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
| Official URL: http://hl7.org/fhir/5.0/StructureDefinition/profile-ClaimResponse | Version: 0.1.0 | |||
| Standards status: Trial-use | Maturity Level: 0 | Computable Name: Profile_R5_ClaimResponse_R3 | ||
This cross-version profile allows R5 ClaimResponse content to be represented via FHIR STU3 ClaimResponse resources.
Usages:
You can also check for usages in the FHIR IG Statistics
Description of Profiles, Differentials, Snapshots and how the different presentations work.
| Path | Status | Usage | ValueSet | Version | Source |
| ClaimResponse.status | Base | required | Financial Resource Status Codes | 📍3.0.2 | FHIR Std. |
| Id | Grade | Path(s) | Description | Expression |
| dom-1 | error | ClaimResponse | If the resource is contained in another resource, it SHALL NOT contain any narrative |
contained.text.empty()
|
| dom-2 | error | ClaimResponse | If the resource is contained in another resource, it SHALL NOT contain nested Resources |
contained.contained.empty()
|
| dom-3 | error | ClaimResponse | 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-4 | error | ClaimResponse | 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()
|
| ele-1 | error | **ALL** elements | All FHIR elements must have a @value or children |
hasValue() | (children().count() > id.count())
|
| ext-1 | error | **ALL** extensions | Must have either extensions or value[x], not both |
extension.exists() != value.exists()
|
This structure is derived from ClaimResponse
| Name | Flags | Card. | Type | Description & Constraints Filter:   | ||||
|---|---|---|---|---|---|---|---|---|
  ClaimResponse |
0..* | ClaimResponse | Remittance resource | |||||
  id |
Σ | 0..1 | id | Logical id of this artifact | ||||
 meta |
Σ | 0..1 | Meta | Metadata about the resource | ||||
| implicitRules |
?!Σ | 0..1 | uri | A set of rules under which this content was created | ||||
| language |
0..1 | code | Language of the resource content Binding: Common Languages  (extensible): A human language.
| |||||
| text |
0..1 | Narrative | Text summary of the resource, for human interpretation This profile does not constrain the narrative in regard to content, language, or traceability to data elements | |||||
| contained |
0..* | Resource | Contained, inline Resources | |||||
  Slices for extension |
2..* | Extension | Extension Slice: Unordered, Open by value:url | |||||
   extension:traceNumber |
0..* | Identifier | R5: Number for tracking (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-ClaimResponse.traceNumber | |||||
| extension:type |
1..1 | CodeableConcept | R5: More granular claim type (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-ClaimResponse.type Binding: Example Claim Type Codes (extensible): The type or discipline-style of the claim. | |||||
| extension:subType |
0..1 | CodeableConcept | R5: More granular claim type (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-ClaimResponse.subType Binding: Example Claim SubType Codes (example): A more granular claim typecode. | |||||
| extension:use |
1..1 | code | R5: claim | preauthorization | predetermination (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-ClaimResponse.use Binding: Use (required): Claim, preauthorization, predetermination. | |||||
| extension:requestor |
0..1 | ?gen-e1? [CanonicalType[http://hl7.org/fhir/StructureDefinition/alternate-reference]] | R5: Party responsible for the claim URL: http://hl7.org/fhir/StructureDefinition/alternate-reference | |||||
| extension:decision |
0..1 | CodeableConcept | R5: Result of the adjudication (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-ClaimResponse.decision Binding: R5ClaimDecisionForR3 (0.1.0) (example): The overall result of the claim adjudication. | |||||
| extension:preAuthPeriod |
0..1 | Period | R5: Preauthorization reference effective period (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-ClaimResponse.preAuthPeriod | |||||
| extension:event |
0..* | (Complex) | R5: Event information (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-ClaimResponse.event | |||||
| extension:encounter |
0..* | Reference(Cross-version Profile for R5.Encounter for use in FHIR STU3(0.1.0) | Encounter) | R5: Encounters associated with the listed treatments (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-ClaimResponse.encounter | |||||
| extension:diagnosisRelatedGroup |
0..1 | CodeableConcept | R5: Package billing code (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-ClaimResponse.diagnosisRelatedGroup Binding: Example Diagnosis Related Group Codes (example) | |||||
| extension:adjudication |
0..* | (Complex) | R5: Header-level adjudication (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-ClaimResponse.item.adjudication | |||||
 extension:total |
0..* | (Complex) | R5: Adjudication totals (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-ClaimResponse.total | |||||
 modifierExtension |
?! | 0..* | Extension | Extensions that cannot be ignored | ||||
| identifier |
0..* | Identifier | Response number | |||||
| status |
?!Σ | 0..1 | code | active | cancelled | draft | entered-in-error Binding: Financial Resource Status Codes (required): A code specifying the state of the resource instance. | ||||
 patient |
0..1 | Reference(Patient) | The subject of the Products and Services | |||||
| id |
0..1 | string | xml:id (or equivalent in JSON) | |||||
| Slices for extension |
1..* | Extension | Extension Slice: Unordered, Open by value:url | |||||
| extension:patient |
1..1 | ?gen-e1? [CanonicalType[http://hl7.org/fhir/StructureDefinition/alternate-reference]] | R5: The recipient of the products and services additional types URL: http://hl7.org/fhir/StructureDefinition/alternate-reference | |||||
| reference |
ΣC | 0..1 | string | Literal reference, Relative, internal or absolute URL | ||||
| identifier |
Σ | 0..1 | Identifier | Logical reference, when literal reference is not known | ||||
 display |
Σ | 0..1 | string | Text alternative for the resource | ||||
| created |
0..1 | dateTime | Creation date | |||||
| insurer |
0..1 | Reference(Organization) | Insurance issuing organization | |||||
| id |
0..1 | string | xml:id (or equivalent in JSON) | |||||
| Slices for extension |
0..* | Extension | Extension Slice: Unordered, Open by value:url | |||||
| extension:insurer |
0..1 | ?gen-e1? [CanonicalType[http://hl7.org/fhir/StructureDefinition/alternate-reference]] | R5: Party responsible for reimbursement additional types URL: http://hl7.org/fhir/StructureDefinition/alternate-reference | |||||
| reference |
ΣC | 0..1 | string | Literal reference, Relative, internal or absolute URL | ||||
| identifier |
Σ | 0..1 | Identifier | Logical reference, when literal reference is not known | ||||
| display |
Σ | 0..1 | string | Text alternative for the resource | ||||
| requestProvider |
0..1 | Reference(Practitioner) | Responsible practitioner | |||||
| requestOrganization |
0..1 | Reference(Organization) | Responsible organization | |||||
| request |
0..1 | Reference(Claim) | Id of resource triggering adjudication | |||||
| id |
0..1 | string | xml:id (or equivalent in JSON) | |||||
| Slices for extension |
0..* | Extension | Extension Slice: Unordered, Open by value:url | |||||
| extension:request |
0..1 | ?gen-e1? [CanonicalType[http://hl7.org/fhir/StructureDefinition/alternate-reference]] | R5: request additional types URL: http://hl7.org/fhir/StructureDefinition/alternate-reference | |||||
| reference |
ΣC | 0..1 | string | Literal reference, Relative, internal or absolute URL | ||||
| identifier |
Σ | 0..1 | Identifier | Logical reference, when literal reference is not known | ||||
| display |
Σ | 0..1 | string | Text alternative for the resource | ||||
| outcome |
0..1 | CodeableConcept | complete | error | partial Binding: Claim Processing Codes (example): The result of the claim processing | |||||
| id |
0..1 | string | xml:id (or equivalent in JSON) | |||||
| Slices for extension |
1..* | Extension | Extension Slice: Unordered, Open by value:url | |||||
| extension:outcome |
1..1 | code | R5: queued | complete | error | partial URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-ClaimResponse.outcome Binding: Claim Processing Codes (required): The result of the claim processing. | |||||
| coding |
Σ | 0..* | Coding | Code defined by a terminology system | ||||
| text |
Σ | 0..1 | string | Plain text representation of the concept | ||||
| disposition |
0..1 | string | Disposition Message | |||||
| payeeType |
0..1 | CodeableConcept | Party to be paid any benefits payable Binding: Claim Payee Type Codes (example): A code for the party to be reimbursed. | |||||
| item |
0..* | BackboneElement | Line items | |||||
| id |
0..1 | string | xml:id (or equivalent in JSON) | |||||
| Slices for extension |
0..* | Extension | Extension Slice: Unordered, Open by value:url | |||||
| extension:traceNumber |
0..* | Identifier | R5: Number for tracking (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-ClaimResponse.item.traceNumber | |||||
| extension:reviewOutcome |
0..1 | (Complex) | R5: Adjudication results (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-ClaimResponse.item.reviewOutcome | |||||
| modifierExtension |
?!Σ | 0..* | Extension | Extensions that cannot be ignored | ||||
| sequenceLinkId |
1..1 | positiveInt | Service instance | |||||
| noteNumber |
0..* | positiveInt | List of note numbers which apply | |||||
| adjudication |
0..* | BackboneElement | Adjudication details | |||||
| id |
0..1 | string | xml:id (or equivalent in JSON) | |||||
| extension |
0..* | Extension | Additional Content defined by implementations | |||||
| modifierExtension |
?!Σ | 0..* | Extension | Extensions that cannot be ignored | ||||
| category |
1..1 | CodeableConcept | Adjudication category such as co-pay, eligible, benefit, etc. Binding: Adjudication Value Codes (example): The adjudication codes. | |||||
| reason |
0..1 | CodeableConcept | Explanation of Adjudication outcome Binding: Adjudication Reason Codes (example): The adjudication reason codes. | |||||
| amount |
0..1 | Money | Monetary amount | |||||
 value |
0..1 | decimal | Non-monetary value | |||||
 id |
0..1 | string | xml:id (or equivalent in JSON) | |||||
| Slices for extension |
0..* | Extension | Extension Slice: Unordered, Open by value:url | |||||
| extension:quantity |
0..1 | Quantity | R5: quantity additional types URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-ClaimResponse.item.adjudication.quantity | |||||
| value |
0..1 | decimal | Primitive value for decimal | |||||
| detail |
0..* | BackboneElement | Detail line items | |||||
| id |
0..1 | string | xml:id (or equivalent in JSON) | |||||
| Slices for extension |
0..* | Extension | Extension Slice: Unordered, Open by value:url | |||||
| extension:traceNumber |
0..* | Identifier | R5: Number for tracking (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-ClaimResponse.item.detail.traceNumber | |||||
| extension:reviewOutcome |
0..1 | (Complex) | R5: Detail level adjudication results (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-ClaimResponse.item.reviewOutcome | |||||
| modifierExtension |
?!Σ | 0..* | Extension | Extensions that cannot be ignored | ||||
| sequenceLinkId |
1..1 | positiveInt | Service instance | |||||
| noteNumber |
0..* | positiveInt | List of note numbers which apply | |||||
 adjudication |
0..* | See adjudication (ClaimResponse) | Detail level adjudication details | |||||
| subDetail |
0..* | BackboneElement | Subdetail line items | |||||
| id |
0..1 | string | xml:id (or equivalent in JSON) | |||||
| Slices for extension |
0..* | Extension | Extension Slice: Unordered, Open by value:url | |||||
| extension:traceNumber |
0..* | Identifier | R5: Number for tracking (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-ClaimResponse.item.detail.subDetail.traceNumber | |||||
| extension:reviewOutcome |
0..1 | (Complex) | R5: Subdetail level adjudication results (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-ClaimResponse.item.reviewOutcome | |||||
| modifierExtension |
?!Σ | 0..* | Extension | Extensions that cannot be ignored | ||||
| sequenceLinkId |
1..1 | positiveInt | Service instance | |||||
| noteNumber |
0..* | positiveInt | List of note numbers which apply | |||||
| adjudication |
0..* | See adjudication (ClaimResponse) | Subdetail level adjudication details | |||||
| addItem |
0..* | BackboneElement | Insurer added line items | |||||
| id |
0..1 | string | xml:id (or equivalent in JSON) | |||||
| Slices for extension |
0..* | Extension | Extension Slice: Unordered, Open by value:url | |||||
| extension:detailSequence |
0..* | positiveInt | R5: Detail sequence number (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-ClaimResponse.addItem.detailSequence | |||||
| extension:subdetailSequence |
0..* | positiveInt | R5: Subdetail sequence number (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-ClaimResponse.addItem.subdetailSequence | |||||
| extension:traceNumber |
0..* | Identifier | R5: Number for tracking (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-ClaimResponse.addItem.traceNumber | |||||
| extension:provider |
0..* | Reference(Cross-version Profile for R5.Practitioner for use in FHIR STU3(0.1.0) | Practitioner | Cross-version Profile for R5.PractitionerRole for use in FHIR STU3(0.1.0) | PractitionerRole | Cross-version Profile for R5.Organization for use in FHIR STU3(0.1.0) | Organization) | R5: Authorized providers (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-ClaimResponse.addItem.provider | |||||
| extension:revenue |
0..1 | CodeableConcept | R5: Revenue or cost center code (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-ClaimResponse.addItem.revenue Binding: Example Revenue Center Codes (example): Codes for the revenue or cost centers supplying the service and/or products. | |||||
| extension:productOrServiceEnd |
0..1 | CodeableConcept | R5: End of a range of codes (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-ClaimResponse.addItem.productOrServiceEnd Binding: USCLS Codes (example) | |||||
| extension:request |
0..* | Reference(Cross-version Profile for R5.DeviceRequest for use in FHIR STU3(0.1.0) | DeviceRequest | Cross-version Profile for R5.MedicationRequest for use in FHIR STU3(0.1.0) | MedicationRequest | Cross-version Profile for R5.NutritionOrder for use in FHIR STU3(0.1.0) | NutritionOrder | Cross-version Profile for R5.ServiceRequest for use in FHIR STU3(0.1.0) | ReferralRequest | Cross-version Profile for R5.SupplyRequest for use in FHIR STU3(0.1.0) | SupplyRequest | Cross-version Profile for R5.VisionPrescription for use in FHIR STU3(0.1.0) | VisionPrescription) | R5: Request or Referral for Service (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-ClaimResponse.addItem.request | |||||
| extension:programCode |
0..* | CodeableConcept | R5: Program the product or service is provided under (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-ClaimResponse.addItem.programCode Binding: Example Program Reason Codes (example): Program specific reason codes. | |||||
| extension:serviced |
0..1 | date, Period | R5: Date or dates of service or product delivery (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-ClaimResponse.addItem.serviced | |||||
| extension:location |
0..1 | CodeableConcept, Address, Reference(Cross-version Profile for R5.Location for use in FHIR STU3(0.1.0) | Location) | R5: Place of service or where product was supplied (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-ClaimResponse.addItem.location Binding: Example Service Place Codes (example): Place of service: pharmacy, school, prison, etc. | |||||
| extension:quantity |
0..1 | SimpleQuantity | R5: Count of products or services (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-ClaimResponse.addItem.quantity | |||||
| extension:unitPrice |
0..1 | Money | R5: Fee, charge or cost per item (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-ClaimResponse.addItem.unitPrice | |||||
| extension:factor |
0..1 | decimal | R5: Price scaling factor (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-ClaimResponse.addItem.factor | |||||
| extension:tax |
0..1 | Money | R5: Total tax (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-ClaimResponse.addItem.tax | |||||
| extension:bodySite |
0..* | (Complex) | R5: Anatomical location (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-ClaimResponse.addItem.bodySite | |||||
| extension:reviewOutcome |
0..1 | (Complex) | R5: Added items adjudication results (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-ClaimResponse.item.reviewOutcome | |||||
| modifierExtension |
?!Σ | 0..* | Extension | Extensions that cannot be ignored | ||||
| sequenceLinkId |
0..* | positiveInt | Service instances | |||||
| revenue |
0..1 | CodeableConcept | Revenue or cost center code Binding: Example Revenue Center Codes (example): Codes for the revenue or cost centers supplying the service and/or products. | |||||
| category |
0..1 | CodeableConcept | Type of service or product Binding: Benefit SubCategory Codes (example): Benefit subcategories such as: oral-basic, major, glasses | |||||
| service |
0..1 | CodeableConcept | Group, Service or Product Binding: USCLS Codes (example): Allowable service and product codes. | |||||
| modifier |
0..* | CodeableConcept | Service/Product billing modifiers Binding: Modifier type Codes (example): Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen. | |||||
| fee |
0..1 | Money | Professional fee or Product charge | |||||
| noteNumber |
0..* | positiveInt | List of note numbers which apply | |||||
| adjudication |
0..* | See adjudication (ClaimResponse) | Added items adjudication | |||||
| detail |
0..* | BackboneElement | Added items details | |||||
| id |
0..1 | string | xml:id (or equivalent in JSON) | |||||
| Slices for extension |
0..* | Extension | Extension Slice: Unordered, Open by value:url | |||||
| extension:traceNumber |
0..* | Identifier | R5: Number for tracking (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-ClaimResponse.addItem.detail.traceNumber | |||||
| extension:revenue |
0..1 | CodeableConcept | R5: Revenue or cost center code (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-ClaimResponse.addItem.detail.revenue Binding: Example Revenue Center Codes (example): Codes for the revenue or cost centers supplying the service and/or products. | |||||
| extension:productOrServiceEnd |
0..1 | CodeableConcept | R5: End of a range of codes (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-ClaimResponse.addItem.detail.productOrServiceEnd Binding: USCLS Codes (example) | |||||
| extension:quantity |
0..1 | SimpleQuantity | R5: Count of products or services (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-ClaimResponse.addItem.detail.quantity | |||||
| extension:unitPrice |
0..1 | Money | R5: Fee, charge or cost per item (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-ClaimResponse.addItem.detail.unitPrice | |||||
| extension:factor |
0..1 | decimal | R5: Price scaling factor (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-ClaimResponse.addItem.detail.factor | |||||
| extension:tax |
0..1 | Money | R5: Total tax (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-ClaimResponse.addItem.detail.tax | |||||
| extension:net |
0..1 | Money | R5: Total item cost (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-ClaimResponse.addItem.detail.net | |||||
| extension:reviewOutcome |
0..1 | (Complex) | R5: Added items detail level adjudication results (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-ClaimResponse.item.reviewOutcome | |||||
| extension:subDetail |
0..* | (Complex) | R5: Insurer added line items (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-ClaimResponse.addItem.detail.subDetail | |||||
| extension:reviewOutcome |
0..1 | (Complex) | R5: Added items subdetail level adjudication results (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-ClaimResponse.item.reviewOutcome | |||||
| extension:adjudication |
0..* | (Complex) | R5: Added items subdetail adjudication (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-ClaimResponse.item.adjudication | |||||
| modifierExtension |
?!Σ | 0..* | Extension | Extensions that cannot be ignored | ||||
| revenue |
0..1 | CodeableConcept | Revenue or cost center code Binding: Example Revenue Center Codes (example): Codes for the revenue or cost centers supplying the service and/or products. | |||||
| category |
0..1 | CodeableConcept | Type of service or product Binding: Benefit SubCategory Codes (example): Benefit subcategories such as: oral-basic, major, glasses | |||||
| service |
0..1 | CodeableConcept | Service or Product Binding: USCLS Codes (example): Allowable service and product codes. | |||||
| modifier |
0..* | CodeableConcept | Service/Product billing modifiers Binding: Modifier type Codes (example): Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen. | |||||
| fee |
0..1 | Money | Professional fee or Product charge | |||||
| noteNumber |
0..* | positiveInt | List of note numbers which apply | |||||
| adjudication |
0..* | See adjudication (ClaimResponse) | Added items detail adjudication | |||||
| error |
0..* | BackboneElement | Processing errors | |||||
| id |
0..1 | string | xml:id (or equivalent in JSON) | |||||
| Slices for extension |
0..* | Extension | Extension Slice: Unordered, Open by value:url | |||||
| extension:expression |
0..* | string | R5: FHIRPath of element(s) related to issue (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-ClaimResponse.error.expression | |||||
| modifierExtension |
?!Σ | 0..* | Extension | Extensions that cannot be ignored | ||||
| sequenceLinkId |
0..1 | positiveInt | Item sequence number | |||||
| detailSequenceLinkId |
0..1 | positiveInt | Detail sequence number | |||||
| subdetailSequenceLinkId |
0..1 | positiveInt | Subdetail sequence number | |||||
| code |
1..1 | CodeableConcept | Error code detailing processing issues Binding: Adjudication Error Codes (example): The adjudication error codes. | |||||
| totalCost |
0..1 | Money | Total Cost of service from the Claim | |||||
| unallocDeductable |
0..1 | Money | Unallocated deductible | |||||
| totalBenefit |
0..1 | Money | Total benefit payable for the Claim | |||||
| payment |
0..1 | BackboneElement | Payment details, if paid | |||||
| id |
0..1 | string | xml:id (or equivalent in JSON) | |||||
| extension |
0..* | Extension | Additional Content defined by implementations | |||||
| modifierExtension |
?!Σ | 0..* | Extension | Extensions that cannot be ignored | ||||
| type |
0..1 | CodeableConcept | Partial or Complete Binding: Example Payment Type Codes (example): The type (partial, complete) of the payment | |||||
| adjustment |
0..1 | Money | Payment adjustment for non-Claim issues | |||||
| adjustmentReason |
0..1 | CodeableConcept | Explanation for the non-claim adjustment Binding: Payment Adjustment Reason Codes (example): Payment Adjustment reason codes. | |||||
| date |
0..1 | date | Expected data of Payment | |||||
| amount |
0..1 | Money | Payable amount after adjustment | |||||
| identifier |
0..1 | Identifier | Identifier of the payment instrument | |||||
| reserved |
0..1 | Coding | Funds reserved status Binding: Funds Reservation Codes (example): For whom funds are to be reserved: (Patient, Provider, None). | |||||
| id |
0..1 | string | xml:id (or equivalent in JSON) | |||||
| Slices for extension |
0..* | Extension | Extension Slice: Unordered, Open by value:url | |||||
| extension:fundsReserve |
0..1 | CodeableConcept | R5: fundsReserve additional types URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-ClaimResponse.fundsReserve Binding: Funds Reservation Codes (example): For whom funds are to be reserved: (Patient, Provider, None). | |||||
| system |
Σ | 0..1 | uri | Identity of the terminology system | ||||
| version |
Σ | 0..1 | string | Version of the system - if relevant | ||||
| code |
Σ | 0..1 | code | Symbol in syntax defined by the system | ||||
| display |
Σ | 0..1 | string | Representation defined by the system | ||||
| userSelected |
Σ | 0..1 | boolean | If this coding was chosen directly by the user | ||||
| form |
0..1 | CodeableConcept | Printed Form Identifier Binding: Form Codes (example): The forms codes. | |||||
| id |
0..1 | string | xml:id (or equivalent in JSON) | |||||
| Slices for extension |
0..* | Extension | Extension Slice: Unordered, Open by value:url | |||||
| extension:form |
0..1 | Attachment | R5: Printed reference or actual form additional types URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-ClaimResponse.form | |||||
| coding |
Σ | 0..* | Coding | Code defined by a terminology system | ||||
| text |
Σ | 0..1 | string | Plain text representation of the concept | ||||
| processNote |
0..* | BackboneElement | Processing notes | |||||
| id |
0..1 | string | xml:id (or equivalent in JSON) | |||||
| extension |
0..* | Extension | Additional Content defined by implementations | |||||
| modifierExtension |
?!Σ | 0..* | Extension | Extensions that cannot be ignored | ||||
| number |
0..1 | positiveInt | Sequence Number for this note | |||||
| type |
0..1 | CodeableConcept | display | print | printoper Binding: NoteType (required): The presentation types of notes. | |||||
| text |
0..1 | string | Note explanatory text | |||||
| language |
0..1 | CodeableConcept | Language if different from the resource Binding: Common Languages (extensible): A human language.
| |||||
| communicationRequest |
0..* | Reference(CommunicationRequest) | Request for additional information | |||||
| id |
0..1 | string | xml:id (or equivalent in JSON) | |||||
| Slices for extension |
0..* | Extension | Extension Slice: Unordered, Open by value:url | |||||
| extension:communicationRequest |
0..* | ?gen-e1? [CanonicalType[http://hl7.org/fhir/StructureDefinition/alternate-reference]] | R5: communicationRequest additional types URL: http://hl7.org/fhir/StructureDefinition/alternate-reference | |||||
| reference |
ΣC | 0..1 | string | Literal reference, Relative, internal or absolute URL | ||||
| identifier |
Σ | 0..1 | Identifier | Logical reference, when literal reference is not known | ||||
| display |
Σ | 0..1 | string | Text alternative for the resource | ||||
| insurance |
0..* | BackboneElement | Insurance or medical plan | |||||
| id |
0..1 | string | xml:id (or equivalent in JSON) | |||||
| extension |
0..* | Extension | Additional Content defined by implementations | |||||
| modifierExtension |
?!Σ | 0..* | Extension | Extensions that cannot be ignored | ||||
| sequence |
1..1 | positiveInt | Service instance identifier | |||||
| focal |
1..1 | boolean | Is the focal Coverage | |||||
| coverage |
1..1 | Reference(Coverage) | Insurance information | |||||
| id |
0..1 | string | xml:id (or equivalent in JSON) | |||||
| Slices for extension |
0..* | Extension | Extension Slice: Unordered, Open by value:url | |||||
| extension:coverage |
0..1 | ?gen-e1? [CanonicalType[http://hl7.org/fhir/StructureDefinition/alternate-reference]] | R5: coverage additional types URL: http://hl7.org/fhir/StructureDefinition/alternate-reference | |||||
| reference |
ΣC | 0..1 | string | Literal reference, Relative, internal or absolute URL | ||||
| identifier |
Σ | 0..1 | Identifier | Logical reference, when literal reference is not known | ||||
| display |
Σ | 0..1 | string | Text alternative for the resource | ||||
| businessArrangement |
0..1 | string | Business agreement | |||||
| preAuthRef |
0..* | string | Pre-Authorization/Determination Reference | |||||
| claimResponse |
0..1 | Reference(ClaimResponse) | Adjudication results | |||||
| id |
0..1 | string | xml:id (or equivalent in JSON) | |||||
| Slices for extension |
0..* | Extension | Extension Slice: Unordered, Open by value:url | |||||
| extension:claimResponse |
0..1 | ?gen-e1? [CanonicalType[http://hl7.org/fhir/StructureDefinition/alternate-reference]] | R5: claimResponse additional types URL: http://hl7.org/fhir/StructureDefinition/alternate-reference | |||||
| reference |
ΣC | 0..1 | string | Literal reference, Relative, internal or absolute URL | ||||
| identifier |
Σ | 0..1 | Identifier | Logical reference, when literal reference is not known | ||||
| display |
Σ | 0..1 | string | Text alternative for the resource | ||||
| Documentation for this format | ||||||||
| Path | Status | Usage | ValueSet | Version | Source |
| ClaimResponse.language | Base | extensible |
Common Languages
|
📍3.0.2 | tx.fhir.org |
| ClaimResponse.status | Base | required | Financial Resource Status Codes | 📍3.0.2 | FHIR Std. |
| ClaimResponse.outcome | Base | example | Claim Processing Codes | 📍3.0.2 | FHIR Std. |
| ClaimResponse.payeeType | Base | example | Claim Payee Type Codes | 📍3.0.2 | FHIR Std. |
| ClaimResponse.item.adjudication.category | Base | example | Adjudication Value Codes | 📍3.0.2 | FHIR Std. |
| ClaimResponse.item.adjudication.reason | Base | example | Adjudication Reason Codes | 📍3.0.2 | FHIR Std. |
| ClaimResponse.addItem.revenue | Base | example | Example Revenue Center Codes | 📍3.0.2 | FHIR Std. |
| ClaimResponse.addItem.category | Base | example | Benefit SubCategory Codes | 📍3.0.2 | FHIR Std. |
| ClaimResponse.addItem.service | Base | example | USCLS Codes | 📍3.0.2 | FHIR Std. |
| ClaimResponse.addItem.modifier | Base | example | Modifier type Codes | 📍3.0.2 | FHIR Std. |
| ClaimResponse.addItem.detail.revenue | Base | example | Example Revenue Center Codes | 📍3.0.2 | FHIR Std. |
| ClaimResponse.addItem.detail.category | Base | example | Benefit SubCategory Codes | 📍3.0.2 | FHIR Std. |
| ClaimResponse.addItem.detail.service | Base | example | USCLS Codes | 📍3.0.2 | FHIR Std. |
| ClaimResponse.addItem.detail.modifier | Base | example | Modifier type Codes | 📍3.0.2 | FHIR Std. |
| ClaimResponse.error.code | Base | example | Adjudication Error Codes | 📍3.0.2 | FHIR Std. |
| ClaimResponse.payment.type | Base | example | Example Payment Type Codes | 📍3.0.2 | FHIR Std. |
| ClaimResponse.payment.adjustmentReason | Base | example | Payment Adjustment Reason Codes | 📍3.0.2 | FHIR Std. |
| ClaimResponse.reserved | Base | example | Funds Reservation Codes | 📍3.0.2 | FHIR Std. |
| ClaimResponse.form | Base | example | Form Codes | 📍3.0.2 | FHIR Std. |
| ClaimResponse.processNote.type | Base | required | NoteType | 📍3.0.2 | FHIR Std. |
| ClaimResponse.processNote.language | Base | extensible |
Common Languages
|
📍3.0.2 | tx.fhir.org |
| Id | Grade | Path(s) | Description | Expression |
| dom-1 | error | ClaimResponse | If the resource is contained in another resource, it SHALL NOT contain any narrative |
contained.text.empty()
|
| dom-2 | error | ClaimResponse | If the resource is contained in another resource, it SHALL NOT contain nested Resources |
contained.contained.empty()
|
| dom-3 | error | ClaimResponse | 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-4 | error | ClaimResponse | 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()
|
| ele-1 | error | **ALL** elements | All FHIR elements must have a @value or children |
hasValue() | (children().count() > id.count())
|
| ext-1 | error | **ALL** extensions | Must have either extensions or value[x], not both |
extension.exists() != value.exists()
|
This structure is derived from ClaimResponse
Summary
Mandatory: 2 elements(4 nested mandatory elements)
Extensions
This structure refers to these extensions:
Maturity: 0
Key Elements View
| Path | Status | Usage | ValueSet | Version | Source |
| ClaimResponse.status | Base | required | Financial Resource Status Codes | 📍3.0.2 | FHIR Std. |
| Id | Grade | Path(s) | Description | Expression |
| dom-1 | error | ClaimResponse | If the resource is contained in another resource, it SHALL NOT contain any narrative |
contained.text.empty()
|
| dom-2 | error | ClaimResponse | If the resource is contained in another resource, it SHALL NOT contain nested Resources |
contained.contained.empty()
|
| dom-3 | error | ClaimResponse | 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-4 | error | ClaimResponse | 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()
|
| ele-1 | error | **ALL** elements | All FHIR elements must have a @value or children |
hasValue() | (children().count() > id.count())
|
| ext-1 | error | **ALL** extensions | Must have either extensions or value[x], not both |
extension.exists() != value.exists()
|
Differential View
This structure is derived from ClaimResponse
Snapshot View
| Name | Flags | Card. | Type | Description & Constraints Filter: | ||||
|---|---|---|---|---|---|---|---|---|
| ClaimResponse |
0..* | ClaimResponse | Remittance resource | |||||
| id |
Σ | 0..1 | id | Logical id of this artifact | ||||
| meta |
Σ | 0..1 | Meta | Metadata about the resource | ||||
| implicitRules |
?!Σ | 0..1 | uri | A set of rules under which this content was created | ||||
| language |
0..1 | code | Language of the resource content Binding: Common Languages (extensible): A human language.
| |||||
| text |
0..1 | Narrative | Text summary of the resource, for human interpretation This profile does not constrain the narrative in regard to content, language, or traceability to data elements | |||||
| contained |
0..* | Resource | Contained, inline Resources | |||||
| Slices for extension |
2..* | Extension | Extension Slice: Unordered, Open by value:url | |||||
| extension:traceNumber |
0..* | Identifier | R5: Number for tracking (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-ClaimResponse.traceNumber | |||||
| extension:type |
1..1 | CodeableConcept | R5: More granular claim type (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-ClaimResponse.type Binding: Example Claim Type Codes (extensible): The type or discipline-style of the claim. | |||||
| extension:subType |
0..1 | CodeableConcept | R5: More granular claim type (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-ClaimResponse.subType Binding: Example Claim SubType Codes (example): A more granular claim typecode. | |||||
| extension:use |
1..1 | code | R5: claim | preauthorization | predetermination (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-ClaimResponse.use Binding: Use (required): Claim, preauthorization, predetermination. | |||||
| extension:requestor |
0..1 | ?gen-e1? [CanonicalType[http://hl7.org/fhir/StructureDefinition/alternate-reference]] | R5: Party responsible for the claim URL: http://hl7.org/fhir/StructureDefinition/alternate-reference | |||||
| extension:decision |
0..1 | CodeableConcept | R5: Result of the adjudication (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-ClaimResponse.decision Binding: R5ClaimDecisionForR3 (0.1.0) (example): The overall result of the claim adjudication. | |||||
| extension:preAuthPeriod |
0..1 | Period | R5: Preauthorization reference effective period (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-ClaimResponse.preAuthPeriod | |||||
| extension:event |
0..* | (Complex) | R5: Event information (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-ClaimResponse.event | |||||
| extension:encounter |
0..* | Reference(Cross-version Profile for R5.Encounter for use in FHIR STU3(0.1.0) | Encounter) | R5: Encounters associated with the listed treatments (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-ClaimResponse.encounter | |||||
| extension:diagnosisRelatedGroup |
0..1 | CodeableConcept | R5: Package billing code (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-ClaimResponse.diagnosisRelatedGroup Binding: Example Diagnosis Related Group Codes (example) | |||||
| extension:adjudication |
0..* | (Complex) | R5: Header-level adjudication (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-ClaimResponse.item.adjudication | |||||
| extension:total |
0..* | (Complex) | R5: Adjudication totals (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-ClaimResponse.total | |||||
| modifierExtension |
?! | 0..* | Extension | Extensions that cannot be ignored | ||||
| identifier |
0..* | Identifier | Response number | |||||
| status |
?!Σ | 0..1 | code | active | cancelled | draft | entered-in-error Binding: Financial Resource Status Codes (required): A code specifying the state of the resource instance. | ||||
| patient |
0..1 | Reference(Patient) | The subject of the Products and Services | |||||
| id |
0..1 | string | xml:id (or equivalent in JSON) | |||||
| Slices for extension |
1..* | Extension | Extension Slice: Unordered, Open by value:url | |||||
| extension:patient |
1..1 | ?gen-e1? [CanonicalType[http://hl7.org/fhir/StructureDefinition/alternate-reference]] | R5: The recipient of the products and services additional types URL: http://hl7.org/fhir/StructureDefinition/alternate-reference | |||||
| reference |
ΣC | 0..1 | string | Literal reference, Relative, internal or absolute URL | ||||
| identifier |
Σ | 0..1 | Identifier | Logical reference, when literal reference is not known | ||||
| display |
Σ | 0..1 | string | Text alternative for the resource | ||||
| created |
0..1 | dateTime | Creation date | |||||
| insurer |
0..1 | Reference(Organization) | Insurance issuing organization | |||||
| id |
0..1 | string | xml:id (or equivalent in JSON) | |||||
| Slices for extension |
0..* | Extension | Extension Slice: Unordered, Open by value:url | |||||
| extension:insurer |
0..1 | ?gen-e1? [CanonicalType[http://hl7.org/fhir/StructureDefinition/alternate-reference]] | R5: Party responsible for reimbursement additional types URL: http://hl7.org/fhir/StructureDefinition/alternate-reference | |||||
| reference |
ΣC | 0..1 | string | Literal reference, Relative, internal or absolute URL | ||||
| identifier |
Σ | 0..1 | Identifier | Logical reference, when literal reference is not known | ||||
| display |
Σ | 0..1 | string | Text alternative for the resource | ||||
| requestProvider |
0..1 | Reference(Practitioner) | Responsible practitioner | |||||
| requestOrganization |
0..1 | Reference(Organization) | Responsible organization | |||||
| request |
0..1 | Reference(Claim) | Id of resource triggering adjudication | |||||
| id |
0..1 | string | xml:id (or equivalent in JSON) | |||||
| Slices for extension |
0..* | Extension | Extension Slice: Unordered, Open by value:url | |||||
| extension:request |
0..1 | ?gen-e1? [CanonicalType[http://hl7.org/fhir/StructureDefinition/alternate-reference]] | R5: request additional types URL: http://hl7.org/fhir/StructureDefinition/alternate-reference | |||||
| reference |
ΣC | 0..1 | string | Literal reference, Relative, internal or absolute URL | ||||
| identifier |
Σ | 0..1 | Identifier | Logical reference, when literal reference is not known | ||||
| display |
Σ | 0..1 | string | Text alternative for the resource | ||||
| outcome |
0..1 | CodeableConcept | complete | error | partial Binding: Claim Processing Codes (example): The result of the claim processing | |||||
| id |
0..1 | string | xml:id (or equivalent in JSON) | |||||
| Slices for extension |
1..* | Extension | Extension Slice: Unordered, Open by value:url | |||||
| extension:outcome |
1..1 | code | R5: queued | complete | error | partial URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-ClaimResponse.outcome Binding: Claim Processing Codes (required): The result of the claim processing. | |||||
| coding |
Σ | 0..* | Coding | Code defined by a terminology system | ||||
| text |
Σ | 0..1 | string | Plain text representation of the concept | ||||
| disposition |
0..1 | string | Disposition Message | |||||
| payeeType |
0..1 | CodeableConcept | Party to be paid any benefits payable Binding: Claim Payee Type Codes (example): A code for the party to be reimbursed. | |||||
| item |
0..* | BackboneElement | Line items | |||||
| id |
0..1 | string | xml:id (or equivalent in JSON) | |||||
| Slices for extension |
0..* | Extension | Extension Slice: Unordered, Open by value:url | |||||
| extension:traceNumber |
0..* | Identifier | R5: Number for tracking (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-ClaimResponse.item.traceNumber | |||||
| extension:reviewOutcome |
0..1 | (Complex) | R5: Adjudication results (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-ClaimResponse.item.reviewOutcome | |||||
| modifierExtension |
?!Σ | 0..* | Extension | Extensions that cannot be ignored | ||||
| sequenceLinkId |
1..1 | positiveInt | Service instance | |||||
| noteNumber |
0..* | positiveInt | List of note numbers which apply | |||||
| adjudication |
0..* | BackboneElement | Adjudication details | |||||
| id |
0..1 | string | xml:id (or equivalent in JSON) | |||||
| extension |
0..* | Extension | Additional Content defined by implementations | |||||
| modifierExtension |
?!Σ | 0..* | Extension | Extensions that cannot be ignored | ||||
| category |
1..1 | CodeableConcept | Adjudication category such as co-pay, eligible, benefit, etc. Binding: Adjudication Value Codes (example): The adjudication codes. | |||||
| reason |
0..1 | CodeableConcept | Explanation of Adjudication outcome Binding: Adjudication Reason Codes (example): The adjudication reason codes. | |||||
| amount |
0..1 | Money | Monetary amount | |||||
| value |
0..1 | decimal | Non-monetary value | |||||
| id |
0..1 | string | xml:id (or equivalent in JSON) | |||||
| Slices for extension |
0..* | Extension | Extension Slice: Unordered, Open by value:url | |||||
| extension:quantity |
0..1 | Quantity | R5: quantity additional types URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-ClaimResponse.item.adjudication.quantity | |||||
| value |
0..1 | decimal | Primitive value for decimal | |||||
| detail |
0..* | BackboneElement | Detail line items | |||||
| id |
0..1 | string | xml:id (or equivalent in JSON) | |||||
| Slices for extension |
0..* | Extension | Extension Slice: Unordered, Open by value:url | |||||
| extension:traceNumber |
0..* | Identifier | R5: Number for tracking (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-ClaimResponse.item.detail.traceNumber | |||||
| extension:reviewOutcome |
0..1 | (Complex) | R5: Detail level adjudication results (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-ClaimResponse.item.reviewOutcome | |||||
| modifierExtension |
?!Σ | 0..* | Extension | Extensions that cannot be ignored | ||||
| sequenceLinkId |
1..1 | positiveInt | Service instance | |||||
| noteNumber |
0..* | positiveInt | List of note numbers which apply | |||||
| adjudication |
0..* | See adjudication (ClaimResponse) | Detail level adjudication details | |||||
| subDetail |
0..* | BackboneElement | Subdetail line items | |||||
| id |
0..1 | string | xml:id (or equivalent in JSON) | |||||
| Slices for extension |
0..* | Extension | Extension Slice: Unordered, Open by value:url | |||||
| extension:traceNumber |
0..* | Identifier | R5: Number for tracking (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-ClaimResponse.item.detail.subDetail.traceNumber | |||||
| extension:reviewOutcome |
0..1 | (Complex) | R5: Subdetail level adjudication results (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-ClaimResponse.item.reviewOutcome | |||||
| modifierExtension |
?!Σ | 0..* | Extension | Extensions that cannot be ignored | ||||
| sequenceLinkId |
1..1 | positiveInt | Service instance | |||||
| noteNumber |
0..* | positiveInt | List of note numbers which apply | |||||
| adjudication |
0..* | See adjudication (ClaimResponse) | Subdetail level adjudication details | |||||
| addItem |
0..* | BackboneElement | Insurer added line items | |||||
| id |
0..1 | string | xml:id (or equivalent in JSON) | |||||
| Slices for extension |
0..* | Extension | Extension Slice: Unordered, Open by value:url | |||||
| extension:detailSequence |
0..* | positiveInt | R5: Detail sequence number (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-ClaimResponse.addItem.detailSequence | |||||
| extension:subdetailSequence |
0..* | positiveInt | R5: Subdetail sequence number (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-ClaimResponse.addItem.subdetailSequence | |||||
| extension:traceNumber |
0..* | Identifier | R5: Number for tracking (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-ClaimResponse.addItem.traceNumber | |||||
| extension:provider |
0..* | Reference(Cross-version Profile for R5.Practitioner for use in FHIR STU3(0.1.0) | Practitioner | Cross-version Profile for R5.PractitionerRole for use in FHIR STU3(0.1.0) | PractitionerRole | Cross-version Profile for R5.Organization for use in FHIR STU3(0.1.0) | Organization) | R5: Authorized providers (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-ClaimResponse.addItem.provider | |||||
| extension:revenue |
0..1 | CodeableConcept | R5: Revenue or cost center code (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-ClaimResponse.addItem.revenue Binding: Example Revenue Center Codes (example): Codes for the revenue or cost centers supplying the service and/or products. | |||||
| extension:productOrServiceEnd |
0..1 | CodeableConcept | R5: End of a range of codes (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-ClaimResponse.addItem.productOrServiceEnd Binding: USCLS Codes (example) | |||||
| extension:request |
0..* | Reference(Cross-version Profile for R5.DeviceRequest for use in FHIR STU3(0.1.0) | DeviceRequest | Cross-version Profile for R5.MedicationRequest for use in FHIR STU3(0.1.0) | MedicationRequest | Cross-version Profile for R5.NutritionOrder for use in FHIR STU3(0.1.0) | NutritionOrder | Cross-version Profile for R5.ServiceRequest for use in FHIR STU3(0.1.0) | ReferralRequest | Cross-version Profile for R5.SupplyRequest for use in FHIR STU3(0.1.0) | SupplyRequest | Cross-version Profile for R5.VisionPrescription for use in FHIR STU3(0.1.0) | VisionPrescription) | R5: Request or Referral for Service (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-ClaimResponse.addItem.request | |||||
| extension:programCode |
0..* | CodeableConcept | R5: Program the product or service is provided under (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-ClaimResponse.addItem.programCode Binding: Example Program Reason Codes (example): Program specific reason codes. | |||||
| extension:serviced |
0..1 | date, Period | R5: Date or dates of service or product delivery (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-ClaimResponse.addItem.serviced | |||||
| extension:location |
0..1 | CodeableConcept, Address, Reference(Cross-version Profile for R5.Location for use in FHIR STU3(0.1.0) | Location) | R5: Place of service or where product was supplied (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-ClaimResponse.addItem.location Binding: Example Service Place Codes (example): Place of service: pharmacy, school, prison, etc. | |||||
| extension:quantity |
0..1 | SimpleQuantity | R5: Count of products or services (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-ClaimResponse.addItem.quantity | |||||
| extension:unitPrice |
0..1 | Money | R5: Fee, charge or cost per item (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-ClaimResponse.addItem.unitPrice | |||||
| extension:factor |
0..1 | decimal | R5: Price scaling factor (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-ClaimResponse.addItem.factor | |||||
| extension:tax |
0..1 | Money | R5: Total tax (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-ClaimResponse.addItem.tax | |||||
| extension:bodySite |
0..* | (Complex) | R5: Anatomical location (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-ClaimResponse.addItem.bodySite | |||||
| extension:reviewOutcome |
0..1 | (Complex) | R5: Added items adjudication results (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-ClaimResponse.item.reviewOutcome | |||||
| modifierExtension |
?!Σ | 0..* | Extension | Extensions that cannot be ignored | ||||
| sequenceLinkId |
0..* | positiveInt | Service instances | |||||
| revenue |
0..1 | CodeableConcept | Revenue or cost center code Binding: Example Revenue Center Codes (example): Codes for the revenue or cost centers supplying the service and/or products. | |||||
| category |
0..1 | CodeableConcept | Type of service or product Binding: Benefit SubCategory Codes (example): Benefit subcategories such as: oral-basic, major, glasses | |||||
| service |
0..1 | CodeableConcept | Group, Service or Product Binding: USCLS Codes (example): Allowable service and product codes. | |||||
| modifier |
0..* | CodeableConcept | Service/Product billing modifiers Binding: Modifier type Codes (example): Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen. | |||||
| fee |
0..1 | Money | Professional fee or Product charge | |||||
| noteNumber |
0..* | positiveInt | List of note numbers which apply | |||||
| adjudication |
0..* | See adjudication (ClaimResponse) | Added items adjudication | |||||
| detail |
0..* | BackboneElement | Added items details | |||||
| id |
0..1 | string | xml:id (or equivalent in JSON) | |||||
| Slices for extension |
0..* | Extension | Extension Slice: Unordered, Open by value:url | |||||
| extension:traceNumber |
0..* | Identifier | R5: Number for tracking (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-ClaimResponse.addItem.detail.traceNumber | |||||
| extension:revenue |
0..1 | CodeableConcept | R5: Revenue or cost center code (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-ClaimResponse.addItem.detail.revenue Binding: Example Revenue Center Codes (example): Codes for the revenue or cost centers supplying the service and/or products. | |||||
| extension:productOrServiceEnd |
0..1 | CodeableConcept | R5: End of a range of codes (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-ClaimResponse.addItem.detail.productOrServiceEnd Binding: USCLS Codes (example) | |||||
| extension:quantity |
0..1 | SimpleQuantity | R5: Count of products or services (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-ClaimResponse.addItem.detail.quantity | |||||
| extension:unitPrice |
0..1 | Money | R5: Fee, charge or cost per item (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-ClaimResponse.addItem.detail.unitPrice | |||||
| extension:factor |
0..1 | decimal | R5: Price scaling factor (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-ClaimResponse.addItem.detail.factor | |||||
| extension:tax |
0..1 | Money | R5: Total tax (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-ClaimResponse.addItem.detail.tax | |||||
| extension:net |
0..1 | Money | R5: Total item cost (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-ClaimResponse.addItem.detail.net | |||||
| extension:reviewOutcome |
0..1 | (Complex) | R5: Added items detail level adjudication results (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-ClaimResponse.item.reviewOutcome | |||||
| extension:subDetail |
0..* | (Complex) | R5: Insurer added line items (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-ClaimResponse.addItem.detail.subDetail | |||||
| extension:reviewOutcome |
0..1 | (Complex) | R5: Added items subdetail level adjudication results (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-ClaimResponse.item.reviewOutcome | |||||
| extension:adjudication |
0..* | (Complex) | R5: Added items subdetail adjudication (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-ClaimResponse.item.adjudication | |||||
| modifierExtension |
?!Σ | 0..* | Extension | Extensions that cannot be ignored | ||||
| revenue |
0..1 | CodeableConcept | Revenue or cost center code Binding: Example Revenue Center Codes (example): Codes for the revenue or cost centers supplying the service and/or products. | |||||
| category |
0..1 | CodeableConcept | Type of service or product Binding: Benefit SubCategory Codes (example): Benefit subcategories such as: oral-basic, major, glasses | |||||
| service |
0..1 | CodeableConcept | Service or Product Binding: USCLS Codes (example): Allowable service and product codes. | |||||
| modifier |
0..* | CodeableConcept | Service/Product billing modifiers Binding: Modifier type Codes (example): Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen. | |||||
| fee |
0..1 | Money | Professional fee or Product charge | |||||
| noteNumber |
0..* | positiveInt | List of note numbers which apply | |||||
| adjudication |
0..* | See adjudication (ClaimResponse) | Added items detail adjudication | |||||
| error |
0..* | BackboneElement | Processing errors | |||||
| id |
0..1 | string | xml:id (or equivalent in JSON) | |||||
| Slices for extension |
0..* | Extension | Extension Slice: Unordered, Open by value:url | |||||
| extension:expression |
0..* | string | R5: FHIRPath of element(s) related to issue (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-ClaimResponse.error.expression | |||||
| modifierExtension |
?!Σ | 0..* | Extension | Extensions that cannot be ignored | ||||
| sequenceLinkId |
0..1 | positiveInt | Item sequence number | |||||
| detailSequenceLinkId |
0..1 | positiveInt | Detail sequence number | |||||
| subdetailSequenceLinkId |
0..1 | positiveInt | Subdetail sequence number | |||||
| code |
1..1 | CodeableConcept | Error code detailing processing issues Binding: Adjudication Error Codes (example): The adjudication error codes. | |||||
| totalCost |
0..1 | Money | Total Cost of service from the Claim | |||||
| unallocDeductable |
0..1 | Money | Unallocated deductible | |||||
| totalBenefit |
0..1 | Money | Total benefit payable for the Claim | |||||
| payment |
0..1 | BackboneElement | Payment details, if paid | |||||
| id |
0..1 | string | xml:id (or equivalent in JSON) | |||||
| extension |
0..* | Extension | Additional Content defined by implementations | |||||
| modifierExtension |
?!Σ | 0..* | Extension | Extensions that cannot be ignored | ||||
| type |
0..1 | CodeableConcept | Partial or Complete Binding: Example Payment Type Codes (example): The type (partial, complete) of the payment | |||||
| adjustment |
0..1 | Money | Payment adjustment for non-Claim issues | |||||
| adjustmentReason |
0..1 | CodeableConcept | Explanation for the non-claim adjustment Binding: Payment Adjustment Reason Codes (example): Payment Adjustment reason codes. | |||||
| date |
0..1 | date | Expected data of Payment | |||||
| amount |
0..1 | Money | Payable amount after adjustment | |||||
| identifier |
0..1 | Identifier | Identifier of the payment instrument | |||||
| reserved |
0..1 | Coding | Funds reserved status Binding: Funds Reservation Codes (example): For whom funds are to be reserved: (Patient, Provider, None). | |||||
| id |
0..1 | string | xml:id (or equivalent in JSON) | |||||
| Slices for extension |
0..* | Extension | Extension Slice: Unordered, Open by value:url | |||||
| extension:fundsReserve |
0..1 | CodeableConcept | R5: fundsReserve additional types URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-ClaimResponse.fundsReserve Binding: Funds Reservation Codes (example): For whom funds are to be reserved: (Patient, Provider, None). | |||||
| system |
Σ | 0..1 | uri | Identity of the terminology system | ||||
| version |
Σ | 0..1 | string | Version of the system - if relevant | ||||
| code |
Σ | 0..1 | code | Symbol in syntax defined by the system | ||||
| display |
Σ | 0..1 | string | Representation defined by the system | ||||
| userSelected |
Σ | 0..1 | boolean | If this coding was chosen directly by the user | ||||
| form |
0..1 | CodeableConcept | Printed Form Identifier Binding: Form Codes (example): The forms codes. | |||||
| id |
0..1 | string | xml:id (or equivalent in JSON) | |||||
| Slices for extension |
0..* | Extension | Extension Slice: Unordered, Open by value:url | |||||
| extension:form |
0..1 | Attachment | R5: Printed reference or actual form additional types URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-ClaimResponse.form | |||||
| coding |
Σ | 0..* | Coding | Code defined by a terminology system | ||||
| text |
Σ | 0..1 | string | Plain text representation of the concept | ||||
| processNote |
0..* | BackboneElement | Processing notes | |||||
| id |
0..1 | string | xml:id (or equivalent in JSON) | |||||
| extension |
0..* | Extension | Additional Content defined by implementations | |||||
| modifierExtension |
?!Σ | 0..* | Extension | Extensions that cannot be ignored | ||||
| number |
0..1 | positiveInt | Sequence Number for this note | |||||
| type |
0..1 | CodeableConcept | display | print | printoper Binding: NoteType (required): The presentation types of notes. | |||||
| text |
0..1 | string | Note explanatory text | |||||
| language |
0..1 | CodeableConcept | Language if different from the resource Binding: Common Languages (extensible): A human language.
| |||||
| communicationRequest |
0..* | Reference(CommunicationRequest) | Request for additional information | |||||
| id |
0..1 | string | xml:id (or equivalent in JSON) | |||||
| Slices for extension |
0..* | Extension | Extension Slice: Unordered, Open by value:url | |||||
| extension:communicationRequest |
0..* | ?gen-e1? [CanonicalType[http://hl7.org/fhir/StructureDefinition/alternate-reference]] | R5: communicationRequest additional types URL: http://hl7.org/fhir/StructureDefinition/alternate-reference | |||||
| reference |
ΣC | 0..1 | string | Literal reference, Relative, internal or absolute URL | ||||
| identifier |
Σ | 0..1 | Identifier | Logical reference, when literal reference is not known | ||||
| display |
Σ | 0..1 | string | Text alternative for the resource | ||||
| insurance |
0..* | BackboneElement | Insurance or medical plan | |||||
| id |
0..1 | string | xml:id (or equivalent in JSON) | |||||
| extension |
0..* | Extension | Additional Content defined by implementations | |||||
| modifierExtension |
?!Σ | 0..* | Extension | Extensions that cannot be ignored | ||||
| sequence |
1..1 | positiveInt | Service instance identifier | |||||
| focal |
1..1 | boolean | Is the focal Coverage | |||||
| coverage |
1..1 | Reference(Coverage) | Insurance information | |||||
| id |
0..1 | string | xml:id (or equivalent in JSON) | |||||
| Slices for extension |
0..* | Extension | Extension Slice: Unordered, Open by value:url | |||||
| extension:coverage |
0..1 | ?gen-e1? [CanonicalType[http://hl7.org/fhir/StructureDefinition/alternate-reference]] | R5: coverage additional types URL: http://hl7.org/fhir/StructureDefinition/alternate-reference | |||||
| reference |
ΣC | 0..1 | string | Literal reference, Relative, internal or absolute URL | ||||
| identifier |
Σ | 0..1 | Identifier | Logical reference, when literal reference is not known | ||||
| display |
Σ | 0..1 | string | Text alternative for the resource | ||||
| businessArrangement |
0..1 | string | Business agreement | |||||
| preAuthRef |
0..* | string | Pre-Authorization/Determination Reference | |||||
| claimResponse |
0..1 | Reference(ClaimResponse) | Adjudication results | |||||
| id |
0..1 | string | xml:id (or equivalent in JSON) | |||||
| Slices for extension |
0..* | Extension | Extension Slice: Unordered, Open by value:url | |||||
| extension:claimResponse |
0..1 | ?gen-e1? [CanonicalType[http://hl7.org/fhir/StructureDefinition/alternate-reference]] | R5: claimResponse additional types URL: http://hl7.org/fhir/StructureDefinition/alternate-reference | |||||
| reference |
ΣC | 0..1 | string | Literal reference, Relative, internal or absolute URL | ||||
| identifier |
Σ | 0..1 | Identifier | Logical reference, when literal reference is not known | ||||
| display |
Σ | 0..1 | string | Text alternative for the resource | ||||
| Documentation for this format | ||||||||
| Path | Status | Usage | ValueSet | Version | Source |
| ClaimResponse.language | Base | extensible |
Common Languages
|
📍3.0.2 | tx.fhir.org |
| ClaimResponse.status | Base | required | Financial Resource Status Codes | 📍3.0.2 | FHIR Std. |
| ClaimResponse.outcome | Base | example | Claim Processing Codes | 📍3.0.2 | FHIR Std. |
| ClaimResponse.payeeType | Base | example | Claim Payee Type Codes | 📍3.0.2 | FHIR Std. |
| ClaimResponse.item.adjudication.category | Base | example | Adjudication Value Codes | 📍3.0.2 | FHIR Std. |
| ClaimResponse.item.adjudication.reason | Base | example | Adjudication Reason Codes | 📍3.0.2 | FHIR Std. |
| ClaimResponse.addItem.revenue | Base | example | Example Revenue Center Codes | 📍3.0.2 | FHIR Std. |
| ClaimResponse.addItem.category | Base | example | Benefit SubCategory Codes | 📍3.0.2 | FHIR Std. |
| ClaimResponse.addItem.service | Base | example | USCLS Codes | 📍3.0.2 | FHIR Std. |
| ClaimResponse.addItem.modifier | Base | example | Modifier type Codes | 📍3.0.2 | FHIR Std. |
| ClaimResponse.addItem.detail.revenue | Base | example | Example Revenue Center Codes | 📍3.0.2 | FHIR Std. |
| ClaimResponse.addItem.detail.category | Base | example | Benefit SubCategory Codes | 📍3.0.2 | FHIR Std. |
| ClaimResponse.addItem.detail.service | Base | example | USCLS Codes | 📍3.0.2 | FHIR Std. |
| ClaimResponse.addItem.detail.modifier | Base | example | Modifier type Codes | 📍3.0.2 | FHIR Std. |
| ClaimResponse.error.code | Base | example | Adjudication Error Codes | 📍3.0.2 | FHIR Std. |
| ClaimResponse.payment.type | Base | example | Example Payment Type Codes | 📍3.0.2 | FHIR Std. |
| ClaimResponse.payment.adjustmentReason | Base | example | Payment Adjustment Reason Codes | 📍3.0.2 | FHIR Std. |
| ClaimResponse.reserved | Base | example | Funds Reservation Codes | 📍3.0.2 | FHIR Std. |
| ClaimResponse.form | Base | example | Form Codes | 📍3.0.2 | FHIR Std. |
| ClaimResponse.processNote.type | Base | required | NoteType | 📍3.0.2 | FHIR Std. |
| ClaimResponse.processNote.language | Base | extensible |
Common Languages
|
📍3.0.2 | tx.fhir.org |
| Id | Grade | Path(s) | Description | Expression |
| dom-1 | error | ClaimResponse | If the resource is contained in another resource, it SHALL NOT contain any narrative |
contained.text.empty()
|
| dom-2 | error | ClaimResponse | If the resource is contained in another resource, it SHALL NOT contain nested Resources |
contained.contained.empty()
|
| dom-3 | error | ClaimResponse | 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-4 | error | ClaimResponse | 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()
|
| ele-1 | error | **ALL** elements | All FHIR elements must have a @value or children |
hasValue() | (children().count() > id.count())
|
| ext-1 | error | **ALL** extensions | Must have either extensions or value[x], not both |
extension.exists() != value.exists()
|
This structure is derived from ClaimResponse
Summary
Mandatory: 2 elements(4 nested mandatory elements)
Extensions
This structure refers to these extensions:
Maturity: 0
Other representations of profile: CSV, Excel, Schematron
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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| Version History |
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