Extensions for Using Data Elements from FHIR STU3 in FHIR R4B - Downloaded Version null See the Directory of published versions

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Resource Profile: Profile_R3_ClaimResponse_R4B

This cross-version profile allows STU3 ClaimResponse content to be represented via FHIR R4B ClaimResponse resources.

Usages:

• This Profile is not used by any profiles in this Implementation Guide

You can also check for usages in the FHIR IG Statistics

Formal Views of Profile Content

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

• Key Elements Table
• Differential Table
• Snapshot Table
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Name	Flags	Card.	Type	Description & Constraints    Filter: Bindings Constraints Obligations
ClaimResponse		0..*	ClaimResponse(4.3.0)	Response to a claim predetermination or preauthorization
implicitRules	?!Σ	0..1	uri	A set of rules under which this content was created
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url Constraints: ext-1
extension:unallocDeductable		0..1	Money	STU3: Unallocated deductible (new) URL: http://hl7.org/fhir/3.0/StructureDefinition/extension-ClaimResponse.unallocDeductable Constraints: ext-1
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored Constraints: ext-1
status	?!Σ	1..1	code	active | cancelled | draft | entered-in-error Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance.
type	Σ	1..1	CodeableConcept	More granular claim type Binding: ClaimTypeCodes (extensible): The type or discipline-style of the claim.
use	Σ	1..1	code	claim | preauthorization | predetermination Binding: Use (required): Claim, preauthorization, predetermination.
patient	Σ	1..1	Reference(Patient)	The recipient of the products and services
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url Constraints: ext-1
extension:patient		0..1	Reference(Resource)	STU3: The subject of the Products and Services additional types URL: http://hl7.org/fhir/StructureDefinition/alternate-reference Constraints: ext-1
created	Σ	1..1	dateTime	Response creation date
insurer	Σ	1..1	Reference(Organization)	Party responsible for reimbursement
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url Constraints: ext-1
extension:insurer		0..1	Reference(Resource)	STU3: Insurance issuing organization additional types URL: http://hl7.org/fhir/StructureDefinition/alternate-reference Constraints: ext-1
outcome	Σ	1..1	code	queued | complete | error | partial Binding: RemittanceOutcome (required): The result of the claim processing.
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url Constraints: ext-1
extension:outcome		0..1	CodeableConcept	STU3: complete | error | partial additional types URL: http://hl7.org/fhir/3.0/StructureDefinition/extension-ClaimResponse.outcome Binding: RemittanceOutcome (example): The result of the claim processing Constraints: ext-1
Documentation for this format

Terminology Bindings

Path	Status	Usage	ValueSet	Version	Source
ClaimResponse.status	Base	required	Financial Resource Status Codes	📍4.3.0	FHIR Std.
ClaimResponse.type	Base	extensible	Claim Type Codes	📍4.3.0	FHIR Std.
ClaimResponse.use	Base	required	Use	📍4.3.0	FHIR Std.
ClaimResponse.outcome	Base	required	RemittanceOutcome	📍4.3.0	FHIR Std.

Constraints

Id	Grade	Path(s)	Description	Expression
dom-2	error	ClaimResponse	If the resource is contained in another resource, it SHALL NOT contain nested Resources	contained.contained.empty()
dom-3	error	ClaimResponse	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	contained.where(((id.exists() and ('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url)))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(uri) = '#').exists()).not()).trace('unmatched', id).empty()
dom-4	error	ClaimResponse	If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated	contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
dom-5	error	ClaimResponse	If a resource is contained in another resource, it SHALL NOT have a security label	contained.meta.security.empty()
dom-6	best practice	ClaimResponse	A resource should have narrative for robust management	text.`div`.exists()
ele-1	error	ClaimResponse.implicitRules, ClaimResponse.extension, ClaimResponse.extension:unallocDeductable, ClaimResponse.modifierExtension, ClaimResponse.status, ClaimResponse.type, ClaimResponse.use, ClaimResponse.patient, ClaimResponse.patient.extension, ClaimResponse.patient.extension:patient, ClaimResponse.created, ClaimResponse.insurer, ClaimResponse.insurer.extension, ClaimResponse.insurer.extension:insurer, ClaimResponse.outcome, ClaimResponse.outcome.extension, ClaimResponse.outcome.extension:outcome	All FHIR elements must have a @value or children	hasValue() or (children().count() > id.count())
ext-1	error	ClaimResponse.extension, ClaimResponse.extension:unallocDeductable, ClaimResponse.modifierExtension, ClaimResponse.patient.extension, ClaimResponse.patient.extension:patient, ClaimResponse.insurer.extension, ClaimResponse.insurer.extension:insurer, ClaimResponse.outcome.extension, ClaimResponse.outcome.extension:outcome	Must have either extensions or value[x], not both	extension.exists() != value.exists()

This structure is derived from ClaimResponse

Name	Flags	Card.	Type	Description & Constraints    Filter: Bindings Constraints Obligations
ClaimResponse		0..*	ClaimResponse(4.3.0)	Response to a claim predetermination or preauthorization
meta
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
extension:meta		0..1	(Complex)	STU3: meta additional types URL: http://hl7.org/fhir/3.0/StructureDefinition/extension-ClaimResponse.meta
text
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
extension:text		0..1	(Complex)	STU3: text additional types URL: http://hl7.org/fhir/3.0/StructureDefinition/extension-ClaimResponse.text
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
extension:unallocDeductable		0..1	Money	STU3: Unallocated deductible (new) URL: http://hl7.org/fhir/3.0/StructureDefinition/extension-ClaimResponse.unallocDeductable
identifier
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
extension:identifier		0..*	Identifier	STU3: Response number additional types URL: http://hl7.org/fhir/3.0/StructureDefinition/extension-ClaimResponse.identifier
patient
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
extension:patient		0..1	Reference(Resource)	STU3: The subject of the Products and Services additional types URL: http://hl7.org/fhir/StructureDefinition/alternate-reference
insurer
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
extension:insurer		0..1	Reference(Resource)	STU3: Insurance issuing organization additional types URL: http://hl7.org/fhir/StructureDefinition/alternate-reference
requestor
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
extension:requestProvider		0..1	Reference(Resource)	STU3: Responsible practitioner additional types URL: http://hl7.org/fhir/StructureDefinition/alternate-reference
extension:requestOrganization		0..1	Reference(Resource)	STU3: Responsible organization additional types URL: http://hl7.org/fhir/StructureDefinition/alternate-reference
request
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
extension:request		0..1	Reference(Resource)	STU3: request additional types URL: http://hl7.org/fhir/StructureDefinition/alternate-reference
outcome
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
extension:outcome		0..1	CodeableConcept	STU3: complete | error | partial additional types URL: http://hl7.org/fhir/3.0/StructureDefinition/extension-ClaimResponse.outcome Binding: RemittanceOutcome (example): The result of the claim processing
addItem
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
extension:revenue		0..1	CodeableConcept	STU3: Revenue or cost center code (new) URL: http://hl7.org/fhir/3.0/StructureDefinition/extension-ClaimResponse.addItem.revenue Binding: ExampleRevenueCenterCodes (example): Codes for the revenue or cost centers supplying the service and/or products.
extension:category		0..1	CodeableConcept	STU3: Type of service or product (new) URL: http://hl7.org/fhir/3.0/StructureDefinition/extension-ClaimResponse.addItem.category Binding: R3BenefitSubcategoryForR4B (0.1.0) (example): Benefit subcategories such as: oral-basic, major, glasses
extension:fee		0..1	Money	STU3: Professional fee or Product charge (new) URL: http://hl7.org/fhir/3.0/StructureDefinition/extension-ClaimResponse.addItem.fee
detail
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
extension:revenue		0..1	CodeableConcept	STU3: Revenue or cost center code (new) URL: http://hl7.org/fhir/3.0/StructureDefinition/extension-ClaimResponse.addItem.detail.revenue Binding: ExampleRevenueCenterCodes (example): Codes for the revenue or cost centers supplying the service and/or products.
extension:category		0..1	CodeableConcept	STU3: Type of service or product (new) URL: http://hl7.org/fhir/3.0/StructureDefinition/extension-ClaimResponse.addItem.detail.category Binding: R3BenefitSubcategoryForR4B (0.1.0) (example): Benefit subcategories such as: oral-basic, major, glasses
extension:fee		0..1	Money	STU3: Professional fee or Product charge (new) URL: http://hl7.org/fhir/3.0/StructureDefinition/extension-ClaimResponse.addItem.detail.fee
payment
identifier
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
extension:identifier		0..1	Identifier	STU3: Identifier of the payment instrument additional types URL: http://hl7.org/fhir/3.0/StructureDefinition/extension-ClaimResponse.payment.identifier
processNote
type
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
extension:type		0..1	CodeableConcept	STU3: type additional types URL: http://hl7.org/fhir/3.0/StructureDefinition/extension-ClaimResponse.processNote.type Binding: NoteType (required): The presentation types of notes.
communicationRequest
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
extension:communicationRequest		0..*	Reference(Resource)	STU3: communicationRequest additional types URL: http://hl7.org/fhir/StructureDefinition/alternate-reference
insurance
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
extension:preAuthRef		0..*	string	STU3: Pre-Authorization/Determination Reference (new) URL: http://hl7.org/fhir/3.0/StructureDefinition/extension-ClaimResponse.insurance.preAuthRef
coverage
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
extension:coverage		0..1	Reference(Resource)	STU3: coverage additional types URL: http://hl7.org/fhir/StructureDefinition/alternate-reference
claimResponse
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
extension:claimResponse		0..1	Reference(Resource)	STU3: claimResponse additional types URL: http://hl7.org/fhir/StructureDefinition/alternate-reference
Documentation for this format

Name	Flags	Card.	Type	Description & Constraints    Filter: Bindings Constraints Obligations
ClaimResponse		0..*	ClaimResponse(4.3.0)	Response to a claim predetermination or preauthorization
id	Σ	0..1	id	Logical id of this artifact
meta	Σ	0..1	Meta	Metadata about the resource
id		0..1	id	Unique id for inter-element referencing
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url Constraints: ext-1
extension:meta		0..1	(Complex)	STU3: meta additional types URL: http://hl7.org/fhir/3.0/StructureDefinition/extension-ClaimResponse.meta Constraints: ext-1
versionId	Σ	0..1	id	Version specific identifier
lastUpdated	Σ	0..1	instant	When the resource version last changed
source	Σ	0..1	uri	Identifies where the resource comes from
profile	Σ	0..*	canonical(StructureDefinition)	Profiles this resource claims to conform to
security	Σ	0..*	Coding	Security Labels applied to this resource Binding: All Security Labels (extensible)
tag	Σ	0..*	Coding	Tags applied to this resource Binding: CommonTags (example)
implicitRules	?!Σ	0..1	uri	A set of rules under which this content was created
language		0..1	code	Language of the resource content Binding: CommonLanguages (preferred): IETF language tag Additional Bindings Purpose AllLanguages Max Binding
text		0..1	Narrative	Text summary of the resource, for human interpretation This profile does not constrain the narrative in regard to content, language, or traceability to data elements
id		0..1	id	Unique id for inter-element referencing
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url Constraints: ext-1
extension:text		0..1	(Complex)	STU3: text additional types URL: http://hl7.org/fhir/3.0/StructureDefinition/extension-ClaimResponse.text Constraints: ext-1
status		1..1	code	generated | extensions | additional | empty Binding: NarrativeStatus (required)
div	C	1..1	xhtml	Limited xhtml content Constraints: txt-1, txt-2
contained		0..*	Resource	Contained, inline Resources Constraints: dom-r4b
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url Constraints: ext-1
extension:unallocDeductable		0..1	Money	STU3: Unallocated deductible (new) URL: http://hl7.org/fhir/3.0/StructureDefinition/extension-ClaimResponse.unallocDeductable Constraints: ext-1
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored Constraints: ext-1
identifier		0..*	Identifier	Business Identifier for a claim response
id		0..1	id	Unique id for inter-element referencing
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url Constraints: ext-1
extension:identifier		0..*	Identifier	STU3: Response number additional types URL: http://hl7.org/fhir/3.0/StructureDefinition/extension-ClaimResponse.identifier Constraints: ext-1
use	?!Σ	0..1	code	usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required)
type	Σ	0..1	CodeableConcept	Description of identifier Binding: Identifier Type Codes (extensible)
system	Σ	0..1	uri	The namespace for the identifier value Example General: http://www.acme.com/identifiers/patient
value	Σ	0..1	string	The value that is unique Example General: 123456
period	Σ	0..1	Period	Time period when id is/was valid for use
assigner	Σ	0..1	Reference(Organization)	Organization that issued id (may be just text)
status	?!Σ	1..1	code	active | cancelled | draft | entered-in-error Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance.
type	Σ	1..1	CodeableConcept	More granular claim type Binding: ClaimTypeCodes (extensible): The type or discipline-style of the claim.
subType		0..1	CodeableConcept	More granular claim type Binding: ExampleClaimSubTypeCodes (example): A more granular claim typecode.
use	Σ	1..1	code	claim | preauthorization | predetermination Binding: Use (required): Claim, preauthorization, predetermination.
patient	Σ	1..1	Reference(Patient)	The recipient of the products and services
id		0..1	id	Unique id for inter-element referencing
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url Constraints: ext-1
extension:patient		0..1	Reference(Resource)	STU3: The subject of the Products and Services additional types URL: http://hl7.org/fhir/StructureDefinition/alternate-reference Constraints: ext-1
reference	ΣC	0..1	string	Literal reference, Relative, internal or absolute URL
type	Σ	0..1	uri	Type the reference refers to (e.g. "Patient") Binding: ResourceType (extensible)
identifier	Σ	0..1	Identifier	Logical reference, when literal reference is not known
display	Σ	0..1	string	Text alternative for the resource
created	Σ	1..1	dateTime	Response creation date
insurer	Σ	1..1	Reference(Organization)	Party responsible for reimbursement
id		0..1	id	Unique id for inter-element referencing
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url Constraints: ext-1
extension:insurer		0..1	Reference(Resource)	STU3: Insurance issuing organization additional types URL: http://hl7.org/fhir/StructureDefinition/alternate-reference Constraints: ext-1
reference	ΣC	0..1	string	Literal reference, Relative, internal or absolute URL
type	Σ	0..1	uri	Type the reference refers to (e.g. "Patient") Binding: ResourceType (extensible)
identifier	Σ	0..1	Identifier	Logical reference, when literal reference is not known
display	Σ	0..1	string	Text alternative for the resource
requestor		0..1	Reference(Practitioner | PractitionerRole | Organization)	Party responsible for the claim
id		0..1	id	Unique id for inter-element referencing
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url Constraints: ext-1
extension:requestProvider		0..1	Reference(Resource)	STU3: Responsible practitioner additional types URL: http://hl7.org/fhir/StructureDefinition/alternate-reference Constraints: ext-1
extension:requestOrganization		0..1	Reference(Resource)	STU3: Responsible organization additional types URL: http://hl7.org/fhir/StructureDefinition/alternate-reference Constraints: ext-1
reference	ΣC	0..1	string	Literal reference, Relative, internal or absolute URL
type	Σ	0..1	uri	Type the reference refers to (e.g. "Patient") Binding: ResourceType (extensible)
identifier	Σ	0..1	Identifier	Logical reference, when literal reference is not known
display	Σ	0..1	string	Text alternative for the resource
request	Σ	0..1	Reference(Claim)	Id of resource triggering adjudication
id		0..1	id	Unique id for inter-element referencing
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url Constraints: ext-1
extension:request		0..1	Reference(Resource)	STU3: request additional types URL: http://hl7.org/fhir/StructureDefinition/alternate-reference Constraints: ext-1
reference	ΣC	0..1	string	Literal reference, Relative, internal or absolute URL
type	Σ	0..1	uri	Type the reference refers to (e.g. "Patient") Binding: ResourceType (extensible)
identifier	Σ	0..1	Identifier	Logical reference, when literal reference is not known
display	Σ	0..1	string	Text alternative for the resource
outcome	Σ	1..1	code	queued | complete | error | partial Binding: RemittanceOutcome (required): The result of the claim processing.
id		0..1	string	xml:id (or equivalent in JSON)
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url Constraints: ext-1
extension:outcome		0..1	CodeableConcept	STU3: complete | error | partial additional types URL: http://hl7.org/fhir/3.0/StructureDefinition/extension-ClaimResponse.outcome Binding: RemittanceOutcome (example): The result of the claim processing Constraints: ext-1
value		0..1	code	Primitive value for code
disposition		0..1	string	Disposition Message
preAuthRef		0..1	string	Preauthorization reference
preAuthPeriod		0..1	Period	Preauthorization reference effective period
payeeType		0..1	CodeableConcept	Party to be paid any benefits payable Binding: Claim Payee Type Codes (example): A code for the party to be reimbursed.
item		0..*	BackboneElement	Adjudication for claim line items
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Constraints: ext-1
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized Constraints: ext-1
itemSequence		1..1	positiveInt	Claim item instance identifier
noteNumber		0..*	positiveInt	Applicable note numbers
adjudication		1..*	BackboneElement	Adjudication details
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Constraints: ext-1
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized Constraints: ext-1
category		1..1	CodeableConcept	Type of adjudication information Binding: AdjudicationValueCodes (example): The adjudication codes.
reason		0..1	CodeableConcept	Explanation of adjudication outcome Binding: AdjudicationReasonCodes (example): The adjudication reason codes.
amount		0..1	Money	Monetary amount
value		0..1	decimal	Non-monetary value
detail		0..*	BackboneElement	Adjudication for claim details
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Constraints: ext-1
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized Constraints: ext-1
detailSequence		1..1	positiveInt	Claim detail instance identifier
noteNumber		0..*	positiveInt	Applicable note numbers
adjudication		1..*	See adjudication (ClaimResponse)	Detail level adjudication details
subDetail		0..*	BackboneElement	Adjudication for claim sub-details
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Constraints: ext-1
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized Constraints: ext-1
subDetailSequence		1..1	positiveInt	Claim sub-detail instance identifier
noteNumber		0..*	positiveInt	Applicable note numbers
adjudication		0..*	See adjudication (ClaimResponse)	Subdetail level adjudication details
addItem		0..*	BackboneElement	Insurer added line items
id		0..1	string	Unique id for inter-element referencing
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url Constraints: ext-1
extension:revenue		0..1	CodeableConcept	STU3: Revenue or cost center code (new) URL: http://hl7.org/fhir/3.0/StructureDefinition/extension-ClaimResponse.addItem.revenue Binding: ExampleRevenueCenterCodes (example): Codes for the revenue or cost centers supplying the service and/or products. Constraints: ext-1
extension:category		0..1	CodeableConcept	STU3: Type of service or product (new) URL: http://hl7.org/fhir/3.0/StructureDefinition/extension-ClaimResponse.addItem.category Binding: R3BenefitSubcategoryForR4B (0.1.0) (example): Benefit subcategories such as: oral-basic, major, glasses Constraints: ext-1
extension:fee		0..1	Money	STU3: Professional fee or Product charge (new) URL: http://hl7.org/fhir/3.0/StructureDefinition/extension-ClaimResponse.addItem.fee Constraints: ext-1
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized Constraints: ext-1
itemSequence		0..*	positiveInt	Item sequence number
detailSequence		0..*	positiveInt	Detail sequence number
subdetailSequence		0..*	positiveInt	Subdetail sequence number
provider		0..*	Reference(Practitioner | PractitionerRole | Organization)	Authorized providers
productOrService		1..1	CodeableConcept	Billing, service, product, or drug code Binding: USCLSCodes (example): Allowable service and product codes.
modifier		0..*	CodeableConcept	Service/Product billing modifiers Binding: ModifierTypeCodes (example): Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen.
programCode		0..*	CodeableConcept	Program the product or service is provided under Binding: ExampleProgramReasonCodes (example): Program specific reason codes.
serviced[x]		0..1		Date or dates of service or product delivery
servicedDate			date
servicedPeriod			Period
location[x]		0..1		Place of service or where product was supplied Binding: ExampleServicePlaceCodes (example): Place of service: pharmacy, school, prison, etc.
locationCodeableConcept			CodeableConcept
locationAddress			Address
locationReference			Reference(Location)
quantity		0..1	SimpleQuantity(4.3.0)	Count of products or services
unitPrice		0..1	Money	Fee, charge or cost per item
factor		0..1	decimal	Price scaling factor
net		0..1	Money	Total item cost
bodySite		0..1	CodeableConcept	Anatomical location Binding: OralSiteCodes (example): The code for the teeth, quadrant, sextant and arch.
subSite		0..*	CodeableConcept	Anatomical sub-location Binding: SurfaceCodes (example): The code for the tooth surface and surface combinations.
noteNumber		0..*	positiveInt	Applicable note numbers
adjudication		1..*	See adjudication (ClaimResponse)	Added items adjudication
detail		0..*	BackboneElement	Insurer added line details
id		0..1	string	Unique id for inter-element referencing
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url Constraints: ext-1
extension:revenue		0..1	CodeableConcept	STU3: Revenue or cost center code (new) URL: http://hl7.org/fhir/3.0/StructureDefinition/extension-ClaimResponse.addItem.detail.revenue Binding: ExampleRevenueCenterCodes (example): Codes for the revenue or cost centers supplying the service and/or products. Constraints: ext-1
extension:category		0..1	CodeableConcept	STU3: Type of service or product (new) URL: http://hl7.org/fhir/3.0/StructureDefinition/extension-ClaimResponse.addItem.detail.category Binding: R3BenefitSubcategoryForR4B (0.1.0) (example): Benefit subcategories such as: oral-basic, major, glasses Constraints: ext-1
extension:fee		0..1	Money	STU3: Professional fee or Product charge (new) URL: http://hl7.org/fhir/3.0/StructureDefinition/extension-ClaimResponse.addItem.detail.fee Constraints: ext-1
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized Constraints: ext-1
productOrService		1..1	CodeableConcept	Billing, service, product, or drug code Binding: USCLSCodes (example): Allowable service and product codes.
modifier		0..*	CodeableConcept	Service/Product billing modifiers Binding: ModifierTypeCodes (example): Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen.
quantity		0..1	SimpleQuantity(4.3.0)	Count of products or services
unitPrice		0..1	Money	Fee, charge or cost per item
factor		0..1	decimal	Price scaling factor
net		0..1	Money	Total item cost
noteNumber		0..*	positiveInt	Applicable note numbers
adjudication		1..*	See adjudication (ClaimResponse)	Added items detail adjudication
subDetail		0..*	BackboneElement	Insurer added line items
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Constraints: ext-1
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized Constraints: ext-1
productOrService		1..1	CodeableConcept	Billing, service, product, or drug code Binding: USCLSCodes (example): Allowable service and product codes.
modifier		0..*	CodeableConcept	Service/Product billing modifiers Binding: ModifierTypeCodes (example): Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen.
quantity		0..1	SimpleQuantity(4.3.0)	Count of products or services
unitPrice		0..1	Money	Fee, charge or cost per item
factor		0..1	decimal	Price scaling factor
net		0..1	Money	Total item cost
noteNumber		0..*	positiveInt	Applicable note numbers
adjudication		1..*	See adjudication (ClaimResponse)	Added items detail adjudication
adjudication		0..*	See adjudication (ClaimResponse)	Header-level adjudication
total	Σ	0..*	BackboneElement	Adjudication totals
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Constraints: ext-1
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized Constraints: ext-1
category	Σ	1..1	CodeableConcept	Type of adjudication information Binding: AdjudicationValueCodes (example): The adjudication codes.
amount	Σ	1..1	Money	Financial total for the category
payment		0..1	BackboneElement	Payment Details
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Constraints: ext-1
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized Constraints: ext-1
type		1..1	CodeableConcept	Partial or complete payment Binding: ExamplePaymentTypeCodes (example): The type (partial, complete) of the payment.
adjustment		0..1	Money	Payment adjustment for non-claim issues
adjustmentReason		0..1	CodeableConcept	Explanation for the adjustment Binding: PaymentAdjustmentReasonCodes (example): Payment Adjustment reason codes.
date		0..1	date	Expected date of payment
amount		1..1	Money	Payable amount after adjustment
identifier		0..1	Identifier	Business identifier for the payment
id		0..1	id	Unique id for inter-element referencing
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url Constraints: ext-1
extension:identifier		0..1	Identifier	STU3: Identifier of the payment instrument additional types URL: http://hl7.org/fhir/3.0/StructureDefinition/extension-ClaimResponse.payment.identifier Constraints: ext-1
use	?!Σ	0..1	code	usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required)
type	Σ	0..1	CodeableConcept	Description of identifier Binding: Identifier Type Codes (extensible)
system	Σ	0..1	uri	The namespace for the identifier value Example General: http://www.acme.com/identifiers/patient
value	Σ	0..1	string	The value that is unique Example General: 123456
period	Σ	0..1	Period	Time period when id is/was valid for use
assigner	Σ	0..1	Reference(Organization)	Organization that issued id (may be just text)
fundsReserve		0..1	CodeableConcept	Funds reserved status Binding: Funds Reservation Codes (example): For whom funds are to be reserved: (Patient, Provider, None).
formCode		0..1	CodeableConcept	Printed form identifier Binding: Form Codes (example): The forms codes.
form		0..1	Attachment	Printed reference or actual form
processNote		0..*	BackboneElement	Note concerning adjudication
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Constraints: ext-1
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized Constraints: ext-1
number		0..1	positiveInt	Note instance identifier
type		0..1	code	display | print | printoper Binding: NoteType (required): The presentation types of notes.
id		0..1	string	xml:id (or equivalent in JSON)
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url Constraints: ext-1
extension:type		0..1	CodeableConcept	STU3: type additional types URL: http://hl7.org/fhir/3.0/StructureDefinition/extension-ClaimResponse.processNote.type Binding: NoteType (required): The presentation types of notes. Constraints: ext-1
value		0..1	code	Primitive value for code
text		1..1	string	Note explanatory text
language		0..1	CodeableConcept	Language of the text Binding: CommonLanguages (preferred): IETF language tag Additional Bindings Purpose AllLanguages Max Binding
communicationRequest		0..*	Reference(CommunicationRequest)	Request for additional information
id		0..1	id	Unique id for inter-element referencing
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url Constraints: ext-1
extension:communicationRequest		0..1	Reference(Resource)	STU3: communicationRequest additional types URL: http://hl7.org/fhir/StructureDefinition/alternate-reference Constraints: ext-1
reference	ΣC	0..1	string	Literal reference, Relative, internal or absolute URL
type	Σ	0..1	uri	Type the reference refers to (e.g. "Patient") Binding: ResourceType (extensible)
identifier	Σ	0..1	Identifier	Logical reference, when literal reference is not known
display	Σ	0..1	string	Text alternative for the resource
insurance		0..*	BackboneElement	Patient insurance information
id		0..1	string	Unique id for inter-element referencing
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url Constraints: ext-1
extension:preAuthRef		0..*	string	STU3: Pre-Authorization/Determination Reference (new) URL: http://hl7.org/fhir/3.0/StructureDefinition/extension-ClaimResponse.insurance.preAuthRef Constraints: ext-1
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized Constraints: ext-1
sequence		1..1	positiveInt	Insurance instance identifier
focal		1..1	boolean	Coverage to be used for adjudication
coverage		1..1	Reference(Coverage)	Insurance information
id		0..1	id	Unique id for inter-element referencing
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url Constraints: ext-1
extension:coverage		0..1	Reference(Resource)	STU3: coverage additional types URL: http://hl7.org/fhir/StructureDefinition/alternate-reference Constraints: ext-1
reference	ΣC	0..1	string	Literal reference, Relative, internal or absolute URL
type	Σ	0..1	uri	Type the reference refers to (e.g. "Patient") Binding: ResourceType (extensible)
identifier	Σ	0..1	Identifier	Logical reference, when literal reference is not known
display	Σ	0..1	string	Text alternative for the resource
businessArrangement		0..1	string	Additional provider contract number
claimResponse		0..1	Reference(ClaimResponse)	Adjudication results
id		0..1	id	Unique id for inter-element referencing
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url Constraints: ext-1
extension:claimResponse		0..1	Reference(Resource)	STU3: claimResponse additional types URL: http://hl7.org/fhir/StructureDefinition/alternate-reference Constraints: ext-1
reference	ΣC	0..1	string	Literal reference, Relative, internal or absolute URL
type	Σ	0..1	uri	Type the reference refers to (e.g. "Patient") Binding: ResourceType (extensible)
identifier	Σ	0..1	Identifier	Logical reference, when literal reference is not known
display	Σ	0..1	string	Text alternative for the resource
error		0..*	BackboneElement	Processing errors
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Constraints: ext-1
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized Constraints: ext-1
itemSequence		0..1	positiveInt	Item sequence number
detailSequence		0..1	positiveInt	Detail sequence number
subDetailSequence		0..1	positiveInt	Subdetail sequence number
code		1..1	CodeableConcept	Error code detailing processing issues Binding: Adjudication Error Codes (example): The adjudication error codes.
Documentation for this format

Terminology Bindings

Path	Status	Usage	ValueSet	Version	Source
ClaimResponse.meta.security	Base	extensible	SecurityLabels	📍4.3.0	FHIR Std.
ClaimResponse.meta.tag	Base	example	Common Tags	📍4.3.0	FHIR Std.
ClaimResponse.language	Base	preferred	Common Languages	📍4.3.0	FHIR Std.
ClaimResponse.text.status	Base	required	NarrativeStatus	📍4.3.0	FHIR Std.
ClaimResponse.identifier.​use	Base	required	IdentifierUse	📍4.3.0	FHIR Std.
ClaimResponse.identifier.​type	Base	extensible	IdentifierType	📍4.3.0	FHIR Std.
ClaimResponse.status	Base	required	Financial Resource Status Codes	📍4.3.0	FHIR Std.
ClaimResponse.type	Base	extensible	Claim Type Codes	📍4.3.0	FHIR Std.
ClaimResponse.subType	Base	example	Example Claim SubType Codes	📍4.3.0	FHIR Std.
ClaimResponse.use	Base	required	Use	📍4.3.0	FHIR Std.
ClaimResponse.patient.​type	Base	extensible	ResourceType	📍4.3.0	FHIR Std.
ClaimResponse.insurer.​type	Base	extensible	ResourceType	📍4.3.0	FHIR Std.
ClaimResponse.requestor.​type	Base	extensible	ResourceType	📍4.3.0	FHIR Std.
ClaimResponse.request.​type	Base	extensible	ResourceType	📍4.3.0	FHIR Std.
ClaimResponse.outcome	Base	required	RemittanceOutcome	📍4.3.0	FHIR Std.
ClaimResponse.payeeType	Base	example	PayeeType	📍4.3.0	FHIR Std.
ClaimResponse.item.adjudication.​category	Base	example	Adjudication Value Codes	📍4.3.0	FHIR Std.
ClaimResponse.item.adjudication.​reason	Base	example	Adjudication Reason Codes	📍4.3.0	FHIR Std.
ClaimResponse.addItem.​productOrService	Base	example	USCLS Codes	📍4.3.0	FHIR Std.
ClaimResponse.addItem.​modifier	Base	example	Modifier type Codes	📍4.3.0	FHIR Std.
ClaimResponse.addItem.​programCode	Base	example	Example Program Reason Codes	📍4.3.0	FHIR Std.
ClaimResponse.addItem.​location[x]	Base	example	Example Service Place Codes	📍4.3.0	FHIR Std.
ClaimResponse.addItem.​bodySite	Base	example	Oral Site Codes	📍4.3.0	FHIR Std.
ClaimResponse.addItem.​subSite	Base	example	Surface Codes	📍4.3.0	FHIR Std.
ClaimResponse.addItem.​detail.productOrService	Base	example	USCLS Codes	📍4.3.0	FHIR Std.
ClaimResponse.addItem.​detail.modifier	Base	example	Modifier type Codes	📍4.3.0	FHIR Std.
ClaimResponse.addItem.​detail.subDetail.productOrService	Base	example	USCLS Codes	📍4.3.0	FHIR Std.
ClaimResponse.addItem.​detail.subDetail.modifier	Base	example	Modifier type Codes	📍4.3.0	FHIR Std.
ClaimResponse.total.​category	Base	example	Adjudication Value Codes	📍4.3.0	FHIR Std.
ClaimResponse.payment.​type	Base	example	Example Payment Type Codes	📍4.3.0	FHIR Std.
ClaimResponse.payment.​adjustmentReason	Base	example	Payment Adjustment Reason Codes	📍4.3.0	FHIR Std.
ClaimResponse.payment.​identifier.use	Base	required	IdentifierUse	📍4.3.0	FHIR Std.
ClaimResponse.payment.​identifier.type	Base	extensible	IdentifierType	📍4.3.0	FHIR Std.
ClaimResponse.fundsReserve	Base	example	FundsReserve	📍4.3.0	FHIR Std.
ClaimResponse.formCode	Base	example	Forms	📍4.3.0	FHIR Std.
ClaimResponse.processNote.​type	Base	required	NoteType	📍4.3.0	FHIR Std.
ClaimResponse.processNote.​language	Base	preferred	Common Languages	📍4.3.0	FHIR Std.
ClaimResponse.communicationRequest.​type	Base	extensible	ResourceType	📍4.3.0	FHIR Std.
ClaimResponse.insurance.​coverage.type	Base	extensible	ResourceType	📍4.3.0	FHIR Std.
ClaimResponse.insurance.​claimResponse.type	Base	extensible	ResourceType	📍4.3.0	FHIR Std.
ClaimResponse.error.​code	Base	example	AdjudicationError	📍4.3.0	FHIR Std.

Constraints

Id	Grade	Path(s)	Description	Expression
dom-2	error	ClaimResponse	If the resource is contained in another resource, it SHALL NOT contain nested Resources	contained.contained.empty()
dom-3	error	ClaimResponse	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	contained.where(((id.exists() and ('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url)))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(uri) = '#').exists()).not()).trace('unmatched', id).empty()
dom-4	error	ClaimResponse	If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated	contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
dom-5	error	ClaimResponse	If a resource is contained in another resource, it SHALL NOT have a security label	contained.meta.security.empty()
dom-6	best practice	ClaimResponse	A resource should have narrative for robust management	text.`div`.exists()
dom-r4b	warning	ClaimResponse.contained	Containing new R4B resources within R4 resources may cause interoperability issues if instances are shared with R4 systems	($this is Citation or $this is Evidence or $this is EvidenceReport or $this is EvidenceVariable or $this is MedicinalProductDefinition or $this is PackagedProductDefinition or $this is AdministrableProductDefinition or $this is Ingredient or $this is ClinicalUseDefinition or $this is RegulatedAuthorization or $this is SubstanceDefinition or $this is SubscriptionStatus or $this is SubscriptionTopic) implies (%resource is Citation or %resource is Evidence or %resource is EvidenceReport or %resource is EvidenceVariable or %resource is MedicinalProductDefinition or %resource is PackagedProductDefinition or %resource is AdministrableProductDefinition or %resource is Ingredient or %resource is ClinicalUseDefinition or %resource is RegulatedAuthorization or %resource is SubstanceDefinition or %resource is SubscriptionStatus or %resource is SubscriptionTopic)
ele-1	error	ClaimResponse.meta, ClaimResponse.meta.extension, ClaimResponse.meta.extension:meta, ClaimResponse.meta.versionId, ClaimResponse.meta.lastUpdated, ClaimResponse.meta.source, ClaimResponse.meta.profile, ClaimResponse.meta.security, ClaimResponse.meta.tag, ClaimResponse.implicitRules, ClaimResponse.language, ClaimResponse.text, ClaimResponse.text.extension, ClaimResponse.text.extension:text, ClaimResponse.text.status, ClaimResponse.text.div, ClaimResponse.extension, ClaimResponse.extension:unallocDeductable, ClaimResponse.modifierExtension, ClaimResponse.identifier, ClaimResponse.identifier.extension, ClaimResponse.identifier.extension:identifier, ClaimResponse.identifier.use, ClaimResponse.identifier.type, ClaimResponse.identifier.system, ClaimResponse.identifier.value, ClaimResponse.identifier.period, ClaimResponse.identifier.assigner, ClaimResponse.status, ClaimResponse.type, ClaimResponse.subType, ClaimResponse.use, ClaimResponse.patient, ClaimResponse.patient.extension, ClaimResponse.patient.extension:patient, ClaimResponse.patient.reference, ClaimResponse.patient.type, ClaimResponse.patient.identifier, ClaimResponse.patient.display, ClaimResponse.created, ClaimResponse.insurer, ClaimResponse.insurer.extension, ClaimResponse.insurer.extension:insurer, ClaimResponse.insurer.reference, ClaimResponse.insurer.type, ClaimResponse.insurer.identifier, ClaimResponse.insurer.display, ClaimResponse.requestor, ClaimResponse.requestor.extension, ClaimResponse.requestor.extension:requestProvider, ClaimResponse.requestor.extension:requestOrganization, ClaimResponse.requestor.reference, ClaimResponse.requestor.type, ClaimResponse.requestor.identifier, ClaimResponse.requestor.display, ClaimResponse.request, ClaimResponse.request.extension, ClaimResponse.request.extension:request, ClaimResponse.request.reference, ClaimResponse.request.type, ClaimResponse.request.identifier, ClaimResponse.request.display, ClaimResponse.outcome, ClaimResponse.outcome.extension, ClaimResponse.outcome.extension:outcome, ClaimResponse.disposition, ClaimResponse.preAuthRef, ClaimResponse.preAuthPeriod, ClaimResponse.payeeType, ClaimResponse.item, ClaimResponse.item.extension, ClaimResponse.item.modifierExtension, ClaimResponse.item.itemSequence, ClaimResponse.item.noteNumber, ClaimResponse.item.adjudication, ClaimResponse.item.adjudication.extension, ClaimResponse.item.adjudication.modifierExtension, ClaimResponse.item.adjudication.category, ClaimResponse.item.adjudication.reason, ClaimResponse.item.adjudication.amount, ClaimResponse.item.adjudication.value, ClaimResponse.item.detail, ClaimResponse.item.detail.extension, ClaimResponse.item.detail.modifierExtension, ClaimResponse.item.detail.detailSequence, ClaimResponse.item.detail.noteNumber, ClaimResponse.item.detail.adjudication, ClaimResponse.item.detail.subDetail, ClaimResponse.item.detail.subDetail.extension, ClaimResponse.item.detail.subDetail.modifierExtension, ClaimResponse.item.detail.subDetail.subDetailSequence, ClaimResponse.item.detail.subDetail.noteNumber, ClaimResponse.item.detail.subDetail.adjudication, ClaimResponse.addItem, ClaimResponse.addItem.extension, ClaimResponse.addItem.extension:revenue, ClaimResponse.addItem.extension:category, ClaimResponse.addItem.extension:fee, ClaimResponse.addItem.modifierExtension, ClaimResponse.addItem.itemSequence, ClaimResponse.addItem.detailSequence, ClaimResponse.addItem.subdetailSequence, ClaimResponse.addItem.provider, ClaimResponse.addItem.productOrService, ClaimResponse.addItem.modifier, ClaimResponse.addItem.programCode, ClaimResponse.addItem.serviced[x], ClaimResponse.addItem.location[x], ClaimResponse.addItem.quantity, ClaimResponse.addItem.unitPrice, ClaimResponse.addItem.factor, ClaimResponse.addItem.net, ClaimResponse.addItem.bodySite, ClaimResponse.addItem.subSite, ClaimResponse.addItem.noteNumber, ClaimResponse.addItem.adjudication, ClaimResponse.addItem.detail, ClaimResponse.addItem.detail.extension, ClaimResponse.addItem.detail.extension:revenue, ClaimResponse.addItem.detail.extension:category, ClaimResponse.addItem.detail.extension:fee, ClaimResponse.addItem.detail.modifierExtension, ClaimResponse.addItem.detail.productOrService, ClaimResponse.addItem.detail.modifier, ClaimResponse.addItem.detail.quantity, ClaimResponse.addItem.detail.unitPrice, ClaimResponse.addItem.detail.factor, ClaimResponse.addItem.detail.net, ClaimResponse.addItem.detail.noteNumber, ClaimResponse.addItem.detail.adjudication, ClaimResponse.addItem.detail.subDetail, ClaimResponse.addItem.detail.subDetail.extension, ClaimResponse.addItem.detail.subDetail.modifierExtension, ClaimResponse.addItem.detail.subDetail.productOrService, ClaimResponse.addItem.detail.subDetail.modifier, ClaimResponse.addItem.detail.subDetail.quantity, ClaimResponse.addItem.detail.subDetail.unitPrice, ClaimResponse.addItem.detail.subDetail.factor, ClaimResponse.addItem.detail.subDetail.net, ClaimResponse.addItem.detail.subDetail.noteNumber, ClaimResponse.addItem.detail.subDetail.adjudication, ClaimResponse.adjudication, ClaimResponse.total, ClaimResponse.total.extension, ClaimResponse.total.modifierExtension, ClaimResponse.total.category, ClaimResponse.total.amount, ClaimResponse.payment, ClaimResponse.payment.extension, ClaimResponse.payment.modifierExtension, ClaimResponse.payment.type, ClaimResponse.payment.adjustment, ClaimResponse.payment.adjustmentReason, ClaimResponse.payment.date, ClaimResponse.payment.amount, ClaimResponse.payment.identifier, ClaimResponse.payment.identifier.extension, ClaimResponse.payment.identifier.extension:identifier, ClaimResponse.payment.identifier.use, ClaimResponse.payment.identifier.type, ClaimResponse.payment.identifier.system, ClaimResponse.payment.identifier.value, ClaimResponse.payment.identifier.period, ClaimResponse.payment.identifier.assigner, ClaimResponse.fundsReserve, ClaimResponse.formCode, ClaimResponse.form, ClaimResponse.processNote, ClaimResponse.processNote.extension, ClaimResponse.processNote.modifierExtension, ClaimResponse.processNote.number, ClaimResponse.processNote.type, ClaimResponse.processNote.type.extension, ClaimResponse.processNote.type.extension:type, ClaimResponse.processNote.text, ClaimResponse.processNote.language, ClaimResponse.communicationRequest, ClaimResponse.communicationRequest.extension, ClaimResponse.communicationRequest.extension:communicationRequest, ClaimResponse.communicationRequest.reference, ClaimResponse.communicationRequest.type, ClaimResponse.communicationRequest.identifier, ClaimResponse.communicationRequest.display, ClaimResponse.insurance, ClaimResponse.insurance.extension, ClaimResponse.insurance.extension:preAuthRef, ClaimResponse.insurance.modifierExtension, ClaimResponse.insurance.sequence, ClaimResponse.insurance.focal, ClaimResponse.insurance.coverage, ClaimResponse.insurance.coverage.extension, ClaimResponse.insurance.coverage.extension:coverage, ClaimResponse.insurance.coverage.reference, ClaimResponse.insurance.coverage.type, ClaimResponse.insurance.coverage.identifier, ClaimResponse.insurance.coverage.display, ClaimResponse.insurance.businessArrangement, ClaimResponse.insurance.claimResponse, ClaimResponse.insurance.claimResponse.extension, ClaimResponse.insurance.claimResponse.extension:claimResponse, ClaimResponse.insurance.claimResponse.reference, ClaimResponse.insurance.claimResponse.type, ClaimResponse.insurance.claimResponse.identifier, ClaimResponse.insurance.claimResponse.display, ClaimResponse.error, ClaimResponse.error.extension, ClaimResponse.error.modifierExtension, ClaimResponse.error.itemSequence, ClaimResponse.error.detailSequence, ClaimResponse.error.subDetailSequence, ClaimResponse.error.code	All FHIR elements must have a @value or children	hasValue() or (children().count() > id.count())
ext-1	error	ClaimResponse.meta.extension, ClaimResponse.meta.extension:meta, ClaimResponse.text.extension, ClaimResponse.text.extension:text, ClaimResponse.extension, ClaimResponse.extension:unallocDeductable, ClaimResponse.modifierExtension, ClaimResponse.identifier.extension, ClaimResponse.identifier.extension:identifier, ClaimResponse.patient.extension, ClaimResponse.patient.extension:patient, ClaimResponse.insurer.extension, ClaimResponse.insurer.extension:insurer, ClaimResponse.requestor.extension, ClaimResponse.requestor.extension:requestProvider, ClaimResponse.requestor.extension:requestOrganization, ClaimResponse.request.extension, ClaimResponse.request.extension:request, ClaimResponse.outcome.extension, ClaimResponse.outcome.extension:outcome, ClaimResponse.item.extension, ClaimResponse.item.modifierExtension, ClaimResponse.item.adjudication.extension, ClaimResponse.item.adjudication.modifierExtension, ClaimResponse.item.detail.extension, ClaimResponse.item.detail.modifierExtension, ClaimResponse.item.detail.subDetail.extension, ClaimResponse.item.detail.subDetail.modifierExtension, ClaimResponse.addItem.extension, ClaimResponse.addItem.extension:revenue, ClaimResponse.addItem.extension:category, ClaimResponse.addItem.extension:fee, ClaimResponse.addItem.modifierExtension, ClaimResponse.addItem.detail.extension, ClaimResponse.addItem.detail.extension:revenue, ClaimResponse.addItem.detail.extension:category, ClaimResponse.addItem.detail.extension:fee, ClaimResponse.addItem.detail.modifierExtension, ClaimResponse.addItem.detail.subDetail.extension, ClaimResponse.addItem.detail.subDetail.modifierExtension, ClaimResponse.total.extension, ClaimResponse.total.modifierExtension, ClaimResponse.payment.extension, ClaimResponse.payment.modifierExtension, ClaimResponse.payment.identifier.extension, ClaimResponse.payment.identifier.extension:identifier, ClaimResponse.processNote.extension, ClaimResponse.processNote.modifierExtension, ClaimResponse.processNote.type.extension, ClaimResponse.processNote.type.extension:type, ClaimResponse.communicationRequest.extension, ClaimResponse.communicationRequest.extension:communicationRequest, ClaimResponse.insurance.extension, ClaimResponse.insurance.extension:preAuthRef, ClaimResponse.insurance.modifierExtension, ClaimResponse.insurance.coverage.extension, ClaimResponse.insurance.coverage.extension:coverage, ClaimResponse.insurance.claimResponse.extension, ClaimResponse.insurance.claimResponse.extension:claimResponse, ClaimResponse.error.extension, ClaimResponse.error.modifierExtension	Must have either extensions or value[x], not both	extension.exists() != value.exists()
txt-1	error	ClaimResponse.text.div	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, <a> elements (either name or href), images and internally contained style attributes	htmlChecks()
txt-2	error	ClaimResponse.text.div	The narrative SHALL have some non-whitespace content	htmlChecks()

This structure is derived from ClaimResponse

Summary

Extensions

This structure refers to these extensions:

• http://hl7.org/fhir/3.0/StructureDefinition/extension-ClaimResponse.meta|0.1.0
• http://hl7.org/fhir/3.0/StructureDefinition/extension-ClaimResponse.text|0.1.0
• http://hl7.org/fhir/3.0/StructureDefinition/extension-ClaimResponse.unallocDeductable|0.1.0
• http://hl7.org/fhir/3.0/StructureDefinition/extension-ClaimResponse.identifier|0.1.0
• http://hl7.org/fhir/StructureDefinition/alternate-reference|5.2.0
• http://hl7.org/fhir/3.0/StructureDefinition/extension-ClaimResponse.outcome|0.1.0
• http://hl7.org/fhir/3.0/StructureDefinition/extension-ClaimResponse.addItem.revenue|0.1.0
• http://hl7.org/fhir/3.0/StructureDefinition/extension-ClaimResponse.addItem.category|0.1.0
• http://hl7.org/fhir/3.0/StructureDefinition/extension-ClaimResponse.addItem.fee|0.1.0
• http://hl7.org/fhir/3.0/StructureDefinition/extension-ClaimResponse.addItem.detail.revenue|0.1.0
• http://hl7.org/fhir/3.0/StructureDefinition/extension-ClaimResponse.addItem.detail.category|0.1.0
• http://hl7.org/fhir/3.0/StructureDefinition/extension-ClaimResponse.addItem.detail.fee|0.1.0
• http://hl7.org/fhir/3.0/StructureDefinition/extension-ClaimResponse.payment.identifier|0.1.0
• http://hl7.org/fhir/3.0/StructureDefinition/extension-ClaimResponse.processNote.type|0.1.0
• http://hl7.org/fhir/3.0/StructureDefinition/extension-ClaimResponse.insurance.preAuthRef|0.1.0

Maturity: 0

Key Elements View

Name	Flags	Card.	Type	Description & Constraints    Filter: Bindings Constraints Obligations
ClaimResponse		0..*	ClaimResponse(4.3.0)	Response to a claim predetermination or preauthorization
implicitRules	?!Σ	0..1	uri	A set of rules under which this content was created
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url Constraints: ext-1
extension:unallocDeductable		0..1	Money	STU3: Unallocated deductible (new) URL: http://hl7.org/fhir/3.0/StructureDefinition/extension-ClaimResponse.unallocDeductable Constraints: ext-1
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored Constraints: ext-1
status	?!Σ	1..1	code	active | cancelled | draft | entered-in-error Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance.
type	Σ	1..1	CodeableConcept	More granular claim type Binding: ClaimTypeCodes (extensible): The type or discipline-style of the claim.
use	Σ	1..1	code	claim | preauthorization | predetermination Binding: Use (required): Claim, preauthorization, predetermination.
patient	Σ	1..1	Reference(Patient)	The recipient of the products and services
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url Constraints: ext-1
extension:patient		0..1	Reference(Resource)	STU3: The subject of the Products and Services additional types URL: http://hl7.org/fhir/StructureDefinition/alternate-reference Constraints: ext-1
created	Σ	1..1	dateTime	Response creation date
insurer	Σ	1..1	Reference(Organization)	Party responsible for reimbursement
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url Constraints: ext-1
extension:insurer		0..1	Reference(Resource)	STU3: Insurance issuing organization additional types URL: http://hl7.org/fhir/StructureDefinition/alternate-reference Constraints: ext-1
outcome	Σ	1..1	code	queued | complete | error | partial Binding: RemittanceOutcome (required): The result of the claim processing.
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url Constraints: ext-1
extension:outcome		0..1	CodeableConcept	STU3: complete | error | partial additional types URL: http://hl7.org/fhir/3.0/StructureDefinition/extension-ClaimResponse.outcome Binding: RemittanceOutcome (example): The result of the claim processing Constraints: ext-1
Documentation for this format

Terminology Bindings

Path	Status	Usage	ValueSet	Version	Source
ClaimResponse.status	Base	required	Financial Resource Status Codes	📍4.3.0	FHIR Std.
ClaimResponse.type	Base	extensible	Claim Type Codes	📍4.3.0	FHIR Std.
ClaimResponse.use	Base	required	Use	📍4.3.0	FHIR Std.
ClaimResponse.outcome	Base	required	RemittanceOutcome	📍4.3.0	FHIR Std.

Constraints

Id	Grade	Path(s)	Description	Expression
dom-2	error	ClaimResponse	If the resource is contained in another resource, it SHALL NOT contain nested Resources	contained.contained.empty()
dom-3	error	ClaimResponse	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	contained.where(((id.exists() and ('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url)))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(uri) = '#').exists()).not()).trace('unmatched', id).empty()
dom-4	error	ClaimResponse	If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated	contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
dom-5	error	ClaimResponse	If a resource is contained in another resource, it SHALL NOT have a security label	contained.meta.security.empty()
dom-6	best practice	ClaimResponse	A resource should have narrative for robust management	text.`div`.exists()
ele-1	error	ClaimResponse.implicitRules, ClaimResponse.extension, ClaimResponse.extension:unallocDeductable, ClaimResponse.modifierExtension, ClaimResponse.status, ClaimResponse.type, ClaimResponse.use, ClaimResponse.patient, ClaimResponse.patient.extension, ClaimResponse.patient.extension:patient, ClaimResponse.created, ClaimResponse.insurer, ClaimResponse.insurer.extension, ClaimResponse.insurer.extension:insurer, ClaimResponse.outcome, ClaimResponse.outcome.extension, ClaimResponse.outcome.extension:outcome	All FHIR elements must have a @value or children	hasValue() or (children().count() > id.count())
ext-1	error	ClaimResponse.extension, ClaimResponse.extension:unallocDeductable, ClaimResponse.modifierExtension, ClaimResponse.patient.extension, ClaimResponse.patient.extension:patient, ClaimResponse.insurer.extension, ClaimResponse.insurer.extension:insurer, ClaimResponse.outcome.extension, ClaimResponse.outcome.extension:outcome	Must have either extensions or value[x], not both	extension.exists() != value.exists()

Differential View

This structure is derived from ClaimResponse

Name	Flags	Card.	Type	Description & Constraints    Filter: Bindings Constraints Obligations
ClaimResponse		0..*	ClaimResponse(4.3.0)	Response to a claim predetermination or preauthorization
meta
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
extension:meta		0..1	(Complex)	STU3: meta additional types URL: http://hl7.org/fhir/3.0/StructureDefinition/extension-ClaimResponse.meta
text
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
extension:text		0..1	(Complex)	STU3: text additional types URL: http://hl7.org/fhir/3.0/StructureDefinition/extension-ClaimResponse.text
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
extension:unallocDeductable		0..1	Money	STU3: Unallocated deductible (new) URL: http://hl7.org/fhir/3.0/StructureDefinition/extension-ClaimResponse.unallocDeductable
identifier
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
extension:identifier		0..*	Identifier	STU3: Response number additional types URL: http://hl7.org/fhir/3.0/StructureDefinition/extension-ClaimResponse.identifier
patient
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
extension:patient		0..1	Reference(Resource)	STU3: The subject of the Products and Services additional types URL: http://hl7.org/fhir/StructureDefinition/alternate-reference
insurer
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
extension:insurer		0..1	Reference(Resource)	STU3: Insurance issuing organization additional types URL: http://hl7.org/fhir/StructureDefinition/alternate-reference
requestor
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
extension:requestProvider		0..1	Reference(Resource)	STU3: Responsible practitioner additional types URL: http://hl7.org/fhir/StructureDefinition/alternate-reference
extension:requestOrganization		0..1	Reference(Resource)	STU3: Responsible organization additional types URL: http://hl7.org/fhir/StructureDefinition/alternate-reference
request
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
extension:request		0..1	Reference(Resource)	STU3: request additional types URL: http://hl7.org/fhir/StructureDefinition/alternate-reference
outcome
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
extension:outcome		0..1	CodeableConcept	STU3: complete | error | partial additional types URL: http://hl7.org/fhir/3.0/StructureDefinition/extension-ClaimResponse.outcome Binding: RemittanceOutcome (example): The result of the claim processing
addItem
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
extension:revenue		0..1	CodeableConcept	STU3: Revenue or cost center code (new) URL: http://hl7.org/fhir/3.0/StructureDefinition/extension-ClaimResponse.addItem.revenue Binding: ExampleRevenueCenterCodes (example): Codes for the revenue or cost centers supplying the service and/or products.
extension:category		0..1	CodeableConcept	STU3: Type of service or product (new) URL: http://hl7.org/fhir/3.0/StructureDefinition/extension-ClaimResponse.addItem.category Binding: R3BenefitSubcategoryForR4B (0.1.0) (example): Benefit subcategories such as: oral-basic, major, glasses
extension:fee		0..1	Money	STU3: Professional fee or Product charge (new) URL: http://hl7.org/fhir/3.0/StructureDefinition/extension-ClaimResponse.addItem.fee
detail
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
extension:revenue		0..1	CodeableConcept	STU3: Revenue or cost center code (new) URL: http://hl7.org/fhir/3.0/StructureDefinition/extension-ClaimResponse.addItem.detail.revenue Binding: ExampleRevenueCenterCodes (example): Codes for the revenue or cost centers supplying the service and/or products.
extension:category		0..1	CodeableConcept	STU3: Type of service or product (new) URL: http://hl7.org/fhir/3.0/StructureDefinition/extension-ClaimResponse.addItem.detail.category Binding: R3BenefitSubcategoryForR4B (0.1.0) (example): Benefit subcategories such as: oral-basic, major, glasses
extension:fee		0..1	Money	STU3: Professional fee or Product charge (new) URL: http://hl7.org/fhir/3.0/StructureDefinition/extension-ClaimResponse.addItem.detail.fee
payment
identifier
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
extension:identifier		0..1	Identifier	STU3: Identifier of the payment instrument additional types URL: http://hl7.org/fhir/3.0/StructureDefinition/extension-ClaimResponse.payment.identifier
processNote
type
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
extension:type		0..1	CodeableConcept	STU3: type additional types URL: http://hl7.org/fhir/3.0/StructureDefinition/extension-ClaimResponse.processNote.type Binding: NoteType (required): The presentation types of notes.
communicationRequest
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
extension:communicationRequest		0..*	Reference(Resource)	STU3: communicationRequest additional types URL: http://hl7.org/fhir/StructureDefinition/alternate-reference
insurance
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
extension:preAuthRef		0..*	string	STU3: Pre-Authorization/Determination Reference (new) URL: http://hl7.org/fhir/3.0/StructureDefinition/extension-ClaimResponse.insurance.preAuthRef
coverage
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
extension:coverage		0..1	Reference(Resource)	STU3: coverage additional types URL: http://hl7.org/fhir/StructureDefinition/alternate-reference
claimResponse
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
extension:claimResponse		0..1	Reference(Resource)	STU3: claimResponse additional types URL: http://hl7.org/fhir/StructureDefinition/alternate-reference
Documentation for this format

Snapshot View

Name	Flags	Card.	Type	Description & Constraints    Filter: Bindings Constraints Obligations
ClaimResponse		0..*	ClaimResponse(4.3.0)	Response to a claim predetermination or preauthorization
id	Σ	0..1	id	Logical id of this artifact
meta	Σ	0..1	Meta	Metadata about the resource
id		0..1	id	Unique id for inter-element referencing
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url Constraints: ext-1
extension:meta		0..1	(Complex)	STU3: meta additional types URL: http://hl7.org/fhir/3.0/StructureDefinition/extension-ClaimResponse.meta Constraints: ext-1
versionId	Σ	0..1	id	Version specific identifier
lastUpdated	Σ	0..1	instant	When the resource version last changed
source	Σ	0..1	uri	Identifies where the resource comes from
profile	Σ	0..*	canonical(StructureDefinition)	Profiles this resource claims to conform to
security	Σ	0..*	Coding	Security Labels applied to this resource Binding: All Security Labels (extensible)
tag	Σ	0..*	Coding	Tags applied to this resource Binding: CommonTags (example)
implicitRules	?!Σ	0..1	uri	A set of rules under which this content was created
language		0..1	code	Language of the resource content Binding: CommonLanguages (preferred): IETF language tag Additional Bindings Purpose AllLanguages Max Binding
text		0..1	Narrative	Text summary of the resource, for human interpretation This profile does not constrain the narrative in regard to content, language, or traceability to data elements
id		0..1	id	Unique id for inter-element referencing
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url Constraints: ext-1
extension:text		0..1	(Complex)	STU3: text additional types URL: http://hl7.org/fhir/3.0/StructureDefinition/extension-ClaimResponse.text Constraints: ext-1
status		1..1	code	generated | extensions | additional | empty Binding: NarrativeStatus (required)
div	C	1..1	xhtml	Limited xhtml content Constraints: txt-1, txt-2
contained		0..*	Resource	Contained, inline Resources Constraints: dom-r4b
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url Constraints: ext-1
extension:unallocDeductable		0..1	Money	STU3: Unallocated deductible (new) URL: http://hl7.org/fhir/3.0/StructureDefinition/extension-ClaimResponse.unallocDeductable Constraints: ext-1
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored Constraints: ext-1
identifier		0..*	Identifier	Business Identifier for a claim response
id		0..1	id	Unique id for inter-element referencing
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url Constraints: ext-1
extension:identifier		0..*	Identifier	STU3: Response number additional types URL: http://hl7.org/fhir/3.0/StructureDefinition/extension-ClaimResponse.identifier Constraints: ext-1
use	?!Σ	0..1	code	usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required)
type	Σ	0..1	CodeableConcept	Description of identifier Binding: Identifier Type Codes (extensible)
system	Σ	0..1	uri	The namespace for the identifier value Example General: http://www.acme.com/identifiers/patient
value	Σ	0..1	string	The value that is unique Example General: 123456
period	Σ	0..1	Period	Time period when id is/was valid for use
assigner	Σ	0..1	Reference(Organization)	Organization that issued id (may be just text)
status	?!Σ	1..1	code	active | cancelled | draft | entered-in-error Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance.
type	Σ	1..1	CodeableConcept	More granular claim type Binding: ClaimTypeCodes (extensible): The type or discipline-style of the claim.
subType		0..1	CodeableConcept	More granular claim type Binding: ExampleClaimSubTypeCodes (example): A more granular claim typecode.
use	Σ	1..1	code	claim | preauthorization | predetermination Binding: Use (required): Claim, preauthorization, predetermination.
patient	Σ	1..1	Reference(Patient)	The recipient of the products and services
id		0..1	id	Unique id for inter-element referencing
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url Constraints: ext-1
extension:patient		0..1	Reference(Resource)	STU3: The subject of the Products and Services additional types URL: http://hl7.org/fhir/StructureDefinition/alternate-reference Constraints: ext-1
reference	ΣC	0..1	string	Literal reference, Relative, internal or absolute URL
type	Σ	0..1	uri	Type the reference refers to (e.g. "Patient") Binding: ResourceType (extensible)
identifier	Σ	0..1	Identifier	Logical reference, when literal reference is not known
display	Σ	0..1	string	Text alternative for the resource
created	Σ	1..1	dateTime	Response creation date
insurer	Σ	1..1	Reference(Organization)	Party responsible for reimbursement
id		0..1	id	Unique id for inter-element referencing
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url Constraints: ext-1
extension:insurer		0..1	Reference(Resource)	STU3: Insurance issuing organization additional types URL: http://hl7.org/fhir/StructureDefinition/alternate-reference Constraints: ext-1
reference	ΣC	0..1	string	Literal reference, Relative, internal or absolute URL
type	Σ	0..1	uri	Type the reference refers to (e.g. "Patient") Binding: ResourceType (extensible)
identifier	Σ	0..1	Identifier	Logical reference, when literal reference is not known
display	Σ	0..1	string	Text alternative for the resource
requestor		0..1	Reference(Practitioner | PractitionerRole | Organization)	Party responsible for the claim
id		0..1	id	Unique id for inter-element referencing
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url Constraints: ext-1
extension:requestProvider		0..1	Reference(Resource)	STU3: Responsible practitioner additional types URL: http://hl7.org/fhir/StructureDefinition/alternate-reference Constraints: ext-1
extension:requestOrganization		0..1	Reference(Resource)	STU3: Responsible organization additional types URL: http://hl7.org/fhir/StructureDefinition/alternate-reference Constraints: ext-1
reference	ΣC	0..1	string	Literal reference, Relative, internal or absolute URL
type	Σ	0..1	uri	Type the reference refers to (e.g. "Patient") Binding: ResourceType (extensible)
identifier	Σ	0..1	Identifier	Logical reference, when literal reference is not known
display	Σ	0..1	string	Text alternative for the resource
request	Σ	0..1	Reference(Claim)	Id of resource triggering adjudication
id		0..1	id	Unique id for inter-element referencing
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url Constraints: ext-1
extension:request		0..1	Reference(Resource)	STU3: request additional types URL: http://hl7.org/fhir/StructureDefinition/alternate-reference Constraints: ext-1
reference	ΣC	0..1	string	Literal reference, Relative, internal or absolute URL
type	Σ	0..1	uri	Type the reference refers to (e.g. "Patient") Binding: ResourceType (extensible)
identifier	Σ	0..1	Identifier	Logical reference, when literal reference is not known
display	Σ	0..1	string	Text alternative for the resource
outcome	Σ	1..1	code	queued | complete | error | partial Binding: RemittanceOutcome (required): The result of the claim processing.
id		0..1	string	xml:id (or equivalent in JSON)
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url Constraints: ext-1
extension:outcome		0..1	CodeableConcept	STU3: complete | error | partial additional types URL: http://hl7.org/fhir/3.0/StructureDefinition/extension-ClaimResponse.outcome Binding: RemittanceOutcome (example): The result of the claim processing Constraints: ext-1
value		0..1	code	Primitive value for code
disposition		0..1	string	Disposition Message
preAuthRef		0..1	string	Preauthorization reference
preAuthPeriod		0..1	Period	Preauthorization reference effective period
payeeType		0..1	CodeableConcept	Party to be paid any benefits payable Binding: Claim Payee Type Codes (example): A code for the party to be reimbursed.
item		0..*	BackboneElement	Adjudication for claim line items
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Constraints: ext-1
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized Constraints: ext-1
itemSequence		1..1	positiveInt	Claim item instance identifier
noteNumber		0..*	positiveInt	Applicable note numbers
adjudication		1..*	BackboneElement	Adjudication details
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Constraints: ext-1
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized Constraints: ext-1
category		1..1	CodeableConcept	Type of adjudication information Binding: AdjudicationValueCodes (example): The adjudication codes.
reason		0..1	CodeableConcept	Explanation of adjudication outcome Binding: AdjudicationReasonCodes (example): The adjudication reason codes.
amount		0..1	Money	Monetary amount
value		0..1	decimal	Non-monetary value
detail		0..*	BackboneElement	Adjudication for claim details
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Constraints: ext-1
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized Constraints: ext-1
detailSequence		1..1	positiveInt	Claim detail instance identifier
noteNumber		0..*	positiveInt	Applicable note numbers
adjudication		1..*	See adjudication (ClaimResponse)	Detail level adjudication details
subDetail		0..*	BackboneElement	Adjudication for claim sub-details
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Constraints: ext-1
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized Constraints: ext-1
subDetailSequence		1..1	positiveInt	Claim sub-detail instance identifier
noteNumber		0..*	positiveInt	Applicable note numbers
adjudication		0..*	See adjudication (ClaimResponse)	Subdetail level adjudication details
addItem		0..*	BackboneElement	Insurer added line items
id		0..1	string	Unique id for inter-element referencing
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url Constraints: ext-1
extension:revenue		0..1	CodeableConcept	STU3: Revenue or cost center code (new) URL: http://hl7.org/fhir/3.0/StructureDefinition/extension-ClaimResponse.addItem.revenue Binding: ExampleRevenueCenterCodes (example): Codes for the revenue or cost centers supplying the service and/or products. Constraints: ext-1
extension:category		0..1	CodeableConcept	STU3: Type of service or product (new) URL: http://hl7.org/fhir/3.0/StructureDefinition/extension-ClaimResponse.addItem.category Binding: R3BenefitSubcategoryForR4B (0.1.0) (example): Benefit subcategories such as: oral-basic, major, glasses Constraints: ext-1
extension:fee		0..1	Money	STU3: Professional fee or Product charge (new) URL: http://hl7.org/fhir/3.0/StructureDefinition/extension-ClaimResponse.addItem.fee Constraints: ext-1
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized Constraints: ext-1
itemSequence		0..*	positiveInt	Item sequence number
detailSequence		0..*	positiveInt	Detail sequence number
subdetailSequence		0..*	positiveInt	Subdetail sequence number
provider		0..*	Reference(Practitioner | PractitionerRole | Organization)	Authorized providers
productOrService		1..1	CodeableConcept	Billing, service, product, or drug code Binding: USCLSCodes (example): Allowable service and product codes.
modifier		0..*	CodeableConcept	Service/Product billing modifiers Binding: ModifierTypeCodes (example): Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen.
programCode		0..*	CodeableConcept	Program the product or service is provided under Binding: ExampleProgramReasonCodes (example): Program specific reason codes.
serviced[x]		0..1		Date or dates of service or product delivery
servicedDate			date
servicedPeriod			Period
location[x]		0..1		Place of service or where product was supplied Binding: ExampleServicePlaceCodes (example): Place of service: pharmacy, school, prison, etc.
locationCodeableConcept			CodeableConcept
locationAddress			Address
locationReference			Reference(Location)
quantity		0..1	SimpleQuantity(4.3.0)	Count of products or services
unitPrice		0..1	Money	Fee, charge or cost per item
factor		0..1	decimal	Price scaling factor
net		0..1	Money	Total item cost
bodySite		0..1	CodeableConcept	Anatomical location Binding: OralSiteCodes (example): The code for the teeth, quadrant, sextant and arch.
subSite		0..*	CodeableConcept	Anatomical sub-location Binding: SurfaceCodes (example): The code for the tooth surface and surface combinations.
noteNumber		0..*	positiveInt	Applicable note numbers
adjudication		1..*	See adjudication (ClaimResponse)	Added items adjudication
detail		0..*	BackboneElement	Insurer added line details
id		0..1	string	Unique id for inter-element referencing
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url Constraints: ext-1
extension:revenue		0..1	CodeableConcept	STU3: Revenue or cost center code (new) URL: http://hl7.org/fhir/3.0/StructureDefinition/extension-ClaimResponse.addItem.detail.revenue Binding: ExampleRevenueCenterCodes (example): Codes for the revenue or cost centers supplying the service and/or products. Constraints: ext-1
extension:category		0..1	CodeableConcept	STU3: Type of service or product (new) URL: http://hl7.org/fhir/3.0/StructureDefinition/extension-ClaimResponse.addItem.detail.category Binding: R3BenefitSubcategoryForR4B (0.1.0) (example): Benefit subcategories such as: oral-basic, major, glasses Constraints: ext-1
extension:fee		0..1	Money	STU3: Professional fee or Product charge (new) URL: http://hl7.org/fhir/3.0/StructureDefinition/extension-ClaimResponse.addItem.detail.fee Constraints: ext-1
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized Constraints: ext-1
productOrService		1..1	CodeableConcept	Billing, service, product, or drug code Binding: USCLSCodes (example): Allowable service and product codes.
modifier		0..*	CodeableConcept	Service/Product billing modifiers Binding: ModifierTypeCodes (example): Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen.
quantity		0..1	SimpleQuantity(4.3.0)	Count of products or services
unitPrice		0..1	Money	Fee, charge or cost per item
factor		0..1	decimal	Price scaling factor
net		0..1	Money	Total item cost
noteNumber		0..*	positiveInt	Applicable note numbers
adjudication		1..*	See adjudication (ClaimResponse)	Added items detail adjudication
subDetail		0..*	BackboneElement	Insurer added line items
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Constraints: ext-1
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized Constraints: ext-1
productOrService		1..1	CodeableConcept	Billing, service, product, or drug code Binding: USCLSCodes (example): Allowable service and product codes.
modifier		0..*	CodeableConcept	Service/Product billing modifiers Binding: ModifierTypeCodes (example): Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen.
quantity		0..1	SimpleQuantity(4.3.0)	Count of products or services
unitPrice		0..1	Money	Fee, charge or cost per item
factor		0..1	decimal	Price scaling factor
net		0..1	Money	Total item cost
noteNumber		0..*	positiveInt	Applicable note numbers
adjudication		1..*	See adjudication (ClaimResponse)	Added items detail adjudication
adjudication		0..*	See adjudication (ClaimResponse)	Header-level adjudication
total	Σ	0..*	BackboneElement	Adjudication totals
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Constraints: ext-1
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized Constraints: ext-1
category	Σ	1..1	CodeableConcept	Type of adjudication information Binding: AdjudicationValueCodes (example): The adjudication codes.
amount	Σ	1..1	Money	Financial total for the category
payment		0..1	BackboneElement	Payment Details
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Constraints: ext-1
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized Constraints: ext-1
type		1..1	CodeableConcept	Partial or complete payment Binding: ExamplePaymentTypeCodes (example): The type (partial, complete) of the payment.
adjustment		0..1	Money	Payment adjustment for non-claim issues
adjustmentReason		0..1	CodeableConcept	Explanation for the adjustment Binding: PaymentAdjustmentReasonCodes (example): Payment Adjustment reason codes.
date		0..1	date	Expected date of payment
amount		1..1	Money	Payable amount after adjustment
identifier		0..1	Identifier	Business identifier for the payment
id		0..1	id	Unique id for inter-element referencing
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url Constraints: ext-1
extension:identifier		0..1	Identifier	STU3: Identifier of the payment instrument additional types URL: http://hl7.org/fhir/3.0/StructureDefinition/extension-ClaimResponse.payment.identifier Constraints: ext-1
use	?!Σ	0..1	code	usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required)
type	Σ	0..1	CodeableConcept	Description of identifier Binding: Identifier Type Codes (extensible)
system	Σ	0..1	uri	The namespace for the identifier value Example General: http://www.acme.com/identifiers/patient
value	Σ	0..1	string	The value that is unique Example General: 123456
period	Σ	0..1	Period	Time period when id is/was valid for use
assigner	Σ	0..1	Reference(Organization)	Organization that issued id (may be just text)
fundsReserve		0..1	CodeableConcept	Funds reserved status Binding: Funds Reservation Codes (example): For whom funds are to be reserved: (Patient, Provider, None).
formCode		0..1	CodeableConcept	Printed form identifier Binding: Form Codes (example): The forms codes.
form		0..1	Attachment	Printed reference or actual form
processNote		0..*	BackboneElement	Note concerning adjudication
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Constraints: ext-1
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized Constraints: ext-1
number		0..1	positiveInt	Note instance identifier
type		0..1	code	display | print | printoper Binding: NoteType (required): The presentation types of notes.
id		0..1	string	xml:id (or equivalent in JSON)
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url Constraints: ext-1
extension:type		0..1	CodeableConcept	STU3: type additional types URL: http://hl7.org/fhir/3.0/StructureDefinition/extension-ClaimResponse.processNote.type Binding: NoteType (required): The presentation types of notes. Constraints: ext-1
value		0..1	code	Primitive value for code
text		1..1	string	Note explanatory text
language		0..1	CodeableConcept	Language of the text Binding: CommonLanguages (preferred): IETF language tag Additional Bindings Purpose AllLanguages Max Binding
communicationRequest		0..*	Reference(CommunicationRequest)	Request for additional information
id		0..1	id	Unique id for inter-element referencing
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url Constraints: ext-1
extension:communicationRequest		0..1	Reference(Resource)	STU3: communicationRequest additional types URL: http://hl7.org/fhir/StructureDefinition/alternate-reference Constraints: ext-1
reference	ΣC	0..1	string	Literal reference, Relative, internal or absolute URL
type	Σ	0..1	uri	Type the reference refers to (e.g. "Patient") Binding: ResourceType (extensible)
identifier	Σ	0..1	Identifier	Logical reference, when literal reference is not known
display	Σ	0..1	string	Text alternative for the resource
insurance		0..*	BackboneElement	Patient insurance information
id		0..1	string	Unique id for inter-element referencing
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url Constraints: ext-1
extension:preAuthRef		0..*	string	STU3: Pre-Authorization/Determination Reference (new) URL: http://hl7.org/fhir/3.0/StructureDefinition/extension-ClaimResponse.insurance.preAuthRef Constraints: ext-1
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized Constraints: ext-1
sequence		1..1	positiveInt	Insurance instance identifier
focal		1..1	boolean	Coverage to be used for adjudication
coverage		1..1	Reference(Coverage)	Insurance information
id		0..1	id	Unique id for inter-element referencing
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url Constraints: ext-1
extension:coverage		0..1	Reference(Resource)	STU3: coverage additional types URL: http://hl7.org/fhir/StructureDefinition/alternate-reference Constraints: ext-1
reference	ΣC	0..1	string	Literal reference, Relative, internal or absolute URL
type	Σ	0..1	uri	Type the reference refers to (e.g. "Patient") Binding: ResourceType (extensible)
identifier	Σ	0..1	Identifier	Logical reference, when literal reference is not known
display	Σ	0..1	string	Text alternative for the resource
businessArrangement		0..1	string	Additional provider contract number
claimResponse		0..1	Reference(ClaimResponse)	Adjudication results
id		0..1	id	Unique id for inter-element referencing
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url Constraints: ext-1
extension:claimResponse		0..1	Reference(Resource)	STU3: claimResponse additional types URL: http://hl7.org/fhir/StructureDefinition/alternate-reference Constraints: ext-1
reference	ΣC	0..1	string	Literal reference, Relative, internal or absolute URL
type	Σ	0..1	uri	Type the reference refers to (e.g. "Patient") Binding: ResourceType (extensible)
identifier	Σ	0..1	Identifier	Logical reference, when literal reference is not known
display	Σ	0..1	string	Text alternative for the resource
error		0..*	BackboneElement	Processing errors
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Constraints: ext-1
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized Constraints: ext-1
itemSequence		0..1	positiveInt	Item sequence number
detailSequence		0..1	positiveInt	Detail sequence number
subDetailSequence		0..1	positiveInt	Subdetail sequence number
code		1..1	CodeableConcept	Error code detailing processing issues Binding: Adjudication Error Codes (example): The adjudication error codes.
Documentation for this format

Terminology Bindings

Path	Status	Usage	ValueSet	Version	Source
ClaimResponse.meta.security	Base	extensible	SecurityLabels	📍4.3.0	FHIR Std.
ClaimResponse.meta.tag	Base	example	Common Tags	📍4.3.0	FHIR Std.
ClaimResponse.language	Base	preferred	Common Languages	📍4.3.0	FHIR Std.
ClaimResponse.text.status	Base	required	NarrativeStatus	📍4.3.0	FHIR Std.
ClaimResponse.identifier.​use	Base	required	IdentifierUse	📍4.3.0	FHIR Std.
ClaimResponse.identifier.​type	Base	extensible	IdentifierType	📍4.3.0	FHIR Std.
ClaimResponse.status	Base	required	Financial Resource Status Codes	📍4.3.0	FHIR Std.
ClaimResponse.type	Base	extensible	Claim Type Codes	📍4.3.0	FHIR Std.
ClaimResponse.subType	Base	example	Example Claim SubType Codes	📍4.3.0	FHIR Std.
ClaimResponse.use	Base	required	Use	📍4.3.0	FHIR Std.
ClaimResponse.patient.​type	Base	extensible	ResourceType	📍4.3.0	FHIR Std.
ClaimResponse.insurer.​type	Base	extensible	ResourceType	📍4.3.0	FHIR Std.
ClaimResponse.requestor.​type	Base	extensible	ResourceType	📍4.3.0	FHIR Std.
ClaimResponse.request.​type	Base	extensible	ResourceType	📍4.3.0	FHIR Std.
ClaimResponse.outcome	Base	required	RemittanceOutcome	📍4.3.0	FHIR Std.
ClaimResponse.payeeType	Base	example	PayeeType	📍4.3.0	FHIR Std.
ClaimResponse.item.adjudication.​category	Base	example	Adjudication Value Codes	📍4.3.0	FHIR Std.
ClaimResponse.item.adjudication.​reason	Base	example	Adjudication Reason Codes	📍4.3.0	FHIR Std.
ClaimResponse.addItem.​productOrService	Base	example	USCLS Codes	📍4.3.0	FHIR Std.
ClaimResponse.addItem.​modifier	Base	example	Modifier type Codes	📍4.3.0	FHIR Std.
ClaimResponse.addItem.​programCode	Base	example	Example Program Reason Codes	📍4.3.0	FHIR Std.
ClaimResponse.addItem.​location[x]	Base	example	Example Service Place Codes	📍4.3.0	FHIR Std.
ClaimResponse.addItem.​bodySite	Base	example	Oral Site Codes	📍4.3.0	FHIR Std.
ClaimResponse.addItem.​subSite	Base	example	Surface Codes	📍4.3.0	FHIR Std.
ClaimResponse.addItem.​detail.productOrService	Base	example	USCLS Codes	📍4.3.0	FHIR Std.
ClaimResponse.addItem.​detail.modifier	Base	example	Modifier type Codes	📍4.3.0	FHIR Std.
ClaimResponse.addItem.​detail.subDetail.productOrService	Base	example	USCLS Codes	📍4.3.0	FHIR Std.
ClaimResponse.addItem.​detail.subDetail.modifier	Base	example	Modifier type Codes	📍4.3.0	FHIR Std.
ClaimResponse.total.​category	Base	example	Adjudication Value Codes	📍4.3.0	FHIR Std.
ClaimResponse.payment.​type	Base	example	Example Payment Type Codes	📍4.3.0	FHIR Std.
ClaimResponse.payment.​adjustmentReason	Base	example	Payment Adjustment Reason Codes	📍4.3.0	FHIR Std.
ClaimResponse.payment.​identifier.use	Base	required	IdentifierUse	📍4.3.0	FHIR Std.
ClaimResponse.payment.​identifier.type	Base	extensible	IdentifierType	📍4.3.0	FHIR Std.
ClaimResponse.fundsReserve	Base	example	FundsReserve	📍4.3.0	FHIR Std.
ClaimResponse.formCode	Base	example	Forms	📍4.3.0	FHIR Std.
ClaimResponse.processNote.​type	Base	required	NoteType	📍4.3.0	FHIR Std.
ClaimResponse.processNote.​language	Base	preferred	Common Languages	📍4.3.0	FHIR Std.
ClaimResponse.communicationRequest.​type	Base	extensible	ResourceType	📍4.3.0	FHIR Std.
ClaimResponse.insurance.​coverage.type	Base	extensible	ResourceType	📍4.3.0	FHIR Std.
ClaimResponse.insurance.​claimResponse.type	Base	extensible	ResourceType	📍4.3.0	FHIR Std.
ClaimResponse.error.​code	Base	example	AdjudicationError	📍4.3.0	FHIR Std.

Constraints

Id	Grade	Path(s)	Description	Expression
dom-2	error	ClaimResponse	If the resource is contained in another resource, it SHALL NOT contain nested Resources	contained.contained.empty()
dom-3	error	ClaimResponse	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	contained.where(((id.exists() and ('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url)))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(uri) = '#').exists()).not()).trace('unmatched', id).empty()
dom-4	error	ClaimResponse	If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated	contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
dom-5	error	ClaimResponse	If a resource is contained in another resource, it SHALL NOT have a security label	contained.meta.security.empty()
dom-6	best practice	ClaimResponse	A resource should have narrative for robust management	text.`div`.exists()
dom-r4b	warning	ClaimResponse.contained	Containing new R4B resources within R4 resources may cause interoperability issues if instances are shared with R4 systems	($this is Citation or $this is Evidence or $this is EvidenceReport or $this is EvidenceVariable or $this is MedicinalProductDefinition or $this is PackagedProductDefinition or $this is AdministrableProductDefinition or $this is Ingredient or $this is ClinicalUseDefinition or $this is RegulatedAuthorization or $this is SubstanceDefinition or $this is SubscriptionStatus or $this is SubscriptionTopic) implies (%resource is Citation or %resource is Evidence or %resource is EvidenceReport or %resource is EvidenceVariable or %resource is MedicinalProductDefinition or %resource is PackagedProductDefinition or %resource is AdministrableProductDefinition or %resource is Ingredient or %resource is ClinicalUseDefinition or %resource is RegulatedAuthorization or %resource is SubstanceDefinition or %resource is SubscriptionStatus or %resource is SubscriptionTopic)
ele-1	error	ClaimResponse.meta, ClaimResponse.meta.extension, ClaimResponse.meta.extension:meta, ClaimResponse.meta.versionId, ClaimResponse.meta.lastUpdated, ClaimResponse.meta.source, ClaimResponse.meta.profile, ClaimResponse.meta.security, ClaimResponse.meta.tag, ClaimResponse.implicitRules, ClaimResponse.language, ClaimResponse.text, ClaimResponse.text.extension, ClaimResponse.text.extension:text, ClaimResponse.text.status, ClaimResponse.text.div, ClaimResponse.extension, ClaimResponse.extension:unallocDeductable, ClaimResponse.modifierExtension, ClaimResponse.identifier, ClaimResponse.identifier.extension, ClaimResponse.identifier.extension:identifier, ClaimResponse.identifier.use, ClaimResponse.identifier.type, ClaimResponse.identifier.system, ClaimResponse.identifier.value, ClaimResponse.identifier.period, ClaimResponse.identifier.assigner, ClaimResponse.status, ClaimResponse.type, ClaimResponse.subType, ClaimResponse.use, ClaimResponse.patient, ClaimResponse.patient.extension, ClaimResponse.patient.extension:patient, ClaimResponse.patient.reference, ClaimResponse.patient.type, ClaimResponse.patient.identifier, ClaimResponse.patient.display, ClaimResponse.created, ClaimResponse.insurer, ClaimResponse.insurer.extension, ClaimResponse.insurer.extension:insurer, ClaimResponse.insurer.reference, ClaimResponse.insurer.type, ClaimResponse.insurer.identifier, ClaimResponse.insurer.display, ClaimResponse.requestor, ClaimResponse.requestor.extension, ClaimResponse.requestor.extension:requestProvider, ClaimResponse.requestor.extension:requestOrganization, ClaimResponse.requestor.reference, ClaimResponse.requestor.type, ClaimResponse.requestor.identifier, ClaimResponse.requestor.display, ClaimResponse.request, ClaimResponse.request.extension, ClaimResponse.request.extension:request, ClaimResponse.request.reference, ClaimResponse.request.type, ClaimResponse.request.identifier, ClaimResponse.request.display, ClaimResponse.outcome, ClaimResponse.outcome.extension, ClaimResponse.outcome.extension:outcome, ClaimResponse.disposition, ClaimResponse.preAuthRef, ClaimResponse.preAuthPeriod, ClaimResponse.payeeType, ClaimResponse.item, ClaimResponse.item.extension, ClaimResponse.item.modifierExtension, ClaimResponse.item.itemSequence, ClaimResponse.item.noteNumber, ClaimResponse.item.adjudication, ClaimResponse.item.adjudication.extension, ClaimResponse.item.adjudication.modifierExtension, ClaimResponse.item.adjudication.category, ClaimResponse.item.adjudication.reason, ClaimResponse.item.adjudication.amount, ClaimResponse.item.adjudication.value, ClaimResponse.item.detail, ClaimResponse.item.detail.extension, ClaimResponse.item.detail.modifierExtension, ClaimResponse.item.detail.detailSequence, ClaimResponse.item.detail.noteNumber, ClaimResponse.item.detail.adjudication, ClaimResponse.item.detail.subDetail, ClaimResponse.item.detail.subDetail.extension, ClaimResponse.item.detail.subDetail.modifierExtension, ClaimResponse.item.detail.subDetail.subDetailSequence, ClaimResponse.item.detail.subDetail.noteNumber, ClaimResponse.item.detail.subDetail.adjudication, ClaimResponse.addItem, ClaimResponse.addItem.extension, ClaimResponse.addItem.extension:revenue, ClaimResponse.addItem.extension:category, ClaimResponse.addItem.extension:fee, ClaimResponse.addItem.modifierExtension, ClaimResponse.addItem.itemSequence, ClaimResponse.addItem.detailSequence, ClaimResponse.addItem.subdetailSequence, ClaimResponse.addItem.provider, ClaimResponse.addItem.productOrService, ClaimResponse.addItem.modifier, ClaimResponse.addItem.programCode, ClaimResponse.addItem.serviced[x], ClaimResponse.addItem.location[x], ClaimResponse.addItem.quantity, ClaimResponse.addItem.unitPrice, ClaimResponse.addItem.factor, ClaimResponse.addItem.net, ClaimResponse.addItem.bodySite, ClaimResponse.addItem.subSite, ClaimResponse.addItem.noteNumber, ClaimResponse.addItem.adjudication, ClaimResponse.addItem.detail, ClaimResponse.addItem.detail.extension, ClaimResponse.addItem.detail.extension:revenue, ClaimResponse.addItem.detail.extension:category, ClaimResponse.addItem.detail.extension:fee, ClaimResponse.addItem.detail.modifierExtension, ClaimResponse.addItem.detail.productOrService, ClaimResponse.addItem.detail.modifier, ClaimResponse.addItem.detail.quantity, ClaimResponse.addItem.detail.unitPrice, ClaimResponse.addItem.detail.factor, ClaimResponse.addItem.detail.net, ClaimResponse.addItem.detail.noteNumber, ClaimResponse.addItem.detail.adjudication, ClaimResponse.addItem.detail.subDetail, ClaimResponse.addItem.detail.subDetail.extension, ClaimResponse.addItem.detail.subDetail.modifierExtension, ClaimResponse.addItem.detail.subDetail.productOrService, ClaimResponse.addItem.detail.subDetail.modifier, ClaimResponse.addItem.detail.subDetail.quantity, ClaimResponse.addItem.detail.subDetail.unitPrice, ClaimResponse.addItem.detail.subDetail.factor, ClaimResponse.addItem.detail.subDetail.net, ClaimResponse.addItem.detail.subDetail.noteNumber, ClaimResponse.addItem.detail.subDetail.adjudication, ClaimResponse.adjudication, ClaimResponse.total, ClaimResponse.total.extension, ClaimResponse.total.modifierExtension, ClaimResponse.total.category, ClaimResponse.total.amount, ClaimResponse.payment, ClaimResponse.payment.extension, ClaimResponse.payment.modifierExtension, ClaimResponse.payment.type, ClaimResponse.payment.adjustment, ClaimResponse.payment.adjustmentReason, ClaimResponse.payment.date, ClaimResponse.payment.amount, ClaimResponse.payment.identifier, ClaimResponse.payment.identifier.extension, ClaimResponse.payment.identifier.extension:identifier, ClaimResponse.payment.identifier.use, ClaimResponse.payment.identifier.type, ClaimResponse.payment.identifier.system, ClaimResponse.payment.identifier.value, ClaimResponse.payment.identifier.period, ClaimResponse.payment.identifier.assigner, ClaimResponse.fundsReserve, ClaimResponse.formCode, ClaimResponse.form, ClaimResponse.processNote, ClaimResponse.processNote.extension, ClaimResponse.processNote.modifierExtension, ClaimResponse.processNote.number, ClaimResponse.processNote.type, ClaimResponse.processNote.type.extension, ClaimResponse.processNote.type.extension:type, ClaimResponse.processNote.text, ClaimResponse.processNote.language, ClaimResponse.communicationRequest, ClaimResponse.communicationRequest.extension, ClaimResponse.communicationRequest.extension:communicationRequest, ClaimResponse.communicationRequest.reference, ClaimResponse.communicationRequest.type, ClaimResponse.communicationRequest.identifier, ClaimResponse.communicationRequest.display, ClaimResponse.insurance, ClaimResponse.insurance.extension, ClaimResponse.insurance.extension:preAuthRef, ClaimResponse.insurance.modifierExtension, ClaimResponse.insurance.sequence, ClaimResponse.insurance.focal, ClaimResponse.insurance.coverage, ClaimResponse.insurance.coverage.extension, ClaimResponse.insurance.coverage.extension:coverage, ClaimResponse.insurance.coverage.reference, ClaimResponse.insurance.coverage.type, ClaimResponse.insurance.coverage.identifier, ClaimResponse.insurance.coverage.display, ClaimResponse.insurance.businessArrangement, ClaimResponse.insurance.claimResponse, ClaimResponse.insurance.claimResponse.extension, ClaimResponse.insurance.claimResponse.extension:claimResponse, ClaimResponse.insurance.claimResponse.reference, ClaimResponse.insurance.claimResponse.type, ClaimResponse.insurance.claimResponse.identifier, ClaimResponse.insurance.claimResponse.display, ClaimResponse.error, ClaimResponse.error.extension, ClaimResponse.error.modifierExtension, ClaimResponse.error.itemSequence, ClaimResponse.error.detailSequence, ClaimResponse.error.subDetailSequence, ClaimResponse.error.code	All FHIR elements must have a @value or children	hasValue() or (children().count() > id.count())
ext-1	error	ClaimResponse.meta.extension, ClaimResponse.meta.extension:meta, ClaimResponse.text.extension, ClaimResponse.text.extension:text, ClaimResponse.extension, ClaimResponse.extension:unallocDeductable, ClaimResponse.modifierExtension, ClaimResponse.identifier.extension, ClaimResponse.identifier.extension:identifier, ClaimResponse.patient.extension, ClaimResponse.patient.extension:patient, ClaimResponse.insurer.extension, ClaimResponse.insurer.extension:insurer, ClaimResponse.requestor.extension, ClaimResponse.requestor.extension:requestProvider, ClaimResponse.requestor.extension:requestOrganization, ClaimResponse.request.extension, ClaimResponse.request.extension:request, ClaimResponse.outcome.extension, ClaimResponse.outcome.extension:outcome, ClaimResponse.item.extension, ClaimResponse.item.modifierExtension, ClaimResponse.item.adjudication.extension, ClaimResponse.item.adjudication.modifierExtension, ClaimResponse.item.detail.extension, ClaimResponse.item.detail.modifierExtension, ClaimResponse.item.detail.subDetail.extension, ClaimResponse.item.detail.subDetail.modifierExtension, ClaimResponse.addItem.extension, ClaimResponse.addItem.extension:revenue, ClaimResponse.addItem.extension:category, ClaimResponse.addItem.extension:fee, ClaimResponse.addItem.modifierExtension, ClaimResponse.addItem.detail.extension, ClaimResponse.addItem.detail.extension:revenue, ClaimResponse.addItem.detail.extension:category, ClaimResponse.addItem.detail.extension:fee, ClaimResponse.addItem.detail.modifierExtension, ClaimResponse.addItem.detail.subDetail.extension, ClaimResponse.addItem.detail.subDetail.modifierExtension, ClaimResponse.total.extension, ClaimResponse.total.modifierExtension, ClaimResponse.payment.extension, ClaimResponse.payment.modifierExtension, ClaimResponse.payment.identifier.extension, ClaimResponse.payment.identifier.extension:identifier, ClaimResponse.processNote.extension, ClaimResponse.processNote.modifierExtension, ClaimResponse.processNote.type.extension, ClaimResponse.processNote.type.extension:type, ClaimResponse.communicationRequest.extension, ClaimResponse.communicationRequest.extension:communicationRequest, ClaimResponse.insurance.extension, ClaimResponse.insurance.extension:preAuthRef, ClaimResponse.insurance.modifierExtension, ClaimResponse.insurance.coverage.extension, ClaimResponse.insurance.coverage.extension:coverage, ClaimResponse.insurance.claimResponse.extension, ClaimResponse.insurance.claimResponse.extension:claimResponse, ClaimResponse.error.extension, ClaimResponse.error.modifierExtension	Must have either extensions or value[x], not both	extension.exists() != value.exists()
txt-1	error	ClaimResponse.text.div	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, <a> elements (either name or href), images and internally contained style attributes	htmlChecks()
txt-2	error	ClaimResponse.text.div	The narrative SHALL have some non-whitespace content	htmlChecks()

This structure is derived from ClaimResponse

Summary

Extensions

This structure refers to these extensions:

• http://hl7.org/fhir/3.0/StructureDefinition/extension-ClaimResponse.meta|0.1.0
• http://hl7.org/fhir/3.0/StructureDefinition/extension-ClaimResponse.text|0.1.0
• http://hl7.org/fhir/3.0/StructureDefinition/extension-ClaimResponse.unallocDeductable|0.1.0
• http://hl7.org/fhir/3.0/StructureDefinition/extension-ClaimResponse.identifier|0.1.0
• http://hl7.org/fhir/StructureDefinition/alternate-reference|5.2.0
• http://hl7.org/fhir/3.0/StructureDefinition/extension-ClaimResponse.outcome|0.1.0
• http://hl7.org/fhir/3.0/StructureDefinition/extension-ClaimResponse.addItem.revenue|0.1.0
• http://hl7.org/fhir/3.0/StructureDefinition/extension-ClaimResponse.addItem.category|0.1.0
• http://hl7.org/fhir/3.0/StructureDefinition/extension-ClaimResponse.addItem.fee|0.1.0
• http://hl7.org/fhir/3.0/StructureDefinition/extension-ClaimResponse.addItem.detail.revenue|0.1.0
• http://hl7.org/fhir/3.0/StructureDefinition/extension-ClaimResponse.addItem.detail.category|0.1.0
• http://hl7.org/fhir/3.0/StructureDefinition/extension-ClaimResponse.addItem.detail.fee|0.1.0
• http://hl7.org/fhir/3.0/StructureDefinition/extension-ClaimResponse.payment.identifier|0.1.0
• http://hl7.org/fhir/3.0/StructureDefinition/extension-ClaimResponse.processNote.type|0.1.0
• http://hl7.org/fhir/3.0/StructureDefinition/extension-ClaimResponse.insurance.preAuthRef|0.1.0

Maturity: 0