{ "resourceType": "StructureDefinition", "id": "profile-ClaimResponse", "url": "https://bpcs.exchange/fhir/StructureDefinition/profile-ClaimResponse", "name": "ClaimResponse", "title": "Claim Response", "status": "active", "experimental": false, "description": "The information returned by BPCS in response to a claims submission", "fhirVersion": "5.0.0", "mapping": [ { "identity": "BPCS", "name": "Internal BPCS API" } ], "kind": "resource", "abstract": true, "type": "ClaimResponse", "baseDefinition": "http://hl7.org/fhir/StructureDefinition/ClaimResponse", "derivation": "constraint", "snapshot": { "element": [ { "id": "ClaimResponse", "path": "ClaimResponse", "short": "Response to a claim predetermination or preauthorization", "definition": "This resource provides the adjudication details from the processing of a Claim resource.", "alias": [ "Remittance Advice" ], "min": 0, "max": "*", "base": { "path": "ClaimResponse", "min": 0, "max": "*" }, "constraint": [ { "key": "dom-2", "severity": "error", "human": "If the resource is contained in another resource, it SHALL NOT contain nested Resources", "expression": "contained.contained.empty()", "source": "http://hl7.org/fhir/StructureDefinition/DomainResource" }, { "key": "dom-4", "severity": "error", "human": "If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated", "expression": "contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()", "source": "http://hl7.org/fhir/StructureDefinition/DomainResource" }, { "key": "dom-3", "severity": "error", "human": "If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource", "expression": "contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().ofType(canonical) | %resource.descendants().ofType(uri) | %resource.descendants().ofType(url))) or descendants().where(reference = '#').exists() or descendants().where(ofType(canonical) = '#').exists() or descendants().where(ofType(canonical) = '#').exists()).not()).trace('unmatched', id).empty()", "source": "http://hl7.org/fhir/StructureDefinition/DomainResource" }, { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bestpractice", "valueBoolean": true }, { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bestpractice-explanation", "valueMarkdown": "When a resource has no narrative, only systems that fully understand the data can display the resource to a human safely. Including a human readable representation in the resource makes for a much more robust eco-system and cheaper handling of resources by intermediary systems. Some ecosystems restrict distribution of resources to only those systems that do fully understand the resources, and as a consequence implementers may believe that the narrative is superfluous. However experience shows that such eco-systems often open up to new participants over time." } ], "key": "dom-6", "severity": "warning", "human": "A resource should have narrative for robust management", "expression": "text.`div`.exists()", "source": "http://hl7.org/fhir/StructureDefinition/DomainResource" }, { "key": "dom-5", "severity": "error", "human": "If a resource is contained in another resource, it SHALL NOT have a security label", "expression": "contained.meta.security.empty()", "source": "http://hl7.org/fhir/StructureDefinition/DomainResource" } ], "mustSupport": false, "isModifier": false, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "rim", "map": "Entity. Role, or Act" }, { "identity": "rim", "map": "Entity, Role, or Act" }, { "identity": "workflow", "map": "Event" }, { "identity": "w5", "map": "financial.billing" } ] }, { "id": "ClaimResponse.id", "path": "ClaimResponse.id", "short": "Logical id of this artifact", "definition": "The logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes.", "comment": "Within the context of the FHIR RESTful interactions, the resource has an id except for cases like the create and conditional update. Otherwise, the use of the resouce id depends on the given use case.", "min": 0, "max": "1", "base": { "path": "Resource.id", "min": 0, "max": "1" }, "type": [ { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type", "valueUrl": "id" } ], "code": "http://hl7.org/fhirpath/System.String" } ], "mustSupport": false, "isModifier": false, "isSummary": true }, { "id": "ClaimResponse.meta", "path": "ClaimResponse.meta", "short": "Metadata about the resource", "definition": "The metadata about the resource. This is content that is maintained by the infrastructure. Changes to the content might not always be associated with version changes to the resource.", "min": 0, "max": "1", "base": { "path": "Resource.meta", "min": 0, "max": "1" }, "type": [ { "code": "Meta" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "mustSupport": false, "isModifier": false, "isSummary": true, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "rim", "map": "N/A" } ] }, { "id": "ClaimResponse.implicitRules", "path": "ClaimResponse.implicitRules", "short": "A set of rules under which this content was created", "definition": "A reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content. Often, this is a reference to an implementation guide that defines the special rules along with other profiles etc.", "comment": "Asserting this rule set restricts the content to be only understood by a limited set of trading partners. This inherently limits the usefulness of the data in the long term. However, the existing health eco-system is highly fractured, and not yet ready to define, collect, and exchange data in a generally computable sense. Wherever possible, implementers and/or specification writers should avoid using this element. Often, when used, the URL is a reference to an implementation guide that defines these special rules as part of its narrative along with other profiles, value sets, etc.", "min": 0, "max": "1", "base": { "path": "Resource.implicitRules", "min": 0, "max": "1" }, "type": [ { "code": "uri" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "mustSupport": false, "isModifier": true, "isModifierReason": "This element is labeled as a modifier because the implicit rules may provide additional knowledge about the resource that modifies its meaning or interpretation", "isSummary": true, "mapping": [ { "identity": "rim", "map": "n/a" } ] }, { "id": "ClaimResponse.language", "path": "ClaimResponse.language", "short": "Language of the resource content", "definition": "The base language in which the resource is written.", "comment": "Language is provided to support indexing and accessibility (typically, services such as text to speech use the language tag). The html language tag in the narrative applies to the narrative. The language tag on the resource may be used to specify the language of other presentations generated from the data in the resource. Not all the content has to be in the base language. The Resource.language should not be assumed to apply to the narrative automatically. If a language is specified, it should it also be specified on the div element in the html (see rules in HTML5 for information about the relationship between xml:lang and the html lang attribute).", "min": 0, "max": "1", "base": { "path": "Resource.language", "min": 0, "max": "1" }, "type": [ { "code": "code" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "mustSupport": false, "isModifier": false, "isSummary": false, "binding": { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString": "Language" } ], "strength": "required", "description": "IETF language tag for a human language", "valueSet": "http://hl7.org/fhir/ValueSet/all-languages|5.0.0", "additional": [ { "purpose": "starter", "valueSet": "http://hl7.org/fhir/ValueSet/languages" } ] }, "mapping": [ { "identity": "rim", "map": "n/a" } ] }, { "id": "ClaimResponse.text", "path": "ClaimResponse.text", "short": "Text summary of the resource, for human interpretation", "definition": "A human-readable narrative that contains a summary of the resource and can be used to represent the content of the resource to a human. The narrative need not encode all the structured data, but is required to contain sufficient detail to make it \"clinically safe\" for a human to just read the narrative. Resource definitions may define what content should be represented in the narrative to ensure clinical safety.", "comment": "Contained resources do not have a 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.", "alias": [ "narrative", "html", "xhtml", "display" ], "min": 0, "max": "1", "base": { "path": "DomainResource.text", "min": 0, "max": "1" }, "type": [ { "code": "Narrative" } ], "condition": [ "dom-6" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "mustSupport": false, "isModifier": false, "isSummary": false, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "rim", "map": "N/A" }, { "identity": "rim", "map": "Act.text?" } ] }, { "id": "ClaimResponse.contained", "path": "ClaimResponse.contained", "slicing": { "discriminator": [ { "type": "profile", "path": "$this" } ], "rules": "open" }, "short": "Contained, inline Resources", "definition": "These resources do not have an independent existence apart from the resource that contains them - they cannot be identified independently, nor can they have their own independent transaction scope. This is allowed to be a Parameters resource if and only if it is referenced by a resource that provides context/meaning.", "comment": "This should never be done when the content can be identified properly, as once identification is lost, it is extremely difficult (and context dependent) to restore it again. Contained resources may have profiles and tags in their meta elements, but SHALL NOT have security labels.", "alias": [ "inline resources", "anonymous resources", "contained resources" ], "min": 0, "max": "*", "base": { "path": "DomainResource.contained", "min": 0, "max": "*" }, "type": [ { "code": "Resource" } ], "condition": [ "dom-2", "dom-4", "dom-3", "dom-5" ], "mustSupport": false, "isModifier": false, "isSummary": false, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "rim", "map": "Entity. Role, or Act" }, { "identity": "rim", "map": "N/A" } ] }, { "id": "ClaimResponse.contained:duplicates", "path": "ClaimResponse.contained", "sliceName": "duplicates", "short": "Explanation of Benefit resource", "definition": "This resource provides: the claim details; adjudication details from the processing of a Claim; and optionally account balance information, for informing the subscriber of the benefits provided.", "comment": "This should never be done when the content can be identified properly, as once identification is lost, it is extremely difficult (and context dependent) to restore it again. Contained resources may have profiles and tags in their meta elements, but SHALL NOT have security labels.", "alias": [ "inline resources", "anonymous resources", "contained resources", "EOB" ], "min": 0, "max": "1", "base": { "path": "DomainResource.contained", "min": 0, "max": "*" }, "type": [ { "code": "ExplanationOfBenefit", "profile": [ "https://bpcs.exchange/fhir/StructureDefinition/profile-ExplanationOfBenefit-duplicate" ] } ], "condition": [ "dom-2", "dom-4", "dom-3", "dom-5" ], "constraint": [ { "key": "dom-2", "severity": "error", "human": "If the resource is contained in another resource, it SHALL NOT contain nested Resources", "expression": "contained.contained.empty()", "source": "http://hl7.org/fhir/StructureDefinition/DomainResource" }, { "key": "dom-4", "severity": "error", "human": "If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated", "expression": "contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()", "source": "http://hl7.org/fhir/StructureDefinition/DomainResource" }, { "key": "dom-3", "severity": "error", "human": "If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource", "expression": "contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().ofType(canonical) | %resource.descendants().ofType(uri) | %resource.descendants().ofType(url))) or descendants().where(reference = '#').exists() or descendants().where(ofType(canonical) = '#').exists() or descendants().where(ofType(canonical) = '#').exists()).not()).trace('unmatched', id).empty()", "source": "http://hl7.org/fhir/StructureDefinition/DomainResource" }, { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bestpractice", "valueBoolean": true }, { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bestpractice-explanation", "valueMarkdown": "When a resource has no narrative, only systems that fully understand the data can display the resource to a human safely. Including a human readable representation in the resource makes for a much more robust eco-system and cheaper handling of resources by intermediary systems. Some ecosystems restrict distribution of resources to only those systems that do fully understand the resources, and as a consequence implementers may believe that the narrative is superfluous. However experience shows that such eco-systems often open up to new participants over time." } ], "key": "dom-6", "severity": "warning", "human": "A resource should have narrative for robust management", "expression": "text.`div`.exists()", "source": "http://hl7.org/fhir/StructureDefinition/DomainResource" }, { "key": "dom-5", "severity": "error", "human": "If a resource is contained in another resource, it SHALL NOT have a security label", "expression": "contained.meta.security.empty()", "source": "http://hl7.org/fhir/StructureDefinition/DomainResource" } ], "mustSupport": true, "isModifier": false, "isSummary": false, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "rim", "map": "Entity. Role, or Act" }, { "identity": "rim", "map": "N/A" }, { "identity": "rim", "map": "Entity, Role, or Act" }, { "identity": "workflow", "map": "Event" }, { "identity": "w5", "map": "financial.other" } ] }, { "id": "ClaimResponse.contained:dispenses", "path": "ClaimResponse.contained", "sliceName": "dispenses", "short": "Dispensing a medication to a named patient", "definition": "Indicates that a medication product is to be or has been dispensed for a named person/patient. This includes a description of the medication product (supply) provided and the instructions for administering the medication. The medication dispense is the result of a pharmacy system responding to a medication order.", "comment": "This should never be done when the content can be identified properly, as once identification is lost, it is extremely difficult (and context dependent) to restore it again. Contained resources may have profiles and tags in their meta elements, but SHALL NOT have security labels.", "alias": [ "inline resources", "anonymous resources", "contained resources" ], "min": 0, "max": "*", "base": { "path": "DomainResource.contained", "min": 0, "max": "*" }, "type": [ { "code": "MedicationDispense", "profile": [ "https://bpcs.exchange/fhir/StructureDefinition/profile-MedicationDispense" ] } ], "condition": [ "dom-2", "dom-4", "dom-3", "dom-5" ], "constraint": [ { "key": "dom-2", "severity": "error", "human": "If the resource is contained in another resource, it SHALL NOT contain nested Resources", "expression": "contained.contained.empty()", "source": "http://hl7.org/fhir/StructureDefinition/DomainResource" }, { "key": "dom-4", "severity": "error", "human": "If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated", "expression": "contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()", "source": "http://hl7.org/fhir/StructureDefinition/DomainResource" }, { "key": "dom-3", "severity": "error", "human": "If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource", "expression": "contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().ofType(canonical) | %resource.descendants().ofType(uri) | %resource.descendants().ofType(url))) or descendants().where(reference = '#').exists() or descendants().where(ofType(canonical) = '#').exists() or descendants().where(ofType(canonical) = '#').exists()).not()).trace('unmatched', id).empty()", "source": "http://hl7.org/fhir/StructureDefinition/DomainResource" }, { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bestpractice", "valueBoolean": true }, { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bestpractice-explanation", "valueMarkdown": "When a resource has no narrative, only systems that fully understand the data can display the resource to a human safely. Including a human readable representation in the resource makes for a much more robust eco-system and cheaper handling of resources by intermediary systems. Some ecosystems restrict distribution of resources to only those systems that do fully understand the resources, and as a consequence implementers may believe that the narrative is superfluous. However experience shows that such eco-systems often open up to new participants over time." } ], "key": "dom-6", "severity": "warning", "human": "A resource should have narrative for robust management", "expression": "text.`div`.exists()", "source": "http://hl7.org/fhir/StructureDefinition/DomainResource" }, { "key": "dom-5", "severity": "error", "human": "If a resource is contained in another resource, it SHALL NOT have a security label", "expression": "contained.meta.security.empty()", "source": "http://hl7.org/fhir/StructureDefinition/DomainResource" }, { "key": "mdd-1", "severity": "error", "human": "whenHandedOver cannot be before whenPrepared", "expression": "whenHandedOver.empty() or whenPrepared.empty() or whenHandedOver >= whenPrepared", "source": "http://hl7.org/fhir/StructureDefinition/MedicationDispense" } ], "mustSupport": true, "isModifier": false, "isSummary": false, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "rim", "map": "Entity. Role, or Act" }, { "identity": "rim", "map": "N/A" }, { "identity": "rim", "map": "Entity, Role, or Act" }, { "identity": "workflow", "map": "Event" }, { "identity": "w5", "map": "clinical.medication" }, { "identity": "rim", "map": "Supply[moodCode=EVN]" } ] }, { "id": "ClaimResponse.extension", "path": "ClaimResponse.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 resource. To make the use of extensions safe and managable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can 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": "DomainResource.extension", "min": 0, "max": "*" }, "type": [ { "code": "Extension" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "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()", "source": "http://hl7.org/fhir/StructureDefinition/Extension" } ], "mustSupport": false, "isModifier": false, "isSummary": false, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "rim", "map": "N/A" } ] }, { "id": "ClaimResponse.modifierExtension", "path": "ClaimResponse.modifierExtension", "slicing": { "discriminator": [ { "type": "value", "path": "url" } ], "description": "Extensions are always sliced by (at least) url", "rules": "open" }, "short": "Extensions that cannot be ignored", "definition": "May be used to represent additional information that is not part of the basic definition of the resource and that modifies the understanding of the element that contains it and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and managable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.\n\nModifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).", "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.", "requirements": "Modifier extensions allow for extensions that *cannot* be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the [definition of modifier extensions](extensibility.html#modifierExtension).", "alias": [ "extensions", "user content" ], "min": 0, "max": "*", "base": { "path": "DomainResource.modifierExtension", "min": 0, "max": "*" }, "type": [ { "code": "Extension" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "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()", "source": "http://hl7.org/fhir/StructureDefinition/Extension" } ], "mustSupport": false, "isModifier": true, "isModifierReason": "Modifier extensions are expected to modify the meaning or interpretation of the resource that contains them", "isSummary": true, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "rim", "map": "N/A" } ] }, { "id": "ClaimResponse.identifier", "path": "ClaimResponse.identifier", "short": "Business Identifier for a claim response", "definition": "A unique identifier assigned to this claim response.", "comment": "The rules of the identifier.type determine if a check digit is part of the ID value or sent separately, such as through the checkDigit extension.", "requirements": "Allows claim responses to be distinguished and referenced.", "min": 0, "max": "*", "base": { "path": "ClaimResponse.identifier", "min": 0, "max": "*" }, "type": [ { "code": "Identifier" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "source": "http://hl7.org/fhir/StructureDefinition/Element" }, { "key": "ident-1", "severity": "warning", "human": "Identifier with no value has limited utility. If communicating that an identifier value has been suppressed or missing, the value element SHOULD be present with an extension indicating the missing semantic - e.g. data-absent-reason", "expression": "value.exists()", "source": "http://hl7.org/fhir/StructureDefinition/Identifier" } ], "mustSupport": false, "isModifier": false, "isSummary": false, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "v2", "map": "CX / EI (occasionally, more often EI maps to a resource id or a URL)" }, { "identity": "rim", "map": "II - The Identifier class is a little looser than the v3 type II because it allows URIs as well as registered OIDs or GUIDs. Also maps to Role[classCode=IDENT]" }, { "identity": "servd", "map": "Identifier" }, { "identity": "workflow", "map": "Event.identifier" }, { "identity": "w5", "map": "FiveWs.identifier" } ] }, { "id": "ClaimResponse.traceNumber", "path": "ClaimResponse.traceNumber", "short": "Number for tracking", "definition": "Trace number for tracking purposes. May be defined at the jurisdiction level or between trading partners.", "comment": "The rules of the identifier.type determine if a check digit is part of the ID value or sent separately, such as through the checkDigit extension.", "requirements": "Allows partners to uniquely identify components for tracking.", "min": 0, "max": "*", "base": { "path": "ClaimResponse.traceNumber", "min": 0, "max": "*" }, "type": [ { "code": "Identifier" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "source": "http://hl7.org/fhir/StructureDefinition/Element" }, { "key": "ident-1", "severity": "warning", "human": "Identifier with no value has limited utility. If communicating that an identifier value has been suppressed or missing, the value element SHOULD be present with an extension indicating the missing semantic - e.g. data-absent-reason", "expression": "value.exists()", "source": "http://hl7.org/fhir/StructureDefinition/Identifier" } ], "mustSupport": false, "isModifier": false, "isSummary": false, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "v2", "map": "CX / EI (occasionally, more often EI maps to a resource id or a URL)" }, { "identity": "rim", "map": "II - The Identifier class is a little looser than the v3 type II because it allows URIs as well as registered OIDs or GUIDs. Also maps to Role[classCode=IDENT]" }, { "identity": "servd", "map": "Identifier" } ] }, { "id": "ClaimResponse.status", "path": "ClaimResponse.status", "short": "draft | active", "definition": "The status of the resource instance.", "comment": "This element is labeled as a modifier because the status contains codes that mark the resource as not currently valid.", "requirements": "Need to track the status of the resource as 'draft' resources may undergo further edits while 'active' resources are immutable and may only have their status changed to 'cancelled'.", "min": 1, "max": "1", "base": { "path": "ClaimResponse.status", "min": 1, "max": "1" }, "type": [ { "code": "code" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "mustSupport": true, "isModifier": true, "isModifierReason": "This element is labeled as a modifier because it is a status element that contains status entered-in-error which means that the resource should not be treated as valid", "isSummary": true, "binding": { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString": "ClaimResponseStatus" } ], "strength": "required", "description": "A code specifying the state of the resource instance.", "valueSet": "https://bpcs.exchange/fhir/ValueSet/vs-FinancialStatus" }, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "workflow", "map": "Event.status" }, { "identity": "w5", "map": "FiveWs.status" }, { "identity": "BPCS", "map": "BatchRecordDTO.batchStatus" } ] }, { "id": "ClaimResponse.type", "path": "ClaimResponse.type", "short": "More granular claim type", "definition": "A finer grained suite of claim type codes which may convey additional information such as Inpatient vs Outpatient and/or a specialty service.", "comment": "This may contain the local bill type codes, for example the US UB-04 bill type code or the CMS bill type.", "requirements": "Some jurisdictions need a finer grained claim type for routing and adjudication.", "min": 1, "max": "1", "base": { "path": "ClaimResponse.type", "min": 1, "max": "1" }, "type": [ { "code": "CodeableConcept" } ], "patternCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "pharmacy" } ] }, "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "mustSupport": false, "isModifier": false, "isSummary": true, "binding": { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString": "ClaimType" } ], "strength": "extensible", "description": "The type or discipline-style of the claim.", "valueSet": "http://hl7.org/fhir/ValueSet/claim-type" }, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "v2", "map": "CE/CNE/CWE" }, { "identity": "rim", "map": "CD" }, { "identity": "orim", "map": "fhir:CodeableConcept rdfs:subClassOf dt:CD" }, { "identity": "w5", "map": "FiveWs.class" } ] }, { "id": "ClaimResponse.subType", "path": "ClaimResponse.subType", "short": "More granular claim type", "definition": "A finer grained suite of claim type codes which may convey additional information such as Inpatient vs Outpatient and/or a specialty service.", "comment": "This may contain the local bill type codes, for example the US UB-04 bill type code or the CMS bill type.", "requirements": "Some jurisdictions need a finer grained claim type for routing and adjudication.", "min": 0, "max": "1", "base": { "path": "ClaimResponse.subType", "min": 0, "max": "1" }, "type": [ { "code": "CodeableConcept" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "mustSupport": false, "isModifier": false, "isSummary": false, "binding": { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString": "ClaimSubType" } ], "strength": "example", "description": "A more granular claim typecode.", "valueSet": "http://hl7.org/fhir/ValueSet/claim-subtype" }, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "v2", "map": "CE/CNE/CWE" }, { "identity": "rim", "map": "CD" }, { "identity": "orim", "map": "fhir:CodeableConcept rdfs:subClassOf dt:CD" }, { "identity": "w5", "map": "FiveWs.class" } ] }, { "id": "ClaimResponse.use", "path": "ClaimResponse.use", "short": "claim | preauthorization | predetermination", "definition": "A code to indicate whether the nature of the request is: Claim - A request to an Insurer to adjudicate the supplied charges for health care goods and services under the identified policy and to pay the determined Benefit amount, if any; Preauthorization - A request to an Insurer to adjudicate the supplied proposed future charges for health care goods and services under the identified policy and to approve the services and provide the expected benefit amounts and potentially to reserve funds to pay the benefits when Claims for the indicated services are later submitted; or, Pre-determination - A request to an Insurer to adjudicate the supplied 'what if' charges for health care goods and services under the identified policy and report back what the Benefit payable would be had the services actually been provided.", "comment": "Note that FHIR strings SHALL NOT exceed 1,048,576 (1024*1024) characters in size", "requirements": "This element is required to understand the nature of the request for adjudication.", "min": 1, "max": "1", "base": { "path": "ClaimResponse.use", "min": 1, "max": "1" }, "type": [ { "code": "code" } ], "patternCode": "claim", "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "mustSupport": false, "isModifier": false, "isSummary": true, "binding": { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString": "Use" } ], "strength": "required", "description": "Claim, preauthorization, predetermination.", "valueSet": "http://hl7.org/fhir/ValueSet/claim-use|5.0.0" }, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "w5", "map": "FiveWs.class" } ] }, { "id": "ClaimResponse.patient", "path": "ClaimResponse.patient", "short": "A reference from one resource to another", "definition": "A reference from one resource to another.", "comment": "References SHALL be a reference to an actual FHIR resource, and SHALL be resolvable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.", "requirements": "The patient must be supplied to the insurer so that confirmation of coverage and service hstory may be considered as part of the authorization and/or adjudiction.", "min": 1, "max": "1", "base": { "path": "ClaimResponse.patient", "min": 1, "max": "1" }, "type": [ { "code": "Reference", "profile": [ "https://bpcs.exchange/fhir/StructureDefinition/profile-Reference-group-or-patient" ], "targetProfile": [ "https://bpcs.exchange/fhir/StructureDefinition/profile-Patient-create" ] } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "source": "http://hl7.org/fhir/StructureDefinition/Element" }, { "key": "ref-1", "severity": "error", "human": "SHALL have a contained resource if a local reference is provided", "expression": "reference.exists() implies (reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids')) or (reference='#' and %rootResource!=%resource))", "source": "http://hl7.org/fhir/StructureDefinition/Reference" }, { "key": "ref-2", "severity": "error", "human": "At least one of reference, identifier and display SHALL be present (unless an extension is provided).", "expression": "reference.exists() or identifier.exists() or display.exists() or extension.exists()", "source": "http://hl7.org/fhir/StructureDefinition/Reference" }, { "key": "bpcs-reference-1", "severity": "error", "human": "Must have either a reference or a subject extension, but not both", "expression": "reference.exists() != extension('https://bpcs.exchange/fhir/StructureDefinition/ext-Resource-Subject').exists()", "source": "https://bpcs.exchange/fhir/StructureDefinition/profile-Reference-group-or-patient" }, { "key": "bpcs-reference-2", "severity": "error", "human": "If reference is not present, must have display", "expression": "reference.exists().not() implies display.exists()", "source": "https://bpcs.exchange/fhir/StructureDefinition/profile-Reference-group-or-patient" } ], "mustSupport": true, "isModifier": false, "isSummary": true, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "rim", "map": "The target of a resource reference is a RIM entry point (Act, Role, or Entity)" }, { "identity": "w5", "map": "FiveWs.subject[x]" } ] }, { "id": "ClaimResponse.created", "path": "ClaimResponse.created", "short": "Response creation date", "definition": "The date this resource was created.", "comment": "This is the 'current' date when the ClaimResponse is produced", "requirements": "Need to record a timestamp for use by both the recipient and the issuer.", "min": 1, "max": "1", "base": { "path": "ClaimResponse.created", "min": 1, "max": "1" }, "type": [ { "code": "dateTime" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "mustSupport": true, "isModifier": false, "isSummary": true, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "workflow", "map": "Event.occurrence[x]" }, { "identity": "w5", "map": "FiveWs.recorded" } ] }, { "id": "ClaimResponse.insurer", "path": "ClaimResponse.insurer", "short": "Party responsible for reimbursement", "definition": "The party responsible for authorization, adjudication and reimbursement.", "comment": "References SHALL be a reference to an actual FHIR resource, and SHALL be resolvable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.", "requirements": "To be a valid claim, preauthorization or predetermination there must be a party who is responsible for adjudicating the contents against a policy which provides benefits for the patient.", "min": 0, "max": "1", "base": { "path": "ClaimResponse.insurer", "min": 0, "max": "1" }, "type": [ { "code": "Reference", "targetProfile": [ "http://hl7.org/fhir/StructureDefinition/Organization" ] } ], "patternReference": { "reference": "Organization/bpcs" }, "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "source": "http://hl7.org/fhir/StructureDefinition/Element" }, { "key": "ref-1", "severity": "error", "human": "SHALL have a contained resource if a local reference is provided", "expression": "reference.exists() implies (reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids')) or (reference='#' and %rootResource!=%resource))", "source": "http://hl7.org/fhir/StructureDefinition/Reference" }, { "key": "ref-2", "severity": "error", "human": "At least one of reference, identifier and display SHALL be present (unless an extension is provided).", "expression": "reference.exists() or identifier.exists() or display.exists() or extension.exists()", "source": "http://hl7.org/fhir/StructureDefinition/Reference" } ], "mustSupport": false, "isModifier": false, "isSummary": true, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "rim", "map": "The target of a resource reference is a RIM entry point (Act, Role, or Entity)" }, { "identity": "workflow", "map": "Event.performer" } ] }, { "id": "ClaimResponse.requestor", "path": "ClaimResponse.requestor", "short": "Party responsible for the claim", "definition": "The provider which is responsible for the claim, predetermination or preauthorization.", "comment": "Typically this field would be 1..1 where this party is accountable for the data content within the claim but is not necessarily the facility, provider group or practitioner who provided the products and services listed within this claim resource. This field is the Billing Provider, for example, a facility, provider group, lab or practitioner..", "min": 0, "max": "1", "base": { "path": "ClaimResponse.requestor", "min": 0, "max": "1" }, "type": [ { "code": "Reference", "targetProfile": [ "http://hl7.org/fhir/StructureDefinition/Practitioner", "http://hl7.org/fhir/StructureDefinition/PractitionerRole", "http://hl7.org/fhir/StructureDefinition/Organization" ] } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "source": "http://hl7.org/fhir/StructureDefinition/Element" }, { "key": "ref-1", "severity": "error", "human": "SHALL have a contained resource if a local reference is provided", "expression": "reference.exists() implies (reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids')) or (reference='#' and %rootResource!=%resource))", "source": "http://hl7.org/fhir/StructureDefinition/Reference" }, { "key": "ref-2", "severity": "error", "human": "At least one of reference, identifier and display SHALL be present (unless an extension is provided).", "expression": "reference.exists() or identifier.exists() or display.exists() or extension.exists()", "source": "http://hl7.org/fhir/StructureDefinition/Reference" } ], "mustSupport": false, "isModifier": false, "isSummary": false, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "rim", "map": "The target of a resource reference is a RIM entry point (Act, Role, or Entity)" }, { "identity": "w5", "map": "FiveWs.source" } ] }, { "id": "ClaimResponse.request", "path": "ClaimResponse.request", "short": "A reference from one resource to another", "definition": "A reference from one resource to another.", "comment": "References SHALL be a reference to an actual FHIR resource, and SHALL be resolvable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.\r\n This will only be present if the submitted Claim has an id (because the Claim has previously been held)", "min": 0, "max": "1", "base": { "path": "ClaimResponse.request", "min": 0, "max": "1" }, "type": [ { "code": "Reference", "profile": [ "https://bpcs.exchange/fhir/StructureDefinition/profile-Reference-rest" ], "targetProfile": [ "https://bpcs.exchange/fhir/StructureDefinition/profile-Claim-create" ] } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "source": "http://hl7.org/fhir/StructureDefinition/Element" }, { "key": "ref-1", "severity": "error", "human": "SHALL have a contained resource if a local reference is provided", "expression": "reference.exists() implies (reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids')) or (reference='#' and %rootResource!=%resource))", "source": "http://hl7.org/fhir/StructureDefinition/Reference" }, { "key": "ref-2", "severity": "error", "human": "At least one of reference, identifier and display SHALL be present (unless an extension is provided).", "expression": "reference.exists() or identifier.exists() or display.exists() or extension.exists()", "source": "http://hl7.org/fhir/StructureDefinition/Reference" } ], "mustSupport": true, "isModifier": false, "isSummary": true, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "rim", "map": "The target of a resource reference is a RIM entry point (Act, Role, or Entity)" }, { "identity": "workflow", "map": "Event.basedOn" }, { "identity": "w5", "map": "FiveWs.why[x]" }, { "identity": "BPCS", "map": "BatchRecordDTO.dateReceived (second-last component of id), BatchRecordDTO.batchSeqNum (last component of id)" } ] }, { "id": "ClaimResponse.outcome", "path": "ClaimResponse.outcome", "short": "queued | complete | error | partial", "definition": "The outcome of the claim, predetermination, or preauthorization processing.", "comment": "The resource may be used to indicate that the Claim/Preauthorization/Pre-determination has been received but processing has not begun (queued); that it has been processed and one or more errors have been detected (error); no errors were detected and some of the adjudication processing has been performed (partial); or all of the adjudication processing has completed without errors (complete).", "requirements": "To advise the requestor of an overall processing outcome.", "min": 1, "max": "1", "base": { "path": "ClaimResponse.outcome", "min": 1, "max": "1" }, "type": [ { "code": "code" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "mustSupport": true, "isModifier": false, "isSummary": true, "binding": { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString": "RemittanceOutcome" } ], "strength": "required", "description": "The result of the claim processing.", "valueSet": "http://hl7.org/fhir/ValueSet/claim-outcome|5.0.0" }, "mapping": [ { "identity": "rim", "map": "n/a" } ] }, { "id": "ClaimResponse.decision", "path": "ClaimResponse.decision", "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).", "requirements": "To advise the requestor of the result of the adjudication process.", "min": 0, "max": "1", "base": { "path": "ClaimResponse.decision", "min": 0, "max": "1" }, "type": [ { "code": "CodeableConcept" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "mustSupport": false, "isModifier": false, "isSummary": true, "binding": { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString": "AdjudicationDecision" } ], "strength": "example", "description": "The overall result of the claim adjudication.", "valueSet": "http://hl7.org/fhir/ValueSet/claim-decision" }, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "v2", "map": "CE/CNE/CWE" }, { "identity": "rim", "map": "CD" }, { "identity": "orim", "map": "fhir:CodeableConcept rdfs:subClassOf dt:CD" } ] }, { "id": "ClaimResponse.disposition", "path": "ClaimResponse.disposition", "short": "Disposition Message", "definition": "A human readable description of the status of the adjudication.", "comment": "Note that FHIR strings SHALL NOT exceed 1,048,576 (1024*1024) characters in size", "requirements": "Provided for user display.", "min": 0, "max": "1", "base": { "path": "ClaimResponse.disposition", "min": 0, "max": "1" }, "type": [ { "code": "string" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "mustSupport": false, "isModifier": false, "isSummary": false, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "workflow", "map": "Event.note" } ] }, { "id": "ClaimResponse.preAuthRef", "path": "ClaimResponse.preAuthRef", "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.", "requirements": "On subsequent claims, the insurer may require the provider to quote this value.", "min": 0, "max": "1", "base": { "path": "ClaimResponse.preAuthRef", "min": 0, "max": "1" }, "type": [ { "code": "string" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "mustSupport": false, "isModifier": false, "isSummary": false, "mapping": [ { "identity": "rim", "map": "n/a" } ] }, { "id": "ClaimResponse.preAuthPeriod", "path": "ClaimResponse.preAuthPeriod", "short": "Preauthorization reference effective period", "definition": "The time frame during which this authorization is effective.", "comment": "A Period specifies a range of time; the context of use will specify whether the entire range applies (e.g. \"the patient was an inpatient of the hospital for this time range\") or one value from the range applies (e.g. \"give to the patient between these two times\").\n\nPeriod is not used for a duration (a measure of elapsed time). See [Duration](datatypes.html#Duration).", "requirements": "To convey to the provider when the authorized products and services must be supplied for the authorized adjudication to apply.", "min": 0, "max": "1", "base": { "path": "ClaimResponse.preAuthPeriod", "min": 0, "max": "1" }, "type": [ { "code": "Period" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "source": "http://hl7.org/fhir/StructureDefinition/Element" }, { "key": "per-1", "severity": "error", "human": "If present, start SHALL have a lower or equal value than end", "expression": "start.hasValue().not() or end.hasValue().not() or (start.lowBoundary() <= end.highBoundary())", "source": "http://hl7.org/fhir/StructureDefinition/Period" } ], "mustSupport": false, "isModifier": false, "isSummary": false, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "v2", "map": "DR" }, { "identity": "rim", "map": "IVL[lowClosed=\"true\" and highClosed=\"true\"] or URG[lowClosed=\"true\" and highClosed=\"true\"]" } ] }, { "id": "ClaimResponse.event", "path": "ClaimResponse.event", "short": "Event information", "definition": "Information code for an event with a corresponding date or period.", "min": 0, "max": "*", "base": { "path": "ClaimResponse.event", "min": 0, "max": "*" }, "type": [ { "code": "BackboneElement" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "mustSupport": false, "isModifier": false, "isSummary": false, "mapping": [ { "identity": "rim", "map": "n/a" } ] }, { "id": "ClaimResponse.event.id", "path": "ClaimResponse.event.id", "representation": [ "xmlAttr" ], "short": "Unique id for inter-element referencing", "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": [ { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type", "valueUrl": "string" } ], "code": "http://hl7.org/fhirpath/System.String" } ], "condition": [ "ele-1" ], "mapping": [ { "identity": "rim", "map": "n/a" } ] }, { "id": "ClaimResponse.event.extension", "path": "ClaimResponse.event.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. To make the use of extensions safe and managable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can 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" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "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()", "source": "http://hl7.org/fhir/StructureDefinition/Extension" } ], "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "rim", "map": "N/A" } ] }, { "id": "ClaimResponse.event.modifierExtension", "path": "ClaimResponse.event.modifierExtension", "short": "Extensions that cannot be ignored even if unrecognized", "definition": "May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and managable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.\n\nModifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).", "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.", "requirements": "Modifier extensions allow for extensions that *cannot* be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the [definition of modifier extensions](extensibility.html#modifierExtension).", "alias": [ "extensions", "user content", "modifiers" ], "min": 0, "max": "*", "base": { "path": "BackboneElement.modifierExtension", "min": 0, "max": "*" }, "type": [ { "code": "Extension" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "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()", "source": "http://hl7.org/fhir/StructureDefinition/Extension" } ], "isModifier": true, "isModifierReason": "Modifier extensions are expected to modify the meaning or interpretation of the element that contains them", "isSummary": true, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "rim", "map": "N/A" } ] }, { "id": "ClaimResponse.event.type", "path": "ClaimResponse.event.type", "short": "Specific event", "definition": "A coded event such as when a service is expected or a card printed.", "comment": "Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination.", "min": 1, "max": "1", "base": { "path": "ClaimResponse.event.type", "min": 1, "max": "1" }, "type": [ { "code": "CodeableConcept" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "mustSupport": false, "isModifier": false, "isSummary": false, "binding": { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString": "DatesType" } ], "strength": "example", "valueSet": "http://hl7.org/fhir/ValueSet/datestype" }, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "v2", "map": "CE/CNE/CWE" }, { "identity": "rim", "map": "CD" }, { "identity": "orim", "map": "fhir:CodeableConcept rdfs:subClassOf dt:CD" } ] }, { "id": "ClaimResponse.event.when[x]", "path": "ClaimResponse.event.when[x]", "short": "Occurance date or period", "definition": "A date or period in the past or future indicating when the event occurred or is expectd to occur.", "min": 1, "max": "1", "base": { "path": "ClaimResponse.event.when[x]", "min": 1, "max": "1" }, "type": [ { "code": "dateTime" }, { "code": "Period" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "mustSupport": false, "isModifier": false, "isSummary": false, "mapping": [ { "identity": "rim", "map": "n/a" } ] }, { "id": "ClaimResponse.payeeType", "path": "ClaimResponse.payeeType", "short": "Party to be paid any benefits payable", "definition": "Type of Party to be reimbursed: subscriber, provider, other.", "comment": "Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination.", "requirements": "Need to know who should receive payment with the most common situations being the Provider (assignment of benefits) or the Subscriber.", "min": 0, "max": "1", "base": { "path": "ClaimResponse.payeeType", "min": 0, "max": "1" }, "type": [ { "code": "CodeableConcept" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "mustSupport": false, "isModifier": false, "isSummary": false, "binding": { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString": "PayeeType" } ], "strength": "example", "description": "A code for the party to be reimbursed.", "valueSet": "http://hl7.org/fhir/ValueSet/payeetype" }, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "v2", "map": "CE/CNE/CWE" }, { "identity": "rim", "map": "CD" }, { "identity": "orim", "map": "fhir:CodeableConcept rdfs:subClassOf dt:CD" } ] }, { "id": "ClaimResponse.encounter", "path": "ClaimResponse.encounter", "short": "Encounters associated with the listed treatments", "definition": "Healthcare encounters related to this claim.", "comment": "This will typically be the encounter the event occurred within, but some activities may be initiated prior to or after the official completion of an encounter but still be tied to the context of the encounter.", "requirements": "Used in some jurisdictions to link clinical events to claim items.", "min": 0, "max": "*", "base": { "path": "ClaimResponse.encounter", "min": 0, "max": "*" }, "type": [ { "code": "Reference", "targetProfile": [ "http://hl7.org/fhir/StructureDefinition/Encounter" ] } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "source": "http://hl7.org/fhir/StructureDefinition/Element" }, { "key": "ref-1", "severity": "error", "human": "SHALL have a contained resource if a local reference is provided", "expression": "reference.exists() implies (reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids')) or (reference='#' and %rootResource!=%resource))", "source": "http://hl7.org/fhir/StructureDefinition/Reference" }, { "key": "ref-2", "severity": "error", "human": "At least one of reference, identifier and display SHALL be present (unless an extension is provided).", "expression": "reference.exists() or identifier.exists() or display.exists() or extension.exists()", "source": "http://hl7.org/fhir/StructureDefinition/Reference" } ], "mustSupport": false, "isModifier": false, "isSummary": false, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "rim", "map": "The target of a resource reference is a RIM entry point (Act, Role, or Entity)" } ] }, { "id": "ClaimResponse.diagnosisRelatedGroup", "path": "ClaimResponse.diagnosisRelatedGroup", "short": "Package billing code", "definition": "A package billing code or bundle code used to group products and services to a particular health condition (such as heart attack) which is based on a predetermined grouping code system.", "comment": "For example DRG (Diagnosis Related Group) or a bundled billing code. A patient may have a diagnosis of a Myocardial Infarction and a DRG for HeartAttack would be assigned. The Claim item (and possible subsequent claims) would refer to the DRG for those line items that were for services related to the heart attack event.", "requirements": "Required to relate the current diagnosis to a package billing code that is then referenced on the individual claim items which are specific to the health condition covered by the package code.", "min": 0, "max": "1", "base": { "path": "ClaimResponse.diagnosisRelatedGroup", "min": 0, "max": "1" }, "type": [ { "code": "CodeableConcept" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "mustSupport": false, "isModifier": false, "isSummary": false, "binding": { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString": "DiagnosisRelatedGroup" } ], "strength": "example", "valueSet": "http://hl7.org/fhir/ValueSet/ex-diagnosisrelatedgroup" }, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "v2", "map": "CE/CNE/CWE" }, { "identity": "rim", "map": "CD" }, { "identity": "orim", "map": "fhir:CodeableConcept rdfs:subClassOf dt:CD" } ] }, { "id": "ClaimResponse.item", "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-explicit-type-name", "valueString": "Item" } ], "path": "ClaimResponse.item", "short": "Adjudication for claim line items", "definition": "A claim line. Either a simple (a product or service) or a 'group' of details which can also be a simple items or groups of sub-details.", "comment": "There will be a ClaimResponse.item for each item in the associated claim submission", "requirements": "The adjudication for items provided on the claim.", "min": 1, "max": "*", "base": { "path": "ClaimResponse.item", "min": 0, "max": "*" }, "type": [ { "code": "BackboneElement" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "mustSupport": true, "isModifier": false, "isSummary": false, "mapping": [ { "identity": "rim", "map": "n/a" } ] }, { "id": "ClaimResponse.item.id", "path": "ClaimResponse.item.id", "representation": [ "xmlAttr" ], "short": "Unique id for inter-element referencing", "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": [ { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type", "valueUrl": "string" } ], "code": "http://hl7.org/fhirpath/System.String" } ], "condition": [ "ele-1" ], "mapping": [ { "identity": "rim", "map": "n/a" } ] }, { "id": "ClaimResponse.item.extension", "path": "ClaimResponse.item.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. To make the use of extensions safe and managable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can 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": 1, "max": "*", "base": { "path": "Element.extension", "min": 0, "max": "*" }, "type": [ { "code": "Extension" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "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()", "source": "http://hl7.org/fhir/StructureDefinition/Extension" } ], "mustSupport": true, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "rim", "map": "N/A" } ] }, { "id": "ClaimResponse.item.extension:receiptPlan", "path": "ClaimResponse.item.extension", "sliceName": "receiptPlan", "short": "Insurance Plan", "definition": "The insurance plan under which the receipt was adjudicated", "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": 1, "max": "1", "base": { "path": "Element.extension", "min": 0, "max": "*" }, "type": [ { "code": "Extension", "profile": [ "https://bpcs.exchange/fhir/StructureDefinition/ext-Resource-ReceiptPlan" ] } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "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()", "source": "http://hl7.org/fhir/StructureDefinition/Extension" } ], "mustSupport": true, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "rim", "map": "N/A" } ] }, { "id": "ClaimResponse.item.extension:presetModifier", "path": "ClaimResponse.item.extension", "sliceName": "presetModifier", "short": "Preset modifier", "definition": "Indicates a modifier override code that is automatically determined by the payer based on the adjudication process. For example, if a duplicate has been automatically matched, the 'MQ' modifier code might be set as part of adjudication rather than requiring user action.", "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", "profile": [ "https://bpcs.exchange/fhir/StructureDefinition/ext-ClaimResponse-PresetModifier" ] } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "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()", "source": "http://hl7.org/fhir/StructureDefinition/Extension" } ], "mustSupport": true, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "rim", "map": "N/A" } ] }, { "id": "ClaimResponse.item.modifierExtension", "path": "ClaimResponse.item.modifierExtension", "short": "Extensions that cannot be ignored even if unrecognized", "definition": "May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and managable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.\n\nModifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).", "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.", "requirements": "Modifier extensions allow for extensions that *cannot* be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the [definition of modifier extensions](extensibility.html#modifierExtension).", "alias": [ "extensions", "user content", "modifiers" ], "min": 0, "max": "*", "base": { "path": "BackboneElement.modifierExtension", "min": 0, "max": "*" }, "type": [ { "code": "Extension" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "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()", "source": "http://hl7.org/fhir/StructureDefinition/Extension" } ], "isModifier": true, "isModifierReason": "Modifier extensions are expected to modify the meaning or interpretation of the element that contains them", "isSummary": true, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "rim", "map": "N/A" } ] }, { "id": "ClaimResponse.item.itemSequence", "path": "ClaimResponse.item.itemSequence", "short": "Claim item instance identifier", "definition": "A number to uniquely reference the claim item entries.", "comment": "This will match the Claim.item.sequence of the corresponding repetition in the associated Claim submission", "requirements": "Necessary to provide a mechanism to link the adjudication result to the submitted claim item.", "min": 1, "max": "1", "base": { "path": "ClaimResponse.item.itemSequence", "min": 1, "max": "1" }, "type": [ { "code": "positiveInt" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "mustSupport": true, "isModifier": false, "isSummary": false, "mapping": [ { "identity": "rim", "map": "n/a" } ] }, { "id": "ClaimResponse.item.traceNumber", "path": "ClaimResponse.item.traceNumber", "short": "Number for tracking", "definition": "Trace number for tracking purposes. May be defined at the jurisdiction level or between trading partners.", "comment": "The rules of the identifier.type determine if a check digit is part of the ID value or sent separately, such as through the checkDigit extension.", "requirements": "Allows partners to uniquely identify components for tracking.", "min": 0, "max": "*", "base": { "path": "ClaimResponse.item.traceNumber", "min": 0, "max": "*" }, "type": [ { "code": "Identifier" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "source": "http://hl7.org/fhir/StructureDefinition/Element" }, { "key": "ident-1", "severity": "warning", "human": "Identifier with no value has limited utility. If communicating that an identifier value has been suppressed or missing, the value element SHOULD be present with an extension indicating the missing semantic - e.g. data-absent-reason", "expression": "value.exists()", "source": "http://hl7.org/fhir/StructureDefinition/Identifier" } ], "mustSupport": false, "isModifier": false, "isSummary": false, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "v2", "map": "CX / EI (occasionally, more often EI maps to a resource id or a URL)" }, { "identity": "rim", "map": "II - The Identifier class is a little looser than the v3 type II because it allows URIs as well as registered OIDs or GUIDs. Also maps to Role[classCode=IDENT]" }, { "identity": "servd", "map": "Identifier" } ] }, { "id": "ClaimResponse.item.noteNumber", "path": "ClaimResponse.item.noteNumber", "short": "Applicable note numbers", "definition": "The numbers associated with notes below which apply to the adjudication of this item.", "comment": "32 bit number; for values larger than this, use decimal", "requirements": "Provides a condensed manner for associating human readable descriptive explanations for adjudications on the line item.", "min": 0, "max": "*", "base": { "path": "ClaimResponse.item.noteNumber", "min": 0, "max": "*" }, "type": [ { "code": "positiveInt" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "mustSupport": false, "isModifier": false, "isSummary": false, "mapping": [ { "identity": "rim", "map": "n/a" } ] }, { "id": "ClaimResponse.item.reviewOutcome", "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-explicit-type-name", "valueString": "ReviewOutcome" } ], "path": "ClaimResponse.item.reviewOutcome", "short": "Adjudication results", "definition": "The high-level results of the adjudication if adjudication has been performed.", "min": 1, "max": "1", "base": { "path": "ClaimResponse.item.reviewOutcome", "min": 0, "max": "1" }, "type": [ { "code": "BackboneElement" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "mustSupport": true, "isModifier": false, "isSummary": false, "mapping": [ { "identity": "rim", "map": "n/a" } ] }, { "id": "ClaimResponse.item.reviewOutcome.id", "path": "ClaimResponse.item.reviewOutcome.id", "representation": [ "xmlAttr" ], "short": "Unique id for inter-element referencing", "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": [ { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type", "valueUrl": "string" } ], "code": "http://hl7.org/fhirpath/System.String" } ], "condition": [ "ele-1" ], "mapping": [ { "identity": "rim", "map": "n/a" } ] }, { "id": "ClaimResponse.item.reviewOutcome.extension", "path": "ClaimResponse.item.reviewOutcome.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. To make the use of extensions safe and managable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can 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" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "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()", "source": "http://hl7.org/fhir/StructureDefinition/Extension" } ], "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "rim", "map": "N/A" } ] }, { "id": "ClaimResponse.item.reviewOutcome.extension:info", "path": "ClaimResponse.item.reviewOutcome.extension", "sliceName": "info", "short": "Information Message", "definition": "Allows a claim response to provide an 'information' message as part of its response to a claim", "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", "profile": [ "https://bpcs.exchange/fhir/StructureDefinition/ext-ClaimResponse-Info" ] } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "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()", "source": "http://hl7.org/fhir/StructureDefinition/Extension" } ], "mustSupport": true, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "rim", "map": "N/A" } ] }, { "id": "ClaimResponse.item.reviewOutcome.modifierExtension", "path": "ClaimResponse.item.reviewOutcome.modifierExtension", "short": "Extensions that cannot be ignored even if unrecognized", "definition": "May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and managable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.\n\nModifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).", "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.", "requirements": "Modifier extensions allow for extensions that *cannot* be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the [definition of modifier extensions](extensibility.html#modifierExtension).", "alias": [ "extensions", "user content", "modifiers" ], "min": 0, "max": "*", "base": { "path": "BackboneElement.modifierExtension", "min": 0, "max": "*" }, "type": [ { "code": "Extension" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "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()", "source": "http://hl7.org/fhir/StructureDefinition/Extension" } ], "isModifier": true, "isModifierReason": "Modifier extensions are expected to modify the meaning or interpretation of the element that contains them", "isSummary": true, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "rim", "map": "N/A" } ] }, { "id": "ClaimResponse.item.reviewOutcome.decision", "path": "ClaimResponse.item.reviewOutcome.decision", "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).", "requirements": "To advise the requestor of the result of the adjudication process.", "min": 1, "max": "1", "base": { "path": "ClaimResponse.item.reviewOutcome.decision", "min": 0, "max": "1" }, "type": [ { "code": "CodeableConcept" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "mustSupport": true, "isModifier": false, "isSummary": false, "binding": { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString": "AdjudicationDecision" } ], "strength": "required", "valueSet": "https://bpcs.exchange/fhir/ValueSet/vs-Receipt-status" }, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "v2", "map": "CE/CNE/CWE" }, { "identity": "rim", "map": "CD" }, { "identity": "orim", "map": "fhir:CodeableConcept rdfs:subClassOf dt:CD" } ] }, { "id": "ClaimResponse.item.reviewOutcome.reason", "path": "ClaimResponse.item.reviewOutcome.reason", "short": "Reason for result of the adjudication", "definition": "The reasons for the result of the claim, predetermination, or preauthorization adjudication.", "comment": "If multiple issues are identified, there is no specific order in which they should be displayed or addressed. In some cases, a UI might display and allow addressing all issues at once.", "requirements": "To advise the requestor of the contributors to the result of the adjudication process.", "min": 0, "max": "*", "base": { "path": "ClaimResponse.item.reviewOutcome.reason", "min": 0, "max": "*" }, "type": [ { "code": "CodeableConcept" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "mustSupport": true, "isModifier": false, "isSummary": false, "binding": { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString": "AdjudicationDecisionReason" } ], "strength": "extensible", "valueSet": "https://bpcs.exchange/fhir/ValueSet/vs-ClaimResponse" }, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "v2", "map": "CE/CNE/CWE" }, { "identity": "rim", "map": "CD" }, { "identity": "orim", "map": "fhir:CodeableConcept rdfs:subClassOf dt:CD" }, { "identity": "BPCS", "map": "AssessContext.responseCodes, AssessmentFlag.(various EFlags)" } ] }, { "id": "ClaimResponse.item.reviewOutcome.reason.id", "path": "ClaimResponse.item.reviewOutcome.reason.id", "representation": [ "xmlAttr" ], "short": "Unique id for inter-element referencing", "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": [ { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type", "valueUrl": "string" } ], "code": "http://hl7.org/fhirpath/System.String" } ], "condition": [ "ele-1" ], "mapping": [ { "identity": "rim", "map": "n/a" } ] }, { "id": "ClaimResponse.item.reviewOutcome.reason.extension", "path": "ClaimResponse.item.reviewOutcome.reason.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. To make the use of extensions safe and managable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can 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" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "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()", "source": "http://hl7.org/fhir/StructureDefinition/Extension" } ], "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "rim", "map": "N/A" } ] }, { "id": "ClaimResponse.item.reviewOutcome.reason.extension:allowedModifier", "path": "ClaimResponse.item.reviewOutcome.reason.extension", "sliceName": "allowedModifier", "short": "Allowed modifier", "definition": "Indicates a code that can be sent as a 'modifier' on the Claim item in a subsequent adjudication call that would override the adjudication reason being extended.", "comment": "Indicates modifier codes permitted to override for this response code (if any).", "alias": [ "extensions", "user content" ], "min": 0, "max": "*", "base": { "path": "Element.extension", "min": 0, "max": "*" }, "type": [ { "code": "Extension", "profile": [ "https://bpcs.exchange/fhir/StructureDefinition/ext-ClaimResponse-AllowedModifier" ] } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "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()", "source": "http://hl7.org/fhir/StructureDefinition/Extension" } ], "mustSupport": true, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "rim", "map": "N/A" } ] }, { "id": "ClaimResponse.item.reviewOutcome.reason.extension:allowedModifier.id", "path": "ClaimResponse.item.reviewOutcome.reason.extension.id", "representation": [ "xmlAttr" ], "short": "Unique id for inter-element referencing", "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": [ { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type", "valueUrl": "string" } ], "code": "http://hl7.org/fhirpath/System.String" } ], "condition": [ "ele-1" ], "mapping": [ { "identity": "rim", "map": "n/a" } ] }, { "id": "ClaimResponse.item.reviewOutcome.reason.extension:allowedModifier.extension", "path": "ClaimResponse.item.reviewOutcome.reason.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. To make the use of extensions safe and managable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can 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" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "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()", "source": "http://hl7.org/fhir/StructureDefinition/Extension" } ], "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "rim", "map": "N/A" } ] }, { "id": "ClaimResponse.item.reviewOutcome.reason.extension:allowedModifier.url", "path": "ClaimResponse.item.reviewOutcome.reason.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": [ { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type", "valueUrl": "uri" } ], "code": "http://hl7.org/fhirpath/System.String" } ], "fixedUri": "https://bpcs.exchange/fhir/StructureDefinition/ext-ClaimResponse-AllowedModifier", "mapping": [ { "identity": "rim", "map": "N/A" } ] }, { "id": "ClaimResponse.item.reviewOutcome.reason.extension:allowedModifier.value[x]", "path": "ClaimResponse.item.reviewOutcome.reason.extension.value[x]", "short": "A reference to a code defined by a terminology system", "definition": "A reference to a code defined by a terminology system.", "comment": "Codes may be defined very casually in enumerations or code lists, up to very formal definitions such as SNOMED CT - see the HL7 v3 Core Principles for more information.", "min": 0, "max": "1", "base": { "path": "Extension.value[x]", "min": 0, "max": "1" }, "type": [ { "code": "Coding", "profile": [ "https://bpcs.exchange/fhir/StructureDefinition/profile-Coding-simple" ] } ], "condition": [ "ext-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "source": "http://hl7.org/fhir/StructureDefinition/Element" }, { "key": "cod-1", "severity": "warning", "human": "A Coding SHOULD NOT have a display unless a code is also present. Computation on Coding.display alone is generally unsafe. Consider using CodeableConcept.text", "expression": "code.exists().not() implies display.exists().not()", "source": "http://hl7.org/fhir/StructureDefinition/Coding" } ], "mustSupport": true, "binding": { "strength": "extensible", "valueSet": "https://bpcs.exchange/fhir/ValueSet/vs-ClaimResponse-AllowedModifier" }, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "rim", "map": "N/A" }, { "identity": "v2", "map": "CE/CNE/CWE subset one of the sets of component 1-3 or 4-6" }, { "identity": "rim", "map": "CV" }, { "identity": "orim", "map": "fhir:Coding rdfs:subClassOf dt:CDCoding" }, { "identity": "BPCS", "map": "AssessmentFlag.reasnUseCd, other override codes populated by intermediary based on what overrides are permitted for a given response code or EFlag" } ] }, { "id": "ClaimResponse.item.reviewOutcome.reason.extension:allowedModifier.value[x].id", "path": "ClaimResponse.item.reviewOutcome.reason.extension.value[x].id", "representation": [ "xmlAttr" ], "short": "Unique id for inter-element referencing", "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": [ { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type", "valueUrl": "string" } ], "code": "http://hl7.org/fhirpath/System.String" } ], "condition": [ "ele-1" ], "mapping": [ { "identity": "rim", "map": "n/a" } ] }, { "id": "ClaimResponse.item.reviewOutcome.reason.extension:allowedModifier.value[x].extension", "path": "ClaimResponse.item.reviewOutcome.reason.extension.value[x].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. To make the use of extensions safe and managable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can 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" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "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()", "source": "http://hl7.org/fhir/StructureDefinition/Extension" } ], "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "rim", "map": "N/A" } ] }, { "id": "ClaimResponse.item.reviewOutcome.reason.extension:allowedModifier.value[x].extension:default", "path": "ClaimResponse.item.reviewOutcome.reason.extension.value[x].extension", "sliceName": "default", "short": "Default Modifier", "definition": "If true, indicates that the allowed modifier on which this extension appears is the 'default' modifier that will be presented to the user. If none of the allowed modifiers are flagged as 'default', there is no default and the user must explicitly choose a modifier in order to override the issue. At most one allowed modifier may have this extension set to true.", "comment": "May only be present on one modifier within a reason.", "alias": [ "extensions", "user content" ], "min": 0, "max": "*", "base": { "path": "Element.extension", "min": 0, "max": "*" }, "type": [ { "code": "Extension", "profile": [ "https://bpcs.exchange/fhir/StructureDefinition/ext-ClaimResponse-AllowedModifierDefault" ] } ], "meaningWhenMissing": "If not present, allowedModifier is not a 'default' value.", "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "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()", "source": "http://hl7.org/fhir/StructureDefinition/Extension" } ], "mustSupport": true, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "rim", "map": "N/A" } ] }, { "id": "ClaimResponse.item.reviewOutcome.reason.extension:allowedModifier.value[x].extension:preExistingCondition", "path": "ClaimResponse.item.reviewOutcome.reason.extension.value[x].extension", "sliceName": "preExistingCondition", "short": "Pre-existing condition", "definition": "If true, indicates that the allowed 'override' medical condition for this receipt (on which this extension appears) is already associated with this member's record.", "comment": "Only allowed where an 'allowed modifier' is a health condition.", "alias": [ "extensions", "user content" ], "min": 0, "max": "*", "base": { "path": "Element.extension", "min": 0, "max": "*" }, "type": [ { "code": "Extension", "profile": [ "https://bpcs.exchange/fhir/StructureDefinition/ext-ClaimResponse-PreExistingCondition" ] } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "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()", "source": "http://hl7.org/fhir/StructureDefinition/Extension" } ], "mustSupport": true, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "rim", "map": "N/A" } ] }, { "id": "ClaimResponse.item.reviewOutcome.reason.extension:allowedModifier.value[x].system", "path": "ClaimResponse.item.reviewOutcome.reason.extension.value[x].system", "short": "Identity of the terminology system", "definition": "The identification of the code system that defines the meaning of the symbol in the code.", "comment": "The URI may be an OID (urn:oid:...) or a UUID (urn:uuid:...). OIDs and UUIDs SHALL be references to the HL7 OID registry. Otherwise, the URI should come from HL7's list of FHIR defined special URIs or it should be an absolute reference to some definition that establishes the system clearly and unambiguously.", "requirements": "Need to be unambiguous about the source of the definition of the symbol.", "min": 1, "max": "1", "base": { "path": "Coding.system", "min": 0, "max": "1" }, "type": [ { "code": "uri" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "mustSupport": true, "isSummary": true, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "v2", "map": "C*E.3" }, { "identity": "rim", "map": "./codeSystem" }, { "identity": "orim", "map": "fhir:Coding.system rdfs:subPropertyOf dt:CDCoding.codeSystem" } ] }, { "id": "ClaimResponse.item.reviewOutcome.reason.extension:allowedModifier.value[x].version", "path": "ClaimResponse.item.reviewOutcome.reason.extension.value[x].version", "short": "Version of the system - if relevant", "definition": "The version of the code system which was used when choosing this code. Note that a well-maintained code system does not need the version reported, because the meaning of codes is consistent across versions. However this cannot consistently be assured, and when the meaning is not guaranteed to be consistent, the version SHOULD be exchanged.", "comment": "Where the terminology does not clearly define what string should be used to identify code system versions, the recommendation is to use the date (expressed in FHIR date format) on which that version was officially published as the version date.", "min": 0, "max": "1", "base": { "path": "Coding.version", "min": 0, "max": "1" }, "type": [ { "code": "string" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "isSummary": true, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "v2", "map": "C*E.7" }, { "identity": "rim", "map": "./codeSystemVersion" }, { "identity": "orim", "map": "fhir:Coding.version rdfs:subPropertyOf dt:CDCoding.codeSystemVersion" } ] }, { "id": "ClaimResponse.item.reviewOutcome.reason.extension:allowedModifier.value[x].code", "extension": [ { "url": "http://hl7.org/fhir/tools/StructureDefinition/no-binding", "valueBoolean": true } ], "path": "ClaimResponse.item.reviewOutcome.reason.extension.value[x].code", "short": "Symbol in syntax defined by the system", "definition": "A symbol in syntax defined by the system. The symbol may be a predefined code or an expression in a syntax defined by the coding system (e.g. post-coordination).", "comment": "Note that FHIR strings SHALL NOT exceed 1,048,576 (1024*1024) characters in size", "requirements": "Need to refer to a particular code in the system.", "min": 1, "max": "1", "base": { "path": "Coding.code", "min": 0, "max": "1" }, "type": [ { "code": "code" } ], "condition": [ "cod-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "mustSupport": true, "isSummary": true, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "v2", "map": "C*E.1" }, { "identity": "rim", "map": "./code" }, { "identity": "orim", "map": "fhir:Coding.code rdfs:subPropertyOf dt:CDCoding.code" } ] }, { "id": "ClaimResponse.item.reviewOutcome.reason.extension:allowedModifier.value[x].display", "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-translatable", "valueBoolean": true }, { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-translatable", "valueBoolean": true } ], "path": "ClaimResponse.item.reviewOutcome.reason.extension.value[x].display", "short": "Representation defined by the system", "definition": "A representation of the meaning of the code in the system, following the rules of the system.", "comment": "Note that FHIR strings SHALL NOT exceed 1,048,576 (1024*1024) characters in size", "requirements": "Need to be able to carry a human-readable meaning of the code for readers that do not know the system.", "min": 0, "max": "1", "base": { "path": "Coding.display", "min": 0, "max": "1" }, "type": [ { "code": "string" } ], "condition": [ "cod-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "mustSupport": true, "isSummary": true, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "v2", "map": "C*E.2 - but note this is not well followed" }, { "identity": "rim", "map": "CV.displayName" }, { "identity": "orim", "map": "fhir:Coding.display rdfs:subPropertyOf dt:CDCoding.displayName" } ] }, { "id": "ClaimResponse.item.reviewOutcome.reason.extension:allowedModifier.value[x].userSelected", "path": "ClaimResponse.item.reviewOutcome.reason.extension.value[x].userSelected", "short": "If this coding was chosen directly by the user", "definition": "Indicates that this coding was chosen by a user directly - e.g. off a pick list of available items (codes or displays).", "comment": "Amongst a set of alternatives, a directly chosen code is the most appropriate starting point for new translations. There is some ambiguity about what exactly 'directly chosen' implies, and trading partner agreement may be needed to clarify the use of this element and its consequences more completely.", "requirements": "This has been identified as a clinical safety criterium - that this exact system/code pair was chosen explicitly, rather than inferred by the system based on some rules or language processing.", "min": 0, "max": "1", "base": { "path": "Coding.userSelected", "min": 0, "max": "1" }, "type": [ { "code": "boolean" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "isSummary": true, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "v2", "map": "Sometimes implied by being first" }, { "identity": "rim", "map": "CD.codingRationale" }, { "identity": "orim", "map": "fhir:Coding.userSelected fhir:mapsTo dt:CDCoding.codingRationale. fhir:Coding.userSelected fhir:hasMap fhir:Coding.userSelected.map. fhir:Coding.userSelected.map a fhir:Map; fhir:target dt:CDCoding.codingRationale. fhir:Coding.userSelected\\#true a [ fhir:source \"true\"; fhir:target dt:CDCoding.codingRationale\\#O ]" } ] }, { "id": "ClaimResponse.item.reviewOutcome.reason.extension:duplicate", "path": "ClaimResponse.item.reviewOutcome.reason.extension", "sliceName": "duplicate", "short": "Duplicate receipts", "definition": "Allows an adjudicationResponse to indicate one or more duplicate receipts associated with a particular claim item", "comment": "This will only be present if the reason code is ED and then only if there is not an exact match. If present, the user must identify which of the submitted claims from the pharmacy point of service correspond to the manually submitted receipt. This allows information such as coverage from other payers to be taken into account when adjudicating the paper claim. The selected duplicate will then be conveyed in the 'duplicateVersion' extension when re-adjudicating the receipt.", "alias": [ "extensions", "user content" ], "min": 0, "max": "1", "base": { "path": "Element.extension", "min": 0, "max": "*" }, "type": [ { "code": "Extension", "profile": [ "https://bpcs.exchange/fhir/StructureDefinition/ext-ClaimResponse-DuplicateReceipts" ] } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "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()", "source": "http://hl7.org/fhir/StructureDefinition/Extension" } ], "mustSupport": true, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "rim", "map": "N/A" } ] }, { "id": "ClaimResponse.item.reviewOutcome.reason.coding", "path": "ClaimResponse.item.reviewOutcome.reason.coding", "short": "Code defined by a terminology system", "definition": "A reference to a code defined by a terminology system.", "comment": "Codes may be defined very casually in enumerations, or code lists, up to very formal definitions such as SNOMED CT - see the HL7 v3 Core Principles for more information. Ordering of codings is undefined and SHALL NOT be used to infer meaning. Generally, at most only one of the coding values will be labeled as UserSelected = true.", "requirements": "Allows for alternative encodings within a code system, and translations to other code systems.", "min": 0, "max": "*", "base": { "path": "CodeableConcept.coding", "min": 0, "max": "*" }, "type": [ { "code": "Coding" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "source": "http://hl7.org/fhir/StructureDefinition/Element" }, { "key": "cod-1", "severity": "warning", "human": "A Coding SHOULD NOT have a display unless a code is also present. Computation on Coding.display alone is generally unsafe. Consider using CodeableConcept.text", "expression": "code.exists().not() implies display.exists().not()", "source": "http://hl7.org/fhir/StructureDefinition/Coding" } ], "isSummary": true, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "v2", "map": "CE/CNE/CWE subset one of the sets of component 1-3 or 4-6" }, { "identity": "rim", "map": "CV" }, { "identity": "orim", "map": "fhir:Coding rdfs:subClassOf dt:CDCoding" }, { "identity": "v2", "map": "C*E.1-8, C*E.10-22" }, { "identity": "rim", "map": "union(., ./translation)" }, { "identity": "orim", "map": "fhir:CodeableConcept.coding rdfs:subPropertyOf dt:CD.coding" } ] }, { "id": "ClaimResponse.item.reviewOutcome.reason.text", "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-translatable", "valueBoolean": true }, { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-translatable", "valueBoolean": true } ], "path": "ClaimResponse.item.reviewOutcome.reason.text", "short": "Plain text representation of the concept", "definition": "A human language representation of the concept as seen/selected/uttered by the user who entered the data and/or which represents the intended meaning of the user.", "comment": "Very often the text is the same as a displayName of one of the codings.", "requirements": "The codes from the terminologies do not always capture the correct meaning with all the nuances of the human using them, or sometimes there is no appropriate code at all. In these cases, the text is used to capture the full meaning of the source.", "min": 0, "max": "1", "base": { "path": "CodeableConcept.text", "min": 0, "max": "1" }, "type": [ { "code": "string" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "isSummary": true, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "v2", "map": "C*E.9. But note many systems use C*E.2 for this" }, { "identity": "rim", "map": "./originalText[mediaType/code=\"text/plain\"]/data" }, { "identity": "orim", "map": "fhir:CodeableConcept.text rdfs:subPropertyOf dt:CD.originalText" } ] }, { "id": "ClaimResponse.item.reviewOutcome.preAuthRef", "path": "ClaimResponse.item.reviewOutcome.preAuthRef", "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.", "requirements": "On subsequent claims, the insurer may require the provider to quote this value.", "min": 0, "max": "1", "base": { "path": "ClaimResponse.item.reviewOutcome.preAuthRef", "min": 0, "max": "1" }, "type": [ { "code": "string" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "mustSupport": false, "isModifier": false, "isSummary": false, "mapping": [ { "identity": "rim", "map": "n/a" } ] }, { "id": "ClaimResponse.item.reviewOutcome.preAuthPeriod", "path": "ClaimResponse.item.reviewOutcome.preAuthPeriod", "short": "Preauthorization reference effective period", "definition": "The time frame during which this authorization is effective.", "comment": "A Period specifies a range of time; the context of use will specify whether the entire range applies (e.g. \"the patient was an inpatient of the hospital for this time range\") or one value from the range applies (e.g. \"give to the patient between these two times\").\n\nPeriod is not used for a duration (a measure of elapsed time). See [Duration](datatypes.html#Duration).", "requirements": "To convey to the provider when the authorized products and services must be supplied for the authorized adjudication to apply.", "min": 0, "max": "1", "base": { "path": "ClaimResponse.item.reviewOutcome.preAuthPeriod", "min": 0, "max": "1" }, "type": [ { "code": "Period" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "source": "http://hl7.org/fhir/StructureDefinition/Element" }, { "key": "per-1", "severity": "error", "human": "If present, start SHALL have a lower or equal value than end", "expression": "start.hasValue().not() or end.hasValue().not() or (start.lowBoundary() <= end.highBoundary())", "source": "http://hl7.org/fhir/StructureDefinition/Period" } ], "mustSupport": false, "isModifier": false, "isSummary": false, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "v2", "map": "DR" }, { "identity": "rim", "map": "IVL[lowClosed=\"true\" and highClosed=\"true\"] or URG[lowClosed=\"true\" and highClosed=\"true\"]" } ] }, { "id": "ClaimResponse.item.adjudication", "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-explicit-type-name", "valueString": "Adjudication" } ], "path": "ClaimResponse.item.adjudication", "slicing": { "discriminator": [ { "type": "value", "path": "category" } ], "rules": "open" }, "short": "Adjudication details", "definition": "If this item is a group then the values here are a summary of the adjudication of the detail items. If this item is a simple product or service then this is the result of the adjudication of this item.", "requirements": "The adjudication results conveys the insurer's assessment of the item provided in the claim under the terms of the patient's insurance coverage.", "min": 2, "max": "*", "base": { "path": "ClaimResponse.item.adjudication", "min": 0, "max": "*" }, "type": [ { "code": "BackboneElement" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "mustSupport": true, "isModifier": false, "isSummary": false, "mapping": [ { "identity": "rim", "map": "n/a" } ] }, { "id": "ClaimResponse.item.adjudication.id", "path": "ClaimResponse.item.adjudication.id", "representation": [ "xmlAttr" ], "short": "Unique id for inter-element referencing", "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": [ { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type", "valueUrl": "string" } ], "code": "http://hl7.org/fhirpath/System.String" } ], "condition": [ "ele-1" ], "mapping": [ { "identity": "rim", "map": "n/a" } ] }, { "id": "ClaimResponse.item.adjudication.extension", "path": "ClaimResponse.item.adjudication.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. To make the use of extensions safe and managable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can 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" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "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()", "source": "http://hl7.org/fhir/StructureDefinition/Extension" } ], "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "rim", "map": "N/A" } ] }, { "id": "ClaimResponse.item.adjudication.modifierExtension", "path": "ClaimResponse.item.adjudication.modifierExtension", "short": "Extensions that cannot be ignored even if unrecognized", "definition": "May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and managable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.\n\nModifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).", "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.", "requirements": "Modifier extensions allow for extensions that *cannot* be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the [definition of modifier extensions](extensibility.html#modifierExtension).", "alias": [ "extensions", "user content", "modifiers" ], "min": 0, "max": "*", "base": { "path": "BackboneElement.modifierExtension", "min": 0, "max": "*" }, "type": [ { "code": "Extension" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "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()", "source": "http://hl7.org/fhir/StructureDefinition/Extension" } ], "isModifier": true, "isModifierReason": "Modifier extensions are expected to modify the meaning or interpretation of the element that contains them", "isSummary": true, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "rim", "map": "N/A" } ] }, { "id": "ClaimResponse.item.adjudication.category", "path": "ClaimResponse.item.adjudication.category", "short": "Type of adjudication information", "definition": "A code to indicate the information type of this adjudication record. Information types may include the value submitted, maximum values or percentages allowed or payable under the plan, amounts that: the patient is responsible for in aggregate or pertaining to this item; amounts paid by other coverages; and, the benefit payable for this item.", "comment": "For example codes indicating: Co-Pay, deductible, eligible, benefit, tax, etc.", "requirements": "Needed to enable understanding of the context of the other information in the adjudication.", "min": 1, "max": "1", "base": { "path": "ClaimResponse.item.adjudication.category", "min": 1, "max": "1" }, "type": [ { "code": "CodeableConcept" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "mustSupport": false, "isModifier": false, "isSummary": false, "binding": { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString": "Adjudication" } ], "strength": "example", "description": "The adjudication codes.", "valueSet": "http://hl7.org/fhir/ValueSet/adjudication" }, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "v2", "map": "CE/CNE/CWE" }, { "identity": "rim", "map": "CD" }, { "identity": "orim", "map": "fhir:CodeableConcept rdfs:subClassOf dt:CD" } ] }, { "id": "ClaimResponse.item.adjudication.reason", "path": "ClaimResponse.item.adjudication.reason", "short": "Explanation of adjudication outcome", "definition": "A code supporting the understanding of the adjudication result and explaining variance from expected amount.", "comment": "For example may indicate that the funds for this benefit type have been exhausted.", "requirements": "To support understanding of variance from adjudication expectations.", "min": 0, "max": "1", "base": { "path": "ClaimResponse.item.adjudication.reason", "min": 0, "max": "1" }, "type": [ { "code": "CodeableConcept" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "mustSupport": false, "isModifier": false, "isSummary": false, "binding": { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString": "AdjudicationReason" } ], "strength": "example", "description": "The adjudication reason codes.", "valueSet": "http://hl7.org/fhir/ValueSet/adjudication-reason" }, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "v2", "map": "CE/CNE/CWE" }, { "identity": "rim", "map": "CD" }, { "identity": "orim", "map": "fhir:CodeableConcept rdfs:subClassOf dt:CD" } ] }, { "id": "ClaimResponse.item.adjudication.amount", "path": "ClaimResponse.item.adjudication.amount", "short": "Monetary amount", "definition": "Monetary amount associated with the category.", "comment": "For example: amount submitted, eligible amount, co-payment, and benefit payable.", "requirements": "Most adjudication categories convey a monetary amount.", "min": 0, "max": "1", "base": { "path": "ClaimResponse.item.adjudication.amount", "min": 0, "max": "1" }, "type": [ { "code": "Money" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "mustSupport": false, "isModifier": false, "isSummary": false, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "rim", "map": "MO" } ] }, { "id": "ClaimResponse.item.adjudication.quantity", "path": "ClaimResponse.item.adjudication.quantity", "short": "Non-monetary value", "definition": "A non-monetary value associated with the category. Mutually exclusive to the amount element above.", "comment": "For example: eligible percentage or co-payment percentage.", "requirements": "Some adjudication categories convey a percentage or a fixed value.", "min": 0, "max": "1", "base": { "path": "ClaimResponse.item.adjudication.quantity", "min": 0, "max": "1" }, "type": [ { "code": "Quantity" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "source": "http://hl7.org/fhir/StructureDefinition/Element" }, { "key": "qty-3", "severity": "error", "human": "If a code for the unit is present, the system SHALL also be present", "expression": "code.empty() or system.exists()", "source": "http://hl7.org/fhir/StructureDefinition/Quantity" } ], "mustSupport": false, "isModifier": false, "isSummary": false, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "v2", "map": "SN (see also Range) or CQ" }, { "identity": "rim", "map": "PQ, IVL, MO, CO, depending on the values" } ] }, { "id": "ClaimResponse.item.adjudication:eligible", "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-explicit-type-name", "valueString": "Adjudication" } ], "path": "ClaimResponse.item.adjudication", "sliceName": "eligible", "short": "Eligible amount", "definition": "If this item is a group then the values here are a summary of the adjudication of the detail items. If this item is a simple product or service then this is the result of the adjudication of this item.", "requirements": "The adjudication results conveys the insurer's assessment of the item provided in the claim under the terms of the patient's insurance coverage.", "min": 1, "max": "1", "base": { "path": "ClaimResponse.item.adjudication", "min": 0, "max": "*" }, "type": [ { "code": "BackboneElement" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "mustSupport": true, "isModifier": false, "isSummary": false, "mapping": [ { "identity": "rim", "map": "n/a" } ] }, { "id": "ClaimResponse.item.adjudication:eligible.id", "path": "ClaimResponse.item.adjudication.id", "representation": [ "xmlAttr" ], "short": "Unique id for inter-element referencing", "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": [ { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type", "valueUrl": "string" } ], "code": "http://hl7.org/fhirpath/System.String" } ], "condition": [ "ele-1" ], "mapping": [ { "identity": "rim", "map": "n/a" } ] }, { "id": "ClaimResponse.item.adjudication:eligible.extension", "path": "ClaimResponse.item.adjudication.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. To make the use of extensions safe and managable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can 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" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "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()", "source": "http://hl7.org/fhir/StructureDefinition/Extension" } ], "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "rim", "map": "N/A" } ] }, { "id": "ClaimResponse.item.adjudication:eligible.modifierExtension", "path": "ClaimResponse.item.adjudication.modifierExtension", "short": "Extensions that cannot be ignored even if unrecognized", "definition": "May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and managable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.\n\nModifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).", "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.", "requirements": "Modifier extensions allow for extensions that *cannot* be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the [definition of modifier extensions](extensibility.html#modifierExtension).", "alias": [ "extensions", "user content", "modifiers" ], "min": 0, "max": "*", "base": { "path": "BackboneElement.modifierExtension", "min": 0, "max": "*" }, "type": [ { "code": "Extension" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "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()", "source": "http://hl7.org/fhir/StructureDefinition/Extension" } ], "isModifier": true, "isModifierReason": "Modifier extensions are expected to modify the meaning or interpretation of the element that contains them", "isSummary": true, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "rim", "map": "N/A" } ] }, { "id": "ClaimResponse.item.adjudication:eligible.category", "path": "ClaimResponse.item.adjudication.category", "short": "Type of adjudication information", "definition": "A code to indicate the information type of this adjudication record. Information types may include the value submitted, maximum values or percentages allowed or payable under the plan, amounts that: the patient is responsible for in aggregate or pertaining to this item; amounts paid by other coverages; and, the benefit payable for this item.", "comment": "For example codes indicating: Co-Pay, deductible, eligible, benefit, tax, etc.", "requirements": "Needed to enable understanding of the context of the other information in the adjudication.", "min": 1, "max": "1", "base": { "path": "ClaimResponse.item.adjudication.category", "min": 1, "max": "1" }, "type": [ { "code": "CodeableConcept" } ], "patternCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "eligible" } ] }, "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "mustSupport": false, "isModifier": false, "isSummary": false, "binding": { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString": "Adjudication" } ], "strength": "example", "description": "The adjudication codes.", "valueSet": "http://hl7.org/fhir/ValueSet/adjudication" }, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "v2", "map": "CE/CNE/CWE" }, { "identity": "rim", "map": "CD" }, { "identity": "orim", "map": "fhir:CodeableConcept rdfs:subClassOf dt:CD" } ] }, { "id": "ClaimResponse.item.adjudication:eligible.reason", "path": "ClaimResponse.item.adjudication.reason", "short": "Explanation of adjudication outcome", "definition": "A code supporting the understanding of the adjudication result and explaining variance from expected amount.", "comment": "For example may indicate that the funds for this benefit type have been exhausted.", "requirements": "To support understanding of variance from adjudication expectations.", "min": 0, "max": "1", "base": { "path": "ClaimResponse.item.adjudication.reason", "min": 0, "max": "1" }, "type": [ { "code": "CodeableConcept" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "mustSupport": false, "isModifier": false, "isSummary": false, "binding": { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString": "AdjudicationReason" } ], "strength": "example", "description": "The adjudication reason codes.", "valueSet": "http://hl7.org/fhir/ValueSet/adjudication-reason" }, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "v2", "map": "CE/CNE/CWE" }, { "identity": "rim", "map": "CD" }, { "identity": "orim", "map": "fhir:CodeableConcept rdfs:subClassOf dt:CD" } ] }, { "id": "ClaimResponse.item.adjudication:eligible.amount", "path": "ClaimResponse.item.adjudication.amount", "short": "An amount of economic utility in some recognized currency", "definition": "An amount of economic utility in some recognized currency.", "comment": "For example: amount submitted, eligible amount, co-payment, and benefit payable.", "requirements": "Most adjudication categories convey a monetary amount.", "min": 1, "max": "1", "base": { "path": "ClaimResponse.item.adjudication.amount", "min": 0, "max": "1" }, "type": [ { "code": "Money", "profile": [ "https://bpcs.exchange/fhir/StructureDefinition/profile-Money-CAD-NonNeg" ] } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "mustSupport": true, "isModifier": false, "isSummary": false, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "rim", "map": "MO" }, { "identity": "BPCS", "map": "ReceiptDTO.allowedRxExp" } ] }, { "id": "ClaimResponse.item.adjudication:eligible.quantity", "path": "ClaimResponse.item.adjudication.quantity", "short": "Non-monetary value", "definition": "A non-monetary value associated with the category. Mutually exclusive to the amount element above.", "comment": "For example: eligible percentage or co-payment percentage.", "requirements": "Some adjudication categories convey a percentage or a fixed value.", "min": 0, "max": "1", "base": { "path": "ClaimResponse.item.adjudication.quantity", "min": 0, "max": "1" }, "type": [ { "code": "Quantity" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "source": "http://hl7.org/fhir/StructureDefinition/Element" }, { "key": "qty-3", "severity": "error", "human": "If a code for the unit is present, the system SHALL also be present", "expression": "code.empty() or system.exists()", "source": "http://hl7.org/fhir/StructureDefinition/Quantity" } ], "mustSupport": false, "isModifier": false, "isSummary": false, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "v2", "map": "SN (see also Range) or CQ" }, { "identity": "rim", "map": "PQ, IVL, MO, CO, depending on the values" } ] }, { "id": "ClaimResponse.item.adjudication:benefit", "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-explicit-type-name", "valueString": "Adjudication" } ], "path": "ClaimResponse.item.adjudication", "sliceName": "benefit", "short": "Benefit amount", "definition": "If this item is a group then the values here are a summary of the adjudication of the detail items. If this item is a simple product or service then this is the result of the adjudication of this item.", "requirements": "The adjudication results conveys the insurer's assessment of the item provided in the claim under the terms of the patient's insurance coverage.", "min": 1, "max": "1", "base": { "path": "ClaimResponse.item.adjudication", "min": 0, "max": "*" }, "type": [ { "code": "BackboneElement" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "mustSupport": true, "isModifier": false, "isSummary": false, "mapping": [ { "identity": "rim", "map": "n/a" } ] }, { "id": "ClaimResponse.item.adjudication:benefit.id", "path": "ClaimResponse.item.adjudication.id", "representation": [ "xmlAttr" ], "short": "Unique id for inter-element referencing", "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": [ { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type", "valueUrl": "string" } ], "code": "http://hl7.org/fhirpath/System.String" } ], "condition": [ "ele-1" ], "mapping": [ { "identity": "rim", "map": "n/a" } ] }, { "id": "ClaimResponse.item.adjudication:benefit.extension", "path": "ClaimResponse.item.adjudication.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. To make the use of extensions safe and managable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can 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" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "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()", "source": "http://hl7.org/fhir/StructureDefinition/Extension" } ], "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "rim", "map": "N/A" } ] }, { "id": "ClaimResponse.item.adjudication:benefit.modifierExtension", "path": "ClaimResponse.item.adjudication.modifierExtension", "short": "Extensions that cannot be ignored even if unrecognized", "definition": "May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and managable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.\n\nModifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).", "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.", "requirements": "Modifier extensions allow for extensions that *cannot* be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the [definition of modifier extensions](extensibility.html#modifierExtension).", "alias": [ "extensions", "user content", "modifiers" ], "min": 0, "max": "*", "base": { "path": "BackboneElement.modifierExtension", "min": 0, "max": "*" }, "type": [ { "code": "Extension" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "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()", "source": "http://hl7.org/fhir/StructureDefinition/Extension" } ], "isModifier": true, "isModifierReason": "Modifier extensions are expected to modify the meaning or interpretation of the element that contains them", "isSummary": true, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "rim", "map": "N/A" } ] }, { "id": "ClaimResponse.item.adjudication:benefit.category", "path": "ClaimResponse.item.adjudication.category", "short": "Type of adjudication information", "definition": "A code to indicate the information type of this adjudication record. Information types may include the value submitted, maximum values or percentages allowed or payable under the plan, amounts that: the patient is responsible for in aggregate or pertaining to this item; amounts paid by other coverages; and, the benefit payable for this item.", "comment": "For example codes indicating: Co-Pay, deductible, eligible, benefit, tax, etc.", "requirements": "Needed to enable understanding of the context of the other information in the adjudication.", "min": 1, "max": "1", "base": { "path": "ClaimResponse.item.adjudication.category", "min": 1, "max": "1" }, "type": [ { "code": "CodeableConcept" } ], "patternCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "benefit" } ] }, "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "mustSupport": false, "isModifier": false, "isSummary": false, "binding": { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString": "Adjudication" } ], "strength": "example", "description": "The adjudication codes.", "valueSet": "http://hl7.org/fhir/ValueSet/adjudication" }, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "v2", "map": "CE/CNE/CWE" }, { "identity": "rim", "map": "CD" }, { "identity": "orim", "map": "fhir:CodeableConcept rdfs:subClassOf dt:CD" } ] }, { "id": "ClaimResponse.item.adjudication:benefit.reason", "path": "ClaimResponse.item.adjudication.reason", "short": "Explanation of adjudication outcome", "definition": "A code supporting the understanding of the adjudication result and explaining variance from expected amount.", "comment": "For example may indicate that the funds for this benefit type have been exhausted.", "requirements": "To support understanding of variance from adjudication expectations.", "min": 0, "max": "1", "base": { "path": "ClaimResponse.item.adjudication.reason", "min": 0, "max": "1" }, "type": [ { "code": "CodeableConcept" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "mustSupport": false, "isModifier": false, "isSummary": false, "binding": { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString": "AdjudicationReason" } ], "strength": "example", "description": "The adjudication reason codes.", "valueSet": "http://hl7.org/fhir/ValueSet/adjudication-reason" }, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "v2", "map": "CE/CNE/CWE" }, { "identity": "rim", "map": "CD" }, { "identity": "orim", "map": "fhir:CodeableConcept rdfs:subClassOf dt:CD" } ] }, { "id": "ClaimResponse.item.adjudication:benefit.amount", "path": "ClaimResponse.item.adjudication.amount", "short": "An amount of economic utility in some recognized currency", "definition": "An amount of economic utility in some recognized currency.", "comment": "For example: amount submitted, eligible amount, co-payment, and benefit payable.", "requirements": "Most adjudication categories convey a monetary amount.", "min": 1, "max": "1", "base": { "path": "ClaimResponse.item.adjudication.amount", "min": 0, "max": "1" }, "type": [ { "code": "Money", "profile": [ "https://bpcs.exchange/fhir/StructureDefinition/profile-Money-CAD-NonNeg" ] } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "mustSupport": true, "isModifier": false, "isSummary": false, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "rim", "map": "MO" }, { "identity": "BPCS", "map": "ReceiptDTO.reimbAmt" } ] }, { "id": "ClaimResponse.item.adjudication:benefit.quantity", "path": "ClaimResponse.item.adjudication.quantity", "short": "Non-monetary value", "definition": "A non-monetary value associated with the category. Mutually exclusive to the amount element above.", "comment": "For example: eligible percentage or co-payment percentage.", "requirements": "Some adjudication categories convey a percentage or a fixed value.", "min": 0, "max": "1", "base": { "path": "ClaimResponse.item.adjudication.quantity", "min": 0, "max": "1" }, "type": [ { "code": "Quantity" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "source": "http://hl7.org/fhir/StructureDefinition/Element" }, { "key": "qty-3", "severity": "error", "human": "If a code for the unit is present, the system SHALL also be present", "expression": "code.empty() or system.exists()", "source": "http://hl7.org/fhir/StructureDefinition/Quantity" } ], "mustSupport": false, "isModifier": false, "isSummary": false, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "v2", "map": "SN (see also Range) or CQ" }, { "identity": "rim", "map": "PQ, IVL, MO, CO, depending on the values" } ] }, { "id": "ClaimResponse.item.detail", "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-explicit-type-name", "valueString": "ItemDetail" } ], "path": "ClaimResponse.item.detail", "short": "Adjudication for claim details", "definition": "A claim detail. Either a simple (a product or service) or a 'group' of sub-details which are simple items.", "requirements": "The adjudication for details provided on the claim.", "min": 0, "max": "*", "base": { "path": "ClaimResponse.item.detail", "min": 0, "max": "*" }, "type": [ { "code": "BackboneElement" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "mustSupport": false, "isModifier": false, "isSummary": false, "mapping": [ { "identity": "rim", "map": "n/a" } ] }, { "id": "ClaimResponse.item.detail.id", "path": "ClaimResponse.item.detail.id", "representation": [ "xmlAttr" ], "short": "Unique id for inter-element referencing", "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": [ { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type", "valueUrl": "string" } ], "code": "http://hl7.org/fhirpath/System.String" } ], "condition": [ "ele-1" ], "mapping": [ { "identity": "rim", "map": "n/a" } ] }, { "id": "ClaimResponse.item.detail.extension", "path": "ClaimResponse.item.detail.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. To make the use of extensions safe and managable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can 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" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "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()", "source": "http://hl7.org/fhir/StructureDefinition/Extension" } ], "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "rim", "map": "N/A" } ] }, { "id": "ClaimResponse.item.detail.modifierExtension", "path": "ClaimResponse.item.detail.modifierExtension", "short": "Extensions that cannot be ignored even if unrecognized", "definition": "May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and managable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.\n\nModifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).", "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.", "requirements": "Modifier extensions allow for extensions that *cannot* be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the [definition of modifier extensions](extensibility.html#modifierExtension).", "alias": [ "extensions", "user content", "modifiers" ], "min": 0, "max": "*", "base": { "path": "BackboneElement.modifierExtension", "min": 0, "max": "*" }, "type": [ { "code": "Extension" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "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()", "source": "http://hl7.org/fhir/StructureDefinition/Extension" } ], "isModifier": true, "isModifierReason": "Modifier extensions are expected to modify the meaning or interpretation of the element that contains them", "isSummary": true, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "rim", "map": "N/A" } ] }, { "id": "ClaimResponse.item.detail.detailSequence", "path": "ClaimResponse.item.detail.detailSequence", "short": "Claim detail instance identifier", "definition": "A number to uniquely reference the claim detail entry.", "comment": "32 bit number; for values larger than this, use decimal", "requirements": "Necessary to provide a mechanism to link the adjudication result to the submitted claim detail.", "min": 1, "max": "1", "base": { "path": "ClaimResponse.item.detail.detailSequence", "min": 1, "max": "1" }, "type": [ { "code": "positiveInt" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "mustSupport": false, "isModifier": false, "isSummary": false, "mapping": [ { "identity": "rim", "map": "n/a" } ] }, { "id": "ClaimResponse.item.detail.traceNumber", "path": "ClaimResponse.item.detail.traceNumber", "short": "Number for tracking", "definition": "Trace number for tracking purposes. May be defined at the jurisdiction level or between trading partners.", "comment": "The rules of the identifier.type determine if a check digit is part of the ID value or sent separately, such as through the checkDigit extension.", "requirements": "Allows partners to uniquely identify components for tracking.", "min": 0, "max": "*", "base": { "path": "ClaimResponse.item.detail.traceNumber", "min": 0, "max": "*" }, "type": [ { "code": "Identifier" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "source": "http://hl7.org/fhir/StructureDefinition/Element" }, { "key": "ident-1", "severity": "warning", "human": "Identifier with no value has limited utility. If communicating that an identifier value has been suppressed or missing, the value element SHOULD be present with an extension indicating the missing semantic - e.g. data-absent-reason", "expression": "value.exists()", "source": "http://hl7.org/fhir/StructureDefinition/Identifier" } ], "mustSupport": false, "isModifier": false, "isSummary": false, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "v2", "map": "CX / EI (occasionally, more often EI maps to a resource id or a URL)" }, { "identity": "rim", "map": "II - The Identifier class is a little looser than the v3 type II because it allows URIs as well as registered OIDs or GUIDs. Also maps to Role[classCode=IDENT]" }, { "identity": "servd", "map": "Identifier" } ] }, { "id": "ClaimResponse.item.detail.noteNumber", "path": "ClaimResponse.item.detail.noteNumber", "short": "Applicable note numbers", "definition": "The numbers associated with notes below which apply to the adjudication of this item.", "comment": "32 bit number; for values larger than this, use decimal", "requirements": "Provides a condensed manner for associating human readable descriptive explanations for adjudications on the line item.", "min": 0, "max": "*", "base": { "path": "ClaimResponse.item.detail.noteNumber", "min": 0, "max": "*" }, "type": [ { "code": "positiveInt" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "mustSupport": false, "isModifier": false, "isSummary": false, "mapping": [ { "identity": "rim", "map": "n/a" } ] }, { "id": "ClaimResponse.item.detail.reviewOutcome", "path": "ClaimResponse.item.detail.reviewOutcome", "short": "Detail level adjudication results", "definition": "The high-level results of the adjudication if adjudication has been performed.", "min": 0, "max": "1", "base": { "path": "ClaimResponse.item.detail.reviewOutcome", "min": 0, "max": "1" }, "contentReference": "#ClaimResponse.item.reviewOutcome", "mustSupport": false, "isModifier": false, "isSummary": false }, { "id": "ClaimResponse.item.detail.adjudication", "path": "ClaimResponse.item.detail.adjudication", "short": "Detail level adjudication details", "definition": "The adjudication results.", "min": 0, "max": "*", "base": { "path": "ClaimResponse.item.detail.adjudication", "min": 0, "max": "*" }, "contentReference": "#ClaimResponse.item.adjudication", "mustSupport": false, "isModifier": false, "isSummary": false }, { "id": "ClaimResponse.item.detail.subDetail", "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-explicit-type-name", "valueString": "SubDetail" } ], "path": "ClaimResponse.item.detail.subDetail", "short": "Adjudication for claim sub-details", "definition": "A sub-detail adjudication of a simple product or service.", "requirements": "The adjudication for sub-details provided on the claim.", "min": 0, "max": "*", "base": { "path": "ClaimResponse.item.detail.subDetail", "min": 0, "max": "*" }, "type": [ { "code": "BackboneElement" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "mustSupport": false, "isModifier": false, "isSummary": false, "mapping": [ { "identity": "rim", "map": "n/a" } ] }, { "id": "ClaimResponse.item.detail.subDetail.id", "path": "ClaimResponse.item.detail.subDetail.id", "representation": [ "xmlAttr" ], "short": "Unique id for inter-element referencing", "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": [ { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type", "valueUrl": "string" } ], "code": "http://hl7.org/fhirpath/System.String" } ], "condition": [ "ele-1" ], "mapping": [ { "identity": "rim", "map": "n/a" } ] }, { "id": "ClaimResponse.item.detail.subDetail.extension", "path": "ClaimResponse.item.detail.subDetail.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. To make the use of extensions safe and managable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can 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" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "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()", "source": "http://hl7.org/fhir/StructureDefinition/Extension" } ], "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "rim", "map": "N/A" } ] }, { "id": "ClaimResponse.item.detail.subDetail.modifierExtension", "path": "ClaimResponse.item.detail.subDetail.modifierExtension", "short": "Extensions that cannot be ignored even if unrecognized", "definition": "May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and managable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.\n\nModifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).", "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.", "requirements": "Modifier extensions allow for extensions that *cannot* be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the [definition of modifier extensions](extensibility.html#modifierExtension).", "alias": [ "extensions", "user content", "modifiers" ], "min": 0, "max": "*", "base": { "path": "BackboneElement.modifierExtension", "min": 0, "max": "*" }, "type": [ { "code": "Extension" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "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()", "source": "http://hl7.org/fhir/StructureDefinition/Extension" } ], "isModifier": true, "isModifierReason": "Modifier extensions are expected to modify the meaning or interpretation of the element that contains them", "isSummary": true, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "rim", "map": "N/A" } ] }, { "id": "ClaimResponse.item.detail.subDetail.subDetailSequence", "path": "ClaimResponse.item.detail.subDetail.subDetailSequence", "short": "Claim sub-detail instance identifier", "definition": "A number to uniquely reference the claim sub-detail entry.", "comment": "32 bit number; for values larger than this, use decimal", "requirements": "Necessary to provide a mechanism to link the adjudication result to the submitted claim sub-detail.", "min": 1, "max": "1", "base": { "path": "ClaimResponse.item.detail.subDetail.subDetailSequence", "min": 1, "max": "1" }, "type": [ { "code": "positiveInt" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "mustSupport": false, "isModifier": false, "isSummary": false, "mapping": [ { "identity": "rim", "map": "n/a" } ] }, { "id": "ClaimResponse.item.detail.subDetail.traceNumber", "path": "ClaimResponse.item.detail.subDetail.traceNumber", "short": "Number for tracking", "definition": "Trace number for tracking purposes. May be defined at the jurisdiction level or between trading partners.", "comment": "The rules of the identifier.type determine if a check digit is part of the ID value or sent separately, such as through the checkDigit extension.", "requirements": "Allows partners to uniquely identify components for tracking.", "min": 0, "max": "*", "base": { "path": "ClaimResponse.item.detail.subDetail.traceNumber", "min": 0, "max": "*" }, "type": [ { "code": "Identifier" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "source": "http://hl7.org/fhir/StructureDefinition/Element" }, { "key": "ident-1", "severity": "warning", "human": "Identifier with no value has limited utility. If communicating that an identifier value has been suppressed or missing, the value element SHOULD be present with an extension indicating the missing semantic - e.g. data-absent-reason", "expression": "value.exists()", "source": "http://hl7.org/fhir/StructureDefinition/Identifier" } ], "mustSupport": false, "isModifier": false, "isSummary": false, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "v2", "map": "CX / EI (occasionally, more often EI maps to a resource id or a URL)" }, { "identity": "rim", "map": "II - The Identifier class is a little looser than the v3 type II because it allows URIs as well as registered OIDs or GUIDs. Also maps to Role[classCode=IDENT]" }, { "identity": "servd", "map": "Identifier" } ] }, { "id": "ClaimResponse.item.detail.subDetail.noteNumber", "path": "ClaimResponse.item.detail.subDetail.noteNumber", "short": "Applicable note numbers", "definition": "The numbers associated with notes below which apply to the adjudication of this item.", "comment": "32 bit number; for values larger than this, use decimal", "requirements": "Provides a condensed manner for associating human readable descriptive explanations for adjudications on the line item.", "min": 0, "max": "*", "base": { "path": "ClaimResponse.item.detail.subDetail.noteNumber", "min": 0, "max": "*" }, "type": [ { "code": "positiveInt" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "mustSupport": false, "isModifier": false, "isSummary": false, "mapping": [ { "identity": "rim", "map": "n/a" } ] }, { "id": "ClaimResponse.item.detail.subDetail.reviewOutcome", "path": "ClaimResponse.item.detail.subDetail.reviewOutcome", "short": "Subdetail level adjudication results", "definition": "The high-level results of the adjudication if adjudication has been performed.", "min": 0, "max": "1", "base": { "path": "ClaimResponse.item.detail.subDetail.reviewOutcome", "min": 0, "max": "1" }, "contentReference": "#ClaimResponse.item.reviewOutcome", "mustSupport": false, "isModifier": false, "isSummary": false }, { "id": "ClaimResponse.item.detail.subDetail.adjudication", "path": "ClaimResponse.item.detail.subDetail.adjudication", "short": "Subdetail level adjudication details", "definition": "The adjudication results.", "min": 0, "max": "*", "base": { "path": "ClaimResponse.item.detail.subDetail.adjudication", "min": 0, "max": "*" }, "contentReference": "#ClaimResponse.item.adjudication", "mustSupport": false, "isModifier": false, "isSummary": false }, { "id": "ClaimResponse.addItem", "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-explicit-type-name", "valueString": "AddedItem" } ], "path": "ClaimResponse.addItem", "short": "Insurer added line items", "definition": "The first-tier service adjudications for payor added product or service lines.", "requirements": "Insurers may redefine the provided product or service or may package and/or decompose groups of products and services. The addItems allows the insurer to provide their line item list with linkage to the submitted items/details/sub-details. In a preauthorization the insurer may use the addItem structure to provide additional information on authorized products and services.", "min": 0, "max": "*", "base": { "path": "ClaimResponse.addItem", "min": 0, "max": "*" }, "type": [ { "code": "BackboneElement" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "mustSupport": false, "isModifier": false, "isSummary": false, "mapping": [ { "identity": "rim", "map": "n/a" } ] }, { "id": "ClaimResponse.addItem.id", "path": "ClaimResponse.addItem.id", "representation": [ "xmlAttr" ], "short": "Unique id for inter-element referencing", "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": [ { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type", "valueUrl": "string" } ], "code": "http://hl7.org/fhirpath/System.String" } ], "condition": [ "ele-1" ], "mapping": [ { "identity": "rim", "map": "n/a" } ] }, { "id": "ClaimResponse.addItem.extension", "path": "ClaimResponse.addItem.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. To make the use of extensions safe and managable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can 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" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "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()", "source": "http://hl7.org/fhir/StructureDefinition/Extension" } ], "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "rim", "map": "N/A" } ] }, { "id": "ClaimResponse.addItem.modifierExtension", "path": "ClaimResponse.addItem.modifierExtension", "short": "Extensions that cannot be ignored even if unrecognized", "definition": "May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and managable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.\n\nModifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).", "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.", "requirements": "Modifier extensions allow for extensions that *cannot* be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the [definition of modifier extensions](extensibility.html#modifierExtension).", "alias": [ "extensions", "user content", "modifiers" ], "min": 0, "max": "*", "base": { "path": "BackboneElement.modifierExtension", "min": 0, "max": "*" }, "type": [ { "code": "Extension" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "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()", "source": "http://hl7.org/fhir/StructureDefinition/Extension" } ], "isModifier": true, "isModifierReason": "Modifier extensions are expected to modify the meaning or interpretation of the element that contains them", "isSummary": true, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "rim", "map": "N/A" } ] }, { "id": "ClaimResponse.addItem.itemSequence", "path": "ClaimResponse.addItem.itemSequence", "short": "Item sequence number", "definition": "Claim items which this service line is intended to replace.", "comment": "32 bit number; for values larger than this, use decimal", "requirements": "Provides references to the claim items.", "min": 0, "max": "*", "base": { "path": "ClaimResponse.addItem.itemSequence", "min": 0, "max": "*" }, "type": [ { "code": "positiveInt" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "mustSupport": false, "isModifier": false, "isSummary": false, "mapping": [ { "identity": "rim", "map": "n/a" } ] }, { "id": "ClaimResponse.addItem.detailSequence", "path": "ClaimResponse.addItem.detailSequence", "short": "Detail sequence number", "definition": "The sequence number of the details within the claim item which this line is intended to replace.", "comment": "32 bit number; for values larger than this, use decimal", "requirements": "Provides references to the claim details within the claim item.", "min": 0, "max": "*", "base": { "path": "ClaimResponse.addItem.detailSequence", "min": 0, "max": "*" }, "type": [ { "code": "positiveInt" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "mustSupport": false, "isModifier": false, "isSummary": false, "mapping": [ { "identity": "rim", "map": "n/a" } ] }, { "id": "ClaimResponse.addItem.subdetailSequence", "path": "ClaimResponse.addItem.subdetailSequence", "short": "Subdetail sequence number", "definition": "The sequence number of the sub-details within the details within the claim item which this line is intended to replace.", "comment": "32 bit number; for values larger than this, use decimal", "requirements": "Provides references to the claim sub-details within the claim detail.", "min": 0, "max": "*", "base": { "path": "ClaimResponse.addItem.subdetailSequence", "min": 0, "max": "*" }, "type": [ { "code": "positiveInt" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "mustSupport": false, "isModifier": false, "isSummary": false, "mapping": [ { "identity": "rim", "map": "n/a" } ] }, { "id": "ClaimResponse.addItem.traceNumber", "path": "ClaimResponse.addItem.traceNumber", "short": "Number for tracking", "definition": "Trace number for tracking purposes. May be defined at the jurisdiction level or between trading partners.", "comment": "The rules of the identifier.type determine if a check digit is part of the ID value or sent separately, such as through the checkDigit extension.", "requirements": "Allows partners to uniquely identify components for tracking.", "min": 0, "max": "*", "base": { "path": "ClaimResponse.addItem.traceNumber", "min": 0, "max": "*" }, "type": [ { "code": "Identifier" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "source": "http://hl7.org/fhir/StructureDefinition/Element" }, { "key": "ident-1", "severity": "warning", "human": "Identifier with no value has limited utility. If communicating that an identifier value has been suppressed or missing, the value element SHOULD be present with an extension indicating the missing semantic - e.g. data-absent-reason", "expression": "value.exists()", "source": "http://hl7.org/fhir/StructureDefinition/Identifier" } ], "mustSupport": false, "isModifier": false, "isSummary": false, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "v2", "map": "CX / EI (occasionally, more often EI maps to a resource id or a URL)" }, { "identity": "rim", "map": "II - The Identifier class is a little looser than the v3 type II because it allows URIs as well as registered OIDs or GUIDs. Also maps to Role[classCode=IDENT]" }, { "identity": "servd", "map": "Identifier" } ] }, { "id": "ClaimResponse.addItem.provider", "path": "ClaimResponse.addItem.provider", "short": "Authorized providers", "definition": "The providers who are authorized for the services rendered to the patient.", "comment": "References SHALL be a reference to an actual FHIR resource, and SHALL be resolvable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.", "requirements": "Insurer may provide authorization specifically to a restricted set of providers rather than an open authorization.", "min": 0, "max": "*", "base": { "path": "ClaimResponse.addItem.provider", "min": 0, "max": "*" }, "type": [ { "code": "Reference", "targetProfile": [ "http://hl7.org/fhir/StructureDefinition/Practitioner", "http://hl7.org/fhir/StructureDefinition/PractitionerRole", "http://hl7.org/fhir/StructureDefinition/Organization" ] } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "source": "http://hl7.org/fhir/StructureDefinition/Element" }, { "key": "ref-1", "severity": "error", "human": "SHALL have a contained resource if a local reference is provided", "expression": "reference.exists() implies (reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids')) or (reference='#' and %rootResource!=%resource))", "source": "http://hl7.org/fhir/StructureDefinition/Reference" }, { "key": "ref-2", "severity": "error", "human": "At least one of reference, identifier and display SHALL be present (unless an extension is provided).", "expression": "reference.exists() or identifier.exists() or display.exists() or extension.exists()", "source": "http://hl7.org/fhir/StructureDefinition/Reference" } ], "mustSupport": false, "isModifier": false, "isSummary": false, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "rim", "map": "The target of a resource reference is a RIM entry point (Act, Role, or Entity)" }, { "identity": "w5", "map": "FiveWs.source" } ] }, { "id": "ClaimResponse.addItem.revenue", "path": "ClaimResponse.addItem.revenue", "short": "Revenue or cost center code", "definition": "The type of revenue or cost center providing the product and/or service.", "comment": "Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination.", "requirements": "Needed in the processing of institutional claims.", "min": 0, "max": "1", "base": { "path": "ClaimResponse.addItem.revenue", "min": 0, "max": "1" }, "type": [ { "code": "CodeableConcept" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "mustSupport": false, "isModifier": false, "isSummary": false, "binding": { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString": "RevenueCenter" } ], "strength": "example", "description": "Codes for the revenue or cost centers supplying the service and/or products.", "valueSet": "http://hl7.org/fhir/ValueSet/ex-revenue-center" }, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "v2", "map": "CE/CNE/CWE" }, { "identity": "rim", "map": "CD" }, { "identity": "orim", "map": "fhir:CodeableConcept rdfs:subClassOf dt:CD" } ] }, { "id": "ClaimResponse.addItem.productOrService", "path": "ClaimResponse.addItem.productOrService", "short": "Billing, service, product, or drug code", "definition": "When the value is a group code then this item collects a set of related item details, otherwise this contains the product, service, drug or other billing code for the item. This element may be the start of a range of .productOrService codes used in conjunction with .productOrServiceEnd or it may be a solo element where .productOrServiceEnd is not used.", "comment": "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'.", "requirements": "Necessary to state what was provided or done.", "min": 0, "max": "1", "base": { "path": "ClaimResponse.addItem.productOrService", "min": 0, "max": "1" }, "type": [ { "code": "CodeableConcept" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "mustSupport": false, "isModifier": false, "isSummary": false, "binding": { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString": "ServiceProduct" } ], "strength": "example", "description": "Allowable service and product codes.", "valueSet": "http://hl7.org/fhir/ValueSet/service-uscls" }, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "v2", "map": "CE/CNE/CWE" }, { "identity": "rim", "map": "CD" }, { "identity": "orim", "map": "fhir:CodeableConcept rdfs:subClassOf dt:CD" } ] }, { "id": "ClaimResponse.addItem.productOrServiceEnd", "path": "ClaimResponse.addItem.productOrServiceEnd", "short": "End of a range of codes", "definition": "This contains the end of a range of product, service, drug or other billing codes for the item. This element is not used when the .productOrService is a group code. This value may only be present when a .productOfService code has been provided to convey the start of the range. Typically this value may be used only with preauthorizations and not with claims.", "comment": "Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination.", "alias": [ "End of a range of Drug Code; Bill Code; Service Cod" ], "min": 0, "max": "1", "base": { "path": "ClaimResponse.addItem.productOrServiceEnd", "min": 0, "max": "1" }, "type": [ { "code": "CodeableConcept" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "mustSupport": false, "isModifier": false, "isSummary": false, "binding": { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString": "ServiceProduct" } ], "strength": "example", "valueSet": "http://hl7.org/fhir/ValueSet/service-uscls" }, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "v2", "map": "CE/CNE/CWE" }, { "identity": "rim", "map": "CD" }, { "identity": "orim", "map": "fhir:CodeableConcept rdfs:subClassOf dt:CD" } ] }, { "id": "ClaimResponse.addItem.request", "path": "ClaimResponse.addItem.request", "short": "Request or Referral for Service", "definition": "Request or Referral for Goods or Service to be rendered.", "comment": "References SHALL be a reference to an actual FHIR resource, and SHALL be resolvable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.", "requirements": "May identify the service to be provided or provider authorization for the service.", "min": 0, "max": "*", "base": { "path": "ClaimResponse.addItem.request", "min": 0, "max": "*" }, "type": [ { "code": "Reference", "targetProfile": [ "http://hl7.org/fhir/StructureDefinition/DeviceRequest", "http://hl7.org/fhir/StructureDefinition/MedicationRequest", "http://hl7.org/fhir/StructureDefinition/NutritionOrder", "http://hl7.org/fhir/StructureDefinition/ServiceRequest", "http://hl7.org/fhir/StructureDefinition/SupplyRequest", "http://hl7.org/fhir/StructureDefinition/VisionPrescription" ] } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "source": "http://hl7.org/fhir/StructureDefinition/Element" }, { "key": "ref-1", "severity": "error", "human": "SHALL have a contained resource if a local reference is provided", "expression": "reference.exists() implies (reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids')) or (reference='#' and %rootResource!=%resource))", "source": "http://hl7.org/fhir/StructureDefinition/Reference" }, { "key": "ref-2", "severity": "error", "human": "At least one of reference, identifier and display SHALL be present (unless an extension is provided).", "expression": "reference.exists() or identifier.exists() or display.exists() or extension.exists()", "source": "http://hl7.org/fhir/StructureDefinition/Reference" } ], "mustSupport": false, "isModifier": false, "isSummary": false, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "rim", "map": "The target of a resource reference is a RIM entry point (Act, Role, or Entity)" } ] }, { "id": "ClaimResponse.addItem.modifier", "path": "ClaimResponse.addItem.modifier", "short": "Service/Product billing modifiers", "definition": "Item typification or modifiers codes to convey additional context for the product or service.", "comment": "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.", "requirements": "To support inclusion of the item for adjudication or to charge an elevated fee.", "min": 0, "max": "*", "base": { "path": "ClaimResponse.addItem.modifier", "min": 0, "max": "*" }, "type": [ { "code": "CodeableConcept" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "mustSupport": false, "isModifier": false, "isSummary": false, "binding": { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString": "Modifiers" } ], "strength": "example", "description": "Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen.", "valueSet": "http://hl7.org/fhir/ValueSet/claim-modifiers" }, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "v2", "map": "CE/CNE/CWE" }, { "identity": "rim", "map": "CD" }, { "identity": "orim", "map": "fhir:CodeableConcept rdfs:subClassOf dt:CD" }, { "identity": "rim", "map": "24.C, 24.D mods" } ] }, { "id": "ClaimResponse.addItem.programCode", "path": "ClaimResponse.addItem.programCode", "short": "Program the product or service is provided under", "definition": "Identifies the program under which this may be recovered.", "comment": "For example: Neonatal program, child dental program or drug users recovery program.", "requirements": "Commonly used in in the identification of publicly provided program focused on population segments or disease classifications.", "min": 0, "max": "*", "base": { "path": "ClaimResponse.addItem.programCode", "min": 0, "max": "*" }, "type": [ { "code": "CodeableConcept" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "mustSupport": false, "isModifier": false, "isSummary": false, "binding": { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString": "ProgramCode" } ], "strength": "example", "description": "Program specific reason codes.", "valueSet": "http://hl7.org/fhir/ValueSet/ex-program-code" }, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "v2", "map": "CE/CNE/CWE" }, { "identity": "rim", "map": "CD" }, { "identity": "orim", "map": "fhir:CodeableConcept rdfs:subClassOf dt:CD" }, { "identity": "rim", "map": "24.H" } ] }, { "id": "ClaimResponse.addItem.serviced[x]", "path": "ClaimResponse.addItem.serviced[x]", "short": "Date or dates of service or product delivery", "definition": "The date or dates when the service or product was supplied, performed or completed.", "requirements": "Needed to determine whether the service or product was provided during the term of the insurance coverage.", "min": 0, "max": "1", "base": { "path": "ClaimResponse.addItem.serviced[x]", "min": 0, "max": "1" }, "type": [ { "code": "date" }, { "code": "Period" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "mustSupport": false, "isModifier": false, "isSummary": false, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "w5", "map": "FiveWs.done[x]" }, { "identity": "rim", "map": "24.A" } ] }, { "id": "ClaimResponse.addItem.location[x]", "path": "ClaimResponse.addItem.location[x]", "short": "Place of service or where product was supplied", "definition": "Where the product or service was provided.", "requirements": "The location can alter whether the item was acceptable for insurance purposes or impact the determination of the benefit amount.", "min": 0, "max": "1", "base": { "path": "ClaimResponse.addItem.location[x]", "min": 0, "max": "1" }, "type": [ { "code": "CodeableConcept" }, { "code": "Address" }, { "code": "Reference", "targetProfile": [ "http://hl7.org/fhir/StructureDefinition/Location" ] } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "mustSupport": false, "isModifier": false, "isSummary": false, "binding": { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString": "ServicePlace" } ], "strength": "example", "description": "Place of service: pharmacy, school, prison, etc.", "valueSet": "http://hl7.org/fhir/ValueSet/service-place" }, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "w5", "map": "FiveWs.where[x]" }, { "identity": "rim", "map": "24.B" } ] }, { "id": "ClaimResponse.addItem.quantity", "path": "ClaimResponse.addItem.quantity", "short": "Count of products or services", "definition": "The number of repetitions of a service or product.", "comment": "The context of use may frequently define what kind of quantity this is and therefore what kind of units can be used. The context of use may also restrict the values for the comparator.", "requirements": "Required when the product or service code does not convey the quantity provided.", "min": 0, "max": "1", "base": { "path": "ClaimResponse.addItem.quantity", "min": 0, "max": "1" }, "type": [ { "code": "Quantity", "profile": [ "http://hl7.org/fhir/StructureDefinition/SimpleQuantity" ] } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "source": "http://hl7.org/fhir/StructureDefinition/Element" }, { "key": "qty-3", "severity": "error", "human": "If a code for the unit is present, the system SHALL also be present", "expression": "code.empty() or system.exists()", "source": "http://hl7.org/fhir/StructureDefinition/Quantity" }, { "key": "sqty-1", "severity": "error", "human": "The comparator is not used on a SimpleQuantity", "expression": "comparator.empty()", "source": "http://hl7.org/fhir/StructureDefinition/SimpleQuantity" } ], "mustSupport": false, "isModifier": false, "isSummary": false, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "v2", "map": "SN (see also Range) or CQ" }, { "identity": "rim", "map": "PQ, IVL, MO, CO, depending on the values" }, { "identity": "rim", "map": "24.G" } ] }, { "id": "ClaimResponse.addItem.unitPrice", "path": "ClaimResponse.addItem.unitPrice", "short": "Fee, charge or cost per item", "definition": "If the item is not a group then this is the fee for the product or service, otherwise this is the total of the fees for the details of the group.", "requirements": "The amount charged to the patient by the provider for a single unit.", "min": 0, "max": "1", "base": { "path": "ClaimResponse.addItem.unitPrice", "min": 0, "max": "1" }, "type": [ { "code": "Money" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "mustSupport": false, "isModifier": false, "isSummary": false, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "rim", "map": "MO" } ] }, { "id": "ClaimResponse.addItem.factor", "path": "ClaimResponse.addItem.factor", "short": "Price scaling factor", "definition": "A real number that represents a multiplier used in determining the overall value of services delivered and/or goods received. The concept of a Factor allows for a discount or surcharge multiplier to be applied to a monetary amount.", "comment": "To show a 10% senior's discount, the value entered is: 0.90 (1.00 - 0.10).", "requirements": "When discounts are provided to a patient (example: Senior's discount) then this must be documented for adjudication.", "min": 0, "max": "1", "base": { "path": "ClaimResponse.addItem.factor", "min": 0, "max": "1" }, "type": [ { "code": "decimal" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "mustSupport": false, "isModifier": false, "isSummary": false, "mapping": [ { "identity": "rim", "map": "n/a" } ] }, { "id": "ClaimResponse.addItem.tax", "path": "ClaimResponse.addItem.tax", "short": "Total tax", "definition": "The total of taxes applicable for this product or service.", "requirements": "Required when taxes are not embedded in the unit price or provided as a separate service.", "min": 0, "max": "1", "base": { "path": "ClaimResponse.addItem.tax", "min": 0, "max": "1" }, "type": [ { "code": "Money" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "mustSupport": false, "isModifier": false, "isSummary": false, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "rim", "map": "MO" } ] }, { "id": "ClaimResponse.addItem.net", "path": "ClaimResponse.addItem.net", "short": "Total item cost", "definition": "The total amount claimed for the group (if a grouper) or the addItem. Net = unit price * quantity * factor.", "comment": "For example, the formula: quantity * unitPrice * factor = net. Quantity and factor are assumed to be 1 if not supplied.", "requirements": "Provides the total amount claimed for the group (if a grouper) or the line item.", "min": 0, "max": "1", "base": { "path": "ClaimResponse.addItem.net", "min": 0, "max": "1" }, "type": [ { "code": "Money" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "mustSupport": false, "isModifier": false, "isSummary": false, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "rim", "map": "MO" }, { "identity": "rim", "map": "24.F" } ] }, { "id": "ClaimResponse.addItem.bodySite", "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-explicit-type-name", "valueString": "BodySite" } ], "path": "ClaimResponse.addItem.bodySite", "short": "Anatomical location", "definition": "Physical location where the service is performed or applies.", "min": 0, "max": "*", "base": { "path": "ClaimResponse.addItem.bodySite", "min": 0, "max": "*" }, "type": [ { "code": "BackboneElement" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "mustSupport": false, "isModifier": false, "isSummary": false, "mapping": [ { "identity": "rim", "map": "n/a" } ] }, { "id": "ClaimResponse.addItem.bodySite.id", "path": "ClaimResponse.addItem.bodySite.id", "representation": [ "xmlAttr" ], "short": "Unique id for inter-element referencing", "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": [ { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type", "valueUrl": "string" } ], "code": "http://hl7.org/fhirpath/System.String" } ], "condition": [ "ele-1" ], "mapping": [ { "identity": "rim", "map": "n/a" } ] }, { "id": "ClaimResponse.addItem.bodySite.extension", "path": "ClaimResponse.addItem.bodySite.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. To make the use of extensions safe and managable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can 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" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "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()", "source": "http://hl7.org/fhir/StructureDefinition/Extension" } ], "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "rim", "map": "N/A" } ] }, { "id": "ClaimResponse.addItem.bodySite.modifierExtension", "path": "ClaimResponse.addItem.bodySite.modifierExtension", "short": "Extensions that cannot be ignored even if unrecognized", "definition": "May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and managable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.\n\nModifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).", "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.", "requirements": "Modifier extensions allow for extensions that *cannot* be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the [definition of modifier extensions](extensibility.html#modifierExtension).", "alias": [ "extensions", "user content", "modifiers" ], "min": 0, "max": "*", "base": { "path": "BackboneElement.modifierExtension", "min": 0, "max": "*" }, "type": [ { "code": "Extension" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "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()", "source": "http://hl7.org/fhir/StructureDefinition/Extension" } ], "isModifier": true, "isModifierReason": "Modifier extensions are expected to modify the meaning or interpretation of the element that contains them", "isSummary": true, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "rim", "map": "N/A" } ] }, { "id": "ClaimResponse.addItem.bodySite.site", "path": "ClaimResponse.addItem.bodySite.site", "short": "Location", "definition": "Physical service site on the patient (limb, tooth, etc.).", "comment": "For example: Providing a tooth code allows an insurer to identify a provider performing a filling on a tooth that was previously removed.", "requirements": "Allows insurer to validate specific procedures.", "min": 1, "max": "*", "base": { "path": "ClaimResponse.addItem.bodySite.site", "min": 1, "max": "*" }, "type": [ { "code": "CodeableReference", "targetProfile": [ "http://hl7.org/fhir/StructureDefinition/BodyStructure" ] } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "mustSupport": false, "isModifier": false, "isSummary": false, "binding": { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString": "OralSites" } ], "strength": "example", "valueSet": "http://hl7.org/fhir/ValueSet/tooth" }, "mapping": [ { "identity": "rim", "map": "n/a" } ] }, { "id": "ClaimResponse.addItem.bodySite.subSite", "path": "ClaimResponse.addItem.bodySite.subSite", "short": "Sub-location", "definition": "A region or surface of the bodySite, e.g. limb region or tooth surface(s).", "comment": "Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination.", "requirements": "Allows insurer to validate specific procedures.", "min": 0, "max": "*", "base": { "path": "ClaimResponse.addItem.bodySite.subSite", "min": 0, "max": "*" }, "type": [ { "code": "CodeableConcept" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "mustSupport": false, "isModifier": false, "isSummary": false, "binding": { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString": "Surface" } ], "strength": "example", "valueSet": "http://hl7.org/fhir/ValueSet/surface" }, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "v2", "map": "CE/CNE/CWE" }, { "identity": "rim", "map": "CD" }, { "identity": "orim", "map": "fhir:CodeableConcept rdfs:subClassOf dt:CD" } ] }, { "id": "ClaimResponse.addItem.noteNumber", "path": "ClaimResponse.addItem.noteNumber", "short": "Applicable note numbers", "definition": "The numbers associated with notes below which apply to the adjudication of this item.", "comment": "32 bit number; for values larger than this, use decimal", "requirements": "Provides a condensed manner for associating human readable descriptive explanations for adjudications on the line item.", "min": 0, "max": "*", "base": { "path": "ClaimResponse.addItem.noteNumber", "min": 0, "max": "*" }, "type": [ { "code": "positiveInt" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "mustSupport": false, "isModifier": false, "isSummary": false, "mapping": [ { "identity": "rim", "map": "n/a" } ] }, { "id": "ClaimResponse.addItem.reviewOutcome", "path": "ClaimResponse.addItem.reviewOutcome", "short": "Added items adjudication results", "definition": "The high-level results of the adjudication if adjudication has been performed.", "min": 0, "max": "1", "base": { "path": "ClaimResponse.addItem.reviewOutcome", "min": 0, "max": "1" }, "contentReference": "#ClaimResponse.item.reviewOutcome", "mustSupport": false, "isModifier": false, "isSummary": false }, { "id": "ClaimResponse.addItem.adjudication", "path": "ClaimResponse.addItem.adjudication", "short": "Added items adjudication", "definition": "The adjudication results.", "min": 0, "max": "*", "base": { "path": "ClaimResponse.addItem.adjudication", "min": 0, "max": "*" }, "contentReference": "#ClaimResponse.item.adjudication", "mustSupport": false, "isModifier": false, "isSummary": false }, { "id": "ClaimResponse.addItem.detail", "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-explicit-type-name", "valueString": "AddedItemDetail" } ], "path": "ClaimResponse.addItem.detail", "short": "Insurer added line details", "definition": "The second-tier service adjudications for payor added services.", "min": 0, "max": "*", "base": { "path": "ClaimResponse.addItem.detail", "min": 0, "max": "*" }, "type": [ { "code": "BackboneElement" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "mustSupport": false, "isModifier": false, "isSummary": false, "mapping": [ { "identity": "rim", "map": "n/a" } ] }, { "id": "ClaimResponse.addItem.detail.id", "path": "ClaimResponse.addItem.detail.id", "representation": [ "xmlAttr" ], "short": "Unique id for inter-element referencing", "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": [ { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type", "valueUrl": "string" } ], "code": "http://hl7.org/fhirpath/System.String" } ], "condition": [ "ele-1" ], "mapping": [ { "identity": "rim", "map": "n/a" } ] }, { "id": "ClaimResponse.addItem.detail.extension", "path": "ClaimResponse.addItem.detail.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. To make the use of extensions safe and managable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can 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" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "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()", "source": "http://hl7.org/fhir/StructureDefinition/Extension" } ], "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "rim", "map": "N/A" } ] }, { "id": "ClaimResponse.addItem.detail.modifierExtension", "path": "ClaimResponse.addItem.detail.modifierExtension", "short": "Extensions that cannot be ignored even if unrecognized", "definition": "May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and managable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.\n\nModifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).", "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.", "requirements": "Modifier extensions allow for extensions that *cannot* be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the [definition of modifier extensions](extensibility.html#modifierExtension).", "alias": [ "extensions", "user content", "modifiers" ], "min": 0, "max": "*", "base": { "path": "BackboneElement.modifierExtension", "min": 0, "max": "*" }, "type": [ { "code": "Extension" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "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()", "source": "http://hl7.org/fhir/StructureDefinition/Extension" } ], "isModifier": true, "isModifierReason": "Modifier extensions are expected to modify the meaning or interpretation of the element that contains them", "isSummary": true, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "rim", "map": "N/A" } ] }, { "id": "ClaimResponse.addItem.detail.traceNumber", "path": "ClaimResponse.addItem.detail.traceNumber", "short": "Number for tracking", "definition": "Trace number for tracking purposes. May be defined at the jurisdiction level or between trading partners.", "comment": "The rules of the identifier.type determine if a check digit is part of the ID value or sent separately, such as through the checkDigit extension.", "requirements": "Allows partners to uniquely identify components for tracking.", "min": 0, "max": "*", "base": { "path": "ClaimResponse.addItem.detail.traceNumber", "min": 0, "max": "*" }, "type": [ { "code": "Identifier" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "source": "http://hl7.org/fhir/StructureDefinition/Element" }, { "key": "ident-1", "severity": "warning", "human": "Identifier with no value has limited utility. If communicating that an identifier value has been suppressed or missing, the value element SHOULD be present with an extension indicating the missing semantic - e.g. data-absent-reason", "expression": "value.exists()", "source": "http://hl7.org/fhir/StructureDefinition/Identifier" } ], "mustSupport": false, "isModifier": false, "isSummary": false, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "v2", "map": "CX / EI (occasionally, more often EI maps to a resource id or a URL)" }, { "identity": "rim", "map": "II - The Identifier class is a little looser than the v3 type II because it allows URIs as well as registered OIDs or GUIDs. Also maps to Role[classCode=IDENT]" }, { "identity": "servd", "map": "Identifier" } ] }, { "id": "ClaimResponse.addItem.detail.revenue", "path": "ClaimResponse.addItem.detail.revenue", "short": "Revenue or cost center code", "definition": "The type of revenue or cost center providing the product and/or service.", "comment": "Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination.", "requirements": "Needed in the processing of institutional claims.", "min": 0, "max": "1", "base": { "path": "ClaimResponse.addItem.detail.revenue", "min": 0, "max": "1" }, "type": [ { "code": "CodeableConcept" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "mustSupport": false, "isModifier": false, "isSummary": false, "binding": { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString": "RevenueCenter" } ], "strength": "example", "description": "Codes for the revenue or cost centers supplying the service and/or products.", "valueSet": "http://hl7.org/fhir/ValueSet/ex-revenue-center" }, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "v2", "map": "CE/CNE/CWE" }, { "identity": "rim", "map": "CD" }, { "identity": "orim", "map": "fhir:CodeableConcept rdfs:subClassOf dt:CD" } ] }, { "id": "ClaimResponse.addItem.detail.productOrService", "path": "ClaimResponse.addItem.detail.productOrService", "short": "Billing, service, product, or drug code", "definition": "When the value is a group code then this item collects a set of related item details, otherwise this contains the product, service, drug or other billing code for the item. This element may be the start of a range of .productOrService codes used in conjunction with .productOrServiceEnd or it may be a solo element where .productOrServiceEnd is not used.", "comment": "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'.", "requirements": "Necessary to state what was provided or done.", "min": 0, "max": "1", "base": { "path": "ClaimResponse.addItem.detail.productOrService", "min": 0, "max": "1" }, "type": [ { "code": "CodeableConcept" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "mustSupport": false, "isModifier": false, "isSummary": false, "binding": { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString": "ServiceProduct" } ], "strength": "example", "description": "Allowable service and product codes.", "valueSet": "http://hl7.org/fhir/ValueSet/service-uscls" }, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "v2", "map": "CE/CNE/CWE" }, { "identity": "rim", "map": "CD" }, { "identity": "orim", "map": "fhir:CodeableConcept rdfs:subClassOf dt:CD" } ] }, { "id": "ClaimResponse.addItem.detail.productOrServiceEnd", "path": "ClaimResponse.addItem.detail.productOrServiceEnd", "short": "End of a range of codes", "definition": "This contains the end of a range of product, service, drug or other billing codes for the item. This element is not used when the .productOrService is a group code. This value may only be present when a .productOfService code has been provided to convey the start of the range. Typically this value may be used only with preauthorizations and not with claims.", "comment": "Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination.", "alias": [ "End of a range of Drug Code; Bill Code; Service Cod" ], "min": 0, "max": "1", "base": { "path": "ClaimResponse.addItem.detail.productOrServiceEnd", "min": 0, "max": "1" }, "type": [ { "code": "CodeableConcept" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "mustSupport": false, "isModifier": false, "isSummary": false, "binding": { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString": "ServiceProduct" } ], "strength": "example", "valueSet": "http://hl7.org/fhir/ValueSet/service-uscls" }, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "v2", "map": "CE/CNE/CWE" }, { "identity": "rim", "map": "CD" }, { "identity": "orim", "map": "fhir:CodeableConcept rdfs:subClassOf dt:CD" } ] }, { "id": "ClaimResponse.addItem.detail.modifier", "path": "ClaimResponse.addItem.detail.modifier", "short": "Service/Product billing modifiers", "definition": "Item typification or modifiers codes to convey additional context for the product or service.", "comment": "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.", "requirements": "To support inclusion of the item for adjudication or to charge an elevated fee.", "min": 0, "max": "*", "base": { "path": "ClaimResponse.addItem.detail.modifier", "min": 0, "max": "*" }, "type": [ { "code": "CodeableConcept" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "mustSupport": false, "isModifier": false, "isSummary": false, "binding": { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString": "Modifiers" } ], "strength": "example", "description": "Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen.", "valueSet": "http://hl7.org/fhir/ValueSet/claim-modifiers" }, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "v2", "map": "CE/CNE/CWE" }, { "identity": "rim", "map": "CD" }, { "identity": "orim", "map": "fhir:CodeableConcept rdfs:subClassOf dt:CD" }, { "identity": "rim", "map": "24.C, 24.D mods" } ] }, { "id": "ClaimResponse.addItem.detail.quantity", "path": "ClaimResponse.addItem.detail.quantity", "short": "Count of products or services", "definition": "The number of repetitions of a service or product.", "comment": "The context of use may frequently define what kind of quantity this is and therefore what kind of units can be used. The context of use may also restrict the values for the comparator.", "requirements": "Required when the product or service code does not convey the quantity provided.", "min": 0, "max": "1", "base": { "path": "ClaimResponse.addItem.detail.quantity", "min": 0, "max": "1" }, "type": [ { "code": "Quantity", "profile": [ "http://hl7.org/fhir/StructureDefinition/SimpleQuantity" ] } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "source": "http://hl7.org/fhir/StructureDefinition/Element" }, { "key": "qty-3", "severity": "error", "human": "If a code for the unit is present, the system SHALL also be present", "expression": "code.empty() or system.exists()", "source": "http://hl7.org/fhir/StructureDefinition/Quantity" }, { "key": "sqty-1", "severity": "error", "human": "The comparator is not used on a SimpleQuantity", "expression": "comparator.empty()", "source": "http://hl7.org/fhir/StructureDefinition/SimpleQuantity" } ], "mustSupport": false, "isModifier": false, "isSummary": false, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "v2", "map": "SN (see also Range) or CQ" }, { "identity": "rim", "map": "PQ, IVL, MO, CO, depending on the values" }, { "identity": "rim", "map": "24.G" } ] }, { "id": "ClaimResponse.addItem.detail.unitPrice", "path": "ClaimResponse.addItem.detail.unitPrice", "short": "Fee, charge or cost per item", "definition": "If the item is not a group then this is the fee for the product or service, otherwise this is the total of the fees for the details of the group.", "requirements": "The amount charged to the patient by the provider for a single unit.", "min": 0, "max": "1", "base": { "path": "ClaimResponse.addItem.detail.unitPrice", "min": 0, "max": "1" }, "type": [ { "code": "Money" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "mustSupport": false, "isModifier": false, "isSummary": false, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "rim", "map": "MO" } ] }, { "id": "ClaimResponse.addItem.detail.factor", "path": "ClaimResponse.addItem.detail.factor", "short": "Price scaling factor", "definition": "A real number that represents a multiplier used in determining the overall value of services delivered and/or goods received. The concept of a Factor allows for a discount or surcharge multiplier to be applied to a monetary amount.", "comment": "To show a 10% senior's discount, the value entered is: 0.90 (1.00 - 0.10).", "requirements": "When discounts are provided to a patient (example: Senior's discount) then this must be documented for adjudication.", "min": 0, "max": "1", "base": { "path": "ClaimResponse.addItem.detail.factor", "min": 0, "max": "1" }, "type": [ { "code": "decimal" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "mustSupport": false, "isModifier": false, "isSummary": false, "mapping": [ { "identity": "rim", "map": "n/a" } ] }, { "id": "ClaimResponse.addItem.detail.tax", "path": "ClaimResponse.addItem.detail.tax", "short": "Total tax", "definition": "The total of taxes applicable for this product or service.", "requirements": "Required when taxes are not embedded in the unit price or provided as a separate service.", "min": 0, "max": "1", "base": { "path": "ClaimResponse.addItem.detail.tax", "min": 0, "max": "1" }, "type": [ { "code": "Money" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "mustSupport": false, "isModifier": false, "isSummary": false, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "rim", "map": "MO" } ] }, { "id": "ClaimResponse.addItem.detail.net", "path": "ClaimResponse.addItem.detail.net", "short": "Total item cost", "definition": "The total amount claimed for the group (if a grouper) or the addItem.detail. Net = unit price * quantity * factor.", "comment": "For example, the formula: quantity * unitPrice * factor = net. Quantity and factor are assumed to be 1 if not supplied.", "requirements": "Provides the total amount claimed for the group (if a grouper) or the line item.", "min": 0, "max": "1", "base": { "path": "ClaimResponse.addItem.detail.net", "min": 0, "max": "1" }, "type": [ { "code": "Money" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "mustSupport": false, "isModifier": false, "isSummary": false, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "rim", "map": "MO" }, { "identity": "rim", "map": "24.F" } ] }, { "id": "ClaimResponse.addItem.detail.noteNumber", "path": "ClaimResponse.addItem.detail.noteNumber", "short": "Applicable note numbers", "definition": "The numbers associated with notes below which apply to the adjudication of this item.", "comment": "32 bit number; for values larger than this, use decimal", "requirements": "Provides a condensed manner for associating human readable descriptive explanations for adjudications on the line item.", "min": 0, "max": "*", "base": { "path": "ClaimResponse.addItem.detail.noteNumber", "min": 0, "max": "*" }, "type": [ { "code": "positiveInt" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "mustSupport": false, "isModifier": false, "isSummary": false, "mapping": [ { "identity": "rim", "map": "n/a" } ] }, { "id": "ClaimResponse.addItem.detail.reviewOutcome", "path": "ClaimResponse.addItem.detail.reviewOutcome", "short": "Added items detail level adjudication results", "definition": "The high-level results of the adjudication if adjudication has been performed.", "min": 0, "max": "1", "base": { "path": "ClaimResponse.addItem.detail.reviewOutcome", "min": 0, "max": "1" }, "contentReference": "#ClaimResponse.item.reviewOutcome", "mustSupport": false, "isModifier": false, "isSummary": false }, { "id": "ClaimResponse.addItem.detail.adjudication", "path": "ClaimResponse.addItem.detail.adjudication", "short": "Added items detail adjudication", "definition": "The adjudication results.", "min": 0, "max": "*", "base": { "path": "ClaimResponse.addItem.detail.adjudication", "min": 0, "max": "*" }, "contentReference": "#ClaimResponse.item.adjudication", "mustSupport": false, "isModifier": false, "isSummary": false }, { "id": "ClaimResponse.addItem.detail.subDetail", "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-explicit-type-name", "valueString": "AddedItemSubDetail" } ], "path": "ClaimResponse.addItem.detail.subDetail", "short": "Insurer added line items", "definition": "The third-tier service adjudications for payor added services.", "min": 0, "max": "*", "base": { "path": "ClaimResponse.addItem.detail.subDetail", "min": 0, "max": "*" }, "type": [ { "code": "BackboneElement" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "mustSupport": false, "isModifier": false, "isSummary": false, "mapping": [ { "identity": "rim", "map": "n/a" } ] }, { "id": "ClaimResponse.addItem.detail.subDetail.id", "path": "ClaimResponse.addItem.detail.subDetail.id", "representation": [ "xmlAttr" ], "short": "Unique id for inter-element referencing", "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": [ { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type", "valueUrl": "string" } ], "code": "http://hl7.org/fhirpath/System.String" } ], "condition": [ "ele-1" ], "mapping": [ { "identity": "rim", "map": "n/a" } ] }, { "id": "ClaimResponse.addItem.detail.subDetail.extension", "path": "ClaimResponse.addItem.detail.subDetail.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. To make the use of extensions safe and managable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can 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" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "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()", "source": "http://hl7.org/fhir/StructureDefinition/Extension" } ], "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "rim", "map": "N/A" } ] }, { "id": "ClaimResponse.addItem.detail.subDetail.modifierExtension", "path": "ClaimResponse.addItem.detail.subDetail.modifierExtension", "short": "Extensions that cannot be ignored even if unrecognized", "definition": "May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and managable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.\n\nModifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).", "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.", "requirements": "Modifier extensions allow for extensions that *cannot* be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the [definition of modifier extensions](extensibility.html#modifierExtension).", "alias": [ "extensions", "user content", "modifiers" ], "min": 0, "max": "*", "base": { "path": "BackboneElement.modifierExtension", "min": 0, "max": "*" }, "type": [ { "code": "Extension" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "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()", "source": "http://hl7.org/fhir/StructureDefinition/Extension" } ], "isModifier": true, "isModifierReason": "Modifier extensions are expected to modify the meaning or interpretation of the element that contains them", "isSummary": true, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "rim", "map": "N/A" } ] }, { "id": "ClaimResponse.addItem.detail.subDetail.traceNumber", "path": "ClaimResponse.addItem.detail.subDetail.traceNumber", "short": "Number for tracking", "definition": "Trace number for tracking purposes. May be defined at the jurisdiction level or between trading partners.", "comment": "The rules of the identifier.type determine if a check digit is part of the ID value or sent separately, such as through the checkDigit extension.", "requirements": "Allows partners to uniquely identify components for tracking.", "min": 0, "max": "*", "base": { "path": "ClaimResponse.addItem.detail.subDetail.traceNumber", "min": 0, "max": "*" }, "type": [ { "code": "Identifier" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "source": "http://hl7.org/fhir/StructureDefinition/Element" }, { "key": "ident-1", "severity": "warning", "human": "Identifier with no value has limited utility. If communicating that an identifier value has been suppressed or missing, the value element SHOULD be present with an extension indicating the missing semantic - e.g. data-absent-reason", "expression": "value.exists()", "source": "http://hl7.org/fhir/StructureDefinition/Identifier" } ], "mustSupport": false, "isModifier": false, "isSummary": false, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "v2", "map": "CX / EI (occasionally, more often EI maps to a resource id or a URL)" }, { "identity": "rim", "map": "II - The Identifier class is a little looser than the v3 type II because it allows URIs as well as registered OIDs or GUIDs. Also maps to Role[classCode=IDENT]" }, { "identity": "servd", "map": "Identifier" } ] }, { "id": "ClaimResponse.addItem.detail.subDetail.revenue", "path": "ClaimResponse.addItem.detail.subDetail.revenue", "short": "Revenue or cost center code", "definition": "The type of revenue or cost center providing the product and/or service.", "comment": "Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination.", "requirements": "Needed in the processing of institutional claims.", "min": 0, "max": "1", "base": { "path": "ClaimResponse.addItem.detail.subDetail.revenue", "min": 0, "max": "1" }, "type": [ { "code": "CodeableConcept" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "mustSupport": false, "isModifier": false, "isSummary": false, "binding": { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString": "RevenueCenter" } ], "strength": "example", "description": "Codes for the revenue or cost centers supplying the service and/or products.", "valueSet": "http://hl7.org/fhir/ValueSet/ex-revenue-center" }, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "v2", "map": "CE/CNE/CWE" }, { "identity": "rim", "map": "CD" }, { "identity": "orim", "map": "fhir:CodeableConcept rdfs:subClassOf dt:CD" } ] }, { "id": "ClaimResponse.addItem.detail.subDetail.productOrService", "path": "ClaimResponse.addItem.detail.subDetail.productOrService", "short": "Billing, service, product, or drug code", "definition": "When the value is a group code then this item collects a set of related item details, otherwise this contains the product, service, drug or other billing code for the item. This element may be the start of a range of .productOrService codes used in conjunction with .productOrServiceEnd or it may be a solo element where .productOrServiceEnd is not used.", "comment": "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'.", "requirements": "Necessary to state what was provided or done.", "min": 0, "max": "1", "base": { "path": "ClaimResponse.addItem.detail.subDetail.productOrService", "min": 0, "max": "1" }, "type": [ { "code": "CodeableConcept" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "mustSupport": false, "isModifier": false, "isSummary": false, "binding": { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString": "ServiceProduct" } ], "strength": "example", "description": "Allowable service and product codes.", "valueSet": "http://hl7.org/fhir/ValueSet/service-uscls" }, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "v2", "map": "CE/CNE/CWE" }, { "identity": "rim", "map": "CD" }, { "identity": "orim", "map": "fhir:CodeableConcept rdfs:subClassOf dt:CD" } ] }, { "id": "ClaimResponse.addItem.detail.subDetail.productOrServiceEnd", "path": "ClaimResponse.addItem.detail.subDetail.productOrServiceEnd", "short": "End of a range of codes", "definition": "This contains the end of a range of product, service, drug or other billing codes for the item. This element is not used when the .productOrService is a group code. This value may only be present when a .productOfService code has been provided to convey the start of the range. Typically this value may be used only with preauthorizations and not with claims.", "comment": "Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination.", "alias": [ "End of a range of Drug Code; Bill Code; Service Cod" ], "min": 0, "max": "1", "base": { "path": "ClaimResponse.addItem.detail.subDetail.productOrServiceEnd", "min": 0, "max": "1" }, "type": [ { "code": "CodeableConcept" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "mustSupport": false, "isModifier": false, "isSummary": false, "binding": { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString": "ServiceProduct" } ], "strength": "example", "valueSet": "http://hl7.org/fhir/ValueSet/service-uscls" }, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "v2", "map": "CE/CNE/CWE" }, { "identity": "rim", "map": "CD" }, { "identity": "orim", "map": "fhir:CodeableConcept rdfs:subClassOf dt:CD" } ] }, { "id": "ClaimResponse.addItem.detail.subDetail.modifier", "path": "ClaimResponse.addItem.detail.subDetail.modifier", "short": "Service/Product billing modifiers", "definition": "Item typification or modifiers codes to convey additional context for the product or service.", "comment": "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.", "requirements": "To support inclusion of the item for adjudication or to charge an elevated fee.", "min": 0, "max": "*", "base": { "path": "ClaimResponse.addItem.detail.subDetail.modifier", "min": 0, "max": "*" }, "type": [ { "code": "CodeableConcept" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "mustSupport": false, "isModifier": false, "isSummary": false, "binding": { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString": "Modifiers" } ], "strength": "example", "description": "Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen.", "valueSet": "http://hl7.org/fhir/ValueSet/claim-modifiers" }, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "v2", "map": "CE/CNE/CWE" }, { "identity": "rim", "map": "CD" }, { "identity": "orim", "map": "fhir:CodeableConcept rdfs:subClassOf dt:CD" }, { "identity": "rim", "map": "24.C, 24.D mods" } ] }, { "id": "ClaimResponse.addItem.detail.subDetail.quantity", "path": "ClaimResponse.addItem.detail.subDetail.quantity", "short": "Count of products or services", "definition": "The number of repetitions of a service or product.", "comment": "The context of use may frequently define what kind of quantity this is and therefore what kind of units can be used. The context of use may also restrict the values for the comparator.", "requirements": "Required when the product or service code does not convey the quantity provided.", "min": 0, "max": "1", "base": { "path": "ClaimResponse.addItem.detail.subDetail.quantity", "min": 0, "max": "1" }, "type": [ { "code": "Quantity", "profile": [ "http://hl7.org/fhir/StructureDefinition/SimpleQuantity" ] } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "source": "http://hl7.org/fhir/StructureDefinition/Element" }, { "key": "qty-3", "severity": "error", "human": "If a code for the unit is present, the system SHALL also be present", "expression": "code.empty() or system.exists()", "source": "http://hl7.org/fhir/StructureDefinition/Quantity" }, { "key": "sqty-1", "severity": "error", "human": "The comparator is not used on a SimpleQuantity", "expression": "comparator.empty()", "source": "http://hl7.org/fhir/StructureDefinition/SimpleQuantity" } ], "mustSupport": false, "isModifier": false, "isSummary": false, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "v2", "map": "SN (see also Range) or CQ" }, { "identity": "rim", "map": "PQ, IVL, MO, CO, depending on the values" }, { "identity": "rim", "map": "24.G" } ] }, { "id": "ClaimResponse.addItem.detail.subDetail.unitPrice", "path": "ClaimResponse.addItem.detail.subDetail.unitPrice", "short": "Fee, charge or cost per item", "definition": "If the item is not a group then this is the fee for the product or service, otherwise this is the total of the fees for the details of the group.", "requirements": "The amount charged to the patient by the provider for a single unit.", "min": 0, "max": "1", "base": { "path": "ClaimResponse.addItem.detail.subDetail.unitPrice", "min": 0, "max": "1" }, "type": [ { "code": "Money" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "mustSupport": false, "isModifier": false, "isSummary": false, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "rim", "map": "MO" } ] }, { "id": "ClaimResponse.addItem.detail.subDetail.factor", "path": "ClaimResponse.addItem.detail.subDetail.factor", "short": "Price scaling factor", "definition": "A real number that represents a multiplier used in determining the overall value of services delivered and/or goods received. The concept of a Factor allows for a discount or surcharge multiplier to be applied to a monetary amount.", "comment": "To show a 10% senior's discount, the value entered is: 0.90 (1.00 - 0.10).", "requirements": "When discounts are provided to a patient (example: Senior's discount) then this must be documented for adjudication.", "min": 0, "max": "1", "base": { "path": "ClaimResponse.addItem.detail.subDetail.factor", "min": 0, "max": "1" }, "type": [ { "code": "decimal" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "mustSupport": false, "isModifier": false, "isSummary": false, "mapping": [ { "identity": "rim", "map": "n/a" } ] }, { "id": "ClaimResponse.addItem.detail.subDetail.tax", "path": "ClaimResponse.addItem.detail.subDetail.tax", "short": "Total tax", "definition": "The total of taxes applicable for this product or service.", "requirements": "Required when taxes are not embedded in the unit price or provided as a separate service.", "min": 0, "max": "1", "base": { "path": "ClaimResponse.addItem.detail.subDetail.tax", "min": 0, "max": "1" }, "type": [ { "code": "Money" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "mustSupport": false, "isModifier": false, "isSummary": false, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "rim", "map": "MO" } ] }, { "id": "ClaimResponse.addItem.detail.subDetail.net", "path": "ClaimResponse.addItem.detail.subDetail.net", "short": "Total item cost", "definition": "The total amount claimed for the addItem.detail.subDetail. Net = unit price * quantity * factor.", "comment": "For example, the formula: quantity * unitPrice * factor = net. Quantity and factor are assumed to be 1 if not supplied.", "requirements": "Provides the total amount claimed for the group (if a grouper) or the line item.", "min": 0, "max": "1", "base": { "path": "ClaimResponse.addItem.detail.subDetail.net", "min": 0, "max": "1" }, "type": [ { "code": "Money" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "mustSupport": false, "isModifier": false, "isSummary": false, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "rim", "map": "MO" }, { "identity": "rim", "map": "24.F" } ] }, { "id": "ClaimResponse.addItem.detail.subDetail.noteNumber", "path": "ClaimResponse.addItem.detail.subDetail.noteNumber", "short": "Applicable note numbers", "definition": "The numbers associated with notes below which apply to the adjudication of this item.", "comment": "32 bit number; for values larger than this, use decimal", "requirements": "Provides a condensed manner for associating human readable descriptive explanations for adjudications on the line item.", "min": 0, "max": "*", "base": { "path": "ClaimResponse.addItem.detail.subDetail.noteNumber", "min": 0, "max": "*" }, "type": [ { "code": "positiveInt" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "mustSupport": false, "isModifier": false, "isSummary": false, "mapping": [ { "identity": "rim", "map": "n/a" } ] }, { "id": "ClaimResponse.addItem.detail.subDetail.reviewOutcome", "path": "ClaimResponse.addItem.detail.subDetail.reviewOutcome", "short": "Added items subdetail level adjudication results", "definition": "The high-level results of the adjudication if adjudication has been performed.", "min": 0, "max": "1", "base": { "path": "ClaimResponse.addItem.detail.subDetail.reviewOutcome", "min": 0, "max": "1" }, "contentReference": "#ClaimResponse.item.reviewOutcome", "mustSupport": false, "isModifier": false, "isSummary": false }, { "id": "ClaimResponse.addItem.detail.subDetail.adjudication", "path": "ClaimResponse.addItem.detail.subDetail.adjudication", "short": "Added items subdetail adjudication", "definition": "The adjudication results.", "min": 0, "max": "*", "base": { "path": "ClaimResponse.addItem.detail.subDetail.adjudication", "min": 0, "max": "*" }, "contentReference": "#ClaimResponse.item.adjudication", "mustSupport": false, "isModifier": false, "isSummary": false }, { "id": "ClaimResponse.adjudication", "path": "ClaimResponse.adjudication", "short": "Header-level adjudication", "definition": "The adjudication results which are presented at the header level rather than at the line-item or add-item levels.", "requirements": "Some insurers will receive line-items but provide the adjudication only at a summary or header-level.", "min": 0, "max": "*", "base": { "path": "ClaimResponse.adjudication", "min": 0, "max": "*" }, "contentReference": "http://hl7.org/fhir/StructureDefinition/ClaimResponse#ClaimResponse.item.adjudication", "mustSupport": false, "isModifier": false, "isSummary": false }, { "id": "ClaimResponse.total", "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-explicit-type-name", "valueString": "Total" } ], "path": "ClaimResponse.total", "short": "Adjudication totals", "definition": "Categorized monetary totals for the adjudication.", "comment": "Totals for amounts submitted, co-pays, benefits payable etc.", "requirements": "To provide the requestor with financial totals by category for the adjudication.", "min": 0, "max": "*", "base": { "path": "ClaimResponse.total", "min": 0, "max": "*" }, "type": [ { "code": "BackboneElement" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "mustSupport": false, "isModifier": false, "isSummary": true, "mapping": [ { "identity": "rim", "map": "n/a" } ] }, { "id": "ClaimResponse.total.id", "path": "ClaimResponse.total.id", "representation": [ "xmlAttr" ], "short": "Unique id for inter-element referencing", "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": [ { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type", "valueUrl": "string" } ], "code": "http://hl7.org/fhirpath/System.String" } ], "condition": [ "ele-1" ], "mapping": [ { "identity": "rim", "map": "n/a" } ] }, { "id": "ClaimResponse.total.extension", "path": "ClaimResponse.total.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. To make the use of extensions safe and managable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can 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" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "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()", "source": "http://hl7.org/fhir/StructureDefinition/Extension" } ], "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "rim", "map": "N/A" } ] }, { "id": "ClaimResponse.total.modifierExtension", "path": "ClaimResponse.total.modifierExtension", "short": "Extensions that cannot be ignored even if unrecognized", "definition": "May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and managable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.\n\nModifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).", "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.", "requirements": "Modifier extensions allow for extensions that *cannot* be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the [definition of modifier extensions](extensibility.html#modifierExtension).", "alias": [ "extensions", "user content", "modifiers" ], "min": 0, "max": "*", "base": { "path": "BackboneElement.modifierExtension", "min": 0, "max": "*" }, "type": [ { "code": "Extension" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "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()", "source": "http://hl7.org/fhir/StructureDefinition/Extension" } ], "isModifier": true, "isModifierReason": "Modifier extensions are expected to modify the meaning or interpretation of the element that contains them", "isSummary": true, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "rim", "map": "N/A" } ] }, { "id": "ClaimResponse.total.category", "path": "ClaimResponse.total.category", "short": "Type of adjudication information", "definition": "A code to indicate the information type of this adjudication record. Information types may include: the value submitted, maximum values or percentages allowed or payable under the plan, amounts that the patient is responsible for in aggregate or pertaining to this item, amounts paid by other coverages, and the benefit payable for this item.", "comment": "For example codes indicating: Co-Pay, deductible, eligible, benefit, tax, etc.", "requirements": "Needed to convey the type of total provided.", "min": 1, "max": "1", "base": { "path": "ClaimResponse.total.category", "min": 1, "max": "1" }, "type": [ { "code": "CodeableConcept" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "mustSupport": false, "isModifier": false, "isSummary": true, "binding": { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString": "Adjudication" } ], "strength": "example", "description": "The adjudication codes.", "valueSet": "http://hl7.org/fhir/ValueSet/adjudication" }, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "v2", "map": "CE/CNE/CWE" }, { "identity": "rim", "map": "CD" }, { "identity": "orim", "map": "fhir:CodeableConcept rdfs:subClassOf dt:CD" } ] }, { "id": "ClaimResponse.total.amount", "path": "ClaimResponse.total.amount", "short": "Financial total for the category", "definition": "Monetary total amount associated with the category.", "requirements": "Needed to convey the total monetary amount.", "min": 1, "max": "1", "base": { "path": "ClaimResponse.total.amount", "min": 1, "max": "1" }, "type": [ { "code": "Money" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "mustSupport": false, "isModifier": false, "isSummary": true, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "rim", "map": "MO" } ] }, { "id": "ClaimResponse.payment", "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-explicit-type-name", "valueString": "Payment" } ], "path": "ClaimResponse.payment", "short": "Payment Details", "definition": "Payment details for the adjudication of the claim.", "requirements": "Needed to convey references to the financial instrument that has been used if payment has been made.", "min": 0, "max": "1", "base": { "path": "ClaimResponse.payment", "min": 0, "max": "1" }, "type": [ { "code": "BackboneElement" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "mustSupport": false, "isModifier": false, "isSummary": false, "mapping": [ { "identity": "rim", "map": "n/a" } ] }, { "id": "ClaimResponse.payment.id", "path": "ClaimResponse.payment.id", "representation": [ "xmlAttr" ], "short": "Unique id for inter-element referencing", "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": [ { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type", "valueUrl": "string" } ], "code": "http://hl7.org/fhirpath/System.String" } ], "condition": [ "ele-1" ], "mapping": [ { "identity": "rim", "map": "n/a" } ] }, { "id": "ClaimResponse.payment.extension", "path": "ClaimResponse.payment.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. To make the use of extensions safe and managable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can 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" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "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()", "source": "http://hl7.org/fhir/StructureDefinition/Extension" } ], "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "rim", "map": "N/A" } ] }, { "id": "ClaimResponse.payment.modifierExtension", "path": "ClaimResponse.payment.modifierExtension", "short": "Extensions that cannot be ignored even if unrecognized", "definition": "May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and managable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.\n\nModifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).", "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.", "requirements": "Modifier extensions allow for extensions that *cannot* be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the [definition of modifier extensions](extensibility.html#modifierExtension).", "alias": [ "extensions", "user content", "modifiers" ], "min": 0, "max": "*", "base": { "path": "BackboneElement.modifierExtension", "min": 0, "max": "*" }, "type": [ { "code": "Extension" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "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()", "source": "http://hl7.org/fhir/StructureDefinition/Extension" } ], "isModifier": true, "isModifierReason": "Modifier extensions are expected to modify the meaning or interpretation of the element that contains them", "isSummary": true, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "rim", "map": "N/A" } ] }, { "id": "ClaimResponse.payment.type", "path": "ClaimResponse.payment.type", "short": "Partial or complete payment", "definition": "Whether this represents partial or complete payment of the benefits payable.", "comment": "Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination.", "requirements": "To advise the requestor when the insurer believes all payments to have been completed.", "min": 1, "max": "1", "base": { "path": "ClaimResponse.payment.type", "min": 1, "max": "1" }, "type": [ { "code": "CodeableConcept" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "mustSupport": false, "isModifier": false, "isSummary": false, "binding": { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString": "PaymentType" } ], "strength": "example", "description": "The type (partial, complete) of the payment.", "valueSet": "http://hl7.org/fhir/ValueSet/ex-paymenttype" }, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "v2", "map": "CE/CNE/CWE" }, { "identity": "rim", "map": "CD" }, { "identity": "orim", "map": "fhir:CodeableConcept rdfs:subClassOf dt:CD" } ] }, { "id": "ClaimResponse.payment.adjustment", "path": "ClaimResponse.payment.adjustment", "short": "Payment adjustment for non-claim issues", "definition": "Total amount of all adjustments to this payment included in this transaction which are not related to this claim's adjudication.", "comment": "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.", "requirements": "To advise the requestor of adjustments applied to the payment.", "min": 0, "max": "1", "base": { "path": "ClaimResponse.payment.adjustment", "min": 0, "max": "1" }, "type": [ { "code": "Money" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "mustSupport": false, "isModifier": false, "isSummary": false, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "rim", "map": "MO" } ] }, { "id": "ClaimResponse.payment.adjustmentReason", "path": "ClaimResponse.payment.adjustmentReason", "short": "Explanation for the adjustment", "definition": "Reason for the payment adjustment.", "comment": "Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination.", "requirements": "Needed to clarify the monetary adjustment.", "min": 0, "max": "1", "base": { "path": "ClaimResponse.payment.adjustmentReason", "min": 0, "max": "1" }, "type": [ { "code": "CodeableConcept" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "mustSupport": false, "isModifier": false, "isSummary": false, "binding": { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString": "PaymentAdjustmentReason" } ], "strength": "example", "description": "Payment Adjustment reason codes.", "valueSet": "http://hl7.org/fhir/ValueSet/payment-adjustment-reason" }, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "v2", "map": "CE/CNE/CWE" }, { "identity": "rim", "map": "CD" }, { "identity": "orim", "map": "fhir:CodeableConcept rdfs:subClassOf dt:CD" } ] }, { "id": "ClaimResponse.payment.date", "path": "ClaimResponse.payment.date", "short": "Expected date of payment", "definition": "Estimated date the payment will be issued or the actual issue date of payment.", "requirements": "To advise the payee when payment can be expected.", "min": 0, "max": "1", "base": { "path": "ClaimResponse.payment.date", "min": 0, "max": "1" }, "type": [ { "code": "date" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "mustSupport": false, "isModifier": false, "isSummary": false, "mapping": [ { "identity": "rim", "map": "n/a" } ] }, { "id": "ClaimResponse.payment.amount", "path": "ClaimResponse.payment.amount", "short": "Payable amount after adjustment", "definition": "Benefits payable less any payment adjustment.", "requirements": "Needed to provide the actual payment amount.", "min": 1, "max": "1", "base": { "path": "ClaimResponse.payment.amount", "min": 1, "max": "1" }, "type": [ { "code": "Money" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "mustSupport": false, "isModifier": false, "isSummary": false, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "rim", "map": "MO" } ] }, { "id": "ClaimResponse.payment.identifier", "path": "ClaimResponse.payment.identifier", "short": "Business identifier for the payment", "definition": "Issuer's unique identifier for the payment instrument.", "comment": "For example: EFT number or check number.", "requirements": "Enable the receiver to reconcile when payment received.", "min": 0, "max": "1", "base": { "path": "ClaimResponse.payment.identifier", "min": 0, "max": "1" }, "type": [ { "code": "Identifier" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "source": "http://hl7.org/fhir/StructureDefinition/Element" }, { "key": "ident-1", "severity": "warning", "human": "Identifier with no value has limited utility. If communicating that an identifier value has been suppressed or missing, the value element SHOULD be present with an extension indicating the missing semantic - e.g. data-absent-reason", "expression": "value.exists()", "source": "http://hl7.org/fhir/StructureDefinition/Identifier" } ], "mustSupport": false, "isModifier": false, "isSummary": false, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "v2", "map": "CX / EI (occasionally, more often EI maps to a resource id or a URL)" }, { "identity": "rim", "map": "II - The Identifier class is a little looser than the v3 type II because it allows URIs as well as registered OIDs or GUIDs. Also maps to Role[classCode=IDENT]" }, { "identity": "servd", "map": "Identifier" } ] }, { "id": "ClaimResponse.fundsReserve", "path": "ClaimResponse.fundsReserve", "short": "Funds reserved status", "definition": "A code, used only on a response to a preauthorization, to indicate whether the benefits payable have been reserved and for whom.", "comment": "Fund would be release by a future claim quoting the preAuthRef of this response. Examples of values include: provider, patient, none.", "requirements": "Needed to advise the submitting provider on whether the rquest for reservation of funds has been honored.", "min": 0, "max": "1", "base": { "path": "ClaimResponse.fundsReserve", "min": 0, "max": "1" }, "type": [ { "code": "CodeableConcept" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "mustSupport": false, "isModifier": false, "isSummary": false, "binding": { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString": "FundsReserve" } ], "strength": "example", "description": "For whom funds are to be reserved: (Patient, Provider, None).", "valueSet": "http://hl7.org/fhir/ValueSet/fundsreserve" }, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "v2", "map": "CE/CNE/CWE" }, { "identity": "rim", "map": "CD" }, { "identity": "orim", "map": "fhir:CodeableConcept rdfs:subClassOf dt:CD" } ] }, { "id": "ClaimResponse.formCode", "path": "ClaimResponse.formCode", "short": "Printed form identifier", "definition": "A code for the form to be used for printing the content.", "comment": "May be needed to identify specific jurisdictional forms.", "requirements": "Needed to specify the specific form used for producing output for this response.", "min": 0, "max": "1", "base": { "path": "ClaimResponse.formCode", "min": 0, "max": "1" }, "type": [ { "code": "CodeableConcept" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "mustSupport": false, "isModifier": false, "isSummary": false, "binding": { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString": "Forms" } ], "strength": "example", "description": "The forms codes.", "valueSet": "http://hl7.org/fhir/ValueSet/forms" }, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "v2", "map": "CE/CNE/CWE" }, { "identity": "rim", "map": "CD" }, { "identity": "orim", "map": "fhir:CodeableConcept rdfs:subClassOf dt:CD" } ] }, { "id": "ClaimResponse.form", "path": "ClaimResponse.form", "short": "Printed reference or actual form", "definition": "The actual form, by reference or inclusion, for printing the content or an EOB.", "comment": "Needed to permit insurers to include the actual form.", "requirements": "Needed to include the specific form used for producing output for this response.", "min": 0, "max": "1", "base": { "path": "ClaimResponse.form", "min": 0, "max": "1" }, "type": [ { "code": "Attachment" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "source": "http://hl7.org/fhir/StructureDefinition/Element" }, { "key": "att-1", "severity": "error", "human": "If the Attachment has data, it SHALL have a contentType", "expression": "data.empty() or contentType.exists()", "source": "http://hl7.org/fhir/StructureDefinition/Attachment" } ], "mustSupport": false, "isModifier": false, "isSummary": false, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "v2", "map": "ED/RP" }, { "identity": "rim", "map": "ED" } ] }, { "id": "ClaimResponse.processNote", "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-explicit-type-name", "valueString": "Note" } ], "path": "ClaimResponse.processNote", "short": "Note concerning adjudication", "definition": "A note that describes or explains adjudication results in a human readable form.", "requirements": "Provides the insurer specific textual explanations associated with the processing.", "min": 0, "max": "*", "base": { "path": "ClaimResponse.processNote", "min": 0, "max": "*" }, "type": [ { "code": "BackboneElement" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "mustSupport": false, "isModifier": false, "isSummary": false, "mapping": [ { "identity": "rim", "map": "n/a" } ] }, { "id": "ClaimResponse.processNote.id", "path": "ClaimResponse.processNote.id", "representation": [ "xmlAttr" ], "short": "Unique id for inter-element referencing", "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": [ { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type", "valueUrl": "string" } ], "code": "http://hl7.org/fhirpath/System.String" } ], "condition": [ "ele-1" ], "mapping": [ { "identity": "rim", "map": "n/a" } ] }, { "id": "ClaimResponse.processNote.extension", "path": "ClaimResponse.processNote.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. To make the use of extensions safe and managable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can 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" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "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()", "source": "http://hl7.org/fhir/StructureDefinition/Extension" } ], "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "rim", "map": "N/A" } ] }, { "id": "ClaimResponse.processNote.modifierExtension", "path": "ClaimResponse.processNote.modifierExtension", "short": "Extensions that cannot be ignored even if unrecognized", "definition": "May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and managable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.\n\nModifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).", "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.", "requirements": "Modifier extensions allow for extensions that *cannot* be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the [definition of modifier extensions](extensibility.html#modifierExtension).", "alias": [ "extensions", "user content", "modifiers" ], "min": 0, "max": "*", "base": { "path": "BackboneElement.modifierExtension", "min": 0, "max": "*" }, "type": [ { "code": "Extension" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "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()", "source": "http://hl7.org/fhir/StructureDefinition/Extension" } ], "isModifier": true, "isModifierReason": "Modifier extensions are expected to modify the meaning or interpretation of the element that contains them", "isSummary": true, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "rim", "map": "N/A" } ] }, { "id": "ClaimResponse.processNote.number", "path": "ClaimResponse.processNote.number", "short": "Note instance identifier", "definition": "A number to uniquely identify a note entry.", "comment": "32 bit number; for values larger than this, use decimal", "requirements": "Necessary to provide a mechanism to link from adjudications.", "min": 0, "max": "1", "base": { "path": "ClaimResponse.processNote.number", "min": 0, "max": "1" }, "type": [ { "code": "positiveInt" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "mustSupport": false, "isModifier": false, "isSummary": false, "mapping": [ { "identity": "rim", "map": "n/a" } ] }, { "id": "ClaimResponse.processNote.type", "path": "ClaimResponse.processNote.type", "short": "Note purpose", "definition": "The business purpose of the note text.", "comment": "Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination.", "requirements": "To convey the expectation for when the text is used.", "min": 0, "max": "1", "base": { "path": "ClaimResponse.processNote.type", "min": 0, "max": "1" }, "type": [ { "code": "CodeableConcept" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "mustSupport": false, "isModifier": false, "isSummary": false, "binding": { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString": "NoteType" } ], "strength": "extensible", "description": "The presentation types of notes.", "valueSet": "http://hl7.org/fhir/ValueSet/note-type" }, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "v2", "map": "CE/CNE/CWE" }, { "identity": "rim", "map": "CD" }, { "identity": "orim", "map": "fhir:CodeableConcept rdfs:subClassOf dt:CD" } ] }, { "id": "ClaimResponse.processNote.text", "path": "ClaimResponse.processNote.text", "short": "Note explanatory text", "definition": "The explanation or description associated with the processing.", "comment": "Note that FHIR strings SHALL NOT exceed 1,048,576 (1024*1024) characters in size", "requirements": "Required to provide human readable explanation.", "min": 1, "max": "1", "base": { "path": "ClaimResponse.processNote.text", "min": 1, "max": "1" }, "type": [ { "code": "string" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "mustSupport": false, "isModifier": false, "isSummary": false, "mapping": [ { "identity": "rim", "map": "n/a" } ] }, { "id": "ClaimResponse.processNote.language", "path": "ClaimResponse.processNote.language", "short": "Language of the text", "definition": "A code to define the language used in the text of the note.", "comment": "Only required if the language is different from the resource language.", "requirements": "Note text may vary from the resource defined language.", "min": 0, "max": "1", "base": { "path": "ClaimResponse.processNote.language", "min": 0, "max": "1" }, "type": [ { "code": "CodeableConcept" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "mustSupport": false, "isModifier": false, "isSummary": false, "binding": { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString": "Language" } ], "strength": "required", "description": "IETF language tag for a human language", "valueSet": "http://hl7.org/fhir/ValueSet/all-languages|5.0.0", "additional": [ { "purpose": "starter", "valueSet": "http://hl7.org/fhir/ValueSet/languages" } ] }, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "v2", "map": "CE/CNE/CWE" }, { "identity": "rim", "map": "CD" }, { "identity": "orim", "map": "fhir:CodeableConcept rdfs:subClassOf dt:CD" } ] }, { "id": "ClaimResponse.communicationRequest", "path": "ClaimResponse.communicationRequest", "short": "Request for additional information", "definition": "Request for additional supporting or authorizing information.", "comment": "For example: professional reports, documents, images, clinical resources, or accident reports.", "requirements": "Need to communicate insurer request for additional information required to support the adjudication.", "min": 0, "max": "*", "base": { "path": "ClaimResponse.communicationRequest", "min": 0, "max": "*" }, "type": [ { "code": "Reference", "targetProfile": [ "http://hl7.org/fhir/StructureDefinition/CommunicationRequest" ] } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "source": "http://hl7.org/fhir/StructureDefinition/Element" }, { "key": "ref-1", "severity": "error", "human": "SHALL have a contained resource if a local reference is provided", "expression": "reference.exists() implies (reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids')) or (reference='#' and %rootResource!=%resource))", "source": "http://hl7.org/fhir/StructureDefinition/Reference" }, { "key": "ref-2", "severity": "error", "human": "At least one of reference, identifier and display SHALL be present (unless an extension is provided).", "expression": "reference.exists() or identifier.exists() or display.exists() or extension.exists()", "source": "http://hl7.org/fhir/StructureDefinition/Reference" } ], "mustSupport": false, "isModifier": false, "isSummary": false, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "rim", "map": "The target of a resource reference is a RIM entry point (Act, Role, or Entity)" } ] }, { "id": "ClaimResponse.insurance", "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-explicit-type-name", "valueString": "Insurance" } ], "path": "ClaimResponse.insurance", "short": "Patient insurance information", "definition": "Financial instruments for reimbursement for the health care products and services specified on the claim.", "comment": "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.", "requirements": "At least one insurer is required for a claim to be a claim.", "min": 0, "max": "*", "base": { "path": "ClaimResponse.insurance", "min": 0, "max": "*" }, "type": [ { "code": "BackboneElement" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "mustSupport": false, "isModifier": false, "isSummary": false, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "rim", "map": "Coverage" } ] }, { "id": "ClaimResponse.insurance.id", "path": "ClaimResponse.insurance.id", "representation": [ "xmlAttr" ], "short": "Unique id for inter-element referencing", "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": [ { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type", "valueUrl": "string" } ], "code": "http://hl7.org/fhirpath/System.String" } ], "condition": [ "ele-1" ], "mapping": [ { "identity": "rim", "map": "n/a" } ] }, { "id": "ClaimResponse.insurance.extension", "path": "ClaimResponse.insurance.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. To make the use of extensions safe and managable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can 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" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "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()", "source": "http://hl7.org/fhir/StructureDefinition/Extension" } ], "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "rim", "map": "N/A" } ] }, { "id": "ClaimResponse.insurance.modifierExtension", "path": "ClaimResponse.insurance.modifierExtension", "short": "Extensions that cannot be ignored even if unrecognized", "definition": "May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and managable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.\n\nModifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).", "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.", "requirements": "Modifier extensions allow for extensions that *cannot* be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the [definition of modifier extensions](extensibility.html#modifierExtension).", "alias": [ "extensions", "user content", "modifiers" ], "min": 0, "max": "*", "base": { "path": "BackboneElement.modifierExtension", "min": 0, "max": "*" }, "type": [ { "code": "Extension" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "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()", "source": "http://hl7.org/fhir/StructureDefinition/Extension" } ], "isModifier": true, "isModifierReason": "Modifier extensions are expected to modify the meaning or interpretation of the element that contains them", "isSummary": true, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "rim", "map": "N/A" } ] }, { "id": "ClaimResponse.insurance.sequence", "path": "ClaimResponse.insurance.sequence", "short": "Insurance instance identifier", "definition": "A number to uniquely identify insurance entries and provide a sequence of coverages to convey coordination of benefit order.", "comment": "32 bit number; for values larger than this, use decimal", "requirements": "To maintain order of the coverages.", "min": 1, "max": "1", "base": { "path": "ClaimResponse.insurance.sequence", "min": 1, "max": "1" }, "type": [ { "code": "positiveInt" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "mustSupport": false, "isModifier": false, "isSummary": false, "mapping": [ { "identity": "rim", "map": "n/a" } ] }, { "id": "ClaimResponse.insurance.focal", "path": "ClaimResponse.insurance.focal", "short": "Coverage to be used for adjudication", "definition": "A flag to indicate that this Coverage is to be used for adjudication of this claim when set to true.", "comment": "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.", "requirements": "To identify which coverage in the list is being used to adjudicate this claim.", "min": 1, "max": "1", "base": { "path": "ClaimResponse.insurance.focal", "min": 1, "max": "1" }, "type": [ { "code": "boolean" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "mustSupport": false, "isModifier": false, "isSummary": false, "mapping": [ { "identity": "rim", "map": "n/a" } ] }, { "id": "ClaimResponse.insurance.coverage", "path": "ClaimResponse.insurance.coverage", "short": "Insurance information", "definition": "Reference to the insurance card level information contained in the Coverage resource. The coverage issuing insurer will use these details to locate the patient's actual coverage within the insurer's information system.", "comment": "References SHALL be a reference to an actual FHIR resource, and SHALL be resolvable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.", "requirements": "Required to allow the adjudicator to locate the correct policy and history within their information system.", "min": 1, "max": "1", "base": { "path": "ClaimResponse.insurance.coverage", "min": 1, "max": "1" }, "type": [ { "code": "Reference", "targetProfile": [ "http://hl7.org/fhir/StructureDefinition/Coverage" ] } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "source": "http://hl7.org/fhir/StructureDefinition/Element" }, { "key": "ref-1", "severity": "error", "human": "SHALL have a contained resource if a local reference is provided", "expression": "reference.exists() implies (reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids')) or (reference='#' and %rootResource!=%resource))", "source": "http://hl7.org/fhir/StructureDefinition/Reference" }, { "key": "ref-2", "severity": "error", "human": "At least one of reference, identifier and display SHALL be present (unless an extension is provided).", "expression": "reference.exists() or identifier.exists() or display.exists() or extension.exists()", "source": "http://hl7.org/fhir/StructureDefinition/Reference" } ], "mustSupport": false, "isModifier": false, "isSummary": false, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "rim", "map": "The target of a resource reference is a RIM entry point (Act, Role, or Entity)" } ] }, { "id": "ClaimResponse.insurance.businessArrangement", "path": "ClaimResponse.insurance.businessArrangement", "short": "Additional provider contract number", "definition": "A business agreement number established between the provider and the insurer for special business processing purposes.", "comment": "Note that FHIR strings SHALL NOT exceed 1,048,576 (1024*1024) characters in size", "requirements": "Providers may have multiple business arrangements with a given insurer and must supply the specific contract number for adjudication.", "min": 0, "max": "1", "base": { "path": "ClaimResponse.insurance.businessArrangement", "min": 0, "max": "1" }, "type": [ { "code": "string" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "mustSupport": false, "isModifier": false, "isSummary": false, "mapping": [ { "identity": "rim", "map": "n/a" } ] }, { "id": "ClaimResponse.insurance.claimResponse", "path": "ClaimResponse.insurance.claimResponse", "short": "Adjudication results", "definition": "The result of the adjudication of the line items for the Coverage specified in this insurance.", "comment": "Must not be specified when 'focal=true' for this insurance.", "requirements": "An insurer need the adjudication results from prior insurers to determine the outstanding balance remaining by item for the items in the curent claim.", "min": 0, "max": "1", "base": { "path": "ClaimResponse.insurance.claimResponse", "min": 0, "max": "1" }, "type": [ { "code": "Reference", "targetProfile": [ "http://hl7.org/fhir/StructureDefinition/ClaimResponse" ] } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "source": "http://hl7.org/fhir/StructureDefinition/Element" }, { "key": "ref-1", "severity": "error", "human": "SHALL have a contained resource if a local reference is provided", "expression": "reference.exists() implies (reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids')) or (reference='#' and %rootResource!=%resource))", "source": "http://hl7.org/fhir/StructureDefinition/Reference" }, { "key": "ref-2", "severity": "error", "human": "At least one of reference, identifier and display SHALL be present (unless an extension is provided).", "expression": "reference.exists() or identifier.exists() or display.exists() or extension.exists()", "source": "http://hl7.org/fhir/StructureDefinition/Reference" } ], "mustSupport": false, "isModifier": false, "isSummary": false, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "rim", "map": "The target of a resource reference is a RIM entry point (Act, Role, or Entity)" } ] }, { "id": "ClaimResponse.error", "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-explicit-type-name", "valueString": "Error" } ], "path": "ClaimResponse.error", "short": "Processing errors", "definition": "Errors encountered during the processing of the adjudication.", "comment": "If the request contains errors then an error element should be provided and no adjudication related sections (item, addItem, or payment) should be present.", "requirements": "Need to communicate processing issues to the requestor.", "min": 0, "max": "*", "base": { "path": "ClaimResponse.error", "min": 0, "max": "*" }, "type": [ { "code": "BackboneElement" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "mustSupport": false, "isModifier": false, "isSummary": false, "mapping": [ { "identity": "rim", "map": "n/a" } ] }, { "id": "ClaimResponse.error.id", "path": "ClaimResponse.error.id", "representation": [ "xmlAttr" ], "short": "Unique id for inter-element referencing", "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": [ { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type", "valueUrl": "string" } ], "code": "http://hl7.org/fhirpath/System.String" } ], "condition": [ "ele-1" ], "mapping": [ { "identity": "rim", "map": "n/a" } ] }, { "id": "ClaimResponse.error.extension", "path": "ClaimResponse.error.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. To make the use of extensions safe and managable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can 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" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "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()", "source": "http://hl7.org/fhir/StructureDefinition/Extension" } ], "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "rim", "map": "N/A" } ] }, { "id": "ClaimResponse.error.modifierExtension", "path": "ClaimResponse.error.modifierExtension", "short": "Extensions that cannot be ignored even if unrecognized", "definition": "May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and managable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.\n\nModifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).", "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.", "requirements": "Modifier extensions allow for extensions that *cannot* be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the [definition of modifier extensions](extensibility.html#modifierExtension).", "alias": [ "extensions", "user content", "modifiers" ], "min": 0, "max": "*", "base": { "path": "BackboneElement.modifierExtension", "min": 0, "max": "*" }, "type": [ { "code": "Extension" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "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()", "source": "http://hl7.org/fhir/StructureDefinition/Extension" } ], "isModifier": true, "isModifierReason": "Modifier extensions are expected to modify the meaning or interpretation of the element that contains them", "isSummary": true, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "rim", "map": "N/A" } ] }, { "id": "ClaimResponse.error.itemSequence", "path": "ClaimResponse.error.itemSequence", "short": "Item sequence number", "definition": "The sequence number of the line item submitted which contains the error. This value is omitted when the error occurs outside of the item structure.", "comment": "32 bit number; for values larger than this, use decimal", "requirements": "Provides references to the claim items.", "min": 0, "max": "1", "base": { "path": "ClaimResponse.error.itemSequence", "min": 0, "max": "1" }, "type": [ { "code": "positiveInt" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "mustSupport": false, "isModifier": false, "isSummary": false, "mapping": [ { "identity": "rim", "map": "n/a" } ] }, { "id": "ClaimResponse.error.detailSequence", "path": "ClaimResponse.error.detailSequence", "short": "Detail sequence number", "definition": "The sequence number of the detail within the line item submitted which contains the error. This value is omitted when the error occurs outside of the item structure.", "comment": "32 bit number; for values larger than this, use decimal", "requirements": "Provides references to the claim details within the claim item.", "min": 0, "max": "1", "base": { "path": "ClaimResponse.error.detailSequence", "min": 0, "max": "1" }, "type": [ { "code": "positiveInt" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "mustSupport": false, "isModifier": false, "isSummary": false, "mapping": [ { "identity": "rim", "map": "n/a" } ] }, { "id": "ClaimResponse.error.subDetailSequence", "path": "ClaimResponse.error.subDetailSequence", "short": "Subdetail sequence number", "definition": "The sequence number of the sub-detail within the detail within the line item submitted which contains the error. This value is omitted when the error occurs outside of the item structure.", "comment": "32 bit number; for values larger than this, use decimal", "requirements": "Provides references to the claim sub-details within the claim detail.", "min": 0, "max": "1", "base": { "path": "ClaimResponse.error.subDetailSequence", "min": 0, "max": "1" }, "type": [ { "code": "positiveInt" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "mustSupport": false, "isModifier": false, "isSummary": false, "mapping": [ { "identity": "rim", "map": "n/a" } ] }, { "id": "ClaimResponse.error.code", "path": "ClaimResponse.error.code", "short": "Error code detailing processing issues", "definition": "An error code, from a specified code system, which details why the claim could not be adjudicated.", "comment": "Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination.", "requirements": "Required to convey processing errors.", "min": 1, "max": "1", "base": { "path": "ClaimResponse.error.code", "min": 1, "max": "1" }, "type": [ { "code": "CodeableConcept" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "mustSupport": false, "isModifier": false, "isSummary": true, "binding": { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString": "AdjudicationError" } ], "strength": "example", "description": "The adjudication error codes.", "valueSet": "http://hl7.org/fhir/ValueSet/adjudication-error" }, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "v2", "map": "CE/CNE/CWE" }, { "identity": "rim", "map": "CD" }, { "identity": "orim", "map": "fhir:CodeableConcept rdfs:subClassOf dt:CD" } ] }, { "id": "ClaimResponse.error.expression", "path": "ClaimResponse.error.expression", "short": "FHIRPath of element(s) related to issue", "definition": "A [simple subset of FHIRPath](fhirpath.html#simple) limited to element names, repetition indicators and the default child accessor that identifies one of the elements in the resource that caused this issue to be raised.", "comment": "The root of the FHIRPath is the resource or bundle that generated OperationOutcome. Each FHIRPath SHALL resolve to a single node.", "requirements": "Allows systems to highlight or otherwise guide users to elements implicated in issues to allow them to be fixed more easily.", "min": 0, "max": "*", "base": { "path": "ClaimResponse.error.expression", "min": 0, "max": "*" }, "type": [ { "code": "string" } ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "mustSupport": false, "isModifier": false, "isSummary": true, "mapping": [ { "identity": "rim", "map": "n/a" } ] } ] }, "differential": { "element": [ { "id": "ClaimResponse.contained", "path": "ClaimResponse.contained", "slicing": { "discriminator": [ { "type": "profile", "path": "$this" } ], "rules": "open" } }, { "id": "ClaimResponse.contained:duplicates", "path": "ClaimResponse.contained", "sliceName": "duplicates", "max": "1", "type": [ { "code": "ExplanationOfBenefit", "profile": [ "https://bpcs.exchange/fhir/StructureDefinition/profile-ExplanationOfBenefit-duplicate" ] } ], "mustSupport": true }, { "id": "ClaimResponse.contained:dispenses", "path": "ClaimResponse.contained", "sliceName": "dispenses", "type": [ { "code": "MedicationDispense", "profile": [ "https://bpcs.exchange/fhir/StructureDefinition/profile-MedicationDispense" ] } ], "mustSupport": true }, { "id": "ClaimResponse.status", "path": "ClaimResponse.status", "short": "draft | active", "mustSupport": true, "binding": { "strength": "required", "valueSet": "https://bpcs.exchange/fhir/ValueSet/vs-FinancialStatus" }, "mapping": [ { "identity": "BPCS", "map": "BatchRecordDTO.batchStatus" } ] }, { "id": "ClaimResponse.type", "path": "ClaimResponse.type", "patternCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "pharmacy" } ] } }, { "id": "ClaimResponse.use", "path": "ClaimResponse.use", "patternCode": "claim" }, { "id": "ClaimResponse.patient", "path": "ClaimResponse.patient", "type": [ { "code": "Reference", "profile": [ "https://bpcs.exchange/fhir/StructureDefinition/profile-Reference-group-or-patient" ], "targetProfile": [ "https://bpcs.exchange/fhir/StructureDefinition/profile-Patient-create" ] } ], "mustSupport": true }, { "id": "ClaimResponse.created", "path": "ClaimResponse.created", "comment": "This is the 'current' date when the ClaimResponse is produced", "mustSupport": true }, { "id": "ClaimResponse.insurer", "path": "ClaimResponse.insurer", "patternReference": { "reference": "Organization/bpcs" } }, { "id": "ClaimResponse.request", "path": "ClaimResponse.request", "comment": "References SHALL be a reference to an actual FHIR resource, and SHALL be resolvable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.\r\n This will only be present if the submitted Claim has an id (because the Claim has previously been held)", "type": [ { "code": "Reference", "profile": [ "https://bpcs.exchange/fhir/StructureDefinition/profile-Reference-rest" ], "targetProfile": [ "https://bpcs.exchange/fhir/StructureDefinition/profile-Claim-create" ] } ], "mustSupport": true, "mapping": [ { "identity": "BPCS", "map": "BatchRecordDTO.dateReceived (second-last component of id), BatchRecordDTO.batchSeqNum (last component of id)" } ] }, { "id": "ClaimResponse.outcome", "path": "ClaimResponse.outcome", "mustSupport": true }, { "id": "ClaimResponse.item", "path": "ClaimResponse.item", "comment": "There will be a ClaimResponse.item for each item in the associated claim submission", "min": 1, "mustSupport": true }, { "id": "ClaimResponse.item.extension", "path": "ClaimResponse.item.extension", "min": 1, "mustSupport": true }, { "id": "ClaimResponse.item.extension:receiptPlan", "path": "ClaimResponse.item.extension", "sliceName": "receiptPlan", "min": 1, "type": [ { "code": "Extension", "profile": [ "https://bpcs.exchange/fhir/StructureDefinition/ext-Resource-ReceiptPlan" ] } ], "mustSupport": true }, { "id": "ClaimResponse.item.extension:presetModifier", "path": "ClaimResponse.item.extension", "sliceName": "presetModifier", "type": [ { "code": "Extension", "profile": [ "https://bpcs.exchange/fhir/StructureDefinition/ext-ClaimResponse-PresetModifier" ] } ], "mustSupport": true }, { "id": "ClaimResponse.item.itemSequence", "path": "ClaimResponse.item.itemSequence", "comment": "This will match the Claim.item.sequence of the corresponding repetition in the associated Claim submission", "mustSupport": true }, { "id": "ClaimResponse.item.reviewOutcome", "path": "ClaimResponse.item.reviewOutcome", "min": 1, "mustSupport": true }, { "id": "ClaimResponse.item.reviewOutcome.extension:info", "path": "ClaimResponse.item.reviewOutcome.extension", "sliceName": "info", "type": [ { "code": "Extension", "profile": [ "https://bpcs.exchange/fhir/StructureDefinition/ext-ClaimResponse-Info" ] } ], "mustSupport": true }, { "id": "ClaimResponse.item.reviewOutcome.decision", "path": "ClaimResponse.item.reviewOutcome.decision", "min": 1, "mustSupport": true, "binding": { "strength": "required", "valueSet": "https://bpcs.exchange/fhir/ValueSet/vs-Receipt-status" } }, { "id": "ClaimResponse.item.reviewOutcome.reason", "path": "ClaimResponse.item.reviewOutcome.reason", "comment": "If multiple issues are identified, there is no specific order in which they should be displayed or addressed. In some cases, a UI might display and allow addressing all issues at once.", "mustSupport": true, "binding": { "strength": "extensible", "valueSet": "https://bpcs.exchange/fhir/ValueSet/vs-ClaimResponse" }, "mapping": [ { "identity": "BPCS", "map": "AssessContext.responseCodes, AssessmentFlag.(various EFlags)" } ] }, { "id": "ClaimResponse.item.reviewOutcome.reason.extension:allowedModifier", "path": "ClaimResponse.item.reviewOutcome.reason.extension", "sliceName": "allowedModifier", "comment": "Indicates modifier codes permitted to override for this response code (if any).", "type": [ { "code": "Extension", "profile": [ "https://bpcs.exchange/fhir/StructureDefinition/ext-ClaimResponse-AllowedModifier" ] } ], "mustSupport": true }, { "id": "ClaimResponse.item.reviewOutcome.reason.extension:allowedModifier.value[x]", "path": "ClaimResponse.item.reviewOutcome.reason.extension.value[x]" }, { "id": "ClaimResponse.item.reviewOutcome.reason.extension:allowedModifier.value[x].extension:default", "path": "ClaimResponse.item.reviewOutcome.reason.extension.value[x].extension", "sliceName": "default", "comment": "May only be present on one modifier within a reason.", "type": [ { "code": "Extension", "profile": [ "https://bpcs.exchange/fhir/StructureDefinition/ext-ClaimResponse-AllowedModifierDefault" ] } ], "mustSupport": true }, { "id": "ClaimResponse.item.reviewOutcome.reason.extension:allowedModifier.value[x].extension:preExistingCondition", "path": "ClaimResponse.item.reviewOutcome.reason.extension.value[x].extension", "sliceName": "preExistingCondition", "comment": "Only allowed where an 'allowed modifier' is a health condition.", "type": [ { "code": "Extension", "profile": [ "https://bpcs.exchange/fhir/StructureDefinition/ext-ClaimResponse-PreExistingCondition" ] } ], "mustSupport": true }, { "id": "ClaimResponse.item.reviewOutcome.reason.extension:duplicate", "path": "ClaimResponse.item.reviewOutcome.reason.extension", "sliceName": "duplicate", "comment": "This will only be present if the reason code is ED and then only if there is not an exact match. If present, the user must identify which of the submitted claims from the pharmacy point of service correspond to the manually submitted receipt. This allows information such as coverage from other payers to be taken into account when adjudicating the paper claim. The selected duplicate will then be conveyed in the 'duplicateVersion' extension when re-adjudicating the receipt.", "type": [ { "code": "Extension", "profile": [ "https://bpcs.exchange/fhir/StructureDefinition/ext-ClaimResponse-DuplicateReceipts" ] } ], "mustSupport": true }, { "id": "ClaimResponse.item.adjudication", "path": "ClaimResponse.item.adjudication", "slicing": { "discriminator": [ { "type": "value", "path": "category" } ], "rules": "open" }, "min": 2, "mustSupport": true }, { "id": "ClaimResponse.item.adjudication:eligible", "path": "ClaimResponse.item.adjudication", "sliceName": "eligible", "short": "Eligible amount", "min": 1, "max": "1", "mustSupport": true }, { "id": "ClaimResponse.item.adjudication:eligible.category", "path": "ClaimResponse.item.adjudication.category", "patternCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "eligible" } ] } }, { "id": "ClaimResponse.item.adjudication:eligible.amount", "path": "ClaimResponse.item.adjudication.amount", "min": 1, "type": [ { "code": "Money", "profile": [ "https://bpcs.exchange/fhir/StructureDefinition/profile-Money-CAD-NonNeg" ] } ], "mustSupport": true, "mapping": [ { "identity": "BPCS", "map": "ReceiptDTO.allowedRxExp" } ] }, { "id": "ClaimResponse.item.adjudication:benefit", "path": "ClaimResponse.item.adjudication", "sliceName": "benefit", "short": "Benefit amount", "min": 1, "max": "1", "mustSupport": true }, { "id": "ClaimResponse.item.adjudication:benefit.category", "path": "ClaimResponse.item.adjudication.category", "patternCodeableConcept": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "benefit" } ] } }, { "id": "ClaimResponse.item.adjudication:benefit.amount", "path": "ClaimResponse.item.adjudication.amount", "min": 1, "type": [ { "code": "Money", "profile": [ "https://bpcs.exchange/fhir/StructureDefinition/profile-Money-CAD-NonNeg" ] } ], "mustSupport": true, "mapping": [ { "identity": "BPCS", "map": "ReceiptDTO.reimbAmt" } ] } ] } }