FHIR IG analytics| Package | hl7.fhir.uv.xver-r4b.r3 |
| Resource Type | StructureDefinition |
| Id | StructureDefinition-ext-R4B-ClaimResponse.ite.adjudication.json |
| FHIR Version | R3 |
| Source | http://hl7.org/fhir/uv/xver-r4b.r3/0.1.0/StructureDefinition-ext-R4B-ClaimResponse.ite.adjudication.html |
| URL | http://hl7.org/fhir/4.3/StructureDefinition/extension-ClaimResponse.item.adjudication |
| Version | 0.1.0 |
| Status | active |
| Date | 2026-03-17T21:02:03.8104715+00:00 |
| Name | ExtensionClaimResponse_Item_Adjudication |
| Title | R4B: adjudication |
| Realm | uv |
| Authority | hl7 |
| Description | R4B: `ClaimResponse.item.adjudication` |
| Purpose | This extension is part of the cross-version definitions generated to enable use of the element `ClaimResponse.item.adjudication` as defined in FHIR R4B in FHIR STU3. The source element is defined as: `ClaimResponse.item.adjudication` 1..* `BackboneElement` Across FHIR versions, the element set has been mapped as: * R4B: `ClaimResponse.item.adjudication` 1..* `BackboneElement` * R4: `ClaimResponse.item.adjudication` 1..* `BackboneElement` * STU3: `ClaimResponse.item.adjudication` 0..* `BackboneElement` Following are the generation technical comments: Element `ClaimResponse.item.adjudication` is mapped to FHIR STU3 element `ClaimResponse.item.adjudication` as `Equivalent`. Creating extension because element `ClaimResponse.item.adjudication` is a content reference and requires an extesion definition. |
| Type | Extension |
| Kind | complex-type |
| ConceptMap | ||
| hl7.fhir.uv.xver-r4b.r3#0.1.0 | R4B-ClaimResponse-element-map-to-R3 | Cross-version mapping for FHIR R4B ClaimResponse to FHIR STU3 ClaimResponse |
No resources found
No extension usage examples found
Note: links and images are rebased to the (stated) source
Generated Narrative: StructureDefinition ext-R4B-ClaimResponse.ite.adjudication
| Name | Flags | Card. | Type | Description & Constraints |
|---|---|---|---|---|
  Extension | 1..* | Extension | R4B: adjudication | |
  Slices for extension | 1..* | Extension | Extension Slice: Unordered, Open by value:url | |
   extension:category | 1..1 | Extension | R4B: Type of adjudication information | |
  url | 1..1 | uri | "category" | |
  value[x] | 1..1 | CodeableConcept | Type of adjudication information Binding: Adjudication Value Codes (example): The adjudication codes. | |
| extension:reason | 0..1 | Extension | R4B: Explanation of adjudication outcome | |
| url | 1..1 | uri | "reason" | |
| value[x] | 0..1 | CodeableConcept | Explanation of adjudication outcome Binding: Adjudication Reason Codes (example): The adjudication reason codes. | |
| extension:amount | 0..1 | Extension | R4B: amount | |
| url | 1..1 | uri | "amount" | |
| value[x] | 0..1 | Money | Monetary amount | |
 extension:value | 0..1 | Extension | R4B: value | |
 url | 1..1 | uri | "value" | |
 value[x] | 0..1 | decimal | Non-monetary value | |
| url | 1..1 | uri | "http://hl7.org/fhir/4.3/StructureDefinition/extension-ClaimResponse.item.adjudication" | |
 value[x] | 0..0 | Value of extension | ||
| Documentation for this format | ||||
FHIR
FHIRsmith{
"resourceType": "StructureDefinition",
"id": "ext-R4B-ClaimResponse.ite.adjudication",
"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-r4b.r3"
},
{
"url": "version",
"valueString": "0.1.0"
},
{
"url": "uri",
"valueUri": "http://hl7.org/fhir/uv/xver/ImplementationGuide/hl7.fhir.uv.xver-r4b.r3"
}
],
"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-r4b.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-r4b.r3"
}
]
}
}
],
"url": "http://hl7.org/fhir/4.3/StructureDefinition/extension-ClaimResponse.item.adjudication",
"version": "0.1.0",
"name": "ExtensionClaimResponse_Item_Adjudication",
"title": "R4B: adjudication",
"status": "active",
"experimental": false,
"date": "2026-03-17T21:02:03.8104715+00:00",
"publisher": "FHIR Infrastructure",
"contact": [
{
"name": "FHIR Infrastructure",
"telecom": [
{
"system": "url",
"value": "http://www.hl7.org/Special/committees/fiwg"
}
]
}
],
"description": "R4B: `ClaimResponse.item.adjudication`",
"jurisdiction": [
{
"coding": [
{
"system": "http://unstats.un.org/unsd/methods/m49/m49.htm",
"code": "001",
"display": "World"
}
]
}
],
"purpose": "This extension is part of the cross-version definitions generated to enable use of the\r\nelement `ClaimResponse.item.adjudication` as defined in FHIR R4B\r\nin FHIR STU3.\r\n\r\nThe source element is defined as:\r\n`ClaimResponse.item.adjudication` 1..* `BackboneElement`\r\n\r\nAcross FHIR versions, the element set has been mapped as:\r\n* R4B: `ClaimResponse.item.adjudication` 1..* `BackboneElement`\n* R4: `ClaimResponse.item.adjudication` 1..* `BackboneElement`\n* STU3: `ClaimResponse.item.adjudication` 0..* `BackboneElement`\r\n\r\nFollowing are the generation technical comments:\r\nElement `ClaimResponse.item.adjudication` is mapped to FHIR STU3 element `ClaimResponse.item.adjudication` as `Equivalent`.\nCreating extension because element `ClaimResponse.item.adjudication` is a content reference and requires an extesion definition.",
"fhirVersion": "3.0.2",
"mapping": [
{
"identity": "rim",
"uri": "http://hl7.org/v3",
"name": "RIM Mapping"
}
],
"kind": "complex-type",
"abstract": false,
"contextType": "resource",
"context": [
"ClaimResponse.item.adjudication"
],
"type": "Extension",
"baseDefinition": "http://hl7.org/fhir/StructureDefinition/Extension",
"derivation": "constraint",
"snapshot": {
"element": [
{
"id": "Extension",
"path": "Extension",
"short": "R4B: adjudication",
"definition": "R4B: `ClaimResponse.item.adjudication`",
"comment": "Element `ClaimResponse.item.adjudication` is mapped to FHIR STU3 element `ClaimResponse.item.adjudication` as `Equivalent`.",
"min": 1,
"max": "*",
"base": {
"path": "Extension",
"min": 0,
"max": "*"
},
"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": "Extension.id",
"path": "Extension.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": "Extension.extension",
"path": "Extension.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": "Extension.extension:category",
"path": "Extension.extension",
"sliceName": "category",
"short": "R4B: Type of adjudication information",
"definition": "R4B: `ClaimResponse.item.adjudication.category`",
"comment": "Element `ClaimResponse.item.adjudication.category` is mapped to FHIR STU3 element `ClaimResponse.item.adjudication.category` as `Equivalent`.\nFor example codes indicating: Co-Pay, deductible, eligible, benefit, tax, etc.",
"requirements": "Needed to enable understanding of the context of the other information in the adjudication. Element `ClaimResponse.item.adjudication.category` is mapped to FHIR STU3 element `ClaimResponse.item.adjudication.category` as `Equivalent`.",
"min": 1,
"max": "1",
"base": {
"path": "Element.extension",
"min": 0,
"max": "*"
},
"type": [
{
"code": "Extension"
}
]
},
{
"id": "Extension.extension:category.id",
"path": "Extension.extension.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": "Extension.extension:category.extension",
"path": "Extension.extension.extension",
"slicing": {
"discriminator": [
{
"type": "value",
"path": "url"
}
],
"description": "Extensions are always sliced by (at least) url",
"rules": "open"
},
"short": "Additional Content defined by implementations",
"definition": "May be used to represent additional information that is not part of the basic definition of the element. 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": "Extension.extension:category.url",
"path": "Extension.extension.url",
"representation": [
"xmlAttr"
],
"short": "identifies the meaning of the extension",
"definition": "Source of the definition for the extension code - a logical name or a URL.",
"comment": "The definition may point directly to a computable or human-readable definition of the extensibility codes, or it may be a logical URI as declared in some other specification. The definition SHALL be a URI for the Structure Definition defining the extension.",
"min": 1,
"max": "1",
"base": {
"path": "Extension.url",
"min": 1,
"max": "1"
},
"type": [
{
"code": "uri"
}
],
"fixedUri": "category",
"mapping": [
{
"identity": "rim",
"map": "N/A"
}
]
},
{
"id": "Extension.extension:category.value[x]",
"path": "Extension.extension.value[x]",
"short": "Type of adjudication information",
"definition": "A code to indicate the information type of this adjudication record. Information types may include the value submitted, maximum values or percentages allowed or payable under the plan, amounts that: the patient is responsible for in aggregate or pertaining to this item; amounts paid by other coverages; and, the benefit payable for this item.",
"comment": "For example codes indicating: Co-Pay, deductible, eligible, benefit, tax, etc.",
"min": 1,
"max": "1",
"base": {
"path": "Extension.value[x]",
"min": 0,
"max": "1"
},
"type": [
{
"code": "CodeableConcept"
}
],
"binding": {
"strength": "example",
"description": "The adjudication codes.",
"valueSetUri": "http://hl7.org/fhir/ValueSet/adjudication|3.0.2"
},
"mapping": [
{
"identity": "rim",
"map": "N/A"
}
]
},
{
"id": "Extension.extension:reason",
"path": "Extension.extension",
"sliceName": "reason",
"short": "R4B: Explanation of adjudication outcome",
"definition": "R4B: `ClaimResponse.item.adjudication.reason`",
"comment": "Element `ClaimResponse.item.adjudication.reason` is mapped to FHIR STU3 element `ClaimResponse.item.adjudication.reason` as `Equivalent`.\nFor example may indicate that the funds for this benefit type have been exhausted.",
"requirements": "To support understanding of variance from adjudication expectations. Element `ClaimResponse.item.adjudication.reason` is mapped to FHIR STU3 element `ClaimResponse.item.adjudication.reason` as `Equivalent`.",
"min": 0,
"max": "1",
"base": {
"path": "Element.extension",
"min": 0,
"max": "*"
},
"type": [
{
"code": "Extension"
}
]
},
{
"id": "Extension.extension:reason.id",
"path": "Extension.extension.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": "Extension.extension:reason.extension",
"path": "Extension.extension.extension",
"slicing": {
"discriminator": [
{
"type": "value",
"path": "url"
}
],
"description": "Extensions are always sliced by (at least) url",
"rules": "open"
},
"short": "Additional Content defined by implementations",
"definition": "May be used to represent additional information that is not part of the basic definition of the element. 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": "Extension.extension:reason.url",
"path": "Extension.extension.url",
"representation": [
"xmlAttr"
],
"short": "identifies the meaning of the extension",
"definition": "Source of the definition for the extension code - a logical name or a URL.",
"comment": "The definition may point directly to a computable or human-readable definition of the extensibility codes, or it may be a logical URI as declared in some other specification. The definition SHALL be a URI for the Structure Definition defining the extension.",
"min": 1,
"max": "1",
"base": {
"path": "Extension.url",
"min": 1,
"max": "1"
},
"type": [
{
"code": "uri"
}
],
"fixedUri": "reason",
"mapping": [
{
"identity": "rim",
"map": "N/A"
}
]
},
{
"id": "Extension.extension:reason.value[x]",
"path": "Extension.extension.value[x]",
"short": "Explanation of adjudication outcome",
"definition": "A code supporting the understanding of the adjudication result and explaining variance from expected amount.",
"comment": "For example may indicate that the funds for this benefit type have been exhausted.",
"min": 0,
"max": "1",
"base": {
"path": "Extension.value[x]",
"min": 0,
"max": "1"
},
"type": [
{
"code": "CodeableConcept"
}
],
"binding": {
"strength": "example",
"description": "The adjudication reason codes.",
"valueSetUri": "http://hl7.org/fhir/ValueSet/adjudication-reason|3.0.2"
},
"mapping": [
{
"identity": "rim",
"map": "N/A"
}
]
},
{
"id": "Extension.extension:amount",
"path": "Extension.extension",
"sliceName": "amount",
"short": "R4B: amount",
"definition": "R4B: `ClaimResponse.item.adjudication.amount`",
"comment": "Element `ClaimResponse.item.adjudication.amount` is mapped to FHIR STU3 element `ClaimResponse.item.adjudication.amount` as `Equivalent`.\nFor example: amount submitted, eligible amount, co-payment, and benefit payable.",
"requirements": "Most adjuciation categories convey a monetary amount. Element `ClaimResponse.item.adjudication.amount` is mapped to FHIR STU3 element `ClaimResponse.item.adjudication.amount` as `Equivalent`.",
"min": 0,
"max": "1",
"base": {
"path": "Element.extension",
"min": 0,
"max": "*"
},
"type": [
{
"code": "Extension"
}
]
},
{
"id": "Extension.extension:amount.id",
"path": "Extension.extension.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": "Extension.extension:amount.extension",
"path": "Extension.extension.extension",
"slicing": {
"discriminator": [
{
"type": "value",
"path": "url"
}
],
"description": "Extensions are always sliced by (at least) url",
"rules": "open"
},
"short": "Additional Content defined by implementations",
"definition": "May be used to represent additional information that is not part of the basic definition of the element. 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": "Extension.extension:amount.url",
"path": "Extension.extension.url",
"representation": [
"xmlAttr"
],
"short": "identifies the meaning of the extension",
"definition": "Source of the definition for the extension code - a logical name or a URL.",
"comment": "The definition may point directly to a computable or human-readable definition of the extensibility codes, or it may be a logical URI as declared in some other specification. The definition SHALL be a URI for the Structure Definition defining the extension.",
"min": 1,
"max": "1",
"base": {
"path": "Extension.url",
"min": 1,
"max": "1"
},
"type": [
{
"code": "uri"
}
],
"fixedUri": "amount",
"mapping": [
{
"identity": "rim",
"map": "N/A"
}
]
},
{
"id": "Extension.extension:amount.value[x]",
"path": "Extension.extension.value[x]",
"short": "Monetary amount",
"definition": "Monetary amount associated with the category.",
"comment": "For example: amount submitted, eligible amount, co-payment, and benefit payable.",
"min": 0,
"max": "1",
"base": {
"path": "Extension.value[x]",
"min": 0,
"max": "1"
},
"type": [
{
"code": "Money"
}
],
"mapping": [
{
"identity": "rim",
"map": "N/A"
}
]
},
{
"id": "Extension.extension:value",
"path": "Extension.extension",
"sliceName": "value",
"short": "R4B: value",
"definition": "R4B: `ClaimResponse.item.adjudication.value`",
"comment": "Element `ClaimResponse.item.adjudication.value` is mapped to FHIR STU3 element `ClaimResponse.item.adjudication.value` as `Equivalent`.\nFor example: eligible percentage or co-payment percentage.",
"requirements": "Some adjudication categories convey a percentage or a fixed value. Element `ClaimResponse.item.adjudication.value` is mapped to FHIR STU3 element `ClaimResponse.item.adjudication.value` as `Equivalent`.",
"min": 0,
"max": "1",
"base": {
"path": "Element.extension",
"min": 0,
"max": "*"
},
"type": [
{
"code": "Extension"
}
]
},
{
"id": "Extension.extension:value.id",
"path": "Extension.extension.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": "Extension.extension:value.extension",
"path": "Extension.extension.extension",
"slicing": {
"discriminator": [
{
"type": "value",
"path": "url"
}
],
"description": "Extensions are always sliced by (at least) url",
"rules": "open"
},
"short": "Additional Content defined by implementations",
"definition": "May be used to represent additional information that is not part of the basic definition of the element. 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": "Extension.extension:value.url",
"path": "Extension.extension.url",
"representation": [
"xmlAttr"
],
"short": "identifies the meaning of the extension",
"definition": "Source of the definition for the extension code - a logical name or a URL.",
"comment": "The definition may point directly to a computable or human-readable definition of the extensibility codes, or it may be a logical URI as declared in some other specification. The definition SHALL be a URI for the Structure Definition defining the extension.",
"min": 1,
"max": "1",
"base": {
"path": "Extension.url",
"min": 1,
"max": "1"
},
"type": [
{
"code": "uri"
}
],
"fixedUri": "value",
"mapping": [
{
"identity": "rim",
"map": "N/A"
}
]
},
{
"id": "Extension.extension:value.value[x]",
"path": "Extension.extension.value[x]",
"short": "Non-monetary value",
"definition": "A non-monetary value associated with the category. Mutually exclusive to the amount element above.",
"comment": "For example: eligible percentage or co-payment percentage.",
"min": 0,
"max": "1",
"base": {
"path": "Extension.value[x]",
"min": 0,
"max": "1"
},
"type": [
{
"code": "decimal"
}
],
"mapping": [
{
"identity": "rim",
"map": "N/A"
}
]
},
{
"id": "Extension.url",
"path": "Extension.url",
"representation": [
"xmlAttr"
],
"short": "identifies the meaning of the extension",
"definition": "Source of the definition for the extension code - a logical name or a URL.",
"comment": "The definition may point directly to a computable or human-readable definition of the extensibility codes, or it may be a logical URI as declared in some other specification. The definition SHALL be a URI for the Structure Definition defining the extension.",
"min": 1,
"max": "1",
"base": {
"path": "Extension.url",
"min": 1,
"max": "1"
},
"type": [
{
"code": "uri"
}
],
"fixedUri": "http://hl7.org/fhir/4.3/StructureDefinition/extension-ClaimResponse.item.adjudication",
"mapping": [
{
"identity": "rim",
"map": "N/A"
}
]
},
{
"id": "Extension.value[x]",
"path": "Extension.value[x]",
"short": "Value of extension",
"definition": "Value of extension - may be a resource or one of a constrained set of the data types (see Extensibility in the spec for list).",
"min": 0,
"max": "0",
"base": {
"path": "Extension.value[x]",
"min": 0,
"max": "1"
},
"type": [
{
"code": "base64Binary"
},
{
"code": "boolean"
},
{
"code": "code"
},
{
"code": "date"
},
{
"code": "dateTime"
},
{
"code": "decimal"
},
{
"code": "id"
},
{
"code": "instant"
},
{
"code": "integer"
},
{
"code": "markdown"
},
{
"code": "oid"
},
{
"code": "positiveInt"
},
{
"code": "string"
},
{
"code": "time"
},
{
"code": "unsignedInt"
},
{
"code": "uri"
},
{
"code": "Address"
},
{
"code": "Age"
},
{
"code": "Annotation"
},
{
"code": "Attachment"
},
{
"code": "CodeableConcept"
},
{
"code": "Coding"
},
{
"code": "ContactPoint"
},
{
"code": "Count"
},
{
"code": "Distance"
},
{
"code": "Duration"
},
{
"code": "HumanName"
},
{
"code": "Identifier"
},
{
"code": "Money"
},
{
"code": "Period"
},
{
"code": "Quantity"
},
{
"code": "Range"
},
{
"code": "Ratio"
},
{
"code": "Reference"
},
{
"code": "SampledData"
},
{
"code": "Signature"
},
{
"code": "Timing"
},
{
"code": "Meta"
}
],
"mapping": [
{
"identity": "rim",
"map": "N/A"
}
]
}
]
},
"differential": {
"element": [
{
"id": "Extension",
"path": "Extension",
"short": "R4B: adjudication",
"definition": "R4B: `ClaimResponse.item.adjudication`",
"comment": "Element `ClaimResponse.item.adjudication` is mapped to FHIR STU3 element `ClaimResponse.item.adjudication` as `Equivalent`.",
"min": 1,
"max": "*",
"base": {
"path": "Extension",
"min": 0,
"max": "*"
},
"isModifier": false
},
{
"id": "Extension.extension",
"path": "Extension.extension",
"slicing": {
"discriminator": [
{
"type": "value",
"path": "url"
}
],
"ordered": false,
"rules": "open"
},
"min": 1,
"max": "*",
"base": {
"path": "Extension.extension",
"min": 0,
"max": "*"
}
},
{
"id": "Extension.extension:category",
"path": "Extension.extension",
"sliceName": "category",
"short": "R4B: Type of adjudication information",
"definition": "R4B: `ClaimResponse.item.adjudication.category`",
"comment": "Element `ClaimResponse.item.adjudication.category` is mapped to FHIR STU3 element `ClaimResponse.item.adjudication.category` as `Equivalent`.\nFor example codes indicating: Co-Pay, deductible, eligible, benefit, tax, etc.",
"requirements": "Needed to enable understanding of the context of the other information in the adjudication. Element `ClaimResponse.item.adjudication.category` is mapped to FHIR STU3 element `ClaimResponse.item.adjudication.category` as `Equivalent`.",
"min": 1,
"max": "1",
"base": {
"path": "Extension.extension",
"min": 0,
"max": "*"
}
},
{
"id": "Extension.extension:category.url",
"path": "Extension.extension.url",
"min": 1,
"max": "1",
"base": {
"path": "Extension.url",
"min": 1,
"max": "1"
},
"fixedUri": "category"
},
{
"id": "Extension.extension:category.value[x]",
"path": "Extension.extension.value[x]",
"short": "Type of adjudication information",
"definition": "A code to indicate the information type of this adjudication record. Information types may include the value submitted, maximum values or percentages allowed or payable under the plan, amounts that: the patient is responsible for in aggregate or pertaining to this item; amounts paid by other coverages; and, the benefit payable for this item.",
"comment": "For example codes indicating: Co-Pay, deductible, eligible, benefit, tax, etc.",
"min": 1,
"max": "1",
"base": {
"path": "Extension.value[x]",
"min": 0,
"max": "1"
},
"type": [
{
"code": "CodeableConcept"
}
],
"binding": {
"strength": "example",
"description": "The adjudication codes.",
"valueSetUri": "http://hl7.org/fhir/ValueSet/adjudication|3.0.2"
}
},
{
"id": "Extension.extension:reason",
"path": "Extension.extension",
"sliceName": "reason",
"short": "R4B: Explanation of adjudication outcome",
"definition": "R4B: `ClaimResponse.item.adjudication.reason`",
"comment": "Element `ClaimResponse.item.adjudication.reason` is mapped to FHIR STU3 element `ClaimResponse.item.adjudication.reason` as `Equivalent`.\nFor example may indicate that the funds for this benefit type have been exhausted.",
"requirements": "To support understanding of variance from adjudication expectations. Element `ClaimResponse.item.adjudication.reason` is mapped to FHIR STU3 element `ClaimResponse.item.adjudication.reason` as `Equivalent`.",
"min": 0,
"max": "1",
"base": {
"path": "Extension.extension",
"min": 0,
"max": "*"
}
},
{
"id": "Extension.extension:reason.url",
"path": "Extension.extension.url",
"min": 1,
"max": "1",
"base": {
"path": "Extension.url",
"min": 1,
"max": "1"
},
"fixedUri": "reason"
},
{
"id": "Extension.extension:reason.value[x]",
"path": "Extension.extension.value[x]",
"short": "Explanation of adjudication outcome",
"definition": "A code supporting the understanding of the adjudication result and explaining variance from expected amount.",
"comment": "For example may indicate that the funds for this benefit type have been exhausted.",
"min": 0,
"max": "1",
"base": {
"path": "Extension.value[x]",
"min": 0,
"max": "1"
},
"type": [
{
"code": "CodeableConcept"
}
],
"binding": {
"strength": "example",
"description": "The adjudication reason codes.",
"valueSetUri": "http://hl7.org/fhir/ValueSet/adjudication-reason|3.0.2"
}
},
{
"id": "Extension.extension:amount",
"path": "Extension.extension",
"sliceName": "amount",
"short": "R4B: amount",
"definition": "R4B: `ClaimResponse.item.adjudication.amount`",
"comment": "Element `ClaimResponse.item.adjudication.amount` is mapped to FHIR STU3 element `ClaimResponse.item.adjudication.amount` as `Equivalent`.\nFor example: amount submitted, eligible amount, co-payment, and benefit payable.",
"requirements": "Most adjuciation categories convey a monetary amount. Element `ClaimResponse.item.adjudication.amount` is mapped to FHIR STU3 element `ClaimResponse.item.adjudication.amount` as `Equivalent`.",
"min": 0,
"max": "1",
"base": {
"path": "Extension.extension",
"min": 0,
"max": "*"
}
},
{
"id": "Extension.extension:amount.url",
"path": "Extension.extension.url",
"min": 1,
"max": "1",
"base": {
"path": "Extension.url",
"min": 1,
"max": "1"
},
"fixedUri": "amount"
},
{
"id": "Extension.extension:amount.value[x]",
"path": "Extension.extension.value[x]",
"short": "Monetary amount",
"definition": "Monetary amount associated with the category.",
"comment": "For example: amount submitted, eligible amount, co-payment, and benefit payable.",
"min": 0,
"max": "1",
"base": {
"path": "Extension.value[x]",
"min": 0,
"max": "1"
},
"type": [
{
"code": "Money"
}
]
},
{
"id": "Extension.extension:value",
"path": "Extension.extension",
"sliceName": "value",
"short": "R4B: value",
"definition": "R4B: `ClaimResponse.item.adjudication.value`",
"comment": "Element `ClaimResponse.item.adjudication.value` is mapped to FHIR STU3 element `ClaimResponse.item.adjudication.value` as `Equivalent`.\nFor example: eligible percentage or co-payment percentage.",
"requirements": "Some adjudication categories convey a percentage or a fixed value. Element `ClaimResponse.item.adjudication.value` is mapped to FHIR STU3 element `ClaimResponse.item.adjudication.value` as `Equivalent`.",
"min": 0,
"max": "1",
"base": {
"path": "Extension.extension",
"min": 0,
"max": "*"
}
},
{
"id": "Extension.extension:value.url",
"path": "Extension.extension.url",
"min": 1,
"max": "1",
"base": {
"path": "Extension.url",
"min": 1,
"max": "1"
},
"fixedUri": "value"
},
{
"id": "Extension.extension:value.value[x]",
"path": "Extension.extension.value[x]",
"short": "Non-monetary value",
"definition": "A non-monetary value associated with the category. Mutually exclusive to the amount element above.",
"comment": "For example: eligible percentage or co-payment percentage.",
"min": 0,
"max": "1",
"base": {
"path": "Extension.value[x]",
"min": 0,
"max": "1"
},
"type": [
{
"code": "decimal"
}
]
},
{
"id": "Extension.url",
"path": "Extension.url",
"min": 1,
"max": "1",
"base": {
"path": "Extension.url",
"min": 1,
"max": "1"
},
"fixedUri": "http://hl7.org/fhir/4.3/StructureDefinition/extension-ClaimResponse.item.adjudication"
},
{
"id": "Extension.value[x]",
"path": "Extension.value[x]",
"min": 0,
"max": "0",
"base": {
"path": "Extension.value[x]",
"min": 0,
"max": "1"
}
}
]
}
}