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) |
Error | StructureDefinition.version | Values for version differ: '1.0.0' vs '1.1.0-ballot' |
Name | Value | Comments | |
---|---|---|---|
![]() | false | ||
![]() | http://hl7.org/fhir/StructureDefinition/ClaimResponse | ||
![]() | |||
![]() | 2020-11-09 | ||
![]() | This profile specifies constraints on ClaimResponse resource to reflect the contents of a pro-active prior authorization returned via a card | ||
![]() | false | ||
![]() | 4.0.1 | ||
![]() | |||
![]() ![]() | urn:iso:std:iso:3166#US | ||
![]() | resource | ||
![]() | ClaimResponse | ||
![]() | HL7 International - Financial Management Work Group | ||
![]() | |||
![]() | draft | ||
![]() | Prior authorization | ||
![]() | ClaimResponse | ||
![]() | http://hl7.org/fhir/us/davinci-crd/StructureDefinition/profile-claimresponse | ||
![]() | 1.0.0 | 1.1.0-ballot |
|
Name | L Flags | L Card. | L Type | L Description & Constraints | R Flags | R Card. | L Type | L Description & Constraints | Comments![]() |
---|---|---|---|---|---|---|---|---|---|
![]() ![]() | 0..* | ClaimResponse | Prior authorization | 0..* | ClaimResponse | Prior authorization | |||
![]() ![]() ![]() | Σ | 0..1 | string | Logical id of this artifact | Σ | 0..1 | string | Logical id of this artifact | |
![]() ![]() ![]() | Σ | 0..1 | Meta | Metadata about the resource | Σ | 0..1 | Meta | Metadata about the resource | |
![]() ![]() ![]() | ?!Σ | 0..1 | uri | A set of rules under which this content was created | ?!Σ | 0..1 | uri | A set of rules under which this content was created | |
![]() ![]() ![]() | 0..1 | code | Language of the resource content Binding: CommonLanguages (preferred) Max Binding: AllLanguages: A human language. | 0..1 | code | Language of the resource content Binding: CommonLanguages (preferred) Max Binding: AllLanguages: A human language. | |||
![]() ![]() ![]() | 0..1 | Narrative | Text summary of the resource, for human interpretation | 0..1 | Narrative | Text summary of the resource, for human interpretation | |||
![]() ![]() ![]() | 0..* | Resource | Contained, inline Resources | 0..* | Resource | Contained, inline Resources | |||
![]() ![]() ![]() | 0..* | Extension | Additional content defined by implementations | 0..* | Extension | Additional content defined by implementations | |||
![]() ![]() ![]() | ?! | 0..* | Extension | Extensions that cannot be ignored | ?! | 0..* | Extension | Extensions that cannot be ignored | |
![]() ![]() ![]() | 0..* | Identifier | Business Identifier for a claim response | 0..* | Identifier | Business Identifier for a claim response | |||
![]() ![]() ![]() | ?!SΣ | 1..1 | code | active | cancelled | draft | entered-in-error Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance. Fixed Value: active | ?!SΣ | 1..1 | code | active | cancelled | draft | entered-in-error Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance. Fixed Value: active | |
![]() ![]() ![]() | SΣ | 1..1 | CodeableConcept | More granular claim type Binding: ClaimTypeCodes (extensible): The type or discipline-style of the claim. | SΣ | 1..1 | CodeableConcept | More granular claim type Binding: ClaimTypeCodes (extensible): The type or discipline-style of the claim. | |
![]() ![]() ![]() | 0..1 | CodeableConcept | More granular claim type Binding: ExampleClaimSubTypeCodes (example): A more granular claim typecode. | 0..1 | CodeableConcept | More granular claim type Binding: ExampleClaimSubTypeCodes (example): A more granular claim typecode. | |||
![]() ![]() ![]() | SΣ | 1..1 | code | claim | preauthorization | predetermination Binding: Use (required): Claim, preauthorization, predetermination. Fixed Value: preauthorization | SΣ | 1..1 | code | claim | preauthorization | predetermination Binding: Use (required): Claim, preauthorization, predetermination. Fixed Value: preauthorization | |
![]() ![]() ![]() | Σ | 1..1 | Reference(Patient) | The recipient of the products and services | Σ | 1..1 | Reference(Patient) | The recipient of the products and services | |
![]() ![]() ![]() | Σ | 1..1 | dateTime | Response creation date | Σ | 1..1 | dateTime | Response creation date | |
![]() ![]() ![]() | Σ | 1..1 | Reference(Organization) | Party responsible for reimbursement | Σ | 1..1 | Reference(Organization) | Party responsible for reimbursement | |
![]() ![]() ![]() | 0..1 | Reference(Practitioner | PractitionerRole | Organization) | Party responsible for the claim | 0..1 | Reference(Practitioner | PractitionerRole | Organization) | Party responsible for the claim | |||
![]() ![]() ![]() | Σ | 0..1 | Reference(Claim) | Id of resource triggering adjudication | Σ | 0..1 | Reference(Claim) | Id of resource triggering adjudication | |
![]() ![]() ![]() | SΣ | 1..1 | code | queued | complete | error | partial Binding: ClaimProcessingCodes (required): The result of the claim processing. Fixed Value: complete | SΣ | 1..1 | code | queued | complete | error | partial Binding: ClaimProcessingCodes (required): The result of the claim processing. Fixed Value: complete | |
![]() ![]() ![]() | 0..1 | string | Disposition Message | 0..1 | string | Disposition Message | |||
![]() ![]() ![]() | S | 1..1 | string | Preauthorization reference | S | 1..1 | string | Preauthorization reference | |
![]() ![]() ![]() | S | 0..1 | Period | Preauthorization reference effective period | S | 0..1 | Period | Preauthorization reference effective period | |
![]() ![]() ![]() | S | 0..1 | CodeableConcept | Party to be paid any benefits payable Binding: Claim Payee Type Codes (example): A code for the party to be reimbursed. | S | 0..1 | CodeableConcept | Party to be paid any benefits payable Binding: Claim Payee Type Codes (example): A code for the party to be reimbursed. | |
![]() ![]() ![]() | 0..* | BackboneElement | Adjudication for claim line items | 0..* | BackboneElement | Adjudication for claim line items | |||
![]() ![]() ![]() ![]() | 0..1 | string | Unique id for inter-element referencing | 0..1 | string | Unique id for inter-element referencing | |||
![]() ![]() ![]() ![]() | 0..* | Extension | Additional content defined by implementations | 0..* | Extension | Additional content defined by implementations | |||
![]() ![]() ![]() ![]() | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | |
![]() ![]() ![]() ![]() | 1..1 | positiveInt | Claim item instance identifier | 1..1 | positiveInt | Claim item instance identifier | |||
![]() ![]() ![]() ![]() | 0..* | positiveInt | Applicable note numbers | 0..* | positiveInt | Applicable note numbers | |||
![]() ![]() ![]() ![]() | 1..* | BackboneElement | Adjudication details | 1..* | BackboneElement | Adjudication details | |||
![]() ![]() ![]() ![]() ![]() | 0..1 | string | Unique id for inter-element referencing | 0..1 | string | Unique id for inter-element referencing | |||
![]() ![]() ![]() ![]() ![]() | 0..* | Extension | Additional content defined by implementations | 0..* | Extension | Additional content defined by implementations | |||
![]() ![]() ![]() ![]() ![]() | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | |
![]() ![]() ![]() ![]() ![]() | 1..1 | CodeableConcept | Type of adjudication information Binding: AdjudicationValueCodes (example): The adjudication codes. | 1..1 | CodeableConcept | Type of adjudication information Binding: AdjudicationValueCodes (example): The adjudication codes. | |||
![]() ![]() ![]() ![]() ![]() | 0..1 | CodeableConcept | Explanation of adjudication outcome Binding: AdjudicationReasonCodes (example): The adjudication reason codes. | 0..1 | CodeableConcept | Explanation of adjudication outcome Binding: AdjudicationReasonCodes (example): The adjudication reason codes. | |||
![]() ![]() ![]() ![]() ![]() | 0..1 | Money | Monetary amount | 0..1 | Money | Monetary amount | |||
![]() ![]() ![]() ![]() ![]() | 0..1 | decimal | Non-monetary value | 0..1 | decimal | Non-monetary value | |||
![]() ![]() ![]() ![]() | 0..* | BackboneElement | Adjudication for claim details | 0..* | BackboneElement | Adjudication for claim details | |||
![]() ![]() ![]() ![]() ![]() | 0..1 | string | Unique id for inter-element referencing | 0..1 | string | Unique id for inter-element referencing | |||
![]() ![]() ![]() ![]() ![]() | 0..* | Extension | Additional content defined by implementations | 0..* | Extension | Additional content defined by implementations | |||
![]() ![]() ![]() ![]() ![]() | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | |
![]() ![]() ![]() ![]() ![]() | 1..1 | positiveInt | Claim detail instance identifier | 1..1 | positiveInt | Claim detail instance identifier | |||
![]() ![]() ![]() ![]() ![]() | 0..* | positiveInt | Applicable note numbers | 0..* | positiveInt | Applicable note numbers | |||
![]() ![]() ![]() ![]() ![]() | 1..* | See adjudication (ClaimResponse) | Detail level adjudication details | 1..* | See adjudication (ClaimResponse) | Detail level adjudication details | |||
![]() ![]() ![]() ![]() ![]() | 0..* | BackboneElement | Adjudication for claim sub-details | 0..* | BackboneElement | Adjudication for claim sub-details | |||
![]() ![]() ![]() ![]() ![]() ![]() | 0..1 | string | Unique id for inter-element referencing | 0..1 | string | Unique id for inter-element referencing | |||
![]() ![]() ![]() ![]() ![]() ![]() | 0..* | Extension | Additional content defined by implementations | 0..* | Extension | Additional content defined by implementations | |||
![]() ![]() ![]() ![]() ![]() ![]() | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | |
![]() ![]() ![]() ![]() ![]() ![]() | 1..1 | positiveInt | Claim sub-detail instance identifier | 1..1 | positiveInt | Claim sub-detail instance identifier | |||
![]() ![]() ![]() ![]() ![]() ![]() | 0..* | positiveInt | Applicable note numbers | 0..* | positiveInt | Applicable note numbers | |||
![]() ![]() ![]() ![]() ![]() ![]() | 0..* | See adjudication (ClaimResponse) | Subdetail level adjudication details | 0..* | See adjudication (ClaimResponse) | Subdetail level adjudication details | |||
![]() ![]() ![]() | S | 1..* | BackboneElement | Insurer added line items | S | 1..* | BackboneElement | Insurer added line items | |
![]() ![]() ![]() ![]() | 0..1 | string | Unique id for inter-element referencing | 0..1 | string | Unique id for inter-element referencing | |||
![]() ![]() ![]() ![]() | 0..* | Extension | Additional content defined by implementations | 0..* | Extension | Additional content defined by implementations | |||
![]() ![]() ![]() ![]() | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | |
![]() ![]() ![]() ![]() | 0..* | positiveInt | Item sequence number | 0..* | positiveInt | Item sequence number | |||
![]() ![]() ![]() ![]() | 0..* | positiveInt | Detail sequence number | 0..* | positiveInt | Detail sequence number | |||
![]() ![]() ![]() ![]() | 0..* | positiveInt | Subdetail sequence number | 0..* | positiveInt | Subdetail sequence number | |||
![]() ![]() ![]() ![]() | S | 0..* | Reference(Practitioner | PractitionerRole | Organization) | Authorized providers | S | 0..* | Reference(Practitioner | PractitionerRole | Organization) | Authorized providers | |
![]() ![]() ![]() ![]() | S | 1..1 | CodeableConcept | Billing, service, product, or drug code Binding: USCLSCodes (example): Allowable service and product codes. | S | 1..1 | CodeableConcept | Billing, service, product, or drug code Binding: USCLSCodes (example): Allowable service and product codes. | |
![]() ![]() ![]() ![]() | S | 0..* | CodeableConcept | Service/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. | S | 0..* | CodeableConcept | Service/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. | |
![]() ![]() ![]() ![]() | S | 0..* | CodeableConcept | Program the product or service is provided under Binding: ExampleProgramReasonCodes (example): Program specific reason codes. | S | 0..* | CodeableConcept | Program the product or service is provided under Binding: ExampleProgramReasonCodes (example): Program specific reason codes. | |
![]() ![]() ![]() ![]() | 0..1 | date, Period | Date or dates of service or product delivery | 0..1 | date, Period | Date or dates of service or product delivery | |||
![]() ![]() ![]() ![]() | S | 0..1 | CodeableConcept, Address, Reference(Location) | Place of service or where product was supplied Binding: ExampleServicePlaceCodes (example): Place of service: pharmacy, school, prison, etc. | S | 0..1 | CodeableConcept, Address, Reference(Location) | Place of service or where product was supplied Binding: ExampleServicePlaceCodes (example): Place of service: pharmacy, school, prison, etc. | |
![]() ![]() ![]() ![]() | S | 0..1 | SimpleQuantity | Count of products or services | S | 0..1 | SimpleQuantity | Count of products or services | |
![]() ![]() ![]() ![]() | S | 0..1 | Money | Fee, charge or cost per item | S | 0..1 | Money | Fee, charge or cost per item | |
![]() ![]() ![]() ![]() | S | 0..1 | decimal | Price scaling factor | S | 0..1 | decimal | Price scaling factor | |
![]() ![]() ![]() ![]() | S | 0..1 | Money | Total item cost | S | 0..1 | Money | Total item cost | |
![]() ![]() ![]() ![]() | S | 0..1 | CodeableConcept | Anatomical location Binding: OralSiteCodes (example): The code for the teeth, quadrant, sextant and arch. | S | 0..1 | CodeableConcept | Anatomical location Binding: OralSiteCodes (example): The code for the teeth, quadrant, sextant and arch. | |
![]() ![]() ![]() ![]() | S | 0..* | CodeableConcept | Anatomical sub-location Binding: SurfaceCodes (example): The code for the tooth surface and surface combinations. | S | 0..* | CodeableConcept | Anatomical sub-location Binding: SurfaceCodes (example): The code for the tooth surface and surface combinations. | |
![]() ![]() ![]() ![]() | S | 0..* | positiveInt | Applicable note numbers | S | 0..* | positiveInt | Applicable note numbers | |
![]() ![]() ![]() ![]() | S | 1..* | BackboneElement | Added items adjudication | S | 1..* | BackboneElement | Added items adjudication | |
![]() ![]() ![]() ![]() ![]() | 0..1 | string | Unique id for inter-element referencing | 0..1 | string | Unique id for inter-element referencing | |||
![]() ![]() ![]() ![]() ![]() | 0..* | Extension | Additional content defined by implementations | 0..* | Extension | Additional content defined by implementations | |||
![]() ![]() ![]() ![]() ![]() | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | |
![]() ![]() ![]() ![]() ![]() | S | 1..1 | CodeableConcept | Type of adjudication information Binding: AdjudicationValueCodes (example): The adjudication codes. | S | 1..1 | CodeableConcept | Type of adjudication information Binding: AdjudicationValueCodes (example): The adjudication codes. | |
![]() ![]() ![]() ![]() ![]() | S | 0..1 | CodeableConcept | Explanation of adjudication outcome Binding: AdjudicationReasonCodes (example): The adjudication reason codes. | S | 0..1 | CodeableConcept | Explanation of adjudication outcome Binding: AdjudicationReasonCodes (example): The adjudication reason codes. | |
![]() ![]() ![]() ![]() ![]() | S | 0..1 | Money | Monetary amount | S | 0..1 | Money | Monetary amount | |
![]() ![]() ![]() ![]() ![]() | S | 0..1 | decimal | Non-monetary value | S | 0..1 | decimal | Non-monetary value | |
![]() ![]() ![]() ![]() | S | 0..* | BackboneElement | Insurer added line details | S | 0..* | BackboneElement | Insurer added line details | |
![]() ![]() ![]() ![]() ![]() | 0..1 | string | Unique id for inter-element referencing | 0..1 | string | Unique id for inter-element referencing | |||
![]() ![]() ![]() ![]() ![]() | 0..* | Extension | Additional content defined by implementations | 0..* | Extension | Additional content defined by implementations | |||
![]() ![]() ![]() ![]() ![]() | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | |
![]() ![]() ![]() ![]() ![]() | S | 1..1 | CodeableConcept | Billing, service, product, or drug code Binding: USCLSCodes (example): Allowable service and product codes. | S | 1..1 | CodeableConcept | Billing, service, product, or drug code Binding: USCLSCodes (example): Allowable service and product codes. | |
![]() ![]() ![]() ![]() ![]() | S | 0..* | CodeableConcept | Service/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. | S | 0..* | CodeableConcept | Service/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. | |
![]() ![]() ![]() ![]() ![]() | S | 0..1 | SimpleQuantity | Count of products or services | S | 0..1 | SimpleQuantity | Count of products or services | |
![]() ![]() ![]() ![]() ![]() | S | 0..1 | Money | Fee, charge or cost per item | S | 0..1 | Money | Fee, charge or cost per item | |
![]() ![]() ![]() ![]() ![]() | S | 0..1 | decimal | Price scaling factor | S | 0..1 | decimal | Price scaling factor | |
![]() ![]() ![]() ![]() ![]() | S | 0..1 | Money | Total item cost | S | 0..1 | Money | Total item cost | |
![]() ![]() ![]() ![]() ![]() | S | 0..* | positiveInt | Applicable note numbers | S | 0..* | positiveInt | Applicable note numbers | |
![]() ![]() ![]() ![]() ![]() | S | 1..* | BackboneElement | Added items detail adjudication | S | 1..* | BackboneElement | Added items detail adjudication | |
![]() ![]() ![]() ![]() ![]() ![]() | 0..1 | string | Unique id for inter-element referencing | 0..1 | string | Unique id for inter-element referencing | |||
![]() ![]() ![]() ![]() ![]() ![]() | 0..* | Extension | Additional content defined by implementations | 0..* | Extension | Additional content defined by implementations | |||
![]() ![]() ![]() ![]() ![]() ![]() | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | |
![]() ![]() ![]() ![]() ![]() ![]() | S | 1..1 | CodeableConcept | Type of adjudication information Binding: AdjudicationValueCodes (example): The adjudication codes. | S | 1..1 | CodeableConcept | Type of adjudication information Binding: AdjudicationValueCodes (example): The adjudication codes. | |
![]() ![]() ![]() ![]() ![]() ![]() | S | 0..1 | CodeableConcept | Explanation of adjudication outcome Binding: AdjudicationReasonCodes (example): The adjudication reason codes. | S | 0..1 | CodeableConcept | Explanation of adjudication outcome Binding: AdjudicationReasonCodes (example): The adjudication reason codes. | |
![]() ![]() ![]() ![]() ![]() ![]() | S | 0..1 | Money | Monetary amount | S | 0..1 | Money | Monetary amount | |
![]() ![]() ![]() ![]() ![]() ![]() | S | 0..1 | decimal | Non-monetary value | S | 0..1 | decimal | Non-monetary value | |
![]() ![]() ![]() ![]() ![]() | S | 0..* | BackboneElement | Insurer added line items | S | 0..* | BackboneElement | Insurer added line items | |
![]() ![]() ![]() ![]() ![]() ![]() | 0..1 | string | Unique id for inter-element referencing | 0..1 | string | Unique id for inter-element referencing | |||
![]() ![]() ![]() ![]() ![]() ![]() | 0..* | Extension | Additional content defined by implementations | 0..* | Extension | Additional content defined by implementations | |||
![]() ![]() ![]() ![]() ![]() ![]() | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | |
![]() ![]() ![]() ![]() ![]() ![]() | S | 1..1 | CodeableConcept | Billing, service, product, or drug code Binding: USCLSCodes (example): Allowable service and product codes. | S | 1..1 | CodeableConcept | Billing, service, product, or drug code Binding: USCLSCodes (example): Allowable service and product codes. | |
![]() ![]() ![]() ![]() ![]() ![]() | S | 0..* | CodeableConcept | Service/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. | S | 0..* | CodeableConcept | Service/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. | |
![]() ![]() ![]() ![]() ![]() ![]() | S | 0..1 | SimpleQuantity | Count of products or services | S | 0..1 | SimpleQuantity | Count of products or services | |
![]() ![]() ![]() ![]() ![]() ![]() | S | 0..1 | Money | Fee, charge or cost per item | S | 0..1 | Money | Fee, charge or cost per item | |
![]() ![]() ![]() ![]() ![]() ![]() | S | 0..1 | decimal | Price scaling factor | S | 0..1 | decimal | Price scaling factor | |
![]() ![]() ![]() ![]() ![]() ![]() | S | 0..1 | Money | Total item cost | S | 0..1 | Money | Total item cost | |
![]() ![]() ![]() ![]() ![]() ![]() | S | 0..* | positiveInt | Applicable note numbers | S | 0..* | positiveInt | Applicable note numbers | |
![]() ![]() ![]() ![]() ![]() ![]() | S | 1..* | BackboneElement | Added items detail adjudication | S | 1..* | BackboneElement | Added items detail adjudication | |
![]() ![]() ![]() ![]() ![]() ![]() ![]() | 0..1 | string | Unique id for inter-element referencing | 0..1 | string | Unique id for inter-element referencing | |||
![]() ![]() ![]() ![]() ![]() ![]() ![]() | 0..* | Extension | Additional content defined by implementations | 0..* | Extension | Additional content defined by implementations | |||
![]() ![]() ![]() ![]() ![]() ![]() ![]() | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | |
![]() ![]() ![]() ![]() ![]() ![]() ![]() | S | 1..1 | CodeableConcept | Type of adjudication information Binding: AdjudicationValueCodes (example): The adjudication codes. | S | 1..1 | CodeableConcept | Type of adjudication information Binding: AdjudicationValueCodes (example): The adjudication codes. | |
![]() ![]() ![]() ![]() ![]() ![]() ![]() | S | 0..1 | CodeableConcept | Explanation of adjudication outcome Binding: AdjudicationReasonCodes (example): The adjudication reason codes. | S | 0..1 | CodeableConcept | Explanation of adjudication outcome Binding: AdjudicationReasonCodes (example): The adjudication reason codes. | |
![]() ![]() ![]() ![]() ![]() ![]() ![]() | S | 0..1 | Money | Monetary amount | S | 0..1 | Money | Monetary amount | |
![]() ![]() ![]() ![]() ![]() ![]() ![]() | S | 0..1 | decimal | Non-monetary value | S | 0..1 | decimal | Non-monetary value | |
![]() ![]() ![]() | 0..* | See adjudication (ClaimResponse) | Header-level adjudication | 0..* | See adjudication (ClaimResponse) | Header-level adjudication | |||
![]() ![]() ![]() | SΣ | 0..* | BackboneElement | Adjudication totals | SΣ | 0..* | BackboneElement | Adjudication totals | |
![]() ![]() ![]() ![]() | 0..1 | string | Unique id for inter-element referencing | 0..1 | string | Unique id for inter-element referencing | |||
![]() ![]() ![]() ![]() | 0..* | Extension | Additional content defined by implementations | 0..* | Extension | Additional content defined by implementations | |||
![]() ![]() ![]() ![]() | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | |
![]() ![]() ![]() ![]() | SΣ | 1..1 | CodeableConcept | Type of adjudication information Binding: AdjudicationValueCodes (example): The adjudication codes. | SΣ | 1..1 | CodeableConcept | Type of adjudication information Binding: AdjudicationValueCodes (example): The adjudication codes. | |
![]() ![]() ![]() ![]() | SΣ | 1..1 | Money | Financial total for the category | SΣ | 1..1 | Money | Financial total for the category | |
![]() ![]() ![]() | 0..0 | 0..0 | |||||||
![]() ![]() ![]() ![]() | 0..1 | string | Unique id for inter-element referencing | 0..1 | string | Unique id for inter-element referencing | |||
![]() ![]() ![]() ![]() | 0..* | Extension | Additional content defined by implementations | 0..* | Extension | Additional content defined by implementations | |||
![]() ![]() ![]() ![]() | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | |
![]() ![]() ![]() ![]() | 1..1 | CodeableConcept | Partial or complete payment Binding: ExamplePaymentTypeCodes (example): The type (partial, complete) of the payment. | 1..1 | CodeableConcept | Partial or complete payment Binding: ExamplePaymentTypeCodes (example): The type (partial, complete) of the payment. | |||
![]() ![]() ![]() ![]() | 0..1 | Money | Payment adjustment for non-claim issues | 0..1 | Money | Payment adjustment for non-claim issues | |||
![]() ![]() ![]() ![]() | 0..1 | CodeableConcept | Explanation for the adjustment Binding: PaymentAdjustmentReasonCodes (example): Payment Adjustment reason codes. | 0..1 | CodeableConcept | Explanation for the adjustment Binding: PaymentAdjustmentReasonCodes (example): Payment Adjustment reason codes. | |||
![]() ![]() ![]() ![]() | 0..1 | date | Expected date of payment | 0..1 | date | Expected date of payment | |||
![]() ![]() ![]() ![]() | 1..1 | Money | Payable amount after adjustment | 1..1 | Money | Payable amount after adjustment | |||
![]() ![]() ![]() ![]() | 0..1 | Identifier | Business identifier for the payment | 0..1 | Identifier | Business identifier for the payment | |||
![]() ![]() ![]() | S | 0..1 | CodeableConcept | Funds reserved status Binding: Funds Reservation Codes (example): For whom funds are to be reserved: (Patient, Provider, None). | S | 0..1 | CodeableConcept | Funds reserved status Binding: Funds Reservation Codes (example): For whom funds are to be reserved: (Patient, Provider, None). | |
![]() ![]() ![]() | 0..1 | CodeableConcept | Printed form identifier Binding: Form Codes (example): The forms codes. | 0..1 | CodeableConcept | Printed form identifier Binding: Form Codes (example): The forms codes. | |||
![]() ![]() ![]() | 0..1 | Attachment | Printed reference or actual form | 0..1 | Attachment | Printed reference or actual form | |||
![]() ![]() ![]() | S | 0..* | BackboneElement | Note concerning adjudication | S | 0..* | BackboneElement | Note concerning adjudication | |
![]() ![]() ![]() ![]() | 0..1 | string | Unique id for inter-element referencing | 0..1 | string | Unique id for inter-element referencing | |||
![]() ![]() ![]() ![]() | 0..* | Extension | Additional content defined by implementations | 0..* | Extension | Additional content defined by implementations | |||
![]() ![]() ![]() ![]() | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | |
![]() ![]() ![]() ![]() | S | 0..1 | positiveInt | Note instance identifier | S | 0..1 | positiveInt | Note instance identifier | |
![]() ![]() ![]() ![]() | S | 0..1 | code | display | print | printoper Binding: NoteType (required): The presentation types of notes. | S | 0..1 | code | display | print | printoper Binding: NoteType (required): The presentation types of notes. | |
![]() ![]() ![]() ![]() | S | 1..1 | string | Note explanatory text | S | 1..1 | string | Note explanatory text | |
![]() ![]() ![]() ![]() | S | 0..1 | CodeableConcept | Language of the text Binding: CommonLanguages (preferred) Max Binding: AllLanguages: A human language. | S | 0..1 | CodeableConcept | Language of the text Binding: CommonLanguages (preferred) Max Binding: AllLanguages: A human language. | |
![]() ![]() ![]() | 0..* | Reference(CommunicationRequest) | Request for additional information | 0..* | Reference(CommunicationRequest) | Request for additional information | |||
![]() ![]() ![]() | S | 0..* | BackboneElement | Patient insurance information | S | 0..* | BackboneElement | Patient insurance information | |
![]() ![]() ![]() ![]() | 0..1 | string | Unique id for inter-element referencing | 0..1 | string | Unique id for inter-element referencing | |||
![]() ![]() ![]() ![]() | 0..* | Extension | Additional content defined by implementations | 0..* | Extension | Additional content defined by implementations | |||
![]() ![]() ![]() ![]() | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | |
![]() ![]() ![]() ![]() | S | 1..1 | positiveInt | Insurance instance identifier | S | 1..1 | positiveInt | Insurance instance identifier | |
![]() ![]() ![]() ![]() | S | 1..1 | boolean | Coverage to be used for adjudication | S | 1..1 | boolean | Coverage to be used for adjudication | |
![]() ![]() ![]() ![]() | S | 1..1 | Reference(Coverage) | Insurance information | S | 1..1 | Reference(Coverage) | Insurance information | |
![]() ![]() ![]() ![]() | 0..1 | string | Additional provider contract number | 0..1 | string | Additional provider contract number | |||
![]() ![]() ![]() ![]() | 0..1 | Reference(ClaimResponse) | Adjudication results | 0..1 | Reference(ClaimResponse) | Adjudication results | |||
![]() ![]() ![]() | 0..0 | 0..0 | |||||||
![]() ![]() ![]() ![]() | 0..1 | string | Unique id for inter-element referencing | 0..1 | string | Unique id for inter-element referencing | |||
![]() ![]() ![]() ![]() | 0..* | Extension | Additional content defined by implementations | 0..* | Extension | Additional content defined by implementations | |||
![]() ![]() ![]() ![]() | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | |
![]() ![]() ![]() ![]() | 0..1 | positiveInt | Item sequence number | 0..1 | positiveInt | Item sequence number | |||
![]() ![]() ![]() ![]() | 0..1 | positiveInt | Detail sequence number | 0..1 | positiveInt | Detail sequence number | |||
![]() ![]() ![]() ![]() | 0..1 | positiveInt | Subdetail sequence number | 0..1 | positiveInt | Subdetail sequence number | |||
![]() ![]() ![]() ![]() | 1..1 | CodeableConcept | Error code detailing processing issues Binding: Adjudication Error Codes (example): The adjudication error codes. | 1..1 | CodeableConcept | Error code detailing processing issues Binding: Adjudication Error Codes (example): The adjudication error codes. | |||
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