Extensions for Using Data Elements from FHIR STU3 in FHIR R5 - Downloaded Version null See the Directory of published versions

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Resource Profile: Profile_R3_ClaimResponse_R5

This cross-version profile allows STU3 ClaimResponse content to be represented via FHIR R5 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
• Statistics/References
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Name	Flags	Card.	Type	Description & Constraints    Filter: Bindings Constraints Obligations
ClaimResponse		0..*	ClaimResponse(5.0.0)	Response to a claim predetermination or preauthorization
implicitRules	?!Σ	0..1	uri	A set of rules under which this content was created
contained		0..*	Resource	Contained, inline Resources
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	?!Σ	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
reference	ΣC	0..1	string	Literal reference, Relative, internal or absolute URL
created	Σ	1..1	dateTime	Response creation date
outcome	Σ	1..1	code	queued | complete | error | partial Binding: ClaimProcessingCodes (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: ClaimProcessingCodes (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	📍5.0.0	FHIR Std.
ClaimResponse.type	Base	extensible	Claim Type Codes	📍5.0.0	FHIR Std.
ClaimResponse.use	Base	required	Use	📍5.0.0	tx.fhir.org
ClaimResponse.outcome	Base	required	Claim Processing Codes	📍5.0.0	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 in (%resource.descendants().reference | %resource.descendants().ofType(canonical) | %resource.descendants().ofType(uri) | %resource.descendants().ofType(url))) or descendants().where(reference = '#').exists() or descendants().where(ofType(canonical) = '#').exists() or descendants().where(ofType(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
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.patient.reference, ClaimResponse.created, 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.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(5.0.0)	Response to a claim predetermination or preauthorization
meta
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
extension:meta		0..1	Meta	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: ClaimProcessingCodes (example): The result of the claim processing
item
adjudication
quantity
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
extension:value		0..1	decimal	STU3: value additional types URL: http://hl7.org/fhir/3.0/StructureDefinition/extension-ClaimResponse.item.adjudication.value
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: R3BenefitSubcategoryForR5 (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: R3BenefitSubcategoryForR5 (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: display | print | printoper 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(5.0.0)	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	Meta	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: AllSecurityLabels (extensible): Security Labels from the Healthcare Privacy and Security Classification System.
tag	Σ	0..*	Coding	Tags applied to this resource Binding: CommonTags (example): Codes that represent various types of tags, commonly workflow-related; e.g. "Needs review by Dr. Jones".
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: AllLanguages (required): IETF language tag for a human language Additional Bindings Purpose CommonLanguages Starter
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): The status of a resource narrative.
div	C	1..1	xhtml	Limited xhtml content Constraints: txt-1, txt-2
contained		0..*	Resource	Contained, inline Resources
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	?!Σ	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): Identifies the purpose for this identifier, if known .
type	Σ	0..1	CodeableConcept	Description of identifier Binding: IdentifierTypeCodes (extensible): A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.
system	Σ	0..1	uri	The namespace for the identifier value Example General: http://www.acme.com/identifiers/patient
value	ΣC	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)
traceNumber		0..*	Identifier	Number for tracking
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") - must be a resource in resources Binding: ResourceType (extensible): Aa resource (or, for logical models, the URI of the logical model).
identifier	ΣC	0..1	Identifier	Logical reference, when literal reference is not known
display	ΣC	0..1	string	Text alternative for the resource
created	Σ	1..1	dateTime	Response creation date
insurer	Σ	0..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") - must be a resource in resources Binding: ResourceType (extensible): Aa resource (or, for logical models, the URI of the logical model).
identifier	ΣC	0..1	Identifier	Logical reference, when literal reference is not known
display	ΣC	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") - must be a resource in resources Binding: ResourceType (extensible): Aa resource (or, for logical models, the URI of the logical model).
identifier	ΣC	0..1	Identifier	Logical reference, when literal reference is not known
display	ΣC	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") - must be a resource in resources Binding: ResourceType (extensible): Aa resource (or, for logical models, the URI of the logical model).
identifier	ΣC	0..1	Identifier	Logical reference, when literal reference is not known
display	ΣC	0..1	string	Text alternative for the resource
outcome	Σ	1..1	code	queued | complete | error | partial Binding: ClaimProcessingCodes (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: ClaimProcessingCodes (example): The result of the claim processing Constraints: ext-1
value		0..1	code	Primitive value for code
decision	Σ	0..1	CodeableConcept	Result of the adjudication Binding: ClaimAdjudicationDecisionsCodes (example): The overall result of the claim adjudication.
disposition		0..1	string	Disposition Message
preAuthRef		0..1	string	Preauthorization reference
preAuthPeriod		0..1	Period	Preauthorization reference effective period
event		0..*	BackboneElement	Event information
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	Specific event Binding: DatesTypeCodes (example)
when[x]		1..1		Occurance date or period
whenDateTime			dateTime
whenPeriod			Period
payeeType		0..1	CodeableConcept	Party to be paid any benefits payable Binding: ClaimPayeeTypeCodes (example): A code for the party to be reimbursed.
encounter		0..*	Reference(Encounter)	Encounters associated with the listed treatments
diagnosisRelatedGroup		0..1	CodeableConcept	Package billing code Binding: ExampleDiagnosisRelatedGroupCodes (example)
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
traceNumber		0..*	Identifier	Number for tracking
noteNumber		0..*	positiveInt	Applicable note numbers
reviewOutcome		0..1	BackboneElement	Adjudication results
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
decision		0..1	CodeableConcept	Result of the adjudication Binding: ClaimAdjudicationDecisionsCodes (example)
reason		0..*	CodeableConcept	Reason for result of the adjudication Binding: ClaimAdjudicationDecisionReasonCodes (example)
preAuthRef		0..1	string	Preauthorization reference
preAuthPeriod		0..1	Period	Preauthorization reference effective period
adjudication		0..*	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
quantity		0..1	Quantity	Non-monetary value
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:value		0..1	decimal	STU3: value additional types URL: http://hl7.org/fhir/3.0/StructureDefinition/extension-ClaimResponse.item.adjudication.value Constraints: ext-1
value	Σ	0..1	decimal	Numerical value (with implicit precision)
comparator	?!Σ	0..1	code	< | <= | >= | > | ad - how to understand the value Binding: QuantityComparator (required): How the Quantity should be understood and represented.
unit	Σ	0..1	string	Unit representation
system	ΣC	0..1	uri	System that defines coded unit form
code	ΣC	0..1	code	Coded form of the unit
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
traceNumber		0..*	Identifier	Number for tracking
noteNumber		0..*	positiveInt	Applicable note numbers
reviewOutcome		0..1	See reviewOutcome (ClaimResponse)	Detail level adjudication results
adjudication		0..*	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
traceNumber		0..*	Identifier	Number for tracking
noteNumber		0..*	positiveInt	Applicable note numbers
reviewOutcome		0..1	See reviewOutcome (ClaimResponse)	Subdetail level adjudication results
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: R3BenefitSubcategoryForR5 (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
traceNumber		0..*	Identifier	Number for tracking
provider		0..*	Reference(Practitioner | PractitionerRole | Organization)	Authorized providers
revenue		0..1	CodeableConcept	Revenue or cost center code Binding: ExampleRevenueCenterCodes (example): Codes for the revenue or cost centers supplying the service and/or products.
productOrService		0..1	CodeableConcept	Billing, service, product, or drug code Binding: USCLSCodes (example): Allowable service and product codes.
productOrServiceEnd		0..1	CodeableConcept	End of a range of codes Binding: USCLSCodes (example)
request		0..*	Reference(DeviceRequest | MedicationRequest | NutritionOrder | ServiceRequest | SupplyRequest | VisionPrescription)	Request or Referral for Service
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(5.0.0)	Count of products or services
unitPrice		0..1	Money	Fee, charge or cost per item
factor		0..1	decimal	Price scaling factor
tax		0..1	Money	Total tax
net		0..1	Money	Total item cost
bodySite		0..*	BackboneElement	Anatomical location
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
site		1..*	CodeableReference(BodyStructure)	Location Binding: OralSiteCodes (example)
subSite		0..*	CodeableConcept	Sub-location Binding: SurfaceCodes (example)
noteNumber		0..*	positiveInt	Applicable note numbers
reviewOutcome		0..1	See reviewOutcome (ClaimResponse)	Added items adjudication results
adjudication		0..*	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: R3BenefitSubcategoryForR5 (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
traceNumber		0..*	Identifier	Number for tracking
revenue		0..1	CodeableConcept	Revenue or cost center code Binding: ExampleRevenueCenterCodes (example): Codes for the revenue or cost centers supplying the service and/or products.
productOrService		0..1	CodeableConcept	Billing, service, product, or drug code Binding: USCLSCodes (example): Allowable service and product codes.
productOrServiceEnd		0..1	CodeableConcept	End of a range of codes Binding: USCLSCodes (example)
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(5.0.0)	Count of products or services
unitPrice		0..1	Money	Fee, charge or cost per item
factor		0..1	decimal	Price scaling factor
tax		0..1	Money	Total tax
net		0..1	Money	Total item cost
noteNumber		0..*	positiveInt	Applicable note numbers
reviewOutcome		0..1	See reviewOutcome (ClaimResponse)	Added items detail level adjudication results
adjudication		0..*	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
traceNumber		0..*	Identifier	Number for tracking
revenue		0..1	CodeableConcept	Revenue or cost center code Binding: ExampleRevenueCenterCodes (example): Codes for the revenue or cost centers supplying the service and/or products.
productOrService		0..1	CodeableConcept	Billing, service, product, or drug code Binding: USCLSCodes (example): Allowable service and product codes.
productOrServiceEnd		0..1	CodeableConcept	End of a range of codes Binding: USCLSCodes (example)
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(5.0.0)	Count of products or services
unitPrice		0..1	Money	Fee, charge or cost per item
factor		0..1	decimal	Price scaling factor
tax		0..1	Money	Total tax
net		0..1	Money	Total item cost
noteNumber		0..*	positiveInt	Applicable note numbers
reviewOutcome		0..1	See reviewOutcome (ClaimResponse)	Added items subdetail level adjudication results
adjudication		0..*	See adjudication (ClaimResponse)	Added items subdetail 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): Identifies the purpose for this identifier, if known .
type	Σ	0..1	CodeableConcept	Description of identifier Binding: IdentifierTypeCodes (extensible): A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.
system	Σ	0..1	uri	The namespace for the identifier value Example General: http://www.acme.com/identifiers/patient
value	ΣC	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: FundsReservationCodes (example): For whom funds are to be reserved: (Patient, Provider, None).
formCode		0..1	CodeableConcept	Printed form identifier Binding: FormCodes (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	CodeableConcept	Note purpose Binding: NoteType (extensible): The presentation types of notes.
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:type		0..1	CodeableConcept	STU3: display | print | printoper URL: http://hl7.org/fhir/3.0/StructureDefinition/extension-ClaimResponse.processNote.type Binding: NoteType (required): The presentation types of notes. Constraints: ext-1
coding	Σ	0..*	Coding	Code defined by a terminology system
text	Σ	0..1	string	Plain text representation of the concept
text		1..1	string	Note explanatory text
language		0..1	CodeableConcept	Language of the text Binding: AllLanguages (required): IETF language tag for a human language Additional Bindings Purpose CommonLanguages Starter
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") - must be a resource in resources Binding: ResourceType (extensible): Aa resource (or, for logical models, the URI of the logical model).
identifier	ΣC	0..1	Identifier	Logical reference, when literal reference is not known
display	ΣC	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") - must be a resource in resources Binding: ResourceType (extensible): Aa resource (or, for logical models, the URI of the logical model).
identifier	ΣC	0..1	Identifier	Logical reference, when literal reference is not known
display	ΣC	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") - must be a resource in resources Binding: ResourceType (extensible): Aa resource (or, for logical models, the URI of the logical model).
identifier	ΣC	0..1	Identifier	Logical reference, when literal reference is not known
display	ΣC	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	Σ	1..1	CodeableConcept	Error code detailing processing issues Binding: AdjudicationErrorCodes (example): The adjudication error codes.
expression	Σ	0..*	string	FHIRPath of element(s) related to issue
Documentation for this format

Terminology Bindings

Path	Status	Usage	ValueSet	Version	Source
ClaimResponse.meta.security	Base	extensible	All Security Labels	📍5.0.0	tx.fhir.org
ClaimResponse.meta.tag	Base	example	Common Tags	📍5.0.0	FHIR Std.
ClaimResponse.language	Base	required	All Languages	📍5.0.0	FHIR Std.
ClaimResponse.text.status	Base	required	NarrativeStatus	📍5.0.0	FHIR Std.
ClaimResponse.identifier.​use	Base	required	IdentifierUse	📍5.0.0	FHIR Std.
ClaimResponse.identifier.​type	Base	extensible	Identifier Type Codes	📍5.0.0	FHIR Std.
ClaimResponse.status	Base	required	Financial Resource Status Codes	📍5.0.0	FHIR Std.
ClaimResponse.type	Base	extensible	Claim Type Codes	📍5.0.0	FHIR Std.
ClaimResponse.subType	Base	example	Example Claim SubType Codes	📍5.0.0	FHIR Std.
ClaimResponse.use	Base	required	Use	📍5.0.0	tx.fhir.org
ClaimResponse.patient.​type	Base	extensible	Resource Types	📍5.0.0	tx.fhir.org
ClaimResponse.insurer.​type	Base	extensible	Resource Types	📍5.0.0	tx.fhir.org
ClaimResponse.requestor.​type	Base	extensible	Resource Types	📍5.0.0	tx.fhir.org
ClaimResponse.request.​type	Base	extensible	Resource Types	📍5.0.0	tx.fhir.org
ClaimResponse.outcome	Base	required	Claim Processing Codes	📍5.0.0	FHIR Std.
ClaimResponse.decision	Base	example	Claim Adjudication Decision Codes	📍5.0.0	FHIR Std.
ClaimResponse.event.​type	Base	example	Dates Type Codes	📍5.0.0	FHIR Std.
ClaimResponse.payeeType	Base	example	Claim Payee Type Codes	📍5.0.0	FHIR Std.
ClaimResponse.diagnosisRelatedGroup	Base	example	Example Diagnosis Related Group Codes	📍5.0.0	FHIR Std.
ClaimResponse.item.reviewOutcome.​decision	Base	example	Claim Adjudication Decision Codes	📍5.0.0	FHIR Std.
ClaimResponse.item.reviewOutcome.​reason	Base	example	Claim Adjudication Decision Reason Codes	📍5.0.0	FHIR Std.
ClaimResponse.item.adjudication.​category	Base	example	Adjudication Value Codes	📍5.0.0	tx.fhir.org
ClaimResponse.item.adjudication.​reason	Base	example	Adjudication Reason Codes	📍5.0.0	FHIR Std.
ClaimResponse.item.adjudication.​quantity.comparator	Base	required	QuantityComparator	📍5.0.0	FHIR Std.
ClaimResponse.addItem.​revenue	Base	example	Example Revenue Center Codes	📍5.0.0	FHIR Std.
ClaimResponse.addItem.​productOrService	Base	example	USCLS Codes	📍5.0.0	FHIR Std.
ClaimResponse.addItem.​productOrServiceEnd	Base	example	USCLS Codes	📍5.0.0	FHIR Std.
ClaimResponse.addItem.​modifier	Base	example	Modifier type Codes	📍5.0.0	FHIR Std.
ClaimResponse.addItem.​programCode	Base	example	Example Program Reason Codes	📍5.0.0	FHIR Std.
ClaimResponse.addItem.​location[x]	Base	example	Example Service Place Codes	📍5.0.0	FHIR Std.
ClaimResponse.addItem.​bodySite.site	Base	example	Oral Site Codes	📍5.0.0	FHIR Std.
ClaimResponse.addItem.​bodySite.subSite	Base	example	Surface Codes	📍5.0.0	FHIR Std.
ClaimResponse.addItem.​detail.revenue	Base	example	Example Revenue Center Codes	📍5.0.0	FHIR Std.
ClaimResponse.addItem.​detail.productOrService	Base	example	USCLS Codes	📍5.0.0	FHIR Std.
ClaimResponse.addItem.​detail.productOrServiceEnd	Base	example	USCLS Codes	📍5.0.0	FHIR Std.
ClaimResponse.addItem.​detail.modifier	Base	example	Modifier type Codes	📍5.0.0	FHIR Std.
ClaimResponse.addItem.​detail.subDetail.revenue	Base	example	Example Revenue Center Codes	📍5.0.0	FHIR Std.
ClaimResponse.addItem.​detail.subDetail.productOrService	Base	example	USCLS Codes	📍5.0.0	FHIR Std.
ClaimResponse.addItem.​detail.subDetail.productOrServiceEnd	Base	example	USCLS Codes	📍5.0.0	FHIR Std.
ClaimResponse.addItem.​detail.subDetail.modifier	Base	example	Modifier type Codes	📍5.0.0	FHIR Std.
ClaimResponse.total.​category	Base	example	Adjudication Value Codes	📍5.0.0	tx.fhir.org
ClaimResponse.payment.​type	Base	example	Example Payment Type Codes	📍5.0.0	FHIR Std.
ClaimResponse.payment.​adjustmentReason	Base	example	Payment Adjustment Reason Codes	📍5.0.0	FHIR Std.
ClaimResponse.payment.​identifier.use	Base	required	IdentifierUse	📍5.0.0	FHIR Std.
ClaimResponse.payment.​identifier.type	Base	extensible	Identifier Type Codes	📍5.0.0	FHIR Std.
ClaimResponse.fundsReserve	Base	example	Funds Reservation Codes	📍5.0.0	FHIR Std.
ClaimResponse.formCode	Base	example	Form Codes	📍5.0.0	FHIR Std.
ClaimResponse.processNote.​type	Base	extensible	NoteType	📍5.0.0	FHIR Std.
ClaimResponse.processNote.​language	Base	required	All Languages	📍5.0.0	FHIR Std.
ClaimResponse.communicationRequest.​type	Base	extensible	Resource Types	📍5.0.0	tx.fhir.org
ClaimResponse.insurance.​coverage.type	Base	extensible	Resource Types	📍5.0.0	tx.fhir.org
ClaimResponse.insurance.​claimResponse.type	Base	extensible	Resource Types	📍5.0.0	tx.fhir.org
ClaimResponse.error.​code	Base	example	Adjudication Error Codes	📍5.0.0	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 in (%resource.descendants().reference | %resource.descendants().ofType(canonical) | %resource.descendants().ofType(uri) | %resource.descendants().ofType(url))) or descendants().where(reference = '#').exists() or descendants().where(ofType(canonical) = '#').exists() or descendants().where(ofType(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
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.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.traceNumber, 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.decision, ClaimResponse.disposition, ClaimResponse.preAuthRef, ClaimResponse.preAuthPeriod, ClaimResponse.event, ClaimResponse.event.extension, ClaimResponse.event.modifierExtension, ClaimResponse.event.type, ClaimResponse.event.when[x], ClaimResponse.payeeType, ClaimResponse.encounter, ClaimResponse.diagnosisRelatedGroup, ClaimResponse.item, ClaimResponse.item.extension, ClaimResponse.item.modifierExtension, ClaimResponse.item.itemSequence, ClaimResponse.item.traceNumber, ClaimResponse.item.noteNumber, ClaimResponse.item.reviewOutcome, ClaimResponse.item.reviewOutcome.extension, ClaimResponse.item.reviewOutcome.modifierExtension, ClaimResponse.item.reviewOutcome.decision, ClaimResponse.item.reviewOutcome.reason, ClaimResponse.item.reviewOutcome.preAuthRef, ClaimResponse.item.reviewOutcome.preAuthPeriod, 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.quantity, ClaimResponse.item.adjudication.quantity.extension, ClaimResponse.item.adjudication.quantity.extension:value, ClaimResponse.item.adjudication.quantity.value, ClaimResponse.item.adjudication.quantity.comparator, ClaimResponse.item.adjudication.quantity.unit, ClaimResponse.item.adjudication.quantity.system, ClaimResponse.item.adjudication.quantity.code, ClaimResponse.item.detail, ClaimResponse.item.detail.extension, ClaimResponse.item.detail.modifierExtension, ClaimResponse.item.detail.detailSequence, ClaimResponse.item.detail.traceNumber, ClaimResponse.item.detail.noteNumber, ClaimResponse.item.detail.reviewOutcome, 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.traceNumber, ClaimResponse.item.detail.subDetail.noteNumber, ClaimResponse.item.detail.subDetail.reviewOutcome, 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.traceNumber, ClaimResponse.addItem.provider, ClaimResponse.addItem.revenue, ClaimResponse.addItem.productOrService, ClaimResponse.addItem.productOrServiceEnd, ClaimResponse.addItem.request, 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.tax, ClaimResponse.addItem.net, ClaimResponse.addItem.bodySite, ClaimResponse.addItem.bodySite.extension, ClaimResponse.addItem.bodySite.modifierExtension, ClaimResponse.addItem.bodySite.site, ClaimResponse.addItem.bodySite.subSite, ClaimResponse.addItem.noteNumber, ClaimResponse.addItem.reviewOutcome, 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.traceNumber, ClaimResponse.addItem.detail.revenue, ClaimResponse.addItem.detail.productOrService, ClaimResponse.addItem.detail.productOrServiceEnd, ClaimResponse.addItem.detail.modifier, ClaimResponse.addItem.detail.quantity, ClaimResponse.addItem.detail.unitPrice, ClaimResponse.addItem.detail.factor, ClaimResponse.addItem.detail.tax, ClaimResponse.addItem.detail.net, ClaimResponse.addItem.detail.noteNumber, ClaimResponse.addItem.detail.reviewOutcome, ClaimResponse.addItem.detail.adjudication, ClaimResponse.addItem.detail.subDetail, ClaimResponse.addItem.detail.subDetail.extension, ClaimResponse.addItem.detail.subDetail.modifierExtension, ClaimResponse.addItem.detail.subDetail.traceNumber, ClaimResponse.addItem.detail.subDetail.revenue, ClaimResponse.addItem.detail.subDetail.productOrService, ClaimResponse.addItem.detail.subDetail.productOrServiceEnd, ClaimResponse.addItem.detail.subDetail.modifier, ClaimResponse.addItem.detail.subDetail.quantity, ClaimResponse.addItem.detail.subDetail.unitPrice, ClaimResponse.addItem.detail.subDetail.factor, ClaimResponse.addItem.detail.subDetail.tax, ClaimResponse.addItem.detail.subDetail.net, ClaimResponse.addItem.detail.subDetail.noteNumber, ClaimResponse.addItem.detail.subDetail.reviewOutcome, 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.type.coding, ClaimResponse.processNote.type.text, 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, ClaimResponse.error.expression	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.event.extension, ClaimResponse.event.modifierExtension, ClaimResponse.item.extension, ClaimResponse.item.modifierExtension, ClaimResponse.item.reviewOutcome.extension, ClaimResponse.item.reviewOutcome.modifierExtension, ClaimResponse.item.adjudication.extension, ClaimResponse.item.adjudication.modifierExtension, ClaimResponse.item.adjudication.quantity.extension, ClaimResponse.item.adjudication.quantity.extension:value, 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.bodySite.extension, ClaimResponse.addItem.bodySite.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.item.adjudication.value|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(5.0.0)	Response to a claim predetermination or preauthorization
implicitRules	?!Σ	0..1	uri	A set of rules under which this content was created
contained		0..*	Resource	Contained, inline Resources
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	?!Σ	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
reference	ΣC	0..1	string	Literal reference, Relative, internal or absolute URL
created	Σ	1..1	dateTime	Response creation date
outcome	Σ	1..1	code	queued | complete | error | partial Binding: ClaimProcessingCodes (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: ClaimProcessingCodes (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	📍5.0.0	FHIR Std.
ClaimResponse.type	Base	extensible	Claim Type Codes	📍5.0.0	FHIR Std.
ClaimResponse.use	Base	required	Use	📍5.0.0	tx.fhir.org
ClaimResponse.outcome	Base	required	Claim Processing Codes	📍5.0.0	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 in (%resource.descendants().reference | %resource.descendants().ofType(canonical) | %resource.descendants().ofType(uri) | %resource.descendants().ofType(url))) or descendants().where(reference = '#').exists() or descendants().where(ofType(canonical) = '#').exists() or descendants().where(ofType(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
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.patient.reference, ClaimResponse.created, 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.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(5.0.0)	Response to a claim predetermination or preauthorization
meta
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
extension:meta		0..1	Meta	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: ClaimProcessingCodes (example): The result of the claim processing
item
adjudication
quantity
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
extension:value		0..1	decimal	STU3: value additional types URL: http://hl7.org/fhir/3.0/StructureDefinition/extension-ClaimResponse.item.adjudication.value
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: R3BenefitSubcategoryForR5 (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: R3BenefitSubcategoryForR5 (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: display | print | printoper 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(5.0.0)	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	Meta	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: AllSecurityLabels (extensible): Security Labels from the Healthcare Privacy and Security Classification System.
tag	Σ	0..*	Coding	Tags applied to this resource Binding: CommonTags (example): Codes that represent various types of tags, commonly workflow-related; e.g. "Needs review by Dr. Jones".
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: AllLanguages (required): IETF language tag for a human language Additional Bindings Purpose CommonLanguages Starter
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): The status of a resource narrative.
div	C	1..1	xhtml	Limited xhtml content Constraints: txt-1, txt-2
contained		0..*	Resource	Contained, inline Resources
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	?!Σ	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): Identifies the purpose for this identifier, if known .
type	Σ	0..1	CodeableConcept	Description of identifier Binding: IdentifierTypeCodes (extensible): A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.
system	Σ	0..1	uri	The namespace for the identifier value Example General: http://www.acme.com/identifiers/patient
value	ΣC	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)
traceNumber		0..*	Identifier	Number for tracking
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") - must be a resource in resources Binding: ResourceType (extensible): Aa resource (or, for logical models, the URI of the logical model).
identifier	ΣC	0..1	Identifier	Logical reference, when literal reference is not known
display	ΣC	0..1	string	Text alternative for the resource
created	Σ	1..1	dateTime	Response creation date
insurer	Σ	0..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") - must be a resource in resources Binding: ResourceType (extensible): Aa resource (or, for logical models, the URI of the logical model).
identifier	ΣC	0..1	Identifier	Logical reference, when literal reference is not known
display	ΣC	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") - must be a resource in resources Binding: ResourceType (extensible): Aa resource (or, for logical models, the URI of the logical model).
identifier	ΣC	0..1	Identifier	Logical reference, when literal reference is not known
display	ΣC	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") - must be a resource in resources Binding: ResourceType (extensible): Aa resource (or, for logical models, the URI of the logical model).
identifier	ΣC	0..1	Identifier	Logical reference, when literal reference is not known
display	ΣC	0..1	string	Text alternative for the resource
outcome	Σ	1..1	code	queued | complete | error | partial Binding: ClaimProcessingCodes (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: ClaimProcessingCodes (example): The result of the claim processing Constraints: ext-1
value		0..1	code	Primitive value for code
decision	Σ	0..1	CodeableConcept	Result of the adjudication Binding: ClaimAdjudicationDecisionsCodes (example): The overall result of the claim adjudication.
disposition		0..1	string	Disposition Message
preAuthRef		0..1	string	Preauthorization reference
preAuthPeriod		0..1	Period	Preauthorization reference effective period
event		0..*	BackboneElement	Event information
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	Specific event Binding: DatesTypeCodes (example)
when[x]		1..1		Occurance date or period
whenDateTime			dateTime
whenPeriod			Period
payeeType		0..1	CodeableConcept	Party to be paid any benefits payable Binding: ClaimPayeeTypeCodes (example): A code for the party to be reimbursed.
encounter		0..*	Reference(Encounter)	Encounters associated with the listed treatments
diagnosisRelatedGroup		0..1	CodeableConcept	Package billing code Binding: ExampleDiagnosisRelatedGroupCodes (example)
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
traceNumber		0..*	Identifier	Number for tracking
noteNumber		0..*	positiveInt	Applicable note numbers
reviewOutcome		0..1	BackboneElement	Adjudication results
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
decision		0..1	CodeableConcept	Result of the adjudication Binding: ClaimAdjudicationDecisionsCodes (example)
reason		0..*	CodeableConcept	Reason for result of the adjudication Binding: ClaimAdjudicationDecisionReasonCodes (example)
preAuthRef		0..1	string	Preauthorization reference
preAuthPeriod		0..1	Period	Preauthorization reference effective period
adjudication		0..*	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
quantity		0..1	Quantity	Non-monetary value
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:value		0..1	decimal	STU3: value additional types URL: http://hl7.org/fhir/3.0/StructureDefinition/extension-ClaimResponse.item.adjudication.value Constraints: ext-1
value	Σ	0..1	decimal	Numerical value (with implicit precision)
comparator	?!Σ	0..1	code	< | <= | >= | > | ad - how to understand the value Binding: QuantityComparator (required): How the Quantity should be understood and represented.
unit	Σ	0..1	string	Unit representation
system	ΣC	0..1	uri	System that defines coded unit form
code	ΣC	0..1	code	Coded form of the unit
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
traceNumber		0..*	Identifier	Number for tracking
noteNumber		0..*	positiveInt	Applicable note numbers
reviewOutcome		0..1	See reviewOutcome (ClaimResponse)	Detail level adjudication results
adjudication		0..*	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
traceNumber		0..*	Identifier	Number for tracking
noteNumber		0..*	positiveInt	Applicable note numbers
reviewOutcome		0..1	See reviewOutcome (ClaimResponse)	Subdetail level adjudication results
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: R3BenefitSubcategoryForR5 (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
traceNumber		0..*	Identifier	Number for tracking
provider		0..*	Reference(Practitioner | PractitionerRole | Organization)	Authorized providers
revenue		0..1	CodeableConcept	Revenue or cost center code Binding: ExampleRevenueCenterCodes (example): Codes for the revenue or cost centers supplying the service and/or products.
productOrService		0..1	CodeableConcept	Billing, service, product, or drug code Binding: USCLSCodes (example): Allowable service and product codes.
productOrServiceEnd		0..1	CodeableConcept	End of a range of codes Binding: USCLSCodes (example)
request		0..*	Reference(DeviceRequest | MedicationRequest | NutritionOrder | ServiceRequest | SupplyRequest | VisionPrescription)	Request or Referral for Service
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(5.0.0)	Count of products or services
unitPrice		0..1	Money	Fee, charge or cost per item
factor		0..1	decimal	Price scaling factor
tax		0..1	Money	Total tax
net		0..1	Money	Total item cost
bodySite		0..*	BackboneElement	Anatomical location
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
site		1..*	CodeableReference(BodyStructure)	Location Binding: OralSiteCodes (example)
subSite		0..*	CodeableConcept	Sub-location Binding: SurfaceCodes (example)
noteNumber		0..*	positiveInt	Applicable note numbers
reviewOutcome		0..1	See reviewOutcome (ClaimResponse)	Added items adjudication results
adjudication		0..*	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: R3BenefitSubcategoryForR5 (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
traceNumber		0..*	Identifier	Number for tracking
revenue		0..1	CodeableConcept	Revenue or cost center code Binding: ExampleRevenueCenterCodes (example): Codes for the revenue or cost centers supplying the service and/or products.
productOrService		0..1	CodeableConcept	Billing, service, product, or drug code Binding: USCLSCodes (example): Allowable service and product codes.
productOrServiceEnd		0..1	CodeableConcept	End of a range of codes Binding: USCLSCodes (example)
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(5.0.0)	Count of products or services
unitPrice		0..1	Money	Fee, charge or cost per item
factor		0..1	decimal	Price scaling factor
tax		0..1	Money	Total tax
net		0..1	Money	Total item cost
noteNumber		0..*	positiveInt	Applicable note numbers
reviewOutcome		0..1	See reviewOutcome (ClaimResponse)	Added items detail level adjudication results
adjudication		0..*	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
traceNumber		0..*	Identifier	Number for tracking
revenue		0..1	CodeableConcept	Revenue or cost center code Binding: ExampleRevenueCenterCodes (example): Codes for the revenue or cost centers supplying the service and/or products.
productOrService		0..1	CodeableConcept	Billing, service, product, or drug code Binding: USCLSCodes (example): Allowable service and product codes.
productOrServiceEnd		0..1	CodeableConcept	End of a range of codes Binding: USCLSCodes (example)
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(5.0.0)	Count of products or services
unitPrice		0..1	Money	Fee, charge or cost per item
factor		0..1	decimal	Price scaling factor
tax		0..1	Money	Total tax
net		0..1	Money	Total item cost
noteNumber		0..*	positiveInt	Applicable note numbers
reviewOutcome		0..1	See reviewOutcome (ClaimResponse)	Added items subdetail level adjudication results
adjudication		0..*	See adjudication (ClaimResponse)	Added items subdetail 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): Identifies the purpose for this identifier, if known .
type	Σ	0..1	CodeableConcept	Description of identifier Binding: IdentifierTypeCodes (extensible): A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.
system	Σ	0..1	uri	The namespace for the identifier value Example General: http://www.acme.com/identifiers/patient
value	ΣC	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: FundsReservationCodes (example): For whom funds are to be reserved: (Patient, Provider, None).
formCode		0..1	CodeableConcept	Printed form identifier Binding: FormCodes (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	CodeableConcept	Note purpose Binding: NoteType (extensible): The presentation types of notes.
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:type		0..1	CodeableConcept	STU3: display | print | printoper URL: http://hl7.org/fhir/3.0/StructureDefinition/extension-ClaimResponse.processNote.type Binding: NoteType (required): The presentation types of notes. Constraints: ext-1
coding	Σ	0..*	Coding	Code defined by a terminology system
text	Σ	0..1	string	Plain text representation of the concept
text		1..1	string	Note explanatory text
language		0..1	CodeableConcept	Language of the text Binding: AllLanguages (required): IETF language tag for a human language Additional Bindings Purpose CommonLanguages Starter
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") - must be a resource in resources Binding: ResourceType (extensible): Aa resource (or, for logical models, the URI of the logical model).
identifier	ΣC	0..1	Identifier	Logical reference, when literal reference is not known
display	ΣC	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") - must be a resource in resources Binding: ResourceType (extensible): Aa resource (or, for logical models, the URI of the logical model).
identifier	ΣC	0..1	Identifier	Logical reference, when literal reference is not known
display	ΣC	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") - must be a resource in resources Binding: ResourceType (extensible): Aa resource (or, for logical models, the URI of the logical model).
identifier	ΣC	0..1	Identifier	Logical reference, when literal reference is not known
display	ΣC	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	Σ	1..1	CodeableConcept	Error code detailing processing issues Binding: AdjudicationErrorCodes (example): The adjudication error codes.
expression	Σ	0..*	string	FHIRPath of element(s) related to issue
Documentation for this format

Terminology Bindings

Path	Status	Usage	ValueSet	Version	Source
ClaimResponse.meta.security	Base	extensible	All Security Labels	📍5.0.0	tx.fhir.org
ClaimResponse.meta.tag	Base	example	Common Tags	📍5.0.0	FHIR Std.
ClaimResponse.language	Base	required	All Languages	📍5.0.0	FHIR Std.
ClaimResponse.text.status	Base	required	NarrativeStatus	📍5.0.0	FHIR Std.
ClaimResponse.identifier.​use	Base	required	IdentifierUse	📍5.0.0	FHIR Std.
ClaimResponse.identifier.​type	Base	extensible	Identifier Type Codes	📍5.0.0	FHIR Std.
ClaimResponse.status	Base	required	Financial Resource Status Codes	📍5.0.0	FHIR Std.
ClaimResponse.type	Base	extensible	Claim Type Codes	📍5.0.0	FHIR Std.
ClaimResponse.subType	Base	example	Example Claim SubType Codes	📍5.0.0	FHIR Std.
ClaimResponse.use	Base	required	Use	📍5.0.0	tx.fhir.org
ClaimResponse.patient.​type	Base	extensible	Resource Types	📍5.0.0	tx.fhir.org
ClaimResponse.insurer.​type	Base	extensible	Resource Types	📍5.0.0	tx.fhir.org
ClaimResponse.requestor.​type	Base	extensible	Resource Types	📍5.0.0	tx.fhir.org
ClaimResponse.request.​type	Base	extensible	Resource Types	📍5.0.0	tx.fhir.org
ClaimResponse.outcome	Base	required	Claim Processing Codes	📍5.0.0	FHIR Std.
ClaimResponse.decision	Base	example	Claim Adjudication Decision Codes	📍5.0.0	FHIR Std.
ClaimResponse.event.​type	Base	example	Dates Type Codes	📍5.0.0	FHIR Std.
ClaimResponse.payeeType	Base	example	Claim Payee Type Codes	📍5.0.0	FHIR Std.
ClaimResponse.diagnosisRelatedGroup	Base	example	Example Diagnosis Related Group Codes	📍5.0.0	FHIR Std.
ClaimResponse.item.reviewOutcome.​decision	Base	example	Claim Adjudication Decision Codes	📍5.0.0	FHIR Std.
ClaimResponse.item.reviewOutcome.​reason	Base	example	Claim Adjudication Decision Reason Codes	📍5.0.0	FHIR Std.
ClaimResponse.item.adjudication.​category	Base	example	Adjudication Value Codes	📍5.0.0	tx.fhir.org
ClaimResponse.item.adjudication.​reason	Base	example	Adjudication Reason Codes	📍5.0.0	FHIR Std.
ClaimResponse.item.adjudication.​quantity.comparator	Base	required	QuantityComparator	📍5.0.0	FHIR Std.
ClaimResponse.addItem.​revenue	Base	example	Example Revenue Center Codes	📍5.0.0	FHIR Std.
ClaimResponse.addItem.​productOrService	Base	example	USCLS Codes	📍5.0.0	FHIR Std.
ClaimResponse.addItem.​productOrServiceEnd	Base	example	USCLS Codes	📍5.0.0	FHIR Std.
ClaimResponse.addItem.​modifier	Base	example	Modifier type Codes	📍5.0.0	FHIR Std.
ClaimResponse.addItem.​programCode	Base	example	Example Program Reason Codes	📍5.0.0	FHIR Std.
ClaimResponse.addItem.​location[x]	Base	example	Example Service Place Codes	📍5.0.0	FHIR Std.
ClaimResponse.addItem.​bodySite.site	Base	example	Oral Site Codes	📍5.0.0	FHIR Std.
ClaimResponse.addItem.​bodySite.subSite	Base	example	Surface Codes	📍5.0.0	FHIR Std.
ClaimResponse.addItem.​detail.revenue	Base	example	Example Revenue Center Codes	📍5.0.0	FHIR Std.
ClaimResponse.addItem.​detail.productOrService	Base	example	USCLS Codes	📍5.0.0	FHIR Std.
ClaimResponse.addItem.​detail.productOrServiceEnd	Base	example	USCLS Codes	📍5.0.0	FHIR Std.
ClaimResponse.addItem.​detail.modifier	Base	example	Modifier type Codes	📍5.0.0	FHIR Std.
ClaimResponse.addItem.​detail.subDetail.revenue	Base	example	Example Revenue Center Codes	📍5.0.0	FHIR Std.
ClaimResponse.addItem.​detail.subDetail.productOrService	Base	example	USCLS Codes	📍5.0.0	FHIR Std.
ClaimResponse.addItem.​detail.subDetail.productOrServiceEnd	Base	example	USCLS Codes	📍5.0.0	FHIR Std.
ClaimResponse.addItem.​detail.subDetail.modifier	Base	example	Modifier type Codes	📍5.0.0	FHIR Std.
ClaimResponse.total.​category	Base	example	Adjudication Value Codes	📍5.0.0	tx.fhir.org
ClaimResponse.payment.​type	Base	example	Example Payment Type Codes	📍5.0.0	FHIR Std.
ClaimResponse.payment.​adjustmentReason	Base	example	Payment Adjustment Reason Codes	📍5.0.0	FHIR Std.
ClaimResponse.payment.​identifier.use	Base	required	IdentifierUse	📍5.0.0	FHIR Std.
ClaimResponse.payment.​identifier.type	Base	extensible	Identifier Type Codes	📍5.0.0	FHIR Std.
ClaimResponse.fundsReserve	Base	example	Funds Reservation Codes	📍5.0.0	FHIR Std.
ClaimResponse.formCode	Base	example	Form Codes	📍5.0.0	FHIR Std.
ClaimResponse.processNote.​type	Base	extensible	NoteType	📍5.0.0	FHIR Std.
ClaimResponse.processNote.​language	Base	required	All Languages	📍5.0.0	FHIR Std.
ClaimResponse.communicationRequest.​type	Base	extensible	Resource Types	📍5.0.0	tx.fhir.org
ClaimResponse.insurance.​coverage.type	Base	extensible	Resource Types	📍5.0.0	tx.fhir.org
ClaimResponse.insurance.​claimResponse.type	Base	extensible	Resource Types	📍5.0.0	tx.fhir.org
ClaimResponse.error.​code	Base	example	Adjudication Error Codes	📍5.0.0	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 in (%resource.descendants().reference | %resource.descendants().ofType(canonical) | %resource.descendants().ofType(uri) | %resource.descendants().ofType(url))) or descendants().where(reference = '#').exists() or descendants().where(ofType(canonical) = '#').exists() or descendants().where(ofType(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
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.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.traceNumber, 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.decision, ClaimResponse.disposition, ClaimResponse.preAuthRef, ClaimResponse.preAuthPeriod, ClaimResponse.event, ClaimResponse.event.extension, ClaimResponse.event.modifierExtension, ClaimResponse.event.type, ClaimResponse.event.when[x], ClaimResponse.payeeType, ClaimResponse.encounter, ClaimResponse.diagnosisRelatedGroup, ClaimResponse.item, ClaimResponse.item.extension, ClaimResponse.item.modifierExtension, ClaimResponse.item.itemSequence, ClaimResponse.item.traceNumber, ClaimResponse.item.noteNumber, ClaimResponse.item.reviewOutcome, ClaimResponse.item.reviewOutcome.extension, ClaimResponse.item.reviewOutcome.modifierExtension, ClaimResponse.item.reviewOutcome.decision, ClaimResponse.item.reviewOutcome.reason, ClaimResponse.item.reviewOutcome.preAuthRef, ClaimResponse.item.reviewOutcome.preAuthPeriod, 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.quantity, ClaimResponse.item.adjudication.quantity.extension, ClaimResponse.item.adjudication.quantity.extension:value, ClaimResponse.item.adjudication.quantity.value, ClaimResponse.item.adjudication.quantity.comparator, ClaimResponse.item.adjudication.quantity.unit, ClaimResponse.item.adjudication.quantity.system, ClaimResponse.item.adjudication.quantity.code, ClaimResponse.item.detail, ClaimResponse.item.detail.extension, ClaimResponse.item.detail.modifierExtension, ClaimResponse.item.detail.detailSequence, ClaimResponse.item.detail.traceNumber, ClaimResponse.item.detail.noteNumber, ClaimResponse.item.detail.reviewOutcome, 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.traceNumber, ClaimResponse.item.detail.subDetail.noteNumber, ClaimResponse.item.detail.subDetail.reviewOutcome, 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.traceNumber, ClaimResponse.addItem.provider, ClaimResponse.addItem.revenue, ClaimResponse.addItem.productOrService, ClaimResponse.addItem.productOrServiceEnd, ClaimResponse.addItem.request, 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.tax, ClaimResponse.addItem.net, ClaimResponse.addItem.bodySite, ClaimResponse.addItem.bodySite.extension, ClaimResponse.addItem.bodySite.modifierExtension, ClaimResponse.addItem.bodySite.site, ClaimResponse.addItem.bodySite.subSite, ClaimResponse.addItem.noteNumber, ClaimResponse.addItem.reviewOutcome, 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.traceNumber, ClaimResponse.addItem.detail.revenue, ClaimResponse.addItem.detail.productOrService, ClaimResponse.addItem.detail.productOrServiceEnd, ClaimResponse.addItem.detail.modifier, ClaimResponse.addItem.detail.quantity, ClaimResponse.addItem.detail.unitPrice, ClaimResponse.addItem.detail.factor, ClaimResponse.addItem.detail.tax, ClaimResponse.addItem.detail.net, ClaimResponse.addItem.detail.noteNumber, ClaimResponse.addItem.detail.reviewOutcome, ClaimResponse.addItem.detail.adjudication, ClaimResponse.addItem.detail.subDetail, ClaimResponse.addItem.detail.subDetail.extension, ClaimResponse.addItem.detail.subDetail.modifierExtension, ClaimResponse.addItem.detail.subDetail.traceNumber, ClaimResponse.addItem.detail.subDetail.revenue, ClaimResponse.addItem.detail.subDetail.productOrService, ClaimResponse.addItem.detail.subDetail.productOrServiceEnd, ClaimResponse.addItem.detail.subDetail.modifier, ClaimResponse.addItem.detail.subDetail.quantity, ClaimResponse.addItem.detail.subDetail.unitPrice, ClaimResponse.addItem.detail.subDetail.factor, ClaimResponse.addItem.detail.subDetail.tax, ClaimResponse.addItem.detail.subDetail.net, ClaimResponse.addItem.detail.subDetail.noteNumber, ClaimResponse.addItem.detail.subDetail.reviewOutcome, 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.type.coding, ClaimResponse.processNote.type.text, 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, ClaimResponse.error.expression	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.event.extension, ClaimResponse.event.modifierExtension, ClaimResponse.item.extension, ClaimResponse.item.modifierExtension, ClaimResponse.item.reviewOutcome.extension, ClaimResponse.item.reviewOutcome.modifierExtension, ClaimResponse.item.adjudication.extension, ClaimResponse.item.adjudication.modifierExtension, ClaimResponse.item.adjudication.quantity.extension, ClaimResponse.item.adjudication.quantity.extension:value, 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.bodySite.extension, ClaimResponse.addItem.bodySite.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.item.adjudication.value|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