FHIR IG analytics| Package | pharmacyeclaim.trial |
| Resource Type | StructureDefinition |
| Id | profile-parameters-OUT-AdjudicationDetails.StructureDefinition.json |
| FHIR Version | R4 |
| Source | https://simplifier.net/resolve?scope=pharmacyeclaim.trial@1.0.0-trial-preview&canonical=http://pharmacyeclaims.ca/FHIR/v1.0/StructureDefinition/profile-parameters-OUT-AdjudicationDetails |
| URL | http://pharmacyeclaims.ca/FHIR/v1.0/StructureDefinition/profile-parameters-OUT-AdjudicationDetails |
| Status | draft |
| Name | AdjudicationDetailsOUT |
| Description | The response to a request for Adjudication Details |
| Type | Parameters |
| Kind | resource |
| StructureDefinition | |
| profile-message-header-response | Message Header Response |
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FHIR
FHIRsmith{
"resourceType": "StructureDefinition",
"id": "profile-parameters-OUT-AdjudicationDetails",
"url": "http://pharmacyeclaims.ca/FHIR/v1.0/StructureDefinition/profile-parameters-OUT-AdjudicationDetails",
"name": "AdjudicationDetailsOUT",
"status": "draft",
"description": "The response to a request for Adjudication Details",
"fhirVersion": "4.0.1",
"kind": "resource",
"abstract": false,
"type": "Parameters",
"baseDefinition": "http://hl7.org/fhir/StructureDefinition/Parameters",
"derivation": "constraint",
"differential": {
"element": [
{
"id": "Parameters.parameter",
"path": "Parameters.parameter",
"slicing": {
"discriminator": [
{
"type": "value",
"path": "name"
}
],
"rules": "open"
},
"min": 1,
"mustSupport": true
},
{
"id": "Parameters.parameter:TraceNumber",
"path": "Parameters.parameter",
"sliceName": "TraceNumber",
"min": 1,
"max": "1",
"mustSupport": true
},
{
"id": "Parameters.parameter:TraceNumber.name",
"path": "Parameters.parameter.name",
"fixedString": "TraceNumber",
"mustSupport": true
},
{
"id": "Parameters.parameter:TraceNumber.value[x]",
"path": "Parameters.parameter.value[x]",
"min": 1,
"type": [
{
"code": "Identifier"
}
],
"mustSupport": true
},
{
"id": "Parameters.parameter:ReferenceNumber",
"path": "Parameters.parameter",
"sliceName": "ReferenceNumber",
"comment": "Usage: The adjudicators reference number for this response\r\nCPHA3: no mapping",
"min": 1,
"max": "1",
"mustSupport": true
},
{
"id": "Parameters.parameter:ReferenceNumber.name",
"path": "Parameters.parameter.name",
"fixedString": "ReferenceNumber",
"mustSupport": true
},
{
"id": "Parameters.parameter:ResponseStatus",
"path": "Parameters.parameter",
"sliceName": "ResponseStatus",
"comment": "This indicates the status of the request transmitted. \r\nZ=detailed record as requested\r\nR=request rejected",
"min": 1,
"max": "1",
"mustSupport": true
},
{
"id": "Parameters.parameter:ResponseStatus.name",
"path": "Parameters.parameter.name",
"fixedString": "ResponseStatus",
"mustSupport": true
},
{
"id": "Parameters.parameter:ResponseStatus.value[x]",
"path": "Parameters.parameter.value[x]",
"min": 1,
"type": [
{
"code": "code"
}
],
"mustSupport": true
},
{
"id": "Parameters.parameter:ResponseCodes",
"path": "Parameters.parameter",
"sliceName": "ResponseCodes",
"comment": "Usage Note: Codes to define responses that identify errors and other reasons that may cause the request to be rejected. \r\nUsage Note: A maximum of 5 codes supported for backward compatibility. \r\nCPHA Map: E.06.03",
"mustSupport": true
},
{
"id": "Parameters.parameter:ResponseCodes.name",
"path": "Parameters.parameter.name",
"fixedString": "ResponseCodes",
"mustSupport": true
},
{
"id": "Parameters.parameter:ResponseCodes.value[x]",
"path": "Parameters.parameter.value[x]",
"min": 1,
"type": [
{
"code": "code"
}
],
"mustSupport": true
},
{
"id": "Parameters.parameter:TotalDetailRecordCount",
"path": "Parameters.parameter",
"sliceName": "TotalDetailRecordCount",
"comment": "Usage Note: The Total Amount of records for the requested period; the sum of claims paid and reversals.\r\nConformance: Adjudicators must cap the number of records to the maximum identified in the query request in the \"MaxRecordsResponse\" field. If the amount of records exceeds this, FHIR paging must be used. \r\nCPHA Map: Number of Detail Records H.65.03 is a loose mappng, however this query is not backward compatibile to CPHA3 as there is no 14 record maximum in FHIR.",
"max": "1",
"mustSupport": true
},
{
"id": "Parameters.parameter:TotalDetailRecordCount.name",
"path": "Parameters.parameter.name",
"fixedString": "TotalDetailRecordCount",
"mustSupport": true
},
{
"id": "Parameters.parameter:TotalDetailRecordCount.value[x]",
"path": "Parameters.parameter.value[x]",
"min": 1,
"type": [
{
"code": "Money"
}
],
"mustSupport": true
},
{
"id": "Parameters.parameter:TimePeriod",
"path": "Parameters.parameter",
"sliceName": "TimePeriod",
"comment": "Usage Note: Identifies the Time Period covered by this request; will match the time period in the Request for Details\r\nCPHA3: No mapping",
"max": "1"
},
{
"id": "Parameters.parameter:TimePeriod.name",
"path": "Parameters.parameter.name",
"fixedString": "StartDate",
"mustSupport": true
},
{
"id": "Parameters.parameter:TimePeriod.value[x]",
"path": "Parameters.parameter.value[x]",
"min": 1,
"type": [
{
"code": "Period"
}
],
"mustSupport": true
},
{
"id": "Parameters.parameter:ReversalTotalAmtForPeriod",
"path": "Parameters.parameter",
"sliceName": "ReversalTotalAmtForPeriod",
"comment": "Usage Note: Reversal Total For the specified Period",
"max": "1",
"mustSupport": true
},
{
"id": "Parameters.parameter:ReversalTotalAmtForPeriod.name",
"path": "Parameters.parameter.name",
"fixedString": "ReversalTotalAmtForPeriod",
"mustSupport": true
},
{
"id": "Parameters.parameter:ReversalTotalAmtForPeriod.value[x]",
"path": "Parameters.parameter.value[x]",
"type": [
{
"code": "Money"
}
],
"mustSupport": true
},
{
"id": "Parameters.parameter:ClaimTotalAmtForPeriod",
"path": "Parameters.parameter",
"sliceName": "ClaimTotalAmtForPeriod",
"comment": "Usage: Claim Total For specified Period",
"max": "1",
"mustSupport": true
},
{
"id": "Parameters.parameter:ClaimTotalAmtForPeriod.name",
"path": "Parameters.parameter.name",
"fixedString": "ClaimTotalAmtForPeriod",
"mustSupport": true
},
{
"id": "Parameters.parameter:ClaimTotalAmtForPeriod.value[x]",
"path": "Parameters.parameter.value[x]",
"min": 1,
"type": [
{
"code": "Money"
}
],
"mustSupport": true
},
{
"id": "Parameters.parameter:DetailedRecordByDate",
"path": "Parameters.parameter",
"sliceName": "DetailedRecordByDate",
"comment": "Conformance Rule: This provides a breakdown of records by date. This repeats for each date in the query time period specified. Adjudication Date, eg YYYYMMDD.\r\nCPHA Map: AdjudicationDate E.01.03. Not present in CPHA3 response as only a single date can be identified as part of the query criteria",
"mustSupport": true
},
{
"id": "Parameters.parameter:DetailedRecordByDate.name",
"path": "Parameters.parameter.name",
"comment": "Usage Note: Name should be \"Record Details\". This may also be used to sort by date, eg \"YYYYMMDD\", where RecordDetails may repeat for each day within the time period requested.\r\n\r\nNote that FHIR strings SHALL NOT exceed 1MB in size",
"fixedString": "AdjudicationDate",
"mustSupport": true
},
{
"id": "Parameters.parameter:DetailedRecordByDate.value[x]",
"path": "Parameters.parameter.value[x]",
"comment": "Conformance: This must be populated with the Adjudication date that the details apply to.\r\nThis is the date assigned by the processor \r\nCPHA Map: E.01.03",
"min": 1,
"type": [
{
"code": "dateTime"
}
],
"mustSupport": true
},
{
"id": "Parameters.parameter:DetailedRecordByDate.part",
"path": "Parameters.parameter.part",
"slicing": {
"discriminator": [
{
"type": "value",
"path": "name"
}
],
"description": "Usage Note: This provides a breakdown for each date requested.",
"rules": "open"
},
"comment": "Usage Note: This represents a single record within the date specified.\r\n\r\nOnly one level of nested parameters is allowed.",
"min": 1,
"mustSupport": true
},
{
"id": "Parameters.parameter:DetailedRecordByDate.part:CurrentRXNumber",
"path": "Parameters.parameter.part",
"sliceName": "CurrentRXNumber",
"comment": "CPHA Map: Prescription Numbers D.55.03\r\nOnly one level of nested parameters is allowed.",
"min": 1,
"max": "1",
"mustSupport": true
},
{
"id": "Parameters.parameter:DetailedRecordByDate.part:CurrentRXNumber.name",
"path": "Parameters.parameter.part.name",
"fixedString": "CurrentRXNumber",
"mustSupport": true
},
{
"id": "Parameters.parameter:DetailedRecordByDate.part:CurrentRXNumber.value[x]",
"path": "Parameters.parameter.part.value[x]",
"min": 1,
"type": [
{
"code": "Identifier"
}
],
"mustSupport": true
},
{
"id": "Parameters.parameter:DetailedRecordByDate.part:TraceNumber",
"path": "Parameters.parameter.part",
"sliceName": "TraceNumber",
"comment": "Usage Note: This is the trace number corresponding with the Adjuidcated detailed record\r\nCPHA3: not returned in the query response\r\n\r\nOnly one level of nested parameters is allowed.",
"max": "1",
"mustSupport": true
},
{
"id": "Parameters.parameter:DetailedRecordByDate.part:TraceNumber.name",
"path": "Parameters.parameter.part.name",
"fixedString": "TraceNumber",
"mustSupport": true
},
{
"id": "Parameters.parameter:DetailedRecordByDate.part:TraceNumber.value[x]",
"path": "Parameters.parameter.part.value[x]",
"comment": "Usage Note: Only the identifier.value is required.",
"min": 1,
"type": [
{
"code": "Identifier"
}
],
"mustSupport": true
},
{
"id": "Parameters.parameter:DetailedRecordByDate.part:AmountPayableReversedPatient",
"path": "Parameters.parameter.part",
"sliceName": "AmountPayableReversedPatient",
"comment": "Conformance Rule: One of Amount Paid to Pharmacy or Amount Paid to patient must be specified.\r\nUsage Note: For reversals, negative values are expressed as <value value=\"-25.00\"/>\r\nValue of individual claims or reversals as identified by prescription numbers \r\n\r\nOnly one level of nested parameters is allowed.",
"max": "1",
"mustSupport": true
},
{
"id": "Parameters.parameter:DetailedRecordByDate.part:AmountPayableReversedPatient.name",
"path": "Parameters.parameter.part.name",
"fixedString": "AmountPayable/ReversedPatient",
"mustSupport": true
},
{
"id": "Parameters.parameter:DetailedRecordByDate.part:AmountPayableReversedPatient.value[x]",
"path": "Parameters.parameter.part.value[x]",
"min": 1,
"type": [
{
"code": "Money"
}
],
"mustSupport": true
},
{
"id": "Parameters.parameter:DetailedRecordByDate.part:AmountPayableReversedPharmacy",
"path": "Parameters.parameter.part",
"sliceName": "AmountPayableReversedPharmacy",
"comment": "Conformance Rule: One of Amount Paid to Pharmacy or Amount Paid to patient must be specified.\r\nUsage Note: For reversals, negative values are expressed as <value value=\"-25.00\"/>\r\n\r\nOnly one level of nested parameters is allowed.",
"max": "1",
"mustSupport": true
},
{
"id": "Parameters.parameter:DetailedRecordByDate.part:AmountPayableReversedPharmacy.name",
"path": "Parameters.parameter.part.name",
"fixedString": "AmountPayable/ReversedPharmacy",
"mustSupport": true
},
{
"id": "Parameters.parameter:DetailedRecordByDate.part:AmountPayableReversedPharmacy.value[x]",
"path": "Parameters.parameter.part.value[x]",
"comment": "Value of individual claims or reversals as identified by prescription numbers",
"min": 1,
"type": [
{
"code": "Money"
}
],
"mustSupport": true
},
{
"id": "Parameters.parameter:DetailedRecordByDate.part:CarrierID",
"path": "Parameters.parameter.part",
"sliceName": "CarrierID",
"comment": "Usage Note: The carrier ID may be optionally specified. Useful if the query request criteria includes more than one carrier.\r\nOnly one level of nested parameters is allowed.",
"max": "1"
},
{
"id": "Parameters.parameter:DetailedRecordByDate.part:CarrierID.name",
"path": "Parameters.parameter.part.name",
"fixedString": "CarrierID",
"mustSupport": true
},
{
"id": "Parameters.parameter:DetailedRecordByDate.part:CarrierID.value[x]",
"path": "Parameters.parameter.part.value[x]",
"comment": "Conformance: Only the identifier.value is required.",
"min": 1,
"type": [
{
"code": "Identifier"
}
],
"mustSupport": true
}
]
}
}