QI-Core Implementation Guide
5.0.0-ballot - STU Ballot US

This page is part of the Quality Improvement Core Framework (v5.0.0-ballot: STU 5 Ballot 1) based on FHIR R4. The current version which supercedes this version is 4.1.1. For a full list of available versions, see the Directory of published versions

Resource Profile: QICore Claim Response

Official URL: http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-claimresponse Version: 5.0.0-ballot
Draft as of 2022-04-20 Computable Name: QICoreClaimResponse

Copyright/Legal: Used by permission of HL7 International, all rights reserved Creative Commons License

The QI Core ClaimResponse profile is used to provide the results of the adjudication and/or authorization of a set of healthcare-related products and services for a patient against the patient’s insurance coverages, or to respond with what the adjudication would be for a supplied set of products or services should they be actually supplied to the patient.It identifies the mandatory core elements, extensions, vocabularies and value sets which SHALL be present in the ClaimResponse resource when using this profile

Usage

See the patterns page for implementation and usage patterns.

Examples

Preauthorization Vision ClaimResponse Example

Usage:

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..*ClaimResponseResponse to a claim predetermination or preauthorization
... status ?!SΣ1..1codeactive | cancelled | draft | entered-in-error
Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance.


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

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


Fixed Value: preauthorization
... created SΣ1..1dateTimeResponse creation date
... insurer SΣ1..1Reference(QICoreOrganization)Party responsible for reimbursement
... requestor S0..1Reference(QICore Practitioner | QICoreOrganization | QICorePractitionerRole)Party responsible for the claim
... request SΣ0..1Reference(QICoreClaim)Id of resource triggering adjudication
... item S0..*BackboneElementAdjudication for claim line items
.... adjudication S1..*BackboneElementAdjudication details
..... category S1..1CodeableConceptThis code is fixed to 'submitted' to indicate that the adjudication result is on what was submitted.
Fixed Value: As shown (Submitted Amount)
...... coding1..1CodingCode defined by a terminology system
Fixed Value: (complex)
....... system1..1uriIdentity of the terminology system
Fixed Value: http://terminology.hl7.org/CodeSystem/adjudication
....... code1..1codeSymbol in syntax defined by the system
Fixed Value: submitted
..... amount S0..1MoneyMonetary amount
.... detail
..... detailSequence S1..1positiveIntClaim detail instance identifier

doco Documentation for this format
NameFlagsCard.TypeDescription & Constraintsdoco
.. ClaimResponse 0..*ClaimResponseResponse to a claim predetermination or preauthorization
... 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): A human language.

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


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

... 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.


Fixed Value: preauthorization
... patient SΣ1..1Reference(QICorePatient)The recipient of the products and services
... created SΣ1..1dateTimeResponse creation date
... insurer SΣ1..1Reference(QICoreOrganization)Party responsible for reimbursement
... requestor S0..1Reference(QICore Practitioner | QICoreOrganization | QICorePractitionerRole)Party responsible for the claim
... request SΣ0..1Reference(QICoreClaim)Id of resource triggering adjudication
... outcome Σ1..1codequeued | complete | error | partial
Binding: ClaimProcessingCodes (required): The result of the claim processing.

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

... item S0..*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 S1..*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 S1..1CodeableConceptThis code is fixed to 'submitted' to indicate that the adjudication result is on what was submitted.
Binding: AdjudicationValueCodes (example): The adjudication codes.


Fixed Value: As shown (Submitted Amount)
...... id0..0stringUnique id for inter-element referencing
...... extension0..0ExtensionAdditional content defined by implementations
...... coding1..1CodingCode defined by a terminology system
Fixed Value: (complex)
....... id0..0stringUnique id for inter-element referencing
....... extension0..0ExtensionAdditional content defined by implementations
....... system1..1uriIdentity of the terminology system
Fixed Value: http://terminology.hl7.org/CodeSystem/adjudication
....... version0..0stringVersion of the system - if relevant
....... code1..1codeSymbol in syntax defined by the system
Fixed Value: submitted
....... display0..0stringRepresentation defined by the system
....... userSelected0..0booleanIf this coding was chosen directly by the user
...... text0..0stringPlain text representation of the concept
..... reason 0..1CodeableConceptExplanation of adjudication outcome
Binding: AdjudicationReasonCodes (example): The adjudication reason codes.

..... amount S0..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 S1..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 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
.... itemSequence 0..*positiveIntItem sequence number
.... detailSequence 0..*positiveIntDetail sequence number
.... subdetailSequence 0..*positiveIntSubdetail sequence number
.... provider 0..*Reference(Practitioner | PractitionerRole | Organization)Authorized providers
.... 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.


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


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

..... locationCodeableConceptCodeableConcept
..... locationAddressAddress
..... locationReferenceReference(Location)
.... 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
.... 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): A human language.

Additional BindingsPurpose
AllLanguagesMax Binding
... 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..*ClaimResponseResponse to a claim predetermination or preauthorization
... status ?!Σ1..1codeactive | cancelled | draft | entered-in-error
Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance.


Fixed Value: active
... 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.


Fixed Value: preauthorization
... created Σ1..1dateTimeResponse creation date
... insurer Σ1..1Reference(QICoreOrganization)Party responsible for reimbursement
... requestor 0..1Reference(QICore Practitioner | QICoreOrganization | QICorePractitionerRole)Party responsible for the claim
... request Σ0..1Reference(QICoreClaim)Id of resource triggering adjudication
... item 0..*BackboneElementAdjudication for claim line items
.... adjudication 1..*BackboneElementAdjudication details
..... category 1..1CodeableConceptThis code is fixed to 'submitted' to indicate that the adjudication result is on what was submitted.
Binding: AdjudicationValueCodes (example): The adjudication codes.


Fixed Value: As shown (Submitted Amount)
...... id0..0stringUnique id for inter-element referencing
...... extension0..0ExtensionAdditional content defined by implementations
...... coding1..1CodingCode defined by a terminology system
Fixed Value: (complex)
....... id0..0stringUnique id for inter-element referencing
....... extension0..0ExtensionAdditional content defined by implementations
....... system1..1uriIdentity of the terminology system
Fixed Value: http://terminology.hl7.org/CodeSystem/adjudication
....... version0..0stringVersion of the system - if relevant
....... code1..1codeSymbol in syntax defined by the system
Fixed Value: submitted
....... display0..0stringRepresentation defined by the system
....... userSelected0..0booleanIf this coding was chosen directly by the user
...... text0..0stringPlain text representation of the concept
..... amount 0..1MoneyMonetary amount
.... detail 0..*BackboneElementAdjudication for claim details
..... detailSequence 1..1positiveIntClaim detail instance identifier

doco Documentation for this format

Differential View

This structure is derived from ClaimResponse

NameFlagsCard.TypeDescription & Constraintsdoco
.. ClaimResponse 0..*ClaimResponseResponse to a claim predetermination or preauthorization
... status ?!SΣ1..1codeactive | cancelled | draft | entered-in-error
Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance.


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

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


Fixed Value: preauthorization
... created SΣ1..1dateTimeResponse creation date
... insurer SΣ1..1Reference(QICoreOrganization)Party responsible for reimbursement
... requestor S0..1Reference(QICore Practitioner | QICoreOrganization | QICorePractitionerRole)Party responsible for the claim
... request SΣ0..1Reference(QICoreClaim)Id of resource triggering adjudication
... item S0..*BackboneElementAdjudication for claim line items
.... adjudication S1..*BackboneElementAdjudication details
..... category S1..1CodeableConceptThis code is fixed to 'submitted' to indicate that the adjudication result is on what was submitted.
Fixed Value: As shown (Submitted Amount)
...... coding1..1CodingCode defined by a terminology system
Fixed Value: (complex)
....... system1..1uriIdentity of the terminology system
Fixed Value: http://terminology.hl7.org/CodeSystem/adjudication
....... code1..1codeSymbol in syntax defined by the system
Fixed Value: submitted
..... amount S0..1MoneyMonetary amount
.... detail
..... detailSequence S1..1positiveIntClaim detail instance identifier

doco Documentation for this format

Snapshot View

NameFlagsCard.TypeDescription & Constraintsdoco
.. ClaimResponse 0..*ClaimResponseResponse to a claim predetermination or preauthorization
... 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): A human language.

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


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

... 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.


Fixed Value: preauthorization
... patient SΣ1..1Reference(QICorePatient)The recipient of the products and services
... created SΣ1..1dateTimeResponse creation date
... insurer SΣ1..1Reference(QICoreOrganization)Party responsible for reimbursement
... requestor S0..1Reference(QICore Practitioner | QICoreOrganization | QICorePractitionerRole)Party responsible for the claim
... request SΣ0..1Reference(QICoreClaim)Id of resource triggering adjudication
... outcome Σ1..1codequeued | complete | error | partial
Binding: ClaimProcessingCodes (required): The result of the claim processing.

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

... item S0..*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 S1..*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 S1..1CodeableConceptThis code is fixed to 'submitted' to indicate that the adjudication result is on what was submitted.
Binding: AdjudicationValueCodes (example): The adjudication codes.


Fixed Value: As shown (Submitted Amount)
...... id0..0stringUnique id for inter-element referencing
...... extension0..0ExtensionAdditional content defined by implementations
...... coding1..1CodingCode defined by a terminology system
Fixed Value: (complex)
....... id0..0stringUnique id for inter-element referencing
....... extension0..0ExtensionAdditional content defined by implementations
....... system1..1uriIdentity of the terminology system
Fixed Value: http://terminology.hl7.org/CodeSystem/adjudication
....... version0..0stringVersion of the system - if relevant
....... code1..1codeSymbol in syntax defined by the system
Fixed Value: submitted
....... display0..0stringRepresentation defined by the system
....... userSelected0..0booleanIf this coding was chosen directly by the user
...... text0..0stringPlain text representation of the concept
..... reason 0..1CodeableConceptExplanation of adjudication outcome
Binding: AdjudicationReasonCodes (example): The adjudication reason codes.

..... amount S0..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 S1..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 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
.... itemSequence 0..*positiveIntItem sequence number
.... detailSequence 0..*positiveIntDetail sequence number
.... subdetailSequence 0..*positiveIntSubdetail sequence number
.... provider 0..*Reference(Practitioner | PractitionerRole | Organization)Authorized providers
.... 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.


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


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

..... locationCodeableConceptCodeableConcept
..... locationAddressAddress
..... locationReferenceReference(Location)
.... 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
.... 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): A human language.

Additional BindingsPurpose
AllLanguagesMax Binding
... 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.userequiredFixed Value: preauthorization
ClaimResponse.outcomerequiredClaimProcessingCodes
ClaimResponse.payeeTypeexampleClaim Payee Type Codes
ClaimResponse.item.adjudication.categoryexampleFixed Value: submitted
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.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())