Left: | PAS Claim Inquiry Response (http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-claiminquiryresponse) |
Right: | PAS Claim Inquiry Response (http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-claiminquiryresponse) |
Error | StructureDefinition.version | Values for version differ: '2.1.0-preview' vs '2.1.0' |
Information | StructureDefinition.date | Values for date differ: '2024-09-26T18:54:51-04:00' vs '2024-12-20T21:49:30+00:00' |
Information | StructureDefinition.short | Values for short differ: 'Count of products or services' vs 'A fixed quantity (no comparator)' |
Information | StructureDefinition.definition | Values for definition differ: 'The number of repetitions of a service or product.' vs 'The comparator is not used on a SimpleQuantity' |
Warning | ClaimResponse.adjudication | Elements differ in definition for mustSupport: 'false' vs 'true' |
Error | ClaimResponse.adjudication | Type Mismatch: vs BackboneElement |
Name | Value | Comments | |
---|---|---|---|
![]() | false | ||
![]() | http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-claimresponse-base | ||
![]() | |||
![]() | 2024-09-26T18:54:51-04:00 | 2024-12-20T21:49:30+00:00 |
|
![]() | PAS constraints on Claim resource mandating support for elements relevant to the response of an inquiry for details of previous authorizations. | ||
![]() | |||
![]() | 4.0.1 | ||
![]() | |||
![]() ![]() | urn:iso:std:iso:3166#US | ||
![]() | resource | ||
![]() | PASClaimInquiryResponse | ||
![]() | HL7 International / Financial Management | ||
![]() | |||
![]() | active | ||
![]() | PAS Claim Inquiry Response | ||
![]() | ClaimResponse | ||
![]() | http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-claiminquiryresponse | ||
![]() | 2.1.0-preview | 2.1.0 |
|
Name | L Flags | L Card. | L Type | L Description & Constraints | R Flags | R Card. | R Type | R Description & Constraints | Comments![]() | ||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
![]() ![]() | 0..* | PASClaimResponseBase | Response to a preauthorization query | 0..* | PASClaimResponseBase | Response to a preauthorization query | |||||||||||
![]() ![]() ![]() | Σ | 0..1 | id | Logical id of this artifact | Σ | 0..1 | id | 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: ?? (preferred): A human language.
| 0..1 | code | Language of the resource content Binding: ?? (preferred): 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 | |||||||||
![]() ![]() ![]() | S | 0..* | ?? | An identifier intended for computation | S | 0..* | ?? | An identifier intended for computation | |||||||||
![]() ![]() ![]() ![]() | 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 Slice: Unordered, Open by value:url | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | |||||||||||
![]() ![]() ![]() ![]() | ?!Σ | 0..1 | code | usual | official | temp | secondary | old (If known) Binding: ?? (required): Identifies the purpose for this identifier, if known . | ?!Σ | 0..1 | code | usual | official | temp | secondary | old (If known) Binding: ?? (required): Identifies the purpose for this identifier, if known . | |||||||||
![]() ![]() ![]() ![]() | Σ | 0..1 | CodeableConcept | Description of identifier Binding: ?? (extensible): A coded type for an identifier that can be used to determine which identifier to use for a specific purpose. | Σ | 0..1 | CodeableConcept | Description of identifier Binding: ?? (extensible): A coded type for an identifier that can be used to determine which identifier to use for a specific purpose. | |||||||||
![]() ![]() ![]() ![]() | SΣ | 1..1 | uri | Should use a scheme of 'urn:trnorg:<TRN03>' Example General: http://www.acme.com/identifiers/patient | SΣ | 1..1 | uri | Should use a scheme of 'urn:trnorg:<TRN03>' Example General: http://www.acme.com/identifiers/patient | |||||||||
![]() ![]() ![]() ![]() | SΣ | 1..1 | string | The value that is unique Example General: 123456 | SΣ | 1..1 | string | The value that is unique Example General: 123456 | |||||||||
![]() ![]() ![]() ![]() | Σ | 0..1 | Period | Time period when id is/was valid for use | Σ | 0..1 | Period | Time period when id is/was valid for use | |||||||||
![]() ![]() ![]() ![]() | Σ | 0..1 | Reference(Organization) | Organization that issued id (may be just text) | Σ | 0..1 | Reference(Organization) | Organization that issued id (may be just text) | |||||||||
![]() ![]() ![]() | ?!SΣ | 1..1 | code | active | cancelled | draft | entered-in-error Binding: ?? (required): A code specifying the state of the resource instance. Required Pattern: active | ?!SΣ | 1..1 | code | active | cancelled | draft | entered-in-error Binding: ?? (required): A code specifying the state of the resource instance. Required Pattern: active | |||||||||
![]() ![]() ![]() | Σ | 1..1 | CodeableConcept | More granular claim type Binding: ?? (extensible): The type or discipline-style of the claim. | Σ | 1..1 | CodeableConcept | More granular claim type Binding: ?? (extensible): The type or discipline-style of the claim. | |||||||||
![]() ![]() ![]() | 0..1 | CodeableConcept | More granular claim type Binding: ?? (example): A more granular claim typecode. | 0..1 | CodeableConcept | More granular claim type Binding: ?? (example): A more granular claim typecode. | |||||||||||
![]() ![]() ![]() | Σ | 1..1 | code | claim | preauthorization | predetermination Binding: ?? (required): Claim, preauthorization, predetermination. Required Pattern: preauthorization | Σ | 1..1 | code | claim | preauthorization | predetermination Binding: ?? (required): Claim, preauthorization, predetermination. Required Pattern: preauthorization | |||||||||
![]() ![]() ![]() | SΣ | 1..1 | Reference(PAS Beneficiary Patient) | The recipient of the products and services | SΣ | 1..1 | Reference(PAS Beneficiary Patient) | The recipient of the products and services | |||||||||
![]() ![]() ![]() | SΣ | 1..1 | dateTime | Response creation date | SΣ | 1..1 | dateTime | Response creation date | |||||||||
![]() ![]() ![]() | SΣ | 1..1 | Reference(PAS Insurer Organization) | Party responsible for reimbursement | SΣ | 1..1 | Reference(PAS Insurer Organization) | Party responsible for reimbursement | |||||||||
![]() ![]() ![]() | S | 0..1 | Reference(PAS Requestor Organization | PAS PractitionerRole) | Party responsible for the claim | S | 0..1 | Reference(PAS Requestor Organization | PAS PractitionerRole) | Party responsible for the claim | |||||||||
![]() ![]() ![]() | SΣ | 1..1 | Reference(PAS Claim) | Id of resource triggering adjudication | SΣ | 1..1 | Reference(PAS Claim) | Id of resource triggering adjudication | |||||||||
![]() ![]() ![]() | SΣ | 1..1 | code | queued | complete | error | partial Binding: ?? (required): The result of the claim processing. | SΣ | 1..1 | code | queued | complete | error | partial Binding: ?? (required): The result of the claim processing. | |||||||||
![]() ![]() ![]() | 0..1 | string | Disposition Message | 0..1 | string | Disposition Message | |||||||||||
![]() ![]() ![]() | 0..1 | string | Preauthorization reference | 0..1 | string | Preauthorization reference | |||||||||||
![]() ![]() ![]() | S | 0..1 | Period | Preauthorization reference effective period | S | 0..1 | Period | Preauthorization reference effective period | |||||||||
![]() ![]() ![]() | 0..1 | CodeableConcept | Party to be paid any benefits payable Binding: ?? (example): A code for the party to be reimbursed. | 0..1 | CodeableConcept | Party to be paid any benefits payable Binding: ?? (example): A code for the party to be reimbursed. | |||||||||||
![]() ![]() ![]() | S | 0..* | BackboneElement | Adjudication for claim line items | S | 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 | Extension Slice: Unordered, Open by value:url | 0..* | Extension | Extension Slice: Unordered, Open by value:url | |||||||||||
![]() ![]() ![]() ![]() | ?!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 | Claim item instance identifier | S | 1..1 | positiveInt | Claim item instance identifier | |||||||||
![]() ![]() ![]() ![]() | 0..* | positiveInt | Applicable note numbers | 0..* | positiveInt | Applicable note numbers | |||||||||||
![]() ![]() ![]() ![]() | S | 1..* | BackboneElement | Adjudication details | S | 1..* | BackboneElement | Adjudication details | |||||||||
![]() ![]() ![]() ![]() ![]() | 0..1 | string | Unique id for inter-element referencing | 0..1 | string | Unique id for inter-element referencing | |||||||||||
![]() ![]() ![]() ![]() ![]() | 0..* | Extension | Extension Slice: Unordered, Open by value:url | 0..* | Extension | Extension Slice: Unordered, Open by value:url | |||||||||||
![]() ![]() ![]() ![]() ![]() | ?!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 | This code is fixed to 'submitted' to indicate that the adjudication result is on what was submitted. Binding: ?? (example): The adjudication codes. Required Pattern: {"coding":[{"system":"http://terminology.hl7.org/CodeSystem/adjudication","code":"submitted"}]} | 1..1 | CodeableConcept | This code is fixed to 'submitted' to indicate that the adjudication result is on what was submitted. Binding: ?? (example): The adjudication codes. Required Pattern: {"coding":[{"system":"http://terminology.hl7.org/CodeSystem/adjudication","code":"submitted"}]} | |||||||||||
![]() ![]() ![]() ![]() ![]() | 0..1 | CodeableConcept | Explanation of adjudication outcome Binding: ?? (example): The adjudication reason codes. | 0..1 | CodeableConcept | Explanation of adjudication outcome Binding: ?? (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 | 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 | Extension Slice: Unordered, Open by value:url | 0..* | Extension | Extension Slice: Unordered, Open by value:url | |||||||||||
![]() ![]() ![]() ![]() | ?!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 | Item sequence number | S | 1..1 | 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(PAS Practitioner | PAS Organization Base Profile) | Authorized providers | S | 0..* | Reference(PAS Practitioner | PAS Organization Base Profile) | Authorized providers | |||||||||
![]() ![]() ![]() ![]() ![]() | 0..1 | string | Unique id for inter-element referencing |
| |||||||||||||
![]() ![]() ![]() ![]() ![]() | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url |
| |||||||||||||
![]() ![]() ![]() ![]() ![]() | ΣC | 0..1 | string | Literal reference, Relative, internal or absolute URL |
| ||||||||||||
![]() ![]() ![]() ![]() ![]() | Σ | 0..1 | uri | Type the reference refers to (e.g. "Patient") Binding: ?? (extensible): Aa resource (or, for logical models, the URI of the logical model). |
| ||||||||||||
![]() ![]() ![]() ![]() ![]() | Σ | 0..1 | Identifier | Logical reference, when literal reference is not known |
| ||||||||||||
![]() ![]() ![]() ![]() ![]() | Σ | 0..1 | string | Text alternative for the resource |
| ||||||||||||
![]() ![]() ![]() ![]() | S | 1..1 | CodeableConcept | Billing, service, product, or drug code Binding: ?? (required) | S | 1..1 | CodeableConcept | Billing, service, product, or drug code Binding: ?? (required) | |||||||||
![]() ![]() ![]() ![]() | S | 0..* | CodeableConcept | Service/Product billing modifiers Binding: ?? (required) | S | 0..* | CodeableConcept | Service/Product billing modifiers Binding: ?? (required) | |||||||||
![]() ![]() ![]() ![]() | 0..* | CodeableConcept | Program the product or service is provided under Binding: ?? (example): Program specific reason codes. | 0..* | CodeableConcept | Program the product or service is provided under Binding: ?? (example): Program specific reason codes. | |||||||||||
![]() ![]() ![]() ![]() | S | 0..1 | date, Period | Date or dates of service or product delivery | S | 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: ?? (example): Place of service: pharmacy, school, prison, etc. | S | 0..1 | CodeableConcept, Address, Reference(Location) | Place of service or where product was supplied Binding: ?? (example): Place of service: pharmacy, school, prison, etc. | |||||||||
![]() ![]() ![]() ![]() | S | 0..1 | ?? | Count of products or services | SC | 0..1 | ?? | A fixed quantity (no comparator) qty-3: If a code for the unit is present, the system SHALL also be present sqty-1: The comparator is not used on a SimpleQuantity | |||||||||
![]() ![]() ![]() ![]() | S | 0..1 | Money | Fee, charge or cost per item | S | 0..1 | Money | Fee, charge or cost per item | |||||||||
![]() ![]() ![]() ![]() | 0..1 | decimal | Price scaling factor | 0..1 | decimal | Price scaling factor | |||||||||||
![]() ![]() ![]() ![]() | 0..1 | Money | Total item cost | 0..1 | Money | Total item cost | |||||||||||
![]() ![]() ![]() ![]() | 0..1 | CodeableConcept | Anatomical location Binding: ?? (example): The code for the teeth, quadrant, sextant and arch. | 0..1 | CodeableConcept | Anatomical location Binding: ?? (example): The code for the teeth, quadrant, sextant and arch. | |||||||||||
![]() ![]() ![]() ![]() | 0..* | CodeableConcept | Anatomical sub-location Binding: ?? (example): The code for the tooth surface and surface combinations. | 0..* | CodeableConcept | Anatomical sub-location Binding: ?? (example): The code for the tooth surface and surface combinations. | |||||||||||
![]() ![]() ![]() ![]() | 0..* | positiveInt | Applicable note numbers | 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 | Extension Slice: Unordered, Open by value:url | 0..* | Extension | Extension Slice: Unordered, Open by value:url | |||||||||||
![]() ![]() ![]() ![]() ![]() | ?!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 | This code is fixed to 'submitted' to indicate that the adjudication result is on what was submitted. Binding: ?? (example): The adjudication codes. Required Pattern: {"coding":[{"system":"http://terminology.hl7.org/CodeSystem/adjudication","code":"submitted"}]} | 1..1 | CodeableConcept | This code is fixed to 'submitted' to indicate that the adjudication result is on what was submitted. Binding: ?? (example): The adjudication codes. Required Pattern: {"coding":[{"system":"http://terminology.hl7.org/CodeSystem/adjudication","code":"submitted"}]} | |||||||||||
![]() ![]() ![]() ![]() ![]() | 0..1 | CodeableConcept | Explanation of adjudication outcome Binding: ?? (example): The adjudication reason codes. | 0..1 | CodeableConcept | Explanation of adjudication outcome Binding: ?? (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 | Insurer added line details | 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 | |||||||||
![]() ![]() ![]() ![]() ![]() | 1..1 | CodeableConcept | Billing, service, product, or drug code Binding: ?? (example): Allowable service and product codes. | 1..1 | CodeableConcept | Billing, service, product, or drug code Binding: ?? (example): Allowable service and product codes. | |||||||||||
![]() ![]() ![]() ![]() ![]() | 0..* | CodeableConcept | Service/Product billing modifiers Binding: ?? (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. | 0..* | CodeableConcept | Service/Product billing modifiers Binding: ?? (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. | |||||||||||
![]() ![]() ![]() ![]() ![]() | 0..1 | ?? | Count of products or services | 0..1 | ?? | Count of products or services | |||||||||||
![]() ![]() ![]() ![]() ![]() | 0..1 | Money | Fee, charge or cost per item | 0..1 | Money | Fee, charge or cost per item | |||||||||||
![]() ![]() ![]() ![]() ![]() | 0..1 | decimal | Price scaling factor | 0..1 | decimal | Price scaling factor | |||||||||||
![]() ![]() ![]() ![]() ![]() | 0..1 | Money | Total item cost | 0..1 | Money | Total item cost | |||||||||||
![]() ![]() ![]() ![]() ![]() | 0..* | positiveInt | Applicable note numbers | 0..* | positiveInt | Applicable note numbers | |||||||||||
![]() ![]() ![]() ![]() ![]() | 1..* | See adjudication (ClaimResponse) | Added items detail adjudication | 1..* | See adjudication (ClaimResponse) | Added items detail adjudication | |||||||||||
![]() ![]() ![]() ![]() ![]() | 0..* | BackboneElement | Insurer added line items | 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 | |||||||||
![]() ![]() ![]() ![]() ![]() ![]() | 1..1 | CodeableConcept | Billing, service, product, or drug code Binding: ?? (example): Allowable service and product codes. | 1..1 | CodeableConcept | Billing, service, product, or drug code Binding: ?? (example): Allowable service and product codes. | |||||||||||
![]() ![]() ![]() ![]() ![]() ![]() | 0..* | CodeableConcept | Service/Product billing modifiers Binding: ?? (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. | 0..* | CodeableConcept | Service/Product billing modifiers Binding: ?? (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. | |||||||||||
![]() ![]() ![]() ![]() ![]() ![]() | 0..1 | ?? | Count of products or services | 0..1 | ?? | Count of products or services | |||||||||||
![]() ![]() ![]() ![]() ![]() ![]() | 0..1 | Money | Fee, charge or cost per item | 0..1 | Money | Fee, charge or cost per item | |||||||||||
![]() ![]() ![]() ![]() ![]() ![]() | 0..1 | decimal | Price scaling factor | 0..1 | decimal | Price scaling factor | |||||||||||
![]() ![]() ![]() ![]() ![]() ![]() | 0..1 | Money | Total item cost | 0..1 | Money | Total item cost | |||||||||||
![]() ![]() ![]() ![]() ![]() ![]() | 0..* | positiveInt | Applicable note numbers | 0..* | positiveInt | Applicable note numbers | |||||||||||
![]() ![]() ![]() ![]() ![]() ![]() | 1..* | See adjudication (ClaimResponse) | Added items detail adjudication | 1..* | See adjudication (ClaimResponse) | Added items detail adjudication | |||||||||||
![]() ![]() ![]() | 0..* | See adjudication (ClaimResponse) | Header-level adjudication | S | 0..* | BackboneElement | Header-level adjudication |
| |||||||||
![]() ![]() ![]() ![]() | 0..1 | string | Unique id for inter-element referencing |
| |||||||||||||
![]() ![]() ![]() ![]() | 0..* | Extension | Extension Slice: Unordered, Open by value:url |
| |||||||||||||
![]() ![]() ![]() ![]() | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
| ||||||||||||
![]() ![]() ![]() ![]() | 1..1 | CodeableConcept | This code is fixed to 'submitted' to indicate that the adjudication result is on what was submitted. Binding: ?? (example): The adjudication codes. Required Pattern: {"coding":[{"system":"http://terminology.hl7.org/CodeSystem/adjudication","code":"submitted"}]} |
| |||||||||||||
![]() ![]() ![]() ![]() | 0..1 | CodeableConcept | Explanation of adjudication outcome Binding: ?? (example): The adjudication reason codes. |
| |||||||||||||
![]() ![]() ![]() ![]() | 0..1 | Money | Monetary amount |
| |||||||||||||
![]() ![]() ![]() ![]() | 0..1 | decimal | Non-monetary value |
| |||||||||||||
![]() ![]() ![]() | Σ | 0..* | BackboneElement | Adjudication totals | Σ | 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 | |||||||||
![]() ![]() ![]() ![]() | Σ | 1..1 | CodeableConcept | Type of adjudication information Binding: ?? (example): The adjudication codes. | Σ | 1..1 | CodeableConcept | Type of adjudication information Binding: ?? (example): The adjudication codes. | |||||||||
![]() ![]() ![]() ![]() | Σ | 1..1 | Money | Financial total for the category | Σ | 1..1 | Money | Financial total for the category | |||||||||
![]() ![]() ![]() | 0..1 | BackboneElement | Payment Details | 0..1 | BackboneElement | Payment 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 | Partial or complete payment Binding: ?? (example): The type (partial, complete) of the payment. | 1..1 | CodeableConcept | Partial or complete payment Binding: ?? (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: ?? (example): Payment Adjustment reason codes. | 0..1 | CodeableConcept | Explanation for the adjustment Binding: ?? (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 | |||||||||||
![]() ![]() ![]() | 0..1 | CodeableConcept | Funds reserved status Binding: ?? (example): For whom funds are to be reserved: (Patient, Provider, None). | 0..1 | CodeableConcept | Funds reserved status Binding: ?? (example): For whom funds are to be reserved: (Patient, Provider, None). | |||||||||||
![]() ![]() ![]() | 0..1 | CodeableConcept | Printed form identifier Binding: ?? (example): The forms codes. | 0..1 | CodeableConcept | Printed form identifier Binding: ?? (example): The forms codes. | |||||||||||
![]() ![]() ![]() | 0..1 | Attachment | Printed reference or actual form | 0..1 | Attachment | Printed reference or actual form | |||||||||||
![]() ![]() ![]() | 0..* | BackboneElement | Note concerning adjudication | 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 | |||||||||
![]() ![]() ![]() ![]() | 0..1 | positiveInt | Note instance identifier | 0..1 | positiveInt | Note instance identifier | |||||||||||
![]() ![]() ![]() ![]() | 0..1 | code | display | print | printoper Binding: ?? (required): The presentation types of notes. | 0..1 | code | display | print | printoper Binding: ?? (required): The presentation types of notes. | |||||||||||
![]() ![]() ![]() ![]() | 1..1 | string | Note explanatory text | 1..1 | string | Note explanatory text | |||||||||||
![]() ![]() ![]() ![]() | 0..1 | CodeableConcept | Language of the text Binding: ?? (preferred): A human language.
| 0..1 | CodeableConcept | Language of the text Binding: ?? (preferred): A human language.
| |||||||||||
![]() ![]() ![]() | 0..* | Reference(CommunicationRequest) | Request for additional information | 0..* | Reference(CommunicationRequest) | Request for additional information | |||||||||||
![]() ![]() ![]() | 0..* | BackboneElement | Patient insurance information | 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 | |||||||||
![]() ![]() ![]() ![]() | 1..1 | positiveInt | Insurance instance identifier | 1..1 | positiveInt | Insurance instance identifier | |||||||||||
![]() ![]() ![]() ![]() | 1..1 | boolean | Coverage to be used for adjudication | 1..1 | boolean | Coverage to be used for adjudication | |||||||||||
![]() ![]() ![]() ![]() | 1..1 | Reference(Coverage) | Insurance information | 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 | |||||||||||
![]() ![]() ![]() | S | 0..* | BackboneElement | Processing errors | S | 0..* | BackboneElement | Processing errors | |||||||||
![]() ![]() ![]() ![]() | 0..1 | string | Unique id for inter-element referencing | 0..1 | string | Unique id for inter-element referencing | |||||||||||
![]() ![]() ![]() ![]() | 0..* | Extension | Extension Slice: Unordered, Open by value:url | 0..* | Extension | Extension Slice: Unordered, Open by value:url | |||||||||||
![]() ![]() ![]() ![]() | ?!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 | |||||||||||
![]() ![]() ![]() ![]() | S | 1..1 | CodeableConcept | Error code detailing processing issues Binding: ?? (required) | S | 1..1 | CodeableConcept | Error code detailing processing issues Binding: ?? (required) | |||||||||
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