": "string.schema.json#/definitions/string"
},
"extension": {
"description": "May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.",
"items": {
"$ref": "Extension.schema.json#/definitions/Extension"
},
"type": "array"
},
"modifierExtension": {
"description": "May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.\n\nModifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).",
"items": {
"$ref": "Extension.schema.json#/definitions/Extension"
},
"type": "array"
},
"itemSequence": {
"description": "The sequence number of the line item submitted which contains the error. This value is omitted when the error is elsewhere.",
"$ref": "#/definitions/positiveInt"
},
"_itemSequence": {
"description": "Extensions for itemSequence",
"$ref": "Element.schema.json#/definitions/Element"
},
"detailSequence": {
"description": "The sequence number of the addition within the line item submitted which contains the error. This value is omitted when the error is not related to an Addition.",
"$ref": "#/definitions/positiveInt"
},
"_detailSequence": {
"description": "Extensions for detailSequence",
"$ref": "Element.schema.json#/definitions/Element"
},
"subDetailSequence": {
"description": "The sequence number of the addition within the line item submitted which contains the error. This value is omitted when the error is not related to an Addition.",
"$ref": "#/definitions/positiveInt"
},
"_subDetailSequence": {
"description": "Extensions for subDetailSequence",
"$ref": "Element.schema.json#/definitions/Element"
},
"code": {
"description": "An error code, from a specified code system, which details why the claim could not be adjudicated.",
"$ref": "CodeableConcept.schema.json#/definitions/CodeableConcept"
}
},
"additionalProperties": false,
"required": [
"code"
]
},
"ClaimResponse_Total": {
"description": "This resource provides the adjudication details from the processing of a Claim resource.",
"properties": {
"id": {
"description": "Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.",
"$ref": "string.schema.json#/definitions/string"
},
"extension": {
"description": "May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.",
"items": {
"$ref": "Extension.schema.json#/definitions/Extension"
},
"type": "array"
},
"modifierExtension": {
"description": "May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.\n\nModifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).",
"items": {
"$ref": "Extension.schema.json#/definitions/Extension"
},
"type": "array"
},
"category": {
"description": "Code indicating: Submitted, Co-Pay, deductible, eligible, benefit, tax, etc.",
"$ref": "CodeableConcept.schema.json#/definitions/CodeableConcept"
},
"amount": {
"description": "Monitory amount associated with the code.",
"$ref": "Money.schema.json#/definitions/Money"
}
},
"additionalProperties": false,
"required": [
"amount",
"category"
]
},
"ClaimResponse_Payment": {
"description": "This resource provides the adjudication details from the processing of a Claim resource.",
"properties": {
"id": {
"description": "Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.",
"$ref": "string.schema.json#/definitions/string"
},
"extension": {
"description": "May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.",
"items": {
"$ref": "Extension.schema.json#/definitions/Extension"
},
"type": "array"
},
"modifierExtension": {
"description": "May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.\n\nModifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).",
"items": {
"$ref": "Extension.schema.json#/definitions/Extension"
},
"type": "array"
},
"type": {
"description": "Whether this represents partial or complete payment of the claim.",
"$ref": "CodeableConcept.schema.json#/definitions/CodeableConcept"
},
"adjustment": {
"description": "Adjustment to the payment of this transaction which is not related to adjudication of this transaction.",
"$ref": "Money.schema.json#/definitions/Money"
},
"adjustmentReason": {
"description": "Reason for the payment adjustment.",
"$ref": "CodeableConcept.schema.json#/definitions/CodeableConcept"
},
"date": {
"description": "Estimated payment data.",
"$ref": "#/definitions/date"
},
"_date": {
"description": "Extensions for date",
"$ref": "Element.schema.json#/definitions/Element"
},
"amount": {
"description": "Payable less any payment adjustment.",
"$ref": "Money.schema.json#/definitions/Money"
},
"identifier": {
"description": "Payment identifier.",
"$ref": "Identifier.schema.json#/definitions/Identifier"
}
},
"additionalProperties": false
},
"ClaimResponse_ProcessNote": {
"description": "This resource provides the adjudication details from the processing of a Claim resource.",
"properties": {
"id": {
"description": "Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.",
"$ref": "string.schema.json#/definitions/string"
},
"extension": {
"description": "May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.",
"items": {
"$ref": "Extension.schema.json#/definitions/Extension"
},
"type": "array"
},
"modifierExtension": {
"description": "May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.\n\nModifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).",
"items": {
"$ref": "Extension.schema.json#/definitions/Extension"
},
"type": "array"
},
"number": {
"description": "An integer associated with each note which may be referred to from each service line item.",
"$ref": "#/definitions/positiveInt"
},
"_number": {
"description": "Extensions for number",
"$ref": "Element.schema.json#/definitions/Element"
},
"type": {
"description": "The note purpose: Print/Display.",
"enum": [
"display",
"print",
"printoper"
]
},
"_type": {
"description": "Extensions for type",
"$ref": "Element.schema.json#/definitions/Element"
},
"text": {
"description": "The note text.",
"$ref": "#/definitions/string"
},
"_text": {
"description": "Extensions for text",
"$ref": "Element.schema.json#/definitions/Element"
},
"language": {
"description": "The ISO-639-1 alpha 2 code in lower case for the language, optionally followed by a hyphen and the ISO-3166-1 alpha 2 code for the region in upper case; e.g. \"en\" for English, or \"en-US\" for American English versus \"en-EN\" for England English.",
"$ref": "CodeableConcept.schema.json#/definitions/CodeableConcept"
}
},
"additionalProperties": false
},
"ClaimResponse_Insurance": {
"description": "This resource provides the adjudication details from the processing of a Claim resource.",
"properties": {
"id": {
"description": "Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.",
"$ref": "string.schema.json#/definitions/string"
},
"extension": {
"description": "May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.",
"items": {
"$ref": "Extension.schema.json#/definitions/Extension"
},
"type": "array"
},
"modifierExtension": {
"description": "May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.\n\nModifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).",
"items": {
"$ref": "Extension.schema.json#/definitions/Extension"
},
"type": "array"
},
"sequence": {
"description": "A service line item.",
"$ref": "#/definitions/positiveInt"
},
"_sequence": {
"description": "Extensions for sequence",
"$ref": "Element.schema.json#/definitions/Element"
},
"focal": {
"description": "The instance number of the Coverage which is the focus for adjudication. The Coverage against which the claim is to be adjudicated.",
"$ref": "#/definitions/boolean"
},
"_focal": {
"description": "Extensions for focal",
"$ref": "Element.schema.json#/definitions/Element"
},
"coverage": {
"description": "Reference to the program or plan identification, underwriter or payor.",
"$ref": "Reference.schema.json#/definitions/Reference"
},
"businessArrangement": {
"description": "The contract number of a business agreement which describes the terms and conditions.",
"$ref": "#/definitions/string"
},
"_businessArrangement": {
"description": "Extensions for businessArrangement",
"$ref": "Element.schema.json#/definitions/Element"
},
"claimResponse": {
"description": "The Coverages adjudication details.",
"$ref": "Reference.schema.json#/definitions/Reference"
}
},
"additionalProperties": false,
"required": [
"coverage"
]
}
}
}
®© HL7.org 2011+. FHIR Mixed Nomative/Trial Use Ballot #2 (v3.5.0-14907) generated on Sun, Aug 19, 2018 21:52+1000. QA Page
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