Resource StructureDefinition/FHIR Server from package eng.fhir.profile.dev#0.0.7-beta (312 ms)
Resources that use this resource
Resources that this resource uses
Source
{
"resourceType" : "StructureDefinition",
"url" : "https://eng.it/fhir/StructureDefinition/ClaimResponse_WBS_Eng",
"name" : "ClaimResponse_WBS_Eng",
"status" : "draft",
"date" : "2023-01-11T11:44:39.6739431+00:00",
"fhirVersion" : "4.0.1",
"kind" : "resource",
"abstract" : false,
"type" : "ClaimResponse",
"baseDefinition" : "http://hl7.org/fhir/StructureDefinition/ClaimResponse",
"derivation" : "constraint",
"snapshot" : {
"element" : [
{
"id" : "ClaimResponse",
"path" : "ClaimResponse",
"short" : "Response to a claim predetermination or preauthorization",
"definition" : "This resource provides the adjudication details from the processing of a Claim resource.",
"alias" : [
"Remittance Advice"
],
"min" : 0,
"max" : "*",
"base" : {
"path" : "ClaimResponse",
"min" : 0,
"max" : "*"
},
"constraint" : [
{
"key" : "dom-2",
"severity" : "error",
"human" : "If the resource is contained in another resource, it SHALL NOT contain nested Resources",
"expression" : "contained.contained.empty()",
"xpath" : "not(parent::f:contained and f:contained)",
"source" : "http://hl7.org/fhir/StructureDefinition/DomainResource"
},
{
"key" : "dom-4",
"severity" : "error",
"human" : "If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated",
"expression" : "contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()",
"xpath" : "not(exists(f:contained/*/f:meta/f:versionId)) and not(exists(f:contained/*/f:meta/f:lastUpdated))",
"source" : "http://hl7.org/fhir/StructureDefinition/DomainResource"
},
{
"key" : "dom-3",
"severity" : "error",
"human" : "If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource",
"expression" : "contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()",
"xpath" : "not(exists(for $id in f:contained/*/f:id/@value return $contained[not(parent::*/descendant::f:reference/@value=concat('#', $contained/*/id/@value) or descendant::f:reference[@value='#'])]))",
"source" : "http://hl7.org/fhir/StructureDefinition/DomainResource"
},
{
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-bestpractice",
"valueBoolean" : true
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-bestpractice-explanation",
"valueMarkdown" : "When a resource has no narrative, only systems that fully understand the data can display the resource to a human safely. Including a human readable representation in the resource makes for a much more robust eco-system and cheaper handling of resources by intermediary systems. Some ecosystems restrict distribution of resources to only those systems that do fully understand the resources, and as a consequence implementers may believe that the narrative is superfluous. However experience shows that such eco-systems often open up to new participants over time."
}
],
"key" : "dom-6",
"severity" : "warning",
"human" : "A resource should have narrative for robust management",
"expression" : "text.`div`.exists()",
"xpath" : "exists(f:text/h:div)",
"source" : "http://hl7.org/fhir/StructureDefinition/DomainResource"
},
{
"key" : "dom-5",
"severity" : "error",
"human" : "If a resource is contained in another resource, it SHALL NOT have a security label",
"expression" : "contained.meta.security.empty()",
"xpath" : "not(exists(f:contained/*/f:meta/f:security))",
"source" : "http://hl7.org/fhir/StructureDefinition/DomainResource"
}
],
"mapping" : [
{
"identity" : "rim",
"map" : "Entity. Role, or Act"
},
{
"identity" : "workflow",
"map" : "Event"
}
]
},
{
"id" : "ClaimResponse.id",
"path" : "ClaimResponse.id",
"short" : "Logical id of this artifact",
"definition" : "The logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes.",
"comment" : "The only time that a resource does not have an id is when it is being submitted to the server using a create operation.",
"min" : 0,
"max" : "1",
"base" : {
"path" : "Resource.id",
"min" : 0,
"max" : "1"
},
"type" : [
{
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type",
"valueUrl" : "string"
}
],
"code" : "http://hl7.org/fhirpath/System.String"
}
],
"isSummary" : true
},
{
"id" : "ClaimResponse.meta",
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status",
"valueCode" : "normative"
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-normative-version",
"valueCode" : "4.0.0"
}
],
"path" : "ClaimResponse.meta",
"short" : "Metadata about the resource",
"definition" : "The metadata about the resource. This is content that is maintained by the infrastructure. Changes to the content might not always be associated with version changes to the resource.",
"min" : 0,
"max" : "1",
"base" : {
"path" : "Resource.meta",
"min" : 0,
"max" : "1"
},
"type" : [
{
"code" : "Meta"
}
],
"condition" : [
"ele-1"
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"isSummary" : true,
"mapping" : [
{
"identity" : "rim",
"map" : "n/a"
},
{
"identity" : "rim",
"map" : "N/A"
}
]
},
{
"id" : "ClaimResponse.implicitRules",
"path" : "ClaimResponse.implicitRules",
"short" : "A set of rules under which this content was created",
"definition" : "A reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content. Often, this is a reference to an implementation guide that defines the special rules along with other profiles etc.",
"comment" : "Asserting this rule set restricts the content to be only understood by a limited set of trading partners. This inherently limits the usefulness of the data in the long term. However, the existing health eco-system is highly fractured, and not yet ready to define, collect, and exchange data in a generally computable sense. Wherever possible, implementers and/or specification writers should avoid using this element. Often, when used, the URL is a reference to an implementation guide that defines these special rules as part of it's narrative along with other profiles, value sets, etc.",
"min" : 0,
"max" : "1",
"base" : {
"path" : "Resource.implicitRules",
"min" : 0,
"max" : "1"
},
"type" : [
{
"code" : "uri"
}
],
"condition" : [
"ele-1"
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"isModifier" : true,
"isModifierReason" : "This element is labeled as a modifier because the implicit rules may provide additional knowledge about the resource that modifies it's meaning or interpretation",
"isSummary" : true,
"mapping" : [
{
"identity" : "rim",
"map" : "n/a"
}
]
},
{
"id" : "ClaimResponse.language",
"path" : "ClaimResponse.language",
"short" : "Language of the resource content",
"definition" : "The base language in which the resource is written.",
"comment" : "Language is provided to support indexing and accessibility (typically, services such as text to speech use the language tag). The html language tag in the narrative applies to the narrative. The language tag on the resource may be used to specify the language of other presentations generated from the data in the resource. Not all the content has to be in the base language. The Resource.language should not be assumed to apply to the narrative automatically. If a language is specified, it should it also be specified on the div element in the html (see rules in HTML5 for information about the relationship between xml:lang and the html lang attribute).",
"min" : 0,
"max" : "1",
"base" : {
"path" : "Resource.language",
"min" : 0,
"max" : "1"
},
"type" : [
{
"code" : "code"
}
],
"condition" : [
"ele-1"
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"binding" : {
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-maxValueSet",
"valueCanonical" : "http://hl7.org/fhir/ValueSet/all-languages"
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString" : "Language"
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-isCommonBinding",
"valueBoolean" : true
}
],
"strength" : "preferred",
"description" : "A human language.",
"valueSet" : "http://hl7.org/fhir/ValueSet/languages"
},
"mapping" : [
{
"identity" : "rim",
"map" : "n/a"
}
]
},
{
"id" : "ClaimResponse.text",
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status",
"valueCode" : "normative"
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-normative-version",
"valueCode" : "4.0.0"
}
],
"path" : "ClaimResponse.text",
"short" : "Text summary of the resource, for human interpretation",
"definition" : "A human-readable narrative that contains a summary of the resource and can be used to represent the content of the resource to a human. The narrative need not encode all the structured data, but is required to contain sufficient detail to make it \"clinically safe\" for a human to just read the narrative. Resource definitions may define what content should be represented in the narrative to ensure clinical safety.",
"comment" : "Contained resources do not have narrative. Resources that are not contained SHOULD have a narrative. In some cases, a resource may only have text with little or no additional discrete data (as long as all minOccurs=1 elements are satisfied). This may be necessary for data from legacy systems where information is captured as a \"text blob\" or where text is additionally entered raw or narrated and encoded information is added later.",
"alias" : [
"narrative",
"html",
"xhtml",
"display"
],
"min" : 0,
"max" : "1",
"base" : {
"path" : "DomainResource.text",
"min" : 0,
"max" : "1"
},
"type" : [
{
"code" : "Narrative"
}
],
"condition" : [
"ele-1"
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"mapping" : [
{
"identity" : "rim",
"map" : "n/a"
},
{
"identity" : "rim",
"map" : "N/A"
},
{
"identity" : "rim",
"map" : "Act.text?"
}
]
},
{
"id" : "ClaimResponse.contained",
"path" : "ClaimResponse.contained",
"short" : "Contained, inline Resources",
"definition" : "These resources do not have an independent existence apart from the resource that contains them - they cannot be identified independently, and nor can they have their own independent transaction scope.",
"comment" : "This should never be done when the content can be identified properly, as once identification is lost, it is extremely difficult (and context dependent) to restore it again. Contained resources may have profiles and tags In their meta elements, but SHALL NOT have security labels.",
"alias" : [
"inline resources",
"anonymous resources",
"contained resources"
],
"min" : 0,
"max" : "*",
"base" : {
"path" : "DomainResource.contained",
"min" : 0,
"max" : "*"
},
"type" : [
{
"code" : "Resource"
}
],
"mapping" : [
{
"identity" : "rim",
"map" : "Entity. Role, or Act"
},
{
"identity" : "rim",
"map" : "N/A"
}
]
},
{
"id" : "ClaimResponse.extension",
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status",
"valueCode" : "normative"
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-normative-version",
"valueCode" : "4.0.0"
}
],
"path" : "ClaimResponse.extension",
"slicing" : {
"discriminator" : [
{
"type" : "value",
"path" : "url"
}
],
"description" : "Extensions are always sliced by (at least) url",
"rules" : "open"
},
"short" : "Additional content defined by implementations",
"definition" : "May be used to represent additional information that is not part of the basic definition of the resource. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.",
"comment" : "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.",
"alias" : [
"extensions",
"user content"
],
"min" : 0,
"max" : "*",
"base" : {
"path" : "DomainResource.extension",
"min" : 0,
"max" : "*"
},
"type" : [
{
"code" : "Extension"
}
],
"condition" : [
"ele-1"
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
},
{
"key" : "ext-1",
"severity" : "error",
"human" : "Must have either extensions or value[x], not both",
"expression" : "extension.exists() != value.exists()",
"xpath" : "exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])",
"source" : "http://hl7.org/fhir/StructureDefinition/Extension"
}
],
"mapping" : [
{
"identity" : "rim",
"map" : "n/a"
},
{
"identity" : "rim",
"map" : "N/A"
}
]
},
{
"id" : "ClaimResponse.modifierExtension",
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status",
"valueCode" : "normative"
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-normative-version",
"valueCode" : "4.0.0"
}
],
"path" : "ClaimResponse.modifierExtension",
"slicing" : {
"discriminator" : [
{
"type" : "value",
"path" : "url"
}
],
"description" : "Extensions are always sliced by (at least) url",
"rules" : "open"
},
"short" : "Extensions that cannot be ignored",
"definition" : "May be used to represent additional information that is not part of the basic definition of the resource and that modifies the understanding of the element that contains it and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.\n\nModifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).",
"comment" : "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.",
"requirements" : "Modifier extensions allow for extensions that *cannot* be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the [definition of modifier extensions](extensibility.html#modifierExtension).",
"alias" : [
"extensions",
"user content"
],
"min" : 0,
"max" : "*",
"base" : {
"path" : "DomainResource.modifierExtension",
"min" : 0,
"max" : "*"
},
"type" : [
{
"code" : "Extension"
}
],
"condition" : [
"ele-1"
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
},
{
"key" : "ext-1",
"severity" : "error",
"human" : "Must have either extensions or value[x], not both",
"expression" : "extension.exists() != value.exists()",
"xpath" : "exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])",
"source" : "http://hl7.org/fhir/StructureDefinition/Extension"
}
],
"isModifier" : true,
"isModifierReason" : "Modifier extensions are expected to modify the meaning or interpretation of the resource that contains them",
"mapping" : [
{
"identity" : "rim",
"map" : "n/a"
},
{
"identity" : "rim",
"map" : "N/A"
}
]
},
{
"id" : "ClaimResponse.identifier",
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status",
"valueCode" : "normative"
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-normative-version",
"valueCode" : "4.0.0"
}
],
"path" : "ClaimResponse.identifier",
"short" : "Business Identifier for a claim response",
"definition" : "A unique identifier assigned to this claim response.",
"requirements" : "Allows claim responses to be distinguished and referenced.",
"min" : 0,
"max" : "*",
"base" : {
"path" : "ClaimResponse.identifier",
"min" : 0,
"max" : "*"
},
"type" : [
{
"code" : "Identifier"
}
],
"condition" : [
"ele-1"
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"mapping" : [
{
"identity" : "rim",
"map" : "n/a"
},
{
"identity" : "v2",
"map" : "CX / EI (occasionally, more often EI maps to a resource id or a URL)"
},
{
"identity" : "rim",
"map" : "II - The Identifier class is a little looser than the v3 type II because it allows URIs as well as registered OIDs or GUIDs. Also maps to Role[classCode=IDENT]"
},
{
"identity" : "servd",
"map" : "Identifier"
},
{
"identity" : "workflow",
"map" : "Event.identifier"
},
{
"identity" : "w5",
"map" : "FiveWs.identifier"
}
]
},
{
"id" : "ClaimResponse.status",
"path" : "ClaimResponse.status",
"short" : "active | cancelled | draft | entered-in-error",
"definition" : "Elemento che contiene lo stato della risposta.",
"comment" : "Questo elemento è etichettato come modificatore perché lo stato contiene codici che contrassegnano la risorsa come non valida al momento.",
"requirements" : "Need to track the status of the resource as 'draft' resources may undergo further edits while 'active' resources are immutable and may only have their status changed to 'cancelled'.",
"min" : 1,
"max" : "1",
"base" : {
"path" : "ClaimResponse.status",
"min" : 1,
"max" : "1"
},
"type" : [
{
"code" : "code"
}
],
"condition" : [
"ele-1"
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"isModifier" : true,
"isModifierReason" : "This element is labeled as a modifier because it is a status element that contains status entered-in-error which means that the resource should not be treated as valid",
"isSummary" : true,
"binding" : {
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString" : "ClaimResponseStatus"
}
],
"strength" : "required",
"description" : "A code specifying the state of the resource instance.",
"valueSet" : "http://hl7.org/fhir/ValueSet/fm-status|4.0.1"
},
"mapping" : [
{
"identity" : "rim",
"map" : "n/a"
},
{
"identity" : "workflow",
"map" : "Event.status"
},
{
"identity" : "w5",
"map" : "FiveWs.status"
}
]
},
{
"id" : "ClaimResponse.type",
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status",
"valueCode" : "normative"
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-normative-version",
"valueCode" : "4.0.0"
}
],
"path" : "ClaimResponse.type",
"short" : "Tipo di richiesta di risarcimento più granulare",
"definition" : "Elemento che definisce il tipo di risposta.",
"comment" : "Può contenere i codici del tipo di fattura locale, ad esempio il codice del tipo di fattura US UB-04 o il tipo di fattura CMS.",
"requirements" : "Some jurisdictions need a finer grained claim type for routing and adjudication.",
"min" : 1,
"max" : "1",
"base" : {
"path" : "ClaimResponse.type",
"min" : 1,
"max" : "1"
},
"type" : [
{
"code" : "CodeableConcept"
}
],
"condition" : [
"ele-1"
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"isSummary" : true,
"binding" : {
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString" : "ClaimType"
}
],
"strength" : "extensible",
"description" : "The type or discipline-style of the claim.",
"valueSet" : "http://hl7.org/fhir/ValueSet/claim-type"
},
"mapping" : [
{
"identity" : "rim",
"map" : "n/a"
},
{
"identity" : "v2",
"map" : "CE/CNE/CWE"
},
{
"identity" : "rim",
"map" : "CD"
},
{
"identity" : "orim",
"map" : "fhir:CodeableConcept rdfs:subClassOf dt:CD"
},
{
"identity" : "w5",
"map" : "FiveWs.class"
}
]
},
{
"id" : "ClaimResponse.type.id",
"path" : "ClaimResponse.type.id",
"representation" : [
"xmlAttr"
],
"short" : "Unique id for inter-element referencing",
"definition" : "Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.",
"min" : 0,
"max" : "1",
"base" : {
"path" : "Element.id",
"min" : 0,
"max" : "1"
},
"type" : [
{
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type",
"valueUrl" : "string"
}
],
"code" : "http://hl7.org/fhirpath/System.String"
}
],
"mapping" : [
{
"identity" : "rim",
"map" : "n/a"
}
]
},
{
"id" : "ClaimResponse.type.extension",
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status",
"valueCode" : "normative"
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-normative-version",
"valueCode" : "4.0.0"
}
],
"path" : "ClaimResponse.type.extension",
"slicing" : {
"discriminator" : [
{
"type" : "value",
"path" : "url"
}
],
"description" : "Extensions are always sliced by (at least) url",
"rules" : "open"
},
"short" : "Additional content defined by implementations",
"definition" : "May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.",
"comment" : "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.",
"alias" : [
"extensions",
"user content"
],
"min" : 0,
"max" : "*",
"base" : {
"path" : "Element.extension",
"min" : 0,
"max" : "*"
},
"type" : [
{
"code" : "Extension"
}
],
"condition" : [
"ele-1"
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
},
{
"key" : "ext-1",
"severity" : "error",
"human" : "Must have either extensions or value[x], not both",
"expression" : "extension.exists() != value.exists()",
"xpath" : "exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])",
"source" : "http://hl7.org/fhir/StructureDefinition/Extension"
}
],
"mapping" : [
{
"identity" : "rim",
"map" : "n/a"
},
{
"identity" : "rim",
"map" : "N/A"
}
]
},
{
"id" : "ClaimResponse.type.coding",
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status",
"valueCode" : "normative"
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-normative-version",
"valueCode" : "4.0.0"
}
],
"path" : "ClaimResponse.type.coding",
"short" : "Codice definito da un sistema terminologico",
"definition" : "Un riferimento a un codice definito da un sistema terminologico.",
"comment" : "I codici possono essere definiti in modo molto casuale in enumerazioni o elenchi di codici, fino a definizioni molto formali come SNOMED CT - si vedano i Core Principles HL7 v3 per maggiori informazioni. L'ordine dei codici non è definito e NON DEVE essere usato per dedurre il significato. In generale, al massimo uno solo dei valori di codifica sarà etichettato come UserSelected = true.",
"requirements" : "Allows for alternative encodings within a code system, and translations to other code systems.",
"min" : 0,
"max" : "*",
"base" : {
"path" : "CodeableConcept.coding",
"min" : 0,
"max" : "*"
},
"type" : [
{
"code" : "Coding"
}
],
"condition" : [
"ele-1"
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"isSummary" : true,
"mapping" : [
{
"identity" : "rim",
"map" : "n/a"
},
{
"identity" : "v2",
"map" : "CE/CNE/CWE subset one of the sets of component 1-3 or 4-6"
},
{
"identity" : "rim",
"map" : "CV"
},
{
"identity" : "orim",
"map" : "fhir:Coding rdfs:subClassOf dt:CDCoding"
},
{
"identity" : "v2",
"map" : "C*E.1-8, C*E.10-22"
},
{
"identity" : "rim",
"map" : "union(., ./translation)"
},
{
"identity" : "orim",
"map" : "fhir:CodeableConcept.coding rdfs:subPropertyOf dt:CD.coding"
}
]
},
{
"id" : "ClaimResponse.type.coding.id",
"path" : "ClaimResponse.type.coding.id",
"representation" : [
"xmlAttr"
],
"short" : "Unique id for inter-element referencing",
"definition" : "Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.",
"min" : 0,
"max" : "1",
"base" : {
"path" : "Element.id",
"min" : 0,
"max" : "1"
},
"type" : [
{
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type",
"valueUrl" : "string"
}
],
"code" : "http://hl7.org/fhirpath/System.String"
}
],
"mapping" : [
{
"identity" : "rim",
"map" : "n/a"
}
]
},
{
"id" : "ClaimResponse.type.coding.extension",
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status",
"valueCode" : "normative"
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-normative-version",
"valueCode" : "4.0.0"
}
],
"path" : "ClaimResponse.type.coding.extension",
"slicing" : {
"discriminator" : [
{
"type" : "value",
"path" : "url"
}
],
"description" : "Extensions are always sliced by (at least) url",
"rules" : "open"
},
"short" : "Additional content defined by implementations",
"definition" : "May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.",
"comment" : "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.",
"alias" : [
"extensions",
"user content"
],
"min" : 0,
"max" : "*",
"base" : {
"path" : "Element.extension",
"min" : 0,
"max" : "*"
},
"type" : [
{
"code" : "Extension"
}
],
"condition" : [
"ele-1"
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
},
{
"key" : "ext-1",
"severity" : "error",
"human" : "Must have either extensions or value[x], not both",
"expression" : "extension.exists() != value.exists()",
"xpath" : "exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])",
"source" : "http://hl7.org/fhir/StructureDefinition/Extension"
}
],
"mapping" : [
{
"identity" : "rim",
"map" : "n/a"
},
{
"identity" : "rim",
"map" : "N/A"
}
]
},
{
"id" : "ClaimResponse.type.coding.system",
"path" : "ClaimResponse.type.coding.system",
"short" : "Identità del sistema terminologico",
"definition" : "L'identificazione del sistema di codice che definisce il significato del simbolo nel codice.",
"comment" : "L'URI può essere un OID (urn:oid:...) o un UUID (urn:uuid:...). Gli OID e gli UUID DEVONO essere riferimenti al registro OID di HL7. Altrimenti, l'URI deve provenire dall'elenco di URI speciali definiti da HL7 per FHIR o deve fare riferimento a qualche definizione che stabilisca il sistema in modo chiaro e non ambiguo.",
"requirements" : "Need to be unambiguous about the source of the definition of the symbol.",
"min" : 0,
"max" : "1",
"base" : {
"path" : "Coding.system",
"min" : 0,
"max" : "1"
},
"type" : [
{
"code" : "uri"
}
],
"fixedUri" : "http://terminology.hl7.org/CodeSystem/claim-type",
"condition" : [
"ele-1"
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"isSummary" : true,
"mapping" : [
{
"identity" : "rim",
"map" : "n/a"
},
{
"identity" : "v2",
"map" : "C*E.3"
},
{
"identity" : "rim",
"map" : "./codeSystem"
},
{
"identity" : "orim",
"map" : "fhir:Coding.system rdfs:subPropertyOf dt:CDCoding.codeSystem"
}
]
},
{
"id" : "ClaimResponse.type.coding.version",
"path" : "ClaimResponse.type.coding.version",
"short" : "Version of the system - if relevant",
"definition" : "The version of the code system which was used when choosing this code. Note that a well-maintained code system does not need the version reported, because the meaning of codes is consistent across versions. However this cannot consistently be assured, and when the meaning is not guaranteed to be consistent, the version SHOULD be exchanged.",
"comment" : "Where the terminology does not clearly define what string should be used to identify code system versions, the recommendation is to use the date (expressed in FHIR date format) on which that version was officially published as the version date.",
"min" : 0,
"max" : "1",
"base" : {
"path" : "Coding.version",
"min" : 0,
"max" : "1"
},
"type" : [
{
"code" : "string"
}
],
"condition" : [
"ele-1"
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"isSummary" : true,
"mapping" : [
{
"identity" : "rim",
"map" : "n/a"
},
{
"identity" : "v2",
"map" : "C*E.7"
},
{
"identity" : "rim",
"map" : "./codeSystemVersion"
},
{
"identity" : "orim",
"map" : "fhir:Coding.version rdfs:subPropertyOf dt:CDCoding.codeSystemVersion"
}
]
},
{
"id" : "ClaimResponse.type.coding.code",
"path" : "ClaimResponse.type.coding.code",
"short" : "Simbolo nella sintassi definita dal sistema",
"definition" : "Un simbolo nella sintassi definita dal sistema. Il simbolo può essere un codice predefinito o un'espressione in una sintassi definita dal sistema di codifica (ad esempio, post-coordinazione).",
"comment" : "Si noti che le stringhe FHIR NON devono superare la dimensione di 1MB.",
"requirements" : "Need to refer to a particular code in the system.",
"min" : 0,
"max" : "1",
"base" : {
"path" : "Coding.code",
"min" : 0,
"max" : "1"
},
"type" : [
{
"code" : "code"
}
],
"condition" : [
"ele-1"
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"isSummary" : true,
"mapping" : [
{
"identity" : "rim",
"map" : "n/a"
},
{
"identity" : "v2",
"map" : "C*E.1"
},
{
"identity" : "rim",
"map" : "./code"
},
{
"identity" : "orim",
"map" : "fhir:Coding.code rdfs:subPropertyOf dt:CDCoding.code"
}
]
},
{
"id" : "ClaimResponse.type.coding.display",
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-translatable",
"valueBoolean" : true
}
],
"path" : "ClaimResponse.type.coding.display",
"short" : "Representation defined by the system",
"definition" : "A representation of the meaning of the code in the system, following the rules of the system.",
"comment" : "Note that FHIR strings SHALL NOT exceed 1MB in size",
"requirements" : "Need to be able to carry a human-readable meaning of the code for readers that do not know the system.",
"min" : 0,
"max" : "1",
"base" : {
"path" : "Coding.display",
"min" : 0,
"max" : "1"
},
"type" : [
{
"code" : "string"
}
],
"condition" : [
"ele-1"
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"isSummary" : true,
"mapping" : [
{
"identity" : "rim",
"map" : "n/a"
},
{
"identity" : "v2",
"map" : "C*E.2 - but note this is not well followed"
},
{
"identity" : "rim",
"map" : "CV.displayName"
},
{
"identity" : "orim",
"map" : "fhir:Coding.display rdfs:subPropertyOf dt:CDCoding.displayName"
}
]
},
{
"id" : "ClaimResponse.type.coding.userSelected",
"path" : "ClaimResponse.type.coding.userSelected",
"short" : "If this coding was chosen directly by the user",
"definition" : "Indicates that this coding was chosen by a user directly - e.g. off a pick list of available items (codes or displays).",
"comment" : "Amongst a set of alternatives, a directly chosen code is the most appropriate starting point for new translations. There is some ambiguity about what exactly 'directly chosen' implies, and trading partner agreement may be needed to clarify the use of this element and its consequences more completely.",
"requirements" : "This has been identified as a clinical safety criterium - that this exact system/code pair was chosen explicitly, rather than inferred by the system based on some rules or language processing.",
"min" : 0,
"max" : "1",
"base" : {
"path" : "Coding.userSelected",
"min" : 0,
"max" : "1"
},
"type" : [
{
"code" : "boolean"
}
],
"condition" : [
"ele-1"
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"isSummary" : true,
"mapping" : [
{
"identity" : "rim",
"map" : "n/a"
},
{
"identity" : "v2",
"map" : "Sometimes implied by being first"
},
{
"identity" : "rim",
"map" : "CD.codingRationale"
},
{
"identity" : "orim",
"map" : "fhir:Coding.userSelected fhir:mapsTo dt:CDCoding.codingRationale. fhir:Coding.userSelected fhir:hasMap fhir:Coding.userSelected.map. fhir:Coding.userSelected.map a fhir:Map; fhir:target dt:CDCoding.codingRationale. fhir:Coding.userSelected\\#true a [ fhir:source \"true\"; fhir:target dt:CDCoding.codingRationale\\#O ]"
}
]
},
{
"id" : "ClaimResponse.type.text",
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-translatable",
"valueBoolean" : true
}
],
"path" : "ClaimResponse.type.text",
"short" : "Plain text representation of the concept",
"definition" : "A human language representation of the concept as seen/selected/uttered by the user who entered the data and/or which represents the intended meaning of the user.",
"comment" : "Very often the text is the same as a displayName of one of the codings.",
"requirements" : "The codes from the terminologies do not always capture the correct meaning with all the nuances of the human using them, or sometimes there is no appropriate code at all. In these cases, the text is used to capture the full meaning of the source.",
"min" : 0,
"max" : "1",
"base" : {
"path" : "CodeableConcept.text",
"min" : 0,
"max" : "1"
},
"type" : [
{
"code" : "string"
}
],
"condition" : [
"ele-1"
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"isSummary" : true,
"mapping" : [
{
"identity" : "rim",
"map" : "n/a"
},
{
"identity" : "v2",
"map" : "C*E.9. But note many systems use C*E.2 for this"
},
{
"identity" : "rim",
"map" : "./originalText[mediaType/code=\"text/plain\"]/data"
},
{
"identity" : "orim",
"map" : "fhir:CodeableConcept.text rdfs:subPropertyOf dt:CD.originalText"
}
]
},
{
"id" : "ClaimResponse.subType",
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status",
"valueCode" : "normative"
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-normative-version",
"valueCode" : "4.0.0"
}
],
"path" : "ClaimResponse.subType",
"short" : "More granular claim type",
"definition" : "A finer grained suite of claim type codes which may convey additional information such as Inpatient vs Outpatient and/or a specialty service.",
"comment" : "This may contain the local bill type codes, for example the US UB-04 bill type code or the CMS bill type.",
"requirements" : "Some jurisdictions need a finer grained claim type for routing and adjudication.",
"min" : 0,
"max" : "1",
"base" : {
"path" : "ClaimResponse.subType",
"min" : 0,
"max" : "1"
},
"type" : [
{
"code" : "CodeableConcept"
}
],
"condition" : [
"ele-1"
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"binding" : {
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString" : "ClaimSubType"
}
],
"strength" : "example",
"description" : "A more granular claim typecode.",
"valueSet" : "http://hl7.org/fhir/ValueSet/claim-subtype"
},
"mapping" : [
{
"identity" : "rim",
"map" : "n/a"
},
{
"identity" : "v2",
"map" : "CE/CNE/CWE"
},
{
"identity" : "rim",
"map" : "CD"
},
{
"identity" : "orim",
"map" : "fhir:CodeableConcept rdfs:subClassOf dt:CD"
},
{
"identity" : "w5",
"map" : "FiveWs.class"
}
]
},
{
"id" : "ClaimResponse.use",
"path" : "ClaimResponse.use",
"short" : "claim | preauthorization | predetermination",
"definition" : "Elemento di tipo code che contiene un codice per indicare se la natura della richiesta è: \r\n\r\n* richiedere l'aggiudicazione di prodotti e servizi precedentemente resi; \r\n\r\n* o richiedere l'autorizzazione e l'aggiudicazione per la fornitura in futuro; \r\n\r\n* o richiedere l'aggiudicazione non vincolante dei prodotti e servizi elencati che potrebbero essere forniti in futuro.",
"comment" : "Si noti che le stringhe FHIR NON devono superare la dimensione di 1MB.",
"requirements" : "This element is required to understand the nature of the request for adjudication.",
"min" : 1,
"max" : "1",
"base" : {
"path" : "ClaimResponse.use",
"min" : 1,
"max" : "1"
},
"type" : [
{
"code" : "code"
}
],
"condition" : [
"ele-1"
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"isSummary" : true,
"binding" : {
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString" : "Use"
}
],
"strength" : "required",
"description" : "Claim, preauthorization, predetermination.",
"valueSet" : "http://hl7.org/fhir/ValueSet/claim-use|4.0.1"
},
"mapping" : [
{
"identity" : "rim",
"map" : "n/a"
},
{
"identity" : "w5",
"map" : "FiveWs.class"
}
]
},
{
"id" : "ClaimResponse.patient",
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status",
"valueCode" : "normative"
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-normative-version",
"valueCode" : "4.0.0"
}
],
"path" : "ClaimResponse.patient",
"short" : "Reference a Patient",
"definition" : "Riferimento al Patient che riceve la prestazione.",
"comment" : "I riferimenti DEVONO essere un riferimento a una risorsa FHIR effettiva e DEVONO essere risolvibili (consentendo il controllo dell'accesso, la non disponibilità temporanea, ecc.) La risoluzione può avvenire tramite recupero dall'URL o, se applicabile per tipo di risorsa, trattando un riferimento assoluto come un URL canonico e cercandolo in un registro/repository locale.",
"requirements" : "The patient must be supplied to the insurer so that confirmation of coverage and service hstory may be considered as part of the authorization and/or adjudiction.",
"min" : 1,
"max" : "1",
"base" : {
"path" : "ClaimResponse.patient",
"min" : 1,
"max" : "1"
},
"type" : [
{
"code" : "Reference",
"targetProfile" : [
"https://eng.it/fhir/StructureDefinition/Patient_Eng"
]
}
],
"condition" : [
"ele-1"
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
},
{
"key" : "ref-1",
"severity" : "error",
"human" : "SHALL have a contained resource if a local reference is provided",
"expression" : "reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))",
"xpath" : "not(starts-with(f:reference/@value, '#')) or exists(ancestor::*[self::f:entry or self::f:parameter]/f:resource/f:*/f:contained/f:*[f:id/@value=substring-after(current()/f:reference/@value, '#')]|/*/f:contained/f:*[f:id/@value=substring-after(current()/f:reference/@value, '#')])",
"source" : "http://hl7.org/fhir/StructureDefinition/Reference"
}
],
"isSummary" : true,
"mapping" : [
{
"identity" : "rim",
"map" : "n/a"
},
{
"identity" : "rim",
"map" : "The target of a resource reference is a RIM entry point (Act, Role, or Entity)"
},
{
"identity" : "w5",
"map" : "FiveWs.subject[x]"
},
{
"identity" : "w5",
"map" : "FiveWs.subject"
}
]
},
{
"id" : "ClaimResponse.created",
"path" : "ClaimResponse.created",
"short" : "Data di creazione della risposta.",
"definition" : "Data di creazione della risposta.",
"requirements" : "Need to record a timestamp for use by both the recipient and the issuer.",
"min" : 1,
"max" : "1",
"base" : {
"path" : "ClaimResponse.created",
"min" : 1,
"max" : "1"
},
"type" : [
{
"code" : "dateTime"
}
],
"condition" : [
"ele-1"
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"isSummary" : true,
"mapping" : [
{
"identity" : "rim",
"map" : "n/a"
},
{
"identity" : "workflow",
"map" : "Event.occurrence[x]"
},
{
"identity" : "w5",
"map" : "FiveWs.recorded"
}
]
},
{
"id" : "ClaimResponse.insurer",
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status",
"valueCode" : "normative"
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-normative-version",
"valueCode" : "4.0.0"
}
],
"path" : "ClaimResponse.insurer",
"short" : "Reference ad Organization",
"definition" : "Elemento di tipo Reference contenente la risorsa Organization che indica il responsabile del rimborso.",
"comment" : "I riferimenti DEVONO essere un riferimento a una risorsa FHIR effettiva e DEVONO essere risolvibili (consentendo il controllo dell'accesso, la non disponibilità temporanea, ecc.) La risoluzione può avvenire tramite recupero dall'URL o, se applicabile per tipo di risorsa, trattando un riferimento assoluto come un URL canonico e cercandolo in un registro/repository locale.",
"requirements" : "To be a valid claim, preauthorization or predetermination there must be a party who is responsible for adjudicating the contents against a policy which provides benefits for the patient.",
"min" : 1,
"max" : "1",
"base" : {
"path" : "ClaimResponse.insurer",
"min" : 1,
"max" : "1"
},
"type" : [
{
"code" : "Reference",
"targetProfile" : [
"https://eng.it/fhir/StructureDefinition/Organization_Eng"
]
}
],
"condition" : [
"ele-1"
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
},
{
"key" : "ref-1",
"severity" : "error",
"human" : "SHALL have a contained resource if a local reference is provided",
"expression" : "reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))",
"xpath" : "not(starts-with(f:reference/@value, '#')) or exists(ancestor::*[self::f:entry or self::f:parameter]/f:resource/f:*/f:contained/f:*[f:id/@value=substring-after(current()/f:reference/@value, '#')]|/*/f:contained/f:*[f:id/@value=substring-after(current()/f:reference/@value, '#')])",
"source" : "http://hl7.org/fhir/StructureDefinition/Reference"
}
],
"isSummary" : true,
"mapping" : [
{
"identity" : "rim",
"map" : "n/a"
},
{
"identity" : "rim",
"map" : "The target of a resource reference is a RIM entry point (Act, Role, or Entity)"
},
{
"identity" : "workflow",
"map" : "Event.performer"
}
]
},
{
"id" : "ClaimResponse.requestor",
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status",
"valueCode" : "normative"
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-normative-version",
"valueCode" : "4.0.0"
}
],
"path" : "ClaimResponse.requestor",
"short" : "Party responsible for the claim",
"definition" : "The provider which is responsible for the claim, predetermination or preauthorization.",
"comment" : "Typically this field would be 1..1 where this party is responsible for the claim but not necessarily professionally responsible for the provision of the individual products and services listed below.",
"min" : 0,
"max" : "1",
"base" : {
"path" : "ClaimResponse.requestor",
"min" : 0,
"max" : "1"
},
"type" : [
{
"code" : "Reference",
"targetProfile" : [
"http://hl7.org/fhir/StructureDefinition/Practitioner",
"http://hl7.org/fhir/StructureDefinition/PractitionerRole",
"http://hl7.org/fhir/StructureDefinition/Organization"
]
}
],
"condition" : [
"ele-1"
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
},
{
"key" : "ref-1",
"severity" : "error",
"human" : "SHALL have a contained resource if a local reference is provided",
"expression" : "reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))",
"xpath" : "not(starts-with(f:reference/@value, '#')) or exists(ancestor::*[self::f:entry or self::f:parameter]/f:resource/f:*/f:contained/f:*[f:id/@value=substring-after(current()/f:reference/@value, '#')]|/*/f:contained/f:*[f:id/@value=substring-after(current()/f:reference/@value, '#')])",
"source" : "http://hl7.org/fhir/StructureDefinition/Reference"
}
],
"mapping" : [
{
"identity" : "rim",
"map" : "n/a"
},
{
"identity" : "rim",
"map" : "The target of a resource reference is a RIM entry point (Act, Role, or Entity)"
},
{
"identity" : "w5",
"map" : "FiveWs.source"
}
]
},
{
"id" : "ClaimResponse.request",
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status",
"valueCode" : "normative"
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-normative-version",
"valueCode" : "4.0.0"
}
],
"path" : "ClaimResponse.request",
"short" : "Id of resource triggering adjudication",
"definition" : "Original request resource reference.",
"comment" : "References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.",
"min" : 0,
"max" : "1",
"base" : {
"path" : "ClaimResponse.request",
"min" : 0,
"max" : "1"
},
"type" : [
{
"code" : "Reference",
"targetProfile" : [
"http://hl7.org/fhir/StructureDefinition/Claim"
]
}
],
"condition" : [
"ele-1"
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
},
{
"key" : "ref-1",
"severity" : "error",
"human" : "SHALL have a contained resource if a local reference is provided",
"expression" : "reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))",
"xpath" : "not(starts-with(f:reference/@value, '#')) or exists(ancestor::*[self::f:entry or self::f:parameter]/f:resource/f:*/f:contained/f:*[f:id/@value=substring-after(current()/f:reference/@value, '#')]|/*/f:contained/f:*[f:id/@value=substring-after(current()/f:reference/@value, '#')])",
"source" : "http://hl7.org/fhir/StructureDefinition/Reference"
}
],
"isSummary" : true,
"mapping" : [
{
"identity" : "rim",
"map" : "n/a"
},
{
"identity" : "rim",
"map" : "The target of a resource reference is a RIM entry point (Act, Role, or Entity)"
},
{
"identity" : "workflow",
"map" : "Event.basedOn"
},
{
"identity" : "w5",
"map" : "FiveWs.why[x]"
}
]
},
{
"id" : "ClaimResponse.outcome",
"path" : "ClaimResponse.outcome",
"short" : "queued | complete | error | partial",
"definition" : "Elemento di tipo code che contiene l'esito dell'elaborazione della richiesta, della predeterminazione o della preautorizzazione.",
"comment" : "Utilizzare:\r\n\r\n* \"complete\" in caso di esito positivo, \r\n\r\n* \"error\" in caso di esito negativo.",
"requirements" : "To advise the requestor of an overall processing outcome.",
"min" : 1,
"max" : "1",
"base" : {
"path" : "ClaimResponse.outcome",
"min" : 1,
"max" : "1"
},
"type" : [
{
"code" : "code"
}
],
"condition" : [
"ele-1"
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"isSummary" : true,
"binding" : {
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString" : "RemittanceOutcome"
}
],
"strength" : "required",
"description" : "The result of the claim processing.",
"valueSet" : "http://hl7.org/fhir/ValueSet/remittance-outcome|4.0.1"
},
"mapping" : [
{
"identity" : "rim",
"map" : "n/a"
}
]
},
{
"id" : "ClaimResponse.disposition",
"path" : "ClaimResponse.disposition",
"short" : "Disposition Message",
"definition" : "A human readable description of the status of the adjudication.",
"comment" : "Note that FHIR strings SHALL NOT exceed 1MB in size",
"requirements" : "Provided for user display.",
"min" : 0,
"max" : "1",
"base" : {
"path" : "ClaimResponse.disposition",
"min" : 0,
"max" : "1"
},
"type" : [
{
"code" : "string"
}
],
"condition" : [
"ele-1"
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"mapping" : [
{
"identity" : "rim",
"map" : "n/a"
},
{
"identity" : "workflow",
"map" : "Event.note"
}
]
},
{
"id" : "ClaimResponse.preAuthRef",
"path" : "ClaimResponse.preAuthRef",
"short" : "Preauthorization reference",
"definition" : "Reference from the Insurer which is used in later communications which refers to this adjudication.",
"comment" : "This value is only present on preauthorization adjudications.",
"requirements" : "On subsequent claims, the insurer may require the provider to quote this value.",
"min" : 0,
"max" : "1",
"base" : {
"path" : "ClaimResponse.preAuthRef",
"min" : 0,
"max" : "1"
},
"type" : [
{
"code" : "string"
}
],
"condition" : [
"ele-1"
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"mapping" : [
{
"identity" : "rim",
"map" : "n/a"
}
]
},
{
"id" : "ClaimResponse.preAuthPeriod",
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status",
"valueCode" : "normative"
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-normative-version",
"valueCode" : "4.0.0"
}
],
"path" : "ClaimResponse.preAuthPeriod",
"short" : "Preauthorization reference effective period",
"definition" : "The time frame during which this authorization is effective.",
"comment" : "A Period specifies a range of time; the context of use will specify whether the entire range applies (e.g. \"the patient was an inpatient of the hospital for this time range\") or one value from the range applies (e.g. \"give to the patient between these two times\").\n\nPeriod is not used for a duration (a measure of elapsed time). See [Duration](datatypes.html#Duration).",
"requirements" : "To convey to the provider when the authorized products and services must be supplied for the authorized adjudication to apply.",
"min" : 0,
"max" : "1",
"base" : {
"path" : "ClaimResponse.preAuthPeriod",
"min" : 0,
"max" : "1"
},
"type" : [
{
"code" : "Period"
}
],
"condition" : [
"ele-1"
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
},
{
"key" : "per-1",
"severity" : "error",
"human" : "If present, start SHALL have a lower value than end",
"expression" : "start.hasValue().not() or end.hasValue().not() or (start <= end)",
"xpath" : "not(exists(f:start/@value)) or not(exists(f:end/@value)) or (xs:dateTime(f:start/@value) <= xs:dateTime(f:end/@value))",
"source" : "http://hl7.org/fhir/StructureDefinition/Period"
}
],
"mapping" : [
{
"identity" : "rim",
"map" : "n/a"
},
{
"identity" : "v2",
"map" : "DR"
},
{
"identity" : "rim",
"map" : "IVL<TS>[lowClosed=\"true\" and highClosed=\"true\"] or URG<TS>[lowClosed=\"true\" and highClosed=\"true\"]"
}
]
},
{
"id" : "ClaimResponse.payeeType",
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status",
"valueCode" : "normative"
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-normative-version",
"valueCode" : "4.0.0"
}
],
"path" : "ClaimResponse.payeeType",
"short" : "Party to be paid any benefits payable",
"definition" : "Type of Party to be reimbursed: subscriber, provider, other.",
"comment" : "Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination.",
"requirements" : "Need to know who should receive payment with the most common situations being the Provider (assignment of benefits) or the Subscriber.",
"min" : 0,
"max" : "1",
"base" : {
"path" : "ClaimResponse.payeeType",
"min" : 0,
"max" : "1"
},
"type" : [
{
"code" : "CodeableConcept"
}
],
"condition" : [
"ele-1"
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"binding" : {
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString" : "PayeeType"
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-isCommonBinding",
"valueBoolean" : true
}
],
"strength" : "example",
"description" : "A code for the party to be reimbursed.",
"valueSet" : "http://hl7.org/fhir/ValueSet/payeetype"
},
"mapping" : [
{
"identity" : "rim",
"map" : "n/a"
},
{
"identity" : "v2",
"map" : "CE/CNE/CWE"
},
{
"identity" : "rim",
"map" : "CD"
},
{
"identity" : "orim",
"map" : "fhir:CodeableConcept rdfs:subClassOf dt:CD"
}
]
},
{
"id" : "ClaimResponse.item",
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status",
"valueCode" : "normative"
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-normative-version",
"valueCode" : "4.0.0"
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-explicit-type-name",
"valueString" : "Item"
}
],
"path" : "ClaimResponse.item",
"short" : "Adjudication for claim line items",
"definition" : "A claim line. Either a simple (a product or service) or a 'group' of details which can also be a simple items or groups of sub-details.",
"requirements" : "The adjudication for items provided on the claim.",
"min" : 0,
"max" : "*",
"base" : {
"path" : "ClaimResponse.item",
"min" : 0,
"max" : "*"
},
"type" : [
{
"code" : "BackboneElement"
}
],
"condition" : [
"ele-1"
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"mapping" : [
{
"identity" : "rim",
"map" : "n/a"
}
]
},
{
"id" : "ClaimResponse.item.id",
"path" : "ClaimResponse.item.id",
"representation" : [
"xmlAttr"
],
"short" : "Unique id for inter-element referencing",
"definition" : "Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.",
"min" : 0,
"max" : "1",
"base" : {
"path" : "Element.id",
"min" : 0,
"max" : "1"
},
"type" : [
{
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type",
"valueUrl" : "string"
}
],
"code" : "http://hl7.org/fhirpath/System.String"
}
],
"mapping" : [
{
"identity" : "rim",
"map" : "n/a"
}
]
},
{
"id" : "ClaimResponse.item.extension",
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status",
"valueCode" : "normative"
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-normative-version",
"valueCode" : "4.0.0"
}
],
"path" : "ClaimResponse.item.extension",
"slicing" : {
"discriminator" : [
{
"type" : "value",
"path" : "url"
}
],
"description" : "Extensions are always sliced by (at least) url",
"rules" : "open"
},
"short" : "Additional content defined by implementations",
"definition" : "May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.",
"comment" : "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.",
"alias" : [
"extensions",
"user content"
],
"min" : 0,
"max" : "*",
"base" : {
"path" : "Element.extension",
"min" : 0,
"max" : "*"
},
"type" : [
{
"code" : "Extension"
}
],
"condition" : [
"ele-1"
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
},
{
"key" : "ext-1",
"severity" : "error",
"human" : "Must have either extensions or value[x], not both",
"expression" : "extension.exists() != value.exists()",
"xpath" : "exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])",
"source" : "http://hl7.org/fhir/StructureDefinition/Extension"
}
],
"mapping" : [
{
"identity" : "rim",
"map" : "n/a"
},
{
"identity" : "rim",
"map" : "N/A"
}
]
},
{
"id" : "ClaimResponse.item.modifierExtension",
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status",
"valueCode" : "normative"
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-normative-version",
"valueCode" : "4.0.0"
}
],
"path" : "ClaimResponse.item.modifierExtension",
"short" : "Extensions that cannot be ignored even if unrecognized",
"definition" : "May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.\n\nModifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).",
"comment" : "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.",
"requirements" : "Modifier extensions allow for extensions that *cannot* be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the [definition of modifier extensions](extensibility.html#modifierExtension).",
"alias" : [
"extensions",
"user content",
"modifiers"
],
"min" : 0,
"max" : "*",
"base" : {
"path" : "BackboneElement.modifierExtension",
"min" : 0,
"max" : "*"
},
"type" : [
{
"code" : "Extension"
}
],
"condition" : [
"ele-1"
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
},
{
"key" : "ext-1",
"severity" : "error",
"human" : "Must have either extensions or value[x], not both",
"expression" : "extension.exists() != value.exists()",
"xpath" : "exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])",
"source" : "http://hl7.org/fhir/StructureDefinition/Extension"
}
],
"isModifier" : true,
"isModifierReason" : "Modifier extensions are expected to modify the meaning or interpretation of the element that contains them",
"isSummary" : true,
"mapping" : [
{
"identity" : "rim",
"map" : "n/a"
},
{
"identity" : "rim",
"map" : "N/A"
}
]
},
{
"id" : "ClaimResponse.item.itemSequence",
"path" : "ClaimResponse.item.itemSequence",
"short" : "Claim item instance identifier",
"definition" : "A number to uniquely reference the claim item entries.",
"comment" : "32 bit number; for values larger than this, use decimal",
"requirements" : "Necessary to provide a mechanism to link the adjudication result to the submitted claim item.",
"min" : 1,
"max" : "1",
"base" : {
"path" : "ClaimResponse.item.itemSequence",
"min" : 1,
"max" : "1"
},
"type" : [
{
"code" : "positiveInt"
}
],
"condition" : [
"ele-1"
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"mapping" : [
{
"identity" : "rim",
"map" : "n/a"
}
]
},
{
"id" : "ClaimResponse.item.noteNumber",
"path" : "ClaimResponse.item.noteNumber",
"short" : "Applicable note numbers",
"definition" : "The numbers associated with notes below which apply to the adjudication of this item.",
"comment" : "32 bit number; for values larger than this, use decimal",
"requirements" : "Provides a condensed manner for associating human readable descriptive explanations for adjudications on the line item.",
"min" : 0,
"max" : "*",
"base" : {
"path" : "ClaimResponse.item.noteNumber",
"min" : 0,
"max" : "*"
},
"type" : [
{
"code" : "positiveInt"
}
],
"condition" : [
"ele-1"
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"mapping" : [
{
"identity" : "rim",
"map" : "n/a"
}
]
},
{
"id" : "ClaimResponse.item.adjudication",
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status",
"valueCode" : "normative"
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-normative-version",
"valueCode" : "4.0.0"
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-explicit-type-name",
"valueString" : "Adjudication"
}
],
"path" : "ClaimResponse.item.adjudication",
"short" : "Adjudication details",
"definition" : "If this item is a group then the values here are a summary of the adjudication of the detail items. If this item is a simple product or service then this is the result of the adjudication of this item.",
"requirements" : "The adjudication results conveys the insurer's assessment of the item provided in the claim under the terms of the patient's insurance coverage.",
"min" : 1,
"max" : "*",
"base" : {
"path" : "ClaimResponse.item.adjudication",
"min" : 1,
"max" : "*"
},
"type" : [
{
"code" : "BackboneElement"
}
],
"condition" : [
"ele-1"
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"mapping" : [
{
"identity" : "rim",
"map" : "n/a"
}
]
},
{
"id" : "ClaimResponse.item.adjudication.id",
"path" : "ClaimResponse.item.adjudication.id",
"representation" : [
"xmlAttr"
],
"short" : "Unique id for inter-element referencing",
"definition" : "Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.",
"min" : 0,
"max" : "1",
"base" : {
"path" : "Element.id",
"min" : 0,
"max" : "1"
},
"type" : [
{
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type",
"valueUrl" : "string"
}
],
"code" : "http://hl7.org/fhirpath/System.String"
}
],
"mapping" : [
{
"identity" : "rim",
"map" : "n/a"
}
]
},
{
"id" : "ClaimResponse.item.adjudication.extension",
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status",
"valueCode" : "normative"
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-normative-version",
"valueCode" : "4.0.0"
}
],
"path" : "ClaimResponse.item.adjudication.extension",
"slicing" : {
"discriminator" : [
{
"type" : "value",
"path" : "url"
}
],
"description" : "Extensions are always sliced by (at least) url",
"rules" : "open"
},
"short" : "Additional content defined by implementations",
"definition" : "May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.",
"comment" : "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.",
"alias" : [
"extensions",
"user content"
],
"min" : 0,
"max" : "*",
"base" : {
"path" : "Element.extension",
"min" : 0,
"max" : "*"
},
"type" : [
{
"code" : "Extension"
}
],
"condition" : [
"ele-1"
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
},
{
"key" : "ext-1",
"severity" : "error",
"human" : "Must have either extensions or value[x], not both",
"expression" : "extension.exists() != value.exists()",
"xpath" : "exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])",
"source" : "http://hl7.org/fhir/StructureDefinition/Extension"
}
],
"mapping" : [
{
"identity" : "rim",
"map" : "n/a"
},
{
"identity" : "rim",
"map" : "N/A"
}
]
},
{
"id" : "ClaimResponse.item.adjudication.modifierExtension",
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status",
"valueCode" : "normative"
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-normative-version",
"valueCode" : "4.0.0"
}
],
"path" : "ClaimResponse.item.adjudication.modifierExtension",
"short" : "Extensions that cannot be ignored even if unrecognized",
"definition" : "May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.\n\nModifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).",
"comment" : "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.",
"requirements" : "Modifier extensions allow for extensions that *cannot* be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the [definition of modifier extensions](extensibility.html#modifierExtension).",
"alias" : [
"extensions",
"user content",
"modifiers"
],
"min" : 0,
"max" : "*",
"base" : {
"path" : "BackboneElement.modifierExtension",
"min" : 0,
"max" : "*"
},
"type" : [
{
"code" : "Extension"
}
],
"condition" : [
"ele-1"
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
},
{
"key" : "ext-1",
"severity" : "error",
"human" : "Must have either extensions or value[x], not both",
"expression" : "extension.exists() != value.exists()",
"xpath" : "exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])",
"source" : "http://hl7.org/fhir/StructureDefinition/Extension"
}
],
"isModifier" : true,
"isModifierReason" : "Modifier extensions are expected to modify the meaning or interpretation of the element that contains them",
"isSummary" : true,
"mapping" : [
{
"identity" : "rim",
"map" : "n/a"
},
{
"identity" : "rim",
"map" : "N/A"
}
]
},
{
"id" : "ClaimResponse.item.adjudication.category",
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status",
"valueCode" : "normative"
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-normative-version",
"valueCode" : "4.0.0"
}
],
"path" : "ClaimResponse.item.adjudication.category",
"short" : "Type of adjudication information",
"definition" : "A code to indicate the information type of this adjudication record. Information types may include the value submitted, maximum values or percentages allowed or payable under the plan, amounts that: the patient is responsible for in aggregate or pertaining to this item; amounts paid by other coverages; and, the benefit payable for this item.",
"comment" : "For example codes indicating: Co-Pay, deductible, eligible, benefit, tax, etc.",
"requirements" : "Needed to enable understanding of the context of the other information in the adjudication.",
"min" : 1,
"max" : "1",
"base" : {
"path" : "ClaimResponse.item.adjudication.category",
"min" : 1,
"max" : "1"
},
"type" : [
{
"code" : "CodeableConcept"
}
],
"condition" : [
"ele-1"
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"binding" : {
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString" : "Adjudication"
}
],
"strength" : "example",
"description" : "The adjudication codes.",
"valueSet" : "http://hl7.org/fhir/ValueSet/adjudication"
},
"mapping" : [
{
"identity" : "rim",
"map" : "n/a"
},
{
"identity" : "v2",
"map" : "CE/CNE/CWE"
},
{
"identity" : "rim",
"map" : "CD"
},
{
"identity" : "orim",
"map" : "fhir:CodeableConcept rdfs:subClassOf dt:CD"
}
]
},
{
"id" : "ClaimResponse.item.adjudication.reason",
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status",
"valueCode" : "normative"
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-normative-version",
"valueCode" : "4.0.0"
}
],
"path" : "ClaimResponse.item.adjudication.reason",
"short" : "Explanation of adjudication outcome",
"definition" : "A code supporting the understanding of the adjudication result and explaining variance from expected amount.",
"comment" : "For example may indicate that the funds for this benefit type have been exhausted.",
"requirements" : "To support understanding of variance from adjudication expectations.",
"min" : 0,
"max" : "1",
"base" : {
"path" : "ClaimResponse.item.adjudication.reason",
"min" : 0,
"max" : "1"
},
"type" : [
{
"code" : "CodeableConcept"
}
],
"condition" : [
"ele-1"
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"binding" : {
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString" : "AdjudicationReason"
}
],
"strength" : "example",
"description" : "The adjudication reason codes.",
"valueSet" : "http://hl7.org/fhir/ValueSet/adjudication-reason"
},
"mapping" : [
{
"identity" : "rim",
"map" : "n/a"
},
{
"identity" : "v2",
"map" : "CE/CNE/CWE"
},
{
"identity" : "rim",
"map" : "CD"
},
{
"identity" : "orim",
"map" : "fhir:CodeableConcept rdfs:subClassOf dt:CD"
}
]
},
{
"id" : "ClaimResponse.item.adjudication.amount",
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status",
"valueCode" : "normative"
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-normative-version",
"valueCode" : "4.0.0"
}
],
"path" : "ClaimResponse.item.adjudication.amount",
"short" : "Monetary amount",
"definition" : "Monetary amount associated with the category.",
"comment" : "For example: amount submitted, eligible amount, co-payment, and benefit payable.",
"requirements" : "Most adjuciation categories convey a monetary amount.",
"min" : 0,
"max" : "1",
"base" : {
"path" : "ClaimResponse.item.adjudication.amount",
"min" : 0,
"max" : "1"
},
"type" : [
{
"code" : "Money"
}
],
"condition" : [
"ele-1"
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"mapping" : [
{
"identity" : "rim",
"map" : "n/a"
},
{
"identity" : "rim",
"map" : "MO"
}
]
},
{
"id" : "ClaimResponse.item.adjudication.value",
"path" : "ClaimResponse.item.adjudication.value",
"short" : "Non-monetary value",
"definition" : "A non-monetary value associated with the category. Mutually exclusive to the amount element above.",
"comment" : "For example: eligible percentage or co-payment percentage.",
"requirements" : "Some adjudication categories convey a percentage or a fixed value.",
"min" : 0,
"max" : "1",
"base" : {
"path" : "ClaimResponse.item.adjudication.value",
"min" : 0,
"max" : "1"
},
"type" : [
{
"code" : "decimal"
}
],
"condition" : [
"ele-1"
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"mapping" : [
{
"identity" : "rim",
"map" : "n/a"
}
]
},
{
"id" : "ClaimResponse.item.detail",
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status",
"valueCode" : "normative"
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-normative-version",
"valueCode" : "4.0.0"
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-explicit-type-name",
"valueString" : "ItemDetail"
}
],
"path" : "ClaimResponse.item.detail",
"short" : "Adjudication for claim details",
"definition" : "A claim detail. Either a simple (a product or service) or a 'group' of sub-details which are simple items.",
"requirements" : "The adjudication for details provided on the claim.",
"min" : 0,
"max" : "*",
"base" : {
"path" : "ClaimResponse.item.detail",
"min" : 0,
"max" : "*"
},
"type" : [
{
"code" : "BackboneElement"
}
],
"condition" : [
"ele-1"
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"mapping" : [
{
"identity" : "rim",
"map" : "n/a"
}
]
},
{
"id" : "ClaimResponse.item.detail.id",
"path" : "ClaimResponse.item.detail.id",
"representation" : [
"xmlAttr"
],
"short" : "Unique id for inter-element referencing",
"definition" : "Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.",
"min" : 0,
"max" : "1",
"base" : {
"path" : "Element.id",
"min" : 0,
"max" : "1"
},
"type" : [
{
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type",
"valueUrl" : "string"
}
],
"code" : "http://hl7.org/fhirpath/System.String"
}
],
"mapping" : [
{
"identity" : "rim",
"map" : "n/a"
}
]
},
{
"id" : "ClaimResponse.item.detail.extension",
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status",
"valueCode" : "normative"
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-normative-version",
"valueCode" : "4.0.0"
}
],
"path" : "ClaimResponse.item.detail.extension",
"slicing" : {
"discriminator" : [
{
"type" : "value",
"path" : "url"
}
],
"description" : "Extensions are always sliced by (at least) url",
"rules" : "open"
},
"short" : "Additional content defined by implementations",
"definition" : "May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.",
"comment" : "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.",
"alias" : [
"extensions",
"user content"
],
"min" : 0,
"max" : "*",
"base" : {
"path" : "Element.extension",
"min" : 0,
"max" : "*"
},
"type" : [
{
"code" : "Extension"
}
],
"condition" : [
"ele-1"
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
},
{
"key" : "ext-1",
"severity" : "error",
"human" : "Must have either extensions or value[x], not both",
"expression" : "extension.exists() != value.exists()",
"xpath" : "exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])",
"source" : "http://hl7.org/fhir/StructureDefinition/Extension"
}
],
"mapping" : [
{
"identity" : "rim",
"map" : "n/a"
},
{
"identity" : "rim",
"map" : "N/A"
}
]
},
{
"id" : "ClaimResponse.item.detail.modifierExtension",
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status",
"valueCode" : "normative"
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-normative-version",
& }
]
},
{
"id" : "ClaimResponse.addItem.provider",
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status",
"valueCode" : "normative"
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-normative-version",
"valueCode" : "4.0.0"
}
],
"path" : "ClaimResponse.addItem.provider",
"short" : "Authorized providers",
"definition" : "The providers who are authorized for the services rendered to the patient.",
"comment" : "References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.",
"requirements" : "Insurer may provide authorization specifically to a restricted set of providers rather than an open authorization.",
"min" : 0,
"max" : "*",
"base" : {
"path" : "ClaimResponse.addItem.provider",
"min" : 0,
"max" : "*"
},
"type" : [
{
"code" : "Reference",
"targetProfile" : [
"http://hl7.org/fhir/StructureDefinition/Practitioner",
"http://hl7.org/fhir/StructureDefinition/PractitionerRole",
"http://hl7.org/fhir/StructureDefinition/Organization"
]
}
],
"condition" : [
"ele-1"
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
},
{
"key" : "ref-1",
"severity" : "error",
"human" : "SHALL have a contained resource if a local reference is provided",
"expression" : "reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))",
"xpath" : "not(starts-with(f:reference/@value, '#')) or exists(ancestor::*[self::f:entry or self::f:parameter]/f:resource/f:*/f:contained/f:*[f:id/@value=substring-after(current()/f:reference/@value, '#')]|/*/f:contained/f:*[f:id/@value=substring-after(current()/f:reference/@value, '#')])",
"source" : "http://hl7.org/fhir/StructureDefinition/Reference"
}
],
"mapping" : [
{
"identity" : "rim",
"map" : "n/a"
},
{
"identity" : "rim",
"map" : "The target of a resource reference is a RIM entry point (Act, Role, or Entity)"
},
{
"identity" : "w5",
"map" : "FiveWs.source"
}
]
},
{
"id" : "ClaimResponse.addItem.productOrService",
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status",
"valueCode" : "normative"
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-normative-version",
"valueCode" : "4.0.0"
}
],
"path" : "ClaimResponse.addItem.productOrService",
"short" : "Billing, service, product, or drug code",
"definition" : "When the value is a group code then this item collects a set of related claim details, otherwise this contains the product, service, drug or other billing code for the item.",
"comment" : "If this is an actual service or product line, i.e. not a Group, then use code to indicate the Professional Service or Product supplied (e.g. CTP, HCPCS, USCLS, ICD10, NCPDP, DIN, RxNorm, ACHI, CCI). If a grouping item then use a group code to indicate the type of thing being grouped e.g. 'glasses' or 'compound'.",
"requirements" : "Necessary to state what was provided or done.",
"min" : 1,
"max" : "1",
"base" : {
"path" : "ClaimResponse.addItem.productOrService",
"min" : 1,
"max" : "1"
},
"type" : [
{
"code" : "CodeableConcept"
}
],
"condition" : [
"ele-1"
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"binding" : {
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString" : "ServiceProduct"
}
],
"strength" : "example",
"description" : "Allowable service and product codes.",
"valueSet" : "http://hl7.org/fhir/ValueSet/service-uscls"
},
"mapping" : [
{
"identity" : "rim",
"map" : "n/a"
},
{
"identity" : "v2",
"map" : "CE/CNE/CWE"
},
{
"identity" : "rim",
"map" : "CD"
},
{
"identity" : "orim",
"map" : "fhir:CodeableConcept rdfs:subClassOf dt:CD"
}
]
},
{
"id" : "ClaimResponse.addItem.modifier",
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status",
"valueCode" : "normative"
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-normative-version",
"valueCode" : "4.0.0"
}
],
"path" : "ClaimResponse.addItem.modifier",
"short" : "Service/Product billing modifiers",
"definition" : "Item typification or modifiers codes to convey additional context for the product or service.",
"comment" : "For example in Oral whether the treatment is cosmetic or associated with TMJ, or for Medical whether the treatment was outside the clinic or outside of office hours.",
"requirements" : "To support inclusion of the item for adjudication or to charge an elevated fee.",
"min" : 0,
"max" : "*",
"base" : {
"path" : "ClaimResponse.addItem.modifier",
"min" : 0,
"max" : "*"
},
"type" : [
{
"code" : "CodeableConcept"
}
],
"condition" : [
"ele-1"
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"binding" : {
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString" : "Modifiers"
}
],
"strength" : "example",
"description" : "Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen.",
"valueSet" : "http://hl7.org/fhir/ValueSet/claim-modifiers"
},
"mapping" : [
{
"identity" : "rim",
"map" : "n/a"
},
{
"identity" : "v2",
"map" : "CE/CNE/CWE"
},
{
"identity" : "rim",
"map" : "CD"
},
{
"identity" : "orim",
"map" : "fhir:CodeableConcept rdfs:subClassOf dt:CD"
},
{
"identity" : "rim",
"map" : "24.C, 24.D mods"
}
]
},
{
"id" : "ClaimResponse.addItem.programCode",
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status",
"valueCode" : "normative"
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-normative-version",
"valueCode" : "4.0.0"
}
],
"path" : "ClaimResponse.addItem.programCode",
"short" : "Program the product or service is provided under",
"definition" : "Identifies the program under which this may be recovered.",
"comment" : "For example: Neonatal program, child dental program or drug users recovery program.",
"requirements" : "Commonly used in in the identification of publicly provided program focused on population segments or disease classifications.",
"min" : 0,
"max" : "*",
"base" : {
"path" : "ClaimResponse.addItem.programCode",
"min" : 0,
"max" : "*"
},
"type" : [
{
"code" : "CodeableConcept"
}
],
"condition" : [
"ele-1"
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"binding" : {
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString" : "ProgramCode"
}
],
"strength" : "example",
"description" : "Program specific reason codes.",
"valueSet" : "http://hl7.org/fhir/ValueSet/ex-program-code"
},
"mapping" : [
{
"identity" : "rim",
"map" : "n/a"
},
{
"identity" : "v2",
"map" : "CE/CNE/CWE"
},
{
"identity" : "rim",
"map" : "CD"
},
{
"identity" : "orim",
"map" : "fhir:CodeableConcept rdfs:subClassOf dt:CD"
},
{
"identity" : "rim",
"map" : "24.H"
}
]
},
{
"id" : "ClaimResponse.addItem.serviced[x]",
"path" : "ClaimResponse.addItem.serviced[x]",
"short" : "Date or dates of service or product delivery",
"definition" : "The date or dates when the service or product was supplied, performed or completed.",
"requirements" : "Needed to determine whether the service or product was provided during the term of the insurance coverage.",
"min" : 0,
"max" : "1",
"base" : {
"path" : "ClaimResponse.addItem.serviced[x]",
"min" : 0,
"max" : "1"
},
"type" : [
{
"code" : "date"
},
{
"code" : "Period"
}
],
"condition" : [
"ele-1"
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"mapping" : [
{
"identity" : "rim",
"map" : "n/a"
},
{
"identity" : "w5",
"map" : "FiveWs.done[x]"
},
{
"identity" : "rim",
"map" : "24.A"
}
]
},
{
"id" : "ClaimResponse.addItem.location[x]",
"path" : "ClaimResponse.addItem.location[x]",
"short" : "Place of service or where product was supplied",
"definition" : "Where the product or service was provided.",
"requirements" : "The location can alter whether the item was acceptable for insurance purposes or impact the determination of the benefit amount.",
"min" : 0,
"max" : "1",
"base" : {
"path" : "ClaimResponse.addItem.location[x]",
"min" : 0,
"max" : "1"
},
"type" : [
{
"code" : "CodeableConcept"
},
{
"code" : "Address"
},
{
"code" : "Reference",
"targetProfile" : [
"http://hl7.org/fhir/StructureDefinition/Location"
]
}
],
"condition" : [
"ele-1"
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"binding" : {
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString" : "ServicePlace"
}
],
"strength" : "example",
"description" : "Place of service: pharmacy, school, prison, etc.",
"valueSet" : "http://hl7.org/fhir/ValueSet/service-place"
},
"mapping" : [
{
"identity" : "rim",
"map" : "n/a"
},
{
"identity" : "w5",
"map" : "FiveWs.where[x]"
},
{
"identity" : "rim",
"map" : "24.B"
}
]
},
{
"id" : "ClaimResponse.addItem.quantity",
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status",
"valueCode" : "normative"
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-normative-version",
"valueCode" : "4.0.0"
}
],
"path" : "ClaimResponse.addItem.quantity",
"short" : "Count of products or services",
"definition" : "The number of repetitions of a service or product.",
"comment" : "The context of use may frequently define what kind of quantity this is and therefore what kind of units can be used. The context of use may also restrict the values for the comparator.",
"requirements" : "Required when the product or service code does not convey the quantity provided.",
"min" : 0,
"max" : "1",
"base" : {
"path" : "ClaimResponse.addItem.quantity",
"min" : 0,
"max" : "1"
},
"type" : [
{
"code" : "Quantity",
"profile" : [
"http://hl7.org/fhir/StructureDefinition/SimpleQuantity"
]
}
],
"condition" : [
"ele-1"
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
},
{
"key" : "qty-3",
"severity" : "error",
"human" : "If a code for the unit is present, the system SHALL also be present",
"expression" : "code.empty() or system.exists()",
"xpath" : "not(exists(f:code)) or exists(f:system)",
"source" : "http://hl7.org/fhir/StructureDefinition/Quantity"
},
{
"key" : "sqty-1",
"severity" : "error",
"human" : "The comparator is not used on a SimpleQuantity",
"expression" : "comparator.empty()",
"xpath" : "not(exists(f:comparator))",
"source" : "http://hl7.org/fhir/StructureDefinition/SimpleQuantity"
}
],
"isModifier" : false,
"mapping" : [
{
"identity" : "rim",
"map" : "n/a"
},
{
"identity" : "v2",
"map" : "SN (see also Range) or CQ"
},
{
"identity" : "rim",
"map" : "PQ, IVL<PQ>, MO, CO, depending on the values"
},
{
"identity" : "rim",
"map" : "24.G"
}
]
},
{
"id" : "ClaimResponse.addItem.unitPrice",
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status",
"valueCode" : "normative"
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-normative-version",
"valueCode" : "4.0.0"
}
],
"path" : "ClaimResponse.addItem.unitPrice",
"short" : "Fee, charge or cost per item",
"definition" : "If the item is not a group then this is the fee for the product or service, otherwise this is the total of the fees for the details of the group.",
"requirements" : "The amount charged to the patient by the provider for a single unit.",
"min" : 0,
"max" : "1",
"base" : {
"path" : "ClaimResponse.addItem.unitPrice",
"min" : 0,
"max" : "1"
},
"type" : [
{
"code" : "Money"
}
],
"condition" : [
"ele-1"
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"mapping" : [
{
"identity" : "rim",
"map" : "n/a"
},
{
"identity" : "rim",
"map" : "MO"
}
]
},
{
"id" : "ClaimResponse.addItem.factor",
"path" : "ClaimResponse.addItem.factor",
"short" : "Price scaling factor",
"definition" : "A real number that represents a multiplier used in determining the overall value of services delivered and/or goods received. The concept of a Factor allows for a discount or surcharge multiplier to be applied to a monetary amount.",
"comment" : "To show a 10% senior's discount, the value entered is: 0.90 (1.00 - 0.10).",
"requirements" : "When discounts are provided to a patient (example: Senior's discount) then this must be documented for adjudication.",
"min" : 0,
"max" : "1",
"base" : {
"path" : "ClaimResponse.addItem.factor",
"min" : 0,
"max" : "1"
},
"type" : [
{
"code" : "decimal"
}
],
"condition" : [
"ele-1"
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"mapping" : [
{
"identity" : "rim",
"map" : "n/a"
}
]
},
{
"id" : "ClaimResponse.addItem.net",
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status",
"valueCode" : "normative"
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-normative-version",
"valueCode" : "4.0.0"
}
],
"path" : "ClaimResponse.addItem.net",
"short" : "Total item cost",
"definition" : "The quantity times the unit price for an additional service or product or charge.",
"comment" : "For example, the formula: quantity * unitPrice * factor = net. Quantity and factor are assumed to be 1 if not supplied.",
"requirements" : "Provides the total amount claimed for the group (if a grouper) or the line item.",
"min" : 0,
"max" : "1",
"base" : {
"path" : "ClaimResponse.addItem.net",
"min" : 0,
"max" : "1"
},
"type" : [
{
"code" : "Money"
}
],
"condition" : [
"ele-1"
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"mapping" : [
{
"identity" : "rim",
"map" : "n/a"
},
{
"identity" : "rim",
"map" : "MO"
},
{
"identity" : "rim",
"map" : "24.F"
}
]
},
{
"id" : "ClaimResponse.addItem.bodySite",
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status",
"valueCode" : "normative"
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-normative-version",
"valueCode" : "4.0.0"
}
],
"path" : "ClaimResponse.addItem.bodySite",
"short" : "Anatomical location",
"definition" : "Physical service site on the patient (limb, tooth, etc.).",
"comment" : "For example: Providing a tooth code allows an insurer to identify a provider performing a filling on a tooth that was previously removed.",
"requirements" : "Allows insurer to validate specific procedures.",
"min" : 0,
"max" : "1",
"base" : {
"path" : "ClaimResponse.addItem.bodySite",
"min" : 0,
"max" : "1"
},
"type" : [
{
"code" : "CodeableConcept"
}
],
"condition" : [
"ele-1"
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"binding" : {
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString" : "OralSites"
}
],
"strength" : "example",
"description" : "The code for the teeth, quadrant, sextant and arch.",
"valueSet" : "http://hl7.org/fhir/ValueSet/tooth"
},
"mapping" : [
{
"identity" : "rim",
"map" : "n/a"
},
{
"identity" : "v2",
"map" : "CE/CNE/CWE"
},
{
"identity" : "rim",
"map" : "CD"
},
{
"identity" : "orim",
"map" : "fhir:CodeableConcept rdfs:subClassOf dt:CD"
}
]
},
{
"id" : "ClaimResponse.addItem.subSite",
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status",
"valueCode" : "normative"
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-normative-version",
"valueCode" : "4.0.0"
}
],
"path" : "ClaimResponse.addItem.subSite",
"short" : "Anatomical sub-location",
"definition" : "A region or surface of the bodySite, e.g. limb region or tooth surface(s).",
"comment" : "Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination.",
"requirements" : "Allows insurer to validate specific procedures.",
"min" : 0,
"max" : "*",
"base" : {
"path" : "ClaimResponse.addItem.subSite",
"min" : 0,
"max" : "*"
},
"type" : [
{
"code" : "CodeableConcept"
}
],
"condition" : [
"ele-1"
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"binding" : {
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString" : "Surface"
}
],
"strength" : "example",
"description" : "The code for the tooth surface and surface combinations.",
"valueSet" : "http://hl7.org/fhir/ValueSet/surface"
},
"mapping" : [
{
"identity" : "rim",
"map" : "n/a"
},
{
"identity" : "v2",
"map" : "CE/CNE/CWE"
},
{
"identity" : "rim",
"map" : "CD"
},
{
"identity" : "orim",
"map" : "fhir:CodeableConcept rdfs:subClassOf dt:CD"
}
]
},
{
"id" : "ClaimResponse.addItem.noteNumber",
"path" : "ClaimResponse.addItem.noteNumber",
"short" : "Applicable note numbers",
"definition" : "The numbers associated with notes below which apply to the adjudication of this item.",
"comment" : "32 bit number; for values larger than this, use decimal",
"requirements" : "Provides a condensed manner for associating human readable descriptive explanations for adjudications on the line item.",
"min" : 0,
"max" : "*",
"base" : {
"path" : "ClaimResponse.addItem.noteNumber",
"min" : 0,
"max" : "*"
},
"type" : [
{
"code" : "positiveInt"
}
],
"condition" : [
"ele-1"
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"mapping" : [
{
"identity" : "rim",
"map" : "n/a"
}
]
},
{
"id" : "ClaimResponse.addItem.adjudication",
"path" : "ClaimResponse.addItem.adjudication",
"short" : "Added items adjudication",
"definition" : "The adjudication results.",
"min" : 1,
"max" : "*",
"base" : {
"path" : "ClaimResponse.addItem.adjudication",
"min" : 1,
"max" : "*"
},
"contentReference" : "#ClaimResponse.item.adjudication"
},
{
"id" : "ClaimResponse.addItem.detail",
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status",
"valueCode" : "normative"
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-normative-version",
"valueCode" : "4.0.0"
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-explicit-type-name",
"valueString" : "AddedItemDetail"
}
],
"path" : "ClaimResponse.addItem.detail",
"short" : "Insurer added line details",
"definition" : "The second-tier service adjudications for payor added services.",
"min" : 0,
"max" : "*",
"base" : {
"path" : "ClaimResponse.addItem.detail",
"min" : 0,
"max" : "*"
},
"type" : [
{
"code" : "BackboneElement"
}
],
"condition" : [
"ele-1"
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"mapping" : [
{
"identity" : "rim",
"map" : "n/a"
}
]
},
{
"id" : "ClaimResponse.addItem.detail.id",
"path" : "ClaimResponse.addItem.detail.id",
"representation" : [
"xmlAttr"
],
"short" : "Unique id for inter-element referencing",
"definition" : "Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.",
"min" : 0,
"max" : "1",
"base" : {
"path" : "Element.id",
"min" : 0,
"max" : "1"
},
"type" : [
{
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type",
"valueUrl" : "string"
}
],
"code" : "http://hl7.org/fhirpath/System.String"
}
],
"mapping" : [
{
"identity" : "rim",
"map" : "n/a"
}
]
},
{
"id" : "ClaimResponse.addItem.detail.extension",
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status",
"valueCode" : "normative"
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-normative-version",
"valueCode" : "4.0.0"
}
],
"path" : "ClaimResponse.addItem.detail.extension",
"slicing" : {
"discriminator" : [
{
"type" : "value",
"path" : "url"
}
],
"description" : "Extensions are always sliced by (at least) url",
"rules" : "open"
},
"short" : "Additional content defined by implementations",
"definition" : "May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.",
"comment" : "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.",
"alias" : [
"extensions",
"user content"
],
"min" : 0,
"max" : "*",
"base" : {
"path" : "Element.extension",
"min" : 0,
"max" : "*"
},
"type" : [
{
"code" : "Extension"
}
],
"condition" : [
"ele-1"
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
},
{
"key" : "ext-1",
"severity" : "error",
"human" : "Must have either extensions or value[x], not both",
"expression" : "extension.exists() != value.exists()",
"xpath" : "exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])",
"source" : "http://hl7.org/fhir/StructureDefinition/Extension"
}
],
"mapping" : [
{
"identity" : "rim",
"map" : "n/a"
},
{
"identity" : "rim",
"map" : "N/A"
}
]
},
{
"id" : "ClaimResponse.addItem.detail.modifierExtension",
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status",
"valueCode" : "normative"
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-normative-version",
"valueCode" : "4.0.0"
}
],
"path" : "ClaimResponse.addItem.detail.modifierExtension",
"short" : "Extensions that cannot be ignored even if unrecognized",
"definition" : "May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.\n\nModifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).",
"comment" : "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.",
"requirements" : "Modifier extensions allow for extensions that *cannot* be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the [definition of modifier extensions](extensibility.html#modifierExtension).",
"alias" : [
"extensions",
"user content",
"modifiers"
],
"min" : 0,
"max" : "*",
"base" : {
"path" : "BackboneElement.modifierExtension",
"min" : 0,
"max" : "*"
},
"type" : [
{
"code" : "Extension"
}
],
"condition" : [
"ele-1"
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
},
{
"key" : "ext-1",
"severity" : "error",
"human" : "Must have either extensions or value[x], not both",
"expression" : "extension.exists() != value.exists()",
"xpath" : "exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])",
"source" : "http://hl7.org/fhir/StructureDefinition/Extension"
}
],
"isModifier" : true,
"isModifierReason" : "Modifier extensions are expected to modify the meaning or interpretation of the element that contains them",
"isSummary" : true,
"mapping" : [
{
"identity" : "rim",
"map" : "n/a"
},
{
"identity" : "rim",
"map" : "N/A"
}
]
},
{
"id" : "ClaimResponse.addItem.detail.productOrService",
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status",
"valueCode" : "normative"
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-normative-version",
"valueCode" : "4.0.0"
}
],
"path" : "ClaimResponse.addItem.detail.productOrService",
"short" : "Billing, service, product, or drug code",
"definition" : "When the value is a group code then this item collects a set of related claim details, otherwise this contains the product, service, drug or other billing code for the item.",
"comment" : "If this is an actual service or product line, i.e. not a Group, then use code to indicate the Professional Service or Product supplied (e.g. CTP, HCPCS, USCLS, ICD10, NCPDP, DIN, RxNorm, ACHI, CCI). If a grouping item then use a group code to indicate the type of thing being grouped e.g. 'glasses' or 'compound'.",
"requirements" : "Necessary to state what was provided or done.",
"min" : 1,
"max" : "1",
"base" : {
"path" : "ClaimResponse.addItem.detail.productOrService",
"min" : 1,
"max" : "1"
},
"type" : [
{
"code" : "CodeableConcept"
}
],
"condition" : [
"ele-1"
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"binding" : {
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString" : "ServiceProduct"
}
],
"strength" : "example",
"description" : "Allowable service and product codes.",
"valueSet" : "http://hl7.org/fhir/ValueSet/service-uscls"
},
"mapping" : [
{
"identity" : "rim",
"map" : "n/a"
},
{
"identity" : "v2",
"map" : "CE/CNE/CWE"
},
{
"identity" : "rim",
"map" : "CD"
},
{
"identity" : "orim",
"map" : "fhir:CodeableConcept rdfs:subClassOf dt:CD"
}
]
},
{
"id" : "ClaimResponse.addItem.detail.modifier",
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status",
"valueCode" : "normative"
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-normative-version",
"valueCode" : "4.0.0"
}
],
"path" : "ClaimResponse.addItem.detail.modifier",
"short" : "Service/Product billing modifiers",
"definition" : "Item typification or modifiers codes to convey additional context for the product or service.",
"comment" : "For example in Oral whether the treatment is cosmetic or associated with TMJ, or for Medical whether the treatment was outside the clinic or outside of office hours.",
"requirements" : "To support inclusion of the item for adjudication or to charge an elevated fee.",
"min" : 0,
"max" : "*",
"base" : {
"path" : "ClaimResponse.addItem.detail.modifier",
"min" : 0,
"max" : "*"
},
"type" : [
{
"code" : "CodeableConcept"
}
],
"condition" : [
"ele-1"
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"binding" : {
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString" : "Modifiers"
}
],
"strength" : "example",
"description" : "Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen.",
"valueSet" : "http://hl7.org/fhir/ValueSet/claim-modifiers"
},
"mapping" : [
{
"identity" : "rim",
"map" : "n/a"
},
{
"identity" : "v2",
"map" : "CE/CNE/CWE"
},
{
"identity" : "rim",
"map" : "CD"
},
{
"identity" : "orim",
"map" : "fhir:CodeableConcept rdfs:subClassOf dt:CD"
},
{
"identity" : "rim",
"map" : "24.C, 24.D mods"
}
]
},
{
"id" : "ClaimResponse.addItem.detail.quantity",
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status",
"valueCode" : "normative"
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-normative-version",
"valueCode" : "4.0.0"
}
],
"path" : "ClaimResponse.addItem.detail.quantity",
"short" : "Count of products or services",
"definition" : "The number of repetitions of a service or product.",
"comment" : "The context of use may frequently define what kind of quantity this is and therefore what kind of units can be used. The context of use may also restrict the values for the comparator.",
"requirements" : "Required when the product or service code does not convey the quantity provided.",
"min" : 0,
"max" : "1",
"base" : {
"path" : "ClaimResponse.addItem.detail.quantity",
"min" : 0,
"max" : "1"
},
"type" : [
{
"code" : "Quantity",
"profile" : [
"http://hl7.org/fhir/StructureDefinition/SimpleQuantity"
]
}
],
"condition" : [
"ele-1"
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
},
{
"key" : "qty-3",
"severity" : "error",
"human" : "If a code for the unit is present, the system SHALL also be present",
"expression" : "code.empty() or system.exists()",
"xpath" : "not(exists(f:code)) or exists(f:system)",
"source" : "http://hl7.org/fhir/StructureDefinition/Quantity"
},
{
"key" : "sqty-1",
"severity" : "error",
"human" : "The comparator is not used on a SimpleQuantity",
"expression" : "comparator.empty()",
"xpath" : "not(exists(f:comparator))",
"source" : "http://hl7.org/fhir/StructureDefinition/SimpleQuantity"
}
],
"isModifier" : false,
"mapping" : [
{
"identity" : "rim",
"map" : "n/a"
},
{
"identity" : "v2",
"map" : "SN (see also Range) or CQ"
},
{
"identity" : "rim",
"map" : "PQ, IVL<PQ>, MO, CO, depending on the values"
},
{
"identity" : "rim",
"map" : "24.G"
}
]
},
{
"id" : "ClaimResponse.addItem.detail.unitPrice",
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status",
"valueCode" : "normative"
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-normative-version",
"valueCode" : "4.0.0"
}
],
"path" : "ClaimResponse.addItem.detail.unitPrice",
"short" : "Fee, charge or cost per item",
"definition" : "If the item is not a group then this is the fee for the product or service, otherwise this is the total of the fees for the details of the group.",
"requirements" : "The amount charged to the patient by the provider for a single unit.",
"min" : 0,
"max" : "1",
"base" : {
"path" : "ClaimResponse.addItem.detail.unitPrice",
"min" : 0,
"max" : "1"
},
"type" : [
{
"code" : "Money"
}
],
"condition" : [
"ele-1"
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"mapping" : [
{
"identity" : "rim",
"map" : "n/a"
},
{
"identity" : "rim",
"map" : "MO"
}
]
},
{
"id" : "ClaimResponse.addItem.detail.factor",
"path" : "ClaimResponse.addItem.detail.factor",
"short" : "Price scaling factor",
"definition" : "A real number that represents a multiplier used in determining the overall value of services delivered and/or goods received. The concept of a Factor allows for a discount or surcharge multiplier to be applied to a monetary amount.",
"comment" : "To show a 10% senior's discount, the value entered is: 0.90 (1.00 - 0.10).",
"requirements" : "When discounts are provided to a patient (example: Senior's discount) then this must be documented for adjudication.",
"min" : 0,
"max" : "1",
"base" : {
"path" : "ClaimResponse.addItem.detail.factor",
"min" : 0,
"max" : "1"
},
"type" : [
{
"code" : "decimal"
}
],
"condition" : [
"ele-1"
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"mapping" : [
{
"identity" : "rim",
"map" : "n/a"
}
]
},
{
"id" : "ClaimResponse.addItem.detail.net",
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status",
"valueCode" : "normative"
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-normative-version",
"valueCode" : "4.0.0"
}
],
"path" : "ClaimResponse.addItem.detail.net",
"short" : "Total item cost",
"definition" : "The quantity times the unit price for an additional service or product or charge.",
"comment" : "For example, the formula: quantity * unitPrice * factor = net. Quantity and factor are assumed to be 1 if not supplied.",
"requirements" : "Provides the total amount claimed for the group (if a grouper) or the line item.",
"min" : 0,
"max" : "1",
"base" : {
"path" : "ClaimResponse.addItem.detail.net",
"min" : 0,
"max" : "1"
},
"type" : [
{
"code" : "Money"
}
],
"condition" : [
"ele-1"
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"mapping" : [
{
"identity" : "rim",
"map" : "n/a"
},
{
"identity" : "rim",
"map" : "MO"
},
{
"identity" : "rim",
"map" : "24.F"
}
]
},
{
"id" : "ClaimResponse.addItem.detail.noteNumber",
"path" : "ClaimResponse.addItem.detail.noteNumber",
"short" : "Applicable note numbers",
"definition" : "The numbers associated with notes below which apply to the adjudication of this item.",
"comment" : "32 bit number; for values larger than this, use decimal",
"requirements" : "Provides a condensed manner for associating human readable descriptive explanations for adjudications on the line item.",
"min" : 0,
"max" : "*",
"base" : {
"path" : "ClaimResponse.addItem.detail.noteNumber",
"min" : 0,
"max" : "*"
},
"type" : [
{
"code" : "positiveInt"
}
],
"condition" : [
"ele-1"
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"mapping" : [
{
"identity" : "rim",
"map" : "n/a"
}
]
},
{
"id" : "ClaimResponse.addItem.detail.adjudication",
"path" : "ClaimResponse.addItem.detail.adjudication",
"short" : "Added items detail adjudication",
"definition" : "The adjudication results.",
"min" : 1,
"max" : "*",
"base" : {
"path" : "ClaimResponse.addItem.detail.adjudication",
"min" : 1,
"max" : "*"
},
"contentReference" : "#ClaimResponse.item.adjudication"
},
{
"id" : "ClaimResponse.addItem.detail.subDetail",
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status",
"valueCode" : "normative"
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-normative-version",
"valueCode" : "4.0.0"
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-explicit-type-name",
"valueString" : "AddedItemSubDetail"
}
],
"path" : "ClaimResponse.addItem.detail.subDetail",
"short" : "Insurer added line items",
"definition" : "The third-tier service adjudications for payor added services.",
"min" : 0,
"max" : "*",
"base" : {
"path" : "ClaimResponse.addItem.detail.subDetail",
"min" : 0,
"max" : "*"
},
"type" : [
{
"code" : "BackboneElement"
}
],
"condition" : [
"ele-1"
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"mapping" : [
{
"identity" : "rim",
"map" : "n/a"
}
]
},
{
"id" : "ClaimResponse.addItem.detail.subDetail.id",
"path" : "ClaimResponse.addItem.detail.subDetail.id",
"representation" : [
"xmlAttr"
],
"short" : "Unique id for inter-element referencing",
"definition" : "Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.",
"min" : 0,
"max" : "1",
"base" : {
"path" : "Element.id",
"min" : 0,
"max" : "1"
},
"type" : [
{
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type",
"valueUrl" : "string"
}
],
"code" : "http://hl7.org/fhirpath/System.String"
}
],
"mapping" : [
{
"identity" : "rim",
"map" : "n/a"
}
]
},
{
"id" : "ClaimResponse.addItem.detail.subDetail.extension",
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status",
"valueCode" : "normative"
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-normative-version",
"valueCode" : "4.0.0"
}
],
"path" : "ClaimResponse.addItem.detail.subDetail.extension",
"slicing" : {
"discriminator" : [
{
"type" : "value",
"path" : "url"
}
],
"description" : "Extensions are always sliced by (at least) url",
"rules" : "open"
},
"short" : "Additional content defined by implementations",
"definition" : "May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.",
"comment" : "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.",
"alias" : [
"extensions",
"user content"
],
"min" : 0,
"max" : "*",
"base" : {
"path" : "Element.extension",
"min" : 0,
"max" : "*"
},
"type" : [
{
"code" : "Extension"
}
],
"condition" : [
"ele-1"
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
},
{
"key" : "ext-1",
"severity" : "error",
"human" : "Must have either extensions or value[x], not both",
"expression" : "extension.exists() != value.exists()",
"xpath" : "exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])",
"source" : "http://hl7.org/fhir/StructureDefinition/Extension"
}
],
"mapping" : [
{
"identity" : "rim",
"map" : "n/a"
},
{
"identity" : "rim",
"map" : "N/A"
}
]
},
{
"id" : "ClaimResponse.addItem.detail.subDetail.modifierExtension",
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status",
"valueCode" : "normative"
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-normative-version",
"valueCode" : "4.0.0"
}
],
"path" : "ClaimResponse.addItem.detail.subDetail.modifierExtension",
"short" : "Extensions that cannot be ignored even if unrecognized",
"definition" : "May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.\n\nModifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).",
"comment" : "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.",
"requirements" : "Modifier extensions allow for extensions that *cannot* be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the [definition of modifier extensions](extensibility.html#modifierExtension).",
"alias" : [
"extensions",
"user content",
"modifiers"
],
"min" : 0,
"max" : "*",
"base" : {
"path" : "BackboneElement.modifierExtension",
"min" : 0,
"max" : "*"
},
"type" : [
{
"code" : "Extension"
}
],
"condition" : [
"ele-1"
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
},
{
"key" : "ext-1",
"severity" : "error",
"human" : "Must have either extensions or value[x], not both",
"expression" : "extension.exists() != value.exists()",
"xpath" : "exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])",
"source" : "http://hl7.org/fhir/StructureDefinition/Extension"
}
],
"isModifier" : true,
"isModifierReason" : "Modifier extensions are expected to modify the meaning or interpretation of the element that contains them",
"isSummary" : true,
"mapping" : [
{
"identity" : "rim",
"map" : "n/a"
},
{
"identity" : "rim",
"map" : "N/A"
}
]
},
{
"id" : "ClaimResponse.addItem.detail.subDetail.productOrService",
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status",
"valueCode" : "normative"
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-normative-version",
"valueCode" : "4.0.0"
}
],
"path" : "ClaimResponse.addItem.detail.subDetail.productOrService",
"short" : "Billing, service, product, or drug code",
"definition" : "When the value is a group code then this item collects a set of related claim details, otherwise this contains the product, service, drug or other billing code for the item.",
"comment" : "If this is an actual service or product line, i.e. not a Group, then use code to indicate the Professional Service or Product supplied (e.g. CTP, HCPCS, USCLS, ICD10, NCPDP, DIN, RxNorm, ACHI, CCI). If a grouping item then use a group code to indicate the type of thing being grouped e.g. 'glasses' or 'compound'.",
"requirements" : "Necessary to state what was provided or done.",
"min" : 1,
"max" : "1",
"base" : {
"path" : "ClaimResponse.addItem.detail.subDetail.productOrService",
"min" : 1,
"max" : "1"
},
"type" : [
{
"code" : "CodeableConcept"
}
],
"condition" : [
"ele-1"
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"binding" : {
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString" : "ServiceProduct"
}
],
"strength" : "example",
"description" : "Allowable service and product codes.",
"valueSet" : "http://hl7.org/fhir/ValueSet/service-uscls"
},
"mapping" : [
{
"identity" : "rim",
"map" : "n/a"
},
{
"identity" : "v2",
"map" : "CE/CNE/CWE"
},
{
"identity" : "rim",
"map" : "CD"
},
{
"identity" : "orim",
"map" : "fhir:CodeableConcept rdfs:subClassOf dt:CD"
}
]
},
{
"id" : "ClaimResponse.addItem.detail.subDetail.modifier",
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status",
"valueCode" : "normative"
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-normative-version",
"valueCode" : "4.0.0"
}
],
"path" : "ClaimResponse.addItem.detail.subDetail.modifier",
"short" : "Service/Product billing modifiers",
"definition" : "Item typification or modifiers codes to convey additional context for the product or service.",
"comment" : "For example in Oral whether the treatment is cosmetic or associated with TMJ, or for Medical whether the treatment was outside the clinic or outside of office hours.",
"requirements" : "To support inclusion of the item for adjudication or to charge an elevated fee.",
"min" : 0,
"max" : "*",
"base" : {
"path" : "ClaimResponse.addItem.detail.subDetail.modifier",
"min" : 0,
"max" : "*"
},
"type" : [
{
"code" : "CodeableConcept"
}
],
"condition" : [
"ele-1"
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"binding" : {
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString" : "Modifiers"
}
],
"strength" : "example",
"description" : "Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen.",
"valueSet" : "http://hl7.org/fhir/ValueSet/claim-modifiers"
},
"mapping" : [
{
"identity" : "rim",
"map" : "n/a"
},
{
"identity" : "v2",
"map" : "CE/CNE/CWE"
},
{
"identity" : "rim",
"map" : "CD"
},
{
"identity" : "orim",
"map" : "fhir:CodeableConcept rdfs:subClassOf dt:CD"
},
{
"identity" : "rim",
"map" : "24.C, 24.D mods"
}
]
},
{
"id" : "ClaimResponse.addItem.detail.subDetail.quantity",
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status",
"valueCode" : "normative"
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-normative-version",
"valueCode" : "4.0.0"
}
],
"path" : "ClaimResponse.addItem.detail.subDetail.quantity",
"short" : "Count of products or services",
"definition" : "The number of repetitions of a service or product.",
"comment" : "The context of use may frequently define what kind of quantity this is and therefore what kind of units can be used. The context of use may also restrict the values for the comparator.",
"requirements" : "Required when the product or service code does not convey the quantity provided.",
"min" : 0,
"max" : "1",
"base" : {
"path" : "ClaimResponse.addItem.detail.subDetail.quantity",
"min" : 0,
"max" : "1"
},
"type" : [
{
"code" : "Quantity",
"profile" : [
"http://hl7.org/fhir/StructureDefinition/SimpleQuantity"
]
}
],
"condition" : [
"ele-1"
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
},
{
"key" : "qty-3",
"severity" : "error",
"human" : "If a code for the unit is present, the system SHALL also be present",
"expression" : "code.empty() or system.exists()",
"xpath" : "not(exists(f:code)) or exists(f:system)",
"source" : "http://hl7.org/fhir/StructureDefinition/Quantity"
},
{
"key" : "sqty-1",
"severity" : "error",
"human" : "The comparator is not used on a SimpleQuantity",
"expression" : "comparator.empty()",
"xpath" : "not(exists(f:comparator))",
"source" : "http://hl7.org/fhir/StructureDefinition/SimpleQuantity"
}
],
"isModifier" : false,
"mapping" : [
{
"identity" : "rim",
"map" : "n/a"
},
{
"identity" : "v2",
"map" : "SN (see also Range) or CQ"
},
{
"identity" : "rim",
"map" : "PQ, IVL<PQ>, MO, CO, depending on the values"
},
{
"identity" : "rim",
"map" : "24.G"
}
]
},
{
"id" : "ClaimResponse.addItem.detail.subDetail.unitPrice",
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status",
"valueCode" : "normative"
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-normative-version",
"valueCode" : "4.0.0"
}
],
"path" : "ClaimResponse.addItem.detail.subDetail.unitPrice",
"short" : "Fee, charge or cost per item",
"definition" : "If the item is not a group then this is the fee for the product or service, otherwise this is the total of the fees for the details of the group.",
"requirements" : "The amount charged to the patient by the provider for a single unit.",
"min" : 0,
"max" : "1",
"base" : {
"path" : "ClaimResponse.addItem.detail.subDetail.unitPrice",
"min" : 0,
"max" : "1"
},
"type" : [
{
"code" : "Money"
}
],
"condition" : [
"ele-1"
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"mapping" : [
{
"identity" : "rim",
"map" : "n/a"
},
{
"identity" : "rim",
"map" : "MO"
}
]
},
{
"id" : "ClaimResponse.addItem.detail.subDetail.factor",
"path" : "ClaimResponse.addItem.detail.subDetail.factor",
"short" : "Price scaling factor",
"definition" : "A real number that represents a multiplier used in determining the overall value of services delivered and/or goods received. The concept of a Factor allows for a discount or surcharge multiplier to be applied to a monetary amount.",
"comment" : "To show a 10% senior's discount, the value entered is: 0.90 (1.00 - 0.10).",
"requirements" : "When discounts are provided to a patient (example: Senior's discount) then this must be documented for adjudication.",
"min" : 0,
"max" : "1",
"base" : {
"path" : "ClaimResponse.addItem.detail.subDetail.factor",
"min" : 0,
"max" : "1"
},
"type" : [
{
"code" : "decimal"
}
],
"condition" : [
"ele-1"
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"mapping" : [
{
"identity" : "rim",
"map" : "n/a"
}
]
},
{
"id" : "ClaimResponse.addItem.detail.subDetail.net",
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status",
"valueCode" : "normative"
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-normative-version",
"valueCode" : "4.0.0"
}
],
"path" : "ClaimResponse.addItem.detail.subDetail.net",
"short" : "Total item cost",
"definition" : "The quantity times the unit price for an additional service or product or charge.",
"comment" : "For example, the formula: quantity * unitPrice * factor = net. Quantity and factor are assumed to be 1 if not supplied.",
"requirements" : "Provides the total amount claimed for the group (if a grouper) or the line item.",
"min" : 0,
"max" : "1",
"base" : {
"path" : "ClaimResponse.addItem.detail.subDetail.net",
"min" : 0,
"max" : "1"
},
"type" : [
{
"code" : "Money"
}
],
"condition" : [
"ele-1"
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"mapping" : [
{
"identity" : "rim",
"map" : "n/a"
},
{
"identity" : "rim",
"map" : "MO"
},
{
"identity" : "rim",
"map" : "24.F"
}
]
},
{
"id" : "ClaimResponse.addItem.detail.subDetail.noteNumber",
"path" : "ClaimResponse.addItem.detail.subDetail.noteNumber",
"short" : "Applicable note numbers",
"definition" : "The numbers associated with notes below which apply to the adjudication of this item.",
"comment" : "32 bit number; for values larger than this, use decimal",
"requirements" : "Provides a condensed manner for associating human readable descriptive explanations for adjudications on the line item.",
"min" : 0,
"max" : "*",
"base" : {
"path" : "ClaimResponse.addItem.detail.subDetail.noteNumber",
"min" : 0,
"max" : "*"
},
"type" : [
{
"code" : "positiveInt"
}
],
"condition" : [
"ele-1"
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"mapping" : [
{
"identity" : "rim",
"map" : "n/a"
}
]
},
{
"id" : "ClaimResponse.addItem.detail.subDetail.adjudication",
"path" : "ClaimResponse.addItem.detail.subDetail.adjudication",
"short" : "Added items detail adjudication",
"definition" : "The adjudication results.",
"min" : 1,
"max" : "*",
"base" : {
"path" : "ClaimResponse.addItem.detail.subDetail.adjudication",
"min" : 1,
"max" : "*"
},
"contentReference" : "#ClaimResponse.item.adjudication"
},
{
"id" : "ClaimResponse.adjudication",
"path" : "ClaimResponse.adjudication",
"short" : "Header-level adjudication",
"definition" : "The adjudication results which are presented at the header level rather than at the line-item or add-item levels.",
"requirements" : "Some insurers will receive line-items but provide the adjudication only at a summary or header-level.",
"min" : 0,
"max" : "*",
"base" : {
"path" : "ClaimResponse.adjudication",
"min" : 0,
"max" : "*"
},
"contentReference" : "http://hl7.org/fhir/StructureDefinition/ClaimResponse#ClaimResponse.item.adjudication"
},
{
"id" : "ClaimResponse.total",
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status",
"valueCode" : "normative"
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-normative-version",
"valueCode" : "4.0.0"
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-explicit-type-name",
"valueString" : "Total"
}
],
"path" : "ClaimResponse.total",
"short" : "Totale aggiudicazione",
"definition" : "Totali monetari categorizzati per l'aggiudicazione.",
"comment" : "Allegare l'estensione claimresponse-encounter quando si vuole fare riferirmento ad una prestazione totale.\r\n\r\nAllegare l'estensione claimresponse-appointment quando si vuole fare riferirmento ad una singola prestazione. Appointment può essere anche una reference di tipo contained.",
"requirements" : "To provide the requestor with financial totals by category for the adjudication.",
"min" : 0,
"max" : "*",
"base" : {
"path" : "ClaimResponse.total",
"min" : 0,
"max" : "*"
},
"type" : [
{
"code" : "BackboneElement"
}
],
"condition" : [
"ele-1"
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"isSummary" : true,
"mapping" : [
{
"identity" : "rim",
"map" : "n/a"
}
]
},
{
"id" : "ClaimResponse.total.id",
"path" : "ClaimResponse.total.id",
"representation" : [
"xmlAttr"
],
"short" : "Unique id for inter-element referencing",
"definition" : "Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.",
"min" : 0,
"max" : "1",
"base" : {
"path" : "Element.id",
"min" : 0,
"max" : "1"
},
"type" : [
{
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type",
"valueUrl" : "string"
}
],
"code" : "http://hl7.org/fhirpath/System.String"
}
],
"mapping" : [
{
"identity" : "rim",
"map" : "n/a"
}
]
},
{
"id" : "ClaimResponse.total.extension",
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status",
"valueCode" : "normative"
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-normative-version",
"valueCode" : "4.0.0"
}
],
"path" : "ClaimResponse.total.extension",
"slicing" : {
"discriminator" : [
{
"type" : "value",
"path" : "url"
}
],
"description" : "Extensions are always sliced by (at least) url",
"rules" : "open"
},
"short" : "Additional content defined by implementations",
"definition" : "May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.",
"comment" : "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.",
"alias" : [
"extensions",
"user content"
],
"min" : 0,
"max" : "*",
"base" : {
"path" : "Element.extension",
"min" : 0,
"max" : "*"
},
"type" : [
{
"code" : "Extension"
}
],
"condition" : [
"ele-1"
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
},
{
"key" : "ext-1",
"severity" : "error",
"human" : "Must have either extensions or value[x], not both",
"expression" : "extension.exists() != value.exists()",
"xpath" : "exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])",
"source" : "http://hl7.org/fhir/StructureDefinition/Extension"
}
],
"mapping" : [
{
"identity" : "rim",
"map" : "n/a"
},
{
"identity" : "rim",
"map" : "N/A"
}
]
},
{
"id" : "ClaimResponse.total.extension:appointment",
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status",
"valueCode" : "normative"
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-normative-version",
"valueCode" : "4.0.0"
}
],
"path" : "ClaimResponse.total.extension",
"sliceName" : "appointment",
"short" : "reference Appointment",
"definition" : "Estensione di tipo reference ad Appointment.",
"comment" : "Va utilizzata nel profilo ClaimResponse_WBS_Eng ed allegata alla voce total, per indicare che il totale è riferito alla singola prestazione. \r\n\r\nAppointment può essere anche una reference di tipo contained.",
"alias" : [
"extensions",
"user content"
],
"min" : 0,
"max" : "1",
"base" : {
"path" : "Element.extension",
"min" : 0,
"max" : "*"
},
"type" : [
{
"code" : "Extension",
"profile" : [
"http://cct.eng.it/FHIR/schema/claimResponse-appointment"
]
}
],
"condition" : [
"ele-1"
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
},
{
"key" : "ext-1",
"severity" : "error",
"human" : "Must have either extensions or value[x], not both",
"expression" : "extension.exists() != value.exists()",
"xpath" : "exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])",
"source" : "http://hl7.org/fhir/StructureDefinition/Extension"
}
],
"isModifier" : false,
"mapping" : [
{
"identity" : "rim",
"map" : "n/a"
},
{
"identity" : "rim",
"map" : "N/A"
}
]
},
{
"id" : "ClaimResponse.total.extension:encounter",
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status",
"valueCode" : "normative"
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-normative-version",
"valueCode" : "4.0.0"
}
],
"path" : "ClaimResponse.total.extension",
"sliceName" : "encounter",
"short" : "Reference ad Encounter",
"definition" : "Estensione di tipo reference ad Encounter AMB.",
"comment" : "Va utilizzata nel profilo ClaimResponse_WBS_Eng ed allegata alla voce total, per indicare che il totale è riferito all'intera prestazione.",
"alias" : [
"extensions",
"user content"
],
"min" : 0,
"max" : "1",
"base" : {
"path" : "Element.extension",
"min" : 0,
"max" : "*"
},
"type" : [
{
"code" : "Extension",
"profile" : [
"http://cct.eng.it/FHIR/schema/claimResponse-encounter"
]
}
],
"condition" : [
"ele-1"
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
},
{
"key" : "ext-1",
"severity" : "error",
"human" : "Must have either extensions or value[x], not both",
"expression" : "extension.exists() != value.exists()",
"xpath" : "exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])",
"source" : "http://hl7.org/fhir/StructureDefinition/Extension"
}
],
"isModifier" : false,
"mapping" : [
{
"identity" : "rim",
"map" : "n/a"
},
{
"identity" : "rim",
"map" : "N/A"
}
]
},
{
"id" : "ClaimResponse.total.modifierExtension",
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status",
"valueCode" : "normative"
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-normative-version",
"valueCode" : "4.0.0"
}
],
"path" : "ClaimResponse.total.modifierExtension",
"short" : "Extensions that cannot be ignored even if unrecognized",
"definition" : "May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.\n\nModifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).",
"comment" : "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.",
"requirements" : "Modifier extensions allow for extensions that *cannot* be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the [definition of modifier extensions](extensibility.html#modifierExtension).",
"alias" : [
"extensions",
"user content",
"modifiers"
],
"min" : 0,
"max" : "*",
"base" : {
"path" : "BackboneElement.modifierExtension",
"min" : 0,
"max" : "*"
},
"type" : [
{
"code" : "Extension"
}
],
"condition" : [
"ele-1"
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
},
{
"key" : "ext-1",
"severity" : "error",
"human" : "Must have either extensions or value[x], not both",
"expression" : "extension.exists() != value.exists()",
"xpath" : "exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])",
"source" : "http://hl7.org/fhir/StructureDefinition/Extension"
}
],
"isModifier" : true,
"isModifierReason" : "Modifier extensions are expected to modify the meaning or interpretation of the element that contains them",
"isSummary" : true,
"mapping" : [
{
"identity" : "rim",
"map" : "n/a"
},
{
"identity" : "rim",
"map" : "N/A"
}
]
},
{
"id" : "ClaimResponse.total.category",
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status",
"valueCode" : "normative"
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-normative-version",
"valueCode" : "4.0.0"
}
],
"path" : "ClaimResponse.total.category",
"short" : "Tipo di informazioni sull'aggiudicazione",
"definition" : "Un codice per indicare il tipo di informazione di questo record di aggiudicazione. I tipi di informazioni possono includere: il valore presentato, i valori massimi o le percentuali consentite o pagabili nell'ambito del piano, gli importi di cui il paziente è responsabile in forma aggregata o pertinente a questa voce, gli importi pagati da altre coperture e il beneficio pagabile per questa voce.",
"comment" : "Category.code può essere valorizzato con:\r\n\r\n* QUOTAFISSA\r\n\r\n* LORDO\r\n\r\n* BOLLO\r\n\r\n* IMPTOT\r\n\r\n* ALI-IVA\r\n\r\n* IVA\r\n\r\n* NETTO",
"requirements" : "Needed to convey the type of total provided.",
"min" : 1,
"max" : "1",
"base" : {
"path" : "ClaimResponse.total.category",
"min" : 1,
"max" : "1"
},
"type" : [
{
"code" : "CodeableConcept"
}
],
"condition" : [
"ele-1"
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"isSummary" : true,
"binding" : {
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString" : "Adjudication"
}
],
"strength" : "example",
"description" : "The adjudication codes.",
"valueSet" : "http://hl7.org/fhir/ValueSet/adjudication"
},
"mapping" : [
{
"identity" : "rim",
"map" : "n/a"
},
{
"identity" : "v2",
"map" : "CE/CNE/CWE"
},
{
"identity" : "rim",
"map" : "CD"
},
{
"identity" : "orim",
"map" : "fhir:CodeableConcept rdfs:subClassOf dt:CD"
}
]
},
{
"id" : "ClaimResponse.total.category.id",
"path" : "ClaimResponse.total.category.id",
"representation" : [
"xmlAttr"
],
"short" : "Unique id for inter-element referencing",
"definition" : "Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.",
"min" : 0,
"max" : "1",
"base" : {
"path" : "Element.id",
"min" : 0,
"max" : "1"
},
"type" : [
{
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type",
"valueUrl" : "string"
}
],
"code" : "http://hl7.org/fhirpath/System.String"
}
],
"mapping" : [
{
"identity" : "rim",
"map" : "n/a"
}
]
},
{
"id" : "ClaimResponse.total.category.extension",
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status",
"valueCode" : "normative"
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-normative-version",
"valueCode" : "4.0.0"
}
],
"path" : "ClaimResponse.total.category.extension",
"slicing" : {
"discriminator" : [
{
"type" : "value",
"path" : "url"
}
],
"description" : "Extensions are always sliced by (at least) url",
"rules" : "open"
},
"short" : "Additional content defined by implementations",
"definition" : "May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.",
"comment" : "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.",
"alias" : [
"extensions",
"user content"
],
"min" : 0,
"max" : "*",
"base" : {
"path" : "Element.extension",
"min" : 0,
"max" : "*"
},
"type" : [
{
"code" : "Extension"
}
],
"condition" : [
"ele-1"
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
},
{
"key" : "ext-1",
"severity" : "error",
"human" : "Must have either extensions or value[x], not both",
"expression" : "extension.exists() != value.exists()",
"xpath" : "exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])",
"source" : "http://hl7.org/fhir/StructureDefinition/Extension"
}
],
"mapping" : [
{
"identity" : "rim",
"map" : "n/a"
},
{
"identity" : "rim",
"map" : "N/A"
}
]
},
{
"id" : "ClaimResponse.total.category.coding",
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status",
"valueCode" : "normative"
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-normative-version",
"valueCode" : "4.0.0"
}
],
"path" : "ClaimResponse.total.category.coding",
"short" : "Codice definito da un sistema terminologico",
"definition" : "Riferimento a un codice definito da un sistema terminologico.",
"comment" : "Code può essere valorizzato con:\r\n\r\n* QUOTAFISSA\r\n\r\n* IMPTOT \r\n\r\n* IMPRES\r\n\r\n* TARTOT",
"requirements" : "Allows for alternative encodings within a code system, and translations to other code systems.",
"min" : 0,
"max" : "*",
"base" : {
"path" : "CodeableConcept.coding",
"min" : 0,
"max" : "*"
},
"type" : [
{
"code" : "Coding"
}
],
"condition" : [
"ele-1"
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"isSummary" : true,
"mapping" : [
{
"identity" : "rim",
"map" : "n/a"
},
{
"identity" : "v2",
"map" : "CE/CNE/CWE subset one of the sets of component 1-3 or 4-6"
},
{
"identity" : "rim",
"map" : "CV"
},
{
"identity" : "orim",
"map" : "fhir:Coding rdfs:subClassOf dt:CDCoding"
},
{
"identity" : "v2",
"map" : "C*E.1-8, C*E.10-22"
},
{
"identity" : "rim",
"map" : "union(., ./translation)"
},
{
"identity" : "orim",
"map" : "fhir:CodeableConcept.coding rdfs:subPropertyOf dt:CD.coding"
}
]
},
{
"id" : "ClaimResponse.total.category.coding.id",
"path" : "ClaimResponse.total.category.coding.id",
"representation" : [
"xmlAttr"
],
"short" : "Unique id for inter-element referencing",
"definition" : "Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.",
"min" : 0,
"max" : "1",
"base" : {
"path" : "Element.id",
"min" : 0,
"max" : "1"
},
"type" : [
{
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type",
"valueUrl" : "string"
}
],
"code" : "http://hl7.org/fhirpath/System.String"
}
],
"mapping" : [
{
"identity" : "rim",
"map" : "n/a"
}
]
},
{
"id" : "ClaimResponse.total.category.coding.extension",
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status",
"valueCode" : "normative"
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-normative-version",
"valueCode" : "4.0.0"
}
],
"path" : "ClaimResponse.total.category.coding.extension",
"slicing" : {
"discriminator" : [
{
"type" : "value",
"path" : "url"
}
],
"description" : "Extensions are always sliced by (at least) url",
"rules" : "open"
},
"short" : "Additional content defined by implementations",
"definition" : "May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.",
"comment" : "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.",
"alias" : [
"extensions",
"user content"
],
"min" : 0,
"max" : "*",
"base" : {
"path" : "Element.extension",
"min" : 0,
"max" : "*"
},
"type" : [
{
"code" : "Extension"
}
],
"condition" : [
"ele-1"
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
},
{
"key" : "ext-1",
"severity" : "error",
"human" : "Must have either extensions or value[x], not both",
"expression" : "extension.exists() != value.exists()",
"xpath" : "exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])",
"source" : "http://hl7.org/fhir/StructureDefinition/Extension"
}
],
"mapping" : [
{
"identity" : "rim",
"map" : "n/a"
},
{
"identity" : "rim",
"map" : "N/A"
}
]
},
{
"id" : "ClaimResponse.total.category.coding.system",
"path" : "ClaimResponse.total.category.coding.system",
"short" : "Identità del sistema terminologico",
"definition" : "L'identificazione del sistema di codice che definisce il significato del simbolo nel codice.",
"comment" : "Code può essere valorizzato con:\r\n\r\n* QUOTAFISSA\r\n\r\n* IMPTOT \r\n\r\n* IMPRES\r\n\r\n* TARTOT",
"requirements" : "Need to be unambiguous about the source of the definition of the symbol.",
"min" : 0,
"max" : "1",
"base" : {
"path" : "Coding.system",
"min" : 0,
"max" : "1"
},
"type" : [
{
"code" : "uri"
}
],
"fixedUri" : "http://cct.eng.it/FHIR/schema/claimResponse-importo",
"condition" : [
"ele-1"
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"isSummary" : true,
"mapping" : [
{
"identity" : "rim",
"map" : "n/a"
},
{
"identity" : "v2",
"map" : "C*E.3"
},
{
"identity" : "rim",
"map" : "./codeSystem"
},
{
"identity" : "orim",
"map" : "fhir:Coding.system rdfs:subPropertyOf dt:CDCoding.codeSystem"
}
]
},
{
"id" : "ClaimResponse.total.category.coding.version",
"path" : "ClaimResponse.total.category.coding.version",
"short" : "Version of the system - if relevant",
"definition" : "The version of the code system which was used when choosing this code. Note that a well-maintained code system does not need the version reported, because the meaning of codes is consistent across versions. However this cannot consistently be assured, and when the meaning is not guaranteed to be consistent, the version SHOULD be exchanged.",
"comment" : "Where the terminology does not clearly define what string should be used to identify code system versions, the recommendation is to use the date (expressed in FHIR date format) on which that version was officially published as the version date.",
"min" : 0,
"max" : "1",
"base" : {
"path" : "Coding.version",
"min" : 0,
"max" : "1"
},
"type" : [
{
"code" : "string"
}
],
"condition" : [
"ele-1"
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"isSummary" : true,
"mapping" : [
{
"identity" : "rim",
"map" : "n/a"
},
{
"identity" : "v2",
"map" : "C*E.7"
},
{
"identity" : "rim",
"map" : "./codeSystemVersion"
},
{
"identity" : "orim",
"map" : "fhir:Coding.version rdfs:subPropertyOf dt:CDCoding.codeSystemVersion"
}
]
},
{
"id" : "ClaimResponse.total.category.coding.code",
"path" : "ClaimResponse.total.category.coding.code",
"short" : "Simbolo nella sintassi definita dal sistema",
"definition" : "Simbolo nella sintassi definita dal sistema. Il simbolo può essere un codice predefinito o un'espressione in una sintassi definita dal sistema di codifica (ad esempio post-coordinamento).",
"comment" : "Può essere valorizzato con:\r\n\r\n* QUOTAFISSA\r\n\r\n* LORDO\r\n\r\n* BOLLO\r\n\r\n* IMPTOT\r\n\r\n* ALI-IVA\r\n\r\n* IVA\r\n\r\n* NETTO",
"requirements" : "Need to refer to a particular code in the system.",
"min" : 0,
"max" : "1",
"base" : {
"path" : "Coding.code",
"min" : 0,
"max" : "1"
},
"type" : [
{
"code" : "code"
}
],
"condition" : [
"ele-1"
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"isSummary" : true,
"mapping" : [
{
"identity" : "rim",
"map" : "n/a"
},
{
"identity" : "v2",
"map" : "C*E.1"
},
{
"identity" : "rim",
"map" : "./code"
},
{
"identity" : "orim",
"map" : "fhir:Coding.code rdfs:subPropertyOf dt:CDCoding.code"
}
]
},
{
"id" : "ClaimResponse.total.category.coding.display",
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-translatable",
"valueBoolean" : true
}
],
"path" : "ClaimResponse.total.category.coding.display",
"short" : "Representation defined by the system",
"definition" : "A representation of the meaning of the code in the system, following the rules of the system.",
"comment" : "Note that FHIR strings SHALL NOT exceed 1MB in size",
"requirements" : "Need to be able to carry a human-readable meaning of the code for readers that do not know the system.",
"min" : 0,
"max" : "1",
"base" : {
"path" : "Coding.display",
"min" : 0,
"max" : "1"
},
"type" : [
{
"code" : "string"
}
],
"condition" : [
"ele-1"
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"isSummary" : true,
"mapping" : [
{
"identity" : "rim",
"map" : "n/a"
},
{
"identity" : "v2",
"map" : "C*E.2 - but note this is not well followed"
},
{
"identity" : "rim",
"map" : "CV.displayName"
},
{
"identity" : "orim",
"map" : "fhir:Coding.display rdfs:subPropertyOf dt:CDCoding.displayName"
}
]
},
{
"id" : "ClaimResponse.total.category.coding.userSelected",
"path" : "ClaimResponse.total.category.coding.userSelected",
"short" : "If this coding was chosen directly by the user",
"definition" : "Indicates that this coding was chosen by a user directly - e.g. off a pick list of available items (codes or displays).",
"comment" : "Amongst a set of alternatives, a directly chosen code is the most appropriate starting point for new translations. There is some ambiguity about what exactly 'directly chosen' implies, and trading partner agreement may be needed to clarify the use of this element and its consequences more completely.",
"requirements" : "This has been identified as a clinical safety criterium - that this exact system/code pair was chosen explicitly, rather than inferred by the system based on some rules or language processing.",
"min" : 0,
"max" : "1",
"base" : {
"path" : "Coding.userSelected",
"min" : 0,
"max" : "1"
},
"type" : [
{
"code" : "boolean"
}
],
"condition" : [
"ele-1"
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"isSummary" : true,
"mapping" : [
{
"identity" : "rim",
"map" : "n/a"
},
{
"identity" : "v2",
"map" : "Sometimes implied by being first"
},
{
"identity" : "rim",
"map" : "CD.codingRationale"
},
{
"identity" : "orim",
"map" : "fhir:Coding.userSelected fhir:mapsTo dt:CDCoding.codingRationale. fhir:Coding.userSelected fhir:hasMap fhir:Coding.userSelected.map. fhir:Coding.userSelected.map a fhir:Map; fhir:target dt:CDCoding.codingRationale. fhir:Coding.userSelected\\#true a [ fhir:source \"true\"; fhir:target dt:CDCoding.codingRationale\\#O ]"
}
]
},
{
"id" : "ClaimResponse.total.category.text",
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-translatable",
"valueBoolean" : true
}
],
"path" : "ClaimResponse.total.category.text",
"short" : "Plain text representation of the concept",
"definition" : "A human language representation of the concept as seen/selected/uttered by the user who entered the data and/or which represents the intended meaning of the user.",
"comment" : "Very often the text is the same as a displayName of one of the codings.",
"requirements" : "The codes from the terminologies do not always capture the correct meaning with all the nuances of the human using them, or sometimes there is no appropriate code at all. In these cases, the text is used to capture the full meaning of the source.",
"min" : 0,
"max" : "1",
"base" : {
"path" : "CodeableConcept.text",
"min" : 0,
"max" : "1"
},
"type" : [
{
"code" : "string"
}
],
"condition" : [
"ele-1"
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"isSummary" : true,
"mapping" : [
{
"identity" : "rim",
"map" : "n/a"
},
{
"identity" : "v2",
"map" : "C*E.9. But note many systems use C*E.2 for this"
},
{
"identity" : "rim",
"map" : "./originalText[mediaType/code=\"text/plain\"]/data"
},
{
"identity" : "orim",
"map" : "fhir:CodeableConcept.text rdfs:subPropertyOf dt:CD.originalText"
}
]
},
{
"id" : "ClaimResponse.total.amount",
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status",
"valueCode" : "normative"
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-normative-version",
"valueCode" : "4.0.0"
}
],
"path" : "ClaimResponse.total.amount",
"short" : "Totale finanziario per la categoria",
"definition" : "Importo totale monetario associato alla categoria.",
"requirements" : "Needed to convey the total monetary amount.",
"min" : 1,
"max" : "1",
"base" : {
"path" : "ClaimResponse.total.amount",
"min" : 1,
"max" : "1"
},
"type" : [
{
"code" : "Money"
}
],
"condition" : [
"ele-1"
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"isSummary" : true,
"mapping" : [
{
"identity" : "rim",
"map" : "n/a"
},
{
"identity" : "rim",
"map" : "MO"
}
]
},
{
"id" : "ClaimResponse.total.amount.id",
"path" : "ClaimResponse.total.amount.id",
"representation" : [
"xmlAttr"
],
"short" : "Unique id for inter-element referencing",
"definition" : "Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.",
"min" : 0,
"max" : "1",
"base" : {
"path" : "Element.id",
"min" : 0,
"max" : "1"
},
"type" : [
{
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type",
"valueUrl" : "string"
}
],
"code" : "http://hl7.org/fhirpath/System.String"
}
],
"mapping" : [
{
"identity" : "rim",
"map" : "n/a"
}
]
},
{
"id" : "ClaimResponse.total.amount.extension",
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status",
"valueCode" : "normative"
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-normative-version",
"valueCode" : "4.0.0"
}
],
"path" : "ClaimResponse.total.amount.extension",
"slicing" : {
"discriminator" : [
{
"type" : "value",
"path" : "url"
}
],
"description" : "Extensions are always sliced by (at least) url",
"rules" : "open"
},
"short" : "Additional content defined by implementations",
"definition" : "May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.",
"comment" : "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.",
"alias" : [
"extensions",
"user content"
],
"min" : 0,
"max" : "*",
"base" : {
"path" : "Element.extension",
"min" : 0,
"max" : "*"
},
"type" : [
{
"code" : "Extension"
}
],
"condition" : [
"ele-1"
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
},
{
"key" : "ext-1",
"severity" : "error",
"human" : "Must have either extensions or value[x], not both",
"expression" : "extension.exists() != value.exists()",
"xpath" : "exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])",
"source" : "http://hl7.org/fhir/StructureDefinition/Extension"
}
],
"mapping" : [
{
"identity" : "rim",
"map" : "n/a"
},
{
"identity" : "rim",
"map" : "N/A"
}
]
},
{
"id" : "ClaimResponse.total.amount.value",
"path" : "ClaimResponse.total.amount.value",
"short" : "Valore numerico (con precisione implicita)",
"definition" : "Valore numerico (con precisione implicita)",
"comment" : "I valori monetari hanno le proprie regole per la gestione della precisione (fare riferimento ai libri di testo contabili standard).",
"requirements" : "The amount of the currency. The value includes an implicit precision in the presentation of the value.",
"min" : 0,
"max" : "1",
"base" : {
"path" : "Money.value",
"min" : 0,
"max" : "1"
},
"type" : [
{
"code" : "decimal"
}
],
"condition" : [
"ele-1"
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"isSummary" : true,
"mapping" : [
{
"identity" : "rim",
"map" : "n/a"
},
{
"identity" : "v2",
"map" : "MO.Value"
}
]
},
{
"id" : "ClaimResponse.total.amount.currency",
"path" : "ClaimResponse.total.amount.currency",
"short" : "Codice valuta ISO 4217",
"definition" : "Codice valuta ISO 4217",
"comment" : "Si noti che le stringhe FHIR NON devono superare 1 MB di dimensione",
"requirements" : "A code indicating the currency, taken from ISO 4217.",
"min" : 0,
"max" : "1",
"base" : {
"path" : "Money.currency",
"min" : 0,
"max" : "1"
},
"type" : [
{
"code" : "code"
}
],
"condition" : [
"ele-1"
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"isSummary" : true,
"binding" : {
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString" : "CurrencyCode"
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-isCommonBinding",
"valueBoolean" : true
}
],
"strength" : "required",
"description" : "A code indicating the currency, taken from ISO 4217.",
"valueSet" : "http://hl7.org/fhir/ValueSet/currencies|4.0.1"
},
"mapping" : [
{
"identity" : "rim",
"map" : "n/a"
},
{
"identity" : "v2",
"map" : "MO.Currency"
}
]
},
{
"id" : "ClaimResponse.payment",
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status",
"valueCode" : "normative"
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-normative-version",
"valueCode" : "4.0.0"
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-explicit-type-name",
"valueString" : "Payment"
}
],
"path" : "ClaimResponse.payment",
"short" : "Payment Details",
"definition" : "Payment details for the adjudication of the claim.",
"requirements" : "Needed to convey references to the financial instrument that has been used if payment has been made.",
"min" : 0,
"max" : "1",
"base" : {
"path" : "ClaimResponse.payment",
"min" : 0,
"max" : "1"
},
"type" : [
{
"code" : "BackboneElement"
}
],
"condition" : [
"ele-1"
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"mapping" : [
{
"identity" : "rim",
"map" : "n/a"
}
]
},
{
"id" : "ClaimResponse.payment.id",
"path" : "ClaimResponse.payment.id",
"representation" : [
"xmlAttr"
],
"short" : "Unique id for inter-element referencing",
"definition" : "Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.",
"min" : 0,
"max" : "1",
"base" : {
"path" : "Element.id",
"min" : 0,
"max" : "1"
},
"type" : [
{
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type",
"valueUrl" : "string"
}
],
"code" : "http://hl7.org/fhirpath/System.String"
}
],
"mapping" : [
{
"identity" : "rim",
"map" : "n/a"
}
]
},
{
"id" : "ClaimResponse.payment.extension",
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status",
"valueCode" : "normative"
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-normative-version",
"valueCode" : "4.0.0"
}
],
"path" : "ClaimResponse.payment.extension",
"slicing" : {
"discriminator" : [
{
"type" : "value",
"path" : "url"
}
],
"description" : "Extensions are always sliced by (at least) url",
"rules" : "open"
},
"short" : "Additional content defined by implementations",
"definition" : "May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.",
"comment" : "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.",
"alias" : [
"extensions",
"user content"
],
"min" : 0,
"max" : "*",
"base" : {
"path" : "Element.extension",
"min" : 0,
"max" : "*"
},
"type" : [
{
"code" : "Extension"
}
],
"condition" : [
"ele-1"
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
},
{
"key" : "ext-1",
"severity" : "error",
"human" : "Must have either extensions or value[x], not both",
"expression" : "extension.exists() != value.exists()",
"xpath" : "exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])",
"source" : "http://hl7.org/fhir/StructureDefinition/Extension"
}
],
"mapping" : [
{
"identity" : "rim",
"map" : "n/a"
},
{
"identity" : "rim",
"map" : "N/A"
}
]
},
{
"id" : "ClaimResponse.payment.modifierExtension",
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status",
"valueCode" : "normative"
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-normative-version",
"valueCode" : "4.0.0"
}
],
"path" : "ClaimResponse.payment.modifierExtension",
"short" : "Extensions that cannot be ignored even if unrecognized",
"definition" : "May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.\n\nModifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).",
"comment" : "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.",
"requirements" : "Modifier extensions allow for extensions that *cannot* be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the [definition of modifier extensions](extensibility.html#modifierExtension).",
"alias" : [
"extensions",
"user content",
"modifiers"
],
"min" : 0,
"max" : "*",
"base" : {
"path" : "BackboneElement.modifierExtension",
"min" : 0,
"max" : "*"
},
"type" : [
{
"code" : "Extension"
}
],
"condition" : [
"ele-1"
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
},
{
"key" : "ext-1",
"severity" : "error",
"human" : "Must have either extensions or value[x], not both",
"expression" : "extension.exists() != value.exists()",
"xpath" : "exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])",
"source" : "http://hl7.org/fhir/StructureDefinition/Extension"
}
],
"isModifier" : true,
"isModifierReason" : "Modifier extensions are expected to modify the meaning or interpretation of the element that contains them",
"isSummary" : true,
"mapping" : [
{
"identity" : "rim",
"map" : "n/a"
},
{
"identity" : "rim",
"map" : "N/A"
}
]
},
{
"id" : "ClaimResponse.payment.type",
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status",
"valueCode" : "normative"
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-normative-version",
"valueCode" : "4.0.0"
}
],
"path" : "ClaimResponse.payment.type",
"short" : "Partial or complete payment",
"definition" : "Whether this represents partial or complete payment of the benefits payable.",
"comment" : "Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination.",
"requirements" : "To advise the requestor when the insurer believes all payments to have been completed.",
"min" : 1,
"max" : "1",
"base" : {
"path" : "ClaimResponse.payment.type",
"min" : 1,
"max" : "1"
},
"type" : [
{
"code" : "CodeableConcept"
}
],
"condition" : [
"ele-1"
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"binding" : {
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString" : "PaymentType"
}
],
"strength" : "example",
"description" : "The type (partial, complete) of the payment.",
"valueSet" : "http://hl7.org/fhir/ValueSet/ex-paymenttype"
},
"mapping" : [
{
"identity" : "rim",
"map" : "n/a"
},
{
"identity" : "v2",
"map" : "CE/CNE/CWE"
},
{
"identity" : "rim",
"map" : "CD"
},
{
"identity" : "orim",
"map" : "fhir:CodeableConcept rdfs:subClassOf dt:CD"
}
]
},
{
"id" : "ClaimResponse.payment.adjustment",
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status",
"valueCode" : "normative"
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-normative-version",
"valueCode" : "4.0.0"
}
],
"path" : "ClaimResponse.payment.adjustment",
"short" : "Payment adjustment for non-claim issues",
"definition" : "Total amount of all adjustments to this payment included in this transaction which are not related to this claim's adjudication.",
"comment" : "Insurers will deduct amounts owing from the provider (adjustment), such as a prior overpayment, from the amount owing to the provider (benefits payable) when payment is made to the provider.",
"requirements" : "To advise the requestor of adjustments applied to the payment.",
"min" : 0,
"max" : "1",
"base" : {
"path" : "ClaimResponse.payment.adjustment",
"min" : 0,
"max" : "1"
},
"type" : [
{
"code" : "Money"
}
],
"condition" : [
"ele-1"
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"mapping" : [
{
"identity" : "rim",
"map" : "n/a"
},
{
"identity" : "rim",
"map" : "MO"
}
]
},
{
"id" : "ClaimResponse.payment.adjustmentReason",
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status",
"valueCode" : "normative"
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-normative-version",
"valueCode" : "4.0.0"
}
],
"path" : "ClaimResponse.payment.adjustmentReason",
"short" : "Explanation for the adjustment",
"definition" : "Reason for the payment adjustment.",
"comment" : "Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination.",
"requirements" : "Needed to clarify the monetary adjustment.",
"min" : 0,
"max" : "1",
"base" : {
"path" : "ClaimResponse.payment.adjustmentReason",
"min" : 0,
"max" : "1"
},
"type" : [
{
"code" : "CodeableConcept"
}
],
"condition" : [
"ele-1"
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"binding" : {
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString" : "PaymentAdjustmentReason"
}
],
"strength" : "example",
"description" : "Payment Adjustment reason codes.",
"valueSet" : "http://hl7.org/fhir/ValueSet/payment-adjustment-reason"
},
"mapping" : [
{
"identity" : "rim",
"map" : "n/a"
},
{
"identity" : "v2",
"map" : "CE/CNE/CWE"
},
{
"identity" : "rim",
"map" : "CD"
},
{
"identity" : "orim",
"map" : "fhir:CodeableConcept rdfs:subClassOf dt:CD"
}
]
},
{
"id" : "ClaimResponse.payment.date",
"path" : "ClaimResponse.payment.date",
"short" : "Expected date of payment",
"definition" : "Estimated date the payment will be issued or the actual issue date of payment.",
"requirements" : "To advise the payee when payment can be expected.",
"min" : 0,
"max" : "1",
"base" : {
"path" : "ClaimResponse.payment.date",
"min" : 0,
"max" : "1"
},
"type" : [
{
"code" : "date"
}
],
"condition" : [
"ele-1"
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"mapping" : [
{
"identity" : "rim",
"map" : "n/a"
}
]
},
{
"id" : "ClaimResponse.payment.amount",
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status",
"valueCode" : "normative"
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-normative-version",
"valueCode" : "4.0.0"
}
],
"path" : "ClaimResponse.payment.amount",
"short" : "Payable amount after adjustment",
"definition" : "Benefits payable less any payment adjustment.",
"requirements" : "Needed to provide the actual payment amount.",
"min" : 1,
"max" : "1",
"base" : {
"path" : "ClaimResponse.payment.amount",
"min" : 1,
"max" : "1"
},
"type" : [
{
"code" : "Money"
}
],
"condition" : [
"ele-1"
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"mapping" : [
{
"identity" : "rim",
"map" : "n/a"
},
{
"identity" : "rim",
"map" : "MO"
}
]
},
{
"id" : "ClaimResponse.payment.identifier",
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status",
"valueCode" : "normative"
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-normative-version",
"valueCode" : "4.0.0"
}
],
"path" : "ClaimResponse.payment.identifier",
"short" : "Business identifier for the payment",
"definition" : "Issuer's unique identifier for the payment instrument.",
"comment" : "For example: EFT number or check number.",
"requirements" : "Enable the receiver to reconcile when payment received.",
"min" : 0,
"max" : "1",
"base" : {
"path" : "ClaimResponse.payment.identifier",
"min" : 0,
"max" : "1"
},
"type" : [
{
"code" : "Identifier"
}
],
"condition" : [
"ele-1"
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"mapping" : [
{
"identity" : "rim",
"map" : "n/a"
},
{
"identity" : "v2",
"map" : "CX / EI (occasionally, more often EI maps to a resource id or a URL)"
},
{
"identity" : "rim",
"map" : "II - The Identifier class is a little looser than the v3 type II because it allows URIs as well as registered OIDs or GUIDs. Also maps to Role[classCode=IDENT]"
},
{
"identity" : "servd",
"map" : "Identifier"
}
]
},
{
"id" : "ClaimResponse.fundsReserve",
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status",
"valueCode" : "normative"
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-normative-version",
"valueCode" : "4.0.0"
}
],
"path" : "ClaimResponse.fundsReserve",
"short" : "Funds reserved status",
"definition" : "A code, used only on a response to a preauthorization, to indicate whether the benefits payable have been reserved and for whom.",
"comment" : "Fund would be release by a future claim quoting the preAuthRef of this response. Examples of values include: provider, patient, none.",
"requirements" : "Needed to advise the submitting provider on whether the rquest for reservation of funds has been honored.",
"min" : 0,
"max" : "1",
"base" : {
"path" : "ClaimResponse.fundsReserve",
"min" : 0,
"max" : "1"
},
"type" : [
{
"code" : "CodeableConcept"
}
],
"condition" : [
"ele-1"
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"binding" : {
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString" : "FundsReserve"
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-isCommonBinding",
"valueBoolean" : true
}
],
"strength" : "example",
"description" : "For whom funds are to be reserved: (Patient, Provider, None).",
"valueSet" : "http://hl7.org/fhir/ValueSet/fundsreserve"
},
"mapping" : [
{
"identity" : "rim",
"map" : "n/a"
},
{
"identity" : "v2",
"map" : "CE/CNE/CWE"
},
{
"identity" : "rim",
"map" : "CD"
},
{
"identity" : "orim",
"map" : "fhir:CodeableConcept rdfs:subClassOf dt:CD"
}
]
},
{
"id" : "ClaimResponse.formCode",
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status",
"valueCode" : "normative"
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-normative-version",
"valueCode" : "4.0.0"
}
],
"path" : "ClaimResponse.formCode",
"short" : "Printed form identifier",
"definition" : "A code for the form to be used for printing the content.",
"comment" : "May be needed to identify specific jurisdictional forms.",
"requirements" : "Needed to specify the specific form used for producing output for this response.",
"min" : 0,
"max" : "1",
"base" : {
"path" : "ClaimResponse.formCode",
"min" : 0,
"max" : "1"
},
"type" : [
{
"code" : "CodeableConcept"
}
],
"condition" : [
"ele-1"
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"binding" : {
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString" : "Forms"
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-isCommonBinding",
"valueBoolean" : true
}
],
"strength" : "example",
"description" : "The forms codes.",
"valueSet" : "http://hl7.org/fhir/ValueSet/forms"
},
"mapping" : [
{
"identity" : "rim",
"map" : "n/a"
},
{
"identity" : "v2",
"map" : "CE/CNE/CWE"
},
{
"identity" : "rim",
"map" : "CD"
},
{
"identity" : "orim",
"map" : "fhir:CodeableConcept rdfs:subClassOf dt:CD"
}
]
},
{
"id" : "ClaimResponse.form",
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status",
"valueCode" : "normative"
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-normative-version",
"valueCode" : "4.0.0"
}
],
"path" : "ClaimResponse.form",
"short" : "Printed reference or actual form",
"definition" : "The actual form, by reference or inclusion, for printing the content or an EOB.",
"comment" : "Needed to permit insurers to include the actual form.",
"requirements" : "Needed to include the specific form used for producing output for this response.",
"min" : 0,
"max" : "1",
"base" : {
"path" : "ClaimResponse.form",
"min" : 0,
"max" : "1"
},
"type" : [
{
"code" : "Attachment"
}
],
"condition" : [
"ele-1"
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
},
{
"key" : "att-1",
"severity" : "error",
"human" : "If the Attachment has data, it SHALL have a contentType",
"expression" : "data.empty() or contentType.exists()",
"xpath" : "not(exists(f:data)) or exists(f:contentType)",
"source" : "http://hl7.org/fhir/StructureDefinition/Attachment"
}
],
"mapping" : [
{
"identity" : "rim",
"map" : "n/a"
},
{
"identity" : "v2",
"map" : "ED/RP"
},
{
"identity" : "rim",
"map" : "ED"
}
]
},
{
"id" : "ClaimResponse.processNote",
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status",
"valueCode" : "normative"
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-normative-version",
"valueCode" : "4.0.0"
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-explicit-type-name",
"valueString" : "Note"
}
],
"path" : "ClaimResponse.processNote",
"short" : "Note concerning adjudication",
"definition" : "A note that describes or explains adjudication results in a human readable form.",
"requirements" : "Provides the insurer specific textual explanations associated with the processing.",
"min" : 0,
"max" : "*",
"base" : {
"path" : "ClaimResponse.processNote",
"min" : 0,
"max" : "*"
},
"type" : [
{
"code" : "BackboneElement"
}
],
"condition" : [
"ele-1"
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"mapping" : [
{
"identity" : "rim",
"map" : "n/a"
}
]
},
{
"id" : "ClaimResponse.processNote.id",
"path" : "ClaimResponse.processNote.id",
"representation" : [
"xmlAttr"
],
"short" : "Unique id for inter-element referencing",
"definition" : "Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.",
"min" : 0,
"max" : "1",
"base" : {
"path" : "Element.id",
"min" : 0,
"max" : "1"
},
"type" : [
{
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type",
"valueUrl" : "string"
}
],
"code" : "http://hl7.org/fhirpath/System.String"
}
],
"mapping" : [
{
"identity" : "rim",
"map" : "n/a"
}
]
},
{
"id" : "ClaimResponse.processNote.extension",
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status",
"valueCode" : "normative"
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-normative-version",
"valueCode" : "4.0.0"
}
],
"path" : "ClaimResponse.processNote.extension",
"slicing" : {
"discriminator" : [
{
"type" : "value",
"path" : "url"
}
],
"description" : "Extensions are always sliced by (at least) url",
"rules" : "open"
},
"short" : "Additional content defined by implementations",
"definition" : "May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.",
"comment" : "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.",
"alias" : [
"extensions",
"user content"
],
"min" : 0,
"max" : "*",
"base" : {
"path" : "Element.extension",
"min" : 0,
"max" : "*"
},
"type" : [
{
"code" : "Extension"
}
],
"condition" : [
"ele-1"
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
},
{
"key" : "ext-1",
"severity" : "error",
"human" : "Must have either extensions or value[x], not both",
"expression" : "extension.exists() != value.exists()",
"xpath" : "exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])",
"source" : "http://hl7.org/fhir/StructureDefinition/Extension"
}
],
"mapping" : [
{
"identity" : "rim",
"map" : "n/a"
},
{
"identity" : "rim",
"map" : "N/A"
}
]
},
{
"id" : "ClaimResponse.processNote.modifierExtension",
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status",
"valueCode" : "normative"
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-normative-version",
"valueCode" : "4.0.0"
}
],
"path" : "ClaimResponse.processNote.modifierExtension",
"short" : "Extensions that cannot be ignored even if unrecognized",
"definition" : "May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.\n\nModifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).",
"comment" : "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.",
"requirements" : "Modifier extensions allow for extensions that *cannot* be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the [definition of modifier extensions](extensibility.html#modifierExtension).",
"alias" : [
"extensions",
"user content",
"modifiers"
],
"min" : 0,
"max" : "*",
"base" : {
"path" : "BackboneElement.modifierExtension",
"min" : 0,
"max" : "*"
},
"type" : [
{
"code" : "Extension"
}
],
"condition" : [
"ele-1"
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
},
{
"key" : "ext-1",
"severity" : "error",
"human" : "Must have either extensions or value[x], not both",
"expression" : "extension.exists() != value.exists()",
"xpath" : "exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])",
"source" : "http://hl7.org/fhir/StructureDefinition/Extension"
}
],
"isModifier" : true,
"isModifierReason" : "Modifier extensions are expected to modify the meaning or interpretation of the element that contains them",
"isSummary" : true,
"mapping" : [
{
"identity" : "rim",
"map" : "n/a"
},
{
"identity" : "rim",
"map" : "N/A"
}
]
},
{
"id" : "ClaimResponse.processNote.number",
"path" : "ClaimResponse.processNote.number",
"short" : "Note instance identifier",
"definition" : "A number to uniquely identify a note entry.",
"comment" : "32 bit number; for values larger than this, use decimal",
"requirements" : "Necessary to provide a mechanism to link from adjudications.",
"min" : 0,
"max" : "1",
"base" : {
"path" : "ClaimResponse.processNote.number",
"min" : 0,
"max" : "1"
},
"type" : [
{
"code" : "positiveInt"
}
],
"condition" : [
"ele-1"
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"mapping" : [
{
"identity" : "rim",
"map" : "n/a"
}
]
},
{
"id" : "ClaimResponse.processNote.type",
"path" : "ClaimResponse.processNote.type",
"short" : "display | print | printoper",
"definition" : "The business purpose of the note text.",
"comment" : "Note that FHIR strings SHALL NOT exceed 1MB in size",
"requirements" : "To convey the expectation for when the text is used.",
"min" : 0,
"max" : "1",
"base" : {
"path" : "ClaimResponse.processNote.type",
"min" : 0,
"max" : "1"
},
"type" : [
{
"code" : "code"
}
],
"condition" : [
"ele-1"
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"binding" : {
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString" : "NoteType"
},
"identity" : "rim",
"map" : "n/a"
}
]
},
{
"id" : "ClaimResponse.insurance.claimResponse",
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status",
"valueCode" : "normative"
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-normative-version",
"valueCode" : "4.0.0"
}
],
"path" : "ClaimResponse.insurance.claimResponse",
"short" : "Adjudication results",
"definition" : "The result of the adjudication of the line items for the Coverage specified in this insurance.",
"comment" : "Must not be specified when 'focal=true' for this insurance.",
"requirements" : "An insurer need the adjudication results from prior insurers to determine the outstanding balance remaining by item for the items in the curent claim.",
"min" : 0,
"max" : "1",
"base" : {
"path" : "ClaimResponse.insurance.claimResponse",
"min" : 0,
"max" : "1"
},
"type" : [
{
"code" : "Reference",
"targetProfile" : [
"http://hl7.org/fhir/StructureDefinition/ClaimResponse"
]
}
],
"condition" : [
"ele-1"
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
},
{
"key" : "ref-1",
"severity" : "error",
"human" : "SHALL have a contained resource if a local reference is provided",
"expression" : "reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))",
"xpath" : "not(starts-with(f:reference/@value, '#')) or exists(ancestor::*[self::f:entry or self::f:parameter]/f:resource/f:*/f:contained/f:*[f:id/@value=substring-after(current()/f:reference/@value, '#')]|/*/f:contained/f:*[f:id/@value=substring-after(current()/f:reference/@value, '#')])",
"source" : "http://hl7.org/fhir/StructureDefinition/Reference"
}
],
"mapping" : [
{
"identity" : "rim",
"map" : "n/a"
},
{
"identity" : "rim",
"map" : "The target of a resource reference is a RIM entry point (Act, Role, or Entity)"
}
]
},
{
"id" : "ClaimResponse.error",
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status",
"valueCode" : "normative"
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-normative-version",
"valueCode" : "4.0.0"
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-explicit-type-name",
"valueString" : "Error"
}
],
"path" : "ClaimResponse.error",
"short" : "Processing errors",
"definition" : "Errors encountered during the processing of the adjudication.",
"comment" : "If the request contains errors then an error element should be provided and no adjudication related sections (item, addItem, or payment) should be present.",
"requirements" : "Need to communicate processing issues to the requestor.",
"min" : 0,
"max" : "*",
"base" : {
"path" : "ClaimResponse.error",
"min" : 0,
"max" : "*"
},
"type" : [
{
"code" : "BackboneElement"
}
],
"condition" : [
"ele-1"
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"mapping" : [
{
"identity" : "rim",
"map" : "n/a"
}
]
},
{
"id" : "ClaimResponse.error.id",
"path" : "ClaimResponse.error.id",
"representation" : [
"xmlAttr"
],
"short" : "Unique id for inter-element referencing",
"definition" : "Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.",
"min" : 0,
"max" : "1",
"base" : {
"path" : "Element.id",
"min" : 0,
"max" : "1"
},
"type" : [
{
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type",
"valueUrl" : "string"
}
],
"code" : "http://hl7.org/fhirpath/System.String"
}
],
"mapping" : [
{
"identity" : "rim",
"map" : "n/a"
}
]
},
{
"id" : "ClaimResponse.error.extension",
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status",
"valueCode" : "normative"
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-normative-version",
"valueCode" : "4.0.0"
}
],
"path" : "ClaimResponse.error.extension",
"slicing" : {
"discriminator" : [
{
"type" : "value",
"path" : "url"
}
],
"description" : "Extensions are always sliced by (at least) url",
"rules" : "open"
},
"short" : "Additional content defined by implementations",
"definition" : "May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.",
"comment" : "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.",
"alias" : [
"extensions",
"user content"
],
"min" : 0,
"max" : "*",
"base" : {
"path" : "Element.extension",
"min" : 0,
"max" : "*"
},
"type" : [
{
"code" : "Extension"
}
],
"condition" : [
"ele-1"
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
},
{
"key" : "ext-1",
"severity" : "error",
"human" : "Must have either extensions or value[x], not both",
"expression" : "extension.exists() != value.exists()",
"xpath" : "exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])",
"source" : "http://hl7.org/fhir/StructureDefinition/Extension"
}
],
"mapping" : [
{
"identity" : "rim",
"map" : "n/a"
},
{
"identity" : "rim",
"map" : "N/A"
}
]
},
{
"id" : "ClaimResponse.error.modifierExtension",
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status",
"valueCode" : "normative"
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-normative-version",
"valueCode" : "4.0.0"
}
],
"path" : "ClaimResponse.error.modifierExtension",
"short" : "Extensions that cannot be ignored even if unrecognized",
"definition" : "May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.\n\nModifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).",
"comment" : "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.",
"requirements" : "Modifier extensions allow for extensions that *cannot* be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the [definition of modifier extensions](extensibility.html#modifierExtension).",
"alias" : [
"extensions",
"user content",
"modifiers"
],
"min" : 0,
"max" : "*",
"base" : {
"path" : "BackboneElement.modifierExtension",
"min" : 0,
"max" : "*"
},
"type" : [
{
"code" : "Extension"
}
],
"condition" : [
"ele-1"
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
},
{
"key" : "ext-1",
"severity" : "error",
"human" : "Must have either extensions or value[x], not both",
"expression" : "extension.exists() != value.exists()",
"xpath" : "exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])",
"source" : "http://hl7.org/fhir/StructureDefinition/Extension"
}
],
"isModifier" : true,
"isModifierReason" : "Modifier extensions are expected to modify the meaning or interpretation of the element that contains them",
"isSummary" : true,
"mapping" : [
{
"identity" : "rim",
"map" : "n/a"
},
{
"identity" : "rim",
"map" : "N/A"
}
]
},
{
"id" : "ClaimResponse.error.itemSequence",
"path" : "ClaimResponse.error.itemSequence",
"short" : "Item sequence number",
"definition" : "The sequence number of the line item submitted which contains the error. This value is omitted when the error occurs outside of the item structure.",
"comment" : "32 bit number; for values larger than this, use decimal",
"requirements" : "Provides references to the claim items.",
"min" : 0,
"max" : "1",
"base" : {
"path" : "ClaimResponse.error.itemSequence",
"min" : 0,
"max" : "1"
},
"type" : [
{
"code" : "positiveInt"
}
],
"condition" : [
"ele-1"
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"mapping" : [
{
"identity" : "rim",
"map" : "n/a"
}
]
},
{
"id" : "ClaimResponse.error.detailSequence",
"path" : "ClaimResponse.error.detailSequence",
"short" : "Detail sequence number",
"definition" : "The sequence number of the detail within the line item submitted which contains the error. This value is omitted when the error occurs outside of the item structure.",
"comment" : "32 bit number; for values larger than this, use decimal",
"requirements" : "Provides references to the claim details within the claim item.",
"min" : 0,
"max" : "1",
"base" : {
"path" : "ClaimResponse.error.detailSequence",
"min" : 0,
"max" : "1"
},
"type" : [
{
"code" : "positiveInt"
}
],
"condition" : [
"ele-1"
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"mapping" : [
{
"identity" : "rim",
"map" : "n/a"
}
]
},
{
"id" : "ClaimResponse.error.subDetailSequence",
"path" : "ClaimResponse.error.subDetailSequence",
"short" : "Subdetail sequence number",
"definition" : "The sequence number of the sub-detail within the detail within the line item submitted which contains the error. This value is omitted when the error occurs outside of the item structure.",
"comment" : "32 bit number; for values larger than this, use decimal",
"requirements" : "Provides references to the claim sub-details within the claim detail.",
"min" : 0,
"max" : "1",
"base" : {
"path" : "ClaimResponse.error.subDetailSequence",
"min" : 0,
"max" : "1"
},
"type" : [
{
"code" : "positiveInt"
}
],
"condition" : [
"ele-1"
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"mapping" : [
{
"identity" : "rim",
"map" : "n/a"
}
]
},
{
"id" : "ClaimResponse.error.code",
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status",
"valueCode" : "normative"
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-normative-version",
"valueCode" : "4.0.0"
}
],
"path" : "ClaimResponse.error.code",
"short" : "Error code detailing processing issues",
"definition" : "An error code, from a specified code system, which details why the claim could not be adjudicated.",
"comment" : "Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination.",
"requirements" : "Required to convey processing errors.",
"min" : 1,
"max" : "1",
"base" : {
"path" : "ClaimResponse.error.code",
"min" : 1,
"max" : "1"
},
"type" : [
{
"code" : "CodeableConcept"
}
],
"condition" : [
"ele-1"
],
"constraint" : [
{
"key" : "ele-1",
"severity" : "error",
"human" : "All FHIR elements must have a @value or children",
"expression" : "hasValue() or (children().count() > id.count())",
"xpath" : "@value|f:*|h:div",
"source" : "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"binding" : {
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString" : "AdjudicationError"
}
],
"strength" : "example",
"description" : "The adjudication error codes.",
"valueSet" : "http://hl7.org/fhir/ValueSet/adjudication-error"
},
"mapping" : [
{
"identity" : "rim",
"map" : "n/a"
},
{
"identity" : "v2",
"map" : "CE/CNE/CWE"
},
{
"identity" : "rim",
"map" : "CD"
},
{
"identity" : "orim",
"map" : "fhir:CodeableConcept rdfs:subClassOf dt:CD"
}
]
}
]
},
"differential" : {
"element" : [
{
"id" : "ClaimResponse.status",
"path" : "ClaimResponse.status",
"definition" : "Elemento che contiene lo stato della risposta.",
"comment" : "Questo elemento è etichettato come modificatore perché lo stato contiene codici che contrassegnano la risorsa come non valida al momento."
},
{
"id" : "ClaimResponse.type",
"path" : "ClaimResponse.type",
"short" : "Tipo di richiesta di risarcimento più granulare",
"definition" : "Elemento che definisce il tipo di risposta.",
"comment" : "Può contenere i codici del tipo di fattura locale, ad esempio il codice del tipo di fattura US UB-04 o il tipo di fattura CMS."
},
{
"id" : "ClaimResponse.type.coding",
"path" : "ClaimResponse.type.coding",
"short" : "Codice definito da un sistema terminologico",
"definition" : "Un riferimento a un codice definito da un sistema terminologico.",
"comment" : "I codici possono essere definiti in modo molto casuale in enumerazioni o elenchi di codici, fino a definizioni molto formali come SNOMED CT - si vedano i Core Principles HL7 v3 per maggiori informazioni. L'ordine dei codici non è definito e NON DEVE essere usato per dedurre il significato. In generale, al massimo uno solo dei valori di codifica sarà etichettato come UserSelected = true."
},
{
"id" : "ClaimResponse.type.coding.system",
"path" : "ClaimResponse.type.coding.system",
"short" : "Identità del sistema terminologico",
"definition" : "L'identificazione del sistema di codice che definisce il significato del simbolo nel codice.",
"comment" : "L'URI può essere un OID (urn:oid:...) o un UUID (urn:uuid:...). Gli OID e gli UUID DEVONO essere riferimenti al registro OID di HL7. Altrimenti, l'URI deve provenire dall'elenco di URI speciali definiti da HL7 per FHIR o deve fare riferimento a qualche definizione che stabilisca il sistema in modo chiaro e non ambiguo.",
"fixedUri" : "http://terminology.hl7.org/CodeSystem/claim-type"
},
{
"id" : "ClaimResponse.type.coding.code",
"path" : "ClaimResponse.type.coding.code",
"short" : "Simbolo nella sintassi definita dal sistema",
"definition" : "Un simbolo nella sintassi definita dal sistema. Il simbolo può essere un codice predefinito o un'espressione in una sintassi definita dal sistema di codifica (ad esempio, post-coordinazione).",
"comment" : "Si noti che le stringhe FHIR NON devono superare la dimensione di 1MB."
},
{
"id" : "ClaimResponse.use",
"path" : "ClaimResponse.use",
"definition" : "Elemento di tipo code che contiene un codice per indicare se la natura della richiesta è: \r\n\r\n* richiedere l'aggiudicazione di prodotti e servizi precedentemente resi; \r\n\r\n* o richiedere l'autorizzazione e l'aggiudicazione per la fornitura in futuro; \r\n\r\n* o richiedere l'aggiudicazione non vincolante dei prodotti e servizi elencati che potrebbero essere forniti in futuro.",
"comment" : "Si noti che le stringhe FHIR NON devono superare la dimensione di 1MB."
},
{
"id" : "ClaimResponse.patient",
"path" : "ClaimResponse.patient",
"short" : "Reference a Patient",
"definition" : "Riferimento al Patient che riceve la prestazione.",
"comment" : "I riferimenti DEVONO essere un riferimento a una risorsa FHIR effettiva e DEVONO essere risolvibili (consentendo il controllo dell'accesso, la non disponibilità temporanea, ecc.) La risoluzione può avvenire tramite recupero dall'URL o, se applicabile per tipo di risorsa, trattando un riferimento assoluto come un URL canonico e cercandolo in un registro/repository locale.",
"type" : [
{
"code" : "Reference",
"targetProfile" : [
"https://eng.it/fhir/StructureDefinition/Patient_Eng"
]
}
]
},
{
"id" : "ClaimResponse.created",
"path" : "ClaimResponse.created",
"short" : "Data di creazione della risposta.",
"definition" : "Data di creazione della risposta."
},
{
"id" : "ClaimResponse.insurer",
"path" : "ClaimResponse.insurer",
"short" : "Reference ad Organization",
"definition" : "Elemento di tipo Reference contenente la risorsa Organization che indica il responsabile del rimborso.",
"comment" : "I riferimenti DEVONO essere un riferimento a una risorsa FHIR effettiva e DEVONO essere risolvibili (consentendo il controllo dell'accesso, la non disponibilità temporanea, ecc.) La risoluzione può avvenire tramite recupero dall'URL o, se applicabile per tipo di risorsa, trattando un riferimento assoluto come un URL canonico e cercandolo in un registro/repository locale.",
"type" : [
{
"code" : "Reference",
"targetProfile" : [
"https://eng.it/fhir/StructureDefinition/Organization_Eng"
]
}
]
},
{
"id" : "ClaimResponse.outcome",
"path" : "ClaimResponse.outcome",
"definition" : "Elemento di tipo code che contiene l'esito dell'elaborazione della richiesta, della predeterminazione o della preautorizzazione.",
"comment" : "Utilizzare:\r\n\r\n* \"complete\" in caso di esito positivo, \r\n\r\n* \"error\" in caso di esito negativo."
},
{
"id" : "ClaimResponse.total",
"path" : "ClaimResponse.total",
"short" : "Totale aggiudicazione",
"definition" : "Totali monetari categorizzati per l'aggiudicazione.",
"comment" : "Allegare l'estensione claimresponse-encounter quando si vuole fare riferirmento ad una prestazione totale.\r\n\r\nAllegare l'estensione claimresponse-appointment quando si vuole fare riferirmento ad una singola prestazione. Appointment può essere anche una reference di tipo contained."
},
{
"id" : "ClaimResponse.total.extension",
"path" : "ClaimResponse.total.extension",
"slicing" : {
"discriminator" : [
{
"type" : "value",
"path" : "url"
}
],
"rules" : "open"
},
"min" : 0
},
{
"id" : "ClaimResponse.total.extension:appointment",
"path" : "ClaimResponse.total.extension",
"sliceName" : "appointment",
"min" : 0,
"max" : "1",
"type" : [
{
"code" : "Extension",
"profile" : [
"http://cct.eng.it/FHIR/schema/claimResponse-appointment"
]
}
],
"isModifier" : false
},
{
"id" : "ClaimResponse.total.extension:encounter",
"path" : "ClaimResponse.total.extension",
"sliceName" : "encounter",
"min" : 0,
"max" : "1",
"type" : [
{
"code" : "Extension",
"profile" : [
"http://cct.eng.it/FHIR/schema/claimResponse-encounter"
]
}
],
"isModifier" : false
},
{
"id" : "ClaimResponse.total.category",
"path" : "ClaimResponse.total.category",
"short" : "Tipo di informazioni sull'aggiudicazione",
"definition" : "Un codice per indicare il tipo di informazione di questo record di aggiudicazione. I tipi di informazioni possono includere: il valore presentato, i valori massimi o le percentuali consentite o pagabili nell'ambito del piano, gli importi di cui il paziente è responsabile in forma aggregata o pertinente a questa voce, gli importi pagati da altre coperture e il beneficio pagabile per questa voce.",
"comment" : "Category.code può essere valorizzato con:\r\n\r\n* QUOTAFISSA\r\n\r\n* LORDO\r\n\r\n* BOLLO\r\n\r\n* IMPTOT\r\n\r\n* ALI-IVA\r\n\r\n* IVA\r\n\r\n* NETTO"
},
{
"id" : "ClaimResponse.total.category.coding",
"path" : "ClaimResponse.total.category.coding",
"short" : "Codice definito da un sistema terminologico",
"definition" : "Riferimento a un codice definito da un sistema terminologico.",
"comment" : "Code può essere valorizzato con:\r\n\r\n* QUOTAFISSA\r\n\r\n* IMPTOT \r\n\r\n* IMPRES\r\n\r\n* TARTOT"
},
{
"id" : "ClaimResponse.total.category.coding.system",
"path" : "ClaimResponse.total.category.coding.system",
"short" : "Identità del sistema terminologico",
"definition" : "L'identificazione del sistema di codice che definisce il significato del simbolo nel codice.",
"comment" : "Code può essere valorizzato con:\r\n\r\n* QUOTAFISSA\r\n\r\n* IMPTOT \r\n\r\n* IMPRES\r\n\r\n* TARTOT",
"fixedUri" : "http://cct.eng.it/FHIR/schema/claimResponse-importo"
},
{
"id" : "ClaimResponse.total.category.coding.code",
"path" : "ClaimResponse.total.category.coding.code",
"short" : "Simbolo nella sintassi definita dal sistema",
"definition" : "Simbolo nella sintassi definita dal sistema. Il simbolo può essere un codice predefinito o un'espressione in una sintassi definita dal sistema di codifica (ad esempio post-coordinamento).",
"comment" : "Può essere valorizzato con:\r\n\r\n* QUOTAFISSA\r\n\r\n* LORDO\r\n\r\n* BOLLO\r\n\r\n* IMPTOT\r\n\r\n* ALI-IVA\r\n\r\n* IVA\r\n\r\n* NETTO"
},
{
"id" : "ClaimResponse.total.amount",
"path" : "ClaimResponse.total.amount",
"short" : "Totale finanziario per la categoria",
"definition" : "Importo totale monetario associato alla categoria."
},
{
"id" : "ClaimResponse.total.amount.value",
"path" : "ClaimResponse.total.amount.value",
"short" : "Valore numerico (con precisione implicita)",
"definition" : "Valore numerico (con precisione implicita)",
"comment" : "I valori monetari hanno le proprie regole per la gestione della precisione (fare riferimento ai libri di testo contabili standard)."
},
{
"id" : "ClaimResponse.total.amount.currency",
"path" : "ClaimResponse.total.amount.currency",
"short" : "Codice valuta ISO 4217",
"definition" : "Codice valuta ISO 4217",
"comment" : "Si noti che le stringhe FHIR NON devono superare 1 MB di dimensione"
}
]
},
"text" : {
}
}
XIG built as of ??metadata-date??. Found ??metadata-resources?? resources in ??metadata-packages?? packages.
FHIR