ext-R4-ClaimResponse.ite.adjudication
type: StructureDefinition
node role: treeRoot
id:
  v: ext-R4-ClaimResponse.ite.adjudication
text:
  status:
    v: extensions
  div:
    v: Generated Narrative: StructureDefinition ext-R4-ClaimResponse.ite.adjudication Name Flags Card. Type Description & Constraints<img src="[binary]" alt="doco" style="background-color: inherit"/> 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; <img src="[binary]" alt="doco" style="background-color: inherit"/> Documentation for this format
extension:
  url:
    v: http://hl7.org/fhir/StructureDefinition/structuredefinition-wg
    l: structuredefinition-wg
  value: Code
    v: fhir
extension:
  extension:
    url:
      v: packageId
      l: packageId
    value: Id
      v: hl7.fhir.uv.xver-r4.r3
  extension:
    url:
      v: version
      l: version
    value: String
      v: 0.1.0
  extension:
    url:
      v: uri
      l: uri
    value: Uri
      v: http://hl7.org/fhir/uv/xver/ImplementationGuide/hl7.fhir.uv.xver-r4.r3
      l: hl7.fhir.uv.xver-r4.r3
  url:
    v: http://hl7.org/fhir/StructureDefinition/package-source
    l: package-source
extension:
  url:
    v: http://hl7.org/fhir/StructureDefinition/structuredefinition-fmm
    l: structuredefinition-fmm
  value: Integer
    v: 0
    extension:
      url:
        v: http://hl7.org/fhir/StructureDefinition/structuredefinition-conformance-derivedFrom
        l: structuredefinition-conformance-derivedFrom
      value: Uri
        v: http://hl7.org/fhir/uv/xver/ImplementationGuide/hl7.fhir.uv.xver-r4.r3
        l: hl7.fhir.uv.xver-r4.r3
extension:
  url:
    v: http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status
    l: structuredefinition-standards-status
  value: Code
    v: trial-use
    extension:
      url:
        v: http://hl7.org/fhir/StructureDefinition/structuredefinition-conformance-derivedFrom
        l: structuredefinition-conformance-derivedFrom
      value: Uri
        v: http://hl7.org/fhir/uv/xver/ImplementationGuide/hl7.fhir.uv.xver-r4.r3
        l: hl7.fhir.uv.xver-r4.r3
url:
  v: http://hl7.org/fhir/4.0/StructureDefinition/extension-ClaimResponse.item.adjudication
  l: extension-ClaimResponse.item.adjudication
version:
  v: 0.1.0
name:
  v: ExtensionClaimResponse_Item_Adjudication
title:
  v: R4: adjudication
status:
  v: active
experimental:
  v: false
date:
  v: 2026-03-17T21:02:03.8104715+00:00
publisher:
  v: FHIR Infrastructure
contact:
  name:
    v: FHIR Infrastructure
  telecom:
    system:
      v: url
    value:
      v: http://www.hl7.org/Special/committees/fiwg
description:
  v: R4: `ClaimResponse.item.adjudication`
jurisdiction:
  coding:
    system:
      v: http://unstats.un.org/unsd/methods/m49/m49.htm
      l: m49.htm
    code:
      v: 001
    display:
      v: World
purpose:
  v: 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.
fhir version:
  v: 3.0.2
mapping:
  identity:
    v: rim
  uri:
    v: http://hl7.org/v3
    l: v3
  name:
    v: RIM Mapping
kind:
  v: complex-type
abstract:
  v: false
context type:
  v: resource
context:
  v: ClaimResponse.item.adjudication
type:
  v: Extension
base definition:
  v: http://hl7.org/fhir/StructureDefinition/Extension
  l: Extension
derivation:
  v: constraint
snapshot:
  element:
    id:
      v: Extension
    path:
      v: Extension
    short:
      v: R4: adjudication
    definition:
      v: R4: `ClaimResponse.item.adjudication`
    comment:
      v: Element `ClaimResponse.item.adjudication` is mapped to FHIR STU3 element `ClaimResponse.item.adjudication` as `Equivalent`.
    min:
      v: 1
    max:
      v: *
    base:
      path:
        v: Extension
      min:
        v: 0
      max:
        v: *
    condition:
      v: ele-1
    constraint:
      key:
        v: ele-1
      severity:
        v: error
      human:
        v: All FHIR elements must have a @value or children
      expression:
        v: hasValue() | (children().count() > id.count())
      xpath:
        v: @value|f:*|h:div
      source:
        v: http://hl7.org/fhir/StructureDefinition/Element
        l: Element
    constraint:
      key:
        v: ext-1
      severity:
        v: error
      human:
        v: Must have either extensions or value[x], not both
      expression:
        v: extension.exists() != value.exists()
      xpath:
        v: exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])
      source:
        v: http://hl7.org/fhir/StructureDefinition/Extension
        l: Extension
    is modifier:
      v: false
  element:
    id:
      v: Extension.id
    path:
      v: Extension.id
    representation:
      v: xmlAttr
    short:
      v: xml:id (or equivalent in JSON)
    definition:
      v: unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
    min:
      v: 0
    max:
      v: 1
    base:
      path:
        v: Element.id
      min:
        v: 0
      max:
        v: 1

code:
  v: string
  l: string

identity:
  v: rim
map:
  v: n/a

id:
  v: Extension.extension
path:
  v: Extension.extension
slicing:
  discriminator:
    type:
      v: value
    path:
      v: url
  description:
    v: Extensions are always sliced by (at least) url
  ordered:
    v: false
  rules:
    v: open
short:
  v: Extension
definition:
  v: An Extension
min:
  v: 1
max:
  v: *
base:
  path:
    v: Element.extension
  min:
    v: 0
  max:
    v: *
type:
  code:
    v: Extension
    l: Extension

id:
  v: Extension.extension:category
path:
  v: Extension.extension
slice name:
  v: category
short:
  v: R4: Type of adjudication information
definition:
  v: R4: `ClaimResponse.item.adjudication.category`
comment:
  v: 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.
requirements:
  v: 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`.
min:
  v: 1
max:
  v: 1
base:
  path:
    v: Element.extension
  min:
    v: 0
  max:
    v: *
type:
  code:
    v: Extension
    l: Extension

id:
  v: Extension.extension:category.id
path:
  v: Extension.extension.id
representation:
  v: xmlAttr
short:
  v: xml:id (or equivalent in JSON)
definition:
  v: unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: Element.id
  min:
    v: 0
  max:
    v: 1
type:
  code:
    v: string
    l: string
mapping:
  identity:
    v: rim
  map:
    v: n/a

id:
  v: Extension.extension:category.extension
path:
  v: Extension.extension.extension
slicing:
  discriminator:
    type:
      v: value
    path:
      v: url
  description:
    v: Extensions are always sliced by (at least) url
  rules:
    v: open
short:
  v: Additional Content defined by implementations
definition:
  v: 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.
comment:
  v: There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
alias:
  v: extensions
alias:
  v: user content
min:
  v: 0
max:
  v: *
base:
  path:
    v: Element.extension
  min:
    v: 0
  max:
    v: *
type:
  code:
    v: Extension
    l: Extension
mapping:
  identity:
    v: rim
  map:
    v: n/a

id:
  v: Extension.extension:category.url
path:
  v: Extension.extension.url
representation:
  v: xmlAttr
short:
  v: identifies the meaning of the extension
definition:
  v: Source of the definition for the extension code - a logical name or a URL.
comment:
  v: 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.
min:
  v: 1
max:
  v: 1
base:
  path:
    v: Extension.url
  min:
    v: 1
  max:
    v: 1
type:
  code:
    v: uri
    l: uri
fixed: Uri
  v: category
  l: category
mapping:
  identity:
    v: rim
  map:
    v: N/A

id:
  v: Extension.extension:category.value[x]
path:
  v: Extension.extension.value[x]
short:
  v: Type of adjudication information
definition:
  v: A code to indicate the information type of this adjudication record. Information types may include the value submitted, maximum values or percentages allowed or payable under the plan, amounts that: the patient is responsible for in aggregate or pertaining to this item; amounts paid by other coverages; and, the benefit payable for this item.
comment:
  v: For example codes indicating: Co-Pay, deductible, eligible, benefit, tax, etc.
min:
  v: 1
max:
  v: 1
base:
  path:
    v: Extension.value[x]
  min:
    v: 0
  max:
    v: 1
type:
  code:
    v: CodeableConcept
    l: CodeableConcept
binding:
  strength:
    v: example
  description:
    v: The adjudication codes.
  value set: Uri
    v: http://hl7.org/fhir/uv/xver/ValueSet/R4-adjudication-for-R3
    l: R4-adjudication-for-R3
mapping:
  identity:
    v: rim
  map:
    v: N/A

id:
  v: Extension.extension:reason
path:
  v: Extension.extension
slice name:
  v: reason
short:
  v: R4: Explanation of adjudication outcome
definition:
  v: R4: `ClaimResponse.item.adjudication.reason`
comment:
  v: 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.
requirements:
  v: 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`.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: Element.extension
  min:
    v: 0
  max:
    v: *
type:
  code:
    v: Extension
    l: Extension

id:
  v: Extension.extension:reason.id
path:
  v: Extension.extension.id
representation:
  v: xmlAttr
short:
  v: xml:id (or equivalent in JSON)
definition:
  v: unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: Element.id
  min:
    v: 0
  max:
    v: 1
type:
  code:
    v: string
    l: string
mapping:
  identity:
    v: rim
  map:
    v: n/a

id:
  v: Extension.extension:reason.extension
path:
  v: Extension.extension.extension
slicing:
  discriminator:
    type:
      v: value
    path:
      v: url
  description:
    v: Extensions are always sliced by (at least) url
  rules:
    v: open
short:
  v: Additional Content defined by implementations
definition:
  v: 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.
comment:
  v: There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
alias:
  v: extensions
alias:
  v: user content
min:
  v: 0
max:
  v: *
base:
  path:
    v: Element.extension
  min:
    v: 0
  max:
    v: *
type:
  code:
    v: Extension
    l: Extension
mapping:
  identity:
    v: rim
  map:
    v: n/a

id:
  v: Extension.extension:reason.url
path:
  v: Extension.extension.url
representation:
  v: xmlAttr
short:
  v: identifies the meaning of the extension
definition:
  v: Source of the definition for the extension code - a logical name or a URL.
comment:
  v: 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.
min:
  v: 1
max:
  v: 1
base:
  path:
    v: Extension.url
  min:
    v: 1
  max:
    v: 1
type:
  code:
    v: uri
    l: uri
fixed: Uri
  v: reason
  l: reason
mapping:
  identity:
    v: rim
  map:
    v: N/A

id:
  v: Extension.extension:reason.value[x]
path:
  v: Extension.extension.value[x]
short:
  v: Explanation of adjudication outcome
definition:
  v: A code supporting the understanding of the adjudication result and explaining variance from expected amount.
comment:
  v: For example may indicate that the funds for this benefit type have been exhausted.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: Extension.value[x]
  min:
    v: 0
  max:
    v: 1
type:
  code:
    v: CodeableConcept
    l: CodeableConcept
binding:
  strength:
    v: example
  description:
    v: The adjudication reason codes.
  value set: Uri
    v: http://hl7.org/fhir/ValueSet/adjudication-reason|3.0.2
    l: http://hl7.org/fhir/ValueSet/adjudication-reason
mapping:
  identity:
    v: rim
  map:
    v: N/A

id:
  v: Extension.extension:amount
path:
  v: Extension.extension
slice name:
  v: amount
short:
  v: R4: amount
definition:
  v: R4: `ClaimResponse.item.adjudication.amount`
comment:
  v: 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.
requirements:
  v: Most adjuciation categories convey a monetary amount. Element `ClaimResponse.item.adjudication.amount` is mapped to FHIR STU3 element `ClaimResponse.item.adjudication.amount` as `Equivalent`.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: Element.extension
  min:
    v: 0
  max:
    v: *
type:
  code:
    v: Extension
    l: Extension

id:
  v: Extension.extension:amount.id
path:
  v: Extension.extension.id
representation:
  v: xmlAttr
short:
  v: xml:id (or equivalent in JSON)
definition:
  v: unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: Element.id
  min:
    v: 0
  max:
    v: 1
type:
  code:
    v: string
    l: string
mapping:
  identity:
    v: rim
  map:
    v: n/a

id:
  v: Extension.extension:amount.extension
path:
  v: Extension.extension.extension
slicing:
  discriminator:
    type:
      v: value
    path:
      v: url
  description:
    v: Extensions are always sliced by (at least) url
  rules:
    v: open
short:
  v: Additional Content defined by implementations
definition:
  v: 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.
comment:
  v: There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
alias:
  v: extensions
alias:
  v: user content
min:
  v: 0
max:
  v: *
base:
  path:
    v: Element.extension
  min:
    v: 0
  max:
    v: *
type:
  code:
    v: Extension
    l: Extension
mapping:
  identity:
    v: rim
  map:
    v: n/a

id:
  v: Extension.extension:amount.url
path:
  v: Extension.extension.url
representation:
  v: xmlAttr
short:
  v: identifies the meaning of the extension
definition:
  v: Source of the definition for the extension code - a logical name or a URL.
comment:
  v: 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.
min:
  v: 1
max:
  v: 1
base:
  path:
    v: Extension.url
  min:
    v: 1
  max:
    v: 1
type:
  code:
    v: uri
    l: uri
fixed: Uri
  v: amount
  l: amount
mapping:
  identity:
    v: rim
  map:
    v: N/A

id:
  v: Extension.extension:amount.value[x]
path:
  v: Extension.extension.value[x]
short:
  v: Monetary amount
definition:
  v: Monetary amount associated with the category.
comment:
  v: For example: amount submitted, eligible amount, co-payment, and benefit payable.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: Extension.value[x]
  min:
    v: 0
  max:
    v: 1
type:
  code:
    v: Money
    l: Money
mapping:
  identity:
    v: rim
  map:
    v: N/A

id:
  v: Extension.extension:value
path:
  v: Extension.extension
slice name:
  v: value
short:
  v: R4: value
definition:
  v: R4: `ClaimResponse.item.adjudication.value`
comment:
  v: 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.
requirements:
  v: 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`.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: Element.extension
  min:
    v: 0
  max:
    v: *
type:
  code:
    v: Extension
    l: Extension

id:
  v: Extension.extension:value.id
path:
  v: Extension.extension.id
representation:
  v: xmlAttr
short:
  v: xml:id (or equivalent in JSON)
definition:
  v: unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: Element.id
  min:
    v: 0
  max:
    v: 1
type:
  code:
    v: string
    l: string
mapping:
  identity:
    v: rim
  map:
    v: n/a

id:
  v: Extension.extension:value.extension
path:
  v: Extension.extension.extension
slicing:
  discriminator:
    type:
      v: value
    path:
      v: url
  description:
    v: Extensions are always sliced by (at least) url
  rules:
    v: open
short:
  v: Additional Content defined by implementations
definition:
  v: 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.
comment:
  v: There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
alias:
  v: extensions
alias:
  v: user content
min:
  v: 0
max:
  v: *
base:
  path:
    v: Element.extension
  min:
    v: 0
  max:
    v: *
type:
  code:
    v: Extension
    l: Extension
mapping:
  identity:
    v: rim
  map:
    v: n/a

id:
  v: Extension.extension:value.url
path:
  v: Extension.extension.url
representation:
  v: xmlAttr
short:
  v: identifies the meaning of the extension
definition:
  v: Source of the definition for the extension code - a logical name or a URL.
comment:
  v: 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.
min:
  v: 1
max:
  v: 1
base:
  path:
    v: Extension.url
  min:
    v: 1
  max:
    v: 1
type:
  code:
    v: uri
    l: uri
fixed: Uri
  v: value
  l: value
mapping:
  identity:
    v: rim
  map:
    v: N/A

id:
  v: Extension.extension:value.value[x]
path:
  v: Extension.extension.value[x]
short:
  v: Non-monetary value
definition:
  v: A non-monetary value associated with the category. Mutually exclusive to the amount element above.
comment:
  v: For example: eligible percentage or co-payment percentage.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: Extension.value[x]
  min:
    v: 0
  max:
    v: 1
type:
  code:
    v: decimal
    l: decimal
mapping:
  identity:
    v: rim
  map:
    v: N/A

id:
  v: Extension.url
path:
  v: Extension.url
representation:
  v: xmlAttr
short:
  v: identifies the meaning of the extension
definition:
  v: Source of the definition for the extension code - a logical name or a URL.
comment:
  v: 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.
min:
  v: 1
max:
  v: 1
base:
  path:
    v: Extension.url
  min:
    v: 1
  max:
    v: 1
type:
  code:
    v: uri
    l: uri
fixed: Uri
  v: http://hl7.org/fhir/4.0/StructureDefinition/extension-ClaimResponse.item.adjudication
  l: extension-ClaimResponse.item.adjudication
mapping:
  identity:
    v: rim
  map:
    v: N/A

id:
  v: Extension.value[x]
path:
  v: Extension.value[x]
short:
  v: Value of extension
definition:
  v: Value of extension - may be a resource or one of a constrained set of the data types (see Extensibility in the spec for list).
min:
  v: 0
max:
  v: 0
base:
  path:
    v: Extension.value[x]
  min:
    v: 0
  max:
    v: 1
type:
  code:
    v: base64Binary
    l: base64Binary
type:
  code:
    v: boolean
    l: boolean
type:
  code:
    v: code
    l: code
type:
  code:
    v: date
    l: date
type:
  code:
    v: dateTime
    l: dateTime
type:
  code:
    v: decimal
    l: decimal
type:
  code:
    v: id
    l: id
type:
  code:
    v: instant
    l: instant
type:
  code:
    v: integer
    l: integer
type:
  code:
    v: markdown
    l: markdown
type:
  code:
    v: oid
    l: oid
type:
  code:
    v: positiveInt
    l: positiveInt
type:
  code:
    v: string
    l: string
type:
  code:
    v: time
    l: time
type:
  code:
    v: unsignedInt
    l: unsignedInt
type:
  code:
    v: uri
    l: uri
type:
  code:
    v: Address
    l: Address
type:
  code:
    v: Age
    l: Age
type:
  code:
    v: Annotation
    l: Annotation
type:
  code:
    v: Attachment
    l: Attachment
type:
  code:
    v: CodeableConcept
    l: CodeableConcept
type:
  code:
    v: Coding
    l: Coding
type:
  code:
    v: ContactPoint
    l: ContactPoint
type:
  code:
    v: Count
    l: Count
type:
  code:
    v: Distance
    l: Distance
type:
  code:
    v: Duration
    l: Duration
type:
  code:
    v: HumanName
    l: HumanName
type:
  code:
    v: Identifier
    l: Identifier
type:
  code:
    v: Money
    l: Money
type:
  code:
    v: Period
    l: Period
type:
  code:
    v: Quantity
    l: Quantity
type:
  code:
    v: Range
    l: Range
type:
  code:
    v: Ratio
    l: Ratio
type:
  code:
    v: Reference
    l: Reference
type:
  code:
    v: SampledData
    l: SampledData
type:
  code:
    v: Signature
    l: Signature
type:
  code:
    v: Timing
    l: Timing
type:
  code:
    v: Meta
    l: Meta
mapping:
  identity:
    v: rim
  map:
    v: N/A

element:
  id:
    v: Extension
  path:
    v: Extension
  short:
    v: R4: adjudication
  definition:
    v: R4: `ClaimResponse.item.adjudication`
  comment:
    v: Element `ClaimResponse.item.adjudication` is mapped to FHIR STU3 element `ClaimResponse.item.adjudication` as `Equivalent`.
  min:
    v: 1
  max:
    v: *
  base:
    path:
      v: Extension
    min:
      v: 0
    max:
      v: *
  is modifier:
    v: false
element:
  id:
    v: Extension.extension
  path:
    v: Extension.extension
  slicing:
    discriminator:
      type:
        v: value
      path:
        v: url
    ordered:
      v: false
    rules:
      v: open
  min:
    v: 1
  max:
    v: *
  base:
    path:
      v: Extension.extension
    min:
      v: 0
    max:
      v: *
element:
  id:
    v: Extension.extension:category
  path:
    v: Extension.extension
  slice name:
    v: category
  short:
    v: R4: Type of adjudication information
  definition:
    v: R4: `ClaimResponse.item.adjudication.category`
  comment:
    v: 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.
  requirements:
    v: 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`.
  min:
    v: 1
  max:
    v: 1
  base:
    path:
      v: Extension.extension
    min:
      v: 0
    max:
      v: *
element:
  id:
    v: Extension.extension:category.url
  path:
    v: Extension.extension.url
  min:
    v: 1
  max:
    v: 1
  base:
    path:
      v: Extension.url
    min:
      v: 1
    max:
      v: 1
  fixed: Uri
    v: category
    l: category
element:
  id:
    v: Extension.extension:category.value[x]
  path:
    v: Extension.extension.value[x]
  short:
    v: Type of adjudication information
  definition:
    v: A code to indicate the information type of this adjudication record. Information types may include the value submitted, maximum values or percentages allowed or payable under the plan, amounts that: the patient is responsible for in aggregate or pertaining to this item; amounts paid by other coverages; and, the benefit payable for this item.
  comment:
    v: For example codes indicating: Co-Pay, deductible, eligible, benefit, tax, etc.
  min:
    v: 1
  max:
    v: 1
  base:
    path:
      v: Extension.value[x]
    min:
      v: 0
    max:
      v: 1
  type:
    code:
      v: CodeableConcept
      l: CodeableConcept
  binding:
    strength:
      v: example
    description:
      v: The adjudication codes.
    value set: Uri
      v: http://hl7.org/fhir/uv/xver/ValueSet/R4-adjudication-for-R3
      l: R4-adjudication-for-R3
element:
  id:
    v: Extension.extension:reason
  path:
    v: Extension.extension
  slice name:
    v: reason
  short:
    v: R4: Explanation of adjudication outcome
  definition:
    v: R4: `ClaimResponse.item.adjudication.reason`
  comment:
    v: 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.
  requirements:
    v: 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`.
  min:
    v: 0
  max:
    v: 1
  base:
    path:
      v: Extension.extension
    min:
      v: 0
    max:
      v: *
element:
  id:
    v: Extension.extension:reason.url
  path:
    v: Extension.extension.url
  min:
    v: 1
  max:
    v: 1
  base:
    path:
      v: Extension.url
    min:
      v: 1
    max:
      v: 1
  fixed: Uri
    v: reason
    l: reason
element:
  id:
    v: Extension.extension:reason.value[x]
  path:
    v: Extension.extension.value[x]
  short:
    v: Explanation of adjudication outcome
  definition:
    v: A code supporting the understanding of the adjudication result and explaining variance from expected amount.
  comment:
    v: For example may indicate that the funds for this benefit type have been exhausted.
  min:
    v: 0
  max:
    v: 1
  base:
    path:
      v: Extension.value[x]
    min:
      v: 0
    max:
      v: 1
  type:
    code:
      v: CodeableConcept
      l: CodeableConcept
  binding:
    strength:
      v: example
    value set: Uri

v: The adjudication reason codes.

id:
  v: Extension.extension:amount
path:
  v: Extension.extension
slice name:
  v: amount
short:
  v: R4: amount
definition:
  v: R4: `ClaimResponse.item.adjudication.amount`
comment:
  v: 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.
requirements:
  v: Most adjuciation categories convey a monetary amount. Element `ClaimResponse.item.adjudication.amount` is mapped to FHIR STU3 element `ClaimResponse.item.adjudication.amount` as `Equivalent`.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: Extension.extension
  min:
    v: 0
  max:
    v: *

id:
  v: Extension.extension:amount.url
path:
  v: Extension.extension.url
min:
  v: 1
max:
  v: 1
base:
  path:
    v: Extension.url
  min:
    v: 1
  max:
    v: 1
fixed: Uri
  v: amount
  l: amount

id:
  v: Extension.extension:amount.value[x]
path:
  v: Extension.extension.value[x]
short:
  v: Monetary amount
definition:
  v: Monetary amount associated with the category.
comment:
  v: For example: amount submitted, eligible amount, co-payment, and benefit payable.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: Extension.value[x]
  min:
    v: 0
  max:
    v: 1
type:
  code:
    v: Money
    l: Money

id:
  v: Extension.extension:value
path:
  v: Extension.extension
slice name:
  v: value
short:
  v: R4: value
definition:
  v: R4: `ClaimResponse.item.adjudication.value`
comment:
  v: 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.
requirements:
  v: 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`.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: Extension.extension
  min:
    v: 0
  max:
    v: *

id:
  v: Extension.extension:value.url
path:
  v: Extension.extension.url
min:
  v: 1
max:
  v: 1
base:
  path:
    v: Extension.url
  min:
    v: 1
  max:
    v: 1
fixed: Uri
  v: value
  l: value

id:
  v: Extension.extension:value.value[x]
path:
  v: Extension.extension.value[x]
short:
  v: Non-monetary value
definition:
  v: A non-monetary value associated with the category. Mutually exclusive to the amount element above.
comment:
  v: For example: eligible percentage or co-payment percentage.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: Extension.value[x]
  min:
    v: 0
  max:
    v: 1
type:
  code:
    v: decimal
    l: decimal

id:
  v: Extension.url
path:
  v: Extension.url
min:
  v: 1
max:
  v: 1
base:
  path:
    v: Extension.url
  min:
    v: 1
  max:
    v: 1
fixed: Uri
  v: http://hl7.org/fhir/4.0/StructureDefinition/extension-ClaimResponse.item.adjudication
  l: extension-ClaimResponse.item.adjudication

id:
  v: Extension.value[x]
path:
  v: Extension.value[x]
min:
  v: 0
max:
  v: 0
base:
  path:
    v: Extension.value[x]
  min:
    v: 0
  max:
    v: 1