FHIR IG analytics| Package | hl7.fhir.uv.xver-r5.r3 |
| Resource Type | StructureDefinition |
| Id | StructureDefinition-ext-R5-ClaimResponse.ite.reviewOutcome.json |
| FHIR Version | R3 |
No resources found
No resources found
Note: links and images are rebased to the (stated) source
Generated Narrative: StructureDefinition ext-R5-ClaimResponse.ite.reviewOutcome
| Name | Flags | Card. | Type | Description & Constraints |
|---|---|---|---|---|
  Extension | 0..1 | Extension | R5: Adjudication results (new) | |
  Slices for extension | 0..* | Extension | Extension Slice: Unordered, Open by value:url | |
   extension:decision | 0..1 | Extension | R5: Result of the adjudication (new) | |
  url | 1..1 | uri | "decision" | |
  value[x] | 0..1 | CodeableConcept | Result of the adjudication Binding: R5ClaimDecisionForR3 (0.1.0) (example) | |
| extension:reason | 0..* | Extension | R5: Reason for result of the adjudication (new) | |
| url | 1..1 | uri | "reason" | |
| value[x] | 0..1 | CodeableConcept | Reason for result of the adjudication Binding: R5ClaimDecisionReasonForR3 (0.1.0) (example) | |
| extension:preAuthRef | 0..1 | Extension | R5: Preauthorization reference (new) | |
| url | 1..1 | uri | "preAuthRef" | |
 value[x] | 0..1 | string | Preauthorization reference | |
 extension:preAuthPeriod | 0..1 | Extension | R5: Preauthorization reference effective period (new) | |
 url | 1..1 | uri | "preAuthPeriod" | |
| value[x] | 0..1 | Period | Preauthorization reference effective period | |
| url | 1..1 | uri | "http://hl7.org/fhir/5.0/StructureDefinition/extension-ClaimResponse.item.reviewOutcome" | |
 value[x] | 0..0 | Value of extension | ||
| Documentation for this format | ||||
FHIR
FHIRsmith{
"resourceType": "StructureDefinition",
"id": "ext-R5-ClaimResponse.ite.reviewOutcome",
"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-r5.r3"
},
{
"url": "version",
"valueString": "0.1.0"
},
{
"url": "uri",
"valueUri": "http://hl7.org/fhir/uv/xver/ImplementationGuide/hl7.fhir.uv.xver-r5.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-r5.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-r5.r3"
}
]
}
}
],
"url": "http://hl7.org/fhir/5.0/StructureDefinition/extension-ClaimResponse.item.reviewOutcome",
"version": "0.1.0",
"name": "ExtensionClaimResponse_Item_ReviewOutcome",
"title": "R5: Adjudication results (new)",
"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": "R5: `ClaimResponse.item.reviewOutcome` (new:BackboneElement)",
"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.reviewOutcome` as defined in FHIR R5\r\nin FHIR STU3.\r\n\r\nThe source element is defined as:\r\n`ClaimResponse.item.reviewOutcome` 0..1 `BackboneElement`\r\n\r\nAcross FHIR versions, the element set has been mapped as:\r\n* R5: `ClaimResponse.item.reviewOutcome` 0..1 `BackboneElement`\r\n\r\nFollowing are the generation technical comments:\r\nElement `ClaimResponse.item.reviewOutcome` has a context of ClaimResponse.item based on following the parent source element upwards and mapping to `ClaimResponse`.\nElement `ClaimResponse.item.reviewOutcome` has no mapping targets in FHIR STU3. Typically, this is because the element has been added (is a new element).",
"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"
],
"type": "Extension",
"baseDefinition": "http://hl7.org/fhir/StructureDefinition/Extension",
"derivation": "constraint",
"snapshot": {
"element": [
{
"id": "Extension",
"path": "Extension",
"short": "R5: Adjudication results (new)",
"definition": "R5: `ClaimResponse.item.reviewOutcome` (new:BackboneElement)",
"comment": "Element `ClaimResponse.item.reviewOutcome` has a context of ClaimResponse.item based on following the parent source element upwards and mapping to `ClaimResponse`.\nElement `ClaimResponse.item.reviewOutcome` has no mapping targets in FHIR STU3. Typically, this is because the element has been added (is a new element).",
"min": 0,
"max": "1",
"base": {
"path": "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": 0,
"max": "*",
"base": {
"path": "Element.extension",
"min": 0,
"max": "*"
},
"type": [
{
"code": "Extension"
}
]
},
{
"id": "Extension.extension:decision",
"path": "Extension.extension",
"sliceName": "decision",
"short": "R5: Result of the adjudication (new)",
"definition": "R5: `ClaimResponse.item.reviewOutcome.decision` (new:CodeableConcept)",
"comment": "Element `ClaimResponse.item.reviewOutcome.decision` is part of an existing definition because parent element `ClaimResponse.item.reviewOutcome` requires a cross-version extension.\nElement `ClaimResponse.item.reviewOutcome.decision` has a context of ClaimResponse.item based on following the parent source element upwards and mapping to `ClaimResponse`.\nElement `ClaimResponse.item.reviewOutcome.decision` has no mapping targets in FHIR STU3. Typically, this is because the element has been added (is a new element).\nThe element is used to indicate the current state of the adjudication overall for the claim resource, for example: the request has been held (pended) for adjudication processing, for manual review or other reasons; that it has been processed and will be paid, or the outstanding paid, as submitted (approved); that no amount will be paid (denied); or that some amount between zero and the submitted amount will be paid (partial).",
"requirements": "To advise the requestor of the result of the adjudication process. Element `ClaimResponse.item.reviewOutcome.decision` is part of an existing definition because parent element `ClaimResponse.item.reviewOutcome` requires a cross-version extension.\nElement `ClaimResponse.item.reviewOutcome.decision` has a context of ClaimResponse.item based on following the parent source element upwards and mapping to `ClaimResponse`.\nElement `ClaimResponse.item.reviewOutcome.decision` has no mapping targets in FHIR STU3. Typically, this is because the element has been added (is a new element).",
"min": 0,
"max": "1",
"base": {
"path": "Element.extension",
"min": 0,
"max": "*"
},
"type": [
{
"code": "Extension"
}
]
},
{
"id": "Extension.extension:decision.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:decision.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:decision.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": "decision",
"mapping": [
{
"identity": "rim",
"map": "N/A"
}
]
},
{
"id": "Extension.extension:decision.value[x]",
"path": "Extension.extension.value[x]",
"short": "Result of the adjudication",
"definition": "The result of the claim, predetermination, or preauthorization adjudication.",
"comment": "The element is used to indicate the current state of the adjudication overall for the claim resource, for example: the request has been held (pended) for adjudication processing, for manual review or other reasons; that it has been processed and will be paid, or the outstanding paid, as submitted (approved); that no amount will be paid (denied); or that some amount between zero and the submitted amount will be paid (partial).",
"min": 0,
"max": "1",
"base": {
"path": "Extension.value[x]",
"min": 0,
"max": "1"
},
"type": [
{
"code": "CodeableConcept"
}
],
"binding": {
"strength": "example",
"valueSetUri": "http://hl7.org/fhir/uv/xver/ValueSet/R5-claim-decision-for-R3|0.1.0"
},
"mapping": [
{
"identity": "rim",
"map": "N/A"
}
]
},
{
"id": "Extension.extension:reason",
"path": "Extension.extension",
"sliceName": "reason",
"short": "R5: Reason for result of the adjudication (new)",
"definition": "R5: `ClaimResponse.item.reviewOutcome.reason` (new:CodeableConcept)",
"comment": "Element `ClaimResponse.item.reviewOutcome.reason` is part of an existing definition because parent element `ClaimResponse.item.reviewOutcome` requires a cross-version extension.\nElement `ClaimResponse.item.reviewOutcome.reason` has a context of ClaimResponse.item based on following the parent source element upwards and mapping to `ClaimResponse`.\nElement `ClaimResponse.item.reviewOutcome.reason` has no mapping targets in FHIR STU3. Typically, this is because the element has been added (is a new element).",
"requirements": "To advise the requestor of the contributors to the result of the adjudication process. Element `ClaimResponse.item.reviewOutcome.reason` is part of an existing definition because parent element `ClaimResponse.item.reviewOutcome` requires a cross-version extension.\nElement `ClaimResponse.item.reviewOutcome.reason` has a context of ClaimResponse.item based on following the parent source element upwards and mapping to `ClaimResponse`.\nElement `ClaimResponse.item.reviewOutcome.reason` has no mapping targets in FHIR STU3. Typically, this is because the element has been added (is a new element).",
"min": 0,
"max": "*",
"base": {
"path": "Element.extension",
"min": 0,
"max": "*"
},
"type": [
{
"code": "Extension"
}
]
},
{
"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": "Reason for result of the adjudication",
"definition": "The reasons for the result of the claim, predetermination, or preauthorization adjudication.",
"min": 0,
"max": "1",
"base": {
"path": "Extension.value[x]",
"min": 0,
"max": "1"
},
"type": [
{
"code": "CodeableConcept"
}
],
"binding": {
"strength": "example",
"valueSetUri": "http://hl7.org/fhir/uv/xver/ValueSet/R5-claim-decision-reason-for-R3|0.1.0"
},
"mapping": [
{
"identity": "rim",
"map": "N/A"
}
]
},
{
"id": "Extension.extension:preAuthRef",
"path": "Extension.extension",
"sliceName": "preAuthRef",
"short": "R5: Preauthorization reference (new)",
"definition": "R5: `ClaimResponse.item.reviewOutcome.preAuthRef` (new:string)",
"comment": "Element `ClaimResponse.item.reviewOutcome.preAuthRef` is part of an existing definition because parent element `ClaimResponse.item.reviewOutcome` requires a cross-version extension.\nElement `ClaimResponse.item.reviewOutcome.preAuthRef` has a context of ClaimResponse.item based on following the parent source element upwards and mapping to `ClaimResponse`.\nElement `ClaimResponse.item.reviewOutcome.preAuthRef` has no mapping targets in FHIR STU3. Typically, this is because the element has been added (is a new element).\nThis value is only present on preauthorization adjudications.",
"requirements": "On subsequent claims, the insurer may require the provider to quote this value. Element `ClaimResponse.item.reviewOutcome.preAuthRef` is part of an existing definition because parent element `ClaimResponse.item.reviewOutcome` requires a cross-version extension.\nElement `ClaimResponse.item.reviewOutcome.preAuthRef` has a context of ClaimResponse.item based on following the parent source element upwards and mapping to `ClaimResponse`.\nElement `ClaimResponse.item.reviewOutcome.preAuthRef` has no mapping targets in FHIR STU3. Typically, this is because the element has been added (is a new element).",
"min": 0,
"max": "1",
"base": {
"path": "Element.extension",
"min": 0,
"max": "*"
},
"type": [
{
"code": "Extension"
}
]
},
{
"id": "Extension.extension:preAuthRef.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:preAuthRef.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:preAuthRef.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": "preAuthRef",
"mapping": [
{
"identity": "rim",
"map": "N/A"
}
]
},
{
"id": "Extension.extension:preAuthRef.value[x]",
"path": "Extension.extension.value[x]",
"short": "Preauthorization reference",
"definition": "Reference from the Insurer which is used in later communications which refers to this adjudication.",
"comment": "This value is only present on preauthorization adjudications.",
"min": 0,
"max": "1",
"base": {
"path": "Extension.value[x]",
"min": 0,
"max": "1"
},
"type": [
{
"code": "string"
}
],
"mapping": [
{
"identity": "rim",
"map": "N/A"
}
]
},
{
"id": "Extension.extension:preAuthPeriod",
"path": "Extension.extension",
"sliceName": "preAuthPeriod",
"short": "R5: Preauthorization reference effective period (new)",
"definition": "R5: `ClaimResponse.item.reviewOutcome.preAuthPeriod` (new:Period)",
"comment": "Element `ClaimResponse.item.reviewOutcome.preAuthPeriod` is part of an existing definition because parent element `ClaimResponse.item.reviewOutcome` requires a cross-version extension.\nElement `ClaimResponse.item.reviewOutcome.preAuthPeriod` has a context of ClaimResponse.item based on following the parent source element upwards and mapping to `ClaimResponse`.\nElement `ClaimResponse.item.reviewOutcome.preAuthPeriod` has no mapping targets in FHIR STU3. Typically, this is because the element has been added (is a new element).",
"requirements": "To convey to the provider when the authorized products and services must be supplied for the authorized adjudication to apply. Element `ClaimResponse.item.reviewOutcome.preAuthPeriod` is part of an existing definition because parent element `ClaimResponse.item.reviewOutcome` requires a cross-version extension.\nElement `ClaimResponse.item.reviewOutcome.preAuthPeriod` has a context of ClaimResponse.item based on following the parent source element upwards and mapping to `ClaimResponse`.\nElement `ClaimResponse.item.reviewOutcome.preAuthPeriod` has no mapping targets in FHIR STU3. Typically, this is because the element has been added (is a new element).",
"min": 0,
"max": "1",
"base": {
"path": "Element.extension",
"min": 0,
"max": "*"
},
"type": [
{
"code": "Extension"
}
]
},
{
"id": "Extension.extension:preAuthPeriod.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:preAuthPeriod.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:preAuthPeriod.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": "preAuthPeriod",
"mapping": [
{
"identity": "rim",
"map": "N/A"
}
]
},
{
"id": "Extension.extension:preAuthPeriod.value[x]",
"path": "Extension.extension.value[x]",
"short": "Preauthorization reference effective period",
"definition": "The time frame during which this authorization is effective.",
"min": 0,
"max": "1",
"base": {
"path": "Extension.value[x]",
"min": 0,
"max": "1"
},
"type": [
{
"code": "Period"
}
],
"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/5.0/StructureDefinition/extension-ClaimResponse.item.reviewOutcome",
"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": "R5: Adjudication results (new)",
"definition": "R5: `ClaimResponse.item.reviewOutcome` (new:BackboneElement)",
"comment": "Element `ClaimResponse.item.reviewOutcome` has a context of ClaimResponse.item based on following the parent source element upwards and mapping to `ClaimResponse`.\nElement `ClaimResponse.item.reviewOutcome` has no mapping targets in FHIR STU3. Typically, this is because the element has been added (is a new element).",
"min": 0,
"max": "1",
"base": {
"path": "Extension",
"min": 0,
"max": "*"
},
"isModifier": false
},
{
"id": "Extension.extension",
"path": "Extension.extension",
"slicing": {
"discriminator": [
{
"type": "value",
"path": "url"
}
],
"ordered": false,
"rules": "open"
},
"min": 0,
"max": "*",
"base": {
"path": "Extension.extension",
"min": 0,
"max": "*"
}
},
{
"id": "Extension.extension:decision",
"path": "Extension.extension",
"sliceName": "decision",
"short": "R5: Result of the adjudication (new)",
"definition": "R5: `ClaimResponse.item.reviewOutcome.decision` (new:CodeableConcept)",
"comment": "Element `ClaimResponse.item.reviewOutcome.decision` is part of an existing definition because parent element `ClaimResponse.item.reviewOutcome` requires a cross-version extension.\nElement `ClaimResponse.item.reviewOutcome.decision` has a context of ClaimResponse.item based on following the parent source element upwards and mapping to `ClaimResponse`.\nElement `ClaimResponse.item.reviewOutcome.decision` has no mapping targets in FHIR STU3. Typically, this is because the element has been added (is a new element).\nThe element is used to indicate the current state of the adjudication overall for the claim resource, for example: the request has been held (pended) for adjudication processing, for manual review or other reasons; that it has been processed and will be paid, or the outstanding paid, as submitted (approved); that no amount will be paid (denied); or that some amount between zero and the submitted amount will be paid (partial).",
"requirements": "To advise the requestor of the result of the adjudication process. Element `ClaimResponse.item.reviewOutcome.decision` is part of an existing definition because parent element `ClaimResponse.item.reviewOutcome` requires a cross-version extension.\nElement `ClaimResponse.item.reviewOutcome.decision` has a context of ClaimResponse.item based on following the parent source element upwards and mapping to `ClaimResponse`.\nElement `ClaimResponse.item.reviewOutcome.decision` has no mapping targets in FHIR STU3. Typically, this is because the element has been added (is a new element).",
"min": 0,
"max": "1",
"base": {
"path": "Extension.extension",
"min": 0,
"max": "*"
}
},
{
"id": "Extension.extension:decision.url",
"path": "Extension.extension.url",
"min": 1,
"max": "1",
"base": {
"path": "Extension.url",
"min": 1,
"max": "1"
},
"fixedUri": "decision"
},
{
"id": "Extension.extension:decision.value[x]",
"path": "Extension.extension.value[x]",
"short": "Result of the adjudication",
"definition": "The result of the claim, predetermination, or preauthorization adjudication.",
"comment": "The element is used to indicate the current state of the adjudication overall for the claim resource, for example: the request has been held (pended) for adjudication processing, for manual review or other reasons; that it has been processed and will be paid, or the outstanding paid, as submitted (approved); that no amount will be paid (denied); or that some amount between zero and the submitted amount will be paid (partial).",
"min": 0,
"max": "1",
"base": {
"path": "Extension.value[x]",
"min": 0,
"max": "1"
},
"type": [
{
"code": "CodeableConcept"
}
],
"binding": {
"strength": "example",
"valueSetUri": "http://hl7.org/fhir/uv/xver/ValueSet/R5-claim-decision-for-R3|0.1.0"
}
},
{
"id": "Extension.extension:reason",
"path": "Extension.extension",
"sliceName": "reason",
"short": "R5: Reason for result of the adjudication (new)",
"definition": "R5: `ClaimResponse.item.reviewOutcome.reason` (new:CodeableConcept)",
"comment": "Element `ClaimResponse.item.reviewOutcome.reason` is part of an existing definition because parent element `ClaimResponse.item.reviewOutcome` requires a cross-version extension.\nElement `ClaimResponse.item.reviewOutcome.reason` has a context of ClaimResponse.item based on following the parent source element upwards and mapping to `ClaimResponse`.\nElement `ClaimResponse.item.reviewOutcome.reason` has no mapping targets in FHIR STU3. Typically, this is because the element has been added (is a new element).",
"requirements": "To advise the requestor of the contributors to the result of the adjudication process. Element `ClaimResponse.item.reviewOutcome.reason` is part of an existing definition because parent element `ClaimResponse.item.reviewOutcome` requires a cross-version extension.\nElement `ClaimResponse.item.reviewOutcome.reason` has a context of ClaimResponse.item based on following the parent source element upwards and mapping to `ClaimResponse`.\nElement `ClaimResponse.item.reviewOutcome.reason` has no mapping targets in FHIR STU3. Typically, this is because the element has been added (is a new element).",
"min": 0,
"max": "*",
"base": {
"path": "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": "Reason for result of the adjudication",
"definition": "The reasons for the result of the claim, predetermination, or preauthorization adjudication.",
"min": 0,
"max": "1",
"base": {
"path": "Extension.value[x]",
"min": 0,
"max": "1"
},
"type": [
{
"code": "CodeableConcept"
}
],
"binding": {
"strength": "example",
"valueSetUri": "http://hl7.org/fhir/uv/xver/ValueSet/R5-claim-decision-reason-for-R3|0.1.0"
}
},
{
"id": "Extension.extension:preAuthRef",
"path": "Extension.extension",
"sliceName": "preAuthRef",
"short": "R5: Preauthorization reference (new)",
"definition": "R5: `ClaimResponse.item.reviewOutcome.preAuthRef` (new:string)",
"comment": "Element `ClaimResponse.item.reviewOutcome.preAuthRef` is part of an existing definition because parent element `ClaimResponse.item.reviewOutcome` requires a cross-version extension.\nElement `ClaimResponse.item.reviewOutcome.preAuthRef` has a context of ClaimResponse.item based on following the parent source element upwards and mapping to `ClaimResponse`.\nElement `ClaimResponse.item.reviewOutcome.preAuthRef` has no mapping targets in FHIR STU3. Typically, this is because the element has been added (is a new element).\nThis value is only present on preauthorization adjudications.",
"requirements": "On subsequent claims, the insurer may require the provider to quote this value. Element `ClaimResponse.item.reviewOutcome.preAuthRef` is part of an existing definition because parent element `ClaimResponse.item.reviewOutcome` requires a cross-version extension.\nElement `ClaimResponse.item.reviewOutcome.preAuthRef` has a context of ClaimResponse.item based on following the parent source element upwards and mapping to `ClaimResponse`.\nElement `ClaimResponse.item.reviewOutcome.preAuthRef` has no mapping targets in FHIR STU3. Typically, this is because the element has been added (is a new element).",
"min": 0,
"max": "1",
"base": {
"path": "Extension.extension",
"min": 0,
"max": "*"
}
},
{
"id": "Extension.extension:preAuthRef.url",
"path": "Extension.extension.url",
"min": 1,
"max": "1",
"base": {
"path": "Extension.url",
"min": 1,
"max": "1"
},
"fixedUri": "preAuthRef"
},
{
"id": "Extension.extension:preAuthRef.value[x]",
"path": "Extension.extension.value[x]",
"short": "Preauthorization reference",
"definition": "Reference from the Insurer which is used in later communications which refers to this adjudication.",
"comment": "This value is only present on preauthorization adjudications.",
"min": 0,
"max": "1",
"base": {
"path": "Extension.value[x]",
"min": 0,
"max": "1"
},
"type": [
{
"code": "string"
}
]
},
{
"id": "Extension.extension:preAuthPeriod",
"path": "Extension.extension",
"sliceName": "preAuthPeriod",
"short": "R5: Preauthorization reference effective period (new)",
"definition": "R5: `ClaimResponse.item.reviewOutcome.preAuthPeriod` (new:Period)",
"comment": "Element `ClaimResponse.item.reviewOutcome.preAuthPeriod` is part of an existing definition because parent element `ClaimResponse.item.reviewOutcome` requires a cross-version extension.\nElement `ClaimResponse.item.reviewOutcome.preAuthPeriod` has a context of ClaimResponse.item based on following the parent source element upwards and mapping to `ClaimResponse`.\nElement `ClaimResponse.item.reviewOutcome.preAuthPeriod` has no mapping targets in FHIR STU3. Typically, this is because the element has been added (is a new element).",
"requirements": "To convey to the provider when the authorized products and services must be supplied for the authorized adjudication to apply. Element `ClaimResponse.item.reviewOutcome.preAuthPeriod` is part of an existing definition because parent element `ClaimResponse.item.reviewOutcome` requires a cross-version extension.\nElement `ClaimResponse.item.reviewOutcome.preAuthPeriod` has a context of ClaimResponse.item based on following the parent source element upwards and mapping to `ClaimResponse`.\nElement `ClaimResponse.item.reviewOutcome.preAuthPeriod` has no mapping targets in FHIR STU3. Typically, this is because the element has been added (is a new element).",
"min": 0,
"max": "1",
"base": {
"path": "Extension.extension",
"min": 0,
"max": "*"
}
},
{
"id": "Extension.extension:preAuthPeriod.url",
"path": "Extension.extension.url",
"min": 1,
"max": "1",
"base": {
"path": "Extension.url",
"min": 1,
"max": "1"
},
"fixedUri": "preAuthPeriod"
},
{
"id": "Extension.extension:preAuthPeriod.value[x]",
"path": "Extension.extension.value[x]",
"short": "Preauthorization reference effective period",
"definition": "The time frame during which this authorization is effective.",
"min": 0,
"max": "1",
"base": {
"path": "Extension.value[x]",
"min": 0,
"max": "1"
},
"type": [
{
"code": "Period"
}
]
},
{
"id": "Extension.url",
"path": "Extension.url",
"min": 1,
"max": "1",
"base": {
"path": "Extension.url",
"min": 1,
"max": "1"
},
"fixedUri": "http://hl7.org/fhir/5.0/StructureDefinition/extension-ClaimResponse.item.reviewOutcome"
},
{
"id": "Extension.value[x]",
"path": "Extension.value[x]",
"min": 0,
"max": "0",
"base": {
"path": "Extension.value[x]",
"min": 0,
"max": "1"
}
}
]
}
}