Da Vinci Health Record Exchange (HRex)
1.0.0 - STU R1 US

This page is part of the Da Vinci Health Record Exchange (v1.0.0: STU1) based on FHIR R4. This is the current published version. For a full list of available versions, see the Directory of published versions

Resource Profile: HRex Prior authorization

Official URL: http://hl7.org/fhir/us/davinci-hrex/StructureDefinition/hrex-claimresponse Version: 1.0.0
Standards status: Draft Maturity Level: 0 Computable Name: HRexClaimResponse

This profile specifies constraints on ClaimResponse resource to reflect the contents of a pro-active prior authorization returned via a card

Formal Views of Profile Content

Description of Profiles, Differentials, Snapshots and how the different presentations work.

This structure is derived from ClaimResponse

NameFlagsCard.TypeDescription & Constraintsdoco
.. ClaimResponse 0..*ClaimResponsePrior authorization
... status 1..1codeactive | cancelled | draft | entered-in-error
Fixed Value: active
... type S1..1CodeableConceptMore granular claim type
... use S1..1codeclaim | preauthorization | predetermination
... created S1..1dateTimeResponse creation date
... insurer S1..1Reference(US Core Organization Profile)Party responsible for reimbursement
... outcome S1..1codequeued | complete | error | partial
... preAuthRef S1..1stringPA Number/Identifier
... preAuthPeriod S0..1PeriodCertification Effective Date and Certification End Date
... addItem S0..*BackboneElementInsurer added line items
.... Slices for extension 0..*ExtensionExtension
Slice: Unordered, Open by value:url
.... extension-itemTraceNumber S0..*IdentifierExtension
URL: http://hl7.org/fhir/us/davinci-hrex/StructureDefinition/extension-itemTraceNumber
.... extension-itemPreAuthIssueDate S0..1dateExtension
URL: http://hl7.org/fhir/us/davinci-hrex/StructureDefinition/extension-itemPreAuthIssueDate
.... extension-itemAuthorizedDate S0..1dateTime, PeriodExtension
URL: http://hl7.org/fhir/us/davinci-hrex/StructureDefinition/extension-itemAuthorizedDate
.... extension-itemAuthorizedProvider S0..1Reference(US Core Practitioner Profile | US Core Organization Profile)Extension
URL: http://hl7.org/fhir/us/davinci-hrex/StructureDefinition/extension-itemAuthorizedProvider
.... productOrService S1..1CodeableConceptBilling, service, product, or drug code
.... modifier S0..*CodeableConceptService/Product billing modifiers
.... serviced[x] S0..1date, PeriodDate or dates of service or product delivery
.... location[x] S0..1CodeableConceptPlace of service or where product was supplied
.... quantity S0..1SimpleQuantityCount of products or services
.... unitPrice S0..1MoneyFee, charge or cost per item

doco Documentation for this format
NameFlagsCard.TypeDescription & Constraintsdoco
.. ClaimResponse 0..*ClaimResponsePrior authorization
... id Σ0..1stringLogical id of this artifact
... meta Σ0..1MetaMetadata about the resource
... implicitRules ?!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.

... text 0..1NarrativeText summary of the resource, for human interpretation
... contained 0..*ResourceContained, inline Resources
... extension 0..*ExtensionAdditional content defined by implementations
... modifierExtension ?!0..*ExtensionExtensions that cannot be ignored
... identifier 0..*IdentifierBusiness Identifier for a claim response
... status ?!Σ1..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.

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

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

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

... disposition 0..1stringDisposition Message
... preAuthRef S1..1stringPA Number/Identifier
... preAuthPeriod S0..1PeriodCertification Effective Date and Certification End Date
... payeeType 0..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
.... id 0..1stringUnique id for inter-element referencing
.... extension 0..*ExtensionAdditional content defined by implementations
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
.... itemSequence 1..1positiveIntClaim item instance identifier
.... noteNumber 0..*positiveIntApplicable note numbers
.... adjudication 1..*BackboneElementAdjudication details
..... id 0..1stringUnique id for inter-element referencing
..... extension 0..*ExtensionAdditional content defined by implementations
..... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
..... category 1..1CodeableConceptType of adjudication information
Binding: AdjudicationValueCodes (example): The adjudication codes.

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

..... amount 0..1MoneyMonetary amount
..... value 0..1decimalNon-monetary value
.... detail 0..*BackboneElementAdjudication for claim details
..... id 0..1stringUnique id for inter-element referencing
..... extension 0..*ExtensionAdditional content defined by implementations
..... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
..... detailSequence 1..1positiveIntClaim detail instance identifier
..... noteNumber 0..*positiveIntApplicable note numbers
..... adjudication 1..*See adjudication (ClaimResponse)Detail level adjudication details
..... subDetail 0..*BackboneElementAdjudication for claim sub-details
...... id 0..1stringUnique id for inter-element referencing
...... extension 0..*ExtensionAdditional content defined by implementations
...... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
...... subDetailSequence 1..1positiveIntClaim sub-detail instance identifier
...... noteNumber 0..*positiveIntApplicable note numbers
...... adjudication 0..*See adjudication (ClaimResponse)Subdetail level adjudication details
... addItem S0..*BackboneElementInsurer added line items
.... id 0..1stringUnique id for inter-element referencing
.... Slices for extension 0..*ExtensionExtension
Slice: Unordered, Open by value:url
.... extension-itemTraceNumber S0..*IdentifierExtension
URL: http://hl7.org/fhir/us/davinci-hrex/StructureDefinition/extension-itemTraceNumber
.... extension-itemPreAuthIssueDate S0..1dateExtension
URL: http://hl7.org/fhir/us/davinci-hrex/StructureDefinition/extension-itemPreAuthIssueDate
.... extension-itemAuthorizedDate S0..1dateTime, PeriodExtension
URL: http://hl7.org/fhir/us/davinci-hrex/StructureDefinition/extension-itemAuthorizedDate
.... extension-itemAuthorizedProvider S0..1Reference(US Core Practitioner Profile | US Core Organization Profile)Extension
URL: http://hl7.org/fhir/us/davinci-hrex/StructureDefinition/extension-itemAuthorizedProvider
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
.... itemSequence 0..*positiveIntItem sequence number
.... detailSequence 0..*positiveIntDetail sequence number
.... subdetailSequence 0..*positiveIntSubdetail sequence number
.... provider 0..*Reference(Practitioner | PractitionerRole | Organization)Authorized providers
.... productOrService 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.


.... programCode 0..*CodeableConceptProgram the product or service is provided under
Binding: ExampleProgramReasonCodes (example): Program specific reason codes.


.... serviced[x] S0..1Date or dates of service or product delivery
..... servicedDatedate
..... servicedPeriodPeriod
.... location[x] S0..1CodeableConceptPlace of service or where product was supplied
Binding: ExampleServicePlaceCodes (example): Place of service: pharmacy, school, prison, etc.

.... quantity S0..1SimpleQuantityCount of products or services
.... unitPrice S0..1MoneyFee, charge or cost per item
.... factor 0..1decimalPrice scaling factor
.... net 0..1MoneyTotal item cost
.... bodySite 0..1CodeableConceptAnatomical location
Binding: OralSiteCodes (example): The code for the teeth, quadrant, sextant and arch.

.... subSite 0..*CodeableConceptAnatomical sub-location
Binding: SurfaceCodes (example): The code for the tooth surface and surface combinations.


.... noteNumber 0..*positiveIntApplicable note numbers
.... adjudication 1..*See adjudication (ClaimResponse)Added items adjudication
.... detail 0..*BackboneElementInsurer added line details
..... id 0..1stringUnique id for inter-element referencing
..... extension 0..*ExtensionAdditional content defined by implementations
..... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
..... productOrService 1..1CodeableConceptBilling, service, product, or drug code
Binding: USCLSCodes (example): Allowable service and product codes.

..... modifier 0..*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 0..1SimpleQuantityCount of products or services
..... unitPrice 0..1MoneyFee, charge or cost per item
..... factor 0..1decimalPrice scaling factor
..... net 0..1MoneyTotal item cost
..... noteNumber 0..*positiveIntApplicable note numbers
..... adjudication 1..*See adjudication (ClaimResponse)Added items detail adjudication
..... subDetail 0..*BackboneElementInsurer added line items
...... id 0..1stringUnique id for inter-element referencing
...... extension 0..*ExtensionAdditional content defined by implementations
...... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
...... productOrService 1..1CodeableConceptBilling, service, product, or drug code
Binding: USCLSCodes (example): Allowable service and product codes.

...... modifier 0..*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 0..1SimpleQuantityCount of products or services
...... unitPrice 0..1MoneyFee, charge or cost per item
...... factor 0..1decimalPrice scaling factor
...... net 0..1MoneyTotal item cost
...... noteNumber 0..*positiveIntApplicable note numbers
...... adjudication 1..*See adjudication (ClaimResponse)Added items detail adjudication
... adjudication 0..*See adjudication (ClaimResponse)Header-level adjudication
... total Σ0..*BackboneElementAdjudication totals
.... id 0..1stringUnique id for inter-element referencing
.... extension 0..*ExtensionAdditional content defined by implementations
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
.... category Σ1..1CodeableConceptType of adjudication information
Binding: AdjudicationValueCodes (example): The adjudication codes.

.... amount Σ1..1MoneyFinancial total for the category
... payment 0..1BackboneElementPayment Details
.... id 0..1stringUnique id for inter-element referencing
.... extension 0..*ExtensionAdditional content defined by implementations
.... modifierExtension ?!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.

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

.... date 0..1dateExpected date of payment
.... amount 1..1MoneyPayable amount after adjustment
.... identifier 0..1IdentifierBusiness identifier for the payment
... fundsReserve 0..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.

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

.... text 1..1stringNote explanatory text
.... language 0..1CodeableConceptLanguage of the text
Binding: CommonLanguages (preferred)
Max Binding: AllLanguages: A human language.

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


doco Documentation for this format
NameFlagsCard.TypeDescription & Constraintsdoco
.. ClaimResponse 0..*ClaimResponsePrior authorization
... type Σ1..1CodeableConceptMore granular claim type
Binding: ClaimTypeCodes (extensible): The type or discipline-style of the claim.

... use Σ1..1codeclaim | preauthorization | predetermination
Binding: Use (required): Claim, preauthorization, predetermination.

... patient Σ1..1Reference(US Core Patient Profile)The recipient of the products and services
... insurer Σ1..1Reference(US Core Organization Profile)Party responsible for reimbursement
... outcome Σ1..1codequeued | complete | error | partial
Binding: ClaimProcessingCodes (required): The result of the claim processing.

... preAuthRef 1..1stringPA Number/Identifier
... preAuthPeriod 0..1PeriodCertification Effective Date and Certification End Date
... addItem 0..*BackboneElementInsurer added line items
.... extension-itemTraceNumber 0..*IdentifierExtension
URL: http://hl7.org/fhir/us/davinci-hrex/StructureDefinition/extension-itemTraceNumber
.... extension-itemPreAuthIssueDate 0..1dateExtension
URL: http://hl7.org/fhir/us/davinci-hrex/StructureDefinition/extension-itemPreAuthIssueDate
.... extension-itemAuthorizedDate 0..1dateTime, PeriodExtension
URL: http://hl7.org/fhir/us/davinci-hrex/StructureDefinition/extension-itemAuthorizedDate
.... extension-itemAuthorizedProvider 0..1Reference(US Core Practitioner Profile | US Core Organization Profile)Extension
URL: http://hl7.org/fhir/us/davinci-hrex/StructureDefinition/extension-itemAuthorizedProvider
.... productOrService 1..1CodeableConceptBilling, service, product, or drug code
Binding: USCLSCodes (example): Allowable service and product codes.

.... modifier 0..*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.


.... serviced[x] 0..1Date or dates of service or product delivery
..... servicedDatedate
..... servicedPeriodPeriod
.... location[x] 0..1CodeableConceptPlace of service or where product was supplied
Binding: ExampleServicePlaceCodes (example): Place of service: pharmacy, school, prison, etc.

.... quantity 0..1SimpleQuantityCount of products or services
.... unitPrice 0..1MoneyFee, charge or cost per item

doco Documentation for this format

Differential View

This structure is derived from ClaimResponse

NameFlagsCard.TypeDescription & Constraintsdoco
.. ClaimResponse 0..*ClaimResponsePrior authorization
... status 1..1codeactive | cancelled | draft | entered-in-error
Fixed Value: active
... type S1..1CodeableConceptMore granular claim type
... use S1..1codeclaim | preauthorization | predetermination
... created S1..1dateTimeResponse creation date
... insurer S1..1Reference(US Core Organization Profile)Party responsible for reimbursement
... outcome S1..1codequeued | complete | error | partial
... preAuthRef S1..1stringPA Number/Identifier
... preAuthPeriod S0..1PeriodCertification Effective Date and Certification End Date
... addItem S0..*BackboneElementInsurer added line items
.... Slices for extension 0..*ExtensionExtension
Slice: Unordered, Open by value:url
.... extension-itemTraceNumber S0..*IdentifierExtension
URL: http://hl7.org/fhir/us/davinci-hrex/StructureDefinition/extension-itemTraceNumber
.... extension-itemPreAuthIssueDate S0..1dateExtension
URL: http://hl7.org/fhir/us/davinci-hrex/StructureDefinition/extension-itemPreAuthIssueDate
.... extension-itemAuthorizedDate S0..1dateTime, PeriodExtension
URL: http://hl7.org/fhir/us/davinci-hrex/StructureDefinition/extension-itemAuthorizedDate
.... extension-itemAuthorizedProvider S0..1Reference(US Core Practitioner Profile | US Core Organization Profile)Extension
URL: http://hl7.org/fhir/us/davinci-hrex/StructureDefinition/extension-itemAuthorizedProvider
.... productOrService S1..1CodeableConceptBilling, service, product, or drug code
.... modifier S0..*CodeableConceptService/Product billing modifiers
.... serviced[x] S0..1date, PeriodDate or dates of service or product delivery
.... location[x] S0..1CodeableConceptPlace of service or where product was supplied
.... quantity S0..1SimpleQuantityCount of products or services
.... unitPrice S0..1MoneyFee, charge or cost per item

doco Documentation for this format

Snapshot View

NameFlagsCard.TypeDescription & Constraintsdoco
.. ClaimResponse 0..*ClaimResponsePrior authorization
... id Σ0..1stringLogical id of this artifact
... meta Σ0..1MetaMetadata about the resource
... implicitRules ?!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.

... text 0..1NarrativeText summary of the resource, for human interpretation
... contained 0..*ResourceContained, inline Resources
... extension 0..*ExtensionAdditional content defined by implementations
... modifierExtension ?!0..*ExtensionExtensions that cannot be ignored
... identifier 0..*IdentifierBusiness Identifier for a claim response
... status ?!Σ1..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.

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

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

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

... disposition 0..1stringDisposition Message
... preAuthRef S1..1stringPA Number/Identifier
... preAuthPeriod S0..1PeriodCertification Effective Date and Certification End Date
... payeeType 0..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
.... id 0..1stringUnique id for inter-element referencing
.... extension 0..*ExtensionAdditional content defined by implementations
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
.... itemSequence 1..1positiveIntClaim item instance identifier
.... noteNumber 0..*positiveIntApplicable note numbers
.... adjudication 1..*BackboneElementAdjudication details
..... id 0..1stringUnique id for inter-element referencing
..... extension 0..*ExtensionAdditional content defined by implementations
..... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
..... category 1..1CodeableConceptType of adjudication information
Binding: AdjudicationValueCodes (example): The adjudication codes.

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

..... amount 0..1MoneyMonetary amount
..... value 0..1decimalNon-monetary value
.... detail 0..*BackboneElementAdjudication for claim details
..... id 0..1stringUnique id for inter-element referencing
..... extension 0..*ExtensionAdditional content defined by implementations
..... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
..... detailSequence 1..1positiveIntClaim detail instance identifier
..... noteNumber 0..*positiveIntApplicable note numbers
..... adjudication 1..*See adjudication (ClaimResponse)Detail level adjudication details
..... subDetail 0..*BackboneElementAdjudication for claim sub-details
...... id 0..1stringUnique id for inter-element referencing
...... extension 0..*ExtensionAdditional content defined by implementations
...... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
...... subDetailSequence 1..1positiveIntClaim sub-detail instance identifier
...... noteNumber 0..*positiveIntApplicable note numbers
...... adjudication 0..*See adjudication (ClaimResponse)Subdetail level adjudication details
... addItem S0..*BackboneElementInsurer added line items
.... id 0..1stringUnique id for inter-element referencing
.... Slices for extension 0..*ExtensionExtension
Slice: Unordered, Open by value:url
.... extension-itemTraceNumber S0..*IdentifierExtension
URL: http://hl7.org/fhir/us/davinci-hrex/StructureDefinition/extension-itemTraceNumber
.... extension-itemPreAuthIssueDate S0..1dateExtension
URL: http://hl7.org/fhir/us/davinci-hrex/StructureDefinition/extension-itemPreAuthIssueDate
.... extension-itemAuthorizedDate S0..1dateTime, PeriodExtension
URL: http://hl7.org/fhir/us/davinci-hrex/StructureDefinition/extension-itemAuthorizedDate
.... extension-itemAuthorizedProvider S0..1Reference(US Core Practitioner Profile | US Core Organization Profile)Extension
URL: http://hl7.org/fhir/us/davinci-hrex/StructureDefinition/extension-itemAuthorizedProvider
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
.... itemSequence 0..*positiveIntItem sequence number
.... detailSequence 0..*positiveIntDetail sequence number
.... subdetailSequence 0..*positiveIntSubdetail sequence number
.... provider 0..*Reference(Practitioner | PractitionerRole | Organization)Authorized providers
.... productOrService 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.


.... programCode 0..*CodeableConceptProgram the product or service is provided under
Binding: ExampleProgramReasonCodes (example): Program specific reason codes.


.... serviced[x] S0..1Date or dates of service or product delivery
..... servicedDatedate
..... servicedPeriodPeriod
.... location[x] S0..1CodeableConceptPlace of service or where product was supplied
Binding: ExampleServicePlaceCodes (example): Place of service: pharmacy, school, prison, etc.

.... quantity S0..1SimpleQuantityCount of products or services
.... unitPrice S0..1MoneyFee, charge or cost per item
.... factor 0..1decimalPrice scaling factor
.... net 0..1MoneyTotal item cost
.... bodySite 0..1CodeableConceptAnatomical location
Binding: OralSiteCodes (example): The code for the teeth, quadrant, sextant and arch.

.... subSite 0..*CodeableConceptAnatomical sub-location
Binding: SurfaceCodes (example): The code for the tooth surface and surface combinations.


.... noteNumber 0..*positiveIntApplicable note numbers
.... adjudication 1..*See adjudication (ClaimResponse)Added items adjudication
.... detail 0..*BackboneElementInsurer added line details
..... id 0..1stringUnique id for inter-element referencing
..... extension 0..*ExtensionAdditional content defined by implementations
..... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
..... productOrService 1..1CodeableConceptBilling, service, product, or drug code
Binding: USCLSCodes (example): Allowable service and product codes.

..... modifier 0..*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 0..1SimpleQuantityCount of products or services
..... unitPrice 0..1MoneyFee, charge or cost per item
..... factor 0..1decimalPrice scaling factor
..... net 0..1MoneyTotal item cost
..... noteNumber 0..*positiveIntApplicable note numbers
..... adjudication 1..*See adjudication (ClaimResponse)Added items detail adjudication
..... subDetail 0..*BackboneElementInsurer added line items
...... id 0..1stringUnique id for inter-element referencing
...... extension 0..*ExtensionAdditional content defined by implementations
...... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
...... productOrService 1..1CodeableConceptBilling, service, product, or drug code
Binding: USCLSCodes (example): Allowable service and product codes.

...... modifier 0..*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 0..1SimpleQuantityCount of products or services
...... unitPrice 0..1MoneyFee, charge or cost per item
...... factor 0..1decimalPrice scaling factor
...... net 0..1MoneyTotal item cost
...... noteNumber 0..*positiveIntApplicable note numbers
...... adjudication 1..*See adjudication (ClaimResponse)Added items detail adjudication
... adjudication 0..*See adjudication (ClaimResponse)Header-level adjudication
... total Σ0..*BackboneElementAdjudication totals
.... id 0..1stringUnique id for inter-element referencing
.... extension 0..*ExtensionAdditional content defined by implementations
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
.... category Σ1..1CodeableConceptType of adjudication information
Binding: AdjudicationValueCodes (example): The adjudication codes.

.... amount Σ1..1MoneyFinancial total for the category
... payment 0..1BackboneElementPayment Details
.... id 0..1stringUnique id for inter-element referencing
.... extension 0..*ExtensionAdditional content defined by implementations
.... modifierExtension ?!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.

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

.... date 0..1dateExpected date of payment
.... amount 1..1MoneyPayable amount after adjustment
.... identifier 0..1IdentifierBusiness identifier for the payment
... fundsReserve 0..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.

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

.... text 1..1stringNote explanatory text
.... language 0..1CodeableConceptLanguage of the text
Binding: CommonLanguages (preferred)
Max Binding: AllLanguages: A human language.

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


doco Documentation for this format

 

Other representations of profile: CSV, Excel, Schematron

Terminology Bindings

PathConformanceValueSet / Code
ClaimResponse.languagepreferredCommonLanguages
Max Binding: AllLanguages
ClaimResponse.statusrequiredFixed Value: active
ClaimResponse.typeextensibleClaimTypeCodes
ClaimResponse.subTypeexampleExampleClaimSubTypeCodes
ClaimResponse.userequiredUse
ClaimResponse.outcomerequiredClaimProcessingCodes
ClaimResponse.payeeTypeexampleClaim Payee Type Codes
ClaimResponse.item.adjudication.categoryexampleAdjudicationValueCodes
ClaimResponse.item.adjudication.reasonexampleAdjudicationReasonCodes
ClaimResponse.addItem.productOrServiceexampleUSCLSCodes
ClaimResponse.addItem.modifierexampleModifierTypeCodes
ClaimResponse.addItem.programCodeexampleExampleProgramReasonCodes
ClaimResponse.addItem.location[x]exampleExampleServicePlaceCodes
ClaimResponse.addItem.bodySiteexampleOralSiteCodes
ClaimResponse.addItem.subSiteexampleSurfaceCodes
ClaimResponse.addItem.detail.productOrServiceexampleUSCLSCodes
ClaimResponse.addItem.detail.modifierexampleModifierTypeCodes
ClaimResponse.addItem.detail.subDetail.productOrServiceexampleUSCLSCodes
ClaimResponse.addItem.detail.subDetail.modifierexampleModifierTypeCodes
ClaimResponse.total.categoryexampleAdjudicationValueCodes
ClaimResponse.payment.typeexampleExamplePaymentTypeCodes
ClaimResponse.payment.adjustmentReasonexamplePaymentAdjustmentReasonCodes
ClaimResponse.fundsReserveexampleFunds Reservation Codes
ClaimResponse.formCodeexampleForm Codes
ClaimResponse.processNote.typerequiredNoteType
ClaimResponse.processNote.languagepreferredCommonLanguages
Max Binding: AllLanguages
ClaimResponse.error.codeexampleAdjudication Error Codes

Constraints

IdGradePathDetailsRequirements
dom-2errorClaimResponseIf the resource is contained in another resource, it SHALL NOT contain nested Resources
: contained.contained.empty()
dom-3errorClaimResponseIf the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource
: contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
dom-4errorClaimResponseIf a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated
: contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
dom-5errorClaimResponseIf a resource is contained in another resource, it SHALL NOT have a security label
: contained.meta.security.empty()
dom-6Best PracticeClaimResponseA resource should have narrative for robust management
: text.`div`.exists()
ele-1errorClaimResponse.metaAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1errorClaimResponse.implicitRulesAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1errorClaimResponse.languageAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1errorClaimResponse.textAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1errorClaimResponse.extensionAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ext-1errorClaimResponse.extensionMust have either extensions or value[x], not both
: extension.exists() != value.exists()
ele-1errorClaimResponse.modifierExtensionAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ext-1errorClaimResponse.modifierExtensionMust have either extensions or value[x], not both
: extension.exists() != value.exists()
ele-1errorClaimResponse.identifierAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1errorClaimResponse.statusAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1errorClaimResponse.typeAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1errorClaimResponse.subTypeAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1errorClaimResponse.useAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1errorClaimResponse.patientAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1errorClaimResponse.createdAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1errorClaimResponse.insurerAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1errorClaimResponse.requestorAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1errorClaimResponse.requestAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1errorClaimResponse.outcomeAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1errorClaimResponse.dispositionAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1errorClaimResponse.preAuthRefAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1errorClaimResponse.preAuthPeriodAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1errorClaimResponse.payeeTypeAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1errorClaimResponse.itemAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1errorClaimResponse.item.extensionAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ext-1errorClaimResponse.item.extensionMust have either extensions or value[x], not both
: extension.exists() != value.exists()
ele-1errorClaimResponse.item.modifierExtensionAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ext-1errorClaimResponse.item.modifierExtensionMust have either extensions or value[x], not both
: extension.exists() != value.exists()
ele-1errorClaimResponse.item.itemSequenceAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1errorClaimResponse.item.noteNumberAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1errorClaimResponse.item.adjudicationAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1errorClaimResponse.item.adjudication.extensionAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ext-1errorClaimResponse.item.adjudication.extensionMust have either extensions or value[x], not both
: extension.exists() != value.exists()
ele-1errorClaimResponse.item.adjudication.modifierExtensionAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ext-1errorClaimResponse.item.adjudication.modifierExtensionMust have either extensions or value[x], not both
: extension.exists() != value.exists()
ele-1errorClaimResponse.item.adjudication.categoryAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1errorClaimResponse.item.adjudication.reasonAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1errorClaimResponse.item.adjudication.amountAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1errorClaimResponse.item.adjudication.valueAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1errorClaimResponse.item.detailAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1errorClaimResponse.item.detail.extensionAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ext-1errorClaimResponse.item.detail.extensionMust have either extensions or value[x], not both
: extension.exists() != value.exists()
ele-1errorClaimResponse.item.detail.modifierExtensionAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ext-1errorClaimResponse.item.detail.modifierExtensionMust have either extensions or value[x], not both
: extension.exists() != value.exists()
ele-1errorClaimResponse.item.detail.detailSequenceAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1errorClaimResponse.item.detail.noteNumberAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1errorClaimResponse.item.detail.adjudicationAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1errorClaimResponse.item.detail.subDetailAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1errorClaimResponse.item.detail.subDetail.extensionAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ext-1errorClaimResponse.item.detail.subDetail.extensionMust have either extensions or value[x], not both
: extension.exists() != value.exists()
ele-1errorClaimResponse.item.detail.subDetail.modifierExtensionAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ext-1errorClaimResponse.item.detail.subDetail.modifierExtensionMust have either extensions or value[x], not both
: extension.exists() != value.exists()
ele-1errorClaimResponse.item.detail.subDetail.subDetailSequenceAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1errorClaimResponse.item.detail.subDetail.noteNumberAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1errorClaimResponse.item.detail.subDetail.adjudicationAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1errorClaimResponse.addItemAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1errorClaimResponse.addItem.extensionAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ext-1errorClaimResponse.addItem.extensionMust have either extensions or value[x], not both
: extension.exists() != value.exists()
ele-1errorClaimResponse.addItem.extension:itemTraceNumberAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ext-1errorClaimResponse.addItem.extension:itemTraceNumberMust have either extensions or value[x], not both
: extension.exists() != value.exists()
ele-1errorClaimResponse.addItem.extension:preAuthIssueDateAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ext-1errorClaimResponse.addItem.extension:preAuthIssueDateMust have either extensions or value[x], not both
: extension.exists() != value.exists()
ele-1errorClaimResponse.addItem.extension:authorizedDateAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ext-1errorClaimResponse.addItem.extension:authorizedDateMust have either extensions or value[x], not both
: extension.exists() != value.exists()
ele-1errorClaimResponse.addItem.extension:authorizedProviderAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ext-1errorClaimResponse.addItem.extension:authorizedProviderMust have either extensions or value[x], not both
: extension.exists() != value.exists()
ele-1errorClaimResponse.addItem.modifierExtensionAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ext-1errorClaimResponse.addItem.modifierExtensionMust have either extensions or value[x], not both
: extension.exists() != value.exists()
ele-1errorClaimResponse.addItem.itemSequenceAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1errorClaimResponse.addItem.detailSequenceAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1errorClaimResponse.addItem.subdetailSequenceAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1errorClaimResponse.addItem.providerAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1errorClaimResponse.addItem.productOrServiceAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1errorClaimResponse.addItem.modifierAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1errorClaimResponse.addItem.programCodeAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1errorClaimResponse.addItem.serviced[x]All FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1errorClaimResponse.addItem.location[x]All FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1errorClaimResponse.addItem.quantityAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1errorClaimResponse.addItem.unitPriceAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1errorClaimResponse.addItem.factorAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1errorClaimResponse.addItem.netAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1errorClaimResponse.addItem.bodySiteAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1errorClaimResponse.addItem.subSiteAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1errorClaimResponse.addItem.noteNumberAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1errorClaimResponse.addItem.adjudicationAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1errorClaimResponse.addItem.detailAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1errorClaimResponse.addItem.detail.extensionAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ext-1errorClaimResponse.addItem.detail.extensionMust have either extensions or value[x], not both
: extension.exists() != value.exists()
ele-1errorClaimResponse.addItem.detail.modifierExtensionAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ext-1errorClaimResponse.addItem.detail.modifierExtensionMust have either extensions or value[x], not both
: extension.exists() != value.exists()
ele-1errorClaimResponse.addItem.detail.productOrServiceAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1errorClaimResponse.addItem.detail.modifierAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1errorClaimResponse.addItem.detail.quantityAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1errorClaimResponse.addItem.detail.unitPriceAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1errorClaimResponse.addItem.detail.factorAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1errorClaimResponse.addItem.detail.netAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1errorClaimResponse.addItem.detail.noteNumberAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1errorClaimResponse.addItem.detail.adjudicationAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1errorClaimResponse.addItem.detail.subDetailAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1errorClaimResponse.addItem.detail.subDetail.extensionAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ext-1errorClaimResponse.addItem.detail.subDetail.extensionMust have either extensions or value[x], not both
: extension.exists() != value.exists()
ele-1errorClaimResponse.addItem.detail.subDetail.modifierExtensionAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ext-1errorClaimResponse.addItem.detail.subDetail.modifierExtensionMust have either extensions or value[x], not both
: extension.exists() != value.exists()
ele-1errorClaimResponse.addItem.detail.subDetail.productOrServiceAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1errorClaimResponse.addItem.detail.subDetail.modifierAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1errorClaimResponse.addItem.detail.subDetail.quantityAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1errorClaimResponse.addItem.detail.subDetail.unitPriceAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1errorClaimResponse.addItem.detail.subDetail.factorAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1errorClaimResponse.addItem.detail.subDetail.netAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1errorClaimResponse.addItem.detail.subDetail.noteNumberAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1errorClaimResponse.addItem.detail.subDetail.adjudicationAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1errorClaimResponse.adjudicationAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1errorClaimResponse.totalAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1errorClaimResponse.total.extensionAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ext-1errorClaimResponse.total.extensionMust have either extensions or value[x], not both
: extension.exists() != value.exists()
ele-1errorClaimResponse.total.modifierExtensionAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ext-1errorClaimResponse.total.modifierExtensionMust have either extensions or value[x], not both
: extension.exists() != value.exists()
ele-1errorClaimResponse.total.categoryAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1errorClaimResponse.total.amountAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1errorClaimResponse.paymentAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1errorClaimResponse.payment.extensionAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ext-1errorClaimResponse.payment.extensionMust have either extensions or value[x], not both
: extension.exists() != value.exists()
ele-1errorClaimResponse.payment.modifierExtensionAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ext-1errorClaimResponse.payment.modifierExtensionMust have either extensions or value[x], not both
: extension.exists() != value.exists()
ele-1errorClaimResponse.payment.typeAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1errorClaimResponse.payment.adjustmentAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1errorClaimResponse.payment.adjustmentReasonAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1errorClaimResponse.payment.dateAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1errorClaimResponse.payment.amountAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1errorClaimResponse.payment.identifierAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1errorClaimResponse.fundsReserveAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1errorClaimResponse.formCodeAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1errorClaimResponse.formAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1errorClaimResponse.processNoteAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1errorClaimResponse.processNote.extensionAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ext-1errorClaimResponse.processNote.extensionMust have either extensions or value[x], not both
: extension.exists() != value.exists()
ele-1errorClaimResponse.processNote.modifierExtensionAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ext-1errorClaimResponse.processNote.modifierExtensionMust have either extensions or value[x], not both
: extension.exists() != value.exists()
ele-1errorClaimResponse.processNote.numberAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1errorClaimResponse.processNote.typeAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1errorClaimResponse.processNote.textAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1errorClaimResponse.processNote.languageAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1errorClaimResponse.communicationRequestAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1errorClaimResponse.insuranceAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1errorClaimResponse.insurance.extensionAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ext-1errorClaimResponse.insurance.extensionMust have either extensions or value[x], not both
: extension.exists() != value.exists()
ele-1errorClaimResponse.insurance.modifierExtensionAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ext-1errorClaimResponse.insurance.modifierExtensionMust have either extensions or value[x], not both
: extension.exists() != value.exists()
ele-1errorClaimResponse.insurance.sequenceAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1errorClaimResponse.insurance.focalAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1errorClaimResponse.insurance.coverageAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1errorClaimResponse.insurance.businessArrangementAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1errorClaimResponse.insurance.claimResponseAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1errorClaimResponse.errorAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1errorClaimResponse.error.extensionAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ext-1errorClaimResponse.error.extensionMust have either extensions or value[x], not both
: extension.exists() != value.exists()
ele-1errorClaimResponse.error.modifierExtensionAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ext-1errorClaimResponse.error.modifierExtensionMust have either extensions or value[x], not both
: extension.exists() != value.exists()
ele-1errorClaimResponse.error.itemSequenceAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1errorClaimResponse.error.detailSequenceAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1errorClaimResponse.error.subDetailSequenceAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1errorClaimResponse.error.codeAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())