DSTU2

This page is part of the FHIR Specification (v1.0.2: DSTU 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 R3 R2

7.2.6 Resource ClaimResponse - Mappings

Mappings:

RIM

Canadian Dental Association eclaims standard

Mappings for the claimresponse resource.

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

ClaimResponse
    identifier
    request
    ruleset
    originalRuleset
    created
    organization
    requestProvider
    requestOrganization
    outcome
    disposition
    payeeType
    item
        sequenceLinkId
        noteNumber
        adjudication
            code
            amount
            value
        detail
            sequenceLinkId
            adjudication
                code
                amount
                value
            subDetail
                sequenceLinkId
                adjudication
                    code
                    amount
                    value
    addItem
        sequenceLinkId
        service
        fee
        noteNumberLinkId
        adjudication
            code
            amount
            value
        detail
            service
            fee
            adjudication
                code
                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
        businessArrangement
        relationship
        preAuthRef
        claimResponse
        originalRuleset

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

ClaimResponse
    identifier
    requestA02|G01
    ruleset
    originalRuleset
    created
    organization
    requestProviderB01
    requestOrganization
    outcome
    disposition
    payeeType
    item
        sequenceLinkIdF07
        noteNumber
        adjudication
            code
            amount
            value
        detail
            sequenceLinkIdF07
            adjudication
                code
                amount
                value
            subDetail
                sequenceLinkIdF07
                adjudication
                    code
                    amount
                    value
    addItem
        sequenceLinkId
        service
        fee
        noteNumberLinkId
        adjudication
            code
            amount
            value
        detail
            service
            fee
            adjudication
                code
                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
        businessArrangement
        relationshipC03
        preAuthRefF03
        claimResponseEOB
        originalRuleset