{ "resourceType" : "StructureDefinition", "id" : "profile-ClaimResponse", "text" : { "status" : "extensions", "div" : "

Generated Narrative: StructureDefinition profile-ClaimResponse

\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n
NameFlagsCard.TypeDescription & Constraints\"doco\"
\".\"\".\" ClaimResponse 0..*ClaimResponse(5.0.0)Response to a claim predetermination or preauthorization
\".\"\".\"\".\" meta
\".\"\".\"\".\"\".\" Slices for extension 0..*ExtensionExtension
Slice: Unordered, Open by value:url
\".\"\".\"\".\"\".\"\".\" extension:meta 0..1MetaDSTU2: meta additional types
URL: http://hl7.org/fhir/1.0/StructureDefinition/extension-ClaimResponse.meta
\".\"\".\"\".\" text
\".\"\".\"\".\"\".\" Slices for extension 0..*ExtensionExtension
Slice: Unordered, Open by value:url
\".\"\".\"\".\"\".\"\".\" extension:text 0..1(Complex)DSTU2: text additional types
URL: http://hl7.org/fhir/1.0/StructureDefinition/extension-ClaimResponse.text
\".\"\".\"\".\" Slices for extension 0..*ExtensionExtension
Slice: Unordered, Open by value:url
\".\"\".\"\".\"\".\" extension:ruleset 0..1CodingDSTU2: Resource version (new)
URL: http://hl7.org/fhir/1.0/StructureDefinition/extension-ClaimResponse.ruleset
Binding: R2RulesetForR5 (0.1.0) (example): The static and dynamic model to which contents conform, which may be business version or standard/version.
\".\"\".\"\".\"\".\" extension:originalRuleset 0..1CodingDSTU2: Original version (new)
URL: http://hl7.org/fhir/1.0/StructureDefinition/extension-ClaimResponse.originalRuleset
Binding: R2RulesetForR5 (0.1.0) (example): The static and dynamic model to which contents conform, which may be business version or standard/version.
\".\"\".\"\".\"\".\" extension:unallocDeductable 0..1MoneyDSTU2: Unallocated deductible (new)
URL: http://hl7.org/fhir/1.0/StructureDefinition/extension-ClaimResponse.unallocDeductable
\".\"\".\"\".\" identifier
\".\"\".\"\".\"\".\" Slices for extension 0..*ExtensionExtension
Slice: Unordered, Open by value:url
\".\"\".\"\".\"\".\"\".\" extension:identifier 0..*IdentifierDSTU2: Response number additional types
URL: http://hl7.org/fhir/1.0/StructureDefinition/extension-ClaimResponse.identifier
\".\"\".\"\".\" insurer
\".\"\".\"\".\"\".\" Slices for extension 0..*ExtensionExtension
Slice: Unordered, Open by value:url
\".\"\".\"\".\"\".\"\".\" extension:organization 0..1Reference(Resource)DSTU2: Insurer additional types
URL: http://hl7.org/fhir/StructureDefinition/alternate-reference
\".\"\".\"\".\" requestor
\".\"\".\"\".\"\".\" Slices for extension 0..*ExtensionExtension
Slice: Unordered, Open by value:url
\".\"\".\"\".\"\".\"\".\" extension:requestProvider 0..1Reference(Resource)DSTU2: Responsible practitioner additional types
URL: http://hl7.org/fhir/StructureDefinition/alternate-reference
\".\"\".\"\".\"\".\"\".\" extension:requestOrganization 0..1Reference(Resource)DSTU2: Responsible organization additional types
URL: http://hl7.org/fhir/StructureDefinition/alternate-reference
\".\"\".\"\".\" request
\".\"\".\"\".\"\".\" Slices for extension 0..*ExtensionExtension
Slice: Unordered, Open by value:url
\".\"\".\"\".\"\".\"\".\" extension:request 0..1Reference(Resource)DSTU2: request additional types
URL: http://hl7.org/fhir/StructureDefinition/alternate-reference
\".\"\".\"\".\" item
\".\"\".\"\".\"\".\" adjudication
\".\"\".\"\".\"\".\"\".\" quantity
\".\"\".\"\".\"\".\"\".\"\".\" Slices for extension 0..*ExtensionExtension
Slice: Unordered, Open by value:url
\".\"\".\"\".\"\".\"\".\"\".\"\".\" extension:value 0..1decimalDSTU2: value additional types
URL: http://hl7.org/fhir/1.0/StructureDefinition/extension-ClaimResponse.item.adjudication.value
\".\"\".\"\".\"\".\" detail
\".\"\".\"\".\"\".\"\".\" adjudication
\".\"\".\"\".\"\".\"\".\"\".\" Slices for extension 0..*ExtensionExtension
Slice: Unordered, Open by value:url
\".\"\".\"\".\"\".\"\".\"\".\"\".\" extension:amount 0..1MoneyDSTU2: Monetary amount (new)
URL: http://hl7.org/fhir/1.0/StructureDefinition/extension-ClaimResponse.item.detail.adjudication.amount
\".\"\".\"\".\"\".\"\".\"\".\"\".\" extension:value 0..1decimalDSTU2: Non-monetary value (new)
URL: http://hl7.org/fhir/1.0/StructureDefinition/extension-ClaimResponse.item.detail.adjudication.value
\".\"\".\"\".\"\".\"\".\" subDetail
\".\"\".\"\".\"\".\"\".\"\".\" adjudication
\".\"\".\"\".\"\".\"\".\"\".\"\".\" Slices for extension 0..*ExtensionExtension
Slice: Unordered, Open by value:url
\".\"\".\"\".\"\".\"\".\"\".\"\".\"\".\" extension:amount 0..1MoneyDSTU2: Monetary amount (new)
URL: http://hl7.org/fhir/1.0/StructureDefinition/extension-ClaimResponse.item.detail.subDetail.adjudication.amount
\".\"\".\"\".\"\".\"\".\"\".\"\".\"\".\" extension:value 0..1decimalDSTU2: Non-monetary value (new)
URL: http://hl7.org/fhir/1.0/StructureDefinition/extension-ClaimResponse.item.detail.subDetail.adjudication.value
\".\"\".\"\".\" addItem
\".\"\".\"\".\"\".\" Slices for extension 0..*ExtensionExtension
Slice: Unordered, Open by value:url
\".\"\".\"\".\"\".\"\".\" extension:fee 0..1MoneyDSTU2: Professional fee or Product charge (new)
URL: http://hl7.org/fhir/1.0/StructureDefinition/extension-ClaimResponse.addItem.fee
\".\"\".\"\".\"\".\" adjudication
\".\"\".\"\".\"\".\"\".\" Slices for extension 0..*ExtensionExtension
Slice: Unordered, Open by value:url
\".\"\".\"\".\"\".\"\".\"\".\" extension:amount 0..1MoneyDSTU2: Monetary amount (new)
URL: http://hl7.org/fhir/1.0/StructureDefinition/extension-ClaimResponse.addItem.adjudication.amount
\".\"\".\"\".\"\".\"\".\"\".\" extension:value 0..1decimalDSTU2: Non-monetary value (new)
URL: http://hl7.org/fhir/1.0/StructureDefinition/extension-ClaimResponse.addItem.adjudication.value
\".\"\".\"\".\"\".\" detail
\".\"\".\"\".\"\".\"\".\" Slices for extension 0..*ExtensionExtension
Slice: Unordered, Open by value:url
\".\"\".\"\".\"\".\"\".\"\".\" extension:fee 0..1MoneyDSTU2: Professional fee or Product charge (new)
URL: http://hl7.org/fhir/1.0/StructureDefinition/extension-ClaimResponse.addItem.detail.fee
\".\"\".\"\".\"\".\"\".\" adjudication
\".\"\".\"\".\"\".\"\".\"\".\" Slices for extension 0..*ExtensionExtension
Slice: Unordered, Open by value:url
\".\"\".\"\".\"\".\"\".\"\".\"\".\" extension:amount 0..1MoneyDSTU2: Monetary amount (new)
URL: http://hl7.org/fhir/1.0/StructureDefinition/extension-ClaimResponse.addItem.detail.adjudication.amount
\".\"\".\"\".\"\".\"\".\"\".\"\".\" extension:value 0..1decimalDSTU2: Non-monetary value (new)
URL: http://hl7.org/fhir/1.0/StructureDefinition/extension-ClaimResponse.addItem.detail.adjudication.value
\".\"\".\"\".\" payment
\".\"\".\"\".\"\".\" identifier
\".\"\".\"\".\"\".\"\".\" Slices for extension 0..*ExtensionExtension
Slice: Unordered, Open by value:url
\".\"\".\"\".\"\".\"\".\"\".\" extension:paymentRef 0..1IdentifierDSTU2: Payment identifier additional types
URL: http://hl7.org/fhir/1.0/StructureDefinition/extension-ClaimResponse.paymentRef
\".\"\".\"\".\" formCode
\".\"\".\"\".\"\".\" Slices for extension 0..*ExtensionExtension
Slice: Unordered, Open by value:url
\".\"\".\"\".\"\".\"\".\" extension:form 0..1CodingDSTU2: Printed Form Identifier
URL: http://hl7.org/fhir/1.0/StructureDefinition/extension-ClaimResponse.form
Binding: FormCodes (required): The forms codes.
\".\"\".\"\".\" processNote
\".\"\".\"\".\"\".\" type
\".\"\".\"\".\"\".\"\".\" Slices for extension 0..*ExtensionExtension
Slice: Unordered, Open by value:url
\".\"\".\"\".\"\".\"\".\"\".\" extension:type 0..1CodingDSTU2: display | print | printoper
URL: http://hl7.org/fhir/1.0/StructureDefinition/extension-ClaimResponse.note.type
Binding: NoteType (required): The presentation types of notes.
\".\"\".\"\".\" insurance
\".\"\".\"\".\"\".\" Slices for extension 1..*ExtensionExtension
Slice: Unordered, Open by value:url
\".\"\".\"\".\"\".\"\".\" extension:relationship 1..1CodingDSTU2: Patient relationship to subscriber (new)
URL: http://hl7.org/fhir/1.0/StructureDefinition/extension-ClaimResponse.coverage.relationship
Binding: BeneficiaryRelationshipCodes (example): The code for the relationship of the patient to the subscriber.
\".\"\".\"\".\"\".\"\".\" extension:preAuthRef 0..*stringDSTU2: Pre-Authorization/Determination Reference (new)
URL: http://hl7.org/fhir/1.0/StructureDefinition/extension-ClaimResponse.coverage.preAuthRef
\".\"\".\"\".\"\".\"\".\" extension:originalRuleset 0..1CodingDSTU2: Original version (new)
URL: http://hl7.org/fhir/1.0/StructureDefinition/extension-ClaimResponse.coverage.originalRuleset
Binding: R2RulesetForR5 (0.1.0) (example): The static and dynamic model to which contents conform, which may be business version or standard/version.
\".\"\".\"\".\"\".\" coverage
\".\"\".\"\".\"\".\"\".\" Slices for extension 0..*ExtensionExtension
Slice: Unordered, Open by value:url
\".\"\".\"\".\"\".\"\".\"\".\" extension:coverage 0..1Reference(Resource)DSTU2: coverage additional types
URL: http://hl7.org/fhir/StructureDefinition/alternate-reference
\".\"\".\"\".\"\".\" claimResponse
\".\"\".\"\".\"\".\"\".\" Slices for extension 0..*ExtensionExtension
Slice: Unordered, Open by value:url
\".\"\".\"\".\"\".\"\".\"\".\" extension:claimResponse 0..1Reference(Resource)DSTU2: claimResponse additional types
URL: http://hl7.org/fhir/StructureDefinition/alternate-reference
\".\"\".\"\".\" error
\".\"\".\"\".\"\".\" code
\".\"\".\"\".\"\".\"\".\" Slices for extension 0..*ExtensionExtension
Slice: Unordered, Open by value:url
\".\"\".\"\".\"\".\"\".\"\".\" extension:code 0..1CodingDSTU2: code
URL: http://hl7.org/fhir/1.0/StructureDefinition/extension-ClaimResponse.error.code
Binding: AdjudicationErrorCodes (required): The error codes for adjudication processing.

\"doco\" Documentation for this format
" }, "extension" : [{ "url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-wg", "valueCode" : "fhir" }, { "extension" : [{ "url" : "packageId", "valueId" : "hl7.fhir.uv.xver-r2.r5" }, { "url" : "version", "valueString" : "0.1.0" }], "url" : "http://hl7.org/fhir/StructureDefinition/package-source" }, { "url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-fmm", "valueInteger" : 0, "_valueInteger" : { "extension" : [{ "url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-conformance-derivedFrom", "valueCanonical" : "http://hl7.org/fhir/uv/xver/ImplementationGuide/hl7.fhir.uv.xver-r2.r5" }] } }, { "url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status", "valueCode" : "trial-use", "_valueCode" : { "extension" : [{ "url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-conformance-derivedFrom", "valueCanonical" : "http://hl7.org/fhir/uv/xver/ImplementationGuide/hl7.fhir.uv.xver-r2.r5" }] } }], "url" : "http://hl7.org/fhir/1.0/StructureDefinition/profile-ClaimResponse", "version" : "0.1.0", "name" : "Profile_R2_ClaimResponse_R5", "title" : "Cross-version Profile for DSTU2.ClaimResponse for use in FHIR R5", "status" : "active", "experimental" : false, "date" : "2026-03-17T16:05:25.6401048-05:00", "publisher" : "FHIR Infrastructure", "contact" : [{ "name" : "FHIR Infrastructure", "telecom" : [{ "system" : "url", "value" : "http://www.hl7.org/Special/committees/fiwg" }] }], "description" : "This cross-version profile allows DSTU2 ClaimResponse content to be represented via FHIR R5 ClaimResponse resources.", "jurisdiction" : [{ "coding" : [{ "system" : "http://unstats.un.org/unsd/methods/m49/m49.htm", "code" : "001", "display" : "World" }] }], "fhirVersion" : "5.0.0", "mapping" : [{ "identity" : "workflow", "uri" : "http://hl7.org/fhir/workflow", "name" : "Workflow Pattern" }, { "identity" : "w5", "uri" : "http://hl7.org/fhir/fivews", "name" : "FiveWs Pattern Mapping" }, { "identity" : "rim", "uri" : "http://hl7.org/v3", "name" : "RIM Mapping" }], "kind" : "resource", "abstract" : false, "type" : "ClaimResponse", "baseDefinition" : "http://hl7.org/fhir/StructureDefinition/ClaimResponse|5.0.0", "derivation" : "constraint", "snapshot" : { "extension" : [{ "url" : "http://hl7.org/fhir/tools/StructureDefinition/snapshot-base-version", "valueString" : "5.0.0" }], "element" : [{ "id" : "ClaimResponse", "path" : "ClaimResponse", "short" : "Response to a claim predetermination or preauthorization", "definition" : "This resource provides the adjudication details from the processing of a Claim resource.", "alias" : ["Remittance Advice"], "min" : 0, "max" : "*", "base" : { "path" : "ClaimResponse", "min" : 0, "max" : "*" }, "constraint" : [{ "key" : "dom-2", "severity" : "error", "human" : "If the resource is contained in another resource, it SHALL NOT contain nested Resources", "expression" : "contained.contained.empty()", "source" : "http://hl7.org/fhir/StructureDefinition/DomainResource|5.0.0" }, { "key" : "dom-3", "severity" : "error", "human" : "If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource", "expression" : "contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().ofType(canonical) | %resource.descendants().ofType(uri) | %resource.descendants().ofType(url))) or descendants().where(reference = '#').exists() or descendants().where(ofType(canonical) = '#').exists() or descendants().where(ofType(canonical) = '#').exists()).not()).trace('unmatched', id).empty()", "source" : "http://hl7.org/fhir/StructureDefinition/DomainResource|5.0.0" }, { "key" : "dom-4", "severity" : "error", "human" : "If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated", "expression" : "contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()", "source" : "http://hl7.org/fhir/StructureDefinition/DomainResource|5.0.0" }, { "key" : "dom-5", "severity" : "error", "human" : "If a resource is contained in another resource, it SHALL NOT have a security label", "expression" : "contained.meta.security.empty()", "source" : "http://hl7.org/fhir/StructureDefinition/DomainResource|5.0.0" }, { "extension" : [{ "url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-bestpractice", "valueBoolean" : true }, { "url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-bestpractice-explanation", "valueMarkdown" : "When a resource has no narrative, only systems that fully understand the data can display the resource to a human safely. Including a human readable representation in the resource makes for a much more robust eco-system and cheaper handling of resources by intermediary systems. Some ecosystems restrict distribution of resources to only those systems that do fully understand the resources, and as a consequence implementers may believe that the narrative is superfluous. However experience shows that such eco-systems often open up to new participants over time." }], "key" : "dom-6", "severity" : "warning", "human" : "A resource should have narrative for robust management", "expression" : "text.`div`.exists()", "source" : "http://hl7.org/fhir/StructureDefinition/DomainResource|5.0.0" }], "mustSupport" : false, "isModifier" : false, "isSummary" : false, "mapping" : [{ "identity" : "rim", "map" : "Entity, Role, or Act" }, { "identity" : "workflow", "map" : "Event" }, { "identity" : "w5", "map" : "financial.billing" }] }, { "id" : "ClaimResponse.id", "path" : "ClaimResponse.id", "short" : "Logical id of this artifact", "definition" : "The logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes.", "comment" : "Within the context of the FHIR RESTful interactions, the resource has an id except for cases like the create and conditional update. Otherwise, the use of the resouce id depends on the given use case.", "min" : 0, "max" : "1", "base" : { "path" : "Resource.id", "min" : 0, "max" : "1" }, "type" : [{ "extension" : [{ "url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type", "valueUrl" : "id" }], "code" : "http://hl7.org/fhirpath/System.String" }], "mustSupport" : false, "isModifier" : false, "isSummary" : true }, { "id" : "ClaimResponse.meta", "path" : "ClaimResponse.meta", "short" : "Metadata about the resource", "definition" : "The metadata about the resource. This is content that is maintained by the infrastructure. Changes to the content might not always be associated with version changes to the resource.", "min" : 0, "max" : "1", "base" : { "path" : "Resource.meta", "min" : 0, "max" : "1" }, "type" : [{ "code" : "Meta" }], "constraint" : [{ "key" : "ele-1", "severity" : "error", "human" : "All FHIR elements must have a @value or children", "expression" : "hasValue() or (children().count() > id.count())", "source" : "http://hl7.org/fhir/StructureDefinition/Element|5.0.0" }], "mustSupport" : false, "isModifier" : false, "isSummary" : true }, { "id" : "ClaimResponse.meta.id", "path" : "ClaimResponse.meta.id", "representation" : ["xmlAttr"], "short" : "Unique id for inter-element referencing", "definition" : "Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.", "min" : 0, "max" : "1", "base" : { "path" : "Element.id", "min" : 0, "max" : "1" }, "type" : [{ "extension" : [{ "url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type", "valueUrl" : "id" }], "code" : "http://hl7.org/fhirpath/System.String" }], "condition" : ["ele-1"], "isModifier" : false, "isSummary" : false, "mapping" : [{ "identity" : "rim", "map" : "n/a" }] }, { "id" : "ClaimResponse.meta.extension", "path" : "ClaimResponse.meta.extension", "slicing" : { "discriminator" : [{ "type" : "value", "path" : "url" }], "description" : "Extensions are always sliced by (at least) url", "ordered" : false, "rules" : "open" }, "short" : "Extension", "definition" : "An Extension", "min" : 0, "max" : "*", "base" : { "path" : "Element.extension", "min" : 0, "max" : "*" }, "type" : [{ "code" : "Extension" }], "constraint" : [{ "key" : "ele-1", "severity" : "error", "human" : "All FHIR elements must have a @value or children", "expression" : "hasValue() or (children().count() > id.count())", "source" : "http://hl7.org/fhir/StructureDefinition/Element|5.0.0" }, { "key" : "ext-1", "severity" : "error", "human" : "Must have either extensions or value[x], not both", "expression" : "extension.exists() != value.exists()", "source" : "http://hl7.org/fhir/StructureDefinition/Extension|5.0.0" }], "isModifier" : false, "isSummary" : false }, { "id" : "ClaimResponse.meta.extension:meta", "path" : "ClaimResponse.meta.extension", "sliceName" : "meta", "short" : "DSTU2: meta additional types", "definition" : "DSTU2: `ClaimResponse.meta` additional types (Meta) additional types from child elements (lastUpdated, profile, security, tag, versionId)", "comment" : "Element `ClaimResponse.meta` is mapped to FHIR R5 element `ClaimResponse.meta` as `SourceIsBroaderThanTarget`.\nThe mappings for `ClaimResponse.meta` do not cover the following types: Meta.\nThe mappings for `ClaimResponse.meta` do not cover the following types based on type expansion: lastUpdated, profile, security, tag, versionId.", "min" : 0, "max" : "1", "base" : { "path" : "Element.extension", "min" : 0, "max" : "*" }, "type" : [{ "code" : "Extension", "profile" : ["http://hl7.org/fhir/1.0/StructureDefinition/extension-ClaimResponse.meta|0.1.0"] }], "constraint" : [{ "key" : "ele-1", "severity" : "error", "human" : "All FHIR elements must have a @value or children", "expression" : "hasValue() or (children().count() > id.count())", "source" : "http://hl7.org/fhir/StructureDefinition/Element|5.0.0" }, { "key" : "ext-1", "severity" : "error", "human" : "Must have either extensions or value[x], not both", "expression" : "extension.exists() != value.exists()", "source" : "http://hl7.org/fhir/StructureDefinition/Extension|5.0.0" }], "isModifier" : false, "isSummary" : false }, { "id" : "ClaimResponse.meta.versionId", "path" : "ClaimResponse.meta.versionId", "short" : "Version specific identifier", "definition" : "The version specific identifier, as it appears in the version portion of the URL. This value changes when the resource is created, updated, or deleted.", "comment" : "The server assigns this value, and ignores what the client specifies, except in the case that the server is imposing version integrity on updates/deletes.", "min" : 0, "max" : "1", "base" : { "path" : "Meta.versionId", "min" : 0, "max" : "1" }, "type" : [{ "code" : "id" }], "constraint" : [{ "key" : "ele-1", "severity" : "error", "human" : "All FHIR elements must have a @value or children", "expression" : "hasValue() or (children().count() > id.count())", "source" : "http://hl7.org/fhir/StructureDefinition/Element|5.0.0" }], "isModifier" : false, "isSummary" : true }, { "id" : "ClaimResponse.meta.lastUpdated", "path" : "ClaimResponse.meta.lastUpdated", "short" : "When the resource version last changed", "definition" : "When the resource last changed - e.g. when the version changed.", "comment" : "This element is generally omitted in instances submitted in a PUT or POST. Instead, it is populated in the response instance and when retrieving information using a GET. The server / resource manager sets this value; what a client provides is irrelevant. This is equivalent to the HTTP Last-Modified and SHOULD have the same value on a [read](http://hl7.org/fhir/R5/http.html#read) interaction.", "min" : 0, "max" : "1", "base" : { "path" : "Meta.lastUpdated", "min" : 0, "max" : "1" }, "type" : [{ "code" : "instant" }], "constraint" : [{ "key" : "ele-1", "severity" : "error", "human" : "All FHIR elements must have a @value or children", "expression" : "hasValue() or (children().count() > id.count())", "source" : "http://hl7.org/fhir/StructureDefinition/Element|5.0.0" }], "isModifier" : false, "isSummary" : true }, { "id" : "ClaimResponse.meta.source", "path" : "ClaimResponse.meta.source", "short" : "Identifies where the resource comes from", "definition" : "A uri that identifies the source system of the resource. This provides a minimal amount of [Provenance](http://hl7.org/fhir/R5/provenance.html#) information that can be used to track or differentiate the source of information in the resource. The source may identify another FHIR server, document, message, database, etc.", "comment" : "The exact use of the source (and the possible implied Provenance.entity.role and agent.role) is left to implementer discretion. Only one nominated source is allowed; for additional provenance details, a full Provenance resource should be used. The source may correspond to Provenance.entity.what[x] or Provenance.agent.who[x], though it may be a more general or abstract reference. \n\nThis element can be used to indicate where the current master source of a resource that has a canonical URL if the resource is no longer hosted at the canonical URL.", "min" : 0, "max" : "1", "base" : { "path" : "Meta.source", "min" : 0, "max" : "1" }, "type" : [{ "code" : "uri" }], "constraint" : [{ "key" : "ele-1", "severity" : "error", "human" : "All FHIR elements must have a @value or children", "expression" : "hasValue() or (children().count() > id.count())", "source" : "http://hl7.org/fhir/StructureDefinition/Element|5.0.0" }], "isModifier" : false, "isSummary" : true }, { "id" : "ClaimResponse.meta.profile", "path" : "ClaimResponse.meta.profile", "short" : "Profiles this resource claims to conform to", "definition" : "A list of profiles (references to [StructureDefinition](http://hl7.org/fhir/R5/structuredefinition.html#) resources) that this resource claims to conform to. The URL is a reference to [StructureDefinition.url](http://hl7.org/fhir/R5/structuredefinition-definitions.html#StructureDefinition.url).", "comment" : "It is up to the server and/or other infrastructure of policy to determine whether/how these claims are verified and/or updated over time. The list of profile URLs is a set.", "min" : 0, "max" : "*", "base" : { "path" : "Meta.profile", "min" : 0, "max" : "*" }, "type" : [{ "code" : "canonical", "targetProfile" : ["http://hl7.org/fhir/StructureDefinition/StructureDefinition|5.0.0"] }], "constraint" : [{ "key" : "ele-1", "severity" : "error", "human" : "All FHIR elements must have a @value or children", "expression" : "hasValue() or (children().count() > id.count())", "source" : "http://hl7.org/fhir/StructureDefinition/Element|5.0.0" }], "isModifier" : false, "isSummary" : true }, { "id" : "ClaimResponse.meta.security", "path" : "ClaimResponse.meta.security", "short" : "Security Labels applied to this resource", "definition" : "Security labels applied to this resource. These tags connect specific resources to the overall security policy and infrastructure.", "comment" : "The security labels can be updated without changing the stated version of the resource. The list of security labels is a set. Uniqueness is based the system/code, and version and display are ignored.", "min" : 0, "max" : "*", "base" : { "path" : "Meta.security", "min" : 0, "max" : "*" }, "type" : [{ "code" : "Coding" }], "constraint" : [{ "key" : "ele-1", "severity" : "error", "human" : "All FHIR elements must have a @value or children", "expression" : "hasValue() or (children().count() > id.count())", "source" : "http://hl7.org/fhir/StructureDefinition/Element|5.0.0" }], "isModifier" : false, "isSummary" : true, "binding" : { "extension" : [{ "url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString" : "SecurityLabels" }], "strength" : "extensible", "description" : "Security Labels from the Healthcare Privacy and Security Classification System.", "valueSet" : "http://hl7.org/fhir/ValueSet/security-labels|5.0.0" } }, { "id" : "ClaimResponse.meta.tag", "path" : "ClaimResponse.meta.tag", "short" : "Tags applied to this resource", "definition" : "Tags applied to this resource. Tags are intended to be used to identify and relate resources to process and workflow, and applications are not required to consider the tags when interpreting the meaning of a resource.", "comment" : "The tags can be updated without changing the stated version of the resource. The list of tags is a set. Uniqueness is based the system/code, and version and display are ignored.", "min" : 0, "max" : "*", "base" : { "path" : "Meta.tag", "min" : 0, "max" : "*" }, "type" : [{ "code" : "Coding" }], "constraint" : [{ "key" : "ele-1", "severity" : "error", "human" : "All FHIR elements must have a @value or children", "expression" : "hasValue() or (children().count() > id.count())", "source" : "http://hl7.org/fhir/StructureDefinition/Element|5.0.0" }], "isModifier" : false, "isSummary" : true, "binding" : { "extension" : [{ "url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString" : "Tags" }], "strength" : "example", "description" : "Codes that represent various types of tags, commonly workflow-related; e.g. \"Needs review by Dr. Jones\".", "valueSet" : "http://hl7.org/fhir/ValueSet/common-tags|5.0.0" } }, { "id" : "ClaimResponse.implicitRules", "path" : "ClaimResponse.implicitRules", "short" : "A set of rules under which this content was created", "definition" : "A reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content. Often, this is a reference to an implementation guide that defines the special rules along with other profiles etc.", "comment" : "Asserting this rule set restricts the content to be only understood by a limited set of trading partners. This inherently limits the usefulness of the data in the long term. However, the existing health eco-system is highly fractured, and not yet ready to define, collect, and exchange data in a generally computable sense. Wherever possible, implementers and/or specification writers should avoid using this element. Often, when used, the URL is a reference to an implementation guide that defines these special rules as part of its narrative along with other profiles, value sets, etc.", "min" : 0, "max" : "1", "base" : { "path" : "Resource.implicitRules", "min" : 0, "max" : "1" }, "type" : [{ "code" : "uri" }], "constraint" : [{ "key" : "ele-1", "severity" : "error", "human" : "All FHIR elements must have a @value or children", "expression" : "hasValue() or (children().count() > id.count())", "source" : "http://hl7.org/fhir/StructureDefinition/Element|5.0.0" }], "mustSupport" : false, "isModifier" : true, "isModifierReason" : "This element is labeled as a modifier because the implicit rules may provide additional knowledge about the resource that modifies its meaning or interpretation", "isSummary" : true }, { "id" : "ClaimResponse.language", "path" : "ClaimResponse.language", "short" : "Language of the resource content", "definition" : "The base language in which the resource is written.", "comment" : "Language is provided to support indexing and accessibility (typically, services such as text to speech use the language tag). The html language tag in the narrative applies to the narrative. The language tag on the resource may be used to specify the language of other presentations generated from the data in the resource. Not all the content has to be in the base language. The Resource.language should not be assumed to apply to the narrative automatically. If a language is specified, it should it also be specified on the div element in the html (see rules in HTML5 for information about the relationship between xml:lang and the html lang attribute).", "min" : 0, "max" : "1", "base" : { "path" : "Resource.language", "min" : 0, "max" : "1" }, "type" : [{ "code" : "code" }], "constraint" : [{ "key" : "ele-1", "severity" : "error", "human" : "All FHIR elements must have a @value or children", "expression" : "hasValue() or (children().count() > id.count())", "source" : "http://hl7.org/fhir/StructureDefinition/Element|5.0.0" }], "mustSupport" : false, "isModifier" : false, "isSummary" : false, "binding" : { "extension" : [{ "url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString" : "Language" }], "strength" : "required", "description" : "IETF language tag for a human language", "valueSet" : "http://hl7.org/fhir/ValueSet/all-languages|5.0.0", "additional" : [{ "purpose" : "starter", "valueSet" : "http://hl7.org/fhir/ValueSet/languages|5.0.0" }] } }, { "id" : "ClaimResponse.text", "path" : "ClaimResponse.text", "short" : "Text summary of the resource, for human interpretation", "definition" : "A human-readable narrative that contains a summary of the resource and can be used to represent the content of the resource to a human. The narrative need not encode all the structured data, but is required to contain sufficient detail to make it \"clinically safe\" for a human to just read the narrative. Resource definitions may define what content should be represented in the narrative to ensure clinical safety.", "comment" : "Contained resources do not have a narrative. Resources that are not contained SHOULD have a narrative. In some cases, a resource may only have text with little or no additional discrete data (as long as all minOccurs=1 elements are satisfied). This may be necessary for data from legacy systems where information is captured as a \"text blob\" or where text is additionally entered raw or narrated and encoded information is added later.", "alias" : ["narrative", "html", "xhtml", "display"], "min" : 0, "max" : "1", "base" : { "path" : "DomainResource.text", "min" : 0, "max" : "1" }, "type" : [{ "code" : "Narrative" }], "condition" : ["dom-6"], "constraint" : [{ "key" : "ele-1", "severity" : "error", "human" : "All FHIR elements must have a @value or children", "expression" : "hasValue() or (children().count() > id.count())", "source" : "http://hl7.org/fhir/StructureDefinition/Element|5.0.0" }], "mustSupport" : false, "isModifier" : false, "isSummary" : false, "mapping" : [{ "identity" : "rim", "map" : "Act.text?" }] }, { "id" : "ClaimResponse.text.id", "path" : "ClaimResponse.text.id", "representation" : ["xmlAttr"], "short" : "Unique id for inter-element referencing", "definition" : "Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.", "min" : 0, "max" : "1", "base" : { "path" : "Element.id", "min" : 0, "max" : "1" }, "type" : [{ "extension" : [{ "url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type", "valueUrl" : "id" }], "code" : "http://hl7.org/fhirpath/System.String" }], "condition" : ["ele-1"], "isModifier" : false, "isSummary" : false, "mapping" : [{ "identity" : "rim", "map" : "n/a" }] }, { "id" : "ClaimResponse.text.extension", "path" : "ClaimResponse.text.extension", "slicing" : { "discriminator" : [{ "type" : "value", "path" : "url" }], "description" : "Extensions are always sliced by (at least) url", "ordered" : false, "rules" : "open" }, "short" : "Extension", "definition" : "An Extension", "min" : 0, "max" : "*", "base" : { "path" : "Element.extension", "min" : 0, "max" : "*" }, "type" : [{ "code" : "Extension" }], "constraint" : [{ "key" : "ele-1", "severity" : "error", "human" : "All FHIR elements must have a @value or children", "expression" : "hasValue() or (children().count() > id.count())", "source" : "http://hl7.org/fhir/StructureDefinition/Element|5.0.0" }, { "key" : "ext-1", "severity" : "error", "human" : "Must have either extensions or value[x], not both", "expression" : "extension.exists() != value.exists()", "source" : "http://hl7.org/fhir/StructureDefinition/Extension|5.0.0" }], "isModifier" : false, "isSummary" : false }, { "id" : "ClaimResponse.text.extension:text", "path" : "ClaimResponse.text.extension", "sliceName" : "text", "short" : "DSTU2: text additional types", "definition" : "DSTU2: `ClaimResponse.text` additional types (Narrative) additional types from child elements (div, status)", "comment" : "Element `ClaimResponse.text` is mapped to FHIR R5 element `ClaimResponse.text` as `SourceIsBroaderThanTarget`.\nThe mappings for `ClaimResponse.text` do not cover the following types: Narrative.\nThe mappings for `ClaimResponse.text` do not cover the following types based on type expansion: div, status.\nContained resources do not have narrative. Resources that are not contained SHOULD have a narrative.", "min" : 0, "max" : "1", "base" : { "path" : "Element.extension", "min" : 0, "max" : "*" }, "type" : [{ "code" : "Extension", "profile" : ["http://hl7.org/fhir/1.0/StructureDefinition/extension-ClaimResponse.text|0.1.0"] }], "constraint" : [{ "key" : "ele-1", "severity" : "error", "human" : "All FHIR elements must have a @value or children", "expression" : "hasValue() or (children().count() > id.count())", "source" : "http://hl7.org/fhir/StructureDefinition/Element|5.0.0" }, { "key" : "ext-1", "severity" : "error", "human" : "Must have either extensions or value[x], not both", "expression" : "extension.exists() != value.exists()", "source" : "http://hl7.org/fhir/StructureDefinition/Extension|5.0.0" }], "isModifier" : false, "isSummary" : false }, { "id" : "ClaimResponse.text.status", "path" : "ClaimResponse.text.status", "short" : "generated | extensions | additional | empty", "definition" : "The status of the narrative - whether it's entirely generated (from just the defined data or the extensions too), or whether a human authored it and it may contain additional data.", "min" : 1, "max" : "1", "base" : { "path" : "Narrative.status", "min" : 1, "max" : "1" }, "type" : [{ "code" : "code" }], "constraint" : [{ "key" : "ele-1", "severity" : "error", "human" : "All FHIR elements must have a @value or children", "expression" : "hasValue() or (children().count() > id.count())", "source" : "http://hl7.org/fhir/StructureDefinition/Element|5.0.0" }], "isModifier" : false, "isSummary" : false, "binding" : { "extension" : [{ "url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString" : "NarrativeStatus" }], "strength" : "required", "description" : "The status of a resource narrative.", "valueSet" : "http://hl7.org/fhir/ValueSet/narrative-status|5.0.0" }, "mapping" : [{ "identity" : "rim", "map" : "N/A" }] }, { "id" : "ClaimResponse.text.div", "path" : "ClaimResponse.text.div", "short" : "Limited xhtml content", "definition" : "The actual narrative content, a stripped down version of XHTML.", "comment" : "The contents of the html element are an XHTML fragment containing only the basic html formatting elements described in chapters 7-11 and 15 of the HTML 4.0 standard, elements (either name or href), images and internally contained stylesheets. The XHTML content SHALL NOT contain a head, a body, external stylesheet references, scripts, forms, base/link/xlink, frames, iframes and objects.", "min" : 1, "max" : "1", "base" : { "path" : "Narrative.div", "min" : 1, "max" : "1" }, "type" : [{ "code" : "xhtml" }], "constraint" : [{ "key" : "ele-1", "severity" : "error", "human" : "All FHIR elements must have a @value or children", "expression" : "hasValue() or (children().count() > id.count())", "source" : "http://hl7.org/fhir/StructureDefinition/Element|5.0.0" }, { "key" : "txt-1", "severity" : "error", "human" : "The narrative SHALL contain only the basic html formatting elements and attributes described in chapters 7-11 (except section 4 of chapter 9) and 15 of the HTML 4.0 standard, elements (either name or href), images and internally contained style attributes", "expression" : "htmlChecks()", "source" : "http://hl7.org/fhir/StructureDefinition/Narrative|5.0.0" }, { "key" : "txt-2", "severity" : "error", "human" : "The narrative SHALL have some non-whitespace content", "expression" : "htmlChecks()", "source" : "http://hl7.org/fhir/StructureDefinition/Narrative|5.0.0" }], "isModifier" : false, "isSummary" : false, "mapping" : [{ "identity" : "rim", "map" : "N/A" }] }, { "id" : "ClaimResponse.contained", "path" : "ClaimResponse.contained", "short" : "Contained, inline Resources", "definition" : "These resources do not have an independent existence apart from the resource that contains them - they cannot be identified independently, nor can they have their own independent transaction scope. This is allowed to be a Parameters resource if and only if it is referenced by a resource that provides context/meaning.", "comment" : "This should never be done when the content can be identified properly, as once identification is lost, it is extremely difficult (and context dependent) to restore it again. Contained resources may have profiles and tags in their meta elements, but SHALL NOT have security labels.", "alias" : ["inline resources", "anonymous resources", "contained resources"], "min" : 0, "max" : "*", "base" : { "path" : "DomainResource.contained", "min" : 0, "max" : "*" }, "type" : [{ "code" : "Resource" }], "condition" : ["dom-2", "dom-4", "dom-3", "dom-5"], "mustSupport" : false, "isModifier" : false, "isSummary" : false, "mapping" : [{ "identity" : "rim", "map" : "N/A" }] }, { "id" : "ClaimResponse.extension", "path" : "ClaimResponse.extension", "slicing" : { "discriminator" : [{ "type" : "value", "path" : "url" }], "ordered" : false, "rules" : "open" }, "short" : "Extension", "definition" : "An Extension", "min" : 0, "max" : "*", "base" : { "path" : "DomainResource.extension", "min" : 0, "max" : "*" }, "type" : [{ "code" : "Extension" }], "constraint" : [{ "key" : "ele-1", "severity" : "error", "human" : "All FHIR elements must have a @value or children", "expression" : "hasValue() or (children().count() > id.count())", "source" : "http://hl7.org/fhir/StructureDefinition/Element|5.0.0" }, { "key" : "ext-1", "severity" : "error", "human" : "Must have either extensions or value[x], not both", "expression" : "extension.exists() != value.exists()", "source" : "http://hl7.org/fhir/StructureDefinition/Extension|5.0.0" }], "mustSupport" : false, "isModifier" : false, "isSummary" : false }, { "id" : "ClaimResponse.extension:ruleset", "path" : "ClaimResponse.extension", "sliceName" : "ruleset", "short" : "DSTU2: Resource version (new)", "definition" : "DSTU2: `ClaimResponse.ruleset` (new:Coding)", "comment" : "Element `ClaimResponse.ruleset` has a context of ClaimResponse based on following the parent source element upwards and mapping to `ClaimResponse`.\nElement `ClaimResponse.ruleset` has no mapping targets in FHIR R5. Typically, this is because the element has been added (is a new element).", "min" : 0, "max" : "1", "base" : { "path" : "DomainResource.extension", "min" : 0, "max" : "*" }, "type" : [{ "code" : "Extension", "profile" : ["http://hl7.org/fhir/1.0/StructureDefinition/extension-ClaimResponse.ruleset|0.1.0"] }], "constraint" : [{ "key" : "ele-1", "severity" : "error", "human" : "All FHIR elements must have a @value or children", "expression" : "hasValue() or (children().count() > id.count())", "source" : "http://hl7.org/fhir/StructureDefinition/Element|5.0.0" }, { "key" : "ext-1", "severity" : "error", "human" : "Must have either extensions or value[x], not both", "expression" : "extension.exists() != value.exists()", "source" : "http://hl7.org/fhir/StructureDefinition/Extension|5.0.0" }], "mustSupport" : false, "isModifier" : false, "isSummary" : false }, { "id" : "ClaimResponse.extension:originalRuleset", "path" : "ClaimResponse.extension", "sliceName" : "originalRuleset", "short" : "DSTU2: Original version (new)", "definition" : "DSTU2: `ClaimResponse.originalRuleset` (new:Coding)", "comment" : "Element `ClaimResponse.originalRuleset` has a context of ClaimResponse based on following the parent source element upwards and mapping to `ClaimResponse`.\nElement `ClaimResponse.originalRuleset` has no mapping targets in FHIR R5. Typically, this is because the element has been added (is a new element).", "min" : 0, "max" : "1", "base" : { "path" : "DomainResource.extension", "min" : 0, "max" : "*" }, "type" : [{ "code" : "Extension", "profile" : ["http://hl7.org/fhir/1.0/StructureDefinition/extension-ClaimResponse.originalRuleset|0.1.0"] }], "constraint" : [{ "key" : "ele-1", "severity" : "error", "human" : "All FHIR elements must have a @value or children", "expression" : "hasValue() or (children().count() > id.count())", "source" : "http://hl7.org/fhir/StructureDefinition/Element|5.0.0" }, { "key" : "ext-1", "severity" : "error", "human" : "Must have either extensions or value[x], not both", "expression" : "extension.exists() != value.exists()", "source" : "http://hl7.org/fhir/StructureDefinition/Extension|5.0.0" }], "mustSupport" : false, "isModifier" : false, "isSummary" : false }, { "id" : "ClaimResponse.extension:unallocDeductable", "path" : "ClaimResponse.extension", "sliceName" : "unallocDeductable", "short" : "DSTU2: Unallocated deductible (new)", "definition" : "DSTU2: `ClaimResponse.unallocDeductable` (new:Quantity[Money])", "comment" : "Element `ClaimResponse.unallocDeductable` has a context of ClaimResponse based on following the parent source element upwards and mapping to `ClaimResponse`.\nElement `ClaimResponse.unallocDeductable` has no mapping targets in FHIR R5. Typically, this is because the element has been added (is a new element).", "min" : 0, "max" : "1", "base" : { "path" : "DomainResource.extension", "min" : 0, "max" : "*" }, "type" : [{ "code" : "Extension", "profile" : ["http://hl7.org/fhir/1.0/StructureDefinition/extension-ClaimResponse.unallocDeductable|0.1.0"] }], "constraint" : [{ "key" : "ele-1", "severity" : "error", "human" : "All FHIR elements must have a @value or children", "expression" : "hasValue() or (children().count() > id.count())", "source" : "http://hl7.org/fhir/StructureDefinition/Element|5.0.0" }, { "key" : "ext-1", "severity" : "error", "human" : "Must have either extensions or value[x], not both", "expression" : "extension.exists() != value.exists()", "source" : "http://hl7.org/fhir/StructureDefinition/Extension|5.0.0" }], "mustSupport" : false, "isModifier" : false, "isSummary" : false }, { "id" : "ClaimResponse.modifierExtension", "path" : "ClaimResponse.modifierExtension", "short" : "Extensions that cannot be ignored", "definition" : "May be used to represent additional information that is not part of the basic definition of the resource and that modifies the understanding of the element that contains it and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and managable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.\n\nModifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).", "comment" : "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.", "requirements" : "Modifier extensions allow for extensions that *cannot* be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the [definition of modifier extensions](http://hl7.org/fhir/R5/extensibility.html#modifierExtension).", "alias" : ["extensions", "user content"], "min" : 0, "max" : "*", "base" : { "path" : "DomainResource.modifierExtension", "min" : 0, "max" : "*" }, "type" : [{ "code" : "Extension" }], "constraint" : [{ "key" : "ele-1", "severity" : "error", "human" : "All FHIR elements must have a @value or children", "expression" : "hasValue() or (children().count() > id.count())", "source" : "http://hl7.org/fhir/StructureDefinition/Element|5.0.0" }, { "key" : "ext-1", "severity" : "error", "human" : "Must have either extensions or value[x], not both", "expression" : "extension.exists() != value.exists()", "source" : "http://hl7.org/fhir/StructureDefinition/Extension|5.0.0" }], "mustSupport" : false, "isModifier" : true, "isModifierReason" : "Modifier extensions are expected to modify the meaning or interpretation of the resource that contains them", "isSummary" : true, "mapping" : [{ "identity" : "rim", "map" : "N/A" }] }, { "id" : "ClaimResponse.identifier", "path" : "ClaimResponse.identifier", "short" : "Business Identifier for a claim response", "definition" : "A unique identifier assigned to this claim response.", "requirements" : "Allows claim responses to be distinguished and referenced.", "min" : 0, "max" : "*", "base" : { "path" : "ClaimResponse.identifier", "min" : 0, "max" : "*" }, "type" : [{ "code" : "Identifier" }], "constraint" : [{ "key" : "ele-1", "severity" : "error", "human" : "All FHIR elements must have a @value or children", "expression" : "hasValue() or (children().count() > id.count())", "source" : "http://hl7.org/fhir/StructureDefinition/Element|5.0.0" }], "mustSupport" : false, "isModifier" : false, "isSummary" : false, "mapping" : [{ "identity" : "workflow", "map" : "Event.identifier" }, { "identity" : "w5", "map" : "FiveWs.identifier" }] }, { "id" : "ClaimResponse.identifier.id", "path" : "ClaimResponse.identifier.id", "representation" : ["xmlAttr"], "short" : "Unique id for inter-element referencing", "definition" : "Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.", "min" : 0, "max" : "1", "base" : { "path" : "Element.id", "min" : 0, "max" : "1" }, "type" : [{ "extension" : [{ "url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type", "valueUrl" : "id" }], "code" : "http://hl7.org/fhirpath/System.String" }], "condition" : ["ele-1"], "isModifier" : false, "isSummary" : false, "mapping" : [{ "identity" : "rim", "map" : "n/a" }] }, { "id" : "ClaimResponse.identifier.extension", "path" : "ClaimResponse.identifier.extension", "slicing" : { "discriminator" : [{ "type" : "value", "path" : "url" }], "description" : "Extensions are always sliced by (at least) url", "ordered" : false, "rules" : "open" }, "short" : "Extension", "definition" : "An Extension", "min" : 0, "max" : "*", "base" : { "path" : "Element.extension", "min" : 0, "max" : "*" }, "type" : [{ "code" : "Extension" }], "constraint" : [{ "key" : "ele-1", "severity" : "error", "human" : "All FHIR elements must have a @value or children", "expression" : "hasValue() or (children().count() > id.count())", "source" : "http://hl7.org/fhir/StructureDefinition/Element|5.0.0" }, { "key" : "ext-1", "severity" : "error", "human" : "Must have either extensions or value[x], not both", "expression" : "extension.exists() != value.exists()", "source" : "http://hl7.org/fhir/StructureDefinition/Extension|5.0.0" }], "isModifier" : false, "isSummary" : false }, { "id" : "ClaimResponse.identifier.extension:identifier", "path" : "ClaimResponse.identifier.extension", "sliceName" : "identifier", "short" : "DSTU2: Response number additional types", "definition" : "DSTU2: `ClaimResponse.identifier` additional types (Identifier) additional types from child elements (assigner, period, system, type, use, value)", "comment" : "Element `ClaimResponse.identifier` is mapped to FHIR R5 element `ClaimResponse.identifier` as `SourceIsBroaderThanTarget`.\nThe mappings for `ClaimResponse.identifier` do not cover the following types: Identifier.\nThe mappings for `ClaimResponse.identifier` do not cover the following types based on type expansion: assigner, period, system, type, use, value.", "min" : 0, "max" : "*", "base" : { "path" : "Element.extension", "min" : 0, "max" : "*" }, "type" : [{ "code" : "Extension", "profile" : ["http://hl7.org/fhir/1.0/StructureDefinition/extension-ClaimResponse.identifier|0.1.0"] }], "constraint" : [{ "key" : "ele-1", "severity" : "error", "human" : "All FHIR elements must have a @value or children", "expression" : "hasValue() or (children().count() > id.count())", "source" : "http://hl7.org/fhir/StructureDefinition/Element|5.0.0" }, { "key" : "ext-1", "severity" : "error", "human" : "Must have either extensions or value[x], not both", "expression" : "extension.exists() != value.exists()", "source" : "http://hl7.org/fhir/StructureDefinition/Extension|5.0.0" }], "isModifier" : false, "isSummary" : false }, { "id" : "ClaimResponse.identifier.use", "path" : "ClaimResponse.identifier.use", "short" : "usual | official | temp | secondary | old (If known)", "definition" : "The purpose of this identifier.", "comment" : "Applications can assume that an identifier is permanent unless it explicitly says that it is temporary.", "requirements" : "Allows the appropriate identifier for a particular context of use to be selected from among a set of identifiers.", "min" : 0, "max" : "1", "base" : { "path" : "Identifier.use", "min" : 0, "max" : "1" }, "type" : [{ "code" : "code" }], "constraint" : [{ "key" : "ele-1", "severity" : "error", "human" : "All FHIR elements must have a @value or children", "expression" : "hasValue() or (children().count() > id.count())", "source" : "http://hl7.org/fhir/StructureDefinition/Element|5.0.0" }], "isModifier" : true, "isModifierReason" : "This is labeled as \"Is Modifier\" because applications should not mistake a temporary id for a permanent one.", "isSummary" : true, "binding" : { "extension" : [{ "url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString" : "IdentifierUse" }], "strength" : "required", "description" : "Identifies the purpose for this identifier, if known .", "valueSet" : "http://hl7.org/fhir/ValueSet/identifier-use|5.0.0" }, "mapping" : [{ "identity" : "v2", "map" : "N/A" }, { "identity" : "rim", "map" : "Role.code or implied by context" }] }, { "id" : "ClaimResponse.identifier.type", "path" : "ClaimResponse.identifier.type", "short" : "Description of identifier", "definition" : "A coded type for the identifier that can be used to determine which identifier to use for a specific purpose.", "comment" : "This element deals only with general categories of identifiers. It SHOULD not be used for codes that correspond 1..1 with the Identifier.system. Some identifiers may fall into multiple categories due to common usage. Where the system is known, a type is unnecessary because the type is always part of the system definition. However systems often need to handle identifiers where the system is not known. There is not a 1:1 relationship between type and system, since many different systems have the same type.", "requirements" : "Allows users to make use of identifiers when the identifier system is not known.", "min" : 0, "max" : "1", "base" : { "path" : "Identifier.type", "min" : 0, "max" : "1" }, "type" : [{ "code" : "CodeableConcept" }], "constraint" : [{ "key" : "ele-1", "severity" : "error", "human" : "All FHIR elements must have a @value or children", "expression" : "hasValue() or (children().count() > id.count())", "source" : "http://hl7.org/fhir/StructureDefinition/Element|5.0.0" }], "isModifier" : false, "isSummary" : true, "binding" : { "extension" : [{ "url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString" : "IdentifierType" }], "strength" : "extensible", "description" : "A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.", "valueSet" : "http://hl7.org/fhir/ValueSet/identifier-type|5.0.0" }, "mapping" : [{ "identity" : "v2", "map" : "CX.5" }, { "identity" : "rim", "map" : "Role.code or implied by context" }] }, { "id" : "ClaimResponse.identifier.system", "path" : "ClaimResponse.identifier.system", "short" : "The namespace for the identifier value", "definition" : "Establishes the namespace for the value - that is, an absolute URL that describes a set values that are unique.", "comment" : "Identifier.system is always case sensitive.", "requirements" : "There are many sets of identifiers. To perform matching of two identifiers, we need to know what set we're dealing with. The system identifies a particular set of unique identifiers.", "min" : 0, "max" : "1", "base" : { "path" : "Identifier.system", "min" : 0, "max" : "1" }, "type" : [{ "code" : "uri" }], "example" : [{ "label" : "General", "valueUri" : "http://www.acme.com/identifiers/patient" }], "constraint" : [{ "key" : "ele-1", "severity" : "error", "human" : "All FHIR elements must have a @value or children", "expression" : "hasValue() or (children().count() > id.count())", "source" : "http://hl7.org/fhir/StructureDefinition/Element|5.0.0" }], "isModifier" : false, "isSummary" : true, "mapping" : [{ "identity" : "v2", "map" : "CX.4 / EI-2-4" }, { "identity" : "rim", "map" : "II.root or Role.id.root" }, { "identity" : "servd", "map" : "./IdentifierType" }] }, { "id" : "ClaimResponse.identifier.value", "path" : "ClaimResponse.identifier.value", "short" : "The value that is unique", "definition" : "The portion of the identifier typically relevant to the user and which is unique within the context of the system.", "comment" : "If the value is a full URI, then the system SHALL be urn:ietf:rfc:3986. The value's primary purpose is computational mapping. As a result, it may be normalized for comparison purposes (e.g. removing non-significant whitespace, dashes, etc.) A value formatted for human display can be conveyed using the [http://hl7.org/fhir/StructureDefinition/rendered-value](http://hl7.org/fhir/extensions/StructureDefinition-rendered-value.html)). Identifier.value is to be treated as case sensitive unless knowledge of the Identifier.system allows the processer to be confident that non-case-sensitive processing is safe.", "min" : 0, "max" : "1", "base" : { "path" : "Identifier.value", "min" : 0, "max" : "1" }, "type" : [{ "code" : "string" }], "example" : [{ "label" : "General", "valueString" : "123456" }], "condition" : ["ident-1"], "constraint" : [{ "key" : "ele-1", "severity" : "error", "human" : "All FHIR elements must have a @value or children", "expression" : "hasValue() or (children().count() > id.count())", "source" : "http://hl7.org/fhir/StructureDefinition/Element|5.0.0" }], "isModifier" : false, "isSummary" : true, "mapping" : [{ "identity" : "v2", "map" : "CX.1 / EI.1" }, { "identity" : "rim", "map" : "II.extension or II.root if system indicates OID or GUID (Or Role.id.extension or root)" }, { "identity" : "servd", "map" : "./Value" }] }, { "id" : "ClaimResponse.identifier.period", "path" : "ClaimResponse.identifier.period", "short" : "Time period when id is/was valid for use", "definition" : "Time period during which identifier is/was valid for use.", "min" : 0, "max" : "1", "base" : { "path" : "Identifier.period", "min" : 0, "max" : "1" }, "type" : [{ "code" : "Period" }], "constraint" : [{ "key" : "ele-1", "severity" : "error", "human" : "All FHIR elements must have a @value or children", "expression" : "hasValue() or (children().count() > id.count())", "source" : "http://hl7.org/fhir/StructureDefinition/Element|5.0.0" }], "isModifier" : false, "isSummary" : true, "mapping" : [{ "identity" : "v2", "map" : "CX.7 + CX.8" }, { "identity" : "rim", "map" : "Role.effectiveTime or implied by context" }, { "identity" : "servd", "map" : "./StartDate and ./EndDate" }] }, { "id" : "ClaimResponse.identifier.assigner", "path" : "ClaimResponse.identifier.assigner", "short" : "Organization that issued id (may be just text)", "definition" : "Organization that issued/manages the identifier.", "comment" : "The Identifier.assigner may omit the .reference element and only contain a .display element reflecting the name or other textual information about the assigning organization.", "min" : 0, "max" : "1", "base" : { "path" : "Identifier.assigner", "min" : 0, "max" : "1" }, "type" : [{ "code" : "Reference", "targetProfile" : ["http://hl7.org/fhir/StructureDefinition/Organization|5.0.0"] }], "constraint" : [{ "key" : "ele-1", "severity" : "error", "human" : "All FHIR elements must have a @value or children", "expression" : "hasValue() or (children().count() > id.count())", "source" : "http://hl7.org/fhir/StructureDefinition/Element|5.0.0" }], "isModifier" : false, "isSummary" : true, "mapping" : [{ "identity" : "v2", "map" : "CX.4 / (CX.4,CX.9,CX.10)" }, { "identity" : "rim", "map" : "II.assigningAuthorityName but note that this is an improper use by the definition of the field. Also Role.scoper" }, { "identity" : "servd", "map" : "./IdentifierIssuingAuthority" }] }, { "id" : "ClaimResponse.traceNumber", "path" : "ClaimResponse.traceNumber", "short" : "Number for tracking", "definition" : "Trace number for tracking purposes. May be defined at the jurisdiction level or between trading partners.", "requirements" : "Allows partners to uniquely identify components for tracking.", "min" : 0, "max" : "*", "base" : { "path" : "ClaimResponse.traceNumber", "min" : 0, "max" : "*" }, "type" : [{ "code" : "Identifier" }], "constraint" : [{ "key" : "ele-1", "severity" : "error", "human" : "All FHIR elements must have a @value or children", "expression" : "hasValue() or (children().count() > id.count())", "source" : "http://hl7.org/fhir/StructureDefinition/Element|5.0.0" }], "mustSupport" : false, "isModifier" : false, "isSummary" : false }, { "id" : "ClaimResponse.status", "path" : "ClaimResponse.status", "short" : "active | cancelled | draft | entered-in-error", "definition" : "The status of the resource instance.", "comment" : "This element is labeled as a modifier because the status contains codes that mark the resource as not currently valid.", "requirements" : "Need to track the status of the resource as 'draft' resources may undergo further edits while 'active' resources are immutable and may only have their status changed to 'cancelled'.", "min" : 1, "max" : "1", "base" : { "path" : "ClaimResponse.status", "min" : 1, "max" : "1" }, "type" : [{ "code" : "code" }], "constraint" : [{ "key" : "ele-1", "severity" : "error", "human" : "All FHIR elements must have a @value or children", "expression" : "hasValue() or (children().count() > id.count())", "source" : "http://hl7.org/fhir/StructureDefinition/Element|5.0.0" }], "mustSupport" : false, "isModifier" : true, "isModifierReason" : "This element is labeled as a modifier because it is a status element that contains status entered-in-error which means that the resource should not be treated as valid", "isSummary" : true, "binding" : { "extension" : [{ "url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString" : "ClaimResponseStatus" }], "strength" : "required", "description" : "A code specifying the state of the resource instance.", "valueSet" : "http://hl7.org/fhir/ValueSet/fm-status|5.0.0" }, "mapping" : [{ "identity" : "workflow", "map" : "Event.status" }, { "identity" : "w5", "map" : "FiveWs.status" }] }, { "id" : "ClaimResponse.type", "path" : "ClaimResponse.type", "short" : "More granular claim type", "definition" : "A finer grained suite of claim type codes which may convey additional information such as Inpatient vs Outpatient and/or a specialty service.", "comment" : "This may contain the local bill type codes, for example the US UB-04 bill type code or the CMS bill type.", "requirements" : "Some jurisdictions need a finer grained claim type for routing and adjudication.", "min" : 1, "max" : "1", "base" : { "path" : "ClaimResponse.type", "min" : 1, "max" : "1" }, "type" : [{ "code" : "CodeableConcept" }], "constraint" : [{ "key" : "ele-1", "severity" : "error", "human" : "All FHIR elements must have a @value or children", "expression" : "hasValue() or (children().count() > id.count())", "source" : "http://hl7.org/fhir/StructureDefinition/Element|5.0.0" }], "mustSupport" : false, "isModifier" : false, "isSummary" : true, "binding" : { "extension" : [{ "url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString" : "ClaimType" }], "strength" : "extensible", "description" : "The type or discipline-style of the claim.", "valueSet" : "http://hl7.org/fhir/ValueSet/claim-type|5.0.0" }, "mapping" : [{ "identity" : "w5", "map" : "FiveWs.class" }] }, { "id" : "ClaimResponse.subType", "path" : "ClaimResponse.subType", "short" : "More granular claim type", "definition" : "A finer grained suite of claim type codes which may convey additional information such as Inpatient vs Outpatient and/or a specialty service.", "comment" : "This may contain the local bill type codes, for example the US UB-04 bill type code or the CMS bill type.", "requirements" : "Some jurisdictions need a finer grained claim type for routing and adjudication.", "min" : 0, "max" : "1", "base" : { "path" : "ClaimResponse.subType", "min" : 0, "max" : "1" }, "type" : [{ "code" : "CodeableConcept" }], "constraint" : [{ "key" : "ele-1", "severity" : "error", "human" : "All FHIR elements must have a @value or children", "expression" : "hasValue() or (children().count() > id.count())", "source" : "http://hl7.org/fhir/StructureDefinition/Element|5.0.0" }], "mustSupport" : false, "isModifier" : false, "isSummary" : false, "binding" : { "extension" : [{ "url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString" : "ClaimSubType" }], "strength" : "example", "description" : "A more granular claim typecode.", "valueSet" : "http://hl7.org/fhir/ValueSet/claim-subtype|5.0.0" }, "mapping" : [{ "identity" : "w5", "map" : "FiveWs.class" }] }, { "id" : "ClaimResponse.use", "path" : "ClaimResponse.use", "short" : "claim | preauthorization | predetermination", "definition" : "A code to indicate whether the nature of the request is: Claim - A request to an Insurer to adjudicate the supplied charges for health care goods and services under the identified policy and to pay the determined Benefit amount, if any; Preauthorization - A request to an Insurer to adjudicate the supplied proposed future charges for health care goods and services under the identified policy and to approve the services and provide the expected benefit amounts and potentially to reserve funds to pay the benefits when Claims for the indicated services are later submitted; or, Pre-determination - A request to an Insurer to adjudicate the supplied 'what if' charges for health care goods and services under the identified policy and report back what the Benefit payable would be had the services actually been provided.", "requirements" : "This element is required to understand the nature of the request for adjudication.", "min" : 1, "max" : "1", "base" : { "path" : "ClaimResponse.use", "min" : 1, "max" : "1" }, "type" : [{ "code" : "code" }], "constraint" : [{ "key" : "ele-1", "severity" : "error", "human" : "All FHIR elements must have a @value or children", "expression" : "hasValue() or (children().count() > id.count())", "source" : "http://hl7.org/fhir/StructureDefinition/Element|5.0.0" }], "mustSupport" : false, "isModifier" : false, "isSummary" : true, "binding" : { "extension" : [{ "url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString" : "Use" }], "strength" : "required", "description" : "Claim, preauthorization, predetermination.", "valueSet" : "http://hl7.org/fhir/ValueSet/claim-use|5.0.0" }, "mapping" : [{ "identity" : "w5", "map" : "FiveWs.class" }] }, { "id" : "ClaimResponse.patient", "path" : "ClaimResponse.patient", "short" : "The recipient of the products and services", "definition" : "The party to whom the professional services and/or products have been supplied or are being considered and for whom actual for facast reimbursement is sought.", "requirements" : "The patient must be supplied to the insurer so that confirmation of coverage and service hstory may be considered as part of the authorization and/or adjudiction.", "min" : 1, "max" : "1", "base" : { "path" : "ClaimResponse.patient", "min" : 1, "max" : "1" }, "type" : [{ "code" : "Reference", "targetProfile" : ["http://hl7.org/fhir/StructureDefinition/Patient|5.0.0"] }], "constraint" : [{ "key" : "ele-1", "severity" : "error", "human" : "All FHIR elements must have a @value or children", "expression" : "hasValue() or (children().count() > id.count())", "source" : "http://hl7.org/fhir/StructureDefinition/Element|5.0.0" }], "mustSupport" : false, "isModifier" : false, "isSummary" : true, "mapping" : [{ "identity" : "w5", "map" : "FiveWs.subject[x]" }] }, { "id" : "ClaimResponse.created", "path" : "ClaimResponse.created", "short" : "Response creation date", "definition" : "The date this resource was created.", "requirements" : "Need to record a timestamp for use by both the recipient and the issuer.", "min" : 1, "max" : "1", "base" : { "path" : "ClaimResponse.created", "min" : 1, "max" : "1" }, "type" : [{ "code" : "dateTime" }], "constraint" : [{ "key" : "ele-1", "severity" : "error", "human" : "All FHIR elements must have a @value or children", "expression" : "hasValue() or (children().count() > id.count())", "source" : "http://hl7.org/fhir/StructureDefinition/Element|5.0.0" }], "mustSupport" : false, "isModifier" : false, "isSummary" : true, "mapping" : [{ "identity" : "workflow", "map" : "Event.occurrence[x]" }, { "identity" : "w5", "map" : "FiveWs.recorded" }] }, { "id" : "ClaimResponse.insurer", "path" : "ClaimResponse.insurer", "short" : "Party responsible for reimbursement", "definition" : "The party responsible for authorization, adjudication and reimbursement.", "requirements" : "To be a valid claim, preauthorization or predetermination there must be a party who is responsible for adjudicating the contents against a policy which provides benefits for the patient.", "min" : 0, "max" : "1", "base" : { "path" : "ClaimResponse.insurer", "min" : 0, "max" : "1" }, "type" : [{ "code" : "Reference", "targetProfile" : ["http://hl7.org/fhir/StructureDefinition/Organization|5.0.0"] }], "constraint" : [{ "key" : "ele-1", "severity" : "error", "human" : "All FHIR elements must have a @value or children", "expression" : "hasValue() or (children().count() > id.count())", "source" : "http://hl7.org/fhir/StructureDefinition/Element|5.0.0" }], "mustSupport" : false, "isModifier" : false, "isSummary" : true, "mapping" : [{ "identity" : "workflow", "map" : "Event.performer" }] }, { "id" : "ClaimResponse.insurer.id", "path" : "ClaimResponse.insurer.id", "representation" : ["xmlAttr"], "short" : "Unique id for inter-element referencing", "definition" : "Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.", "min" : 0, "max" : "1", "base" : { "path" : "Element.id", "min" : 0, "max" : "1" }, "type" : [{ "extension" : [{ "url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type", "valueUrl" : "id" }], "code" : "http://hl7.org/fhirpath/System.String" }], "condition" : ["ele-1"], "isModifier" : false, "isSummary" : false, "mapping" : [{ "identity" : "rim", "map" : "n/a" }] }, { "id" : "ClaimResponse.insurer.extension", "path" : "ClaimResponse.insurer.extension", "slicing" : { "discriminator" : [{ "type" : "value", "path" : "url" }], "description" : "Extensions are always sliced by (at least) url", "ordered" : false, "rules" : "open" }, "short" : "Extension", "definition" : "An Extension", "min" : 0, "max" : "*", "base" : { "path" : "Element.extension", "min" : 0, "max" : "*" }, "type" : [{ "code" : "Extension" }], "constraint" : [{ "key" : "ele-1", "severity" : "error", "human" : "All FHIR elements must have a @value or children", "expression" : "hasValue() or (children().count() > id.count())", "source" : "http://hl7.org/fhir/StructureDefinition/Element|5.0.0" }, { "key" : "ext-1", "severity" : "error", "human" : "Must have either extensions or value[x], not both", "expression" : "extension.exists() != value.exists()", "source" : "http://hl7.org/fhir/StructureDefinition/Extension|5.0.0" }], "isModifier" : false, "isSummary" : false }, { "id" : "ClaimResponse.insurer.extension:organization", "path" : "ClaimResponse.insurer.extension", "sliceName" : "organization", "short" : "DSTU2: Insurer additional types", "definition" : "DSTU2: `ClaimResponse.organization` additional types from child elements (display, reference)", "comment" : "Element `ClaimResponse.organization` is mapped to FHIR R5 element `ClaimResponse.insurer` as `SourceIsBroaderThanTarget`.\nThe mappings for `ClaimResponse.organization` do not cover the following types based on type expansion: display, reference.\nThe standard extension `alternate-reference` has been mapped as the representation of FHIR DSTU2 element `ClaimResponse.organization` with unmapped reference targets: Organization.", "min" : 0, "max" : "1", "base" : { "path" : "Element.extension", "min" : 0, "max" : "*" }, "type" : [{ "code" : "Extension", "profile" : ["http://hl7.org/fhir/StructureDefinition/alternate-reference|5.2.0"] }], "constraint" : [{ "key" : "ele-1", "severity" : "error", "human" : "All FHIR elements must have a @value or children", "expression" : "hasValue() or (children().count() > id.count())", "source" : "http://hl7.org/fhir/StructureDefinition/Element|5.0.0" }, { "key" : "ext-1", "severity" : "error", "human" : "Must have either extensions or value[x], not both", "expression" : "extension.exists() != value.exists()", "source" : "http://hl7.org/fhir/StructureDefinition/Extension|5.0.0" }], "isModifier" : false, "isSummary" : false }, { "id" : "ClaimResponse.insurer.reference", "path" : "ClaimResponse.insurer.reference", "short" : "Literal reference, Relative, internal or absolute URL", "definition" : "A reference to a location at which the other resource is found. The reference may be a relative reference, in which case it is relative to the service base URL, or an absolute URL that resolves to the location where the resource is found. The reference may be version specific or not. If the reference is not to a FHIR RESTful server, then it should be assumed to be version specific. Internal fragment references (start with '#') refer to contained resources.", "comment" : "Using absolute URLs provides a stable scalable approach suitable for a cloud/web context, while using relative/logical references provides a flexible approach suitable for use when trading across closed eco-system boundaries. Absolute URLs do not need to point to a FHIR RESTful server, though this is the preferred approach. If the URL conforms to the structure \"[type]/[id]\" then it should be assumed that the reference is to a FHIR RESTful server.", "min" : 0, "max" : "1", "base" : { "path" : "Reference.reference", "min" : 0, "max" : "1" }, "type" : [{ "code" : "string" }], "condition" : ["ref-2", "ref-1"], "constraint" : [{ "key" : "ele-1", "severity" : "error", "human" : "All FHIR elements must have a @value or children", "expression" : "hasValue() or (children().count() > id.count())", "source" : "http://hl7.org/fhir/StructureDefinition/Element|5.0.0" }], "isModifier" : false, "isSummary" : true, "mapping" : [{ "identity" : "rim", "map" : "N/A" }] }, { "id" : "ClaimResponse.insurer.type", "path" : "ClaimResponse.insurer.type", "short" : "Type the reference refers to (e.g. \"Patient\") - must be a resource in resources", "definition" : "The expected type of the target of the reference. If both Reference.type and Reference.reference are populated and Reference.reference is a FHIR URL, both SHALL be consistent.\n\nThe type is the Canonical URL of Resource Definition that is the type this reference refers to. References are URLs that are relative to http://hl7.org/fhir/StructureDefinition/ e.g. \"Patient\" is a reference to http://hl7.org/fhir/StructureDefinition/Patient. Absolute URLs are only allowed for logical models (and can only be used in references in logical models, not resources).", "comment" : "This element is used to indicate the type of the target of the reference. This may be used which ever of the other elements are populated (or not). In some cases, the type of the target may be determined by inspection of the reference (e.g. a known RESTful URL) or by resolving the target of the reference.", "min" : 0, "max" : "1", "base" : { "path" : "Reference.type", "min" : 0, "max" : "1" }, "type" : [{ "code" : "uri" }], "constraint" : [{ "key" : "ele-1", "severity" : "error", "human" : "All FHIR elements must have a @value or children", "expression" : "hasValue() or (children().count() > id.count())", "source" : "http://hl7.org/fhir/StructureDefinition/Element|5.0.0" }], "isModifier" : false, "isSummary" : true, "binding" : { "extension" : [{ "url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString" : "FHIRResourceTypeExt" }], "strength" : "extensible", "description" : "Aa resource (or, for logical models, the URI of the logical model).", "valueSet" : "http://hl7.org/fhir/ValueSet/resource-types|5.0.0" }, "mapping" : [{ "identity" : "rim", "map" : "N/A" }] }, { "id" : "ClaimResponse.insurer.identifier", "path" : "ClaimResponse.insurer.identifier", "short" : "Logical reference, when literal reference is not known", "definition" : "An identifier for the target resource. This is used when there is no way to reference the other resource directly, either because the entity it represents is not available through a FHIR server, or because there is no way for the author of the resource to convert a known identifier to an actual location. There is no requirement that a Reference.identifier point to something that is actually exposed as a FHIR instance, but it SHALL point to a business concept that would be expected to be exposed as a FHIR instance, and that instance would need to be of a FHIR resource type allowed by the reference.", "comment" : "When an identifier is provided in place of a reference, any system processing the reference will only be able to resolve the identifier to a reference if it understands the business context in which the identifier is used. Sometimes this is global (e.g. a national identifier) but often it is not. For this reason, none of the useful mechanisms described for working with references (e.g. chaining, includes) are possible, nor should servers be expected to be able resolve the reference. Servers may accept an identifier based reference untouched, resolve it, and/or reject it - see CapabilityStatement.rest.resource.referencePolicy. \n\nWhen both an identifier and a literal reference are provided, the literal reference is preferred. Applications processing the resource are allowed - but not required - to check that the identifier matches the literal reference\n\nApplications converting a logical reference to a literal reference may choose to leave the logical reference present, or remove it.\n\nReference is intended to point to a structure that can potentially be expressed as a FHIR resource, though there is no need for it to exist as an actual FHIR resource instance - except in as much as an application wishes to actual find the target of the reference. The content referred to be the identifier must meet the logical constraints implied by any limitations on what resource types are permitted for the reference. For example, it would not be legitimate to send the identifier for a drug prescription if the type were Reference(Observation|DiagnosticReport). One of the use-cases for Reference.identifier is the situation where no FHIR representation exists (where the type is Reference (Any).\n\nThis element only allows for a single identifier. In the case where additional identifers are required, use the [http://hl7.org/fhir/StructureDefinition/additionalIdentifier](http://hl7.org/fhir/extensions/StructureDefinition-additionalIdentifier.html) extension.", "min" : 0, "max" : "1", "base" : { "path" : "Reference.identifier", "min" : 0, "max" : "1" }, "type" : [{ "code" : "Identifier" }], "condition" : ["ref-2"], "constraint" : [{ "key" : "ele-1", "severity" : "error", "human" : "All FHIR elements must have a @value or children", "expression" : "hasValue() or (children().count() > id.count())", "source" : "http://hl7.org/fhir/StructureDefinition/Element|5.0.0" }], "isModifier" : false, "isSummary" : true, "mapping" : [{ "identity" : "rim", "map" : ".identifier" }] }, { "id" : "ClaimResponse.insurer.display", "extension" : [{ "url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-translatable", "valueBoolean" : true }, { "url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-translatable", "valueBoolean" : true }], "path" : "ClaimResponse.insurer.display", "short" : "Text alternative for the resource", "definition" : "Plain text narrative that identifies the resource in addition to the resource reference.", "comment" : "This is generally not the same as the Resource.text of the referenced resource. The purpose is to identify what's being referenced, not to fully describe it.", "min" : 0, "max" : "1", "base" : { "path" : "Reference.display", "min" : 0, "max" : "1" }, "type" : [{ "code" : "string" }], "condition" : ["ref-2"], "constraint" : [{ "key" : "ele-1", "severity" : "error", "human" : "All FHIR elements must have a @value or children", "expression" : "hasValue() or (children().count() > id.count())", "source" : "http://hl7.org/fhir/StructureDefinition/Element|5.0.0" }], "isModifier" : false, "isSummary" : true, "mapping" : [{ "identity" : "rim", "map" : "N/A" }] }, { "id" : "ClaimResponse.requestor", "path" : "ClaimResponse.requestor", "short" : "Party responsible for the claim", "definition" : "The provider which is responsible for the claim, predetermination or preauthorization.", "comment" : "Typically this field would be 1..1 where this party is accountable for the data content within the claim but is not necessarily the facility, provider group or practitioner who provided the products and services listed within this claim resource. This field is the Billing Provider, for example, a facility, provider group, lab or practitioner..", "min" : 0, "max" : "1", "base" : { "path" : "ClaimResponse.requestor", "min" : 0, "max" : "1" }, "type" : [{ "code" : "Reference", "targetProfile" : ["http://hl7.org/fhir/StructureDefinition/Practitioner|5.0.0", "http://hl7.org/fhir/StructureDefinition/PractitionerRole|5.0.0", "http://hl7.org/fhir/StructureDefinition/Organization|5.0.0"] }], "constraint" : [{ "key" : "ele-1", "severity" : "error", "human" : "All FHIR elements must have a @value or children", "expression" : "hasValue() or (children().count() > id.count())", "source" : "http://hl7.org/fhir/StructureDefinition/Element|5.0.0" }], "mustSupport" : false, "isModifier" : false, "isSummary" : false, "mapping" : [{ "identity" : "w5", "map" : "FiveWs.source" }] }, { "id" : "ClaimResponse.requestor.id", "path" : "ClaimResponse.requestor.id", "representation" : ["xmlAttr"], "short" : "Unique id for inter-element referencing", "definition" : "Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.", "min" : 0, "max" : "1", "base" : { "path" : "Element.id", "min" : 0, "max" : "1" }, "type" : [{ "extension" : [{ "url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type", "valueUrl" : "id" }], "code" : "http://hl7.org/fhirpath/System.String" }], "condition" : ["ele-1"], "isModifier" : false, "isSummary" : false, "mapping" : [{ "identity" : "rim", "map" : "n/a" }] }, { "id" : "ClaimResponse.requestor.extension", "path" : "ClaimResponse.requestor.extension", "slicing" : { "discriminator" : [{ "type" : "value", "path" : "url" }], "description" : "Extensions are always sliced by (at least) url", "ordered" : false, "rules" : "open" }, "short" : "Extension", "definition" : "An Extension", "min" : 0, "max" : "*", "base" : { "path" : "Element.extension", "min" : 0, "max" : "*" }, "type" : [{ "code" : "Extension" }], "constraint" : [{ "key" : "ele-1", "severity" : "error", "human" : "All FHIR elements must have a @value or children", "expression" : "hasValue() or (children().count() > id.count())", "source" : "http://hl7.org/fhir/StructureDefinition/Element|5.0.0" }, { "key" : "ext-1", "severity" : "error", "human" : "Must have either extensions or value[x], not both", "expression" : "extension.exists() != value.exists()", "source" : "http://hl7.org/fhir/StructureDefinition/Extension|5.0.0" }], "isModifier" : false, "isSummary" : false }, { "id" : "ClaimResponse.requestor.extension:requestProvider", "path" : "ClaimResponse.requestor.extension", "sliceName" : "requestProvider", "short" : "DSTU2: Responsible practitioner additional types", "definition" : "DSTU2: `ClaimResponse.requestProvider` additional types from child elements (display, reference)", "comment" : "Element `ClaimResponse.requestProvider` is mapped to FHIR R5 element `ClaimResponse.requestor` as `RelatedTo`.\nThe mappings for `ClaimResponse.requestProvider` do not cover the following types based on type expansion: display, reference.\nThe standard extension `alternate-reference` has been mapped as the representation of FHIR DSTU2 element `ClaimResponse.requestProvider` with unmapped reference targets: Practitioner.", "min" : 0, "max" : "1", "base" : { "path" : "Element.extension", "min" : 0, "max" : "*" }, "type" : [{ "code" : "Extension", "profile" : ["http://hl7.org/fhir/StructureDefinition/alternate-reference|5.2.0"] }], "constraint" : [{ "key" : "ele-1", "severity" : "error", "human" : "All FHIR elements must have a @value or children", "expression" : "hasValue() or (children().count() > id.count())", "source" : "http://hl7.org/fhir/StructureDefinition/Element|5.0.0" }, { "key" : "ext-1", "severity" : "error", "human" : "Must have either extensions or value[x], not both", "expression" : "extension.exists() != value.exists()", "source" : "http://hl7.org/fhir/StructureDefinition/Extension|5.0.0" }], "isModifier" : false, "isSummary" : false }, { "id" : "ClaimResponse.requestor.extension:requestOrganization", "path" : "ClaimResponse.requestor.extension", "sliceName" : "requestOrganization", "short" : "DSTU2: Responsible organization additional types", "definition" : "DSTU2: `ClaimResponse.requestOrganization` additional types from child elements (display, reference)", "comment" : "Element `ClaimResponse.requestOrganization` is mapped to FHIR R5 element `ClaimResponse.requestor` as `SourceIsBroaderThanTarget`.\nThe mappings for `ClaimResponse.requestOrganization` do not cover the following types based on type expansion: display, reference.\nThe standard extension `alternate-reference` has been mapped as the representation of FHIR DSTU2 element `ClaimResponse.requestOrganization` with unmapped reference targets: Organization.", "min" : 0, "max" : "1", "base" : { "path" : "Element.extension", "min" : 0, "max" : "*" }, "type" : [{ "code" : "Extension", "profile" : ["http://hl7.org/fhir/StructureDefinition/alternate-reference|5.2.0"] }], "constraint" : [{ "key" : "ele-1", "severity" : "error", "human" : "All FHIR elements must have a @value or children", "expression" : "hasValue() or (children().count() > id.count())", "source" : "http://hl7.org/fhir/StructureDefinition/Element|5.0.0" }, { "key" : "ext-1", "severity" : "error", "human" : "Must have either extensions or value[x], not both", "expression" : "extension.exists() != value.exists()", "source" : "http://hl7.org/fhir/StructureDefinition/Extension|5.0.0" }], "isModifier" : false, "isSummary" : false }, { "id" : "ClaimResponse.requestor.reference", "path" : "ClaimResponse.requestor.reference", "short" : "Literal reference, Relative, internal or absolute URL", "definition" : "A reference to a location at which the other resource is found. The reference may be a relative reference, in which case it is relative to the service base URL, or an absolute URL that resolves to the location where the resource is found. The reference may be version specific or not. If the reference is not to a FHIR RESTful server, then it should be assumed to be version specific. Internal fragment references (start with '#') refer to contained resources.", "comment" : "Using absolute URLs provides a stable scalable approach suitable for a cloud/web context, while using relative/logical references provides a flexible approach suitable for use when trading across closed eco-system boundaries. Absolute URLs do not need to point to a FHIR RESTful server, though this is the preferred approach. If the URL conforms to the structure \"[type]/[id]\" then it should be assumed that the reference is to a FHIR RESTful server.", "min" : 0, "max" : "1", "base" : { "path" : "Reference.reference", "min" : 0, "max" : "1" }, "type" : [{ "code" : "string" }], "condition" : ["ref-2", "ref-1"], "constraint" : [{ "key" : "ele-1", "severity" : "error", "human" : "All FHIR elements must have a @value or children", "expression" : "hasValue() or (children().count() > id.count())", "source" : "http://hl7.org/fhir/StructureDefinition/Element|5.0.0" }], "isModifier" : false, "isSummary" : true, "mapping" : [{ "identity" : "rim", "map" : "N/A" }] }, { "id" : "ClaimResponse.requestor.type", "path" : "ClaimResponse.requestor.type", "short" : "Type the reference refers to (e.g. \"Patient\") - must be a resource in resources", "definition" : "The expected type of the target of the reference. If both Reference.type and Reference.reference are populated and Reference.reference is a FHIR URL, both SHALL be consistent.\n\nThe type is the Canonical URL of Resource Definition that is the type this reference refers to. References are URLs that are relative to http://hl7.org/fhir/StructureDefinition/ e.g. \"Patient\" is a reference to http://hl7.org/fhir/StructureDefinition/Patient. Absolute URLs are only allowed for logical models (and can only be used in references in logical models, not resources).", "comment" : "This element is used to indicate the type of the target of the reference. This may be used which ever of the other elements are populated (or not). In some cases, the type of the target may be determined by inspection of the reference (e.g. a known RESTful URL) or by resolving the target of the reference.", "min" : 0, "max" : "1", "base" : { "path" : "Reference.type", "min" : 0, "max" : "1" }, "type" : [{ "code" : "uri" }], "constraint" : [{ "key" : "ele-1", "severity" : "error", "human" : "All FHIR elements must have a @value or children", "expression" : "hasValue() or (children().count() > id.count())", "source" : "http://hl7.org/fhir/StructureDefinition/Element|5.0.0" }], "isModifier" : false, "isSummary" : true, "binding" : { "extension" : [{ "url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString" : "FHIRResourceTypeExt" }], "strength" : "extensible", "description" : "Aa resource (or, for logical models, the URI of the logical model).", "valueSet" : "http://hl7.org/fhir/ValueSet/resource-types|5.0.0" }, "mapping" : [{ "identity" : "rim", "map" : "N/A" }] }, { "id" : "ClaimResponse.requestor.identifier", "path" : "ClaimResponse.requestor.identifier", "short" : "Logical reference, when literal reference is not known", "definition" : "An identifier for the target resource. This is used when there is no way to reference the other resource directly, either because the entity it represents is not available through a FHIR server, or because there is no way for the author of the resource to convert a known identifier to an actual location. There is no requirement that a Reference.identifier point to something that is actually exposed as a FHIR instance, but it SHALL point to a business concept that would be expected to be exposed as a FHIR instance, and that instance would need to be of a FHIR resource type allowed by the reference.", "comment" : "When an identifier is provided in place of a reference, any system processing the reference will only be able to resolve the identifier to a reference if it understands the business context in which the identifier is used. Sometimes this is global (e.g. a national identifier) but often it is not. For this reason, none of the useful mechanisms described for working with references (e.g. chaining, includes) are possible, nor should servers be expected to be able resolve the reference. Servers may accept an identifier based reference untouched, resolve it, and/or reject it - see CapabilityStatement.rest.resource.referencePolicy. \n\nWhen both an identifier and a literal reference are provided, the literal reference is preferred. Applications processing the resource are allowed - but not required - to check that the identifier matches the literal reference\n\nApplications converting a logical reference to a literal reference may choose to leave the logical reference present, or remove it.\n\nReference is intended to point to a structure that can potentially be expressed as a FHIR resource, though there is no need for it to exist as an actual FHIR resource instance - except in as much as an application wishes to actual find the target of the reference. The content referred to be the identifier must meet the logical constraints implied by any limitations on what resource types are permitted for the reference. For example, it would not be legitimate to send the identifier for a drug prescription if the type were Reference(Observation|DiagnosticReport). One of the use-cases for Reference.identifier is the situation where no FHIR representation exists (where the type is Reference (Any).\n\nThis element only allows for a single identifier. In the case where additional identifers are required, use the [http://hl7.org/fhir/StructureDefinition/additionalIdentifier](http://hl7.org/fhir/extensions/StructureDefinition-additionalIdentifier.html) extension.", "min" : 0, "max" : "1", "base" : { "path" : "Reference.identifier", "min" : 0, "max" : "1" }, "type" : [{ "code" : "Identifier" }], "condition" : ["ref-2"], "constraint" : [{ "key" : "ele-1", "severity" : "error", "human" : "All FHIR elements must have a @value or children", "expression" : "hasValue() or (children().count() > id.count())", "source" : "http://hl7.org/fhir/StructureDefinition/Element|5.0.0" }], "isModifier" : false, "isSummary" : true, "mapping" : [{ "identity" : "rim", "map" : ".identifier" }] }, { "id" : "ClaimResponse.requestor.display", "extension" : [{ "url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-translatable", "valueBoolean" : true }, { "url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-translatable", "valueBoolean" : true }], "path" : "ClaimResponse.requestor.display", "short" : "Text alternative for the resource", "definition" : "Plain text narrative that identifies the resource in addition to the resource reference.", "comment" : "This is generally not the same as the Resource.text of the referenced resource. The purpose is to identify what's being referenced, not to fully describe it.", "min" : 0, "max" : "1", "base" : { "path" : "Reference.display", "min" : 0, "max" : "1" }, "type" : [{ "code" : "string" }], "condition" : ["ref-2"], "constraint" : [{ "key" : "ele-1", "severity" : "error", "human" : "All FHIR elements must have a @value or children", "expression" : "hasValue() or (children().count() > id.count())", "source" : "http://hl7.org/fhir/StructureDefinition/Element|5.0.0" }], "isModifier" : false, "isSummary" : true, "mapping" : [{ "identity" : "rim", "map" : "N/A" }] }, { "id" : "ClaimResponse.request", "path" : "ClaimResponse.request", "short" : "Id of resource triggering adjudication", "definition" : "Original request resource reference.", "min" : 0, "max" : "1", "base" : { "path" : "ClaimResponse.request", "min" : 0, "max" : "1" }, "type" : [{ "code" : "Reference", "targetProfile" : ["http://hl7.org/fhir/StructureDefinition/Claim|5.0.0"] }], "constraint" : [{ "key" : "ele-1", "severity" : "error", "human" : "All FHIR elements must have a @value or children", "expression" : "hasValue() or (children().count() > id.count())", "source" : "http://hl7.org/fhir/StructureDefinition/Element|5.0.0" }], "mustSupport" : false, "isModifier" : false, "isSummary" : true, "mapping" : [{ "identity" : "workflow", "map" : "Event.basedOn" }, { "identity" : "w5", "map" : "FiveWs.why[x]" }] }, { "id" : "ClaimResponse.request.id", "path" : "ClaimResponse.request.id", "representation" : ["xmlAttr"], "short" : "Unique id for inter-element referencing", "definition" : "Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.", "min" : 0, "max" : "1", "base" : { "path" : "Element.id", "min" : 0, "max" : "1" }, "type" : [{ "extension" : [{ "url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type", "valueUrl" : "id" }], "code" : "http://hl7.org/fhirpath/System.String" }], "condition" : ["ele-1"], "isModifier" : false, "isSummary" : false, "mapping" : [{ "identity" : "rim", "map" : "n/a" }] }, { "id" : "ClaimResponse.request.extension", "path" : "ClaimResponse.request.extension", "slicing" : { "discriminator" : [{ "type" : "value", "path" : "url" }], "description" : "Extensions are always sliced by (at least) url", "ordered" : false, "rules" : "open" }, "short" : "Extension", "definition" : "An Extension", "min" : 0, "max" : "*", "base" : { "path" : "Element.extension", "min" : 0, "max" : "*" }, "type" : [{ "code" : "Extension" }], "constraint" : [{ "key" : "ele-1", "severity" : "error", "human" : "All FHIR elements must have a @value or children", "expression" : "hasValue() or (children().count() > id.count())", "source" : "http://hl7.org/fhir/StructureDefinition/Element|5.0.0" }, { "key" : "ext-1", "severity" : "error", "human" : "Must have either extensions or value[x], not both", "expression" : "extension.exists() != value.exists()", "source" : "http://hl7.org/fhir/StructureDefinition/Extension|5.0.0" }], "isModifier" : false, "isSummary" : false }, { "id" : "ClaimResponse.request.extension:request", "path" : "ClaimResponse.request.extension", "sliceName" : "request", "short" : "DSTU2: request additional types", "definition" : "DSTU2: `ClaimResponse.request` additional types from child elements (display, reference)", "comment" : "Element `ClaimResponse.request` is mapped to FHIR R5 element `ClaimResponse.request` as `SourceIsBroaderThanTarget`.\nThe mappings for `ClaimResponse.request` do not cover the following types based on type expansion: display, reference.\nThe standard extension `alternate-reference` has been mapped as the representation of FHIR DSTU2 element `ClaimResponse.request` with unmapped reference targets: Claim.", "min" : 0, "max" : "1", "base" : { "path" : "Element.extension", "min" : 0, "max" : "*" }, "type" : [{ "code" : "Extension", "profile" : ["http://hl7.org/fhir/StructureDefinition/alternate-reference|5.2.0"] }], "constraint" : [{ "key" : "ele-1", "severity" : "error", "human" : "All FHIR elements must have a @value or children", "expression" : "hasValue() or (children().count() > id.count())", "source" : "http://hl7.org/fhir/StructureDefinition/Element|5.0.0" }, { "key" : "ext-1", "severity" : "error", "human" : "Must have either extensions or value[x], not both", "expression" : "extension.exists() != value.exists()", "source" : "http://hl7.org/fhir/StructureDefinition/Extension|5.0.0" }], "isModifier" : false, "isSummary" : false }, { "id" : "ClaimResponse.request.reference", "path" : "ClaimResponse.request.reference", "short" : "Literal reference, Relative, internal or absolute URL", "definition" : "A reference to a location at which the other resource is found. The reference may be a relative reference, in which case it is relative to the service base URL, or an absolute URL that resolves to the location where the resource is found. The reference may be version specific or not. If the reference is not to a FHIR RESTful server, then it should be assumed to be version specific. Internal fragment references (start with '#') refer to contained resources.", "comment" : "Using absolute URLs provides a stable scalable approach suitable for a cloud/web context, while using relative/logical references provides a flexible approach suitable for use when trading across closed eco-system boundaries. Absolute URLs do not need to point to a FHIR RESTful server, though this is the preferred approach. If the URL conforms to the structure \"[type]/[id]\" then it should be assumed that the reference is to a FHIR RESTful server.", "min" : 0, "max" : "1", "base" : { "path" : "Reference.reference", "min" : 0, "max" : "1" }, "type" : [{ "code" : "string" }], "condition" : ["ref-2", "ref-1"], "constraint" : [{ "key" : "ele-1", "severity" : "error", "human" : "All FHIR elements must have a @value or children", "expression" : "hasValue() or (children().count() > id.count())", "source" : "http://hl7.org/fhir/StructureDefinition/Element|5.0.0" }], "isModifier" : false, "isSummary" : true, "mapping" : [{ "identity" : "rim", "map" : "N/A" }] }, { "id" : "ClaimResponse.request.type", "path" : "ClaimResponse.request.type", "short" : "Type the reference refers to (e.g. \"Patient\") - must be a resource in resources", "definition" : "The expected type of the target of the reference. If both Reference.type and Reference.reference are populated and Reference.reference is a FHIR URL, both SHALL be consistent.\n\nThe type is the Canonical URL of Resource Definition that is the type this reference refers to. References are URLs that are relative to http://hl7.org/fhir/StructureDefinition/ e.g. \"Patient\" is a reference to http://hl7.org/fhir/StructureDefinition/Patient. Absolute URLs are only allowed for logical models (and can only be used in references in logical models, not resources).", "comment" : "This element is used to indicate the type of the target of the reference. This may be used which ever of the other elements are populated (or not). In some cases, the type of the target may be determined by inspection of the reference (e.g. a known RESTful URL) or by resolving the target of the reference.", "min" : 0, "max" : "1", "base" : { "path" : "Reference.type", "min" : 0, "max" : "1" }, "type" : [{ "code" : "uri" }], "constraint" : [{ "key" : "ele-1", "severity" : "error", "human" : "All FHIR elements must have a @value or children", "expression" : "hasValue() or (children().count() > id.count())", "source" : "http://hl7.org/fhir/StructureDefinition/Element|5.0.0" }], "isModifier" : false, "isSummary" : true, "binding" : { "extension" : [{ "url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString" : "FHIRResourceTypeExt" }], "strength" : "extensible", "description" : "Aa resource (or, for logical models, the URI of the logical model).", "valueSet" : "http://hl7.org/fhir/ValueSet/resource-types|5.0.0" }, "mapping" : [{ "identity" : "rim", "map" : "N/A" }] }, { "id" : "ClaimResponse.request.identifier", "path" : "ClaimResponse.request.identifier", "short" : "Logical reference, when literal reference is not known", "definition" : "An identifier for the target resource. This is used when there is no way to reference the other resource directly, either because the entity it represents is not available through a FHIR server, or because there is no way for the author of the resource to convert a known identifier to an actual location. There is no requirement that a Reference.identifier point to something that is actually exposed as a FHIR instance, but it SHALL point to a business concept that would be expected to be exposed as a FHIR instance, and that instance would need to be of a FHIR resource type allowed by the reference.", "comment" : "When an identifier is provided in place of a reference, any system processing the reference will only be able to resolve the identifier to a reference if it understands the business context in which the identifier is used. Sometimes this is global (e.g. a national identifier) but often it is not. For this reason, none of the useful mechanisms described for working with references (e.g. chaining, includes) are possible, nor should servers be expected to be able resolve the reference. Servers may accept an identifier based reference untouched, resolve it, and/or reject it - see CapabilityStatement.rest.resource.referencePolicy. \n\nWhen both an identifier and a literal reference are provided, the literal reference is preferred. Applications processing the resource are allowed - but not required - to check that the identifier matches the literal reference\n\nApplications converting a logical reference to a literal reference may choose to leave the logical reference present, or remove it.\n\nReference is intended to point to a structure that can potentially be expressed as a FHIR resource, though there is no need for it to exist as an actual FHIR resource instance - except in as much as an application wishes to actual find the target of the reference. The content referred to be the identifier must meet the logical constraints implied by any limitations on what resource types are permitted for the reference. For example, it would not be legitimate to send the identifier for a drug prescription if the type were Reference(Observation|DiagnosticReport). One of the use-cases for Reference.identifier is the situation where no FHIR representation exists (where the type is Reference (Any).\n\nThis element only allows for a single identifier. In the case where additional identifers are required, use the [http://hl7.org/fhir/StructureDefinition/additionalIdentifier](http://hl7.org/fhir/extensions/StructureDefinition-additionalIdentifier.html) extension.", "min" : 0, "max" : "1", "base" : { "path" : "Reference.identifier", "min" : 0, "max" : "1" }, "type" : [{ "code" : "Identifier" }], "condition" : ["ref-2"], "constraint" : [{ "key" : "ele-1", "severity" : "error", "human" : "All FHIR elements must have a @value or children", "expression" : "hasValue() or (children().count() > id.count())", "source" : "http://hl7.org/fhir/StructureDefinition/Element|5.0.0" }], "isModifier" : false, "isSummary" : true, "mapping" : [{ "identity" : "rim", "map" : ".identifier" }] }, { "id" : "ClaimResponse.request.display", "extension" : [{ "url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-translatable", "valueBoolean" : true }, { "url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-translatable", "valueBoolean" : true }], "path" : "ClaimResponse.request.display", "short" : "Text alternative for the resource", "definition" : "Plain text narrative that identifies the resource in addition to the resource reference.", "comment" : "This is generally not the same as the Resource.text of the referenced resource. The purpose is to identify what's being referenced, not to fully describe it.", "min" : 0, "max" : "1", "base" : { "path" : "Reference.display", "min" : 0, "max" : "1" }, "type" : [{ "code" : "string" }], "condition" : ["ref-2"], "constraint" : [{ "key" : "ele-1", "severity" : "error", "human" : "All FHIR elements must have a @value or children", "expression" : "hasValue() or (children().count() > id.count())", "source" : "http://hl7.org/fhir/StructureDefinition/Element|5.0.0" }], "isModifier" : false, "isSummary" : true, "mapping" : [{ "identity" : "rim", "map" : "N/A" }] }, { "id" : "ClaimResponse.outcome", "path" : "ClaimResponse.outcome", "short" : "queued | complete | error | partial", "definition" : "The outcome of the claim, predetermination, or preauthorization processing.", "comment" : "The resource may be used to indicate that the Claim/Preauthorization/Pre-determination has been received but processing has not begun (queued); that it has been processed and one or more errors have been detected (error); no errors were detected and some of the adjudication processing has been performed (partial); or all of the adjudication processing has completed without errors (complete).", "requirements" : "To advise the requestor of an overall processing outcome.", "min" : 1, "max" : "1", "base" : { "path" : "ClaimResponse.outcome", "min" : 1, "max" : "1" }, "type" : [{ "code" : "code" }], "constraint" : [{ "key" : "ele-1", "severity" : "error", "human" : "All FHIR elements must have a @value or children", "expression" : "hasValue() or (children().count() > id.count())", "source" : "http://hl7.org/fhir/StructureDefinition/Element|5.0.0" }], "mustSupport" : false, "isModifier" : false, "isSummary" : true, "binding" : { "extension" : [{ "url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString" : "RemittanceOutcome" }], "strength" : "required", "description" : "The result of the claim processing.", "valueSet" : "http://hl7.org/fhir/ValueSet/claim-outcome|5.0.0" } }, { "id" : "ClaimResponse.decision", "path" : "ClaimResponse.decision", "short" : "Result of the adjudication", "definition" : "The result of the claim, predetermination, or preauthorization adjudication.", "comment" : "The element is used to indicate the current state of the adjudication overall for the claim resource, for example: the request has been held (pended) for adjudication processing, for manual review or other reasons; that it has been processed and will be paid, or the outstanding paid, as submitted (approved); that no amount will be paid (denied); or that some amount between zero and the submitted amount will be paid (partial).", "requirements" : "To advise the requestor of the result of the adjudication process.", "min" : 0, "max" : "1", "base" : { "path" : "ClaimResponse.decision", "min" : 0, "max" : "1" }, "type" : [{ "code" : "CodeableConcept" }], "constraint" : [{ "key" : "ele-1", "severity" : "error", "human" : "All FHIR elements must have a @value or children", "expression" : "hasValue() or (children().count() > id.count())", "source" : "http://hl7.org/fhir/StructureDefinition/Element|5.0.0" }], "mustSupport" : false, "isModifier" : false, "isSummary" : true, "binding" : { "extension" : [{ "url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString" : "AdjudicationDecision" }], "strength" : "example", "description" : "The overall result of the claim adjudication.", "valueSet" : "http://hl7.org/fhir/ValueSet/claim-decision|5.0.0" } }, { "id" : "ClaimResponse.disposition", "path" : "ClaimResponse.disposition", "short" : "Disposition Message", "definition" : "A human readable description of the status of the adjudication.", "requirements" : "Provided for user display.", "min" : 0, "max" : "1", "base" : { "path" : "ClaimResponse.disposition", "min" : 0, "max" : "1" }, "type" : [{ "code" : "string" }], "constraint" : [{ "key" : "ele-1", "severity" : "error", "human" : "All FHIR elements must have a @value or children", "expression" : "hasValue() or (children().count() > id.count())", "source" : "http://hl7.org/fhir/StructureDefinition/Element|5.0.0" }], "mustSupport" : false, "isModifier" : false, "isSummary" : false, "mapping" : [{ "identity" : "workflow", "map" : "Event.note" }] }, { "id" : "ClaimResponse.preAuthRef", "path" : "ClaimResponse.preAuthRef", "short" : "Preauthorization reference", "definition" : "Reference from the Insurer which is used in later communications which refers to this adjudication.", "comment" : "This value is only present on preauthorization adjudications.", "requirements" : "On subsequent claims, the insurer may require the provider to quote this value.", "min" : 0, "max" : "1", "base" : { "path" : "ClaimResponse.preAuthRef", "min" : 0, "max" : "1" }, "type" : [{ "code" : "string" }], "constraint" : [{ "key" : "ele-1", "severity" : "error", "human" : "All FHIR elements must have a @value or children", "expression" : "hasValue() or (children().count() > id.count())", "source" : "http://hl7.org/fhir/StructureDefinition/Element|5.0.0" }], "mustSupport" : false, "isModifier" : false, "isSummary" : false }, { "id" : "ClaimResponse.preAuthPeriod", "path" : "ClaimResponse.preAuthPeriod", "short" : "Preauthorization reference effective period", "definition" : "The time frame during which this authorization is effective.", "requirements" : "To convey to the provider when the authorized products and services must be supplied for the authorized adjudication to apply.", "min" : 0, "max" : "1", "base" : { "path" : "ClaimResponse.preAuthPeriod", "min" : 0, "max" : "1" }, "type" : [{ "code" : "Period" }], "constraint" : [{ "key" : "ele-1", "severity" : "error", "human" : "All FHIR elements must have a @value or children", "expression" : "hasValue() or (children().count() > id.count())", "source" : "http://hl7.org/fhir/StructureDefinition/Element|5.0.0" }], "mustSupport" : false, "isModifier" : false, "isSummary" : false }, { "id" : "ClaimResponse.event", "path" : "ClaimResponse.event", "short" : "Event information", "definition" : "Information code for an event with a corresponding date or period.", "min" : 0, "max" : "*", "base" : { "path" : "ClaimResponse.event", "min" : 0, "max" : "*" }, "type" : [{ "code" : "BackboneElement" }], "constraint" : [{ "key" : "ele-1", "severity" : "error", "human" : "All FHIR elements must have a @value or children", "expression" : "hasValue() or (children().count() > id.count())", "source" : "http://hl7.org/fhir/StructureDefinition/Element|5.0.0" }], "mustSupport" : false, "isModifier" : false, "isSummary" : false }, { "id" : "ClaimResponse.event.id", "path" : "ClaimResponse.event.id", "representation" : ["xmlAttr"], "short" : "Unique id for inter-element referencing", "definition" : "Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.", "min" : 0, "max" : "1", "base" : { "path" : "Element.id", "min" : 0, "max" : "1" }, "type" : [{ "extension" : [{ "url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type", "valueUrl" : "string" }], "code" : "http://hl7.org/fhirpath/System.String" }], "condition" : ["ele-1"], "isModifier" : false, "isSummary" : false, "mapping" : [{ "identity" : "rim", "map" : "n/a" }] }, { "id" : "ClaimResponse.event.extension", "path" : "ClaimResponse.event.extension", "short" : "Additional content defined by implementations", "definition" : "May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and managable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.", "comment" : "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.", "alias" : ["extensions", "user content"], "min" : 0, "max" : "*", "base" : { "path" : "Element.extension", "min" : 0, "max" : "*" }, "type" : [{ "code" : "Extension" }], "constraint" : [{ "key" : "ele-1", "severity" : "error", "human" : "All FHIR elements must have a @value or children", "expression" : "hasValue() or (children().count() > id.count())", "source" : "http://hl7.org/fhir/StructureDefinition/Element|5.0.0" }, { "key" : "ext-1", "severity" : "error", "human" : "Must have either extensions or value[x], not both", "expression" : "extension.exists() != value.exists()", "source" : "http://hl7.org/fhir/StructureDefinition/Extension|5.0.0" }], "isModifier" : false, "isSummary" : false, "mapping" : [{ "identity" : "rim", "map" : "n/a" }] }, { "id" : "ClaimResponse.event.modifierExtension", "path" : "ClaimResponse.event.modifierExtension", "short" : "Extensions that cannot be ignored even if unrecognized", "definition" : "May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and managable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.\n\nModifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).", "comment" : "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.", "requirements" : "Modifier extensions allow for extensions that *cannot* be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the [definition of modifier extensions](http://hl7.org/fhir/R5/extensibility.html#modifierExtension).", "alias" : ["extensions", "user content", "modifiers"], "min" : 0, "max" : "*", "base" : { "path" : "BackboneElement.modifierExtension", "min" : 0, "max" : "*" }, "type" : [{ "code" : "Extension" }], "constraint" : [{ "key" : "ele-1", "severity" : "error", "human" : "All FHIR elements must have a @value or children", "expression" : "hasValue() or (children().count() > id.count())", "source" : "http://hl7.org/fhir/StructureDefinition/Element|5.0.0" }, { "key" : "ext-1", "severity" : "error", "human" : "Must have either extensions or value[x], not both", "expression" : "extension.exists() != value.exists()", "source" : "http://hl7.org/fhir/StructureDefinition/Extension|5.0.0" }], "isModifier" : true, "isModifierReason" : "Modifier extensions are expected to modify the meaning or interpretation of the element that contains them", "isSummary" : true, "mapping" : [{ "identity" : "rim", "map" : "N/A" }] }, { "id" : "ClaimResponse.event.type", "path" : "ClaimResponse.event.type", "short" : "Specific event", "definition" : "A coded event such as when a service is expected or a card printed.", "min" : 1, "max" : "1", "base" : { "path" : "ClaimResponse.event.type", "min" : 1, "max" : "1" }, "type" : [{ "code" : "CodeableConcept" }], "constraint" : [{ "key" : "ele-1", "severity" : "error", "human" : "All FHIR elements must have a @value or children", "expression" : "hasValue() or (children().count() > id.count())", "source" : "http://hl7.org/fhir/StructureDefinition/Element|5.0.0" }], "mustSupport" : false, "isModifier" : false, "isSummary" : false, "binding" : { "extension" : [{ "url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString" : "DatesType" }], "strength" : "example", "valueSet" : "http://hl7.org/fhir/ValueSet/datestype|5.0.0" } }, { "id" : "ClaimResponse.event.when[x]", "path" : "ClaimResponse.event.when[x]", "short" : "Occurance date or period", "definition" : "A date or period in the past or future indicating when the event occurred or is expectd to occur.", "min" : 1, "max" : "1", "base" : { "path" : "ClaimResponse.event.when[x]", "min" : 1, "max" : "1" }, "type" : [{ "code" : "dateTime" }, { "code" : "Period" }], "constraint" : [{ "key" : "ele-1", "severity" : "error", "human" : "All FHIR elements must have a @value or children", "expression" : "hasValue() or (children().count() > id.count())", "source" : "http://hl7.org/fhir/StructureDefinition/Element|5.0.0" }], "mustSupport" : false, "isModifier" : false, "isSummary" : false }, { "id" : "ClaimResponse.payeeType", "path" : "ClaimResponse.payeeType", "short" : "Party to be paid any benefits payable", "definition" : "Type of Party to be reimbursed: subscriber, provider, other.", "requirements" : "Need to know who should receive payment with the most common situations being the Provider (assignment of benefits) or the Subscriber.", "min" : 0, "max" : "1", "base" : { "path" : "ClaimResponse.payeeType", "min" : 0, "max" : "1" }, "type" : [{ "code" : "CodeableConcept" }], "constraint" : [{ "key" : "ele-1", "severity" : "error", "human" : "All FHIR elements must have a @value or children", "expression" : "hasValue() or (children().count() > id.count())", "source" : "http://hl7.org/fhir/StructureDefinition/Element|5.0.0" }], "mustSupport" : false, "isModifier" : false, "isSummary" : false, "binding" : { "extension" : [{ "url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString" : "PayeeType" }], "strength" : "example", "description" : "A code for the party to be reimbursed.", "valueSet" : "http://hl7.org/fhir/ValueSet/payeetype|5.0.0" } }, { "id" : "ClaimResponse.encounter", "path" : "ClaimResponse.encounter", "short" : "Encounters associated with the listed treatments", "definition" : "Healthcare encounters related to this claim.", "comment" : "This will typically be the encounter the event occurred within, but some activities may be initiated prior to or after the official completion of an encounter but still be tied to the context of the encounter.", "requirements" : "Used in some jurisdictions to link clinical events to claim items.", "min" : 0, "max" : "*", "base" : { "path" : "ClaimResponse.encounter", "min" : 0, "max" : "*" }, "type" : [{ "code" : "Reference", "targetProfile" : ["http://hl7.org/fhir/StructureDefinition/Encounter|5.0.0"] }], "constraint" : [{ "key" : "ele-1", "severity" : "error", "human" : "All FHIR elements must have a @value or children", "expression" : "hasValue() or (children().count() > id.count())", "source" : "http://hl7.org/fhir/StructureDefinition/Element|5.0.0" }], "mustSupport" : false, "isModifier" : false, "isSummary" : false }, { "id" : "ClaimResponse.diagnosisRelatedGroup", "path" : "ClaimResponse.diagnosisRelatedGroup", "short" : "Package billing code", "definition" : "A package billing code or bundle code used to group products and services to a particular health condition (such as heart attack) which is based on a predetermined grouping code system.", "comment" : "For example DRG (Diagnosis Related Group) or a bundled billing code. A patient may have a diagnosis of a Myocardial Infarction and a DRG for HeartAttack would be assigned. The Claim item (and possible subsequent claims) would refer to the DRG for those line items that were for services related to the heart attack event.", "requirements" : "Required to relate the current diagnosis to a package billing code that is then referenced on the individual claim items which are specific to the health condition covered by the package code.", "min" : 0, "max" : "1", "base" : { "path" : "ClaimResponse.diagnosisRelatedGroup", "min" : 0, "max" : "1" }, "type" : [{ "code" : "CodeableConcept" }], "constraint" : [{ "key" : "ele-1", "severity" : "error", "human" : "All FHIR elements must have a @value or children", "expression" : "hasValue() or (children().count() > id.count())", "source" : "http://hl7.org/fhir/StructureDefinition/Element|5.0.0" }], "mustSupport" : false, "isModifier" : false, "isSummary" : false, "binding" : { "extension" : [{ "url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString" : "DiagnosisRelatedGroup" }], "strength" : "example", "valueSet" : "http://hl7.org/fhir/ValueSet/ex-diagnosisrelatedgroup|5.0.0" } }, { "id" : "ClaimResponse.item", "path" : "ClaimResponse.item", "short" : "Adjudication for claim line items", "definition" : "A claim line. Either a simple (a product or service) or a 'group' of details which can also be a simple items or groups of sub-details.", "requirements" : "The adjudication for items provided on the claim.", "min" : 0, "max" : "*", "base" : { "path" : "ClaimResponse.item", "min" : 0, "max" : "*" }, "type" : [{ "code" : "BackboneElement" }], "constraint" : [{ "key" : "ele-1", "severity" : "error", "human" : "All FHIR elements must have a @value or children", "expression" : "hasValue() or (children().count() > id.count())", "source" : "http://hl7.org/fhir/StructureDefinition/Element|5.0.0" }], "mustSupport" : false, "isModifier" : false, "isSummary" : false }, { "id" : "ClaimResponse.item.id", "path" : "ClaimResponse.item.id", "representation" : ["xmlAttr"], "short" : "Unique id for inter-element referencing", "definition" : "Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.", "min" : 0, "max" : "1", "base" : { "path" : "Element.id", "min" : 0, "max" : "1" }, "type" : [{ "extension" : [{ "url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type", "valueUrl" : "string" }], "code" : "http://hl7.org/fhirpath/System.String" }], "condition" : ["ele-1"], "isModifier" : false, "isSummary" : false, "mapping" : [{ "identity" : "rim", "map" : "n/a" }] }, { "id" : "ClaimResponse.item.extension", "path" : "ClaimResponse.item.extension", "short" : "Additional content defined by implementations", "definition" : "May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and managable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.", "comment" : "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.", "alias" : ["extensions", "user content"], "min" : 0, "max" : "*", "base" : { "path" : "Element.extension", "min" : 0, "max" : "*" }, "type" : [{ "code" : "Extension" }], "constraint" : [{ "key" : "ele-1", "severity" : "error", "human" : "All FHIR elements must have a @value or children", "expression" : "hasValue() or (children().count() > id.count())", "source" : "http://hl7.org/fhir/StructureDefinition/Element|5.0.0" }, { "key" : "ext-1", "severity" : "error", "human" : "Must have either extensions or value[x], not both", "expression" : "extension.exists() != value.exists()", "source" : "http://hl7.org/fhir/StructureDefinition/Extension|5.0.0" }], "isModifier" : false, "isSummary" : false, "mapping" : [{ "identity" : "rim", "map" : "n/a" }] }, { "id" : "ClaimResponse.item.modifierExtension", "path" : "ClaimResponse.item.modifierExtension", "short" : "Extensions that cannot be ignored even if unrecognized", "definition" : "May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and managable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.\n\nModifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).", "comment" : "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.", "requirements" : "Modifier extensions allow for extensions that *cannot* be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the [definition of modifier extensions](http://hl7.org/fhir/R5/extensibility.html#modifierExtension).", "alias" : ["extensions", "user content", "modifiers"], "min" : 0, "max" : "*", "base" : { "path" : "BackboneElement.modifierExtension", "min" : 0, "max" : "*" }, "type" : [{ "code" : "Extension" }], "constraint" : [{ "key" : "ele-1", "severity" : "error", "human" : "All FHIR elements must have a @value or children", "expression" : "hasValue() or (children().count() > id.count())", "source" : "http://hl7.org/fhir/StructureDefinition/Element|5.0.0" }, { "key" : "ext-1", "severity" : "error", "human" : "Must have either extensions or value[x], not both", "expression" : "extension.exists() != value.exists()", "source" : "http://hl7.org/fhir/StructureDefinition/Extension|5.0.0" }], "isModifier" : true, "isModifierReason" : "Modifier extensions are expected to modify the meaning or interpretation of the element that contains them", "isSummary" : true, "mapping" : [{ "identity" : "rim", "map" : "N/A" }] }, { "id" : "ClaimResponse.item.itemSequence", "path" : "ClaimResponse.item.itemSequence", "short" : "Claim item instance identifier", "definition" : "A number to uniquely reference the claim item entries.", "requirements" : "Necessary to provide a mechanism to link the adjudication result to the submitted claim item.", "min" : 1, "max" : "1", "base" : { "path" : "ClaimResponse.item.itemSequence", "min" : 1, "max" : "1" }, "type" : [{ "code" : "positiveInt" }], "constraint" : [{ "key" : "ele-1", "severity" : "error", "human" : "All FHIR elements must have a @value or children", "expression" : "hasValue() or (children().count() > id.count())", "source" : "http://hl7.org/fhir/StructureDefinition/Element|5.0.0" }], "mustSupport" : false, "isModifier" : false, "isSummary" : false }, { "id" : "ClaimResponse.item.traceNumber", "path" : "ClaimResponse.item.traceNumber", "short" : "Number for tracking", "definition" : "Trace number for tracking purposes. May be defined at the jurisdiction level or between trading partners.", "requirements" : "Allows partners to uniquely identify components for tracking.", "min" : 0, "max" : "*", "base" : { "path" : "ClaimResponse.item.traceNumber", "min" : 0, "max" : "*" }, "type" : [{ "code" : "Identifier" }], "constraint" : [{ "key" : "ele-1", "severity" : "error", "human" : "All FHIR elements must have a @value or children", "expression" : "hasValue() or (children().count() > id.count())", "source" : "http://hl7.org/fhir/StructureDefinition/Element|5.0.0" }], "mustSupport" : false, "isModifier" : false, "isSummary" : false }, { "id" : "ClaimResponse.item.noteNumber", "path" : "ClaimResponse.item.noteNumber", "short" : "Applicable note numbers", "definition" : "The numbers associated with notes below which apply to the adjudication of this item.", "requirements" : "Provides a condensed manner for associating human readable descriptive explanations for adjudications on the line item.", "min" : 0, "max" : "*", "base" : { "path" : "ClaimResponse.item.noteNumber", "min" : 0, "max" : "*" }, "type" : [{ "code" : "positiveInt" }], "constraint" : [{ "key" : "ele-1", "severity" : "error", "human" : "All FHIR elements must have a @value or children", "expression" : "hasValue() or (children().count() > id.count())", "source" : "http://hl7.org/fhir/StructureDefinition/Element|5.0.0" }], "mustSupport" : false, "isModifier" : false, "isSummary" : false }, { "id" : "ClaimResponse.item.reviewOutcome", "path" : "ClaimResponse.item.reviewOutcome", "short" : "Adjudication results", "definition" : "The high-level results of the adjudication if adjudication has been performed.", "min" : 0, "max" : "1", "base" : { "path" : "ClaimResponse.item.reviewOutcome", "min" : 0, "max" : "1" }, "type" : [{ "code" : "BackboneElement" }], "constraint" : [{ "key" : "ele-1", "severity" : "error", "human" : "All FHIR elements must have a @value or children", "expression" : "hasValue() or (children().count() > id.count())", "source" : "http://hl7.org/fhir/StructureDefinition/Element|5.0.0" }], "mustSupport" : false, "isModifier" : false, "isSummary" : false }, { "id" : "ClaimResponse.item.reviewOutcome.id", "path" : "ClaimResponse.item.reviewOutcome.id", "representation" : ["xmlAttr"], "short" : "Unique id for inter-element referencing", "definition" : "Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.", "min" : 0, "max" : "1", "base" : { "path" : "Element.id", "min" : 0, "max" : "1" }, "type" : [{ "extension" : [{ "url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type", "valueUrl" : "string" }], "code" : "http://hl7.org/fhirpath/System.String" }], "condition" : ["ele-1"], "isModifier" : false, "isSummary" : false, "mapping" : [{ "identity" : "rim", "map" : "n/a" }] }, { "id" : "ClaimResponse.item.reviewOutcome.extension", "path" : "ClaimResponse.item.reviewOutcome.extension", "short" : "Additional content defined by implementations", "definition" : "May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and managable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.", "comment" : "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.", "alias" : ["extensions", "user content"], "min" : 0, "max" : "*", "base" : { "path" : "Element.extension", "min" : 0, "max" : "*" }, "type" : [{ "code" : "Extension" }], "constraint" : [{ "key" : "ele-1", "severity" : "error", "human" : "All FHIR elements must have a @value or children", "expression" : "hasValue() or (children().count() > id.count())", "source" : "http://hl7.org/fhir/StructureDefinition/Element|5.0.0" }, { "key" : "ext-1", "severity" : "error", "human" : "Must have either extensions or value[x], not both", "expression" : "extension.exists() != value.exists()", "source" : "http://hl7.org/fhir/StructureDefinition/Extension|5.0.0" }], "isModifier" : false, "isSummary" : false, "mapping" : [{ "identity" : "rim", "map" : "n/a" }] }, { "id" : "ClaimResponse.item.reviewOutcome.modifierExtension", "path" : "ClaimResponse.item.reviewOutcome.modifierExtension", "short" : "Extensions that cannot be ignored even if unrecognized", "definition" : "May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and managable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.\n\nModifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).", "comment" : "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.", "requirements" : "Modifier extensions allow for extensions that *cannot* be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the [definition of modifier extensions](http://hl7.org/fhir/R5/extensibility.html#modifierExtension).", "alias" : ["extensions", "user content", "modifiers"], "min" : 0, "max" : "*", "base" : { "path" : "BackboneElement.modifierExtension", "min" : 0, "max" : "*" }, "type" : [{ "code" : "Extension" }], "constraint" : [{ "key" : "ele-1", "severity" : "error", "human" : "All FHIR elements must have a @value or children", "expression" : "hasValue() or (children().count() > id.count())", "source" : "http://hl7.org/fhir/StructureDefinition/Element|5.0.0" }, { "key" : "ext-1", "severity" : "error", "human" : "Must have either extensions or value[x], not both", "expression" : "extension.exists() != value.exists()", "source" : "http://hl7.org/fhir/StructureDefinition/Extension|5.0.0" }], "isModifier" : true, "isModifierReason" : "Modifier extensions are expected to modify the meaning or interpretation of the element that contains them", "isSummary" : true, "mapping" : [{ "identity" : "rim", "map" : "N/A" }] }, { "id" : "ClaimResponse.item.reviewOutcome.decision", "path" : "ClaimResponse.item.reviewOutcome.decision", "short" : "Result of the adjudication", "definition" : "The result of the claim, predetermination, or preauthorization adjudication.", "comment" : "The element is used to indicate the current state of the adjudication overall for the claim resource, for example: the request has been held (pended) for adjudication processing, for manual review or other reasons; that it has been processed and will be paid, or the outstanding paid, as submitted (approved); that no amount will be paid (denied); or that some amount between zero and the submitted amount will be paid (partial).", "requirements" : "To advise the requestor of the result of the adjudication process.", "min" : 0, "max" : "1", "base" : { "path" : "ClaimResponse.item.reviewOutcome.decision", "min" : 0, "max" : "1" }, "type" : [{ "code" : "CodeableConcept" }], "constraint" : [{ "key" : "ele-1", "severity" : "error", "human" : "All FHIR elements must have a @value or children", "expression" : "hasValue() or (children().count() > id.count())", "source" : "http://hl7.org/fhir/StructureDefinition/Element|5.0.0" }], "mustSupport" : false, "isModifier" : false, "isSummary" : false, "binding" : { "extension" : [{ "url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString" : "AdjudicationDecision" }], "strength" : "example", "valueSet" : "http://hl7.org/fhir/ValueSet/claim-decision|5.0.0" } }, { "id" : "ClaimResponse.item.reviewOutcome.reason", "path" : "ClaimResponse.item.reviewOutcome.reason", "short" : "Reason for result of the adjudication", "definition" : "The reasons for the result of the claim, predetermination, or preauthorization adjudication.", "requirements" : "To advise the requestor of the contributors to the result of the adjudication process.", "min" : 0, "max" : "*", "base" : { "path" : "ClaimResponse.item.reviewOutcome.reason", "min" : 0, "max" : "*" }, "type" : [{ "code" : "CodeableConcept" }], "constraint" : [{ "key" : "ele-1", "severity" : "error", "human" : "All FHIR elements must have a @value or children", "expression" : "hasValue() or (children().count() > id.count())", "source" : "http://hl7.org/fhir/StructureDefinition/Element|5.0.0" }], "mustSupport" : false, "isModifier" : false, "isSummary" : false, "binding" : { "extension" : [{ "url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString" : "AdjudicationDecisionReason" }], "strength" : "example", "valueSet" : "http://hl7.org/fhir/ValueSet/claim-decision-reason|5.0.0" } }, { "id" : "ClaimResponse.item.reviewOutcome.preAuthRef", "path" : "ClaimResponse.item.reviewOutcome.preAuthRef", "short" : "Preauthorization reference", "definition" : "Reference from the Insurer which is used in later communications which refers to this adjudication.", "comment" : "This value is only present on preauthorization adjudications.", "requirements" : "On subsequent claims, the insurer may require the provider to quote this value.", "min" : 0, "max" : "1", "base" : { "path" : "ClaimResponse.item.reviewOutcome.preAuthRef", "min" : 0, "max" : "1" }, "type" : [{ "code" : "string" }], "constraint" : [{ "key" : "ele-1", "severity" : "error", "human" : "All FHIR elements must have a @value or children", "expression" : "hasValue() or (children().count() > id.count())", "source" : "http://hl7.org/fhir/StructureDefinition/Element|5.0.0" }], "mustSupport" : false, "isModifier" : false, "isSummary" : false }, { "id" : "ClaimResponse.item.reviewOutcome.preAuthPeriod", "path" : "ClaimResponse.item.reviewOutcome.preAuthPeriod", "short" : "Preauthorization reference effective period", "definition" : "The time frame during which this authorization is effective.", "requirements" : "To convey to the provider when the authorized products and services must be supplied for the authorized adjudication to apply.", "min" : 0, "max" : "1", "base" : { "path" : "ClaimResponse.item.reviewOutcome.preAuthPeriod", "min" : 0, "max" : "1" }, "type" : [{ "code" : "Period" }], "constraint" : [{ "key" : "ele-1", "severity" : "error", "human" : "All FHIR elements must have a @value or children", "expression" : "hasValue() or (children().count() > id.count())", "source" : "http://hl7.org/fhir/StructureDefinition/Element|5.0.0" }], "mustSupport" : false, "isModifier" : false, "isSummary" : false }, { "id" : "ClaimResponse.item.adjudication", "path" : "ClaimResponse.item.adjudication", "short" : "Adjudication details", "definition" : "If this item is a group then the values here are a summary of the adjudication of the detail items. If this item is a simple product or service then this is the result of the adjudication of this item.", "requirements" : "The adjudication results conveys the insurer's assessment of the item provided in the claim under the terms of the patient's insurance coverage.", "min" : 0, "max" : "*", "base" : { "path" : "ClaimResponse.item.adjudication", "min" : 0, "max" : "*" }, "type" : [{ "code" : "BackboneElement" }], "constraint" : [{ "key" : "ele-1", "severity" : "error", "human" : "All FHIR elements must have a @value or children", "expression" : "hasValue() or (children().count() > id.count())", "source" : "http://hl7.org/fhir/StructureDefinition/Element|5.0.0" }], "mustSupport" : false, "isModifier" : false, "isSummary" : false }, { "id" : "ClaimResponse.item.adjudication.id", "path" : "ClaimResponse.item.adjudication.id", "representation" : ["xmlAttr"], "short" : "Unique id for inter-element referencing", "definition" : "Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.", "min" : 0, "max" : "1", "base" : { "path" : "Element.id", "min" : 0, "max" : "1" }, "type" : [{ "extension" : [{ "url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type", "valueUrl" : "string" }], "code" : "http://hl7.org/fhirpath/System.String" }], "condition" : ["ele-1"], "isModifier" : false, "isSummary" : false, "mapping" : [{ "identity" : "rim", "map" : "n/a" }] }, { "id" : "ClaimResponse.item.adjudication.extension", "path" : "ClaimResponse.item.adjudication.extension", "short" : "Additional content defined by implementations", "definition" : "May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and managable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.", "comment" : "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.", "alias" : ["extensions", "user content"], "min" : 0, "max" : "*", "base" : { "path" : "Element.extension", "min" : 0, "max" : "*" }, "type" : [{ "code" : "Extension" }], "constraint" : [{ "key" : "ele-1", "severity" : "error", "human" : "All FHIR elements must have a @value or children", "expression" : "hasValue() or (children().count() > id.count())", "source" : "http://hl7.org/fhir/StructureDefinition/Element|5.0.0" }, { "key" : "ext-1", "severity" : "error", "human" : "Must have either extensions or value[x], not both", "expression" : "extension.exists() != value.exists()", "source" : "http://hl7.org/fhir/StructureDefinition/Extension|5.0.0" }], "isModifier" : false, "isSummary" : false, "mapping" : [{ "identity" : "rim", "map" : "n/a" }] }, { "id" : "ClaimResponse.item.adjudication.modifierExtension", "path" : "ClaimResponse.item.adjudication.modifierExtension", "short" : "Extensions that cannot be ignored even if unrecognized", "definition" : "May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and managable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.\n\nModifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).", "comment" : "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.", "requirements" : "Modifier extensions allow for extensions that *cannot* be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the [definition of modifier extensions](http://hl7.org/fhir/R5/extensibility.html#modifierExtension).", "alias" : ["extensions", "user content", "modifiers"], "min" : 0, "max" : "*", "base" : { "path" : "BackboneElement.modifierExtension", "min" : 0, "max" : "*" }, "type" : [{ "code" : "Extension" }], "constraint" : [{ "key" : "ele-1", "severity" : "error", "human" : "All FHIR elements must have a @value or children", "expression" : "hasValue() or (children().count() > id.count())", "source" : "http://hl7.org/fhir/StructureDefinition/Element|5.0.0" }, { "key" : "ext-1", "severity" : "error", "human" : "Must have either extensions or value[x], not both", "expression" : "extension.exists() != value.exists()", "source" : "http://hl7.org/fhir/StructureDefinition/Extension|5.0.0" }], "isModifier" : true, "isModifierReason" : "Modifier extensions are expected to modify the meaning or interpretation of the element that contains them", "isSummary" : true, "mapping" : [{ "identity" : "rim", "map" : "N/A" }] }, { "id" : "ClaimResponse.item.adjudication.category", "path" : "ClaimResponse.item.adjudication.category", "short" : "Type of adjudication information", "definition" : "A code to indicate the information type of this adjudication record. Information types may include the value submitted, maximum values or percentages allowed or payable under the plan, amounts that: the patient is responsible for in aggregate or pertaining to this item; amounts paid by other coverages; and, the benefit payable for this item.", "comment" : "For example codes indicating: Co-Pay, deductible, eligible, benefit, tax, etc.", "requirements" : "Needed to enable understanding of the context of the other information in the adjudication.", "min" : 1, "max" : "1", "base" : { "path" : "ClaimResponse.item.adjudication.category", "min" : 1, "max" : "1" }, "type" : [{ "code" : "CodeableConcept" }], "constraint" : [{ "key" : "ele-1", "severity" : "error", "human" : "All FHIR elements must have a @value or children", "expression" : "hasValue() or (children().count() > id.count())", "source" : "http://hl7.org/fhir/StructureDefinition/Element|5.0.0" }], "mustSupport" : false, "isModifier" : false, "isSummary" : false, "binding" : { "extension" : [{ "url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString" : "Adjudication" }], "strength" : "example", "description" : "The adjudication codes.", "valueSet" : "http://hl7.org/fhir/ValueSet/adjudication|5.0.0" } }, { "id" : "ClaimResponse.item.adjudication.reason", "path" : "ClaimResponse.item.adjudication.reason", "short" : "Explanation of adjudication outcome", "definition" : "A code supporting the understanding of the adjudication result and explaining variance from expected amount.", "comment" : "For example may indicate that the funds for this benefit type have been exhausted.", "requirements" : "To support understanding of variance from adjudication expectations.", "min" : 0, "max" : "1", "base" : { "path" : "ClaimResponse.item.adjudication.reason", "min" : 0, "max" : "1" }, "type" : [{ "code" : "CodeableConcept" }], "constraint" : [{ "key" : "ele-1", "severity" : "error", "human" : "All FHIR elements must have a @value or children", "expression" : "hasValue() or (children().count() > id.count())", "source" : "http://hl7.org/fhir/StructureDefinition/Element|5.0.0" }], "mustSupport" : false, "isModifier" : false, "isSummary" : false, "binding" : { "extension" : [{ "url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString" : "AdjudicationReason" }], "strength" : "example", "description" : "The adjudication reason codes.", "valueSet" : "http://hl7.org/fhir/ValueSet/adjudication-reason|5.0.0" } }, { "id" : "ClaimResponse.item.adjudication.amount", "path" : "ClaimResponse.item.adjudication.amount", "short" : "Monetary amount", "definition" : "Monetary amount associated with the category.", "comment" : "For example: amount submitted, eligible amount, co-payment, and benefit payable.", "requirements" : "Most adjudication categories convey a monetary amount.", "min" : 0, "max" : "1", "base" : { "path" : "ClaimResponse.item.adjudication.amount", "min" : 0, "max" : "1" }, "type" : [{ "code" : "Money" }], "constraint" : [{ "key" : "ele-1", "severity" : "error", "human" : "All FHIR elements must have a @value or children", "expression" : "hasValue() or (children().count() > id.count())", "source" : "http://hl7.org/fhir/StructureDefinition/Element|5.0.0" }], "mustSupport" : false, "isModifier" : false, "isSummary" : false }, { "id" : "ClaimResponse.item.adjudication.quantity", "path" : "ClaimResponse.item.adjudication.quantity", "short" : "Non-monetary value", "definition" : "A non-monetary value associated with the category. Mutually exclusive to the amount element above.", "comment" : "For example: eligible percentage or co-payment percentage.", "requirements" : "Some adjudication categories convey a percentage or a fixed value.", "min" : 0, "max" : "1", "base" : { "path" : "ClaimResponse.item.adjudication.quantity", "min" : 0, "max" : "1" }, "type" : [{ "code" : "Quantity" }], "constraint" : [{ "key" : "ele-1", "severity" : "error", "human" : "All FHIR elements must have a @value or children", "expression" : "hasValue() or (children().count() > id.count())", "source" : "http://hl7.org/fhir/StructureDefinition/Element|5.0.0" }], "mustSupport" : false, "isModifier" : false, "isSummary" : false }, { "id" : "ClaimResponse.item.adjudication.quantity.id", "path" : "ClaimResponse.item.adjudication.quantity.id", "representation" : ["xmlAttr"], "short" : "Unique id for inter-element referencing", "definition" : "Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.", "min" : 0, "max" : "1", "base" : { "path" : "Element.id", "min" : 0, "max" : "1" }, "type" : [{ "extension" : [{ "url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type", "valueUrl" : "id" }], "code" : "http://hl7.org/fhirpath/System.String" }], "condition" : ["ele-1"], "isModifier" : false, "isSummary" : false, "mapping" : [{ "identity" : "rim", "map" : "n/a" }] }, { "id" : "ClaimResponse.item.adjudication.quantity.extension", "path" : "ClaimResponse.item.adjudication.quantity.extension", "slicing" : { "discriminator" : [{ "type" : "value", "path" : "url" }], "description" : "Extensions are always sliced by (at least) url", "ordered" : false, "rules" : "open" }, "short" : "Extension", "definition" : "An Extension", "min" : 0, "max" : "*", "base" : { "path" : "Element.extension", "min" : 0, "max" : "*" }, "type" : [{ "code" : "Extension" }], "constraint" : [{ "key" : "ele-1", "severity" : "error", "human" : "All FHIR elements must have a @value or children", "expression" : "hasValue() or (children().count() > id.count())", "source" : "http://hl7.org/fhir/StructureDefinition/Element|5.0.0" }, { "key" : "ext-1", "severity" : "error", "human" : "Must have either extensions or value[x], not both", "expression" : "extension.exists() != value.exists()", "source" : "http://hl7.org/fhir/StructureDefinition/Extension|5.0.0" }], "isModifier" : false, "isSummary" : false }, { "id" : "ClaimResponse.item.adjudication.quantity.extension:value", "path" : "ClaimResponse.item.adjudication.quantity.extension", "sliceName" : "value", "short" : "DSTU2: value additional types", "definition" : "DSTU2: `ClaimResponse.item.adjudication.value` additional types (decimal) additional types from child elements (value)", "comment" : "Element `ClaimResponse.item.adjudication.value` is mapped to FHIR R5 element `ClaimResponse.item.adjudication.quantity` as `SourceIsBroaderThanTarget`.\nThe mappings for `ClaimResponse.item.adjudication.value` do not cover the following types: decimal.\nThe mappings for `ClaimResponse.item.adjudication.value` do not cover the following types based on type expansion: value.", "min" : 0, "max" : "1", "base" : { "path" : "Element.extension", "min" : 0, "max" : "*" }, "type" : [{ "code" : "Extension", "profile" : ["http://hl7.org/fhir/1.0/StructureDefinition/extension-ClaimResponse.item.adjudication.value|0.1.0"] }], "constraint" : [{ "key" : "ele-1", "severity" : "error", "human" : "All FHIR elements must have a @value or children", "expression" : "hasValue() or (children().count() > id.count())", "source" : "http://hl7.org/fhir/StructureDefinition/Element|5.0.0" }, { "key" : "ext-1", "severity" : "error", "human" : "Must have either extensions or value[x], not both", "expression" : "extension.exists() != value.exists()", "source" : "http://hl7.org/fhir/StructureDefinition/Extension|5.0.0" }], "isModifier" : false, "isSummary" : false }, { "id" : "ClaimResponse.item.adjudication.quantity.value", "path" : "ClaimResponse.item.adjudication.quantity.value", "short" : "Numerical value (with implicit precision)", "definition" : "The value of the measured amount. The value includes an implicit precision in the presentation of the value.", "comment" : "The implicit precision in the value should always be honored. Monetary values have their own rules for handling precision (refer to standard accounting text books).", "requirements" : "Precision is handled implicitly in almost all cases of measurement.", "min" : 0, "max" : "1", "base" : { "path" : "Quantity.value", "min" : 0, "max" : "1" }, "type" : [{ "code" : "decimal" }], "constraint" : [{ "key" : "ele-1", "severity" : "error", "human" : "All FHIR elements must have a @value or children", "expression" : "hasValue() or (children().count() > id.count())", "source" : "http://hl7.org/fhir/StructureDefinition/Element|5.0.0" }], "isModifier" : false, "isSummary" : true, "mapping" : [{ "identity" : "v2", "map" : "SN.2 / CQ - N/A" }, { "identity" : "rim", "map" : "PQ.value, CO.value, MO.value, IVL.high or IVL.low depending on the value" }] }, { "id" : "ClaimResponse.item.adjudication.quantity.comparator", "path" : "ClaimResponse.item.adjudication.quantity.comparator", "short" : "< | <= | >= | > | ad - how to understand the value", "definition" : "How the value should be understood and represented - whether the actual value is greater or less than the stated value due to measurement issues; e.g. if the comparator is \"<\" , then the real value is < stated value.", "requirements" : "Need a framework for handling measures where the value is <5ug/L or >400mg/L due to the limitations of measuring methodology.", "min" : 0, "max" : "1", "base" : { "path" : "Quantity.comparator", "min" : 0, "max" : "1" }, "type" : [{ "code" : "code" }], "meaningWhenMissing" : "If there is no comparator, then there is no modification of the value", "constraint" : [{ "key" : "ele-1", "severity" : "error", "human" : "All FHIR elements must have a @value or children", "expression" : "hasValue() or (children().count() > id.count())", "source" : "http://hl7.org/fhir/StructureDefinition/Element|5.0.0" }], "isModifier" : true, "isModifierReason" : "This is labeled as \"Is Modifier\" because the comparator modifies the interpretation of the value significantly. If there is no comparator, then there is no modification of the value", "isSummary" : true, "binding" : { "extension" : [{ "url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString" : "QuantityComparator" }], "strength" : "required", "description" : "How the Quantity should be understood and represented.", "valueSet" : "http://hl7.org/fhir/ValueSet/quantity-comparator|5.0.0" }, "mapping" : [{ "identity" : "v2", "map" : "SN.1 / CQ.1" }, { "identity" : "rim", "map" : "IVL properties" }] }, { "id" : "ClaimResponse.item.adjudication.quantity.unit", "extension" : [{ "url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-translatable", "valueBoolean" : true }, { "url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-translatable", "valueBoolean" : true }], "path" : "ClaimResponse.item.adjudication.quantity.unit", "short" : "Unit representation", "definition" : "A human-readable form of the unit.", "requirements" : "There are many representations for units of measure and in many contexts, particular representations are fixed and required. I.e. mcg for micrograms.", "min" : 0, "max" : "1", "base" : { "path" : "Quantity.unit", "min" : 0, "max" : "1" }, "type" : [{ "code" : "string" }], "constraint" : [{ "key" : "ele-1", "severity" : "error", "human" : "All FHIR elements must have a @value or children", "expression" : "hasValue() or (children().count() > id.count())", "source" : "http://hl7.org/fhir/StructureDefinition/Element|5.0.0" }], "isModifier" : false, "isSummary" : true, "mapping" : [{ "identity" : "v2", "map" : "(see OBX.6 etc.) / CQ.2" }, { "identity" : "rim", "map" : "PQ.unit" }] }, { "id" : "ClaimResponse.item.adjudication.quantity.system", "path" : "ClaimResponse.item.adjudication.quantity.system", "short" : "System that defines coded unit form", "definition" : "The identification of the system that provides the coded form of the unit.", "requirements" : "Need to know the system that defines the coded form of the unit.", "min" : 0, "max" : "1", "base" : { "path" : "Quantity.system", "min" : 0, "max" : "1" }, "type" : [{ "code" : "uri" }], "condition" : ["qty-3"], "constraint" : [{ "key" : "ele-1", "severity" : "error", "human" : "All FHIR elements must have a @value or children", "expression" : "hasValue() or (children().count() > id.count())", "source" : "http://hl7.org/fhir/StructureDefinition/Element|5.0.0" }], "isModifier" : false, "isSummary" : true, "mapping" : [{ "identity" : "v2", "map" : "(see OBX.6 etc.) / CQ.2" }, { "identity" : "rim", "map" : "CO.codeSystem, PQ.translation.codeSystem" }] }, { "id" : "ClaimResponse.item.adjudication.quantity.code", "path" : "ClaimResponse.item.adjudication.quantity.code", "short" : "Coded form of the unit", "definition" : "A computer processable form of the unit in some unit representation system.", "comment" : "The preferred system is UCUM, but SNOMED CT can also be used (for customary units) or ISO 4217 for currency. The context of use may additionally require a code from a particular system.", "requirements" : "Need a computable form of the unit that is fixed across all forms. UCUM provides this for quantities, but SNOMED CT provides many units of interest.", "min" : 0, "max" : "1", "base" : { "path" : "Quantity.code", "min" : 0, "max" : "1" }, "type" : [{ "code" : "code" }], "condition" : ["qty-3"], "constraint" : [{ "key" : "ele-1", "severity" : "error", "human" : "All FHIR elements must have a @value or children", "expression" : "hasValue() or (children().count() > id.count())", "source" : "http://hl7.org/fhir/StructureDefinition/Element|5.0.0" }], "isModifier" : false, "isSummary" : true, "mapping" : [{ "identity" : "v2", "map" : "(see OBX.6 etc.) / CQ.2" }, { "identity" : "rim", "map" : "PQ.code, MO.currency, PQ.translation.code" }] }, { "id" : "ClaimResponse.item.detail", "path" : "ClaimResponse.item.detail", "short" : "Adjudication for claim details", "definition" : "A claim detail. Either a simple (a product or service) or a 'group' of sub-details which are simple items.", "requirements" : "The adjudication for details provided on the claim.", "min" : 0, "max" : "*", "base" : { "path" : "ClaimResponse.item.detail", "min" : 0, "max" : "*" }, "type" : [{ "code" : "BackboneElement" }], "constraint" : [{ "key" : "ele-1", "severity" : "error", "human" : "All FHIR elements must have a @value or children", "expression" : "hasValue() or (children().count() > id.count())", "source" : "http://hl7.org/fhir/StructureDefinition/Element|5.0.0" }], "mustSupport" : false, "isModifier" : false, "isSummary" : false }, { "id" : "ClaimResponse.item.detail.id", "path" : "ClaimResponse.item.detail.id", "representation" : ["xmlAttr"], "short" : "Unique id for inter-element referencing", "definition" : "Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.", "min" : 0, "max" : "1", "base" : { "path" : "Element.id", "min" : 0, "max" : "1" }, "type" : [{ "extension" : [{ "url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type", "valueUrl" : "string" }], "code" : "http://hl7.org/fhirpath/System.String" }], "condition" : ["ele-1"], "isModifier" : false, "isSummary" : false, "mapping" : [{ "identity" : "rim", "map" : "n/a" }] }, { "id" : "ClaimResponse.item.detail.extension", "path" : "ClaimResponse.item.detail.extension", "short" : "Additional content defined by implementations", "definition" : "May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and managable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.", "comment" : "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.", "alias" : ["extensions", "user content"], "min" : 0, "max" : "*", "base" : { "path" : "Element.extension", "min" : 0, "max" : "*" }, "type" : [{ "code" : "Extension" }], "constraint" : [{ "key" : "ele-1", "severity" : "error", "human" : "All FHIR elements must have a @value or children", "expression" : "hasValue() or (children().count() > id.count())", "source" : "http://hl7.org/fhir/StructureDefinition/Element|5.0.0" }, { "key" : "ext-1", "severity" : "error", "human" : "Must have either extensions or value[x], not both", "expression" : "extension.exists() != value.exists()", "source" : "http://hl7.org/fhir/StructureDefinition/Extension|5.0.0" }], "isModifier" : false, "isSummary" : false, "mapping" : [{ "identity" : "rim", "map" : "n/a" }] }, { "id" : "ClaimResponse.item.detail.modifierExtension", "path" : "ClaimResponse.item.detail.modifierExtension", "short" : "Extensions that cannot be ignored even if unrecognized", "definition" : "May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and managable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.\n\nModifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).", "comment" : "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.", "requirements" : "Modifier extensions allow for extensions that *cannot* be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the [definition of modifier extensions](http://hl7.org/fhir/R5/extensibility.html#modifierExtension).", "alias" : ["extensions", "user content", "modifiers"], "min" : 0, "max" : "*", "base" : { "path" : "BackboneElement.modifierExtension", "min" : 0, "max" : "*" }, "type" : [{ "code" : "Extension" }], "constraint" : [{ "key" : "ele-1", "severity" : "error", "human" : "All FHIR elements must have a @value or children", "expression" : "hasValue() or (children().count() > id.count())", "source" : "http://hl7.org/fhir/StructureDefinition/Element|5.0.0" }, { "key" : "ext-1", "severity" : "error", "human" : "Must have either extensions or value[x], not both", "expression" : "extension.exists() != value.exists()", "source" : "http://hl7.org/fhir/StructureDefinition/Extension|5.0.0" }], "isModifier" : true, "isModifierReason" : "Modifier extensions are expected to modify the meaning or interpretation of the element that contains them", "isSummary" : true, "mapping" : [{ "identity" : "rim", "map" : "N/A" }] }, { "id" : "ClaimResponse.item.detail.detailSequence", "path" : "ClaimResponse.item.detail.detailSequence", "short" : "Claim detail instance identifier", "definition" : "A number to uniquely reference the claim detail entry.", "requirements" : "Necessary to provide a mechanism to link the adjudication result to the submitted claim detail.", "min" : 1, "max" : "1", "base" : { "path" : "ClaimResponse.item.detail.detailSequence", "min" : 1, "max" : "1" }, "type" : [{ "code" : "positiveInt" }], "constraint" : [{ "key" : "ele-1", "severity" : "error", "human" : "All FHIR elements must have a @value or children", "expression" : "hasValue() or (children().count() > id.count())", "source" : "http://hl7.org/fhir/StructureDefinition/Element|5.0.0" }], "mustSupport" : false, "isModifier" : false, "isSummary" : false }, { "id" : "ClaimResponse.item.detail.traceNumber", "path" : "ClaimResponse.item.detail.traceNumber", "short" : "Number for tracking", "definition" : "Trace number for tracking purposes. May be defined at the jurisdiction level or between trading partners.", "requirements" : "Allows partners to uniquely identify components for tracking.", "min" : 0, "max" : "*", "base" : { "path" : "ClaimResponse.item.detail.traceNumber", "min" : 0, "max" : "*" }, "type" : [{ "code" : "Identifier" }], "constraint" : [{ "key" : "ele-1", "severity" : "error", "human" : "All FHIR elements must have a @value or children", "expression" : "hasValue() or (children().count() > id.count())", "source" : "http://hl7.org/fhir/StructureDefinition/Element|5.0.0" }], "mustSupport" : false, "isModifier" : false, "isSummary" : false }, { "id" : "ClaimResponse.item.detail.noteNumber", "path" : "ClaimResponse.item.detail.noteNumber", "short" : "Applicable note numbers", "definition" : "The numbers associated with notes below which apply to the adjudication of this item.", "requirements" : "Provides a condensed manner for associating human readable descriptive explanations for adjudications on the line item.", "min" : 0, "max" : "*", "base" : { "path" : "ClaimResponse.item.detail.noteNumber", "min" : 0, "max" : "*" }, "type" : [{ "code" : "positiveInt" }], "constraint" : [{ "key" : "ele-1", "severity" : "error", "human" : "All FHIR elements must have a @value or children", "expression" : "hasValue() or (children().count() > id.count())", "source" : "http://hl7.org/fhir/StructureDefinition/Element|5.0.0" }], "mustSupport" : false, "isModifier" : false, "isSummary" : false }, { "id" : "ClaimResponse.item.detail.reviewOutcome", "path" : "ClaimResponse.item.detail.reviewOutcome", "short" : "Detail level adjudication results", "definition" : "The high-level results of the adjudication if adjudication has been performed.", "min" : 0, "max" : "1", "base" : { "path" : "ClaimResponse.item.detail.reviewOutcome", "min" : 0, "max" : "1" }, "contentReference" : "http://hl7.org/fhir/StructureDefinition/ClaimResponse#ClaimResponse.item.reviewOutcome", "constraint" : [{ "key" : "ele-1", "severity" : "error", "human" : "All FHIR elements must have a @value or children", "expression" : "hasValue() or (children().count() > id.count())", "source" : "http://hl7.org/fhir/StructureDefinition/Element|5.0.0" }], "mustSupport" : false, "isModifier" : false, "isSummary" : false }, { "id" : "ClaimResponse.item.detail.adjudication", "path" : "ClaimResponse.item.detail.adjudication", "short" : "Detail level adjudication details", "definition" : "The adjudication results.", "min" : 0, "max" : "*", "base" : { "path" : "ClaimResponse.item.detail.adjudication", "min" : 0, "max" : "*" }, "type" : [{ "code" : "BackboneElement" }], "constraint" : [{ "key" : "ele-1", "severity" : "error", "human" : "All FHIR elements must have a @value or children", "expression" : "hasValue() or (children().count() > id.count())", "source" : "http://hl7.org/fhir/StructureDefinition/Element|5.0.0" }], "mustSupport" : false, "isModifier" : false, "isSummary" : false }, { "id" : "ClaimResponse.item.detail.adjudication.id", "path" : "ClaimResponse.item.detail.adjudication.id", "representation" : ["xmlAttr"], "short" : "Unique id for inter-element referencing", "definition" : "Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.", "min" : 0, "max" : "1", "base" : { "path" : "Element.id", "min" : 0, "max" : "1" }, "type" : [{ "extension" : [{ "url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type", "valueUrl" : "string" }], "code" : "http://hl7.org/fhirpath/System.String" }], "condition" : ["ele-1"], "isModifier" : false, "isSummary" : false, "mapping" : [{ "identity" : "rim", "map" : "n/a" }] }, { "id" : "ClaimResponse.item.detail.adjudication.extension", "path" : "ClaimResponse.item.detail.adjudication.extension", "slicing" : { "discriminator" : [{ "type" : "value", "path" : "url" }], "ordered" : false, "rules" : "open" }, "short" : "Extension", "definition" : "An Extension", "min" : 0, "max" : "*", "base" : { "path" : "Element.extension", "min" : 0, "max" : "*" }, "type" : [{ "code" : "Extension" }], "constraint" : [{ "key" : "ele-1", "severity" : "error", "human" : "All FHIR elements must have a @value or children", "expression" : "hasValue() or (children().count() > id.count())", "source" : "http://hl7.org/fhir/StructureDefinition/Element|5.0.0" }, { "key" : "ext-1", "severity" : "error", "human" : "Must have either extensions or value[x], not both", "expression" : "extension.exists() != value.exists()", "source" : "http://hl7.org/fhir/StructureDefinition/Extension|5.0.0" }], "isModifier" : false, "isSummary" : false }, { "id" : "ClaimResponse.item.detail.adjudication.extension:amount", "path" : "ClaimResponse.item.detail.adjudication.extension", "sliceName" : "amount", "short" : "DSTU2: Monetary amount (new)", "definition" : "DSTU2: `ClaimResponse.item.detail.adjudication.amount` (new:Quantity[Money])", "comment" : "Element `ClaimResponse.item.detail.adjudication.amount` has a context of ClaimResponse.item.detail.adjudication based on following the parent source element upwards and mapping to `ClaimResponse`.\nElement `ClaimResponse.item.detail.adjudication.amount` has no mapping targets in FHIR R5. Typically, this is because the element has been added (is a new element).", "min" : 0, "max" : "1", "base" : { "path" : "Element.extension", "min" : 0, "max" : "*" }, "type" : [{ "code" : "Extension", "profile" : ["http://hl7.org/fhir/1.0/StructureDefinition/extension-ClaimResponse.item.detail.adjudication.amount|0.1.0"] }], "constraint" : [{ "key" : "ele-1", "severity" : "error", "human" : "All FHIR elements must have a @value or children", "expression" : "hasValue() or (children().count() > id.count())", "source" : "http://hl7.org/fhir/StructureDefinition/Element|5.0.0" }, { "key" : "ext-1", "severity" : "error", "human" : "Must have either extensions or value[x], not both", "expression" : "extension.exists() != value.exists()", "source" : "http://hl7.org/fhir/StructureDefinition/Extension|5.0.0" }], "isModifier" : false, "isSummary" : false }, { "id" : "ClaimResponse.item.detail.adjudication.extension:value", "path" : "ClaimResponse.item.detail.adjudication.extension", "sliceName" : "value", "short" : "DSTU2: Non-monetary value (new)", "definition" : "DSTU2: `ClaimResponse.item.detail.adjudication.value` (new:decimal)", "comment" : "Element `ClaimResponse.item.detail.adjudication.value` has a context of ClaimResponse.item.detail.adjudication based on following the parent source element upwards and mapping to `ClaimResponse`.\nElement `ClaimResponse.item.detail.adjudication.value` has no mapping targets in FHIR R5. Typically, this is because the element has been added (is a new element).", "min" : 0, "max" : "1", "base" : { "path" : "Element.extension", "min" : 0, "max" : "*" }, "type" : [{ "code" : "Extension", "profile" : ["http://hl7.org/fhir/1.0/StructureDefinition/extension-ClaimResponse.item.detail.adjudication.value|0.1.0"] }], "constraint" : [{ "key" : "ele-1", "severity" : "error", "human" : "All FHIR elements must have a @value or children", "expression" : "hasValue() or (children().count() > id.count())", "source" : "http://hl7.org/fhir/StructureDefinition/Element|5.0.0" }, { "key" : "ext-1", "severity" : "error", "human" : "Must have either extensions or value[x], not both", "expression" : "extension.exists() != value.exists()", "source" : "http://hl7.org/fhir/StructureDefinition/Extension|5.0.0" }], "isModifier" : false, "isSummary" : false }, { "id" : "ClaimResponse.item.detail.adjudication.modifierExtension", "path" : "ClaimResponse.item.detail.adjudication.modifierExtension", "short" : "Extensions that cannot be ignored even if unrecognized", "definition" : "May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and managable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.\n\nModifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).", "comment" : "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.", "requirements" : "Modifier extensions allow for extensions that *cannot* be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the [definition of modifier extensions](http://hl7.org/fhir/R5/extensibility.html#modifierExtension).", "alias" : ["extensions", "user content", "modifiers"], "min" : 0, "max" : "*", "base" : { "path" : "BackboneElement.modifierExtension", "min" : 0, "max" : "*" }, "type" : [{ "code" : "Extension" }], "constraint" : [{ "key" : "ele-1", "severity" : "error", "human" : "All FHIR elements must have a @value or children", "expression" : "hasValue() or (children().count() > id.count())", "source" : "http://hl7.org/fhir/StructureDefinition/Element|5.0.0" }, { "key" : "ext-1", "severity" : "error", "human" : "Must have either extensions or value[x], not both", "expression" : "extension.exists() != value.exists()", "source" : "http://hl7.org/fhir/StructureDefinition/Extension|5.0.0" }], "isModifier" : true, "isModifierReason" : "Modifier extensions are expected to modify the meaning or interpretation of the element that contains them", "isSummary" : true, "mapping" : [{ "identity" : "rim", "map" : "N/A" }] }, { "id" : "ClaimResponse.item.detail.adjudication.category", "path" : "ClaimResponse.item.detail.adjudication.category", "short" : "Type of adjudication information", "definition" : "A code to indicate the information type of this adjudication record. Information types may include the value submitted, maximum values or percentages allowed or payable under the plan, amounts that: the patient is responsible for in aggregate or pertaining to this item; amounts paid by other coverages; and, the benefit payable for this item.", "comment" : "For example codes indicating: Co-Pay, deductible, eligible, benefit, tax, etc.", "requirements" : "Needed to enable understanding of the context of the other information in the adjudication.", "min" : 1, "max" : "1", "base" : { "path" : "ClaimResponse.item.adjudication.category", "min" : 1, "max" : "1" }, "type" : [{ "code" : "CodeableConcept" }], "constraint" : [{ "key" : "ele-1", "severity" : "error", "human" : "All FHIR elements must have a @value or children", "expression" : "hasValue() or (children().count() > id.count())", "source" : "http://hl7.org/fhir/StructureDefinition/Element|5.0.0" }], "mustSupport" : false, "isModifier" : false, "isSummary" : false, "binding" : { "extension" : [{ "url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString" : "Adjudication" }], "strength" : "example", "description" : "The adjudication codes.", "valueSet" : "http://hl7.org/fhir/ValueSet/adjudication|5.0.0" } }, { "id" : "ClaimResponse.item.detail.adjudication.reason", "path" : "ClaimResponse.item.detail.adjudication.reason", "short" : "Explanation of adjudication outcome", "definition" : "A code supporting the understanding of the adjudication result and explaining variance from expected amount.", "comment" : "For example may indicate that the funds for this benefit type have been exhausted.", "requirements" : "To support understanding of variance from adjudication expectations.", "min" : 0, "max" : "1", "base" : { "path" : "ClaimResponse.item.adjudication.reason", "min" : 0, "max" : "1" }, "type" : [{ "code" : "CodeableConcept" }], "constraint" : [{ "key" : "ele-1", "severity" : "error", "human" : "All FHIR elements must have a @value or children", "expression" : "hasValue() or (children().count() > id.count())", "source" : "http://hl7.org/fhir/StructureDefinition/Element|5.0.0" }], "mustSupport" : false, "isModifier" : false, "isSummary" : false, "binding" : { "extension" : [{ "url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString" : "AdjudicationReason" }], "strength" : "example", "description" : "The adjudication reason codes.", "valueSet" : "http://hl7.org/fhir/ValueSet/adjudication-reason|5.0.0" } }, { "id" : "ClaimResponse.item.detail.adjudication.amount", "path" : "ClaimResponse.item.detail.adjudication.amount", "short" : "Monetary amount", "definition" : "Monetary amount associated with the category.", "comment" : "For example: amount submitted, eligible amount, co-payment, and benefit payable.", "requirements" : "Most adjudication categories convey a monetary amount.", "min" : 0, "max" : "1", "base" : { "path" : "ClaimResponse.item.adjudication.amount", "min" : 0, "max" : "1" }, "type" : [{ "code" : "Money" }], "constraint" : [{ "key" : "ele-1", "severity" : "error", "human" : "All FHIR elements must have a @value or children", "expression" : "hasValue() or (children().count() > id.count())", "source" : "http://hl7.org/fhir/StructureDefinition/Element|5.0.0" }], "mustSupport" : false, "isModifier" : false, "isSummary" : false }, { "id" : "ClaimResponse.item.detail.adjudication.quantity", "path" : "ClaimResponse.item.detail.adjudication.quantity", "short" : "Non-monetary value", "definition" : "A non-monetary value associated with the category. Mutually exclusive to the amount element above.", "comment" : "For example: eligible percentage or co-payment percentage.", "requirements" : "Some adjudication categories convey a percentage or a fixed value.", "min" : 0, "max" : "1", "base" : { "path" : "ClaimResponse.item.adjudication.quantity", "min" : 0, "max" : "1" }, "type" : [{ "code" : "Quantity" }], "constraint" : [{ "key" : "ele-1", "severity" : "error", "human" : "All FHIR elements must have a @value or children", "expression" : "hasValue() or (children().count() > id.count())", "source" : "http://hl7.org/fhir/StructureDefinition/Element|5.0.0" }], "mustSupport" : false, "isModifier" : false, "isSummary" : false }, { "id" : "ClaimResponse.item.detail.subDetail", "path" : "ClaimResponse.item.detail.subDetail", "short" : "Adjudication for claim sub-details", "definition" : "A sub-detail adjudication of a simple product or service.", "requirements" : "The adjudication for sub-details provided on the claim.", "min" : 0, "max" : "*", "base" : { "path" : "ClaimResponse.item.detail.subDetail", "min" : 0, "max" : "*" }, "type" : [{ "code" : "BackboneElement" }], "constraint" : [{ "key" : "ele-1", "severity" : "error", "human" : "All FHIR elements must have a @value or children", "expression" : "hasValue() or (children().count() > id.count())", "source" : "http://hl7.org/fhir/StructureDefinition/Element|5.0.0" }], "mustSupport" : false, "isModifier" : false, "isSummary" : false }, { "id" : "ClaimResponse.item.detail.subDetail.id", "path" : "ClaimResponse.item.detail.subDetail.id", "representation" : ["xmlAttr"], "short" : "Unique id for inter-element referencing", "definition" : "Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.", "min" : 0, "max" : "1", "base" : { "path" : "Element.id", "min" : 0, "max" : "1" }, "type" : [{ "extension" : [{ "url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type", "valueUrl" : "string" }], "code" : "http://hl7.org/fhirpath/System.String" }], "condition" : ["ele-1"], "isModifier" : false, "isSummary" : false, "mapping" : [{ "identity" : "rim", "map" : "n/a" }] }, { "id" : "ClaimResponse.item.detail.subDetail.extension", "path" : "ClaimResponse.item.detail.subDetail.extension", "short" : "Additional content defined by implementations", "definition" : "May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and managable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.", "comment" : "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.", "alias" : ["extensions", "user content"], "min" : 0, "max" : "*", "base" : { "path" : "Element.extension", "min" : 0, "max" : "*" }, "type" : [{ "code" : "Extension" }], "constraint" : [{ "key" : "ele-1", "severity" : "error", "human" : "All FHIR elements must have a @value or children", "expression" : "hasValue() or (children().count() > id.count())", "source" : "http://hl7.org/fhir/StructureDefinition/Element|5.0.0" }, { "key" : "ext-1", "severity" : "error", "human" : "Must have either extensions or value[x], not both", "expression" : "extension.exists() != value.exists()", "source" : "http://hl7.org/fhir/StructureDefinition/Extension|5.0.0" }], "isModifier" : false, "isSummary" : false, "mapping" : [{ "identity" : "rim", "map" : "n/a" }] }, { "id" : "ClaimResponse.item.detail.subDetail.modifierExtension", "path" : "ClaimResponse.item.detail.subDetail.modifierExtension", "short" : "Extensions that cannot be ignored even if unrecognized", "definition" : "May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and managable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.\n\nModifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).", "comment" : "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.", "requirements" : "Modifier extensions allow for extensions that *cannot* be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the [definition of modifier extensions](http://hl7.org/fhir/R5/extensibility.html#modifierExtension).", "alias" : ["extensions", "user content", "modifiers"], "min" : 0, "max" : "*", "base" : { "path" : "BackboneElement.modifierExtension", "min" : 0, "max" : "*" }, "type" : [{ "code" : "Extension" }], "constraint" : [{ "key" : "ele-1", "severity" : "error", "human" : "All FHIR elements must have a @value or children", "expression" : "hasValue() or (children().count() > id.count())", "source" : "http://hl7.org/fhir/StructureDefinition/Element|5.0.0" }, { "key" : "ext-1", "severity" : "error", "human" : "Must have either extensions or value[x], not both", "expression" : "extension.exists() != value.exists()", "source" : "http://hl7.org/fhir/StructureDefinition/Extension|5.0.0" }], "isModifier" : true, "isModifierReason" : "Modifier extensions are expected to modify the meaning or interpretation of the element that contains them", "isSummary" : true, "mapping" : [{ "identity" : "rim", "map" : "N/A" }] }, { "id" : "ClaimResponse.item.detail.subDetail.subDetailSequence", "path" : "ClaimResponse.item.detail.subDetail.subDetailSequence", "short" : "Claim sub-detail instance identifier", "definition" : "A number to uniquely reference the claim sub-detail entry.", "requirements" : "Necessary to provide a mechanism to link the adjudication result to the submitted claim sub-detail.", "min" : 1, "max" : "1", "base" : { "path" : "ClaimResponse.item.detail.subDetail.subDetailSequence", "min" : 1, "max" : "1" }, "type" : [{ "code" : "positiveInt" }], "constraint" : [{ "key" : "ele-1", "severity" : "error", "human" : "All FHIR elements must have a @value or children", "expression" : "hasValue() or (children().count() > id.count())", "source" : "http://hl7.org/fhir/StructureDefinition/Element|5.0.0" }], "mustSupport" : false, "isModifier" : false, "isSummary" : false }, { "id" : "ClaimResponse.item.detail.subDetail.traceNumber", "path" : "ClaimResponse.item.detail.subDetail.traceNumber", "short" : "Number for tracking", "definition" : "Trace number for tracking purposes. May be defined at the jurisdiction level or between trading partners.", "requirements" : "Allows partners to uniquely identify components for tracking.", "min" : 0, "max" : "*", "base" : { "path" : "ClaimResponse.item.detail.subDetail.traceNumber", "min" : 0, "max" : "*" }, "type" : [{ "code" : "Identifier" }], "constraint" : [{ "key" : "ele-1", "severity" : "error", "human" : "All FHIR elements must have a @value or children", "expression" : "hasValue() or (children().count() > id.count())", "source" : "http://hl7.org/fhir/StructureDefinition/Element|5.0.0" }], "mustSupport" : false, "isModifier" : false, "isSummary" : false }, { "id" : "ClaimResponse.item.detail.subDetail.noteNumber", "path" : "ClaimResponse.item.detail.subDetail.noteNumber", "short" : "Applicable note numbers", "definition" : "The numbers associated with notes below which apply to the adjudication of this item.", "requirements" : "Provides a condensed manner for associating human readable descriptive explanations for adjudications on the line item.", "min" : 0, "max" : "*", "base" : { "path" : "ClaimResponse.item.detail.subDetail.noteNumber", "min" : 0, "max" : "*" }, "type" : [{ "code" : "positiveInt" }], "constraint" : [{ "key" : "ele-1", "severity" : "error", "human" : "All FHIR elements must have a @value or children", "expression" : "hasValue() or (children().count() > id.count())", "source" : "http://hl7.org/fhir/StructureDefinition/Element|5.0.0" }], "mustSupport" : false, "isModifier" : false, "isSummary" : false }, { "id" : "ClaimResponse.item.detail.subDetail.reviewOutcome", "path" : "ClaimResponse.item.detail.subDetail.reviewOutcome", "short" : "Subdetail level adjudication results", "definition" : "The high-level results of the adjudication if adjudication has been performed.", "min" : 0, "max" : "1", "base" : { "path" : "ClaimResponse.item.detail.subDetail.reviewOutcome", "min" : 0, "max" : "1" }, "contentReference" : "http://hl7.org/fhir/StructureDefinition/ClaimResponse#ClaimResponse.item.reviewOutcome", "constraint" : [{ "key" : "ele-1", "severity" : "error", "human" : "All FHIR elements must have a @value or children", "expression" : "hasValue() or (children().count() > id.count())", "source" : "http://hl7.org/fhir/StructureDefinition/Element|5.0.0" }], "mustSupport" : false, "isModifier" : false, "isSummary" : false }, { "id" : "ClaimResponse.item.detail.subDetail.adjudication", "path" : "ClaimResponse.item.detail.subDetail.adjudication", "short" : "Subdetail level adjudication details", "definition" : "The adjudication results.", "min" : 0, "max" : "*", "base" : { "path" : "ClaimResponse.item.detail.subDetail.adjudication", "min" : 0, "max" : "*" }, "type" : [{ "code" : "BackboneElement" }], "constraint" : [{ "key" : "ele-1", "severity" : "error", "human" : "All FHIR elements must have a @value or children", "expression" : "hasValue() or (children().count() > id.count())", "source" : "http://hl7.org/fhir/StructureDefinition/Element|5.0.0" }], "mustSupport" : false, "isModifier" : false, "isSummary" : false }, { "id" : "ClaimResponse.item.detail.subDetail.adjudication.id", "path" : "ClaimResponse.item.detail.subDetail.adjudication.id", "representation" : ["xmlAttr"], "short" : "Unique id for inter-element referencing", "definition" : "Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.", "min" : 0, "max" : "1", "base" : { "path" : "Element.id", "min" : 0, "max" : "1" }, "type" : [{ "extension" : [{ "url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type", "valueUrl" : "string" }], "code" : "http://hl7.org/fhirpath/System.String" }], "condition" : ["ele-1"], "isModifier" : false, "isSummary" : false, "mapping" : [{ "identity" : "rim", "map" : "n/a" }] }, { "id" : "ClaimResponse.item.detail.subDetail.adjudication.extension", "path" : "ClaimResponse.item.detail.subDetail.adjudication.extension", "slicing" : { "discriminator" : [{ "type" : "value", "path" : "url" }], "ordered" : false, "rules" : "open" }, "short" : "Extension", "definition" : "An Extension", "min" : 0, "max" : "*", "base" : { "path" : "Element.extension", "min" : 0, "max" : "*" }, "type" : [{ "code" : "Extension" }], "constraint" : [{ "key" : "ele-1", "severity" : "error", "human" : "All FHIR elements must have a @value or children", "expression" : "hasValue() or (children().count() > id.count())", "source" : "http://hl7.org/fhir/StructureDefinition/Element|5.0.0" }, { "key" : "ext-1", "severity" : "error", "human" : "Must have either extensions or value[x], not both", "expression" : "extension.exists() != value.exists()", "source" : "http://hl7.org/fhir/StructureDefinition/Extension|5.0.0" }], "isModifier" : false, "isSummary" : false }, { "id" : "ClaimResponse.item.detail.subDetail.adjudication.extension:amount", "path" : "ClaimResponse.item.detail.subDetail.adjudication.extension", "sliceName" : "amount", "short" : "DSTU2: Monetary amount (new)", "definition" : "DSTU2: `ClaimResponse.item.detail.subDetail.adjudication.amount` (new:Quantity[Money])", "comment" : "Element `ClaimResponse.item.detail.subDetail.adjudication.amount` has a context of ClaimResponse.item.detail.subDetail.adjudication based on following the parent source element upwards and mapping to `ClaimResponse`.\nElement `ClaimResponse.item.detail.subDetail.adjudication.amount` has no mapping targets in FHIR R5. Typically, this is because the element has been added (is a new element).", "min" : 0, "max" : "1", "base" : { "path" : "Element.extension", "min" : 0, "max" : "*" }, "type" : [{ "code" : "Extension", "profile" : ["http://hl7.org/fhir/1.0/StructureDefinition/extension-ClaimResponse.item.detail.subDetail.adjudication.amount|0.1.0"] }], "constraint" : [{ "key" : "ele-1", "severity" : "error", "human" : "All FHIR elements must have a @value or children", "expression" : "hasValue() or (children().count() > id.count())", "source" : "http://hl7.org/fhir/StructureDefinition/Element|5.0.0" }, { "key" : "ext-1", "severity" : "error", "human" : "Must have either extensions or value[x], not both", "expression" : "extension.exists() != value.exists()", "source" : "http://hl7.org/fhir/StructureDefinition/Extension|5.0.0" }], "isModifier" : false, "isSummary" : false }, { "id" : "ClaimResponse.item.detail.subDetail.adjudication.extension:value", "path" : "ClaimResponse.item.detail.subDetail.adjudication.extension", "sliceName" : "value", "short" : "DSTU2: Non-monetary value (new)", "definition" : "DSTU2: `ClaimResponse.item.detail.subDetail.adjudication.value` (new:decimal)", "comment" : "Element `ClaimResponse.item.detail.subDetail.adjudication.value` has a context of ClaimResponse.item.detail.subDetail.adjudication based on following the parent source element upwards and mapping to `ClaimResponse`.\nElement `ClaimResponse.item.detail.subDetail.adjudication.value` has no mapping targets in FHIR R5. Typically, this is because the element has been added (is a new element).", "min" : 0, "max" : "1", "base" : { "path" : "Element.extension", "min" : 0, "max" : "*" }, "type" : [{ "code" : "Extension", "profile" : ["http://hl7.org/fhir/1.0/StructureDefinition/extension-ClaimResponse.item.detail.subDetail.adjudication.value|0.1.0"] }], "constraint" : [{ "key" : "ele-1", "severity" : "error", "human" : "All FHIR elements must have a @value or children", "expression" : "hasValue() or (children().count() > id.count())", "source" : "http://hl7.org/fhir/StructureDefinition/Element|5.0.0" }, { "key" : "ext-1", "severity" : "error", "human" : "Must have either extensions or value[x], not both", "expression" : "extension.exists() != value.exists()", "source" : "http://hl7.org/fhir/StructureDefinition/Extension|5.0.0" }], "isModifier" : false, "isSummary" : false }, { "id" : "ClaimResponse.item.detail.subDetail.adjudication.modifierExtension", "path" : "ClaimResponse.item.detail.subDetail.adjudication.modifierExtension", "short" : "Extensions that cannot be ignored even if unrecognized", "definition" : "May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and managable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.\n\nModifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).", "comment" : "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.", "requirements" : "Modifier extensions allow for extensions that *cannot* be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the [definition of modifier extensions](http://hl7.org/fhir/R5/extensibility.html#modifierExtension).", "alias" : ["extensions", "user content", "modifiers"], "min" : 0, "max" : "*", "base" : { "path" : "BackboneElement.modifierExtension", "min" : 0, "max" : "*" }, "type" : [{ "code" : "Extension" }], "constraint" : [{ "key" : "ele-1", "severity" : "error", "human" : "All FHIR elements must have a @value or children", "expression" : "hasValue() or (children().count() > id.count())", "source" : "http://hl7.org/fhir/StructureDefinition/Element|5.0.0" }, { "key" : "ext-1", "severity" : "error", "human" : "Must have either extensions or value[x], not both", "expression" : "extension.exists() != value.exists()", "source" : "http://hl7.org/fhir/StructureDefinition/Extension|5.0.0" }], "isModifier" : true, "isModifierReason" : "Modifier extensions are expected to modify the meaning or interpretation of the element that contains them", "isSummary" : true, "mapping" : [{ "identity" : "rim", "map" : "N/A" }] }, { "id" : "ClaimResponse.item.detail.subDetail.adjudication.category", "path" : "ClaimResponse.item.detail.subDetail.adjudication.category", "short" : "Type of adjudication information", "definition" : "A code to indicate the information type of this adjudication record. Information types may include the value submitted, maximum values or percentages allowed or payable under the plan, amounts that: the patient is responsible for in aggregate or pertaining to this item; amounts paid by other coverages; and, the benefit payable for this item.", "comment" : "For example codes indicating: Co-Pay, deductible, eligible, benefit, tax, etc.", "requirements" : "Needed to enable understanding of the context of the other information in the adjudication.", "min" : 1, "max" : "1", "base" : { "path" : "ClaimResponse.item.adjudication.category", "min" : 1, "max" : "1" }, "type" : [{ "code" : "CodeableConcept" }], "constraint" : [{ "key" : "ele-1", "severity" : "error", "human" : "All FHIR elements must have a @value or children", "expression" : "hasValue() or (children().count() > id.count())", "source" : "http://hl7.org/fhir/StructureDefinition/Element|5.0.0" }], "mustSupport" : false, "isModifier" : false, "isSummary" : false, "binding" : { "extension" : [{ "url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString" : "Adjudication" }], "strength" : "example", "description" : "The adjudication codes.", "valueSet" : "http://hl7.org/fhir/ValueSet/adjudication|5.0.0" } }, { "id" : "ClaimResponse.item.detail.subDetail.adjudication.reason", "path" : "ClaimResponse.item.detail.subDetail.adjudication.reason", "short" : "Explanation of adjudication outcome", "definition" : "A code supporting the understanding of the adjudication result and explaining variance from expected amount.", "comment" : "For example may indicate that the funds for this benefit type have been exhausted.", "requirements" : "To support understanding of variance from adjudication expectations.", "min" : 0, "max" : "1", "base" : { "path" : "ClaimResponse.item.adjudication.reason", "min" : 0, "max" : "1" }, "type" : [{ "code" : "CodeableConcept" }], "constraint" : [{ "key" : "ele-1", "severity" : "error", "human" : "All FHIR elements must have a @value or children", "expression" : "hasValue() or (children().count() > id.count())", "source" : "http://hl7.org/fhir/StructureDefinition/Element|5.0.0" }], "mustSupport" : false, "isModifier" : false, "isSummary" : false, "binding" : { "extension" : [{ "url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString" : "AdjudicationReason" }], "strength" : "example", "description" : "The adjudication reason codes.", "valueSet" : "http://hl7.org/fhir/ValueSet/adjudication-reason|5.0.0" } }, { "id" : "ClaimResponse.item.detail.subDetail.adjudication.amount", "path" : "ClaimResponse.item.detail.subDetail.adjudication.amount", "short" : "Monetary amount", "definition" : "Monetary amount associated with the category.", "comment" : "For example: amount submitted, eligible amount, co-payment, and benefit payable.", "requirements" : "Most adjudication categories convey a monetary amount.", "min" : 0, "max" : "1", "base" : { "path" : "ClaimResponse.item.adjudication.amount", "min" : 0, "max" : "1" }, "type" : [{ "code" : "Money" }], "constraint" : [{ "key" : "ele-1", "severity" : "error", "human" : "All FHIR elements must have a @value or children", "expression" : "hasValue() or (children().count() > id.count())", "source" : "http://hl7.org/fhir/StructureDefinition/Element|5.0.0" }], "mustSupport" : false, "isModifier" : false, "isSummary" : false }, { "id" : "ClaimResponse.item.detail.subDetail.adjudication.quantity", "path" : "ClaimResponse.item.detail.subDetail.adjudication.quantity", "short" : "Non-monetary value", "definition" : "A non-monetary value associated with the category. Mutually exclusive to the amount element above.", "comment" : "For example: eligible percentage or co-payment percentage.", "requirements" : "Some adjudication categories convey a percentage or a fixed value.", "min" : 0, "max" : "1", "base" : { "path" : "ClaimResponse.item.adjudication.quantity", "min" : 0, "max" : "1" }, "type" : [{ "code" : "Quantity" }], "constraint" : [{ "key" : "ele-1", "severity" : "error", "human" : "All FHIR elements must have a @value or children", "expression" : "hasValue() or (children().count() > id.count())", "source" : "http://hl7.org/fhir/StructureDefinition/Element|5.0.0" }], "mustSupport" : false, "isModifier" : false, "isSummary" : false }, { "id" : "ClaimResponse.addItem", "path" : "ClaimResponse.addItem", "short" : "Insurer added line items", "definition" : "The first-tier service adjudications for payor added product or service lines.", "requirements" : "Insurers may redefine the provided product or service or may package and/or decompose groups of products and services. The addItems allows the insurer to provide their line item list with linkage to the submitted items/details/sub-details. In a preauthorization the insurer may use the addItem structure to provide additional information on authorized products and services.", "min" : 0, "max" : "*", "base" : { "path" : "ClaimResponse.addItem", "min" : 0, "max" : "*" }, "type" : [{ "code" : "BackboneElement" }], "constraint" : [{ "key" : "ele-1", "severity" : "error", "human" : "All FHIR elements must have a @value or children", "expression" : "hasValue() or (children().count() > id.count())", "source" : "http://hl7.org/fhir/StructureDefinition/Element|5.0.0" }], "mustSupport" : false, "isModifier" : false, "isSummary" : false }, { "id" : "ClaimResponse.addItem.id", "path" : "ClaimResponse.addItem.id", "representation" : ["xmlAttr"], "short" : "Unique id for inter-element referencing", "definition" : "Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.", "min" : 0, "max" : "1", "base" : { "path" : "Element.id", "min" : 0, "max" : "1" }, "type" : [{ "extension" : [{ "url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type", "valueUrl" : "string" }], "code" : "http://hl7.org/fhirpath/System.String" }], "condition" : ["ele-1"], "isModifier" : false, "isSummary" : false, "mapping" : [{ "identity" : "rim", "map" : "n/a" }] }, { "id" : "ClaimResponse.addItem.extension", "path" : "ClaimResponse.addItem.extension", "slicing" : { "discriminator" : [{ "type" : "value", "path" : "url" }], "ordered" : false, "rules" : "open" }, "short" : "Extension", "definition" : "An Extension", "min" : 0, "max" : "*", "base" : { "path" : "Element.extension", "min" : 0, "max" : "*" }, "type" : [{ "code" : "Extension" }], "constraint" : [{ "key" : "ele-1", "severity" : "error", "human" : "All FHIR elements must have a @value or children", "expression" : "hasValue() or (children().count() > id.count())", "source" : "http://hl7.org/fhir/StructureDefinition/Element|5.0.0" }, { "key" : "ext-1", "severity" : "error", "human" : "Must have either extensions or value[x], not both", "expression" : "extension.exists() != value.exists()", "source" : "http://hl7.org/fhir/StructureDefinition/Extension|5.0.0" }], "isModifier" : false, "isSummary" : false }, { "id" : "ClaimResponse.addItem.extension:fee", "path" : "ClaimResponse.addItem.extension", "sliceName" : "fee", "short" : "DSTU2: Professional fee or Product charge (new)", "definition" : "DSTU2: `ClaimResponse.addItem.fee` (new:Quantity[Money])", "comment" : "Element `ClaimResponse.addItem.fee` has a context of ClaimResponse.addItem based on following the parent source element upwards and mapping to `ClaimResponse`.\nElement `ClaimResponse.addItem.fee` has no mapping targets in FHIR R5. Typically, this is because the element has been added (is a new element).", "min" : 0, "max" : "1", "base" : { "path" : "Element.extension", "min" : 0, "max" : "*" }, "type" : [{ "code" : "Extension", "profile" : ["http://hl7.org/fhir/1.0/StructureDefinition/extension-ClaimResponse.addItem.fee|0.1.0"] }], "constraint" : [{ "key" : "ele-1", "severity" : "error", "human" : "All FHIR elements must have a @value or children", "expression" : "hasValue() or (children().count() > id.count())", "source" : "http://hl7.org/fhir/StructureDefinition/Element|5.0.0" }, { "key" : "ext-1", "severity" : "error", "human" : "Must have either extensions or value[x], not both", "expression" : "extension.exists() != value.exists()", "source" : "http://hl7.org/fhir/StructureDefinition/Extension|5.0.0" }], "isModifier" : false, "isSummary" : false }, { "id" : "ClaimResponse.addItem.modifierExtension", "path" : "ClaimResponse.addItem.modifierExtension", "short" : "Extensions that cannot be ignored even if unrecognized", "definition" : "May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and managable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.\n\nModifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).", "comment" : "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.", "requirements" : "Modifier extensions allow for extensions that *cannot* be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the [definition of modifier extensions](http://hl7.org/fhir/R5/extensibility.html#modifierExtension).", "alias" : ["extensions", "user content", "modifiers"], "min" : 0, "max" : "*", "base" : { "path" : "BackboneElement.modifierExtension", "min" : 0, "max" : "*" }, "type" : [{ "code" : "Extension" }], "constraint" : [{ "key" : "ele-1", "severity" : "error", "human" : "All FHIR elements must have a @value or children", "expression" : "hasValue() or (children().count() > id.count())", "source" : "http://hl7.org/fhir/StructureDefinition/Element|5.0.0" }, { "key" : "ext-1", "severity" : "error", "human" : "Must have either extensions or value[x], not both", "expression" : "extension.exists() != value.exists()", "source" : "http://hl7.org/fhir/StructureDefinition/Extension|5.0.0" }], "isModifier" : true, "isModifierReason" : "Modifier extensions are expected to modify the meaning or interpretation of the element that contains them", "isSummary" : true, "mapping" : [{ "identity" : "rim", "map" : "N/A" }] }, { "id" : "ClaimResponse.addItem.itemSequence", "path" : "ClaimResponse.addItem.itemSequence", "short" : "Item sequence number", "definition" : "Claim items which this service line is intended to replace.", "requirements" : "Provides references to the claim items.", "min" : 0, "max" : "*", "base" : { "path" : "ClaimResponse.addItem.itemSequence", "min" : 0, "max" : "*" }, "type" : [{ "code" : "positiveInt" }], "constraint" : [{ "key" : "ele-1", "severity" : "error", "human" : "All FHIR elements must have a @value or children", "expression" : "hasValue() or (children().count() > id.count())", "source" : "http://hl7.org/fhir/StructureDefinition/Element|5.0.0" }], "mustSupport" : false, "isModifier" : false, "isSummary" : false }, { "id" : "ClaimResponse.addItem.detailSequence", "path" : "ClaimResponse.addItem.detailSequence", "short" : "Detail sequence number", "definition" : "The sequence number of the details within the claim item which this line is intended to replace.", "requirements" : "Provides references to the claim details within the claim item.", "min" : 0, "max" : "*", "base" : { "path" : "ClaimResponse.addItem.detailSequence", "min" : 0, "max" : "*" }, "type" : [{ "code" : "positiveInt" }], "constraint" : [{ "key" : "ele-1", "severity" : "error", "human" : "All FHIR elements must have a @value or children", "expression" : "hasValue() or (children().count() > id.count())", "source" : "http://hl7.org/fhir/StructureDefinition/Element|5.0.0" }], "mustSupport" : false, "isModifier" : false, "isSummary" : false }, { "id" : "ClaimResponse.addItem.subdetailSequence", "path" : "ClaimResponse.addItem.subdetailSequence", "short" : "Subdetail sequence number", "definition" : "The sequence number of the sub-details within the details within the claim item which this line is intended to replace.", "requirements" : "Provides references to the claim sub-details within the claim detail.", "min" : 0, "max" : "*", "base" : { "path" : "ClaimResponse.addItem.subdetailSequence", "min" : 0, "max" : "*" }, "type" : [{ "code" : "positiveInt" }], "constraint" : [{ "key" : "ele-1", "severity" : "error", "human" : "All FHIR elements must have a @value or children", "expression" : "hasValue() or (children().count() > id.count())", "source" : "http://hl7.org/fhir/StructureDefinition/Element|5.0.0" }], "mustSupport" : false, "isModifier" : false, "isSummary" : false }, { "id" : "ClaimResponse.addItem.traceNumber", "path" : "ClaimResponse.addItem.traceNumber", "short" : "Number for tracking", "definition" : "Trace number for tracking purposes. May be defined at the jurisdiction level or between trading partners.", "requirements" : "Allows partners to uniquely identify components for tracking.", "min" : 0, "max" : "*", "base" : { "path" : "ClaimResponse.addItem.traceNumber", "min" : 0, "max" : "*" }, "type" : [{ "code" : "Identifier" }], "constraint" : [{ "key" : "ele-1", "severity" : "error", "human" : "All FHIR elements must have a @value or children", "expression" : "hasValue() or (children().count() > id.count())", "source" : "http://hl7.org/fhir/StructureDefinition/Element|5.0.0" }], "mustSupport" : false, "isModifier" : false, "isSummary" : false }, { "id" : "ClaimResponse.addItem.provider", "path" : "ClaimResponse.addItem.provider", "short" : "Authorized providers", "definition" : "The providers who are authorized for the services rendered to the patient.", "requirements" : "Insurer may provide authorization specifically to a restricted set of providers rather than an open authorization.", "min" : 0, "max" : "*", "base" : { "path" : "ClaimResponse.addItem.provider", "min" : 0, "max" : "*" }, "type" : [{ "code" : "Reference", "targetProfile" : ["http://hl7.org/fhir/StructureDefinition/Practitioner|5.0.0", "http://hl7.org/fhir/StructureDefinition/PractitionerRole|5.0.0", "http://hl7.org/fhir/StructureDefinition/Organization|5.0.0"] }], "constraint" : [{ "key" : "ele-1", "severity" : "error", "human" : "All FHIR elements must have a @value or children", "expression" : "hasValue() or (children().count() > id.count())", "source" : "http://hl7.org/fhir/StructureDefinition/Element|5.0.0" }], "mustSupport" : false, "isModifier" : false, "isSummary" : false, "mapping" : [{ "identity" : "w5", "map" : "FiveWs.source" }] }, { "id" : "ClaimResponse.addItem.revenue", "path" : "ClaimResponse.addItem.revenue", "short" : "Revenue or cost center code", "definition" : "The type of revenue or cost center providing the product and/or service.", "requirements" : "Needed in the processing of institutional claims.", "min" : 0, "max" : "1", "base" : { "path" : "ClaimResponse.addItem.revenue", "min" : 0, "max" : "1" }, "type" : [{ "code" : "CodeableConcept" }], "constraint" : [{ "key" : "ele-1", "severity" : "error", "human" : "All FHIR elements must have a @value or children", "expression" : "hasValue() or (children().count() > id.count())", "source" : "http://hl7.org/fhir/StructureDefinition/Element|5.0.0" }], "mustSupport" : false, "isModifier" : false, "isSummary" : false, "binding" : { "extension" : [{ "url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString" : "RevenueCenter" }], "strength" : "example", "description" : "Codes for the revenue or cost centers supplying the service and/or products.", "valueSet" : "http://hl7.org/fhir/ValueSet/ex-revenue-center|5.0.0" } }, { "id" : "ClaimResponse.addItem.productOrService", "path" : "ClaimResponse.addItem.productOrService", "short" : "Billing, service, product, or drug code", "definition" : "When the value is a group code then this item collects a set of related item details, otherwise this contains the product, service, drug or other billing code for the item. This element may be the start of a range of .productOrService codes used in conjunction with .productOrServiceEnd or it may be a solo element where .productOrServiceEnd is not used.", "comment" : "If this is an actual service or product line, i.e. not a Group, then use code to indicate the Professional Service or Product supplied (e.g. CTP, HCPCS, USCLS, ICD10, NCPDP, DIN, RxNorm, ACHI, CCI). If a grouping item then use a group code to indicate the type of thing being grouped e.g. 'glasses' or 'compound'.", "requirements" : "Necessary to state what was provided or done.", "min" : 0, "max" : "1", "base" : { "path" : "ClaimResponse.addItem.productOrService", "min" : 0, "max" : "1" }, "type" : [{ "code" : "CodeableConcept" }], "constraint" : [{ "key" : "ele-1", "severity" : "error", "human" : "All FHIR elements must have a @value or children", "expression" : "hasValue() or (children().count() > id.count())", "source" : "http://hl7.org/fhir/StructureDefinition/Element|5.0.0" }], "mustSupport" : false, "isModifier" : false, "isSummary" : false, "binding" : { "extension" : [{ "url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString" : "ServiceProduct" }], "strength" : "example", "description" : "Allowable service and product codes.", "valueSet" : "http://hl7.org/fhir/ValueSet/service-uscls|5.0.0" } }, { "id" : "ClaimResponse.addItem.productOrServiceEnd", "path" : "ClaimResponse.addItem.productOrServiceEnd", "short" : "End of a range of codes", "definition" : "This contains the end of a range of product, service, drug or other billing codes for the item. This element is not used when the .productOrService is a group code. This value may only be present when a .productOfService code has been provided to convey the start of the range. Typically this value may be used only with preauthorizations and not with claims.", "alias" : ["End of a range of Drug Code; Bill Code; Service Cod"], "min" : 0, "max" : "1", "base" : { "path" : "ClaimResponse.addItem.productOrServiceEnd", "min" : 0, "max" : "1" }, "type" : [{ "code" : "CodeableConcept" }], "constraint" : [{ "key" : "ele-1", "severity" : "error", "human" : "All FHIR elements must have a @value or children", "expression" : "hasValue() or (children().count() > id.count())", "source" : "http://hl7.org/fhir/StructureDefinition/Element|5.0.0" }], "mustSupport" : false, "isModifier" : false, "isSummary" : false, "binding" : { "extension" : [{ "url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString" : "ServiceProduct" }], "strength" : "example", "valueSet" : "http://hl7.org/fhir/ValueSet/service-uscls|5.0.0" } }, { "id" : "ClaimResponse.addItem.request", "path" : "ClaimResponse.addItem.request", "short" : "Request or Referral for Service", "definition" : "Request or Referral for Goods or Service to be rendered.", "requirements" : "May identify the service to be provided or provider authorization for the service.", "min" : 0, "max" : "*", "base" : { "path" : "ClaimResponse.addItem.request", "min" : 0, "max" : "*" }, "type" : [{ "code" : "Reference", "targetProfile" : ["http://hl7.org/fhir/StructureDefinition/DeviceRequest|5.0.0", "http://hl7.org/fhir/StructureDefinition/MedicationRequest|5.0.0", "http://hl7.org/fhir/StructureDefinition/NutritionOrder|5.0.0", "http://hl7.org/fhir/StructureDefinition/ServiceRequest|5.0.0", "http://hl7.org/fhir/StructureDefinition/SupplyRequest|5.0.0", "http://hl7.org/fhir/StructureDefinition/VisionPrescription|5.0.0"] }], "constraint" : [{ "key" : "ele-1", "severity" : "error", "human" : "All FHIR elements must have a @value or children", "expression" : "hasValue() or (children().count() > id.count())", "source" : "http://hl7.org/fhir/StructureDefinition/Element|5.0.0" }], "mustSupport" : false, "isModifier" : false, "isSummary" : false }, { "id" : "ClaimResponse.addItem.modifier", "path" : "ClaimResponse.addItem.modifier", "short" : "Service/Product billing modifiers", "definition" : "Item typification or modifiers codes to convey additional context for the product or service.", "comment" : "For example in Oral whether the treatment is cosmetic or associated with TMJ, or for Medical whether the treatment was outside the clinic or outside of office hours.", "requirements" : "To support inclusion of the item for adjudication or to charge an elevated fee.", "min" : 0, "max" : "*", "base" : { "path" : "ClaimResponse.addItem.modifier", "min" : 0, "max" : "*" }, "type" : [{ "code" : "CodeableConcept" }], "constraint" : [{ "key" : "ele-1", "severity" : "error", "human" : "All FHIR elements must have a @value or children", "expression" : "hasValue() or (children().count() > id.count())", "source" : "http://hl7.org/fhir/StructureDefinition/Element|5.0.0" }], "mustSupport" : false, "isModifier" : false, "isSummary" : false, "binding" : { "extension" : [{ "url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString" : "Modifiers" }], "strength" : "example", "description" : "Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen.", "valueSet" : "http://hl7.org/fhir/ValueSet/claim-modifiers|5.0.0" }, "mapping" : [{ "identity" : "rim", "map" : "24.C, 24.D mods" }] }, { "id" : "ClaimResponse.addItem.programCode", "path" : "ClaimResponse.addItem.programCode", "short" : "Program the product or service is provided under", "definition" : "Identifies the program under which this may be recovered.", "comment" : "For example: Neonatal program, child dental program or drug users recovery program.", "requirements" : "Commonly used in in the identification of publicly provided program focused on population segments or disease classifications.", "min" : 0, "max" : "*", "base" : { "path" : "ClaimResponse.addItem.programCode", "min" : 0, "max" : "*" }, "type" : [{ "code" : "CodeableConcept" }], "constraint" : [{ "key" : "ele-1", "severity" : "error", "human" : "All FHIR elements must have a @value or children", "expression" : "hasValue() or (children().count() > id.count())", "source" : "http://hl7.org/fhir/StructureDefinition/Element|5.0.0" }], "mustSupport" : false, "isModifier" : false, "isSummary" : false, "binding" : { "extension" : [{ "url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString" : "ProgramCode" }], "strength" : "example", "description" : "Program specific reason codes.", "valueSet" : "http://hl7.org/fhir/ValueSet/ex-program-code|5.0.0" }, "mapping" : [{ "identity" : "rim", "map" : "24.H" }] }, { "id" : "ClaimResponse.addItem.serviced[x]", "path" : "ClaimResponse.addItem.serviced[x]", "short" : "Date or dates of service or product delivery", "definition" : "The date or dates when the service or product was supplied, performed or completed.", "requirements" : "Needed to determine whether the service or product was provided during the term of the insurance coverage.", "min" : 0, "max" : "1", "base" : { "path" : "ClaimResponse.addItem.serviced[x]", "min" : 0, "max" : "1" }, "type" : [{ "code" : "date" }, { "code" : "Period" }], "constraint" : [{ "key" : "ele-1", "severity" : "error", "human" : "All FHIR elements must have a @value or children", "expression" : "hasValue() or (children().count() > id.count())", "source" : "http://hl7.org/fhir/StructureDefinition/Element|5.0.0" }], "mustSupport" : false, "isModifier" : false, "isSummary" : false, "mapping" : [{ "identity" : "w5", "map" : "FiveWs.done[x]" }, { "identity" : "rim", "map" : "24.A" }] }, { "id" : "ClaimResponse.addItem.location[x]", "path" : "ClaimResponse.addItem.location[x]", "short" : "Place of service or where product was supplied", "definition" : "Where the product or service was provided.", "requirements" : "The location can alter whether the item was acceptable for insurance purposes or impact the determination of the benefit amount.", "min" : 0, "max" : "1", "base" : { "path" : "ClaimResponse.addItem.location[x]", "min" : 0, "max" : "1" }, "type" : [{ "code" : "CodeableConcept" }, { "code" : "Address" }, { "code" : "Reference", "targetProfile" : ["http://hl7.org/fhir/StructureDefinition/Location|5.0.0"] }], "constraint" : [{ "key" : "ele-1", "severity" : "error", "human" : "All FHIR elements must have a @value or children", "expression" : "hasValue() or (children().count() > id.count())", "source" : "http://hl7.org/fhir/StructureDefinition/Element|5.0.0" }], "mustSupport" : false, "isModifier" : false, "isSummary" : false, "binding" : { "extension" : [{ "url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString" : "ServicePlace" }], "strength" : "example", "description" : "Place of service: pharmacy, school, prison, etc.", "valueSet" : "http://hl7.org/fhir/ValueSet/service-place|5.0.0" }, "mapping" : [{ "identity" : "w5", "map" : "FiveWs.where[x]" }, { "identity" : "rim", "map" : "24.B" }] }, { "id" : "ClaimResponse.addItem.quantity", "path" : "ClaimResponse.addItem.quantity", "short" : "Count of products or services", "definition" : "The number of repetitions of a service or product.", "requirements" : "Required when the product or service code does not convey the quantity provided.", "min" : 0, "max" : "1", "base" : { "path" : "ClaimResponse.addItem.quantity", "min" : 0, "max" : "1" }, "type" : [{ "code" : "Quantity", "profile" : ["http://hl7.org/fhir/StructureDefinition/SimpleQuantity|5.0.0"] }], "constraint" : [{ "key" : "ele-1", "severity" : "error", "human" : "All FHIR elements must have a @value or children", "expression" : "hasValue() or (children().count() > id.count())", "source" : "http://hl7.org/fhir/StructureDefinition/Element|5.0.0" }], "mustSupport" : false, "isModifier" : false, "isSummary" : false, "mapping" : [{ "identity" : "rim", "map" : "24.G" }] }, { "id" : "ClaimResponse.addItem.unitPrice", "path" : "ClaimResponse.addItem.unitPrice", "short" : "Fee, charge or cost per item", "definition" : "If the item is not a group then this is the fee for the product or service, otherwise this is the total of the fees for the details of the group.", "requirements" : "The amount charged to the patient by the provider for a single unit.", "min" : 0, "max" : "1", "base" : { "path" : "ClaimResponse.addItem.unitPrice", "min" : 0, "max" : "1" }, "type" : [{ "code" : "Money" }], "constraint" : [{ "key" : "ele-1", "severity" : "error", "human" : "All FHIR elements must have a @value or children", "expression" : "hasValue() or (children().count() > id.count())", "source" : "http://hl7.org/fhir/StructureDefinition/Element|5.0.0" }], "mustSupport" : false, "isModifier" : false, "isSummary" : false }, { "id" : "ClaimResponse.addItem.factor", "path" : "ClaimResponse.addItem.factor", "short" : "Price scaling factor", "definition" : "A real number that represents a multiplier used in determining the overall value of services delivered and/or goods received. The concept of a Factor allows for a discount or surcharge multiplier to be applied to a monetary amount.", "comment" : "To show a 10% senior's discount, the value entered is: 0.90 (1.00 - 0.10).", "requirements" : "When discounts are provided to a patient (example: Senior's discount) then this must be documented for adjudication.", "min" : 0, "max" : "1", "base" : { "path" : "ClaimResponse.addItem.factor", "min" : 0, "max" : "1" }, "type" : [{ "code" : "decimal" }], "constraint" : [{ "key" : "ele-1", "severity" : "error", "human" : "All FHIR elements must have a @value or children", "expression" : "hasValue() or (children().count() > id.count())", "source" : "http://hl7.org/fhir/StructureDefinition/Element|5.0.0" }], "mustSupport" : false, "isModifier" : false, "isSummary" : false }, { "id" : "ClaimResponse.addItem.tax", "path" : "ClaimResponse.addItem.tax", "short" : "Total tax", "definition" : "The total of taxes applicable for this product or service.", "requirements" : "Required when taxes are not embedded in the unit price or provided as a separate service.", "min" : 0, "max" : "1", "base" : { "path" : "ClaimResponse.addItem.tax", "min" : 0, "max" : "1" }, "type" : [{ "code" : "Money" }], "constraint" : [{ "key" : "ele-1", "severity" : "error", "human" : "All FHIR elements must have a @value or children", "expression" : "hasValue() or (children().count() > id.count())", "source" : "http://hl7.org/fhir/StructureDefinition/Element|5.0.0" }], "mustSupport" : false, "isModifier" : false, "isSummary" : false }, { "id" : "ClaimResponse.addItem.net", "path" : "ClaimResponse.addItem.net", "short" : "Total item cost", "definition" : "The total amount claimed for the group (if a grouper) or the addItem. Net = unit price * quantity * factor.", "comment" : "For example, the formula: quantity * unitPrice * factor = net. Quantity and factor are assumed to be 1 if not supplied.", "requirements" : "Provides the total amount claimed for the group (if a grouper) or the line item.", "min" : 0, "max" : "1", "base" : { "path" : "ClaimResponse.addItem.net", "min" : 0, "max" : "1" }, "type" : [{ "code" : "Money" }], "constraint" : [{ "key" : "ele-1", "severity" : "error", "human" : "All FHIR elements must have a @value or children", "expression" : "hasValue() or (children().count() > id.count())", "source" : "http://hl7.org/fhir/StructureDefinition/Element|5.0.0" }], "mustSupport" : false, "isModifier" : false, "isSummary" : false, "mapping" : [{ "identity" : "rim", "map" : "24.F" }] }, { "id" : "ClaimResponse.addItem.bodySite", "path" : "ClaimResponse.addItem.bodySite", "short" : "Anatomical location", "definition" : "Physical location where the service is performed or applies.", "min" : 0, "max" : "*", "base" : { "path" : "ClaimResponse.addItem.bodySite", "min" : 0, "max" : "*" }, "type" : [{ "code" : "BackboneElement" }], "constraint" : [{ "key" : "ele-1", "severity" : "error", "human" : "All FHIR elements must have a @value or children", "expression" : "hasValue() or (children().count() > id.count())", "source" : "http://hl7.org/fhir/StructureDefinition/Element|5.0.0" }], "mustSupport" : false, "isModifier" : false, "isSummary" : false }, { "id" : "ClaimResponse.addItem.bodySite.id", "path" : "ClaimResponse.addItem.bodySite.id", "representation" : ["xmlAttr"], "short" : "Unique id for inter-element referencing", "definition" : "Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.", "min" : 0, "max" : "1", "base" : { "path" : "Element.id", "min" : 0, "max" : "1" }, "type" : [{ "extension" : [{ "url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type", "valueUrl" : "string" }], "code" : "http://hl7.org/fhirpath/System.String" }], "condition" : ["ele-1"], "isModifier" : false, "isSummary" : false, "mapping" : [{ "identity" : "rim", "map" : "n/a" }] }, { "id" : "ClaimResponse.addItem.bodySite.extension", "path" : "ClaimResponse.addItem.bodySite.extension", "short" : "Additional content defined by implementations", "definition" : "May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and managable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.", "comment" : "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.", "alias" : ["extensions", "user content"], "min" : 0, "max" : "*", "base" : { "path" : "Element.extension", "min" : 0, "max" : "*" }, "type" : [{ "code" : "Extension" }], "constraint" : [{ "key" : "ele-1", "severity" : "error", "human" : "All FHIR elements must have a @value or children", "expression" : "hasValue() or (children().count() > id.count())", "source" : "http://hl7.org/fhir/StructureDefinition/Element|5.0.0" }, { "key" : "ext-1", "severity" : "error", "human" : "Must have either extensions or value[x], not both", "expression" : "extension.exists() != value.exists()", "source" : "http://hl7.org/fhir/StructureDefinition/Extension|5.0.0" }], "isModifier" : false, "isSummary" : false, "mapping" : [{ "identity" : "rim", "map" : "n/a" }] }, { "id" : "ClaimResponse.addItem.bodySite.modifierExtension", "path" : "ClaimResponse.addItem.bodySite.modifierExtension", "short" : "Extensions that cannot be ignored even if unrecognized", "definition" : "May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and managable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.\n\nModifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).", "comment" : "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.", "requirements" : "Modifier extensions allow for extensions that *cannot* be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the [definition of modifier extensions](http://hl7.org/fhir/R5/extensibility.html#modifierExtension).", "alias" : ["extensions", "user content", "modifiers"], "min" : 0, "max" : "*", "base" : { "path" : "BackboneElement.modifierExtension", "min" : 0, "max" : "*" }, "type" : [{ "code" : "Extension" }], "constraint" : [{ "key" : "ele-1", "severity" : "error", "human" : "All FHIR elements must have a @value or children", "expression" : "hasValue() or (children().count() > id.count())", "source" : "http://hl7.org/fhir/StructureDefinition/Element|5.0.0" }, { "key" : "ext-1", "severity" : "error", "human" : "Must have either extensions or value[x], not both", "expression" : "extension.exists() != value.exists()", "source" : "http://hl7.org/fhir/StructureDefinition/Extension|5.0.0" }], "isModifier" : true, "isModifierReason" : "Modifier extensions are expected to modify the meaning or interpretation of the element that contains them", "isSummary" : true, "mapping" : [{ "identity" : "rim", "map" : "N/A" }] }, { "id" : "ClaimResponse.addItem.bodySite.site", "path" : "ClaimResponse.addItem.bodySite.site", "short" : "Location", "definition" : "Physical service site on the patient (limb, tooth, etc.).", "comment" : "For example: Providing a tooth code allows an insurer to identify a provider performing a filling on a tooth that was previously removed.", "requirements" : "Allows insurer to validate specific procedures.", "min" : 1, "max" : "*", "base" : { "path" : "ClaimResponse.addItem.bodySite.site", "min" : 1, "max" : "*" }, "type" : [{ "code" : "CodeableReference", "targetProfile" : ["http://hl7.org/fhir/StructureDefinition/BodyStructure|5.0.0"] }], "constraint" : [{ "key" : "ele-1", "severity" : "error", "human" : "All FHIR elements must have a @value or children", "expression" : "hasValue() or (children().count() > id.count())", "source" : "http://hl7.org/fhir/StructureDefinition/Element|5.0.0" }], "mustSupport" : false, "isModifier" : false, "isSummary" : false, "binding" : { "extension" : [{ "url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString" : "OralSites" }], "strength" : "example", "valueSet" : "http://hl7.org/fhir/ValueSet/tooth|5.0.0" } }, { "id" : "ClaimResponse.addItem.bodySite.subSite", "path" : "ClaimResponse.addItem.bodySite.subSite", "short" : "Sub-location", "definition" : "A region or surface of the bodySite, e.g. limb region or tooth surface(s).", "requirements" : "Allows insurer to validate specific procedures.", "min" : 0, "max" : "*", "base" : { "path" : "ClaimResponse.addItem.bodySite.subSite", "min" : 0, "max" : "*" }, "type" : [{ "code" : "CodeableConcept" }], "constraint" : [{ "key" : "ele-1", "severity" : "error", "human" : "All FHIR elements must have a @value or children", "expression" : "hasValue() or (children().count() > id.count())", "source" : "http://hl7.org/fhir/StructureDefinition/Element|5.0.0" }], "mustSupport" : false, "isModifier" : false, "isSummary" : false, "binding" : { "extension" : [{ "url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString" : "Surface" }], "strength" : "example", "valueSet" : "http://hl7.org/fhir/ValueSet/surface|5.0.0" } }, { "id" : "ClaimResponse.addItem.noteNumber", "path" : "ClaimResponse.addItem.noteNumber", "short" : "Applicable note numbers", "definition" : "The numbers associated with notes below which apply to the adjudication of this item.", "requirements" : "Provides a condensed manner for associating human readable descriptive explanations for adjudications on the line item.", "min" : 0, "max" : "*", "base" : { "path" : "ClaimResponse.addItem.noteNumber", "min" : 0, "max" : "*" }, "type" : [{ "code" : "positiveInt" }], "constraint" : [{ "key" : "ele-1", "severity" : "error", "human" : "All FHIR elements must have a @value or children", "expression" : "hasValue() or (children().count() > id.count())", "source" : "http://hl7.org/fhir/StructureDefinition/Element|5.0.0" }], "mustSupport" : false, "isModifier" : false, "isSummary" : false }, { "id" : "ClaimResponse.addItem.reviewOutcome", "path" : "ClaimResponse.addItem.reviewOutcome", "short" : "Added items adjudication results", "definition" : "The high-level results of the adjudication if adjudication has been performed.", "min" : 0, "max" : "1", "base" : { "path" : "ClaimResponse.addItem.reviewOutcome", "min" : 0, "max" : "1" }, "contentReference" : "http://hl7.org/fhir/StructureDefinition/ClaimResponse#ClaimResponse.item.reviewOutcome", "constraint" : [{ "key" : "ele-1", "severity" : "error", "human" : "All FHIR elements must have a @value or children", "expression" : "hasValue() or (children().count() > id.count())", "source" : "http://hl7.org/fhir/StructureDefinition/Element|5.0.0" }], "mustSupport" : false, "isModifier" : false, "isSummary" : false }, { "id" : "ClaimResponse.addItem.adjudication", "path" : "ClaimResponse.addItem.adjudication", "short" : "Added items adjudication", "definition" : "The adjudication results.", "min" : 0, "max" : "*", "base" : { "path" : "ClaimResponse.addItem.adjudication", "min" : 0, "max" : "*" }, "type" : [{ "code" : "BackboneElement" }], "constraint" : [{ "key" : "ele-1", "severity" : "error", "human" : "All FHIR elements must have a @value or children", "expression" : "hasValue() or (children().count() > id.count())", "source" : "http://hl7.org/fhir/StructureDefinition/Element|5.0.0" }], "mustSupport" : false, "isModifier" : false, "isSummary" : false }, { "id" : "ClaimResponse.addItem.adjudication.id", "path" : "ClaimResponse.addItem.adjudication.id", "representation" : ["xmlAttr"], "short" : "Unique id for inter-element referencing", "definition" : "Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.", "min" : 0, "max" : "1", "base" : { "path" : "Element.id", "min" : 0, "max" : "1" }, "type" : [{ "extension" : [{ "url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type", "valueUrl" : "string" }], "code" : "http://hl7.org/fhirpath/System.String" }], "condition" : ["ele-1"], "isModifier" : false, "isSummary" : false, "mapping" : [{ "identity" : "rim", "map" : "n/a" }] }, { "id" : "ClaimResponse.addItem.adjudication.extension", "path" : "ClaimResponse.addItem.adjudication.extension", "slicing" : { "discriminator" : [{ "type" : "value", "path" : "url" }], "ordered" : false, "rules" : "open" }, "short" : "Extension", "definition" : "An Extension", "min" : 0, "max" : "*", "base" : { "path" : "Element.extension", "min" : 0, "max" : "*" }, "type" : [{ "code" : "Extension" }], "constraint" : [{ "key" : "ele-1", "severity" : "error", "human" : "All FHIR elements must have a @value or children", "expression" : "hasValue() or (children().count() > id.count())", "source" : "http://hl7.org/fhir/StructureDefinition/Element|5.0.0" }, { "key" : "ext-1", "severity" : "error", "human" : "Must have either extensions or value[x], not both", "expression" : "extension.exists() != value.exists()", "source" : "http://hl7.org/fhir/StructureDefinition/Extension|5.0.0" }], "isModifier" : false, "isSummary" : false }, { "id" : "ClaimResponse.addItem.adjudication.extension:amount", "path" : "ClaimResponse.addItem.adjudication.extension", "sliceName" : "amount", "short" : "DSTU2: Monetary amount (new)", "definition" : "DSTU2: `ClaimResponse.addItem.adjudication.amount` (new:Quantity[Money])", "comment" : "Element `ClaimResponse.addItem.adjudication.amount` has a context of ClaimResponse.addItem.adjudication based on following the parent source element upwards and mapping to `ClaimResponse`.\nElement `ClaimResponse.addItem.adjudication.amount` has no mapping targets in FHIR R5. Typically, this is because the element has been added (is a new element).", "min" : 0, "max" : "1", "base" : { "path" : "Element.extension", "min" : 0, "max" : "*" }, "type" : [{ "code" : "Extension", "profile" : ["http://hl7.org/fhir/1.0/StructureDefinition/extension-ClaimResponse.addItem.adjudication.amount|0.1.0"] }], "constraint" : [{ "key" : "ele-1", "severity" : "error", "human" : "All FHIR elements must have a @value or children", "expression" : "hasValue() or (children().count() > id.count())", "source" : "http://hl7.org/fhir/StructureDefinition/Element|5.0.0" }, { "key" : "ext-1", "severity" : "error", "human" : "Must have either extensions or value[x], not both", "expression" : "extension.exists() != value.exists()", "source" : "http://hl7.org/fhir/StructureDefinition/Extension|5.0.0" }], "isModifier" : false, "isSummary" : false }, { "id" : "ClaimResponse.addItem.adjudication.extension:value", "path" : "ClaimResponse.addItem.adjudication.extension", "sliceName" : "value", "short" : "DSTU2: Non-monetary value (new)", "definition" : "DSTU2: `ClaimResponse.addItem.adjudication.value` (new:decimal)", "comment" : "Element `ClaimResponse.addItem.adjudication.value` has a context of ClaimResponse.addItem.adjudication based on following the parent source element upwards and mapping to `ClaimResponse`.\nElement `ClaimResponse.addItem.adjudication.value` has no mapping targets in FHIR R5. Typically, this is because the element has been added (is a new element).", "min" : 0, "max" : "1", "base" : { "path" : "Element.extension", "min" : 0, "max" : "*" }, "type" : [{ "code" : "Extension", "profile" : ["http://hl7.org/fhir/1.0/StructureDefinition/extension-ClaimResponse.addItem.adjudication.value|0.1.0"] }], "constraint" : [{ "key" : "ele-1", "severity" : "error", "human" : "All FHIR elements must have a @value or children", "expression" : "hasValue() or (children().count() > id.count())", "source" : "http://hl7.org/fhir/StructureDefinition/Element|5.0.0" }, { "key" : "ext-1", "severity" : "error", "human" : "Must have either extensions or value[x], not both", "expression" : "extension.exists() != value.exists()", "source" : "http://hl7.org/fhir/StructureDefinition/Extension|5.0.0" }], "isModifier" : false, "isSummary" : false }, { "id" : "ClaimResponse.addItem.adjudication.modifierExtension", "path" : "ClaimResponse.addItem.adjudication.modifierExtension", "short" : "Extensions that cannot be ignored even if unrecognized", "definition" : "May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and managable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.\n\nModifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).", "comment" : "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.", "requirements" : "Modifier extensions allow for extensions that *cannot* be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the [definition of modifier extensions](http://hl7.org/fhir/R5/extensibility.html#modifierExtension).", "alias" : ["extensions", "user content", "modifiers"], "min" : 0, "max" : "*", "base" : { "path" : "BackboneElement.modifierExtension", "min" : 0, "max" : "*" }, "type" : [{ "code" : "Extension" }], "constraint" : [{ "key" : "ele-1", "severity" : "error", "human" : "All FHIR elements must have a @value or children", "expression" : "hasValue() or (children().count() > id.count())", "source" : "http://hl7.org/fhir/StructureDefinition/Element|5.0.0" }, { "key" : "ext-1", "severity" : "error", "human" : "Must have either extensions or value[x], not both", "expression" : "extension.exists() != value.exists()", "source" : "http://hl7.org/fhir/StructureDefinition/Extension|5.0.0" }], "isModifier" : true, "isModifierReason" : "Modifier extensions are expected to modify the meaning or interpretation of the element that contains them", "isSummary" : true, "mapping" : [{ "identity" : "rim", "map" : "N/A" }] }, { "id" : "ClaimResponse.addItem.adjudication.category", "path" : "ClaimResponse.addItem.adjudication.category", "short" : "Type of adjudication information", "definition" : "A code to indicate the information type of this adjudication record. Information types may include the value submitted, maximum values or percentages allowed or payable under the plan, amounts that: the patient is responsible for in aggregate or pertaining to this item; amounts paid by other coverages; and, the benefit payable for this item.", "comment" : "For example codes indicating: Co-Pay, deductible, eligible, benefit, tax, etc.", "requirements" : "Needed to enable understanding of the context of the other information in the adjudication.", "min" : 1, "max" : "1", "base" : { "path" : "ClaimResponse.item.adjudication.category", "min" : 1, "max" : "1" }, "type" : [{ "code" : "CodeableConcept" }], "constraint" : [{ "key" : "ele-1", "severity" : "error", "human" : "All FHIR elements must have a @value or children", "expression" : "hasValue() or (children().count() > id.count())", "source" : "http://hl7.org/fhir/StructureDefinition/Element|5.0.0" }], "mustSupport" : false, "isModifier" : false, "isSummary" : false, "binding" : { "extension" : [{ "url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString" : "Adjudication" }], "strength" : "example", "description" : "The adjudication codes.", "valueSet" : "http://hl7.org/fhir/ValueSet/adjudication|5.0.0" } }, { "id" : "ClaimResponse.addItem.adjudication.reason", "path" : "ClaimResponse.addItem.adjudication.reason", "short" : "Explanation of adjudication outcome", "definition" : "A code supporting the understanding of the adjudication result and explaining variance from expected amount.", "comment" : "For example may indicate that the funds for this benefit type have been exhausted.", "requirements" : "To support understanding of variance from adjudication expectations.", "min" : 0, "max" : "1", "base" : { "path" : "ClaimResponse.item.adjudication.reason", "min" : 0, "max" : "1" }, "type" : [{ "code" : "CodeableConcept" }], "constraint" : [{ "key" : "ele-1", "severity" : "error", "human" : "All FHIR elements must have a @value or children", "expression" : "hasValue() or (children().count() > id.count())", "source" : "http://hl7.org/fhir/StructureDefinition/Element|5.0.0" }], "mustSupport" : false, "isModifier" : false, "isSummary" : false, "binding" : { "extension" : [{ "url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString" : "AdjudicationReason" }], "strength" : "example", "description" : "The adjudication reason codes.", "valueSet" : "http://hl7.org/fhir/ValueSet/adjudication-reason|5.0.0" } }, { "id" : "ClaimResponse.addItem.adjudication.amount", "path" : "ClaimResponse.addItem.adjudication.amount", "short" : "Monetary amount", "definition" : "Monetary amount associated with the category.", "comment" : "For example: amount submitted, eligible amount, co-payment, and benefit payable.", "requirements" : "Most adjudication categories convey a monetary amount.", "min" : 0, "max" : "1", "base" : { "path" : "ClaimResponse.item.adjudication.amount", "min" : 0, "max" : "1" }, "type" : [{ "code" : "Money" }], "constraint" : [{ "key" : "ele-1", "severity" : "error", "human" : "All FHIR elements must have a @value or children", "expression" : "hasValue() or (children().count() > id.count())", "source" : "http://hl7.org/fhir/StructureDefinition/Element|5.0.0" }], "mustSupport" : false, "isModifier" : false, "isSummary" : false }, { "id" : "ClaimResponse.addItem.adjudication.quantity", "path" : "ClaimResponse.addItem.adjudication.quantity", "short" : "Non-monetary value", "definition" : "A non-monetary value associated with the category. Mutually exclusive to the amount element above.", "comment" : "For example: eligible percentage or co-payment percentage.", "requirements" : "Some adjudication categories convey a percentage or a fixed value.", "min" : 0, "max" : "1", "base" : { "path" : "ClaimResponse.item.adjudication.quantity", "min" : 0, "max" : "1" }, "type" : [{ "code" : "Quantity" }], "constraint" : [{ "key" : "ele-1", "severity" : "error", "human" : "All FHIR elements must have a @value or children", "expression" : "hasValue() or (children().count() > id.count())", "source" : "http://hl7.org/fhir/StructureDefinition/Element|5.0.0" }], "mustSupport" : false, "isModifier" : false, "isSummary" : false }, { "id" : "ClaimResponse.addItem.detail", "path" : "ClaimResponse.addItem.detail", "short" : "Insurer added line details", "definition" : "The second-tier service adjudications for payor added services.", "min" : 0, "max" : "*", "base" : { "path" : "ClaimResponse.addItem.detail", "min" : 0, "max" : "*" }, "type" : [{ "code" : "BackboneElement" }], "constraint" : [{ "key" : "ele-1", "severity" : "error", "human" : "All FHIR elements must have a @value or children", "expression" : "hasValue() or (children().count() > id.count())", "source" : "http://hl7.org/fhir/StructureDefinition/Element|5.0.0" }], "mustSupport" : false, "isModifier" : false, "isSummary" : false }, { "id" : "ClaimResponse.addItem.detail.id", "path" : "ClaimResponse.addItem.detail.id", "representation" : ["xmlAttr"], "short" : "Unique id for inter-element referencing", "definition" : "Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.", "min" : 0, "max" : "1", "base" : { "path" : "Element.id", "min" : 0, "max" : "1" }, "type" : [{ "extension" : [{ "url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type", "valueUrl" : "string" }], "code" : "http://hl7.org/fhirpath/System.String" }], "condition" : ["ele-1"], "isModifier" : false, "isSummary" : false, "mapping" : [{ "identity" : "rim", "map" : "n/a" }] }, { "id" : "ClaimResponse.addItem.detail.extension", "path" : "ClaimResponse.addItem.detail.extension", "slicing" : { "discriminator" : [{ "type" : "value", "path" : "url" }], "ordered" : false, "rules" : "open" }, "short" : "Extension", "definition" : "An Extension", "min" : 0, "max" : "*", "base" : { "path" : "Element.extension", "min" : 0, "max" : "*" }, "type" : [{ "code" : "Extension" }], "constraint" : [{ "key" : "ele-1", "severity" : "error", "human" : "All FHIR elements must have a @value or children", "expression" : "hasValue() or (children().count() > id.count())", "source" : "http://hl7.org/fhir/StructureDefinition/Element|5.0.0" }, { "key" : "ext-1", "severity" : "error", "human" : "Must have either extensions or value[x], not both", "expression" : "extension.exists() != value.exists()", "source" : "http://hl7.org/fhir/StructureDefinition/Extension|5.0.0" }], "isModifier" : false, "isSummary" : false }, { "id" : "ClaimResponse.addItem.detail.extension:fee", "path" : "ClaimResponse.addItem.detail.extension", "sliceName" : "fee", "short" : "DSTU2: Professional fee or Product charge (new)", "definition" : "DSTU2: `ClaimResponse.addItem.detail.fee` (new:Quantity[Money])", "comment" : "Element `ClaimResponse.addItem.detail.fee` has a context of ClaimResponse.addItem.detail based on following the parent source element upwards and mapping to `ClaimResponse`.\nElement `ClaimResponse.addItem.detail.fee` has no mapping targets in FHIR R5. Typically, this is because the element has been added (is a new element).", "min" : 0, "max" : "1", "base" : { "path" : "Element.extension", "min" : 0, "max" : "*" }, "type" : [{ "code" : "Extension", "profile" : ["http://hl7.org/fhir/1.0/StructureDefinition/extension-ClaimResponse.addItem.detail.fee|0.1.0"] }], "constraint" : [{ "key" : "ele-1", "severity" : "error", "human" : "All FHIR elements must have a @value or children", "expression" : "hasValue() or (children().count() > id.count())", "source" : "http://hl7.org/fhir/StructureDefinition/Element|5.0.0" }, { "key" : "ext-1", "severity" : "error", "human" : "Must have either extensions or value[x], not both", "expression" : "extension.exists() != value.exists()", "source" : "http://hl7.org/fhir/StructureDefinition/Extension|5.0.0" }], "isModifier" : false, "isSummary" : false }, { "id" : "ClaimResponse.addItem.detail.modifierExtension", "path" : "ClaimResponse.addItem.detail.modifierExtension", "short" : "Extensions that cannot be ignored even if unrecognized", "definition" : "May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and managable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.\n\nModifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).", "comment" : "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.", "requirements" : "Modifier extensions allow for extensions that *cannot* be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the [definition of modifier extensions](http://hl7.org/fhir/R5/extensibility.html#modifierExtension).", "alias" : ["extensions", "user content", "modifiers"], "min" : 0, "max" : "*", "base" : { "path" : "BackboneElement.modifierExtension", "min" : 0, "max" : "*" }, "type" : [{ "code" : "Extension" }], "constraint" : [{ "key" : "ele-1", "severity" : "error", "human" : "All FHIR elements must have a @value or children", "expression" : "hasValue() or (children().count() > id.count())", "source" : "http://hl7.org/fhir/StructureDefinition/Element|5.0.0" }, { "key" : "ext-1", "severity" : "error", "human" : "Must have either extensions or value[x], not both", "expression" : "extension.exists() != value.exists()", "source" : "http://hl7.org/fhir/StructureDefinition/Extension|5.0.0" }], "isModifier" : true, "isModifierReason" : "Modifier extensions are expected to modify the meaning or interpretation of the element that contains them", "isSummary" : true, "mapping" : [{ "identity" : "rim", "map" : "N/A" }] }, { "id" : "ClaimResponse.addItem.detail.traceNumber", "path" : "ClaimResponse.addItem.detail.traceNumber", "short" : "Number for tracking", "definition" : "Trace number for tracking purposes. May be defined at the jurisdiction level or between trading partners.", "requirements" : "Allows partners to uniquely identify components for tracking.", "min" : 0, "max" : "*", "base" : { "path" : "ClaimResponse.addItem.detail.traceNumber", "min" : 0, "max" : "*" }, "type" : [{ "code" : "Identifier" }], "constraint" : [{ "key" : "ele-1", "severity" : "error", "human" : "All FHIR elements must have a @value or children", "expression" : "hasValue() or (children().count() > id.count())", "source" : "http://hl7.org/fhir/StructureDefinition/Element|5.0.0" }], "mustSupport" : false, "isModifier" : false, "isSummary" : false }, { "id" : "ClaimResponse.addItem.detail.revenue", "path" : "ClaimResponse.addItem.detail.revenue", "short" : "Revenue or cost center code", "definition" : "The type of revenue or cost center providing the product and/or service.", "requirements" : "Needed in the processing of institutional claims.", "min" : 0, "max" : "1", "base" : { "path" : "ClaimResponse.addItem.detail.revenue", "min" : 0, "max" : "1" }, "type" : [{ "code" : "CodeableConcept" }], "constraint" : [{ "key" : "ele-1", "severity" : "error", "human" : "All FHIR elements must have a @value or children", "expression" : "hasValue() or (children().count() > id.count())", "source" : "http://hl7.org/fhir/StructureDefinition/Element|5.0.0" }], "mustSupport" : false, "isModifier" : false, "isSummary" : false, "binding" : { "extension" : [{ "url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString" : "RevenueCenter" }], "strength" : "example", "description" : "Codes for the revenue or cost centers supplying the service and/or products.", "valueSet" : "http://hl7.org/fhir/ValueSet/ex-revenue-center|5.0.0" } }, { "id" : "ClaimResponse.addItem.detail.productOrService", "path" : "ClaimResponse.addItem.detail.productOrService", "short" : "Billing, service, product, or drug code", "definition" : "When the value is a group code then this item collects a set of related item details, otherwise this contains the product, service, drug or other billing code for the item. This element may be the start of a range of .productOrService codes used in conjunction with .productOrServiceEnd or it may be a solo element where .productOrServiceEnd is not used.", "comment" : "If this is an actual service or product line, i.e. not a Group, then use code to indicate the Professional Service or Product supplied (e.g. CTP, HCPCS, USCLS, ICD10, NCPDP, DIN, RxNorm, ACHI, CCI). If a grouping item then use a group code to indicate the type of thing being grouped e.g. 'glasses' or 'compound'.", "requirements" : "Necessary to state what was provided or done.", "min" : 0, "max" : "1", "base" : { "path" : "ClaimResponse.addItem.detail.productOrService", "min" : 0, "max" : "1" }, "type" : [{ "code" : "CodeableConcept" }], "constraint" : [{ "key" : "ele-1", "severity" : "error", "human" : "All FHIR elements must have a @value or children", "expression" : "hasValue() or (children().count() > id.count())", "source" : "http://hl7.org/fhir/StructureDefinition/Element|5.0.0" }], "mustSupport" : false, "isModifier" : false, "isSummary" : false, "binding" : { "extension" : [{ "url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString" : "ServiceProduct" }], "strength" : "example", "description" : "Allowable service and product codes.", "valueSet" : "http://hl7.org/fhir/ValueSet/service-uscls|5.0.0" } }, { "id" : "ClaimResponse.addItem.detail.productOrServiceEnd", "path" : "ClaimResponse.addItem.detail.productOrServiceEnd", "short" : "End of a range of codes", "definition" : "This contains the end of a range of product, service, drug or other billing codes for the item. This element is not used when the .productOrService is a group code. This value may only be present when a .productOfService code has been provided to convey the start of the range. Typically this value may be used only with preauthorizations and not with claims.", "alias" : ["End of a range of Drug Code; Bill Code; Service Cod"], "min" : 0, "max" : "1", "base" : { "path" : "ClaimResponse.addItem.detail.productOrServiceEnd", "min" : 0, "max" : "1" }, "type" : [{ "code" : "CodeableConcept" }], "constraint" : [{ "key" : "ele-1", "severity" : "error", "human" : "All FHIR elements must have a @value or children", "expression" : "hasValue() or (children().count() > id.count())", "source" : "http://hl7.org/fhir/StructureDefinition/Element|5.0.0" }], "mustSupport" : false, "isModifier" : false, "isSummary" : false, "binding" : { "extension" : [{ "url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString" : "ServiceProduct" }], "strength" : "example", "valueSet" : "http://hl7.org/fhir/ValueSet/service-uscls|5.0.0" } }, { "id" : "ClaimResponse.addItem.detail.modifier", "path" : "ClaimResponse.addItem.detail.modifier", "short" : "Service/Product billing modifiers", "definition" : "Item typification or modifiers codes to convey additional context for the product or service.", "comment" : "For example in Oral whether the treatment is cosmetic or associated with TMJ, or for Medical whether the treatment was outside the clinic or outside of office hours.", "requirements" : "To support inclusion of the item for adjudication or to charge an elevated fee.", "min" : 0, "max" : "*", "base" : { "path" : "ClaimResponse.addItem.detail.modifier", "min" : 0, "max" : "*" }, "type" : [{ "code" : "CodeableConcept" }], "constraint" : [{ "key" : "ele-1", "severity" : "error", "human" : "All FHIR elements must have a @value or children", "expression" : "hasValue() or (children().count() > id.count())", "source" : "http://hl7.org/fhir/StructureDefinition/Element|5.0.0" }], "mustSupport" : false, "isModifier" : false, "isSummary" : false, "binding" : { "extension" : [{ "url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString" : "Modifiers" }], "strength" : "example", "description" : "Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen.", "valueSet" : "http://hl7.org/fhir/ValueSet/claim-modifiers|5.0.0" }, "mapping" : [{ "identity" : "rim", "map" : "24.C, 24.D mods" }] }, { "id" : "ClaimResponse.addItem.detail.quantity", "path" : "ClaimResponse.addItem.detail.quantity", "short" : "Count of products or services", "definition" : "The number of repetitions of a service or product.", "requirements" : "Required when the product or service code does not convey the quantity provided.", "min" : 0, "max" : "1", "base" : { "path" : "ClaimResponse.addItem.detail.quantity", "min" : 0, "max" : "1" }, "type" : [{ "code" : "Quantity", "profile" : ["http://hl7.org/fhir/StructureDefinition/SimpleQuantity|5.0.0"] }], "constraint" : [{ "key" : "ele-1", "severity" : "error", "human" : "All FHIR elements must have a @value or children", "expression" : "hasValue() or (children().count() > id.count())", "source" : "http://hl7.org/fhir/StructureDefinition/Element|5.0.0" }], "mustSupport" : false, "isModifier" : false, "isSummary" : false, "mapping" : [{ "identity" : "rim", "map" : "24.G" }] }, { "id" : "ClaimResponse.addItem.detail.unitPrice", "path" : "ClaimResponse.addItem.detail.unitPrice", "short" : "Fee, charge or cost per item", "definition" : "If the item is not a group then this is the fee for the product or service, otherwise this is the total of the fees for the details of the group.", "requirements" : "The amount charged to the patient by the provider for a single unit.", "min" : 0, "max" : "1", "base" : { "path" : "ClaimResponse.addItem.detail.unitPrice", "min" : 0, "max" : "1" }, "type" : [{ "code" : "Money" }], "constraint" : [{ "key" : "ele-1", "severity" : "error", "human" : "All FHIR elements must have a @value or children", "expression" : "hasValue() or (children().count() > id.count())", "source" : "http://hl7.org/fhir/StructureDefinition/Element|5.0.0" }], "mustSupport" : false, "isModifier" : false, "isSummary" : false }, { "id" : "ClaimResponse.addItem.detail.factor", "path" : "ClaimResponse.addItem.detail.factor", "short" : "Price scaling factor", "definition" : "A real number that represents a multiplier used in determining the overall value of services delivered and/or goods received. The concept of a Factor allows for a discount or surcharge multiplier to be applied to a monetary amount.", "comment" : "To show a 10% senior's discount, the value entered is: 0.90 (1.00 - 0.10).", "requirements" : "When discounts are provided to a patient (example: Senior's discount) then this must be documented for adjudication.", "min" : 0, "max" : "1", "base" : { "path" : "ClaimResponse.addItem.detail.factor", "min" : 0, "max" : "1" }, "type" : [{ "code" : "decimal" }], "constraint" : [{ "key" : "ele-1", "severity" : "error", "human" : "All FHIR elements must have a @value or children", "expression" : "hasValue() or (children().count() > id.count())", "source" : "http://hl7.org/fhir/StructureDefinition/Element|5.0.0" }], "mustSupport" : false, "isModifier" : false, "isSummary" : false }, { "id" : "ClaimResponse.addItem.detail.tax", "path" : "ClaimResponse.addItem.detail.tax", "short" : "Total tax", "definition" : "The total of taxes applicable for this product or service.", "requirements" : "Required when taxes are not embedded in the unit price or provided as a separate service.", "min" : 0, "max" : "1", "base" : { "path" : "ClaimResponse.addItem.detail.tax", "min" : 0, "max" : "1" }, "type" : [{ "code" : "Money" }], "constraint" : [{ "key" : "ele-1", "severity" : "error", "human" : "All FHIR elements must have a @value or children", "expression" : "hasValue() or (children().count() > id.count())", "source" : "http://hl7.org/fhir/StructureDefinition/Element|5.0.0" }], "mustSupport" : false, "isModifier" : false, "isSummary" : false }, { "id" : "ClaimResponse.addItem.detail.net", "path" : "ClaimResponse.addItem.detail.net", "short" : "Total item cost", "definition" : "The total amount claimed for the group (if a grouper) or the addItem.detail. Net = unit price * quantity * factor.", "comment" : "For example, the formula: quantity * unitPrice * factor = net. Quantity and factor are assumed to be 1 if not supplied.", "requirements" : "Provides the total amount claimed for the group (if a grouper) or the line item.", "min" : 0, "max" : "1", "base" : { "path" : "ClaimResponse.addItem.detail.net", "min" : 0, "max" : "1" }, "type" : [{ "code" : "Money" }], "constraint" : [{ "key" : "ele-1", "severity" : "error", "human" : "All FHIR elements must have a @value or children", "expression" : "hasValue() or (children().count() > id.count())", "source" : "http://hl7.org/fhir/StructureDefinition/Element|5.0.0" }], "mustSupport" : false, "isModifier" : false, "isSummary" : false, "mapping" : [{ "identity" : "rim", "map" : "24.F" }] }, { "id" : "ClaimResponse.addItem.detail.noteNumber", "path" : "ClaimResponse.addItem.detail.noteNumber", "short" : "Applicable note numbers", "definition" : "The numbers associated with notes below which apply to the adjudication of this item.", "requirements" : "Provides a condensed manner for associating human readable descriptive explanations for adjudications on the line item.", "min" : 0, "max" : "*", "base" : { "path" : "ClaimResponse.addItem.detail.noteNumber", "min" : 0, "max" : "*" }, "type" : [{ "code" : "positiveInt" }], "constraint" : [{ "key" : "ele-1", "severity" : "error", "human" : "All FHIR elements must have a @value or children", "expression" : "hasValue() or (children().count() > id.count())", "source" : "http://hl7.org/fhir/StructureDefinition/Element|5.0.0" }], "mustSupport" : false, "isModifier" : false, "isSummary" : false }, { "id" : "ClaimResponse.addItem.detail.reviewOutcome", "path" : "ClaimResponse.addItem.detail.reviewOutcome", "short" : "Added items detail level adjudication results", "definition" : "The high-level results of the adjudication if adjudication has been performed.", "min" : 0, "max" : "1", "base" : { "path" : "ClaimResponse.addItem.detail.reviewOutcome", "min" : 0, "max" : "1" }, "contentReference" : "http://hl7.org/fhir/StructureDefinition/ClaimResponse#ClaimResponse.item.reviewOutcome", "constraint" : [{ "key" : "ele-1", "severity" : "error", "human" : "All FHIR elements must have a @value or children", "expression" : "hasValue() or (children().count() > id.count())", "source" : "http://hl7.org/fhir/StructureDefinition/Element|5.0.0" }], "mustSupport" : false, "isModifier" : false, "isSummary" : false }, { "id" : "ClaimResponse.addItem.detail.adjudication", "path" : "ClaimResponse.addItem.detail.adjudication", "short" : "Added items detail adjudication", "definition" : "The adjudication results.", "min" : 0, "max" : "*", "base" : { "path" : "ClaimResponse.addItem.detail.adjudication", "min" : 0, "max" : "*" }, "type" : [{ "code" : "BackboneElement" }], "constraint" : [{ "key" : "ele-1", "severity" : "error", "human" : "All FHIR elements must have a @value or children", "expression" : "hasValue() or (children().count() > id.count())", "source" : "http://hl7.org/fhir/StructureDefinition/Element|5.0.0" }], "mustSupport" : false, "isModifier" : false, "isSummary" : false }, { "id" : "ClaimResponse.addItem.detail.adjudication.id", "path" : "ClaimResponse.addItem.detail.adjudication.id", "representation" : ["xmlAttr"], "short" : "Unique id for inter-element referencing", "definition" : "Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.", "min" : 0, "max" : "1", "base" : { "path" : "Element.id", "min" : 0, "max" : "1" }, "type" : [{ "extension" : [{ "url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type", "valueUrl" : "string" }], "code" : "http://hl7.org/fhirpath/System.String" }], "condition" : ["ele-1"], "isModifier" : false, "isSummary" : false, "mapping" : [{ "identity" : "rim", "map" : "n/a" }] }, { "id" : "ClaimResponse.addItem.detail.adjudication.extension", "path" : "ClaimResponse.addItem.detail.adjudication.extension", "slicing" : { "discriminator" : [{ "type" : "value", "path" : "url" }], "ordered" : false, "rules" : "open" }, "short" : "Extension", "definition" : "An Extension", "min" : 0, "max" : "*", "base" : { "path" : "Element.extension", "min" : 0, "max" : "*" }, "type" : [{ "code" : "Extension" }], "constraint" : [{ "key" : "ele-1", "severity" : "error", "human" : "All FHIR elements must have a @value or children", "expression" : "hasValue() or (children().count() > id.count())", "source" : "http://hl7.org/fhir/StructureDefinition/Element|5.0.0" }, { "key" : "ext-1", "severity" : "error", "human" : "Must have either extensions or value[x], not both", "expression" : "extension.exists() != value.exists()", "source" : "http://hl7.org/fhir/StructureDefinition/Extension|5.0.0" }], "isModifier" : false, "isSummary" : false }, { "id" : "ClaimResponse.addItem.detail.adjudication.extension:amount", "path" : "ClaimResponse.addItem.detail.adjudication.extension", "sliceName" : "amount", "short" : "DSTU2: Monetary amount (new)", "definition" : "DSTU2: `ClaimResponse.addItem.detail.adjudication.amount` (new:Quantity[Money])", "comment" : "Element `ClaimResponse.addItem.detail.adjudication.amount` has a context of ClaimResponse.addItem.detail.adjudication based on following the parent source element upwards and mapping to `ClaimResponse`.\nElement `ClaimResponse.addItem.detail.adjudication.amount` has no mapping targets in FHIR R5. Typically, this is because the element has been added (is a new element).", "min" : 0, "max" : "1", "base" : { "path" : "Element.extension", "min" : 0, "max" : "*" }, "type" : [{ "code" : "Extension", "profile" : ["http://hl7.org/fhir/1.0/StructureDefinition/extension-ClaimResponse.addItem.detail.adjudication.amount|0.1.0"] }], "constraint" : [{ "key" : "ele-1", "severity" : "error", "human" : "All FHIR elements must have a @value or children", "expression" : "hasValue() or (children().count() > id.count())", "source" : "http://hl7.org/fhir/StructureDefinition/Element|5.0.0" }, { "key" : "ext-1", "severity" : "error", "human" : "Must have either extensions or value[x], not both", "expression" : "extension.exists() != value.exists()", "source" : "http://hl7.org/fhir/StructureDefinition/Extension|5.0.0" }], "isModifier" : false, "isSummary" : false }, { "id" : "ClaimResponse.addItem.detail.adjudication.extension:value", "path" : "ClaimResponse.addItem.detail.adjudication.extension", "sliceName" : "value", "short" : "DSTU2: Non-monetary value (new)", "definition" : "DSTU2: `ClaimResponse.addItem.detail.adjudication.value` (new:decimal)", "comment" : "Element `ClaimResponse.addItem.detail.adjudication.value` has a context of ClaimResponse.addItem.detail.adjudication based on following the parent source element upwards and mapping to `ClaimResponse`.\nElement `ClaimResponse.addItem.detail.adjudication.value` has no mapping targets in FHIR R5. Typically, this is because the element has been added (is a new element).", "min" : 0, "max" : "1", "base" : { "path" : "Element.extension", "min" : 0, "max" : "*" }, "type" : [{ "code" : "Extension", "profile" : ["http://hl7.org/fhir/1.0/StructureDefinition/extension-ClaimResponse.addItem.detail.adjudication.value|0.1.0"] }], "constraint" : [{ "key" : "ele-1", "severity" : "error", "human" : "All FHIR elements must have a @value or children", "expression" : "hasValue() or (children().count() > id.count())", "source" : "http://hl7.org/fhir/StructureDefinition/Element|5.0.0" }, { "key" : "ext-1", "severity" : "error", "human" : "Must have either extensions or value[x], not both", "expression" : "extension.exists() != value.exists()", "source" : "http://hl7.org/fhir/StructureDefinition/Extension|5.0.0" }], "isModifier" : false, "isSummary" : false }, { "id" : "ClaimResponse.addItem.detail.adjudication.modifierExtension", "path" : "ClaimResponse.addItem.detail.adjudication.modifierExtension", "short" : "Extensions that cannot be ignored even if unrecognized", "definition" : "May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and managable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.\n\nModifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).", "comment" : "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.", "requirements" : "Modifier extensions allow for extensions that *cannot* be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the [definition of modifier extensions](http://hl7.org/fhir/R5/extensibility.html#modifierExtension).", "alias" : ["extensions", "user content", "modifiers"], "min" : 0, "max" : "*", "base" : { "path" : "BackboneElement.modifierExtension", "min" : 0, "max" : "*" }, "type" : [{ "code" : "Extension" }], "constraint" : [{ "key" : "ele-1", "severity" : "error", "human" : "All FHIR elements must have a @value or children", "expression" : "hasValue() or (children().count() > id.count())", "source" : "http://hl7.org/fhir/StructureDefinition/Element|5.0.0" }, { "key" : "ext-1", "severity" : "error", "human" : "Must have either extensions or value[x], not both", "expression" : "extension.exists() != value.exists()", "source" : "http://hl7.org/fhir/StructureDefinition/Extension|5.0.0" }], "isModifier" : true, "isModifierReason" : "Modifier extensions are expected to modify the meaning or interpretation of the element that contains them", "isSummary" : true, "mapping" : [{ "identity" : "rim", "map" : "N/A" }] }, { "id" : "ClaimResponse.addItem.detail.adjudication.category", "path" : "ClaimResponse.addItem.detail.adjudication.category", "short" : "Type of adjudication information", "definition" : "A code to indicate the information type of this adjudication record. Information types may include the value submitted, maximum values or percentages allowed or payable under the plan, amounts that: the patient is responsible for in aggregate or pertaining to this item; amounts paid by other coverages; and, the benefit payable for this item.", "comment" : "For example codes indicating: Co-Pay, deductible, eligible, benefit, tax, etc.", "requirements" : "Needed to enable understanding of the context of the other information in the adjudication.", "min" : 1, "max" : "1", "base" : { "path" : "ClaimResponse.item.adjudication.category", "min" : 1, "max" : "1" }, "type" : [{ "code" : "CodeableConcept" }], "constraint" : [{ "key" : "ele-1", "severity" : "error", "human" : "All FHIR elements must have a @value or children", "expression" : "hasValue() or (children().count() > id.count())", "source" : "http://hl7.org/fhir/StructureDefinition/Element|5.0.0" }], "mustSupport" : false, "isModifier" : false, "isSummary" : false, "binding" : { "extension" : [{ "url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString" : "Adjudication" }], "strength" : "example", "description" : "The adjudication codes.", "valueSet" : "http://hl7.org/fhir/ValueSet/adjudication|5.0.0" } }, { "id" : "ClaimResponse.addItem.detail.adjudication.reason", "path" : "ClaimResponse.addItem.detail.adjudication.reason", "short" : "Explanation of adjudication outcome", "definition" : "A code supporting the understanding of the adjudication result and explaining variance from expected amount.", "comment" : "For example may indicate that the funds for this benefit type have been exhausted.", "requirements" : "To support understanding of variance from adjudication expectations.", "min" : 0, "max" : "1", "base" : { "path" : "ClaimResponse.item.adjudication.reason", "min" : 0, "max" : "1" }, "type" : [{ "code" : "CodeableConcept" }], "constraint" : [{ "key" : "ele-1", "severity" : "error", "human" : "All FHIR elements must have a @value or children", "expression" : "hasValue() or (children().count() > id.count())", "source" : "http://hl7.org/fhir/StructureDefinition/Element|5.0.0" }], "mustSupport" : false, "isModifier" : false, "isSummary" : false, "binding" : { "extension" : [{ "url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString" : "AdjudicationReason" }], "strength" : "example", "description" : "The adjudication reason codes.", "valueSet" : "http://hl7.org/fhir/ValueSet/adjudication-reason|5.0.0" } }, { "id" : "ClaimResponse.addItem.detail.adjudication.amount", "path" : "ClaimResponse.addItem.detail.adjudication.amount", "short" : "Monetary amount", "definition" : "Monetary amount associated with the category.", "comment" : "For example: amount submitted, eligible amount, co-payment, and benefit payable.", "requirements" : "Most adjudication categories convey a monetary amount.", "min" : 0, "max" : "1", "base" : { "path" : "ClaimResponse.item.adjudication.amount", "min" : 0, "max" : "1" }, "type" : [{ "code" : "Money" }], "constraint" : [{ "key" : "ele-1", "severity" : "error", "human" : "All FHIR elements must have a @value or children", "expression" : "hasValue() or (children().count() > id.count())", "source" : "http://hl7.org/fhir/StructureDefinition/Element|5.0.0" }], "mustSupport" : false, "isModifier" : false, "isSummary" : false }, { "id" : "ClaimResponse.addItem.detail.adjudication.quantity", "path" : "ClaimResponse.addItem.detail.adjudication.quantity", "short" : "Non-monetary value", "definition" : "A non-monetary value associated with the category. Mutually exclusive to the amount element above.", "comment" : "For example: eligible percentage or co-payment percentage.", "requirements" : "Some adjudication categories convey a percentage or a fixed value.", "min" : 0, "max" : "1", "base" : { "path" : "ClaimResponse.item.adjudication.quantity", "min" : 0, "max" : "1" }, "type" : [{ "code" : "Quantity" }], "constraint" : [{ "key" : "ele-1", "severity" : "error", "human" : "All FHIR elements must have a @value or children", "expression" : "hasValue() or (children().count() > id.count())", "source" : "http://hl7.org/fhir/StructureDefinition/Element|5.0.0" }], "mustSupport" : false, "isModifier" : false, "isSummary" : false }, { "id" : "ClaimResponse.addItem.detail.subDetail", "path" : "ClaimResponse.addItem.detail.subDetail", "short" : "Insurer added line items", "definition" : "The third-tier service adjudications for payor added services.", "min" : 0, "max" : "*", "base" : { "path" : "ClaimResponse.addItem.detail.subDetail", "min" : 0, "max" : "*" }, "type" : [{ "code" : "BackboneElement" }], "constraint" : [{ "key" : "ele-1", "severity" : "error", "human" : "All FHIR elements must have a @value or children", "expression" : "hasValue() or (children().count() > id.count())", "source" : "http://hl7.org/fhir/StructureDefinition/Element|5.0.0" }], "mustSupport" : false, "isModifier" : false, "isSummary" : false }, { "id" : "ClaimResponse.addItem.detail.subDetail.id", "path" : "ClaimResponse.addItem.detail.subDetail.id", "representation" : ["xmlAttr"], "short" : "Unique id for inter-element referencing", "definition" : "Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.", "min" : 0, "max" : "1", "base" : { "path" : "Element.id", "min" : 0, "max" : "1" }, "type" : [{ "extension" : [{ "url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type", "valueUrl" : "string" }], "code" : "http://hl7.org/fhirpath/System.String" }], "condition" : ["ele-1"], "isModifier" : false, "isSummary" : false, "mapping" : [{ "identity" : "rim", "map" : "n/a" }] }, { "id" : "ClaimResponse.addItem.detail.subDetail.extension", "path" : "ClaimResponse.addItem.detail.subDetail.extension", "short" : "Additional content defined by implementations", "definition" : "May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and managable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.", "comment" : "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.", "alias" : ["extensions", "user content"], "min" : 0, "max" : "*", "base" : { "path" : "Element.extension", "min" : 0, "max" : "*" }, "type" : [{ "code" : "Extension" }], "constraint" : [{ "key" : "ele-1", "severity" : "error", "human" : "All FHIR elements must have a @value or children", "expression" : "hasValue() or (children().count() > id.count())", "source" : "http://hl7.org/fhir/StructureDefinition/Element|5.0.0" }, { "key" : "ext-1", "severity" : "error", "human" : "Must have either extensions or value[x], not both", "expression" : "extension.exists() != value.exists()", "source" : "http://hl7.org/fhir/StructureDefinition/Extension|5.0.0" }], "isModifier" : false, "isSummary" : false, "mapping" : [{ "identity" : "rim", "map" : "n/a" }] }, { "id" : "ClaimResponse.addItem.detail.subDetail.modifierExtension", "path" : "ClaimResponse.addItem.detail.subDetail.modifierExtension", "short" : "Extensions that cannot be ignored even if unrecognized", "definition" : "May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and managable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.\n\nModifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).", "comment" : "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.", "requirements" : "Modifier extensions allow for extensions that *cannot* be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the [definition of modifier extensions](http://hl7.org/fhir/R5/extensibility.html#modifierExtension).", "alias" : ["extensions", "user content", "modifiers"], "min" : 0, "max" : "*", "base" : { "path" : "BackboneElement.modifierExtension", "min" : 0, "max" : "*" }, "type" : [{ "code" : "Extension" }], "constraint" : [{ "key" : "ele-1", "severity" : "error", "human" : "All FHIR elements must have a @value or children", "expression" : "hasValue() or (children().count() > id.count())", "source" : "http://hl7.org/fhir/StructureDefinition/Element|5.0.0" }, { "key" : "ext-1", "severity" : "error", "human" : "Must have either extensions or value[x], not both", "expression" : "extension.exists() != value.exists()", "source" : "http://hl7.org/fhir/StructureDefinition/Extension|5.0.0" }], "isModifier" : true, "isModifierReason" : "Modifier extensions are expected to modify the meaning or interpretation of the element that contains them", "isSummary" : true, "mapping" : [{ "identity" : "rim", "map" : "N/A" }] }, { "id" : "ClaimResponse.addItem.detail.subDetail.traceNumber", "path" : "ClaimResponse.addItem.detail.subDetail.traceNumber", "short" : "Number for tracking", "definition" : "Trace number for tracking purposes. May be defined at the jurisdiction level or between trading partners.", "requirements" : "Allows partners to uniquely identify components for tracking.", "min" : 0, "max" : "*", "base" : { "path" : "ClaimResponse.addItem.detail.subDetail.traceNumber", "min" : 0, "max" : "*" }, "type" : [{ "code" : "Identifier" }], "constraint" : [{ "key" : "ele-1", "severity" : "error", "human" : "All FHIR elements must have a @value or children", "expression" : "hasValue() or (children().count() > id.count())", "source" : "http://hl7.org/fhir/StructureDefinition/Element|5.0.0" }], "mustSupport" : false, "isModifier" : false, "isSummary" : false }, { "id" : "ClaimResponse.addItem.detail.subDetail.revenue", "path" : "ClaimResponse.addItem.detail.subDetail.revenue", "short" : "Revenue or cost center code", "definition" : "The type of revenue or cost center providing the product and/or service.", "requirements" : "Needed in the processing of institutional claims.", "min" : 0, "max" : "1", "base" : { "path" : "ClaimResponse.addItem.detail.subDetail.revenue", "min" : 0, "max" : "1" }, "type" : [{ "code" : "CodeableConcept" }], "constraint" : [{ "key" : "ele-1", "severity" : "error", "human" : "All FHIR elements must have a @value or children", "expression" : "hasValue() or (children().count() > id.count())", "source" : "http://hl7.org/fhir/StructureDefinition/Element|5.0.0" }], "mustSupport" : false, "isModifier" : false, "isSummary" : false, "binding" : { "extension" : [{ "url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString" : "RevenueCenter" }], "strength" : "example", "description" : "Codes for the revenue or cost centers supplying the service and/or products.", "valueSet" : "http://hl7.org/fhir/ValueSet/ex-revenue-center|5.0.0" } }, { "id" : "ClaimResponse.addItem.detail.subDetail.productOrService", "path" : "ClaimResponse.addItem.detail.subDetail.productOrService", "short" : "Billing, service, product, or drug code", "definition" : "When the value is a group code then this item collects a set of related item details, otherwise this contains the product, service, drug or other billing code for the item. This element may be the start of a range of .productOrService codes used in conjunction with .productOrServiceEnd or it may be a solo element where .productOrServiceEnd is not used.", "comment" : "If this is an actual service or product line, i.e. not a Group, then use code to indicate the Professional Service or Product supplied (e.g. CTP, HCPCS, USCLS, ICD10, NCPDP, DIN, RxNorm, ACHI, CCI). If a grouping item then use a group code to indicate the type of thing being grouped e.g. 'glasses' or 'compound'.", "requirements" : "Necessary to state what was provided or done.", "min" : 0, "max" : "1", "base" : { "path" : "ClaimResponse.addItem.detail.subDetail.productOrService", "min" : 0, "max" : "1" }, "type" : [{ "code" : "CodeableConcept" }], "constraint" : [{ "key" : "ele-1", "severity" : "error", "human" : "All FHIR elements must have a @value or children", "expression" : "hasValue() or (children().count() > id.count())", "source" : "http://hl7.org/fhir/StructureDefinition/Element|5.0.0" }], "mustSupport" : false, "isModifier" : false, "isSummary" : false, "binding" : { "extension" : [{ "url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString" : "ServiceProduct" }], "strength" : "example", "description" : "Allowable service and product codes.", "valueSet" : "http://hl7.org/fhir/ValueSet/service-uscls|5.0.0" } }, { "id" : "ClaimResponse.addItem.detail.subDetail.productOrServiceEnd", "path" : "ClaimResponse.addItem.detail.subDetail.productOrServiceEnd", "short" : "End of a range of codes", "definition" : "This contains the end of a range of product, service, drug or other billing codes for the item. This element is not used when the .productOrService is a group code. This value may only be present when a .productOfService code has been provided to convey the start of the range. Typically this value may be used only with preauthorizations and not with claims.", "alias" : ["End of a range of Drug Code; Bill Code; Service Cod"], "min" : 0, "max" : "1", "base" : { "path" : "ClaimResponse.addItem.detail.subDetail.productOrServiceEnd", "min" : 0, "max" : "1" }, "type" : [{ "code" : "CodeableConcept" }], "constraint" : [{ "key" : "ele-1", "severity" : "error", "human" : "All FHIR elements must have a @value or children", "expression" : "hasValue() or (children().count() > id.count())", "source" : "http://hl7.org/fhir/StructureDefinition/Element|5.0.0" }], "mustSupport" : false, "isModifier" : false, "isSummary" : false, "binding" : { "extension" : [{ "url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString" : "ServiceProduct" }], "strength" : "example", "valueSet" : "http://hl7.org/fhir/ValueSet/service-uscls|5.0.0" } }, { "id" : "ClaimResponse.addItem.detail.subDetail.modifier", "path" : "ClaimResponse.addItem.detail.subDetail.modifier", "short" : "Service/Product billing modifiers", "definition" : "Item typification or modifiers codes to convey additional context for the product or service.", "comment" : "For example in Oral whether the treatment is cosmetic or associated with TMJ, or for Medical whether the treatment was outside the clinic or outside of office hours.", "requirements" : "To support inclusion of the item for adjudication or to charge an elevated fee.", "min" : 0, "max" : "*", "base" : { "path" : "ClaimResponse.addItem.detail.subDetail.modifier", "min" : 0, "max" : "*" }, "type" : [{ "code" : "CodeableConcept" }], "constraint" : [{ "key" : "ele-1", "severity" : "error", "human" : "All FHIR elements must have a @value or children", "expression" : "hasValue() or (children().count() > id.count())", "source" : "http://hl7.org/fhir/StructureDefinition/Element|5.0.0" }], "mustSupport" : false, "isModifier" : false, "isSummary" : false, "binding" : { "extension" : [{ "url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString" : "Modifiers" }], "strength" : "example", "description" : "Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen.", "valueSet" : "http://hl7.org/fhir/ValueSet/claim-modifiers|5.0.0" }, "mapping" : [{ "identity" : "rim", "map" : "24.C, 24.D mods" }] }, { "id" : "ClaimResponse.addItem.detail.subDetail.quantity", "path" : "ClaimResponse.addItem.detail.subDetail.quantity", "short" : "Count of products or services", "definition" : "The number of repetitions of a service or product.", "requirements" : "Required when the product or service code does not convey the quantity provided.", "min" : 0, "max" : "1", "base" : { "path" : "ClaimResponse.addItem.detail.subDetail.quantity", "min" : 0, "max" : "1" }, "type" : [{ "code" : "Quantity", "profile" : ["http://hl7.org/fhir/StructureDefinition/SimpleQuantity|5.0.0"] }], "constraint" : [{ "key" : "ele-1", "severity" : "error", "human" : "All FHIR elements must have a @value or children", "expression" : "hasValue() or (children().count() > id.count())", "source" : "http://hl7.org/fhir/StructureDefinition/Element|5.0.0" }], "mustSupport" : false, "isModifier" : false, "isSummary" : false, "mapping" : [{ "identity" : "rim", "map" : "24.G" }] }, { "id" : "ClaimResponse.addItem.detail.subDetail.unitPrice", "path" : "ClaimResponse.addItem.detail.subDetail.unitPrice", "short" : "Fee, charge or cost per item", "definition" : "If the item is not a group then this is the fee for the product or service, otherwise this is the total of the fees for the details of the group.", "requirements" : "The amount charged to the patient by the provider for a single unit.", "min" : 0, "max" : "1", "base" : { "path" : "ClaimResponse.addItem.detail.subDetail.unitPrice", "min" : 0, "max" : "1" }, "type" : [{ "code" : "Money" }], "constraint" : [{ "key" : "ele-1", "severity" : "error", "human" : "All FHIR elements must have a @value or children", "expression" : "hasValue() or (children().count() > id.count())", "source" : "http://hl7.org/fhir/StructureDefinition/Element|5.0.0" }], "mustSupport" : false, "isModifier" : false, "isSummary" : false }, { "id" : "ClaimResponse.addItem.detail.subDetail.factor", "path" : "ClaimResponse.addItem.detail.subDetail.factor", "short" : "Price scaling factor", "definition" : "A real number that represents a multiplier used in determining the overall value of services delivered and/or goods received. The concept of a Factor allows for a discount or surcharge multiplier to be applied to a monetary amount.", "comment" : "To show a 10% senior's discount, the value entered is: 0.90 (1.00 - 0.10).", "requirements" : "When discounts are provided to a patient (example: Senior's discount) then this must be documented for adjudication.", "min" : 0, "max" : "1", "base" : { "path" : "ClaimResponse.addItem.detail.subDetail.factor", "min" : 0, "max" : "1" }, "type" : [{ "code" : "decimal" }], "constraint" : [{ "key" : "ele-1", "severity" : "error", "human" : "All FHIR elements must have a @value or children", "expression" : "hasValue() or (children().count() > id.count())", "source" : "http://hl7.org/fhir/StructureDefinition/Element|5.0.0" }], "mustSupport" : false, "isModifier" : false, "isSummary" : false }, { "id" : "ClaimResponse.addItem.detail.subDetail.tax", "path" : "ClaimResponse.addItem.detail.subDetail.tax", "short" : "Total tax", "definition" : "The total of taxes applicable for this product or service.", "requirements" : "Required when taxes are not embedded in the unit price or provided as a separate service.", "min" : 0, "max" : "1", "base" : { "path" : "ClaimResponse.addItem.detail.subDetail.tax", "min" : 0, "max" : "1" }, "type" : [{ "code" : "Money" }], "constraint" : [{ "key" : "ele-1", "severity" : "error", "human" : "All FHIR elements must have a @value or children", "expression" : "hasValue() or (children().count() > id.count())", "source" : "http://hl7.org/fhir/StructureDefinition/Element|5.0.0" }], "mustSupport" : false, "isModifier" : false, "isSummary" : false }, { "id" : "ClaimResponse.addItem.detail.subDetail.net", "path" : "ClaimResponse.addItem.detail.subDetail.net", "short" : "Total item cost", "definition" : "The total amount claimed for the addItem.detail.subDetail. Net = unit price * quantity * factor.", "comment" : "For example, the formula: quantity * unitPrice * factor = net. Quantity and factor are assumed to be 1 if not supplied.", "requirements" : "Provides the total amount claimed for the group (if a grouper) or the line item.", "min" : 0, "max" : "1", "base" : { "path" : "ClaimResponse.addItem.detail.subDetail.net", "min" : 0, "max" : "1" }, "type" : [{ "code" : "Money" }], "constraint" : [{ "key" : "ele-1", "severity" : "error", "human" : "All FHIR elements must have a @value or children", "expression" : "hasValue() or (children().count() > id.count())", "source" : "http://hl7.org/fhir/StructureDefinition/Element|5.0.0" }], "mustSupport" : false, "isModifier" : false, "isSummary" : false, "mapping" : [{ "identity" : "rim", "map" : "24.F" }] }, { "id" : "ClaimResponse.addItem.detail.subDetail.noteNumber", "path" : "ClaimResponse.addItem.detail.subDetail.noteNumber", "short" : "Applicable note numbers", "definition" : "The numbers associated with notes below which apply to the adjudication of this item.", "requirements" : "Provides a condensed manner for associating human readable descriptive explanations for adjudications on the line item.", "min" : 0, "max" : "*", "base" : { "path" : "ClaimResponse.addItem.detail.subDetail.noteNumber", "min" : 0, "max" : "*" }, "type" : [{ "code" : "positiveInt" }], "constraint" : [{ "key" : "ele-1", "severity" : "error", "human" : "All FHIR elements must have a @value or children", "expression" : "hasValue() or (children().count() > id.count())", "source" : "http://hl7.org/fhir/StructureDefinition/Element|5.0.0" }], "mustSupport" : false, "isModifier" : false, "isSummary" : false }, { "id" : "ClaimResponse.addItem.detail.subDetail.reviewOutcome", "path" : "ClaimResponse.addItem.detail.subDetail.reviewOutcome", "short" : "Added items subdetail level adjudication results", "definition" : "The high-level results of the adjudication if adjudication has been performed.", "min" : 0, "max" : "1", "base" : { "path" : "ClaimResponse.addItem.detail.subDetail.reviewOutcome", "min" : 0, "max" : "1" }, "contentReference" : "http://hl7.org/fhir/StructureDefinition/ClaimResponse#ClaimResponse.item.reviewOutcome", "constraint" : [{ "key" : "ele-1", "severity" : "error", "human" : "All FHIR elements must have a @value or children", "expression" : "hasValue() or (children().count() > id.count())", "source" : "http://hl7.org/fhir/StructureDefinition/Element|5.0.0" }], "mustSupport" : false, "isModifier" : false, "isSummary" : false }, { "id" : "ClaimResponse.addItem.detail.subDetail.adjudication", "path" : "ClaimResponse.addItem.detail.subDetail.adjudication", "short" : "Added items subdetail adjudication", "definition" : "The adjudication results.", "min" : 0, "max" : "*", "base" : { "path" : "ClaimResponse.addItem.detail.subDetail.adjudication", "min" : 0, "max" : "*" }, "contentReference" : "http://hl7.org/fhir/StructureDefinition/ClaimResponse#ClaimResponse.item.adjudication", "constraint" : [{ "key" : "ele-1", "severity" : "error", "human" : "All FHIR elements must have a @value or children", "expression" : "hasValue() or (children().count() > id.count())", "source" : "http://hl7.org/fhir/StructureDefinition/Element|5.0.0" }], "mustSupport" : false, "isModifier" : false, "isSummary" : false }, { "id" : "ClaimResponse.adjudication", "path" : "ClaimResponse.adjudication", "short" : "Header-level adjudication", "definition" : "The adjudication results which are presented at the header level rather than at the line-item or add-item levels.", "requirements" : "Some insurers will receive line-items but provide the adjudication only at a summary or header-level.", "min" : 0, "max" : "*", "base" : { "path" : "ClaimResponse.adjudication", "min" : 0, "max" : "*" }, "contentReference" : "http://hl7.org/fhir/StructureDefinition/ClaimResponse#ClaimResponse.item.adjudication", "constraint" : [{ "key" : "ele-1", "severity" : "error", "human" : "All FHIR elements must have a @value or children", "expression" : "hasValue() or (children().count() > id.count())", "source" : "http://hl7.org/fhir/StructureDefinition/Element|5.0.0" }], "mustSupport" : false, "isModifier" : false, "isSummary" : false }, { "id" : "ClaimResponse.total", "path" : "ClaimResponse.total", "short" : "Adjudication totals", "definition" : "Categorized monetary totals for the adjudication.", "comment" : "Totals for amounts submitted, co-pays, benefits payable etc.", "requirements" : "To provide the requestor with financial totals by category for the adjudication.", "min" : 0, "max" : "*", "base" : { "path" : "ClaimResponse.total", "min" : 0, "max" : "*" }, "type" : [{ "code" : "BackboneElement" }], "constraint" : [{ "key" : "ele-1", "severity" : "error", "human" : "All FHIR elements must have a @value or children", "expression" : "hasValue() or (children().count() > id.count())", "source" : "http://hl7.org/fhir/StructureDefinition/Element|5.0.0" }], "mustSupport" : false, "isModifier" : false, "isSummary" : true }, { "id" : "ClaimResponse.total.id", "path" : "ClaimResponse.total.id", "representation" : ["xmlAttr"], "short" : "Unique id for inter-element referencing", "definition" : "Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.", "min" : 0, "max" : "1", "base" : { "path" : "Element.id", "min" : 0, "max" : "1" }, "type" : [{ "extension" : [{ "url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type", "valueUrl" : "string" }], "code" : "http://hl7.org/fhirpath/System.String" }], "condition" : ["ele-1"], "isModifier" : false, "isSummary" : false, "mapping" : [{ "identity" : "rim", "map" : "n/a" }] }, { "id" : "ClaimResponse.total.extension", "path" : "ClaimResponse.total.extension", "short" : "Additional content defined by implementations", "definition" : "May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and managable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.", "comment" : "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.", "alias" : ["extensions", "user content"], "min" : 0, "max" : "*", "base" : { "path" : "Element.extension", "min" : 0, "max" : "*" }, "type" : [{ "code" : "Extension" }], "constraint" : [{ "key" : "ele-1", "severity" : "error", "human" : "All FHIR elements must have a @value or children", "expression" : "hasValue() or (children().count() > id.count())", "source" : "http://hl7.org/fhir/StructureDefinition/Element|5.0.0" }, { "key" : "ext-1", "severity" : "error", "human" : "Must have either extensions or value[x], not both", "expression" : "extension.exists() != value.exists()", "source" : "http://hl7.org/fhir/StructureDefinition/Extension|5.0.0" }], "isModifier" : false, "isSummary" : false, "mapping" : [{ "identity" : "rim", "map" : "n/a" }] }, { "id" : "ClaimResponse.total.modifierExtension", "path" : "ClaimResponse.total.modifierExtension", "short" : "Extensions that cannot be ignored even if unrecognized", "definition" : "May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and managable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.\n\nModifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).", "comment" : "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.", "requirements" : "Modifier extensions allow for extensions that *cannot* be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the [definition of modifier extensions](http://hl7.org/fhir/R5/extensibility.html#modifierExtension).", "alias" : ["extensions", "user content", "modifiers"], "min" : 0, "max" : "*", "base" : { "path" : "BackboneElement.modifierExtension", "min" : 0, "max" : "*" }, "type" : [{ "code" : "Extension" }], "constraint" : [{ "key" : "ele-1", "severity" : "error", "human" : "All FHIR elements must have a @value or children", "expression" : "hasValue() or (children().count() > id.count())", "source" : "http://hl7.org/fhir/StructureDefinition/Element|5.0.0" }, { "key" : "ext-1", "severity" : "error", "human" : "Must have either extensions or value[x], not both", "expression" : "extension.exists() != value.exists()", "source" : "http://hl7.org/fhir/StructureDefinition/Extension|5.0.0" }], "isModifier" : true, "isModifierReason" : "Modifier extensions are expected to modify the meaning or interpretation of the element that contains them", "isSummary" : true, "mapping" : [{ "identity" : "rim", "map" : "N/A" }] }, { "id" : "ClaimResponse.total.category", "path" : "ClaimResponse.total.category", "short" : "Type of adjudication information", "definition" : "A code to indicate the information type of this adjudication record. Information types may include: the value submitted, maximum values or percentages allowed or payable under the plan, amounts that the patient is responsible for in aggregate or pertaining to this item, amounts paid by other coverages, and the benefit payable for this item.", "comment" : "For example codes indicating: Co-Pay, deductible, eligible, benefit, tax, etc.", "requirements" : "Needed to convey the type of total provided.", "min" : 1, "max" : "1", "base" : { "path" : "ClaimResponse.total.category", "min" : 1, "max" : "1" }, "type" : [{ "code" : "CodeableConcept" }], "constraint" : [{ "key" : "ele-1", "severity" : "error", "human" : "All FHIR elements must have a @value or children", "expression" : "hasValue() or (children().count() > id.count())", "source" : "http://hl7.org/fhir/StructureDefinition/Element|5.0.0" }], "mustSupport" : false, "isModifier" : false, "isSummary" : true, "binding" : { "extension" : [{ "url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString" : "Adjudication" }], "strength" : "example", "description" : "The adjudication codes.", "valueSet" : "http://hl7.org/fhir/ValueSet/adjudication|5.0.0" } }, { "id" : "ClaimResponse.total.amount", "path" : "ClaimResponse.total.amount", "short" : "Financial total for the category", "definition" : "Monetary total amount associated with the category.", "requirements" : "Needed to convey the total monetary amount.", "min" : 1, "max" : "1", "base" : { "path" : "ClaimResponse.total.amount", "min" : 1, "max" : "1" }, "type" : [{ "code" : "Money" }], "constraint" : [{ "key" : "ele-1", "severity" : "error", "human" : "All FHIR elements must have a @value or children", "expression" : "hasValue() or (children().count() > id.count())", "source" : "http://hl7.org/fhir/StructureDefinition/Element|5.0.0" }], "mustSupport" : false, "isModifier" : false, "isSummary" : true }, { "id" : "ClaimResponse.payment", "path" : "ClaimResponse.payment", "short" : "Payment Details", "definition" : "Payment details for the adjudication of the claim.", "requirements" : "Needed to convey references to the financial instrument that has been used if payment has been made.", "min" : 0, "max" : "1", "base" : { "path" : "ClaimResponse.payment", "min" : 0, "max" : "1" }, "type" : [{ "code" : "BackboneElement" }], "constraint" : [{ "key" : "ele-1", "severity" : "error", "human" : "All FHIR elements must have a @value or children", "expression" : "hasValue() or (children().count() > id.count())", "source" : "http://hl7.org/fhir/StructureDefinition/Element|5.0.0" }], "mustSupport" : false, "isModifier" : false, "isSummary" : false }, { "id" : "ClaimResponse.payment.id", "path" : "ClaimResponse.payment.id", "representation" : ["xmlAttr"], "short" : "Unique id for inter-element referencing", "definition" : "Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.", "min" : 0, "max" : "1", "base" : { "path" : "Element.id", "min" : 0, "max" : "1" }, "type" : [{ "extension" : [{ "url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type", "valueUrl" : "string" }], "code" : "http://hl7.org/fhirpath/System.String" }], "condition" : ["ele-1"], "isModifier" : false, "isSummary" : false, "mapping" : [{ "identity" : "rim", "map" : "n/a" }] }, { "id" : "ClaimResponse.payment.extension", "path" : "ClaimResponse.payment.extension", "short" : "Additional content defined by implementations", "definition" : "May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and managable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.", "comment" : "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.", "alias" : ["extensions", "user content"], "min" : 0, "max" : "*", "base" : { "path" : "Element.extension", "min" : 0, "max" : "*" }, "type" : [{ "code" : "Extension" }], "constraint" : [{ "key" : "ele-1", "severity" : "error", "human" : "All FHIR elements must have a @value or children", "expression" : "hasValue() or (children().count() > id.count())", "source" : "http://hl7.org/fhir/StructureDefinition/Element|5.0.0" }, { "key" : "ext-1", "severity" : "error", "human" : "Must have either extensions or value[x], not both", "expression" : "extension.exists() != value.exists()", "source" : "http://hl7.org/fhir/StructureDefinition/Extension|5.0.0" }], "isModifier" : false, "isSummary" : false, "mapping" : [{ "identity" : "rim", "map" : "n/a" }] }, { "id" : "ClaimResponse.payment.modifierExtension", "path" : "ClaimResponse.payment.modifierExtension", "short" : "Extensions that cannot be ignored even if unrecognized", "definition" : "May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and managable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.\n\nModifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).", "comment" : "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.", "requirements" : "Modifier extensions allow for extensions that *cannot* be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the [definition of modifier extensions](http://hl7.org/fhir/R5/extensibility.html#modifierExtension).", "alias" : ["extensions", "user content", "modifiers"], "min" : 0, "max" : "*", "base" : { "path" : "BackboneElement.modifierExtension", "min" : 0, "max" : "*" }, "type" : [{ "code" : "Extension" }], "constraint" : [{ "key" : "ele-1", "severity" : "error", "human" : "All FHIR elements must have a @value or children", "expression" : "hasValue() or (children().count() > id.count())", "source" : "http://hl7.org/fhir/StructureDefinition/Element|5.0.0" }, { "key" : "ext-1", "severity" : "error", "human" : "Must have either extensions or value[x], not both", "expression" : "extension.exists() != value.exists()", "source" : "http://hl7.org/fhir/StructureDefinition/Extension|5.0.0" }], "isModifier" : true, "isModifierReason" : "Modifier extensions are expected to modify the meaning or interpretation of the element that contains them", "isSummary" : true, "mapping" : [{ "identity" : "rim", "map" : "N/A" }] }, { "id" : "ClaimResponse.payment.type", "path" : "ClaimResponse.payment.type", "short" : "Partial or complete payment", "definition" : "Whether this represents partial or complete payment of the benefits payable.", "requirements" : "To advise the requestor when the insurer believes all payments to have been completed.", "min" : 1, "max" : "1", "base" : { "path" : "ClaimResponse.payment.type", "min" : 1, "max" : "1" }, "type" : [{ "code" : "CodeableConcept" }], "constraint" : [{ "key" : "ele-1", "severity" : "error", "human" : "All FHIR elements must have a @value or children", "expression" : "hasValue() or (children().count() > id.count())", "source" : "http://hl7.org/fhir/StructureDefinition/Element|5.0.0" }], "mustSupport" : false, "isModifier" : false, "isSummary" : false, "binding" : { "extension" : [{ "url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString" : "PaymentType" }], "strength" : "example", "description" : "The type (partial, complete) of the payment.", "valueSet" : "http://hl7.org/fhir/ValueSet/ex-paymenttype|5.0.0" } }, { "id" : "ClaimResponse.payment.adjustment", "path" : "ClaimResponse.payment.adjustment", "short" : "Payment adjustment for non-claim issues", "definition" : "Total amount of all adjustments to this payment included in this transaction which are not related to this claim's adjudication.", "comment" : "Insurers will deduct amounts owing from the provider (adjustment), such as a prior overpayment, from the amount owing to the provider (benefits payable) when payment is made to the provider.", "requirements" : "To advise the requestor of adjustments applied to the payment.", "min" : 0, "max" : "1", "base" : { "path" : "ClaimResponse.payment.adjustment", "min" : 0, "max" : "1" }, "type" : [{ "code" : "Money" }], "constraint" : [{ "key" : "ele-1", "severity" : "error", "human" : "All FHIR elements must have a @value or children", "expression" : "hasValue() or (children().count() > id.count())", "source" : "http://hl7.org/fhir/StructureDefinition/Element|5.0.0" }], "mustSupport" : false, "isModifier" : false, "isSummary" : false }, { "id" : "ClaimResponse.payment.adjustmentReason", "path" : "ClaimResponse.payment.adjustmentReason", "short" : "Explanation for the adjustment", "definition" : "Reason for the payment adjustment.", "requirements" : "Needed to clarify the monetary adjustment.", "min" : 0, "max" : "1", "base" : { "path" : "ClaimResponse.payment.adjustmentReason", "min" : 0, "max" : "1" }, "type" : [{ "code" : "CodeableConcept" }], "constraint" : [{ "key" : "ele-1", "severity" : "error", "human" : "All FHIR elements must have a @value or children", "expression" : "hasValue() or (children().count() > id.count())", "source" : "http://hl7.org/fhir/StructureDefinition/Element|5.0.0" }], "mustSupport" : false, "isModifier" : false, "isSummary" : false, "binding" : { "extension" : [{ "url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString" : "PaymentAdjustmentReason" }], "strength" : "example", "description" : "Payment Adjustment reason codes.", "valueSet" : "http://hl7.org/fhir/ValueSet/payment-adjustment-reason|5.0.0" } }, { "id" : "ClaimResponse.payment.date", "path" : "ClaimResponse.payment.date", "short" : "Expected date of payment", "definition" : "Estimated date the payment will be issued or the actual issue date of payment.", "requirements" : "To advise the payee when payment can be expected.", "min" : 0, "max" : "1", "base" : { "path" : "ClaimResponse.payment.date", "min" : 0, "max" : "1" }, "type" : [{ "code" : "date" }], "constraint" : [{ "key" : "ele-1", "severity" : "error", "human" : "All FHIR elements must have a @value or children", "expression" : "hasValue() or (children().count() > id.count())", "source" : "http://hl7.org/fhir/StructureDefinition/Element|5.0.0" }], "mustSupport" : false, "isModifier" : false, "isSummary" : false }, { "id" : "ClaimResponse.payment.amount", "path" : "ClaimResponse.payment.amount", "short" : "Payable amount after adjustment", "definition" : "Benefits payable less any payment adjustment.", "requirements" : "Needed to provide the actual payment amount.", "min" : 1, "max" : "1", "base" : { "path" : "ClaimResponse.payment.amount", "min" : 1, "max" : "1" }, "type" : [{ "code" : "Money" }], "constraint" : [{ "key" : "ele-1", "severity" : "error", "human" : "All FHIR elements must have a @value or children", "expression" : "hasValue() or (children().count() > id.count())", "source" : "http://hl7.org/fhir/StructureDefinition/Element|5.0.0" }], "mustSupport" : false, "isModifier" : false, "isSummary" : false }, { "id" : "ClaimResponse.payment.identifier", "path" : "ClaimResponse.payment.identifier", "short" : "Business identifier for the payment", "definition" : "Issuer's unique identifier for the payment instrument.", "comment" : "For example: EFT number or check number.", "requirements" : "Enable the receiver to reconcile when payment received.", "min" : 0, "max" : "1", "base" : { "path" : "ClaimResponse.payment.identifier", "min" : 0, "max" : "1" }, "type" : [{ "code" : "Identifier" }], "constraint" : [{ "key" : "ele-1", "severity" : "error", "human" : "All FHIR elements must have a @value or children", "expression" : "hasValue() or (children().count() > id.count())", "source" : "http://hl7.org/fhir/StructureDefinition/Element|5.0.0" }], "mustSupport" : false, "isModifier" : false, "isSummary" : false }, { "id" : "ClaimResponse.payment.identifier.id", "path" : "ClaimResponse.payment.identifier.id", "representation" : ["xmlAttr"], "short" : "Unique id for inter-element referencing", "definition" : "Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.", "min" : 0, "max" : "1", "base" : { "path" : "Element.id", "min" : 0, "max" : "1" }, "type" : [{ "extension" : [{ "url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type", "valueUrl" : "id" }], "code" : "http://hl7.org/fhirpath/System.String" }], "condition" : ["ele-1"], "isModifier" : false, "isSummary" : false, "mapping" : [{ "identity" : "rim", "map" : "n/a" }] }, { "id" : "ClaimResponse.payment.identifier.extension", "path" : "ClaimResponse.payment.identifier.extension", "slicing" : { "discriminator" : [{ "type" : "value", "path" : "url" }], "description" : "Extensions are always sliced by (at least) url", "ordered" : false, "rules" : "open" }, "short" : "Extension", "definition" : "An Extension", "min" : 0, "max" : "*", "base" : { "path" : "Element.extension", "min" : 0, "max" : "*" }, "type" : [{ "code" : "Extension" }], "constraint" : [{ "key" : "ele-1", "severity" : "error", "human" : "All FHIR elements must have a @value or children", "expression" : "hasValue() or (children().count() > id.count())", "source" : "http://hl7.org/fhir/StructureDefinition/Element|5.0.0" }, { "key" : "ext-1", "severity" : "error", "human" : "Must have either extensions or value[x], not both", "expression" : "extension.exists() != value.exists()", "source" : "http://hl7.org/fhir/StructureDefinition/Extension|5.0.0" }], "isModifier" : false, "isSummary" : false }, { "id" : "ClaimResponse.payment.identifier.extension:paymentRef", "path" : "ClaimResponse.payment.identifier.extension", "sliceName" : "paymentRef", "short" : "DSTU2: Payment identifier additional types", "definition" : "DSTU2: `ClaimResponse.paymentRef` additional types (Identifier) additional types from child elements (assigner, period, system, type, use, value)", "comment" : "Element `ClaimResponse.paymentRef` is mapped to FHIR R5 element `ClaimResponse.payment.identifier` as `SourceIsBroaderThanTarget`.\nThe mappings for `ClaimResponse.paymentRef` do not cover the following types: Identifier.\nThe mappings for `ClaimResponse.paymentRef` do not cover the following types based on type expansion: assigner, period, system, type, use, value.", "min" : 0, "max" : "1", "base" : { "path" : "Element.extension", "min" : 0, "max" : "*" }, "type" : [{ "code" : "Extension", "profile" : ["http://hl7.org/fhir/1.0/StructureDefinition/extension-ClaimResponse.paymentRef|0.1.0"] }], "constraint" : [{ "key" : "ele-1", "severity" : "error", "human" : "All FHIR elements must have a @value or children", "expression" : "hasValue() or (children().count() > id.count())", "source" : "http://hl7.org/fhir/StructureDefinition/Element|5.0.0" }, { "key" : "ext-1", "severity" : "error", "human" : "Must have either extensions or value[x], not both", "expression" : "extension.exists() != value.exists()", "source" : "http://hl7.org/fhir/StructureDefinition/Extension|5.0.0" }], "isModifier" : false, "isSummary" : false }, { "id" : "ClaimResponse.payment.identifier.use", "path" : "ClaimResponse.payment.identifier.use", "short" : "usual | official | temp | secondary | old (If known)", "definition" : "The purpose of this identifier.", "comment" : "Applications can assume that an identifier is permanent unless it explicitly says that it is temporary.", "requirements" : "Allows the appropriate identifier for a particular context of use to be selected from among a set of identifiers.", "min" : 0, "max" : "1", "base" : { "path" : "Identifier.use", "min" : 0, "max" : "1" }, "type" : [{ "code" : "code" }], "constraint" : [{ "key" : "ele-1", "severity" : "error", "human" : "All FHIR elements must have a @value or children", "expression" : "hasValue() or (children().count() > id.count())", "source" : "http://hl7.org/fhir/StructureDefinition/Element|5.0.0" }], "isModifier" : true, "isModifierReason" : "This is labeled as \"Is Modifier\" because applications should not mistake a temporary id for a permanent one.", "isSummary" : true, "binding" : { "extension" : [{ "url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString" : "IdentifierUse" }], "strength" : "required", "description" : "Identifies the purpose for this identifier, if known .", "valueSet" : "http://hl7.org/fhir/ValueSet/identifier-use|5.0.0" }, "mapping" : [{ "identity" : "v2", "map" : "N/A" }, { "identity" : "rim", "map" : "Role.code or implied by context" }] }, { "id" : "ClaimResponse.payment.identifier.type", "path" : "ClaimResponse.payment.identifier.type", "short" : "Description of identifier", "definition" : "A coded type for the identifier that can be used to determine which identifier to use for a specific purpose.", "comment" : "This element deals only with general categories of identifiers. It SHOULD not be used for codes that correspond 1..1 with the Identifier.system. Some identifiers may fall into multiple categories due to common usage. Where the system is known, a type is unnecessary because the type is always part of the system definition. However systems often need to handle identifiers where the system is not known. There is not a 1:1 relationship between type and system, since many different systems have the same type.", "requirements" : "Allows users to make use of identifiers when the identifier system is not known.", "min" : 0, "max" : "1", "base" : { "path" : "Identifier.type", "min" : 0, "max" : "1" }, "type" : [{ "code" : "CodeableConcept" }], "constraint" : [{ "key" : "ele-1", "severity" : "error", "human" : "All FHIR elements must have a @value or children", "expression" : "hasValue() or (children().count() > id.count())", "source" : "http://hl7.org/fhir/StructureDefinition/Element|5.0.0" }], "isModifier" : false, "isSummary" : true, "binding" : { "extension" : [{ "url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString" : "IdentifierType" }], "strength" : "extensible", "description" : "A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.", "valueSet" : "http://hl7.org/fhir/ValueSet/identifier-type|5.0.0" }, "mapping" : [{ "identity" : "v2", "map" : "CX.5" }, { "identity" : "rim", "map" : "Role.code or implied by context" }] }, { "id" : "ClaimResponse.payment.identifier.system", "path" : "ClaimResponse.payment.identifier.system", "short" : "The namespace for the identifier value", "definition" : "Establishes the namespace for the value - that is, an absolute URL that describes a set values that are unique.", "comment" : "Identifier.system is always case sensitive.", "requirements" : "There are many sets of identifiers. To perform matching of two identifiers, we need to know what set we're dealing with. The system identifies a particular set of unique identifiers.", "min" : 0, "max" : "1", "base" : { "path" : "Identifier.system", "min" : 0, "max" : "1" }, "type" : [{ "code" : "uri" }], "example" : [{ "label" : "General", "valueUri" : "http://www.acme.com/identifiers/patient" }], "constraint" : [{ "key" : "ele-1", "severity" : "error", "human" : "All FHIR elements must have a @value or children", "expression" : "hasValue() or (children().count() > id.count())", "source" : "http://hl7.org/fhir/StructureDefinition/Element|5.0.0" }], "isModifier" : false, "isSummary" : true, "mapping" : [{ "identity" : "v2", "map" : "CX.4 / EI-2-4" }, { "identity" : "rim", "map" : "II.root or Role.id.root" }, { "identity" : "servd", "map" : "./IdentifierType" }] }, { "id" : "ClaimResponse.payment.identifier.value", "path" : "ClaimResponse.payment.identifier.value", "short" : "The value that is unique", "definition" : "The portion of the identifier typically relevant to the user and which is unique within the context of the system.", "comment" : "If the value is a full URI, then the system SHALL be urn:ietf:rfc:3986. The value's primary purpose is computational mapping. As a result, it may be normalized for comparison purposes (e.g. removing non-significant whitespace, dashes, etc.) A value formatted for human display can be conveyed using the [http://hl7.org/fhir/StructureDefinition/rendered-value](http://hl7.org/fhir/extensions/StructureDefinition-rendered-value.html)). Identifier.value is to be treated as case sensitive unless knowledge of the Identifier.system allows the processer to be confident that non-case-sensitive processing is safe.", "min" : 0, "max" : "1", "base" : { "path" : "Identifier.value", "min" : 0, "max" : "1" }, "type" : [{ "code" : "string" }], "example" : [{ "label" : "General", "valueString" : "123456" }], "condition" : ["ident-1"], "constraint" : [{ "key" : "ele-1", "severity" : "error", "human" : "All FHIR elements must have a @value or children", "expression" : "hasValue() or (children().count() > id.count())", "source" : "http://hl7.org/fhir/StructureDefinition/Element|5.0.0" }], "isModifier" : false, "isSummary" : true, "mapping" : [{ "identity" : "v2", "map" : "CX.1 / EI.1" }, { "identity" : "rim", "map" : "II.extension or II.root if system indicates OID or GUID (Or Role.id.extension or root)" }, { "identity" : "servd", "map" : "./Value" }] }, { "id" : "ClaimResponse.payment.identifier.period", "path" : "ClaimResponse.payment.identifier.period", "short" : "Time period when id is/was valid for use", "definition" : "Time period during which identifier is/was valid for use.", "min" : 0, "max" : "1", "base" : { "path" : "Identifier.period", "min" : 0, "max" : "1" }, "type" : [{ "code" : "Period" }], "constraint" : [{ "key" : "ele-1", "severity" : "error", "human" : "All FHIR elements must have a @value or children", "expression" : "hasValue() or (children().count() > id.count())", "source" : "http://hl7.org/fhir/StructureDefinition/Element|5.0.0" }], "isModifier" : false, "isSummary" : true, "mapping" : [{ "identity" : "v2", "map" : "CX.7 + CX.8" }, { "identity" : "rim", "map" : "Role.effectiveTime or implied by context" }, { "identity" : "servd", "map" : "./StartDate and ./EndDate" }] }, { "id" : "ClaimResponse.payment.identifier.assigner", "path" : "ClaimResponse.payment.identifier.assigner", "short" : "Organization that issued id (may be just text)", "definition" : "Organization that issued/manages the identifier.", "comment" : "The Identifier.assigner may omit the .reference element and only contain a .display element reflecting the name or other textual information about the assigning organization.", "min" : 0, "max" : "1", "base" : { "path" : "Identifier.assigner", "min" : 0, "max" : "1" }, "type" : [{ "code" : "Reference", "targetProfile" : ["http://hl7.org/fhir/StructureDefinition/Organization|5.0.0"] }], "constraint" : [{ "key" : "ele-1", "severity" : "error", "human" : "All FHIR elements must have a @value or children", "expression" : "hasValue() or (children().count() > id.count())", "source" : "http://hl7.org/fhir/StructureDefinition/Element|5.0.0" }], "isModifier" : false, "isSummary" : true, "mapping" : [{ "identity" : "v2", "map" : "CX.4 / (CX.4,CX.9,CX.10)" }, { "identity" : "rim", "map" : "II.assigningAuthorityName but note that this is an improper use by the definition of the field. Also Role.scoper" }, { "identity" : "servd", "map" : "./IdentifierIssuingAuthority" }] }, { "id" : "ClaimResponse.fundsReserve", "path" : "ClaimResponse.fundsReserve", "short" : "Funds reserved status", "definition" : "A code, used only on a response to a preauthorization, to indicate whether the benefits payable have been reserved and for whom.", "comment" : "Fund would be release by a future claim quoting the preAuthRef of this response. Examples of values include: provider, patient, none.", "requirements" : "Needed to advise the submitting provider on whether the rquest for reservation of funds has been honored.", "min" : 0, "max" : "1", "base" : { "path" : "ClaimResponse.fundsReserve", "min" : 0, "max" : "1" }, "type" : [{ "code" : "CodeableConcept" }], "constraint" : [{ "key" : "ele-1", "severity" : "error", "human" : "All FHIR elements must have a @value or children", "expression" : "hasValue() or (children().count() > id.count())", "source" : "http://hl7.org/fhir/StructureDefinition/Element|5.0.0" }], "mustSupport" : false, "isModifier" : false, "isSummary" : false, "binding" : { "extension" : [{ "url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString" : "FundsReserve" }], "strength" : "example", "description" : "For whom funds are to be reserved: (Patient, Provider, None).", "valueSet" : "http://hl7.org/fhir/ValueSet/fundsreserve|5.0.0" } }, { "id" : "ClaimResponse.formCode", "path" : "ClaimResponse.formCode", "short" : "Printed form identifier", "definition" : "A code for the form to be used for printing the content.", "comment" : "May be needed to identify specific jurisdictional forms.", "requirements" : "Needed to specify the specific form used for producing output for this response.", "min" : 0, "max" : "1", "base" : { "path" : "ClaimResponse.formCode", "min" : 0, "max" : "1" }, "type" : [{ "code" : "CodeableConcept" }], "constraint" : [{ "key" : "ele-1", "severity" : "error", "human" : "All FHIR elements must have a @value or children", "expression" : "hasValue() or (children().count() > id.count())", "source" : "http://hl7.org/fhir/StructureDefinition/Element|5.0.0" }], "mustSupport" : false, "isModifier" : false, "isSummary" : false, "binding" : { "extension" : [{ "url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString" : "Forms" }], "strength" : "example", "description" : "The forms codes.", "valueSet" : "http://hl7.org/fhir/ValueSet/forms|5.0.0" } }, { "id" : "ClaimResponse.formCode.id", "path" : "ClaimResponse.formCode.id", "representation" : ["xmlAttr"], "short" : "Unique id for inter-element referencing", "definition" : "Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.", "min" : 0, "max" : "1", "base" : { "path" : "Element.id", "min" : 0, "max" : "1" }, "type" : [{ "extension" : [{ "url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type", "valueUrl" : "id" }], "code" : "http://hl7.org/fhirpath/System.String" }], "condition" : ["ele-1"], "isModifier" : false, "isSummary" : false, "mapping" : [{ "identity" : "rim", "map" : "n/a" }] }, { "id" : "ClaimResponse.formCode.extension", "path" : "ClaimResponse.formCode.extension", "slicing" : { "discriminator" : [{ "type" : "value", "path" : "url" }], "description" : "Extensions are always sliced by (at least) url", "ordered" : false, "rules" : "open" }, "short" : "Extension", "definition" : "An Extension", "min" : 0, "max" : "*", "base" : { "path" : "Element.extension", "min" : 0, "max" : "*" }, "type" : [{ "code" : "Extension" }], "constraint" : [{ "key" : "ele-1", "severity" : "error", "human" : "All FHIR elements must have a @value or children", "expression" : "hasValue() or (children().count() > id.count())", "source" : "http://hl7.org/fhir/StructureDefinition/Element|5.0.0" }, { "key" : "ext-1", "severity" : "error", "human" : "Must have either extensions or value[x], not both", "expression" : "extension.exists() != value.exists()", "source" : "http://hl7.org/fhir/StructureDefinition/Extension|5.0.0" }], "isModifier" : false, "isSummary" : false }, { "id" : "ClaimResponse.formCode.extension:form", "path" : "ClaimResponse.formCode.extension", "sliceName" : "form", "short" : "DSTU2: Printed Form Identifier", "definition" : "DSTU2: `ClaimResponse.form`", "comment" : "Element `ClaimResponse.form` is mapped to FHIR R5 element `ClaimResponse.formCode` as `SourceIsNarrowerThanTarget`.", "min" : 0, "max" : "1", "base" : { "path" : "Element.extension", "min" : 0, "max" : "*" }, "type" : [{ "code" : "Extension", "profile" : ["http://hl7.org/fhir/1.0/StructureDefinition/extension-ClaimResponse.form|0.1.0"] }], "constraint" : [{ "key" : "ele-1", "severity" : "error", "human" : "All FHIR elements must have a @value or children", "expression" : "hasValue() or (children().count() > id.count())", "source" : "http://hl7.org/fhir/StructureDefinition/Element|5.0.0" }, { "key" : "ext-1", "severity" : "error", "human" : "Must have either extensions or value[x], not both", "expression" : "extension.exists() != value.exists()", "source" : "http://hl7.org/fhir/StructureDefinition/Extension|5.0.0" }], "isModifier" : false, "isSummary" : false }, { "id" : "ClaimResponse.formCode.coding", "path" : "ClaimResponse.formCode.coding", "short" : "Code defined by a terminology system", "definition" : "A reference to a code defined by a terminology system.", "comment" : "Codes may be defined very casually in enumerations, or code lists, up to very formal definitions such as SNOMED CT - see the HL7 v3 Core Principles for more information. Ordering of codings is undefined and SHALL NOT be used to infer meaning. Generally, at most only one of the coding values will be labeled as UserSelected = true.", "requirements" : "Allows for alternative encodings within a code system, and translations to other code systems.", "min" : 0, "max" : "*", "base" : { "path" : "CodeableConcept.coding", "min" : 0, "max" : "*" }, "type" : [{ "code" : "Coding" }], "constraint" : [{ "key" : "ele-1", "severity" : "error", "human" : "All FHIR elements must have a @value or children", "expression" : "hasValue() or (children().count() > id.count())", "source" : "http://hl7.org/fhir/StructureDefinition/Element|5.0.0" }], "isModifier" : false, "isSummary" : true, "mapping" : [{ "identity" : "v2", "map" : "C*E.1-8, C*E.10-22" }, { "identity" : "rim", "map" : "union(., ./translation)" }, { "identity" : "orim", "map" : "fhir:CodeableConcept.coding rdfs:subPropertyOf dt:CD.coding" }] }, { "id" : "ClaimResponse.formCode.text", "extension" : [{ "url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-translatable", "valueBoolean" : true }, { "url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-translatable", "valueBoolean" : true }], "path" : "ClaimResponse.formCode.text", "short" : "Plain text representation of the concept", "definition" : "A human language representation of the concept as seen/selected/uttered by the user who entered the data and/or which represents the intended meaning of the user.", "comment" : "Very often the text is the same as a displayName of one of the codings.", "requirements" : "The codes from the terminologies do not always capture the correct meaning with all the nuances of the human using them, or sometimes there is no appropriate code at all. In these cases, the text is used to capture the full meaning of the source.", "min" : 0, "max" : "1", "base" : { "path" : "CodeableConcept.text", "min" : 0, "max" : "1" }, "type" : [{ "code" : "string" }], "constraint" : [{ "key" : "ele-1", "severity" : "error", "human" : "All FHIR elements must have a @value or children", "expression" : "hasValue() or (children().count() > id.count())", "source" : "http://hl7.org/fhir/StructureDefinition/Element|5.0.0" }], "isModifier" : false, "isSummary" : true, "mapping" : [{ "identity" : "v2", "map" : "C*E.9. But note many systems use C*E.2 for this" }, { "identity" : "rim", "map" : "./originalText[mediaType/code=\"text/plain\"]/data" }, { "identity" : "orim", "map" : "fhir:CodeableConcept.text rdfs:subPropertyOf dt:CD.originalText" }] }, { "id" : "ClaimResponse.form", "path" : "ClaimResponse.form", "short" : "Printed reference or actual form", "definition" : "The actual form, by reference or inclusion, for printing the content or an EOB.", "comment" : "Needed to permit insurers to include the actual form.", "requirements" : "Needed to include the specific form used for producing output for this response.", "min" : 0, "max" : "1", "base" : { "path" : "ClaimResponse.form", "min" : 0, "max" : "1" }, "type" : [{ "code" : "Attachment" }], "constraint" : [{ "key" : "ele-1", "severity" : "error", "human" : "All FHIR elements must have a @value or children", "expression" : "hasValue() or (children().count() > id.count())", "source" : "http://hl7.org/fhir/StructureDefinition/Element|5.0.0" }], "mustSupport" : false, "isModifier" : false, "isSummary" : false }, { "id" : "ClaimResponse.processNote", "path" : "ClaimResponse.processNote", "short" : "Note concerning adjudication", "definition" : "A note that describes or explains adjudication results in a human readable form.", "requirements" : "Provides the insurer specific textual explanations associated with the processing.", "min" : 0, "max" : "*", "base" : { "path" : "ClaimResponse.processNote", "min" : 0, "max" : "*" }, "type" : [{ "code" : "BackboneElement" }], "constraint" : [{ "key" : "ele-1", "severity" : "error", "human" : "All FHIR elements must have a @value or children", "expression" : "hasValue() or (children().count() > id.count())", "source" : "http://hl7.org/fhir/StructureDefinition/Element|5.0.0" }], "mustSupport" : false, "isModifier" : false, "isSummary" : false }, { "id" : "ClaimResponse.processNote.id", "path" : "ClaimResponse.processNote.id", "representation" : ["xmlAttr"], "short" : "Unique id for inter-element referencing", "definition" : "Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.", "min" : 0, "max" : "1", "base" : { "path" : "Element.id", "min" : 0, "max" : "1" }, "type" : [{ "extension" : [{ "url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type", "valueUrl" : "string" }], "code" : "http://hl7.org/fhirpath/System.String" }], "condition" : ["ele-1"], "isModifier" : false, "isSummary" : false, "mapping" : [{ "identity" : "rim", "map" : "n/a" }] }, { "id" : "ClaimResponse.processNote.extension", "path" : "ClaimResponse.processNote.extension", "short" : "Additional content defined by implementations", "definition" : "May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and managable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.", "comment" : "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.", "alias" : ["extensions", "user content"], "min" : 0, "max" : "*", "base" : { "path" : "Element.extension", "min" : 0, "max" : "*" }, "type" : [{ "code" : "Extension" }], "constraint" : [{ "key" : "ele-1", "severity" : "error", "human" : "All FHIR elements must have a @value or children", "expression" : "hasValue() or (children().count() > id.count())", "source" : "http://hl7.org/fhir/StructureDefinition/Element|5.0.0" }, { "key" : "ext-1", "severity" : "error", "human" : "Must have either extensions or value[x], not both", "expression" : "extension.exists() != value.exists()", "source" : "http://hl7.org/fhir/StructureDefinition/Extension|5.0.0" }], "isModifier" : false, "isSummary" : false, "mapping" : [{ "identity" : "rim", "map" : "n/a" }] }, { "id" : "ClaimResponse.processNote.modifierExtension", "path" : "ClaimResponse.processNote.modifierExtension", "short" : "Extensions that cannot be ignored even if unrecognized", "definition" : "May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and managable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.\n\nModifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).", "comment" : "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.", "requirements" : "Modifier extensions allow for extensions that *cannot* be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the [definition of modifier extensions](http://hl7.org/fhir/R5/extensibility.html#modifierExtension).", "alias" : ["extensions", "user content", "modifiers"], "min" : 0, "max" : "*", "base" : { "path" : "BackboneElement.modifierExtension", "min" : 0, "max" : "*" }, "type" : [{ "code" : "Extension" }], "constraint" : [{ "key" : "ele-1", "severity" : "error", "human" : "All FHIR elements must have a @value or children", "expression" : "hasValue() or (children().count() > id.count())", "source" : "http://hl7.org/fhir/StructureDefinition/Element|5.0.0" }, { "key" : "ext-1", "severity" : "error", "human" : "Must have either extensions or value[x], not both", "expression" : "extension.exists() != value.exists()", "source" : "http://hl7.org/fhir/StructureDefinition/Extension|5.0.0" }], "isModifier" : true, "isModifierReason" : "Modifier extensions are expected to modify the meaning or interpretation of the element that contains them", "isSummary" : true, "mapping" : [{ "identity" : "rim", "map" : "N/A" }] }, { "id" : "ClaimResponse.processNote.number", "path" : "ClaimResponse.processNote.number", "short" : "Note instance identifier", "definition" : "A number to uniquely identify a note entry.", "requirements" : "Necessary to provide a mechanism to link from adjudications.", "min" : 0, "max" : "1", "base" : { "path" : "ClaimResponse.processNote.number", "min" : 0, "max" : "1" }, "type" : [{ "code" : "positiveInt" }], "constraint" : [{ "key" : "ele-1", "severity" : "error", "human" : "All FHIR elements must have a @value or children", "expression" : "hasValue() or (children().count() > id.count())", "source" : "http://hl7.org/fhir/StructureDefinition/Element|5.0.0" }], "mustSupport" : false, "isModifier" : false, "isSummary" : false }, { "id" : "ClaimResponse.processNote.type", "path" : "ClaimResponse.processNote.type", "short" : "Note purpose", "definition" : "The business purpose of the note text.", "requirements" : "To convey the expectation for when the text is used.", "min" : 0, "max" : "1", "base" : { "path" : "ClaimResponse.processNote.type", "min" : 0, "max" : "1" }, "type" : [{ "code" : "CodeableConcept" }], "constraint" : [{ "key" : "ele-1", "severity" : "error", "human" : "All FHIR elements must have a @value or children", "expression" : "hasValue() or (children().count() > id.count())", "source" : "http://hl7.org/fhir/StructureDefinition/Element|5.0.0" }], "mustSupport" : false, "isModifier" : false, "isSummary" : false, "binding" : { "extension" : [{ "url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString" : "NoteType" }], "strength" : "extensible", "description" : "The presentation types of notes.", "valueSet" : "http://hl7.org/fhir/ValueSet/note-type|5.0.0" } }, { "id" : "ClaimResponse.processNote.type.id", "path" : "ClaimResponse.processNote.type.id", "representation" : ["xmlAttr"], "short" : "Unique id for inter-element referencing", "definition" : "Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.", "min" : 0, "max" : "1", "base" : { "path" : "Element.id", "min" : 0, "max" : "1" }, "type" : [{ "extension" : [{ "url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type", "valueUrl" : "id" }], "code" : "http://hl7.org/fhirpath/System.String" }], "condition" : ["ele-1"], "isModifier" : false, "isSummary" : false, "mapping" : [{ "identity" : "rim", "map" : "n/a" }] }, { "id" : "ClaimResponse.processNote.type.extension", "path" : "ClaimResponse.processNote.type.extension", "slicing" : { "discriminator" : [{ "type" : "value", "path" : "url" }], "description" : "Extensions are always sliced by (at least) url", "ordered" : false, "rules" : "open" }, "short" : "Extension", "definition" : "An Extension", "min" : 0, "max" : "*", "base" : { "path" : "Element.extension", "min" : 0, "max" : "*" }, "type" : [{ "code" : "Extension" }], "constraint" : [{ "key" : "ele-1", "severity" : "error", "human" : "All FHIR elements must have a @value or children", "expression" : "hasValue() or (children().count() > id.count())", "source" : "http://hl7.org/fhir/StructureDefinition/Element|5.0.0" }, { "key" : "ext-1", "severity" : "error", "human" : "Must have either extensions or value[x], not both", "expression" : "extension.exists() != value.exists()", "source" : "http://hl7.org/fhir/StructureDefinition/Extension|5.0.0" }], "isModifier" : false, "isSummary" : false }, { "id" : "ClaimResponse.processNote.type.extension:type", "path" : "ClaimResponse.processNote.type.extension", "sliceName" : "type", "short" : "DSTU2: display | print | printoper", "definition" : "DSTU2: `ClaimResponse.note.type`", "comment" : "Element `ClaimResponse.note.type` is mapped to FHIR R5 element `ClaimResponse.processNote.type` as `RelatedTo`.", "min" : 0, "max" : "1", "base" : { "path" : "Element.extension", "min" : 0, "max" : "*" }, "type" : [{ "code" : "Extension", "profile" : ["http://hl7.org/fhir/1.0/StructureDefinition/extension-ClaimResponse.note.type|0.1.0"] }], "constraint" : [{ "key" : "ele-1", "severity" : "error", "human" : "All FHIR elements must have a @value or children", "expression" : "hasValue() or (children().count() > id.count())", "source" : "http://hl7.org/fhir/StructureDefinition/Element|5.0.0" }, { "key" : "ext-1", "severity" : "error", "human" : "Must have either extensions or value[x], not both", "expression" : "extension.exists() != value.exists()", "source" : "http://hl7.org/fhir/StructureDefinition/Extension|5.0.0" }], "isModifier" : false, "isSummary" : false }, { "id" : "ClaimResponse.processNote.type.coding", "path" : "ClaimResponse.processNote.type.coding", "short" : "Code defined by a terminology system", "definition" : "A reference to a code defined by a terminology system.", "comment" : "Codes may be defined very casually in enumerations, or code lists, up to very formal definitions such as SNOMED CT - see the HL7 v3 Core Principles for more information. Ordering of codings is undefined and SHALL NOT be used to infer meaning. Generally, at most only one of the coding values will be labeled as UserSelected = true.", "requirements" : "Allows for alternative encodings within a code system, and translations to other code systems.", "min" : 0, "max" : "*", "base" : { "path" : "CodeableConcept.coding", "min" : 0, "max" : "*" }, "type" : [{ "code" : "Coding" }], "constraint" : [{ "key" : "ele-1", "severity" : "error", "human" : "All FHIR elements must have a @value or children", "expression" : "hasValue() or (children().count() > id.count())", "source" : "http://hl7.org/fhir/StructureDefinition/Element|5.0.0" }], "isModifier" : false, "isSummary" : true, "mapping" : [{ "identity" : "v2", "map" : "C*E.1-8, C*E.10-22" }, { "identity" : "rim", "map" : "union(., ./translation)" }, { "identity" : "orim", "map" : "fhir:CodeableConcept.coding rdfs:subPropertyOf dt:CD.coding" }] }, { "id" : "ClaimResponse.processNote.type.text", "extension" : [{ "url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-translatable", "valueBoolean" : true }, { "url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-translatable", "valueBoolean" : true }], "path" : "ClaimResponse.processNote.type.text", "short" : "Plain text representation of the concept", "definition" : "A human language representation of the concept as seen/selected/uttered by the user who entered the data and/or which represents the intended meaning of the user.", "comment" : "Very often the text is the same as a displayName of one of the codings.", "requirements" : "The codes from the terminologies do not always capture the correct meaning with all the nuances of the human using them, or sometimes there is no appropriate code at all. In these cases, the text is used to capture the full meaning of the source.", "min" : 0, "max" : "1", "base" : { "path" : "CodeableConcept.text", "min" : 0, "max" : "1" }, "type" : [{ "code" : "string" }], "constraint" : [{ "key" : "ele-1", "severity" : "error", "human" : "All FHIR elements must have a @value or children", "expression" : "hasValue() or (children().count() > id.count())", "source" : "http://hl7.org/fhir/StructureDefinition/Element|5.0.0" }], "isModifier" : false, "isSummary" : true, "mapping" : [{ "identity" : "v2", "map" : "C*E.9. But note many systems use C*E.2 for this" }, { "identity" : "rim", "map" : "./originalText[mediaType/code=\"text/plain\"]/data" }, { "identity" : "orim", "map" : "fhir:CodeableConcept.text rdfs:subPropertyOf dt:CD.originalText" }] }, { "id" : "ClaimResponse.processNote.text", "path" : "ClaimResponse.processNote.text", "short" : "Note explanatory text", "definition" : "The explanation or description associated with the processing.", "requirements" : "Required to provide human readable explanation.", "min" : 1, "max" : "1", "base" : { "path" : "ClaimResponse.processNote.text", "min" : 1, "max" : "1" }, "type" : [{ "code" : "string" }], "constraint" : [{ "key" : "ele-1", "severity" : "error", "human" : "All FHIR elements must have a @value or children", "expression" : "hasValue() or (children().count() > id.count())", "source" : "http://hl7.org/fhir/StructureDefinition/Element|5.0.0" }], "mustSupport" : false, "isModifier" : false, "isSummary" : false }, { "id" : "ClaimResponse.processNote.language", "path" : "ClaimResponse.processNote.language", "short" : "Language of the text", "definition" : "A code to define the language used in the text of the note.", "comment" : "Only required if the language is different from the resource language.", "requirements" : "Note text may vary from the resource defined language.", "min" : 0, "max" : "1", "base" : { "path" : "ClaimResponse.processNote.language", "min" : 0, "max" : "1" }, "type" : [{ "code" : "CodeableConcept" }], "constraint" : [{ "key" : "ele-1", "severity" : "error", "human" : "All FHIR elements must have a @value or children", "expression" : "hasValue() or (children().count() > id.count())", "source" : "http://hl7.org/fhir/StructureDefinition/Element|5.0.0" }], "mustSupport" : false, "isModifier" : false, "isSummary" : false, "binding" : { "extension" : [{ "url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString" : "Language" }], "strength" : "required", "description" : "IETF language tag for a human language", "valueSet" : "http://hl7.org/fhir/ValueSet/all-languages|5.0.0", "additional" : [{ "purpose" : "starter", "valueSet" : "http://hl7.org/fhir/ValueSet/languages|5.0.0" }] } }, { "id" : "ClaimResponse.communicationRequest", "path" : "ClaimResponse.communicationRequest", "short" : "Request for additional information", "definition" : "Request for additional supporting or authorizing information.", "comment" : "For example: professional reports, documents, images, clinical resources, or accident reports.", "requirements" : "Need to communicate insurer request for additional information required to support the adjudication.", "min" : 0, "max" : "*", "base" : { "path" : "ClaimResponse.communicationRequest", "min" : 0, "max" : "*" }, "type" : [{ "code" : "Reference", "targetProfile" : ["http://hl7.org/fhir/StructureDefinition/CommunicationRequest|5.0.0"] }], "constraint" : [{ "key" : "ele-1", "severity" : "error", "human" : "All FHIR elements must have a @value or children", "expression" : "hasValue() or (children().count() > id.count())", "source" : "http://hl7.org/fhir/StructureDefinition/Element|5.0.0" }], "mustSupport" : false, "isModifier" : false, "isSummary" : false }, { "id" : "ClaimResponse.insurance", "path" : "ClaimResponse.insurance", "short" : "Patient insurance information", "definition" : "Financial instruments for reimbursement for the health care products and services specified on the claim.", "comment" : "All insurance coverages for the patient which may be applicable for reimbursement, of the products and services listed in the claim, are typically provided in the claim to allow insurers to confirm the ordering of the insurance coverages relative to local 'coordination of benefit' rules. One coverage (and only one) with 'focal=true' is to be used in the adjudication of this claim. Coverages appearing before the focal Coverage in the list, and where 'subrogation=false', should provide a reference to the ClaimResponse containing the adjudication results of the prior claim.", "requirements" : "At least one insurer is required for a claim to be a claim.", "min" : 0, "max" : "*", "base" : { "path" : "ClaimResponse.insurance", "min" : 0, "max" : "*" }, "type" : [{ "code" : "BackboneElement" }], "constraint" : [{ "key" : "ele-1", "severity" : "error", "human" : "All FHIR elements must have a @value or children", "expression" : "hasValue() or (children().count() > id.count())", "source" : "http://hl7.org/fhir/StructureDefinition/Element|5.0.0" }], "mustSupport" : false, "isModifier" : false, "isSummary" : false, "mapping" : [{ "identity" : "rim", "map" : "Coverage" }] }, { "id" : "ClaimResponse.insurance.id", "path" : "ClaimResponse.insurance.id", "representation" : ["xmlAttr"], "short" : "Unique id for inter-element referencing", "definition" : "Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.", "min" : 0, "max" : "1", "base" : { "path" : "Element.id", "min" : 0, "max" : "1" }, "type" : [{ "extension" : [{ "url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type", "valueUrl" : "string" }], "code" : "http://hl7.org/fhirpath/System.String" }], "condition" : ["ele-1"], "isModifier" : false, "isSummary" : false, "mapping" : [{ "identity" : "rim", "map" : "n/a" }] }, { "id" : "ClaimResponse.insurance.extension", "path" : "ClaimResponse.insurance.extension", "slicing" : { "discriminator" : [{ "type" : "value", "path" : "url" }], "ordered" : false, "rules" : "open" }, "short" : "Extension", "definition" : "An Extension", "min" : 1, "max" : "*", "base" : { "path" : "Element.extension", "min" : 0, "max" : "*" }, "type" : [{ "code" : "Extension" }], "constraint" : [{ "key" : "ele-1", "severity" : "error", "human" : "All FHIR elements must have a @value or children", "expression" : "hasValue() or (children().count() > id.count())", "source" : "http://hl7.org/fhir/StructureDefinition/Element|5.0.0" }, { "key" : "ext-1", "severity" : "error", "human" : "Must have either extensions or value[x], not both", "expression" : "extension.exists() != value.exists()", "source" : "http://hl7.org/fhir/StructureDefinition/Extension|5.0.0" }], "isModifier" : false, "isSummary" : false }, { "id" : "ClaimResponse.insurance.extension:relationship", "path" : "ClaimResponse.insurance.extension", "sliceName" : "relationship", "short" : "DSTU2: Patient relationship to subscriber (new)", "definition" : "DSTU2: `ClaimResponse.coverage.relationship` (new:Coding)", "comment" : "Element `ClaimResponse.coverage.relationship` has a context of ClaimResponse.insurance based on following the parent source element upwards and mapping to `ClaimResponse`.\nElement `ClaimResponse.coverage.relationship` has no mapping targets in FHIR R5. Typically, this is because the element has been added (is a new element).", "min" : 1, "max" : "1", "base" : { "path" : "Element.extension", "min" : 0, "max" : "*" }, "type" : [{ "code" : "Extension", "profile" : ["http://hl7.org/fhir/1.0/StructureDefinition/extension-ClaimResponse.coverage.relationship|0.1.0"] }], "constraint" : [{ "key" : "ele-1", "severity" : "error", "human" : "All FHIR elements must have a @value or children", "expression" : "hasValue() or (children().count() > id.count())", "source" : "http://hl7.org/fhir/StructureDefinition/Element|5.0.0" }, { "key" : "ext-1", "severity" : "error", "human" : "Must have either extensions or value[x], not both", "expression" : "extension.exists() != value.exists()", "source" : "http://hl7.org/fhir/StructureDefinition/Extension|5.0.0" }], "isModifier" : false, "isSummary" : false }, { "id" : "ClaimResponse.insurance.extension:preAuthRef", "path" : "ClaimResponse.insurance.extension", "sliceName" : "preAuthRef", "short" : "DSTU2: Pre-Authorization/Determination Reference (new)", "definition" : "DSTU2: `ClaimResponse.coverage.preAuthRef` (new:string)", "comment" : "Element `ClaimResponse.coverage.preAuthRef` has a context of ClaimResponse.insurance based on following the parent source element upwards and mapping to `ClaimResponse`.\nElement `ClaimResponse.coverage.preAuthRef` has no mapping targets in FHIR R5. Typically, this is because the element has been added (is a new element).", "min" : 0, "max" : "*", "base" : { "path" : "Element.extension", "min" : 0, "max" : "*" }, "type" : [{ "code" : "Extension", "profile" : ["http://hl7.org/fhir/1.0/StructureDefinition/extension-ClaimResponse.coverage.preAuthRef|0.1.0"] }], "constraint" : [{ "key" : "ele-1", "severity" : "error", "human" : "All FHIR elements must have a @value or children", "expression" : "hasValue() or (children().count() > id.count())", "source" : "http://hl7.org/fhir/StructureDefinition/Element|5.0.0" }, { "key" : "ext-1", "severity" : "error", "human" : "Must have either extensions or value[x], not both", "expression" : "extension.exists() != value.exists()", "source" : "http://hl7.org/fhir/StructureDefinition/Extension|5.0.0" }], "isModifier" : false, "isSummary" : false }, { "id" : "ClaimResponse.insurance.extension:originalRuleset", "path" : "ClaimResponse.insurance.extension", "sliceName" : "originalRuleset", "short" : "DSTU2: Original version (new)", "definition" : "DSTU2: `ClaimResponse.coverage.originalRuleset` (new:Coding)", "comment" : "Element `ClaimResponse.coverage.originalRuleset` has a context of ClaimResponse.insurance based on following the parent source element upwards and mapping to `ClaimResponse`.\nElement `ClaimResponse.coverage.originalRuleset` has no mapping targets in FHIR R5. Typically, this is because the element has been added (is a new element).", "min" : 0, "max" : "1", "base" : { "path" : "Element.extension", "min" : 0, "max" : "*" }, "type" : [{ "code" : "Extension", "profile" : ["http://hl7.org/fhir/1.0/StructureDefinition/extension-ClaimResponse.coverage.originalRuleset|0.1.0"] }], "constraint" : [{ "key" : "ele-1", "severity" : "error", "human" : "All FHIR elements must have a @value or children", "expression" : "hasValue() or (children().count() > id.count())", "source" : "http://hl7.org/fhir/StructureDefinition/Element|5.0.0" }, { "key" : "ext-1", "severity" : "error", "human" : "Must have either extensions or value[x], not both", "expression" : "extension.exists() != value.exists()", "source" : "http://hl7.org/fhir/StructureDefinition/Extension|5.0.0" }], "isModifier" : false, "isSummary" : false }, { "id" : "ClaimResponse.insurance.modifierExtension", "path" : "ClaimResponse.insurance.modifierExtension", "short" : "Extensions that cannot be ignored even if unrecognized", "definition" : "May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and managable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.\n\nModifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).", "comment" : "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.", "requirements" : "Modifier extensions allow for extensions that *cannot* be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the [definition of modifier extensions](http://hl7.org/fhir/R5/extensibility.html#modifierExtension).", "alias" : ["extensions", "user content", "modifiers"], "min" : 0, "max" : "*", "base" : { "path" : "BackboneElement.modifierExtension", "min" : 0, "max" : "*" }, "type" : [{ "code" : "Extension" }], "constraint" : [{ "key" : "ele-1", "severity" : "error", "human" : "All FHIR elements must have a @value or children", "expression" : "hasValue() or (children().count() > id.count())", "source" : "http://hl7.org/fhir/StructureDefinition/Element|5.0.0" }, { "key" : "ext-1", "severity" : "error", "human" : "Must have either extensions or value[x], not both", "expression" : "extension.exists() != value.exists()", "source" : "http://hl7.org/fhir/StructureDefinition/Extension|5.0.0" }], "isModifier" : true, "isModifierReason" : "Modifier extensions are expected to modify the meaning or interpretation of the element that contains them", "isSummary" : true, "mapping" : [{ "identity" : "rim", "map" : "N/A" }] }, { "id" : "ClaimResponse.insurance.sequence", "path" : "ClaimResponse.insurance.sequence", "short" : "Insurance instance identifier", "definition" : "A number to uniquely identify insurance entries and provide a sequence of coverages to convey coordination of benefit order.", "requirements" : "To maintain order of the coverages.", "min" : 1, "max" : "1", "base" : { "path" : "ClaimResponse.insurance.sequence", "min" : 1, "max" : "1" }, "type" : [{ "code" : "positiveInt" }], "constraint" : [{ "key" : "ele-1", "severity" : "error", "human" : "All FHIR elements must have a @value or children", "expression" : "hasValue() or (children().count() > id.count())", "source" : "http://hl7.org/fhir/StructureDefinition/Element|5.0.0" }], "mustSupport" : false, "isModifier" : false, "isSummary" : false }, { "id" : "ClaimResponse.insurance.focal", "path" : "ClaimResponse.insurance.focal", "short" : "Coverage to be used for adjudication", "definition" : "A flag to indicate that this Coverage is to be used for adjudication of this claim when set to true.", "comment" : "A patient may (will) have multiple insurance policies which provide reimbursement for healthcare services and products. For example a person may also be covered by their spouse's policy and both appear in the list (and may be from the same insurer). This flag will be set to true for only one of the listed policies and that policy will be used for adjudicating this claim. Other claims would be created to request adjudication against the other listed policies.", "requirements" : "To identify which coverage in the list is being used to adjudicate this claim.", "min" : 1, "max" : "1", "base" : { "path" : "ClaimResponse.insurance.focal", "min" : 1, "max" : "1" }, "type" : [{ "code" : "boolean" }], "constraint" : [{ "key" : "ele-1", "severity" : "error", "human" : "All FHIR elements must have a @value or children", "expression" : "hasValue() or (children().count() > id.count())", "source" : "http://hl7.org/fhir/StructureDefinition/Element|5.0.0" }], "mustSupport" : false, "isModifier" : false, "isSummary" : false }, { "id" : "ClaimResponse.insurance.coverage", "path" : "ClaimResponse.insurance.coverage", "short" : "Insurance information", "definition" : "Reference to the insurance card level information contained in the Coverage resource. The coverage issuing insurer will use these details to locate the patient's actual coverage within the insurer's information system.", "requirements" : "Required to allow the adjudicator to locate the correct policy and history within their information system.", "min" : 1, "max" : "1", "base" : { "path" : "ClaimResponse.insurance.coverage", "min" : 1, "max" : "1" }, "type" : [{ "code" : "Reference", "targetProfile" : ["http://hl7.org/fhir/StructureDefinition/Coverage|5.0.0"] }], "constraint" : [{ "key" : "ele-1", "severity" : "error", "human" : "All FHIR elements must have a @value or children", "expression" : "hasValue() or (children().count() > id.count())", "source" : "http://hl7.org/fhir/StructureDefinition/Element|5.0.0" }], "mustSupport" : false, "isModifier" : false, "isSummary" : false }, { "id" : "ClaimResponse.insurance.coverage.id", "path" : "ClaimResponse.insurance.coverage.id", "representation" : ["xmlAttr"], "short" : "Unique id for inter-element referencing", "definition" : "Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.", "min" : 0, "max" : "1", "base" : { "path" : "Element.id", "min" : 0, "max" : "1" }, "type" : [{ "extension" : [{ "url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type", "valueUrl" : "id" }], "code" : "http://hl7.org/fhirpath/System.String" }], "condition" : ["ele-1"], "isModifier" : false, "isSummary" : false, "mapping" : [{ "identity" : "rim", "map" : "n/a" }] }, { "id" : "ClaimResponse.insurance.coverage.extension", "path" : "ClaimResponse.insurance.coverage.extension", "slicing" : { "discriminator" : [{ "type" : "value", "path" : "url" }], "description" : "Extensions are always sliced by (at least) url", "ordered" : false, "rules" : "open" }, "short" : "Extension", "definition" : "An Extension", "min" : 0, "max" : "*", "base" : { "path" : "Element.extension", "min" : 0, "max" : "*" }, "type" : [{ "code" : "Extension" }], "constraint" : [{ "key" : "ele-1", "severity" : "error", "human" : "All FHIR elements must have a @value or children", "expression" : "hasValue() or (children().count() > id.count())", "source" : "http://hl7.org/fhir/StructureDefinition/Element|5.0.0" }, { "key" : "ext-1", "severity" : "error", "human" : "Must have either extensions or value[x], not both", "expression" : "extension.exists() != value.exists()", "source" : "http://hl7.org/fhir/StructureDefinition/Extension|5.0.0" }], "isModifier" : false, "isSummary" : false }, { "id" : "ClaimResponse.insurance.coverage.extension:coverage", "path" : "ClaimResponse.insurance.coverage.extension", "sliceName" : "coverage", "short" : "DSTU2: coverage additional types", "definition" : "DSTU2: `ClaimResponse.coverage.coverage` additional types from child elements (display, reference)", "comment" : "Element `ClaimResponse.coverage.coverage` is mapped to FHIR R5 element `ClaimResponse.insurance.coverage` as `SourceIsBroaderThanTarget`.\nThe mappings for `ClaimResponse.coverage.coverage` do not cover the following types based on type expansion: display, reference.\nThe standard extension `alternate-reference` has been mapped as the representation of FHIR DSTU2 element `ClaimResponse.coverage.coverage` with unmapped reference targets: Coverage.", "min" : 0, "max" : "1", "base" : { "path" : "Element.extension", "min" : 0, "max" : "*" }, "type" : [{ "code" : "Extension", "profile" : ["http://hl7.org/fhir/StructureDefinition/alternate-reference|5.2.0"] }], "constraint" : [{ "key" : "ele-1", "severity" : "error", "human" : "All FHIR elements must have a @value or children", "expression" : "hasValue() or (children().count() > id.count())", "source" : "http://hl7.org/fhir/StructureDefinition/Element|5.0.0" }, { "key" : "ext-1", "severity" : "error", "human" : "Must have either extensions or value[x], not both", "expression" : "extension.exists() != value.exists()", "source" : "http://hl7.org/fhir/StructureDefinition/Extension|5.0.0" }], "isModifier" : false, "isSummary" : false }, { "id" : "ClaimResponse.insurance.coverage.reference", "path" : "ClaimResponse.insurance.coverage.reference", "short" : "Literal reference, Relative, internal or absolute URL", "definition" : "A reference to a location at which the other resource is found. The reference may be a relative reference, in which case it is relative to the service base URL, or an absolute URL that resolves to the location where the resource is found. The reference may be version specific or not. If the reference is not to a FHIR RESTful server, then it should be assumed to be version specific. Internal fragment references (start with '#') refer to contained resources.", "comment" : "Using absolute URLs provides a stable scalable approach suitable for a cloud/web context, while using relative/logical references provides a flexible approach suitable for use when trading across closed eco-system boundaries. Absolute URLs do not need to point to a FHIR RESTful server, though this is the preferred approach. If the URL conforms to the structure \"[type]/[id]\" then it should be assumed that the reference is to a FHIR RESTful server.", "min" : 0, "max" : "1", "base" : { "path" : "Reference.reference", "min" : 0, "max" : "1" }, "type" : [{ "code" : "string" }], "condition" : ["ref-2", "ref-1"], "constraint" : [{ "key" : "ele-1", "severity" : "error", "human" : "All FHIR elements must have a @value or children", "expression" : "hasValue() or (children().count() > id.count())", "source" : "http://hl7.org/fhir/StructureDefinition/Element|5.0.0" }], "isModifier" : false, "isSummary" : true, "mapping" : [{ "identity" : "rim", "map" : "N/A" }] }, { "id" : "ClaimResponse.insurance.coverage.type", "path" : "ClaimResponse.insurance.coverage.type", "short" : "Type the reference refers to (e.g. \"Patient\") - must be a resource in resources", "definition" : "The expected type of the target of the reference. If both Reference.type and Reference.reference are populated and Reference.reference is a FHIR URL, both SHALL be consistent.\n\nThe type is the Canonical URL of Resource Definition that is the type this reference refers to. References are URLs that are relative to http://hl7.org/fhir/StructureDefinition/ e.g. \"Patient\" is a reference to http://hl7.org/fhir/StructureDefinition/Patient. Absolute URLs are only allowed for logical models (and can only be used in references in logical models, not resources).", "comment" : "This element is used to indicate the type of the target of the reference. This may be used which ever of the other elements are populated (or not). In some cases, the type of the target may be determined by inspection of the reference (e.g. a known RESTful URL) or by resolving the target of the reference.", "min" : 0, "max" : "1", "base" : { "path" : "Reference.type", "min" : 0, "max" : "1" }, "type" : [{ "code" : "uri" }], "constraint" : [{ "key" : "ele-1", "severity" : "error", "human" : "All FHIR elements must have a @value or children", "expression" : "hasValue() or (children().count() > id.count())", "source" : "http://hl7.org/fhir/StructureDefinition/Element|5.0.0" }], "isModifier" : false, "isSummary" : true, "binding" : { "extension" : [{ "url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString" : "FHIRResourceTypeExt" }], "strength" : "extensible", "description" : "Aa resource (or, for logical models, the URI of the logical model).", "valueSet" : "http://hl7.org/fhir/ValueSet/resource-types|5.0.0" }, "mapping" : [{ "identity" : "rim", "map" : "N/A" }] }, { "id" : "ClaimResponse.insurance.coverage.identifier", "path" : "ClaimResponse.insurance.coverage.identifier", "short" : "Logical reference, when literal reference is not known", "definition" : "An identifier for the target resource. This is used when there is no way to reference the other resource directly, either because the entity it represents is not available through a FHIR server, or because there is no way for the author of the resource to convert a known identifier to an actual location. There is no requirement that a Reference.identifier point to something that is actually exposed as a FHIR instance, but it SHALL point to a business concept that would be expected to be exposed as a FHIR instance, and that instance would need to be of a FHIR resource type allowed by the reference.", "comment" : "When an identifier is provided in place of a reference, any system processing the reference will only be able to resolve the identifier to a reference if it understands the business context in which the identifier is used. Sometimes this is global (e.g. a national identifier) but often it is not. For this reason, none of the useful mechanisms described for working with references (e.g. chaining, includes) are possible, nor should servers be expected to be able resolve the reference. Servers may accept an identifier based reference untouched, resolve it, and/or reject it - see CapabilityStatement.rest.resource.referencePolicy. \n\nWhen both an identifier and a literal reference are provided, the literal reference is preferred. Applications processing the resource are allowed - but not required - to check that the identifier matches the literal reference\n\nApplications converting a logical reference to a literal reference may choose to leave the logical reference present, or remove it.\n\nReference is intended to point to a structure that can potentially be expressed as a FHIR resource, though there is no need for it to exist as an actual FHIR resource instance - except in as much as an application wishes to actual find the target of the reference. The content referred to be the identifier must meet the logical constraints implied by any limitations on what resource types are permitted for the reference. For example, it would not be legitimate to send the identifier for a drug prescription if the type were Reference(Observation|DiagnosticReport). One of the use-cases for Reference.identifier is the situation where no FHIR representation exists (where the type is Reference (Any).\n\nThis element only allows for a single identifier. In the case where additional identifers are required, use the [http://hl7.org/fhir/StructureDefinition/additionalIdentifier](http://hl7.org/fhir/extensions/StructureDefinition-additionalIdentifier.html) extension.", "min" : 0, "max" : "1", "base" : { "path" : "Reference.identifier", "min" : 0, "max" : "1" }, "type" : [{ "code" : "Identifier" }], "condition" : ["ref-2"], "constraint" : [{ "key" : "ele-1", "severity" : "error", "human" : "All FHIR elements must have a @value or children", "expression" : "hasValue() or (children().count() > id.count())", "source" : "http://hl7.org/fhir/StructureDefinition/Element|5.0.0" }], "isModifier" : false, "isSummary" : true, "mapping" : [{ "identity" : "rim", "map" : ".identifier" }] }, { "id" : "ClaimResponse.insurance.coverage.display", "extension" : [{ "url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-translatable", "valueBoolean" : true }, { "url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-translatable", "valueBoolean" : true }], "path" : "ClaimResponse.insurance.coverage.display", "short" : "Text alternative for the resource", "definition" : "Plain text narrative that identifies the resource in addition to the resource reference.", "comment" : "This is generally not the same as the Resource.text of the referenced resource. The purpose is to identify what's being referenced, not to fully describe it.", "min" : 0, "max" : "1", "base" : { "path" : "Reference.display", "min" : 0, "max" : "1" }, "type" : [{ "code" : "string" }], "condition" : ["ref-2"], "constraint" : [{ "key" : "ele-1", "severity" : "error", "human" : "All FHIR elements must have a @value or children", "expression" : "hasValue() or (children().count() > id.count())", "source" : "http://hl7.org/fhir/StructureDefinition/Element|5.0.0" }], "isModifier" : false, "isSummary" : true, "mapping" : [{ "identity" : "rim", "map" : "N/A" }] }, { "id" : "ClaimResponse.insurance.businessArrangement", "path" : "ClaimResponse.insurance.businessArrangement", "short" : "Additional provider contract number", "definition" : "A business agreement number established between the provider and the insurer for special business processing purposes.", "requirements" : "Providers may have multiple business arrangements with a given insurer and must supply the specific contract number for adjudication.", "min" : 0, "max" : "1", "base" : { "path" : "ClaimResponse.insurance.businessArrangement", "min" : 0, "max" : "1" }, "type" : [{ "code" : "string" }], "constraint" : [{ "key" : "ele-1", "severity" : "error", "human" : "All FHIR elements must have a @value or children", "expression" : "hasValue() or (children().count() > id.count())", "source" : "http://hl7.org/fhir/StructureDefinition/Element|5.0.0" }], "mustSupport" : false, "isModifier" : false, "isSummary" : false }, { "id" : "ClaimResponse.insurance.claimResponse", "path" : "ClaimResponse.insurance.claimResponse", "short" : "Adjudication results", "definition" : "The result of the adjudication of the line items for the Coverage specified in this insurance.", "comment" : "Must not be specified when 'focal=true' for this insurance.", "requirements" : "An insurer need the adjudication results from prior insurers to determine the outstanding balance remaining by item for the items in the curent claim.", "min" : 0, "max" : "1", "base" : { "path" : "ClaimResponse.insurance.claimResponse", "min" : 0, "max" : "1" }, "type" : [{ "extension" : [{ "url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-hierarchy", "valueBoolean" : false }], "code" : "Reference", "targetProfile" : ["http://hl7.org/fhir/StructureDefinition/ClaimResponse|5.0.0"] }], "constraint" : [{ "key" : "ele-1", "severity" : "error", "human" : "All FHIR elements must have a @value or children", "expression" : "hasValue() or (children().count() > id.count())", "source" : "http://hl7.org/fhir/StructureDefinition/Element|5.0.0" }], "mustSupport" : false, "isModifier" : false, "isSummary" : false }, { "id" : "ClaimResponse.insurance.claimResponse.id", "path" : "ClaimResponse.insurance.claimResponse.id", "representation" : ["xmlAttr"], "short" : "Unique id for inter-element referencing", "definition" : "Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.", "min" : 0, "max" : "1", "base" : { "path" : "Element.id", "min" : 0, "max" : "1" }, "type" : [{ "extension" : [{ "url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type", "valueUrl" : "id" }], "code" : "http://hl7.org/fhirpath/System.String" }], "condition" : ["ele-1"], "isModifier" : false, "isSummary" : false, "mapping" : [{ "identity" : "rim", "map" : "n/a" }] }, { "id" : "ClaimResponse.insurance.claimResponse.extension", "path" : "ClaimResponse.insurance.claimResponse.extension", "slicing" : { "discriminator" : [{ "type" : "value", "path" : "url" }], "description" : "Extensions are always sliced by (at least) url", "ordered" : false, "rules" : "open" }, "short" : "Extension", "definition" : "An Extension", "min" : 0, "max" : "*", "base" : { "path" : "Element.extension", "min" : 0, "max" : "*" }, "type" : [{ "code" : "Extension" }], "constraint" : [{ "key" : "ele-1", "severity" : "error", "human" : "All FHIR elements must have a @value or children", "expression" : "hasValue() or (children().count() > id.count())", "source" : "http://hl7.org/fhir/StructureDefinition/Element|5.0.0" }, { "key" : "ext-1", "severity" : "error", "human" : "Must have either extensions or value[x], not both", "expression" : "extension.exists() != value.exists()", "source" : "http://hl7.org/fhir/StructureDefinition/Extension|5.0.0" }], "isModifier" : false, "isSummary" : false }, { "id" : "ClaimResponse.insurance.claimResponse.extension:claimResponse", "path" : "ClaimResponse.insurance.claimResponse.extension", "sliceName" : "claimResponse", "short" : "DSTU2: claimResponse additional types", "definition" : "DSTU2: `ClaimResponse.coverage.claimResponse` additional types from child elements (display, reference)", "comment" : "Element `ClaimResponse.coverage.claimResponse` is mapped to FHIR R5 element `ClaimResponse.insurance.claimResponse` as `SourceIsBroaderThanTarget`.\nThe mappings for `ClaimResponse.coverage.claimResponse` do not cover the following types based on type expansion: display, reference.\nThe standard extension `alternate-reference` has been mapped as the representation of FHIR DSTU2 element `ClaimResponse.coverage.claimResponse` with unmapped reference targets: ClaimResponse.", "min" : 0, "max" : "1", "base" : { "path" : "Element.extension", "min" : 0, "max" : "*" }, "type" : [{ "code" : "Extension", "profile" : ["http://hl7.org/fhir/StructureDefinition/alternate-reference|5.2.0"] }], "constraint" : [{ "key" : "ele-1", "severity" : "error", "human" : "All FHIR elements must have a @value or children", "expression" : "hasValue() or (children().count() > id.count())", "source" : "http://hl7.org/fhir/StructureDefinition/Element|5.0.0" }, { "key" : "ext-1", "severity" : "error", "human" : "Must have either extensions or value[x], not both", "expression" : "extension.exists() != value.exists()", "source" : "http://hl7.org/fhir/StructureDefinition/Extension|5.0.0" }], "isModifier" : false, "isSummary" : false }, { "id" : "ClaimResponse.insurance.claimResponse.reference", "path" : "ClaimResponse.insurance.claimResponse.reference", "short" : "Literal reference, Relative, internal or absolute URL", "definition" : "A reference to a location at which the other resource is found. The reference may be a relative reference, in which case it is relative to the service base URL, or an absolute URL that resolves to the location where the resource is found. The reference may be version specific or not. If the reference is not to a FHIR RESTful server, then it should be assumed to be version specific. Internal fragment references (start with '#') refer to contained resources.", "comment" : "Using absolute URLs provides a stable scalable approach suitable for a cloud/web context, while using relative/logical references provides a flexible approach suitable for use when trading across closed eco-system boundaries. Absolute URLs do not need to point to a FHIR RESTful server, though this is the preferred approach. If the URL conforms to the structure \"[type]/[id]\" then it should be assumed that the reference is to a FHIR RESTful server.", "min" : 0, "max" : "1", "base" : { "path" : "Reference.reference", "min" : 0, "max" : "1" }, "type" : [{ "code" : "string" }], "condition" : ["ref-2", "ref-1"], "constraint" : [{ "key" : "ele-1", "severity" : "error", "human" : "All FHIR elements must have a @value or children", "expression" : "hasValue() or (children().count() > id.count())", "source" : "http://hl7.org/fhir/StructureDefinition/Element|5.0.0" }], "isModifier" : false, "isSummary" : true, "mapping" : [{ "identity" : "rim", "map" : "N/A" }] }, { "id" : "ClaimResponse.insurance.claimResponse.type", "path" : "ClaimResponse.insurance.claimResponse.type", "short" : "Type the reference refers to (e.g. \"Patient\") - must be a resource in resources", "definition" : "The expected type of the target of the reference. If both Reference.type and Reference.reference are populated and Reference.reference is a FHIR URL, both SHALL be consistent.\n\nThe type is the Canonical URL of Resource Definition that is the type this reference refers to. References are URLs that are relative to http://hl7.org/fhir/StructureDefinition/ e.g. \"Patient\" is a reference to http://hl7.org/fhir/StructureDefinition/Patient. Absolute URLs are only allowed for logical models (and can only be used in references in logical models, not resources).", "comment" : "This element is used to indicate the type of the target of the reference. This may be used which ever of the other elements are populated (or not). In some cases, the type of the target may be determined by inspection of the reference (e.g. a known RESTful URL) or by resolving the target of the reference.", "min" : 0, "max" : "1", "base" : { "path" : "Reference.type", "min" : 0, "max" : "1" }, "type" : [{ "code" : "uri" }], "constraint" : [{ "key" : "ele-1", "severity" : "error", "human" : "All FHIR elements must have a @value or children", "expression" : "hasValue() or (children().count() > id.count())", "source" : "http://hl7.org/fhir/StructureDefinition/Element|5.0.0" }], "isModifier" : false, "isSummary" : true, "binding" : { "extension" : [{ "url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString" : "FHIRResourceTypeExt" }], "strength" : "extensible", "description" : "Aa resource (or, for logical models, the URI of the logical model).", "valueSet" : "http://hl7.org/fhir/ValueSet/resource-types|5.0.0" }, "mapping" : [{ "identity" : "rim", "map" : "N/A" }] }, { "id" : "ClaimResponse.insurance.claimResponse.identifier", "path" : "ClaimResponse.insurance.claimResponse.identifier", "short" : "Logical reference, when literal reference is not known", "definition" : "An identifier for the target resource. This is used when there is no way to reference the other resource directly, either because the entity it represents is not available through a FHIR server, or because there is no way for the author of the resource to convert a known identifier to an actual location. There is no requirement that a Reference.identifier point to something that is actually exposed as a FHIR instance, but it SHALL point to a business concept that would be expected to be exposed as a FHIR instance, and that instance would need to be of a FHIR resource type allowed by the reference.", "comment" : "When an identifier is provided in place of a reference, any system processing the reference will only be able to resolve the identifier to a reference if it understands the business context in which the identifier is used. Sometimes this is global (e.g. a national identifier) but often it is not. For this reason, none of the useful mechanisms described for working with references (e.g. chaining, includes) are possible, nor should servers be expected to be able resolve the reference. Servers may accept an identifier based reference untouched, resolve it, and/or reject it - see CapabilityStatement.rest.resource.referencePolicy. \n\nWhen both an identifier and a literal reference are provided, the literal reference is preferred. Applications processing the resource are allowed - but not required - to check that the identifier matches the literal reference\n\nApplications converting a logical reference to a literal reference may choose to leave the logical reference present, or remove it.\n\nReference is intended to point to a structure that can potentially be expressed as a FHIR resource, though there is no need for it to exist as an actual FHIR resource instance - except in as much as an application wishes to actual find the target of the reference. The content referred to be the identifier must meet the logical constraints implied by any limitations on what resource types are permitted for the reference. For example, it would not be legitimate to send the identifier for a drug prescription if the type were Reference(Observation|DiagnosticReport). One of the use-cases for Reference.identifier is the situation where no FHIR representation exists (where the type is Reference (Any).\n\nThis element only allows for a single identifier. In the case where additional identifers are required, use the [http://hl7.org/fhir/StructureDefinition/additionalIdentifier](http://hl7.org/fhir/extensions/StructureDefinition-additionalIdentifier.html) extension.", "min" : 0, "max" : "1", "base" : { "path" : "Reference.identifier", "min" : 0, "max" : "1" }, "type" : [{ "code" : "Identifier" }], "condition" : ["ref-2"], "constraint" : [{ "key" : "ele-1", "severity" : "error", "human" : "All FHIR elements must have a @value or children", "expression" : "hasValue() or (children().count() > id.count())", "source" : "http://hl7.org/fhir/StructureDefinition/Element|5.0.0" }], "isModifier" : false, "isSummary" : true, "mapping" : [{ "identity" : "rim", "map" : ".identifier" }] }, { "id" : "ClaimResponse.insurance.claimResponse.display", "extension" : [{ "url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-translatable", "valueBoolean" : true }, { "url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-translatable", "valueBoolean" : true }], "path" : "ClaimResponse.insurance.claimResponse.display", "short" : "Text alternative for the resource", "definition" : "Plain text narrative that identifies the resource in addition to the resource reference.", "comment" : "This is generally not the same as the Resource.text of the referenced resource. The purpose is to identify what's being referenced, not to fully describe it.", "min" : 0, "max" : "1", "base" : { "path" : "Reference.display", "min" : 0, "max" : "1" }, "type" : [{ "code" : "string" }], "condition" : ["ref-2"], "constraint" : [{ "key" : "ele-1", "severity" : "error", "human" : "All FHIR elements must have a @value or children", "expression" : "hasValue() or (children().count() > id.count())", "source" : "http://hl7.org/fhir/StructureDefinition/Element|5.0.0" }], "isModifier" : false, "isSummary" : true, "mapping" : [{ "identity" : "rim", "map" : "N/A" }] }, { "id" : "ClaimResponse.error", "path" : "ClaimResponse.error", "short" : "Processing errors", "definition" : "Errors encountered during the processing of the adjudication.", "comment" : "If the request contains errors then an error element should be provided and no adjudication related sections (item, addItem, or payment) should be present.", "requirements" : "Need to communicate processing issues to the requestor.", "min" : 0, "max" : "*", "base" : { "path" : "ClaimResponse.error", "min" : 0, "max" : "*" }, "type" : [{ "code" : "BackboneElement" }], "constraint" : [{ "key" : "ele-1", "severity" : "error", "human" : "All FHIR elements must have a @value or children", "expression" : "hasValue() or (children().count() > id.count())", "source" : "http://hl7.org/fhir/StructureDefinition/Element|5.0.0" }], "mustSupport" : false, "isModifier" : false, "isSummary" : false }, { "id" : "ClaimResponse.error.id", "path" : "ClaimResponse.error.id", "representation" : ["xmlAttr"], "short" : "Unique id for inter-element referencing", "definition" : "Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.", "min" : 0, "max" : "1", "base" : { "path" : "Element.id", "min" : 0, "max" : "1" }, "type" : [{ "extension" : [{ "url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type", "valueUrl" : "string" }], "code" : "http://hl7.org/fhirpath/System.String" }], "condition" : ["ele-1"], "isModifier" : false, "isSummary" : false, "mapping" : [{ "identity" : "rim", "map" : "n/a" }] }, { "id" : "ClaimResponse.error.extension", "path" : "ClaimResponse.error.extension", "short" : "Additional content defined by implementations", "definition" : "May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and managable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.", "comment" : "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.", "alias" : ["extensions", "user content"], "min" : 0, "max" : "*", "base" : { "path" : "Element.extension", "min" : 0, "max" : "*" }, "type" : [{ "code" : "Extension" }], "constraint" : [{ "key" : "ele-1", "severity" : "error", "human" : "All FHIR elements must have a @value or children", "expression" : "hasValue() or (children().count() > id.count())", "source" : "http://hl7.org/fhir/StructureDefinition/Element|5.0.0" }, { "key" : "ext-1", "severity" : "error", "human" : "Must have either extensions or value[x], not both", "expression" : "extension.exists() != value.exists()", "source" : "http://hl7.org/fhir/StructureDefinition/Extension|5.0.0" }], "isModifier" : false, "isSummary" : false, "mapping" : [{ "identity" : "rim", "map" : "n/a" }] }, { "id" : "ClaimResponse.error.modifierExtension", "path" : "ClaimResponse.error.modifierExtension", "short" : "Extensions that cannot be ignored even if unrecognized", "definition" : "May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and managable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.\n\nModifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).", "comment" : "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.", "requirements" : "Modifier extensions allow for extensions that *cannot* be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the [definition of modifier extensions](http://hl7.org/fhir/R5/extensibility.html#modifierExtension).", "alias" : ["extensions", "user content", "modifiers"], "min" : 0, "max" : "*", "base" : { "path" : "BackboneElement.modifierExtension", "min" : 0, "max" : "*" }, "type" : [{ "code" : "Extension" }], "constraint" : [{ "key" : "ele-1", "severity" : "error", "human" : "All FHIR elements must have a @value or children", "expression" : "hasValue() or (children().count() > id.count())", "source" : "http://hl7.org/fhir/StructureDefinition/Element|5.0.0" }, { "key" : "ext-1", "severity" : "error", "human" : "Must have either extensions or value[x], not both", "expression" : "extension.exists() != value.exists()", "source" : "http://hl7.org/fhir/StructureDefinition/Extension|5.0.0" }], "isModifier" : true, "isModifierReason" : "Modifier extensions are expected to modify the meaning or interpretation of the element that contains them", "isSummary" : true, "mapping" : [{ "identity" : "rim", "map" : "N/A" }] }, { "id" : "ClaimResponse.error.itemSequence", "path" : "ClaimResponse.error.itemSequence", "short" : "Item sequence number", "definition" : "The sequence number of the line item submitted which contains the error. This value is omitted when the error occurs outside of the item structure.", "requirements" : "Provides references to the claim items.", "min" : 0, "max" : "1", "base" : { "path" : "ClaimResponse.error.itemSequence", "min" : 0, "max" : "1" }, "type" : [{ "code" : "positiveInt" }], "constraint" : [{ "key" : "ele-1", "severity" : "error", "human" : "All FHIR elements must have a @value or children", "expression" : "hasValue() or (children().count() > id.count())", "source" : "http://hl7.org/fhir/StructureDefinition/Element|5.0.0" }], "mustSupport" : false, "isModifier" : false, "isSummary" : false }, { "id" : "ClaimResponse.error.detailSequence", "path" : "ClaimResponse.error.detailSequence", "short" : "Detail sequence number", "definition" : "The sequence number of the detail within the line item submitted which contains the error. This value is omitted when the error occurs outside of the item structure.", "requirements" : "Provides references to the claim details within the claim item.", "min" : 0, "max" : "1", "base" : { "path" : "ClaimResponse.error.detailSequence", "min" : 0, "max" : "1" }, "type" : [{ "code" : "positiveInt" }], "constraint" : [{ "key" : "ele-1", "severity" : "error", "human" : "All FHIR elements must have a @value or children", "expression" : "hasValue() or (children().count() > id.count())", "source" : "http://hl7.org/fhir/StructureDefinition/Element|5.0.0" }], "mustSupport" : false, "isModifier" : false, "isSummary" : false }, { "id" : "ClaimResponse.error.subDetailSequence", "path" : "ClaimResponse.error.subDetailSequence", "short" : "Subdetail sequence number", "definition" : "The sequence number of the sub-detail within the detail within the line item submitted which contains the error. This value is omitted when the error occurs outside of the item structure.", "requirements" : "Provides references to the claim sub-details within the claim detail.", "min" : 0, "max" : "1", "base" : { "path" : "ClaimResponse.error.subDetailSequence", "min" : 0, "max" : "1" }, "type" : [{ "code" : "positiveInt" }], "constraint" : [{ "key" : "ele-1", "severity" : "error", "human" : "All FHIR elements must have a @value or children", "expression" : "hasValue() or (children().count() > id.count())", "source" : "http://hl7.org/fhir/StructureDefinition/Element|5.0.0" }], "mustSupport" : false, "isModifier" : false, "isSummary" : false }, { "id" : "ClaimResponse.error.code", "path" : "ClaimResponse.error.code", "short" : "Error code detailing processing issues", "definition" : "An error code, from a specified code system, which details why the claim could not be adjudicated.", "requirements" : "Required to convey processing errors.", "min" : 1, "max" : "1", "base" : { "path" : "ClaimResponse.error.code", "min" : 1, "max" : "1" }, "type" : [{ "code" : "CodeableConcept" }], "constraint" : [{ "key" : "ele-1", "severity" : "error", "human" : "All FHIR elements must have a @value or children", "expression" : "hasValue() or (children().count() > id.count())", "source" : "http://hl7.org/fhir/StructureDefinition/Element|5.0.0" }], "mustSupport" : false, "isModifier" : false, "isSummary" : true, "binding" : { "extension" : [{ "url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString" : "AdjudicationError" }], "strength" : "example", "description" : "The adjudication error codes.", "valueSet" : "http://hl7.org/fhir/ValueSet/adjudication-error|5.0.0" } }, { "id" : "ClaimResponse.error.code.id", "path" : "ClaimResponse.error.code.id", "representation" : ["xmlAttr"], "short" : "Unique id for inter-element referencing", "definition" : "Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.", "min" : 0, "max" : "1", "base" : { "path" : "Element.id", "min" : 0, "max" : "1" }, "type" : [{ "extension" : [{ "url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type", "valueUrl" : "id" }], "code" : "http://hl7.org/fhirpath/System.String" }], "condition" : ["ele-1"], "isModifier" : false, "isSummary" : false, "mapping" : [{ "identity" : "rim", "map" : "n/a" }] }, { "id" : "ClaimResponse.error.code.extension", "path" : "ClaimResponse.error.code.extension", "slicing" : { "discriminator" : [{ "type" : "value", "path" : "url" }], "description" : "Extensions are always sliced by (at least) url", "ordered" : false, "rules" : "open" }, "short" : "Extension", "definition" : "An Extension", "min" : 0, "max" : "*", "base" : { "path" : "Element.extension", "min" : 0, "max" : "*" }, "type" : [{ "code" : "Extension" }], "constraint" : [{ "key" : "ele-1", "severity" : "error", "human" : "All FHIR elements must have a @value or children", "expression" : "hasValue() or (children().count() > id.count())", "source" : "http://hl7.org/fhir/StructureDefinition/Element|5.0.0" }, { "key" : "ext-1", "severity" : "error", "human" : "Must have either extensions or value[x], not both", "expression" : "extension.exists() != value.exists()", "source" : "http://hl7.org/fhir/StructureDefinition/Extension|5.0.0" }], "isModifier" : false, "isSummary" : false }, { "id" : "ClaimResponse.error.code.extension:code", "path" : "ClaimResponse.error.code.extension", "sliceName" : "code", "short" : "DSTU2: code", "definition" : "DSTU2: `ClaimResponse.error.code`", "comment" : "Element `ClaimResponse.error.code` is mapped to FHIR R5 element `ClaimResponse.error.code` as `SourceIsNarrowerThanTarget`.", "min" : 1, "max" : "1", "base" : { "path" : "Element.extension", "min" : 0, "max" : "*" }, "type" : [{ "code" : "Extension", "profile" : ["http://hl7.org/fhir/1.0/StructureDefinition/extension-ClaimResponse.error.code|0.1.0"] }], "constraint" : [{ "key" : "ele-1", "severity" : "error", "human" : "All FHIR elements must have a @value or children", "expression" : "hasValue() or (children().count() > id.count())", "source" : "http://hl7.org/fhir/StructureDefinition/Element|5.0.0" }, { "key" : "ext-1", "severity" : "error", "human" : "Must have either extensions or value[x], not both", "expression" : "extension.exists() != value.exists()", "source" : "http://hl7.org/fhir/StructureDefinition/Extension|5.0.0" }], "isModifier" : false, "isSummary" : false }, { "id" : "ClaimResponse.error.code.coding", "path" : "ClaimResponse.error.code.coding", "short" : "Code defined by a terminology system", "definition" : "A reference to a code defined by a terminology system.", "comment" : "Codes may be defined very casually in enumerations, or code lists, up to very formal definitions such as SNOMED CT - see the HL7 v3 Core Principles for more information. Ordering of codings is undefined and SHALL NOT be used to infer meaning. Generally, at most only one of the coding values will be labeled as UserSelected = true.", "requirements" : "Allows for alternative encodings within a code system, and translations to other code systems.", "min" : 0, "max" : "*", "base" : { "path" : "CodeableConcept.coding", "min" : 0, "max" : "*" }, "type" : [{ "code" : "Coding" }], "constraint" : [{ "key" : "ele-1", "severity" : "error", "human" : "All FHIR elements must have a @value or children", "expression" : "hasValue() or (children().count() > id.count())", "source" : "http://hl7.org/fhir/StructureDefinition/Element|5.0.0" }], "isModifier" : false, "isSummary" : true, "mapping" : [{ "identity" : "v2", "map" : "C*E.1-8, C*E.10-22" }, { "identity" : "rim", "map" : "union(., ./translation)" }, { "identity" : "orim", "map" : "fhir:CodeableConcept.coding rdfs:subPropertyOf dt:CD.coding" }] }, { "id" : "ClaimResponse.error.code.text", "extension" : [{ "url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-translatable", "valueBoolean" : true }, { "url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-translatable", "valueBoolean" : true }], "path" : "ClaimResponse.error.code.text", "short" : "Plain text representation of the concept", "definition" : "A human language representation of the concept as seen/selected/uttered by the user who entered the data and/or which represents the intended meaning of the user.", "comment" : "Very often the text is the same as a displayName of one of the codings.", "requirements" : "The codes from the terminologies do not always capture the correct meaning with all the nuances of the human using them, or sometimes there is no appropriate code at all. In these cases, the text is used to capture the full meaning of the source.", "min" : 0, "max" : "1", "base" : { "path" : "CodeableConcept.text", "min" : 0, "max" : "1" }, "type" : [{ "code" : "string" }], "constraint" : [{ "key" : "ele-1", "severity" : "error", "human" : "All FHIR elements must have a @value or children", "expression" : "hasValue() or (children().count() > id.count())", "source" : "http://hl7.org/fhir/StructureDefinition/Element|5.0.0" }], "isModifier" : false, "isSummary" : true, "mapping" : [{ "identity" : "v2", "map" : "C*E.9. But note many systems use C*E.2 for this" }, { "identity" : "rim", "map" : "./originalText[mediaType/code=\"text/plain\"]/data" }, { "identity" : "orim", "map" : "fhir:CodeableConcept.text rdfs:subPropertyOf dt:CD.originalText" }] }, { "id" : "ClaimResponse.error.expression", "path" : "ClaimResponse.error.expression", "short" : "FHIRPath of element(s) related to issue", "definition" : "A [simple subset of FHIRPath](http://hl7.org/fhir/R5/fhirpath.html#simple) limited to element names, repetition indicators and the default child accessor that identifies one of the elements in the resource that caused this issue to be raised.", "comment" : "The root of the FHIRPath is the resource or bundle that generated OperationOutcome. Each FHIRPath SHALL resolve to a single node.", "requirements" : "Allows systems to highlight or otherwise guide users to elements implicated in issues to allow them to be fixed more easily.", "min" : 0, "max" : "*", "base" : { "path" : "ClaimResponse.error.expression", "min" : 0, "max" : "*" }, "type" : [{ "code" : "string" }], "constraint" : [{ "key" : "ele-1", "severity" : "error", "human" : "All FHIR elements must have a @value or children", "expression" : "hasValue() or (children().count() > id.count())", "source" : "http://hl7.org/fhir/StructureDefinition/Element|5.0.0" }], "mustSupport" : false, "isModifier" : false, "isSummary" : true }] }, "differential" : { "element" : [{ "id" : "ClaimResponse", "path" : "ClaimResponse" }, { "id" : "ClaimResponse.meta.extension", "path" : "ClaimResponse.meta.extension", "slicing" : { "discriminator" : [{ "type" : "value", "path" : "url" }], "ordered" : false, "rules" : "open" }, "min" : 0, "max" : "*" }, { "id" : "ClaimResponse.meta.extension:meta", "path" : "ClaimResponse.meta.extension", "sliceName" : "meta", "short" : "DSTU2: meta additional types", "definition" : "DSTU2: `ClaimResponse.meta` additional types (Meta) additional types from child elements (lastUpdated, profile, security, tag, versionId)", "comment" : "Element `ClaimResponse.meta` is mapped to FHIR R5 element `ClaimResponse.meta` as `SourceIsBroaderThanTarget`.\nThe mappings for `ClaimResponse.meta` do not cover the following types: Meta.\nThe mappings for `ClaimResponse.meta` do not cover the following types based on type expansion: lastUpdated, profile, security, tag, versionId.", "min" : 0, "max" : "1", "base" : { "path" : "DomainResource.extension", "min" : 0, "max" : "*" }, "type" : [{ "code" : "Extension", "profile" : ["http://hl7.org/fhir/1.0/StructureDefinition/extension-ClaimResponse.meta|0.1.0"] }] }, { "id" : "ClaimResponse.text.extension", "path" : "ClaimResponse.text.extension", "slicing" : { "discriminator" : [{ "type" : "value", "path" : "url" }], "ordered" : false, "rules" : "open" }, "min" : 0, "max" : "*" }, { "id" : "ClaimResponse.text.extension:text", "path" : "ClaimResponse.text.extension", "sliceName" : "text", "short" : "DSTU2: text additional types", "definition" : "DSTU2: `ClaimResponse.text` additional types (Narrative) additional types from child elements (div, status)", "comment" : "Element `ClaimResponse.text` is mapped to FHIR R5 element `ClaimResponse.text` as `SourceIsBroaderThanTarget`.\nThe mappings for `ClaimResponse.text` do not cover the following types: Narrative.\nThe mappings for `ClaimResponse.text` do not cover the following types based on type expansion: div, status.\nContained resources do not have narrative. Resources that are not contained SHOULD have a narrative.", "min" : 0, "max" : "1", "base" : { "path" : "DomainResource.extension", "min" : 0, "max" : "*" }, "type" : [{ "code" : "Extension", "profile" : ["http://hl7.org/fhir/1.0/StructureDefinition/extension-ClaimResponse.text|0.1.0"] }] }, { "id" : "ClaimResponse.extension", "path" : "ClaimResponse.extension", "slicing" : { "discriminator" : [{ "type" : "value", "path" : "url" }], "ordered" : false, "rules" : "open" }, "min" : 0, "max" : "*" }, { "id" : "ClaimResponse.extension:ruleset", "path" : "ClaimResponse.extension", "sliceName" : "ruleset", "short" : "DSTU2: Resource version (new)", "definition" : "DSTU2: `ClaimResponse.ruleset` (new:Coding)", "comment" : "Element `ClaimResponse.ruleset` has a context of ClaimResponse based on following the parent source element upwards and mapping to `ClaimResponse`.\nElement `ClaimResponse.ruleset` has no mapping targets in FHIR R5. Typically, this is because the element has been added (is a new element).", "min" : 0, "max" : "1", "base" : { "path" : "DomainResource.extension", "min" : 0, "max" : "*" }, "type" : [{ "code" : "Extension", "profile" : ["http://hl7.org/fhir/1.0/StructureDefinition/extension-ClaimResponse.ruleset|0.1.0"] }] }, { "id" : "ClaimResponse.extension:originalRuleset", "path" : "ClaimResponse.extension", "sliceName" : "originalRuleset", "short" : "DSTU2: Original version (new)", "definition" : "DSTU2: `ClaimResponse.originalRuleset` (new:Coding)", "comment" : "Element `ClaimResponse.originalRuleset` has a context of ClaimResponse based on following the parent source element upwards and mapping to `ClaimResponse`.\nElement `ClaimResponse.originalRuleset` has no mapping targets in FHIR R5. Typically, this is because the element has been added (is a new element).", "min" : 0, "max" : "1", "base" : { "path" : "DomainResource.extension", "min" : 0, "max" : "*" }, "type" : [{ "code" : "Extension", "profile" : ["http://hl7.org/fhir/1.0/StructureDefinition/extension-ClaimResponse.originalRuleset|0.1.0"] }] }, { "id" : "ClaimResponse.extension:unallocDeductable", "path" : "ClaimResponse.extension", "sliceName" : "unallocDeductable", "short" : "DSTU2: Unallocated deductible (new)", "definition" : "DSTU2: `ClaimResponse.unallocDeductable` (new:Quantity[Money])", "comment" : "Element `ClaimResponse.unallocDeductable` has a context of ClaimResponse based on following the parent source element upwards and mapping to `ClaimResponse`.\nElement `ClaimResponse.unallocDeductable` has no mapping targets in FHIR R5. Typically, this is because the element has been added (is a new element).", "min" : 0, "max" : "1", "base" : { "path" : "DomainResource.extension", "min" : 0, "max" : "*" }, "type" : [{ "code" : "Extension", "profile" : ["http://hl7.org/fhir/1.0/StructureDefinition/extension-ClaimResponse.unallocDeductable|0.1.0"] }] }, { "id" : "ClaimResponse.identifier.extension", "path" : "ClaimResponse.identifier.extension", "slicing" : { "discriminator" : [{ "type" : "value", "path" : "url" }], "ordered" : false, "rules" : "open" }, "min" : 0, "max" : "*" }, { "id" : "ClaimResponse.identifier.extension:identifier", "path" : "ClaimResponse.identifier.extension", "sliceName" : "identifier", "short" : "DSTU2: Response number additional types", "definition" : "DSTU2: `ClaimResponse.identifier` additional types (Identifier) additional types from child elements (assigner, period, system, type, use, value)", "comment" : "Element `ClaimResponse.identifier` is mapped to FHIR R5 element `ClaimResponse.identifier` as `SourceIsBroaderThanTarget`.\nThe mappings for `ClaimResponse.identifier` do not cover the following types: Identifier.\nThe mappings for `ClaimResponse.identifier` do not cover the following types based on type expansion: assigner, period, system, type, use, value.", "min" : 0, "max" : "*", "base" : { "path" : "DomainResource.extension", "min" : 0, "max" : "*" }, "type" : [{ "code" : "Extension", "profile" : ["http://hl7.org/fhir/1.0/StructureDefinition/extension-ClaimResponse.identifier|0.1.0"] }] }, { "id" : "ClaimResponse.insurer.extension", "path" : "ClaimResponse.insurer.extension", "slicing" : { "discriminator" : [{ "type" : "value", "path" : "url" }], "ordered" : false, "rules" : "open" }, "min" : 0, "max" : "*" }, { "id" : "ClaimResponse.insurer.extension:organization", "path" : "ClaimResponse.insurer.extension", "sliceName" : "organization", "short" : "DSTU2: Insurer additional types", "definition" : "DSTU2: `ClaimResponse.organization` additional types from child elements (display, reference)", "comment" : "Element `ClaimResponse.organization` is mapped to FHIR R5 element `ClaimResponse.insurer` as `SourceIsBroaderThanTarget`.\nThe mappings for `ClaimResponse.organization` do not cover the following types based on type expansion: display, reference.\nThe standard extension `alternate-reference` has been mapped as the representation of FHIR DSTU2 element `ClaimResponse.organization` with unmapped reference targets: Organization.", "min" : 0, "max" : "1", "base" : { "path" : "DomainResource.extension", "min" : 0, "max" : "*" }, "type" : [{ "code" : "Extension", "profile" : ["http://hl7.org/fhir/StructureDefinition/alternate-reference|5.2.0"] }] }, { "id" : "ClaimResponse.requestor.extension", "path" : "ClaimResponse.requestor.extension", "slicing" : { "discriminator" : [{ "type" : "value", "path" : "url" }], "ordered" : false, "rules" : "open" }, "min" : 0, "max" : "*" }, { "id" : "ClaimResponse.requestor.extension:requestProvider", "path" : "ClaimResponse.requestor.extension", "sliceName" : "requestProvider", "short" : "DSTU2: Responsible practitioner additional types", "definition" : "DSTU2: `ClaimResponse.requestProvider` additional types from child elements (display, reference)", "comment" : "Element `ClaimResponse.requestProvider` is mapped to FHIR R5 element `ClaimResponse.requestor` as `RelatedTo`.\nThe mappings for `ClaimResponse.requestProvider` do not cover the following types based on type expansion: display, reference.\nThe standard extension `alternate-reference` has been mapped as the representation of FHIR DSTU2 element `ClaimResponse.requestProvider` with unmapped reference targets: Practitioner.", "min" : 0, "max" : "1", "base" : { "path" : "DomainResource.extension", "min" : 0, "max" : "*" }, "type" : [{ "code" : "Extension", "profile" : ["http://hl7.org/fhir/StructureDefinition/alternate-reference|5.2.0"] }] }, { "id" : "ClaimResponse.requestor.extension:requestOrganization", "path" : "ClaimResponse.requestor.extension", "sliceName" : "requestOrganization", "short" : "DSTU2: Responsible organization additional types", "definition" : "DSTU2: `ClaimResponse.requestOrganization` additional types from child elements (display, reference)", "comment" : "Element `ClaimResponse.requestOrganization` is mapped to FHIR R5 element `ClaimResponse.requestor` as `SourceIsBroaderThanTarget`.\nThe mappings for `ClaimResponse.requestOrganization` do not cover the following types based on type expansion: display, reference.\nThe standard extension `alternate-reference` has been mapped as the representation of FHIR DSTU2 element `ClaimResponse.requestOrganization` with unmapped reference targets: Organization.", "min" : 0, "max" : "1", "base" : { "path" : "DomainResource.extension", "min" : 0, "max" : "*" }, "type" : [{ "code" : "Extension", "profile" : ["http://hl7.org/fhir/StructureDefinition/alternate-reference|5.2.0"] }] }, { "id" : "ClaimResponse.request.extension", "path" : "ClaimResponse.request.extension", "slicing" : { "discriminator" : [{ "type" : "value", "path" : "url" }], "ordered" : false, "rules" : "open" }, "min" : 0, "max" : "*" }, { "id" : "ClaimResponse.request.extension:request", "path" : "ClaimResponse.request.extension", "sliceName" : "request", "short" : "DSTU2: request additional types", "definition" : "DSTU2: `ClaimResponse.request` additional types from child elements (display, reference)", "comment" : "Element `ClaimResponse.request` is mapped to FHIR R5 element `ClaimResponse.request` as `SourceIsBroaderThanTarget`.\nThe mappings for `ClaimResponse.request` do not cover the following types based on type expansion: display, reference.\nThe standard extension `alternate-reference` has been mapped as the representation of FHIR DSTU2 element `ClaimResponse.request` with unmapped reference targets: Claim.", "min" : 0, "max" : "1", "base" : { "path" : "DomainResource.extension", "min" : 0, "max" : "*" }, "type" : [{ "code" : "Extension", "profile" : ["http://hl7.org/fhir/StructureDefinition/alternate-reference|5.2.0"] }] }, { "id" : "ClaimResponse.item.adjudication.quantity.extension", "path" : "ClaimResponse.item.adjudication.quantity.extension", "slicing" : { "discriminator" : [{ "type" : "value", "path" : "url" }], "ordered" : false, "rules" : "open" }, "min" : 0, "max" : "*" }, { "id" : "ClaimResponse.item.adjudication.quantity.extension:value", "path" : "ClaimResponse.item.adjudication.quantity.extension", "sliceName" : "value", "short" : "DSTU2: value additional types", "definition" : "DSTU2: `ClaimResponse.item.adjudication.value` additional types (decimal) additional types from child elements (value)", "comment" : "Element `ClaimResponse.item.adjudication.value` is mapped to FHIR R5 element `ClaimResponse.item.adjudication.quantity` as `SourceIsBroaderThanTarget`.\nThe mappings for `ClaimResponse.item.adjudication.value` do not cover the following types: decimal.\nThe mappings for `ClaimResponse.item.adjudication.value` do not cover the following types based on type expansion: value.", "min" : 0, "max" : "1", "base" : { "path" : "DomainResource.extension", "min" : 0, "max" : "*" }, "type" : [{ "code" : "Extension", "profile" : ["http://hl7.org/fhir/1.0/StructureDefinition/extension-ClaimResponse.item.adjudication.value|0.1.0"] }] }, { "id" : "ClaimResponse.item.detail.adjudication.extension", "path" : "ClaimResponse.item.detail.adjudication.extension", "slicing" : { "discriminator" : [{ "type" : "value", "path" : "url" }], "ordered" : false, "rules" : "open" }, "min" : 0, "max" : "*" }, { "id" : "ClaimResponse.item.detail.adjudication.extension:amount", "path" : "ClaimResponse.item.detail.adjudication.extension", "sliceName" : "amount", "short" : "DSTU2: Monetary amount (new)", "definition" : "DSTU2: `ClaimResponse.item.detail.adjudication.amount` (new:Quantity[Money])", "comment" : "Element `ClaimResponse.item.detail.adjudication.amount` has a context of ClaimResponse.item.detail.adjudication based on following the parent source element upwards and mapping to `ClaimResponse`.\nElement `ClaimResponse.item.detail.adjudication.amount` has no mapping targets in FHIR R5. Typically, this is because the element has been added (is a new element).", "min" : 0, "max" : "1", "base" : { "path" : "DomainResource.extension", "min" : 0, "max" : "*" }, "type" : [{ "code" : "Extension", "profile" : ["http://hl7.org/fhir/1.0/StructureDefinition/extension-ClaimResponse.item.detail.adjudication.amount|0.1.0"] }] }, { "id" : "ClaimResponse.item.detail.adjudication.extension:value", "path" : "ClaimResponse.item.detail.adjudication.extension", "sliceName" : "value", "short" : "DSTU2: Non-monetary value (new)", "definition" : "DSTU2: `ClaimResponse.item.detail.adjudication.value` (new:decimal)", "comment" : "Element `ClaimResponse.item.detail.adjudication.value` has a context of ClaimResponse.item.detail.adjudication based on following the parent source element upwards and mapping to `ClaimResponse`.\nElement `ClaimResponse.item.detail.adjudication.value` has no mapping targets in FHIR R5. Typically, this is because the element has been added (is a new element).", "min" : 0, "max" : "1", "base" : { "path" : "DomainResource.extension", "min" : 0, "max" : "*" }, "type" : [{ "code" : "Extension", "profile" : ["http://hl7.org/fhir/1.0/StructureDefinition/extension-ClaimResponse.item.detail.adjudication.value|0.1.0"] }] }, { "id" : "ClaimResponse.item.detail.subDetail.adjudication.extension", "path" : "ClaimResponse.item.detail.subDetail.adjudication.extension", "slicing" : { "discriminator" : [{ "type" : "value", "path" : "url" }], "ordered" : false, "rules" : "open" }, "min" : 0, "max" : "*" }, { "id" : "ClaimResponse.item.detail.subDetail.adjudication.extension:amount", "path" : "ClaimResponse.item.detail.subDetail.adjudication.extension", "sliceName" : "amount", "short" : "DSTU2: Monetary amount (new)", "definition" : "DSTU2: `ClaimResponse.item.detail.subDetail.adjudication.amount` (new:Quantity[Money])", "comment" : "Element `ClaimResponse.item.detail.subDetail.adjudication.amount` has a context of ClaimResponse.item.detail.subDetail.adjudication based on following the parent source element upwards and mapping to `ClaimResponse`.\nElement `ClaimResponse.item.detail.subDetail.adjudication.amount` has no mapping targets in FHIR R5. Typically, this is because the element has been added (is a new element).", "min" : 0, "max" : "1", "base" : { "path" : "DomainResource.extension", "min" : 0, "max" : "*" }, "type" : [{ "code" : "Extension", "profile" : ["http://hl7.org/fhir/1.0/StructureDefinition/extension-ClaimResponse.item.detail.subDetail.adjudication.amount|0.1.0"] }] }, { "id" : "ClaimResponse.item.detail.subDetail.adjudication.extension:value", "path" : "ClaimResponse.item.detail.subDetail.adjudication.extension", "sliceName" : "value", "short" : "DSTU2: Non-monetary value (new)", "definition" : "DSTU2: `ClaimResponse.item.detail.subDetail.adjudication.value` (new:decimal)", "comment" : "Element `ClaimResponse.item.detail.subDetail.adjudication.value` has a context of ClaimResponse.item.detail.subDetail.adjudication based on following the parent source element upwards and mapping to `ClaimResponse`.\nElement `ClaimResponse.item.detail.subDetail.adjudication.value` has no mapping targets in FHIR R5. Typically, this is because the element has been added (is a new element).", "min" : 0, "max" : "1", "base" : { "path" : "DomainResource.extension", "min" : 0, "max" : "*" }, "type" : [{ "code" : "Extension", "profile" : ["http://hl7.org/fhir/1.0/StructureDefinition/extension-ClaimResponse.item.detail.subDetail.adjudication.value|0.1.0"] }] }, { "id" : "ClaimResponse.addItem.extension", "path" : "ClaimResponse.addItem.extension", "slicing" : { "discriminator" : [{ "type" : "value", "path" : "url" }], "ordered" : false, "rules" : "open" }, "min" : 0, "max" : "*" }, { "id" : "ClaimResponse.addItem.extension:fee", "path" : "ClaimResponse.addItem.extension", "sliceName" : "fee", "short" : "DSTU2: Professional fee or Product charge (new)", "definition" : "DSTU2: `ClaimResponse.addItem.fee` (new:Quantity[Money])", "comment" : "Element `ClaimResponse.addItem.fee` has a context of ClaimResponse.addItem based on following the parent source element upwards and mapping to `ClaimResponse`.\nElement `ClaimResponse.addItem.fee` has no mapping targets in FHIR R5. Typically, this is because the element has been added (is a new element).", "min" : 0, "max" : "1", "base" : { "path" : "DomainResource.extension", "min" : 0, "max" : "*" }, "type" : [{ "code" : "Extension", "profile" : ["http://hl7.org/fhir/1.0/StructureDefinition/extension-ClaimResponse.addItem.fee|0.1.0"] }] }, { "id" : "ClaimResponse.addItem.adjudication.extension", "path" : "ClaimResponse.addItem.adjudication.extension", "slicing" : { "discriminator" : [{ "type" : "value", "path" : "url" }], "ordered" : false, "rules" : "open" }, "min" : 0, "max" : "*" }, { "id" : "ClaimResponse.addItem.adjudication.extension:amount", "path" : "ClaimResponse.addItem.adjudication.extension", "sliceName" : "amount", "short" : "DSTU2: Monetary amount (new)", "definition" : "DSTU2: `ClaimResponse.addItem.adjudication.amount` (new:Quantity[Money])", "comment" : "Element `ClaimResponse.addItem.adjudication.amount` has a context of ClaimResponse.addItem.adjudication based on following the parent source element upwards and mapping to `ClaimResponse`.\nElement `ClaimResponse.addItem.adjudication.amount` has no mapping targets in FHIR R5. Typically, this is because the element has been added (is a new element).", "min" : 0, "max" : "1", "base" : { "path" : "DomainResource.extension", "min" : 0, "max" : "*" }, "type" : [{ "code" : "Extension", "profile" : ["http://hl7.org/fhir/1.0/StructureDefinition/extension-ClaimResponse.addItem.adjudication.amount|0.1.0"] }] }, { "id" : "ClaimResponse.addItem.adjudication.extension:value", "path" : "ClaimResponse.addItem.adjudication.extension", "sliceName" : "value", "short" : "DSTU2: Non-monetary value (new)", "definition" : "DSTU2: `ClaimResponse.addItem.adjudication.value` (new:decimal)", "comment" : "Element `ClaimResponse.addItem.adjudication.value` has a context of ClaimResponse.addItem.adjudication based on following the parent source element upwards and mapping to `ClaimResponse`.\nElement `ClaimResponse.addItem.adjudication.value` has no mapping targets in FHIR R5. Typically, this is because the element has been added (is a new element).", "min" : 0, "max" : "1", "base" : { "path" : "DomainResource.extension", "min" : 0, "max" : "*" }, "type" : [{ "code" : "Extension", "profile" : ["http://hl7.org/fhir/1.0/StructureDefinition/extension-ClaimResponse.addItem.adjudication.value|0.1.0"] }] }, { "id" : "ClaimResponse.addItem.detail.extension", "path" : "ClaimResponse.addItem.detail.extension", "slicing" : { "discriminator" : [{ "type" : "value", "path" : "url" }], "ordered" : false, "rules" : "open" }, "min" : 0, "max" : "*" }, { "id" : "ClaimResponse.addItem.detail.extension:fee", "path" : "ClaimResponse.addItem.detail.extension", "sliceName" : "fee", "short" : "DSTU2: Professional fee or Product charge (new)", "definition" : "DSTU2: `ClaimResponse.addItem.detail.fee` (new:Quantity[Money])", "comment" : "Element `ClaimResponse.addItem.detail.fee` has a context of ClaimResponse.addItem.detail based on following the parent source element upwards and mapping to `ClaimResponse`.\nElement `ClaimResponse.addItem.detail.fee` has no mapping targets in FHIR R5. Typically, this is because the element has been added (is a new element).", "min" : 0, "max" : "1", "base" : { "path" : "DomainResource.extension", "min" : 0, "max" : "*" }, "type" : [{ "code" : "Extension", "profile" : ["http://hl7.org/fhir/1.0/StructureDefinition/extension-ClaimResponse.addItem.detail.fee|0.1.0"] }] }, { "id" : "ClaimResponse.addItem.detail.adjudication.extension", "path" : "ClaimResponse.addItem.detail.adjudication.extension", "slicing" : { "discriminator" : [{ "type" : "value", "path" : "url" }], "ordered" : false, "rules" : "open" }, "min" : 0, "max" : "*" }, { "id" : "ClaimResponse.addItem.detail.adjudication.extension:amount", "path" : "ClaimResponse.addItem.detail.adjudication.extension", "sliceName" : "amount", "short" : "DSTU2: Monetary amount (new)", "definition" : "DSTU2: `ClaimResponse.addItem.detail.adjudication.amount` (new:Quantity[Money])", "comment" : "Element `ClaimResponse.addItem.detail.adjudication.amount` has a context of ClaimResponse.addItem.detail.adjudication based on following the parent source element upwards and mapping to `ClaimResponse`.\nElement `ClaimResponse.addItem.detail.adjudication.amount` has no mapping targets in FHIR R5. Typically, this is because the element has been added (is a new element).", "min" : 0, "max" : "1", "base" : { "path" : "DomainResource.extension", "min" : 0, "max" : "*" }, "type" : [{ "code" : "Extension", "profile" : ["http://hl7.org/fhir/1.0/StructureDefinition/extension-ClaimResponse.addItem.detail.adjudication.amount|0.1.0"] }] }, { "id" : "ClaimResponse.addItem.detail.adjudication.extension:value", "path" : "ClaimResponse.addItem.detail.adjudication.extension", "sliceName" : "value", "short" : "DSTU2: Non-monetary value (new)", "definition" : "DSTU2: `ClaimResponse.addItem.detail.adjudication.value` (new:decimal)", "comment" : "Element `ClaimResponse.addItem.detail.adjudication.value` has a context of ClaimResponse.addItem.detail.adjudication based on following the parent source element upwards and mapping to `ClaimResponse`.\nElement `ClaimResponse.addItem.detail.adjudication.value` has no mapping targets in FHIR R5. Typically, this is because the element has been added (is a new element).", "min" : 0, "max" : "1", "base" : { "path" : "DomainResource.extension", "min" : 0, "max" : "*" }, "type" : [{ "code" : "Extension", "profile" : ["http://hl7.org/fhir/1.0/StructureDefinition/extension-ClaimResponse.addItem.detail.adjudication.value|0.1.0"] }] }, { "id" : "ClaimResponse.payment.identifier.extension", "path" : "ClaimResponse.payment.identifier.extension", "slicing" : { "discriminator" : [{ "type" : "value", "path" : "url" }], "ordered" : false, "rules" : "open" }, "min" : 0, "max" : "*" }, { "id" : "ClaimResponse.payment.identifier.extension:paymentRef", "path" : "ClaimResponse.payment.identifier.extension", "sliceName" : "paymentRef", "short" : "DSTU2: Payment identifier additional types", "definition" : "DSTU2: `ClaimResponse.paymentRef` additional types (Identifier) additional types from child elements (assigner, period, system, type, use, value)", "comment" : "Element `ClaimResponse.paymentRef` is mapped to FHIR R5 element `ClaimResponse.payment.identifier` as `SourceIsBroaderThanTarget`.\nThe mappings for `ClaimResponse.paymentRef` do not cover the following types: Identifier.\nThe mappings for `ClaimResponse.paymentRef` do not cover the following types based on type expansion: assigner, period, system, type, use, value.", "min" : 0, "max" : "1", "base" : { "path" : "DomainResource.extension", "min" : 0, "max" : "*" }, "type" : [{ "code" : "Extension", "profile" : ["http://hl7.org/fhir/1.0/StructureDefinition/extension-ClaimResponse.paymentRef|0.1.0"] }] }, { "id" : "ClaimResponse.formCode.extension", "path" : "ClaimResponse.formCode.extension", "slicing" : { "discriminator" : [{ "type" : "value", "path" : "url" }], "ordered" : false, "rules" : "open" }, "min" : 0, "max" : "*" }, { "id" : "ClaimResponse.formCode.extension:form", "path" : "ClaimResponse.formCode.extension", "sliceName" : "form", "short" : "DSTU2: Printed Form Identifier", "definition" : "DSTU2: `ClaimResponse.form`", "comment" : "Element `ClaimResponse.form` is mapped to FHIR R5 element `ClaimResponse.formCode` as `SourceIsNarrowerThanTarget`.", "min" : 0, "max" : "1", "base" : { "path" : "DomainResource.extension", "min" : 0, "max" : "*" }, "type" : [{ "code" : "Extension", "profile" : ["http://hl7.org/fhir/1.0/StructureDefinition/extension-ClaimResponse.form|0.1.0"] }] }, { "id" : "ClaimResponse.processNote.type.extension", "path" : "ClaimResponse.processNote.type.extension", "slicing" : { "discriminator" : [{ "type" : "value", "path" : "url" }], "ordered" : false, "rules" : "open" }, "min" : 0, "max" : "*" }, { "id" : "ClaimResponse.processNote.type.extension:type", "path" : "ClaimResponse.processNote.type.extension", "sliceName" : "type", "short" : "DSTU2: display | print | printoper", "definition" : "DSTU2: `ClaimResponse.note.type`", "comment" : "Element `ClaimResponse.note.type` is mapped to FHIR R5 element `ClaimResponse.processNote.type` as `RelatedTo`.", "min" : 0, "max" : "1", "base" : { "path" : "DomainResource.extension", "min" : 0, "max" : "*" }, "type" : [{ "code" : "Extension", "profile" : ["http://hl7.org/fhir/1.0/StructureDefinition/extension-ClaimResponse.note.type|0.1.0"] }] }, { "id" : "ClaimResponse.insurance.extension", "path" : "ClaimResponse.insurance.extension", "slicing" : { "discriminator" : [{ "type" : "value", "path" : "url" }], "ordered" : false, "rules" : "open" }, "min" : 1, "max" : "*" }, { "id" : "ClaimResponse.insurance.extension:relationship", "path" : "ClaimResponse.insurance.extension", "sliceName" : "relationship", "short" : "DSTU2: Patient relationship to subscriber (new)", "definition" : "DSTU2: `ClaimResponse.coverage.relationship` (new:Coding)", "comment" : "Element `ClaimResponse.coverage.relationship` has a context of ClaimResponse.insurance based on following the parent source element upwards and mapping to `ClaimResponse`.\nElement `ClaimResponse.coverage.relationship` has no mapping targets in FHIR R5. Typically, this is because the element has been added (is a new element).", "min" : 1, "max" : "1", "base" : { "path" : "DomainResource.extension", "min" : 0, "max" : "*" }, "type" : [{ "code" : "Extension", "profile" : ["http://hl7.org/fhir/1.0/StructureDefinition/extension-ClaimResponse.coverage.relationship|0.1.0"] }] }, { "id" : "ClaimResponse.insurance.extension:preAuthRef", "path" : "ClaimResponse.insurance.extension", "sliceName" : "preAuthRef", "short" : "DSTU2: Pre-Authorization/Determination Reference (new)", "definition" : "DSTU2: `ClaimResponse.coverage.preAuthRef` (new:string)", "comment" : "Element `ClaimResponse.coverage.preAuthRef` has a context of ClaimResponse.insurance based on following the parent source element upwards and mapping to `ClaimResponse`.\nElement `ClaimResponse.coverage.preAuthRef` has no mapping targets in FHIR R5. Typically, this is because the element has been added (is a new element).", "min" : 0, "max" : "*", "base" : { "path" : "DomainResource.extension", "min" : 0, "max" : "*" }, "type" : [{ "code" : "Extension", "profile" : ["http://hl7.org/fhir/1.0/StructureDefinition/extension-ClaimResponse.coverage.preAuthRef|0.1.0"] }] }, { "id" : "ClaimResponse.insurance.extension:originalRuleset", "path" : "ClaimResponse.insurance.extension", "sliceName" : "originalRuleset", "short" : "DSTU2: Original version (new)", "definition" : "DSTU2: `ClaimResponse.coverage.originalRuleset` (new:Coding)", "comment" : "Element `ClaimResponse.coverage.originalRuleset` has a context of ClaimResponse.insurance based on following the parent source element upwards and mapping to `ClaimResponse`.\nElement `ClaimResponse.coverage.originalRuleset` has no mapping targets in FHIR R5. Typically, this is because the element has been added (is a new element).", "min" : 0, "max" : "1", "base" : { "path" : "DomainResource.extension", "min" : 0, "max" : "*" }, "type" : [{ "code" : "Extension", "profile" : ["http://hl7.org/fhir/1.0/StructureDefinition/extension-ClaimResponse.coverage.originalRuleset|0.1.0"] }] }, { "id" : "ClaimResponse.insurance.coverage.extension", "path" : "ClaimResponse.insurance.coverage.extension", "slicing" : { "discriminator" : [{ "type" : "value", "path" : "url" }], "ordered" : false, "rules" : "open" }, "min" : 0, "max" : "*" }, { "id" : "ClaimResponse.insurance.coverage.extension:coverage", "path" : "ClaimResponse.insurance.coverage.extension", "sliceName" : "coverage", "short" : "DSTU2: coverage additional types", "definition" : "DSTU2: `ClaimResponse.coverage.coverage` additional types from child elements (display, reference)", "comment" : "Element `ClaimResponse.coverage.coverage` is mapped to FHIR R5 element `ClaimResponse.insurance.coverage` as `SourceIsBroaderThanTarget`.\nThe mappings for `ClaimResponse.coverage.coverage` do not cover the following types based on type expansion: display, reference.\nThe standard extension `alternate-reference` has been mapped as the representation of FHIR DSTU2 element `ClaimResponse.coverage.coverage` with unmapped reference targets: Coverage.", "min" : 0, "max" : "1", "base" : { "path" : "DomainResource.extension", "min" : 0, "max" : "*" }, "type" : [{ "code" : "Extension", "profile" : ["http://hl7.org/fhir/StructureDefinition/alternate-reference|5.2.0"] }] }, { "id" : "ClaimResponse.insurance.claimResponse.extension", "path" : "ClaimResponse.insurance.claimResponse.extension", "slicing" : { "discriminator" : [{ "type" : "value", "path" : "url" }], "ordered" : false, "rules" : "open" }, "min" : 0, "max" : "*" }, { "id" : "ClaimResponse.insurance.claimResponse.extension:claimResponse", "path" : "ClaimResponse.insurance.claimResponse.extension", "sliceName" : "claimResponse", "short" : "DSTU2: claimResponse additional types", "definition" : "DSTU2: `ClaimResponse.coverage.claimResponse` additional types from child elements (display, reference)", "comment" : "Element `ClaimResponse.coverage.claimResponse` is mapped to FHIR R5 element `ClaimResponse.insurance.claimResponse` as `SourceIsBroaderThanTarget`.\nThe mappings for `ClaimResponse.coverage.claimResponse` do not cover the following types based on type expansion: display, reference.\nThe standard extension `alternate-reference` has been mapped as the representation of FHIR DSTU2 element `ClaimResponse.coverage.claimResponse` with unmapped reference targets: ClaimResponse.", "min" : 0, "max" : "1", "base" : { "path" : "DomainResource.extension", "min" : 0, "max" : "*" }, "type" : [{ "code" : "Extension", "profile" : ["http://hl7.org/fhir/StructureDefinition/alternate-reference|5.2.0"] }] }, { "id" : "ClaimResponse.error.code.extension", "path" : "ClaimResponse.error.code.extension", "slicing" : { "discriminator" : [{ "type" : "value", "path" : "url" }], "ordered" : false, "rules" : "open" }, "min" : 0, "max" : "*" }, { "id" : "ClaimResponse.error.code.extension:code", "path" : "ClaimResponse.error.code.extension", "sliceName" : "code", "short" : "DSTU2: code", "definition" : "DSTU2: `ClaimResponse.error.code`", "comment" : "Element `ClaimResponse.error.code` is mapped to FHIR R5 element `ClaimResponse.error.code` as `SourceIsNarrowerThanTarget`.", "min" : 0, "max" : "1", "base" : { "path" : "DomainResource.extension", "min" : 0, "max" : "*" }, "type" : [{ "code" : "Extension", "profile" : ["http://hl7.org/fhir/1.0/StructureDefinition/extension-ClaimResponse.error.code|0.1.0"] }] }] } }