FHIR IG analytics| Package | hl7.fhir.uv.xver-r4.r3 |
| Resource Type | StructureDefinition |
| Id | StructureDefinition-profile-ClaimResponse.json |
| FHIR Version | R3 |
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No resources found
Note: links and images are rebased to the (stated) source
Generated Narrative: StructureDefinition profile-ClaimResponse
FHIR
FHIRsmith
{
"resourceType": "StructureDefinition",
"id": "profile-ClaimResponse",
"text": {
"status": "extensions",
"div": "<!-- snip (see above) -->"
},
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-wg",
"valueCode": "fhir"
},
{
"extension": [
{
"url": "packageId",
"valueId": "hl7.fhir.uv.xver-r4.r3"
},
{
"url": "version",
"valueString": "0.1.0"
}
],
"url": "http://hl7.org/fhir/StructureDefinition/package-source"
},
{
"url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-fmm",
"valueInteger": 0,
"_valueInteger": {
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-conformance-derivedFrom",
"valueUri": "http://hl7.org/fhir/uv/xver/ImplementationGuide/hl7.fhir.uv.xver-r4.r3"
}
]
}
},
{
"url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status",
"valueCode": "trial-use",
"_valueCode": {
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-conformance-derivedFrom",
"valueUri": "http://hl7.org/fhir/uv/xver/ImplementationGuide/hl7.fhir.uv.xver-r4.r3"
}
]
}
}
],
"url": "http://hl7.org/fhir/4.0/StructureDefinition/profile-ClaimResponse",
"version": "0.1.0",
"name": "Profile_R4_ClaimResponse_R3",
"title": "Cross-version Profile for R4.ClaimResponse for use in FHIR STU3",
"status": "active",
"experimental": false,
"date": "2026-03-17T16:03:29.6172479-05:00",
"publisher": "FHIR Infrastructure",
"contact": [
{
"name": "FHIR Infrastructure",
"telecom": [
{
"system": "url",
"value": "http://www.hl7.org/Special/committees/fiwg"
}
]
}
],
"description": "This cross-version profile allows R4 ClaimResponse content to be represented via FHIR STU3 ClaimResponse resources.",
"jurisdiction": [
{
"coding": [
{
"system": "http://unstats.un.org/unsd/methods/m49/m49.htm",
"code": "001",
"display": "World"
}
]
}
],
"fhirVersion": "3.0.2",
"mapping": [
{
"identity": "workflow",
"uri": "http://hl7.org/fhir/workflow",
"name": "Workflow Mapping"
},
{
"identity": "w5",
"uri": "http://hl7.org/fhir/w5",
"name": "W5 Mapping"
},
{
"identity": "cdanetv4",
"uri": "http://www.cda-adc.ca/en/services/cdanet/",
"name": "Canadian Dental Association eclaims standard"
},
{
"identity": "rim",
"uri": "http://hl7.org/v3",
"name": "RIM Mapping"
}
],
"kind": "resource",
"abstract": false,
"type": "ClaimResponse",
"baseDefinition": "http://hl7.org/fhir/StructureDefinition/ClaimResponse",
"derivation": "constraint",
"snapshot": {
"element": [
{
"id": "ClaimResponse",
"path": "ClaimResponse",
"short": "Remittance resource",
"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-1",
"severity": "error",
"human": "If the resource is contained in another resource, it SHALL NOT contain any narrative",
"expression": "contained.text.empty()",
"xpath": "not(parent::f:contained and f:text)",
"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",
"expression": "contained.where(('#'+id in %resource.descendants().reference).not()).empty()",
"xpath": "not(exists(for $id in f:contained/*/@id return $id[not(ancestor::f:contained/parent::*/descendant::f:reference/@value=concat('#', $id))]))",
"source": "http://hl7.org/fhir/StructureDefinition/DomainResource"
}
],
"mapping": [
{
"identity": "rim",
"map": "Entity. Role, or Act"
},
{
"identity": "workflow",
"map": "Event"
},
{
"identity": "w5",
"map": "financial.billing"
}
]
},
{
"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": [
{
"code": "id"
}
],
"isSummary": true
},
{
"id": "ClaimResponse.meta",
"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 may 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"
}
],
"isSummary": true
},
{
"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.",
"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. \n\nThis element is labelled as a modifier because the implicit rules may provide additional knowledge about the resource that modifies it's meaning or interpretation.",
"min": 0,
"max": "1",
"base": {
"path": "Resource.implicitRules",
"min": 0,
"max": "1"
},
"type": [
{
"code": "uri"
}
],
"isModifier": true,
"isSummary": true
},
{
"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"
}
],
"binding": {
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-maxValueSet",
"valueReference": {
"reference": "http://hl7.org/fhir/ValueSet/all-languages|3.0.2"
}
},
{
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString": "Language"
}
],
"strength": "extensible",
"description": "A human language.",
"valueSetReference": {
"reference": "http://hl7.org/fhir/ValueSet/languages|3.0.2"
}
}
},
{
"id": "ClaimResponse.text",
"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 may 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 in formation is added later.",
"alias": [
"narrative",
"html",
"xhtml",
"display"
],
"min": 0,
"max": "1",
"base": {
"path": "DomainResource.text",
"min": 0,
"max": "1"
},
"type": [
{
"code": "Narrative"
}
],
"condition": [
"dom-1"
],
"mapping": [
{
"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.",
"alias": [
"inline resources",
"anonymous resources",
"contained resources"
],
"min": 0,
"max": "*",
"base": {
"path": "DomainResource.contained",
"min": 0,
"max": "*"
},
"type": [
{
"code": "Resource"
}
],
"mapping": [
{
"identity": "rim",
"map": "N/A"
}
]
},
{
"id": "ClaimResponse.extension",
"path": "ClaimResponse.extension",
"slicing": {
"discriminator": [
{
"type": "value",
"path": "url"
}
],
"ordered": false,
"rules": "open"
},
"short": "Extension",
"definition": "An Extension",
"min": 2,
"max": "*",
"base": {
"path": "DomainResource.extension",
"min": 0,
"max": "*"
},
"type": [
{
"code": "Extension"
}
]
},
{
"id": "ClaimResponse.extension:type",
"path": "ClaimResponse.extension",
"sliceName": "type",
"short": "R4: More granular claim type (new)",
"definition": "R4: `ClaimResponse.type` (new:CodeableConcept)",
"comment": "Element `ClaimResponse.type` has a context of ClaimResponse based on following the parent source element upwards and mapping to `ClaimResponse`.\nElement `ClaimResponse.type` has no mapping targets in FHIR STU3. Typically, this is because the element has been added (is a new element).\nThis may contain the local bill type codes, for example the US UB-04 bill type code or the CMS bill type.",
"min": 1,
"max": "1",
"base": {
"path": "DomainResource.extension",
"min": 0,
"max": "*"
},
"type": [
{
"code": "Extension",
"profile": "http://hl7.org/fhir/4.0/StructureDefinition/extension-ClaimResponse.type|0.1.0"
}
],
"condition": [
"ele-1"
],
"constraint": [
{
"key": "ele-1",
"severity": "error",
"human": "All FHIR elements must have a @value or children",
"expression": "hasValue() | (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
},
{
"id": "ClaimResponse.extension:subType",
"path": "ClaimResponse.extension",
"sliceName": "subType",
"short": "R4: More granular claim type (new)",
"definition": "R4: `ClaimResponse.subType` (new:CodeableConcept)",
"comment": "Element `ClaimResponse.subType` has a context of ClaimResponse based on following the parent source element upwards and mapping to `ClaimResponse`.\nElement `ClaimResponse.subType` has no mapping targets in FHIR STU3. Typically, this is because the element has been added (is a new element).\nThis may contain the local bill type codes, for example the US UB-04 bill type code or the CMS bill type.",
"min": 0,
"max": "1",
"base": {
"path": "DomainResource.extension",
"min": 0,
"max": "*"
},
"type": [
{
"code": "Extension",
"profile": "http://hl7.org/fhir/4.0/StructureDefinition/extension-ClaimResponse.subType|0.1.0"
}
],
"condition": [
"ele-1"
],
"constraint": [
{
"key": "ele-1",
"severity": "error",
"human": "All FHIR elements must have a @value or children",
"expression": "hasValue() | (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
},
{
"id": "ClaimResponse.extension:use",
"path": "ClaimResponse.extension",
"sliceName": "use",
"short": "R4: claim | preauthorization | predetermination (new)",
"definition": "R4: `ClaimResponse.use` (new:code)",
"comment": "Element `ClaimResponse.use` has a context of ClaimResponse based on following the parent source element upwards and mapping to `ClaimResponse`.\nElement `ClaimResponse.use` has no mapping targets in FHIR STU3. Typically, this is because the element has been added (is a new element).",
"min": 1,
"max": "1",
"base": {
"path": "DomainResource.extension",
"min": 0,
"max": "*"
},
"type": [
{
"code": "Extension",
"profile": "http://hl7.org/fhir/4.0/StructureDefinition/extension-ClaimResponse.use|0.1.0"
}
],
"condition": [
"ele-1"
],
"constraint": [
{
"key": "ele-1",
"severity": "error",
"human": "All FHIR elements must have a @value or children",
"expression": "hasValue() | (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
},
{
"id": "ClaimResponse.extension:requestor",
"path": "ClaimResponse.extension",
"sliceName": "requestor",
"short": "R4: Party responsible for the claim",
"definition": "R4: `ClaimResponse.requestor`",
"comment": "Element `ClaimResponse.requestor` is mapped to FHIR STU3 element `ClaimResponse.requestProvider` as `SourceIsBroaderThanTarget`.\nElement `ClaimResponse.requestor` is mapped to FHIR STU3 element `ClaimResponse.requestOrganization` as `SourceIsBroaderThanTarget`.\nThe standard extension `alternate-reference` has been mapped as the representation of FHIR R4 element `ClaimResponse.requestor` with unmapped reference targets: PractitionerRole.\nTypically 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": "DomainResource.extension",
"min": 0,
"max": "*"
},
"type": [
{
"code": "Extension",
"profile": "http://hl7.org/fhir/StructureDefinition/alternate-reference"
}
]
},
{
"id": "ClaimResponse.extension:preAuthPeriod",
"path": "ClaimResponse.extension",
"sliceName": "preAuthPeriod",
"short": "R4: Preauthorization reference effective period (new)",
"definition": "R4: `ClaimResponse.preAuthPeriod` (new:Period)",
"comment": "Element `ClaimResponse.preAuthPeriod` has a context of ClaimResponse based on following the parent source element upwards and mapping to `ClaimResponse`.\nElement `ClaimResponse.preAuthPeriod` has no mapping targets in FHIR STU3. Typically, this is because the element has been added (is a new element).",
"min": 0,
"max": "1",
"base": {
"path": "DomainResource.extension",
"min": 0,
"max": "*"
},
"type": [
{
"code": "Extension",
"profile": "http://hl7.org/fhir/4.0/StructureDefinition/extension-ClaimResponse.preAuthPeriod|0.1.0"
}
],
"condition": [
"ele-1"
],
"constraint": [
{
"key": "ele-1",
"severity": "error",
"human": "All FHIR elements must have a @value or children",
"expression": "hasValue() | (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
},
{
"id": "ClaimResponse.extension:adjudication",
"path": "ClaimResponse.extension",
"sliceName": "adjudication",
"short": "R4: Header-level adjudication (new)",
"definition": "R4: `ClaimResponse.adjudication` (new:ClaimResponse.item.adjudication)",
"comment": "Element `ClaimResponse.adjudication` has a context of ClaimResponse based on following the parent source element upwards and mapping to `ClaimResponse`.\nElement `ClaimResponse.adjudication` has no mapping targets in FHIR STU3. Typically, this is because the element has been added (is a new element).",
"min": 0,
"max": "*",
"base": {
"path": "DomainResource.extension",
"min": 0,
"max": "*"
},
"type": [
{
"code": "Extension",
"profile": "http://hl7.org/fhir/4.0/StructureDefinition/extension-ClaimResponse.item.adjudication|0.1.0"
}
],
"condition": [
"ele-1"
],
"constraint": [
{
"key": "ele-1",
"severity": "error",
"human": "All FHIR elements must have a @value or children",
"expression": "hasValue() | (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
},
{
"id": "ClaimResponse.extension:total",
"path": "ClaimResponse.extension",
"sliceName": "total",
"short": "R4: Adjudication totals (new)",
"definition": "R4: `ClaimResponse.total` (new:BackboneElement)",
"comment": "Element `ClaimResponse.total` has a context of ClaimResponse based on following the parent source element upwards and mapping to `ClaimResponse`.\nElement `ClaimResponse.total` has no mapping targets in FHIR STU3. Typically, this is because the element has been added (is a new element).\nTotals for amounts submitted, co-pays, benefits payable etc.",
"min": 0,
"max": "*",
"base": {
"path": "DomainResource.extension",
"min": 0,
"max": "*"
},
"type": [
{
"code": "Extension",
"profile": "http://hl7.org/fhir/4.0/StructureDefinition/extension-ClaimResponse.total|0.1.0"
}
],
"condition": [
"ele-1"
],
"constraint": [
{
"key": "ele-1",
"severity": "error",
"human": "All FHIR elements must have a @value or children",
"expression": "hasValue() | (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
},
{
"id": "ClaimResponse.modifierExtension",
"path": "ClaimResponse.modifierExtension",
"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. Usually modifier elements provide negation or qualification. In order 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.",
"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.modifierExtension",
"min": 0,
"max": "*"
},
"type": [
{
"code": "Extension"
}
],
"isModifier": true,
"mapping": [
{
"identity": "rim",
"map": "N/A"
}
]
},
{
"id": "ClaimResponse.identifier",
"path": "ClaimResponse.identifier",
"short": "Response number",
"definition": "The Response business identifier.",
"min": 0,
"max": "*",
"base": {
"path": "ClaimResponse.identifier",
"min": 0,
"max": "*"
},
"type": [
{
"code": "Identifier"
}
],
"mapping": [
{
"identity": "workflow",
"map": "Event.identifier"
},
{
"identity": "w5",
"map": "id"
}
]
},
{
"id": "ClaimResponse.status",
"path": "ClaimResponse.status",
"short": "active | cancelled | draft | entered-in-error",
"definition": "The status of the resource instance.",
"comment": "This element is labeled as a modifier because the status contains the code cancelled and entered-in-error that mark the response as not currently valid.",
"min": 0,
"max": "1",
"base": {
"path": "ClaimResponse.status",
"min": 0,
"max": "1"
},
"type": [
{
"code": "code"
}
],
"isModifier": true,
"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.",
"valueSetReference": {
"reference": "http://hl7.org/fhir/ValueSet/fm-status|3.0.2"
}
},
"mapping": [
{
"identity": "workflow",
"map": "Event.status"
},
{
"identity": "w5",
"map": "status"
}
]
},
{
"id": "ClaimResponse.patient",
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-display-hint",
"valueString": "who.focus"
}
],
"path": "ClaimResponse.patient",
"short": "The subject of the Products and Services",
"definition": "Patient Resource.",
"min": 0,
"max": "1",
"base": {
"path": "ClaimResponse.patient",
"min": 0,
"max": "1"
},
"type": [
{
"code": "Reference",
"targetProfile": "http://hl7.org/fhir/StructureDefinition/Patient"
}
]
},
{
"id": "ClaimResponse.created",
"path": "ClaimResponse.created",
"short": "Creation date",
"definition": "The date when the enclosed suite of services were performed or completed.",
"min": 0,
"max": "1",
"base": {
"path": "ClaimResponse.created",
"min": 0,
"max": "1"
},
"type": [
{
"code": "dateTime"
}
],
"mapping": [
{
"identity": "workflow",
"map": "Event.occurrence"
},
{
"identity": "w5",
"map": "when.recorded"
}
]
},
{
"id": "ClaimResponse.insurer",
"path": "ClaimResponse.insurer",
"short": "Insurance issuing organization",
"definition": "The Insurer who produced this adjudicated response.",
"min": 0,
"max": "1",
"base": {
"path": "ClaimResponse.insurer",
"min": 0,
"max": "1"
},
"type": [
{
"code": "Reference",
"targetProfile": "http://hl7.org/fhir/StructureDefinition/Organization"
}
],
"mapping": [
{
"identity": "workflow",
"map": "Event.performer.onBehalfOf"
}
]
},
{
"id": "ClaimResponse.requestProvider",
"path": "ClaimResponse.requestProvider",
"short": "Responsible practitioner",
"definition": "The practitioner who is responsible for the services rendered to the patient.",
"min": 0,
"max": "1",
"base": {
"path": "ClaimResponse.requestProvider",
"min": 0,
"max": "1"
},
"type": [
{
"code": "Reference",
"targetProfile": "http://hl7.org/fhir/StructureDefinition/Practitioner"
}
],
"mapping": [
{
"identity": "cdanetv4",
"map": "B01"
},
{
"identity": "w5",
"map": "who.source"
}
]
},
{
"id": "ClaimResponse.requestOrganization",
"path": "ClaimResponse.requestOrganization",
"short": "Responsible organization",
"definition": "The organization which is responsible for the services rendered to the patient.",
"min": 0,
"max": "1",
"base": {
"path": "ClaimResponse.requestOrganization",
"min": 0,
"max": "1"
},
"type": [
{
"code": "Reference",
"targetProfile": "http://hl7.org/fhir/StructureDefinition/Organization"
}
],
"mapping": [
{
"identity": "w5",
"map": "who.source"
}
]
},
{
"id": "ClaimResponse.request",
"path": "ClaimResponse.request",
"short": "Id of resource triggering adjudication",
"definition": "Original request resource referrence.",
"min": 0,
"max": "1",
"base": {
"path": "ClaimResponse.request",
"min": 0,
"max": "1"
},
"type": [
{
"code": "Reference",
"targetProfile": "http://hl7.org/fhir/StructureDefinition/Claim"
}
],
"mapping": [
{
"identity": "workflow",
"map": "Event.basedOn"
},
{
"identity": "cdanetv4",
"map": "A02|G01"
},
{
"identity": "w5",
"map": "why"
}
]
},
{
"id": "ClaimResponse.outcome",
"path": "ClaimResponse.outcome",
"short": "complete | error | partial",
"definition": "Processing outcome errror, partial or complete processing.",
"min": 0,
"max": "1",
"base": {
"path": "ClaimResponse.outcome",
"min": 0,
"max": "1"
},
"type": [
{
"code": "CodeableConcept"
}
],
"binding": {
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString": "RemittanceOutcome"
}
],
"strength": "example",
"description": "The result of the claim processing",
"valueSetReference": {
"reference": "http://hl7.org/fhir/ValueSet/remittance-outcome|3.0.2"
}
}
},
{
"id": "ClaimResponse.outcome.id",
"path": "ClaimResponse.outcome.id",
"representation": [
"xmlAttr"
],
"short": "xml:id (or equivalent in JSON)",
"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": [
{
"code": "string"
}
],
"mapping": [
{
"identity": "rim",
"map": "n/a"
}
]
},
{
"id": "ClaimResponse.outcome.extension",
"path": "ClaimResponse.outcome.extension",
"slicing": {
"discriminator": [
{
"type": "value",
"path": "url"
}
],
"description": "Extensions are always sliced by (at least) url",
"ordered": false,
"rules": "open"
},
"short": "Extension",
"definition": "An Extension",
"min": 1,
"max": "*",
"base": {
"path": "Element.extension",
"min": 0,
"max": "*"
},
"type": [
{
"code": "Extension"
}
]
},
{
"id": "ClaimResponse.outcome.extension:outcome",
"path": "ClaimResponse.outcome.extension",
"sliceName": "outcome",
"short": "R4: queued | complete | error | partial",
"definition": "R4: `ClaimResponse.outcome`",
"comment": "Element `ClaimResponse.outcome` is mapped to FHIR STU3 element `ClaimResponse.outcome` as `RelatedTo`.\nThe resource may be used to indicate that: the request has been held (queued) for processing; that it has been processed and errors found (error); that no errors were found and that some of the adjudication has been undertaken (partial) or that all of the adjudication has been undertaken (complete).",
"min": 1,
"max": "1",
"base": {
"path": "Element.extension",
"min": 0,
"max": "*"
},
"type": [
{
"code": "Extension",
"profile": "http://hl7.org/fhir/4.0/StructureDefinition/extension-ClaimResponse.outcome|0.1.0"
}
]
},
{
"id": "ClaimResponse.outcome.coding",
"path": "ClaimResponse.outcome.coding",
"short": "Code defined by a terminology system",
"definition": "A reference to a code defined by a terminology system.",
"comment": "Codes may be defined very casually in enumerations, or code lists, up to very formal definitions such as SNOMED CT - see the HL7 v3 Core Principles for more information. Ordering of codings is undefined and SHALL NOT be used to infer meaning. Generally, at most only one of the coding values will be labeled as UserSelected = true.",
"requirements": "Allows for translations and alternate encodings within a code system. Also supports communication of the same instance to systems requiring different encodings.",
"min": 0,
"max": "*",
"base": {
"path": "CodeableConcept.coding",
"min": 0,
"max": "*"
},
"type": [
{
"code": "Coding"
}
],
"isSummary": true,
"mapping": [
{
"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.outcome.text",
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-translatable",
"valueBoolean": true
}
],
"path": "ClaimResponse.outcome.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"
}
],
"isSummary": true,
"mapping": [
{
"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.disposition",
"path": "ClaimResponse.disposition",
"short": "Disposition Message",
"definition": "A description of the status of the adjudication.",
"min": 0,
"max": "1",
"base": {
"path": "ClaimResponse.disposition",
"min": 0,
"max": "1"
},
"type": [
{
"code": "string"
}
],
"mapping": [
{
"identity": "workflow",
"map": "Event.note"
}
]
},
{
"id": "ClaimResponse.payeeType",
"path": "ClaimResponse.payeeType",
"short": "Party to be paid any benefits payable",
"definition": "Party to be reimbursed: Subscriber, provider, other.",
"min": 0,
"max": "1",
"base": {
"path": "ClaimResponse.payeeType",
"min": 0,
"max": "1"
},
"type": [
{
"code": "CodeableConcept"
}
],
"binding": {
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString": "PayeeType"
}
],
"strength": "example",
"description": "A code for the party to be reimbursed.",
"valueSetReference": {
"reference": "http://hl7.org/fhir/ValueSet/payeetype|3.0.2"
}
}
},
{
"id": "ClaimResponse.item",
"path": "ClaimResponse.item",
"short": "Line items",
"definition": "The first tier service adjudications for submitted services.",
"min": 0,
"max": "*",
"base": {
"path": "ClaimResponse.item",
"min": 0,
"max": "*"
},
"type": [
{
"code": "BackboneElement"
}
],
"constraint": [
{
"key": "ele-1",
"severity": "error",
"human": "All FHIR elements must have a @value or children",
"expression": "hasValue() | (children().count() > id.count())",
"xpath": "@value|f:*|h:div",
"source": "http://hl7.org/fhir/StructureDefinition/Element"
}
]
},
{
"id": "ClaimResponse.item.id",
"path": "ClaimResponse.item.id",
"representation": [
"xmlAttr"
],
"short": "xml:id (or equivalent in JSON)",
"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": [
{
"code": "string"
}
],
"mapping": [
{
"identity": "rim",
"map": "n/a"
}
]
},
{
"id": "ClaimResponse.item.extension",
"path": "ClaimResponse.item.extension",
"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. In order 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.",
"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"
}
],
"mapping": [
{
"identity": "rim",
"map": "n/a"
}
]
},
{
"id": "ClaimResponse.item.modifierExtension",
"path": "ClaimResponse.item.modifierExtension",
"short": "Extensions that cannot be ignored",
"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 that contains it. Usually modifier elements provide negation or qualification. In order 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.",
"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",
"modifiers"
],
"min": 0,
"max": "*",
"base": {
"path": "BackboneElement.modifierExtension",
"min": 0,
"max": "*"
},
"type": [
{
"code": "Extension"
}
],
"isModifier": true,
"isSummary": true,
"mapping": [
{
"identity": "rim",
"map": "N/A"
}
]
},
{
"id": "ClaimResponse.item.sequenceLinkId",
"path": "ClaimResponse.item.sequenceLinkId",
"short": "Service instance",
"definition": "A service line number.",
"min": 1,
"max": "1",
"base": {
"path": "ClaimResponse.item.sequenceLinkId",
"min": 1,
"max": "1"
},
"type": [
{
"code": "positiveInt"
}
],
"mapping": [
{
"identity": "cdanetv4",
"map": "F07"
}
]
},
{
"id": "ClaimResponse.item.noteNumber",
"path": "ClaimResponse.item.noteNumber",
"short": "List of note numbers which apply",
"definition": "A list of note references to the notes provided below.",
"min": 0,
"max": "*",
"base": {
"path": "ClaimResponse.item.noteNumber",
"min": 0,
"max": "*"
},
"type": [
{
"code": "positiveInt"
}
]
},
{
"id": "ClaimResponse.item.adjudication",
"path": "ClaimResponse.item.adjudication",
"short": "Adjudication details",
"definition": "The adjudication results.",
"min": 0,
"max": "*",
"base": {
"path": "ClaimResponse.item.adjudication",
"min": 0,
"max": "*"
},
"type": [
{
"code": "BackboneElement"
}
],
"constraint": [
{
"key": "ele-1",
"severity": "error",
"human": "All FHIR elements must have a @value or children",
"expression": "hasValue() | (children().count() > id.count())",
"xpath": "@value|f:*|h:div",
"source": "http://hl7.org/fhir/StructureDefinition/Element"
}
]
},
{
"id": "ClaimResponse.item.adjudication.id",
"path": "ClaimResponse.item.adjudication.id",
"representation": [
"xmlAttr"
],
"short": "xml:id (or equivalent in JSON)",
"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": [
{
"code": "string"
}
],
"mapping": [
{
"identity": "rim",
"map": "n/a"
}
]
},
{
"id": "ClaimResponse.item.adjudication.extension",
"path": "ClaimResponse.item.adjudication.extension",
"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. In order 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.",
"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"
}
],
"mapping": [
{
"identity": "rim",
"map": "n/a"
}
]
},
{
"id": "ClaimResponse.item.adjudication.modifierExtension",
"path": "ClaimResponse.item.adjudication.modifierExtension",
"short": "Extensions that cannot be ignored",
"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 that contains it. Usually modifier elements provide negation or qualification. In order 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.",
"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",
"modifiers"
],
"min": 0,
"max": "*",
"base": {
"path": "BackboneElement.modifierExtension",
"min": 0,
"max": "*"
},
"type": [
{
"code": "Extension"
}
],
"isModifier": true,
"isSummary": true,
"mapping": [
{
"identity": "rim",
"map": "N/A"
}
]
},
{
"id": "ClaimResponse.item.adjudication.category",
"path": "ClaimResponse.item.adjudication.category",
"short": "Adjudication category such as co-pay, eligible, benefit, etc.",
"definition": "Code indicating: Co-Pay, deductible, eligible, benefit, tax, etc.",
"min": 1,
"max": "1",
"base": {
"path": "ClaimResponse.item.adjudication.category",
"min": 1,
"max": "1"
},
"type": [
{
"code": "CodeableConcept"
}
],
"binding": {
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString": "Adjudication"
}
],
"strength": "example",
"description": "The adjudication codes.",
"valueSetReference": {
"reference": "http://hl7.org/fhir/ValueSet/adjudication|3.0.2"
}
}
},
{
"id": "ClaimResponse.item.adjudication.reason",
"path": "ClaimResponse.item.adjudication.reason",
"short": "Explanation of Adjudication outcome",
"definition": "Adjudication reason such as limit reached.",
"min": 0,
"max": "1",
"base": {
"path": "ClaimResponse.item.adjudication.reason",
"min": 0,
"max": "1"
},
"type": [
{
"code": "CodeableConcept"
}
],
"binding": {
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString": "AdjudicationReason"
}
],
"strength": "example",
"description": "The adjudication reason codes.",
"valueSetReference": {
"reference": "http://hl7.org/fhir/ValueSet/adjudication-reason|3.0.2"
}
}
},
{
"id": "ClaimResponse.item.adjudication.amount",
"path": "ClaimResponse.item.adjudication.amount",
"short": "Monetary amount",
"definition": "Monetary amount associated with the code.",
"min": 0,
"max": "1",
"base": {
"path": "ClaimResponse.item.adjudication.amount",
"min": 0,
"max": "1"
},
"type": [
{
"code": "Money"
}
]
},
{
"id": "ClaimResponse.item.adjudication.value",
"path": "ClaimResponse.item.adjudication.value",
"short": "Non-monetary value",
"definition": "A non-monetary value for example a percentage. Mutually exclusive to the amount element above.",
"min": 0,
"max": "1",
"base": {
"path": "ClaimResponse.item.adjudication.value",
"min": 0,
"max": "1"
},
"type": [
{
"code": "decimal"
}
]
},
{
"id": "ClaimResponse.item.detail",
"path": "ClaimResponse.item.detail",
"short": "Detail line items",
"definition": "The second tier service adjudications for submitted services.",
"min": 0,
"max": "*",
"base": {
"path": "ClaimResponse.item.detail",
"min": 0,
"max": "*"
},
"type": [
{
"code": "BackboneElement"
}
],
"constraint": [
{
"key": "ele-1",
"severity": "error",
"human": "All FHIR elements must have a @value or children",
"expression": "hasValue() | (children().count() > id.count())",
"xpath": "@value|f:*|h:div",
"source": "http://hl7.org/fhir/StructureDefinition/Element"
}
]
},
{
"id": "ClaimResponse.item.detail.id",
"path": "ClaimResponse.item.detail.id",
"representation": [
"xmlAttr"
],
"short": "xml:id (or equivalent in JSON)",
"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": [
{
"code": "string"
}
],
"mapping": [
{
"identity": "rim",
"map": "n/a"
}
]
},
{
"id": "ClaimResponse.item.detail.extension",
"path": "ClaimResponse.item.detail.extension",
"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. In order 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.",
"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"
}
],
"mapping": [
{
"identity": "rim",
"map": "n/a"
}
]
},
{
"id": "ClaimResponse.item.detail.modifierExtension",
"path": "ClaimResponse.item.detail.modifierExtension",
"short": "Extensions that cannot be ignored",
"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 that contains it. Usually modifier elements provide negation or qualification. In order 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.",
"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",
"modifiers"
],
"min": 0,
"max": "*",
"base": {
"path": "BackboneElement.modifierExtension",
"min": 0,
"max": "*"
},
"type": [
{
"code": "Extension"
}
],
"isModifier": true,
"isSummary": true,
"mapping": [
{
"identity": "rim",
"map": "N/A"
}
]
},
{
"id": "ClaimResponse.item.detail.sequenceLinkId",
"path": "ClaimResponse.item.detail.sequenceLinkId",
"short": "Service instance",
"definition": "A service line number.",
"min": 1,
"max": "1",
"base": {
"path": "ClaimResponse.item.detail.sequenceLinkId",
"min": 1,
"max": "1"
},
"type": [
{
"code": "positiveInt"
}
],
"mapping": [
{
"identity": "cdanetv4",
"map": "F07"
}
]
},
{
"id": "ClaimResponse.item.detail.noteNumber",
"path": "ClaimResponse.item.detail.noteNumber",
"short": "List of note numbers which apply",
"definition": "A list of note references to the notes provided below.",
"min": 0,
"max": "*",
"base": {
"path": "ClaimResponse.item.detail.noteNumber",
"min": 0,
"max": "*"
},
"type": [
{
"code": "positiveInt"
}
]
},
{
"id": "ClaimResponse.item.detail.adjudication",
"path": "ClaimResponse.item.detail.adjudication",
"short": "Detail level adjudication details",
"definition": "The adjudications results.",
"min": 0,
"max": "*",
"base": {
"path": "ClaimResponse.item.detail.adjudication",
"min": 0,
"max": "*"
},
"contentReference": "http://hl7.org/fhir/StructureDefinition/ClaimResponse#ClaimResponse.item.adjudication"
},
{
"id": "ClaimResponse.item.detail.subDetail",
"path": "ClaimResponse.item.detail.subDetail",
"short": "Subdetail line items",
"definition": "The third tier service adjudications for submitted services.",
"min": 0,
"max": "*",
"base": {
"path": "ClaimResponse.item.detail.subDetail",
"min": 0,
"max": "*"
},
"type": [
{
"code": "BackboneElement"
}
],
"constraint": [
{
"key": "ele-1",
"severity": "error",
"human": "All FHIR elements must have a @value or children",
"expression": "hasValue() | (children().count() > id.count())",
"xpath": "@value|f:*|h:div",
"source": "http://hl7.org/fhir/StructureDefinition/Element"
}
]
},
{
"id": "ClaimResponse.item.detail.subDetail.id",
"path": "ClaimResponse.item.detail.subDetail.id",
"representation": [
"xmlAttr"
],
"short": "xml:id (or equivalent in JSON)",
"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": [
{
"code": "string"
}
],
"mapping": [
{
"identity": "rim",
"map": "n/a"
}
]
},
{
"id": "ClaimResponse.item.detail.subDetail.extension",
"path": "ClaimResponse.item.detail.subDetail.extension",
"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. In order 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.",
"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"
}
],
"mapping": [
{
"identity": "rim",
"map": "n/a"
}
]
},
{
"id": "ClaimResponse.item.detail.subDetail.modifierExtension",
"path": "ClaimResponse.item.detail.subDetail.modifierExtension",
"short": "Extensions that cannot be ignored",
"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 that contains it. Usually modifier elements provide negation or qualification. In order 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.",
"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",
"modifiers"
],
"min": 0,
"max": "*",
"base": {
"path": "BackboneElement.modifierExtension",
"min": 0,
"max": "*"
},
"type": [
{
"code": "Extension"
}
],
"isModifier": true,
"isSummary": true,
"mapping": [
{
"identity": "rim",
"map": "N/A"
}
]
},
{
"id": "ClaimResponse.item.detail.subDetail.sequenceLinkId",
"path": "ClaimResponse.item.detail.subDetail.sequenceLinkId",
"short": "Service instance",
"definition": "A service line number.",
"min": 1,
"max": "1",
"base": {
"path": "ClaimResponse.item.detail.subDetail.sequenceLinkId",
"min": 1,
"max": "1"
},
"type": [
{
"code": "positiveInt"
}
],
"mapping": [
{
"identity": "cdanetv4",
"map": "F07"
}
]
},
{
"id": "ClaimResponse.item.detail.subDetail.noteNumber",
"path": "ClaimResponse.item.detail.subDetail.noteNumber",
"short": "List of note numbers which apply",
"definition": "A list of note references to the notes provided below.",
"min": 0,
"max": "*",
"base": {
"path": "ClaimResponse.item.detail.subDetail.noteNumber",
"min": 0,
"max": "*"
},
"type": [
{
"code": "positiveInt"
}
]
},
{
"id": "ClaimResponse.item.detail.subDetail.adjudication",
"path": "ClaimResponse.item.detail.subDetail.adjudication",
"short": "Subdetail level adjudication details",
"definition": "The adjudications results.",
"min": 0,
"max": "*",
"base": {
"path": "ClaimResponse.item.detail.subDetail.adjudication",
"min": 0,
"max": "*"
},
"contentReference": "http://hl7.org/fhir/StructureDefinition/ClaimResponse#ClaimResponse.item.adjudication"
},
{
"id": "ClaimResponse.addItem",
"path": "ClaimResponse.addItem",
"short": "Insurer added line items",
"definition": "The first tier service adjudications for payor added services.",
"min": 0,
"max": "*",
"base": {
"path": "ClaimResponse.addItem",
"min": 0,
"max": "*"
},
"type": [
{
"code": "BackboneElement"
}
],
"constraint": [
{
"key": "ele-1",
"severity": "error",
"human": "All FHIR elements must have a @value or children",
"expression": "hasValue() | (children().count() > id.count())",
"xpath": "@value|f:*|h:div",
"source": "http://hl7.org/fhir/StructureDefinition/Element"
}
]
},
{
"id": "ClaimResponse.addItem.id",
"path": "ClaimResponse.addItem.id",
"representation": [
"xmlAttr"
],
"short": "xml:id (or equivalent in JSON)",
"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": [
{
"code": "string"
}
],
"mapping": [
{
"identity": "rim",
"map": "n/a"
}
]
},
{
"id": "ClaimResponse.addItem.extension",
"path": "ClaimResponse.addItem.extension",
"slicing": {
"discriminator": [
{
"type": "value",
"path": "url"
}
],
"ordered": false,
"rules": "open"
},
"short": "Extension",
"definition": "An Extension",
"min": 0,
"max": "*",
"base": {
"path": "Element.extension",
"min": 0,
"max": "*"
},
"type": [
{
"code": "Extension"
}
]
},
{
"id": "ClaimResponse.addItem.extension:detailSequence",
"path": "ClaimResponse.addItem.extension",
"sliceName": "detailSequence",
"short": "R4: Detail sequence number (new)",
"definition": "R4: `ClaimResponse.addItem.detailSequence` (new:positiveInt)",
"comment": "Element `ClaimResponse.addItem.detailSequence` has a context of ClaimResponse.addItem based on following the parent source element upwards and mapping to `ClaimResponse`.\nElement `ClaimResponse.addItem.detailSequence` has no mapping targets in FHIR STU3. Typically, this is because the element has been added (is a new element).",
"min": 0,
"max": "*",
"base": {
"path": "Element.extension",
"min": 0,
"max": "*"
},
"type": [
{
"code": "Extension",
"profile": "http://hl7.org/fhir/4.0/StructureDefinition/extension-ClaimResponse.addItem.detailSequence|0.1.0"
}
],
"condition": [
"ele-1"
],
"constraint": [
{
"key": "ele-1",
"severity": "error",
"human": "All FHIR elements must have a @value or children",
"expression": "hasValue() | (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
},
{
"id": "ClaimResponse.addItem.extension:subdetailSequence",
"path": "ClaimResponse.addItem.extension",
"sliceName": "subdetailSequence",
"short": "R4: Subdetail sequence number (new)",
"definition": "R4: `ClaimResponse.addItem.subdetailSequence` (new:positiveInt)",
"comment": "Element `ClaimResponse.addItem.subdetailSequence` has a context of ClaimResponse.addItem based on following the parent source element upwards and mapping to `ClaimResponse`.\nElement `ClaimResponse.addItem.subdetailSequence` has no mapping targets in FHIR STU3. Typically, this is because the element has been added (is a new element).",
"min": 0,
"max": "*",
"base": {
"path": "Element.extension",
"min": 0,
"max": "*"
},
"type": [
{
"code": "Extension",
"profile": "http://hl7.org/fhir/4.0/StructureDefinition/extension-ClaimResponse.addItem.subdetailSequence|0.1.0"
}
],
"condition": [
"ele-1"
],
"constraint": [
{
"key": "ele-1",
"severity": "error",
"human": "All FHIR elements must have a @value or children",
"expression": "hasValue() | (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
},
{
"id": "ClaimResponse.addItem.extension:provider",
"path": "ClaimResponse.addItem.extension",
"sliceName": "provider",
"short": "R4: Authorized providers (new)",
"definition": "R4: `ClaimResponse.addItem.provider` (new:Reference(Practitioner,PractitionerRole,Organization))",
"comment": "Element `ClaimResponse.addItem.provider` has a context of ClaimResponse.addItem based on following the parent source element upwards and mapping to `ClaimResponse`.\nElement `ClaimResponse.addItem.provider` has no mapping targets in FHIR STU3. Typically, this is because the element has been added (is a new element).",
"min": 0,
"max": "*",
"base": {
"path": "Element.extension",
"min": 0,
"max": "*"
},
"type": [
{
"code": "Extension",
"profile": "http://hl7.org/fhir/4.0/StructureDefinition/extension-ClaimResponse.addItem.provider|0.1.0"
}
],
"condition": [
"ele-1"
],
"constraint": [
{
"key": "ele-1",
"severity": "error",
"human": "All FHIR elements must have a @value or children",
"expression": "hasValue() | (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
},
{
"id": "ClaimResponse.addItem.extension:programCode",
"path": "ClaimResponse.addItem.extension",
"sliceName": "programCode",
"short": "R4: Program the product or service is provided under (new)",
"definition": "R4: `ClaimResponse.addItem.programCode` (new:CodeableConcept)",
"comment": "Element `ClaimResponse.addItem.programCode` has a context of ClaimResponse.addItem based on following the parent source element upwards and mapping to `ClaimResponse`.\nElement `ClaimResponse.addItem.programCode` has no mapping targets in FHIR STU3. Typically, this is because the element has been added (is a new element).\nFor example: Neonatal program, child dental program or drug users recovery program.",
"min": 0,
"max": "*",
"base": {
"path": "Element.extension",
"min": 0,
"max": "*"
},
"type": [
{
"code": "Extension",
"profile": "http://hl7.org/fhir/4.0/StructureDefinition/extension-ClaimResponse.addItem.programCode|0.1.0"
}
],
"condition": [
"ele-1"
],
"constraint": [
{
"key": "ele-1",
"severity": "error",
"human": "All FHIR elements must have a @value or children",
"expression": "hasValue() | (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
},
{
"id": "ClaimResponse.addItem.extension:serviced",
"path": "ClaimResponse.addItem.extension",
"sliceName": "serviced",
"short": "R4: Date or dates of service or product delivery (new)",
"definition": "R4: `ClaimResponse.addItem.serviced[x]` (new:date, Period)",
"comment": "Element `ClaimResponse.addItem.serviced[x]` has a context of ClaimResponse.addItem based on following the parent source element upwards and mapping to `ClaimResponse`.\nElement `ClaimResponse.addItem.serviced[x]` has no mapping targets in FHIR STU3. Typically, this is because the element has been added (is a new element).",
"min": 0,
"max": "1",
"base": {
"path": "Element.extension",
"min": 0,
"max": "*"
},
"type": [
{
"code": "Extension",
"profile": "http://hl7.org/fhir/4.0/StructureDefinition/extension-ClaimResponse.addItem.serviced|0.1.0"
}
],
"condition": [
"ele-1"
],
"constraint": [
{
"key": "ele-1",
"severity": "error",
"human": "All FHIR elements must have a @value or children",
"expression": "hasValue() | (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
},
{
"id": "ClaimResponse.addItem.extension:location",
"path": "ClaimResponse.addItem.extension",
"sliceName": "location",
"short": "R4: Place of service or where product was supplied (new)",
"definition": "R4: `ClaimResponse.addItem.location[x]` (new:Address, CodeableConcept, Reference(Location))",
"comment": "Element `ClaimResponse.addItem.location[x]` has a context of ClaimResponse.addItem based on following the parent source element upwards and mapping to `ClaimResponse`.\nElement `ClaimResponse.addItem.location[x]` has no mapping targets in FHIR STU3. Typically, this is because the element has been added (is a new element).",
"min": 0,
"max": "1",
"base": {
"path": "Element.extension",
"min": 0,
"max": "*"
},
"type": [
{
"code": "Extension",
"profile": "http://hl7.org/fhir/4.0/StructureDefinition/extension-ClaimResponse.addItem.location|0.1.0"
}
],
"condition": [
"ele-1"
],
"constraint": [
{
"key": "ele-1",
"severity": "error",
"human": "All FHIR elements must have a @value or children",
"expression": "hasValue() | (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
},
{
"id": "ClaimResponse.addItem.extension:quantity",
"path": "ClaimResponse.addItem.extension",
"sliceName": "quantity",
"short": "R4: Count of products or services (new)",
"definition": "R4: `ClaimResponse.addItem.quantity` (new:Quantity[SimpleQuantity])",
"comment": "Element `ClaimResponse.addItem.quantity` has a context of ClaimResponse.addItem based on following the parent source element upwards and mapping to `ClaimResponse`.\nElement `ClaimResponse.addItem.quantity` has no mapping targets in FHIR STU3. Typically, this is because the element has been added (is a new element).",
"min": 0,
"max": "1",
"base": {
"path": "Element.extension",
"min": 0,
"max": "*"
},
"type": [
{
"code": "Extension",
"profile": "http://hl7.org/fhir/4.0/StructureDefinition/extension-ClaimResponse.addItem.quantity|0.1.0"
}
],
"condition": [
"ele-1"
],
"constraint": [
{
"key": "ele-1",
"severity": "error",
"human": "All FHIR elements must have a @value or children",
"expression": "hasValue() | (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
},
{
"id": "ClaimResponse.addItem.extension:unitPrice",
"path": "ClaimResponse.addItem.extension",
"sliceName": "unitPrice",
"short": "R4: Fee, charge or cost per item (new)",
"definition": "R4: `ClaimResponse.addItem.unitPrice` (new:Money)",
"comment": "Element `ClaimResponse.addItem.unitPrice` has a context of ClaimResponse.addItem based on following the parent source element upwards and mapping to `ClaimResponse`.\nElement `ClaimResponse.addItem.unitPrice` has no mapping targets in FHIR STU3. Typically, this is because the element has been added (is a new element).",
"min": 0,
"max": "1",
"base": {
"path": "Element.extension",
"min": 0,
"max": "*"
},
"type": [
{
"code": "Extension",
"profile": "http://hl7.org/fhir/4.0/StructureDefinition/extension-ClaimResponse.addItem.unitPrice|0.1.0"
}
],
"condition": [
"ele-1"
],
"constraint": [
{
"key": "ele-1",
"severity": "error",
"human": "All FHIR elements must have a @value or children",
"expression": "hasValue() | (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
},
{
"id": "ClaimResponse.addItem.extension:factor",
"path": "ClaimResponse.addItem.extension",
"sliceName": "factor",
"short": "R4: Price scaling factor (new)",
"definition": "R4: `ClaimResponse.addItem.factor` (new:decimal)",
"comment": "Element `ClaimResponse.addItem.factor` has a context of ClaimResponse.addItem based on following the parent source element upwards and mapping to `ClaimResponse`.\nElement `ClaimResponse.addItem.factor` has no mapping targets in FHIR STU3. Typically, this is because the element has been added (is a new element).\nTo show a 10% senior's discount, the value entered is: 0.90 (1.00 - 0.10).",
"min": 0,
"max": "1",
"base": {
"path": "Element.extension",
"min": 0,
"max": "*"
},
"type": [
{
"code": "Extension",
"profile": "http://hl7.org/fhir/4.0/StructureDefinition/extension-ClaimResponse.addItem.factor|0.1.0"
}
],
"condition": [
"ele-1"
],
"constraint": [
{
"key": "ele-1",
"severity": "error",
"human": "All FHIR elements must have a @value or children",
"expression": "hasValue() | (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
},
{
"id": "ClaimResponse.addItem.extension:bodySite",
"path": "ClaimResponse.addItem.extension",
"sliceName": "bodySite",
"short": "R4: Anatomical location (new)",
"definition": "R4: `ClaimResponse.addItem.bodySite` (new:CodeableConcept)",
"comment": "Element `ClaimResponse.addItem.bodySite` has a context of ClaimResponse.addItem based on following the parent source element upwards and mapping to `ClaimResponse`.\nElement `ClaimResponse.addItem.bodySite` has no mapping targets in FHIR STU3. Typically, this is because the element has been added (is a new element).\nFor example: Providing a tooth code allows an insurer to identify a provider performing a filling on a tooth that was previously removed.",
"min": 0,
"max": "1",
"base": {
"path": "Element.extension",
"min": 0,
"max": "*"
},
"type": [
{
"code": "Extension",
"profile": "http://hl7.org/fhir/4.0/StructureDefinition/extension-ClaimResponse.addItem.bodySite|0.1.0"
}
],
"condition": [
"ele-1"
],
"constraint": [
{
"key": "ele-1",
"severity": "error",
"human": "All FHIR elements must have a @value or children",
"expression": "hasValue() | (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
},
{
"id": "ClaimResponse.addItem.extension:subSite",
"path": "ClaimResponse.addItem.extension",
"sliceName": "subSite",
"short": "R4: Anatomical sub-location (new)",
"definition": "R4: `ClaimResponse.addItem.subSite` (new:CodeableConcept)",
"comment": "Element `ClaimResponse.addItem.subSite` has a context of ClaimResponse.addItem based on following the parent source element upwards and mapping to `ClaimResponse`.\nElement `ClaimResponse.addItem.subSite` has no mapping targets in FHIR STU3. Typically, this is because the element has been added (is a new element).",
"min": 0,
"max": "*",
"base": {
"path": "Element.extension",
"min": 0,
"max": "*"
},
"type": [
{
"code": "Extension",
"profile": "http://hl7.org/fhir/4.0/StructureDefinition/extension-ClaimResponse.addItem.subSite|0.1.0"
}
],
"condition": [
"ele-1"
],
"constraint": [
{
"key": "ele-1",
"severity": "error",
"human": "All FHIR elements must have a @value or children",
"expression": "hasValue() | (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
},
{
"id": "ClaimResponse.addItem.modifierExtension",
"path": "ClaimResponse.addItem.modifierExtension",
"short": "Extensions that cannot be ignored",
"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 that contains it. Usually modifier elements provide negation or qualification. In order 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.",
"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",
"modifiers"
],
"min": 0,
"max": "*",
"base": {
"path": "BackboneElement.modifierExtension",
"min": 0,
"max": "*"
},
"type": [
{
"code": "Extension"
}
],
"isModifier": true,
"isSummary": true,
"mapping": [
{
"identity": "rim",
"map": "N/A"
}
]
},
{
"id": "ClaimResponse.addItem.sequenceLinkId",
"path": "ClaimResponse.addItem.sequenceLinkId",
"short": "Service instances",
"definition": "List of input service items which this service line is intended to replace.",
"min": 0,
"max": "*",
"base": {
"path": "ClaimResponse.addItem.sequenceLinkId",
"min": 0,
"max": "*"
},
"type": [
{
"code": "positiveInt"
}
]
},
{
"id": "ClaimResponse.addItem.revenue",
"path": "ClaimResponse.addItem.revenue",
"short": "Revenue or cost center code",
"definition": "The type of reveneu or cost center providing the product and/or service.",
"min": 0,
"max": "1",
"base": {
"path": "ClaimResponse.addItem.revenue",
"min": 0,
"max": "1"
},
"type": [
{
"code": "CodeableConcept"
}
],
"binding": {
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString": "RevenueCenter"
}
],
"strength": "example",
"description": "Codes for the revenue or cost centers supplying the service and/or products.",
"valueSetReference": {
"reference": "http://hl7.org/fhir/ValueSet/ex-revenue-center|3.0.2"
}
}
},
{
"id": "ClaimResponse.addItem.category",
"path": "ClaimResponse.addItem.category",
"short": "Type of service or product",
"definition": "Health Care Service Type Codes to identify the classification of service or benefits.",
"min": 0,
"max": "1",
"base": {
"path": "ClaimResponse.addItem.category",
"min": 0,
"max": "1"
},
"type": [
{
"code": "CodeableConcept"
}
],
"binding": {
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString": "BenefitSubCategory"
}
],
"strength": "example",
"description": "Benefit subcategories such as: oral-basic, major, glasses",
"valueSetReference": {
"reference": "http://hl7.org/fhir/ValueSet/benefit-subcategory|3.0.2"
}
}
},
{
"id": "ClaimResponse.addItem.service",
"path": "ClaimResponse.addItem.service",
"short": "Group, Service or Product",
"definition": "A code to indicate the Professional Service or Product supplied.",
"min": 0,
"max": "1",
"base": {
"path": "ClaimResponse.addItem.service",
"min": 0,
"max": "1"
},
"type": [
{
"code": "CodeableConcept"
}
],
"binding": {
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString": "ServiceProduct"
}
],
"strength": "example",
"description": "Allowable service and product codes.",
"valueSetReference": {
"reference": "http://hl7.org/fhir/ValueSet/service-uscls|3.0.2"
}
}
},
{
"id": "ClaimResponse.addItem.modifier",
"path": "ClaimResponse.addItem.modifier",
"short": "Service/Product billing modifiers",
"definition": "Item typification or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or for medical whether the treatment was outside the clinic or out of office hours.",
"requirements": "May impact on adjudication.",
"min": 0,
"max": "*",
"base": {
"path": "ClaimResponse.addItem.modifier",
"min": 0,
"max": "*"
},
"type": [
{
"code": "CodeableConcept"
}
],
"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.",
"valueSetReference": {
"reference": "http://hl7.org/fhir/ValueSet/claim-modifiers|3.0.2"
}
},
"mapping": [
{
"identity": "rim",
"map": "24.C, 24.D mods"
}
]
},
{
"id": "ClaimResponse.addItem.fee",
"path": "ClaimResponse.addItem.fee",
"short": "Professional fee or Product charge",
"definition": "The fee charged for the professional service or product..",
"min": 0,
"max": "1",
"base": {
"path": "ClaimResponse.addItem.fee",
"min": 0,
"max": "1"
},
"type": [
{
"code": "Money"
}
]
},
{
"id": "ClaimResponse.addItem.noteNumber",
"path": "ClaimResponse.addItem.noteNumber",
"short": "List of note numbers which apply",
"definition": "A list of note references to the notes provided below.",
"min": 0,
"max": "*",
"base": {
"path": "ClaimResponse.addItem.noteNumber",
"min": 0,
"max": "*"
},
"type": [
{
"code": "positiveInt"
}
]
},
{
"id": "ClaimResponse.addItem.adjudication",
"path": "ClaimResponse.addItem.adjudication",
"short": "Added items adjudication",
"definition": "The adjudications results.",
"min": 0,
"max": "*",
"base": {
"path": "ClaimResponse.addItem.adjudication",
"min": 0,
"max": "*"
},
"contentReference": "http://hl7.org/fhir/StructureDefinition/ClaimResponse#ClaimResponse.item.adjudication"
},
{
"id": "ClaimResponse.addItem.detail",
"path": "ClaimResponse.addItem.detail",
"short": "Added items 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"
}
],
"constraint": [
{
"key": "ele-1",
"severity": "error",
"human": "All FHIR elements must have a @value or children",
"expression": "hasValue() | (children().count() > id.count())",
"xpath": "@value|f:*|h:div",
"source": "http://hl7.org/fhir/StructureDefinition/Element"
}
]
},
{
"id": "ClaimResponse.addItem.detail.id",
"path": "ClaimResponse.addItem.detail.id",
"representation": [
"xmlAttr"
],
"short": "xml:id (or equivalent in JSON)",
"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": [
{
"code": "string"
}
],
"mapping": [
{
"identity": "rim",
"map": "n/a"
}
]
},
{
"id": "ClaimResponse.addItem.detail.extension",
"path": "ClaimResponse.addItem.detail.extension",
"slicing": {
"discriminator": [
{
"type": "value",
"path": "url"
}
],
"ordered": false,
"rules": "open"
},
"short": "Extension",
"definition": "An Extension",
"min": 1,
"max": "*",
"base": {
"path": "Element.extension",
"min": 0,
"max": "*"
},
"type": [
{
"code": "Extension"
}
]
},
{
"id": "ClaimResponse.addItem.detail.extension:quantity",
"path": "ClaimResponse.addItem.detail.extension",
"sliceName": "quantity",
"short": "R4: Count of products or services (new)",
"definition": "R4: `ClaimResponse.addItem.detail.quantity` (new:Quantity[SimpleQuantity])",
"comment": "Element `ClaimResponse.addItem.detail.quantity` has a context of ClaimResponse.addItem.detail based on following the parent source element upwards and mapping to `ClaimResponse`.\nElement `ClaimResponse.addItem.detail.quantity` has no mapping targets in FHIR STU3. Typically, this is because the element has been added (is a new element).",
"min": 0,
"max": "1",
"base": {
"path": "Element.extension",
"min": 0,
"max": "*"
},
"type": [
{
"code": "Extension",
"profile": "http://hl7.org/fhir/4.0/StructureDefinition/extension-ClaimResponse.addItem.detail.quantity|0.1.0"
}
],
"condition": [
"ele-1"
],
"constraint": [
{
"key": "ele-1",
"severity": "error",
"human": "All FHIR elements must have a @value or children",
"expression": "hasValue() | (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
},
{
"id": "ClaimResponse.addItem.detail.extension:unitPrice",
"path": "ClaimResponse.addItem.detail.extension",
"sliceName": "unitPrice",
"short": "R4: Fee, charge or cost per item (new)",
"definition": "R4: `ClaimResponse.addItem.detail.unitPrice` (new:Money)",
"comment": "Element `ClaimResponse.addItem.detail.unitPrice` has a context of ClaimResponse.addItem.detail based on following the parent source element upwards and mapping to `ClaimResponse`.\nElement `ClaimResponse.addItem.detail.unitPrice` has no mapping targets in FHIR STU3. Typically, this is because the element has been added (is a new element).",
"min": 0,
"max": "1",
"base": {
"path": "Element.extension",
"min": 0,
"max": "*"
},
"type": [
{
"code": "Extension",
"profile": "http://hl7.org/fhir/4.0/StructureDefinition/extension-ClaimResponse.addItem.detail.unitPrice|0.1.0"
}
],
"condition": [
"ele-1"
],
"constraint": [
{
"key": "ele-1",
"severity": "error",
"human": "All FHIR elements must have a @value or children",
"expression": "hasValue() | (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
},
{
"id": "ClaimResponse.addItem.detail.extension:factor",
"path": "ClaimResponse.addItem.detail.extension",
"sliceName": "factor",
"short": "R4: Price scaling factor (new)",
"definition": "R4: `ClaimResponse.addItem.detail.factor` (new:decimal)",
"comment": "Element `ClaimResponse.addItem.detail.factor` has a context of ClaimResponse.addItem.detail based on following the parent source element upwards and mapping to `ClaimResponse`.\nElement `ClaimResponse.addItem.detail.factor` has no mapping targets in FHIR STU3. Typically, this is because the element has been added (is a new element).\nTo show a 10% senior's discount, the value entered is: 0.90 (1.00 - 0.10).",
"min": 0,
"max": "1",
"base": {
"path": "Element.extension",
"min": 0,
"max": "*"
},
"type": [
{
"code": "Extension",
"profile": "http://hl7.org/fhir/4.0/StructureDefinition/extension-ClaimResponse.addItem.detail.factor|0.1.0"
}
],
"condition": [
"ele-1"
],
"constraint": [
{
"key": "ele-1",
"severity": "error",
"human": "All FHIR elements must have a @value or children",
"expression": "hasValue() | (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
},
{
"id": "ClaimResponse.addItem.detail.extension:net",
"path": "ClaimResponse.addItem.detail.extension",
"sliceName": "net",
"short": "R4: Total item cost (new)",
"definition": "R4: `ClaimResponse.addItem.detail.net` (new:Money)",
"comment": "Element `ClaimResponse.addItem.detail.net` has a context of ClaimResponse.addItem.detail based on following the parent source element upwards and mapping to `ClaimResponse`.\nElement `ClaimResponse.addItem.detail.net` has no mapping targets in FHIR STU3. Typically, this is because the element has been added (is a new element).\nFor example, the formula: quantity * unitPrice * factor = net. Quantity and factor are assumed to be 1 if not supplied.",
"min": 0,
"max": "1",
"base": {
"path": "Element.extension",
"min": 0,
"max": "*"
},
"type": [
{
"code": "Extension",
"profile": "http://hl7.org/fhir/4.0/StructureDefinition/extension-ClaimResponse.addItem.detail.net|0.1.0"
}
],
"condition": [
"ele-1"
],
"constraint": [
{
"key": "ele-1",
"severity": "error",
"human": "All FHIR elements must have a @value or children",
"expression": "hasValue() | (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
},
{
"id": "ClaimResponse.addItem.detail.extension:subDetail",
"path": "ClaimResponse.addItem.detail.extension",
"sliceName": "subDetail",
"short": "R4: Insurer added line items (new)",
"definition": "R4: `ClaimResponse.addItem.detail.subDetail` (new:BackboneElement)",
"comment": "Element `ClaimResponse.addItem.detail.subDetail` has a context of ClaimResponse.addItem.detail based on following the parent source element upwards and mapping to `ClaimResponse`.\nElement `ClaimResponse.addItem.detail.subDetail` has no mapping targets in FHIR STU3. Typically, this is because the element has been added (is a new element).",
"min": 0,
"max": "*",
"base": {
"path": "Element.extension",
"min": 0,
"max": "*"
},
"type": [
{
"code": "Extension",
"profile": "http://hl7.org/fhir/4.0/StructureDefinition/extension-ClaimResponse.addItem.detail.subDetail|0.1.0"
}
],
"condition": [
"ele-1"
],
"constraint": [
{
"key": "ele-1",
"severity": "error",
"human": "All FHIR elements must have a @value or children",
"expression": "hasValue() | (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
},
{
"id": "ClaimResponse.addItem.detail.extension:adjudication",
"path": "ClaimResponse.addItem.detail.extension",
"sliceName": "adjudication",
"short": "R4: Added items detail adjudication (new)",
"definition": "R4: `ClaimResponse.addItem.detail.subDetail.adjudication` (new:ClaimResponse.item.adjudication)",
"comment": "Element `ClaimResponse.addItem.detail.subDetail.adjudication` is part of an existing definition because parent element `ClaimResponse.addItem.detail.subDetail` requires a cross-version extension.\nElement `ClaimResponse.addItem.detail.subDetail.adjudication` has a context of ClaimResponse.addItem.detail based on following the parent source element upwards and mapping to `ClaimResponse`.\nElement `ClaimResponse.addItem.detail.subDetail.adjudication` has no mapping targets in FHIR STU3. Typically, this is because the element has been added (is a new element).",
"min": 1,
"max": "*",
"base": {
"path": "Element.extension",
"min": 0,
"max": "*"
},
"type": [
{
"code": "Extension",
"profile": "http://hl7.org/fhir/4.0/StructureDefinition/extension-ClaimResponse.item.adjudication|0.1.0"
}
],
"condition": [
"ele-1"
],
"constraint": [
{
"key": "ele-1",
"severity": "error",
"human": "All FHIR elements must have a @value or children",
"expression": "hasValue() | (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
},
{
"id": "ClaimResponse.addItem.detail.modifierExtension",
"path": "ClaimResponse.addItem.detail.modifierExtension",
"short": "Extensions that cannot be ignored",
"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 that contains it. Usually modifier elements provide negation or qualification. In order 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.",
"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",
"modifiers"
],
"min": 0,
"max": "*",
"base": {
"path": "BackboneElement.modifierExtension",
"min": 0,
"max": "*"
},
"type": [
{
"code": "Extension"
}
],
"isModifier": true,
"isSummary": true,
"mapping": [
{
"identity": "rim",
"map": "N/A"
}
]
},
{
"id": "ClaimResponse.addItem.detail.revenue",
"path": "ClaimResponse.addItem.detail.revenue",
"short": "Revenue or cost center code",
"definition": "The type of reveneu or cost center providing the product and/or service.",
"min": 0,
"max": "1",
"base": {
"path": "ClaimResponse.addItem.detail.revenue",
"min": 0,
"max": "1"
},
"type": [
{
"code": "CodeableConcept"
}
],
"binding": {
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString": "RevenueCenter"
}
],
"strength": "example",
"description": "Codes for the revenue or cost centers supplying the service and/or products.",
"valueSetReference": {
"reference": "http://hl7.org/fhir/ValueSet/ex-revenue-center|3.0.2"
}
}
},
{
"id": "ClaimResponse.addItem.detail.category",
"path": "ClaimResponse.addItem.detail.category",
"short": "Type of service or product",
"definition": "Health Care Service Type Codes to identify the classification of service or benefits.",
"min": 0,
"max": "1",
"base": {
"path": "ClaimResponse.addItem.detail.category",
"min": 0,
"max": "1"
},
"type": [
{
"code": "CodeableConcept"
}
],
"binding": {
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString": "BenefitSubCategory"
}
],
"strength": "example",
"description": "Benefit subcategories such as: oral-basic, major, glasses",
"valueSetReference": {
"reference": "http://hl7.org/fhir/ValueSet/benefit-subcategory|3.0.2"
}
}
},
{
"id": "ClaimResponse.addItem.detail.service",
"path": "ClaimResponse.addItem.detail.service",
"short": "Service or Product",
"definition": "A code to indicate the Professional Service or Product supplied.",
"min": 0,
"max": "1",
"base": {
"path": "ClaimResponse.addItem.detail.service",
"min": 0,
"max": "1"
},
"type": [
{
"code": "CodeableConcept"
}
],
"binding": {
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString": "ServiceProduct"
}
],
"strength": "example",
"description": "Allowable service and product codes.",
"valueSetReference": {
"reference": "http://hl7.org/fhir/ValueSet/service-uscls|3.0.2"
}
}
},
{
"id": "ClaimResponse.addItem.detail.modifier",
"path": "ClaimResponse.addItem.detail.modifier",
"short": "Service/Product billing modifiers",
"definition": "Item typification or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or for medical whether the treatment was outside the clinic or out of office hours.",
"requirements": "May impact on adjudication.",
"min": 0,
"max": "*",
"base": {
"path": "ClaimResponse.addItem.detail.modifier",
"min": 0,
"max": "*"
},
"type": [
{
"code": "CodeableConcept"
}
],
"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.",
"valueSetReference": {
"reference": "http://hl7.org/fhir/ValueSet/claim-modifiers|3.0.2"
}
},
"mapping": [
{
"identity": "rim",
"map": "24.C, 24.D mods"
}
]
},
{
"id": "ClaimResponse.addItem.detail.fee",
"path": "ClaimResponse.addItem.detail.fee",
"short": "Professional fee or Product charge",
"definition": "The fee charged for the professional service or product..",
"min": 0,
"max": "1",
"base": {
"path": "ClaimResponse.addItem.detail.fee",
"min": 0,
"max": "1"
},
"type": [
{
"code": "Money"
}
]
},
{
"id": "ClaimResponse.addItem.detail.noteNumber",
"path": "ClaimResponse.addItem.detail.noteNumber",
"short": "List of note numbers which apply",
"definition": "A list of note references to the notes provided below.",
"min": 0,
"max": "*",
"base": {
"path": "ClaimResponse.addItem.detail.noteNumber",
"min": 0,
"max": "*"
},
"type": [
{
"code": "positiveInt"
}
]
},
{
"id": "ClaimResponse.addItem.detail.adjudication",
"path": "ClaimResponse.addItem.detail.adjudication",
"short": "Added items detail adjudication",
"definition": "The adjudications results.",
"min": 0,
"max": "*",
"base": {
"path": "ClaimResponse.addItem.detail.adjudication",
"min": 0,
"max": "*"
},
"contentReference": "http://hl7.org/fhir/StructureDefinition/ClaimResponse#ClaimResponse.item.adjudication"
},
{
"id": "ClaimResponse.error",
"path": "ClaimResponse.error",
"short": "Processing errors",
"definition": "Mutually exclusive with Services Provided (Item).",
"min": 0,
"max": "*",
"base": {
"path": "ClaimResponse.error",
"min": 0,
"max": "*"
},
"type": [
{
"code": "BackboneElement"
}
],
"constraint": [
{
"key": "ele-1",
"severity": "error",
"human": "All FHIR elements must have a @value or children",
"expression": "hasValue() | (children().count() > id.count())",
"xpath": "@value|f:*|h:div",
"source": "http://hl7.org/fhir/StructureDefinition/Element"
}
]
},
{
"id": "ClaimResponse.error.id",
"path": "ClaimResponse.error.id",
"representation": [
"xmlAttr"
],
"short": "xml:id (or equivalent in JSON)",
"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": [
{
"code": "string"
}
],
"mapping": [
{
"identity": "rim",
"map": "n/a"
}
]
},
{
"id": "ClaimResponse.error.extension",
"path": "ClaimResponse.error.extension",
"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. In order 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.",
"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"
}
],
"mapping": [
{
"identity": "rim",
"map": "n/a"
}
]
},
{
"id": "ClaimResponse.error.modifierExtension",
"path": "ClaimResponse.error.modifierExtension",
"short": "Extensions that cannot be ignored",
"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 that contains it. Usually modifier elements provide negation or qualification. In order 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.",
"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",
"modifiers"
],
"min": 0,
"max": "*",
"base": {
"path": "BackboneElement.modifierExtension",
"min": 0,
"max": "*"
},
"type": [
{
"code": "Extension"
}
],
"isModifier": true,
"isSummary": true,
"mapping": [
{
"identity": "rim",
"map": "N/A"
}
]
},
{
"id": "ClaimResponse.error.sequenceLinkId",
"path": "ClaimResponse.error.sequenceLinkId",
"short": "Item sequence number",
"definition": "The sequence number of the line item submitted which contains the error. This value is omitted when the error is elsewhere.",
"min": 0,
"max": "1",
"base": {
"path": "ClaimResponse.error.sequenceLinkId",
"min": 0,
"max": "1"
},
"type": [
{
"code": "positiveInt"
}
]
},
{
"id": "ClaimResponse.error.detailSequenceLinkId",
"path": "ClaimResponse.error.detailSequenceLinkId",
"short": "Detail sequence number",
"definition": "The sequence number of the addition within the line item submitted which contains the error. This value is omitted when the error is not related to an Addition.",
"min": 0,
"max": "1",
"base": {
"path": "ClaimResponse.error.detailSequenceLinkId",
"min": 0,
"max": "1"
},
"type": [
{
"code": "positiveInt"
}
]
},
{
"id": "ClaimResponse.error.subdetailSequenceLinkId",
"path": "ClaimResponse.error.subdetailSequenceLinkId",
"short": "Subdetail sequence number",
"definition": "The sequence number of the addition within the line item submitted which contains the error. This value is omitted when the error is not related to an Addition.",
"min": 0,
"max": "1",
"base": {
"path": "ClaimResponse.error.subdetailSequenceLinkId",
"min": 0,
"max": "1"
},
"type": [
{
"code": "positiveInt"
}
]
},
{
"id": "ClaimResponse.error.code",
"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.",
"min": 1,
"max": "1",
"base": {
"path": "ClaimResponse.error.code",
"min": 1,
"max": "1"
},
"type": [
{
"code": "CodeableConcept"
}
],
"binding": {
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString": "AdjudicationError"
}
],
"strength": "example",
"description": "The adjudication error codes.",
"valueSetReference": {
"reference": "http://hl7.org/fhir/ValueSet/adjudication-error|3.0.2"
}
}
},
{
"id": "ClaimResponse.totalCost",
"path": "ClaimResponse.totalCost",
"short": "Total Cost of service from the Claim",
"definition": "The total cost of the services reported.",
"requirements": "This is a check value that the receiver calculates and returns.",
"min": 0,
"max": "1",
"base": {
"path": "ClaimResponse.totalCost",
"min": 0,
"max": "1"
},
"type": [
{
"code": "Money"
}
]
},
{
"id": "ClaimResponse.unallocDeductable",
"path": "ClaimResponse.unallocDeductable",
"short": "Unallocated deductible",
"definition": "The amount of deductible applied which was not allocated to any particular service line.",
"min": 0,
"max": "1",
"base": {
"path": "ClaimResponse.unallocDeductable",
"min": 0,
"max": "1"
},
"type": [
{
"code": "Money"
}
]
},
{
"id": "ClaimResponse.totalBenefit",
"path": "ClaimResponse.totalBenefit",
"short": "Total benefit payable for the Claim",
"definition": "Total amount of benefit payable (Equal to sum of the Benefit amounts from all detail lines and additions less the Unallocated Deductible).",
"min": 0,
"max": "1",
"base": {
"path": "ClaimResponse.totalBenefit",
"min": 0,
"max": "1"
},
"type": [
{
"code": "Money"
}
]
},
{
"id": "ClaimResponse.payment",
"path": "ClaimResponse.payment",
"short": "Payment details, if paid",
"definition": "Payment details for the claim if the claim has been paid.",
"min": 0,
"max": "1",
"base": {
"path": "ClaimResponse.payment",
"min": 0,
"max": "1"
},
"type": [
{
"code": "BackboneElement"
}
],
"constraint": [
{
"key": "ele-1",
"severity": "error",
"human": "All FHIR elements must have a @value or children",
"expression": "hasValue() | (children().count() > id.count())",
"xpath": "@value|f:*|h:div",
"source": "http://hl7.org/fhir/StructureDefinition/Element"
}
]
},
{
"id": "ClaimResponse.payment.id",
"path": "ClaimResponse.payment.id",
"representation": [
"xmlAttr"
],
"short": "xml:id (or equivalent in JSON)",
"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": [
{
"code": "string"
}
],
"mapping": [
{
"identity": "rim",
"map": "n/a"
}
]
},
{
"id": "ClaimResponse.payment.extension",
"path": "ClaimResponse.payment.extension",
"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. In order 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.",
"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"
}
],
"mapping": [
{
"identity": "rim",
"map": "n/a"
}
]
},
{
"id": "ClaimResponse.payment.modifierExtension",
"path": "ClaimResponse.payment.modifierExtension",
"short": "Extensions that cannot be ignored",
"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 that contains it. Usually modifier elements provide negation or qualification. In order 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.",
"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",
"modifiers"
],
"min": 0,
"max": "*",
"base": {
"path": "BackboneElement.modifierExtension",
"min": 0,
"max": "*"
},
"type": [
{
"code": "Extension"
}
],
"isModifier": true,
"isSummary": true,
"mapping": [
{
"identity": "rim",
"map": "N/A"
}
]
},
{
"id": "ClaimResponse.payment.type",
"path": "ClaimResponse.payment.type",
"short": "Partial or Complete",
"definition": "Whether this represents partial or complete payment of the claim.",
"min": 0,
"max": "1",
"base": {
"path": "ClaimResponse.payment.type",
"min": 0,
"max": "1"
},
"type": [
{
"code": "CodeableConcept"
}
],
"binding": {
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString": "PaymentType"
}
],
"strength": "example",
"description": "The type (partial, complete) of the payment",
"valueSetReference": {
"reference": "http://hl7.org/fhir/ValueSet/ex-paymenttype|3.0.2"
}
}
},
{
"id": "ClaimResponse.payment.adjustment",
"path": "ClaimResponse.payment.adjustment",
"short": "Payment adjustment for non-Claim issues",
"definition": "Adjustment to the payment of this transaction which is not related to adjudication of this transaction.",
"min": 0,
"max": "1",
"base": {
"path": "ClaimResponse.payment.adjustment",
"min": 0,
"max": "1"
},
"type": [
{
"code": "Money"
}
]
},
{
"id": "ClaimResponse.payment.adjustmentReason",
"path": "ClaimResponse.payment.adjustmentReason",
"short": "Explanation for the non-claim adjustment",
"definition": "Reason for the payment adjustment.",
"min": 0,
"max": "1",
"base": {
"path": "ClaimResponse.payment.adjustmentReason",
"min": 0,
"max": "1"
},
"type": [
{
"code": "CodeableConcept"
}
],
"binding": {
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString": "PaymentAdjustmentReason"
}
],
"strength": "example",
"description": "Payment Adjustment reason codes.",
"valueSetReference": {
"reference": "http://hl7.org/fhir/ValueSet/payment-adjustment-reason|3.0.2"
}
}
},
{
"id": "ClaimResponse.payment.date",
"path": "ClaimResponse.payment.date",
"short": "Expected data of Payment",
"definition": "Estimated payment data.",
"min": 0,
"max": "1",
"base": {
"path": "ClaimResponse.payment.date",
"min": 0,
"max": "1"
},
"type": [
{
"code": "date"
}
]
},
{
"id": "ClaimResponse.payment.amount",
"path": "ClaimResponse.payment.amount",
"short": "Payable amount after adjustment",
"definition": "Payable less any payment adjustment.",
"min": 0,
"max": "1",
"base": {
"path": "ClaimResponse.payment.amount",
"min": 0,
"max": "1"
},
"type": [
{
"code": "Money"
}
]
},
{
"id": "ClaimResponse.payment.identifier",
"path": "ClaimResponse.payment.identifier",
"short": "Identifier of the payment instrument",
"definition": "Payment identifier.",
"min": 0,
"max": "1",
"base": {
"path": "ClaimResponse.payment.identifier",
"min": 0,
"max": "1"
},
"type": [
{
"code": "Identifier"
}
]
},
{
"id": "ClaimResponse.reserved",
"path": "ClaimResponse.reserved",
"short": "Funds reserved status",
"definition": "Status of funds reservation (For provider, for Patient, None).",
"min": 0,
"max": "1",
"base": {
"path": "ClaimResponse.reserved",
"min": 0,
"max": "1"
},
"type": [
{
"code": "Coding"
}
],
"binding": {
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString": "FundsReserve"
}
],
"strength": "example",
"description": "For whom funds are to be reserved: (Patient, Provider, None).",
"valueSetReference": {
"reference": "http://hl7.org/fhir/ValueSet/fundsreserve|3.0.2"
}
}
},
{
"id": "ClaimResponse.reserved.id",
"path": "ClaimResponse.reserved.id",
"representation": [
"xmlAttr"
],
"short": "xml:id (or equivalent in JSON)",
"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": [
{
"code": "string"
}
],
"mapping": [
{
"identity": "rim",
"map": "n/a"
}
]
},
{
"id": "ClaimResponse.reserved.extension",
"path": "ClaimResponse.reserved.extension",
"slicing": {
"discriminator": [
{
"type": "value",
"path": "url"
}
],
"description": "Extensions are always sliced by (at least) url",
"ordered": false,
"rules": "open"
},
"short": "Extension",
"definition": "An Extension",
"min": 0,
"max": "*",
"base": {
"path": "Element.extension",
"min": 0,
"max": "*"
},
"type": [
{
"code": "Extension"
}
]
},
{
"id": "ClaimResponse.reserved.extension:fundsReserve",
"path": "ClaimResponse.reserved.extension",
"sliceName": "fundsReserve",
"short": "R4: fundsReserve additional types",
"definition": "R4: `ClaimResponse.fundsReserve` additional types (CodeableConcept) additional types from child elements (text)",
"comment": "Element `ClaimResponse.fundsReserve` is mapped to FHIR STU3 element `ClaimResponse.reserved` as `SourceIsBroaderThanTarget`.\nThe mappings for `ClaimResponse.fundsReserve` do not cover the following types: CodeableConcept.\nThe mappings for `ClaimResponse.fundsReserve` do not cover the following types based on type expansion: text.\nFund would be release by a future claim quoting the preAuthRef of this response. Examples of values include: provider, patient, none.",
"min": 0,
"max": "1",
"base": {
"path": "Element.extension",
"min": 0,
"max": "*"
},
"type": [
{
"code": "Extension",
"profile": "http://hl7.org/fhir/4.0/StructureDefinition/extension-ClaimResponse.fundsReserve|0.1.0"
}
]
},
{
"id": "ClaimResponse.reserved.system",
"path": "ClaimResponse.reserved.system",
"short": "Identity of the terminology system",
"definition": "The identification of the code system that defines the meaning of the symbol in the code.",
"comment": "The URI may be an OID (urn:oid:...) or a UUID (urn:uuid:...). OIDs and UUIDs SHALL be references to the HL7 OID registry. Otherwise, the URI should come from HL7's list of FHIR defined special URIs or it should de-reference to some definition that establish the system clearly and unambiguously.",
"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"
}
],
"isSummary": true,
"mapping": [
{
"identity": "v2",
"map": "C*E.3"
},
{
"identity": "rim",
"map": "./codeSystem"
},
{
"identity": "orim",
"map": "fhir:Coding.system rdfs:subPropertyOf dt:CDCoding.codeSystem"
}
]
},
{
"id": "ClaimResponse.reserved.version",
"path": "ClaimResponse.reserved.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"
}
],
"isSummary": true,
"mapping": [
{
"identity": "v2",
"map": "C*E.7"
},
{
"identity": "rim",
"map": "./codeSystemVersion"
},
{
"identity": "orim",
"map": "fhir:Coding.version rdfs:subPropertyOf dt:CDCoding.codeSystemVersion"
}
]
},
{
"id": "ClaimResponse.reserved.code",
"path": "ClaimResponse.reserved.code",
"short": "Symbol in syntax defined by the system",
"definition": "A symbol in syntax defined by the system. The symbol may be a predefined code or an expression in a syntax defined by the coding system (e.g. post-coordination).",
"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"
}
],
"isSummary": true,
"mapping": [
{
"identity": "v2",
"map": "C*E.1"
},
{
"identity": "rim",
"map": "./code"
},
{
"identity": "orim",
"map": "fhir:Coding.code rdfs:subPropertyOf dt:CDCoding.code"
}
]
},
{
"id": "ClaimResponse.reserved.display",
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-translatable",
"valueBoolean": true
}
],
"path": "ClaimResponse.reserved.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.",
"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"
}
],
"isSummary": true,
"mapping": [
{
"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.reserved.userSelected",
"path": "ClaimResponse.reserved.userSelected",
"short": "If this coding was chosen directly by the user",
"definition": "Indicates that this coding was chosen by a user directly - i.e. 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"
}
],
"isSummary": true,
"mapping": [
{
"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.form",
"path": "ClaimResponse.form",
"short": "Printed Form Identifier",
"definition": "The form to be used for printing the content.",
"min": 0,
"max": "1",
"base": {
"path": "ClaimResponse.form",
"min": 0,
"max": "1"
},
"type": [
{
"code": "CodeableConcept"
}
],
"binding": {
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString": "Forms"
}
],
"strength": "example",
"description": "The forms codes.",
"valueSetReference": {
"reference": "http://hl7.org/fhir/ValueSet/forms|3.0.2"
}
},
"mapping": [
{
"identity": "cdanetv4",
"map": "G42"
}
]
},
{
"id": "ClaimResponse.form.id",
"path": "ClaimResponse.form.id",
"representation": [
"xmlAttr"
],
"short": "xml:id (or equivalent in JSON)",
"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": [
{
"code": "string"
}
],
"mapping": [
{
"identity": "rim",
"map": "n/a"
}
]
},
{
"id": "ClaimResponse.form.extension",
"path": "ClaimResponse.form.extension",
"slicing": {
"discriminator": [
{
"type": "value",
"path": "url"
}
],
"description": "Extensions are always sliced by (at least) url",
"ordered": false,
"rules": "open"
},
"short": "Extension",
"definition": "An Extension",
"min": 0,
"max": "*",
"base": {
"path": "Element.extension",
"min": 0,
"max": "*"
},
"type": [
{
"code": "Extension"
}
]
},
{
"id": "ClaimResponse.form.extension:form",
"path": "ClaimResponse.form.extension",
"sliceName": "form",
"short": "R4: Printed reference or actual form additional types",
"definition": "R4: `ClaimResponse.form` additional types (Attachment) additional types from child elements (creation, data, hash, size, title, url)",
"comment": "Element `ClaimResponse.form` is mapped to FHIR STU3 element `ClaimResponse.form` as `SourceIsBroaderThanTarget`.\nThe mappings for `ClaimResponse.form` do not cover the following types: Attachment.\nThe mappings for `ClaimResponse.form` do not cover the following types based on type expansion: creation, data, hash, size, title, url.\nNeeded to permit insurers to include the actual form.",
"min": 0,
"max": "1",
"base": {
"path": "Element.extension",
"min": 0,
"max": "*"
},
"type": [
{
"code": "Extension",
"profile": "http://hl7.org/fhir/4.0/StructureDefinition/extension-ClaimResponse.form|0.1.0"
}
]
},
{
"id": "ClaimResponse.form.coding",
"path": "ClaimResponse.form.coding",
"short": "Code defined by a terminology system",
"definition": "A reference to a code defined by a terminology system.",
"comment": "Codes may be defined very casually in enumerations, or code lists, up to very formal definitions such as SNOMED CT - see the HL7 v3 Core Principles for more information. Ordering of codings is undefined and SHALL NOT be used to infer meaning. Generally, at most only one of the coding values will be labeled as UserSelected = true.",
"requirements": "Allows for translations and alternate encodings within a code system. Also supports communication of the same instance to systems requiring different encodings.",
"min": 0,
"max": "*",
"base": {
"path": "CodeableConcept.coding",
"min": 0,
"max": "*"
},
"type": [
{
"code": "Coding"
}
],
"isSummary": true,
"mapping": [
{
"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.form.text",
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-translatable",
"valueBoolean": true
}
],
"path": "ClaimResponse.form.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"
}
],
"isSummary": true,
"mapping": [
{
"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.processNote",
"path": "ClaimResponse.processNote",
"short": "Processing notes",
"definition": "Note text.",
"min": 0,
"max": "*",
"base": {
"path": "ClaimResponse.processNote",
"min": 0,
"max": "*"
},
"type": [
{
"code": "BackboneElement"
}
],
"constraint": [
{
"key": "ele-1",
"severity": "error",
"human": "All FHIR elements must have a @value or children",
"expression": "hasValue() | (children().count() > id.count())",
"xpath": "@value|f:*|h:div",
"source": "http://hl7.org/fhir/StructureDefinition/Element"
}
]
},
{
"id": "ClaimResponse.processNote.id",
"path": "ClaimResponse.processNote.id",
"representation": [
"xmlAttr"
],
"short": "xml:id (or equivalent in JSON)",
"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": [
{
"code": "string"
}
],
"mapping": [
{
"identity": "rim",
"map": "n/a"
}
]
},
{
"id": "ClaimResponse.processNote.extension",
"path": "ClaimResponse.processNote.extension",
"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. In order 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.",
"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"
}
],
"mapping": [
{
"identity": "rim",
"map": "n/a"
}
]
},
{
"id": "ClaimResponse.processNote.modifierExtension",
"path": "ClaimResponse.processNote.modifierExtension",
"short": "Extensions that cannot be ignored",
"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 that contains it. Usually modifier elements provide negation or qualification. In order 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.",
"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",
"modifiers"
],
"min": 0,
"max": "*",
"base": {
"path": "BackboneElement.modifierExtension",
"min": 0,
"max": "*"
},
"type": [
{
"code": "Extension"
}
],
"isModifier": true,
"isSummary": true,
"mapping": [
{
"identity": "rim",
"map": "N/A"
}
]
},
{
"id": "ClaimResponse.processNote.number",
"path": "ClaimResponse.processNote.number",
"short": "Sequence Number for this note",
"definition": "An integer associated with each note which may be referred to from each service line item.",
"min": 0,
"max": "1",
"base": {
"path": "ClaimResponse.processNote.number",
"min": 0,
"max": "1"
},
"type": [
{
"code": "positiveInt"
}
]
},
{
"id": "ClaimResponse.processNote.type",
"path": "ClaimResponse.processNote.type",
"short": "display | print | printoper",
"definition": "The note purpose: Print/Display.",
"min": 0,
"max": "1",
"base": {
"path": "ClaimResponse.processNote.type",
"min": 0,
"max": "1"
},
"type": [
{
"code": "CodeableConcept"
}
],
"binding": {
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString": "NoteType"
}
],
"strength": "required",
"description": "The presentation types of notes.",
"valueSetReference": {
"reference": "http://hl7.org/fhir/ValueSet/note-type|3.0.2"
}
}
},
{
"id": "ClaimResponse.processNote.text",
"path": "ClaimResponse.processNote.text",
"short": "Note explanatory text",
"definition": "The note text.",
"min": 0,
"max": "1",
"base": {
"path": "ClaimResponse.processNote.text",
"min": 0,
"max": "1"
},
"type": [
{
"code": "string"
}
],
"mapping": [
{
"identity": "cdanetv4",
"map": "G32"
}
]
},
{
"id": "ClaimResponse.processNote.language",
"path": "ClaimResponse.processNote.language",
"short": "Language if different from the resource",
"definition": "The ISO-639-1 alpha 2 code in lower case for the language, optionally followed by a hyphen and the ISO-3166-1 alpha 2 code for the region in upper case; e.g. \"en\" for English, or \"en-US\" for American English versus \"en-EN\" for England English.",
"min": 0,
"max": "1",
"base": {
"path": "ClaimResponse.processNote.language",
"min": 0,
"max": "1"
},
"type": [
{
"code": "CodeableConcept"
}
],
"binding": {
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-maxValueSet",
"valueReference": {
"reference": "http://hl7.org/fhir/ValueSet/all-languages|3.0.2"
}
},
{
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString": "Language"
}
],
"strength": "extensible",
"description": "A human language.",
"valueSetReference": {
"reference": "http://hl7.org/fhir/ValueSet/languages|3.0.2"
}
}
},
{
"id": "ClaimResponse.communicationRequest",
"path": "ClaimResponse.communicationRequest",
"short": "Request for additional information",
"definition": "Request for additional supporting or authorizing information, such as: documents, images or resources.",
"min": 0,
"max": "*",
"base": {
"path": "ClaimResponse.communicationRequest",
"min": 0,
"max": "*"
},
"type": [
{
"code": "Reference",
"targetProfile": "http://hl7.org/fhir/StructureDefinition/CommunicationRequest"
}
]
},
{
"id": "ClaimResponse.insurance",
"path": "ClaimResponse.insurance",
"short": "Insurance or medical plan",
"definition": "Financial instrument by which payment information for health care.",
"requirements": "Health care programs and insurers are significant payors of health service costs.",
"min": 0,
"max": "*",
"base": {
"path": "ClaimResponse.insurance",
"min": 0,
"max": "*"
},
"type": [
{
"code": "BackboneElement"
}
],
"constraint": [
{
"key": "ele-1",
"severity": "error",
"human": "All FHIR elements must have a @value or children",
"expression": "hasValue() | (children().count() > id.count())",
"xpath": "@value|f:*|h:div",
"source": "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"mapping": [
{
"identity": "rim",
"map": "Coverage"
}
]
},
{
"id": "ClaimResponse.insurance.id",
"path": "ClaimResponse.insurance.id",
"representation": [
"xmlAttr"
],
"short": "xml:id (or equivalent in JSON)",
"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": [
{
"code": "string"
}
],
"mapping": [
{
"identity": "rim",
"map": "n/a"
}
]
},
{
"id": "ClaimResponse.insurance.extension",
"path": "ClaimResponse.insurance.extension",
"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. In order 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.",
"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"
}
],
"mapping": [
{
"identity": "rim",
"map": "n/a"
}
]
},
{
"id": "ClaimResponse.insurance.modifierExtension",
"path": "ClaimResponse.insurance.modifierExtension",
"short": "Extensions that cannot be ignored",
"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 that contains it. Usually modifier elements provide negation or qualification. In order 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.",
"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",
"modifiers"
],
"min": 0,
"max": "*",
"base": {
"path": "BackboneElement.modifierExtension",
"min": 0,
"max": "*"
},
"type": [
{
"code": "Extension"
}
],
"isModifier": true,
"isSummary": true,
"mapping": [
{
"identity": "rim",
"map": "N/A"
}
]
},
{
"id": "ClaimResponse.insurance.sequence",
"path": "ClaimResponse.insurance.sequence",
"short": "Service instance identifier",
"definition": "A service line item.",
"requirements": "To maintain order of the coverages.",
"min": 1,
"max": "1",
"base": {
"path": "ClaimResponse.insurance.sequence",
"min": 1,
"max": "1"
},
"type": [
{
"code": "positiveInt"
}
]
},
{
"id": "ClaimResponse.insurance.focal",
"path": "ClaimResponse.insurance.focal",
"short": "Is the focal Coverage",
"definition": "The instance number of the Coverage which is the focus for adjudication. The Coverage against which the claim is to be adjudicated.",
"requirements": "To identify which coverage is being adjudicated.",
"min": 1,
"max": "1",
"base": {
"path": "ClaimResponse.insurance.focal",
"min": 1,
"max": "1"
},
"type": [
{
"code": "boolean"
}
]
},
{
"id": "ClaimResponse.insurance.coverage",
"path": "ClaimResponse.insurance.coverage",
"short": "Insurance information",
"definition": "Reference to the program or plan identification, underwriter or payor.",
"requirements": "Need to identify the issuer to target for processing and for coordination of benefit processing.",
"min": 1,
"max": "1",
"base": {
"path": "ClaimResponse.insurance.coverage",
"min": 1,
"max": "1"
},
"type": [
{
"code": "Reference",
"targetProfile": "http://hl7.org/fhir/StructureDefinition/Coverage"
}
]
},
{
"id": "ClaimResponse.insurance.businessArrangement",
"path": "ClaimResponse.insurance.businessArrangement",
"short": "Business agreement",
"definition": "The contract number of a business agreement which describes the terms and conditions.",
"min": 0,
"max": "1",
"base": {
"path": "ClaimResponse.insurance.businessArrangement",
"min": 0,
"max": "1"
},
"type": [
{
"code": "string"
}
]
},
{
"id": "ClaimResponse.insurance.preAuthRef",
"path": "ClaimResponse.insurance.preAuthRef",
"short": "Pre-Authorization/Determination Reference",
"definition": "A list of references from the Insurer to which these services pertain.",
"requirements": "To provide any pre-determination or prior authorization reference.",
"min": 0,
"max": "*",
"base": {
"path": "ClaimResponse.insurance.preAuthRef",
"min": 0,
"max": "*"
},
"type": [
{
"code": "string"
}
],
"mapping": [
{
"identity": "cdanetv4",
"map": "F03"
}
]
},
{
"id": "ClaimResponse.insurance.claimResponse",
"path": "ClaimResponse.insurance.claimResponse",
"short": "Adjudication results",
"definition": "The Coverages adjudication details.",
"requirements": "Used by downstream payers to determine what balance remains and the net payable.",
"min": 0,
"max": "1",
"base": {
"path": "ClaimResponse.insurance.claimResponse",
"min": 0,
"max": "1"
},
"type": [
{
"code": "Reference",
"targetProfile": "http://hl7.org/fhir/StructureDefinition/ClaimResponse"
}
],
"mapping": [
{
"identity": "cdanetv4",
"map": "EOB"
}
]
}
]
},
"differential": {
"element": [
{
"id": "ClaimResponse",
"path": "ClaimResponse"
},
{
"id": "ClaimResponse.extension",
"path": "ClaimResponse.extension",
"slicing": {
"discriminator": [
{
"type": "value",
"path": "url"
}
],
"ordered": false,
"rules": "open"
},
"min": 2,
"max": "*"
},
{
"id": "ClaimResponse.extension:type",
"path": "ClaimResponse.extension",
"sliceName": "type",
"short": "R4: More granular claim type (new)",
"definition": "R4: `ClaimResponse.type` (new:CodeableConcept)",
"comment": "Element `ClaimResponse.type` has a context of ClaimResponse based on following the parent source element upwards and mapping to `ClaimResponse`.\nElement `ClaimResponse.type` has no mapping targets in FHIR STU3. Typically, this is because the element has been added (is a new element).\nThis may contain the local bill type codes, for example the US UB-04 bill type code or the CMS bill type.",
"min": 1,
"max": "1",
"base": {
"path": "DomainResource.extension",
"min": 0,
"max": "*"
},
"type": [
{
"code": "Extension",
"profile": "http://hl7.org/fhir/4.0/StructureDefinition/extension-ClaimResponse.type|0.1.0"
}
]
},
{
"id": "ClaimResponse.extension:subType",
"path": "ClaimResponse.extension",
"sliceName": "subType",
"short": "R4: More granular claim type (new)",
"definition": "R4: `ClaimResponse.subType` (new:CodeableConcept)",
"comment": "Element `ClaimResponse.subType` has a context of ClaimResponse based on following the parent source element upwards and mapping to `ClaimResponse`.\nElement `ClaimResponse.subType` has no mapping targets in FHIR STU3. Typically, this is because the element has been added (is a new element).\nThis may contain the local bill type codes, for example the US UB-04 bill type code or the CMS bill type.",
"min": 0,
"max": "1",
"base": {
"path": "DomainResource.extension",
"min": 0,
"max": "*"
},
"type": [
{
"code": "Extension",
"profile": "http://hl7.org/fhir/4.0/StructureDefinition/extension-ClaimResponse.subType|0.1.0"
}
]
},
{
"id": "ClaimResponse.extension:use",
"path": "ClaimResponse.extension",
"sliceName": "use",
"short": "R4: claim | preauthorization | predetermination (new)",
"definition": "R4: `ClaimResponse.use` (new:code)",
"comment": "Element `ClaimResponse.use` has a context of ClaimResponse based on following the parent source element upwards and mapping to `ClaimResponse`.\nElement `ClaimResponse.use` has no mapping targets in FHIR STU3. Typically, this is because the element has been added (is a new element).",
"min": 1,
"max": "1",
"base": {
"path": "DomainResource.extension",
"min": 0,
"max": "*"
},
"type": [
{
"code": "Extension",
"profile": "http://hl7.org/fhir/4.0/StructureDefinition/extension-ClaimResponse.use|0.1.0"
}
]
},
{
"id": "ClaimResponse.extension:requestor",
"path": "ClaimResponse.extension",
"sliceName": "requestor",
"short": "R4: Party responsible for the claim",
"definition": "R4: `ClaimResponse.requestor`",
"comment": "Element `ClaimResponse.requestor` is mapped to FHIR STU3 element `ClaimResponse.requestProvider` as `SourceIsBroaderThanTarget`.\nElement `ClaimResponse.requestor` is mapped to FHIR STU3 element `ClaimResponse.requestOrganization` as `SourceIsBroaderThanTarget`.\nThe standard extension `alternate-reference` has been mapped as the representation of FHIR R4 element `ClaimResponse.requestor` with unmapped reference targets: PractitionerRole.\nTypically 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": "DomainResource.extension",
"min": 0,
"max": "*"
},
"type": [
{
"code": "Extension",
"profile": "http://hl7.org/fhir/StructureDefinition/alternate-reference"
}
]
},
{
"id": "ClaimResponse.extension:preAuthPeriod",
"path": "ClaimResponse.extension",
"sliceName": "preAuthPeriod",
"short": "R4: Preauthorization reference effective period (new)",
"definition": "R4: `ClaimResponse.preAuthPeriod` (new:Period)",
"comment": "Element `ClaimResponse.preAuthPeriod` has a context of ClaimResponse based on following the parent source element upwards and mapping to `ClaimResponse`.\nElement `ClaimResponse.preAuthPeriod` has no mapping targets in FHIR STU3. Typically, this is because the element has been added (is a new element).",
"min": 0,
"max": "1",
"base": {
"path": "DomainResource.extension",
"min": 0,
"max": "*"
},
"type": [
{
"code": "Extension",
"profile": "http://hl7.org/fhir/4.0/StructureDefinition/extension-ClaimResponse.preAuthPeriod|0.1.0"
}
]
},
{
"id": "ClaimResponse.extension:adjudication",
"path": "ClaimResponse.extension",
"sliceName": "adjudication",
"short": "R4: Header-level adjudication (new)",
"definition": "R4: `ClaimResponse.adjudication` (new:ClaimResponse.item.adjudication)",
"comment": "Element `ClaimResponse.adjudication` has a context of ClaimResponse based on following the parent source element upwards and mapping to `ClaimResponse`.\nElement `ClaimResponse.adjudication` has no mapping targets in FHIR STU3. Typically, this is because the element has been added (is a new element).",
"min": 0,
"max": "*",
"base": {
"path": "DomainResource.extension",
"min": 0,
"max": "*"
},
"type": [
{
"code": "Extension",
"profile": "http://hl7.org/fhir/4.0/StructureDefinition/extension-ClaimResponse.item.adjudication|0.1.0"
}
]
},
{
"id": "ClaimResponse.extension:total",
"path": "ClaimResponse.extension",
"sliceName": "total",
"short": "R4: Adjudication totals (new)",
"definition": "R4: `ClaimResponse.total` (new:BackboneElement)",
"comment": "Element `ClaimResponse.total` has a context of ClaimResponse based on following the parent source element upwards and mapping to `ClaimResponse`.\nElement `ClaimResponse.total` has no mapping targets in FHIR STU3. Typically, this is because the element has been added (is a new element).\nTotals for amounts submitted, co-pays, benefits payable etc.",
"min": 0,
"max": "*",
"base": {
"path": "DomainResource.extension",
"min": 0,
"max": "*"
},
"type": [
{
"code": "Extension",
"profile": "http://hl7.org/fhir/4.0/StructureDefinition/extension-ClaimResponse.total|0.1.0"
}
]
},
{
"id": "ClaimResponse.outcome.extension",
"path": "ClaimResponse.outcome.extension",
"slicing": {
"discriminator": [
{
"type": "value",
"path": "url"
}
],
"ordered": false,
"rules": "open"
},
"min": 1,
"max": "*"
},
{
"id": "ClaimResponse.outcome.extension:outcome",
"path": "ClaimResponse.outcome.extension",
"sliceName": "outcome",
"short": "R4: queued | complete | error | partial",
"definition": "R4: `ClaimResponse.outcome`",
"comment": "Element `ClaimResponse.outcome` is mapped to FHIR STU3 element `ClaimResponse.outcome` as `RelatedTo`.\nThe resource may be used to indicate that: the request has been held (queued) for processing; that it has been processed and errors found (error); that no errors were found and that some of the adjudication has been undertaken (partial) or that all of the adjudication has been undertaken (complete).",
"min": 1,
"max": "1",
"base": {
"path": "DomainResource.extension",
"min": 0,
"max": "*"
},
"type": [
{
"code": "Extension",
"profile": "http://hl7.org/fhir/4.0/StructureDefinition/extension-ClaimResponse.outcome|0.1.0"
}
]
},
{
"id": "ClaimResponse.addItem.extension",
"path": "ClaimResponse.addItem.extension",
"slicing": {
"discriminator": [
{
"type": "value",
"path": "url"
}
],
"ordered": false,
"rules": "open"
},
"min": 0,
"max": "*"
},
{
"id": "ClaimResponse.addItem.extension:detailSequence",
"path": "ClaimResponse.addItem.extension",
"sliceName": "detailSequence",
"short": "R4: Detail sequence number (new)",
"definition": "R4: `ClaimResponse.addItem.detailSequence` (new:positiveInt)",
"comment": "Element `ClaimResponse.addItem.detailSequence` has a context of ClaimResponse.addItem based on following the parent source element upwards and mapping to `ClaimResponse`.\nElement `ClaimResponse.addItem.detailSequence` has no mapping targets in FHIR STU3. Typically, this is because the element has been added (is a new element).",
"min": 0,
"max": "*",
"base": {
"path": "DomainResource.extension",
"min": 0,
"max": "*"
},
"type": [
{
"code": "Extension",
"profile": "http://hl7.org/fhir/4.0/StructureDefinition/extension-ClaimResponse.addItem.detailSequence|0.1.0"
}
]
},
{
"id": "ClaimResponse.addItem.extension:subdetailSequence",
"path": "ClaimResponse.addItem.extension",
"sliceName": "subdetailSequence",
"short": "R4: Subdetail sequence number (new)",
"definition": "R4: `ClaimResponse.addItem.subdetailSequence` (new:positiveInt)",
"comment": "Element `ClaimResponse.addItem.subdetailSequence` has a context of ClaimResponse.addItem based on following the parent source element upwards and mapping to `ClaimResponse`.\nElement `ClaimResponse.addItem.subdetailSequence` has no mapping targets in FHIR STU3. Typically, this is because the element has been added (is a new element).",
"min": 0,
"max": "*",
"base": {
"path": "DomainResource.extension",
"min": 0,
"max": "*"
},
"type": [
{
"code": "Extension",
"profile": "http://hl7.org/fhir/4.0/StructureDefinition/extension-ClaimResponse.addItem.subdetailSequence|0.1.0"
}
]
},
{
"id": "ClaimResponse.addItem.extension:provider",
"path": "ClaimResponse.addItem.extension",
"sliceName": "provider",
"short": "R4: Authorized providers (new)",
"definition": "R4: `ClaimResponse.addItem.provider` (new:Reference(Practitioner,PractitionerRole,Organization))",
"comment": "Element `ClaimResponse.addItem.provider` has a context of ClaimResponse.addItem based on following the parent source element upwards and mapping to `ClaimResponse`.\nElement `ClaimResponse.addItem.provider` has no mapping targets in FHIR STU3. Typically, this is because the element has been added (is a new element).",
"min": 0,
"max": "*",
"base": {
"path": "DomainResource.extension",
"min": 0,
"max": "*"
},
"type": [
{
"code": "Extension",
"profile": "http://hl7.org/fhir/4.0/StructureDefinition/extension-ClaimResponse.addItem.provider|0.1.0"
}
]
},
{
"id": "ClaimResponse.addItem.extension:programCode",
"path": "ClaimResponse.addItem.extension",
"sliceName": "programCode",
"short": "R4: Program the product or service is provided under (new)",
"definition": "R4: `ClaimResponse.addItem.programCode` (new:CodeableConcept)",
"comment": "Element `ClaimResponse.addItem.programCode` has a context of ClaimResponse.addItem based on following the parent source element upwards and mapping to `ClaimResponse`.\nElement `ClaimResponse.addItem.programCode` has no mapping targets in FHIR STU3. Typically, this is because the element has been added (is a new element).\nFor example: Neonatal program, child dental program or drug users recovery program.",
"min": 0,
"max": "*",
"base": {
"path": "DomainResource.extension",
"min": 0,
"max": "*"
},
"type": [
{
"code": "Extension",
"profile": "http://hl7.org/fhir/4.0/StructureDefinition/extension-ClaimResponse.addItem.programCode|0.1.0"
}
]
},
{
"id": "ClaimResponse.addItem.extension:serviced",
"path": "ClaimResponse.addItem.extension",
"sliceName": "serviced",
"short": "R4: Date or dates of service or product delivery (new)",
"definition": "R4: `ClaimResponse.addItem.serviced[x]` (new:date, Period)",
"comment": "Element `ClaimResponse.addItem.serviced[x]` has a context of ClaimResponse.addItem based on following the parent source element upwards and mapping to `ClaimResponse`.\nElement `ClaimResponse.addItem.serviced[x]` has no mapping targets in FHIR STU3. Typically, this is because the element has been added (is a new element).",
"min": 0,
"max": "1",
"base": {
"path": "DomainResource.extension",
"min": 0,
"max": "*"
},
"type": [
{
"code": "Extension",
"profile": "http://hl7.org/fhir/4.0/StructureDefinition/extension-ClaimResponse.addItem.serviced|0.1.0"
}
]
},
{
"id": "ClaimResponse.addItem.extension:location",
"path": "ClaimResponse.addItem.extension",
"sliceName": "location",
"short": "R4: Place of service or where product was supplied (new)",
"definition": "R4: `ClaimResponse.addItem.location[x]` (new:Address, CodeableConcept, Reference(Location))",
"comment": "Element `ClaimResponse.addItem.location[x]` has a context of ClaimResponse.addItem based on following the parent source element upwards and mapping to `ClaimResponse`.\nElement `ClaimResponse.addItem.location[x]` has no mapping targets in FHIR STU3. Typically, this is because the element has been added (is a new element).",
"min": 0,
"max": "1",
"base": {
"path": "DomainResource.extension",
"min": 0,
"max": "*"
},
"type": [
{
"code": "Extension",
"profile": "http://hl7.org/fhir/4.0/StructureDefinition/extension-ClaimResponse.addItem.location|0.1.0"
}
]
},
{
"id": "ClaimResponse.addItem.extension:quantity",
"path": "ClaimResponse.addItem.extension",
"sliceName": "quantity",
"short": "R4: Count of products or services (new)",
"definition": "R4: `ClaimResponse.addItem.quantity` (new:Quantity[SimpleQuantity])",
"comment": "Element `ClaimResponse.addItem.quantity` has a context of ClaimResponse.addItem based on following the parent source element upwards and mapping to `ClaimResponse`.\nElement `ClaimResponse.addItem.quantity` has no mapping targets in FHIR STU3. Typically, this is because the element has been added (is a new element).",
"min": 0,
"max": "1",
"base": {
"path": "DomainResource.extension",
"min": 0,
"max": "*"
},
"type": [
{
"code": "Extension",
"profile": "http://hl7.org/fhir/4.0/StructureDefinition/extension-ClaimResponse.addItem.quantity|0.1.0"
}
]
},
{
"id": "ClaimResponse.addItem.extension:unitPrice",
"path": "ClaimResponse.addItem.extension",
"sliceName": "unitPrice",
"short": "R4: Fee, charge or cost per item (new)",
"definition": "R4: `ClaimResponse.addItem.unitPrice` (new:Money)",
"comment": "Element `ClaimResponse.addItem.unitPrice` has a context of ClaimResponse.addItem based on following the parent source element upwards and mapping to `ClaimResponse`.\nElement `ClaimResponse.addItem.unitPrice` has no mapping targets in FHIR STU3. Typically, this is because the element has been added (is a new element).",
"min": 0,
"max": "1",
"base": {
"path": "DomainResource.extension",
"min": 0,
"max": "*"
},
"type": [
{
"code": "Extension",
"profile": "http://hl7.org/fhir/4.0/StructureDefinition/extension-ClaimResponse.addItem.unitPrice|0.1.0"
}
]
},
{
"id": "ClaimResponse.addItem.extension:factor",
"path": "ClaimResponse.addItem.extension",
"sliceName": "factor",
"short": "R4: Price scaling factor (new)",
"definition": "R4: `ClaimResponse.addItem.factor` (new:decimal)",
"comment": "Element `ClaimResponse.addItem.factor` has a context of ClaimResponse.addItem based on following the parent source element upwards and mapping to `ClaimResponse`.\nElement `ClaimResponse.addItem.factor` has no mapping targets in FHIR STU3. Typically, this is because the element has been added (is a new element).\nTo show a 10% senior's discount, the value entered is: 0.90 (1.00 - 0.10).",
"min": 0,
"max": "1",
"base": {
"path": "DomainResource.extension",
"min": 0,
"max": "*"
},
"type": [
{
"code": "Extension",
"profile": "http://hl7.org/fhir/4.0/StructureDefinition/extension-ClaimResponse.addItem.factor|0.1.0"
}
]
},
{
"id": "ClaimResponse.addItem.extension:bodySite",
"path": "ClaimResponse.addItem.extension",
"sliceName": "bodySite",
"short": "R4: Anatomical location (new)",
"definition": "R4: `ClaimResponse.addItem.bodySite` (new:CodeableConcept)",
"comment": "Element `ClaimResponse.addItem.bodySite` has a context of ClaimResponse.addItem based on following the parent source element upwards and mapping to `ClaimResponse`.\nElement `ClaimResponse.addItem.bodySite` has no mapping targets in FHIR STU3. Typically, this is because the element has been added (is a new element).\nFor example: Providing a tooth code allows an insurer to identify a provider performing a filling on a tooth that was previously removed.",
"min": 0,
"max": "1",
"base": {
"path": "DomainResource.extension",
"min": 0,
"max": "*"
},
"type": [
{
"code": "Extension",
"profile": "http://hl7.org/fhir/4.0/StructureDefinition/extension-ClaimResponse.addItem.bodySite|0.1.0"
}
]
},
{
"id": "ClaimResponse.addItem.extension:subSite",
"path": "ClaimResponse.addItem.extension",
"sliceName": "subSite",
"short": "R4: Anatomical sub-location (new)",
"definition": "R4: `ClaimResponse.addItem.subSite` (new:CodeableConcept)",
"comment": "Element `ClaimResponse.addItem.subSite` has a context of ClaimResponse.addItem based on following the parent source element upwards and mapping to `ClaimResponse`.\nElement `ClaimResponse.addItem.subSite` has no mapping targets in FHIR STU3. Typically, this is because the element has been added (is a new element).",
"min": 0,
"max": "*",
"base": {
"path": "DomainResource.extension",
"min": 0,
"max": "*"
},
"type": [
{
"code": "Extension",
"profile": "http://hl7.org/fhir/4.0/StructureDefinition/extension-ClaimResponse.addItem.subSite|0.1.0"
}
]
},
{
"id": "ClaimResponse.addItem.detail.extension",
"path": "ClaimResponse.addItem.detail.extension",
"slicing": {
"discriminator": [
{
"type": "value",
"path": "url"
}
],
"ordered": false,
"rules": "open"
},
"min": 1,
"max": "*"
},
{
"id": "ClaimResponse.addItem.detail.extension:quantity",
"path": "ClaimResponse.addItem.detail.extension",
"sliceName": "quantity",
"short": "R4: Count of products or services (new)",
"definition": "R4: `ClaimResponse.addItem.detail.quantity` (new:Quantity[SimpleQuantity])",
"comment": "Element `ClaimResponse.addItem.detail.quantity` has a context of ClaimResponse.addItem.detail based on following the parent source element upwards and mapping to `ClaimResponse`.\nElement `ClaimResponse.addItem.detail.quantity` has no mapping targets in FHIR STU3. Typically, this is because the element has been added (is a new element).",
"min": 0,
"max": "1",
"base": {
"path": "DomainResource.extension",
"min": 0,
"max": "*"
},
"type": [
{
"code": "Extension",
"profile": "http://hl7.org/fhir/4.0/StructureDefinition/extension-ClaimResponse.addItem.detail.quantity|0.1.0"
}
]
},
{
"id": "ClaimResponse.addItem.detail.extension:unitPrice",
"path": "ClaimResponse.addItem.detail.extension",
"sliceName": "unitPrice",
"short": "R4: Fee, charge or cost per item (new)",
"definition": "R4: `ClaimResponse.addItem.detail.unitPrice` (new:Money)",
"comment": "Element `ClaimResponse.addItem.detail.unitPrice` has a context of ClaimResponse.addItem.detail based on following the parent source element upwards and mapping to `ClaimResponse`.\nElement `ClaimResponse.addItem.detail.unitPrice` has no mapping targets in FHIR STU3. Typically, this is because the element has been added (is a new element).",
"min": 0,
"max": "1",
"base": {
"path": "DomainResource.extension",
"min": 0,
"max": "*"
},
"type": [
{
"code": "Extension",
"profile": "http://hl7.org/fhir/4.0/StructureDefinition/extension-ClaimResponse.addItem.detail.unitPrice|0.1.0"
}
]
},
{
"id": "ClaimResponse.addItem.detail.extension:factor",
"path": "ClaimResponse.addItem.detail.extension",
"sliceName": "factor",
"short": "R4: Price scaling factor (new)",
"definition": "R4: `ClaimResponse.addItem.detail.factor` (new:decimal)",
"comment": "Element `ClaimResponse.addItem.detail.factor` has a context of ClaimResponse.addItem.detail based on following the parent source element upwards and mapping to `ClaimResponse`.\nElement `ClaimResponse.addItem.detail.factor` has no mapping targets in FHIR STU3. Typically, this is because the element has been added (is a new element).\nTo show a 10% senior's discount, the value entered is: 0.90 (1.00 - 0.10).",
"min": 0,
"max": "1",
"base": {
"path": "DomainResource.extension",
"min": 0,
"max": "*"
},
"type": [
{
"code": "Extension",
"profile": "http://hl7.org/fhir/4.0/StructureDefinition/extension-ClaimResponse.addItem.detail.factor|0.1.0"
}
]
},
{
"id": "ClaimResponse.addItem.detail.extension:net",
"path": "ClaimResponse.addItem.detail.extension",
"sliceName": "net",
"short": "R4: Total item cost (new)",
"definition": "R4: `ClaimResponse.addItem.detail.net` (new:Money)",
"comment": "Element `ClaimResponse.addItem.detail.net` has a context of ClaimResponse.addItem.detail based on following the parent source element upwards and mapping to `ClaimResponse`.\nElement `ClaimResponse.addItem.detail.net` has no mapping targets in FHIR STU3. Typically, this is because the element has been added (is a new element).\nFor example, the formula: quantity * unitPrice * factor = net. Quantity and factor are assumed to be 1 if not supplied.",
"min": 0,
"max": "1",
"base": {
"path": "DomainResource.extension",
"min": 0,
"max": "*"
},
"type": [
{
"code": "Extension",
"profile": "http://hl7.org/fhir/4.0/StructureDefinition/extension-ClaimResponse.addItem.detail.net|0.1.0"
}
]
},
{
"id": "ClaimResponse.addItem.detail.extension:subDetail",
"path": "ClaimResponse.addItem.detail.extension",
"sliceName": "subDetail",
"short": "R4: Insurer added line items (new)",
"definition": "R4: `ClaimResponse.addItem.detail.subDetail` (new:BackboneElement)",
"comment": "Element `ClaimResponse.addItem.detail.subDetail` has a context of ClaimResponse.addItem.detail based on following the parent source element upwards and mapping to `ClaimResponse`.\nElement `ClaimResponse.addItem.detail.subDetail` has no mapping targets in FHIR STU3. Typically, this is because the element has been added (is a new element).",
"min": 0,
"max": "*",
"base": {
"path": "DomainResource.extension",
"min": 0,
"max": "*"
},
"type": [
{
"code": "Extension",
"profile": "http://hl7.org/fhir/4.0/StructureDefinition/extension-ClaimResponse.addItem.detail.subDetail|0.1.0"
}
]
},
{
"id": "ClaimResponse.addItem.detail.extension:adjudication",
"path": "ClaimResponse.addItem.detail.extension",
"sliceName": "adjudication",
"short": "R4: Added items detail adjudication (new)",
"definition": "R4: `ClaimResponse.addItem.detail.subDetail.adjudication` (new:ClaimResponse.item.adjudication)",
"comment": "Element `ClaimResponse.addItem.detail.subDetail.adjudication` is part of an existing definition because parent element `ClaimResponse.addItem.detail.subDetail` requires a cross-version extension.\nElement `ClaimResponse.addItem.detail.subDetail.adjudication` has a context of ClaimResponse.addItem.detail based on following the parent source element upwards and mapping to `ClaimResponse`.\nElement `ClaimResponse.addItem.detail.subDetail.adjudication` has no mapping targets in FHIR STU3. Typically, this is because the element has been added (is a new element).",
"min": 1,
"max": "*",
"base": {
"path": "DomainResource.extension",
"min": 0,
"max": "*"
},
"type": [
{
"code": "Extension",
"profile": "http://hl7.org/fhir/4.0/StructureDefinition/extension-ClaimResponse.item.adjudication|0.1.0"
}
]
},
{
"id": "ClaimResponse.reserved.extension",
"path": "ClaimResponse.reserved.extension",
"slicing": {
"discriminator": [
{
"type": "value",
"path": "url"
}
],
"ordered": false,
"rules": "open"
},
"min": 0,
"max": "*"
},
{
"id": "ClaimResponse.reserved.extension:fundsReserve",
"path": "ClaimResponse.reserved.extension",
"sliceName": "fundsReserve",
"short": "R4: fundsReserve additional types",
"definition": "R4: `ClaimResponse.fundsReserve` additional types (CodeableConcept) additional types from child elements (text)",
"comment": "Element `ClaimResponse.fundsReserve` is mapped to FHIR STU3 element `ClaimResponse.reserved` as `SourceIsBroaderThanTarget`.\nThe mappings for `ClaimResponse.fundsReserve` do not cover the following types: CodeableConcept.\nThe mappings for `ClaimResponse.fundsReserve` do not cover the following types based on type expansion: text.\nFund would be release by a future claim quoting the preAuthRef of this response. Examples of values include: provider, patient, none.",
"min": 0,
"max": "1",
"base": {
"path": "DomainResource.extension",
"min": 0,
"max": "*"
},
"type": [
{
"code": "Extension",
"profile": "http://hl7.org/fhir/4.0/StructureDefinition/extension-ClaimResponse.fundsReserve|0.1.0"
}
]
},
{
"id": "ClaimResponse.form.extension",
"path": "ClaimResponse.form.extension",
"slicing": {
"discriminator": [
{
"type": "value",
"path": "url"
}
],
"ordered": false,
"rules": "open"
},
"min": 0,
"max": "*"
},
{
"id": "ClaimResponse.form.extension:form",
"path": "ClaimResponse.form.extension",
"sliceName": "form",
"short": "R4: Printed reference or actual form additional types",
"definition": "R4: `ClaimResponse.form` additional types (Attachment) additional types from child elements (creation, data, hash, size, title, url)",
"comment": "Element `ClaimResponse.form` is mapped to FHIR STU3 element `ClaimResponse.form` as `SourceIsBroaderThanTarget`.\nThe mappings for `ClaimResponse.form` do not cover the following types: Attachment.\nThe mappings for `ClaimResponse.form` do not cover the following types based on type expansion: creation, data, hash, size, title, url.\nNeeded to permit insurers to include the actual form.",
"min": 0,
"max": "1",
"base": {
"path": "DomainResource.extension",
"min": 0,
"max": "*"
},
"type": [
{
"code": "Extension",
"profile": "http://hl7.org/fhir/4.0/StructureDefinition/extension-ClaimResponse.form|0.1.0"
}
]
}
]
}
}