LinuxForHealth FHIR Implementation Guide
8.0.0 - draft
LinuxForHealth FHIR Implementation Guide
8.0.0 - draft
LinuxForHealth FHIR Implementation Guide - Local Development build (v8.0.0). See the Directory of published versions
| 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:
Description of Profiles, Differentials, Snapshots and how the different presentations work.
This structure is derived from ClaimResponse
| Path | Conformance | ValueSet |
| ClaimResponse.identifier.type | extensible | IdentifierTypeValueSet |
| ClaimResponse.type | extensible | ClaimTypeValueSet (a valid code from Payer Claim Type Codes) |
| ClaimResponse.item.adjudication.category | example | AdjudicationCategoryValueSet (a valid code from Adjudication Category Codes) |
| Name | Flags | Card. | Type | Description & Constraints |
|---|---|---|---|---|
  ClaimResponse | 0..* | ClaimResponse | Response to a claim predetermination or preauthorization | |
  meta | 0..1 | ProcessMeta | Metadata about a resource | |
 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 | |
 claimReceivedDate | 0..1 | date | Date the claim was received URL: http://linuxforhealth.org/fhir/cdm/StructureDefinition/claim-received-date | |
| claimStatus | 0..1 | CodeableConcept | Custom code for the claim status URL: http://linuxforhealth.org/fhir/cdm/StructureDefinition/claim-status | |
| daysToProcess | 0..1 | integer | Number 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..* | Extension | Extensions that cannot be ignored |
 identifier | 1..* | Identifier | Business Identifier for a claim response | |
 use | ?!Σ | 0..1 | code | usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known . |
| type | Σ | 0..1 | CodeableConcept | Description of identifier Binding: Identifier Type Value Set (extensible) |
| system | Σ | 1..1 | uri | The namespace for the identifier value Example General: http://www.acme.com/identifiers/patient |
 value | Σ | 1..1 | string | The value that is unique Example General: 123456 |
| 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: Claim Type Value Set (extensible) |
| 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. |
 adjudication | 0..* | BackboneElement | Header-level adjudication | |
 Slices for extension | 0..* | Extension | Extension Slice: Unordered, Open by value:url | |
| adjudicationDate | 0..1 | date | Date on which the payment status of the claim was adjudicated URL: http://linuxforhealth.org/fhir/cdm/StructureDefinition/adjudication-date | |
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
| category | 1..1 | CodeableConcept | Type of adjudication information Binding: AdjudicationValueCodes (example): The adjudication codes. | |
| Documentation for this format | ||||
| Path | Conformance | ValueSet |
| ClaimResponse.identifier.use | required | IdentifierUse |
| ClaimResponse.identifier.type | extensible | IdentifierTypeValueSet |
| ClaimResponse.status | required | FinancialResourceStatusCodes |
| ClaimResponse.type | extensible | ClaimTypeValueSet (a valid code from Payer Claim Type Codes) |
| ClaimResponse.use | required | Use |
| ClaimResponse.outcome | required | ClaimProcessingCodes |
| ClaimResponse.adjudication.category | example | AdjudicationValueCodes |
| Name | Flags | Card. | Type | Description & Constraints | ||||
|---|---|---|---|---|---|---|---|---|
| ClaimResponse | 0..* | ClaimResponse | Response to a claim predetermination or preauthorization | |||||
| id | Σ | 0..1 | id | Logical id of this artifact | ||||
| meta | 0..1 | ProcessMeta | Metadata about a 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.
| |||||
| text | 0..1 | Narrative | Text summary of the resource, for human interpretation | |||||
| Slices for extension | 0..* | Extension | Extension Slice: Unordered, Open by value:url | |||||
| claimReceivedDate | 0..1 | date | Date the claim was received URL: http://linuxforhealth.org/fhir/cdm/StructureDefinition/claim-received-date | |||||
| claimStatus | 0..1 | CodeableConcept | Custom code for the claim status URL: http://linuxforhealth.org/fhir/cdm/StructureDefinition/claim-status | |||||
| daysToProcess | 0..1 | integer | Number 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..* | Extension | Extensions that cannot be ignored | ||||
| identifier | 1..* | Identifier | Business Identifier for a claim response | |||||
| id | 0..1 | string | Unique id for inter-element referencing | |||||
| extension | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | |||||
| use | ?!Σ | 0..1 | code | usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known . | ||||
| type | Σ | 0..1 | CodeableConcept | Description of identifier Binding: Identifier Type Value Set (extensible) | ||||
| system | Σ | 1..1 | uri | The namespace for the identifier value Example General: http://www.acme.com/identifiers/patient | ||||
| value | Σ | 1..1 | string | The value that is unique Example General: 123456 | ||||
| period | Σ | 0..1 | Period | Time period when id is/was valid for use | ||||
| assigner | Σ | 0..1 | Reference(Organization) | Organization that issued id (may be just text) | ||||
| 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: Claim Type Value Set (extensible) | ||||
| 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 | |||||
| claimResponseItemStatus | 0..1 | CodeableConcept | The 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..1 | Reference(Coverage) | The benefit plan that covers the service rendered URL: http://linuxforhealth.org/fhir/cdm/StructureDefinition/claim-response-benefit-plan | |||||
| copayExclusion | 0..1 | CodeableConcept | Customer-specific code for the exclusion reason of a copayment URL: http://linuxforhealth.org/fhir/cdm/StructureDefinition/copay-exclusion | |||||
| numberOfUnitsAllowed | 0..1 | integer | Customer-specific quantity of services or units allowed URL: http://linuxforhealth.org/fhir/cdm/StructureDefinition/number-of-units-allowed | |||||
| reinsuranceMetIndicator | 0..1 | string | Indicator that the reinsurance amount was met URL: http://linuxforhealth.org/fhir/cdm/StructureDefinition/reinsurance-met-indicator | |||||
| utilizationReview | 0..1 | CodeableConcept | Customer-specific code for the type of utilization review URL: http://linuxforhealth.org/fhir/cdm/StructureDefinition/utilization-review | |||||
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
| 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 | |||||
| Slices for extension | 0..* | Extension | Extension Slice: Unordered, Open by value:url | |||||
| routingNumberCode | 0..1 | string | Customer-specific code for the ITS routing number URL: http://linuxforhealth.org/fhir/cdm/StructureDefinition/routing-number-code | |||||
| savingsType | 0..1 | CodeableConcept | Customer-specific code for the type of third party savings URL: http://linuxforhealth.org/fhir/cdm/StructureDefinition/savings-type | |||||
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
| category | 1..1 | CodeableConcept | Type of adjudication information Binding: Adjudication Category Value Set (example) | |||||
| 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 | |||||
| detail | 0..* | BackboneElement | Adjudication for claim details | |||||
| id | 0..1 | string | Unique id for inter-element referencing | |||||
| extension | 0..* | Extension | Additional content defined by implementations | |||||
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
| 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 | |||||
| extension | 0..* | Extension | Additional content defined by implementations | |||||
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
| 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 | |||||
| extension | 0..* | Extension | Additional content defined by implementations | |||||
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
| 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 | 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. | |||||
| 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 | |||||
| extension | 0..* | Extension | Additional content defined by implementations | |||||
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
| 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 | 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 | |||||
| extension | 0..* | Extension | Additional content defined by implementations | |||||
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
| 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 | 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..* | BackboneElement | Header-level adjudication | |||||
| id | 0..1 | string | Unique id for inter-element referencing | |||||
| Slices for extension | 0..* | Extension | Extension Slice: Unordered, Open by value:url | |||||
| adjudicationDate | 0..1 | date | Date on which the payment status of the claim was adjudicated URL: http://linuxforhealth.org/fhir/cdm/StructureDefinition/adjudication-date | |||||
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
| 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 | |||||
| total | Σ | 0..* | BackboneElement | Adjudication totals | ||||
| id | 0..1 | string | Unique id for inter-element referencing | |||||
| extension | 0..* | Extension | Additional content defined by implementations | |||||
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
| 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 | |||||
| Slices for extension | 0..* | Extension | Extension Slice: Unordered, Open by value:url | |||||
| claimAdjustmentType | 0..* | CodeableConcept | The 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..* | CodeableConcept | Customer-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..1 | CodeableConcept | Method of payment code for the claim URL: http://linuxforhealth.org/fhir/cdm/StructureDefinition/reimburse-type | |||||
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
| 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 | |||||
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
| number | 0..1 | positiveInt | Note instance identifier | |||||
| type | 0..1 | code | display | print | printoper Binding: NoteType (required): The presentation types of notes. | |||||
| text | 1..1 | string | Note explanatory text | |||||
| language | 0..1 | CodeableConcept | Language of the text Binding: CommonLanguages (preferred): A human language.
| |||||
| 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 | |||||
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
| 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 | |||||
| extension | 0..* | Extension | Additional content defined by implementations | |||||
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
| 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 | ||||||||
| Path | Conformance | ValueSet | ||||
| ClaimResponse.language | preferred | CommonLanguages
| ||||
| ClaimResponse.identifier.use | required | IdentifierUse | ||||
| ClaimResponse.identifier.type | extensible | IdentifierTypeValueSet | ||||
| ClaimResponse.status | required | FinancialResourceStatusCodes | ||||
| ClaimResponse.type | extensible | ClaimTypeValueSet (a valid code from Payer Claim Type Codes) | ||||
| ClaimResponse.subType | example | ExampleClaimSubTypeCodes | ||||
| ClaimResponse.use | required | Use | ||||
| ClaimResponse.outcome | required | ClaimProcessingCodes | ||||
| ClaimResponse.payeeType | example | Claim Payee Type Codes | ||||
| ClaimResponse.item.adjudication.category | example | AdjudicationCategoryValueSet (a valid code from Adjudication Category Codes) | ||||
| ClaimResponse.item.adjudication.reason | example | AdjudicationReasonCodes | ||||
| ClaimResponse.addItem.productOrService | example | USCLSCodes | ||||
| ClaimResponse.addItem.modifier | example | ModifierTypeCodes | ||||
| ClaimResponse.addItem.programCode | example | ExampleProgramReasonCodes | ||||
| ClaimResponse.addItem.location[x] | example | ExampleServicePlaceCodes | ||||
| ClaimResponse.addItem.bodySite | example | OralSiteCodes | ||||
| ClaimResponse.addItem.subSite | example | SurfaceCodes | ||||
| ClaimResponse.addItem.detail.productOrService | example | USCLSCodes | ||||
| ClaimResponse.addItem.detail.modifier | example | ModifierTypeCodes | ||||
| ClaimResponse.addItem.detail.subDetail.productOrService | example | USCLSCodes | ||||
| ClaimResponse.addItem.detail.subDetail.modifier | example | ModifierTypeCodes | ||||
| ClaimResponse.adjudication.category | example | AdjudicationValueCodes | ||||
| ClaimResponse.adjudication.reason | example | AdjudicationReasonCodes | ||||
| ClaimResponse.total.category | example | AdjudicationValueCodes | ||||
| ClaimResponse.payment.type | example | ExamplePaymentTypeCodes | ||||
| ClaimResponse.payment.adjustmentReason | example | PaymentAdjustmentReasonCodes | ||||
| ClaimResponse.fundsReserve | example | Funds Reservation Codes | ||||
| ClaimResponse.formCode | example | Form Codes | ||||
| ClaimResponse.processNote.type | required | NoteType | ||||
| ClaimResponse.processNote.language | preferred | CommonLanguages
| ||||
| ClaimResponse.error.code | example | Adjudication Error Codes |
This structure is derived from ClaimResponse
Summary
Mandatory: 3 elements
Prohibited: 1 element
Structures
This structure refers to these other structures:
Extensions
This structure refers to these extensions:
Differential View
This structure is derived from ClaimResponse
| Path | Conformance | ValueSet |
| ClaimResponse.identifier.type | extensible | IdentifierTypeValueSet |
| ClaimResponse.type | extensible | ClaimTypeValueSet (a valid code from Payer Claim Type Codes) |
| ClaimResponse.item.adjudication.category | example | AdjudicationCategoryValueSet (a valid code from Adjudication Category Codes) |
Key Elements View
| Name | Flags | Card. | Type | Description & Constraints |
|---|---|---|---|---|
| ClaimResponse | 0..* | ClaimResponse | Response to a claim predetermination or preauthorization | |
| meta | 0..1 | ProcessMeta | Metadata about a resource | |
| 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 | |
| claimReceivedDate | 0..1 | date | Date the claim was received URL: http://linuxforhealth.org/fhir/cdm/StructureDefinition/claim-received-date | |
| claimStatus | 0..1 | CodeableConcept | Custom code for the claim status URL: http://linuxforhealth.org/fhir/cdm/StructureDefinition/claim-status | |
| daysToProcess | 0..1 | integer | Number 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..* | Extension | Extensions that cannot be ignored |
| identifier | 1..* | Identifier | Business Identifier for a claim response | |
| use | ?!Σ | 0..1 | code | usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known . |
| type | Σ | 0..1 | CodeableConcept | Description of identifier Binding: Identifier Type Value Set (extensible) |
| system | Σ | 1..1 | uri | The namespace for the identifier value Example General: http://www.acme.com/identifiers/patient |
| value | Σ | 1..1 | string | The value that is unique Example General: 123456 |
| 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: Claim Type Value Set (extensible) |
| 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. |
| adjudication | 0..* | BackboneElement | Header-level adjudication | |
| Slices for extension | 0..* | Extension | Extension Slice: Unordered, Open by value:url | |
| adjudicationDate | 0..1 | date | Date on which the payment status of the claim was adjudicated URL: http://linuxforhealth.org/fhir/cdm/StructureDefinition/adjudication-date | |
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
| category | 1..1 | CodeableConcept | Type of adjudication information Binding: AdjudicationValueCodes (example): The adjudication codes. | |
| Documentation for this format | ||||
| Path | Conformance | ValueSet |
| ClaimResponse.identifier.use | required | IdentifierUse |
| ClaimResponse.identifier.type | extensible | IdentifierTypeValueSet |
| ClaimResponse.status | required | FinancialResourceStatusCodes |
| ClaimResponse.type | extensible | ClaimTypeValueSet (a valid code from Payer Claim Type Codes) |
| ClaimResponse.use | required | Use |
| ClaimResponse.outcome | required | ClaimProcessingCodes |
| ClaimResponse.adjudication.category | example | AdjudicationValueCodes |
Snapshot View
| Name | Flags | Card. | Type | Description & Constraints | ||||
|---|---|---|---|---|---|---|---|---|
| ClaimResponse | 0..* | ClaimResponse | Response to a claim predetermination or preauthorization | |||||
| id | Σ | 0..1 | id | Logical id of this artifact | ||||
| meta | 0..1 | ProcessMeta | Metadata about a 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.
| |||||
| text | 0..1 | Narrative | Text summary of the resource, for human interpretation | |||||
| Slices for extension | 0..* | Extension | Extension Slice: Unordered, Open by value:url | |||||
| claimReceivedDate | 0..1 | date | Date the claim was received URL: http://linuxforhealth.org/fhir/cdm/StructureDefinition/claim-received-date | |||||
| claimStatus | 0..1 | CodeableConcept | Custom code for the claim status URL: http://linuxforhealth.org/fhir/cdm/StructureDefinition/claim-status | |||||
| daysToProcess | 0..1 | integer | Number 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..* | Extension | Extensions that cannot be ignored | ||||
| identifier | 1..* | Identifier | Business Identifier for a claim response | |||||
| id | 0..1 | string | Unique id for inter-element referencing | |||||
| extension | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | |||||
| use | ?!Σ | 0..1 | code | usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known . | ||||
| type | Σ | 0..1 | CodeableConcept | Description of identifier Binding: Identifier Type Value Set (extensible) | ||||
| system | Σ | 1..1 | uri | The namespace for the identifier value Example General: http://www.acme.com/identifiers/patient | ||||
| value | Σ | 1..1 | string | The value that is unique Example General: 123456 | ||||
| period | Σ | 0..1 | Period | Time period when id is/was valid for use | ||||
| assigner | Σ | 0..1 | Reference(Organization) | Organization that issued id (may be just text) | ||||
| 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: Claim Type Value Set (extensible) | ||||
| 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 | |||||
| claimResponseItemStatus | 0..1 | CodeableConcept | The 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..1 | Reference(Coverage) | The benefit plan that covers the service rendered URL: http://linuxforhealth.org/fhir/cdm/StructureDefinition/claim-response-benefit-plan | |||||
| copayExclusion | 0..1 | CodeableConcept | Customer-specific code for the exclusion reason of a copayment URL: http://linuxforhealth.org/fhir/cdm/StructureDefinition/copay-exclusion | |||||
| numberOfUnitsAllowed | 0..1 | integer | Customer-specific quantity of services or units allowed URL: http://linuxforhealth.org/fhir/cdm/StructureDefinition/number-of-units-allowed | |||||
| reinsuranceMetIndicator | 0..1 | string | Indicator that the reinsurance amount was met URL: http://linuxforhealth.org/fhir/cdm/StructureDefinition/reinsurance-met-indicator | |||||
| utilizationReview | 0..1 | CodeableConcept | Customer-specific code for the type of utilization review URL: http://linuxforhealth.org/fhir/cdm/StructureDefinition/utilization-review | |||||
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
| 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 | |||||
| Slices for extension | 0..* | Extension | Extension Slice: Unordered, Open by value:url | |||||
| routingNumberCode | 0..1 | string | Customer-specific code for the ITS routing number URL: http://linuxforhealth.org/fhir/cdm/StructureDefinition/routing-number-code | |||||
| savingsType | 0..1 | CodeableConcept | Customer-specific code for the type of third party savings URL: http://linuxforhealth.org/fhir/cdm/StructureDefinition/savings-type | |||||
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
| category | 1..1 | CodeableConcept | Type of adjudication information Binding: Adjudication Category Value Set (example) | |||||
| 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 | |||||
| detail | 0..* | BackboneElement | Adjudication for claim details | |||||
| id | 0..1 | string | Unique id for inter-element referencing | |||||
| extension | 0..* | Extension | Additional content defined by implementations | |||||
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
| 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 | |||||
| extension | 0..* | Extension | Additional content defined by implementations | |||||
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
| 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 | |||||
| extension | 0..* | Extension | Additional content defined by implementations | |||||
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
| 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 | 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. | |||||
| 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 | |||||
| extension | 0..* | Extension | Additional content defined by implementations | |||||
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
| 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 | 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 | |||||
| extension | 0..* | Extension | Additional content defined by implementations | |||||
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
| 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 | 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..* | BackboneElement | Header-level adjudication | |||||
| id | 0..1 | string | Unique id for inter-element referencing | |||||
| Slices for extension | 0..* | Extension | Extension Slice: Unordered, Open by value:url | |||||
| adjudicationDate | 0..1 | date | Date on which the payment status of the claim was adjudicated URL: http://linuxforhealth.org/fhir/cdm/StructureDefinition/adjudication-date | |||||
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
| 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 | |||||
| total | Σ | 0..* | BackboneElement | Adjudication totals | ||||
| id | 0..1 | string | Unique id for inter-element referencing | |||||
| extension | 0..* | Extension | Additional content defined by implementations | |||||
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
| 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 | |||||
| Slices for extension | 0..* | Extension | Extension Slice: Unordered, Open by value:url | |||||
| claimAdjustmentType | 0..* | CodeableConcept | The 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..* | CodeableConcept | Customer-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..1 | CodeableConcept | Method of payment code for the claim URL: http://linuxforhealth.org/fhir/cdm/StructureDefinition/reimburse-type | |||||
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
| 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 | |||||
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
| number | 0..1 | positiveInt | Note instance identifier | |||||
| type | 0..1 | code | display | print | printoper Binding: NoteType (required): The presentation types of notes. | |||||
| text | 1..1 | string | Note explanatory text | |||||
| language | 0..1 | CodeableConcept | Language of the text Binding: CommonLanguages (preferred): A human language.
| |||||
| 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 | |||||
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
| 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 | |||||
| extension | 0..* | Extension | Additional content defined by implementations | |||||
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
| 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 | ||||||||
| Path | Conformance | ValueSet | ||||
| ClaimResponse.language | preferred | CommonLanguages
| ||||
| ClaimResponse.identifier.use | required | IdentifierUse | ||||
| ClaimResponse.identifier.type | extensible | IdentifierTypeValueSet | ||||
| ClaimResponse.status | required | FinancialResourceStatusCodes | ||||
| ClaimResponse.type | extensible | ClaimTypeValueSet (a valid code from Payer Claim Type Codes) | ||||
| ClaimResponse.subType | example | ExampleClaimSubTypeCodes | ||||
| ClaimResponse.use | required | Use | ||||
| ClaimResponse.outcome | required | ClaimProcessingCodes | ||||
| ClaimResponse.payeeType | example | Claim Payee Type Codes | ||||
| ClaimResponse.item.adjudication.category | example | AdjudicationCategoryValueSet (a valid code from Adjudication Category Codes) | ||||
| ClaimResponse.item.adjudication.reason | example | AdjudicationReasonCodes | ||||
| ClaimResponse.addItem.productOrService | example | USCLSCodes | ||||
| ClaimResponse.addItem.modifier | example | ModifierTypeCodes | ||||
| ClaimResponse.addItem.programCode | example | ExampleProgramReasonCodes | ||||
| ClaimResponse.addItem.location[x] | example | ExampleServicePlaceCodes | ||||
| ClaimResponse.addItem.bodySite | example | OralSiteCodes | ||||
| ClaimResponse.addItem.subSite | example | SurfaceCodes | ||||
| ClaimResponse.addItem.detail.productOrService | example | USCLSCodes | ||||
| ClaimResponse.addItem.detail.modifier | example | ModifierTypeCodes | ||||
| ClaimResponse.addItem.detail.subDetail.productOrService | example | USCLSCodes | ||||
| ClaimResponse.addItem.detail.subDetail.modifier | example | ModifierTypeCodes | ||||
| ClaimResponse.adjudication.category | example | AdjudicationValueCodes | ||||
| ClaimResponse.adjudication.reason | example | AdjudicationReasonCodes | ||||
| ClaimResponse.total.category | example | AdjudicationValueCodes | ||||
| ClaimResponse.payment.type | example | ExamplePaymentTypeCodes | ||||
| ClaimResponse.payment.adjustmentReason | example | PaymentAdjustmentReasonCodes | ||||
| ClaimResponse.fundsReserve | example | Funds Reservation Codes | ||||
| ClaimResponse.formCode | example | Form Codes | ||||
| ClaimResponse.processNote.type | required | NoteType | ||||
| ClaimResponse.processNote.language | preferred | CommonLanguages
| ||||
| ClaimResponse.error.code | example | Adjudication Error Codes |
This structure is derived from ClaimResponse
Summary
Mandatory: 3 elements
Prohibited: 1 element
Structures
This structure refers to these other structures:
Extensions
This structure refers to these extensions:
Other representations of profile: CSV, Excel, Schematron