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

Extension: ExtensionExplanationOfBenefit_Item_ReviewOutcome - Detailed Descriptions

Page standards status: Trial-use Maturity Level: 0

Definitions for the ext-R5-ExplanationOfBenefit.ite.reviewOutcome extension.

Guidance on how to interpret the contents of this table can be foundhere

0. Extension
Definition

R5: ExplanationOfBenefit.item.reviewOutcome (new:BackboneElement)


Optional Extension Element - found in all resources.

ShortR5: Adjudication results (new)Optional Extensions Element
Comments

Element ExplanationOfBenefit.item.reviewOutcome has a context of ExplanationOfBenefit.item based on following the parent source element upwards and mapping to ExplanationOfBenefit. Element ExplanationOfBenefit.item.reviewOutcome has no mapping targets in FHIR STU3. Typically, this is because the element has been added (is a new element).

Control0..1*
This element is affected by the following invariants: ele-1
Is Modifierfalse
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() | (children().count() > id.count()))
ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
ele-1: All FHIR elements must have a @value or children (hasValue() | (children().count() > id.count()))
ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
2. Extension.extension
Definition

An Extension


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.

ShortExtensionAdditional Content defined by implementations
Comments

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.

Control0..*
TypeExtension
Alternate Namesextensions, user content
SlicingThis element introduces a set of slices on Extension.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
  • value @ url
  • 4. Extension.extension:decision
    Slice Namedecision
    Definition

    R5: ExplanationOfBenefit.item.reviewOutcome.decision (new:CodeableConcept)

    ShortR5: Result of the adjudication (new)Additional Content defined by implementations
    Comments

    Element ExplanationOfBenefit.item.reviewOutcome.decision is part of an existing definition because parent element ExplanationOfBenefit.item.reviewOutcome requires a cross-version extension. Element ExplanationOfBenefit.item.reviewOutcome.decision has a context of ExplanationOfBenefit.item based on following the parent source element upwards and mapping to ExplanationOfBenefit. Element ExplanationOfBenefit.item.reviewOutcome.decision has no mapping targets in FHIR STU3. Typically, this is because the element has been added (is a new element). The element is used to indicate the current state of the adjudication overall for the claim resource, for example: the request has been held (pended) for adjudication processing, for manual review or other reasons; that it has been processed and will be paid, or the outstanding paid, as submitted (approved); that no amount will be paid (denied); or that some amount between zero and the submitted amount will be paid (partial).

    Control0..1*
    TypeExtension
    Requirements

    To advise the requestor of the result of the adjudication process. Element ExplanationOfBenefit.item.reviewOutcome.decision is part of an existing definition because parent element ExplanationOfBenefit.item.reviewOutcome requires a cross-version extension. Element ExplanationOfBenefit.item.reviewOutcome.decision has a context of ExplanationOfBenefit.item based on following the parent source element upwards and mapping to ExplanationOfBenefit. Element ExplanationOfBenefit.item.reviewOutcome.decision has no mapping targets in FHIR STU3. Typically, this is because the element has been added (is a new element).

    6. Extension.extension:decision.url
    Definition

    Source of the definition for the extension code - a logical name or a URL.

    Shortidentifies the meaning of the extension
    Comments

    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.

    Control1..1
    Typeuri
    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
    XML FormatIn the XML format, this property is represented as an attribute.
    Fixed Valuedecision
    8. Extension.extension:decision.value[x]
    Definition

    The result of the claim, predetermination, or preauthorization adjudication.


    Value of extension - may be a resource or one of a constrained set of the data types (see Extensibility in the spec for list).

    ShortResult of the adjudicationValue of extension
    Comments

    The element is used to indicate the current state of the adjudication overall for the claim resource, for example: the request has been held (pended) for adjudication processing, for manual review or other reasons; that it has been processed and will be paid, or the outstanding paid, as submitted (approved); that no amount will be paid (denied); or that some amount between zero and the submitted amount will be paid (partial).

    Control0..1
    BindingFor example codes, see For codes, see R5ClaimDecisionForR3 (0.1.0)
    (example to http://hl7.org/fhir/uv/xver/ValueSet/R5-claim-decision-for-R3|0.1.0)
    TypeCodeableConcept, date, dateTime, Meta, code, string, Address, Attachment, integer, oid, Count, instant, ContactPoint, HumanName, Money, Identifier, Coding, markdown, SampledData, Ratio, id, positiveInt, Age, Distance, Reference, Period, Quantity, Duration, Range, uri, Annotation, boolean, base64Binary, Signature, unsignedInt, time, Timing, decimal
    [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
    10. Extension.extension:reason
    Slice Namereason
    Definition

    R5: ExplanationOfBenefit.item.reviewOutcome.reason (new:CodeableConcept)

    ShortR5: Reason for result of the adjudication (new)Additional Content defined by implementations
    Comments

    Element ExplanationOfBenefit.item.reviewOutcome.reason is part of an existing definition because parent element ExplanationOfBenefit.item.reviewOutcome requires a cross-version extension. Element ExplanationOfBenefit.item.reviewOutcome.reason has a context of ExplanationOfBenefit.item based on following the parent source element upwards and mapping to ExplanationOfBenefit. Element ExplanationOfBenefit.item.reviewOutcome.reason has no mapping targets in FHIR STU3. Typically, this is because the element has been added (is a new element).

    Control0..*
    TypeExtension
    Requirements

    To advise the requestor of the contributors to the result of the adjudication process. Element ExplanationOfBenefit.item.reviewOutcome.reason is part of an existing definition because parent element ExplanationOfBenefit.item.reviewOutcome requires a cross-version extension. Element ExplanationOfBenefit.item.reviewOutcome.reason has a context of ExplanationOfBenefit.item based on following the parent source element upwards and mapping to ExplanationOfBenefit. Element ExplanationOfBenefit.item.reviewOutcome.reason has no mapping targets in FHIR STU3. Typically, this is because the element has been added (is a new element).

    12. Extension.extension:reason.url
    Definition

    Source of the definition for the extension code - a logical name or a URL.

    Shortidentifies the meaning of the extension
    Comments

    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.

    Control1..1
    Typeuri
    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
    XML FormatIn the XML format, this property is represented as an attribute.
    Fixed Valuereason
    14. Extension.extension:reason.value[x]
    Definition

    The reasons for the result of the claim, predetermination, or preauthorization adjudication.


    Value of extension - may be a resource or one of a constrained set of the data types (see Extensibility in the spec for list).

    ShortReason for result of the adjudicationValue of extension
    Control0..1
    BindingFor example codes, see For codes, see R5ClaimDecisionReasonForR3 (0.1.0)
    (example to http://hl7.org/fhir/uv/xver/ValueSet/R5-claim-decision-reason-for-R3|0.1.0)
    TypeCodeableConcept, date, dateTime, Meta, code, string, Address, Attachment, integer, oid, Count, instant, ContactPoint, HumanName, Money, Identifier, Coding, markdown, SampledData, Ratio, id, positiveInt, Age, Distance, Reference, Period, Quantity, Duration, Range, uri, Annotation, boolean, base64Binary, Signature, unsignedInt, time, Timing, decimal
    [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
    16. Extension.extension:preAuthRef
    Slice NamepreAuthRef
    Definition

    R5: ExplanationOfBenefit.item.reviewOutcome.preAuthRef (new:string)

    ShortR5: Preauthorization reference (new)Additional Content defined by implementations
    Comments

    Element ExplanationOfBenefit.item.reviewOutcome.preAuthRef is part of an existing definition because parent element ExplanationOfBenefit.item.reviewOutcome requires a cross-version extension. Element ExplanationOfBenefit.item.reviewOutcome.preAuthRef has a context of ExplanationOfBenefit.item based on following the parent source element upwards and mapping to ExplanationOfBenefit. Element ExplanationOfBenefit.item.reviewOutcome.preAuthRef has no mapping targets in FHIR STU3. Typically, this is because the element has been added (is a new element). This value is only present on preauthorization adjudications.

    Control0..1*
    TypeExtension
    Requirements

    On subsequent claims, the insurer may require the provider to quote this value. Element ExplanationOfBenefit.item.reviewOutcome.preAuthRef is part of an existing definition because parent element ExplanationOfBenefit.item.reviewOutcome requires a cross-version extension. Element ExplanationOfBenefit.item.reviewOutcome.preAuthRef has a context of ExplanationOfBenefit.item based on following the parent source element upwards and mapping to ExplanationOfBenefit. Element ExplanationOfBenefit.item.reviewOutcome.preAuthRef has no mapping targets in FHIR STU3. Typically, this is because the element has been added (is a new element).

    18. Extension.extension:preAuthRef.url
    Definition

    Source of the definition for the extension code - a logical name or a URL.

    Shortidentifies the meaning of the extension
    Comments

    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.

    Control1..1
    Typeuri
    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
    XML FormatIn the XML format, this property is represented as an attribute.
    Fixed ValuepreAuthRef
    20. Extension.extension:preAuthRef.value[x]
    Definition

    Reference from the Insurer which is used in later communications which refers to this adjudication.


    Value of extension - may be a resource or one of a constrained set of the data types (see Extensibility in the spec for list).

    ShortPreauthorization referenceValue of extension
    Comments

    This value is only present on preauthorization adjudications.

    Control0..1
    Typestring, date, dateTime, Meta, code, Address, Attachment, integer, oid, Count, instant, ContactPoint, HumanName, Money, Identifier, Coding, markdown, SampledData, Ratio, id, positiveInt, Age, Distance, Reference, Period, Quantity, Duration, Range, uri, Annotation, boolean, base64Binary, Signature, unsignedInt, time, Timing, decimal, CodeableConcept
    [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
    22. Extension.extension:preAuthPeriod
    Slice NamepreAuthPeriod
    Definition

    R5: ExplanationOfBenefit.item.reviewOutcome.preAuthPeriod (new:Period)

    ShortR5: Preauthorization reference effective period (new)Additional Content defined by implementations
    Comments

    Element ExplanationOfBenefit.item.reviewOutcome.preAuthPeriod is part of an existing definition because parent element ExplanationOfBenefit.item.reviewOutcome requires a cross-version extension. Element ExplanationOfBenefit.item.reviewOutcome.preAuthPeriod has a context of ExplanationOfBenefit.item based on following the parent source element upwards and mapping to ExplanationOfBenefit. Element ExplanationOfBenefit.item.reviewOutcome.preAuthPeriod has no mapping targets in FHIR STU3. Typically, this is because the element has been added (is a new element).

    Control0..1*
    TypeExtension
    Requirements

    To convey to the provider when the authorized products and services must be supplied for the authorized adjudication to apply. Element ExplanationOfBenefit.item.reviewOutcome.preAuthPeriod is part of an existing definition because parent element ExplanationOfBenefit.item.reviewOutcome requires a cross-version extension. Element ExplanationOfBenefit.item.reviewOutcome.preAuthPeriod has a context of ExplanationOfBenefit.item based on following the parent source element upwards and mapping to ExplanationOfBenefit. Element ExplanationOfBenefit.item.reviewOutcome.preAuthPeriod has no mapping targets in FHIR STU3. Typically, this is because the element has been added (is a new element).

    24. Extension.extension:preAuthPeriod.url
    Definition

    Source of the definition for the extension code - a logical name or a URL.

    Shortidentifies the meaning of the extension
    Comments

    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.

    Control1..1
    Typeuri
    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
    XML FormatIn the XML format, this property is represented as an attribute.
    Fixed ValuepreAuthPeriod
    26. Extension.extension:preAuthPeriod.value[x]
    Definition

    The time frame during which this authorization is effective.


    Value of extension - may be a resource or one of a constrained set of the data types (see Extensibility in the spec for list).

    ShortPreauthorization reference effective periodValue of extension
    Control0..1
    TypePeriod, date, dateTime, Meta, code, string, Address, Attachment, integer, oid, Count, instant, ContactPoint, HumanName, Money, Identifier, Coding, markdown, SampledData, Ratio, id, positiveInt, Age, Distance, Reference, Quantity, Duration, Range, uri, Annotation, boolean, base64Binary, Signature, unsignedInt, time, Timing, decimal, CodeableConcept
    [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
    28. Extension.url
    Definition

    Source of the definition for the extension code - a logical name or a URL.

    Shortidentifies the meaning of the extension
    Comments

    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.

    Control1..1
    Typeuri
    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
    XML FormatIn the XML format, this property is represented as an attribute.
    Fixed Valuehttp://hl7.org/fhir/5.0/StructureDefinition/extension-ExplanationOfBenefit.item.reviewOutcome
    30. Extension.value[x]
    Definition

    Value of extension - may be a resource or one of a constrained set of the data types (see Extensibility in the spec for list).

    ShortValue of extension
    Control0..01
    TypeChoice of: base64Binary, boolean, code, date, dateTime, decimal, id, instant, integer, markdown, oid, positiveInt, string, time, unsignedInt, uri, Address, Age, Annotation, Attachment, CodeableConcept, Coding, ContactPoint, Count, Distance, Duration, HumanName, Identifier, Money, Period, Quantity, Range, Ratio, Reference, SampledData, Signature, Timing, Meta
    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension

    Guidance on how to interpret the contents of this table can be foundhere

    0. Extension
    Definition

    R5: ExplanationOfBenefit.item.reviewOutcome (new:BackboneElement)

    ShortR5: Adjudication results (new)
    Comments

    Element ExplanationOfBenefit.item.reviewOutcome has a context of ExplanationOfBenefit.item based on following the parent source element upwards and mapping to ExplanationOfBenefit. Element ExplanationOfBenefit.item.reviewOutcome has no mapping targets in FHIR STU3. Typically, this is because the element has been added (is a new element).

    Control0..1
    Is Modifierfalse
    2. Extension.extension
    Control0..*
    SlicingThis element introduces a set of slices on Extension.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
    • value @ url
    • 4. Extension.extension:decision
      Slice Namedecision
      Definition

      R5: ExplanationOfBenefit.item.reviewOutcome.decision (new:CodeableConcept)

      ShortR5: Result of the adjudication (new)
      Comments

      Element ExplanationOfBenefit.item.reviewOutcome.decision is part of an existing definition because parent element ExplanationOfBenefit.item.reviewOutcome requires a cross-version extension. Element ExplanationOfBenefit.item.reviewOutcome.decision has a context of ExplanationOfBenefit.item based on following the parent source element upwards and mapping to ExplanationOfBenefit. Element ExplanationOfBenefit.item.reviewOutcome.decision has no mapping targets in FHIR STU3. Typically, this is because the element has been added (is a new element). The element is used to indicate the current state of the adjudication overall for the claim resource, for example: the request has been held (pended) for adjudication processing, for manual review or other reasons; that it has been processed and will be paid, or the outstanding paid, as submitted (approved); that no amount will be paid (denied); or that some amount between zero and the submitted amount will be paid (partial).

      Control0..1
      Requirements

      To advise the requestor of the result of the adjudication process. Element ExplanationOfBenefit.item.reviewOutcome.decision is part of an existing definition because parent element ExplanationOfBenefit.item.reviewOutcome requires a cross-version extension. Element ExplanationOfBenefit.item.reviewOutcome.decision has a context of ExplanationOfBenefit.item based on following the parent source element upwards and mapping to ExplanationOfBenefit. Element ExplanationOfBenefit.item.reviewOutcome.decision has no mapping targets in FHIR STU3. Typically, this is because the element has been added (is a new element).

      6. Extension.extension:decision.url
      Control1..1
      Fixed Valuedecision
      8. Extension.extension:decision.value[x]
      Definition

      The result of the claim, predetermination, or preauthorization adjudication.

      ShortResult of the adjudication
      Comments

      The element is used to indicate the current state of the adjudication overall for the claim resource, for example: the request has been held (pended) for adjudication processing, for manual review or other reasons; that it has been processed and will be paid, or the outstanding paid, as submitted (approved); that no amount will be paid (denied); or that some amount between zero and the submitted amount will be paid (partial).

      Control0..1
      BindingFor example codes, see R5ClaimDecisionForR3 (0.1.0)
      (example to http://hl7.org/fhir/uv/xver/ValueSet/R5-claim-decision-for-R3|0.1.0)
      TypeCodeableConcept
      [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
      10. Extension.extension:reason
      Slice Namereason
      Definition

      R5: ExplanationOfBenefit.item.reviewOutcome.reason (new:CodeableConcept)

      ShortR5: Reason for result of the adjudication (new)
      Comments

      Element ExplanationOfBenefit.item.reviewOutcome.reason is part of an existing definition because parent element ExplanationOfBenefit.item.reviewOutcome requires a cross-version extension. Element ExplanationOfBenefit.item.reviewOutcome.reason has a context of ExplanationOfBenefit.item based on following the parent source element upwards and mapping to ExplanationOfBenefit. Element ExplanationOfBenefit.item.reviewOutcome.reason has no mapping targets in FHIR STU3. Typically, this is because the element has been added (is a new element).

      Control0..*
      Requirements

      To advise the requestor of the contributors to the result of the adjudication process. Element ExplanationOfBenefit.item.reviewOutcome.reason is part of an existing definition because parent element ExplanationOfBenefit.item.reviewOutcome requires a cross-version extension. Element ExplanationOfBenefit.item.reviewOutcome.reason has a context of ExplanationOfBenefit.item based on following the parent source element upwards and mapping to ExplanationOfBenefit. Element ExplanationOfBenefit.item.reviewOutcome.reason has no mapping targets in FHIR STU3. Typically, this is because the element has been added (is a new element).

      12. Extension.extension:reason.url
      Control1..1
      Fixed Valuereason
      14. Extension.extension:reason.value[x]
      Definition

      The reasons for the result of the claim, predetermination, or preauthorization adjudication.

      ShortReason for result of the adjudication
      Control0..1
      BindingFor example codes, see R5ClaimDecisionReasonForR3 (0.1.0)
      (example to http://hl7.org/fhir/uv/xver/ValueSet/R5-claim-decision-reason-for-R3|0.1.0)
      TypeCodeableConcept
      [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
      16. Extension.extension:preAuthRef
      Slice NamepreAuthRef
      Definition

      R5: ExplanationOfBenefit.item.reviewOutcome.preAuthRef (new:string)

      ShortR5: Preauthorization reference (new)
      Comments

      Element ExplanationOfBenefit.item.reviewOutcome.preAuthRef is part of an existing definition because parent element ExplanationOfBenefit.item.reviewOutcome requires a cross-version extension. Element ExplanationOfBenefit.item.reviewOutcome.preAuthRef has a context of ExplanationOfBenefit.item based on following the parent source element upwards and mapping to ExplanationOfBenefit. Element ExplanationOfBenefit.item.reviewOutcome.preAuthRef has no mapping targets in FHIR STU3. Typically, this is because the element has been added (is a new element). This value is only present on preauthorization adjudications.

      Control0..1
      Requirements

      On subsequent claims, the insurer may require the provider to quote this value. Element ExplanationOfBenefit.item.reviewOutcome.preAuthRef is part of an existing definition because parent element ExplanationOfBenefit.item.reviewOutcome requires a cross-version extension. Element ExplanationOfBenefit.item.reviewOutcome.preAuthRef has a context of ExplanationOfBenefit.item based on following the parent source element upwards and mapping to ExplanationOfBenefit. Element ExplanationOfBenefit.item.reviewOutcome.preAuthRef has no mapping targets in FHIR STU3. Typically, this is because the element has been added (is a new element).

      18. Extension.extension:preAuthRef.url
      Control1..1
      Fixed ValuepreAuthRef
      20. Extension.extension:preAuthRef.value[x]
      Definition

      Reference from the Insurer which is used in later communications which refers to this adjudication.

      ShortPreauthorization reference
      Comments

      This value is only present on preauthorization adjudications.

      Control0..1
      Typestring
      [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
      22. Extension.extension:preAuthPeriod
      Slice NamepreAuthPeriod
      Definition

      R5: ExplanationOfBenefit.item.reviewOutcome.preAuthPeriod (new:Period)

      ShortR5: Preauthorization reference effective period (new)
      Comments

      Element ExplanationOfBenefit.item.reviewOutcome.preAuthPeriod is part of an existing definition because parent element ExplanationOfBenefit.item.reviewOutcome requires a cross-version extension. Element ExplanationOfBenefit.item.reviewOutcome.preAuthPeriod has a context of ExplanationOfBenefit.item based on following the parent source element upwards and mapping to ExplanationOfBenefit. Element ExplanationOfBenefit.item.reviewOutcome.preAuthPeriod has no mapping targets in FHIR STU3. Typically, this is because the element has been added (is a new element).

      Control0..1
      Requirements

      To convey to the provider when the authorized products and services must be supplied for the authorized adjudication to apply. Element ExplanationOfBenefit.item.reviewOutcome.preAuthPeriod is part of an existing definition because parent element ExplanationOfBenefit.item.reviewOutcome requires a cross-version extension. Element ExplanationOfBenefit.item.reviewOutcome.preAuthPeriod has a context of ExplanationOfBenefit.item based on following the parent source element upwards and mapping to ExplanationOfBenefit. Element ExplanationOfBenefit.item.reviewOutcome.preAuthPeriod has no mapping targets in FHIR STU3. Typically, this is because the element has been added (is a new element).

      24. Extension.extension:preAuthPeriod.url
      Control1..1
      Fixed ValuepreAuthPeriod
      26. Extension.extension:preAuthPeriod.value[x]
      Definition

      The time frame during which this authorization is effective.

      ShortPreauthorization reference effective period
      Control0..1
      TypePeriod
      [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
      28. Extension.url
      Control1..1
      Fixed Valuehttp://hl7.org/fhir/5.0/StructureDefinition/extension-ExplanationOfBenefit.item.reviewOutcome
      30. Extension.value[x]
      Control0..0

      Guidance on how to interpret the contents of this table can be foundhere

      0. Extension
      Definition

      R5: ExplanationOfBenefit.item.reviewOutcome (new:BackboneElement)

      ShortR5: Adjudication results (new)
      Comments

      Element ExplanationOfBenefit.item.reviewOutcome has a context of ExplanationOfBenefit.item based on following the parent source element upwards and mapping to ExplanationOfBenefit. Element ExplanationOfBenefit.item.reviewOutcome has no mapping targets in FHIR STU3. Typically, this is because the element has been added (is a new element).

      Control0..1
      This element is affected by the following invariants: ele-1
      Is Modifierfalse
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() | (children().count() > id.count()))
      ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
      2. Extension.id
      Definition

      unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

      Shortxml:id (or equivalent in JSON)
      Control0..1
      Typestring
      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
      XML FormatIn the XML format, this property is represented as an attribute.
      4. Extension.extension
      Definition

      An Extension

      ShortExtension
      Control0..*
      TypeExtension
      SlicingThis element introduces a set of slices on Extension.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
      • value @ url
      • 6. Extension.extension:decision
        Slice Namedecision
        Definition

        R5: ExplanationOfBenefit.item.reviewOutcome.decision (new:CodeableConcept)

        ShortR5: Result of the adjudication (new)
        Comments

        Element ExplanationOfBenefit.item.reviewOutcome.decision is part of an existing definition because parent element ExplanationOfBenefit.item.reviewOutcome requires a cross-version extension. Element ExplanationOfBenefit.item.reviewOutcome.decision has a context of ExplanationOfBenefit.item based on following the parent source element upwards and mapping to ExplanationOfBenefit. Element ExplanationOfBenefit.item.reviewOutcome.decision has no mapping targets in FHIR STU3. Typically, this is because the element has been added (is a new element). The element is used to indicate the current state of the adjudication overall for the claim resource, for example: the request has been held (pended) for adjudication processing, for manual review or other reasons; that it has been processed and will be paid, or the outstanding paid, as submitted (approved); that no amount will be paid (denied); or that some amount between zero and the submitted amount will be paid (partial).

        Control0..1
        TypeExtension
        Requirements

        To advise the requestor of the result of the adjudication process. Element ExplanationOfBenefit.item.reviewOutcome.decision is part of an existing definition because parent element ExplanationOfBenefit.item.reviewOutcome requires a cross-version extension. Element ExplanationOfBenefit.item.reviewOutcome.decision has a context of ExplanationOfBenefit.item based on following the parent source element upwards and mapping to ExplanationOfBenefit. Element ExplanationOfBenefit.item.reviewOutcome.decision has no mapping targets in FHIR STU3. Typically, this is because the element has been added (is a new element).

        8. Extension.extension:decision.id
        Definition

        unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

        Shortxml:id (or equivalent in JSON)
        Control0..1
        Typestring
        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
        XML FormatIn the XML format, this property is represented as an attribute.
        10. Extension.extension:decision.extension
        Definition

        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.

        ShortAdditional Content defined by implementations
        Comments

        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.

        Control0..*
        TypeExtension
        Alternate Namesextensions, user content
        SlicingThis element introduces a set of slices on Extension.extension.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
        • value @ url
        • 12. Extension.extension:decision.url
          Definition

          Source of the definition for the extension code - a logical name or a URL.

          Shortidentifies the meaning of the extension
          Comments

          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.

          Control1..1
          Typeuri
          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
          XML FormatIn the XML format, this property is represented as an attribute.
          Fixed Valuedecision
          14. Extension.extension:decision.value[x]
          Definition

          The result of the claim, predetermination, or preauthorization adjudication.

          ShortResult of the adjudication
          Comments

          The element is used to indicate the current state of the adjudication overall for the claim resource, for example: the request has been held (pended) for adjudication processing, for manual review or other reasons; that it has been processed and will be paid, or the outstanding paid, as submitted (approved); that no amount will be paid (denied); or that some amount between zero and the submitted amount will be paid (partial).

          Control0..1
          BindingFor example codes, see R5ClaimDecisionForR3 (0.1.0)
          (example to http://hl7.org/fhir/uv/xver/ValueSet/R5-claim-decision-for-R3|0.1.0)
          TypeCodeableConcept
          [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
          16. Extension.extension:reason
          Slice Namereason
          Definition

          R5: ExplanationOfBenefit.item.reviewOutcome.reason (new:CodeableConcept)

          ShortR5: Reason for result of the adjudication (new)
          Comments

          Element ExplanationOfBenefit.item.reviewOutcome.reason is part of an existing definition because parent element ExplanationOfBenefit.item.reviewOutcome requires a cross-version extension. Element ExplanationOfBenefit.item.reviewOutcome.reason has a context of ExplanationOfBenefit.item based on following the parent source element upwards and mapping to ExplanationOfBenefit. Element ExplanationOfBenefit.item.reviewOutcome.reason has no mapping targets in FHIR STU3. Typically, this is because the element has been added (is a new element).

          Control0..*
          TypeExtension
          Requirements

          To advise the requestor of the contributors to the result of the adjudication process. Element ExplanationOfBenefit.item.reviewOutcome.reason is part of an existing definition because parent element ExplanationOfBenefit.item.reviewOutcome requires a cross-version extension. Element ExplanationOfBenefit.item.reviewOutcome.reason has a context of ExplanationOfBenefit.item based on following the parent source element upwards and mapping to ExplanationOfBenefit. Element ExplanationOfBenefit.item.reviewOutcome.reason has no mapping targets in FHIR STU3. Typically, this is because the element has been added (is a new element).

          18. Extension.extension:reason.id
          Definition

          unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

          Shortxml:id (or equivalent in JSON)
          Control0..1
          Typestring
          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
          XML FormatIn the XML format, this property is represented as an attribute.
          20. Extension.extension:reason.extension
          Definition

          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.

          ShortAdditional Content defined by implementations
          Comments

          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.

          Control0..*
          TypeExtension
          Alternate Namesextensions, user content
          SlicingThis element introduces a set of slices on Extension.extension.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
          • value @ url
          • 22. Extension.extension:reason.url
            Definition

            Source of the definition for the extension code - a logical name or a URL.

            Shortidentifies the meaning of the extension
            Comments

            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.

            Control1..1
            Typeuri
            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
            XML FormatIn the XML format, this property is represented as an attribute.
            Fixed Valuereason
            24. Extension.extension:reason.value[x]
            Definition

            The reasons for the result of the claim, predetermination, or preauthorization adjudication.

            ShortReason for result of the adjudication
            Control0..1
            BindingFor example codes, see R5ClaimDecisionReasonForR3 (0.1.0)
            (example to http://hl7.org/fhir/uv/xver/ValueSet/R5-claim-decision-reason-for-R3|0.1.0)
            TypeCodeableConcept
            [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
            26. Extension.extension:preAuthRef
            Slice NamepreAuthRef
            Definition

            R5: ExplanationOfBenefit.item.reviewOutcome.preAuthRef (new:string)

            ShortR5: Preauthorization reference (new)
            Comments

            Element ExplanationOfBenefit.item.reviewOutcome.preAuthRef is part of an existing definition because parent element ExplanationOfBenefit.item.reviewOutcome requires a cross-version extension. Element ExplanationOfBenefit.item.reviewOutcome.preAuthRef has a context of ExplanationOfBenefit.item based on following the parent source element upwards and mapping to ExplanationOfBenefit. Element ExplanationOfBenefit.item.reviewOutcome.preAuthRef has no mapping targets in FHIR STU3. Typically, this is because the element has been added (is a new element). This value is only present on preauthorization adjudications.

            Control0..1
            TypeExtension
            Requirements

            On subsequent claims, the insurer may require the provider to quote this value. Element ExplanationOfBenefit.item.reviewOutcome.preAuthRef is part of an existing definition because parent element ExplanationOfBenefit.item.reviewOutcome requires a cross-version extension. Element ExplanationOfBenefit.item.reviewOutcome.preAuthRef has a context of ExplanationOfBenefit.item based on following the parent source element upwards and mapping to ExplanationOfBenefit. Element ExplanationOfBenefit.item.reviewOutcome.preAuthRef has no mapping targets in FHIR STU3. Typically, this is because the element has been added (is a new element).

            28. Extension.extension:preAuthRef.id
            Definition

            unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

            Shortxml:id (or equivalent in JSON)
            Control0..1
            Typestring
            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
            XML FormatIn the XML format, this property is represented as an attribute.
            30. Extension.extension:preAuthRef.extension
            Definition

            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.

            ShortAdditional Content defined by implementations
            Comments

            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.

            Control0..*
            TypeExtension
            Alternate Namesextensions, user content
            SlicingThis element introduces a set of slices on Extension.extension.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
            • value @ url
            • 32. Extension.extension:preAuthRef.url
              Definition

              Source of the definition for the extension code - a logical name or a URL.

              Shortidentifies the meaning of the extension
              Comments

              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.

              Control1..1
              Typeuri
              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
              XML FormatIn the XML format, this property is represented as an attribute.
              Fixed ValuepreAuthRef
              34. Extension.extension:preAuthRef.value[x]
              Definition

              Reference from the Insurer which is used in later communications which refers to this adjudication.

              ShortPreauthorization reference
              Comments

              This value is only present on preauthorization adjudications.

              Control0..1
              Typestring
              [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
              36. Extension.extension:preAuthPeriod
              Slice NamepreAuthPeriod
              Definition

              R5: ExplanationOfBenefit.item.reviewOutcome.preAuthPeriod (new:Period)

              ShortR5: Preauthorization reference effective period (new)
              Comments

              Element ExplanationOfBenefit.item.reviewOutcome.preAuthPeriod is part of an existing definition because parent element ExplanationOfBenefit.item.reviewOutcome requires a cross-version extension. Element ExplanationOfBenefit.item.reviewOutcome.preAuthPeriod has a context of ExplanationOfBenefit.item based on following the parent source element upwards and mapping to ExplanationOfBenefit. Element ExplanationOfBenefit.item.reviewOutcome.preAuthPeriod has no mapping targets in FHIR STU3. Typically, this is because the element has been added (is a new element).

              Control0..1
              TypeExtension
              Requirements

              To convey to the provider when the authorized products and services must be supplied for the authorized adjudication to apply. Element ExplanationOfBenefit.item.reviewOutcome.preAuthPeriod is part of an existing definition because parent element ExplanationOfBenefit.item.reviewOutcome requires a cross-version extension. Element ExplanationOfBenefit.item.reviewOutcome.preAuthPeriod has a context of ExplanationOfBenefit.item based on following the parent source element upwards and mapping to ExplanationOfBenefit. Element ExplanationOfBenefit.item.reviewOutcome.preAuthPeriod has no mapping targets in FHIR STU3. Typically, this is because the element has been added (is a new element).

              38. Extension.extension:preAuthPeriod.id
              Definition

              unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

              Shortxml:id (or equivalent in JSON)
              Control0..1
              Typestring
              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
              XML FormatIn the XML format, this property is represented as an attribute.
              40. Extension.extension:preAuthPeriod.extension
              Definition

              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.

              ShortAdditional Content defined by implementations
              Comments

              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.

              Control0..*
              TypeExtension
              Alternate Namesextensions, user content
              SlicingThis element introduces a set of slices on Extension.extension.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
              • value @ url
              • 42. Extension.extension:preAuthPeriod.url
                Definition

                Source of the definition for the extension code - a logical name or a URL.

                Shortidentifies the meaning of the extension
                Comments

                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.

                Control1..1
                Typeuri
                Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                XML FormatIn the XML format, this property is represented as an attribute.
                Fixed ValuepreAuthPeriod
                44. Extension.extension:preAuthPeriod.value[x]
                Definition

                The time frame during which this authorization is effective.

                ShortPreauthorization reference effective period
                Control0..1
                TypePeriod
                [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                46. Extension.url
                Definition

                Source of the definition for the extension code - a logical name or a URL.

                Shortidentifies the meaning of the extension
                Comments

                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.

                Control1..1
                Typeuri
                Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                XML FormatIn the XML format, this property is represented as an attribute.
                Fixed Valuehttp://hl7.org/fhir/5.0/StructureDefinition/extension-ExplanationOfBenefit.item.reviewOutcome
                48. Extension.value[x]
                Definition

                Value of extension - may be a resource or one of a constrained set of the data types (see Extensibility in the spec for list).

                ShortValue of extension
                Control0..0
                TypeChoice of: base64Binary, boolean, code, date, dateTime, decimal, id, instant, integer, markdown, oid, positiveInt, string, time, unsignedInt, uri, Address, Age, Annotation, Attachment, CodeableConcept, Coding, ContactPoint, Count, Distance, Duration, HumanName, Identifier, Money, Period, Quantity, Range, Ratio, Reference, SampledData, Signature, Timing, Meta
                Primitive ValueThis primitive element may be present, or absent, or replaced by an extension