Extensions for Using Data Elements from FHIR R5 in FHIR R4 - Downloaded Version null See the Directory of published versions

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Resource Profile: Profile_R5_ClaimResponse_R4

This cross-version profile allows R5 ClaimResponse content to be represented via FHIR R4 ClaimResponse resources.

Usages:

• Refer to this Profile: R5: Associated insurance coverage (new)

You can also check for usages in the FHIR IG Statistics

Formal Views of Profile Content

Description of Profiles, Differentials, Snapshots and how the different presentations work.

• Key Elements Table
• Differential Table
• Snapshot Table
• Statistics/References
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Name	Flags	Card.	Type	Description & Constraints    Filter: Bindings Constraints Obligations
ClaimResponse		0..*	ClaimResponse(4.0.1)	Response to a claim predetermination or preauthorization
implicitRules	?!Σ	0..1	uri	A set of rules under which this content was created
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url Constraints: ext-1
extension:traceNumber		0..*	Identifier	R5: Number for tracking (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-ClaimResponse.traceNumber Constraints: ext-1
extension:decision		0..1	CodeableConcept	R5: Result of the adjudication (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-ClaimResponse.decision Binding: R5ClaimDecisionForR4 (0.1.0) (example): The overall result of the claim adjudication. Constraints: ext-1
extension:event		0..*	(Complex)	R5: Event information (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-ClaimResponse.event Constraints: ext-1
extension:encounter		0..*	Reference(Cross-version Profile for R5.Encounter for use in FHIR R4(0.1.0) | Encounter)	R5: Encounters associated with the listed treatments (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-ClaimResponse.encounter Constraints: ext-1
extension:diagnosisRelatedGroup		0..1	CodeableConcept	R5: Package billing code (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-ClaimResponse.diagnosisRelatedGroup Binding: ExampleDiagnosisRelatedGroupCodes (example) Constraints: ext-1
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored Constraints: ext-1
status	?!Σ	1..1	code	active | cancelled | draft | entered-in-error Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance.
type	Σ	1..1	CodeableConcept	More granular claim type Binding: ClaimTypeCodes (extensible): The type or discipline-style of the claim.
use	Σ	1..1	code	claim | preauthorization | predetermination Binding: Use (required): Claim, preauthorization, predetermination.
patient	Σ	1..1	Reference(Patient)	The recipient of the products and services
created	Σ	1..1	dateTime	Response creation date
insurer	Σ	1..1	Reference(Organization)	Party responsible for reimbursement
outcome	Σ	1..1	code	queued | complete | error | partial Binding: ClaimProcessingCodes (required): The result of the claim processing.
Documentation for this format

Terminology Bindings

Path	Status	Usage	ValueSet	Version	Source
ClaimResponse.status	Base	required	Financial Resource Status Codes	📍4.0.1	FHIR Std.
ClaimResponse.type	Base	extensible	Claim Type Codes	📍4.0.1	FHIR Std.
ClaimResponse.use	Base	required	Use	📍4.0.1	FHIR Std.
ClaimResponse.outcome	Base	required	Claim Processing Codes	📍4.0.1	FHIR Std.

Constraints

Id	Grade	Path(s)	Description	Expression
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 or SHALL refer to the containing resource	contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).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()
dom-5	error	ClaimResponse	If a resource is contained in another resource, it SHALL NOT have a security label	contained.meta.security.empty()
dom-6	best practice	ClaimResponse	A resource should have narrative for robust management	text.`div`.exists()
ele-1	error	ClaimResponse.implicitRules, ClaimResponse.extension, ClaimResponse.extension:traceNumber, ClaimResponse.extension:decision, ClaimResponse.extension:event, ClaimResponse.extension:encounter, ClaimResponse.extension:diagnosisRelatedGroup, ClaimResponse.modifierExtension, ClaimResponse.status, ClaimResponse.type, ClaimResponse.use, ClaimResponse.patient, ClaimResponse.created, ClaimResponse.insurer, ClaimResponse.outcome	All FHIR elements must have a @value or children	hasValue() or (children().count() > id.count())
ext-1	error	ClaimResponse.extension, ClaimResponse.extension:traceNumber, ClaimResponse.extension:decision, ClaimResponse.extension:event, ClaimResponse.extension:encounter, ClaimResponse.extension:diagnosisRelatedGroup, ClaimResponse.modifierExtension	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: Bindings Constraints Obligations
ClaimResponse		0..*	ClaimResponse(4.0.1)	Response to a claim predetermination or preauthorization
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.traceNumber
extension:decision		0..1	CodeableConcept	R5: Result of the adjudication (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-ClaimResponse.decision Binding: R5ClaimDecisionForR4 (0.1.0) (example): The overall result of the claim adjudication.
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 R4(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: ExampleDiagnosisRelatedGroupCodes (example)
item
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
adjudication
value
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
detail
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
subDetail
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
addItem
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.traceNumber
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: ExampleRevenueCenterCodes (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: USCLSCodes (example)
extension:request		0..*	Reference(Cross-version Profile for R5.DeviceRequest for use in FHIR R4(0.1.0) | DeviceRequest | Cross-version Profile for R5.MedicationRequest for use in FHIR R4(0.1.0) | MedicationRequest | Cross-version Profile for R5.NutritionOrder for use in FHIR R4(0.1.0) | NutritionOrder | Cross-version Profile for R5.ServiceRequest for use in FHIR R4(0.1.0) | ServiceRequest | Cross-version Profile for R5.SupplyRequest for use in FHIR R4(0.1.0) | SupplyRequest | Cross-version Profile for R5.VisionPrescription for use in FHIR R4(0.1.0) | VisionPrescription)	R5: Request or Referral for Service (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-ClaimResponse.addItem.request
extension:tax		0..1	Money	R5: Total tax (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-ClaimResponse.addItem.tax
extension:reviewOutcome		0..1	(Complex)	R5: Added items adjudication results (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-ClaimResponse.item.reviewOutcome
bodySite
Slices for extension		1..*	Extension	Extension Slice: Unordered, Open by value:url
extension:site		1..*	(Complex)	R5: Location (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-ClaimResponse.addItem.bodySite.site
extension:subSite		0..*	CodeableConcept	R5: Sub-location (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-ClaimResponse.addItem.bodySite.subSite Binding: SurfaceCodes (example)
detail
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: ExampleRevenueCenterCodes (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: USCLSCodes (example)
extension:tax		0..1	Money	R5: Total tax (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-ClaimResponse.addItem.detail.tax
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
subDetail
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.subDetail.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.subDetail.revenue Binding: ExampleRevenueCenterCodes (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.subDetail.productOrServiceEnd Binding: USCLSCodes (example)
extension:tax		0..1	Money	R5: Total tax (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-ClaimResponse.addItem.detail.subDetail.tax
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
processNote
type
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
extension:type		0..1	CodeableConcept	R5: Note purpose additional types URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-ClaimResponse.processNote.type Binding: NoteType (extensible): The presentation types of notes.
error
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
Documentation for this format

Name	Flags	Card.	Type	Description & Constraints    Filter: Bindings Constraints Obligations
ClaimResponse		0..*	ClaimResponse(4.0.1)	Response to a claim predetermination or preauthorization
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: CommonLanguages (preferred): A human language. Additional Bindings Purpose AllLanguages Max Binding
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		0..*	Extension	Extension Slice: Unordered, Open by value:url Constraints: ext-1
extension:traceNumber		0..*	Identifier	R5: Number for tracking (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-ClaimResponse.traceNumber Constraints: ext-1
extension:decision		0..1	CodeableConcept	R5: Result of the adjudication (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-ClaimResponse.decision Binding: R5ClaimDecisionForR4 (0.1.0) (example): The overall result of the claim adjudication. Constraints: ext-1
extension:event		0..*	(Complex)	R5: Event information (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-ClaimResponse.event Constraints: ext-1
extension:encounter		0..*	Reference(Cross-version Profile for R5.Encounter for use in FHIR R4(0.1.0) | Encounter)	R5: Encounters associated with the listed treatments (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-ClaimResponse.encounter Constraints: ext-1
extension:diagnosisRelatedGroup		0..1	CodeableConcept	R5: Package billing code (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-ClaimResponse.diagnosisRelatedGroup Binding: ExampleDiagnosisRelatedGroupCodes (example) Constraints: ext-1
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored Constraints: ext-1
identifier		0..*	Identifier	Business Identifier for a claim response
status	?!Σ	1..1	code	active | cancelled | draft | entered-in-error Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance.
type	Σ	1..1	CodeableConcept	More granular claim type Binding: ClaimTypeCodes (extensible): The type or discipline-style of the claim.
subType		0..1	CodeableConcept	More granular claim type Binding: ExampleClaimSubTypeCodes (example): A more granular claim typecode.
use	Σ	1..1	code	claim | preauthorization | predetermination Binding: Use (required): Claim, preauthorization, predetermination.
patient	Σ	1..1	Reference(Patient)	The recipient of the products and services
created	Σ	1..1	dateTime	Response creation date
insurer	Σ	1..1	Reference(Organization)	Party responsible for reimbursement
requestor		0..1	Reference(Practitioner | PractitionerRole | Organization)	Party responsible for the claim
request	Σ	0..1	Reference(Claim)	Id of resource triggering adjudication
outcome	Σ	1..1	code	queued | complete | error | partial Binding: ClaimProcessingCodes (required): The result of the claim processing.
disposition		0..1	string	Disposition Message
preAuthRef		0..1	string	Preauthorization reference
preAuthPeriod		0..1	Period	Preauthorization reference effective period
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	Adjudication for claim line items
id		0..1	string	Unique id for inter-element referencing
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url Constraints: ext-1
extension:traceNumber		0..*	Identifier	R5: Number for tracking (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-ClaimResponse.item.traceNumber Constraints: ext-1
extension:reviewOutcome		0..1	(Complex)	R5: Adjudication results (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-ClaimResponse.item.reviewOutcome Constraints: ext-1
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized Constraints: ext-1
itemSequence		1..1	positiveInt	Claim item instance identifier
noteNumber		0..*	positiveInt	Applicable note numbers
adjudication		1..*	BackboneElement	Adjudication details
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Constraints: ext-1
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized Constraints: ext-1
category		1..1	CodeableConcept	Type of adjudication information Binding: AdjudicationValueCodes (example): The adjudication codes.
reason		0..1	CodeableConcept	Explanation of adjudication outcome Binding: AdjudicationReasonCodes (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 Constraints: ext-1
extension:quantity		0..1	Quantity	R5: quantity additional types URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-ClaimResponse.item.adjudication.quantity Constraints: ext-1
value		0..1	decimal	Primitive value for decimal
detail		0..*	BackboneElement	Adjudication for claim details
id		0..1	string	Unique id for inter-element referencing
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url Constraints: ext-1
extension:traceNumber		0..*	Identifier	R5: Number for tracking (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-ClaimResponse.item.detail.traceNumber Constraints: ext-1
extension:reviewOutcome		0..1	(Complex)	R5: Detail level adjudication results (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-ClaimResponse.item.reviewOutcome Constraints: ext-1
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized Constraints: ext-1
detailSequence		1..1	positiveInt	Claim detail instance identifier
noteNumber		0..*	positiveInt	Applicable note numbers
adjudication		1..*	See adjudication (ClaimResponse)	Detail level adjudication details
subDetail		0..*	BackboneElement	Adjudication for claim sub-details
id		0..1	string	Unique id for inter-element referencing
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url Constraints: ext-1
extension:traceNumber		0..*	Identifier	R5: Number for tracking (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-ClaimResponse.item.detail.subDetail.traceNumber Constraints: ext-1
extension:reviewOutcome		0..1	(Complex)	R5: Subdetail level adjudication results (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-ClaimResponse.item.reviewOutcome Constraints: ext-1
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized Constraints: ext-1
subDetailSequence		1..1	positiveInt	Claim sub-detail instance identifier
noteNumber		0..*	positiveInt	Applicable note numbers
adjudication		0..*	See adjudication (ClaimResponse)	Subdetail level adjudication details
addItem		0..*	BackboneElement	Insurer added line items
id		0..1	string	Unique id for inter-element referencing
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url Constraints: ext-1
extension:traceNumber		0..*	Identifier	R5: Number for tracking (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-ClaimResponse.addItem.traceNumber Constraints: ext-1
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: ExampleRevenueCenterCodes (example): Codes for the revenue or cost centers supplying the service and/or products. Constraints: ext-1
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: USCLSCodes (example) Constraints: ext-1
extension:request		0..*	Reference(Cross-version Profile for R5.DeviceRequest for use in FHIR R4(0.1.0) | DeviceRequest | Cross-version Profile for R5.MedicationRequest for use in FHIR R4(0.1.0) | MedicationRequest | Cross-version Profile for R5.NutritionOrder for use in FHIR R4(0.1.0) | NutritionOrder | Cross-version Profile for R5.ServiceRequest for use in FHIR R4(0.1.0) | ServiceRequest | Cross-version Profile for R5.SupplyRequest for use in FHIR R4(0.1.0) | SupplyRequest | Cross-version Profile for R5.VisionPrescription for use in FHIR R4(0.1.0) | VisionPrescription)	R5: Request or Referral for Service (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-ClaimResponse.addItem.request Constraints: ext-1
extension:tax		0..1	Money	R5: Total tax (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-ClaimResponse.addItem.tax Constraints: ext-1
extension:reviewOutcome		0..1	(Complex)	R5: Added items adjudication results (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-ClaimResponse.item.reviewOutcome Constraints: ext-1
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized Constraints: ext-1
itemSequence		0..*	positiveInt	Item sequence number
detailSequence		0..*	positiveInt	Detail sequence number
subdetailSequence		0..*	positiveInt	Subdetail sequence number
provider		0..*	Reference(Practitioner | PractitionerRole | Organization)	Authorized providers
productOrService		1..1	CodeableConcept	Billing, service, product, or drug code Binding: USCLSCodes (example): Allowable service and product codes.
modifier		0..*	CodeableConcept	Service/Product billing modifiers Binding: ModifierTypeCodes (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.
programCode		0..*	CodeableConcept	Program the product or service is provided under Binding: ExampleProgramReasonCodes (example): Program specific reason codes.
serviced[x]		0..1		Date or dates of service or product delivery
servicedDate			date
servicedPeriod			Period
location[x]		0..1		Place of service or where product was supplied Binding: ExampleServicePlaceCodes (example): Place of service: pharmacy, school, prison, etc.
locationCodeableConcept			CodeableConcept
locationAddress			Address
locationReference			Reference(Location)
quantity		0..1	SimpleQuantity(4.0.1)	Count of products or services
unitPrice		0..1	Money	Fee, charge or cost per item
factor		0..1	decimal	Price scaling factor
net		0..1	Money	Total item cost
bodySite		0..1	CodeableConcept	Anatomical location Binding: OralSiteCodes (example): The code for the teeth, quadrant, sextant and arch.
id		0..1	string	Unique id for inter-element referencing
Slices for extension		1..*	Extension	Extension Slice: Unordered, Open by value:url Constraints: ext-1
extension:site		1..*	(Complex)	R5: Location (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-ClaimResponse.addItem.bodySite.site Constraints: ext-1
extension:subSite		0..*	CodeableConcept	R5: Sub-location (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-ClaimResponse.addItem.bodySite.subSite Binding: SurfaceCodes (example) Constraints: ext-1
coding	Σ	0..*	Coding	Code defined by a terminology system
text	Σ	0..1	string	Plain text representation of the concept
subSite		0..*	CodeableConcept	Anatomical sub-location Binding: SurfaceCodes (example): The code for the tooth surface and surface combinations.
noteNumber		0..*	positiveInt	Applicable note numbers
adjudication		1..*	See adjudication (ClaimResponse)	Added items adjudication
detail		0..*	BackboneElement	Insurer added line details
id		0..1	string	Unique id for inter-element referencing
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url Constraints: ext-1
extension:traceNumber		0..*	Identifier	R5: Number for tracking (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-ClaimResponse.addItem.detail.traceNumber Constraints: ext-1
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: ExampleRevenueCenterCodes (example): Codes for the revenue or cost centers supplying the service and/or products. Constraints: ext-1
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: USCLSCodes (example) Constraints: ext-1
extension:tax		0..1	Money	R5: Total tax (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-ClaimResponse.addItem.detail.tax Constraints: ext-1
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 Constraints: ext-1
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized Constraints: ext-1
productOrService		1..1	CodeableConcept	Billing, service, product, or drug code Binding: USCLSCodes (example): Allowable service and product codes.
modifier		0..*	CodeableConcept	Service/Product billing modifiers Binding: ModifierTypeCodes (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.
quantity		0..1	SimpleQuantity(4.0.1)	Count of products or services
unitPrice		0..1	Money	Fee, charge or cost per item
factor		0..1	decimal	Price scaling factor
net		0..1	Money	Total item cost
noteNumber		0..*	positiveInt	Applicable note numbers
adjudication		1..*	See adjudication (ClaimResponse)	Added items detail adjudication
subDetail		0..*	BackboneElement	Insurer added line items
id		0..1	string	Unique id for inter-element referencing
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url Constraints: ext-1
extension:traceNumber		0..*	Identifier	R5: Number for tracking (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-ClaimResponse.addItem.detail.subDetail.traceNumber Constraints: ext-1
extension:revenue		0..1	CodeableConcept	R5: Revenue or cost center code (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-ClaimResponse.addItem.detail.subDetail.revenue Binding: ExampleRevenueCenterCodes (example): Codes for the revenue or cost centers supplying the service and/or products. Constraints: ext-1
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.subDetail.productOrServiceEnd Binding: USCLSCodes (example) Constraints: ext-1
extension:tax		0..1	Money	R5: Total tax (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-ClaimResponse.addItem.detail.subDetail.tax Constraints: ext-1
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 Constraints: ext-1
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized Constraints: ext-1
productOrService		1..1	CodeableConcept	Billing, service, product, or drug code Binding: USCLSCodes (example): Allowable service and product codes.
modifier		0..*	CodeableConcept	Service/Product billing modifiers Binding: ModifierTypeCodes (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.
quantity		0..1	SimpleQuantity(4.0.1)	Count of products or services
unitPrice		0..1	Money	Fee, charge or cost per item
factor		0..1	decimal	Price scaling factor
net		0..1	Money	Total item cost
noteNumber		0..*	positiveInt	Applicable note numbers
adjudication		1..*	See adjudication (ClaimResponse)	Added items detail adjudication
adjudication		0..*	See adjudication (ClaimResponse)	Header-level adjudication
total	Σ	0..*	BackboneElement	Adjudication totals
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Constraints: ext-1
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized Constraints: ext-1
category	Σ	1..1	CodeableConcept	Type of adjudication information Binding: AdjudicationValueCodes (example): The adjudication codes.
amount	Σ	1..1	Money	Financial total for the category
payment		0..1	BackboneElement	Payment Details
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Constraints: ext-1
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized Constraints: ext-1
type		1..1	CodeableConcept	Partial or complete payment Binding: ExamplePaymentTypeCodes (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 adjustment Binding: PaymentAdjustmentReasonCodes (example): Payment Adjustment reason codes.
date		0..1	date	Expected date of payment
amount		1..1	Money	Payable amount after adjustment
identifier		0..1	Identifier	Business identifier for the payment
fundsReserve		0..1	CodeableConcept	Funds reserved status Binding: Funds Reservation Codes (example): For whom funds are to be reserved: (Patient, Provider, None).
formCode		0..1	CodeableConcept	Printed form identifier Binding: Form Codes (example): The forms codes.
form		0..1	Attachment	Printed reference or actual form
processNote		0..*	BackboneElement	Note concerning adjudication
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Constraints: ext-1
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized Constraints: ext-1
number		0..1	positiveInt	Note instance identifier
type		0..1	code	display | print | printoper Binding: NoteType (required): The presentation types of notes.
id		0..1	string	xml:id (or equivalent in JSON)
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url Constraints: ext-1
extension:type		0..1	CodeableConcept	R5: Note purpose additional types URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-ClaimResponse.processNote.type Binding: NoteType (extensible): The presentation types of notes. Constraints: ext-1
value		0..1	string	Primitive value for code
text		1..1	string	Note explanatory text
language		0..1	CodeableConcept	Language of the text Binding: CommonLanguages (preferred): A human language. Additional Bindings Purpose AllLanguages Max Binding
communicationRequest		0..*	Reference(CommunicationRequest)	Request for additional information
insurance		0..*	BackboneElement	Patient insurance information
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Constraints: ext-1
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized Constraints: ext-1
sequence		1..1	positiveInt	Insurance instance identifier
focal		1..1	boolean	Coverage to be used for adjudication
coverage		1..1	Reference(Coverage)	Insurance information
businessArrangement		0..1	string	Additional provider contract number
claimResponse		0..1	Reference(ClaimResponse)	Adjudication results
error		0..*	BackboneElement	Processing errors
id		0..1	string	Unique id for inter-element referencing
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url Constraints: ext-1
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 Constraints: ext-1
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized Constraints: ext-1
itemSequence		0..1	positiveInt	Item sequence number
detailSequence		0..1	positiveInt	Detail sequence number
subDetailSequence		0..1	positiveInt	Subdetail sequence number
code		1..1	CodeableConcept	Error code detailing processing issues Binding: Adjudication Error Codes (example): The adjudication error codes.
Documentation for this format

Terminology Bindings

Path	Status	Usage	ValueSet	Version	Source
ClaimResponse.language	Base	preferred	Common Languages	📍4.0.1	tx.fhir.org
ClaimResponse.status	Base	required	Financial Resource Status Codes	📍4.0.1	FHIR Std.
ClaimResponse.type	Base	extensible	Claim Type Codes	📍4.0.1	FHIR Std.
ClaimResponse.subType	Base	example	Example Claim SubType Codes	📍4.0.1	FHIR Std.
ClaimResponse.use	Base	required	Use	📍4.0.1	FHIR Std.
ClaimResponse.outcome	Base	required	Claim Processing Codes	📍4.0.1	FHIR Std.
ClaimResponse.payeeType	Base	example	PayeeType	📍4.0.1	FHIR Std.
ClaimResponse.item.adjudication.​category	Base	example	Adjudication Value Codes	📍4.0.1	FHIR Std.
ClaimResponse.item.adjudication.​reason	Base	example	Adjudication Reason Codes	📍4.0.1	FHIR Std.
ClaimResponse.addItem.​productOrService	Base	example	USCLS Codes	📍4.0.1	FHIR Std.
ClaimResponse.addItem.​modifier	Base	example	Modifier type Codes	📍4.0.1	FHIR Std.
ClaimResponse.addItem.​programCode	Base	example	Example Program Reason Codes	📍4.0.1	FHIR Std.
ClaimResponse.addItem.​location[x]	Base	example	Example Service Place Codes	📍4.0.1	FHIR Std.
ClaimResponse.addItem.​bodySite	Base	example	Oral Site Codes	📍4.0.1	FHIR Std.
ClaimResponse.addItem.​subSite	Base	example	Surface Codes	📍4.0.1	FHIR Std.
ClaimResponse.addItem.​detail.productOrService	Base	example	USCLS Codes	📍4.0.1	FHIR Std.
ClaimResponse.addItem.​detail.modifier	Base	example	Modifier type Codes	📍4.0.1	FHIR Std.
ClaimResponse.addItem.​detail.subDetail.productOrService	Base	example	USCLS Codes	📍4.0.1	FHIR Std.
ClaimResponse.addItem.​detail.subDetail.modifier	Base	example	Modifier type Codes	📍4.0.1	FHIR Std.
ClaimResponse.total.​category	Base	example	Adjudication Value Codes	📍4.0.1	FHIR Std.
ClaimResponse.payment.​type	Base	example	Example Payment Type Codes	📍4.0.1	FHIR Std.
ClaimResponse.payment.​adjustmentReason	Base	example	Payment Adjustment Reason Codes	📍4.0.1	FHIR Std.
ClaimResponse.fundsReserve	Base	example	FundsReserve	📍4.0.1	FHIR Std.
ClaimResponse.formCode	Base	example	Forms	📍4.0.1	FHIR Std.
ClaimResponse.processNote.​type	Base	required	NoteType	📍4.0.1	FHIR Std.
ClaimResponse.processNote.​language	Base	preferred	Common Languages	📍4.0.1	tx.fhir.org
ClaimResponse.error.​code	Base	example	AdjudicationError	📍4.0.1	FHIR Std.

Constraints

Id	Grade	Path(s)	Description	Expression
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 or SHALL refer to the containing resource	contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).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()
dom-5	error	ClaimResponse	If a resource is contained in another resource, it SHALL NOT have a security label	contained.meta.security.empty()
dom-6	best practice	ClaimResponse	A resource should have narrative for robust management	text.`div`.exists()
ele-1	error	ClaimResponse.meta, ClaimResponse.implicitRules, ClaimResponse.language, ClaimResponse.text, ClaimResponse.extension, ClaimResponse.extension:traceNumber, ClaimResponse.extension:decision, ClaimResponse.extension:event, ClaimResponse.extension:encounter, ClaimResponse.extension:diagnosisRelatedGroup, ClaimResponse.modifierExtension, ClaimResponse.identifier, ClaimResponse.status, ClaimResponse.type, ClaimResponse.subType, ClaimResponse.use, ClaimResponse.patient, ClaimResponse.created, ClaimResponse.insurer, ClaimResponse.requestor, ClaimResponse.request, ClaimResponse.outcome, ClaimResponse.disposition, ClaimResponse.preAuthRef, ClaimResponse.preAuthPeriod, ClaimResponse.payeeType, ClaimResponse.item, ClaimResponse.item.extension, ClaimResponse.item.extension:traceNumber, ClaimResponse.item.extension:reviewOutcome, ClaimResponse.item.modifierExtension, ClaimResponse.item.itemSequence, ClaimResponse.item.noteNumber, ClaimResponse.item.adjudication, ClaimResponse.item.adjudication.extension, ClaimResponse.item.adjudication.modifierExtension, ClaimResponse.item.adjudication.category, ClaimResponse.item.adjudication.reason, ClaimResponse.item.adjudication.amount, ClaimResponse.item.adjudication.value, ClaimResponse.item.adjudication.value.extension, ClaimResponse.item.adjudication.value.extension:quantity, ClaimResponse.item.detail, ClaimResponse.item.detail.extension, ClaimResponse.item.detail.extension:traceNumber, ClaimResponse.item.detail.extension:reviewOutcome, ClaimResponse.item.detail.modifierExtension, ClaimResponse.item.detail.detailSequence, ClaimResponse.item.detail.noteNumber, ClaimResponse.item.detail.adjudication, ClaimResponse.item.detail.subDetail, ClaimResponse.item.detail.subDetail.extension, ClaimResponse.item.detail.subDetail.extension:traceNumber, ClaimResponse.item.detail.subDetail.extension:reviewOutcome, ClaimResponse.item.detail.subDetail.modifierExtension, ClaimResponse.item.detail.subDetail.subDetailSequence, ClaimResponse.item.detail.subDetail.noteNumber, ClaimResponse.item.detail.subDetail.adjudication, ClaimResponse.addItem, ClaimResponse.addItem.extension, ClaimResponse.addItem.extension:traceNumber, ClaimResponse.addItem.extension:revenue, ClaimResponse.addItem.extension:productOrServiceEnd, ClaimResponse.addItem.extension:request, ClaimResponse.addItem.extension:tax, ClaimResponse.addItem.extension:reviewOutcome, ClaimResponse.addItem.modifierExtension, ClaimResponse.addItem.itemSequence, ClaimResponse.addItem.detailSequence, ClaimResponse.addItem.subdetailSequence, ClaimResponse.addItem.provider, ClaimResponse.addItem.productOrService, ClaimResponse.addItem.modifier, ClaimResponse.addItem.programCode, ClaimResponse.addItem.serviced[x], ClaimResponse.addItem.location[x], ClaimResponse.addItem.quantity, ClaimResponse.addItem.unitPrice, ClaimResponse.addItem.factor, ClaimResponse.addItem.net, ClaimResponse.addItem.bodySite, ClaimResponse.addItem.bodySite.extension, ClaimResponse.addItem.bodySite.extension:site, ClaimResponse.addItem.bodySite.extension:subSite, ClaimResponse.addItem.bodySite.coding, ClaimResponse.addItem.bodySite.text, ClaimResponse.addItem.subSite, ClaimResponse.addItem.noteNumber, ClaimResponse.addItem.adjudication, ClaimResponse.addItem.detail, ClaimResponse.addItem.detail.extension, ClaimResponse.addItem.detail.extension:traceNumber, ClaimResponse.addItem.detail.extension:revenue, ClaimResponse.addItem.detail.extension:productOrServiceEnd, ClaimResponse.addItem.detail.extension:tax, ClaimResponse.addItem.detail.extension:reviewOutcome, ClaimResponse.addItem.detail.modifierExtension, ClaimResponse.addItem.detail.productOrService, ClaimResponse.addItem.detail.modifier, ClaimResponse.addItem.detail.quantity, ClaimResponse.addItem.detail.unitPrice, ClaimResponse.addItem.detail.factor, ClaimResponse.addItem.detail.net, ClaimResponse.addItem.detail.noteNumber, ClaimResponse.addItem.detail.adjudication, ClaimResponse.addItem.detail.subDetail, ClaimResponse.addItem.detail.subDetail.extension, ClaimResponse.addItem.detail.subDetail.extension:traceNumber, ClaimResponse.addItem.detail.subDetail.extension:revenue, ClaimResponse.addItem.detail.subDetail.extension:productOrServiceEnd, ClaimResponse.addItem.detail.subDetail.extension:tax, ClaimResponse.addItem.detail.subDetail.extension:reviewOutcome, ClaimResponse.addItem.detail.subDetail.modifierExtension, ClaimResponse.addItem.detail.subDetail.productOrService, ClaimResponse.addItem.detail.subDetail.modifier, ClaimResponse.addItem.detail.subDetail.quantity, ClaimResponse.addItem.detail.subDetail.unitPrice, ClaimResponse.addItem.detail.subDetail.factor, ClaimResponse.addItem.detail.subDetail.net, ClaimResponse.addItem.detail.subDetail.noteNumber, ClaimResponse.addItem.detail.subDetail.adjudication, ClaimResponse.adjudication, ClaimResponse.total, ClaimResponse.total.extension, ClaimResponse.total.modifierExtension, ClaimResponse.total.category, ClaimResponse.total.amount, ClaimResponse.payment, ClaimResponse.payment.extension, ClaimResponse.payment.modifierExtension, ClaimResponse.payment.type, ClaimResponse.payment.adjustment, ClaimResponse.payment.adjustmentReason, ClaimResponse.payment.date, ClaimResponse.payment.amount, ClaimResponse.payment.identifier, ClaimResponse.fundsReserve, ClaimResponse.formCode, ClaimResponse.form, ClaimResponse.processNote, ClaimResponse.processNote.extension, ClaimResponse.processNote.modifierExtension, ClaimResponse.processNote.number, ClaimResponse.processNote.type, ClaimResponse.processNote.type.extension, ClaimResponse.processNote.type.extension:type, ClaimResponse.processNote.text, ClaimResponse.processNote.language, ClaimResponse.communicationRequest, ClaimResponse.insurance, ClaimResponse.insurance.extension, ClaimResponse.insurance.modifierExtension, ClaimResponse.insurance.sequence, ClaimResponse.insurance.focal, ClaimResponse.insurance.coverage, ClaimResponse.insurance.businessArrangement, ClaimResponse.insurance.claimResponse, ClaimResponse.error, ClaimResponse.error.extension, ClaimResponse.error.extension:expression, ClaimResponse.error.modifierExtension, ClaimResponse.error.itemSequence, ClaimResponse.error.detailSequence, ClaimResponse.error.subDetailSequence, ClaimResponse.error.code	All FHIR elements must have a @value or children	hasValue() or (children().count() > id.count())
ext-1	error	ClaimResponse.extension, ClaimResponse.extension:traceNumber, ClaimResponse.extension:decision, ClaimResponse.extension:event, ClaimResponse.extension:encounter, ClaimResponse.extension:diagnosisRelatedGroup, ClaimResponse.modifierExtension, ClaimResponse.item.extension, ClaimResponse.item.extension:traceNumber, ClaimResponse.item.extension:reviewOutcome, ClaimResponse.item.modifierExtension, ClaimResponse.item.adjudication.extension, ClaimResponse.item.adjudication.modifierExtension, ClaimResponse.item.adjudication.value.extension, ClaimResponse.item.adjudication.value.extension:quantity, ClaimResponse.item.detail.extension, ClaimResponse.item.detail.extension:traceNumber, ClaimResponse.item.detail.extension:reviewOutcome, ClaimResponse.item.detail.modifierExtension, ClaimResponse.item.detail.subDetail.extension, ClaimResponse.item.detail.subDetail.extension:traceNumber, ClaimResponse.item.detail.subDetail.extension:reviewOutcome, ClaimResponse.item.detail.subDetail.modifierExtension, ClaimResponse.addItem.extension, ClaimResponse.addItem.extension:traceNumber, ClaimResponse.addItem.extension:revenue, ClaimResponse.addItem.extension:productOrServiceEnd, ClaimResponse.addItem.extension:request, ClaimResponse.addItem.extension:tax, ClaimResponse.addItem.extension:reviewOutcome, ClaimResponse.addItem.modifierExtension, ClaimResponse.addItem.bodySite.extension, ClaimResponse.addItem.bodySite.extension:site, ClaimResponse.addItem.bodySite.extension:subSite, ClaimResponse.addItem.detail.extension, ClaimResponse.addItem.detail.extension:traceNumber, ClaimResponse.addItem.detail.extension:revenue, ClaimResponse.addItem.detail.extension:productOrServiceEnd, ClaimResponse.addItem.detail.extension:tax, ClaimResponse.addItem.detail.extension:reviewOutcome, ClaimResponse.addItem.detail.modifierExtension, ClaimResponse.addItem.detail.subDetail.extension, ClaimResponse.addItem.detail.subDetail.extension:traceNumber, ClaimResponse.addItem.detail.subDetail.extension:revenue, ClaimResponse.addItem.detail.subDetail.extension:productOrServiceEnd, ClaimResponse.addItem.detail.subDetail.extension:tax, ClaimResponse.addItem.detail.subDetail.extension:reviewOutcome, ClaimResponse.addItem.detail.subDetail.modifierExtension, ClaimResponse.total.extension, ClaimResponse.total.modifierExtension, ClaimResponse.payment.extension, ClaimResponse.payment.modifierExtension, ClaimResponse.processNote.extension, ClaimResponse.processNote.modifierExtension, ClaimResponse.processNote.type.extension, ClaimResponse.processNote.type.extension:type, ClaimResponse.insurance.extension, ClaimResponse.insurance.modifierExtension, ClaimResponse.error.extension, ClaimResponse.error.extension:expression, ClaimResponse.error.modifierExtension	Must have either extensions or value[x], not both	extension.exists() != value.exists()

This structure is derived from ClaimResponse

Summary

Mandatory: 0 element(2 nested mandatory elements)

Extensions

This structure refers to these extensions:

• http://hl7.org/fhir/5.0/StructureDefinition/extension-ClaimResponse.traceNumber|0.1.0
• http://hl7.org/fhir/5.0/StructureDefinition/extension-ClaimResponse.decision|0.1.0
• http://hl7.org/fhir/5.0/StructureDefinition/extension-ClaimResponse.event|0.1.0
• http://hl7.org/fhir/5.0/StructureDefinition/extension-ClaimResponse.encounter|0.1.0
• http://hl7.org/fhir/5.0/StructureDefinition/extension-ClaimResponse.diagnosisRelatedGroup|0.1.0
• http://hl7.org/fhir/5.0/StructureDefinition/extension-ClaimResponse.item.traceNumber|0.1.0
• http://hl7.org/fhir/5.0/StructureDefinition/extension-ClaimResponse.item.reviewOutcome|0.1.0
• http://hl7.org/fhir/5.0/StructureDefinition/extension-ClaimResponse.item.adjudication.quantity|0.1.0
• http://hl7.org/fhir/5.0/StructureDefinition/extension-ClaimResponse.item.detail.traceNumber|0.1.0
• http://hl7.org/fhir/5.0/StructureDefinition/extension-ClaimResponse.item.detail.subDetail.traceNumber|0.1.0
• http://hl7.org/fhir/5.0/StructureDefinition/extension-ClaimResponse.addItem.traceNumber|0.1.0
• http://hl7.org/fhir/5.0/StructureDefinition/extension-ClaimResponse.addItem.revenue|0.1.0
• http://hl7.org/fhir/5.0/StructureDefinition/extension-ClaimResponse.addItem.productOrServiceEnd|0.1.0
• http://hl7.org/fhir/5.0/StructureDefinition/extension-ClaimResponse.addItem.request|0.1.0
• http://hl7.org/fhir/5.0/StructureDefinition/extension-ClaimResponse.addItem.tax|0.1.0
• http://hl7.org/fhir/5.0/StructureDefinition/extension-ClaimResponse.addItem.bodySite.site|0.1.0
• http://hl7.org/fhir/5.0/StructureDefinition/extension-ClaimResponse.addItem.bodySite.subSite|0.1.0
• http://hl7.org/fhir/5.0/StructureDefinition/extension-ClaimResponse.addItem.detail.traceNumber|0.1.0
• http://hl7.org/fhir/5.0/StructureDefinition/extension-ClaimResponse.addItem.detail.revenue|0.1.0
• http://hl7.org/fhir/5.0/StructureDefinition/extension-ClaimResponse.addItem.detail.productOrServiceEnd|0.1.0
• http://hl7.org/fhir/5.0/StructureDefinition/extension-ClaimResponse.addItem.detail.tax|0.1.0
• http://hl7.org/fhir/5.0/StructureDefinition/extension-ClaimResponse.addItem.detail.subDetail.traceNumber|0.1.0
• http://hl7.org/fhir/5.0/StructureDefinition/extension-ClaimResponse.addItem.detail.subDetail.revenue|0.1.0
• http://hl7.org/fhir/5.0/StructureDefinition/extension-ClaimResponse.addItem.detail.subDetail.productOrServiceEnd|0.1.0
• http://hl7.org/fhir/5.0/StructureDefinition/extension-ClaimResponse.addItem.detail.subDetail.tax|0.1.0
• http://hl7.org/fhir/5.0/StructureDefinition/extension-ClaimResponse.processNote.type|0.1.0
• http://hl7.org/fhir/5.0/StructureDefinition/extension-ClaimResponse.error.expression|0.1.0

Maturity: 0

Key Elements View

Name	Flags	Card.	Type	Description & Constraints    Filter: Bindings Constraints Obligations
ClaimResponse		0..*	ClaimResponse(4.0.1)	Response to a claim predetermination or preauthorization
implicitRules	?!Σ	0..1	uri	A set of rules under which this content was created
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url Constraints: ext-1
extension:traceNumber		0..*	Identifier	R5: Number for tracking (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-ClaimResponse.traceNumber Constraints: ext-1
extension:decision		0..1	CodeableConcept	R5: Result of the adjudication (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-ClaimResponse.decision Binding: R5ClaimDecisionForR4 (0.1.0) (example): The overall result of the claim adjudication. Constraints: ext-1
extension:event		0..*	(Complex)	R5: Event information (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-ClaimResponse.event Constraints: ext-1
extension:encounter		0..*	Reference(Cross-version Profile for R5.Encounter for use in FHIR R4(0.1.0) | Encounter)	R5: Encounters associated with the listed treatments (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-ClaimResponse.encounter Constraints: ext-1
extension:diagnosisRelatedGroup		0..1	CodeableConcept	R5: Package billing code (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-ClaimResponse.diagnosisRelatedGroup Binding: ExampleDiagnosisRelatedGroupCodes (example) Constraints: ext-1
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored Constraints: ext-1
status	?!Σ	1..1	code	active | cancelled | draft | entered-in-error Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance.
type	Σ	1..1	CodeableConcept	More granular claim type Binding: ClaimTypeCodes (extensible): The type or discipline-style of the claim.
use	Σ	1..1	code	claim | preauthorization | predetermination Binding: Use (required): Claim, preauthorization, predetermination.
patient	Σ	1..1	Reference(Patient)	The recipient of the products and services
created	Σ	1..1	dateTime	Response creation date
insurer	Σ	1..1	Reference(Organization)	Party responsible for reimbursement
outcome	Σ	1..1	code	queued | complete | error | partial Binding: ClaimProcessingCodes (required): The result of the claim processing.
Documentation for this format

Terminology Bindings

Path	Status	Usage	ValueSet	Version	Source
ClaimResponse.status	Base	required	Financial Resource Status Codes	📍4.0.1	FHIR Std.
ClaimResponse.type	Base	extensible	Claim Type Codes	📍4.0.1	FHIR Std.
ClaimResponse.use	Base	required	Use	📍4.0.1	FHIR Std.
ClaimResponse.outcome	Base	required	Claim Processing Codes	📍4.0.1	FHIR Std.

Constraints

Id	Grade	Path(s)	Description	Expression
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 or SHALL refer to the containing resource	contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).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()
dom-5	error	ClaimResponse	If a resource is contained in another resource, it SHALL NOT have a security label	contained.meta.security.empty()
dom-6	best practice	ClaimResponse	A resource should have narrative for robust management	text.`div`.exists()
ele-1	error	ClaimResponse.implicitRules, ClaimResponse.extension, ClaimResponse.extension:traceNumber, ClaimResponse.extension:decision, ClaimResponse.extension:event, ClaimResponse.extension:encounter, ClaimResponse.extension:diagnosisRelatedGroup, ClaimResponse.modifierExtension, ClaimResponse.status, ClaimResponse.type, ClaimResponse.use, ClaimResponse.patient, ClaimResponse.created, ClaimResponse.insurer, ClaimResponse.outcome	All FHIR elements must have a @value or children	hasValue() or (children().count() > id.count())
ext-1	error	ClaimResponse.extension, ClaimResponse.extension:traceNumber, ClaimResponse.extension:decision, ClaimResponse.extension:event, ClaimResponse.extension:encounter, ClaimResponse.extension:diagnosisRelatedGroup, ClaimResponse.modifierExtension	Must have either extensions or value[x], not both	extension.exists() != value.exists()

Differential View

This structure is derived from ClaimResponse

Name	Flags	Card.	Type	Description & Constraints    Filter: Bindings Constraints Obligations
ClaimResponse		0..*	ClaimResponse(4.0.1)	Response to a claim predetermination or preauthorization
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.traceNumber
extension:decision		0..1	CodeableConcept	R5: Result of the adjudication (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-ClaimResponse.decision Binding: R5ClaimDecisionForR4 (0.1.0) (example): The overall result of the claim adjudication.
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 R4(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: ExampleDiagnosisRelatedGroupCodes (example)
item
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
adjudication
value
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
detail
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
subDetail
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
addItem
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.traceNumber
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: ExampleRevenueCenterCodes (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: USCLSCodes (example)
extension:request		0..*	Reference(Cross-version Profile for R5.DeviceRequest for use in FHIR R4(0.1.0) | DeviceRequest | Cross-version Profile for R5.MedicationRequest for use in FHIR R4(0.1.0) | MedicationRequest | Cross-version Profile for R5.NutritionOrder for use in FHIR R4(0.1.0) | NutritionOrder | Cross-version Profile for R5.ServiceRequest for use in FHIR R4(0.1.0) | ServiceRequest | Cross-version Profile for R5.SupplyRequest for use in FHIR R4(0.1.0) | SupplyRequest | Cross-version Profile for R5.VisionPrescription for use in FHIR R4(0.1.0) | VisionPrescription)	R5: Request or Referral for Service (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-ClaimResponse.addItem.request
extension:tax		0..1	Money	R5: Total tax (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-ClaimResponse.addItem.tax
extension:reviewOutcome		0..1	(Complex)	R5: Added items adjudication results (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-ClaimResponse.item.reviewOutcome
bodySite
Slices for extension		1..*	Extension	Extension Slice: Unordered, Open by value:url
extension:site		1..*	(Complex)	R5: Location (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-ClaimResponse.addItem.bodySite.site
extension:subSite		0..*	CodeableConcept	R5: Sub-location (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-ClaimResponse.addItem.bodySite.subSite Binding: SurfaceCodes (example)
detail
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: ExampleRevenueCenterCodes (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: USCLSCodes (example)
extension:tax		0..1	Money	R5: Total tax (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-ClaimResponse.addItem.detail.tax
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
subDetail
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.subDetail.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.subDetail.revenue Binding: ExampleRevenueCenterCodes (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.subDetail.productOrServiceEnd Binding: USCLSCodes (example)
extension:tax		0..1	Money	R5: Total tax (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-ClaimResponse.addItem.detail.subDetail.tax
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
processNote
type
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
extension:type		0..1	CodeableConcept	R5: Note purpose additional types URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-ClaimResponse.processNote.type Binding: NoteType (extensible): The presentation types of notes.
error
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
Documentation for this format

Snapshot View

Name	Flags	Card.	Type	Description & Constraints    Filter: Bindings Constraints Obligations
ClaimResponse		0..*	ClaimResponse(4.0.1)	Response to a claim predetermination or preauthorization
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: CommonLanguages (preferred): A human language. Additional Bindings Purpose AllLanguages Max Binding
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		0..*	Extension	Extension Slice: Unordered, Open by value:url Constraints: ext-1
extension:traceNumber		0..*	Identifier	R5: Number for tracking (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-ClaimResponse.traceNumber Constraints: ext-1
extension:decision		0..1	CodeableConcept	R5: Result of the adjudication (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-ClaimResponse.decision Binding: R5ClaimDecisionForR4 (0.1.0) (example): The overall result of the claim adjudication. Constraints: ext-1
extension:event		0..*	(Complex)	R5: Event information (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-ClaimResponse.event Constraints: ext-1
extension:encounter		0..*	Reference(Cross-version Profile for R5.Encounter for use in FHIR R4(0.1.0) | Encounter)	R5: Encounters associated with the listed treatments (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-ClaimResponse.encounter Constraints: ext-1
extension:diagnosisRelatedGroup		0..1	CodeableConcept	R5: Package billing code (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-ClaimResponse.diagnosisRelatedGroup Binding: ExampleDiagnosisRelatedGroupCodes (example) Constraints: ext-1
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored Constraints: ext-1
identifier		0..*	Identifier	Business Identifier for a claim response
status	?!Σ	1..1	code	active | cancelled | draft | entered-in-error Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance.
type	Σ	1..1	CodeableConcept	More granular claim type Binding: ClaimTypeCodes (extensible): The type or discipline-style of the claim.
subType		0..1	CodeableConcept	More granular claim type Binding: ExampleClaimSubTypeCodes (example): A more granular claim typecode.
use	Σ	1..1	code	claim | preauthorization | predetermination Binding: Use (required): Claim, preauthorization, predetermination.
patient	Σ	1..1	Reference(Patient)	The recipient of the products and services
created	Σ	1..1	dateTime	Response creation date
insurer	Σ	1..1	Reference(Organization)	Party responsible for reimbursement
requestor		0..1	Reference(Practitioner | PractitionerRole | Organization)	Party responsible for the claim
request	Σ	0..1	Reference(Claim)	Id of resource triggering adjudication
outcome	Σ	1..1	code	queued | complete | error | partial Binding: ClaimProcessingCodes (required): The result of the claim processing.
disposition		0..1	string	Disposition Message
preAuthRef		0..1	string	Preauthorization reference
preAuthPeriod		0..1	Period	Preauthorization reference effective period
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	Adjudication for claim line items
id		0..1	string	Unique id for inter-element referencing
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url Constraints: ext-1
extension:traceNumber		0..*	Identifier	R5: Number for tracking (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-ClaimResponse.item.traceNumber Constraints: ext-1
extension:reviewOutcome		0..1	(Complex)	R5: Adjudication results (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-ClaimResponse.item.reviewOutcome Constraints: ext-1
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized Constraints: ext-1
itemSequence		1..1	positiveInt	Claim item instance identifier
noteNumber		0..*	positiveInt	Applicable note numbers
adjudication		1..*	BackboneElement	Adjudication details
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Constraints: ext-1
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized Constraints: ext-1
category		1..1	CodeableConcept	Type of adjudication information Binding: AdjudicationValueCodes (example): The adjudication codes.
reason		0..1	CodeableConcept	Explanation of adjudication outcome Binding: AdjudicationReasonCodes (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 Constraints: ext-1
extension:quantity		0..1	Quantity	R5: quantity additional types URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-ClaimResponse.item.adjudication.quantity Constraints: ext-1
value		0..1	decimal	Primitive value for decimal
detail		0..*	BackboneElement	Adjudication for claim details
id		0..1	string	Unique id for inter-element referencing
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url Constraints: ext-1
extension:traceNumber		0..*	Identifier	R5: Number for tracking (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-ClaimResponse.item.detail.traceNumber Constraints: ext-1
extension:reviewOutcome		0..1	(Complex)	R5: Detail level adjudication results (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-ClaimResponse.item.reviewOutcome Constraints: ext-1
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized Constraints: ext-1
detailSequence		1..1	positiveInt	Claim detail instance identifier
noteNumber		0..*	positiveInt	Applicable note numbers
adjudication		1..*	See adjudication (ClaimResponse)	Detail level adjudication details
subDetail		0..*	BackboneElement	Adjudication for claim sub-details
id		0..1	string	Unique id for inter-element referencing
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url Constraints: ext-1
extension:traceNumber		0..*	Identifier	R5: Number for tracking (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-ClaimResponse.item.detail.subDetail.traceNumber Constraints: ext-1
extension:reviewOutcome		0..1	(Complex)	R5: Subdetail level adjudication results (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-ClaimResponse.item.reviewOutcome Constraints: ext-1
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized Constraints: ext-1
subDetailSequence		1..1	positiveInt	Claim sub-detail instance identifier
noteNumber		0..*	positiveInt	Applicable note numbers
adjudication		0..*	See adjudication (ClaimResponse)	Subdetail level adjudication details
addItem		0..*	BackboneElement	Insurer added line items
id		0..1	string	Unique id for inter-element referencing
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url Constraints: ext-1
extension:traceNumber		0..*	Identifier	R5: Number for tracking (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-ClaimResponse.addItem.traceNumber Constraints: ext-1
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: ExampleRevenueCenterCodes (example): Codes for the revenue or cost centers supplying the service and/or products. Constraints: ext-1
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: USCLSCodes (example) Constraints: ext-1
extension:request		0..*	Reference(Cross-version Profile for R5.DeviceRequest for use in FHIR R4(0.1.0) | DeviceRequest | Cross-version Profile for R5.MedicationRequest for use in FHIR R4(0.1.0) | MedicationRequest | Cross-version Profile for R5.NutritionOrder for use in FHIR R4(0.1.0) | NutritionOrder | Cross-version Profile for R5.ServiceRequest for use in FHIR R4(0.1.0) | ServiceRequest | Cross-version Profile for R5.SupplyRequest for use in FHIR R4(0.1.0) | SupplyRequest | Cross-version Profile for R5.VisionPrescription for use in FHIR R4(0.1.0) | VisionPrescription)	R5: Request or Referral for Service (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-ClaimResponse.addItem.request Constraints: ext-1
extension:tax		0..1	Money	R5: Total tax (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-ClaimResponse.addItem.tax Constraints: ext-1
extension:reviewOutcome		0..1	(Complex)	R5: Added items adjudication results (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-ClaimResponse.item.reviewOutcome Constraints: ext-1
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized Constraints: ext-1
itemSequence		0..*	positiveInt	Item sequence number
detailSequence		0..*	positiveInt	Detail sequence number
subdetailSequence		0..*	positiveInt	Subdetail sequence number
provider		0..*	Reference(Practitioner | PractitionerRole | Organization)	Authorized providers
productOrService		1..1	CodeableConcept	Billing, service, product, or drug code Binding: USCLSCodes (example): Allowable service and product codes.
modifier		0..*	CodeableConcept	Service/Product billing modifiers Binding: ModifierTypeCodes (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.
programCode		0..*	CodeableConcept	Program the product or service is provided under Binding: ExampleProgramReasonCodes (example): Program specific reason codes.
serviced[x]		0..1		Date or dates of service or product delivery
servicedDate			date
servicedPeriod			Period
location[x]		0..1		Place of service or where product was supplied Binding: ExampleServicePlaceCodes (example): Place of service: pharmacy, school, prison, etc.
locationCodeableConcept			CodeableConcept
locationAddress			Address
locationReference			Reference(Location)
quantity		0..1	SimpleQuantity(4.0.1)	Count of products or services
unitPrice		0..1	Money	Fee, charge or cost per item
factor		0..1	decimal	Price scaling factor
net		0..1	Money	Total item cost
bodySite		0..1	CodeableConcept	Anatomical location Binding: OralSiteCodes (example): The code for the teeth, quadrant, sextant and arch.
id		0..1	string	Unique id for inter-element referencing
Slices for extension		1..*	Extension	Extension Slice: Unordered, Open by value:url Constraints: ext-1
extension:site		1..*	(Complex)	R5: Location (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-ClaimResponse.addItem.bodySite.site Constraints: ext-1
extension:subSite		0..*	CodeableConcept	R5: Sub-location (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-ClaimResponse.addItem.bodySite.subSite Binding: SurfaceCodes (example) Constraints: ext-1
coding	Σ	0..*	Coding	Code defined by a terminology system
text	Σ	0..1	string	Plain text representation of the concept
subSite		0..*	CodeableConcept	Anatomical sub-location Binding: SurfaceCodes (example): The code for the tooth surface and surface combinations.
noteNumber		0..*	positiveInt	Applicable note numbers
adjudication		1..*	See adjudication (ClaimResponse)	Added items adjudication
detail		0..*	BackboneElement	Insurer added line details
id		0..1	string	Unique id for inter-element referencing
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url Constraints: ext-1
extension:traceNumber		0..*	Identifier	R5: Number for tracking (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-ClaimResponse.addItem.detail.traceNumber Constraints: ext-1
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: ExampleRevenueCenterCodes (example): Codes for the revenue or cost centers supplying the service and/or products. Constraints: ext-1
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: USCLSCodes (example) Constraints: ext-1
extension:tax		0..1	Money	R5: Total tax (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-ClaimResponse.addItem.detail.tax Constraints: ext-1
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 Constraints: ext-1
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized Constraints: ext-1
productOrService		1..1	CodeableConcept	Billing, service, product, or drug code Binding: USCLSCodes (example): Allowable service and product codes.
modifier		0..*	CodeableConcept	Service/Product billing modifiers Binding: ModifierTypeCodes (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.
quantity		0..1	SimpleQuantity(4.0.1)	Count of products or services
unitPrice		0..1	Money	Fee, charge or cost per item
factor		0..1	decimal	Price scaling factor
net		0..1	Money	Total item cost
noteNumber		0..*	positiveInt	Applicable note numbers
adjudication		1..*	See adjudication (ClaimResponse)	Added items detail adjudication
subDetail		0..*	BackboneElement	Insurer added line items
id		0..1	string	Unique id for inter-element referencing
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url Constraints: ext-1
extension:traceNumber		0..*	Identifier	R5: Number for tracking (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-ClaimResponse.addItem.detail.subDetail.traceNumber Constraints: ext-1
extension:revenue		0..1	CodeableConcept	R5: Revenue or cost center code (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-ClaimResponse.addItem.detail.subDetail.revenue Binding: ExampleRevenueCenterCodes (example): Codes for the revenue or cost centers supplying the service and/or products. Constraints: ext-1
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.subDetail.productOrServiceEnd Binding: USCLSCodes (example) Constraints: ext-1
extension:tax		0..1	Money	R5: Total tax (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-ClaimResponse.addItem.detail.subDetail.tax Constraints: ext-1
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 Constraints: ext-1
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized Constraints: ext-1
productOrService		1..1	CodeableConcept	Billing, service, product, or drug code Binding: USCLSCodes (example): Allowable service and product codes.
modifier		0..*	CodeableConcept	Service/Product billing modifiers Binding: ModifierTypeCodes (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.
quantity		0..1	SimpleQuantity(4.0.1)	Count of products or services
unitPrice		0..1	Money	Fee, charge or cost per item
factor		0..1	decimal	Price scaling factor
net		0..1	Money	Total item cost
noteNumber		0..*	positiveInt	Applicable note numbers
adjudication		1..*	See adjudication (ClaimResponse)	Added items detail adjudication
adjudication		0..*	See adjudication (ClaimResponse)	Header-level adjudication
total	Σ	0..*	BackboneElement	Adjudication totals
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Constraints: ext-1
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized Constraints: ext-1
category	Σ	1..1	CodeableConcept	Type of adjudication information Binding: AdjudicationValueCodes (example): The adjudication codes.
amount	Σ	1..1	Money	Financial total for the category
payment		0..1	BackboneElement	Payment Details
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Constraints: ext-1
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized Constraints: ext-1
type		1..1	CodeableConcept	Partial or complete payment Binding: ExamplePaymentTypeCodes (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 adjustment Binding: PaymentAdjustmentReasonCodes (example): Payment Adjustment reason codes.
date		0..1	date	Expected date of payment
amount		1..1	Money	Payable amount after adjustment
identifier		0..1	Identifier	Business identifier for the payment
fundsReserve		0..1	CodeableConcept	Funds reserved status Binding: Funds Reservation Codes (example): For whom funds are to be reserved: (Patient, Provider, None).
formCode		0..1	CodeableConcept	Printed form identifier Binding: Form Codes (example): The forms codes.
form		0..1	Attachment	Printed reference or actual form
processNote		0..*	BackboneElement	Note concerning adjudication
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Constraints: ext-1
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized Constraints: ext-1
number		0..1	positiveInt	Note instance identifier
type		0..1	code	display | print | printoper Binding: NoteType (required): The presentation types of notes.
id		0..1	string	xml:id (or equivalent in JSON)
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url Constraints: ext-1
extension:type		0..1	CodeableConcept	R5: Note purpose additional types URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-ClaimResponse.processNote.type Binding: NoteType (extensible): The presentation types of notes. Constraints: ext-1
value		0..1	string	Primitive value for code
text		1..1	string	Note explanatory text
language		0..1	CodeableConcept	Language of the text Binding: CommonLanguages (preferred): A human language. Additional Bindings Purpose AllLanguages Max Binding
communicationRequest		0..*	Reference(CommunicationRequest)	Request for additional information
insurance		0..*	BackboneElement	Patient insurance information
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Constraints: ext-1
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized Constraints: ext-1
sequence		1..1	positiveInt	Insurance instance identifier
focal		1..1	boolean	Coverage to be used for adjudication
coverage		1..1	Reference(Coverage)	Insurance information
businessArrangement		0..1	string	Additional provider contract number
claimResponse		0..1	Reference(ClaimResponse)	Adjudication results
error		0..*	BackboneElement	Processing errors
id		0..1	string	Unique id for inter-element referencing
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url Constraints: ext-1
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 Constraints: ext-1
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized Constraints: ext-1
itemSequence		0..1	positiveInt	Item sequence number
detailSequence		0..1	positiveInt	Detail sequence number
subDetailSequence		0..1	positiveInt	Subdetail sequence number
code		1..1	CodeableConcept	Error code detailing processing issues Binding: Adjudication Error Codes (example): The adjudication error codes.
Documentation for this format

Terminology Bindings

Path	Status	Usage	ValueSet	Version	Source
ClaimResponse.language	Base	preferred	Common Languages	📍4.0.1	tx.fhir.org
ClaimResponse.status	Base	required	Financial Resource Status Codes	📍4.0.1	FHIR Std.
ClaimResponse.type	Base	extensible	Claim Type Codes	📍4.0.1	FHIR Std.
ClaimResponse.subType	Base	example	Example Claim SubType Codes	📍4.0.1	FHIR Std.
ClaimResponse.use	Base	required	Use	📍4.0.1	FHIR Std.
ClaimResponse.outcome	Base	required	Claim Processing Codes	📍4.0.1	FHIR Std.
ClaimResponse.payeeType	Base	example	PayeeType	📍4.0.1	FHIR Std.
ClaimResponse.item.adjudication.​category	Base	example	Adjudication Value Codes	📍4.0.1	FHIR Std.
ClaimResponse.item.adjudication.​reason	Base	example	Adjudication Reason Codes	📍4.0.1	FHIR Std.
ClaimResponse.addItem.​productOrService	Base	example	USCLS Codes	📍4.0.1	FHIR Std.
ClaimResponse.addItem.​modifier	Base	example	Modifier type Codes	📍4.0.1	FHIR Std.
ClaimResponse.addItem.​programCode	Base	example	Example Program Reason Codes	📍4.0.1	FHIR Std.
ClaimResponse.addItem.​location[x]	Base	example	Example Service Place Codes	📍4.0.1	FHIR Std.
ClaimResponse.addItem.​bodySite	Base	example	Oral Site Codes	📍4.0.1	FHIR Std.
ClaimResponse.addItem.​subSite	Base	example	Surface Codes	📍4.0.1	FHIR Std.
ClaimResponse.addItem.​detail.productOrService	Base	example	USCLS Codes	📍4.0.1	FHIR Std.
ClaimResponse.addItem.​detail.modifier	Base	example	Modifier type Codes	📍4.0.1	FHIR Std.
ClaimResponse.addItem.​detail.subDetail.productOrService	Base	example	USCLS Codes	📍4.0.1	FHIR Std.
ClaimResponse.addItem.​detail.subDetail.modifier	Base	example	Modifier type Codes	📍4.0.1	FHIR Std.
ClaimResponse.total.​category	Base	example	Adjudication Value Codes	📍4.0.1	FHIR Std.
ClaimResponse.payment.​type	Base	example	Example Payment Type Codes	📍4.0.1	FHIR Std.
ClaimResponse.payment.​adjustmentReason	Base	example	Payment Adjustment Reason Codes	📍4.0.1	FHIR Std.
ClaimResponse.fundsReserve	Base	example	FundsReserve	📍4.0.1	FHIR Std.
ClaimResponse.formCode	Base	example	Forms	📍4.0.1	FHIR Std.
ClaimResponse.processNote.​type	Base	required	NoteType	📍4.0.1	FHIR Std.
ClaimResponse.processNote.​language	Base	preferred	Common Languages	📍4.0.1	tx.fhir.org
ClaimResponse.error.​code	Base	example	AdjudicationError	📍4.0.1	FHIR Std.

Constraints

Id	Grade	Path(s)	Description	Expression
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 or SHALL refer to the containing resource	contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).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()
dom-5	error	ClaimResponse	If a resource is contained in another resource, it SHALL NOT have a security label	contained.meta.security.empty()
dom-6	best practice	ClaimResponse	A resource should have narrative for robust management	text.`div`.exists()
ele-1	error	ClaimResponse.meta, ClaimResponse.implicitRules, ClaimResponse.language, ClaimResponse.text, ClaimResponse.extension, ClaimResponse.extension:traceNumber, ClaimResponse.extension:decision, ClaimResponse.extension:event, ClaimResponse.extension:encounter, ClaimResponse.extension:diagnosisRelatedGroup, ClaimResponse.modifierExtension, ClaimResponse.identifier, ClaimResponse.status, ClaimResponse.type, ClaimResponse.subType, ClaimResponse.use, ClaimResponse.patient, ClaimResponse.created, ClaimResponse.insurer, ClaimResponse.requestor, ClaimResponse.request, ClaimResponse.outcome, ClaimResponse.disposition, ClaimResponse.preAuthRef, ClaimResponse.preAuthPeriod, ClaimResponse.payeeType, ClaimResponse.item, ClaimResponse.item.extension, ClaimResponse.item.extension:traceNumber, ClaimResponse.item.extension:reviewOutcome, ClaimResponse.item.modifierExtension, ClaimResponse.item.itemSequence, ClaimResponse.item.noteNumber, ClaimResponse.item.adjudication, ClaimResponse.item.adjudication.extension, ClaimResponse.item.adjudication.modifierExtension, ClaimResponse.item.adjudication.category, ClaimResponse.item.adjudication.reason, ClaimResponse.item.adjudication.amount, ClaimResponse.item.adjudication.value, ClaimResponse.item.adjudication.value.extension, ClaimResponse.item.adjudication.value.extension:quantity, ClaimResponse.item.detail, ClaimResponse.item.detail.extension, ClaimResponse.item.detail.extension:traceNumber, ClaimResponse.item.detail.extension:reviewOutcome, ClaimResponse.item.detail.modifierExtension, ClaimResponse.item.detail.detailSequence, ClaimResponse.item.detail.noteNumber, ClaimResponse.item.detail.adjudication, ClaimResponse.item.detail.subDetail, ClaimResponse.item.detail.subDetail.extension, ClaimResponse.item.detail.subDetail.extension:traceNumber, ClaimResponse.item.detail.subDetail.extension:reviewOutcome, ClaimResponse.item.detail.subDetail.modifierExtension, ClaimResponse.item.detail.subDetail.subDetailSequence, ClaimResponse.item.detail.subDetail.noteNumber, ClaimResponse.item.detail.subDetail.adjudication, ClaimResponse.addItem, ClaimResponse.addItem.extension, ClaimResponse.addItem.extension:traceNumber, ClaimResponse.addItem.extension:revenue, ClaimResponse.addItem.extension:productOrServiceEnd, ClaimResponse.addItem.extension:request, ClaimResponse.addItem.extension:tax, ClaimResponse.addItem.extension:reviewOutcome, ClaimResponse.addItem.modifierExtension, ClaimResponse.addItem.itemSequence, ClaimResponse.addItem.detailSequence, ClaimResponse.addItem.subdetailSequence, ClaimResponse.addItem.provider, ClaimResponse.addItem.productOrService, ClaimResponse.addItem.modifier, ClaimResponse.addItem.programCode, ClaimResponse.addItem.serviced[x], ClaimResponse.addItem.location[x], ClaimResponse.addItem.quantity, ClaimResponse.addItem.unitPrice, ClaimResponse.addItem.factor, ClaimResponse.addItem.net, ClaimResponse.addItem.bodySite, ClaimResponse.addItem.bodySite.extension, ClaimResponse.addItem.bodySite.extension:site, ClaimResponse.addItem.bodySite.extension:subSite, ClaimResponse.addItem.bodySite.coding, ClaimResponse.addItem.bodySite.text, ClaimResponse.addItem.subSite, ClaimResponse.addItem.noteNumber, ClaimResponse.addItem.adjudication, ClaimResponse.addItem.detail, ClaimResponse.addItem.detail.extension, ClaimResponse.addItem.detail.extension:traceNumber, ClaimResponse.addItem.detail.extension:revenue, ClaimResponse.addItem.detail.extension:productOrServiceEnd, ClaimResponse.addItem.detail.extension:tax, ClaimResponse.addItem.detail.extension:reviewOutcome, ClaimResponse.addItem.detail.modifierExtension, ClaimResponse.addItem.detail.productOrService, ClaimResponse.addItem.detail.modifier, ClaimResponse.addItem.detail.quantity, ClaimResponse.addItem.detail.unitPrice, ClaimResponse.addItem.detail.factor, ClaimResponse.addItem.detail.net, ClaimResponse.addItem.detail.noteNumber, ClaimResponse.addItem.detail.adjudication, ClaimResponse.addItem.detail.subDetail, ClaimResponse.addItem.detail.subDetail.extension, ClaimResponse.addItem.detail.subDetail.extension:traceNumber, ClaimResponse.addItem.detail.subDetail.extension:revenue, ClaimResponse.addItem.detail.subDetail.extension:productOrServiceEnd, ClaimResponse.addItem.detail.subDetail.extension:tax, ClaimResponse.addItem.detail.subDetail.extension:reviewOutcome, ClaimResponse.addItem.detail.subDetail.modifierExtension, ClaimResponse.addItem.detail.subDetail.productOrService, ClaimResponse.addItem.detail.subDetail.modifier, ClaimResponse.addItem.detail.subDetail.quantity, ClaimResponse.addItem.detail.subDetail.unitPrice, ClaimResponse.addItem.detail.subDetail.factor, ClaimResponse.addItem.detail.subDetail.net, ClaimResponse.addItem.detail.subDetail.noteNumber, ClaimResponse.addItem.detail.subDetail.adjudication, ClaimResponse.adjudication, ClaimResponse.total, ClaimResponse.total.extension, ClaimResponse.total.modifierExtension, ClaimResponse.total.category, ClaimResponse.total.amount, ClaimResponse.payment, ClaimResponse.payment.extension, ClaimResponse.payment.modifierExtension, ClaimResponse.payment.type, ClaimResponse.payment.adjustment, ClaimResponse.payment.adjustmentReason, ClaimResponse.payment.date, ClaimResponse.payment.amount, ClaimResponse.payment.identifier, ClaimResponse.fundsReserve, ClaimResponse.formCode, ClaimResponse.form, ClaimResponse.processNote, ClaimResponse.processNote.extension, ClaimResponse.processNote.modifierExtension, ClaimResponse.processNote.number, ClaimResponse.processNote.type, ClaimResponse.processNote.type.extension, ClaimResponse.processNote.type.extension:type, ClaimResponse.processNote.text, ClaimResponse.processNote.language, ClaimResponse.communicationRequest, ClaimResponse.insurance, ClaimResponse.insurance.extension, ClaimResponse.insurance.modifierExtension, ClaimResponse.insurance.sequence, ClaimResponse.insurance.focal, ClaimResponse.insurance.coverage, ClaimResponse.insurance.businessArrangement, ClaimResponse.insurance.claimResponse, ClaimResponse.error, ClaimResponse.error.extension, ClaimResponse.error.extension:expression, ClaimResponse.error.modifierExtension, ClaimResponse.error.itemSequence, ClaimResponse.error.detailSequence, ClaimResponse.error.subDetailSequence, ClaimResponse.error.code	All FHIR elements must have a @value or children	hasValue() or (children().count() > id.count())
ext-1	error	ClaimResponse.extension, ClaimResponse.extension:traceNumber, ClaimResponse.extension:decision, ClaimResponse.extension:event, ClaimResponse.extension:encounter, ClaimResponse.extension:diagnosisRelatedGroup, ClaimResponse.modifierExtension, ClaimResponse.item.extension, ClaimResponse.item.extension:traceNumber, ClaimResponse.item.extension:reviewOutcome, ClaimResponse.item.modifierExtension, ClaimResponse.item.adjudication.extension, ClaimResponse.item.adjudication.modifierExtension, ClaimResponse.item.adjudication.value.extension, ClaimResponse.item.adjudication.value.extension:quantity, ClaimResponse.item.detail.extension, ClaimResponse.item.detail.extension:traceNumber, ClaimResponse.item.detail.extension:reviewOutcome, ClaimResponse.item.detail.modifierExtension, ClaimResponse.item.detail.subDetail.extension, ClaimResponse.item.detail.subDetail.extension:traceNumber, ClaimResponse.item.detail.subDetail.extension:reviewOutcome, ClaimResponse.item.detail.subDetail.modifierExtension, ClaimResponse.addItem.extension, ClaimResponse.addItem.extension:traceNumber, ClaimResponse.addItem.extension:revenue, ClaimResponse.addItem.extension:productOrServiceEnd, ClaimResponse.addItem.extension:request, ClaimResponse.addItem.extension:tax, ClaimResponse.addItem.extension:reviewOutcome, ClaimResponse.addItem.modifierExtension, ClaimResponse.addItem.bodySite.extension, ClaimResponse.addItem.bodySite.extension:site, ClaimResponse.addItem.bodySite.extension:subSite, ClaimResponse.addItem.detail.extension, ClaimResponse.addItem.detail.extension:traceNumber, ClaimResponse.addItem.detail.extension:revenue, ClaimResponse.addItem.detail.extension:productOrServiceEnd, ClaimResponse.addItem.detail.extension:tax, ClaimResponse.addItem.detail.extension:reviewOutcome, ClaimResponse.addItem.detail.modifierExtension, ClaimResponse.addItem.detail.subDetail.extension, ClaimResponse.addItem.detail.subDetail.extension:traceNumber, ClaimResponse.addItem.detail.subDetail.extension:revenue, ClaimResponse.addItem.detail.subDetail.extension:productOrServiceEnd, ClaimResponse.addItem.detail.subDetail.extension:tax, ClaimResponse.addItem.detail.subDetail.extension:reviewOutcome, ClaimResponse.addItem.detail.subDetail.modifierExtension, ClaimResponse.total.extension, ClaimResponse.total.modifierExtension, ClaimResponse.payment.extension, ClaimResponse.payment.modifierExtension, ClaimResponse.processNote.extension, ClaimResponse.processNote.modifierExtension, ClaimResponse.processNote.type.extension, ClaimResponse.processNote.type.extension:type, ClaimResponse.insurance.extension, ClaimResponse.insurance.modifierExtension, ClaimResponse.error.extension, ClaimResponse.error.extension:expression, ClaimResponse.error.modifierExtension	Must have either extensions or value[x], not both	extension.exists() != value.exists()

This structure is derived from ClaimResponse

Summary

Mandatory: 0 element(2 nested mandatory elements)

Extensions

This structure refers to these extensions:

• http://hl7.org/fhir/5.0/StructureDefinition/extension-ClaimResponse.traceNumber|0.1.0
• http://hl7.org/fhir/5.0/StructureDefinition/extension-ClaimResponse.decision|0.1.0
• http://hl7.org/fhir/5.0/StructureDefinition/extension-ClaimResponse.event|0.1.0
• http://hl7.org/fhir/5.0/StructureDefinition/extension-ClaimResponse.encounter|0.1.0
• http://hl7.org/fhir/5.0/StructureDefinition/extension-ClaimResponse.diagnosisRelatedGroup|0.1.0
• http://hl7.org/fhir/5.0/StructureDefinition/extension-ClaimResponse.item.traceNumber|0.1.0
• http://hl7.org/fhir/5.0/StructureDefinition/extension-ClaimResponse.item.reviewOutcome|0.1.0
• http://hl7.org/fhir/5.0/StructureDefinition/extension-ClaimResponse.item.adjudication.quantity|0.1.0
• http://hl7.org/fhir/5.0/StructureDefinition/extension-ClaimResponse.item.detail.traceNumber|0.1.0
• http://hl7.org/fhir/5.0/StructureDefinition/extension-ClaimResponse.item.detail.subDetail.traceNumber|0.1.0
• http://hl7.org/fhir/5.0/StructureDefinition/extension-ClaimResponse.addItem.traceNumber|0.1.0
• http://hl7.org/fhir/5.0/StructureDefinition/extension-ClaimResponse.addItem.revenue|0.1.0
• http://hl7.org/fhir/5.0/StructureDefinition/extension-ClaimResponse.addItem.productOrServiceEnd|0.1.0
• http://hl7.org/fhir/5.0/StructureDefinition/extension-ClaimResponse.addItem.request|0.1.0
• http://hl7.org/fhir/5.0/StructureDefinition/extension-ClaimResponse.addItem.tax|0.1.0
• http://hl7.org/fhir/5.0/StructureDefinition/extension-ClaimResponse.addItem.bodySite.site|0.1.0
• http://hl7.org/fhir/5.0/StructureDefinition/extension-ClaimResponse.addItem.bodySite.subSite|0.1.0
• http://hl7.org/fhir/5.0/StructureDefinition/extension-ClaimResponse.addItem.detail.traceNumber|0.1.0
• http://hl7.org/fhir/5.0/StructureDefinition/extension-ClaimResponse.addItem.detail.revenue|0.1.0
• http://hl7.org/fhir/5.0/StructureDefinition/extension-ClaimResponse.addItem.detail.productOrServiceEnd|0.1.0
• http://hl7.org/fhir/5.0/StructureDefinition/extension-ClaimResponse.addItem.detail.tax|0.1.0
• http://hl7.org/fhir/5.0/StructureDefinition/extension-ClaimResponse.addItem.detail.subDetail.traceNumber|0.1.0
• http://hl7.org/fhir/5.0/StructureDefinition/extension-ClaimResponse.addItem.detail.subDetail.revenue|0.1.0
• http://hl7.org/fhir/5.0/StructureDefinition/extension-ClaimResponse.addItem.detail.subDetail.productOrServiceEnd|0.1.0
• http://hl7.org/fhir/5.0/StructureDefinition/extension-ClaimResponse.addItem.detail.subDetail.tax|0.1.0
• http://hl7.org/fhir/5.0/StructureDefinition/extension-ClaimResponse.processNote.type|0.1.0
• http://hl7.org/fhir/5.0/StructureDefinition/extension-ClaimResponse.error.expression|0.1.0

Maturity: 0