LinuxForHealth FHIR Implementation Guide
8.0.0 - draft United States of America flag

LinuxForHealth FHIR Implementation Guide - Local Development build (v8.0.0). See the Directory of published versions

Resource Profile: CDM Claim Response

Official URL: http://linuxforhealth.org/fhir/cdm/StructureDefinition/cdm-claim-response Version: 8.0.0
Active as of 2022-11-10 Computable Name: CDMClaimResponse

This resource provides the adjudication details from the processing of a Claim resource. The CDMClaimResponse profile extends the base FHIR ClaimResponse resource with additional adjudication details.

Usage:

Formal Views of Profile Content

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

This structure is derived from ClaimResponse

NameFlagsCard.TypeDescription & Constraintsdoco
.. ClaimResponse 0..*ClaimResponseResponse to a claim predetermination or preauthorization
... meta 0..1ProcessMetaMetadata about a resource
... contained 0..0
... Slices for extension 0..*ExtensionExtension
Slice: Unordered, Open by value:url
... claimStatus 0..1CodeableConceptCustom code for the claim status
URL: http://linuxforhealth.org/fhir/cdm/StructureDefinition/claim-status
... daysToProcess 0..1integerNumber of days between the date the claim was received and the date the claim was processed
URL: http://linuxforhealth.org/fhir/cdm/StructureDefinition/days-to-process
... identifier 1..*IdentifierBusiness Identifier for a claim response
.... type 0..1CodeableConceptDescription of identifier
Binding: Identifier Type Value Set (extensible)
.... system 1..1uriThe namespace for the identifier value
.... value 1..1stringThe value that is unique
... type 1..1CodeableConceptMore granular claim type
Binding: Claim Type Value Set (extensible)
... item
.... Slices for extension 0..*ExtensionExtension
Slice: Unordered, Open by value:url
.... claimResponseItemStatus 0..1CodeableConceptThe status of claim payment on claim item
URL: http://linuxforhealth.org/fhir/cdm/StructureDefinition/claim-response-item-status
Binding: Payer Claim Status Codes Value Set (extensible)
.... claimResponseBenefitPlan 0..1Reference(Coverage)The benefit plan that covers the service rendered
URL: http://linuxforhealth.org/fhir/cdm/StructureDefinition/claim-response-benefit-plan
.... copayExclusion 0..1CodeableConceptCustomer-specific code for the exclusion reason of a copayment
URL: http://linuxforhealth.org/fhir/cdm/StructureDefinition/copay-exclusion
.... numberOfUnitsAllowed 0..1integerCustomer-specific quantity of services or units allowed
URL: http://linuxforhealth.org/fhir/cdm/StructureDefinition/number-of-units-allowed
.... reinsuranceMetIndicator 0..1stringIndicator that the reinsurance amount was met
URL: http://linuxforhealth.org/fhir/cdm/StructureDefinition/reinsurance-met-indicator
.... utilizationReview 0..1CodeableConceptCustomer-specific code for the type of utilization review
URL: http://linuxforhealth.org/fhir/cdm/StructureDefinition/utilization-review
.... adjudication
..... Slices for extension 0..*ExtensionExtension
Slice: Unordered, Open by value:url
..... routingNumberCode 0..1stringCustomer-specific code for the ITS routing number
URL: http://linuxforhealth.org/fhir/cdm/StructureDefinition/routing-number-code
..... savingsType 0..1CodeableConceptCustomer-specific code for the type of third party savings
URL: http://linuxforhealth.org/fhir/cdm/StructureDefinition/savings-type
..... category 1..1CodeableConceptType of adjudication information
Binding: Adjudication Category Value Set (example)
... adjudication 0..*BackboneElementHeader-level adjudication
.... Slices for extension 0..*ExtensionExtension
Slice: Unordered, Open by value:url
.... adjudicationDate 0..1dateDate on which the payment status of the claim was adjudicated
URL: http://linuxforhealth.org/fhir/cdm/StructureDefinition/adjudication-date
... payment
.... Slices for extension 0..*ExtensionExtension
Slice: Unordered, Open by value:url
.... claimAdjustmentType 0..*CodeableConceptThe code for the type of adjustment for the claim
URL: http://linuxforhealth.org/fhir/cdm/StructureDefinition/claim-adjustment-type
Binding: Payer Claim Adjustment Type Value Set (extensible)
.... dispositionReason 0..*CodeableConceptCustomer-specific code for the disposition reason, as related to how the claim was paid
URL: http://linuxforhealth.org/fhir/cdm/StructureDefinition/disposition-reason
.... reimburseType 0..1CodeableConceptMethod of payment code for the claim
URL: http://linuxforhealth.org/fhir/cdm/StructureDefinition/reimburse-type

doco Documentation for this format

Terminology Bindings (Differential)

PathConformanceValueSet
ClaimResponse.identifier.typeextensibleIdentifierTypeValueSet
ClaimResponse.typeextensibleClaimTypeValueSet (a valid code from Payer Claim Type Codes)
ClaimResponse.item.adjudication.categoryexampleAdjudicationCategoryValueSet (a valid code from Adjudication Category Codes)
NameFlagsCard.TypeDescription & Constraintsdoco
.. ClaimResponse 0..*ClaimResponseResponse to a claim predetermination or preauthorization
... meta 0..1ProcessMetaMetadata about a resource
... implicitRules ?!Σ0..1uriA set of rules under which this content was created
... Slices for extension 0..*ExtensionExtension
Slice: Unordered, Open by value:url
... claimStatus 0..1CodeableConceptCustom code for the claim status
URL: http://linuxforhealth.org/fhir/cdm/StructureDefinition/claim-status
... daysToProcess 0..1integerNumber of days between the date the claim was received and the date the claim was processed
URL: http://linuxforhealth.org/fhir/cdm/StructureDefinition/days-to-process
... modifierExtension ?!0..*ExtensionExtensions that cannot be ignored
... identifier 1..*IdentifierBusiness Identifier for a claim response
.... use ?!Σ0..1codeusual | official | temp | secondary | old (If known)
Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .

.... type Σ0..1CodeableConceptDescription of identifier
Binding: Identifier Type Value Set (extensible)
.... system Σ1..1uriThe namespace for the identifier value
Example General: http://www.acme.com/identifiers/patient
.... value Σ1..1stringThe value that is unique
Example General: 123456
... status ?!Σ1..1codeactive | cancelled | draft | entered-in-error
Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance.

... type Σ1..1CodeableConceptMore granular claim type
Binding: Claim Type Value Set (extensible)
... use Σ1..1codeclaim | preauthorization | predetermination
Binding: Use (required): Claim, preauthorization, predetermination.

... patient Σ1..1Reference(Patient)The recipient of the products and services
... created Σ1..1dateTimeResponse creation date
... insurer Σ1..1Reference(Organization)Party responsible for reimbursement
... outcome Σ1..1codequeued | complete | error | partial
Binding: ClaimProcessingCodes (required): The result of the claim processing.

... adjudication 0..*BackboneElementHeader-level adjudication
.... Slices for extension 0..*ExtensionExtension
Slice: Unordered, Open by value:url
.... adjudicationDate 0..1dateDate on which the payment status of the claim was adjudicated
URL: http://linuxforhealth.org/fhir/cdm/StructureDefinition/adjudication-date
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
.... category 1..1CodeableConceptType of adjudication information
Binding: AdjudicationValueCodes (example): The adjudication codes.


doco Documentation for this format

Terminology Bindings

PathConformanceValueSet
ClaimResponse.identifier.userequiredIdentifierUse
ClaimResponse.identifier.typeextensibleIdentifierTypeValueSet
ClaimResponse.statusrequiredFinancialResourceStatusCodes
ClaimResponse.typeextensibleClaimTypeValueSet (a valid code from Payer Claim Type Codes)
ClaimResponse.userequiredUse
ClaimResponse.outcomerequiredClaimProcessingCodes
ClaimResponse.adjudication.categoryexampleAdjudicationValueCodes
NameFlagsCard.TypeDescription & Constraintsdoco
.. ClaimResponse 0..*ClaimResponseResponse to a claim predetermination or preauthorization
... id Σ0..1idLogical id of this artifact
... meta 0..1ProcessMetaMetadata about a resource
... implicitRules ?!Σ0..1uriA set of rules under which this content was created
... language 0..1codeLanguage of the resource content
Binding: CommonLanguages (preferred): A human language.

Additional BindingsPurpose
AllLanguagesMax Binding
... text 0..1NarrativeText summary of the resource, for human interpretation
... Slices for extension 0..*ExtensionExtension
Slice: Unordered, Open by value:url
... claimReceivedDate 0..1dateDate the claim was received
URL: http://linuxforhealth.org/fhir/cdm/StructureDefinition/claim-received-date
... claimStatus 0..1CodeableConceptCustom code for the claim status
URL: http://linuxforhealth.org/fhir/cdm/StructureDefinition/claim-status
... daysToProcess 0..1integerNumber of days between the date the claim was received and the date the claim was processed
URL: http://linuxforhealth.org/fhir/cdm/StructureDefinition/days-to-process
... modifierExtension ?!0..*ExtensionExtensions that cannot be ignored
... identifier 1..*IdentifierBusiness Identifier for a claim response
.... id 0..1stringUnique id for inter-element referencing
.... extension 0..*ExtensionAdditional content defined by implementations
Slice: Unordered, Open by value:url
.... use ?!Σ0..1codeusual | official | temp | secondary | old (If known)
Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .

.... type Σ0..1CodeableConceptDescription of identifier
Binding: Identifier Type Value Set (extensible)
.... system Σ1..1uriThe namespace for the identifier value
Example General: http://www.acme.com/identifiers/patient
.... value Σ1..1stringThe value that is unique
Example General: 123456
.... period Σ0..1PeriodTime period when id is/was valid for use
.... assigner Σ0..1Reference(Organization)Organization that issued id (may be just text)
... status ?!Σ1..1codeactive | cancelled | draft | entered-in-error
Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance.

... type Σ1..1CodeableConceptMore granular claim type
Binding: Claim Type Value Set (extensible)
... subType 0..1CodeableConceptMore granular claim type
Binding: ExampleClaimSubTypeCodes (example): A more granular claim typecode.

... use Σ1..1codeclaim | preauthorization | predetermination
Binding: Use (required): Claim, preauthorization, predetermination.

... patient Σ1..1Reference(Patient)The recipient of the products and services
... created Σ1..1dateTimeResponse creation date
... insurer Σ1..1Reference(Organization)Party responsible for reimbursement
... requestor 0..1Reference(Practitioner | PractitionerRole | Organization)Party responsible for the claim
... request Σ0..1Reference(Claim)Id of resource triggering adjudication
... outcome Σ1..1codequeued | complete | error | partial
Binding: ClaimProcessingCodes (required): The result of the claim processing.

... disposition 0..1stringDisposition Message
... preAuthRef 0..1stringPreauthorization reference
... preAuthPeriod 0..1PeriodPreauthorization reference effective period
... payeeType 0..1CodeableConceptParty to be paid any benefits payable
Binding: Claim Payee Type Codes (example): A code for the party to be reimbursed.

... item 0..*BackboneElementAdjudication for claim line items
.... id 0..1stringUnique id for inter-element referencing
.... Slices for extension 0..*ExtensionExtension
Slice: Unordered, Open by value:url
.... claimResponseItemStatus 0..1CodeableConceptThe status of claim payment on claim item
URL: http://linuxforhealth.org/fhir/cdm/StructureDefinition/claim-response-item-status
Binding: Payer Claim Status Codes Value Set (extensible)
.... claimResponseBenefitPlan 0..1Reference(Coverage)The benefit plan that covers the service rendered
URL: http://linuxforhealth.org/fhir/cdm/StructureDefinition/claim-response-benefit-plan
.... copayExclusion 0..1CodeableConceptCustomer-specific code for the exclusion reason of a copayment
URL: http://linuxforhealth.org/fhir/cdm/StructureDefinition/copay-exclusion
.... numberOfUnitsAllowed 0..1integerCustomer-specific quantity of services or units allowed
URL: http://linuxforhealth.org/fhir/cdm/StructureDefinition/number-of-units-allowed
.... reinsuranceMetIndicator 0..1stringIndicator that the reinsurance amount was met
URL: http://linuxforhealth.org/fhir/cdm/StructureDefinition/reinsurance-met-indicator
.... utilizationReview 0..1CodeableConceptCustomer-specific code for the type of utilization review
URL: http://linuxforhealth.org/fhir/cdm/StructureDefinition/utilization-review
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
.... itemSequence 1..1positiveIntClaim item instance identifier
.... noteNumber 0..*positiveIntApplicable note numbers
.... adjudication 1..*BackboneElementAdjudication details
..... id 0..1stringUnique id for inter-element referencing
..... Slices for extension 0..*ExtensionExtension
Slice: Unordered, Open by value:url
..... routingNumberCode 0..1stringCustomer-specific code for the ITS routing number
URL: http://linuxforhealth.org/fhir/cdm/StructureDefinition/routing-number-code
..... savingsType 0..1CodeableConceptCustomer-specific code for the type of third party savings
URL: http://linuxforhealth.org/fhir/cdm/StructureDefinition/savings-type
..... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
..... category 1..1CodeableConceptType of adjudication information
Binding: Adjudication Category Value Set (example)
..... reason 0..1CodeableConceptExplanation of adjudication outcome
Binding: AdjudicationReasonCodes (example): The adjudication reason codes.

..... amount 0..1MoneyMonetary amount
..... value 0..1decimalNon-monetary value
.... detail 0..*BackboneElementAdjudication for claim details
..... id 0..1stringUnique id for inter-element referencing
..... extension 0..*ExtensionAdditional content defined by implementations
..... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
..... detailSequence 1..1positiveIntClaim detail instance identifier
..... noteNumber 0..*positiveIntApplicable note numbers
..... adjudication 1..*See adjudication (ClaimResponse)Detail level adjudication details
..... subDetail 0..*BackboneElementAdjudication for claim sub-details
...... id 0..1stringUnique id for inter-element referencing
...... extension 0..*ExtensionAdditional content defined by implementations
...... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
...... subDetailSequence 1..1positiveIntClaim sub-detail instance identifier
...... noteNumber 0..*positiveIntApplicable note numbers
...... adjudication 0..*See adjudication (ClaimResponse)Subdetail level adjudication details
... addItem 0..*BackboneElementInsurer added line items
.... id 0..1stringUnique id for inter-element referencing
.... extension 0..*ExtensionAdditional content defined by implementations
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
.... itemSequence 0..*positiveIntItem sequence number
.... detailSequence 0..*positiveIntDetail sequence number
.... subdetailSequence 0..*positiveIntSubdetail sequence number
.... provider 0..*Reference(Practitioner | PractitionerRole | Organization)Authorized providers
.... productOrService 1..1CodeableConceptBilling, service, product, or drug code
Binding: USCLSCodes (example): Allowable service and product codes.

.... modifier 0..*CodeableConceptService/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..*CodeableConceptProgram the product or service is provided under
Binding: ExampleProgramReasonCodes (example): Program specific reason codes.


.... serviced[x] 0..1Date or dates of service or product delivery
..... servicedDatedate
..... servicedPeriodPeriod
.... location[x] 0..1Place of service or where product was supplied
Binding: ExampleServicePlaceCodes (example): Place of service: pharmacy, school, prison, etc.

..... locationCodeableConceptCodeableConcept
..... locationAddressAddress
..... locationReferenceReference(Location)
.... quantity 0..1SimpleQuantityCount of products or services
.... unitPrice 0..1MoneyFee, charge or cost per item
.... factor 0..1decimalPrice scaling factor
.... net 0..1MoneyTotal item cost
.... bodySite 0..1CodeableConceptAnatomical location
Binding: OralSiteCodes (example): The code for the teeth, quadrant, sextant and arch.

.... subSite 0..*CodeableConceptAnatomical sub-location
Binding: SurfaceCodes (example): The code for the tooth surface and surface combinations.


.... noteNumber 0..*positiveIntApplicable note numbers
.... adjudication 1..*See adjudication (ClaimResponse)Added items adjudication
.... detail 0..*BackboneElementInsurer added line details
..... id 0..1stringUnique id for inter-element referencing
..... extension 0..*ExtensionAdditional content defined by implementations
..... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
..... productOrService 1..1CodeableConceptBilling, service, product, or drug code
Binding: USCLSCodes (example): Allowable service and product codes.

..... modifier 0..*CodeableConceptService/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..1SimpleQuantityCount of products or services
..... unitPrice 0..1MoneyFee, charge or cost per item
..... factor 0..1decimalPrice scaling factor
..... net 0..1MoneyTotal item cost
..... noteNumber 0..*positiveIntApplicable note numbers
..... adjudication 1..*See adjudication (ClaimResponse)Added items detail adjudication
..... subDetail 0..*BackboneElementInsurer added line items
...... id 0..1stringUnique id for inter-element referencing
...... extension 0..*ExtensionAdditional content defined by implementations
...... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
...... productOrService 1..1CodeableConceptBilling, service, product, or drug code
Binding: USCLSCodes (example): Allowable service and product codes.

...... modifier 0..*CodeableConceptService/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..1SimpleQuantityCount of products or services
...... unitPrice 0..1MoneyFee, charge or cost per item
...... factor 0..1decimalPrice scaling factor
...... net 0..1MoneyTotal item cost
...... noteNumber 0..*positiveIntApplicable note numbers
...... adjudication 1..*See adjudication (ClaimResponse)Added items detail adjudication
... adjudication 0..*BackboneElementHeader-level adjudication
.... id 0..1stringUnique id for inter-element referencing
.... Slices for extension 0..*ExtensionExtension
Slice: Unordered, Open by value:url
.... adjudicationDate 0..1dateDate on which the payment status of the claim was adjudicated
URL: http://linuxforhealth.org/fhir/cdm/StructureDefinition/adjudication-date
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
.... category 1..1CodeableConceptType of adjudication information
Binding: AdjudicationValueCodes (example): The adjudication codes.

.... reason 0..1CodeableConceptExplanation of adjudication outcome
Binding: AdjudicationReasonCodes (example): The adjudication reason codes.

.... amount 0..1MoneyMonetary amount
.... value 0..1decimalNon-monetary value
... total Σ0..*BackboneElementAdjudication totals
.... id 0..1stringUnique id for inter-element referencing
.... extension 0..*ExtensionAdditional content defined by implementations
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
.... category Σ1..1CodeableConceptType of adjudication information
Binding: AdjudicationValueCodes (example): The adjudication codes.

.... amount Σ1..1MoneyFinancial total for the category
... payment 0..1BackboneElementPayment Details
.... id 0..1stringUnique id for inter-element referencing
.... Slices for extension 0..*ExtensionExtension
Slice: Unordered, Open by value:url
.... claimAdjustmentType 0..*CodeableConceptThe code for the type of adjustment for the claim
URL: http://linuxforhealth.org/fhir/cdm/StructureDefinition/claim-adjustment-type
Binding: Payer Claim Adjustment Type Value Set (extensible)
.... dispositionReason 0..*CodeableConceptCustomer-specific code for the disposition reason, as related to how the claim was paid
URL: http://linuxforhealth.org/fhir/cdm/StructureDefinition/disposition-reason
.... reimburseType 0..1CodeableConceptMethod of payment code for the claim
URL: http://linuxforhealth.org/fhir/cdm/StructureDefinition/reimburse-type
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
.... type 1..1CodeableConceptPartial or complete payment
Binding: ExamplePaymentTypeCodes (example): The type (partial, complete) of the payment.

.... adjustment 0..1MoneyPayment adjustment for non-claim issues
.... adjustmentReason 0..1CodeableConceptExplanation for the adjustment
Binding: PaymentAdjustmentReasonCodes (example): Payment Adjustment reason codes.

.... date 0..1dateExpected date of payment
.... amount 1..1MoneyPayable amount after adjustment
.... identifier 0..1IdentifierBusiness identifier for the payment
... fundsReserve 0..1CodeableConceptFunds reserved status
Binding: Funds Reservation Codes (example): For whom funds are to be reserved: (Patient, Provider, None).

... formCode 0..1CodeableConceptPrinted form identifier
Binding: Form Codes (example): The forms codes.

... form 0..1AttachmentPrinted reference or actual form
... processNote 0..*BackboneElementNote concerning adjudication
.... id 0..1stringUnique id for inter-element referencing
.... extension 0..*ExtensionAdditional content defined by implementations
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
.... number 0..1positiveIntNote instance identifier
.... type 0..1codedisplay | print | printoper
Binding: NoteType (required): The presentation types of notes.

.... text 1..1stringNote explanatory text
.... language 0..1CodeableConceptLanguage of the text
Binding: CommonLanguages (preferred): A human language.

Additional BindingsPurpose
AllLanguagesMax Binding
... communicationRequest 0..*Reference(CommunicationRequest)Request for additional information
... insurance 0..*BackboneElementPatient insurance information
.... id 0..1stringUnique id for inter-element referencing
.... extension 0..*ExtensionAdditional content defined by implementations
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
.... sequence 1..1positiveIntInsurance instance identifier
.... focal 1..1booleanCoverage to be used for adjudication
.... coverage 1..1Reference(Coverage)Insurance information
.... businessArrangement 0..1stringAdditional provider contract number
.... claimResponse 0..1Reference(ClaimResponse)Adjudication results
... error 0..*BackboneElementProcessing errors
.... id 0..1stringUnique id for inter-element referencing
.... extension 0..*ExtensionAdditional content defined by implementations
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
.... itemSequence 0..1positiveIntItem sequence number
.... detailSequence 0..1positiveIntDetail sequence number
.... subDetailSequence 0..1positiveIntSubdetail sequence number
.... code 1..1CodeableConceptError code detailing processing issues
Binding: Adjudication Error Codes (example): The adjudication error codes.


doco Documentation for this format

Terminology Bindings

PathConformanceValueSet
ClaimResponse.languagepreferredCommonLanguages
Additional Bindings Purpose
AllLanguages Max Binding
ClaimResponse.identifier.userequiredIdentifierUse
ClaimResponse.identifier.typeextensibleIdentifierTypeValueSet
ClaimResponse.statusrequiredFinancialResourceStatusCodes
ClaimResponse.typeextensibleClaimTypeValueSet (a valid code from Payer Claim Type Codes)
ClaimResponse.subTypeexampleExampleClaimSubTypeCodes
ClaimResponse.userequiredUse
ClaimResponse.outcomerequiredClaimProcessingCodes
ClaimResponse.payeeTypeexampleClaim Payee Type Codes
ClaimResponse.item.adjudication.categoryexampleAdjudicationCategoryValueSet (a valid code from Adjudication Category Codes)
ClaimResponse.item.adjudication.reasonexampleAdjudicationReasonCodes
ClaimResponse.addItem.productOrServiceexampleUSCLSCodes
ClaimResponse.addItem.modifierexampleModifierTypeCodes
ClaimResponse.addItem.programCodeexampleExampleProgramReasonCodes
ClaimResponse.addItem.location[x]exampleExampleServicePlaceCodes
ClaimResponse.addItem.bodySiteexampleOralSiteCodes
ClaimResponse.addItem.subSiteexampleSurfaceCodes
ClaimResponse.addItem.detail.productOrServiceexampleUSCLSCodes
ClaimResponse.addItem.detail.modifierexampleModifierTypeCodes
ClaimResponse.addItem.detail.subDetail.productOrServiceexampleUSCLSCodes
ClaimResponse.addItem.detail.subDetail.modifierexampleModifierTypeCodes
ClaimResponse.adjudication.categoryexampleAdjudicationValueCodes
ClaimResponse.adjudication.reasonexampleAdjudicationReasonCodes
ClaimResponse.total.categoryexampleAdjudicationValueCodes
ClaimResponse.payment.typeexampleExamplePaymentTypeCodes
ClaimResponse.payment.adjustmentReasonexamplePaymentAdjustmentReasonCodes
ClaimResponse.fundsReserveexampleFunds Reservation Codes
ClaimResponse.formCodeexampleForm Codes
ClaimResponse.processNote.typerequiredNoteType
ClaimResponse.processNote.languagepreferredCommonLanguages
Additional Bindings Purpose
AllLanguages Max Binding
ClaimResponse.error.codeexampleAdjudication Error Codes

Differential View

This structure is derived from ClaimResponse

NameFlagsCard.TypeDescription & Constraintsdoco
.. ClaimResponse 0..*ClaimResponseResponse to a claim predetermination or preauthorization
... meta 0..1ProcessMetaMetadata about a resource
... contained 0..0
... Slices for extension 0..*ExtensionExtension
Slice: Unordered, Open by value:url
... claimStatus 0..1CodeableConceptCustom code for the claim status
URL: http://linuxforhealth.org/fhir/cdm/StructureDefinition/claim-status
... daysToProcess 0..1integerNumber of days between the date the claim was received and the date the claim was processed
URL: http://linuxforhealth.org/fhir/cdm/StructureDefinition/days-to-process
... identifier 1..*IdentifierBusiness Identifier for a claim response
.... type 0..1CodeableConceptDescription of identifier
Binding: Identifier Type Value Set (extensible)
.... system 1..1uriThe namespace for the identifier value
.... value 1..1stringThe value that is unique
... type 1..1CodeableConceptMore granular claim type
Binding: Claim Type Value Set (extensible)
... item
.... Slices for extension 0..*ExtensionExtension
Slice: Unordered, Open by value:url
.... claimResponseItemStatus 0..1CodeableConceptThe status of claim payment on claim item
URL: http://linuxforhealth.org/fhir/cdm/StructureDefinition/claim-response-item-status
Binding: Payer Claim Status Codes Value Set (extensible)
.... claimResponseBenefitPlan 0..1Reference(Coverage)The benefit plan that covers the service rendered
URL: http://linuxforhealth.org/fhir/cdm/StructureDefinition/claim-response-benefit-plan
.... copayExclusion 0..1CodeableConceptCustomer-specific code for the exclusion reason of a copayment
URL: http://linuxforhealth.org/fhir/cdm/StructureDefinition/copay-exclusion
.... numberOfUnitsAllowed 0..1integerCustomer-specific quantity of services or units allowed
URL: http://linuxforhealth.org/fhir/cdm/StructureDefinition/number-of-units-allowed
.... reinsuranceMetIndicator 0..1stringIndicator that the reinsurance amount was met
URL: http://linuxforhealth.org/fhir/cdm/StructureDefinition/reinsurance-met-indicator
.... utilizationReview 0..1CodeableConceptCustomer-specific code for the type of utilization review
URL: http://linuxforhealth.org/fhir/cdm/StructureDefinition/utilization-review
.... adjudication
..... Slices for extension 0..*ExtensionExtension
Slice: Unordered, Open by value:url
..... routingNumberCode 0..1stringCustomer-specific code for the ITS routing number
URL: http://linuxforhealth.org/fhir/cdm/StructureDefinition/routing-number-code
..... savingsType 0..1CodeableConceptCustomer-specific code for the type of third party savings
URL: http://linuxforhealth.org/fhir/cdm/StructureDefinition/savings-type
..... category 1..1CodeableConceptType of adjudication information
Binding: Adjudication Category Value Set (example)
... adjudication 0..*BackboneElementHeader-level adjudication
.... Slices for extension 0..*ExtensionExtension
Slice: Unordered, Open by value:url
.... adjudicationDate 0..1dateDate on which the payment status of the claim was adjudicated
URL: http://linuxforhealth.org/fhir/cdm/StructureDefinition/adjudication-date
... payment
.... Slices for extension 0..*ExtensionExtension
Slice: Unordered, Open by value:url
.... claimAdjustmentType 0..*CodeableConceptThe code for the type of adjustment for the claim
URL: http://linuxforhealth.org/fhir/cdm/StructureDefinition/claim-adjustment-type
Binding: Payer Claim Adjustment Type Value Set (extensible)
.... dispositionReason 0..*CodeableConceptCustomer-specific code for the disposition reason, as related to how the claim was paid
URL: http://linuxforhealth.org/fhir/cdm/StructureDefinition/disposition-reason
.... reimburseType 0..1CodeableConceptMethod of payment code for the claim
URL: http://linuxforhealth.org/fhir/cdm/StructureDefinition/reimburse-type

doco Documentation for this format

Terminology Bindings (Differential)

PathConformanceValueSet
ClaimResponse.identifier.typeextensibleIdentifierTypeValueSet
ClaimResponse.typeextensibleClaimTypeValueSet (a valid code from Payer Claim Type Codes)
ClaimResponse.item.adjudication.categoryexampleAdjudicationCategoryValueSet (a valid code from Adjudication Category Codes)

Key Elements View

NameFlagsCard.TypeDescription & Constraintsdoco
.. ClaimResponse 0..*ClaimResponseResponse to a claim predetermination or preauthorization
... meta 0..1ProcessMetaMetadata about a resource
... implicitRules ?!Σ0..1uriA set of rules under which this content was created
... Slices for extension 0..*ExtensionExtension
Slice: Unordered, Open by value:url
... claimStatus 0..1CodeableConceptCustom code for the claim status
URL: http://linuxforhealth.org/fhir/cdm/StructureDefinition/claim-status
... daysToProcess 0..1integerNumber of days between the date the claim was received and the date the claim was processed
URL: http://linuxforhealth.org/fhir/cdm/StructureDefinition/days-to-process
... modifierExtension ?!0..*ExtensionExtensions that cannot be ignored
... identifier 1..*IdentifierBusiness Identifier for a claim response
.... use ?!Σ0..1codeusual | official | temp | secondary | old (If known)
Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .

.... type Σ0..1CodeableConceptDescription of identifier
Binding: Identifier Type Value Set (extensible)
.... system Σ1..1uriThe namespace for the identifier value
Example General: http://www.acme.com/identifiers/patient
.... value Σ1..1stringThe value that is unique
Example General: 123456
... status ?!Σ1..1codeactive | cancelled | draft | entered-in-error
Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance.

... type Σ1..1CodeableConceptMore granular claim type
Binding: Claim Type Value Set (extensible)
... use Σ1..1codeclaim | preauthorization | predetermination
Binding: Use (required): Claim, preauthorization, predetermination.

... patient Σ1..1Reference(Patient)The recipient of the products and services
... created Σ1..1dateTimeResponse creation date
... insurer Σ1..1Reference(Organization)Party responsible for reimbursement
... outcome Σ1..1codequeued | complete | error | partial
Binding: ClaimProcessingCodes (required): The result of the claim processing.

... adjudication 0..*BackboneElementHeader-level adjudication
.... Slices for extension 0..*ExtensionExtension
Slice: Unordered, Open by value:url
.... adjudicationDate 0..1dateDate on which the payment status of the claim was adjudicated
URL: http://linuxforhealth.org/fhir/cdm/StructureDefinition/adjudication-date
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
.... category 1..1CodeableConceptType of adjudication information
Binding: AdjudicationValueCodes (example): The adjudication codes.


doco Documentation for this format

Terminology Bindings

PathConformanceValueSet
ClaimResponse.identifier.userequiredIdentifierUse
ClaimResponse.identifier.typeextensibleIdentifierTypeValueSet
ClaimResponse.statusrequiredFinancialResourceStatusCodes
ClaimResponse.typeextensibleClaimTypeValueSet (a valid code from Payer Claim Type Codes)
ClaimResponse.userequiredUse
ClaimResponse.outcomerequiredClaimProcessingCodes
ClaimResponse.adjudication.categoryexampleAdjudicationValueCodes

Snapshot View

NameFlagsCard.TypeDescription & Constraintsdoco
.. ClaimResponse 0..*ClaimResponseResponse to a claim predetermination or preauthorization
... id Σ0..1idLogical id of this artifact
... meta 0..1ProcessMetaMetadata about a resource
... implicitRules ?!Σ0..1uriA set of rules under which this content was created
... language 0..1codeLanguage of the resource content
Binding: CommonLanguages (preferred): A human language.

Additional BindingsPurpose
AllLanguagesMax Binding
... text 0..1NarrativeText summary of the resource, for human interpretation
... Slices for extension 0..*ExtensionExtension
Slice: Unordered, Open by value:url
... claimReceivedDate 0..1dateDate the claim was received
URL: http://linuxforhealth.org/fhir/cdm/StructureDefinition/claim-received-date
... claimStatus 0..1CodeableConceptCustom code for the claim status
URL: http://linuxforhealth.org/fhir/cdm/StructureDefinition/claim-status
... daysToProcess 0..1integerNumber of days between the date the claim was received and the date the claim was processed
URL: http://linuxforhealth.org/fhir/cdm/StructureDefinition/days-to-process
... modifierExtension ?!0..*ExtensionExtensions that cannot be ignored
... identifier 1..*IdentifierBusiness Identifier for a claim response
.... id 0..1stringUnique id for inter-element referencing
.... extension 0..*ExtensionAdditional content defined by implementations
Slice: Unordered, Open by value:url
.... use ?!Σ0..1codeusual | official | temp | secondary | old (If known)
Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .

.... type Σ0..1CodeableConceptDescription of identifier
Binding: Identifier Type Value Set (extensible)
.... system Σ1..1uriThe namespace for the identifier value
Example General: http://www.acme.com/identifiers/patient
.... value Σ1..1stringThe value that is unique
Example General: 123456
.... period Σ0..1PeriodTime period when id is/was valid for use
.... assigner Σ0..1Reference(Organization)Organization that issued id (may be just text)
... status ?!Σ1..1codeactive | cancelled | draft | entered-in-error
Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance.

... type Σ1..1CodeableConceptMore granular claim type
Binding: Claim Type Value Set (extensible)
... subType 0..1CodeableConceptMore granular claim type
Binding: ExampleClaimSubTypeCodes (example): A more granular claim typecode.

... use Σ1..1codeclaim | preauthorization | predetermination
Binding: Use (required): Claim, preauthorization, predetermination.

... patient Σ1..1Reference(Patient)The recipient of the products and services
... created Σ1..1dateTimeResponse creation date
... insurer Σ1..1Reference(Organization)Party responsible for reimbursement
... requestor 0..1Reference(Practitioner | PractitionerRole | Organization)Party responsible for the claim
... request Σ0..1Reference(Claim)Id of resource triggering adjudication
... outcome Σ1..1codequeued | complete | error | partial
Binding: ClaimProcessingCodes (required): The result of the claim processing.

... disposition 0..1stringDisposition Message
... preAuthRef 0..1stringPreauthorization reference
... preAuthPeriod 0..1PeriodPreauthorization reference effective period
... payeeType 0..1CodeableConceptParty to be paid any benefits payable
Binding: Claim Payee Type Codes (example): A code for the party to be reimbursed.

... item 0..*BackboneElementAdjudication for claim line items
.... id 0..1stringUnique id for inter-element referencing
.... Slices for extension 0..*ExtensionExtension
Slice: Unordered, Open by value:url
.... claimResponseItemStatus 0..1CodeableConceptThe status of claim payment on claim item
URL: http://linuxforhealth.org/fhir/cdm/StructureDefinition/claim-response-item-status
Binding: Payer Claim Status Codes Value Set (extensible)
.... claimResponseBenefitPlan 0..1Reference(Coverage)The benefit plan that covers the service rendered
URL: http://linuxforhealth.org/fhir/cdm/StructureDefinition/claim-response-benefit-plan
.... copayExclusion 0..1CodeableConceptCustomer-specific code for the exclusion reason of a copayment
URL: http://linuxforhealth.org/fhir/cdm/StructureDefinition/copay-exclusion
.... numberOfUnitsAllowed 0..1integerCustomer-specific quantity of services or units allowed
URL: http://linuxforhealth.org/fhir/cdm/StructureDefinition/number-of-units-allowed
.... reinsuranceMetIndicator 0..1stringIndicator that the reinsurance amount was met
URL: http://linuxforhealth.org/fhir/cdm/StructureDefinition/reinsurance-met-indicator
.... utilizationReview 0..1CodeableConceptCustomer-specific code for the type of utilization review
URL: http://linuxforhealth.org/fhir/cdm/StructureDefinition/utilization-review
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
.... itemSequence 1..1positiveIntClaim item instance identifier
.... noteNumber 0..*positiveIntApplicable note numbers
.... adjudication 1..*BackboneElementAdjudication details
..... id 0..1stringUnique id for inter-element referencing
..... Slices for extension 0..*ExtensionExtension
Slice: Unordered, Open by value:url
..... routingNumberCode 0..1stringCustomer-specific code for the ITS routing number
URL: http://linuxforhealth.org/fhir/cdm/StructureDefinition/routing-number-code
..... savingsType 0..1CodeableConceptCustomer-specific code for the type of third party savings
URL: http://linuxforhealth.org/fhir/cdm/StructureDefinition/savings-type
..... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
..... category 1..1CodeableConceptType of adjudication information
Binding: Adjudication Category Value Set (example)
..... reason 0..1CodeableConceptExplanation of adjudication outcome
Binding: AdjudicationReasonCodes (example): The adjudication reason codes.

..... amount 0..1MoneyMonetary amount
..... value 0..1decimalNon-monetary value
.... detail 0..*BackboneElementAdjudication for claim details
..... id 0..1stringUnique id for inter-element referencing
..... extension 0..*ExtensionAdditional content defined by implementations
..... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
..... detailSequence 1..1positiveIntClaim detail instance identifier
..... noteNumber 0..*positiveIntApplicable note numbers
..... adjudication 1..*See adjudication (ClaimResponse)Detail level adjudication details
..... subDetail 0..*BackboneElementAdjudication for claim sub-details
...... id 0..1stringUnique id for inter-element referencing
...... extension 0..*ExtensionAdditional content defined by implementations
...... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
...... subDetailSequence 1..1positiveIntClaim sub-detail instance identifier
...... noteNumber 0..*positiveIntApplicable note numbers
...... adjudication 0..*See adjudication (ClaimResponse)Subdetail level adjudication details
... addItem 0..*BackboneElementInsurer added line items
.... id 0..1stringUnique id for inter-element referencing
.... extension 0..*ExtensionAdditional content defined by implementations
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
.... itemSequence 0..*positiveIntItem sequence number
.... detailSequence 0..*positiveIntDetail sequence number
.... subdetailSequence 0..*positiveIntSubdetail sequence number
.... provider 0..*Reference(Practitioner | PractitionerRole | Organization)Authorized providers
.... productOrService 1..1CodeableConceptBilling, service, product, or drug code
Binding: USCLSCodes (example): Allowable service and product codes.

.... modifier 0..*CodeableConceptService/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..*CodeableConceptProgram the product or service is provided under
Binding: ExampleProgramReasonCodes (example): Program specific reason codes.


.... serviced[x] 0..1Date or dates of service or product delivery
..... servicedDatedate
..... servicedPeriodPeriod
.... location[x] 0..1Place of service or where product was supplied
Binding: ExampleServicePlaceCodes (example): Place of service: pharmacy, school, prison, etc.

..... locationCodeableConceptCodeableConcept
..... locationAddressAddress
..... locationReferenceReference(Location)
.... quantity 0..1SimpleQuantityCount of products or services
.... unitPrice 0..1MoneyFee, charge or cost per item
.... factor 0..1decimalPrice scaling factor
.... net 0..1MoneyTotal item cost
.... bodySite 0..1CodeableConceptAnatomical location
Binding: OralSiteCodes (example): The code for the teeth, quadrant, sextant and arch.

.... subSite 0..*CodeableConceptAnatomical sub-location
Binding: SurfaceCodes (example): The code for the tooth surface and surface combinations.


.... noteNumber 0..*positiveIntApplicable note numbers
.... adjudication 1..*See adjudication (ClaimResponse)Added items adjudication
.... detail 0..*BackboneElementInsurer added line details
..... id 0..1stringUnique id for inter-element referencing
..... extension 0..*ExtensionAdditional content defined by implementations
..... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
..... productOrService 1..1CodeableConceptBilling, service, product, or drug code
Binding: USCLSCodes (example): Allowable service and product codes.

..... modifier 0..*CodeableConceptService/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..1SimpleQuantityCount of products or services
..... unitPrice 0..1MoneyFee, charge or cost per item
..... factor 0..1decimalPrice scaling factor
..... net 0..1MoneyTotal item cost
..... noteNumber 0..*positiveIntApplicable note numbers
..... adjudication 1..*See adjudication (ClaimResponse)Added items detail adjudication
..... subDetail 0..*BackboneElementInsurer added line items
...... id 0..1stringUnique id for inter-element referencing
...... extension 0..*ExtensionAdditional content defined by implementations
...... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
...... productOrService 1..1CodeableConceptBilling, service, product, or drug code
Binding: USCLSCodes (example): Allowable service and product codes.

...... modifier 0..*CodeableConceptService/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..1SimpleQuantityCount of products or services
...... unitPrice 0..1MoneyFee, charge or cost per item
...... factor 0..1decimalPrice scaling factor
...... net 0..1MoneyTotal item cost
...... noteNumber 0..*positiveIntApplicable note numbers
...... adjudication 1..*See adjudication (ClaimResponse)Added items detail adjudication
... adjudication 0..*BackboneElementHeader-level adjudication
.... id 0..1stringUnique id for inter-element referencing
.... Slices for extension 0..*ExtensionExtension
Slice: Unordered, Open by value:url
.... adjudicationDate 0..1dateDate on which the payment status of the claim was adjudicated
URL: http://linuxforhealth.org/fhir/cdm/StructureDefinition/adjudication-date
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
.... category 1..1CodeableConceptType of adjudication information
Binding: AdjudicationValueCodes (example): The adjudication codes.

.... reason 0..1CodeableConceptExplanation of adjudication outcome
Binding: AdjudicationReasonCodes (example): The adjudication reason codes.

.... amount 0..1MoneyMonetary amount
.... value 0..1decimalNon-monetary value
... total Σ0..*BackboneElementAdjudication totals
.... id 0..1stringUnique id for inter-element referencing
.... extension 0..*ExtensionAdditional content defined by implementations
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
.... category Σ1..1CodeableConceptType of adjudication information
Binding: AdjudicationValueCodes (example): The adjudication codes.

.... amount Σ1..1MoneyFinancial total for the category
... payment 0..1BackboneElementPayment Details
.... id 0..1stringUnique id for inter-element referencing
.... Slices for extension 0..*ExtensionExtension
Slice: Unordered, Open by value:url
.... claimAdjustmentType 0..*CodeableConceptThe code for the type of adjustment for the claim
URL: http://linuxforhealth.org/fhir/cdm/StructureDefinition/claim-adjustment-type
Binding: Payer Claim Adjustment Type Value Set (extensible)
.... dispositionReason 0..*CodeableConceptCustomer-specific code for the disposition reason, as related to how the claim was paid
URL: http://linuxforhealth.org/fhir/cdm/StructureDefinition/disposition-reason
.... reimburseType 0..1CodeableConceptMethod of payment code for the claim
URL: http://linuxforhealth.org/fhir/cdm/StructureDefinition/reimburse-type
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
.... type 1..1CodeableConceptPartial or complete payment
Binding: ExamplePaymentTypeCodes (example): The type (partial, complete) of the payment.

.... adjustment 0..1MoneyPayment adjustment for non-claim issues
.... adjustmentReason 0..1CodeableConceptExplanation for the adjustment
Binding: PaymentAdjustmentReasonCodes (example): Payment Adjustment reason codes.

.... date 0..1dateExpected date of payment
.... amount 1..1MoneyPayable amount after adjustment
.... identifier 0..1IdentifierBusiness identifier for the payment
... fundsReserve 0..1CodeableConceptFunds reserved status
Binding: Funds Reservation Codes (example): For whom funds are to be reserved: (Patient, Provider, None).

... formCode 0..1CodeableConceptPrinted form identifier
Binding: Form Codes (example): The forms codes.

... form 0..1AttachmentPrinted reference or actual form
... processNote 0..*BackboneElementNote concerning adjudication
.... id 0..1stringUnique id for inter-element referencing
.... extension 0..*ExtensionAdditional content defined by implementations
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
.... number 0..1positiveIntNote instance identifier
.... type 0..1codedisplay | print | printoper
Binding: NoteType (required): The presentation types of notes.

.... text 1..1stringNote explanatory text
.... language 0..1CodeableConceptLanguage of the text
Binding: CommonLanguages (preferred): A human language.

Additional BindingsPurpose
AllLanguagesMax Binding
... communicationRequest 0..*Reference(CommunicationRequest)Request for additional information
... insurance 0..*BackboneElementPatient insurance information
.... id 0..1stringUnique id for inter-element referencing
.... extension 0..*ExtensionAdditional content defined by implementations
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
.... sequence 1..1positiveIntInsurance instance identifier
.... focal 1..1booleanCoverage to be used for adjudication
.... coverage 1..1Reference(Coverage)Insurance information
.... businessArrangement 0..1stringAdditional provider contract number
.... claimResponse 0..1Reference(ClaimResponse)Adjudication results
... error 0..*BackboneElementProcessing errors
.... id 0..1stringUnique id for inter-element referencing
.... extension 0..*ExtensionAdditional content defined by implementations
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
.... itemSequence 0..1positiveIntItem sequence number
.... detailSequence 0..1positiveIntDetail sequence number
.... subDetailSequence 0..1positiveIntSubdetail sequence number
.... code 1..1CodeableConceptError code detailing processing issues
Binding: Adjudication Error Codes (example): The adjudication error codes.


doco Documentation for this format

Terminology Bindings

PathConformanceValueSet
ClaimResponse.languagepreferredCommonLanguages
Additional Bindings Purpose
AllLanguages Max Binding
ClaimResponse.identifier.userequiredIdentifierUse
ClaimResponse.identifier.typeextensibleIdentifierTypeValueSet
ClaimResponse.statusrequiredFinancialResourceStatusCodes
ClaimResponse.typeextensibleClaimTypeValueSet (a valid code from Payer Claim Type Codes)
ClaimResponse.subTypeexampleExampleClaimSubTypeCodes
ClaimResponse.userequiredUse
ClaimResponse.outcomerequiredClaimProcessingCodes
ClaimResponse.payeeTypeexampleClaim Payee Type Codes
ClaimResponse.item.adjudication.categoryexampleAdjudicationCategoryValueSet (a valid code from Adjudication Category Codes)
ClaimResponse.item.adjudication.reasonexampleAdjudicationReasonCodes
ClaimResponse.addItem.productOrServiceexampleUSCLSCodes
ClaimResponse.addItem.modifierexampleModifierTypeCodes
ClaimResponse.addItem.programCodeexampleExampleProgramReasonCodes
ClaimResponse.addItem.location[x]exampleExampleServicePlaceCodes
ClaimResponse.addItem.bodySiteexampleOralSiteCodes
ClaimResponse.addItem.subSiteexampleSurfaceCodes
ClaimResponse.addItem.detail.productOrServiceexampleUSCLSCodes
ClaimResponse.addItem.detail.modifierexampleModifierTypeCodes
ClaimResponse.addItem.detail.subDetail.productOrServiceexampleUSCLSCodes
ClaimResponse.addItem.detail.subDetail.modifierexampleModifierTypeCodes
ClaimResponse.adjudication.categoryexampleAdjudicationValueCodes
ClaimResponse.adjudication.reasonexampleAdjudicationReasonCodes
ClaimResponse.total.categoryexampleAdjudicationValueCodes
ClaimResponse.payment.typeexampleExamplePaymentTypeCodes
ClaimResponse.payment.adjustmentReasonexamplePaymentAdjustmentReasonCodes
ClaimResponse.fundsReserveexampleFunds Reservation Codes
ClaimResponse.formCodeexampleForm Codes
ClaimResponse.processNote.typerequiredNoteType
ClaimResponse.processNote.languagepreferredCommonLanguages
Additional Bindings Purpose
AllLanguages Max Binding
ClaimResponse.error.codeexampleAdjudication Error Codes

 

Other representations of profile: CSV, Excel, Schematron