Profile Comparison between http://hl7.org/fhir/us/davinci-crd/StructureDefinition/profile-claimresponse vs http://hl7.org/fhir/us/davinci-crd/StructureDefinition/profile-claimresponse

Left:Prior authorization (http://hl7.org/fhir/us/davinci-crd/StructureDefinition/profile-claimresponse)
Right:Prior authorization (http://hl7.org/fhir/us/davinci-crd/StructureDefinition/profile-claimresponse)

Messages

ErrorStructureDefinition.versionValues for version differ: '1.0.0' vs '1.1.0-ballot'

Metadata

NameValueComments
.abstractfalse
    .baseDefinitionhttp://hl7.org/fhir/StructureDefinition/ClaimResponse
      .copyright
        .date2020-11-09
          .descriptionThis profile specifies constraints on ClaimResponse resource to reflect the contents of a pro-active prior authorization returned via a card
            .experimentalfalse
              .fhirVersion4.0.1
                .jurisdiction
                  ..jurisdiction[0]urn:iso:std:iso:3166#US
                    .kindresource
                      .nameClaimResponse
                        .publisherHL7 International - Financial Management Work Group
                          .purpose
                            .statusdraft
                              .titlePrior authorization
                                .typeClaimResponse
                                  .urlhttp://hl7.org/fhir/us/davinci-crd/StructureDefinition/profile-claimresponse
                                    .version1.0.01.1.0-ballot
                                    • Values Differ

                                    Structure

                                    NameL FlagsL Card.L TypeL Description & ConstraintsR FlagsR Card.L TypeL Description & ConstraintsCommentsdoco
                                    .. ClaimResponse 0..*ClaimResponsePrior authorization
                                    0..*ClaimResponsePrior authorization
                                      ... id Σ0..1stringLogical id of this artifactΣ0..1stringLogical id of this artifact
                                        ... meta Σ0..1MetaMetadata about the resourceΣ0..1MetaMetadata about the resource
                                          ... implicitRules ?!Σ0..1uriA set of rules under which this content was created?!Σ0..1uriA set of rules under which this content was created
                                            ... language 0..1codeLanguage of the resource content
                                            Binding: CommonLanguages (preferred)
                                            Max Binding: AllLanguages: A human language.

                                            0..1codeLanguage of the resource content
                                            Binding: CommonLanguages (preferred)
                                            Max Binding: AllLanguages: A human language.

                                              ... text 0..1NarrativeText summary of the resource, for human interpretation0..1NarrativeText summary of the resource, for human interpretation
                                                ... contained 0..*ResourceContained, inline Resources
                                                0..*ResourceContained, inline Resources
                                                  ... extension 0..*ExtensionAdditional content defined by implementations
                                                  0..*ExtensionAdditional content defined by implementations
                                                    ... modifierExtension ?!0..*ExtensionExtensions that cannot be ignored
                                                    ?!0..*ExtensionExtensions that cannot be ignored
                                                      ... identifier 0..*IdentifierBusiness Identifier for a claim response
                                                      0..*IdentifierBusiness Identifier for a claim response
                                                        ... status ?!SΣ1..1codeactive | cancelled | draft | entered-in-error
                                                        Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance.


                                                        Fixed Value: active
                                                        ?!SΣ1..1codeactive | cancelled | draft | entered-in-error
                                                        Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance.


                                                        Fixed Value: active
                                                          ... type SΣ1..1CodeableConceptMore granular claim type
                                                          Binding: ClaimTypeCodes (extensible): The type or discipline-style of the claim.

                                                          SΣ1..1CodeableConceptMore granular claim type
                                                          Binding: ClaimTypeCodes (extensible): The type or discipline-style of the claim.

                                                            ... subType 0..1CodeableConceptMore granular claim type
                                                            Binding: ExampleClaimSubTypeCodes (example): A more granular claim typecode.

                                                            0..1CodeableConceptMore granular claim type
                                                            Binding: ExampleClaimSubTypeCodes (example): A more granular claim typecode.

                                                              ... use SΣ1..1codeclaim | preauthorization | predetermination
                                                              Binding: Use (required): Claim, preauthorization, predetermination.


                                                              Fixed Value: preauthorization
                                                              SΣ1..1codeclaim | preauthorization | predetermination
                                                              Binding: Use (required): Claim, preauthorization, predetermination.


                                                              Fixed Value: preauthorization
                                                                ... patient Σ1..1Reference(Patient)The recipient of the products and servicesΣ1..1Reference(Patient)The recipient of the products and services
                                                                  ... created Σ1..1dateTimeResponse creation dateΣ1..1dateTimeResponse creation date
                                                                    ... insurer Σ1..1Reference(Organization)Party responsible for reimbursementΣ1..1Reference(Organization)Party responsible for reimbursement
                                                                      ... requestor 0..1Reference(Practitioner | PractitionerRole | Organization)Party responsible for the claim0..1Reference(Practitioner | PractitionerRole | Organization)Party responsible for the claim
                                                                        ... request Σ0..1Reference(Claim)Id of resource triggering adjudicationΣ0..1Reference(Claim)Id of resource triggering adjudication
                                                                          ... outcome SΣ1..1codequeued | complete | error | partial
                                                                          Binding: ClaimProcessingCodes (required): The result of the claim processing.


                                                                          Fixed Value: complete
                                                                          SΣ1..1codequeued | complete | error | partial
                                                                          Binding: ClaimProcessingCodes (required): The result of the claim processing.


                                                                          Fixed Value: complete
                                                                            ... disposition 0..1stringDisposition Message0..1stringDisposition Message
                                                                              ... preAuthRef S1..1stringPreauthorization referenceS1..1stringPreauthorization reference
                                                                                ... preAuthPeriod S0..1PeriodPreauthorization reference effective periodS0..1PeriodPreauthorization reference effective period
                                                                                  ... payeeType S0..1CodeableConceptParty to be paid any benefits payable
                                                                                  Binding: Claim Payee Type Codes (example): A code for the party to be reimbursed.

                                                                                  S0..1CodeableConceptParty to be paid any benefits payable
                                                                                  Binding: Claim Payee Type Codes (example): A code for the party to be reimbursed.

                                                                                    ... item 0..*BackboneElementAdjudication for claim line items
                                                                                    0..*BackboneElementAdjudication for claim line items
                                                                                      .... id 0..1stringUnique id for inter-element referencing0..1stringUnique id for inter-element referencing
                                                                                        .... extension 0..*ExtensionAdditional content defined by implementations
                                                                                        0..*ExtensionAdditional content defined by implementations
                                                                                          .... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
                                                                                          ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
                                                                                            .... itemSequence 1..1positiveIntClaim item instance identifier1..1positiveIntClaim item instance identifier
                                                                                              .... noteNumber 0..*positiveIntApplicable note numbers
                                                                                              0..*positiveIntApplicable note numbers
                                                                                                .... adjudication 1..*BackboneElementAdjudication details
                                                                                                1..*BackboneElementAdjudication details
                                                                                                  ..... id 0..1stringUnique id for inter-element referencing0..1stringUnique id for inter-element referencing
                                                                                                    ..... extension 0..*ExtensionAdditional content defined by implementations
                                                                                                    0..*ExtensionAdditional content defined by implementations
                                                                                                      ..... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
                                                                                                      ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
                                                                                                        ..... category 1..1CodeableConceptType of adjudication information
                                                                                                        Binding: AdjudicationValueCodes (example): The adjudication codes.

                                                                                                        1..1CodeableConceptType of adjudication information
                                                                                                        Binding: AdjudicationValueCodes (example): The adjudication codes.

                                                                                                          ..... reason 0..1CodeableConceptExplanation of adjudication outcome
                                                                                                          Binding: AdjudicationReasonCodes (example): The adjudication reason codes.

                                                                                                          0..1CodeableConceptExplanation of adjudication outcome
                                                                                                          Binding: AdjudicationReasonCodes (example): The adjudication reason codes.

                                                                                                            ..... amount 0..1MoneyMonetary amount0..1MoneyMonetary amount
                                                                                                              ..... value 0..1decimalNon-monetary value0..1decimalNon-monetary value
                                                                                                                .... detail 0..*BackboneElementAdjudication for claim details
                                                                                                                0..*BackboneElementAdjudication for claim details
                                                                                                                  ..... id 0..1stringUnique id for inter-element referencing0..1stringUnique id for inter-element referencing
                                                                                                                    ..... extension 0..*ExtensionAdditional content defined by implementations
                                                                                                                    0..*ExtensionAdditional content defined by implementations
                                                                                                                      ..... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
                                                                                                                      ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
                                                                                                                        ..... detailSequence 1..1positiveIntClaim detail instance identifier1..1positiveIntClaim detail instance identifier
                                                                                                                          ..... noteNumber 0..*positiveIntApplicable note numbers
                                                                                                                          0..*positiveIntApplicable note numbers
                                                                                                                            ..... adjudication 1..*See adjudication (ClaimResponse)Detail level adjudication details
                                                                                                                            1..*See adjudication (ClaimResponse)Detail level adjudication details
                                                                                                                              ..... subDetail 0..*BackboneElementAdjudication for claim sub-details
                                                                                                                              0..*BackboneElementAdjudication for claim sub-details
                                                                                                                                ...... id 0..1stringUnique id for inter-element referencing0..1stringUnique id for inter-element referencing
                                                                                                                                  ...... extension 0..*ExtensionAdditional content defined by implementations
                                                                                                                                  0..*ExtensionAdditional content defined by implementations
                                                                                                                                    ...... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
                                                                                                                                    ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
                                                                                                                                      ...... subDetailSequence 1..1positiveIntClaim sub-detail instance identifier1..1positiveIntClaim sub-detail instance identifier
                                                                                                                                        ...... noteNumber 0..*positiveIntApplicable note numbers
                                                                                                                                        0..*positiveIntApplicable note numbers
                                                                                                                                          ...... adjudication 0..*See adjudication (ClaimResponse)Subdetail level adjudication details
                                                                                                                                          0..*See adjudication (ClaimResponse)Subdetail level adjudication details
                                                                                                                                            ... addItem S1..*BackboneElementInsurer added line items
                                                                                                                                            S1..*BackboneElementInsurer added line items
                                                                                                                                              .... id 0..1stringUnique id for inter-element referencing0..1stringUnique id for inter-element referencing
                                                                                                                                                .... extension 0..*ExtensionAdditional content defined by implementations
                                                                                                                                                0..*ExtensionAdditional content defined by implementations
                                                                                                                                                  .... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
                                                                                                                                                  ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
                                                                                                                                                    .... itemSequence 0..*positiveIntItem sequence number
                                                                                                                                                    0..*positiveIntItem sequence number
                                                                                                                                                      .... detailSequence 0..*positiveIntDetail sequence number
                                                                                                                                                      0..*positiveIntDetail sequence number
                                                                                                                                                        .... subdetailSequence 0..*positiveIntSubdetail sequence number
                                                                                                                                                        0..*positiveIntSubdetail sequence number
                                                                                                                                                          .... provider S0..*Reference(Practitioner | PractitionerRole | Organization)Authorized providers
                                                                                                                                                          S0..*Reference(Practitioner | PractitionerRole | Organization)Authorized providers
                                                                                                                                                            .... productOrService S1..1CodeableConceptBilling, service, product, or drug code
                                                                                                                                                            Binding: USCLSCodes (example): Allowable service and product codes.

                                                                                                                                                            S1..1CodeableConceptBilling, service, product, or drug code
                                                                                                                                                            Binding: USCLSCodes (example): Allowable service and product codes.

                                                                                                                                                              .... modifier S0..*CodeableConceptService/Product billing modifiers
                                                                                                                                                              Binding: ModifierTypeCodes (example): Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen.


                                                                                                                                                              S0..*CodeableConceptService/Product billing modifiers
                                                                                                                                                              Binding: ModifierTypeCodes (example): Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen.


                                                                                                                                                                .... programCode S0..*CodeableConceptProgram the product or service is provided under
                                                                                                                                                                Binding: ExampleProgramReasonCodes (example): Program specific reason codes.


                                                                                                                                                                S0..*CodeableConceptProgram the product or service is provided under
                                                                                                                                                                Binding: ExampleProgramReasonCodes (example): Program specific reason codes.


                                                                                                                                                                  .... serviced[x] 0..1date, PeriodDate or dates of service or product delivery0..1date, PeriodDate or dates of service or product delivery
                                                                                                                                                                    .... location[x] S0..1CodeableConcept, Address, Reference(Location)Place of service or where product was supplied
                                                                                                                                                                    Binding: ExampleServicePlaceCodes (example): Place of service: pharmacy, school, prison, etc.

                                                                                                                                                                    S0..1CodeableConcept, Address, Reference(Location)Place of service or where product was supplied
                                                                                                                                                                    Binding: ExampleServicePlaceCodes (example): Place of service: pharmacy, school, prison, etc.

                                                                                                                                                                      .... quantity S0..1SimpleQuantityCount of products or servicesS0..1SimpleQuantityCount of products or services
                                                                                                                                                                        .... unitPrice S0..1MoneyFee, charge or cost per itemS0..1MoneyFee, charge or cost per item
                                                                                                                                                                          .... factor S0..1decimalPrice scaling factorS0..1decimalPrice scaling factor
                                                                                                                                                                            .... net S0..1MoneyTotal item costS0..1MoneyTotal item cost
                                                                                                                                                                              .... bodySite S0..1CodeableConceptAnatomical location
                                                                                                                                                                              Binding: OralSiteCodes (example): The code for the teeth, quadrant, sextant and arch.

                                                                                                                                                                              S0..1CodeableConceptAnatomical location
                                                                                                                                                                              Binding: OralSiteCodes (example): The code for the teeth, quadrant, sextant and arch.

                                                                                                                                                                                .... subSite S0..*CodeableConceptAnatomical sub-location
                                                                                                                                                                                Binding: SurfaceCodes (example): The code for the tooth surface and surface combinations.


                                                                                                                                                                                S0..*CodeableConceptAnatomical sub-location
                                                                                                                                                                                Binding: SurfaceCodes (example): The code for the tooth surface and surface combinations.


                                                                                                                                                                                  .... noteNumber S0..*positiveIntApplicable note numbers
                                                                                                                                                                                  S0..*positiveIntApplicable note numbers
                                                                                                                                                                                    .... adjudication S1..*BackboneElementAdded items adjudication
                                                                                                                                                                                    S1..*BackboneElementAdded items adjudication
                                                                                                                                                                                      ..... id 0..1stringUnique id for inter-element referencing0..1stringUnique id for inter-element referencing
                                                                                                                                                                                        ..... extension 0..*ExtensionAdditional content defined by implementations
                                                                                                                                                                                        0..*ExtensionAdditional content defined by implementations
                                                                                                                                                                                          ..... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
                                                                                                                                                                                          ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
                                                                                                                                                                                            ..... category S1..1CodeableConceptType of adjudication information
                                                                                                                                                                                            Binding: AdjudicationValueCodes (example): The adjudication codes.

                                                                                                                                                                                            S1..1CodeableConceptType of adjudication information
                                                                                                                                                                                            Binding: AdjudicationValueCodes (example): The adjudication codes.

                                                                                                                                                                                              ..... reason S0..1CodeableConceptExplanation of adjudication outcome
                                                                                                                                                                                              Binding: AdjudicationReasonCodes (example): The adjudication reason codes.

                                                                                                                                                                                              S0..1CodeableConceptExplanation of adjudication outcome
                                                                                                                                                                                              Binding: AdjudicationReasonCodes (example): The adjudication reason codes.

                                                                                                                                                                                                ..... amount S0..1MoneyMonetary amountS0..1MoneyMonetary amount
                                                                                                                                                                                                  ..... value S0..1decimalNon-monetary valueS0..1decimalNon-monetary value
                                                                                                                                                                                                    .... detail S0..*BackboneElementInsurer added line details
                                                                                                                                                                                                    S0..*BackboneElementInsurer added line details
                                                                                                                                                                                                      ..... id 0..1stringUnique id for inter-element referencing0..1stringUnique id for inter-element referencing
                                                                                                                                                                                                        ..... extension 0..*ExtensionAdditional content defined by implementations
                                                                                                                                                                                                        0..*ExtensionAdditional content defined by implementations
                                                                                                                                                                                                          ..... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
                                                                                                                                                                                                          ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
                                                                                                                                                                                                            ..... productOrService S1..1CodeableConceptBilling, service, product, or drug code
                                                                                                                                                                                                            Binding: USCLSCodes (example): Allowable service and product codes.

                                                                                                                                                                                                            S1..1CodeableConceptBilling, service, product, or drug code
                                                                                                                                                                                                            Binding: USCLSCodes (example): Allowable service and product codes.

                                                                                                                                                                                                              ..... modifier S0..*CodeableConceptService/Product billing modifiers
                                                                                                                                                                                                              Binding: ModifierTypeCodes (example): Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen.


                                                                                                                                                                                                              S0..*CodeableConceptService/Product billing modifiers
                                                                                                                                                                                                              Binding: ModifierTypeCodes (example): Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen.


                                                                                                                                                                                                                ..... quantity S0..1SimpleQuantityCount of products or servicesS0..1SimpleQuantityCount of products or services
                                                                                                                                                                                                                  ..... unitPrice S0..1MoneyFee, charge or cost per itemS0..1MoneyFee, charge or cost per item
                                                                                                                                                                                                                    ..... factor S0..1decimalPrice scaling factorS0..1decimalPrice scaling factor
                                                                                                                                                                                                                      ..... net S0..1MoneyTotal item costS0..1MoneyTotal item cost
                                                                                                                                                                                                                        ..... noteNumber S0..*positiveIntApplicable note numbers
                                                                                                                                                                                                                        S0..*positiveIntApplicable note numbers
                                                                                                                                                                                                                          ..... adjudication S1..*BackboneElementAdded items detail adjudication
                                                                                                                                                                                                                          S1..*BackboneElementAdded items detail adjudication
                                                                                                                                                                                                                            ...... id 0..1stringUnique id for inter-element referencing0..1stringUnique id for inter-element referencing
                                                                                                                                                                                                                              ...... extension 0..*ExtensionAdditional content defined by implementations
                                                                                                                                                                                                                              0..*ExtensionAdditional content defined by implementations
                                                                                                                                                                                                                                ...... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
                                                                                                                                                                                                                                ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
                                                                                                                                                                                                                                  ...... category S1..1CodeableConceptType of adjudication information
                                                                                                                                                                                                                                  Binding: AdjudicationValueCodes (example): The adjudication codes.

                                                                                                                                                                                                                                  S1..1CodeableConceptType of adjudication information
                                                                                                                                                                                                                                  Binding: AdjudicationValueCodes (example): The adjudication codes.

                                                                                                                                                                                                                                    ...... reason S0..1CodeableConceptExplanation of adjudication outcome
                                                                                                                                                                                                                                    Binding: AdjudicationReasonCodes (example): The adjudication reason codes.

                                                                                                                                                                                                                                    S0..1CodeableConceptExplanation of adjudication outcome
                                                                                                                                                                                                                                    Binding: AdjudicationReasonCodes (example): The adjudication reason codes.

                                                                                                                                                                                                                                      ...... amount S0..1MoneyMonetary amountS0..1MoneyMonetary amount
                                                                                                                                                                                                                                        ...... value S0..1decimalNon-monetary valueS0..1decimalNon-monetary value
                                                                                                                                                                                                                                          ..... subDetail S0..*BackboneElementInsurer added line items
                                                                                                                                                                                                                                          S0..*BackboneElementInsurer added line items
                                                                                                                                                                                                                                            ...... id 0..1stringUnique id for inter-element referencing0..1stringUnique id for inter-element referencing
                                                                                                                                                                                                                                              ...... extension 0..*ExtensionAdditional content defined by implementations
                                                                                                                                                                                                                                              0..*ExtensionAdditional content defined by implementations
                                                                                                                                                                                                                                                ...... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
                                                                                                                                                                                                                                                ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
                                                                                                                                                                                                                                                  ...... productOrService S1..1CodeableConceptBilling, service, product, or drug code
                                                                                                                                                                                                                                                  Binding: USCLSCodes (example): Allowable service and product codes.

                                                                                                                                                                                                                                                  S1..1CodeableConceptBilling, service, product, or drug code
                                                                                                                                                                                                                                                  Binding: USCLSCodes (example): Allowable service and product codes.

                                                                                                                                                                                                                                                    ...... modifier S0..*CodeableConceptService/Product billing modifiers
                                                                                                                                                                                                                                                    Binding: ModifierTypeCodes (example): Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen.


                                                                                                                                                                                                                                                    S0..*CodeableConceptService/Product billing modifiers
                                                                                                                                                                                                                                                    Binding: ModifierTypeCodes (example): Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen.


                                                                                                                                                                                                                                                      ...... quantity S0..1SimpleQuantityCount of products or servicesS0..1SimpleQuantityCount of products or services
                                                                                                                                                                                                                                                        ...... unitPrice S0..1MoneyFee, charge or cost per itemS0..1MoneyFee, charge or cost per item
                                                                                                                                                                                                                                                          ...... factor S0..1decimalPrice scaling factorS0..1decimalPrice scaling factor
                                                                                                                                                                                                                                                            ...... net S0..1MoneyTotal item costS0..1MoneyTotal item cost
                                                                                                                                                                                                                                                              ...... noteNumber S0..*positiveIntApplicable note numbers
                                                                                                                                                                                                                                                              S0..*positiveIntApplicable note numbers
                                                                                                                                                                                                                                                                ...... adjudication S1..*BackboneElementAdded items detail adjudication
                                                                                                                                                                                                                                                                S1..*BackboneElementAdded items detail adjudication
                                                                                                                                                                                                                                                                  ....... id 0..1stringUnique id for inter-element referencing0..1stringUnique id for inter-element referencing
                                                                                                                                                                                                                                                                    ....... extension 0..*ExtensionAdditional content defined by implementations
                                                                                                                                                                                                                                                                    0..*ExtensionAdditional content defined by implementations
                                                                                                                                                                                                                                                                      ....... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
                                                                                                                                                                                                                                                                      ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
                                                                                                                                                                                                                                                                        ....... category S1..1CodeableConceptType of adjudication information
                                                                                                                                                                                                                                                                        Binding: AdjudicationValueCodes (example): The adjudication codes.

                                                                                                                                                                                                                                                                        S1..1CodeableConceptType of adjudication information
                                                                                                                                                                                                                                                                        Binding: AdjudicationValueCodes (example): The adjudication codes.

                                                                                                                                                                                                                                                                          ....... reason S0..1CodeableConceptExplanation of adjudication outcome
                                                                                                                                                                                                                                                                          Binding: AdjudicationReasonCodes (example): The adjudication reason codes.

                                                                                                                                                                                                                                                                          S0..1CodeableConceptExplanation of adjudication outcome
                                                                                                                                                                                                                                                                          Binding: AdjudicationReasonCodes (example): The adjudication reason codes.

                                                                                                                                                                                                                                                                            ....... amount S0..1MoneyMonetary amountS0..1MoneyMonetary amount
                                                                                                                                                                                                                                                                              ....... value S0..1decimalNon-monetary valueS0..1decimalNon-monetary value
                                                                                                                                                                                                                                                                                ... adjudication 0..*See adjudication (ClaimResponse)Header-level adjudication
                                                                                                                                                                                                                                                                                0..*See adjudication (ClaimResponse)Header-level adjudication
                                                                                                                                                                                                                                                                                  ... total SΣ0..*BackboneElementAdjudication totals
                                                                                                                                                                                                                                                                                  SΣ0..*BackboneElementAdjudication totals
                                                                                                                                                                                                                                                                                    .... id 0..1stringUnique id for inter-element referencing0..1stringUnique id for inter-element referencing
                                                                                                                                                                                                                                                                                      .... extension 0..*ExtensionAdditional content defined by implementations
                                                                                                                                                                                                                                                                                      0..*ExtensionAdditional content defined by implementations
                                                                                                                                                                                                                                                                                        .... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
                                                                                                                                                                                                                                                                                        ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
                                                                                                                                                                                                                                                                                          .... category SΣ1..1CodeableConceptType of adjudication information
                                                                                                                                                                                                                                                                                          Binding: AdjudicationValueCodes (example): The adjudication codes.

                                                                                                                                                                                                                                                                                          SΣ1..1CodeableConceptType of adjudication information
                                                                                                                                                                                                                                                                                          Binding: AdjudicationValueCodes (example): The adjudication codes.

                                                                                                                                                                                                                                                                                            .... amount SΣ1..1MoneyFinancial total for the categorySΣ1..1MoneyFinancial total for the category
                                                                                                                                                                                                                                                                                              ... payment 0..00..0
                                                                                                                                                                                                                                                                                                .... id 0..1stringUnique id for inter-element referencing0..1stringUnique id for inter-element referencing
                                                                                                                                                                                                                                                                                                  .... extension 0..*ExtensionAdditional content defined by implementations
                                                                                                                                                                                                                                                                                                  0..*ExtensionAdditional content defined by implementations
                                                                                                                                                                                                                                                                                                    .... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
                                                                                                                                                                                                                                                                                                    ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
                                                                                                                                                                                                                                                                                                      .... type 1..1CodeableConceptPartial or complete payment
                                                                                                                                                                                                                                                                                                      Binding: ExamplePaymentTypeCodes (example): The type (partial, complete) of the payment.

                                                                                                                                                                                                                                                                                                      1..1CodeableConceptPartial or complete payment
                                                                                                                                                                                                                                                                                                      Binding: ExamplePaymentTypeCodes (example): The type (partial, complete) of the payment.

                                                                                                                                                                                                                                                                                                        .... adjustment 0..1MoneyPayment adjustment for non-claim issues0..1MoneyPayment adjustment for non-claim issues
                                                                                                                                                                                                                                                                                                          .... adjustmentReason 0..1CodeableConceptExplanation for the adjustment
                                                                                                                                                                                                                                                                                                          Binding: PaymentAdjustmentReasonCodes (example): Payment Adjustment reason codes.

                                                                                                                                                                                                                                                                                                          0..1CodeableConceptExplanation for the adjustment
                                                                                                                                                                                                                                                                                                          Binding: PaymentAdjustmentReasonCodes (example): Payment Adjustment reason codes.

                                                                                                                                                                                                                                                                                                            .... date 0..1dateExpected date of payment0..1dateExpected date of payment
                                                                                                                                                                                                                                                                                                              .... amount 1..1MoneyPayable amount after adjustment1..1MoneyPayable amount after adjustment
                                                                                                                                                                                                                                                                                                                .... identifier 0..1IdentifierBusiness identifier for the payment0..1IdentifierBusiness identifier for the payment
                                                                                                                                                                                                                                                                                                                  ... fundsReserve S0..1CodeableConceptFunds reserved status
                                                                                                                                                                                                                                                                                                                  Binding: Funds Reservation Codes (example): For whom funds are to be reserved: (Patient, Provider, None).

                                                                                                                                                                                                                                                                                                                  S0..1CodeableConceptFunds reserved status
                                                                                                                                                                                                                                                                                                                  Binding: Funds Reservation Codes (example): For whom funds are to be reserved: (Patient, Provider, None).

                                                                                                                                                                                                                                                                                                                    ... formCode 0..1CodeableConceptPrinted form identifier
                                                                                                                                                                                                                                                                                                                    Binding: Form Codes (example): The forms codes.

                                                                                                                                                                                                                                                                                                                    0..1CodeableConceptPrinted form identifier
                                                                                                                                                                                                                                                                                                                    Binding: Form Codes (example): The forms codes.

                                                                                                                                                                                                                                                                                                                      ... form 0..1AttachmentPrinted reference or actual form0..1AttachmentPrinted reference or actual form
                                                                                                                                                                                                                                                                                                                        ... processNote S0..*BackboneElementNote concerning adjudication
                                                                                                                                                                                                                                                                                                                        S0..*BackboneElementNote concerning adjudication
                                                                                                                                                                                                                                                                                                                          .... id 0..1stringUnique id for inter-element referencing0..1stringUnique id for inter-element referencing
                                                                                                                                                                                                                                                                                                                            .... extension 0..*ExtensionAdditional content defined by implementations
                                                                                                                                                                                                                                                                                                                            0..*ExtensionAdditional content defined by implementations
                                                                                                                                                                                                                                                                                                                              .... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
                                                                                                                                                                                                                                                                                                                              ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
                                                                                                                                                                                                                                                                                                                                .... number S0..1positiveIntNote instance identifierS0..1positiveIntNote instance identifier
                                                                                                                                                                                                                                                                                                                                  .... type S0..1codedisplay | print | printoper
                                                                                                                                                                                                                                                                                                                                  Binding: NoteType (required): The presentation types of notes.

                                                                                                                                                                                                                                                                                                                                  S0..1codedisplay | print | printoper
                                                                                                                                                                                                                                                                                                                                  Binding: NoteType (required): The presentation types of notes.

                                                                                                                                                                                                                                                                                                                                    .... text S1..1stringNote explanatory textS1..1stringNote explanatory text
                                                                                                                                                                                                                                                                                                                                      .... language S0..1CodeableConceptLanguage of the text
                                                                                                                                                                                                                                                                                                                                      Binding: CommonLanguages (preferred)
                                                                                                                                                                                                                                                                                                                                      Max Binding: AllLanguages: A human language.

                                                                                                                                                                                                                                                                                                                                      S0..1CodeableConceptLanguage of the text
                                                                                                                                                                                                                                                                                                                                      Binding: CommonLanguages (preferred)
                                                                                                                                                                                                                                                                                                                                      Max Binding: AllLanguages: A human language.

                                                                                                                                                                                                                                                                                                                                        ... communicationRequest 0..*Reference(CommunicationRequest)Request for additional information
                                                                                                                                                                                                                                                                                                                                        0..*Reference(CommunicationRequest)Request for additional information
                                                                                                                                                                                                                                                                                                                                          ... insurance S0..*BackboneElementPatient insurance information
                                                                                                                                                                                                                                                                                                                                          S0..*BackboneElementPatient insurance information
                                                                                                                                                                                                                                                                                                                                            .... id 0..1stringUnique id for inter-element referencing0..1stringUnique id for inter-element referencing
                                                                                                                                                                                                                                                                                                                                              .... extension 0..*ExtensionAdditional content defined by implementations
                                                                                                                                                                                                                                                                                                                                              0..*ExtensionAdditional content defined by implementations
                                                                                                                                                                                                                                                                                                                                                .... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
                                                                                                                                                                                                                                                                                                                                                ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
                                                                                                                                                                                                                                                                                                                                                  .... sequence S1..1positiveIntInsurance instance identifierS1..1positiveIntInsurance instance identifier
                                                                                                                                                                                                                                                                                                                                                    .... focal S1..1booleanCoverage to be used for adjudicationS1..1booleanCoverage to be used for adjudication
                                                                                                                                                                                                                                                                                                                                                      .... coverage S1..1Reference(Coverage)Insurance informationS1..1Reference(Coverage)Insurance information
                                                                                                                                                                                                                                                                                                                                                        .... businessArrangement 0..1stringAdditional provider contract number0..1stringAdditional provider contract number
                                                                                                                                                                                                                                                                                                                                                          .... claimResponse 0..1Reference(ClaimResponse)Adjudication results0..1Reference(ClaimResponse)Adjudication results
                                                                                                                                                                                                                                                                                                                                                            ... error 0..00..0
                                                                                                                                                                                                                                                                                                                                                              .... id 0..1stringUnique id for inter-element referencing0..1stringUnique id for inter-element referencing
                                                                                                                                                                                                                                                                                                                                                                .... extension 0..*ExtensionAdditional content defined by implementations
                                                                                                                                                                                                                                                                                                                                                                0..*ExtensionAdditional content defined by implementations
                                                                                                                                                                                                                                                                                                                                                                  .... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
                                                                                                                                                                                                                                                                                                                                                                  ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
                                                                                                                                                                                                                                                                                                                                                                    .... itemSequence 0..1positiveIntItem sequence number0..1positiveIntItem sequence number
                                                                                                                                                                                                                                                                                                                                                                      .... detailSequence 0..1positiveIntDetail sequence number0..1positiveIntDetail sequence number
                                                                                                                                                                                                                                                                                                                                                                        .... subDetailSequence 0..1positiveIntSubdetail sequence number0..1positiveIntSubdetail sequence number
                                                                                                                                                                                                                                                                                                                                                                          .... code 1..1CodeableConceptError code detailing processing issues
                                                                                                                                                                                                                                                                                                                                                                          Binding: Adjudication Error Codes (example): The adjudication error codes.

                                                                                                                                                                                                                                                                                                                                                                          1..1CodeableConceptError code detailing processing issues
                                                                                                                                                                                                                                                                                                                                                                          Binding: Adjudication Error Codes (example): The adjudication error codes.


                                                                                                                                                                                                                                                                                                                                                                            doco Documentation for this format