FHIR Release 3 (STU)

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13.7.6 Resource ClaimResponse - Mappings

Financial Management Work GroupMaturity Level: N/ABallot Status: InformativeCompartments: Patient, Practitioner

Mappings:

RIM Mapping

Canadian Dental Association eclaims standard

Workflow Mapping

Mappings for the claimresponse resource.

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

ClaimResponse
    identifier
    status
    patient
    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
    processNote
        number
        type
        text
        language
    communicationRequest
    insuranceCoverage
        sequence
        focal
        coverage
        businessArrangement
        preAuthRef
        claimResponse

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

ClaimResponse
    identifier
    status
    patient
    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
    processNote
        number
        type
        textG32
        language
    communicationRequest
    insurance
        sequence
        focal
        coverage
        businessArrangement
        preAuthRefF03
        claimResponseEOB

13.7.6.3 Mappings for Workflow Mapping (http://hl7.org/fhir/workflow)

ClaimResponseEvent
    identifierEvent.identifier
    statusEvent.status
    patient
    createdEvent.occurrence
    insurerEvent.performer.onBehalfOf
    requestProvider
    requestOrganization
    requestEvent.basedOn
    outcome
    dispositionEvent.note
    payeeType
    item
        sequenceLinkId
        noteNumber
        adjudication
            category
            reason
            amount
            value
        detail
            sequenceLinkId
            noteNumber
            adjudication
            subDetail
                sequenceLinkId
                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
    form
    processNote
        number
        type
        text
        language
    communicationRequest
    insurance
        sequence
        focal
        coverage
        businessArrangement
        preAuthRef
        claimResponse