This page is part of the FHIR Specification (v5.0.0: R5 - STU). This is the current published version in it's permanent home (it will always be available at this URL). 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 | Standards Status: Informative | Security Category: Patient | Compartments: Patient, Practitioner |
R4 : R5 Conversion maps for ClaimResponse.
Functional status for this map: See Conversions Summary. (see documentation)
map "http://hl7.org/fhir/StructureMap/ClaimResponse3to4" = "R3 to R4 Conversions for ClaimResponse" uses "http://hl7.org/fhir/3.0/StructureDefinition/ClaimResponse" alias ClaimResponseR3 as source uses "http://hl7.org/fhir/StructureDefinition/ClaimResponse" alias ClaimResponse as target imports "http://hl7.org/fhir/StructureMap/*3to4" group ClaimResponse(source src : ClaimResponseR3, target tgt : ClaimResponse) extends DomainResource <<type+>> { src.identifier -> tgt.identifier; src.status -> tgt.status; src.type -> tgt.type; src.subType -> tgt.subType; src.use -> tgt.use; src.patient -> tgt.patient; src.created -> tgt.created; src.insurer -> tgt.insurer; src.requestProvider -> tgt.requestor; src.request -> tgt.request; src.outcome as vs then { vs.coding as c then { c.code where value in ('queued' | 'complete' | 'error' | 'partial') -> tgt.outcome; }; }; src.disposition -> tgt.disposition; src.payeeType -> tgt.payeeType; src.item as s -> tgt.item as t then ClaimResponseItem(s, t); src.addItem as s -> tgt.addItem as t then ClaimResponseAddItem(s, t); src.error as s -> tgt.error as t then ClaimResponseError(s, t); src.totalCost as s -> tgt.total as t then ClaimResponseTotalCost(s, t); src.totalBenefit as s -> tgt.total as t then ClaimResponseTotalBenefit(s, t); src.payment as s -> tgt.payment as t then ClaimResponsePayment(s, t); src.reserved as vs -> tgt.fundsReserve as vt, vt.coding = vs; src.form -> tgt.form; src.processNote as s -> tgt.processNote as t then ClaimResponseProcessNote(s, t); src.communicationRequest -> tgt.communicationRequest; src.insurance as s -> tgt.insurance as t then ClaimResponseInsurance(s, t); } group ClaimResponseItem(source src, target tgt) extends BackboneElement { src.sequenceLinkId -> tgt.itemSequence; src.noteNumber -> tgt.noteNumber; src.adjudication as s -> tgt.adjudication as t then ClaimResponseItemAdjudication(s, t); src.detail as s -> tgt.detail as t then ClaimResponseItemDetail(s, t); } group ClaimResponseItemAdjudication(source src, target tgt) extends BackboneElement { src.category -> tgt.category; src.reason -> tgt.reason; src.amount -> tgt.amount; src.value -> tgt.value; } group ClaimResponseItemDetail(source src, target tgt) extends BackboneElement { src.detailSequence -> tgt.detailSequence; src.noteNumber -> tgt.noteNumber; src.adjudication -> tgt.adjudication; src.subDetail as s -> tgt.subDetail as t then ClaimResponseItemDetailSubDetail(s, t); } group ClaimResponseItemDetailSubDetail(source src, target tgt) extends BackboneElement { src.subDetailSequence -> tgt.subDetailSequence; src.noteNumber -> tgt.noteNumber; src.adjudication -> tgt.adjudication; } group ClaimResponseAddItem(source src, target tgt) extends BackboneElement { src.itemSequence -> tgt.itemSequence; src.detailSequence -> tgt.detailSequence; src.subdetailSequence -> tgt.subdetailSequence; src.service -> tgt.service; src.modifier -> tgt.modifier; src.programCode -> tgt.programCode; src.serviced -> tgt.serviced; src.location -> tgt.location; src.quantity -> tgt.quantity; src.unitPrice -> tgt.unitPrice; src.factor -> tgt.factor; src.net -> tgt.net; src.bodySite -> tgt.bodySite; src.subSite -> tgt.subSite; src.noteNumber -> tgt.noteNumber; src.adjudication -> tgt.adjudication; src.detail as s -> tgt.detail as t then ClaimResponseAddItemDetail(s, t); } group ClaimResponseAddItemDetail(source src, target tgt) extends BackboneElement { src.service -> tgt.service; src.modifier -> tgt.modifier; src.programCode -> tgt.programCode; src.quantity -> tgt.quantity; src.unitPrice -> tgt.unitPrice; src.factor -> tgt.factor; src.net -> tgt.net; src.noteNumber -> tgt.noteNumber; src.adjudication -> tgt.adjudication; src.subDetail as s -> tgt.subDetail as t then ClaimResponseAddItemDetailSubDetail(s, t); } group ClaimResponseAddItemDetailSubDetail(source src, target tgt) extends BackboneElement { src.service -> tgt.service; src.modifier -> tgt.modifier; src.programCode -> tgt.programCode; src.quantity -> tgt.quantity; src.unitPrice -> tgt.unitPrice; src.factor -> tgt.factor; src.net -> tgt.net; src.noteNumber -> tgt.noteNumber; src.adjudication -> tgt.adjudication; } group ClaimResponseError(source src, target tgt) extends BackboneElement { src.itemSequence -> tgt.itemSequence; src.detailSequence -> tgt.detailSequence; src.subDetailSequence -> tgt.subDetailSequence; src.code -> tgt.code; } group ClaimResponsePayment(source src, target tgt) extends BackboneElement { src.type -> tgt.type; src.adjustment -> tgt.adjustment; src.adjustmentReason -> tgt.adjustmentReason; src.date -> tgt.date; src.amount -> tgt.amount; src.identifier -> tgt.identifier; } group ClaimResponseProcessNote(source src, target tgt) extends BackboneElement { src.number -> tgt.number; src.type -> tgt.type; src.text -> tgt.text; src.language -> tgt.language; } group ClaimResponseInsurance(source src, target tgt) extends BackboneElement { src.sequence -> tgt.sequence; src.focal -> tgt.focal; src.coverage -> tgt.coverage; src.businessArrangement -> tgt.businessArrangement; src.preAuthRef -> tgt.preAuthRef; src.claimResponse -> tgt.claimResponse; } group ClaimResponseTotalCost(source src, target tgt) extends BackboneElement { src -> tgt.category as cc, cc.text = 'Submitted Amount', cc.coding as coding, coding.code = 'submitted', coding.system = 'http://terminology.hl7.org/CodeSystem/adjudication' "category"; src as vs -> tgt.amount as vt then Money(vs, vt) "amount"; } group ClaimResponseTotalBenefit(source src, target tgt) extends BackboneElement { src -> tgt.category as cc, cc.text = 'Benefit Amount', cc.coding as coding, coding.code = 'benefit', coding.system = 'http://terminology.hl7.org/CodeSystem/adjudication' "amount"; src as vs -> tgt.amount as vt then Money(vs, vt) "amount"; }
map "http://hl7.org/fhir/StructureMap/ClaimResponse4to3" = "R4 to R3 Conversion for ClaimResponse" uses "http://hl7.org/fhir/StructureDefinition/ClaimResponse" alias ClaimResponse as source uses "http://hl7.org/fhir/3.0/StructureDefinition/ClaimResponse" alias ClaimResponseR3 as target imports "http://hl7.org/fhir/StructureMap/*4to3" group ClaimResponse(source src : ClaimResponse, target tgt : ClaimResponseR3) extends DomainResource <<type+>> { src.identifier -> tgt.identifier; src.status -> tgt.status; src.type -> tgt.type; src.subType -> tgt.subType; src.use -> tgt.use; src.patient -> tgt.patient; src.created -> tgt.created; src.insurer -> tgt.insurer; src.requestor -> tgt.requestProvider; src.request -> tgt.request; src.outcome as vs where value in ('complete' | 'error' | 'partial') -> tgt.outcome as vt, vt.coding as c, c.system = 'http://hl7.org/fhir/remittance-outcome', c.code = vs; src.disposition -> tgt.disposition; src.payeeType -> tgt.payeeType; src.item as s -> tgt.item as t then ClaimResponseItem(s, t); src.addItem as s -> tgt.addItem as t then ClaimResponseAddItem(s, t); src.error as s -> tgt.error as t then ClaimResponseError(s, t); src.total as total then { total.category as vs then { total.amount as va then { vs.coding as c where code = 'submitted' then { c -> tgt.totalCost as cost then Money(va, cost) "cost"; }; }; }; }; src.total as total then { total.category as vs then { total.amount as va then { vs.coding as c where code = 'benefit' then { c -> tgt.totalBenefit as cost then Money(va, cost) "totalBenefit"; }; }; }; }; src.payment as s -> tgt.payment as t then ClaimResponsePayment(s, t); src.fundsReserve as vs then { vs.coding -> tgt.reserved; }; src.form -> tgt.form; src.processNote as s -> tgt.processNote as t then ClaimResponseProcessNote(s, t); src.communicationRequest -> tgt.communicationRequest; src.insurance as s -> tgt.insurance as t then ClaimResponseInsurance(s, t); } group ClaimResponseItem(source src, target tgt) extends BackboneElement { src.itemSequence -> tgt.sequenceLinkId; src.noteNumber -> tgt.noteNumber; src.adjudication as s -> tgt.adjudication as t then ClaimResponseItemAdjudication(s, t); src.detail as s -> tgt.detail as t then ClaimResponseItemDetail(s, t); } group ClaimResponseItemAdjudication(source src, target tgt) extends BackboneElement { src.category -> tgt.category; src.reason -> tgt.reason; src.amount -> tgt.amount; src.value -> tgt.value; } group ClaimResponseItemDetail(source src, target tgt) extends BackboneElement { src.detailSequence -> tgt.detailSequence; src.noteNumber -> tgt.noteNumber; src.adjudication -> tgt.adjudication; src.subDetail as s -> tgt.subDetail as t then ClaimResponseItemDetailSubDetail(s, t); } group ClaimResponseItemDetailSubDetail(source src, target tgt) extends BackboneElement { src.subDetailSequence -> tgt.subDetailSequence; src.noteNumber -> tgt.noteNumber; src.adjudication -> tgt.adjudication; } group ClaimResponseAddItem(source src, target tgt) extends BackboneElement { src.itemSequence -> tgt.itemSequence; src.detailSequence -> tgt.detailSequence; src.subdetailSequence -> tgt.subdetailSequence; src.service -> tgt.service; src.modifier -> tgt.modifier; src.programCode -> tgt.programCode; src.serviced -> tgt.serviced; src.location -> tgt.location; src.quantity -> tgt.quantity; src.unitPrice -> tgt.unitPrice; src.factor -> tgt.factor; src.net -> tgt.net; src.bodySite -> tgt.bodySite; src.subSite -> tgt.subSite; src.noteNumber -> tgt.noteNumber; src.adjudication -> tgt.adjudication; src.detail as s -> tgt.detail as t then ClaimResponseAddItemDetail(s, t); } group ClaimResponseAddItemDetail(source src, target tgt) extends BackboneElement { src.service -> tgt.service; src.modifier -> tgt.modifier; src.programCode -> tgt.programCode; src.quantity -> tgt.quantity; src.unitPrice -> tgt.unitPrice; src.factor -> tgt.factor; src.net -> tgt.net; src.noteNumber -> tgt.noteNumber; src.adjudication -> tgt.adjudication; src.subDetail as s -> tgt.subDetail as t then ClaimResponseAddItemDetailSubDetail(s, t); } group ClaimResponseAddItemDetailSubDetail(source src, target tgt) extends BackboneElement { src.service -> tgt.service; src.modifier -> tgt.modifier; src.programCode -> tgt.programCode; src.quantity -> tgt.quantity; src.unitPrice -> tgt.unitPrice; src.factor -> tgt.factor; src.net -> tgt.net; src.noteNumber -> tgt.noteNumber; src.adjudication -> tgt.adjudication; } group ClaimResponseError(source src, target tgt) extends BackboneElement { src.itemSequence -> tgt.itemSequence; src.detailSequence -> tgt.detailSequence; src.subDetailSequence -> tgt.subDetailSequence; src.code -> tgt.code; } group ClaimResponsePayment(source src, target tgt) extends BackboneElement { src.type -> tgt.type; src.adjustment -> tgt.adjustment; src.adjustmentReason -> tgt.adjustmentReason; src.date -> tgt.date; src.amount -> tgt.amount; src.identifier -> tgt.identifier; } group ClaimResponseProcessNote(source src, target tgt) extends BackboneElement { src.number -> tgt.number; src.type -> tgt.type; src.text -> tgt.text; src.language -> tgt.language; } group ClaimResponseInsurance(source src, target tgt) extends BackboneElement { src.sequence -> tgt.sequence; src.focal -> tgt.focal; src.coverage -> tgt.coverage; src.businessArrangement -> tgt.businessArrangement; src.preAuthRef -> tgt.preAuthRef; src.claimResponse -> tgt.claimResponse; }
No validation errors - all conversions are clean