Extensions for Using Data Elements from FHIR R5 in FHIR STU3
0.1.0 - STU
Extensions for Using Data Elements from FHIR R5 in FHIR STU3
0.1.0 - STU
Extensions for Using Data Elements from FHIR R5 in FHIR STU3 - Downloaded Version null See the Directory of published versions
| Page standards status: Trial-use | Maturity Level: 0 |
Definitions for the profile-ClaimResponse resource profile.
Guidance on how to interpret the contents of this table can be foundhere
| 0. ClaimResponse | |
| Definition | This resource provides the adjudication details from the processing of a Claim resource. |
| Short | Remittance resource |
| Control | 0..* |
| Alternate Names | Remittance Advice |
| Invariants | dom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources (contained.contained.empty())dom-1: If the resource is contained in another resource, it SHALL NOT contain any narrative ( contained.text.empty())dom-4: If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated ( contained.meta.versionId.empty() and contained.meta.lastUpdated.empty())dom-3: If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource ( contained.where(('#'+id in %resource.descendants().reference).not()).empty())dom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources (contained.contained.empty()) dom-1: If the resource is contained in another resource, it SHALL NOT contain any narrative (contained.text.empty()) dom-4: If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated (contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()) dom-3: If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource (contained.where(('#'+id in %resource.descendants().reference).not()).empty()) |
| 2. ClaimResponse.implicitRules | |
| Definition | A reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content. |
| Short | A set of rules under which this content was created |
| Comments | 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. This element is labelled as a modifier because the implicit rules may provide additional knowledge about the resource that modifies it's meaning or interpretation. |
| Control | 0..1 |
| Type | uri |
| Is Modifier | true because No Modifier Reason provideed in previous versions of FHIR |
| Primitive Value | This primitive element may be present, or absent, or replaced by an extension |
| Summary | true |
| 4. ClaimResponse.extension | |
| Definition | An Extension May be used to represent additional information that is not part of the basic definition of the resource. 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. |
| Short | ExtensionAdditional 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. |
| Control | 20..* |
| Type | Extension |
| Alternate Names | extensions, user content |
| Slicing | This element introduces a set of slices on ClaimResponse.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators: |
| 6. ClaimResponse.extension:traceNumber | |
| Slice Name | traceNumber |
| Definition | R5: |
| Short | R5: Number for tracking (new) |
| Comments | Element |
| Control | 0..* This element is affected by the following invariants: ele-1 |
| Type | Extension(R5: Number for tracking (new)) (Extension Type: Identifier) |
| Is Modifier | false |
| Invariants | 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()) |
| 8. ClaimResponse.extension:type | |
| Slice Name | type |
| Definition | R5: |
| Short | R5: More granular claim type (new) |
| Comments | Element |
| Control | 1..1 This element is affected by the following invariants: ele-1 |
| Type | Extension(R5: More granular claim type (new)) (Extension Type: CodeableConcept) |
| Is Modifier | false |
| Invariants | 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()) |
| 10. ClaimResponse.extension:subType | |
| Slice Name | subType |
| Definition | R5: |
| Short | R5: More granular claim type (new) |
| Comments | Element |
| Control | 0..1 This element is affected by the following invariants: ele-1 |
| Type | Extension(R5: More granular claim type (new)) (Extension Type: CodeableConcept) |
| Is Modifier | false |
| Invariants | 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()) |
| 12. ClaimResponse.extension:use | |
| Slice Name | use |
| Definition | R5: |
| Short | R5: claim | preauthorization | predetermination (new) |
| Comments | Element |
| Control | 1..1 This element is affected by the following invariants: ele-1 |
| Type | Extension(R5: claim | preauthorization | predetermination (new)) (Extension Type: code) |
| Is Modifier | false |
| Invariants | 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()) |
| 14. ClaimResponse.extension:requestor | |
| Slice Name | requestor |
| Definition | R5: |
| Short | R5: Party responsible for the claim |
| Comments | Element |
| Control | 0..1 |
| Type | Extension(http://hl7.org/fhir/StructureDefinition/alternate-reference) |
| 16. ClaimResponse.extension:decision | |
| Slice Name | decision |
| Definition | R5: |
| Short | R5: Result of the adjudication (new) |
| Comments | Element |
| Control | 0..1 This element is affected by the following invariants: ele-1 |
| Type | Extension(R5: Result of the adjudication (new)) (Extension Type: CodeableConcept) |
| Is Modifier | false |
| Invariants | 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()) |
| 18. ClaimResponse.extension:preAuthPeriod | |
| Slice Name | preAuthPeriod |
| Definition | R5: |
| Short | R5: Preauthorization reference effective period (new) |
| Comments | Element |
| Control | 0..1 This element is affected by the following invariants: ele-1 |
| Type | Extension(R5: Preauthorization reference effective period (new)) (Extension Type: Period) |
| Is Modifier | false |
| Invariants | 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()) |
| 20. ClaimResponse.extension:event | |
| Slice Name | event |
| Definition | R5: |
| Short | R5: Event information (new) |
| Comments | Element |
| Control | 0..* This element is affected by the following invariants: ele-1 |
| Type | Extension(R5: Event information (new)) (Complex Extension) |
| Is Modifier | false |
| Invariants | 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()) |
| 22. ClaimResponse.extension:encounter | |
| Slice Name | encounter |
| Definition | R5: |
| Short | R5: Encounters associated with the listed treatments (new) |
| Comments | Element |
| Control | 0..* This element is affected by the following invariants: ele-1 |
| Type | Extension(R5: Encounters associated with the listed treatments (new)) (Extension Type: Reference(Cross-version Profile for R5.Encounter for use in FHIR STU3, Encounter)) |
| Is Modifier | false |
| Invariants | 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()) |
| 24. ClaimResponse.extension:diagnosisRelatedGroup | |
| Slice Name | diagnosisRelatedGroup |
| Definition | R5: |
| Short | R5: Package billing code (new) |
| Comments | Element |
| Control | 0..1 This element is affected by the following invariants: ele-1 |
| Type | Extension(R5: Package billing code (new)) (Extension Type: CodeableConcept) |
| Is Modifier | false |
| Invariants | 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()) |
| 26. ClaimResponse.extension:adjudication | |
| Slice Name | adjudication |
| Definition | R5: |
| Short | R5: Header-level adjudication (new) |
| Comments | Element |
| Control | 0..* This element is affected by the following invariants: ele-1 |
| Type | Extension(R5: adjudication) (Complex Extension) |
| Is Modifier | false |
| Invariants | 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()) |
| 28. ClaimResponse.extension:total | |
| Slice Name | total |
| Definition | R5: |
| Short | R5: Adjudication totals (new) |
| Comments | Element |
| Control | 0..* This element is affected by the following invariants: ele-1 |
| Type | Extension(R5: Adjudication totals (new)) (Complex Extension) |
| Is Modifier | false |
| Invariants | 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()) |
| 30. ClaimResponse.modifierExtension | |
| Definition | May be used to represent additional information that is not part of the basic definition of the resource, and that modifies the understanding of the element that contains it. Usually modifier elements provide negation or qualification. 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. Applications processing a resource are required to check for modifier extensions. |
| Short | Extensions that cannot be ignored |
| 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. |
| Control | 0..* |
| Type | Extension |
| Is Modifier | true because No Modifier Reason provideed in previous versions of FHIR |
| Alternate Names | extensions, user content |
| 32. ClaimResponse.status | |
| Definition | The status of the resource instance. |
| Short | active | cancelled | draft | entered-in-error |
| Comments | This element is labeled as a modifier because the status contains the code cancelled and entered-in-error that mark the response as not currently valid. |
| Control | 0..1 |
| Binding | The codes SHALL be taken from Financial Resource Status Codeshttp://hl7.org/fhir/ValueSet/fm-status|3.0.2 (required to http://hl7.org/fhir/ValueSet/fm-status|3.0.2)A code specifying the state of the resource instance. |
| Type | code |
| Is Modifier | true because No Modifier Reason provideed in previous versions of FHIR |
| Primitive Value | This primitive element may be present, or absent, or replaced by an extension |
| Summary | true |
Guidance on how to interpret the contents of this table can be foundhere
| 0. ClaimResponse | |
| 2. ClaimResponse.extension | |
| Control | 2..* |
| Slicing | This element introduces a set of slices on ClaimResponse.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators: |
| 4. ClaimResponse.extension:traceNumber | |
| Slice Name | traceNumber |
| Definition | R5: |
| Short | R5: Number for tracking (new) |
| Comments | Element |
| Control | 0..* |
| Type | Extension(R5: Number for tracking (new)) (Extension Type: Identifier) |
| 6. ClaimResponse.extension:type | |
| Slice Name | type |
| Definition | R5: |
| Short | R5: More granular claim type (new) |
| Comments | Element |
| Control | 1..1 |
| Type | Extension(R5: More granular claim type (new)) (Extension Type: CodeableConcept) |
| 8. ClaimResponse.extension:subType | |
| Slice Name | subType |
| Definition | R5: |
| Short | R5: More granular claim type (new) |
| Comments | Element |
| Control | 0..1 |
| Type | Extension(R5: More granular claim type (new)) (Extension Type: CodeableConcept) |
| 10. ClaimResponse.extension:use | |
| Slice Name | use |
| Definition | R5: |
| Short | R5: claim | preauthorization | predetermination (new) |
| Comments | Element |
| Control | 1..1 |
| Type | Extension(R5: claim | preauthorization | predetermination (new)) (Extension Type: code) |
| 12. ClaimResponse.extension:requestor | |
| Slice Name | requestor |
| Definition | R5: |
| Short | R5: Party responsible for the claim |
| Comments | Element |
| Control | 0..1 |
| Type | Extension(http://hl7.org/fhir/StructureDefinition/alternate-reference) |
| 14. ClaimResponse.extension:decision | |
| Slice Name | decision |
| Definition | R5: |
| Short | R5: Result of the adjudication (new) |
| Comments | Element |
| Control | 0..1 |
| Type | Extension(R5: Result of the adjudication (new)) (Extension Type: CodeableConcept) |
| 16. ClaimResponse.extension:preAuthPeriod | |
| Slice Name | preAuthPeriod |
| Definition | R5: |
| Short | R5: Preauthorization reference effective period (new) |
| Comments | Element |
| Control | 0..1 |
| Type | Extension(R5: Preauthorization reference effective period (new)) (Extension Type: Period) |
| 18. ClaimResponse.extension:event | |
| Slice Name | event |
| Definition | R5: |
| Short | R5: Event information (new) |
| Comments | Element |
| Control | 0..* |
| Type | Extension(R5: Event information (new)) (Complex Extension) |
| 20. ClaimResponse.extension:encounter | |
| Slice Name | encounter |
| Definition | R5: |
| Short | R5: Encounters associated with the listed treatments (new) |
| Comments | Element |
| Control | 0..* |
| Type | Extension(R5: Encounters associated with the listed treatments (new)) (Extension Type: Reference(Cross-version Profile for R5.Encounter for use in FHIR STU3, Encounter)) |
| 22. ClaimResponse.extension:diagnosisRelatedGroup | |
| Slice Name | diagnosisRelatedGroup |
| Definition | R5: |
| Short | R5: Package billing code (new) |
| Comments | Element |
| Control | 0..1 |
| Type | Extension(R5: Package billing code (new)) (Extension Type: CodeableConcept) |
| 24. ClaimResponse.extension:adjudication | |
| Slice Name | adjudication |
| Definition | R5: |
| Short | R5: Header-level adjudication (new) |
| Comments | Element |
| Control | 0..* |
| Type | Extension(R5: adjudication) (Complex Extension) |
| 26. ClaimResponse.extension:total | |
| Slice Name | total |
| Definition | R5: |
| Short | R5: Adjudication totals (new) |
| Comments | Element |
| Control | 0..* |
| Type | Extension(R5: Adjudication totals (new)) (Complex Extension) |
| 28. ClaimResponse.patient | |
| 30. ClaimResponse.patient.extension | |
| Control | 1..* |
| Slicing | This element introduces a set of slices on ClaimResponse.patient.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators: |
| 32. ClaimResponse.patient.extension:patient | |
| Slice Name | patient |
| Definition | R5: |
| Short | R5: The recipient of the products and services additional types |
| Comments | Element |
| Control | 1..1 |
| Type | Extension(http://hl7.org/fhir/StructureDefinition/alternate-reference) |
| 34. ClaimResponse.insurer | |
| 36. ClaimResponse.insurer.extension | |
| Control | 0..* |
| Slicing | This element introduces a set of slices on ClaimResponse.insurer.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators: |
| 38. ClaimResponse.insurer.extension:insurer | |
| Slice Name | insurer |
| Definition | R5: |
| Short | R5: Party responsible for reimbursement additional types |
| Comments | Element |
| Control | 0..1 |
| Type | Extension(http://hl7.org/fhir/StructureDefinition/alternate-reference) |
| 40. ClaimResponse.request | |
| 42. ClaimResponse.request.extension | |
| Control | 0..* |
| Slicing | This element introduces a set of slices on ClaimResponse.request.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators: |
| 44. ClaimResponse.request.extension:request | |
| Slice Name | request |
| Definition | R5: |
| Short | R5: request additional types |
| Comments | Element |
| Control | 0..1 |
| Type | Extension(http://hl7.org/fhir/StructureDefinition/alternate-reference) |
| 46. ClaimResponse.outcome | |
| 48. ClaimResponse.outcome.extension | |
| Control | 1..* |
| Slicing | This element introduces a set of slices on ClaimResponse.outcome.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators: |
| 50. ClaimResponse.outcome.extension:outcome | |
| Slice Name | outcome |
| Definition | R5: |
| Short | R5: queued | complete | error | partial |
| Comments | Element |
| Control | 1..1 |
| Type | Extension(R5: queued | complete | error | partial) (Extension Type: code) |
| 52. ClaimResponse.item | |
| 54. ClaimResponse.item.extension | |
| Control | 0..* |
| Slicing | This element introduces a set of slices on ClaimResponse.item.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators: |
| 56. ClaimResponse.item.extension:traceNumber | |
| Slice Name | traceNumber |
| Definition | R5: |
| Short | R5: Number for tracking (new) |
| Comments | Element |
| Control | 0..* |
| Type | Extension(R5: Number for tracking (new)) (Extension Type: Identifier) |
| 58. ClaimResponse.item.extension:reviewOutcome | |
| Slice Name | reviewOutcome |
| Definition | R5: |
| Short | R5: Adjudication results (new) |
| Comments | Element |
| Control | 0..1 |
| Type | Extension(R5: Adjudication results (new)) (Complex Extension) |
| 60. ClaimResponse.item.adjudication | |
| 62. ClaimResponse.item.adjudication.value | |
| 64. ClaimResponse.item.adjudication.value.extension | |
| Control | 0..* |
| Slicing | This element introduces a set of slices on ClaimResponse.item.adjudication.value.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators: |
| 66. ClaimResponse.item.adjudication.value.extension:quantity | |
| Slice Name | quantity |
| Definition | R5: |
| Short | R5: quantity additional types |
| Comments | Element |
| Control | 0..1 |
| Type | Extension(R5: quantity additional types) (Extension Type: Quantity) |
| 68. ClaimResponse.item.detail | |
| 70. ClaimResponse.item.detail.extension | |
| Control | 0..* |
| Slicing | This element introduces a set of slices on ClaimResponse.item.detail.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators: |
| 72. ClaimResponse.item.detail.extension:traceNumber | |
| Slice Name | traceNumber |
| Definition | R5: |
| Short | R5: Number for tracking (new) |
| Comments | Element |
| Control | 0..* |
| Type | Extension(R5: Number for tracking (new)) (Extension Type: Identifier) |
| 74. ClaimResponse.item.detail.extension:reviewOutcome | |
| Slice Name | reviewOutcome |
| Definition | R5: |
| Short | R5: Detail level adjudication results (new) |
| Comments | Element |
| Control | 0..1 |
| Type | Extension(R5: Adjudication results (new)) (Complex Extension) |
| 76. ClaimResponse.item.detail.subDetail | |
| 78. ClaimResponse.item.detail.subDetail.extension | |
| Control | 0..* |
| Slicing | This element introduces a set of slices on ClaimResponse.item.detail.subDetail.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators: |
| 80. ClaimResponse.item.detail.subDetail.extension:traceNumber | |
| Slice Name | traceNumber |
| Definition | R5: |
| Short | R5: Number for tracking (new) |
| Comments | Element |
| Control | 0..* |
| Type | Extension(R5: Number for tracking (new)) (Extension Type: Identifier) |
| 82. ClaimResponse.item.detail.subDetail.extension:reviewOutcome | |
| Slice Name | reviewOutcome |
| Definition | R5: |
| Short | R5: Subdetail level adjudication results (new) |
| Comments | Element |
| Control | 0..1 |
| Type | Extension(R5: Adjudication results (new)) (Complex Extension) |
| 84. ClaimResponse.addItem | |
| 86. ClaimResponse.addItem.extension | |
| Control | 0..* |
| Slicing | This element introduces a set of slices on ClaimResponse.addItem.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators: |
| 88. ClaimResponse.addItem.extension:detailSequence | |
| Slice Name | detailSequence |
| Definition | R5: |
| Short | R5: Detail sequence number (new) |
| Comments | Element |
| Control | 0..* |
| Type | Extension(R5: Detail sequence number (new)) (Extension Type: positiveInt) |
| 90. ClaimResponse.addItem.extension:subdetailSequence | |
| Slice Name | subdetailSequence |
| Definition | R5: |
| Short | R5: Subdetail sequence number (new) |
| Comments | Element |
| Control | 0..* |
| Type | Extension(R5: Subdetail sequence number (new)) (Extension Type: positiveInt) |
| 92. ClaimResponse.addItem.extension:traceNumber | |
| Slice Name | traceNumber |
| Definition | R5: |
| Short | R5: Number for tracking (new) |
| Comments | Element |
| Control | 0..* |
| Type | Extension(R5: Number for tracking (new)) (Extension Type: Identifier) |
| 94. ClaimResponse.addItem.extension:provider | |
| Slice Name | provider |
| Definition | R5: |
| Short | R5: Authorized providers (new) |
| Comments | Element |
| Control | 0..* |
| Type | Extension(R5: Authorized providers (new)) (Extension Type: Reference(Cross-version Profile for R5.Practitioner for use in FHIR STU3, Practitioner, Cross-version Profile for R5.PractitionerRole for use in FHIR STU3, PractitionerRole, Cross-version Profile for R5.Organization for use in FHIR STU3, Organization)) |
| 96. ClaimResponse.addItem.extension:revenue | |
| Slice Name | revenue |
| Definition | R5: |
| Short | R5: Revenue or cost center code (new) |
| Comments | Element |
| Control | 0..1 |
| Type | Extension(R5: Revenue or cost center code (new)) (Extension Type: CodeableConcept) |
| 98. ClaimResponse.addItem.extension:productOrServiceEnd | |
| Slice Name | productOrServiceEnd |
| Definition | R5: |
| Short | R5: End of a range of codes (new) |
| Comments | Element |
| Control | 0..1 |
| Type | Extension(R5: End of a range of codes (new)) (Extension Type: CodeableConcept) |
| 100. ClaimResponse.addItem.extension:request | |
| Slice Name | request |
| Definition | R5: |
| Short | R5: Request or Referral for Service (new) |
| Comments | Element |
| Control | 0..* |
| Type | Extension(R5: Request or Referral for Service (new)) (Extension Type: Reference(Cross-version Profile for R5.DeviceRequest for use in FHIR STU3, DeviceRequest, Cross-version Profile for R5.MedicationRequest for use in FHIR STU3, MedicationRequest, Cross-version Profile for R5.NutritionOrder for use in FHIR STU3, NutritionOrder, Cross-version Profile for R5.ServiceRequest for use in FHIR STU3, ReferralRequest, Cross-version Profile for R5.SupplyRequest for use in FHIR STU3, SupplyRequest, Cross-version Profile for R5.VisionPrescription for use in FHIR STU3, VisionPrescription)) |
| 102. ClaimResponse.addItem.extension:programCode | |
| Slice Name | programCode |
| Definition | R5: |
| Short | R5: Program the product or service is provided under (new) |
| Comments | Element |
| Control | 0..* |
| Type | Extension(R5: Program the product or service is provided under (new)) (Extension Type: CodeableConcept) |
| 104. ClaimResponse.addItem.extension:serviced | |
| Slice Name | serviced |
| Definition | R5: |
| Short | R5: Date or dates of service or product delivery (new) |
| Comments | Element |
| Control | 0..1 |
| Type | Extension(R5: Date or dates of service or product delivery (new)) (Extension Type: Choice of: date, Period) |
| 106. ClaimResponse.addItem.extension:location | |
| Slice Name | location |
| Definition | R5: |
| Short | R5: Place of service or where product was supplied (new) |
| Comments | Element |
| Control | 0..1 |
| Type | Extension(R5: Place of service or where product was supplied (new)) (Extension Type: Choice of: CodeableConcept, Address, Reference(Cross-version Profile for R5.Location for use in FHIR STU3, Location)) |
| 108. ClaimResponse.addItem.extension:quantity | |
| Slice Name | quantity |
| Definition | R5: |
| Short | R5: Count of products or services (new) |
| Comments | Element |
| Control | 0..1 |
| Type | Extension(R5: Count of products or services (new)) (Extension Type: Quantity(SimpleQuantity)) |
| 110. ClaimResponse.addItem.extension:unitPrice | |
| Slice Name | unitPrice |
| Definition | R5: |
| Short | R5: Fee, charge or cost per item (new) |
| Comments | Element |
| Control | 0..1 |
| Type | Extension(R5: Fee, charge or cost per item (new)) (Extension Type: Money) |
| 112. ClaimResponse.addItem.extension:factor | |
| Slice Name | factor |
| Definition | R5: |
| Short | R5: Price scaling factor (new) |
| Comments | Element |
| Control | 0..1 |
| Type | Extension(R5: Price scaling factor (new)) (Extension Type: decimal) |
| 114. ClaimResponse.addItem.extension:tax | |
| Slice Name | tax |
| Definition | R5: |
| Short | R5: Total tax (new) |
| Comments | Element |
| Control | 0..1 |
| Type | Extension(R5: Total tax (new)) (Extension Type: Money) |
| 116. ClaimResponse.addItem.extension:bodySite | |
| Slice Name | bodySite |
| Definition | R5: |
| Short | R5: Anatomical location (new) |
| Comments | Element |
| Control | 0..* |
| Type | Extension(R5: Anatomical location (new)) (Complex Extension) |
| 118. ClaimResponse.addItem.extension:reviewOutcome | |
| Slice Name | reviewOutcome |
| Definition | R5: |
| Short | R5: Added items adjudication results (new) |
| Comments | Element |
| Control | 0..1 |
| Type | Extension(R5: Adjudication results (new)) (Complex Extension) |
| 120. ClaimResponse.addItem.detail | |
| 122. ClaimResponse.addItem.detail.extension | |
| Control | 0..* |
| Slicing | This element introduces a set of slices on ClaimResponse.addItem.detail.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators: |
| 124. ClaimResponse.addItem.detail.extension:traceNumber | |
| Slice Name | traceNumber |
| Definition | R5: |
| Short | R5: Number for tracking (new) |
| Comments | Element |
| Control | 0..* |
| Type | Extension(R5: Number for tracking (new)) (Extension Type: Identifier) |
| 126. ClaimResponse.addItem.detail.extension:revenue | |
| Slice Name | revenue |
| Definition | R5: |
| Short | R5: Revenue or cost center code (new) |
| Comments | Element |
| Control | 0..1 |
| Type | Extension(R5: Revenue or cost center code (new)) (Extension Type: CodeableConcept) |
| 128. ClaimResponse.addItem.detail.extension:productOrServiceEnd | |
| Slice Name | productOrServiceEnd |
| Definition | R5: |
| Short | R5: End of a range of codes (new) |
| Comments | Element |
| Control | 0..1 |
| Type | Extension(R5: End of a range of codes (new)) (Extension Type: CodeableConcept) |
| 130. ClaimResponse.addItem.detail.extension:quantity | |
| Slice Name | quantity |
| Definition | R5: |
| Short | R5: Count of products or services (new) |
| Comments | Element |
| Control | 0..1 |
| Type | Extension(R5: Count of products or services (new)) (Extension Type: Quantity(SimpleQuantity)) |
| 132. ClaimResponse.addItem.detail.extension:unitPrice | |
| Slice Name | unitPrice |
| Definition | R5: |
| Short | R5: Fee, charge or cost per item (new) |
| Comments | Element |
| Control | 0..1 |
| Type | Extension(R5: Fee, charge or cost per item (new)) (Extension Type: Money) |
| 134. ClaimResponse.addItem.detail.extension:factor | |
| Slice Name | factor |
| Definition | R5: |
| Short | R5: Price scaling factor (new) |
| Comments | Element |
| Control | 0..1 |
| Type | Extension(R5: Price scaling factor (new)) (Extension Type: decimal) |
| 136. ClaimResponse.addItem.detail.extension:tax | |
| Slice Name | tax |
| Definition | R5: |
| Short | R5: Total tax (new) |
| Comments | Element |
| Control | 0..1 |
| Type | Extension(R5: Total tax (new)) (Extension Type: Money) |
| 138. ClaimResponse.addItem.detail.extension:net | |
| Slice Name | net |
| Definition | R5: |
| Short | R5: Total item cost (new) |
| Comments | Element |
| Control | 0..1 |
| Type | Extension(R5: Total item cost (new)) (Extension Type: Money) |
| 140. ClaimResponse.addItem.detail.extension:reviewOutcome | |
| Slice Name | reviewOutcome |
| Definition | R5: |
| Short | R5: Added items detail level adjudication results (new) |
| Comments | Element |
| Control | 0..1 |
| Type | Extension(R5: Adjudication results (new)) (Complex Extension) |
| 142. ClaimResponse.addItem.detail.extension:subDetail | |
| Slice Name | subDetail |
| Definition | R5: |
| Short | R5: Insurer added line items (new) |
| Comments | Element |
| Control | 0..* |
| Type | Extension(R5: Insurer added line items (new)) (Complex Extension) |
| 144. ClaimResponse.addItem.detail.extension:reviewOutcome | |
| Slice Name | reviewOutcome |
| Definition | R5: |
| Short | R5: Added items subdetail level adjudication results (new) |
| Comments | Element |
| Control | 0..1 |
| Type | Extension(R5: Adjudication results (new)) (Complex Extension) |
| 146. ClaimResponse.addItem.detail.extension:adjudication | |
| Slice Name | adjudication |
| Definition | R5: |
| Short | R5: Added items subdetail adjudication (new) |
| Comments | Element |
| Control | 0..* |
| Type | Extension(R5: adjudication) (Complex Extension) |
| 148. ClaimResponse.error | |
| 150. ClaimResponse.error.extension | |
| Control | 0..* |
| Slicing | This element introduces a set of slices on ClaimResponse.error.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators: |
| 152. ClaimResponse.error.extension:expression | |
| Slice Name | expression |
| Definition | R5: |
| Short | R5: FHIRPath of element(s) related to issue (new) |
| Comments | Element |
| Control | 0..* |
| Type | Extension(R5: FHIRPath of element(s) related to issue (new)) (Extension Type: string) |
| 154. ClaimResponse.reserved | |
| 156. ClaimResponse.reserved.extension | |
| Control | 0..* |
| Slicing | This element introduces a set of slices on ClaimResponse.reserved.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators: |
| 158. ClaimResponse.reserved.extension:fundsReserve | |
| Slice Name | fundsReserve |
| Definition | R5: |
| Short | R5: fundsReserve additional types |
| Comments | Element |
| Control | 0..1 |
| Type | Extension(R5: fundsReserve additional types) (Extension Type: CodeableConcept) |
| 160. ClaimResponse.form | |
| 162. ClaimResponse.form.extension | |
| Control | 0..* |
| Slicing | This element introduces a set of slices on ClaimResponse.form.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators: |
| 164. ClaimResponse.form.extension:form | |
| Slice Name | form |
| Definition | R5: |
| Short | R5: Printed reference or actual form additional types |
| Comments | Element |
| Control | 0..1 |
| Type | Extension(R5: Printed reference or actual form additional types) (Extension Type: Attachment) |
| 166. ClaimResponse.communicationRequest | |
| 168. ClaimResponse.communicationRequest.extension | |
| Control | 0..* |
| Slicing | This element introduces a set of slices on ClaimResponse.communicationRequest.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators: |
| 170. ClaimResponse.communicationRequest.extension:communicationRequest | |
| Slice Name | communicationRequest |
| Definition | R5: |
| Short | R5: communicationRequest additional types |
| Comments | Element |
| Control | 0..* |
| Type | Extension(http://hl7.org/fhir/StructureDefinition/alternate-reference) |
| 172. ClaimResponse.insurance | |
| 174. ClaimResponse.insurance.coverage | |
| 176. ClaimResponse.insurance.coverage.extension | |
| Control | 0..* |
| Slicing | This element introduces a set of slices on ClaimResponse.insurance.coverage.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators: |
| 178. ClaimResponse.insurance.coverage.extension:coverage | |
| Slice Name | coverage |
| Definition | R5: |
| Short | R5: coverage additional types |
| Comments | Element |
| Control | 0..1 |
| Type | Extension(http://hl7.org/fhir/StructureDefinition/alternate-reference) |
| 180. ClaimResponse.insurance.claimResponse | |
| 182. ClaimResponse.insurance.claimResponse.extension | |
| Control | 0..* |
| Slicing | This element introduces a set of slices on ClaimResponse.insurance.claimResponse.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators: |
| 184. ClaimResponse.insurance.claimResponse.extension:claimResponse | |
| Slice Name | claimResponse |
| Definition | R5: |
| Short | R5: claimResponse additional types |
| Comments | Element |
| Control | 0..1 |
| Type | Extension(http://hl7.org/fhir/StructureDefinition/alternate-reference) |
Guidance on how to interpret the contents of this table can be foundhere
| 0. ClaimResponse | |||||
| Definition | This resource provides the adjudication details from the processing of a Claim resource. | ||||
| Short | Remittance resource | ||||
| Control | 0..* | ||||
| Alternate Names | Remittance Advice | ||||
| Invariants | dom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources (contained.contained.empty())dom-1: If the resource is contained in another resource, it SHALL NOT contain any narrative ( contained.text.empty())dom-4: If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated ( contained.meta.versionId.empty() and contained.meta.lastUpdated.empty())dom-3: If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource ( contained.where(('#'+id in %resource.descendants().reference).not()).empty()) | ||||
| 2. ClaimResponse.id | |||||
| Definition | The logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes. | ||||
| Short | Logical id of this artifact | ||||
| Comments | The only time that a resource does not have an id is when it is being submitted to the server using a create operation. | ||||
| Control | 0..1 | ||||
| Type | id | ||||
| Primitive Value | This primitive element may be present, or absent, or replaced by an extension | ||||
| Summary | true | ||||
| 4. ClaimResponse.meta | |||||
| Definition | The metadata about the resource. This is content that is maintained by the infrastructure. Changes to the content may not always be associated with version changes to the resource. | ||||
| Short | Metadata about the resource | ||||
| Control | 0..1 | ||||
| Type | Meta | ||||
| Summary | true | ||||
| 6. ClaimResponse.implicitRules | |||||
| Definition | A reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content. | ||||
| Short | A set of rules under which this content was created | ||||
| Comments | 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. This element is labelled as a modifier because the implicit rules may provide additional knowledge about the resource that modifies it's meaning or interpretation. | ||||
| Control | 0..1 | ||||
| Type | uri | ||||
| Is Modifier | true because No Modifier Reason provideed in previous versions of FHIR | ||||
| Primitive Value | This primitive element may be present, or absent, or replaced by an extension | ||||
| Summary | true | ||||
| 8. ClaimResponse.language | |||||
| Definition | The base language in which the resource is written. | ||||
| Short | Language of the resource content | ||||
| Comments | 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). | ||||
| Control | 0..1 | ||||
| Binding | Unless not suitable, these codes SHALL be taken from Common Languages  (extensible to http://hl7.org/fhir/ValueSet/languages|3.0.2)A human language.
| ||||
| Type | code | ||||
| Primitive Value | This primitive element may be present, or absent, or replaced by an extension | ||||
| 10. ClaimResponse.text | |||||
| Definition | A human-readable narrative that contains a summary of the resource, and may be used to represent the content of the resource to a human. The narrative need not encode all the structured data, but is required to contain sufficient detail to make it "clinically safe" for a human to just read the narrative. Resource definitions may define what content should be represented in the narrative to ensure clinical safety. | ||||
| Short | Text summary of the resource, for human interpretation | ||||
| Comments | 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 in formation is added later. | ||||
| Control | 0..1 This element is affected by the following invariants: dom-1 | ||||
| Type | Narrative | ||||
| Alternate Names | narrative, html, xhtml, display | ||||
| 12. ClaimResponse.contained | |||||
| Definition | These resources do not have an independent existence apart from the resource that contains them - they cannot be identified independently, and nor can they have their own independent transaction scope. | ||||
| Short | Contained, inline Resources | ||||
| Comments | 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. | ||||
| Control | 0..* | ||||
| Type | Resource | ||||
| Alternate Names | inline resources, anonymous resources, contained resources | ||||
| 14. ClaimResponse.extension | |||||
| Definition | An Extension | ||||
| Short | Extension | ||||
| Control | 2..* | ||||
| Type | Extension | ||||
| Slicing | This element introduces a set of slices on ClaimResponse.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators: | ||||
| 16. ClaimResponse.extension:traceNumber | |||||
| Slice Name | traceNumber | ||||
| Definition | R5: | ||||
| Short | R5: Number for tracking (new) | ||||
| Comments | Element | ||||
| Control | 0..* This element is affected by the following invariants: ele-1 | ||||
| Type | Extension(R5: Number for tracking (new)) (Extension Type: Identifier) | ||||
| Is Modifier | false | ||||
| Invariants | 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()) | ||||
| 18. ClaimResponse.extension:type | |||||
| Slice Name | type | ||||
| Definition | R5: | ||||
| Short | R5: More granular claim type (new) | ||||
| Comments | Element | ||||
| Control | 1..1 This element is affected by the following invariants: ele-1 | ||||
| Type | Extension(R5: More granular claim type (new)) (Extension Type: CodeableConcept) | ||||
| Is Modifier | false | ||||
| Invariants | 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()) | ||||
| 20. ClaimResponse.extension:subType | |||||
| Slice Name | subType | ||||
| Definition | R5: | ||||
| Short | R5: More granular claim type (new) | ||||
| Comments | Element | ||||
| Control | 0..1 This element is affected by the following invariants: ele-1 | ||||
| Type | Extension(R5: More granular claim type (new)) (Extension Type: CodeableConcept) | ||||
| Is Modifier | false | ||||
| Invariants | 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()) | ||||
| 22. ClaimResponse.extension:use | |||||
| Slice Name | use | ||||
| Definition | R5: | ||||
| Short | R5: claim | preauthorization | predetermination (new) | ||||
| Comments | Element | ||||
| Control | 1..1 This element is affected by the following invariants: ele-1 | ||||
| Type | Extension(R5: claim | preauthorization | predetermination (new)) (Extension Type: code) | ||||
| Is Modifier | false | ||||
| Invariants | 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()) | ||||
| 24. ClaimResponse.extension:requestor | |||||
| Slice Name | requestor | ||||
| Definition | R5: | ||||
| Short | R5: Party responsible for the claim | ||||
| Comments | Element | ||||
| Control | 0..1 | ||||
| Type | Extension(http://hl7.org/fhir/StructureDefinition/alternate-reference) | ||||
| 26. ClaimResponse.extension:decision | |||||
| Slice Name | decision | ||||
| Definition | R5: | ||||
| Short | R5: Result of the adjudication (new) | ||||
| Comments | Element | ||||
| Control | 0..1 This element is affected by the following invariants: ele-1 | ||||
| Type | Extension(R5: Result of the adjudication (new)) (Extension Type: CodeableConcept) | ||||
| Is Modifier | false | ||||
| Invariants | 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()) | ||||
| 28. ClaimResponse.extension:preAuthPeriod | |||||
| Slice Name | preAuthPeriod | ||||
| Definition | R5: | ||||
| Short | R5: Preauthorization reference effective period (new) | ||||
| Comments | Element | ||||
| Control | 0..1 This element is affected by the following invariants: ele-1 | ||||
| Type | Extension(R5: Preauthorization reference effective period (new)) (Extension Type: Period) | ||||
| Is Modifier | false | ||||
| Invariants | 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()) | ||||
| 30. ClaimResponse.extension:event | |||||
| Slice Name | event | ||||
| Definition | R5: | ||||
| Short | R5: Event information (new) | ||||
| Comments | Element | ||||
| Control | 0..* This element is affected by the following invariants: ele-1 | ||||
| Type | Extension(R5: Event information (new)) (Complex Extension) | ||||
| Is Modifier | false | ||||
| Invariants | 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()) | ||||
| 32. ClaimResponse.extension:encounter | |||||
| Slice Name | encounter | ||||
| Definition | R5: | ||||
| Short | R5: Encounters associated with the listed treatments (new) | ||||
| Comments | Element | ||||
| Control | 0..* This element is affected by the following invariants: ele-1 | ||||
| Type | Extension(R5: Encounters associated with the listed treatments (new)) (Extension Type: Reference(Cross-version Profile for R5.Encounter for use in FHIR STU3, Encounter)) | ||||
| Is Modifier | false | ||||
| Invariants | 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()) | ||||
| 34. ClaimResponse.extension:diagnosisRelatedGroup | |||||
| Slice Name | diagnosisRelatedGroup | ||||
| Definition | R5: | ||||
| Short | R5: Package billing code (new) | ||||
| Comments | Element | ||||
| Control | 0..1 This element is affected by the following invariants: ele-1 | ||||
| Type | Extension(R5: Package billing code (new)) (Extension Type: CodeableConcept) | ||||
| Is Modifier | false | ||||
| Invariants | 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()) | ||||
| 36. ClaimResponse.extension:adjudication | |||||
| Slice Name | adjudication | ||||
| Definition | R5: | ||||
| Short | R5: Header-level adjudication (new) | ||||
| Comments | Element | ||||
| Control | 0..* This element is affected by the following invariants: ele-1 | ||||
| Type | Extension(R5: adjudication) (Complex Extension) | ||||
| Is Modifier | false | ||||
| Invariants | 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()) | ||||
| 38. ClaimResponse.extension:total | |||||
| Slice Name | total | ||||
| Definition | R5: | ||||
| Short | R5: Adjudication totals (new) | ||||
| Comments | Element | ||||
| Control | 0..* This element is affected by the following invariants: ele-1 | ||||
| Type | Extension(R5: Adjudication totals (new)) (Complex Extension) | ||||
| Is Modifier | false | ||||
| Invariants | 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()) | ||||
| 40. ClaimResponse.modifierExtension | |||||
| Definition | May be used to represent additional information that is not part of the basic definition of the resource, and that modifies the understanding of the element that contains it. Usually modifier elements provide negation or qualification. 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. Applications processing a resource are required to check for modifier extensions. | ||||
| Short | Extensions that cannot be ignored | ||||
| 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. | ||||
| Control | 0..* | ||||
| Type | Extension | ||||
| Is Modifier | true because No Modifier Reason provideed in previous versions of FHIR | ||||
| Alternate Names | extensions, user content | ||||
| 42. ClaimResponse.identifier | |||||
| Definition | The Response business identifier. | ||||
| Short | Response number | ||||
| Note | This is a business identifier, not a resource identifier (see discussion) | ||||
| Control | 0..* | ||||
| Type | Identifier | ||||
| 44. ClaimResponse.status | |||||
| Definition | The status of the resource instance. | ||||
| Short | active | cancelled | draft | entered-in-error | ||||
| Comments | This element is labeled as a modifier because the status contains the code cancelled and entered-in-error that mark the response as not currently valid. | ||||
| Control | 0..1 | ||||
| Binding | The codes SHALL be taken from Financial Resource Status Codes (required to http://hl7.org/fhir/ValueSet/fm-status|3.0.2)A code specifying the state of the resource instance. | ||||
| Type | code | ||||
| Is Modifier | true because No Modifier Reason provideed in previous versions of FHIR | ||||
| Primitive Value | This primitive element may be present, or absent, or replaced by an extension | ||||
| Summary | true | ||||
| 46. ClaimResponse.patient | |||||
| Definition | Patient Resource. | ||||
| Short | The subject of the Products and Services | ||||
| Control | 0..1 | ||||
| Type | Reference(Patient) | ||||
| 48. ClaimResponse.patient.id | |||||
| Definition | unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. | ||||
| Short | xml:id (or equivalent in JSON) | ||||
| Control | 0..1 | ||||
| Type | string | ||||
| Primitive Value | This primitive element may be present, or absent, or replaced by an extension | ||||
| XML Format | In the XML format, this property is represented as an attribute. | ||||
| 50. ClaimResponse.patient.extension | |||||
| Definition | An Extension | ||||
| Short | Extension | ||||
| Control | 1..* | ||||
| Type | Extension | ||||
| Slicing | This element introduces a set of slices on ClaimResponse.patient.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators: | ||||
| 52. ClaimResponse.patient.extension:patient | |||||
| Slice Name | patient | ||||
| Definition | R5: | ||||
| Short | R5: The recipient of the products and services additional types | ||||
| Comments | Element | ||||
| Control | 1..1 | ||||
| Type | Extension(http://hl7.org/fhir/StructureDefinition/alternate-reference) | ||||
| 54. ClaimResponse.patient.reference | |||||
| Definition | A reference to a location at which the other resource is found. The reference may be a relative reference, in which case it is relative to the service base URL, or an absolute URL that resolves to the location where the resource is found. The reference may be version specific or not. If the reference is not to a FHIR RESTful server, then it should be assumed to be version specific. Internal fragment references (start with '#') refer to contained resources. | ||||
| Short | Literal reference, Relative, internal or absolute URL | ||||
| Comments | Using absolute URLs provides a stable scalable approach suitable for a cloud/web context, while using relative/logical references provides a flexible approach suitable for use when trading across closed eco-system boundaries. Absolute URLs do not need to point to a FHIR RESTful server, though this is the preferred approach. If the URL conforms to the structure "/[type]/[id]" then it should be assumed that the reference is to a FHIR RESTful server. | ||||
| Control | 0..1 This element is affected by the following invariants: ref-1 | ||||
| Type | string | ||||
| Primitive Value | This primitive element may be present, or absent, or replaced by an extension | ||||
| Summary | true | ||||
| 56. ClaimResponse.patient.identifier | |||||
| Definition | An identifier for the other resource. This is used when there is no way to reference the other resource directly, either because the entity is not available through a FHIR server, or because there is no way for the author of the resource to convert a known identifier to an actual location. There is no requirement that a Reference.identifier point to something that is actually exposed as a FHIR instance, but it SHALL point to a business concept that would be expected to be exposed as a FHIR instance, and that instance would need to be of a FHIR resource type allowed by the reference. | ||||
| Short | Logical reference, when literal reference is not known | ||||
| Comments | When an identifier is provided in place of a reference, any system processing the reference will only be able to resolve the identifier to a reference if it understands the business context in which the identifier is used. Sometimes this is global (e.g. a national identifier) but often it is not. For this reason, none of the useful mechanisms described for working with references (e.g. chaining, includes) are possible, nor should servers be expected to be able resolve the reference. Servers may accept an identifier based reference untouched, resolve it, and/or reject it - see CapabilityStatement.rest.resource.referencePolicy. When both an identifier and a literal reference are provided, the literal reference is preferred. Applications processing the resource are allowed - but not required - to check that the identifier matches the literal reference Applications converting a logical reference to a literal reference may choose to leave the logical reference present, or remove it. | ||||
| Note | This is a business identifier, not a resource identifier (see discussion) | ||||
| Control | 0..1 | ||||
| Type | Identifier | ||||
| Summary | true | ||||
| 58. ClaimResponse.patient.display | |||||
| Definition | Plain text narrative that identifies the resource in addition to the resource reference. | ||||
| Short | Text alternative for the resource | ||||
| Comments | This is generally not the same as the Resource.text of the referenced resource. The purpose is to identify what's being referenced, not to fully describe it. | ||||
| Control | 0..1 | ||||
| Type | string | ||||
| Primitive Value | This primitive element may be present, or absent, or replaced by an extension | ||||
| Summary | true | ||||
| 60. ClaimResponse.created | |||||
| Definition | The date when the enclosed suite of services were performed or completed. | ||||
| Short | Creation date | ||||
| Control | 0..1 | ||||
| Type | dateTime | ||||
| Primitive Value | This primitive element may be present, or absent, or replaced by an extension | ||||
| 62. ClaimResponse.insurer | |||||
| Definition | The Insurer who produced this adjudicated response. | ||||
| Short | Insurance issuing organization | ||||
| Control | 0..1 | ||||
| Type | Reference(Organization) | ||||
| 64. ClaimResponse.insurer.id | |||||
| Definition | unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. | ||||
| Short | xml:id (or equivalent in JSON) | ||||
| Control | 0..1 | ||||
| Type | string | ||||
| Primitive Value | This primitive element may be present, or absent, or replaced by an extension | ||||
| XML Format | In the XML format, this property is represented as an attribute. | ||||
| 66. ClaimResponse.insurer.extension | |||||
| Definition | An Extension | ||||
| Short | Extension | ||||
| Control | 0..* | ||||
| Type | Extension | ||||
| Slicing | This element introduces a set of slices on ClaimResponse.insurer.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators: | ||||
| 68. ClaimResponse.insurer.extension:insurer | |||||
| Slice Name | insurer | ||||
| Definition | R5: | ||||
| Short | R5: Party responsible for reimbursement additional types | ||||
| Comments | Element | ||||
| Control | 0..1 | ||||
| Type | Extension(http://hl7.org/fhir/StructureDefinition/alternate-reference) | ||||
| 70. ClaimResponse.insurer.reference | |||||
| Definition | A reference to a location at which the other resource is found. The reference may be a relative reference, in which case it is relative to the service base URL, or an absolute URL that resolves to the location where the resource is found. The reference may be version specific or not. If the reference is not to a FHIR RESTful server, then it should be assumed to be version specific. Internal fragment references (start with '#') refer to contained resources. | ||||
| Short | Literal reference, Relative, internal or absolute URL | ||||
| Comments | Using absolute URLs provides a stable scalable approach suitable for a cloud/web context, while using relative/logical references provides a flexible approach suitable for use when trading across closed eco-system boundaries. Absolute URLs do not need to point to a FHIR RESTful server, though this is the preferred approach. If the URL conforms to the structure "/[type]/[id]" then it should be assumed that the reference is to a FHIR RESTful server. | ||||
| Control | 0..1 This element is affected by the following invariants: ref-1 | ||||
| Type | string | ||||
| Primitive Value | This primitive element may be present, or absent, or replaced by an extension | ||||
| Summary | true | ||||
| 72. ClaimResponse.insurer.identifier | |||||
| Definition | An identifier for the other resource. This is used when there is no way to reference the other resource directly, either because the entity is not available through a FHIR server, or because there is no way for the author of the resource to convert a known identifier to an actual location. There is no requirement that a Reference.identifier point to something that is actually exposed as a FHIR instance, but it SHALL point to a business concept that would be expected to be exposed as a FHIR instance, and that instance would need to be of a FHIR resource type allowed by the reference. | ||||
| Short | Logical reference, when literal reference is not known | ||||
| Comments | When an identifier is provided in place of a reference, any system processing the reference will only be able to resolve the identifier to a reference if it understands the business context in which the identifier is used. Sometimes this is global (e.g. a national identifier) but often it is not. For this reason, none of the useful mechanisms described for working with references (e.g. chaining, includes) are possible, nor should servers be expected to be able resolve the reference. Servers may accept an identifier based reference untouched, resolve it, and/or reject it - see CapabilityStatement.rest.resource.referencePolicy. When both an identifier and a literal reference are provided, the literal reference is preferred. Applications processing the resource are allowed - but not required - to check that the identifier matches the literal reference Applications converting a logical reference to a literal reference may choose to leave the logical reference present, or remove it. | ||||
| Note | This is a business identifier, not a resource identifier (see discussion) | ||||
| Control | 0..1 | ||||
| Type | Identifier | ||||
| Summary | true | ||||
| 74. ClaimResponse.insurer.display | |||||
| Definition | Plain text narrative that identifies the resource in addition to the resource reference. | ||||
| Short | Text alternative for the resource | ||||
| Comments | This is generally not the same as the Resource.text of the referenced resource. The purpose is to identify what's being referenced, not to fully describe it. | ||||
| Control | 0..1 | ||||
| Type | string | ||||
| Primitive Value | This primitive element may be present, or absent, or replaced by an extension | ||||
| Summary | true | ||||
| 76. ClaimResponse.requestProvider | |||||
| Definition | The practitioner who is responsible for the services rendered to the patient. | ||||
| Short | Responsible practitioner | ||||
| Control | 0..1 | ||||
| Type | Reference(Practitioner) | ||||
| 78. ClaimResponse.requestOrganization | |||||
| Definition | The organization which is responsible for the services rendered to the patient. | ||||
| Short | Responsible organization | ||||
| Control | 0..1 | ||||
| Type | Reference(Organization) | ||||
| 80. ClaimResponse.request | |||||
| Definition | Original request resource referrence. | ||||
| Short | Id of resource triggering adjudication | ||||
| Control | 0..1 | ||||
| Type | Reference(Claim) | ||||
| 82. ClaimResponse.request.id | |||||
| Definition | unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. | ||||
| Short | xml:id (or equivalent in JSON) | ||||
| Control | 0..1 | ||||
| Type | string | ||||
| Primitive Value | This primitive element may be present, or absent, or replaced by an extension | ||||
| XML Format | In the XML format, this property is represented as an attribute. | ||||
| 84. ClaimResponse.request.extension | |||||
| Definition | An Extension | ||||
| Short | Extension | ||||
| Control | 0..* | ||||
| Type | Extension | ||||
| Slicing | This element introduces a set of slices on ClaimResponse.request.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators: | ||||
| 86. ClaimResponse.request.extension:request | |||||
| Slice Name | request | ||||
| Definition | R5: | ||||
| Short | R5: request additional types | ||||
| Comments | Element | ||||
| Control | 0..1 | ||||
| Type | Extension(http://hl7.org/fhir/StructureDefinition/alternate-reference) | ||||
| 88. ClaimResponse.request.reference | |||||
| Definition | A reference to a location at which the other resource is found. The reference may be a relative reference, in which case it is relative to the service base URL, or an absolute URL that resolves to the location where the resource is found. The reference may be version specific or not. If the reference is not to a FHIR RESTful server, then it should be assumed to be version specific. Internal fragment references (start with '#') refer to contained resources. | ||||
| Short | Literal reference, Relative, internal or absolute URL | ||||
| Comments | Using absolute URLs provides a stable scalable approach suitable for a cloud/web context, while using relative/logical references provides a flexible approach suitable for use when trading across closed eco-system boundaries. Absolute URLs do not need to point to a FHIR RESTful server, though this is the preferred approach. If the URL conforms to the structure "/[type]/[id]" then it should be assumed that the reference is to a FHIR RESTful server. | ||||
| Control | 0..1 This element is affected by the following invariants: ref-1 | ||||
| Type | string | ||||
| Primitive Value | This primitive element may be present, or absent, or replaced by an extension | ||||
| Summary | true | ||||
| 90. ClaimResponse.request.identifier | |||||
| Definition | An identifier for the other resource. This is used when there is no way to reference the other resource directly, either because the entity is not available through a FHIR server, or because there is no way for the author of the resource to convert a known identifier to an actual location. There is no requirement that a Reference.identifier point to something that is actually exposed as a FHIR instance, but it SHALL point to a business concept that would be expected to be exposed as a FHIR instance, and that instance would need to be of a FHIR resource type allowed by the reference. | ||||
| Short | Logical reference, when literal reference is not known | ||||
| Comments | When an identifier is provided in place of a reference, any system processing the reference will only be able to resolve the identifier to a reference if it understands the business context in which the identifier is used. Sometimes this is global (e.g. a national identifier) but often it is not. For this reason, none of the useful mechanisms described for working with references (e.g. chaining, includes) are possible, nor should servers be expected to be able resolve the reference. Servers may accept an identifier based reference untouched, resolve it, and/or reject it - see CapabilityStatement.rest.resource.referencePolicy. When both an identifier and a literal reference are provided, the literal reference is preferred. Applications processing the resource are allowed - but not required - to check that the identifier matches the literal reference Applications converting a logical reference to a literal reference may choose to leave the logical reference present, or remove it. | ||||
| Note | This is a business identifier, not a resource identifier (see discussion) | ||||
| Control | 0..1 | ||||
| Type | Identifier | ||||
| Summary | true | ||||
| 92. ClaimResponse.request.display | |||||
| Definition | Plain text narrative that identifies the resource in addition to the resource reference. | ||||
| Short | Text alternative for the resource | ||||
| Comments | This is generally not the same as the Resource.text of the referenced resource. The purpose is to identify what's being referenced, not to fully describe it. | ||||
| Control | 0..1 | ||||
| Type | string | ||||
| Primitive Value | This primitive element may be present, or absent, or replaced by an extension | ||||
| Summary | true | ||||
| 94. ClaimResponse.outcome | |||||
| Definition | Processing outcome errror, partial or complete processing. | ||||
| Short | complete | error | partial | ||||
| Control | 0..1 | ||||
| Binding | For example codes, see Claim Processing Codes (example to http://hl7.org/fhir/ValueSet/remittance-outcome|3.0.2)The result of the claim processing | ||||
| Type | CodeableConcept | ||||
| 96. ClaimResponse.outcome.id | |||||
| Definition | unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. | ||||
| Short | xml:id (or equivalent in JSON) | ||||
| Control | 0..1 | ||||
| Type | string | ||||
| Primitive Value | This primitive element may be present, or absent, or replaced by an extension | ||||
| XML Format | In the XML format, this property is represented as an attribute. | ||||
| 98. ClaimResponse.outcome.extension | |||||
| Definition | An Extension | ||||
| Short | Extension | ||||
| Control | 1..* | ||||
| Type | Extension | ||||
| Slicing | This element introduces a set of slices on ClaimResponse.outcome.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators: | ||||
| 100. ClaimResponse.outcome.extension:outcome | |||||
| Slice Name | outcome | ||||
| Definition | R5: | ||||
| Short | R5: queued | complete | error | partial | ||||
| Comments | Element | ||||
| Control | 1..1 | ||||
| Type | Extension(R5: queued | complete | error | partial) (Extension Type: code) | ||||
| 102. ClaimResponse.outcome.coding | |||||
| Definition | A reference to a code defined by a terminology system. | ||||
| Short | Code defined by a terminology system | ||||
| Comments | Codes may be defined very casually in enumerations, or code lists, up to very formal definitions such as SNOMED CT - see the HL7 v3 Core Principles for more information. Ordering of codings is undefined and SHALL NOT be used to infer meaning. Generally, at most only one of the coding values will be labeled as UserSelected = true. | ||||
| Control | 0..* | ||||
| Type | Coding | ||||
| Summary | true | ||||
| Requirements | Allows for translations and alternate encodings within a code system. Also supports communication of the same instance to systems requiring different encodings. | ||||
| 104. ClaimResponse.outcome.text | |||||
| Definition | A human language representation of the concept as seen/selected/uttered by the user who entered the data and/or which represents the intended meaning of the user. | ||||
| Short | Plain text representation of the concept | ||||
| Comments | Very often the text is the same as a displayName of one of the codings. | ||||
| Control | 0..1 | ||||
| Type | string | ||||
| Primitive Value | This primitive element may be present, or absent, or replaced by an extension | ||||
| Summary | true | ||||
| Requirements | The codes from the terminologies do not always capture the correct meaning with all the nuances of the human using them, or sometimes there is no appropriate code at all. In these cases, the text is used to capture the full meaning of the source. | ||||
| 106. ClaimResponse.disposition | |||||
| Definition | A description of the status of the adjudication. | ||||
| Short | Disposition Message | ||||
| Control | 0..1 | ||||
| Type | string | ||||
| Primitive Value | This primitive element may be present, or absent, or replaced by an extension | ||||
| 108. ClaimResponse.payeeType | |||||
| Definition | Party to be reimbursed: Subscriber, provider, other. | ||||
| Short | Party to be paid any benefits payable | ||||
| Control | 0..1 | ||||
| Binding | For example codes, see Claim Payee Type Codes (example to http://hl7.org/fhir/ValueSet/payeetype|3.0.2)A code for the party to be reimbursed. | ||||
| Type | CodeableConcept | ||||
| 110. ClaimResponse.item | |||||
| Definition | The first tier service adjudications for submitted services. | ||||
| Short | Line items | ||||
| Control | 0..* | ||||
| Type | BackboneElement | ||||
| Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() | (children().count() > id.count())) | ||||
| 112. ClaimResponse.item.id | |||||
| Definition | unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. | ||||
| Short | xml:id (or equivalent in JSON) | ||||
| Control | 0..1 | ||||
| Type | string | ||||
| Primitive Value | This primitive element may be present, or absent, or replaced by an extension | ||||
| XML Format | In the XML format, this property is represented as an attribute. | ||||
| 114. ClaimResponse.item.extension | |||||
| Definition | An Extension | ||||
| Short | Extension | ||||
| Control | 0..* | ||||
| Type | Extension | ||||
| Slicing | This element introduces a set of slices on ClaimResponse.item.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators: | ||||
| 116. ClaimResponse.item.extension:traceNumber | |||||
| Slice Name | traceNumber | ||||
| Definition | R5: | ||||
| Short | R5: Number for tracking (new) | ||||
| Comments | Element | ||||
| Control | 0..* This element is affected by the following invariants: ele-1 | ||||
| Type | Extension(R5: Number for tracking (new)) (Extension Type: Identifier) | ||||
| Is Modifier | false | ||||
| Invariants | 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()) | ||||
| 118. ClaimResponse.item.extension:reviewOutcome | |||||
| Slice Name | reviewOutcome | ||||
| Definition | R5: | ||||
| Short | R5: Adjudication results (new) | ||||
| Comments | Element | ||||
| Control | 0..1 This element is affected by the following invariants: ele-1 | ||||
| Type | Extension(R5: Adjudication results (new)) (Complex Extension) | ||||
| Is Modifier | false | ||||
| Invariants | 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()) | ||||
| 120. ClaimResponse.item.modifierExtension | |||||
| Definition | May be used to represent additional information that is not part of the basic definition of the element, and that modifies the understanding of the element that contains it. Usually modifier elements provide negation or qualification. 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. Applications processing a resource are required to check for modifier extensions. | ||||
| Short | Extensions that cannot be ignored | ||||
| 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. | ||||
| Control | 0..* | ||||
| Type | Extension | ||||
| Is Modifier | true because No Modifier Reason provideed in previous versions of FHIR | ||||
| Summary | true | ||||
| Alternate Names | extensions, user content, modifiers | ||||
| 122. ClaimResponse.item.sequenceLinkId | |||||
| Definition | A service line number. | ||||
| Short | Service instance | ||||
| Control | 1..1 | ||||
| Type | positiveInt | ||||
| Primitive Value | This primitive element may be present, or absent, or replaced by an extension | ||||
| 124. ClaimResponse.item.noteNumber | |||||
| Definition | A list of note references to the notes provided below. | ||||
| Short | List of note numbers which apply | ||||
| Control | 0..* | ||||
| Type | positiveInt | ||||
| Primitive Value | This primitive element may be present, or absent, or replaced by an extension | ||||
| 126. ClaimResponse.item.adjudication | |||||
| Definition | The adjudication results. | ||||
| Short | Adjudication details | ||||
| Control | 0..* | ||||
| Type | BackboneElement | ||||
| Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() | (children().count() > id.count())) | ||||
| 128. ClaimResponse.item.adjudication.id | |||||
| Definition | unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. | ||||
| Short | xml:id (or equivalent in JSON) | ||||
| Control | 0..1 | ||||
| Type | string | ||||
| Primitive Value | This primitive element may be present, or absent, or replaced by an extension | ||||
| XML Format | In the XML format, this property is represented as an attribute. | ||||
| 130. ClaimResponse.item.adjudication.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. | ||||
| Short | Additional 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. | ||||
| Control | 0..* | ||||
| Type | Extension | ||||
| Alternate Names | extensions, user content | ||||
| 132. ClaimResponse.item.adjudication.modifierExtension | |||||
| Definition | May be used to represent additional information that is not part of the basic definition of the element, and that modifies the understanding of the element that contains it. Usually modifier elements provide negation or qualification. 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. Applications processing a resource are required to check for modifier extensions. | ||||
| Short | Extensions that cannot be ignored | ||||
| 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. | ||||
| Control | 0..* | ||||
| Type | Extension | ||||
| Is Modifier | true because No Modifier Reason provideed in previous versions of FHIR | ||||
| Summary | true | ||||
| Alternate Names | extensions, user content, modifiers | ||||
| 134. ClaimResponse.item.adjudication.category | |||||
| Definition | Code indicating: Co-Pay, deductible, eligible, benefit, tax, etc. | ||||
| Short | Adjudication category such as co-pay, eligible, benefit, etc. | ||||
| Control | 1..1 | ||||
| Binding | For example codes, see Adjudication Value Codes (example to http://hl7.org/fhir/ValueSet/adjudication|3.0.2)The adjudication codes. | ||||
| Type | CodeableConcept | ||||
| 136. ClaimResponse.item.adjudication.reason | |||||
| Definition | Adjudication reason such as limit reached. | ||||
| Short | Explanation of Adjudication outcome | ||||
| Control | 0..1 | ||||
| Binding | For example codes, see Adjudication Reason Codes (example to http://hl7.org/fhir/ValueSet/adjudication-reason|3.0.2)The adjudication reason codes. | ||||
| Type | CodeableConcept | ||||
| 138. ClaimResponse.item.adjudication.amount | |||||
| Definition | Monetary amount associated with the code. | ||||
| Short | Monetary amount | ||||
| Control | 0..1 | ||||
| Type | Money | ||||
| 140. ClaimResponse.item.adjudication.value | |||||
| Definition | A non-monetary value for example a percentage. Mutually exclusive to the amount element above. | ||||
| Short | Non-monetary value | ||||
| Control | 0..1 | ||||
| Type | decimal | ||||
| Primitive Value | This primitive element may be present, or absent, or replaced by an extension | ||||
| 142. ClaimResponse.item.adjudication.value.id | |||||
| Definition | unique id for the element within a resource (for internal references) | ||||
| Short | xml:id (or equivalent in JSON) | ||||
| Control | 0..1 | ||||
| Type | string | ||||
| Primitive Value | This primitive element may be present, or absent, or replaced by an extension | ||||
| XML Format | In the XML format, this property is represented as an attribute. | ||||
| 144. ClaimResponse.item.adjudication.value.extension | |||||
| Definition | An Extension | ||||
| Short | Extension | ||||
| Control | 0..* | ||||
| Type | Extension | ||||
| Slicing | This element introduces a set of slices on ClaimResponse.item.adjudication.value.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators: | ||||
| 146. ClaimResponse.item.adjudication.value.extension:quantity | |||||
| Slice Name | quantity | ||||
| Definition | R5: | ||||
| Short | R5: quantity additional types | ||||
| Comments | Element | ||||
| Control | 0..1 This element is affected by the following invariants: ele-1 | ||||
| Type | Extension(R5: quantity additional types) (Extension Type: Quantity) | ||||
| Is Modifier | false | ||||
| Invariants | 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()) | ||||
| 148. ClaimResponse.item.adjudication.value.value | |||||
| Definition | The actual value | ||||
| Short | Primitive value for decimal | ||||
| Control | 0..1 | ||||
| Type | decimal | ||||
| XML Format | In the XML format, this property is represented as an attribute. | ||||
| 150. ClaimResponse.item.detail | |||||
| Definition | The second tier service adjudications for submitted services. | ||||
| Short | Detail line items | ||||
| Control | 0..* | ||||
| Type | BackboneElement | ||||
| Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() | (children().count() > id.count())) | ||||
| 152. ClaimResponse.item.detail.id | |||||
| Definition | unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. | ||||
| Short | xml:id (or equivalent in JSON) | ||||
| Control | 0..1 | ||||
| Type | string | ||||
| Primitive Value | This primitive element may be present, or absent, or replaced by an extension | ||||
| XML Format | In the XML format, this property is represented as an attribute. | ||||
| 154. ClaimResponse.item.detail.extension | |||||
| Definition | An Extension | ||||
| Short | Extension | ||||
| Control | 0..* | ||||
| Type | Extension | ||||
| Slicing | This element introduces a set of slices on ClaimResponse.item.detail.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators: | ||||
| 156. ClaimResponse.item.detail.extension:traceNumber | |||||
| Slice Name | traceNumber | ||||
| Definition | R5: | ||||
| Short | R5: Number for tracking (new) | ||||
| Comments | Element | ||||
| Control | 0..* This element is affected by the following invariants: ele-1 | ||||
| Type | Extension(R5: Number for tracking (new)) (Extension Type: Identifier) | ||||
| Is Modifier | false | ||||
| Invariants | 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()) | ||||
| 158. ClaimResponse.item.detail.extension:reviewOutcome | |||||
| Slice Name | reviewOutcome | ||||
| Definition | R5: | ||||
| Short | R5: Detail level adjudication results (new) | ||||
| Comments | Element | ||||
| Control | 0..1 This element is affected by the following invariants: ele-1 | ||||
| Type | Extension(R5: Adjudication results (new)) (Complex Extension) | ||||
| Is Modifier | false | ||||
| Invariants | 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()) | ||||
| 160. ClaimResponse.item.detail.modifierExtension | |||||
| Definition | May be used to represent additional information that is not part of the basic definition of the element, and that modifies the understanding of the element that contains it. Usually modifier elements provide negation or qualification. 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. Applications processing a resource are required to check for modifier extensions. | ||||
| Short | Extensions that cannot be ignored | ||||
| 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. | ||||
| Control | 0..* | ||||
| Type | Extension | ||||
| Is Modifier | true because No Modifier Reason provideed in previous versions of FHIR | ||||
| Summary | true | ||||
| Alternate Names | extensions, user content, modifiers | ||||
| 162. ClaimResponse.item.detail.sequenceLinkId | |||||
| Definition | A service line number. | ||||
| Short | Service instance | ||||
| Control | 1..1 | ||||
| Type | positiveInt | ||||
| Primitive Value | This primitive element may be present, or absent, or replaced by an extension | ||||
| 164. ClaimResponse.item.detail.noteNumber | |||||
| Definition | A list of note references to the notes provided below. | ||||
| Short | List of note numbers which apply | ||||
| Control | 0..* | ||||
| Type | positiveInt | ||||
| Primitive Value | This primitive element may be present, or absent, or replaced by an extension | ||||
| 166. ClaimResponse.item.detail.adjudication | |||||
| Definition | The adjudications results. | ||||
| Short | Detail level adjudication details | ||||
| Control | 0..* | ||||
| Type | Seettp://hl7.org/fhir/StructureDefinition/ClaimResponse#ClaimResponse.item.adjudication | ||||
| 168. ClaimResponse.item.detail.subDetail | |||||
| Definition | The third tier service adjudications for submitted services. | ||||
| Short | Subdetail line items | ||||
| Control | 0..* | ||||
| Type | BackboneElement | ||||
| Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() | (children().count() > id.count())) | ||||
| 170. ClaimResponse.item.detail.subDetail.id | |||||
| Definition | unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. | ||||
| Short | xml:id (or equivalent in JSON) | ||||
| Control | 0..1 | ||||
| Type | string | ||||
| Primitive Value | This primitive element may be present, or absent, or replaced by an extension | ||||
| XML Format | In the XML format, this property is represented as an attribute. | ||||
| 172. ClaimResponse.item.detail.subDetail.extension | |||||
| Definition | An Extension | ||||
| Short | Extension | ||||
| Control | 0..* | ||||
| Type | Extension | ||||
| Slicing | This element introduces a set of slices on ClaimResponse.item.detail.subDetail.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators: | ||||
| 174. ClaimResponse.item.detail.subDetail.extension:traceNumber | |||||
| Slice Name | traceNumber | ||||
| Definition | R5: | ||||
| Short | R5: Number for tracking (new) | ||||
| Comments | Element | ||||
| Control | 0..* This element is affected by the following invariants: ele-1 | ||||
| Type | Extension(R5: Number for tracking (new)) (Extension Type: Identifier) | ||||
| Is Modifier | false | ||||
| Invariants | 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()) | ||||
| 176. ClaimResponse.item.detail.subDetail.extension:reviewOutcome | |||||
| Slice Name | reviewOutcome | ||||
| Definition | R5: | ||||
| Short | R5: Subdetail level adjudication results (new) | ||||
| Comments | Element | ||||
| Control | 0..1 This element is affected by the following invariants: ele-1 | ||||
| Type | Extension(R5: Adjudication results (new)) (Complex Extension) | ||||
| Is Modifier | false | ||||
| Invariants | 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()) | ||||
| 178. ClaimResponse.item.detail.subDetail.modifierExtension | |||||
| Definition | May be used to represent additional information that is not part of the basic definition of the element, and that modifies the understanding of the element that contains it. Usually modifier elements provide negation or qualification. 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. Applications processing a resource are required to check for modifier extensions. | ||||
| Short | Extensions that cannot be ignored | ||||
| 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. | ||||
| Control | 0..* | ||||
| Type | Extension | ||||
| Is Modifier | true because No Modifier Reason provideed in previous versions of FHIR | ||||
| Summary | true | ||||
| Alternate Names | extensions, user content, modifiers | ||||
| 180. ClaimResponse.item.detail.subDetail.sequenceLinkId | |||||
| Definition | A service line number. | ||||
| Short | Service instance | ||||
| Control | 1..1 | ||||
| Type | positiveInt | ||||
| Primitive Value | This primitive element may be present, or absent, or replaced by an extension | ||||
| 182. ClaimResponse.item.detail.subDetail.noteNumber | |||||
| Definition | A list of note references to the notes provided below. | ||||
| Short | List of note numbers which apply | ||||
| Control | 0..* | ||||
| Type | positiveInt | ||||
| Primitive Value | This primitive element may be present, or absent, or replaced by an extension | ||||
| 184. ClaimResponse.item.detail.subDetail.adjudication | |||||
| Definition | The adjudications results. | ||||
| Short | Subdetail level adjudication details | ||||
| Control | 0..* | ||||
| Type | Seettp://hl7.org/fhir/StructureDefinition/ClaimResponse#ClaimResponse.item.adjudication | ||||
| 186. ClaimResponse.addItem | |||||
| Definition | The first tier service adjudications for payor added services. | ||||
| Short | Insurer added line items | ||||
| Control | 0..* | ||||
| Type | BackboneElement | ||||
| Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() | (children().count() > id.count())) | ||||
| 188. ClaimResponse.addItem.id | |||||
| Definition | unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. | ||||
| Short | xml:id (or equivalent in JSON) | ||||
| Control | 0..1 | ||||
| Type | string | ||||
| Primitive Value | This primitive element may be present, or absent, or replaced by an extension | ||||
| XML Format | In the XML format, this property is represented as an attribute. | ||||
| 190. ClaimResponse.addItem.extension | |||||
| Definition | An Extension | ||||
| Short | Extension | ||||
| Control | 0..* | ||||
| Type | Extension | ||||
| Slicing | This element introduces a set of slices on ClaimResponse.addItem.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators: | ||||
| 192. ClaimResponse.addItem.extension:detailSequence | |||||
| Slice Name | detailSequence | ||||
| Definition | R5: | ||||
| Short | R5: Detail sequence number (new) | ||||
| Comments | Element | ||||
| Control | 0..* This element is affected by the following invariants: ele-1 | ||||
| Type | Extension(R5: Detail sequence number (new)) (Extension Type: positiveInt) | ||||
| Is Modifier | false | ||||
| Invariants | 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()) | ||||
| 194. ClaimResponse.addItem.extension:subdetailSequence | |||||
| Slice Name | subdetailSequence | ||||
| Definition | R5: | ||||
| Short | R5: Subdetail sequence number (new) | ||||
| Comments | Element | ||||
| Control | 0..* This element is affected by the following invariants: ele-1 | ||||
| Type | Extension(R5: Subdetail sequence number (new)) (Extension Type: positiveInt) | ||||
| Is Modifier | false | ||||
| Invariants | 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()) | ||||
| 196. ClaimResponse.addItem.extension:traceNumber | |||||
| Slice Name | traceNumber | ||||
| Definition | R5: | ||||
| Short | R5: Number for tracking (new) | ||||
| Comments | Element | ||||
| Control | 0..* This element is affected by the following invariants: ele-1 | ||||
| Type | Extension(R5: Number for tracking (new)) (Extension Type: Identifier) | ||||
| Is Modifier | false | ||||
| Invariants | 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()) | ||||
| 198. ClaimResponse.addItem.extension:provider | |||||
| Slice Name | provider | ||||
| Definition | R5: | ||||
| Short | R5: Authorized providers (new) | ||||
| Comments | Element | ||||
| Control | 0..* This element is affected by the following invariants: ele-1 | ||||
| Type | Extension(R5: Authorized providers (new)) (Extension Type: Reference(Cross-version Profile for R5.Practitioner for use in FHIR STU3, Practitioner, Cross-version Profile for R5.PractitionerRole for use in FHIR STU3, PractitionerRole, Cross-version Profile for R5.Organization for use in FHIR STU3, Organization)) | ||||
| Is Modifier | false | ||||
| Invariants | 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()) | ||||
| 200. ClaimResponse.addItem.extension:revenue | |||||
| Slice Name | revenue | ||||
| Definition | R5: | ||||
| Short | R5: Revenue or cost center code (new) | ||||
| Comments | Element | ||||
| Control | 0..1 This element is affected by the following invariants: ele-1 | ||||
| Type | Extension(R5: Revenue or cost center code (new)) (Extension Type: CodeableConcept) | ||||
| Is Modifier | false | ||||
| Invariants | 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()) | ||||
| 202. ClaimResponse.addItem.extension:productOrServiceEnd | |||||
| Slice Name | productOrServiceEnd | ||||
| Definition | R5: | ||||
| Short | R5: End of a range of codes (new) | ||||
| Comments | Element | ||||
| Control | 0..1 This element is affected by the following invariants: ele-1 | ||||
| Type | Extension(R5: End of a range of codes (new)) (Extension Type: CodeableConcept) | ||||
| Is Modifier | false | ||||
| Invariants | 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()) | ||||
| 204. ClaimResponse.addItem.extension:request | |||||
| Slice Name | request | ||||
| Definition | R5: | ||||
| Short | R5: Request or Referral for Service (new) | ||||
| Comments | Element | ||||
| Control | 0..* This element is affected by the following invariants: ele-1 | ||||
| Type | Extension(R5: Request or Referral for Service (new)) (Extension Type: Reference(Cross-version Profile for R5.DeviceRequest for use in FHIR STU3, DeviceRequest, Cross-version Profile for R5.MedicationRequest for use in FHIR STU3, MedicationRequest, Cross-version Profile for R5.NutritionOrder for use in FHIR STU3, NutritionOrder, Cross-version Profile for R5.ServiceRequest for use in FHIR STU3, ReferralRequest, Cross-version Profile for R5.SupplyRequest for use in FHIR STU3, SupplyRequest, Cross-version Profile for R5.VisionPrescription for use in FHIR STU3, VisionPrescription)) | ||||
| Is Modifier | false | ||||
| Invariants | 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()) | ||||
| 206. ClaimResponse.addItem.extension:programCode | |||||
| Slice Name | programCode | ||||
| Definition | R5: | ||||
| Short | R5: Program the product or service is provided under (new) | ||||
| Comments | Element | ||||
| Control | 0..* This element is affected by the following invariants: ele-1 | ||||
| Type | Extension(R5: Program the product or service is provided under (new)) (Extension Type: CodeableConcept) | ||||
| Is Modifier | false | ||||
| Invariants | 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()) | ||||
| 208. ClaimResponse.addItem.extension:serviced | |||||
| Slice Name | serviced | ||||
| Definition | R5: | ||||
| Short | R5: Date or dates of service or product delivery (new) | ||||
| Comments | Element | ||||
| Control | 0..1 This element is affected by the following invariants: ele-1 | ||||
| Type | Extension(R5: Date or dates of service or product delivery (new)) (Extension Type: Choice of: date, Period) | ||||
| Is Modifier | false | ||||
| Invariants | 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()) | ||||
| 210. ClaimResponse.addItem.extension:location | |||||
| Slice Name | location | ||||
| Definition | R5: | ||||
| Short | R5: Place of service or where product was supplied (new) | ||||
| Comments | Element | ||||
| Control | 0..1 This element is affected by the following invariants: ele-1 | ||||
| Type | Extension(R5: Place of service or where product was supplied (new)) (Extension Type: Choice of: CodeableConcept, Address, Reference(Cross-version Profile for R5.Location for use in FHIR STU3, Location)) | ||||
| Is Modifier | false | ||||
| Invariants | 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()) | ||||
| 212. ClaimResponse.addItem.extension:quantity | |||||
| Slice Name | quantity | ||||
| Definition | R5: | ||||
| Short | R5: Count of products or services (new) | ||||
| Comments | Element | ||||
| Control | 0..1 This element is affected by the following invariants: ele-1 | ||||
| Type | Extension(R5: Count of products or services (new)) (Extension Type: Quantity(SimpleQuantity)) | ||||
| Is Modifier | false | ||||
| Invariants | 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()) | ||||
| 214. ClaimResponse.addItem.extension:unitPrice | |||||
| Slice Name | unitPrice | ||||
| Definition | R5: | ||||
| Short | R5: Fee, charge or cost per item (new) | ||||
| Comments | Element | ||||
| Control | 0..1 This element is affected by the following invariants: ele-1 | ||||
| Type | Extension(R5: Fee, charge or cost per item (new)) (Extension Type: Money) | ||||
| Is Modifier | false | ||||
| Invariants | 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()) | ||||
| 216. ClaimResponse.addItem.extension:factor | |||||
| Slice Name | factor | ||||
| Definition | R5: | ||||
| Short | R5: Price scaling factor (new) | ||||
| Comments | Element | ||||
| Control | 0..1 This element is affected by the following invariants: ele-1 | ||||
| Type | Extension(R5: Price scaling factor (new)) (Extension Type: decimal) | ||||
| Is Modifier | false | ||||
| Invariants | 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()) | ||||
| 218. ClaimResponse.addItem.extension:tax | |||||
| Slice Name | tax | ||||
| Definition | R5: | ||||
| Short | R5: Total tax (new) | ||||
| Comments | Element | ||||
| Control | 0..1 This element is affected by the following invariants: ele-1 | ||||
| Type | Extension(R5: Total tax (new)) (Extension Type: Money) | ||||
| Is Modifier | false | ||||
| Invariants | 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()) | ||||
| 220. ClaimResponse.addItem.extension:bodySite | |||||
| Slice Name | bodySite | ||||
| Definition | R5: | ||||
| Short | R5: Anatomical location (new) | ||||
| Comments | Element | ||||
| Control | 0..* This element is affected by the following invariants: ele-1 | ||||
| Type | Extension(R5: Anatomical location (new)) (Complex Extension) | ||||
| Is Modifier | false | ||||
| Invariants | 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()) | ||||
| 222. ClaimResponse.addItem.extension:reviewOutcome | |||||
| Slice Name | reviewOutcome | ||||
| Definition | R5: | ||||
| Short | R5: Added items adjudication results (new) | ||||
| Comments | Element | ||||
| Control | 0..1 This element is affected by the following invariants: ele-1 | ||||
| Type | Extension(R5: Adjudication results (new)) (Complex Extension) | ||||
| Is Modifier | false | ||||
| Invariants | 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()) | ||||
| 224. ClaimResponse.addItem.modifierExtension | |||||
| Definition | May be used to represent additional information that is not part of the basic definition of the element, and that modifies the understanding of the element that contains it. Usually modifier elements provide negation or qualification. 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. Applications processing a resource are required to check for modifier extensions. | ||||
| Short | Extensions that cannot be ignored | ||||
| 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. | ||||
| Control | 0..* | ||||
| Type | Extension | ||||
| Is Modifier | true because No Modifier Reason provideed in previous versions of FHIR | ||||
| Summary | true | ||||
| Alternate Names | extensions, user content, modifiers | ||||
| 226. ClaimResponse.addItem.sequenceLinkId | |||||
| Definition | List of input service items which this service line is intended to replace. | ||||
| Short | Service instances | ||||
| Control | 0..* | ||||
| Type | positiveInt | ||||
| Primitive Value | This primitive element may be present, or absent, or replaced by an extension | ||||
| 228. ClaimResponse.addItem.revenue | |||||
| Definition | The type of reveneu or cost center providing the product and/or service. | ||||
| Short | Revenue or cost center code | ||||
| Control | 0..1 | ||||
| Binding | For example codes, see Example Revenue Center Codes (example to http://hl7.org/fhir/ValueSet/ex-revenue-center|3.0.2)Codes for the revenue or cost centers supplying the service and/or products. | ||||
| Type | CodeableConcept | ||||
| 230. ClaimResponse.addItem.category | |||||
| Definition | Health Care Service Type Codes to identify the classification of service or benefits. | ||||
| Short | Type of service or product | ||||
| Control | 0..1 | ||||
| Binding | For example codes, see Benefit SubCategory Codes (example to http://hl7.org/fhir/ValueSet/benefit-subcategory|3.0.2)Benefit subcategories such as: oral-basic, major, glasses | ||||
| Type | CodeableConcept | ||||
| 232. ClaimResponse.addItem.service | |||||
| Definition | A code to indicate the Professional Service or Product supplied. | ||||
| Short | Group, Service or Product | ||||
| Control | 0..1 | ||||
| Binding | For example codes, see USCLS Codes (example to http://hl7.org/fhir/ValueSet/service-uscls|3.0.2)Allowable service and product codes. | ||||
| Type | CodeableConcept | ||||
| 234. ClaimResponse.addItem.modifier | |||||
| Definition | Item typification or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or for medical whether the treatment was outside the clinic or out of office hours. | ||||
| Short | Service/Product billing modifiers | ||||
| Control | 0..* | ||||
| Binding | For example codes, see Modifier type Codes (example to http://hl7.org/fhir/ValueSet/claim-modifiers|3.0.2)Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen. | ||||
| Type | CodeableConcept | ||||
| Requirements | May impact on adjudication. | ||||
| 236. ClaimResponse.addItem.fee | |||||
| Definition | The fee charged for the professional service or product.. | ||||
| Short | Professional fee or Product charge | ||||
| Control | 0..1 | ||||
| Type | Money | ||||
| 238. ClaimResponse.addItem.noteNumber | |||||
| Definition | A list of note references to the notes provided below. | ||||
| Short | List of note numbers which apply | ||||
| Control | 0..* | ||||
| Type | positiveInt | ||||
| Primitive Value | This primitive element may be present, or absent, or replaced by an extension | ||||
| 240. ClaimResponse.addItem.adjudication | |||||
| Definition | The adjudications results. | ||||
| Short | Added items adjudication | ||||
| Control | 0..* | ||||
| Type | Seettp://hl7.org/fhir/StructureDefinition/ClaimResponse#ClaimResponse.item.adjudication | ||||
| 242. ClaimResponse.addItem.detail | |||||
| Definition | The second tier service adjudications for payor added services. | ||||
| Short | Added items details | ||||
| Control | 0..* | ||||
| Type | BackboneElement | ||||
| Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() | (children().count() > id.count())) | ||||
| 244. ClaimResponse.addItem.detail.id | |||||
| Definition | unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. | ||||
| Short | xml:id (or equivalent in JSON) | ||||
| Control | 0..1 | ||||
| Type | string | ||||
| Primitive Value | This primitive element may be present, or absent, or replaced by an extension | ||||
| XML Format | In the XML format, this property is represented as an attribute. | ||||
| 246. ClaimResponse.addItem.detail.extension | |||||
| Definition | An Extension | ||||
| Short | Extension | ||||
| Control | 0..* | ||||
| Type | Extension | ||||
| Slicing | This element introduces a set of slices on ClaimResponse.addItem.detail.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators: | ||||
| 248. ClaimResponse.addItem.detail.extension:traceNumber | |||||
| Slice Name | traceNumber | ||||
| Definition | R5: | ||||
| Short | R5: Number for tracking (new) | ||||
| Comments | Element | ||||
| Control | 0..* This element is affected by the following invariants: ele-1 | ||||
| Type | Extension(R5: Number for tracking (new)) (Extension Type: Identifier) | ||||
| Is Modifier | false | ||||
| Invariants | 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()) | ||||
| 250. ClaimResponse.addItem.detail.extension:revenue | |||||
| Slice Name | revenue | ||||
| Definition | R5: | ||||
| Short | R5: Revenue or cost center code (new) | ||||
| Comments | Element | ||||
| Control | 0..1 This element is affected by the following invariants: ele-1 | ||||
| Type | Extension(R5: Revenue or cost center code (new)) (Extension Type: CodeableConcept) | ||||
| Is Modifier | false | ||||
| Invariants | 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()) | ||||
| 252. ClaimResponse.addItem.detail.extension:productOrServiceEnd | |||||
| Slice Name | productOrServiceEnd | ||||
| Definition | R5: | ||||
| Short | R5: End of a range of codes (new) | ||||
| Comments | Element | ||||
| Control | 0..1 This element is affected by the following invariants: ele-1 | ||||
| Type | Extension(R5: End of a range of codes (new)) (Extension Type: CodeableConcept) | ||||
| Is Modifier | false | ||||
| Invariants | 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()) | ||||
| 254. ClaimResponse.addItem.detail.extension:quantity | |||||
| Slice Name | quantity | ||||
| Definition | R5: | ||||
| Short | R5: Count of products or services (new) | ||||
| Comments | Element | ||||
| Control | 0..1 This element is affected by the following invariants: ele-1 | ||||
| Type | Extension(R5: Count of products or services (new)) (Extension Type: Quantity(SimpleQuantity)) | ||||
| Is Modifier | false | ||||
| Invariants | 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()) | ||||
| 256. ClaimResponse.addItem.detail.extension:unitPrice | |||||
| Slice Name | unitPrice | ||||
| Definition | R5: | ||||
| Short | R5: Fee, charge or cost per item (new) | ||||
| Comments | Element | ||||
| Control | 0..1 This element is affected by the following invariants: ele-1 | ||||
| Type | Extension(R5: Fee, charge or cost per item (new)) (Extension Type: Money) | ||||
| Is Modifier | false | ||||
| Invariants | 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()) | ||||
| 258. ClaimResponse.addItem.detail.extension:factor | |||||
| Slice Name | factor | ||||
| Definition | R5: | ||||
| Short | R5: Price scaling factor (new) | ||||
| Comments | Element | ||||
| Control | 0..1 This element is affected by the following invariants: ele-1 | ||||
| Type | Extension(R5: Price scaling factor (new)) (Extension Type: decimal) | ||||
| Is Modifier | false | ||||
| Invariants | 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()) | ||||
| 260. ClaimResponse.addItem.detail.extension:tax | |||||
| Slice Name | tax | ||||
| Definition | R5: | ||||
| Short | R5: Total tax (new) | ||||
| Comments | Element | ||||
| Control | 0..1 This element is affected by the following invariants: ele-1 | ||||
| Type | Extension(R5: Total tax (new)) (Extension Type: Money) | ||||
| Is Modifier | false | ||||
| Invariants | 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()) | ||||
| 262. ClaimResponse.addItem.detail.extension:net | |||||
| Slice Name | net | ||||
| Definition | R5: | ||||
| Short | R5: Total item cost (new) | ||||
| Comments | Element | ||||
| Control | 0..1 This element is affected by the following invariants: ele-1 | ||||
| Type | Extension(R5: Total item cost (new)) (Extension Type: Money) | ||||
| Is Modifier | false | ||||
| Invariants | 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()) | ||||
| 264. ClaimResponse.addItem.detail.extension:reviewOutcome | |||||
| Slice Name | reviewOutcome | ||||
| Definition | R5: | ||||
| Short | R5: Added items detail level adjudication results (new) | ||||
| Comments | Element | ||||
| Control | 0..1 This element is affected by the following invariants: ele-1 | ||||
| Type | Extension(R5: Adjudication results (new)) (Complex Extension) | ||||
| Is Modifier | false | ||||
| Invariants | 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()) | ||||
| 266. ClaimResponse.addItem.detail.extension:subDetail | |||||
| Slice Name | subDetail | ||||
| Definition | R5: | ||||
| Short | R5: Insurer added line items (new) | ||||
| Comments | Element | ||||
| Control | 0..* This element is affected by the following invariants: ele-1 | ||||
| Type | Extension(R5: Insurer added line items (new)) (Complex Extension) | ||||
| Is Modifier | false | ||||
| Invariants | 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()) | ||||
| 268. ClaimResponse.addItem.detail.extension:reviewOutcome | |||||
| Slice Name | reviewOutcome | ||||
| Definition | R5: | ||||
| Short | R5: Added items subdetail level adjudication results (new) | ||||
| Comments | Element | ||||
| Control | 0..1 This element is affected by the following invariants: ele-1 | ||||
| Type | Extension(R5: Adjudication results (new)) (Complex Extension) | ||||
| Is Modifier | false | ||||
| Invariants | 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()) | ||||
| 270. ClaimResponse.addItem.detail.extension:adjudication | |||||
| Slice Name | adjudication | ||||
| Definition | R5: | ||||
| Short | R5: Added items subdetail adjudication (new) | ||||
| Comments | Element | ||||
| Control | 0..* This element is affected by the following invariants: ele-1 | ||||
| Type | Extension(R5: adjudication) (Complex Extension) | ||||
| Is Modifier | false | ||||
| Invariants | 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()) | ||||
| 272. ClaimResponse.addItem.detail.modifierExtension | |||||
| Definition | May be used to represent additional information that is not part of the basic definition of the element, and that modifies the understanding of the element that contains it. Usually modifier elements provide negation or qualification. 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. Applications processing a resource are required to check for modifier extensions. | ||||
| Short | Extensions that cannot be ignored | ||||
| 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. | ||||
| Control | 0..* | ||||
| Type | Extension | ||||
| Is Modifier | true because No Modifier Reason provideed in previous versions of FHIR | ||||
| Summary | true | ||||
| Alternate Names | extensions, user content, modifiers | ||||
| 274. ClaimResponse.addItem.detail.revenue | |||||
| Definition | The type of reveneu or cost center providing the product and/or service. | ||||
| Short | Revenue or cost center code | ||||
| Control | 0..1 | ||||
| Binding | For example codes, see Example Revenue Center Codes (example to http://hl7.org/fhir/ValueSet/ex-revenue-center|3.0.2)Codes for the revenue or cost centers supplying the service and/or products. | ||||
| Type | CodeableConcept | ||||
| 276. ClaimResponse.addItem.detail.category | |||||
| Definition | Health Care Service Type Codes to identify the classification of service or benefits. | ||||
| Short | Type of service or product | ||||
| Control | 0..1 | ||||
| Binding | For example codes, see Benefit SubCategory Codes (example to http://hl7.org/fhir/ValueSet/benefit-subcategory|3.0.2)Benefit subcategories such as: oral-basic, major, glasses | ||||
| Type | CodeableConcept | ||||
| 278. ClaimResponse.addItem.detail.service | |||||
| Definition | A code to indicate the Professional Service or Product supplied. | ||||
| Short | Service or Product | ||||
| Control | 0..1 | ||||
| Binding | For example codes, see USCLS Codes (example to http://hl7.org/fhir/ValueSet/service-uscls|3.0.2)Allowable service and product codes. | ||||
| Type | CodeableConcept | ||||
| 280. ClaimResponse.addItem.detail.modifier | |||||
| Definition | Item typification or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or for medical whether the treatment was outside the clinic or out of office hours. | ||||
| Short | Service/Product billing modifiers | ||||
| Control | 0..* | ||||
| Binding | For example codes, see Modifier type Codes (example to http://hl7.org/fhir/ValueSet/claim-modifiers|3.0.2)Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen. | ||||
| Type | CodeableConcept | ||||
| Requirements | May impact on adjudication. | ||||
| 282. ClaimResponse.addItem.detail.fee | |||||
| Definition | The fee charged for the professional service or product.. | ||||
| Short | Professional fee or Product charge | ||||
| Control | 0..1 | ||||
| Type | Money | ||||
| 284. ClaimResponse.addItem.detail.noteNumber | |||||
| Definition | A list of note references to the notes provided below. | ||||
| Short | List of note numbers which apply | ||||
| Control | 0..* | ||||
| Type | positiveInt | ||||
| Primitive Value | This primitive element may be present, or absent, or replaced by an extension | ||||
| 286. ClaimResponse.addItem.detail.adjudication | |||||
| Definition | The adjudications results. | ||||
| Short | Added items detail adjudication | ||||
| Control | 0..* | ||||
| Type | Seettp://hl7.org/fhir/StructureDefinition/ClaimResponse#ClaimResponse.item.adjudication | ||||
| 288. ClaimResponse.error | |||||
| Definition | Mutually exclusive with Services Provided (Item). | ||||
| Short | Processing errors | ||||
| Control | 0..* | ||||
| Type | BackboneElement | ||||
| Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() | (children().count() > id.count())) | ||||
| 290. ClaimResponse.error.id | |||||
| Definition | unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. | ||||
| Short | xml:id (or equivalent in JSON) | ||||
| Control | 0..1 | ||||
| Type | string | ||||
| Primitive Value | This primitive element may be present, or absent, or replaced by an extension | ||||
| XML Format | In the XML format, this property is represented as an attribute. | ||||
| 292. ClaimResponse.error.extension | |||||
| Definition | An Extension | ||||
| Short | Extension | ||||
| Control | 0..* | ||||
| Type | Extension | ||||
| Slicing | This element introduces a set of slices on ClaimResponse.error.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators: | ||||
| 294. ClaimResponse.error.extension:expression | |||||
| Slice Name | expression | ||||
| Definition | R5: | ||||
| Short | R5: FHIRPath of element(s) related to issue (new) | ||||
| Comments | Element | ||||
| Control | 0..* This element is affected by the following invariants: ele-1 | ||||
| Type | Extension(R5: FHIRPath of element(s) related to issue (new)) (Extension Type: string) | ||||
| Is Modifier | false | ||||
| Invariants | 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()) | ||||
| 296. ClaimResponse.error.modifierExtension | |||||
| Definition | May be used to represent additional information that is not part of the basic definition of the element, and that modifies the understanding of the element that contains it. Usually modifier elements provide negation or qualification. 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. Applications processing a resource are required to check for modifier extensions. | ||||
| Short | Extensions that cannot be ignored | ||||
| 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. | ||||
| Control | 0..* | ||||
| Type | Extension | ||||
| Is Modifier | true because No Modifier Reason provideed in previous versions of FHIR | ||||
| Summary | true | ||||
| Alternate Names | extensions, user content, modifiers | ||||
| 298. ClaimResponse.error.sequenceLinkId | |||||
| Definition | The sequence number of the line item submitted which contains the error. This value is omitted when the error is elsewhere. | ||||
| Short | Item sequence number | ||||
| Control | 0..1 | ||||
| Type | positiveInt | ||||
| Primitive Value | This primitive element may be present, or absent, or replaced by an extension | ||||
| 300. ClaimResponse.error.detailSequenceLinkId | |||||
| Definition | The sequence number of the addition within the line item submitted which contains the error. This value is omitted when the error is not related to an Addition. | ||||
| Short | Detail sequence number | ||||
| Control | 0..1 | ||||
| Type | positiveInt | ||||
| Primitive Value | This primitive element may be present, or absent, or replaced by an extension | ||||
| 302. ClaimResponse.error.subdetailSequenceLinkId | |||||
| Definition | The sequence number of the addition within the line item submitted which contains the error. This value is omitted when the error is not related to an Addition. | ||||
| Short | Subdetail sequence number | ||||
| Control | 0..1 | ||||
| Type | positiveInt | ||||
| Primitive Value | This primitive element may be present, or absent, or replaced by an extension | ||||
| 304. ClaimResponse.error.code | |||||
| Definition | An error code,from a specified code system, which details why the claim could not be adjudicated. | ||||
| Short | Error code detailing processing issues | ||||
| Control | 1..1 | ||||
| Binding | For example codes, see Adjudication Error Codes (example to http://hl7.org/fhir/ValueSet/adjudication-error|3.0.2)The adjudication error codes. | ||||
| Type | CodeableConcept | ||||
| 306. ClaimResponse.totalCost | |||||
| Definition | The total cost of the services reported. | ||||
| Short | Total Cost of service from the Claim | ||||
| Control | 0..1 | ||||
| Type | Money | ||||
| Requirements | This is a check value that the receiver calculates and returns. | ||||
| 308. ClaimResponse.unallocDeductable | |||||
| Definition | The amount of deductible applied which was not allocated to any particular service line. | ||||
| Short | Unallocated deductible | ||||
| Control | 0..1 | ||||
| Type | Money | ||||
| 310. ClaimResponse.totalBenefit | |||||
| Definition | Total amount of benefit payable (Equal to sum of the Benefit amounts from all detail lines and additions less the Unallocated Deductible). | ||||
| Short | Total benefit payable for the Claim | ||||
| Control | 0..1 | ||||
| Type | Money | ||||
| 312. ClaimResponse.payment | |||||
| Definition | Payment details for the claim if the claim has been paid. | ||||
| Short | Payment details, if paid | ||||
| Control | 0..1 | ||||
| Type | BackboneElement | ||||
| Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() | (children().count() > id.count())) | ||||
| 314. ClaimResponse.payment.id | |||||
| Definition | unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. | ||||
| Short | xml:id (or equivalent in JSON) | ||||
| Control | 0..1 | ||||
| Type | string | ||||
| Primitive Value | This primitive element may be present, or absent, or replaced by an extension | ||||
| XML Format | In the XML format, this property is represented as an attribute. | ||||
| 316. ClaimResponse.payment.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. | ||||
| Short | Additional 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. | ||||
| Control | 0..* | ||||
| Type | Extension | ||||
| Alternate Names | extensions, user content | ||||
| 318. ClaimResponse.payment.modifierExtension | |||||
| Definition | May be used to represent additional information that is not part of the basic definition of the element, and that modifies the understanding of the element that contains it. Usually modifier elements provide negation or qualification. 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. Applications processing a resource are required to check for modifier extensions. | ||||
| Short | Extensions that cannot be ignored | ||||
| 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. | ||||
| Control | 0..* | ||||
| Type | Extension | ||||
| Is Modifier | true because No Modifier Reason provideed in previous versions of FHIR | ||||
| Summary | true | ||||
| Alternate Names | extensions, user content, modifiers | ||||
| 320. ClaimResponse.payment.type | |||||
| Definition | Whether this represents partial or complete payment of the claim. | ||||
| Short | Partial or Complete | ||||
| Control | 0..1 | ||||
| Binding | For example codes, see Example Payment Type Codes (example to http://hl7.org/fhir/ValueSet/ex-paymenttype|3.0.2)The type (partial, complete) of the payment | ||||
| Type | CodeableConcept | ||||
| 322. ClaimResponse.payment.adjustment | |||||
| Definition | Adjustment to the payment of this transaction which is not related to adjudication of this transaction. | ||||
| Short | Payment adjustment for non-Claim issues | ||||
| Control | 0..1 | ||||
| Type | Money | ||||
| 324. ClaimResponse.payment.adjustmentReason | |||||
| Definition | Reason for the payment adjustment. | ||||
| Short | Explanation for the non-claim adjustment | ||||
| Control | 0..1 | ||||
| Binding | For example codes, see Payment Adjustment Reason Codes (example to http://hl7.org/fhir/ValueSet/payment-adjustment-reason|3.0.2)Payment Adjustment reason codes. | ||||
| Type | CodeableConcept | ||||
| 326. ClaimResponse.payment.date | |||||
| Definition | Estimated payment data. | ||||
| Short | Expected data of Payment | ||||
| Control | 0..1 | ||||
| Type | date | ||||
| Primitive Value | This primitive element may be present, or absent, or replaced by an extension | ||||
| 328. ClaimResponse.payment.amount | |||||
| Definition | Payable less any payment adjustment. | ||||
| Short | Payable amount after adjustment | ||||
| Control | 0..1 | ||||
| Type | Money | ||||
| 330. ClaimResponse.payment.identifier | |||||
| Definition | Payment identifier. | ||||
| Short | Identifier of the payment instrument | ||||
| Note | This is a business identifier, not a resource identifier (see discussion) | ||||
| Control | 0..1 | ||||
| Type | Identifier | ||||
| 332. ClaimResponse.reserved | |||||
| Definition | Status of funds reservation (For provider, for Patient, None). | ||||
| Short | Funds reserved status | ||||
| Control | 0..1 | ||||
| Binding | For example codes, see Funds Reservation Codes (example to http://hl7.org/fhir/ValueSet/fundsreserve|3.0.2)For whom funds are to be reserved: (Patient, Provider, None). | ||||
| Type | Coding | ||||
| 334. ClaimResponse.reserved.id | |||||
| Definition | unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. | ||||
| Short | xml:id (or equivalent in JSON) | ||||
| Control | 0..1 | ||||
| Type | string | ||||
| Primitive Value | This primitive element may be present, or absent, or replaced by an extension | ||||
| XML Format | In the XML format, this property is represented as an attribute. | ||||
| 336. ClaimResponse.reserved.extension | |||||
| Definition | An Extension | ||||
| Short | Extension | ||||
| Control | 0..* | ||||
| Type | Extension | ||||
| Slicing | This element introduces a set of slices on ClaimResponse.reserved.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators: | ||||
| 338. ClaimResponse.reserved.extension:fundsReserve | |||||
| Slice Name | fundsReserve | ||||
| Definition | R5: | ||||
| Short | R5: fundsReserve additional types | ||||
| Comments | Element | ||||
| Control | 0..1 | ||||
| Type | Extension(R5: fundsReserve additional types) (Extension Type: CodeableConcept) | ||||
| 340. ClaimResponse.reserved.system | |||||
| Definition | The identification of the code system that defines the meaning of the symbol in the code. | ||||
| Short | Identity of the terminology system | ||||
| Comments | The URI may be an OID (urn:oid:...) or a UUID (urn:uuid:...). OIDs and UUIDs SHALL be references to the HL7 OID registry. Otherwise, the URI should come from HL7's list of FHIR defined special URIs or it should de-reference to some definition that establish the system clearly and unambiguously. | ||||
| Control | 0..1 | ||||
| Type | uri | ||||
| Primitive Value | This primitive element may be present, or absent, or replaced by an extension | ||||
| Summary | true | ||||
| Requirements | Need to be unambiguous about the source of the definition of the symbol. | ||||
| 342. ClaimResponse.reserved.version | |||||
| Definition | The version of the code system which was used when choosing this code. Note that a well-maintained code system does not need the version reported, because the meaning of codes is consistent across versions. However this cannot consistently be assured. and when the meaning is not guaranteed to be consistent, the version SHOULD be exchanged. | ||||
| Short | Version of the system - if relevant | ||||
| Comments | Where the terminology does not clearly define what string should be used to identify code system versions, the recommendation is to use the date (expressed in FHIR date format) on which that version was officially published as the version date. | ||||
| Note | This is a business version Id, not a resource version Id (see discussion) | ||||
| Control | 0..1 | ||||
| Type | string | ||||
| Primitive Value | This primitive element may be present, or absent, or replaced by an extension | ||||
| Summary | true | ||||
| 344. ClaimResponse.reserved.code | |||||
| Definition | A symbol in syntax defined by the system. The symbol may be a predefined code or an expression in a syntax defined by the coding system (e.g. post-coordination). | ||||
| Short | Symbol in syntax defined by the system | ||||
| Control | 0..1 | ||||
| Type | code | ||||
| Primitive Value | This primitive element may be present, or absent, or replaced by an extension | ||||
| Summary | true | ||||
| Requirements | Need to refer to a particular code in the system. | ||||
| 346. ClaimResponse.reserved.display | |||||
| Definition | A representation of the meaning of the code in the system, following the rules of the system. | ||||
| Short | Representation defined by the system | ||||
| Control | 0..1 | ||||
| Type | string | ||||
| Primitive Value | This primitive element may be present, or absent, or replaced by an extension | ||||
| Summary | true | ||||
| Requirements | Need to be able to carry a human-readable meaning of the code for readers that do not know the system. | ||||
| 348. ClaimResponse.reserved.userSelected | |||||
| Definition | Indicates that this coding was chosen by a user directly - i.e. off a pick list of available items (codes or displays). | ||||
| Short | If this coding was chosen directly by the user | ||||
| Comments | Amongst a set of alternatives, a directly chosen code is the most appropriate starting point for new translations. There is some ambiguity about what exactly 'directly chosen' implies, and trading partner agreement may be needed to clarify the use of this element and its consequences more completely. | ||||
| Control | 0..1 | ||||
| Type | boolean | ||||
| Primitive Value | This primitive element may be present, or absent, or replaced by an extension | ||||
| Summary | true | ||||
| Requirements | This has been identified as a clinical safety criterium - that this exact system/code pair was chosen explicitly, rather than inferred by the system based on some rules or language processing. | ||||
| 350. ClaimResponse.form | |||||
| Definition | The form to be used for printing the content. | ||||
| Short | Printed Form Identifier | ||||
| Control | 0..1 | ||||
| Binding | For example codes, see Form Codes (example to http://hl7.org/fhir/ValueSet/forms|3.0.2)The forms codes. | ||||
| Type | CodeableConcept | ||||
| 352. ClaimResponse.form.id | |||||
| Definition | unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. | ||||
| Short | xml:id (or equivalent in JSON) | ||||
| Control | 0..1 | ||||
| Type | string | ||||
| Primitive Value | This primitive element may be present, or absent, or replaced by an extension | ||||
| XML Format | In the XML format, this property is represented as an attribute. | ||||
| 354. ClaimResponse.form.extension | |||||
| Definition | An Extension | ||||
| Short | Extension | ||||
| Control | 0..* | ||||
| Type | Extension | ||||
| Slicing | This element introduces a set of slices on ClaimResponse.form.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators: | ||||
| 356. ClaimResponse.form.extension:form | |||||
| Slice Name | form | ||||
| Definition | R5: | ||||
| Short | R5: Printed reference or actual form additional types | ||||
| Comments | Element | ||||
| Control | 0..1 | ||||
| Type | Extension(R5: Printed reference or actual form additional types) (Extension Type: Attachment) | ||||
| 358. ClaimResponse.form.coding | |||||
| Definition | A reference to a code defined by a terminology system. | ||||
| Short | Code defined by a terminology system | ||||
| Comments | Codes may be defined very casually in enumerations, or code lists, up to very formal definitions such as SNOMED CT - see the HL7 v3 Core Principles for more information. Ordering of codings is undefined and SHALL NOT be used to infer meaning. Generally, at most only one of the coding values will be labeled as UserSelected = true. | ||||
| Control | 0..* | ||||
| Type | Coding | ||||
| Summary | true | ||||
| Requirements | Allows for translations and alternate encodings within a code system. Also supports communication of the same instance to systems requiring different encodings. | ||||
| 360. ClaimResponse.form.text | |||||
| Definition | A human language representation of the concept as seen/selected/uttered by the user who entered the data and/or which represents the intended meaning of the user. | ||||
| Short | Plain text representation of the concept | ||||
| Comments | Very often the text is the same as a displayName of one of the codings. | ||||
| Control | 0..1 | ||||
| Type | string | ||||
| Primitive Value | This primitive element may be present, or absent, or replaced by an extension | ||||
| Summary | true | ||||
| Requirements | The codes from the terminologies do not always capture the correct meaning with all the nuances of the human using them, or sometimes there is no appropriate code at all. In these cases, the text is used to capture the full meaning of the source. | ||||
| 362. ClaimResponse.processNote | |||||
| Definition | Note text. | ||||
| Short | Processing notes | ||||
| Control | 0..* | ||||
| Type | BackboneElement | ||||
| Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() | (children().count() > id.count())) | ||||
| 364. ClaimResponse.processNote.id | |||||
| Definition | unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. | ||||
| Short | xml:id (or equivalent in JSON) | ||||
| Control | 0..1 | ||||
| Type | string | ||||
| Primitive Value | This primitive element may be present, or absent, or replaced by an extension | ||||
| XML Format | In the XML format, this property is represented as an attribute. | ||||
| 366. ClaimResponse.processNote.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. | ||||
| Short | Additional 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. | ||||
| Control | 0..* | ||||
| Type | Extension | ||||
| Alternate Names | extensions, user content | ||||
| 368. ClaimResponse.processNote.modifierExtension | |||||
| Definition | May be used to represent additional information that is not part of the basic definition of the element, and that modifies the understanding of the element that contains it. Usually modifier elements provide negation or qualification. 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. Applications processing a resource are required to check for modifier extensions. | ||||
| Short | Extensions that cannot be ignored | ||||
| 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. | ||||
| Control | 0..* | ||||
| Type | Extension | ||||
| Is Modifier | true because No Modifier Reason provideed in previous versions of FHIR | ||||
| Summary | true | ||||
| Alternate Names | extensions, user content, modifiers | ||||
| 370. ClaimResponse.processNote.number | |||||
| Definition | An integer associated with each note which may be referred to from each service line item. | ||||
| Short | Sequence Number for this note | ||||
| Control | 0..1 | ||||
| Type | positiveInt | ||||
| Primitive Value | This primitive element may be present, or absent, or replaced by an extension | ||||
| 372. ClaimResponse.processNote.type | |||||
| Definition | The note purpose: Print/Display. | ||||
| Short | display | print | printoper | ||||
| Control | 0..1 | ||||
| Binding | The codes SHALL be taken from NoteType (required to http://hl7.org/fhir/ValueSet/note-type|3.0.2)The presentation types of notes. | ||||
| Type | CodeableConcept | ||||
| 374. ClaimResponse.processNote.text | |||||
| Definition | The note text. | ||||
| Short | Note explanatory text | ||||
| Control | 0..1 | ||||
| Type | string | ||||
| Primitive Value | This primitive element may be present, or absent, or replaced by an extension | ||||
| 376. ClaimResponse.processNote.language | |||||
| Definition | The ISO-639-1 alpha 2 code in lower case for the language, optionally followed by a hyphen and the ISO-3166-1 alpha 2 code for the region in upper case; e.g. "en" for English, or "en-US" for American English versus "en-EN" for England English. | ||||
| Short | Language if different from the resource | ||||
| Control | 0..1 | ||||
| Binding | Unless not suitable, these codes SHALL be taken from Common Languages (extensible to http://hl7.org/fhir/ValueSet/languages|3.0.2)A human language.
| ||||
| Type | CodeableConcept | ||||
| 378. ClaimResponse.communicationRequest | |||||
| Definition | Request for additional supporting or authorizing information, such as: documents, images or resources. | ||||
| Short | Request for additional information | ||||
| Control | 0..* | ||||
| Type | Reference(CommunicationRequest) | ||||
| 380. ClaimResponse.communicationRequest.id | |||||
| Definition | unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. | ||||
| Short | xml:id (or equivalent in JSON) | ||||
| Control | 0..1 | ||||
| Type | string | ||||
| Primitive Value | This primitive element may be present, or absent, or replaced by an extension | ||||
| XML Format | In the XML format, this property is represented as an attribute. | ||||
| 382. ClaimResponse.communicationRequest.extension | |||||
| Definition | An Extension | ||||
| Short | Extension | ||||
| Control | 0..* | ||||
| Type | Extension | ||||
| Slicing | This element introduces a set of slices on ClaimResponse.communicationRequest.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators: | ||||
| 384. ClaimResponse.communicationRequest.extension:communicationRequest | |||||
| Slice Name | communicationRequest | ||||
| Definition | R5: | ||||
| Short | R5: communicationRequest additional types | ||||
| Comments | Element | ||||
| Control | 0..* | ||||
| Type | Extension(http://hl7.org/fhir/StructureDefinition/alternate-reference) | ||||
| 386. ClaimResponse.communicationRequest.reference | |||||
| Definition | A reference to a location at which the other resource is found. The reference may be a relative reference, in which case it is relative to the service base URL, or an absolute URL that resolves to the location where the resource is found. The reference may be version specific or not. If the reference is not to a FHIR RESTful server, then it should be assumed to be version specific. Internal fragment references (start with '#') refer to contained resources. | ||||
| Short | Literal reference, Relative, internal or absolute URL | ||||
| Comments | Using absolute URLs provides a stable scalable approach suitable for a cloud/web context, while using relative/logical references provides a flexible approach suitable for use when trading across closed eco-system boundaries. Absolute URLs do not need to point to a FHIR RESTful server, though this is the preferred approach. If the URL conforms to the structure "/[type]/[id]" then it should be assumed that the reference is to a FHIR RESTful server. | ||||
| Control | 0..1 This element is affected by the following invariants: ref-1 | ||||
| Type | string | ||||
| Primitive Value | This primitive element may be present, or absent, or replaced by an extension | ||||
| Summary | true | ||||
| 388. ClaimResponse.communicationRequest.identifier | |||||
| Definition | An identifier for the other resource. This is used when there is no way to reference the other resource directly, either because the entity is not available through a FHIR server, or because there is no way for the author of the resource to convert a known identifier to an actual location. There is no requirement that a Reference.identifier point to something that is actually exposed as a FHIR instance, but it SHALL point to a business concept that would be expected to be exposed as a FHIR instance, and that instance would need to be of a FHIR resource type allowed by the reference. | ||||
| Short | Logical reference, when literal reference is not known | ||||
| Comments | When an identifier is provided in place of a reference, any system processing the reference will only be able to resolve the identifier to a reference if it understands the business context in which the identifier is used. Sometimes this is global (e.g. a national identifier) but often it is not. For this reason, none of the useful mechanisms described for working with references (e.g. chaining, includes) are possible, nor should servers be expected to be able resolve the reference. Servers may accept an identifier based reference untouched, resolve it, and/or reject it - see CapabilityStatement.rest.resource.referencePolicy. When both an identifier and a literal reference are provided, the literal reference is preferred. Applications processing the resource are allowed - but not required - to check that the identifier matches the literal reference Applications converting a logical reference to a literal reference may choose to leave the logical reference present, or remove it. | ||||
| Note | This is a business identifier, not a resource identifier (see discussion) | ||||
| Control | 0..1 | ||||
| Type | Identifier | ||||
| Summary | true | ||||
| 390. ClaimResponse.communicationRequest.display | |||||
| Definition | Plain text narrative that identifies the resource in addition to the resource reference. | ||||
| Short | Text alternative for the resource | ||||
| Comments | This is generally not the same as the Resource.text of the referenced resource. The purpose is to identify what's being referenced, not to fully describe it. | ||||
| Control | 0..1 | ||||
| Type | string | ||||
| Primitive Value | This primitive element may be present, or absent, or replaced by an extension | ||||
| Summary | true | ||||
| 392. ClaimResponse.insurance | |||||
| Definition | Financial instrument by which payment information for health care. | ||||
| Short | Insurance or medical plan | ||||
| Control | 0..* | ||||
| Type | BackboneElement | ||||
| Requirements | Health care programs and insurers are significant payors of health service costs. | ||||
| Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() | (children().count() > id.count())) | ||||
| 394. ClaimResponse.insurance.id | |||||
| Definition | unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. | ||||
| Short | xml:id (or equivalent in JSON) | ||||
| Control | 0..1 | ||||
| Type | string | ||||
| Primitive Value | This primitive element may be present, or absent, or replaced by an extension | ||||
| XML Format | In the XML format, this property is represented as an attribute. | ||||
| 396. ClaimResponse.insurance.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. | ||||
| Short | Additional 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. | ||||
| Control | 0..* | ||||
| Type | Extension | ||||
| Alternate Names | extensions, user content | ||||
| 398. ClaimResponse.insurance.modifierExtension | |||||
| Definition | May be used to represent additional information that is not part of the basic definition of the element, and that modifies the understanding of the element that contains it. Usually modifier elements provide negation or qualification. 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. Applications processing a resource are required to check for modifier extensions. | ||||
| Short | Extensions that cannot be ignored | ||||
| 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. | ||||
| Control | 0..* | ||||
| Type | Extension | ||||
| Is Modifier | true because No Modifier Reason provideed in previous versions of FHIR | ||||
| Summary | true | ||||
| Alternate Names | extensions, user content, modifiers | ||||
| 400. ClaimResponse.insurance.sequence | |||||
| Definition | A service line item. | ||||
| Short | Service instance identifier | ||||
| Control | 1..1 | ||||
| Type | positiveInt | ||||
| Primitive Value | This primitive element may be present, or absent, or replaced by an extension | ||||
| Requirements | To maintain order of the coverages. | ||||
| 402. ClaimResponse.insurance.focal | |||||
| Definition | The instance number of the Coverage which is the focus for adjudication. The Coverage against which the claim is to be adjudicated. | ||||
| Short | Is the focal Coverage | ||||
| Control | 1..1 | ||||
| Type | boolean | ||||
| Primitive Value | This primitive element may be present, or absent, or replaced by an extension | ||||
| Requirements | To identify which coverage is being adjudicated. | ||||
| 404. ClaimResponse.insurance.coverage | |||||
| Definition | Reference to the program or plan identification, underwriter or payor. | ||||
| Short | Insurance information | ||||
| Control | 1..1 | ||||
| Type | Reference(Coverage) | ||||
| Requirements | Need to identify the issuer to target for processing and for coordination of benefit processing. | ||||
| 406. ClaimResponse.insurance.coverage.id | |||||
| Definition | unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. | ||||
| Short | xml:id (or equivalent in JSON) | ||||
| Control | 0..1 | ||||
| Type | string | ||||
| Primitive Value | This primitive element may be present, or absent, or replaced by an extension | ||||
| XML Format | In the XML format, this property is represented as an attribute. | ||||
| 408. ClaimResponse.insurance.coverage.extension | |||||
| Definition | An Extension | ||||
| Short | Extension | ||||
| Control | 0..* | ||||
| Type | Extension | ||||
| Slicing | This element introduces a set of slices on ClaimResponse.insurance.coverage.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators: | ||||
| 410. ClaimResponse.insurance.coverage.extension:coverage | |||||
| Slice Name | coverage | ||||
| Definition | R5: | ||||
| Short | R5: coverage additional types | ||||
| Comments | Element | ||||
| Control | 0..1 | ||||
| Type | Extension(http://hl7.org/fhir/StructureDefinition/alternate-reference) | ||||
| 412. ClaimResponse.insurance.coverage.reference | |||||
| Definition | A reference to a location at which the other resource is found. The reference may be a relative reference, in which case it is relative to the service base URL, or an absolute URL that resolves to the location where the resource is found. The reference may be version specific or not. If the reference is not to a FHIR RESTful server, then it should be assumed to be version specific. Internal fragment references (start with '#') refer to contained resources. | ||||
| Short | Literal reference, Relative, internal or absolute URL | ||||
| Comments | Using absolute URLs provides a stable scalable approach suitable for a cloud/web context, while using relative/logical references provides a flexible approach suitable for use when trading across closed eco-system boundaries. Absolute URLs do not need to point to a FHIR RESTful server, though this is the preferred approach. If the URL conforms to the structure "/[type]/[id]" then it should be assumed that the reference is to a FHIR RESTful server. | ||||
| Control | 0..1 This element is affected by the following invariants: ref-1 | ||||
| Type | string | ||||
| Primitive Value | This primitive element may be present, or absent, or replaced by an extension | ||||
| Summary | true | ||||
| 414. ClaimResponse.insurance.coverage.identifier | |||||
| Definition | An identifier for the other resource. This is used when there is no way to reference the other resource directly, either because the entity is not available through a FHIR server, or because there is no way for the author of the resource to convert a known identifier to an actual location. There is no requirement that a Reference.identifier point to something that is actually exposed as a FHIR instance, but it SHALL point to a business concept that would be expected to be exposed as a FHIR instance, and that instance would need to be of a FHIR resource type allowed by the reference. | ||||
| Short | Logical reference, when literal reference is not known | ||||
| Comments | When an identifier is provided in place of a reference, any system processing the reference will only be able to resolve the identifier to a reference if it understands the business context in which the identifier is used. Sometimes this is global (e.g. a national identifier) but often it is not. For this reason, none of the useful mechanisms described for working with references (e.g. chaining, includes) are possible, nor should servers be expected to be able resolve the reference. Servers may accept an identifier based reference untouched, resolve it, and/or reject it - see CapabilityStatement.rest.resource.referencePolicy. When both an identifier and a literal reference are provided, the literal reference is preferred. Applications processing the resource are allowed - but not required - to check that the identifier matches the literal reference Applications converting a logical reference to a literal reference may choose to leave the logical reference present, or remove it. | ||||
| Note | This is a business identifier, not a resource identifier (see discussion) | ||||
| Control | 0..1 | ||||
| Type | Identifier | ||||
| Summary | true | ||||
| 416. ClaimResponse.insurance.coverage.display | |||||
| Definition | Plain text narrative that identifies the resource in addition to the resource reference. | ||||
| Short | Text alternative for the resource | ||||
| Comments | This is generally not the same as the Resource.text of the referenced resource. The purpose is to identify what's being referenced, not to fully describe it. | ||||
| Control | 0..1 | ||||
| Type | string | ||||
| Primitive Value | This primitive element may be present, or absent, or replaced by an extension | ||||
| Summary | true | ||||
| 418. ClaimResponse.insurance.businessArrangement | |||||
| Definition | The contract number of a business agreement which describes the terms and conditions. | ||||
| Short | Business agreement | ||||
| Control | 0..1 | ||||
| Type | string | ||||
| Primitive Value | This primitive element may be present, or absent, or replaced by an extension | ||||
| 420. ClaimResponse.insurance.preAuthRef | |||||
| Definition | A list of references from the Insurer to which these services pertain. | ||||
| Short | Pre-Authorization/Determination Reference | ||||
| Control | 0..* | ||||
| Type | string | ||||
| Primitive Value | This primitive element may be present, or absent, or replaced by an extension | ||||
| Requirements | To provide any pre-determination or prior authorization reference. | ||||
| 422. ClaimResponse.insurance.claimResponse | |||||
| Definition | The Coverages adjudication details. | ||||
| Short | Adjudication results | ||||
| Control | 0..1 | ||||
| Type | Reference(ClaimResponse) | ||||
| Requirements | Used by downstream payers to determine what balance remains and the net payable. | ||||
| 424. ClaimResponse.insurance.claimResponse.id | |||||
| Definition | unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. | ||||
| Short | xml:id (or equivalent in JSON) | ||||
| Control | 0..1 | ||||
| Type | string | ||||
| Primitive Value | This primitive element may be present, or absent, or replaced by an extension | ||||
| XML Format | In the XML format, this property is represented as an attribute. | ||||
| 426. ClaimResponse.insurance.claimResponse.extension | |||||
| Definition | An Extension | ||||
| Short | Extension | ||||
| Control | 0..* | ||||
| Type | Extension | ||||
| Slicing | This element introduces a set of slices on ClaimResponse.insurance.claimResponse.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators: | ||||
| 428. ClaimResponse.insurance.claimResponse.extension:claimResponse | |||||
| Slice Name | claimResponse | ||||
| Definition | R5: | ||||
| Short | R5: claimResponse additional types | ||||
| Comments | Element | ||||
| Control | 0..1 | ||||
| Type | Extension(http://hl7.org/fhir/StructureDefinition/alternate-reference) | ||||
| 430. ClaimResponse.insurance.claimResponse.reference | |||||
| Definition | A reference to a location at which the other resource is found. The reference may be a relative reference, in which case it is relative to the service base URL, or an absolute URL that resolves to the location where the resource is found. The reference may be version specific or not. If the reference is not to a FHIR RESTful server, then it should be assumed to be version specific. Internal fragment references (start with '#') refer to contained resources. | ||||
| Short | Literal reference, Relative, internal or absolute URL | ||||
| Comments | Using absolute URLs provides a stable scalable approach suitable for a cloud/web context, while using relative/logical references provides a flexible approach suitable for use when trading across closed eco-system boundaries. Absolute URLs do not need to point to a FHIR RESTful server, though this is the preferred approach. If the URL conforms to the structure "/[type]/[id]" then it should be assumed that the reference is to a FHIR RESTful server. | ||||
| Control | 0..1 This element is affected by the following invariants: ref-1 | ||||
| Type | string | ||||
| Primitive Value | This primitive element may be present, or absent, or replaced by an extension | ||||
| Summary | true | ||||
| 432. ClaimResponse.insurance.claimResponse.identifier | |||||
| Definition | An identifier for the other resource. This is used when there is no way to reference the other resource directly, either because the entity is not available through a FHIR server, or because there is no way for the author of the resource to convert a known identifier to an actual location. There is no requirement that a Reference.identifier point to something that is actually exposed as a FHIR instance, but it SHALL point to a business concept that would be expected to be exposed as a FHIR instance, and that instance would need to be of a FHIR resource type allowed by the reference. | ||||
| Short | Logical reference, when literal reference is not known | ||||
| Comments | When an identifier is provided in place of a reference, any system processing the reference will only be able to resolve the identifier to a reference if it understands the business context in which the identifier is used. Sometimes this is global (e.g. a national identifier) but often it is not. For this reason, none of the useful mechanisms described for working with references (e.g. chaining, includes) are possible, nor should servers be expected to be able resolve the reference. Servers may accept an identifier based reference untouched, resolve it, and/or reject it - see CapabilityStatement.rest.resource.referencePolicy. When both an identifier and a literal reference are provided, the literal reference is preferred. Applications processing the resource are allowed - but not required - to check that the identifier matches the literal reference Applications converting a logical reference to a literal reference may choose to leave the logical reference present, or remove it. | ||||
| Note | This is a business identifier, not a resource identifier (see discussion) | ||||
| Control | 0..1 | ||||
| Type | Identifier | ||||
| Summary | true | ||||
| 434. ClaimResponse.insurance.claimResponse.display | |||||
| Definition | Plain text narrative that identifies the resource in addition to the resource reference. | ||||
| Short | Text alternative for the resource | ||||
| Comments | This is generally not the same as the Resource.text of the referenced resource. The purpose is to identify what's being referenced, not to fully describe it. | ||||
| Control | 0..1 | ||||
| Type | string | ||||
| Primitive Value | This primitive element may be present, or absent, or replaced by an extension | ||||
| Summary | true | ||||
IG © 2025+ FHIR Infrastructure. Package hl7.fhir.uv.xver-r5.r3#0.1.0 based on FHIR 3.0.2. Generated 2026-03-20
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