Intersection of http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-claimresponse and http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-claimresponse

This is the set of resources that conform to both QICore ClaimResponse (http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-claimresponse) and QICore ClaimResponse (http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-claimresponse).

Structure

Name	Flags	Card.	Type	Description & Constraints
ClaimResponse		0..*		Response to a claim predetermination or preauthorization dom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources dom-3: 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 dom-4: If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated dom-5: If a resource is contained in another resource, it SHALL NOT have a security label dom-6: A resource should have narrative for robust management
meta	Σ	0..1	Meta	Metadata about the resource ele-1: All FHIR elements must have a @value or children
implicitRules	?!Σ	0..1	uri	A set of rules under which this content was created ele-1: All FHIR elements must have a @value or children
language		0..1	code	Language of the resource content Binding: ?? (preferred): A human language. Additional Bindings Purpose ?? Max Binding ele-1: All FHIR elements must have a @value or children
text		0..1	Narrative	Text summary of the resource, for human interpretation ele-1: All FHIR elements must have a @value or children
contained		0..*	Resource	Contained, inline Resources
extension		0..*	Extension	Additional content defined by implementations ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
identifier		0..*	Identifier	Business Identifier for a claim response ele-1: All FHIR elements must have a @value or children
status	?!SΣ	1..1	code	left: active | cancelled | draft | entered-in-error; right: (QI-Core) active | cancelled | draft | entered-in-error Binding: ?? (required): A code specifying the state of the resource instance. ele-1: All FHIR elements must have a @value or children
type	SΣ	1..1	CodeableConcept	left: More granular claim type; right: (QI-Core) More granular claim type Binding: ?? (extensible): The type or discipline-style of the claim. ele-1: All FHIR elements must have a @value or children
subType		0..1	CodeableConcept	More granular claim type Binding: ?? (example): A more granular claim typecode. ele-1: All FHIR elements must have a @value or children
use	SΣ	1..1	code	left: claim | preauthorization | predetermination; right: (QI-Core) claim | preauthorization | predetermination Binding: ?? (required): Claim, preauthorization, predetermination. ele-1: All FHIR elements must have a @value or children
patient	SΣ	1..1	Reference(QICore Patient | #sd-qicore-patient-qicore-patient)	left: The recipient of the products and services; right: (QI-Core) The recipient of the products and services ele-1: All FHIR elements must have a @value or children
created	SΣ	1..1	dateTime	left: Response creation date; right: (QI-Core) Response creation date ele-1: All FHIR elements must have a @value or children
insurer	SΣ	1..1	Reference(QICore Organization | #sd-qicore-organization-qicore-organization)	left: Party responsible for reimbursement; right: (QI-Core) Party responsible for reimbursement ele-1: All FHIR elements must have a @value or children
requestor	S	0..1	Reference(QICore Practitioner | QICore Organization | QICore PractitionerRole | #sd-qicore-practitioner-qicore-practitioner)	left: Party responsible for the claim; right: (QI-Core) Party responsible for the claim ele-1: All FHIR elements must have a @value or children
request	SΣ	0..1	Reference(QICore Claim | #sd-qicore-claim-qicore-claim)	left: Id of resource triggering adjudication; right: (QI-Core) Id of resource triggering adjudication ele-1: All FHIR elements must have a @value or children
outcome	Σ	1..1	code	queued | complete | error | partial Binding: ?? (required): The result of the claim processing. ele-1: All FHIR elements must have a @value or children
disposition		0..1	string	Disposition Message ele-1: All FHIR elements must have a @value or children
preAuthRef		0..1	string	Preauthorization reference ele-1: All FHIR elements must have a @value or children
preAuthPeriod		0..1	Period	Preauthorization reference effective period ele-1: All FHIR elements must have a @value or children
payeeType		0..1	CodeableConcept	Party to be paid any benefits payable Binding: ?? (example): A code for the party to be reimbursed. ele-1: All FHIR elements must have a @value or children
item	S	0..*	BackboneElement	left: Adjudication for claim line items; right: (QI-Core) Adjudication for claim line items ele-1: All FHIR elements must have a @value or children
extension		0..*	Extension	Additional content defined by implementations ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
itemSequence		1..1	positiveInt	Claim item instance identifier ele-1: All FHIR elements must have a @value or children
noteNumber		0..*	positiveInt	Applicable note numbers ele-1: All FHIR elements must have a @value or children
adjudication	S	1..*	BackboneElement	left: Adjudication details; right: (QI-Core) Adjudication details ele-1: All FHIR elements must have a @value or children
extension		0..*	Extension	Additional content defined by implementations ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
category	S	1..1	CodeableConcept	left: This code is fixed to 'submitted' to indicate that the adjudication result is on what was submitted.; right: (QI-Core) This code is fixed to 'submitted' to indicate that the adjudication result is on what was submitted. Binding: ?? (example): The adjudication codes. ele-1: All FHIR elements must have a @value or children
reason		0..1	CodeableConcept	Explanation of adjudication outcome Binding: ?? (example): The adjudication reason codes. ele-1: All FHIR elements must have a @value or children
amount	S	0..1	Money	left: Monetary amount; right: (QI-Core) Monetary amount ele-1: All FHIR elements must have a @value or children
value		0..1	decimal	Non-monetary value ele-1: All FHIR elements must have a @value or children
detail		0..*	BackboneElement	Adjudication for claim details ele-1: All FHIR elements must have a @value or children
extension		0..*	Extension	Additional content defined by implementations ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
detailSequence	S	1..1	positiveInt	left: Claim detail instance identifier; right: (QI-Core) Claim detail instance identifier ele-1: All FHIR elements must have a @value or children
noteNumber		0..*	positiveInt	Applicable note numbers ele-1: All FHIR elements must have a @value or children
adjudication		1..*		Detail level adjudication details ele-1: All FHIR elements must have a @value or children
subDetail		0..*	BackboneElement	Adjudication for claim sub-details ele-1: All FHIR elements must have a @value or children
extension		0..*	Extension	Additional content defined by implementations ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
subDetailSequence		1..1	positiveInt	Claim sub-detail instance identifier ele-1: All FHIR elements must have a @value or children
noteNumber		0..*	positiveInt	Applicable note numbers ele-1: All FHIR elements must have a @value or children
adjudication		0..*		Subdetail level adjudication details ele-1: All FHIR elements must have a @value or children
addItem		0..*	BackboneElement	Insurer added line items ele-1: All FHIR elements must have a @value or children
extension		0..*	Extension	Additional content defined by implementations ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
itemSequence		0..*	positiveInt	Item sequence number ele-1: All FHIR elements must have a @value or children
detailSequence		0..*	positiveInt	Detail sequence number ele-1: All FHIR elements must have a @value or children
subdetailSequence		0..*	positiveInt	Subdetail sequence number ele-1: All FHIR elements must have a @value or children
provider		0..*	Reference(Practitioner | PractitionerRole | Organization)	Authorized providers ele-1: All FHIR elements must have a @value or children
productOrService		1..1	CodeableConcept	Billing, service, product, or drug code Binding: ?? (example): Allowable service and product codes. ele-1: All FHIR elements must have a @value or children
modifier		0..*	CodeableConcept	Service/Product billing modifiers Binding: ?? (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. ele-1: All FHIR elements must have a @value or children
programCode		0..*	CodeableConcept	Program the product or service is provided under Binding: ?? (example): Program specific reason codes. ele-1: All FHIR elements must have a @value or children
serviced[x]		0..1		Date or dates of service or product delivery ele-1: All FHIR elements must have a @value or children
servicedDate			date
servicedPeriod			Period
location[x]		0..1		Place of service or where product was supplied Binding: ?? (example): Place of service: pharmacy, school, prison, etc. ele-1: All FHIR elements must have a @value or children
locationCodeableConcept			CodeableConcept
locationAddress			Address
locationReference			Reference(Location)
quantity		0..1	??, ??	Count of products or services ele-1: All FHIR elements must have a @value or children
unitPrice		0..1	Money	Fee, charge or cost per item ele-1: All FHIR elements must have a @value or children
factor		0..1	decimal	Price scaling factor ele-1: All FHIR elements must have a @value or children
net		0..1	Money	Total item cost ele-1: All FHIR elements must have a @value or children
bodySite		0..1	CodeableConcept	Anatomical location Binding: ?? (example): The code for the teeth, quadrant, sextant and arch. ele-1: All FHIR elements must have a @value or children
subSite		0..*	CodeableConcept	Anatomical sub-location Binding: ?? (example): The code for the tooth surface and surface combinations. ele-1: All FHIR elements must have a @value or children
noteNumber		0..*	positiveInt	Applicable note numbers ele-1: All FHIR elements must have a @value or children
adjudication		1..*		Added items adjudication ele-1: All FHIR elements must have a @value or children
detail		0..*	BackboneElement	Insurer added line details ele-1: All FHIR elements must have a @value or children
extension		0..*	Extension	Additional content defined by implementations ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
productOrService		1..1	CodeableConcept	Billing, service, product, or drug code Binding: ?? (example): Allowable service and product codes. ele-1: All FHIR elements must have a @value or children
modifier		0..*	CodeableConcept	Service/Product billing modifiers Binding: ?? (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. ele-1: All FHIR elements must have a @value or children
quantity		0..1	??, ??	Count of products or services ele-1: All FHIR elements must have a @value or children
unitPrice		0..1	Money	Fee, charge or cost per item ele-1: All FHIR elements must have a @value or children
factor		0..1	decimal	Price scaling factor ele-1: All FHIR elements must have a @value or children
net		0..1	Money	Total item cost ele-1: All FHIR elements must have a @value or children
noteNumber		0..*	positiveInt	Applicable note numbers ele-1: All FHIR elements must have a @value or children
adjudication		1..*		Added items detail adjudication ele-1: All FHIR elements must have a @value or children
subDetail		0..*	BackboneElement	Insurer added line items ele-1: All FHIR elements must have a @value or children
extension		0..*	Extension	Additional content defined by implementations ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
productOrService		1..1	CodeableConcept	Billing, service, product, or drug code Binding: ?? (example): Allowable service and product codes. ele-1: All FHIR elements must have a @value or children
modifier		0..*	CodeableConcept	Service/Product billing modifiers Binding: ?? (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. ele-1: All FHIR elements must have a @value or children
quantity		0..1	??, ??	Count of products or services ele-1: All FHIR elements must have a @value or children
unitPrice		0..1	Money	Fee, charge or cost per item ele-1: All FHIR elements must have a @value or children
factor		0..1	decimal	Price scaling factor ele-1: All FHIR elements must have a @value or children
net		0..1	Money	Total item cost ele-1: All FHIR elements must have a @value or children
noteNumber		0..*	positiveInt	Applicable note numbers ele-1: All FHIR elements must have a @value or children
adjudication		1..*		Added items detail adjudication ele-1: All FHIR elements must have a @value or children
adjudication		0..*		Header-level adjudication ele-1: All FHIR elements must have a @value or children
total	Σ	0..*	BackboneElement	Adjudication totals ele-1: All FHIR elements must have a @value or children
extension		0..*	Extension	Additional content defined by implementations ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
category	Σ	1..1	CodeableConcept	Type of adjudication information Binding: ?? (example): The adjudication codes. ele-1: All FHIR elements must have a @value or children
amount	Σ	1..1	Money	Financial total for the category ele-1: All FHIR elements must have a @value or children
payment		0..1	BackboneElement	Payment Details ele-1: All FHIR elements must have a @value or children
extension		0..*	Extension	Additional content defined by implementations ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
type		1..1	CodeableConcept	Partial or complete payment Binding: ?? (example): The type (partial, complete) of the payment. ele-1: All FHIR elements must have a @value or children
adjustment		0..1	Money	Payment adjustment for non-claim issues ele-1: All FHIR elements must have a @value or children
adjustmentReason		0..1	CodeableConcept	Explanation for the adjustment Binding: ?? (example): Payment Adjustment reason codes. ele-1: All FHIR elements must have a @value or children
date		0..1	date	Expected date of payment ele-1: All FHIR elements must have a @value or children
amount		1..1	Money	Payable amount after adjustment ele-1: All FHIR elements must have a @value or children
identifier		0..1	Identifier	Business identifier for the payment ele-1: All FHIR elements must have a @value or children
fundsReserve		0..1	CodeableConcept	Funds reserved status Binding: ?? (example): For whom funds are to be reserved: (Patient, Provider, None). ele-1: All FHIR elements must have a @value or children
formCode		0..1	CodeableConcept	Printed form identifier Binding: ?? (example): The forms codes. ele-1: All FHIR elements must have a @value or children
form		0..1	Attachment	Printed reference or actual form ele-1: All FHIR elements must have a @value or children
processNote		0..*	BackboneElement	Note concerning adjudication ele-1: All FHIR elements must have a @value or children
extension		0..*	Extension	Additional content defined by implementations ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
number		0..1	positiveInt	Note instance identifier ele-1: All FHIR elements must have a @value or children
type		0..1	code	display | print | printoper Binding: ?? (required): The presentation types of notes. ele-1: All FHIR elements must have a @value or children
text		1..1	string	Note explanatory text ele-1: All FHIR elements must have a @value or children
language		0..1	CodeableConcept	Language of the text Binding: ?? (preferred): A human language. Additional Bindings Purpose ?? Max Binding ele-1: All FHIR elements must have a @value or children
communicationRequest		0..*	Reference(CommunicationRequest)	Request for additional information ele-1: All FHIR elements must have a @value or children
insurance		0..*	BackboneElement	Patient insurance information ele-1: All FHIR elements must have a @value or children
extension		0..*	Extension	Additional content defined by implementations ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
sequence		1..1	positiveInt	Insurance instance identifier ele-1: All FHIR elements must have a @value or children
focal		1..1	boolean	Coverage to be used for adjudication ele-1: All FHIR elements must have a @value or children
coverage		1..1	Reference(Coverage)	Insurance information ele-1: All FHIR elements must have a @value or children
businessArrangement		0..1	string	Additional provider contract number ele-1: All FHIR elements must have a @value or children
claimResponse		0..1	Reference(ClaimResponse)	Adjudication results ele-1: All FHIR elements must have a @value or children
error		0..*	BackboneElement	Processing errors ele-1: All FHIR elements must have a @value or children
extension		0..*	Extension	Additional content defined by implementations ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
itemSequence		0..1	positiveInt	Item sequence number ele-1: All FHIR elements must have a @value or children
detailSequence		0..1	positiveInt	Detail sequence number ele-1: All FHIR elements must have a @value or children
subDetailSequence		0..1	positiveInt	Subdetail sequence number ele-1: All FHIR elements must have a @value or children
code		1..1	CodeableConcept	Error code detailing processing issues Binding: ?? (example): The adjudication error codes. ele-1: All FHIR elements must have a @value or children
Documentation for this format