Generated Narrative: StructureDefinition ext-R4-ClaimResponse.ite.adjudication Name Flags Card. Type Description & Constraints Extension 1..* Extension R4: adjudication #xD; Slices for extension 1..* Extension Extension Slice: Unordered, Open by value:url #xD; extension:category 1..1 Extension R4: Type of adjudication information #xD; url 1..1 uri "category" #xD; <a href="StructureDefinition-ext-R4-ClaimResponse.ite.adjudication-definitions.html#Extension.extension:category.value[x]" title="A code to indicate the information type of this adjudication record. Information types may include the value submitted, maximum values or percentages allowed or payable under the plan, amounts that: the patient is responsible for in aggregate or pertaining to this item; amounts paid by other coverages; and, the benefit payable for this item.">value[x] 1..1 CodeableConcept Type of adjudication information Binding: http://hl7.org/fhir/uv/xver/ValueSet/R4-adjudication-for-R3 (example): The adjudication codes. #xD; extension:reason 0..1 Extension R4: Explanation of adjudication outcome #xD; url 1..1 uri "reason" #xD; value[x] 0..1 CodeableConcept Explanation of adjudication outcome Binding: Adjudication Reason Codes (example): The adjudication reason codes. #xD; extension:amount 0..1 Extension R4: amount #xD; url 1..1 uri "amount" #xD; value[x] 0..1 Money Monetary amount #xD; extension:value 0..1 Extension R4: value #xD; url 1..1 uri "value" #xD; value[x] 0..1 decimal Non-monetary value #xD; url 1..1 uri "http://hl7.org/fhir/4.0/StructureDefinition/extension-ClaimResponse.item.adjudication" #xD; value[x] 0..0 Value of extension #xD; Documentation for this format
This extension is part of the cross-version definitions generated to enable use of the element `ClaimResponse.item.adjudication` as defined in FHIR R4 in FHIR STU3. The source element is defined as: `ClaimResponse.item.adjudication` 1..* `BackboneElement` Following are the generation technical comments: Element `ClaimResponse.item.adjudication` is mapped to FHIR STU3 element `ClaimResponse.item.adjudication` as `Equivalent`. Creating extension because element `ClaimResponse.item.adjudication` is a content reference and requires an extesion definition.
Element `ClaimResponse.item.adjudication` is mapped to FHIR STU3 element `ClaimResponse.item.adjudication` as `Equivalent`.
All FHIR elements must have a @value or children
hasValue() | (children().count() > id.count())
Must have either extensions or value[x], not both
exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])
unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Extensions are always sliced by (at least) url
R4: `ClaimResponse.item.adjudication.category`
Element `ClaimResponse.item.adjudication.category` is mapped to FHIR STU3 element `ClaimResponse.item.adjudication.category` as `Equivalent`. For example codes indicating: Co-Pay, deductible, eligible, benefit, tax, etc.
Needed to enable understanding of the context of the other information in the adjudication. Element `ClaimResponse.item.adjudication.category` is mapped to FHIR STU3 element `ClaimResponse.item.adjudication.category` as `Equivalent`.
Additional Content defined by implementations
May be used to represent additional information that is not part of the basic definition of the element. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
Source of the definition for the extension code - a logical name or a URL.
The definition may point directly to a computable or human-readable definition of the extensibility codes, or it may be a logical URI as declared in some other specification. The definition SHALL be a URI for the Structure Definition defining the extension.
A code to indicate the information type of this adjudication record. Information types may include the value submitted, maximum values or percentages allowed or payable under the plan, amounts that: the patient is responsible for in aggregate or pertaining to this item; amounts paid by other coverages; and, the benefit payable for this item.
For example codes indicating: Co-Pay, deductible, eligible, benefit, tax, etc.
R4: `ClaimResponse.item.adjudication.reason`
Element `ClaimResponse.item.adjudication.reason` is mapped to FHIR STU3 element `ClaimResponse.item.adjudication.reason` as `Equivalent`. For example may indicate that the funds for this benefit type have been exhausted.
To support understanding of variance from adjudication expectations. Element `ClaimResponse.item.adjudication.reason` is mapped to FHIR STU3 element `ClaimResponse.item.adjudication.reason` as `Equivalent`.
A code supporting the understanding of the adjudication result and explaining variance from expected amount.
For example may indicate that the funds for this benefit type have been exhausted.
R4: `ClaimResponse.item.adjudication.amount`
Element `ClaimResponse.item.adjudication.amount` is mapped to FHIR STU3 element `ClaimResponse.item.adjudication.amount` as `Equivalent`. For example: amount submitted, eligible amount, co-payment, and benefit payable.
Most adjuciation categories convey a monetary amount. Element `ClaimResponse.item.adjudication.amount` is mapped to FHIR STU3 element `ClaimResponse.item.adjudication.amount` as `Equivalent`.
Monetary amount associated with the category.
For example: amount submitted, eligible amount, co-payment, and benefit payable.
R4: `ClaimResponse.item.adjudication.value`
Element `ClaimResponse.item.adjudication.value` is mapped to FHIR STU3 element `ClaimResponse.item.adjudication.value` as `Equivalent`. For example: eligible percentage or co-payment percentage.
Some adjudication categories convey a percentage or a fixed value. Element `ClaimResponse.item.adjudication.value` is mapped to FHIR STU3 element `ClaimResponse.item.adjudication.value` as `Equivalent`.
A non-monetary value associated with the category. Mutually exclusive to the amount element above.
For example: eligible percentage or co-payment percentage.
Value of extension - may be a resource or one of a constrained set of the data types (see Extensibility in the spec for list).