Generated Narrative: ConceptMap R4-ClaimResponse-element-map-to-R4B Mapping from http://hl7.org/fhir/4.0 to http://hl7.org/fhir/4.3 Group 1 Mapping from http://hl7.org/fhir/StructureDefinition/ClaimResponse|4.0.1 to ClaimResponseversion: 4.3.0) Source Code Relationship Target Code Comment ClaimResponse.meta (meta) is equivalent to ClaimResponse.meta Element `ClaimResponse.meta` is mapped to FHIR R4B element `ClaimResponse.meta` as `Equivalent`. ClaimResponse.implicitRules (implicitRules) is equivalent to ClaimResponse.implicitRules Element `ClaimResponse.implicitRules` is mapped to FHIR R4B element `ClaimResponse.implicitRules` as `Equivalent`. Asserting this rule set restricts the content to be only understood by a limited set of trading partners. This inherently limits the usefulness of the data in the long term. However, the existing health eco-system is highly fractured, and not yet ready to define, collect, and exchange data in a generally computable sense. Wherever possible, implementers and/or specification writers should avoid using this element. Often, when used, the URL is a reference to an implementation guide that defines these special rules as part of it's narrative along with other profiles, value sets, etc. ClaimResponse.language (language) is equivalent to ClaimResponse.language Element `ClaimResponse.language` is mapped to FHIR R4B element `ClaimResponse.language` as `Equivalent`. Language is provided to support indexing and accessibility (typically, services such as text to speech use the language tag). The html language tag in the narrative applies to the narrative. The language tag on the resource may be used to specify the language of other presentations generated from the data in the resource. Not all the content has to be in the base language. The Resource.language should not be assumed to apply to the narrative automatically. If a language is specified, it should it also be specified on the div element in the html (see rules in HTML5 for information about the relationship between xml:lang and the html lang attribute). ClaimResponse.text (text) is equivalent to ClaimResponse.text Element `ClaimResponse.text` is mapped to FHIR R4B element `ClaimResponse.text` as `Equivalent`. Contained resources do not have narrative. Resources that are not contained SHOULD have a narrative. In some cases, a resource may only have text with little or no additional discrete data (as long as all minOccurs=1 elements are satisfied). This may be necessary for data from legacy systems where information is captured as a "text blob" or where text is additionally entered raw or narrated and encoded information is added later. ClaimResponse.contained (contained) is equivalent to ClaimResponse.contained Element `ClaimResponse.contained` is mapped to FHIR R4B element `ClaimResponse.contained` as `Equivalent`. This should never be done when the content can be identified properly, as once identification is lost, it is extremely difficult (and context dependent) to restore it again. Contained resources may have profiles and tags In their meta elements, but SHALL NOT have security labels. ClaimResponse.identifier (identifier) is equivalent to ClaimResponse.identifier Element `ClaimResponse.identifier` is mapped to FHIR R4B element `ClaimResponse.identifier` as `Equivalent`. ClaimResponse.status (status) is equivalent to ClaimResponse.status Element `ClaimResponse.status` is mapped to FHIR R4B element `ClaimResponse.status` as `Equivalent`. This element is labeled as a modifier because the status contains codes that mark the resource as not currently valid. ClaimResponse.type (type) is equivalent to ClaimResponse.type Element `ClaimResponse.type` is mapped to FHIR R4B element `ClaimResponse.type` as `Equivalent`. This may contain the local bill type codes, for example the US UB-04 bill type code or the CMS bill type. ClaimResponse.subType (subType) is equivalent to ClaimResponse.subType Element `ClaimResponse.subType` is mapped to FHIR R4B element `ClaimResponse.subType` as `Equivalent`. This may contain the local bill type codes, for example the US UB-04 bill type code or the CMS bill type. ClaimResponse.use (use) is equivalent to ClaimResponse.use Element `ClaimResponse.use` is mapped to FHIR R4B element `ClaimResponse.use` as `Equivalent`. ClaimResponse.patient (patient) is equivalent to ClaimResponse.patient Element `ClaimResponse.patient` is mapped to FHIR R4B element `ClaimResponse.patient` as `Equivalent`. ClaimResponse.created (created) is equivalent to ClaimResponse.created Element `ClaimResponse.created` is mapped to FHIR R4B element `ClaimResponse.created` as `Equivalent`. ClaimResponse.insurer (insurer) is equivalent to ClaimResponse.insurer Element `ClaimResponse.insurer` is mapped to FHIR R4B element `ClaimResponse.insurer` as `Equivalent`. ClaimResponse.requestor (requestor) is equivalent to ClaimResponse.requestor Element `ClaimResponse.requestor` is mapped to FHIR R4B element `ClaimResponse.requestor` as `Equivalent`. Typically this field would be 1..1 where this party is responsible for the claim but not necessarily professionally responsible for the provision of the individual products and services listed below. ClaimResponse.request (request) is equivalent to ClaimResponse.request Element `ClaimResponse.request` is mapped to FHIR R4B element `ClaimResponse.request` as `Equivalent`. ClaimResponse.outcome (outcome) is equivalent to ClaimResponse.outcome Element `ClaimResponse.outcome` is mapped to FHIR R4B element `ClaimResponse.outcome` as `Equivalent`. The resource may be used to indicate that: the request has been held (queued) for processing; that it has been processed and errors found (error); that no errors were found and that some of the adjudication has been undertaken (partial) or that all of the adjudication has been undertaken (complete). ClaimResponse.disposition (disposition) is equivalent to ClaimResponse.disposition Element `ClaimResponse.disposition` is mapped to FHIR R4B element `ClaimResponse.disposition` as `Equivalent`. ClaimResponse.preAuthRef (preAuthRef) is equivalent to ClaimResponse.preAuthRef Element `ClaimResponse.preAuthRef` is mapped to FHIR R4B element `ClaimResponse.preAuthRef` as `Equivalent`. This value is only present on preauthorization adjudications. ClaimResponse.preAuthPeriod (preAuthPeriod) is equivalent to ClaimResponse.preAuthPeriod Element `ClaimResponse.preAuthPeriod` is mapped to FHIR R4B element `ClaimResponse.preAuthPeriod` as `Equivalent`. ClaimResponse.payeeType (payeeType) is equivalent to ClaimResponse.payeeType Element `ClaimResponse.payeeType` is mapped to FHIR R4B element `ClaimResponse.payeeType` as `Equivalent`. ClaimResponse.item (item) maps to wider concept ClaimResponse.item Element `ClaimResponse.item` is mapped to FHIR R4B element `ClaimResponse.item` as `Equivalent`. ClaimResponse.item.itemSequence (itemSequence) is equivalent to ClaimResponse.item.itemSequence Element `ClaimResponse.item.itemSequence` is mapped to FHIR R4B element `ClaimResponse.item.itemSequence` as `Equivalent`. ClaimResponse.item.noteNumber (noteNumber) is equivalent to ClaimResponse.item.noteNumber Element `ClaimResponse.item.noteNumber` is mapped to FHIR R4B element `ClaimResponse.item.noteNumber` as `Equivalent`. ClaimResponse.item.adjudication (adjudication) maps to wider concept ClaimResponse.item.adjudication Element `ClaimResponse.item.adjudication` is mapped to FHIR R4B element `ClaimResponse.item.adjudication` as `Equivalent`. ClaimResponse.item.adjudication.category (category) is equivalent to ClaimResponse.item.adjudication.category Element `ClaimResponse.item.adjudication.category` is mapped to FHIR R4B element `ClaimResponse.item.adjudication.category` as `Equivalent`. For example codes indicating: Co-Pay, deductible, eligible, benefit, tax, etc. ClaimResponse.item.adjudication.reason (reason) is equivalent to ClaimResponse.item.adjudication.reason Element `ClaimResponse.item.adjudication.reason` is mapped to FHIR R4B element `ClaimResponse.item.adjudication.reason` as `Equivalent`. For example may indicate that the funds for this benefit type have been exhausted. ClaimResponse.item.adjudication.amount (amount) is equivalent to ClaimResponse.item.adjudication.amount Element `ClaimResponse.item.adjudication.amount` is mapped to FHIR R4B element `ClaimResponse.item.adjudication.amount` as `Equivalent`. For example: amount submitted, eligible amount, co-payment, and benefit payable. ClaimResponse.item.adjudication.value (value) is equivalent to ClaimResponse.item.adjudication.value Element `ClaimResponse.item.adjudication.value` is mapped to FHIR R4B element `ClaimResponse.item.adjudication.value` as `Equivalent`. For example: eligible percentage or co-payment percentage. ClaimResponse.item.detail (detail) maps to wider concept ClaimResponse.item.detail Element `ClaimResponse.item.detail` is mapped to FHIR R4B element `ClaimResponse.item.detail` as `Equivalent`. ClaimResponse.item.detail.detailSequence (detailSequence) is equivalent to ClaimResponse.item.detail.detailSequence Element `ClaimResponse.item.detail.detailSequence` is mapped to FHIR R4B element `ClaimResponse.item.detail.detailSequence` as `Equivalent`. ClaimResponse.item.detail.noteNumber (noteNumber) is equivalent to ClaimResponse.item.detail.noteNumber Element `ClaimResponse.item.detail.noteNumber` is mapped to FHIR R4B element `ClaimResponse.item.detail.noteNumber` as `Equivalent`. ClaimResponse.item.detail.adjudication (adjudication) is equivalent to ClaimResponse.item.detail.adjudication Element `ClaimResponse.item.detail.adjudication` is mapped to FHIR R4B element `ClaimResponse.item.detail.adjudication` as `Equivalent`. ClaimResponse.item.detail.subDetail (subDetail) maps to wider concept ClaimResponse.item.detail.subDetail Element `ClaimResponse.item.detail.subDetail` is mapped to FHIR R4B element `ClaimResponse.item.detail.subDetail` as `Equivalent`. ClaimResponse.item.detail.subDetail.subDetailSequence (subDetailSequence) is equivalent to ClaimResponse.item.detail.subDetail.subDetailSequence Element `ClaimResponse.item.detail.subDetail.subDetailSequence` is mapped to FHIR R4B element `ClaimResponse.item.detail.subDetail.subDetailSequence` as `Equivalent`. ClaimResponse.item.detail.subDetail.noteNumber (noteNumber) is equivalent to ClaimResponse.item.detail.subDetail.noteNumber Element `ClaimResponse.item.detail.subDetail.noteNumber` is mapped to FHIR R4B element `ClaimResponse.item.detail.subDetail.noteNumber` as `Equivalent`. ClaimResponse.item.detail.subDetail.adjudication (adjudication) is equivalent to ClaimResponse.item.detail.subDetail.adjudication Element `ClaimResponse.item.detail.subDetail.adjudication` is mapped to FHIR R4B element `ClaimResponse.item.detail.subDetail.adjudication` as `Equivalent`. ClaimResponse.addItem (addItem) maps to wider concept ClaimResponse.addItem Element `ClaimResponse.addItem` is mapped to FHIR R4B element `ClaimResponse.addItem` as `Equivalent`. ClaimResponse.addItem.itemSequence (itemSequence) is equivalent to ClaimResponse.addItem.itemSequence Element `ClaimResponse.addItem.itemSequence` is mapped to FHIR R4B element `ClaimResponse.addItem.itemSequence` as `Equivalent`. ClaimResponse.addItem.detailSequence (detailSequence) is equivalent to ClaimResponse.addItem.detailSequence Element `ClaimResponse.addItem.detailSequence` is mapped to FHIR R4B element `ClaimResponse.addItem.detailSequence` as `Equivalent`. ClaimResponse.addItem.subdetailSequence (subdetailSequence) is equivalent to ClaimResponse.addItem.subdetailSequence Element `ClaimResponse.addItem.subdetailSequence` is mapped to FHIR R4B element `ClaimResponse.addItem.subdetailSequence` as `Equivalent`. ClaimResponse.addItem.provider (provider) is equivalent to ClaimResponse.addItem.provider Element `ClaimResponse.addItem.provider` is mapped to FHIR R4B element `ClaimResponse.addItem.provider` as `Equivalent`. ClaimResponse.addItem.productOrService (productOrService) is equivalent to ClaimResponse.addItem.productOrService Element `ClaimResponse.addItem.productOrService` is mapped to FHIR R4B element `ClaimResponse.addItem.productOrService` as `Equivalent`. If this is an actual service or product line, i.e. not a Group, then use code to indicate the Professional Service or Product supplied (e.g. CTP, HCPCS, USCLS, ICD10, NCPDP, DIN, RxNorm, ACHI, CCI). If a grouping item then use a group code to indicate the type of thing being grouped e.g. 'glasses' or 'compound'. ClaimResponse.addItem.modifier (modifier) is equivalent to ClaimResponse.addItem.modifier Element `ClaimResponse.addItem.modifier` is mapped to FHIR R4B element `ClaimResponse.addItem.modifier` as `Equivalent`. For example in Oral whether the treatment is cosmetic or associated with TMJ, or for Medical whether the treatment was outside the clinic or outside of office hours. ClaimResponse.addItem.programCode (programCode) is equivalent to ClaimResponse.addItem.programCode Element `ClaimResponse.addItem.programCode` is mapped to FHIR R4B element `ClaimResponse.addItem.programCode` as `Equivalent`. For example: Neonatal program, child dental program or drug users recovery program. ClaimResponse.addItem.serviced[x] (serviced[x]) is equivalent to ClaimResponse.addItem.serviced[x] Element `ClaimResponse.addItem.serviced[x]` is mapped to FHIR R4B element `ClaimResponse.addItem.serviced[x]` as `Equivalent`. The target context `ClaimResponse.addItem.serviced[x]` is a choice-type element and cannot directly hold extensions. The context is moved up to parent element `ClaimResponse.addItem`. ClaimResponse.addItem.location[x] (location[x]) is equivalent to ClaimResponse.addItem.location[x] Element `ClaimResponse.addItem.location[x]` is mapped to FHIR R4B element `ClaimResponse.addItem.location[x]` as `Equivalent`. The target context `ClaimResponse.addItem.location[x]` is a choice-type element and cannot directly hold extensions. The context is moved up to parent element `ClaimResponse.addItem`. ClaimResponse.addItem.quantity (quantity) is equivalent to ClaimResponse.addItem.quantity Element `ClaimResponse.addItem.quantity` is mapped to FHIR R4B element `ClaimResponse.addItem.quantity` as `Equivalent`. ClaimResponse.addItem.unitPrice (unitPrice) is equivalent to ClaimResponse.addItem.unitPrice Element `ClaimResponse.addItem.unitPrice` is mapped to FHIR R4B element `ClaimResponse.addItem.unitPrice` as `Equivalent`. ClaimResponse.addItem.factor (factor) is equivalent to ClaimResponse.addItem.factor Element `ClaimResponse.addItem.factor` is mapped to FHIR R4B element `ClaimResponse.addItem.factor` as `Equivalent`. To show a 10% senior's discount, the value entered is: 0.90 (1.00 - 0.10). ClaimResponse.addItem.net (net) is equivalent to ClaimResponse.addItem.net Element `ClaimResponse.addItem.net` is mapped to FHIR R4B element `ClaimResponse.addItem.net` as `Equivalent`. For example, the formula: quantity * unitPrice * factor = net. Quantity and factor are assumed to be 1 if not supplied. ClaimResponse.addItem.bodySite (bodySite) is equivalent to ClaimResponse.addItem.bodySite Element `ClaimResponse.addItem.bodySite` is mapped to FHIR R4B element `ClaimResponse.addItem.bodySite` as `Equivalent`. For example: Providing a tooth code allows an insurer to identify a provider performing a filling on a tooth that was previously removed. ClaimResponse.addItem.subSite (subSite) is equivalent to ClaimResponse.addItem.subSite Element `ClaimResponse.addItem.subSite` is mapped to FHIR R4B element `ClaimResponse.addItem.subSite` as `Equivalent`. ClaimResponse.addItem.noteNumber (noteNumber) is equivalent to ClaimResponse.addItem.noteNumber Element `ClaimResponse.addItem.noteNumber` is mapped to FHIR R4B element `ClaimResponse.addItem.noteNumber` as `Equivalent`. ClaimResponse.addItem.adjudication (adjudication) is equivalent to ClaimResponse.addItem.adjudication Element `ClaimResponse.addItem.adjudication` is mapped to FHIR R4B element `ClaimResponse.addItem.adjudication` as `Equivalent`. ClaimResponse.addItem.detail (detail) maps to wider concept ClaimResponse.addItem.detail Element `ClaimResponse.addItem.detail` is mapped to FHIR R4B element `ClaimResponse.addItem.detail` as `Equivalent`. ClaimResponse.addItem.detail.productOrService (productOrService) is equivalent to ClaimResponse.addItem.detail.productOrService Element `ClaimResponse.addItem.detail.productOrService` is mapped to FHIR R4B element `ClaimResponse.addItem.detail.productOrService` as `Equivalent`. If this is an actual service or product line, i.e. not a Group, then use code to indicate the Professional Service or Product supplied (e.g. CTP, HCPCS, USCLS, ICD10, NCPDP, DIN, RxNorm, ACHI, CCI). If a grouping item then use a group code to indicate the type of thing being grouped e.g. 'glasses' or 'compound'. ClaimResponse.addItem.detail.modifier (modifier) is equivalent to ClaimResponse.addItem.detail.modifier Element `ClaimResponse.addItem.detail.modifier` is mapped to FHIR R4B element `ClaimResponse.addItem.detail.modifier` as `Equivalent`. For example in Oral whether the treatment is cosmetic or associated with TMJ, or for Medical whether the treatment was outside the clinic or outside of office hours. ClaimResponse.addItem.detail.quantity (quantity) is equivalent to ClaimResponse.addItem.detail.quantity Element `ClaimResponse.addItem.detail.quantity` is mapped to FHIR R4B element `ClaimResponse.addItem.detail.quantity` as `Equivalent`. ClaimResponse.addItem.detail.unitPrice (unitPrice) is equivalent to ClaimResponse.addItem.detail.unitPrice Element `ClaimResponse.addItem.detail.unitPrice` is mapped to FHIR R4B element `ClaimResponse.addItem.detail.unitPrice` as `Equivalent`. ClaimResponse.addItem.detail.factor (factor) is equivalent to ClaimResponse.addItem.detail.factor Element `ClaimResponse.addItem.detail.factor` is mapped to FHIR R4B element `ClaimResponse.addItem.detail.factor` as `Equivalent`. To show a 10% senior's discount, the value entered is: 0.90 (1.00 - 0.10). ClaimResponse.addItem.detail.net (net) is equivalent to ClaimResponse.addItem.detail.net Element `ClaimResponse.addItem.detail.net` is mapped to FHIR R4B element `ClaimResponse.addItem.detail.net` as `Equivalent`. For example, the formula: quantity * unitPrice * factor = net. Quantity and factor are assumed to be 1 if not supplied. ClaimResponse.addItem.detail.noteNumber (noteNumber) is equivalent to ClaimResponse.addItem.detail.noteNumber Element `ClaimResponse.addItem.detail.noteNumber` is mapped to FHIR R4B element `ClaimResponse.addItem.detail.noteNumber` as `Equivalent`. ClaimResponse.addItem.detail.adjudication (adjudication) is equivalent to ClaimResponse.addItem.detail.adjudication Element `ClaimResponse.addItem.detail.adjudication` is mapped to FHIR R4B element `ClaimResponse.addItem.detail.adjudication` as `Equivalent`. ClaimResponse.addItem.detail.subDetail (subDetail) maps to wider concept ClaimResponse.addItem.detail.subDetail Element `ClaimResponse.addItem.detail.subDetail` is mapped to FHIR R4B element `ClaimResponse.addItem.detail.subDetail` as `Equivalent`. ClaimResponse.addItem.detail.subDetail.productOrService (productOrService) is equivalent to ClaimResponse.addItem.detail.subDetail.productOrService Element `ClaimResponse.addItem.detail.subDetail.productOrService` is mapped to FHIR R4B element `ClaimResponse.addItem.detail.subDetail.productOrService` as `Equivalent`. If this is an actual service or product line, i.e. not a Group, then use code to indicate the Professional Service or Product supplied (e.g. CTP, HCPCS, USCLS, ICD10, NCPDP, DIN, RxNorm, ACHI, CCI). If a grouping item then use a group code to indicate the type of thing being grouped e.g. 'glasses' or 'compound'. ClaimResponse.addItem.detail.subDetail.modifier (modifier) is equivalent to ClaimResponse.addItem.detail.subDetail.modifier Element `ClaimResponse.addItem.detail.subDetail.modifier` is mapped to FHIR R4B element `ClaimResponse.addItem.detail.subDetail.modifier` as `Equivalent`. For example in Oral whether the treatment is cosmetic or associated with TMJ, or for Medical whether the treatment was outside the clinic or outside of office hours. ClaimResponse.addItem.detail.subDetail.quantity (quantity) is equivalent to ClaimResponse.addItem.detail.subDetail.quantity Element `ClaimResponse.addItem.detail.subDetail.quantity` is mapped to FHIR R4B element `ClaimResponse.addItem.detail.subDetail.quantity` as `Equivalent`. ClaimResponse.addItem.detail.subDetail.unitPrice (unitPrice) is equivalent to ClaimResponse.addItem.detail.subDetail.unitPrice Element `ClaimResponse.addItem.detail.subDetail.unitPrice` is mapped to FHIR R4B element `ClaimResponse.addItem.detail.subDetail.unitPrice` as `Equivalent`. ClaimResponse.addItem.detail.subDetail.factor (factor) is equivalent to ClaimResponse.addItem.detail.subDetail.factor Element `ClaimResponse.addItem.detail.subDetail.factor` is mapped to FHIR R4B element `ClaimResponse.addItem.detail.subDetail.factor` as `Equivalent`. To show a 10% senior's discount, the value entered is: 0.90 (1.00 - 0.10). ClaimResponse.addItem.detail.subDetail.net (net) is equivalent to ClaimResponse.addItem.detail.subDetail.net Element `ClaimResponse.addItem.detail.subDetail.net` is mapped to FHIR R4B element `ClaimResponse.addItem.detail.subDetail.net` as `Equivalent`. For example, the formula: quantity * unitPrice * factor = net. Quantity and factor are assumed to be 1 if not supplied. ClaimResponse.addItem.detail.subDetail.noteNumber (noteNumber) is equivalent to ClaimResponse.addItem.detail.subDetail.noteNumber Element `ClaimResponse.addItem.detail.subDetail.noteNumber` is mapped to FHIR R4B element `ClaimResponse.addItem.detail.subDetail.noteNumber` as `Equivalent`. ClaimResponse.addItem.detail.subDetail.adjudication (adjudication) is equivalent to ClaimResponse.addItem.detail.subDetail.adjudication Element `ClaimResponse.addItem.detail.subDetail.adjudication` is mapped to FHIR R4B element `ClaimResponse.addItem.detail.subDetail.adjudication` as `Equivalent`. ClaimResponse.adjudication (adjudication) is equivalent to ClaimResponse.adjudication Element `ClaimResponse.adjudication` is mapped to FHIR R4B element `ClaimResponse.adjudication` as `Equivalent`. ClaimResponse.total (total) maps to wider concept ClaimResponse.total Element `ClaimResponse.total` is mapped to FHIR R4B element `ClaimResponse.total` as `Equivalent`. Totals for amounts submitted, co-pays, benefits payable etc. ClaimResponse.total.category (category) is equivalent to ClaimResponse.total.category Element `ClaimResponse.total.category` is mapped to FHIR R4B element `ClaimResponse.total.category` as `Equivalent`. For example codes indicating: Co-Pay, deductible, eligible, benefit, tax, etc. ClaimResponse.total.amount (amount) is equivalent to ClaimResponse.total.amount Element `ClaimResponse.total.amount` is mapped to FHIR R4B element `ClaimResponse.total.amount` as `Equivalent`. ClaimResponse.payment (payment) maps to wider concept ClaimResponse.payment Element `ClaimResponse.payment` is mapped to FHIR R4B element `ClaimResponse.payment` as `Equivalent`. ClaimResponse.payment.type (type) is equivalent to ClaimResponse.payment.type Element `ClaimResponse.payment.type` is mapped to FHIR R4B element `ClaimResponse.payment.type` as `Equivalent`. ClaimResponse.payment.adjustment (adjustment) is equivalent to ClaimResponse.payment.adjustment Element `ClaimResponse.payment.adjustment` is mapped to FHIR R4B element `ClaimResponse.payment.adjustment` as `Equivalent`. Insurers will deduct amounts owing from the provider (adjustment), such as a prior overpayment, from the amount owing to the provider (benefits payable) when payment is made to the provider. ClaimResponse.payment.adjustmentReason (adjustmentReason) is equivalent to ClaimResponse.payment.adjustmentReason Element `ClaimResponse.payment.adjustmentReason` is mapped to FHIR R4B element `ClaimResponse.payment.adjustmentReason` as `Equivalent`. ClaimResponse.payment.date (date) is equivalent to ClaimResponse.payment.date Element `ClaimResponse.payment.date` is mapped to FHIR R4B element `ClaimResponse.payment.date` as `Equivalent`. ClaimResponse.payment.amount (amount) is equivalent to ClaimResponse.payment.amount Element `ClaimResponse.payment.amount` is mapped to FHIR R4B element `ClaimResponse.payment.amount` as `Equivalent`. ClaimResponse.payment.identifier (identifier) is equivalent to ClaimResponse.payment.identifier Element `ClaimResponse.payment.identifier` is mapped to FHIR R4B element `ClaimResponse.payment.identifier` as `Equivalent`. For example: EFT number or check number. ClaimResponse.fundsReserve (fundsReserve) is equivalent to ClaimResponse.fundsReserve Element `ClaimResponse.fundsReserve` is mapped to FHIR R4B element `ClaimResponse.fundsReserve` as `Equivalent`. Fund would be release by a future claim quoting the preAuthRef of this response. Examples of values include: provider, patient, none. ClaimResponse.formCode (formCode) is equivalent to ClaimResponse.formCode Element `ClaimResponse.formCode` is mapped to FHIR R4B element `ClaimResponse.formCode` as `Equivalent`. May be needed to identify specific jurisdictional forms. ClaimResponse.form (form) is equivalent to ClaimResponse.form Element `ClaimResponse.form` is mapped to FHIR R4B element `ClaimResponse.form` as `Equivalent`. Needed to permit insurers to include the actual form. ClaimResponse.processNote (processNote) maps to wider concept ClaimResponse.processNote Element `ClaimResponse.processNote` is mapped to FHIR R4B element `ClaimResponse.processNote` as `Equivalent`. ClaimResponse.processNote.number (number) is equivalent to ClaimResponse.processNote.number Element `ClaimResponse.processNote.number` is mapped to FHIR R4B element `ClaimResponse.processNote.number` as `Equivalent`. ClaimResponse.processNote.type (type) is equivalent to ClaimResponse.processNote.type Element `ClaimResponse.processNote.type` is mapped to FHIR R4B element `ClaimResponse.processNote.type` as `Equivalent`. ClaimResponse.processNote.text (text) is equivalent to ClaimResponse.processNote.text Element `ClaimResponse.processNote.text` is mapped to FHIR R4B element `ClaimResponse.processNote.text` as `Equivalent`. ClaimResponse.processNote.language (language) is equivalent to ClaimResponse.processNote.language Element `ClaimResponse.processNote.language` is mapped to FHIR R4B element `ClaimResponse.processNote.language` as `Equivalent`. Only required if the language is different from the resource language. ClaimResponse.communicationRequest (communicationRequest) is equivalent to ClaimResponse.communicationRequest Element `ClaimResponse.communicationRequest` is mapped to FHIR R4B element `ClaimResponse.communicationRequest` as `Equivalent`. For example: professional reports, documents, images, clinical resources, or accident reports. ClaimResponse.insurance (insurance) maps to wider concept ClaimResponse.insurance Element `ClaimResponse.insurance` is mapped to FHIR R4B element `ClaimResponse.insurance` as `Equivalent`. All insurance coverages for the patient which may be applicable for reimbursement, of the products and services listed in the claim, are typically provided in the claim to allow insurers to confirm the ordering of the insurance coverages relative to local 'coordination of benefit' rules. One coverage (and only one) with 'focal=true' is to be used in the adjudication of this claim. Coverages appearing before the focal Coverage in the list, and where 'subrogation=false', should provide a reference to the ClaimResponse containing the adjudication results of the prior claim. ClaimResponse.insurance.sequence (sequence) is equivalent to ClaimResponse.insurance.sequence Element `ClaimResponse.insurance.sequence` is mapped to FHIR R4B element `ClaimResponse.insurance.sequence` as `Equivalent`. ClaimResponse.insurance.focal (focal) is equivalent to ClaimResponse.insurance.focal Element `ClaimResponse.insurance.focal` is mapped to FHIR R4B element `ClaimResponse.insurance.focal` as `Equivalent`. A patient may (will) have multiple insurance policies which provide reimbursement for healthcare services and products. For example a person may also be covered by their spouse's policy and both appear in the list (and may be from the same insurer). This flag will be set to true for only one of the listed policies and that policy will be used for adjudicating this claim. Other claims would be created to request adjudication against the other listed policies. ClaimResponse.insurance.coverage (coverage) is equivalent to ClaimResponse.insurance.coverage Element `ClaimResponse.insurance.coverage` is mapped to FHIR R4B element `ClaimResponse.insurance.coverage` as `Equivalent`. ClaimResponse.insurance.businessArrangement (businessArrangement) is equivalent to ClaimResponse.insurance.businessArrangement Element `ClaimResponse.insurance.businessArrangement` is mapped to FHIR R4B element `ClaimResponse.insurance.businessArrangement` as `Equivalent`. ClaimResponse.insurance.claimResponse (claimResponse) is equivalent to ClaimResponse.insurance.claimResponse Element `ClaimResponse.insurance.claimResponse` is mapped to FHIR R4B element `ClaimResponse.insurance.claimResponse` as `Equivalent`. Must not be specified when 'focal=true' for this insurance. ClaimResponse.error (error) maps to wider concept ClaimResponse.error Element `ClaimResponse.error` is mapped to FHIR R4B element `ClaimResponse.error` as `Equivalent`. If the request contains errors then an error element should be provided and no adjudication related sections (item, addItem, or payment) should be present. ClaimResponse.error.itemSequence (itemSequence) is equivalent to ClaimResponse.error.itemSequence Element `ClaimResponse.error.itemSequence` is mapped to FHIR R4B element `ClaimResponse.error.itemSequence` as `Equivalent`. ClaimResponse.error.detailSequence (detailSequence) is equivalent to ClaimResponse.error.detailSequence Element `ClaimResponse.error.detailSequence` is mapped to FHIR R4B element `ClaimResponse.error.detailSequence` as `Equivalent`. ClaimResponse.error.subDetailSequence (subDetailSequence) is equivalent to ClaimResponse.error.subDetailSequence Element `ClaimResponse.error.subDetailSequence` is mapped to FHIR R4B element `ClaimResponse.error.subDetailSequence` as `Equivalent`. ClaimResponse.error.code (code) is equivalent to ClaimResponse.error.code Element `ClaimResponse.error.code` is mapped to FHIR R4B element `ClaimResponse.error.code` as `Equivalent`.
Cross-version mapping for FHIR R4 ClaimResponse to FHIR R4B ClaimResponse
This ConceptMap represents cross-version mappings for elements from a FHIR R4 ClaimResponse to FHIR R4B.
Element `ClaimResponse.meta` is mapped to FHIR R4B element `ClaimResponse.meta` as `Equivalent`.
Element `ClaimResponse.implicitRules` is mapped to FHIR R4B element `ClaimResponse.implicitRules` as `Equivalent`. Asserting this rule set restricts the content to be only understood by a limited set of trading partners. This inherently limits the usefulness of the data in the long term. However, the existing health eco-system is highly fractured, and not yet ready to define, collect, and exchange data in a generally computable sense. Wherever possible, implementers and/or specification writers should avoid using this element. Often, when used, the URL is a reference to an implementation guide that defines these special rules as part of it's narrative along with other profiles, value sets, etc.
Element `ClaimResponse.language` is mapped to FHIR R4B element `ClaimResponse.language` as `Equivalent`. Language is provided to support indexing and accessibility (typically, services such as text to speech use the language tag). The html language tag in the narrative applies to the narrative. The language tag on the resource may be used to specify the language of other presentations generated from the data in the resource. Not all the content has to be in the base language. The Resource.language should not be assumed to apply to the narrative automatically. If a language is specified, it should it also be specified on the div element in the html (see rules in HTML5 for information about the relationship between xml:lang and the html lang attribute).
Element `ClaimResponse.text` is mapped to FHIR R4B element `ClaimResponse.text` as `Equivalent`. Contained resources do not have narrative. Resources that are not contained SHOULD have a narrative. In some cases, a resource may only have text with little or no additional discrete data (as long as all minOccurs=1 elements are satisfied). This may be necessary for data from legacy systems where information is captured as a "text blob" or where text is additionally entered raw or narrated and encoded information is added later.
Element `ClaimResponse.contained` is mapped to FHIR R4B element `ClaimResponse.contained` as `Equivalent`. This should never be done when the content can be identified properly, as once identification is lost, it is extremely difficult (and context dependent) to restore it again. Contained resources may have profiles and tags In their meta elements, but SHALL NOT have security labels.
Element `ClaimResponse.identifier` is mapped to FHIR R4B element `ClaimResponse.identifier` as `Equivalent`.
Element `ClaimResponse.status` is mapped to FHIR R4B element `ClaimResponse.status` as `Equivalent`. This element is labeled as a modifier because the status contains codes that mark the resource as not currently valid.
Element `ClaimResponse.type` is mapped to FHIR R4B element `ClaimResponse.type` as `Equivalent`. This may contain the local bill type codes, for example the US UB-04 bill type code or the CMS bill type.
Element `ClaimResponse.subType` is mapped to FHIR R4B element `ClaimResponse.subType` as `Equivalent`. This may contain the local bill type codes, for example the US UB-04 bill type code or the CMS bill type.
Element `ClaimResponse.use` is mapped to FHIR R4B element `ClaimResponse.use` as `Equivalent`.
Element `ClaimResponse.patient` is mapped to FHIR R4B element `ClaimResponse.patient` as `Equivalent`.
Element `ClaimResponse.created` is mapped to FHIR R4B element `ClaimResponse.created` as `Equivalent`.
Element `ClaimResponse.insurer` is mapped to FHIR R4B element `ClaimResponse.insurer` as `Equivalent`.
Element `ClaimResponse.requestor` is mapped to FHIR R4B element `ClaimResponse.requestor` as `Equivalent`. Typically this field would be 1..1 where this party is responsible for the claim but not necessarily professionally responsible for the provision of the individual products and services listed below.
Element `ClaimResponse.request` is mapped to FHIR R4B element `ClaimResponse.request` as `Equivalent`.
Element `ClaimResponse.outcome` is mapped to FHIR R4B element `ClaimResponse.outcome` as `Equivalent`. The resource may be used to indicate that: the request has been held (queued) for processing; that it has been processed and errors found (error); that no errors were found and that some of the adjudication has been undertaken (partial) or that all of the adjudication has been undertaken (complete).
Element `ClaimResponse.disposition` is mapped to FHIR R4B element `ClaimResponse.disposition` as `Equivalent`.
Element `ClaimResponse.preAuthRef` is mapped to FHIR R4B element `ClaimResponse.preAuthRef` as `Equivalent`. This value is only present on preauthorization adjudications.
Element `ClaimResponse.preAuthPeriod` is mapped to FHIR R4B element `ClaimResponse.preAuthPeriod` as `Equivalent`.
Element `ClaimResponse.payeeType` is mapped to FHIR R4B element `ClaimResponse.payeeType` as `Equivalent`.
Element `ClaimResponse.item` is mapped to FHIR R4B element `ClaimResponse.item` as `Equivalent`.
Element `ClaimResponse.item.itemSequence` is mapped to FHIR R4B element `ClaimResponse.item.itemSequence` as `Equivalent`.
Element `ClaimResponse.item.noteNumber` is mapped to FHIR R4B element `ClaimResponse.item.noteNumber` as `Equivalent`.
Element `ClaimResponse.item.adjudication` is mapped to FHIR R4B element `ClaimResponse.item.adjudication` as `Equivalent`.
Element `ClaimResponse.item.adjudication.category` is mapped to FHIR R4B element `ClaimResponse.item.adjudication.category` as `Equivalent`. For example codes indicating: Co-Pay, deductible, eligible, benefit, tax, etc.
Element `ClaimResponse.item.adjudication.reason` is mapped to FHIR R4B element `ClaimResponse.item.adjudication.reason` as `Equivalent`. For example may indicate that the funds for this benefit type have been exhausted.
Element `ClaimResponse.item.adjudication.amount` is mapped to FHIR R4B element `ClaimResponse.item.adjudication.amount` as `Equivalent`. For example: amount submitted, eligible amount, co-payment, and benefit payable.
Element `ClaimResponse.item.adjudication.value` is mapped to FHIR R4B element `ClaimResponse.item.adjudication.value` as `Equivalent`. For example: eligible percentage or co-payment percentage.
Element `ClaimResponse.item.detail` is mapped to FHIR R4B element `ClaimResponse.item.detail` as `Equivalent`.
Element `ClaimResponse.item.detail.detailSequence` is mapped to FHIR R4B element `ClaimResponse.item.detail.detailSequence` as `Equivalent`.
Element `ClaimResponse.item.detail.noteNumber` is mapped to FHIR R4B element `ClaimResponse.item.detail.noteNumber` as `Equivalent`.
Element `ClaimResponse.item.detail.adjudication` is mapped to FHIR R4B element `ClaimResponse.item.detail.adjudication` as `Equivalent`.
Element `ClaimResponse.item.detail.subDetail` is mapped to FHIR R4B element `ClaimResponse.item.detail.subDetail` as `Equivalent`.
Element `ClaimResponse.item.detail.subDetail.subDetailSequence` is mapped to FHIR R4B element `ClaimResponse.item.detail.subDetail.subDetailSequence` as `Equivalent`.
Element `ClaimResponse.item.detail.subDetail.noteNumber` is mapped to FHIR R4B element `ClaimResponse.item.detail.subDetail.noteNumber` as `Equivalent`.
Element `ClaimResponse.item.detail.subDetail.adjudication` is mapped to FHIR R4B element `ClaimResponse.item.detail.subDetail.adjudication` as `Equivalent`.
Element `ClaimResponse.addItem` is mapped to FHIR R4B element `ClaimResponse.addItem` as `Equivalent`.
Element `ClaimResponse.addItem.itemSequence` is mapped to FHIR R4B element `ClaimResponse.addItem.itemSequence` as `Equivalent`.
Element `ClaimResponse.addItem.detailSequence` is mapped to FHIR R4B element `ClaimResponse.addItem.detailSequence` as `Equivalent`.
Element `ClaimResponse.addItem.subdetailSequence` is mapped to FHIR R4B element `ClaimResponse.addItem.subdetailSequence` as `Equivalent`.
Element `ClaimResponse.addItem.provider` is mapped to FHIR R4B element `ClaimResponse.addItem.provider` as `Equivalent`.
Element `ClaimResponse.addItem.productOrService` is mapped to FHIR R4B element `ClaimResponse.addItem.productOrService` as `Equivalent`. If this is an actual service or product line, i.e. not a Group, then use code to indicate the Professional Service or Product supplied (e.g. CTP, HCPCS, USCLS, ICD10, NCPDP, DIN, RxNorm, ACHI, CCI). If a grouping item then use a group code to indicate the type of thing being grouped e.g. 'glasses' or 'compound'.
Element `ClaimResponse.addItem.modifier` is mapped to FHIR R4B element `ClaimResponse.addItem.modifier` as `Equivalent`. For example in Oral whether the treatment is cosmetic or associated with TMJ, or for Medical whether the treatment was outside the clinic or outside of office hours.
Element `ClaimResponse.addItem.programCode` is mapped to FHIR R4B element `ClaimResponse.addItem.programCode` as `Equivalent`. For example: Neonatal program, child dental program or drug users recovery program.
Element `ClaimResponse.addItem.serviced[x]` is mapped to FHIR R4B element `ClaimResponse.addItem.serviced[x]` as `Equivalent`. The target context `ClaimResponse.addItem.serviced[x]` is a choice-type element and cannot directly hold extensions. The context is moved up to parent element `ClaimResponse.addItem`.
Element `ClaimResponse.addItem.location[x]` is mapped to FHIR R4B element `ClaimResponse.addItem.location[x]` as `Equivalent`. The target context `ClaimResponse.addItem.location[x]` is a choice-type element and cannot directly hold extensions. The context is moved up to parent element `ClaimResponse.addItem`.
Element `ClaimResponse.addItem.quantity` is mapped to FHIR R4B element `ClaimResponse.addItem.quantity` as `Equivalent`.
Element `ClaimResponse.addItem.unitPrice` is mapped to FHIR R4B element `ClaimResponse.addItem.unitPrice` as `Equivalent`.
Element `ClaimResponse.addItem.factor` is mapped to FHIR R4B element `ClaimResponse.addItem.factor` as `Equivalent`. To show a 10% senior's discount, the value entered is: 0.90 (1.00 - 0.10).
Element `ClaimResponse.addItem.net` is mapped to FHIR R4B element `ClaimResponse.addItem.net` as `Equivalent`. For example, the formula: quantity * unitPrice * factor = net. Quantity and factor are assumed to be 1 if not supplied.
Element `ClaimResponse.addItem.bodySite` is mapped to FHIR R4B element `ClaimResponse.addItem.bodySite` as `Equivalent`. For example: Providing a tooth code allows an insurer to identify a provider performing a filling on a tooth that was previously removed.
Element `ClaimResponse.addItem.subSite` is mapped to FHIR R4B element `ClaimResponse.addItem.subSite` as `Equivalent`.
Element `ClaimResponse.addItem.noteNumber` is mapped to FHIR R4B element `ClaimResponse.addItem.noteNumber` as `Equivalent`.
Element `ClaimResponse.addItem.adjudication` is mapped to FHIR R4B element `ClaimResponse.addItem.adjudication` as `Equivalent`.
Element `ClaimResponse.addItem.detail` is mapped to FHIR R4B element `ClaimResponse.addItem.detail` as `Equivalent`.
Element `ClaimResponse.addItem.detail.productOrService` is mapped to FHIR R4B element `ClaimResponse.addItem.detail.productOrService` as `Equivalent`. If this is an actual service or product line, i.e. not a Group, then use code to indicate the Professional Service or Product supplied (e.g. CTP, HCPCS, USCLS, ICD10, NCPDP, DIN, RxNorm, ACHI, CCI). If a grouping item then use a group code to indicate the type of thing being grouped e.g. 'glasses' or 'compound'.
Element `ClaimResponse.addItem.detail.modifier` is mapped to FHIR R4B element `ClaimResponse.addItem.detail.modifier` as `Equivalent`. For example in Oral whether the treatment is cosmetic or associated with TMJ, or for Medical whether the treatment was outside the clinic or outside of office hours.
Element `ClaimResponse.addItem.detail.quantity` is mapped to FHIR R4B element `ClaimResponse.addItem.detail.quantity` as `Equivalent`.
Element `ClaimResponse.addItem.detail.unitPrice` is mapped to FHIR R4B element `ClaimResponse.addItem.detail.unitPrice` as `Equivalent`.
Element `ClaimResponse.addItem.detail.factor` is mapped to FHIR R4B element `ClaimResponse.addItem.detail.factor` as `Equivalent`. To show a 10% senior's discount, the value entered is: 0.90 (1.00 - 0.10).
Element `ClaimResponse.addItem.detail.net` is mapped to FHIR R4B element `ClaimResponse.addItem.detail.net` as `Equivalent`. For example, the formula: quantity * unitPrice * factor = net. Quantity and factor are assumed to be 1 if not supplied.
Element `ClaimResponse.addItem.detail.noteNumber` is mapped to FHIR R4B element `ClaimResponse.addItem.detail.noteNumber` as `Equivalent`.
Element `ClaimResponse.addItem.detail.adjudication` is mapped to FHIR R4B element `ClaimResponse.addItem.detail.adjudication` as `Equivalent`.
Element `ClaimResponse.addItem.detail.subDetail` is mapped to FHIR R4B element `ClaimResponse.addItem.detail.subDetail` as `Equivalent`.
Element `ClaimResponse.addItem.detail.subDetail.productOrService` is mapped to FHIR R4B element `ClaimResponse.addItem.detail.subDetail.productOrService` as `Equivalent`. If this is an actual service or product line, i.e. not a Group, then use code to indicate the Professional Service or Product supplied (e.g. CTP, HCPCS, USCLS, ICD10, NCPDP, DIN, RxNorm, ACHI, CCI). If a grouping item then use a group code to indicate the type of thing being grouped e.g. 'glasses' or 'compound'.
Element `ClaimResponse.addItem.detail.subDetail.modifier` is mapped to FHIR R4B element `ClaimResponse.addItem.detail.subDetail.modifier` as `Equivalent`. For example in Oral whether the treatment is cosmetic or associated with TMJ, or for Medical whether the treatment was outside the clinic or outside of office hours.
Element `ClaimResponse.addItem.detail.subDetail.quantity` is mapped to FHIR R4B element `ClaimResponse.addItem.detail.subDetail.quantity` as `Equivalent`.
Element `ClaimResponse.addItem.detail.subDetail.unitPrice` is mapped to FHIR R4B element `ClaimResponse.addItem.detail.subDetail.unitPrice` as `Equivalent`.
Element `ClaimResponse.addItem.detail.subDetail.factor` is mapped to FHIR R4B element `ClaimResponse.addItem.detail.subDetail.factor` as `Equivalent`. To show a 10% senior's discount, the value entered is: 0.90 (1.00 - 0.10).
Element `ClaimResponse.addItem.detail.subDetail.net` is mapped to FHIR R4B element `ClaimResponse.addItem.detail.subDetail.net` as `Equivalent`. For example, the formula: quantity * unitPrice * factor = net. Quantity and factor are assumed to be 1 if not supplied.
Element `ClaimResponse.addItem.detail.subDetail.noteNumber` is mapped to FHIR R4B element `ClaimResponse.addItem.detail.subDetail.noteNumber` as `Equivalent`.
Element `ClaimResponse.addItem.detail.subDetail.adjudication` is mapped to FHIR R4B element `ClaimResponse.addItem.detail.subDetail.adjudication` as `Equivalent`.
Element `ClaimResponse.adjudication` is mapped to FHIR R4B element `ClaimResponse.adjudication` as `Equivalent`.
Element `ClaimResponse.total` is mapped to FHIR R4B element `ClaimResponse.total` as `Equivalent`. Totals for amounts submitted, co-pays, benefits payable etc.
Element `ClaimResponse.total.category` is mapped to FHIR R4B element `ClaimResponse.total.category` as `Equivalent`. For example codes indicating: Co-Pay, deductible, eligible, benefit, tax, etc.
Element `ClaimResponse.total.amount` is mapped to FHIR R4B element `ClaimResponse.total.amount` as `Equivalent`.
Element `ClaimResponse.payment` is mapped to FHIR R4B element `ClaimResponse.payment` as `Equivalent`.
Element `ClaimResponse.payment.type` is mapped to FHIR R4B element `ClaimResponse.payment.type` as `Equivalent`.
Element `ClaimResponse.payment.adjustment` is mapped to FHIR R4B element `ClaimResponse.payment.adjustment` as `Equivalent`. Insurers will deduct amounts owing from the provider (adjustment), such as a prior overpayment, from the amount owing to the provider (benefits payable) when payment is made to the provider.
Element `ClaimResponse.payment.adjustmentReason` is mapped to FHIR R4B element `ClaimResponse.payment.adjustmentReason` as `Equivalent`.
Element `ClaimResponse.payment.date` is mapped to FHIR R4B element `ClaimResponse.payment.date` as `Equivalent`.
Element `ClaimResponse.payment.amount` is mapped to FHIR R4B element `ClaimResponse.payment.amount` as `Equivalent`.
Element `ClaimResponse.payment.identifier` is mapped to FHIR R4B element `ClaimResponse.payment.identifier` as `Equivalent`. For example: EFT number or check number.
Element `ClaimResponse.fundsReserve` is mapped to FHIR R4B element `ClaimResponse.fundsReserve` as `Equivalent`. Fund would be release by a future claim quoting the preAuthRef of this response. Examples of values include: provider, patient, none.
Element `ClaimResponse.formCode` is mapped to FHIR R4B element `ClaimResponse.formCode` as `Equivalent`. May be needed to identify specific jurisdictional forms.
Element `ClaimResponse.form` is mapped to FHIR R4B element `ClaimResponse.form` as `Equivalent`. Needed to permit insurers to include the actual form.
Element `ClaimResponse.processNote` is mapped to FHIR R4B element `ClaimResponse.processNote` as `Equivalent`.
Element `ClaimResponse.processNote.number` is mapped to FHIR R4B element `ClaimResponse.processNote.number` as `Equivalent`.
Element `ClaimResponse.processNote.type` is mapped to FHIR R4B element `ClaimResponse.processNote.type` as `Equivalent`.
Element `ClaimResponse.processNote.text` is mapped to FHIR R4B element `ClaimResponse.processNote.text` as `Equivalent`.
Element `ClaimResponse.processNote.language` is mapped to FHIR R4B element `ClaimResponse.processNote.language` as `Equivalent`. Only required if the language is different from the resource language.
Element `ClaimResponse.communicationRequest` is mapped to FHIR R4B element `ClaimResponse.communicationRequest` as `Equivalent`. For example: professional reports, documents, images, clinical resources, or accident reports.
Element `ClaimResponse.insurance` is mapped to FHIR R4B element `ClaimResponse.insurance` as `Equivalent`. All insurance coverages for the patient which may be applicable for reimbursement, of the products and services listed in the claim, are typically provided in the claim to allow insurers to confirm the ordering of the insurance coverages relative to local 'coordination of benefit' rules. One coverage (and only one) with 'focal=true' is to be used in the adjudication of this claim. Coverages appearing before the focal Coverage in the list, and where 'subrogation=false', should provide a reference to the ClaimResponse containing the adjudication results of the prior claim.
Element `ClaimResponse.insurance.sequence` is mapped to FHIR R4B element `ClaimResponse.insurance.sequence` as `Equivalent`.
Element `ClaimResponse.insurance.focal` is mapped to FHIR R4B element `ClaimResponse.insurance.focal` as `Equivalent`. A patient may (will) have multiple insurance policies which provide reimbursement for healthcare services and products. For example a person may also be covered by their spouse's policy and both appear in the list (and may be from the same insurer). This flag will be set to true for only one of the listed policies and that policy will be used for adjudicating this claim. Other claims would be created to request adjudication against the other listed policies.
Element `ClaimResponse.insurance.coverage` is mapped to FHIR R4B element `ClaimResponse.insurance.coverage` as `Equivalent`.
Element `ClaimResponse.insurance.businessArrangement` is mapped to FHIR R4B element `ClaimResponse.insurance.businessArrangement` as `Equivalent`.
Element `ClaimResponse.insurance.claimResponse` is mapped to FHIR R4B element `ClaimResponse.insurance.claimResponse` as `Equivalent`. Must not be specified when 'focal=true' for this insurance.
Element `ClaimResponse.error` is mapped to FHIR R4B element `ClaimResponse.error` as `Equivalent`. If the request contains errors then an error element should be provided and no adjudication related sections (item, addItem, or payment) should be present.
Element `ClaimResponse.error.itemSequence` is mapped to FHIR R4B element `ClaimResponse.error.itemSequence` as `Equivalent`.
Element `ClaimResponse.error.detailSequence` is mapped to FHIR R4B element `ClaimResponse.error.detailSequence` as `Equivalent`.
Element `ClaimResponse.error.subDetailSequence` is mapped to FHIR R4B element `ClaimResponse.error.subDetailSequence` as `Equivalent`.
Element `ClaimResponse.error.code` is mapped to FHIR R4B element `ClaimResponse.error.code` as `Equivalent`.