Generated Narrative: StructureDefinition ext-R5-ExplanationOfBenefit.ite.reviewOutcome Name Flags Card. Type Description & Constraints Extension 0..1 Extension(4.0.1) R5: Adjudication results (new) #xD; Slices for extension 0..* Extension Extension Slice: Unordered, Open by value:url #xD; extension:decision 0..1 Extension R5: Result of the adjudication (new) #xD; url 1..1 uri "decision" #xD; value[x] 0..1 CodeableConcept Result of the adjudication Binding: R5ClaimDecisionForR4 (0.1.0) (example) #xD; extension:reason 0..* Extension R5: Reason for result of the adjudication (new) #xD; url 1..1 uri "reason" #xD; value[x] 0..1 CodeableConcept Reason for result of the adjudication Binding: R5ClaimDecisionReasonForR4 (0.1.0) (example) #xD; extension:preAuthRef 0..1 Extension R5: Preauthorization reference (new) #xD; url 1..1 uri "preAuthRef" #xD; value[x] 0..1 string Preauthorization reference #xD; extension:preAuthPeriod 0..1 Extension R5: Preauthorization reference effective period (new) #xD; url 1..1 uri "preAuthPeriod" #xD; value[x] 0..1 Period Preauthorization reference effective period #xD; url 1..1 uri "http://hl7.org/fhir/5.0/StructureDefinition/extension-ExplanationOfBenefit.item.reviewOutcome" #xD; value[x] 0..0 Value of extension #xD; Documentation for this format
R5: `ExplanationOfBenefit.item.reviewOutcome` (new:BackboneElement)
This extension is part of the cross-version definitions generated to enable use of the element `ExplanationOfBenefit.item.reviewOutcome` as defined in FHIR R5 in FHIR R4. The source element is defined as: `ExplanationOfBenefit.item.reviewOutcome` 0..1 `BackboneElement` Across FHIR versions, the element set has been mapped as: * R5: `ExplanationOfBenefit.item.reviewOutcome` 0..1 `BackboneElement` Following are the generation technical comments: Element `ExplanationOfBenefit.item.reviewOutcome` has a context of ExplanationOfBenefit.item based on following the parent source element upwards and mapping to `ExplanationOfBenefit`. Element `ExplanationOfBenefit.item.reviewOutcome` has no mapping targets in FHIR R4. Typically, this is because the element has been added (is a new element).
Element `ExplanationOfBenefit.item.reviewOutcome` has a context of ExplanationOfBenefit.item based on following the parent source element upwards and mapping to `ExplanationOfBenefit`. Element `ExplanationOfBenefit.item.reviewOutcome` has no mapping targets in FHIR R4. Typically, this is because the element has been added (is a new element).
All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
Must have either extensions or value[x], not both
exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])
Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Extensions are always sliced by (at least) url
exists(f:extension)!=exists(f:*[starts-with(local-name(.), "value")])
R5: `ExplanationOfBenefit.item.reviewOutcome.decision` (new:CodeableConcept)
Element `ExplanationOfBenefit.item.reviewOutcome.decision` is part of an existing definition because parent element `ExplanationOfBenefit.item.reviewOutcome` requires a cross-version extension. Element `ExplanationOfBenefit.item.reviewOutcome.decision` has a context of ExplanationOfBenefit.item based on following the parent source element upwards and mapping to `ExplanationOfBenefit`. Element `ExplanationOfBenefit.item.reviewOutcome.decision` has no mapping targets in FHIR R4. Typically, this is because the element has been added (is a new element). The element is used to indicate the current state of the adjudication overall for the claim resource, for example: the request has been held (pended) for adjudication processing, for manual review or other reasons; that it has been processed and will be paid, or the outstanding paid, as submitted (approved); that no amount will be paid (denied); or that some amount between zero and the submitted amount will be paid (partial).
To advise the requestor of the result of the adjudication process. Element `ExplanationOfBenefit.item.reviewOutcome.decision` is part of an existing definition because parent element `ExplanationOfBenefit.item.reviewOutcome` requires a cross-version extension. Element `ExplanationOfBenefit.item.reviewOutcome.decision` has a context of ExplanationOfBenefit.item based on following the parent source element upwards and mapping to `ExplanationOfBenefit`. Element `ExplanationOfBenefit.item.reviewOutcome.decision` has no mapping targets in FHIR R4. Typically, this is because the element has been added (is a new element).
Additional content defined by implementations
May be used to represent additional information that is not part of the basic definition of the element. 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 can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
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.
Source of the definition for the extension code - a logical name or a URL.
The definition may point directly to a computable or human-readable definition of the extensibility codes, or it may be a logical URI as declared in some other specification. The definition SHALL be a URI for the Structure Definition defining the extension.
The result of the claim, predetermination, or preauthorization adjudication.
The element is used to indicate the current state of the adjudication overall for the claim resource, for example: the request has been held (pended) for adjudication processing, for manual review or other reasons; that it has been processed and will be paid, or the outstanding paid, as submitted (approved); that no amount will be paid (denied); or that some amount between zero and the submitted amount will be paid (partial).
R5: Reason for result of the adjudication (new)
R5: `ExplanationOfBenefit.item.reviewOutcome.reason` (new:CodeableConcept)
Element `ExplanationOfBenefit.item.reviewOutcome.reason` is part of an existing definition because parent element `ExplanationOfBenefit.item.reviewOutcome` requires a cross-version extension. Element `ExplanationOfBenefit.item.reviewOutcome.reason` has a context of ExplanationOfBenefit.item based on following the parent source element upwards and mapping to `ExplanationOfBenefit`. Element `ExplanationOfBenefit.item.reviewOutcome.reason` has no mapping targets in FHIR R4. Typically, this is because the element has been added (is a new element).
To advise the requestor of the contributors to the result of the adjudication process. Element `ExplanationOfBenefit.item.reviewOutcome.reason` is part of an existing definition because parent element `ExplanationOfBenefit.item.reviewOutcome` requires a cross-version extension. Element `ExplanationOfBenefit.item.reviewOutcome.reason` has a context of ExplanationOfBenefit.item based on following the parent source element upwards and mapping to `ExplanationOfBenefit`. Element `ExplanationOfBenefit.item.reviewOutcome.reason` has no mapping targets in FHIR R4. Typically, this is because the element has been added (is a new element).
The reasons for the result of the claim, predetermination, or preauthorization adjudication.
R5: `ExplanationOfBenefit.item.reviewOutcome.preAuthRef` (new:string)
Element `ExplanationOfBenefit.item.reviewOutcome.preAuthRef` is part of an existing definition because parent element `ExplanationOfBenefit.item.reviewOutcome` requires a cross-version extension. Element `ExplanationOfBenefit.item.reviewOutcome.preAuthRef` has a context of ExplanationOfBenefit.item based on following the parent source element upwards and mapping to `ExplanationOfBenefit`. Element `ExplanationOfBenefit.item.reviewOutcome.preAuthRef` has no mapping targets in FHIR R4. Typically, this is because the element has been added (is a new element). This value is only present on preauthorization adjudications.
On subsequent claims, the insurer may require the provider to quote this value. Element `ExplanationOfBenefit.item.reviewOutcome.preAuthRef` is part of an existing definition because parent element `ExplanationOfBenefit.item.reviewOutcome` requires a cross-version extension. Element `ExplanationOfBenefit.item.reviewOutcome.preAuthRef` has a context of ExplanationOfBenefit.item based on following the parent source element upwards and mapping to `ExplanationOfBenefit`. Element `ExplanationOfBenefit.item.reviewOutcome.preAuthRef` has no mapping targets in FHIR R4. Typically, this is because the element has been added (is a new element).
Reference from the Insurer which is used in later communications which refers to this adjudication.
This value is only present on preauthorization adjudications.
R5: Preauthorization reference effective period (new)
R5: `ExplanationOfBenefit.item.reviewOutcome.preAuthPeriod` (new:Period)
Element `ExplanationOfBenefit.item.reviewOutcome.preAuthPeriod` is part of an existing definition because parent element `ExplanationOfBenefit.item.reviewOutcome` requires a cross-version extension. Element `ExplanationOfBenefit.item.reviewOutcome.preAuthPeriod` has a context of ExplanationOfBenefit.item based on following the parent source element upwards and mapping to `ExplanationOfBenefit`. Element `ExplanationOfBenefit.item.reviewOutcome.preAuthPeriod` has no mapping targets in FHIR R4. Typically, this is because the element has been added (is a new element).
To convey to the provider when the authorized products and services must be supplied for the authorized adjudication to apply. Element `ExplanationOfBenefit.item.reviewOutcome.preAuthPeriod` is part of an existing definition because parent element `ExplanationOfBenefit.item.reviewOutcome` requires a cross-version extension. Element `ExplanationOfBenefit.item.reviewOutcome.preAuthPeriod` has a context of ExplanationOfBenefit.item based on following the parent source element upwards and mapping to `ExplanationOfBenefit`. Element `ExplanationOfBenefit.item.reviewOutcome.preAuthPeriod` has no mapping targets in FHIR R4. Typically, this is because the element has been added (is a new element).
Preauthorization reference effective period
The time frame during which this authorization is effective.
Value of extension - must be one of a constrained set of the data types (see [Extensibility](http://hl7.org/fhir/R4/extensibility.html) for a list).