FHIR IG analytics| Package | hl7.fhir.uv.xver-r4b.r4 |
| Resource Type | ConceptMap |
| Id | ConceptMap-R4B-ClaimResponse-element-map-to-R4.json |
| FHIR Version | R4 |
| Source | http://hl7.org/fhir/uv/xver-r4b.r4/0.1.0/ConceptMap-R4B-ClaimResponse-element-map-to-R4.html |
| URL | http://hl7.org/fhir/uv/xver/ConceptMap/R4B-ClaimResponse-element-map-to-R4 |
| Version | 0.1.0 |
| Status | active |
| Date | 2026-03-17T16:03:46.8806274-05:00 |
| Name | R4BClaimResponseElementMapToR4 |
| Title | Cross-version mapping for FHIR R4B ClaimResponse to FHIR R4 ClaimResponse |
| Realm | uv |
| Authority | hl7 |
| Description | This ConceptMap represents cross-version mappings for elements from a FHIR R4B ClaimResponse to FHIR R4. |
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Note: links and images are rebased to the (stated) source
Generated Narrative: ConceptMap R4B-ClaimResponse-element-map-to-R4
Mapping from http://hl7.org/fhir/4.3 to http://hl7.org/fhir/4.0
Group 1 Mapping from http://hl7.org/fhir/StructureDefinition/ClaimResponse|4.3.0 to ClaimResponseversion: 4.0.1)
| Source Code | Relationship | Target Code | Comment |
| ClaimResponse.meta (meta) | is equivalent to | ClaimResponse.meta | Element `ClaimResponse.meta` is mapped to FHIR R4 element `ClaimResponse.meta` as `Equivalent`. |
| ClaimResponse.implicitRules (implicitRules) | is equivalent to | ClaimResponse.implicitRules | Element `ClaimResponse.implicitRules` is mapped to FHIR R4 element `ClaimResponse.implicitRules` as `Equivalent`. Asserting this rule set restricts the content to be only understood by a limited set of trading partners. This inherently limits the usefulness of the data in the long term. However, the existing health eco-system is highly fractured, and not yet ready to define, collect, and exchange data in a generally computable sense. Wherever possible, implementers and/or specification writers should avoid using this element. Often, when used, the URL is a reference to an implementation guide that defines these special rules as part of it's narrative along with other profiles, value sets, etc. |
| ClaimResponse.language (language) | is equivalent to | ClaimResponse.language | Element `ClaimResponse.language` is mapped to FHIR R4 element `ClaimResponse.language` as `Equivalent`. 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). |
| ClaimResponse.text (text) | is equivalent to | ClaimResponse.text | Element `ClaimResponse.text` is mapped to FHIR R4 element `ClaimResponse.text` as `Equivalent`. Contained resources do not have narrative. Resources that are not contained SHOULD have a narrative. In some cases, a resource may only have text with little or no additional discrete data (as long as all minOccurs=1 elements are satisfied). This may be necessary for data from legacy systems where information is captured as a "text blob" or where text is additionally entered raw or narrated and encoded information is added later. |
| ClaimResponse.contained (contained) | is equivalent to | ClaimResponse.contained | Element `ClaimResponse.contained` is mapped to FHIR R4 element `ClaimResponse.contained` as `Equivalent`. This should never be done when the content can be identified properly, as once identification is lost, it is extremely difficult (and context dependent) to restore it again. Contained resources may have profiles and tags In their meta elements, but SHALL NOT have security labels. |
| ClaimResponse.identifier (identifier) | is equivalent to | ClaimResponse.identifier | Element `ClaimResponse.identifier` is mapped to FHIR R4 element `ClaimResponse.identifier` as `Equivalent`. |
| ClaimResponse.status (status) | is equivalent to | ClaimResponse.status | Element `ClaimResponse.status` is mapped to FHIR R4 element `ClaimResponse.status` as `Equivalent`. This element is labeled as a modifier because the status contains codes that mark the resource as not currently valid. |
| ClaimResponse.type (type) | is equivalent to | ClaimResponse.type | Element `ClaimResponse.type` is mapped to FHIR R4 element `ClaimResponse.type` as `Equivalent`. This may contain the local bill type codes, for example the US UB-04 bill type code or the CMS bill type. |
| ClaimResponse.subType (subType) | is equivalent to | ClaimResponse.subType | Element `ClaimResponse.subType` is mapped to FHIR R4 element `ClaimResponse.subType` as `Equivalent`. This may contain the local bill type codes, for example the US UB-04 bill type code or the CMS bill type. |
| ClaimResponse.use (use) | is equivalent to | ClaimResponse.use | Element `ClaimResponse.use` is mapped to FHIR R4 element `ClaimResponse.use` as `Equivalent`. |
| ClaimResponse.patient (patient) | is equivalent to | ClaimResponse.patient | Element `ClaimResponse.patient` is mapped to FHIR R4 element `ClaimResponse.patient` as `Equivalent`. |
| ClaimResponse.created (created) | is equivalent to | ClaimResponse.created | Element `ClaimResponse.created` is mapped to FHIR R4 element `ClaimResponse.created` as `Equivalent`. |
| ClaimResponse.insurer (insurer) | is equivalent to | ClaimResponse.insurer | Element `ClaimResponse.insurer` is mapped to FHIR R4 element `ClaimResponse.insurer` as `Equivalent`. |
| ClaimResponse.requestor (requestor) | is equivalent to | ClaimResponse.requestor | Element `ClaimResponse.requestor` is mapped to FHIR R4 element `ClaimResponse.requestor` as `Equivalent`. Typically this field would be 1..1 where this party is responsible for the claim but not necessarily professionally responsible for the provision of the individual products and services listed below. |
| ClaimResponse.request (request) | is equivalent to | ClaimResponse.request | Element `ClaimResponse.request` is mapped to FHIR R4 element `ClaimResponse.request` as `Equivalent`. |
| ClaimResponse.outcome (outcome) | is equivalent to | ClaimResponse.outcome | Element `ClaimResponse.outcome` is mapped to FHIR R4 element `ClaimResponse.outcome` as `Equivalent`. The 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). |
| ClaimResponse.disposition (disposition) | is equivalent to | ClaimResponse.disposition | Element `ClaimResponse.disposition` is mapped to FHIR R4 element `ClaimResponse.disposition` as `Equivalent`. |
| ClaimResponse.preAuthRef (preAuthRef) | is equivalent to | ClaimResponse.preAuthRef | Element `ClaimResponse.preAuthRef` is mapped to FHIR R4 element `ClaimResponse.preAuthRef` as `Equivalent`. This value is only present on preauthorization adjudications. |
| ClaimResponse.preAuthPeriod (preAuthPeriod) | is equivalent to | ClaimResponse.preAuthPeriod | Element `ClaimResponse.preAuthPeriod` is mapped to FHIR R4 element `ClaimResponse.preAuthPeriod` as `Equivalent`. |
| ClaimResponse.payeeType (payeeType) | is equivalent to | ClaimResponse.payeeType | Element `ClaimResponse.payeeType` is mapped to FHIR R4 element `ClaimResponse.payeeType` as `Equivalent`. |
| ClaimResponse.item (item) | maps to wider concept | ClaimResponse.item | Element `ClaimResponse.item` is mapped to FHIR R4 element `ClaimResponse.item` as `Equivalent`. |
| ClaimResponse.item.itemSequence (itemSequence) | is equivalent to | ClaimResponse.item.itemSequence | Element `ClaimResponse.item.itemSequence` is mapped to FHIR R4 element `ClaimResponse.item.itemSequence` as `Equivalent`. |
| ClaimResponse.item.noteNumber (noteNumber) | is equivalent to | ClaimResponse.item.noteNumber | Element `ClaimResponse.item.noteNumber` is mapped to FHIR R4 element `ClaimResponse.item.noteNumber` as `Equivalent`. |
| ClaimResponse.item.adjudication (adjudication) | maps to wider concept | ClaimResponse.item.adjudication | Element `ClaimResponse.item.adjudication` is mapped to FHIR R4 element `ClaimResponse.item.adjudication` as `Equivalent`. |
| ClaimResponse.item.adjudication.category (category) | is equivalent to | ClaimResponse.item.adjudication.category | Element `ClaimResponse.item.adjudication.category` is mapped to FHIR R4 element `ClaimResponse.item.adjudication.category` as `Equivalent`. For example codes indicating: Co-Pay, deductible, eligible, benefit, tax, etc. |
| ClaimResponse.item.adjudication.reason (reason) | is equivalent to | ClaimResponse.item.adjudication.reason | Element `ClaimResponse.item.adjudication.reason` is mapped to FHIR R4 element `ClaimResponse.item.adjudication.reason` as `Equivalent`. For example may indicate that the funds for this benefit type have been exhausted. |
| ClaimResponse.item.adjudication.amount (amount) | is equivalent to | ClaimResponse.item.adjudication.amount | Element `ClaimResponse.item.adjudication.amount` is mapped to FHIR R4 element `ClaimResponse.item.adjudication.amount` as `Equivalent`. For example: amount submitted, eligible amount, co-payment, and benefit payable. |
| ClaimResponse.item.adjudication.value (value) | is equivalent to | ClaimResponse.item.adjudication.value | Element `ClaimResponse.item.adjudication.value` is mapped to FHIR R4 element `ClaimResponse.item.adjudication.value` as `Equivalent`. For example: eligible percentage or co-payment percentage. |
| ClaimResponse.item.detail (detail) | maps to wider concept | ClaimResponse.item.detail | Element `ClaimResponse.item.detail` is mapped to FHIR R4 element `ClaimResponse.item.detail` as `Equivalent`. |
| ClaimResponse.item.detail.detailSequence (detailSequence) | is equivalent to | ClaimResponse.item.detail.detailSequence | Element `ClaimResponse.item.detail.detailSequence` is mapped to FHIR R4 element `ClaimResponse.item.detail.detailSequence` as `Equivalent`. |
| ClaimResponse.item.detail.noteNumber (noteNumber) | is equivalent to | ClaimResponse.item.detail.noteNumber | Element `ClaimResponse.item.detail.noteNumber` is mapped to FHIR R4 element `ClaimResponse.item.detail.noteNumber` as `Equivalent`. |
| ClaimResponse.item.detail.adjudication (adjudication) | is equivalent to | ClaimResponse.item.detail.adjudication | Element `ClaimResponse.item.detail.adjudication` is mapped to FHIR R4 element `ClaimResponse.item.detail.adjudication` as `Equivalent`. |
| ClaimResponse.item.detail.subDetail (subDetail) | maps to wider concept | ClaimResponse.item.detail.subDetail | Element `ClaimResponse.item.detail.subDetail` is mapped to FHIR R4 element `ClaimResponse.item.detail.subDetail` as `Equivalent`. |
| ClaimResponse.item.detail.subDetail.subDetailSequence (subDetailSequence) | is equivalent to | ClaimResponse.item.detail.subDetail.subDetailSequence | Element `ClaimResponse.item.detail.subDetail.subDetailSequence` is mapped to FHIR R4 element `ClaimResponse.item.detail.subDetail.subDetailSequence` as `Equivalent`. |
| ClaimResponse.item.detail.subDetail.noteNumber (noteNumber) | is equivalent to | ClaimResponse.item.detail.subDetail.noteNumber | Element `ClaimResponse.item.detail.subDetail.noteNumber` is mapped to FHIR R4 element `ClaimResponse.item.detail.subDetail.noteNumber` as `Equivalent`. |
| ClaimResponse.item.detail.subDetail.adjudication (adjudication) | is equivalent to | ClaimResponse.item.detail.subDetail.adjudication | Element `ClaimResponse.item.detail.subDetail.adjudication` is mapped to FHIR R4 element `ClaimResponse.item.detail.subDetail.adjudication` as `Equivalent`. |
| ClaimResponse.addItem (addItem) | maps to wider concept | ClaimResponse.addItem | Element `ClaimResponse.addItem` is mapped to FHIR R4 element `ClaimResponse.addItem` as `Equivalent`. |
| ClaimResponse.addItem.itemSequence (itemSequence) | is equivalent to | ClaimResponse.addItem.itemSequence | Element `ClaimResponse.addItem.itemSequence` is mapped to FHIR R4 element `ClaimResponse.addItem.itemSequence` as `Equivalent`. |
| ClaimResponse.addItem.detailSequence (detailSequence) | is equivalent to | ClaimResponse.addItem.detailSequence | Element `ClaimResponse.addItem.detailSequence` is mapped to FHIR R4 element `ClaimResponse.addItem.detailSequence` as `Equivalent`. |
| ClaimResponse.addItem.subdetailSequence (subdetailSequence) | is equivalent to | ClaimResponse.addItem.subdetailSequence | Element `ClaimResponse.addItem.subdetailSequence` is mapped to FHIR R4 element `ClaimResponse.addItem.subdetailSequence` as `Equivalent`. |
| ClaimResponse.addItem.provider (provider) | is equivalent to | ClaimResponse.addItem.provider | Element `ClaimResponse.addItem.provider` is mapped to FHIR R4 element `ClaimResponse.addItem.provider` as `Equivalent`. |
| ClaimResponse.addItem.productOrService (productOrService) | is equivalent to | ClaimResponse.addItem.productOrService | Element `ClaimResponse.addItem.productOrService` is mapped to FHIR R4 element `ClaimResponse.addItem.productOrService` as `Equivalent`. If this is an actual service or product line, i.e. not a Group, then use code to indicate the Professional Service or Product supplied (e.g. CTP, HCPCS, USCLS, ICD10, NCPDP, DIN, RxNorm, ACHI, CCI). If a grouping item then use a group code to indicate the type of thing being grouped e.g. 'glasses' or 'compound'. |
| ClaimResponse.addItem.modifier (modifier) | is equivalent to | ClaimResponse.addItem.modifier | Element `ClaimResponse.addItem.modifier` is mapped to FHIR R4 element `ClaimResponse.addItem.modifier` as `Equivalent`. For example in Oral whether the treatment is cosmetic or associated with TMJ, or for Medical whether the treatment was outside the clinic or outside of office hours. |
| ClaimResponse.addItem.programCode (programCode) | is equivalent to | ClaimResponse.addItem.programCode | Element `ClaimResponse.addItem.programCode` is mapped to FHIR R4 element `ClaimResponse.addItem.programCode` as `Equivalent`. For example: Neonatal program, child dental program or drug users recovery program. |
| ClaimResponse.addItem.serviced[x] (serviced[x]) | is equivalent to | ClaimResponse.addItem.serviced[x] | Element `ClaimResponse.addItem.serviced[x]` is mapped to FHIR R4 element `ClaimResponse.addItem.serviced[x]` as `Equivalent`. The target context `ClaimResponse.addItem.serviced[x]` is a choice-type element and cannot directly hold extensions. The context is moved up to parent element `ClaimResponse.addItem`. |
| ClaimResponse.addItem.location[x] (location[x]) | is equivalent to | ClaimResponse.addItem.location[x] | Element `ClaimResponse.addItem.location[x]` is mapped to FHIR R4 element `ClaimResponse.addItem.location[x]` as `Equivalent`. The target context `ClaimResponse.addItem.location[x]` is a choice-type element and cannot directly hold extensions. The context is moved up to parent element `ClaimResponse.addItem`. |
| ClaimResponse.addItem.quantity (quantity) | is equivalent to | ClaimResponse.addItem.quantity | Element `ClaimResponse.addItem.quantity` is mapped to FHIR R4 element `ClaimResponse.addItem.quantity` as `Equivalent`. |
| ClaimResponse.addItem.unitPrice (unitPrice) | is equivalent to | ClaimResponse.addItem.unitPrice | Element `ClaimResponse.addItem.unitPrice` is mapped to FHIR R4 element `ClaimResponse.addItem.unitPrice` as `Equivalent`. |
| ClaimResponse.addItem.factor (factor) | is equivalent to | ClaimResponse.addItem.factor | Element `ClaimResponse.addItem.factor` is mapped to FHIR R4 element `ClaimResponse.addItem.factor` as `Equivalent`. To show a 10% senior's discount, the value entered is: 0.90 (1.00 - 0.10). |
| ClaimResponse.addItem.net (net) | is equivalent to | ClaimResponse.addItem.net | Element `ClaimResponse.addItem.net` is mapped to FHIR R4 element `ClaimResponse.addItem.net` as `Equivalent`. For example, the formula: quantity * unitPrice * factor = net. Quantity and factor are assumed to be 1 if not supplied. |
| ClaimResponse.addItem.bodySite (bodySite) | is equivalent to | ClaimResponse.addItem.bodySite | Element `ClaimResponse.addItem.bodySite` is mapped to FHIR R4 element `ClaimResponse.addItem.bodySite` as `Equivalent`. For example: Providing a tooth code allows an insurer to identify a provider performing a filling on a tooth that was previously removed. |
| ClaimResponse.addItem.subSite (subSite) | is equivalent to | ClaimResponse.addItem.subSite | Element `ClaimResponse.addItem.subSite` is mapped to FHIR R4 element `ClaimResponse.addItem.subSite` as `Equivalent`. |
| ClaimResponse.addItem.noteNumber (noteNumber) | is equivalent to | ClaimResponse.addItem.noteNumber | Element `ClaimResponse.addItem.noteNumber` is mapped to FHIR R4 element `ClaimResponse.addItem.noteNumber` as `Equivalent`. |
| ClaimResponse.addItem.adjudication (adjudication) | is equivalent to | ClaimResponse.addItem.adjudication | Element `ClaimResponse.addItem.adjudication` is mapped to FHIR R4 element `ClaimResponse.addItem.adjudication` as `Equivalent`. |
| ClaimResponse.addItem.detail (detail) | maps to wider concept | ClaimResponse.addItem.detail | Element `ClaimResponse.addItem.detail` is mapped to FHIR R4 element `ClaimResponse.addItem.detail` as `Equivalent`. |
| ClaimResponse.addItem.detail.productOrService (productOrService) | is equivalent to | ClaimResponse.addItem.detail.productOrService | Element `ClaimResponse.addItem.detail.productOrService` is mapped to FHIR R4 element `ClaimResponse.addItem.detail.productOrService` as `Equivalent`. If this is an actual service or product line, i.e. not a Group, then use code to indicate the Professional Service or Product supplied (e.g. CTP, HCPCS, USCLS, ICD10, NCPDP, DIN, RxNorm, ACHI, CCI). If a grouping item then use a group code to indicate the type of thing being grouped e.g. 'glasses' or 'compound'. |
| ClaimResponse.addItem.detail.modifier (modifier) | is equivalent to | ClaimResponse.addItem.detail.modifier | Element `ClaimResponse.addItem.detail.modifier` is mapped to FHIR R4 element `ClaimResponse.addItem.detail.modifier` as `Equivalent`. For example in Oral whether the treatment is cosmetic or associated with TMJ, or for Medical whether the treatment was outside the clinic or outside of office hours. |
| ClaimResponse.addItem.detail.quantity (quantity) | is equivalent to | ClaimResponse.addItem.detail.quantity | Element `ClaimResponse.addItem.detail.quantity` is mapped to FHIR R4 element `ClaimResponse.addItem.detail.quantity` as `Equivalent`. |
| ClaimResponse.addItem.detail.unitPrice (unitPrice) | is equivalent to | ClaimResponse.addItem.detail.unitPrice | Element `ClaimResponse.addItem.detail.unitPrice` is mapped to FHIR R4 element `ClaimResponse.addItem.detail.unitPrice` as `Equivalent`. |
| ClaimResponse.addItem.detail.factor (factor) | is equivalent to | ClaimResponse.addItem.detail.factor | Element `ClaimResponse.addItem.detail.factor` is mapped to FHIR R4 element `ClaimResponse.addItem.detail.factor` as `Equivalent`. To show a 10% senior's discount, the value entered is: 0.90 (1.00 - 0.10). |
| ClaimResponse.addItem.detail.net (net) | is equivalent to | ClaimResponse.addItem.detail.net | Element `ClaimResponse.addItem.detail.net` is mapped to FHIR R4 element `ClaimResponse.addItem.detail.net` as `Equivalent`. For example, the formula: quantity * unitPrice * factor = net. Quantity and factor are assumed to be 1 if not supplied. |
| ClaimResponse.addItem.detail.noteNumber (noteNumber) | is equivalent to | ClaimResponse.addItem.detail.noteNumber | Element `ClaimResponse.addItem.detail.noteNumber` is mapped to FHIR R4 element `ClaimResponse.addItem.detail.noteNumber` as `Equivalent`. |
| ClaimResponse.addItem.detail.adjudication (adjudication) | is equivalent to | ClaimResponse.addItem.detail.adjudication | Element `ClaimResponse.addItem.detail.adjudication` is mapped to FHIR R4 element `ClaimResponse.addItem.detail.adjudication` as `Equivalent`. |
| ClaimResponse.addItem.detail.subDetail (subDetail) | maps to wider concept | ClaimResponse.addItem.detail.subDetail | Element `ClaimResponse.addItem.detail.subDetail` is mapped to FHIR R4 element `ClaimResponse.addItem.detail.subDetail` as `Equivalent`. |
| ClaimResponse.addItem.detail.subDetail.productOrService (productOrService) | is equivalent to | ClaimResponse.addItem.detail.subDetail.productOrService | Element `ClaimResponse.addItem.detail.subDetail.productOrService` is mapped to FHIR R4 element `ClaimResponse.addItem.detail.subDetail.productOrService` as `Equivalent`. If this is an actual service or product line, i.e. not a Group, then use code to indicate the Professional Service or Product supplied (e.g. CTP, HCPCS, USCLS, ICD10, NCPDP, DIN, RxNorm, ACHI, CCI). If a grouping item then use a group code to indicate the type of thing being grouped e.g. 'glasses' or 'compound'. |
| ClaimResponse.addItem.detail.subDetail.modifier (modifier) | is equivalent to | ClaimResponse.addItem.detail.subDetail.modifier | Element `ClaimResponse.addItem.detail.subDetail.modifier` is mapped to FHIR R4 element `ClaimResponse.addItem.detail.subDetail.modifier` as `Equivalent`. For example in Oral whether the treatment is cosmetic or associated with TMJ, or for Medical whether the treatment was outside the clinic or outside of office hours. |
| ClaimResponse.addItem.detail.subDetail.quantity (quantity) | is equivalent to | ClaimResponse.addItem.detail.subDetail.quantity | Element `ClaimResponse.addItem.detail.subDetail.quantity` is mapped to FHIR R4 element `ClaimResponse.addItem.detail.subDetail.quantity` as `Equivalent`. |
| ClaimResponse.addItem.detail.subDetail.unitPrice (unitPrice) | is equivalent to | ClaimResponse.addItem.detail.subDetail.unitPrice | Element `ClaimResponse.addItem.detail.subDetail.unitPrice` is mapped to FHIR R4 element `ClaimResponse.addItem.detail.subDetail.unitPrice` as `Equivalent`. |
| ClaimResponse.addItem.detail.subDetail.factor (factor) | is equivalent to | ClaimResponse.addItem.detail.subDetail.factor | Element `ClaimResponse.addItem.detail.subDetail.factor` is mapped to FHIR R4 element `ClaimResponse.addItem.detail.subDetail.factor` as `Equivalent`. To show a 10% senior's discount, the value entered is: 0.90 (1.00 - 0.10). |
| ClaimResponse.addItem.detail.subDetail.net (net) | is equivalent to | ClaimResponse.addItem.detail.subDetail.net | Element `ClaimResponse.addItem.detail.subDetail.net` is mapped to FHIR R4 element `ClaimResponse.addItem.detail.subDetail.net` as `Equivalent`. For example, the formula: quantity * unitPrice * factor = net. Quantity and factor are assumed to be 1 if not supplied. |
| ClaimResponse.addItem.detail.subDetail.noteNumber (noteNumber) | is equivalent to | ClaimResponse.addItem.detail.subDetail.noteNumber | Element `ClaimResponse.addItem.detail.subDetail.noteNumber` is mapped to FHIR R4 element `ClaimResponse.addItem.detail.subDetail.noteNumber` as `Equivalent`. |
| ClaimResponse.addItem.detail.subDetail.adjudication (adjudication) | is equivalent to | ClaimResponse.addItem.detail.subDetail.adjudication | Element `ClaimResponse.addItem.detail.subDetail.adjudication` is mapped to FHIR R4 element `ClaimResponse.addItem.detail.subDetail.adjudication` as `Equivalent`. |
| ClaimResponse.adjudication (adjudication) | is equivalent to | ClaimResponse.adjudication | Element `ClaimResponse.adjudication` is mapped to FHIR R4 element `ClaimResponse.adjudication` as `Equivalent`. |
| ClaimResponse.total (total) | maps to wider concept | ClaimResponse.total | Element `ClaimResponse.total` is mapped to FHIR R4 element `ClaimResponse.total` as `Equivalent`. Totals for amounts submitted, co-pays, benefits payable etc. |
| ClaimResponse.total.category (category) | is equivalent to | ClaimResponse.total.category | Element `ClaimResponse.total.category` is mapped to FHIR R4 element `ClaimResponse.total.category` as `Equivalent`. For example codes indicating: Co-Pay, deductible, eligible, benefit, tax, etc. |
| ClaimResponse.total.amount (amount) | is equivalent to | ClaimResponse.total.amount | Element `ClaimResponse.total.amount` is mapped to FHIR R4 element `ClaimResponse.total.amount` as `Equivalent`. |
| ClaimResponse.payment (payment) | maps to wider concept | ClaimResponse.payment | Element `ClaimResponse.payment` is mapped to FHIR R4 element `ClaimResponse.payment` as `Equivalent`. |
| ClaimResponse.payment.type (type) | is equivalent to | ClaimResponse.payment.type | Element `ClaimResponse.payment.type` is mapped to FHIR R4 element `ClaimResponse.payment.type` as `Equivalent`. |
| ClaimResponse.payment.adjustment (adjustment) | is equivalent to | ClaimResponse.payment.adjustment | Element `ClaimResponse.payment.adjustment` is mapped to FHIR R4 element `ClaimResponse.payment.adjustment` as `Equivalent`. Insurers will deduct amounts owing from the provider (adjustment), such as a prior overpayment, from the amount owing to the provider (benefits payable) when payment is made to the provider. |
| ClaimResponse.payment.adjustmentReason (adjustmentReason) | is equivalent to | ClaimResponse.payment.adjustmentReason | Element `ClaimResponse.payment.adjustmentReason` is mapped to FHIR R4 element `ClaimResponse.payment.adjustmentReason` as `Equivalent`. |
| ClaimResponse.payment.date (date) | is equivalent to | ClaimResponse.payment.date | Element `ClaimResponse.payment.date` is mapped to FHIR R4 element `ClaimResponse.payment.date` as `Equivalent`. |
| ClaimResponse.payment.amount (amount) | is equivalent to | ClaimResponse.payment.amount | Element `ClaimResponse.payment.amount` is mapped to FHIR R4 element `ClaimResponse.payment.amount` as `Equivalent`. |
| ClaimResponse.payment.identifier (identifier) | is equivalent to | ClaimResponse.payment.identifier | Element `ClaimResponse.payment.identifier` is mapped to FHIR R4 element `ClaimResponse.payment.identifier` as `Equivalent`. For example: EFT number or check number. |
| ClaimResponse.fundsReserve (fundsReserve) | is equivalent to | ClaimResponse.fundsReserve | Element `ClaimResponse.fundsReserve` is mapped to FHIR R4 element `ClaimResponse.fundsReserve` as `Equivalent`. Fund would be release by a future claim quoting the preAuthRef of this response. Examples of values include: provider, patient, none. |
| ClaimResponse.formCode (formCode) | is equivalent to | ClaimResponse.formCode | Element `ClaimResponse.formCode` is mapped to FHIR R4 element `ClaimResponse.formCode` as `Equivalent`. May be needed to identify specific jurisdictional forms. |
| ClaimResponse.form (form) | is equivalent to | ClaimResponse.form | Element `ClaimResponse.form` is mapped to FHIR R4 element `ClaimResponse.form` as `Equivalent`. Needed to permit insurers to include the actual form. |
| ClaimResponse.processNote (processNote) | maps to wider concept | ClaimResponse.processNote | Element `ClaimResponse.processNote` is mapped to FHIR R4 element `ClaimResponse.processNote` as `Equivalent`. |
| ClaimResponse.processNote.number (number) | is equivalent to | ClaimResponse.processNote.number | Element `ClaimResponse.processNote.number` is mapped to FHIR R4 element `ClaimResponse.processNote.number` as `Equivalent`. |
| ClaimResponse.processNote.type (type) | is equivalent to | ClaimResponse.processNote.type | Element `ClaimResponse.processNote.type` is mapped to FHIR R4 element `ClaimResponse.processNote.type` as `Equivalent`. |
| ClaimResponse.processNote.text (text) | is equivalent to | ClaimResponse.processNote.text | Element `ClaimResponse.processNote.text` is mapped to FHIR R4 element `ClaimResponse.processNote.text` as `Equivalent`. |
| ClaimResponse.processNote.language (language) | is equivalent to | ClaimResponse.processNote.language | Element `ClaimResponse.processNote.language` is mapped to FHIR R4 element `ClaimResponse.processNote.language` as `Equivalent`. Only required if the language is different from the resource language. |
| ClaimResponse.communicationRequest (communicationRequest) | is equivalent to | ClaimResponse.communicationRequest | Element `ClaimResponse.communicationRequest` is mapped to FHIR R4 element `ClaimResponse.communicationRequest` as `Equivalent`. For example: professional reports, documents, images, clinical resources, or accident reports. |
| ClaimResponse.insurance (insurance) | maps to wider concept | ClaimResponse.insurance | Element `ClaimResponse.insurance` is mapped to FHIR R4 element `ClaimResponse.insurance` as `Equivalent`. All insurance coverages for the patient which may be applicable for reimbursement, of the products and services listed in the claim, are typically provided in the claim to allow insurers to confirm the ordering of the insurance coverages relative to local 'coordination of benefit' rules. One coverage (and only one) with 'focal=true' is to be used in the adjudication of this claim. Coverages appearing before the focal Coverage in the list, and where 'subrogation=false', should provide a reference to the ClaimResponse containing the adjudication results of the prior claim. |
| ClaimResponse.insurance.sequence (sequence) | is equivalent to | ClaimResponse.insurance.sequence | Element `ClaimResponse.insurance.sequence` is mapped to FHIR R4 element `ClaimResponse.insurance.sequence` as `Equivalent`. |
| ClaimResponse.insurance.focal (focal) | is equivalent to | ClaimResponse.insurance.focal | Element `ClaimResponse.insurance.focal` is mapped to FHIR R4 element `ClaimResponse.insurance.focal` as `Equivalent`. A patient may (will) have multiple insurance policies which provide reimbursement for healthcare services and products. For example a person may also be covered by their spouse's policy and both appear in the list (and may be from the same insurer). This flag will be set to true for only one of the listed policies and that policy will be used for adjudicating this claim. Other claims would be created to request adjudication against the other listed policies. |
| ClaimResponse.insurance.coverage (coverage) | is equivalent to | ClaimResponse.insurance.coverage | Element `ClaimResponse.insurance.coverage` is mapped to FHIR R4 element `ClaimResponse.insurance.coverage` as `Equivalent`. |
| ClaimResponse.insurance.businessArrangement (businessArrangement) | is equivalent to | ClaimResponse.insurance.businessArrangement | Element `ClaimResponse.insurance.businessArrangement` is mapped to FHIR R4 element `ClaimResponse.insurance.businessArrangement` as `Equivalent`. |
| ClaimResponse.insurance.claimResponse (claimResponse) | is equivalent to | ClaimResponse.insurance.claimResponse | Element `ClaimResponse.insurance.claimResponse` is mapped to FHIR R4 element `ClaimResponse.insurance.claimResponse` as `Equivalent`. Must not be specified when 'focal=true' for this insurance. |
| ClaimResponse.error (error) | maps to wider concept | ClaimResponse.error | Element `ClaimResponse.error` is mapped to FHIR R4 element `ClaimResponse.error` as `Equivalent`. If the request contains errors then an error element should be provided and no adjudication related sections (item, addItem, or payment) should be present. |
| ClaimResponse.error.itemSequence (itemSequence) | is equivalent to | ClaimResponse.error.itemSequence | Element `ClaimResponse.error.itemSequence` is mapped to FHIR R4 element `ClaimResponse.error.itemSequence` as `Equivalent`. |
| ClaimResponse.error.detailSequence (detailSequence) | is equivalent to | ClaimResponse.error.detailSequence | Element `ClaimResponse.error.detailSequence` is mapped to FHIR R4 element `ClaimResponse.error.detailSequence` as `Equivalent`. |
| ClaimResponse.error.subDetailSequence (subDetailSequence) | is equivalent to | ClaimResponse.error.subDetailSequence | Element `ClaimResponse.error.subDetailSequence` is mapped to FHIR R4 element `ClaimResponse.error.subDetailSequence` as `Equivalent`. |
| ClaimResponse.error.code (code) | is equivalent to | ClaimResponse.error.code | Element `ClaimResponse.error.code` is mapped to FHIR R4 element `ClaimResponse.error.code` as `Equivalent`. |
FHIR
FHIRsmith{
"resourceType": "ConceptMap",
"id": "R4B-ClaimResponse-element-map-to-R4",
"text": {
"status": "generated",
"div": "<!-- snip (see above) -->"
},
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-wg",
"valueCode": "fhir"
},
{
"url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-fmm",
"valueInteger": 0,
"_valueInteger": {
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-conformance-derivedFrom",
"valueCanonical": "http://hl7.org/fhir/uv/xver/ImplementationGuide/hl7.fhir.uv.xver-r4b.r4"
}
]
}
},
{
"url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status",
"valueCode": "trial-use",
"_valueCode": {
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-conformance-derivedFrom",
"valueCanonical": "http://hl7.org/fhir/uv/xver/ImplementationGuide/hl7.fhir.uv.xver-r4b.r4"
}
]
}
}
],
"url": "http://hl7.org/fhir/uv/xver/ConceptMap/R4B-ClaimResponse-element-map-to-R4",
"version": "0.1.0",
"name": "R4BClaimResponseElementMapToR4",
"title": "Cross-version mapping for FHIR R4B ClaimResponse to FHIR R4 ClaimResponse",
"status": "active",
"experimental": false,
"date": "2026-03-17T16:03:46.8806274-05:00",
"contact": [
{
"name": "FHIR Infrastructure",
"telecom": [
{
"system": "url",
"value": "http://www.hl7.org/Special/committees/fiwg"
}
]
}
],
"description": "This ConceptMap represents cross-version mappings for elements from a FHIR R4B ClaimResponse to FHIR R4.",
"jurisdiction": [
{
"coding": [
{
"system": "http://unstats.un.org/unsd/methods/m49/m49.htm",
"code": "001",
"display": "World"
}
]
}
],
"sourceCanonical": "http://hl7.org/fhir/4.3",
"targetUri": "http://hl7.org/fhir/4.0",
"group": [
{
"source": "http://hl7.org/fhir/StructureDefinition/ClaimResponse",
"sourceVersion": "4.3.0",
"target": "http://hl7.org/fhir/StructureDefinition/ClaimResponse",
"targetVersion": "4.0.1",
"element": [
{
"code": "ClaimResponse.meta",
"display": "meta",
"target": [
{
"code": "ClaimResponse.meta",
"display": "ClaimResponse.meta",
"equivalence": "equivalent",
"comment": "Element `ClaimResponse.meta` is mapped to FHIR R4 element `ClaimResponse.meta` as `Equivalent`."
}
]
},
{
"code": "ClaimResponse.implicitRules",
"display": "implicitRules",
"target": [
{
"code": "ClaimResponse.implicitRules",
"display": "ClaimResponse.implicitRules",
"equivalence": "equivalent",
"comment": "Element `ClaimResponse.implicitRules` is mapped to FHIR R4 element `ClaimResponse.implicitRules` as `Equivalent`.\nAsserting this rule set restricts the content to be only understood by a limited set of trading partners. This inherently limits the usefulness of the data in the long term. However, the existing health eco-system is highly fractured, and not yet ready to define, collect, and exchange data in a generally computable sense. Wherever possible, implementers and/or specification writers should avoid using this element. Often, when used, the URL is a reference to an implementation guide that defines these special rules as part of it's narrative along with other profiles, value sets, etc."
}
]
},
{
"code": "ClaimResponse.language",
"display": "language",
"target": [
{
"code": "ClaimResponse.language",
"display": "ClaimResponse.language",
"equivalence": "equivalent",
"comment": "Element `ClaimResponse.language` is mapped to FHIR R4 element `ClaimResponse.language` as `Equivalent`.\nLanguage 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)."
}
]
},
{
"code": "ClaimResponse.text",
"display": "text",
"target": [
{
"code": "ClaimResponse.text",
"display": "ClaimResponse.text",
"equivalence": "equivalent",
"comment": "Element `ClaimResponse.text` is mapped to FHIR R4 element `ClaimResponse.text` as `Equivalent`.\nContained resources do not have narrative. Resources that are not contained SHOULD have a narrative. In some cases, a resource may only have text with little or no additional discrete data (as long as all minOccurs=1 elements are satisfied). This may be necessary for data from legacy systems where information is captured as a \"text blob\" or where text is additionally entered raw or narrated and encoded information is added later."
}
]
},
{
"code": "ClaimResponse.contained",
"display": "contained",
"target": [
{
"code": "ClaimResponse.contained",
"display": "ClaimResponse.contained",
"equivalence": "equivalent",
"comment": "Element `ClaimResponse.contained` is mapped to FHIR R4 element `ClaimResponse.contained` as `Equivalent`.\nThis should never be done when the content can be identified properly, as once identification is lost, it is extremely difficult (and context dependent) to restore it again. Contained resources may have profiles and tags In their meta elements, but SHALL NOT have security labels."
}
]
},
{
"code": "ClaimResponse.identifier",
"display": "identifier",
"target": [
{
"code": "ClaimResponse.identifier",
"display": "ClaimResponse.identifier",
"equivalence": "equivalent",
"comment": "Element `ClaimResponse.identifier` is mapped to FHIR R4 element `ClaimResponse.identifier` as `Equivalent`."
}
]
},
{
"code": "ClaimResponse.status",
"display": "status",
"target": [
{
"code": "ClaimResponse.status",
"display": "ClaimResponse.status",
"equivalence": "equivalent",
"comment": "Element `ClaimResponse.status` is mapped to FHIR R4 element `ClaimResponse.status` as `Equivalent`.\nThis element is labeled as a modifier because the status contains codes that mark the resource as not currently valid."
}
]
},
{
"code": "ClaimResponse.type",
"display": "type",
"target": [
{
"code": "ClaimResponse.type",
"display": "ClaimResponse.type",
"equivalence": "equivalent",
"comment": "Element `ClaimResponse.type` is mapped to FHIR R4 element `ClaimResponse.type` as `Equivalent`.\nThis may contain the local bill type codes, for example the US UB-04 bill type code or the CMS bill type."
}
]
},
{
"code": "ClaimResponse.subType",
"display": "subType",
"target": [
{
"code": "ClaimResponse.subType",
"display": "ClaimResponse.subType",
"equivalence": "equivalent",
"comment": "Element `ClaimResponse.subType` is mapped to FHIR R4 element `ClaimResponse.subType` as `Equivalent`.\nThis may contain the local bill type codes, for example the US UB-04 bill type code or the CMS bill type."
}
]
},
{
"code": "ClaimResponse.use",
"display": "use",
"target": [
{
"code": "ClaimResponse.use",
"display": "ClaimResponse.use",
"equivalence": "equivalent",
"comment": "Element `ClaimResponse.use` is mapped to FHIR R4 element `ClaimResponse.use` as `Equivalent`."
}
]
},
{
"code": "ClaimResponse.patient",
"display": "patient",
"target": [
{
"code": "ClaimResponse.patient",
"display": "ClaimResponse.patient",
"equivalence": "equivalent",
"comment": "Element `ClaimResponse.patient` is mapped to FHIR R4 element `ClaimResponse.patient` as `Equivalent`."
}
]
},
{
"code": "ClaimResponse.created",
"display": "created",
"target": [
{
"code": "ClaimResponse.created",
"display": "ClaimResponse.created",
"equivalence": "equivalent",
"comment": "Element `ClaimResponse.created` is mapped to FHIR R4 element `ClaimResponse.created` as `Equivalent`."
}
]
},
{
"code": "ClaimResponse.insurer",
"display": "insurer",
"target": [
{
"code": "ClaimResponse.insurer",
"display": "ClaimResponse.insurer",
"equivalence": "equivalent",
"comment": "Element `ClaimResponse.insurer` is mapped to FHIR R4 element `ClaimResponse.insurer` as `Equivalent`."
}
]
},
{
"code": "ClaimResponse.requestor",
"display": "requestor",
"target": [
{
"code": "ClaimResponse.requestor",
"display": "ClaimResponse.requestor",
"equivalence": "equivalent",
"comment": "Element `ClaimResponse.requestor` is mapped to FHIR R4 element `ClaimResponse.requestor` as `Equivalent`.\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."
}
]
},
{
"code": "ClaimResponse.request",
"display": "request",
"target": [
{
"code": "ClaimResponse.request",
"display": "ClaimResponse.request",
"equivalence": "equivalent",
"comment": "Element `ClaimResponse.request` is mapped to FHIR R4 element `ClaimResponse.request` as `Equivalent`."
}
]
},
{
"code": "ClaimResponse.outcome",
"display": "outcome",
"target": [
{
"code": "ClaimResponse.outcome",
"display": "ClaimResponse.outcome",
"equivalence": "equivalent",
"comment": "Element `ClaimResponse.outcome` is mapped to FHIR R4 element `ClaimResponse.outcome` as `Equivalent`.\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)."
}
]
},
{
"code": "ClaimResponse.disposition",
"display": "disposition",
"target": [
{
"code": "ClaimResponse.disposition",
"display": "ClaimResponse.disposition",
"equivalence": "equivalent",
"comment": "Element `ClaimResponse.disposition` is mapped to FHIR R4 element `ClaimResponse.disposition` as `Equivalent`."
}
]
},
{
"code": "ClaimResponse.preAuthRef",
"display": "preAuthRef",
"target": [
{
"code": "ClaimResponse.preAuthRef",
"display": "ClaimResponse.preAuthRef",
"equivalence": "equivalent",
"comment": "Element `ClaimResponse.preAuthRef` is mapped to FHIR R4 element `ClaimResponse.preAuthRef` as `Equivalent`.\nThis value is only present on preauthorization adjudications."
}
]
},
{
"code": "ClaimResponse.preAuthPeriod",
"display": "preAuthPeriod",
"target": [
{
"code": "ClaimResponse.preAuthPeriod",
"display": "ClaimResponse.preAuthPeriod",
"equivalence": "equivalent",
"comment": "Element `ClaimResponse.preAuthPeriod` is mapped to FHIR R4 element `ClaimResponse.preAuthPeriod` as `Equivalent`."
}
]
},
{
"code": "ClaimResponse.payeeType",
"display": "payeeType",
"target": [
{
"code": "ClaimResponse.payeeType",
"display": "ClaimResponse.payeeType",
"equivalence": "equivalent",
"comment": "Element `ClaimResponse.payeeType` is mapped to FHIR R4 element `ClaimResponse.payeeType` as `Equivalent`."
}
]
},
{
"code": "ClaimResponse.item",
"display": "item",
"target": [
{
"code": "ClaimResponse.item",
"display": "ClaimResponse.item",
"equivalence": "wider",
"comment": "Element `ClaimResponse.item` is mapped to FHIR R4 element `ClaimResponse.item` as `Equivalent`."
}
]
},
{
"code": "ClaimResponse.item.itemSequence",
"display": "itemSequence",
"target": [
{
"code": "ClaimResponse.item.itemSequence",
"display": "ClaimResponse.item.itemSequence",
"equivalence": "equivalent",
"comment": "Element `ClaimResponse.item.itemSequence` is mapped to FHIR R4 element `ClaimResponse.item.itemSequence` as `Equivalent`."
}
]
},
{
"code": "ClaimResponse.item.noteNumber",
"display": "noteNumber",
"target": [
{
"code": "ClaimResponse.item.noteNumber",
"display": "ClaimResponse.item.noteNumber",
"equivalence": "equivalent",
"comment": "Element `ClaimResponse.item.noteNumber` is mapped to FHIR R4 element `ClaimResponse.item.noteNumber` as `Equivalent`."
}
]
},
{
"code": "ClaimResponse.item.adjudication",
"display": "adjudication",
"target": [
{
"code": "ClaimResponse.item.adjudication",
"display": "ClaimResponse.item.adjudication",
"equivalence": "wider",
"comment": "Element `ClaimResponse.item.adjudication` is mapped to FHIR R4 element `ClaimResponse.item.adjudication` as `Equivalent`."
}
]
},
{
"code": "ClaimResponse.item.adjudication.category",
"display": "category",
"target": [
{
"code": "ClaimResponse.item.adjudication.category",
"display": "ClaimResponse.item.adjudication.category",
"equivalence": "equivalent",
"comment": "Element `ClaimResponse.item.adjudication.category` is mapped to FHIR R4 element `ClaimResponse.item.adjudication.category` as `Equivalent`.\nFor example codes indicating: Co-Pay, deductible, eligible, benefit, tax, etc."
}
]
},
{
"code": "ClaimResponse.item.adjudication.reason",
"display": "reason",
"target": [
{
"code": "ClaimResponse.item.adjudication.reason",
"display": "ClaimResponse.item.adjudication.reason",
"equivalence": "equivalent",
"comment": "Element `ClaimResponse.item.adjudication.reason` is mapped to FHIR R4 element `ClaimResponse.item.adjudication.reason` as `Equivalent`.\nFor example may indicate that the funds for this benefit type have been exhausted."
}
]
},
{
"code": "ClaimResponse.item.adjudication.amount",
"display": "amount",
"target": [
{
"code": "ClaimResponse.item.adjudication.amount",
"display": "ClaimResponse.item.adjudication.amount",
"equivalence": "equivalent",
"comment": "Element `ClaimResponse.item.adjudication.amount` is mapped to FHIR R4 element `ClaimResponse.item.adjudication.amount` as `Equivalent`.\nFor example: amount submitted, eligible amount, co-payment, and benefit payable."
}
]
},
{
"code": "ClaimResponse.item.adjudication.value",
"display": "value",
"target": [
{
"code": "ClaimResponse.item.adjudication.value",
"display": "ClaimResponse.item.adjudication.value",
"equivalence": "equivalent",
"comment": "Element `ClaimResponse.item.adjudication.value` is mapped to FHIR R4 element `ClaimResponse.item.adjudication.value` as `Equivalent`.\nFor example: eligible percentage or co-payment percentage."
}
]
},
{
"code": "ClaimResponse.item.detail",
"display": "detail",
"target": [
{
"code": "ClaimResponse.item.detail",
"display": "ClaimResponse.item.detail",
"equivalence": "wider",
"comment": "Element `ClaimResponse.item.detail` is mapped to FHIR R4 element `ClaimResponse.item.detail` as `Equivalent`."
}
]
},
{
"code": "ClaimResponse.item.detail.detailSequence",
"display": "detailSequence",
"target": [
{
"code": "ClaimResponse.item.detail.detailSequence",
"display": "ClaimResponse.item.detail.detailSequence",
"equivalence": "equivalent",
"comment": "Element `ClaimResponse.item.detail.detailSequence` is mapped to FHIR R4 element `ClaimResponse.item.detail.detailSequence` as `Equivalent`."
}
]
},
{
"code": "ClaimResponse.item.detail.noteNumber",
"display": "noteNumber",
"target": [
{
"code": "ClaimResponse.item.detail.noteNumber",
"display": "ClaimResponse.item.detail.noteNumber",
"equivalence": "equivalent",
"comment": "Element `ClaimResponse.item.detail.noteNumber` is mapped to FHIR R4 element `ClaimResponse.item.detail.noteNumber` as `Equivalent`."
}
]
},
{
"code": "ClaimResponse.item.detail.adjudication",
"display": "adjudication",
"target": [
{
"code": "ClaimResponse.item.detail.adjudication",
"display": "ClaimResponse.item.detail.adjudication",
"equivalence": "equivalent",
"comment": "Element `ClaimResponse.item.detail.adjudication` is mapped to FHIR R4 element `ClaimResponse.item.detail.adjudication` as `Equivalent`."
}
]
},
{
"code": "ClaimResponse.item.detail.subDetail",
"display": "subDetail",
"target": [
{
"code": "ClaimResponse.item.detail.subDetail",
"display": "ClaimResponse.item.detail.subDetail",
"equivalence": "wider",
"comment": "Element `ClaimResponse.item.detail.subDetail` is mapped to FHIR R4 element `ClaimResponse.item.detail.subDetail` as `Equivalent`."
}
]
},
{
"code": "ClaimResponse.item.detail.subDetail.subDetailSequence",
"display": "subDetailSequence",
"target": [
{
"code": "ClaimResponse.item.detail.subDetail.subDetailSequence",
"display": "ClaimResponse.item.detail.subDetail.subDetailSequence",
"equivalence": "equivalent",
"comment": "Element `ClaimResponse.item.detail.subDetail.subDetailSequence` is mapped to FHIR R4 element `ClaimResponse.item.detail.subDetail.subDetailSequence` as `Equivalent`."
}
]
},
{
"code": "ClaimResponse.item.detail.subDetail.noteNumber",
"display": "noteNumber",
"target": [
{
"code": "ClaimResponse.item.detail.subDetail.noteNumber",
"display": "ClaimResponse.item.detail.subDetail.noteNumber",
"equivalence": "equivalent",
"comment": "Element `ClaimResponse.item.detail.subDetail.noteNumber` is mapped to FHIR R4 element `ClaimResponse.item.detail.subDetail.noteNumber` as `Equivalent`."
}
]
},
{
"code": "ClaimResponse.item.detail.subDetail.adjudication",
"display": "adjudication",
"target": [
{
"code": "ClaimResponse.item.detail.subDetail.adjudication",
"display": "ClaimResponse.item.detail.subDetail.adjudication",
"equivalence": "equivalent",
"comment": "Element `ClaimResponse.item.detail.subDetail.adjudication` is mapped to FHIR R4 element `ClaimResponse.item.detail.subDetail.adjudication` as `Equivalent`."
}
]
},
{
"code": "ClaimResponse.addItem",
"display": "addItem",
"target": [
{
"code": "ClaimResponse.addItem",
"display": "ClaimResponse.addItem",
"equivalence": "wider",
"comment": "Element `ClaimResponse.addItem` is mapped to FHIR R4 element `ClaimResponse.addItem` as `Equivalent`."
}
]
},
{
"code": "ClaimResponse.addItem.itemSequence",
"display": "itemSequence",
"target": [
{
"code": "ClaimResponse.addItem.itemSequence",
"display": "ClaimResponse.addItem.itemSequence",
"equivalence": "equivalent",
"comment": "Element `ClaimResponse.addItem.itemSequence` is mapped to FHIR R4 element `ClaimResponse.addItem.itemSequence` as `Equivalent`."
}
]
},
{
"code": "ClaimResponse.addItem.detailSequence",
"display": "detailSequence",
"target": [
{
"code": "ClaimResponse.addItem.detailSequence",
"display": "ClaimResponse.addItem.detailSequence",
"equivalence": "equivalent",
"comment": "Element `ClaimResponse.addItem.detailSequence` is mapped to FHIR R4 element `ClaimResponse.addItem.detailSequence` as `Equivalent`."
}
]
},
{
"code": "ClaimResponse.addItem.subdetailSequence",
"display": "subdetailSequence",
"target": [
{
"code": "ClaimResponse.addItem.subdetailSequence",
"display": "ClaimResponse.addItem.subdetailSequence",
"equivalence": "equivalent",
"comment": "Element `ClaimResponse.addItem.subdetailSequence` is mapped to FHIR R4 element `ClaimResponse.addItem.subdetailSequence` as `Equivalent`."
}
]
},
{
"code": "ClaimResponse.addItem.provider",
"display": "provider",
"target": [
{
"code": "ClaimResponse.addItem.provider",
"display": "ClaimResponse.addItem.provider",
"equivalence": "equivalent",
"comment": "Element `ClaimResponse.addItem.provider` is mapped to FHIR R4 element `ClaimResponse.addItem.provider` as `Equivalent`."
}
]
},
{
"code": "ClaimResponse.addItem.productOrService",
"display": "productOrService",
"target": [
{
"code": "ClaimResponse.addItem.productOrService",
"display": "ClaimResponse.addItem.productOrService",
"equivalence": "equivalent",
"comment": "Element `ClaimResponse.addItem.productOrService` is mapped to FHIR R4 element `ClaimResponse.addItem.productOrService` as `Equivalent`.\nIf this is an actual service or product line, i.e. not a Group, then use code to indicate the Professional Service or Product supplied (e.g. CTP, HCPCS, USCLS, ICD10, NCPDP, DIN, RxNorm, ACHI, CCI). If a grouping item then use a group code to indicate the type of thing being grouped e.g. 'glasses' or 'compound'."
}
]
},
{
"code": "ClaimResponse.addItem.modifier",
"display": "modifier",
"target": [
{
"code": "ClaimResponse.addItem.modifier",
"display": "ClaimResponse.addItem.modifier",
"equivalence": "equivalent",
"comment": "Element `ClaimResponse.addItem.modifier` is mapped to FHIR R4 element `ClaimResponse.addItem.modifier` as `Equivalent`.\nFor example in Oral whether the treatment is cosmetic or associated with TMJ, or for Medical whether the treatment was outside the clinic or outside of office hours."
}
]
},
{
"code": "ClaimResponse.addItem.programCode",
"display": "programCode",
"target": [
{
"code": "ClaimResponse.addItem.programCode",
"display": "ClaimResponse.addItem.programCode",
"equivalence": "equivalent",
"comment": "Element `ClaimResponse.addItem.programCode` is mapped to FHIR R4 element `ClaimResponse.addItem.programCode` as `Equivalent`.\nFor example: Neonatal program, child dental program or drug users recovery program."
}
]
},
{
"code": "ClaimResponse.addItem.serviced[x]",
"display": "serviced[x]",
"target": [
{
"code": "ClaimResponse.addItem.serviced[x]",
"display": "ClaimResponse.addItem.serviced[x]",
"equivalence": "equivalent",
"comment": "Element `ClaimResponse.addItem.serviced[x]` is mapped to FHIR R4 element `ClaimResponse.addItem.serviced[x]` as `Equivalent`.\nThe target context `ClaimResponse.addItem.serviced[x]` is a choice-type element and cannot directly hold extensions. The context is moved up to parent element `ClaimResponse.addItem`."
}
]
},
{
"code": "ClaimResponse.addItem.location[x]",
"display": "location[x]",
"target": [
{
"code": "ClaimResponse.addItem.location[x]",
"display": "ClaimResponse.addItem.location[x]",
"equivalence": "equivalent",
"comment": "Element `ClaimResponse.addItem.location[x]` is mapped to FHIR R4 element `ClaimResponse.addItem.location[x]` as `Equivalent`.\nThe target context `ClaimResponse.addItem.location[x]` is a choice-type element and cannot directly hold extensions. The context is moved up to parent element `ClaimResponse.addItem`."
}
]
},
{
"code": "ClaimResponse.addItem.quantity",
"display": "quantity",
"target": [
{
"code": "ClaimResponse.addItem.quantity",
"display": "ClaimResponse.addItem.quantity",
"equivalence": "equivalent",
"comment": "Element `ClaimResponse.addItem.quantity` is mapped to FHIR R4 element `ClaimResponse.addItem.quantity` as `Equivalent`."
}
]
},
{
"code": "ClaimResponse.addItem.unitPrice",
"display": "unitPrice",
"target": [
{
"code": "ClaimResponse.addItem.unitPrice",
"display": "ClaimResponse.addItem.unitPrice",
"equivalence": "equivalent",
"comment": "Element `ClaimResponse.addItem.unitPrice` is mapped to FHIR R4 element `ClaimResponse.addItem.unitPrice` as `Equivalent`."
}
]
},
{
"code": "ClaimResponse.addItem.factor",
"display": "factor",
"target": [
{
"code": "ClaimResponse.addItem.factor",
"display": "ClaimResponse.addItem.factor",
"equivalence": "equivalent",
"comment": "Element `ClaimResponse.addItem.factor` is mapped to FHIR R4 element `ClaimResponse.addItem.factor` as `Equivalent`.\nTo show a 10% senior's discount, the value entered is: 0.90 (1.00 - 0.10)."
}
]
},
{
"code": "ClaimResponse.addItem.net",
"display": "net",
"target": [
{
"code": "ClaimResponse.addItem.net",
"display": "ClaimResponse.addItem.net",
"equivalence": "equivalent",
"comment": "Element `ClaimResponse.addItem.net` is mapped to FHIR R4 element `ClaimResponse.addItem.net` as `Equivalent`.\nFor example, the formula: quantity * unitPrice * factor = net. Quantity and factor are assumed to be 1 if not supplied."
}
]
},
{
"code": "ClaimResponse.addItem.bodySite",
"display": "bodySite",
"target": [
{
"code": "ClaimResponse.addItem.bodySite",
"display": "ClaimResponse.addItem.bodySite",
"equivalence": "equivalent",
"comment": "Element `ClaimResponse.addItem.bodySite` is mapped to FHIR R4 element `ClaimResponse.addItem.bodySite` as `Equivalent`.\nFor example: Providing a tooth code allows an insurer to identify a provider performing a filling on a tooth that was previously removed."
}
]
},
{
"code": "ClaimResponse.addItem.subSite",
"display": "subSite",
"target": [
{
"code": "ClaimResponse.addItem.subSite",
"display": "ClaimResponse.addItem.subSite",
"equivalence": "equivalent",
"comment": "Element `ClaimResponse.addItem.subSite` is mapped to FHIR R4 element `ClaimResponse.addItem.subSite` as `Equivalent`."
}
]
},
{
"code": "ClaimResponse.addItem.noteNumber",
"display": "noteNumber",
"target": [
{
"code": "ClaimResponse.addItem.noteNumber",
"display": "ClaimResponse.addItem.noteNumber",
"equivalence": "equivalent",
"comment": "Element `ClaimResponse.addItem.noteNumber` is mapped to FHIR R4 element `ClaimResponse.addItem.noteNumber` as `Equivalent`."
}
]
},
{
"code": "ClaimResponse.addItem.adjudication",
"display": "adjudication",
"target": [
{
"code": "ClaimResponse.addItem.adjudication",
"display": "ClaimResponse.addItem.adjudication",
"equivalence": "equivalent",
"comment": "Element `ClaimResponse.addItem.adjudication` is mapped to FHIR R4 element `ClaimResponse.addItem.adjudication` as `Equivalent`."
}
]
},
{
"code": "ClaimResponse.addItem.detail",
"display": "detail",
"target": [
{
"code": "ClaimResponse.addItem.detail",
"display": "ClaimResponse.addItem.detail",
"equivalence": "wider",
"comment": "Element `ClaimResponse.addItem.detail` is mapped to FHIR R4 element `ClaimResponse.addItem.detail` as `Equivalent`."
}
]
},
{
"code": "ClaimResponse.addItem.detail.productOrService",
"display": "productOrService",
"target": [
{
"code": "ClaimResponse.addItem.detail.productOrService",
"display": "ClaimResponse.addItem.detail.productOrService",
"equivalence": "equivalent",
"comment": "Element `ClaimResponse.addItem.detail.productOrService` is mapped to FHIR R4 element `ClaimResponse.addItem.detail.productOrService` as `Equivalent`.\nIf this is an actual service or product line, i.e. not a Group, then use code to indicate the Professional Service or Product supplied (e.g. CTP, HCPCS, USCLS, ICD10, NCPDP, DIN, RxNorm, ACHI, CCI). If a grouping item then use a group code to indicate the type of thing being grouped e.g. 'glasses' or 'compound'."
}
]
},
{
"code": "ClaimResponse.addItem.detail.modifier",
"display": "modifier",
"target": [
{
"code": "ClaimResponse.addItem.detail.modifier",
"display": "ClaimResponse.addItem.detail.modifier",
"equivalence": "equivalent",
"comment": "Element `ClaimResponse.addItem.detail.modifier` is mapped to FHIR R4 element `ClaimResponse.addItem.detail.modifier` as `Equivalent`.\nFor example in Oral whether the treatment is cosmetic or associated with TMJ, or for Medical whether the treatment was outside the clinic or outside of office hours."
}
]
},
{
"code": "ClaimResponse.addItem.detail.quantity",
"display": "quantity",
"target": [
{
"code": "ClaimResponse.addItem.detail.quantity",
"display": "ClaimResponse.addItem.detail.quantity",
"equivalence": "equivalent",
"comment": "Element `ClaimResponse.addItem.detail.quantity` is mapped to FHIR R4 element `ClaimResponse.addItem.detail.quantity` as `Equivalent`."
}
]
},
{
"code": "ClaimResponse.addItem.detail.unitPrice",
"display": "unitPrice",
"target": [
{
"code": "ClaimResponse.addItem.detail.unitPrice",
"display": "ClaimResponse.addItem.detail.unitPrice",
"equivalence": "equivalent",
"comment": "Element `ClaimResponse.addItem.detail.unitPrice` is mapped to FHIR R4 element `ClaimResponse.addItem.detail.unitPrice` as `Equivalent`."
}
]
},
{
"code": "ClaimResponse.addItem.detail.factor",
"display": "factor",
"target": [
{
"code": "ClaimResponse.addItem.detail.factor",
"display": "ClaimResponse.addItem.detail.factor",
"equivalence": "equivalent",
"comment": "Element `ClaimResponse.addItem.detail.factor` is mapped to FHIR R4 element `ClaimResponse.addItem.detail.factor` as `Equivalent`.\nTo show a 10% senior's discount, the value entered is: 0.90 (1.00 - 0.10)."
}
]
},
{
"code": "ClaimResponse.addItem.detail.net",
"display": "net",
"target": [
{
"code": "ClaimResponse.addItem.detail.net",
"display": "ClaimResponse.addItem.detail.net",
"equivalence": "equivalent",
"comment": "Element `ClaimResponse.addItem.detail.net` is mapped to FHIR R4 element `ClaimResponse.addItem.detail.net` as `Equivalent`.\nFor example, the formula: quantity * unitPrice * factor = net. Quantity and factor are assumed to be 1 if not supplied."
}
]
},
{
"code": "ClaimResponse.addItem.detail.noteNumber",
"display": "noteNumber",
"target": [
{
"code": "ClaimResponse.addItem.detail.noteNumber",
"display": "ClaimResponse.addItem.detail.noteNumber",
"equivalence": "equivalent",
"comment": "Element `ClaimResponse.addItem.detail.noteNumber` is mapped to FHIR R4 element `ClaimResponse.addItem.detail.noteNumber` as `Equivalent`."
}
]
},
{
"code": "ClaimResponse.addItem.detail.adjudication",
"display": "adjudication",
"target": [
{
"code": "ClaimResponse.addItem.detail.adjudication",
"display": "ClaimResponse.addItem.detail.adjudication",
"equivalence": "equivalent",
"comment": "Element `ClaimResponse.addItem.detail.adjudication` is mapped to FHIR R4 element `ClaimResponse.addItem.detail.adjudication` as `Equivalent`."
}
]
},
{
"code": "ClaimResponse.addItem.detail.subDetail",
"display": "subDetail",
"target": [
{
"code": "ClaimResponse.addItem.detail.subDetail",
"display": "ClaimResponse.addItem.detail.subDetail",
"equivalence": "wider",
"comment": "Element `ClaimResponse.addItem.detail.subDetail` is mapped to FHIR R4 element `ClaimResponse.addItem.detail.subDetail` as `Equivalent`."
}
]
},
{
"code": "ClaimResponse.addItem.detail.subDetail.productOrService",
"display": "productOrService",
"target": [
{
"code": "ClaimResponse.addItem.detail.subDetail.productOrService",
"display": "ClaimResponse.addItem.detail.subDetail.productOrService",
"equivalence": "equivalent",
"comment": "Element `ClaimResponse.addItem.detail.subDetail.productOrService` is mapped to FHIR R4 element `ClaimResponse.addItem.detail.subDetail.productOrService` as `Equivalent`.\nIf this is an actual service or product line, i.e. not a Group, then use code to indicate the Professional Service or Product supplied (e.g. CTP, HCPCS, USCLS, ICD10, NCPDP, DIN, RxNorm, ACHI, CCI). If a grouping item then use a group code to indicate the type of thing being grouped e.g. 'glasses' or 'compound'."
}
]
},
{
"code": "ClaimResponse.addItem.detail.subDetail.modifier",
"display": "modifier",
"target": [
{
"code": "ClaimResponse.addItem.detail.subDetail.modifier",
"display": "ClaimResponse.addItem.detail.subDetail.modifier",
"equivalence": "equivalent",
"comment": "Element `ClaimResponse.addItem.detail.subDetail.modifier` is mapped to FHIR R4 element `ClaimResponse.addItem.detail.subDetail.modifier` as `Equivalent`.\nFor example in Oral whether the treatment is cosmetic or associated with TMJ, or for Medical whether the treatment was outside the clinic or outside of office hours."
}
]
},
{
"code": "ClaimResponse.addItem.detail.subDetail.quantity",
"display": "quantity",
"target": [
{
"code": "ClaimResponse.addItem.detail.subDetail.quantity",
"display": "ClaimResponse.addItem.detail.subDetail.quantity",
"equivalence": "equivalent",
"comment": "Element `ClaimResponse.addItem.detail.subDetail.quantity` is mapped to FHIR R4 element `ClaimResponse.addItem.detail.subDetail.quantity` as `Equivalent`."
}
]
},
{
"code": "ClaimResponse.addItem.detail.subDetail.unitPrice",
"display": "unitPrice",
"target": [
{
"code": "ClaimResponse.addItem.detail.subDetail.unitPrice",
"display": "ClaimResponse.addItem.detail.subDetail.unitPrice",
"equivalence": "equivalent",
"comment": "Element `ClaimResponse.addItem.detail.subDetail.unitPrice` is mapped to FHIR R4 element `ClaimResponse.addItem.detail.subDetail.unitPrice` as `Equivalent`."
}
]
},
{
"code": "ClaimResponse.addItem.detail.subDetail.factor",
"display": "factor",
"target": [
{
"code": "ClaimResponse.addItem.detail.subDetail.factor",
"display": "ClaimResponse.addItem.detail.subDetail.factor",
"equivalence": "equivalent",
"comment": "Element `ClaimResponse.addItem.detail.subDetail.factor` is mapped to FHIR R4 element `ClaimResponse.addItem.detail.subDetail.factor` as `Equivalent`.\nTo show a 10% senior's discount, the value entered is: 0.90 (1.00 - 0.10)."
}
]
},
{
"code": "ClaimResponse.addItem.detail.subDetail.net",
"display": "net",
"target": [
{
"code": "ClaimResponse.addItem.detail.subDetail.net",
"display": "ClaimResponse.addItem.detail.subDetail.net",
"equivalence": "equivalent",
"comment": "Element `ClaimResponse.addItem.detail.subDetail.net` is mapped to FHIR R4 element `ClaimResponse.addItem.detail.subDetail.net` as `Equivalent`.\nFor example, the formula: quantity * unitPrice * factor = net. Quantity and factor are assumed to be 1 if not supplied."
}
]
},
{
"code": "ClaimResponse.addItem.detail.subDetail.noteNumber",
"display": "noteNumber",
"target": [
{
"code": "ClaimResponse.addItem.detail.subDetail.noteNumber",
"display": "ClaimResponse.addItem.detail.subDetail.noteNumber",
"equivalence": "equivalent",
"comment": "Element `ClaimResponse.addItem.detail.subDetail.noteNumber` is mapped to FHIR R4 element `ClaimResponse.addItem.detail.subDetail.noteNumber` as `Equivalent`."
}
]
},
{
"code": "ClaimResponse.addItem.detail.subDetail.adjudication",
"display": "adjudication",
"target": [
{
"code": "ClaimResponse.addItem.detail.subDetail.adjudication",
"display": "ClaimResponse.addItem.detail.subDetail.adjudication",
"equivalence": "equivalent",
"comment": "Element `ClaimResponse.addItem.detail.subDetail.adjudication` is mapped to FHIR R4 element `ClaimResponse.addItem.detail.subDetail.adjudication` as `Equivalent`."
}
]
},
{
"code": "ClaimResponse.adjudication",
"display": "adjudication",
"target": [
{
"code": "ClaimResponse.adjudication",
"display": "ClaimResponse.adjudication",
"equivalence": "equivalent",
"comment": "Element `ClaimResponse.adjudication` is mapped to FHIR R4 element `ClaimResponse.adjudication` as `Equivalent`."
}
]
},
{
"code": "ClaimResponse.total",
"display": "total",
"target": [
{
"code": "ClaimResponse.total",
"display": "ClaimResponse.total",
"equivalence": "wider",
"comment": "Element `ClaimResponse.total` is mapped to FHIR R4 element `ClaimResponse.total` as `Equivalent`.\nTotals for amounts submitted, co-pays, benefits payable etc."
}
]
},
{
"code": "ClaimResponse.total.category",
"display": "category",
"target": [
{
"code": "ClaimResponse.total.category",
"display": "ClaimResponse.total.category",
"equivalence": "equivalent",
"comment": "Element `ClaimResponse.total.category` is mapped to FHIR R4 element `ClaimResponse.total.category` as `Equivalent`.\nFor example codes indicating: Co-Pay, deductible, eligible, benefit, tax, etc."
}
]
},
{
"code": "ClaimResponse.total.amount",
"display": "amount",
"target": [
{
"code": "ClaimResponse.total.amount",
"display": "ClaimResponse.total.amount",
"equivalence": "equivalent",
"comment": "Element `ClaimResponse.total.amount` is mapped to FHIR R4 element `ClaimResponse.total.amount` as `Equivalent`."
}
]
},
{
"code": "ClaimResponse.payment",
"display": "payment",
"target": [
{
"code": "ClaimResponse.payment",
"display": "ClaimResponse.payment",
"equivalence": "wider",
"comment": "Element `ClaimResponse.payment` is mapped to FHIR R4 element `ClaimResponse.payment` as `Equivalent`."
}
]
},
{
"code": "ClaimResponse.payment.type",
"display": "type",
"target": [
{
"code": "ClaimResponse.payment.type",
"display": "ClaimResponse.payment.type",
"equivalence": "equivalent",
"comment": "Element `ClaimResponse.payment.type` is mapped to FHIR R4 element `ClaimResponse.payment.type` as `Equivalent`."
}
]
},
{
"code": "ClaimResponse.payment.adjustment",
"display": "adjustment",
"target": [
{
"code": "ClaimResponse.payment.adjustment",
"display": "ClaimResponse.payment.adjustment",
"equivalence": "equivalent",
"comment": "Element `ClaimResponse.payment.adjustment` is mapped to FHIR R4 element `ClaimResponse.payment.adjustment` as `Equivalent`.\nInsurers will deduct amounts owing from the provider (adjustment), such as a prior overpayment, from the amount owing to the provider (benefits payable) when payment is made to the provider."
}
]
},
{
"code": "ClaimResponse.payment.adjustmentReason",
"display": "adjustmentReason",
"target": [
{
"code": "ClaimResponse.payment.adjustmentReason",
"display": "ClaimResponse.payment.adjustmentReason",
"equivalence": "equivalent",
"comment": "Element `ClaimResponse.payment.adjustmentReason` is mapped to FHIR R4 element `ClaimResponse.payment.adjustmentReason` as `Equivalent`."
}
]
},
{
"code": "ClaimResponse.payment.date",
"display": "date",
"target": [
{
"code": "ClaimResponse.payment.date",
"display": "ClaimResponse.payment.date",
"equivalence": "equivalent",
"comment": "Element `ClaimResponse.payment.date` is mapped to FHIR R4 element `ClaimResponse.payment.date` as `Equivalent`."
}
]
},
{
"code": "ClaimResponse.payment.amount",
"display": "amount",
"target": [
{
"code": "ClaimResponse.payment.amount",
"display": "ClaimResponse.payment.amount",
"equivalence": "equivalent",
"comment": "Element `ClaimResponse.payment.amount` is mapped to FHIR R4 element `ClaimResponse.payment.amount` as `Equivalent`."
}
]
},
{
"code": "ClaimResponse.payment.identifier",
"display": "identifier",
"target": [
{
"code": "ClaimResponse.payment.identifier",
"display": "ClaimResponse.payment.identifier",
"equivalence": "equivalent",
"comment": "Element `ClaimResponse.payment.identifier` is mapped to FHIR R4 element `ClaimResponse.payment.identifier` as `Equivalent`.\nFor example: EFT number or check number."
}
]
},
{
"code": "ClaimResponse.fundsReserve",
"display": "fundsReserve",
"target": [
{
"code": "ClaimResponse.fundsReserve",
"display": "ClaimResponse.fundsReserve",
"equivalence": "equivalent",
"comment": "Element `ClaimResponse.fundsReserve` is mapped to FHIR R4 element `ClaimResponse.fundsReserve` as `Equivalent`.\nFund would be release by a future claim quoting the preAuthRef of this response. Examples of values include: provider, patient, none."
}
]
},
{
"code": "ClaimResponse.formCode",
"display": "formCode",
"target": [
{
"code": "ClaimResponse.formCode",
"display": "ClaimResponse.formCode",
"equivalence": "equivalent",
"comment": "Element `ClaimResponse.formCode` is mapped to FHIR R4 element `ClaimResponse.formCode` as `Equivalent`.\nMay be needed to identify specific jurisdictional forms."
}
]
},
{
"code": "ClaimResponse.form",
"display": "form",
"target": [
{
"code": "ClaimResponse.form",
"display": "ClaimResponse.form",
"equivalence": "equivalent",
"comment": "Element `ClaimResponse.form` is mapped to FHIR R4 element `ClaimResponse.form` as `Equivalent`.\nNeeded to permit insurers to include the actual form."
}
]
},
{
"code": "ClaimResponse.processNote",
"display": "processNote",
"target": [
{
"code": "ClaimResponse.processNote",
"display": "ClaimResponse.processNote",
"equivalence": "wider",
"comment": "Element `ClaimResponse.processNote` is mapped to FHIR R4 element `ClaimResponse.processNote` as `Equivalent`."
}
]
},
{
"code": "ClaimResponse.processNote.number",
"display": "number",
"target": [
{
"code": "ClaimResponse.processNote.number",
"display": "ClaimResponse.processNote.number",
"equivalence": "equivalent",
"comment": "Element `ClaimResponse.processNote.number` is mapped to FHIR R4 element `ClaimResponse.processNote.number` as `Equivalent`."
}
]
},
{
"code": "ClaimResponse.processNote.type",
"display": "type",
"target": [
{
"code": "ClaimResponse.processNote.type",
"display": "ClaimResponse.processNote.type",
"equivalence": "equivalent",
"comment": "Element `ClaimResponse.processNote.type` is mapped to FHIR R4 element `ClaimResponse.processNote.type` as `Equivalent`."
}
]
},
{
"code": "ClaimResponse.processNote.text",
"display": "text",
"target": [
{
"code": "ClaimResponse.processNote.text",
"display": "ClaimResponse.processNote.text",
"equivalence": "equivalent",
"comment": "Element `ClaimResponse.processNote.text` is mapped to FHIR R4 element `ClaimResponse.processNote.text` as `Equivalent`."
}
]
},
{
"code": "ClaimResponse.processNote.language",
"display": "language",
"target": [
{
"code": "ClaimResponse.processNote.language",
"display": "ClaimResponse.processNote.language",
"equivalence": "equivalent",
"comment": "Element `ClaimResponse.processNote.language` is mapped to FHIR R4 element `ClaimResponse.processNote.language` as `Equivalent`.\nOnly required if the language is different from the resource language."
}
]
},
{
"code": "ClaimResponse.communicationRequest",
"display": "communicationRequest",
"target": [
{
"code": "ClaimResponse.communicationRequest",
"display": "ClaimResponse.communicationRequest",
"equivalence": "equivalent",
"comment": "Element `ClaimResponse.communicationRequest` is mapped to FHIR R4 element `ClaimResponse.communicationRequest` as `Equivalent`.\nFor example: professional reports, documents, images, clinical resources, or accident reports."
}
]
},
{
"code": "ClaimResponse.insurance",
"display": "insurance",
"target": [
{
"code": "ClaimResponse.insurance",
"display": "ClaimResponse.insurance",
"equivalence": "wider",
"comment": "Element `ClaimResponse.insurance` is mapped to FHIR R4 element `ClaimResponse.insurance` as `Equivalent`.\nAll insurance coverages for the patient which may be applicable for reimbursement, of the products and services listed in the claim, are typically provided in the claim to allow insurers to confirm the ordering of the insurance coverages relative to local 'coordination of benefit' rules. One coverage (and only one) with 'focal=true' is to be used in the adjudication of this claim. Coverages appearing before the focal Coverage in the list, and where 'subrogation=false', should provide a reference to the ClaimResponse containing the adjudication results of the prior claim."
}
]
},
{
"code": "ClaimResponse.insurance.sequence",
"display": "sequence",
"target": [
{
"code": "ClaimResponse.insurance.sequence",
"display": "ClaimResponse.insurance.sequence",
"equivalence": "equivalent",
"comment": "Element `ClaimResponse.insurance.sequence` is mapped to FHIR R4 element `ClaimResponse.insurance.sequence` as `Equivalent`."
}
]
},
{
"code": "ClaimResponse.insurance.focal",
"display": "focal",
"target": [
{
"code": "ClaimResponse.insurance.focal",
"display": "ClaimResponse.insurance.focal",
"equivalence": "equivalent",
"comment": "Element `ClaimResponse.insurance.focal` is mapped to FHIR R4 element `ClaimResponse.insurance.focal` as `Equivalent`.\nA patient may (will) have multiple insurance policies which provide reimbursement for healthcare services and products. For example a person may also be covered by their spouse's policy and both appear in the list (and may be from the same insurer). This flag will be set to true for only one of the listed policies and that policy will be used for adjudicating this claim. Other claims would be created to request adjudication against the other listed policies."
}
]
},
{
"code": "ClaimResponse.insurance.coverage",
"display": "coverage",
"target": [
{
"code": "ClaimResponse.insurance.coverage",
"display": "ClaimResponse.insurance.coverage",
"equivalence": "equivalent",
"comment": "Element `ClaimResponse.insurance.coverage` is mapped to FHIR R4 element `ClaimResponse.insurance.coverage` as `Equivalent`."
}
]
},
{
"code": "ClaimResponse.insurance.businessArrangement",
"display": "businessArrangement",
"target": [
{
"code": "ClaimResponse.insurance.businessArrangement",
"display": "ClaimResponse.insurance.businessArrangement",
"equivalence": "equivalent",
"comment": "Element `ClaimResponse.insurance.businessArrangement` is mapped to FHIR R4 element `ClaimResponse.insurance.businessArrangement` as `Equivalent`."
}
]
},
{
"code": "ClaimResponse.insurance.claimResponse",
"display": "claimResponse",
"target": [
{
"code": "ClaimResponse.insurance.claimResponse",
"display": "ClaimResponse.insurance.claimResponse",
"equivalence": "equivalent",
"comment": "Element `ClaimResponse.insurance.claimResponse` is mapped to FHIR R4 element `ClaimResponse.insurance.claimResponse` as `Equivalent`.\nMust not be specified when 'focal=true' for this insurance."
}
]
},
{
"code": "ClaimResponse.error",
"display": "error",
"target": [
{
"code": "ClaimResponse.error",
"display": "ClaimResponse.error",
"equivalence": "wider",
"comment": "Element `ClaimResponse.error` is mapped to FHIR R4 element `ClaimResponse.error` as `Equivalent`.\nIf the request contains errors then an error element should be provided and no adjudication related sections (item, addItem, or payment) should be present."
}
]
},
{
"code": "ClaimResponse.error.itemSequence",
"display": "itemSequence",
"target": [
{
"code": "ClaimResponse.error.itemSequence",
"display": "ClaimResponse.error.itemSequence",
"equivalence": "equivalent",
"comment": "Element `ClaimResponse.error.itemSequence` is mapped to FHIR R4 element `ClaimResponse.error.itemSequence` as `Equivalent`."
}
]
},
{
"code": "ClaimResponse.error.detailSequence",
"display": "detailSequence",
"target": [
{
"code": "ClaimResponse.error.detailSequence",
"display": "ClaimResponse.error.detailSequence",
"equivalence": "equivalent",
"comment": "Element `ClaimResponse.error.detailSequence` is mapped to FHIR R4 element `ClaimResponse.error.detailSequence` as `Equivalent`."
}
]
},
{
"code": "ClaimResponse.error.subDetailSequence",
"display": "subDetailSequence",
"target": [
{
"code": "ClaimResponse.error.subDetailSequence",
"display": "ClaimResponse.error.subDetailSequence",
"equivalence": "equivalent",
"comment": "Element `ClaimResponse.error.subDetailSequence` is mapped to FHIR R4 element `ClaimResponse.error.subDetailSequence` as `Equivalent`."
}
]
},
{
"code": "ClaimResponse.error.code",
"display": "code",
"target": [
{
"code": "ClaimResponse.error.code",
"display": "ClaimResponse.error.code",
"equivalence": "equivalent",
"comment": "Element `ClaimResponse.error.code` is mapped to FHIR R4 element `ClaimResponse.error.code` as `Equivalent`."
}
]
}
]
}
]
}