<status value="active" /> <experimental value="false" /> <description value="The information returned by BPCS in response to a claims submission" /> <fhirVersion value="5.0.0" /> <mapping> <identity value="BPCS" /> <name value="Internal BPCS API" /> </mapping> <kind value="resource" /> <abstract value="true" /> <type value="ClaimResponse" /> <baseDefinition value="http://hl7.org/fhir/StructureDefinition/ClaimResponse" /> <derivation value="constraint" /> <snapshot> <element id="ClaimResponse"> <path value="ClaimResponse" /> <short value="Response to a claim predetermination or preauthorization" /> <definition value="This resource provides the adjudication details from the processing of a Claim resource." /> <alias value="Remittance Advice" /> <min value="0" /> <max value="*" /> <base> <path value="ClaimResponse" /> <min value="0" /> <max value="*" /> </base> <constraint> <key value="dom-2" /> <severity value="error" /> <human value="If the resource is contained in another resource, it SHALL NOT contain nested Resources" /> <expression value="contained.contained.empty()" /> <source value="http://hl7.org/fhir/StructureDefinition/DomainResource" /> </constraint> <constraint> <key value="dom-4" /> <severity value="error" /> <human value="If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated" /> <expression value="contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()" /> <source value="http://hl7.org/fhir/StructureDefinition/DomainResource" /> </constraint> <constraint> <key value="dom-3" /> <severity value="error" /> <human value="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 value="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 value="http://hl7.org/fhir/StructureDefinition/DomainResource" /> </constraint> <constraint> <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bestpractice"> <valueBoolean value="true" /> </extension> <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bestpractice-explanation"> <valueMarkdown value="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." /> </extension> <key value="dom-6" /> <severity value="warning" /> <human value="A resource should have narrative for robust management" /> <expression value="text.`div`.exists()" /> <source value="http://hl7.org/fhir/StructureDefinition/DomainResource" /> </constraint> <constraint> <key value="dom-5" /> <severity value="error" /> <human value="If a resource is contained in another resource, it SHALL NOT have a security label" /> <expression value="contained.meta.security.empty()" /> <source value="http://hl7.org/fhir/StructureDefinition/DomainResource" /> </constraint> <mustSupport value="false" /> <isModifier value="false" /> <mapping> <identity value="rim" /> <map value="n/a" /> </mapping> <mapping> <identity value="rim" /> <map value="Entity. Role, or Act" /> </mapping> <mapping> <identity value="rim" /> <map value="Entity, Role, or Act" /> </mapping> <mapping> <identity value="workflow" /> <map value="Event" /> </mapping> <mapping> <identity value="w5" /> <map value="financial.billing" /> </mapping> </element> <element id="ClaimResponse.id"> <path value="ClaimResponse.id" /> <short value="Logical id of this artifact" /> <definition value="The logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes." /> <comment value="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 value="0" /> <max value="1" /> <base> <path value="Resource.id" /> <min value="0" /> <max value="1" /> </base> <type> <extension url="http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type"> <valueUrl value="id" /> </extension> <code value="http://hl7.org/fhirpath/System.String" /> </type> <mustSupport value="false" /> <isModifier value="false" /> <isSummary value="true" /> </element> <element id="ClaimResponse.meta"> <path value="ClaimResponse.meta" /> <short value="Metadata about the resource" /> <definition value="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 value="0" /> <max value="1" /> <base> <path value="Resource.meta" /> <min value="0" /> <max value="1" /> </base> <type> <code value="Meta" /> </type> <constraint> <key value="ele-1" /> <severity value="error" /> <human value="All FHIR elements must have a @value or children" /> <expression value="hasValue() or (children().count() > id.count())" /> <source value="http://hl7.org/fhir/StructureDefinition/Element" /> </constraint> <mustSupport value="false" /> <isModifier value="false" /> <isSummary value="true" /> <mapping> <identity value="rim" /> <map value="n/a" /> </mapping> <mapping> <identity value="rim" /> <map value="N/A" /> </mapping> </element> <element id="ClaimResponse.implicitRules"> <path value="ClaimResponse.implicitRules" /> <short value="A set of rules under which this content was created" /> <definition value="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 value="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 value="0" /> <max value="1" /> <base> <path value="Resource.implicitRules" /> <min value="0" /> <max value="1" /> </base> <type> <code value="uri" /> </type> <constraint> <key value="ele-1" /> <severity value="error" /> <human value="All FHIR elements must have a @value or children" /> <expression value="hasValue() or (children().count() > id.count())" /> <source value="http://hl7.org/fhir/StructureDefinition/Element" /> </constraint> <mustSupport value="false" /> <isModifier value="true" /> <isModifierReason value="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 value="true" /> <mapping> <identity value="rim" /> <map value="n/a" /> </mapping> </element> <element id="ClaimResponse.language"> <path value="ClaimResponse.language" /> <short value="Language of the resource content" /> <definition value="The base language in which the resource is written." /> <comment value="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 value="0" /> <max value="1" /> <base> <path value="Resource.language" /> <min value="0" /> <max value="1" /> </base> <type> <code value="code" /> </type> <constraint> <key value="ele-1" /> <severity value="error" /> <human value="All FHIR elements must have a @value or children" /> <expression value="hasValue() or (children().count() > id.count())" /> <source value="http://hl7.org/fhir/StructureDefinition/Element" /> </constraint> <mustSupport value="false" /> <isModifier value="false" /> <isSummary value="false" /> <binding> <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName"> <valueString value="Language" /> </extension> <strength value="required" /> <description value="IETF language tag for a human language" /> <valueSet value="http://hl7.org/fhir/ValueSet/all-languages|5.0.0" /> <additional> <purpose value="starter" /> <valueSet value="http://hl7.org/fhir/ValueSet/languages" /> </additional> </binding> <mapping> <identity value="rim" /> <map value="n/a" /> </mapping> </element> <element id="ClaimResponse.text"> <path value="ClaimResponse.text" /> <short value="Text summary of the resource, for human interpretation" /> <definition value="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 value="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 value="narrative" /> <alias value="html" /> <alias value="xhtml" /> <alias value="display" /> <min value="0" /> <max value="1" /> <base> <path value="DomainResource.text" /> <min value="0" /> <max value="1" /> </base> <type> <code value="Narrative" /> </type> <condition value="dom-6" /> <constraint> <key value="ele-1" /> <severity value="error" /> <human value="All FHIR elements must have a @value or children" /> <expression value="hasValue() or (children().count() > id.count())" /> <source value="http://hl7.org/fhir/StructureDefinition/Element" /> </constraint> <mustSupport value="false" /> <isModifier value="false" /> <isSummary value="false" /> <mapping> <identity value="rim" /> <map value="n/a" /> </mapping> <mapping> <identity value="rim" /> <map value="N/A" /> </mapping> <mapping> <identity value="rim" /> <map value="Act.text?" /> </mapping> </element> <element id="ClaimResponse.contained"> <path value="ClaimResponse.contained" /> <slicing> <discriminator> <type value="profile" /> <path value="$this" /> </discriminator> <rules value="open" /> </slicing> <short value="Contained, inline Resources" /> <definition value="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 value="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 value="inline resources" /> <alias value="anonymous resources" /> <alias value="contained resources" /> <min value="0" /> <max value="*" /> <base> <path value="DomainResource.contained" /> <min value="0" /> <max value="*" /> </base> <type> <code value="Resource" /> </type> <condition value="dom-2" /> <condition value="dom-4" /> <condition value="dom-3" /> <condition value="dom-5" /> <mustSupport value="false" /> <isModifier value="false" /> <isSummary value="false" /> <mapping> <identity value="rim" /> <map value="n/a" /> </mapping> <mapping> <identity value="rim" /> <map value="Entity. Role, or Act" /> </mapping> <mapping> <identity value="rim" /> <map value="N/A" /> </mapping> </element> <element id="ClaimResponse.contained:duplicates"> <path value="ClaimResponse.contained" /> <sliceName value="duplicates" /> <short value="Explanation of Benefit resource" /> <definition value="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 value="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 value="inline resources" /> <alias value="anonymous resources" /> <alias value="contained resources" /> <alias value="EOB" /> <min value="0" /> <max value="1" /> <base> <path value="DomainResource.contained" /> <min value="0" /> <max value="*" /> </base> <type> <code value="ExplanationOfBenefit" /> <profile value="https://bpcs.exchange/fhir/StructureDefinition/profile-ExplanationOfBenefit-duplicate" /> </type> <condition value="dom-2" /> <condition value="dom-4" /> <condition value="dom-3" /> <condition value="dom-5" /> <constraint> <key value="dom-2" /> <severity value="error" /> <human value="If the resource is contained in another resource, it SHALL NOT contain nested Resources" /> <expression value="contained.contained.empty()" /> <source value="http://hl7.org/fhir/StructureDefinition/DomainResource" /> </constraint> <constraint> <key value="dom-4" /> <severity value="error" /> <human value="If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated" /> <expression value="contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()" /> <source value="http://hl7.org/fhir/StructureDefinition/DomainResource" /> </constraint> <constraint> <key value="dom-3" /> <severity value="error" /> <human value="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 value="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 value="http://hl7.org/fhir/StructureDefinition/DomainResource" /> </constraint> <constraint> <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bestpractice"> <valueBoolean value="true" /> </extension> <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bestpractice-explanation"> <valueMarkdown value="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." /> </extension> <key value="dom-6" /> <severity value="warning" /> <human value="A resource should have narrative for robust management" /> <expression value="text.`div`.exists()" /> <source value="http://hl7.org/fhir/StructureDefinition/DomainResource" /> </constraint> <constraint> <key value="dom-5" /> <severity value="error" /> <human value="If a resource is contained in another resource, it SHALL NOT have a security label" /> <expression value="contained.meta.security.empty()" /> <source value="http://hl7.org/fhir/StructureDefinition/DomainResource" /> </constraint> <mustSupport value="true" /> <isModifier value="false" /> <isSummary value="false" /> <mapping> <identity value="rim" /> <map value="n/a" /> </mapping> <mapping> <identity value="rim" /> <map value="Entity. Role, or Act" /> </mapping> <mapping> <identity value="rim" /> <map value="N/A" /> </mapping> <mapping> <identity value="rim" /> <map value="Entity, Role, or Act" /> </mapping> <mapping> <identity value="workflow" /> <map value="Event" /> </mapping> <mapping> <identity value="w5" /> <map value="financial.other" /> </mapping> </element> <element id="ClaimResponse.contained:dispenses"> <path value="ClaimResponse.contained" /> <sliceName value="dispenses" /> <short value="Dispensing a medication to a named patient" /> <definition value="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 value="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 value="inline resources" /> <alias value="anonymous resources" /> <alias value="contained resources" /> <min value="0" /> <max value="*" /> <base> <path value="DomainResource.contained" /> <min value="0" /> <max value="*" /> </base> <type> <code value="MedicationDispense" /> <profile value="https://bpcs.exchange/fhir/StructureDefinition/profile-MedicationDispense" /> </type> <condition value="dom-2" /> <condition value="dom-4" /> <condition value="dom-3" /> <condition value="dom-5" /> <constraint> <key value="dom-2" /> <severity value="error" /> <human value="If the resource is contained in another resource, it SHALL NOT contain nested Resources" /> <expression value="contained.contained.empty()" /> <source value="http://hl7.org/fhir/StructureDefinition/DomainResource" /> </constraint> <constraint> <key value="dom-4" /> <severity value="error" /> <human value="If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated" /> <expression value="contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()" /> <source value="http://hl7.org/fhir/StructureDefinition/DomainResource" /> </constraint> <constraint> <key value="dom-3" /> <severity value="error" /> <human value="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 value="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 value="http://hl7.org/fhir/StructureDefinition/DomainResource" /> </constraint> <constraint> <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bestpractice"> <valueBoolean value="true" /> </extension> <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bestpractice-explanation"> <valueMarkdown value="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." /> </extension> <key value="dom-6" /> <severity value="warning" /> <human value="A resource should have narrative for robust management" /> <expression value="text.`div`.exists()" /> <source value="http://hl7.org/fhir/StructureDefinition/DomainResource" /> </constraint> <constraint> <key value="dom-5" /> <severity value="error" /> <human value="If a resource is contained in another resource, it SHALL NOT have a security label" /> <expression value="contained.meta.security.empty()" /> <source value="http://hl7.org/fhir/StructureDefinition/DomainResource" /> </constraint> <constraint> <key value="mdd-1" /> <severity value="error" /> <human value="whenHandedOver cannot be before whenPrepared" /> <expression value="whenHandedOver.empty() or whenPrepared.empty() or whenHandedOver >= whenPrepared" /> <source value="http://hl7.org/fhir/StructureDefinition/MedicationDispense" /> </constraint> <mustSupport value="true" /> <isModifier value="false" /> <isSummary value="false" /> <mapping> <identity value="rim" /> <map value="n/a" /> </mapping> <mapping> <identity value="rim" /> <map value="Entity. Role, or Act" /> </mapping> <mapping> <identity value="rim" /> <map value="N/A" /> </mapping> <mapping> <identity value="rim" /> <map value="Entity, Role, or Act" /> </mapping> <mapping> <identity value="workflow" /> <map value="Event" /> </mapping> <mapping> <identity value="w5" /> <map value="clinical.medication" /> </mapping> <mapping> <identity value="rim" /> <map value="Supply[moodCode=EVN]" /> </mapping> </element> <element id="ClaimResponse.extension"> <path value="ClaimResponse.extension" /> <slicing> <discriminator> <type value="value" /> <path value="url" /> </discriminator> <description value="Extensions are always sliced by (at least) url" /> <rules value="open" /> </slicing> <short value="Additional content defined by implementations" /> <definition value="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 value="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 value="extensions" /> <alias value="user content" /> <min value="0" /> <max value="*" /> <base> <path value="DomainResource.extension" /> <min value="0" /> <max value="*" /> </base> <type> <code value="Extension" /> </type> <constraint> <key value="ele-1" /> <severity value="error" /> <human value="All FHIR elements must have a @value or children" /> <expression value="hasValue() or (children().count() > id.count())" /> <source value="http://hl7.org/fhir/StructureDefinition/Element" /> </constraint> <constraint> <key value="ext-1" /> <severity value="error" /> <human value="Must have either extensions or value[x], not both" /> <expression value="extension.exists() != value.exists()" /> <source value="http://hl7.org/fhir/StructureDefinition/Extension" /> </constraint> <mustSupport value="false" /> <isModifier value="false" /> <isSummary value="false" /> <mapping> <identity value="rim" /> <map value="n/a" /> </mapping> <mapping> <identity value="rim" /> <map value="N/A" /> </mapping> </element> <element id="ClaimResponse.modifierExtension"> <path value="ClaimResponse.modifierExtension" /> <slicing> <discriminator> <type value="value" /> <path value="url" /> </discriminator> <description value="Extensions are always sliced by (at least) url" /> <rules value="open" /> </slicing> <short value="Extensions that cannot be ignored" /> <definition value="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. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself)." /> <comment value="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 value="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 value="extensions" /> <alias value="user content" /> <min value="0" /> <max value="*" /> <base> <path value="DomainResource.modifierExtension" /> <min value="0" /> <max value="*" /> </base> <type> <code value="Extension" /> </type> <constraint> <key value="ele-1" /> <severity value="error" /> <human value="All FHIR elements must have a @value or children" /> <expression value="hasValue() or (children().count() > id.count())" /> <source value="http://hl7.org/fhir/StructureDefinition/Element" /> </constraint> <constraint> <key value="ext-1" /> <severity value="error" /> <human value="Must have either extensions or value[x], not both" /> <expression value="extension.exists() != value.exists()" /> <source value="http://hl7.org/fhir/StructureDefinition/Extension" /> </constraint> <mustSupport value="false" /> <isModifier value="true" /> <isModifierReason value="Modifier extensions are expected to modify the meaning or interpretation of the resource that contains them" /> <isSummary value="true" /> <mapping> <identity value="rim" /> <map value="n/a" /> </mapping> <mapping> <identity value="rim" /> <map value="N/A" /> </mapping> </element> <element id="ClaimResponse.identifier"> <path value="ClaimResponse.identifier" /> <short value="Business Identifier for a claim response" /> <definition value="A unique identifier assigned to this claim response." /> <comment value="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 value="Allows claim responses to be distinguished and referenced." /> <min value="0" /> <max value="*" /> <base> <path value="ClaimResponse.identifier" /> <min value="0" /> <max value="*" /> </base> <type> <code value="Identifier" /> </type> <constraint> <key value="ele-1" /> <severity value="error" /> <human value="All FHIR elements must have a @value or children" /> <expression value="hasValue() or (children().count() > id.count())" /> <source value="http://hl7.org/fhir/StructureDefinition/Element" /> </constraint> <constraint> <key value="ident-1" /> <severity value="warning" /> <human value="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="value.exists()" /> <source value="http://hl7.org/fhir/StructureDefinition/Identifier" /> </constraint> <mustSupport value="false" /> <isModifier value="false" /> <isSummary value="false" /> <mapping> <identity value="rim" /> <map value="n/a" /> </mapping> <mapping> <identity value="v2" /> <map value="CX / EI (occasionally, more often EI maps to a resource id or a URL)" /> </mapping> <mapping> <identity value="rim" /> <map value="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]" /> </mapping> <mapping> <identity value="servd" /> <map value="Identifier" /> </mapping> <mapping> <identity value="workflow" /> <map value="Event.identifier" /> </mapping> <mapping> <identity value="w5" /> <map value="FiveWs.identifier" /> </mapping> </element> <element id="ClaimResponse.traceNumber"> <path value="ClaimResponse.traceNumber" /> <short value="Number for tracking" /> <definition value="Trace number for tracking purposes. May be defined at the jurisdiction level or between trading partners." /> <comment value="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 value="Allows partners to uniquely identify components for tracking." /> <min value="0" /> <max value="*" /> <base> <path value="ClaimResponse.traceNumber" /> <min value="0" /> <max value="*" /> </base> <type> <code value="Identifier" /> </type> <constraint> <key value="ele-1" /> <severity value="error" /> <human value="All FHIR elements must have a @value or children" /> <expression value="hasValue() or (children().count() > id.count())" /> <source value="http://hl7.org/fhir/StructureDefinition/Element" /> </constraint> <constraint> <key value="ident-1" /> <severity value="warning" /> <human value="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="value.exists()" /> <source value="http://hl7.org/fhir/StructureDefinition/Identifier" /> </constraint> <mustSupport value="false" /> <isModifier value="false" /> <isSummary value="false" /> <mapping> <identity value="rim" /> <map value="n/a" /> </mapping> <mapping> <identity value="v2" /> <map value="CX / EI (occasionally, more often EI maps to a resource id or a URL)" /> </mapping> <mapping> <identity value="rim" /> <map value="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]" /> </mapping> <mapping> <identity value="servd" /> <map value="Identifier" /> </mapping> </element> <element id="ClaimResponse.status"> <path value="ClaimResponse.status" /> <short value="draft | active" /> <definition value="The status of the resource instance." /> <comment value="This element is labeled as a modifier because the status contains codes that mark the resource as not currently valid." /> <requirements value="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 value="1" /> <max value="1" /> <base> <path value="ClaimResponse.status" /> <min value="1" /> <max value="1" /> </base> <type> <code value="code" /> </type> <constraint> <key value="ele-1" /> <severity value="error" /> <human value="All FHIR elements must have a @value or children" /> <expression value="hasValue() or (children().count() > id.count())" /> <source value="http://hl7.org/fhir/StructureDefinition/Element" /> </constraint> <mustSupport value="true" /> <isModifier value="true" /> <isModifierReason value="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 value="true" /> <binding> <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName"> <valueString value="ClaimResponseStatus" /> </extension> <strength value="required" /> <description value="A code specifying the state of the resource instance." /> <valueSet value="https://bpcs.exchange/fhir/ValueSet/vs-FinancialStatus" /> </binding> <mapping> <identity value="rim" /> <map value="n/a" /> </mapping> <mapping> <identity value="workflow" /> <map value="Event.status" /> </mapping> <mapping> <identity value="w5" /> <map value="FiveWs.status" /> </mapping> <mapping> <identity value="BPCS" /> <map value="BatchRecordDTO.batchStatus" /> </mapping> </element> <element id="ClaimResponse.type"> <path value="ClaimResponse.type" /> <short value="More granular claim type" /> <definition value="A finer grained suite of claim type codes which may convey additional information such as Inpatient vs Outpatient and/or a specialty service." /> <comment value="This may contain the local bill type codes, for example the US UB-04 bill type code or the CMS bill type." /> <requirements value="Some jurisdictions need a finer grained claim type for routing and adjudication." /> <min value="1" /> <max value="1" /> <base> <path value="ClaimResponse.type" /> <min value="1" /> <max value="1" /> </base> <type> <code value="CodeableConcept" /> </type> <patternCodeableConcept> <coding> <system value="http://terminology.hl7.org/CodeSystem/claim-type" /> <code value="pharmacy" /> </coding> </patternCodeableConcept> <constraint> <key value="ele-1" /> <severity value="error" /> <human value="All FHIR elements must have a @value or children" /> <expression value="hasValue() or (children().count() > id.count())" /> <source value="http://hl7.org/fhir/StructureDefinition/Element" /> </constraint> <mustSupport value="false" /> <isModifier value="false" /> <isSummary value="true" /> <binding> <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName"> <valueString value="ClaimType" /> </extension> <strength value="extensible" /> <description value="The type or discipline-style of the claim." /> <valueSet value="http://hl7.org/fhir/ValueSet/claim-type" /> </binding> <mapping> <identity value="rim" /> <map value="n/a" /> </mapping> <mapping> <identity value="v2" /> <map value="CE/CNE/CWE" /> </mapping> <mapping> <identity value="rim" /> <map value="CD" /> </mapping> <mapping> <identity value="orim" /> <map value="fhir:CodeableConcept rdfs:subClassOf dt:CD" /> </mapping> <mapping> <identity value="w5" /> <map value="FiveWs.class" /> </mapping> </element> <element id="ClaimResponse.subType"> <path value="ClaimResponse.subType" /> <short value="More granular claim type" /> <definition value="A finer grained suite of claim type codes which may convey additional information such as Inpatient vs Outpatient and/or a specialty service." /> <comment value="This may contain the local bill type codes, for example the US UB-04 bill type code or the CMS bill type." /> <requirements value="Some jurisdictions need a finer grained claim type for routing and adjudication." /> <min value="0" /> <max value="1" /> <base> <path value="ClaimResponse.subType" /> <min value="0" /> <max value="1" /> </base> <type> <code value="CodeableConcept" /> </type> <constraint> <key value="ele-1" /> <severity value="error" /> <human value="All FHIR elements must have a @value or children" /> <expression value="hasValue() or (children().count() > id.count())" /> <source value="http://hl7.org/fhir/StructureDefinition/Element" /> </constraint> <mustSupport value="false" /> <isModifier value="false" /> <isSummary value="false" /> <binding> <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName"> <valueString value="ClaimSubType" /> </extension> <strength value="example" /> <description value="A more granular claim typecode." /> <valueSet value="http://hl7.org/fhir/ValueSet/claim-subtype" /> </binding> <mapping> <identity value="rim" /> <map value="n/a" /> </mapping> <mapping> <identity value="v2" /> <map value="CE/CNE/CWE" /> </mapping> <mapping> <identity value="rim" /> <map value="CD" /> </mapping> <mapping> <identity value="orim" /> <map value="fhir:CodeableConcept rdfs:subClassOf dt:CD" /> </mapping> <mapping> <identity value="w5" /> <map value="FiveWs.class" /> </mapping> </element> <element id="ClaimResponse.use"> <path value="ClaimResponse.use" /> <short value="claim | preauthorization | predetermination" /> <definition value="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 value="Note that FHIR strings SHALL NOT exceed 1,048,576 (1024*1024) characters in size" /> <requirements value="This element is required to understand the nature of the request for adjudication." /> <min value="1" /> <max value="1" /> <base> <path value="ClaimResponse.use" /> <min value="1" /> <max value="1" /> </base> <type> <code value="code" /> </type> <patternCode value="claim" /> <constraint> <key value="ele-1" /> <severity value="error" /> <human value="All FHIR elements must have a @value or children" /> <expression value="hasValue() or (children().count() > id.count())" /> <source value="http://hl7.org/fhir/StructureDefinition/Element" /> </constraint> <mustSupport value="false" /> <isModifier value="false" /> <isSummary value="true" /> <binding> <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName"> <valueString value="Use" /> </extension> <strength value="required" /> <description value="Claim, preauthorization, predetermination." /> <valueSet value="http://hl7.org/fhir/ValueSet/claim-use|5.0.0" /> </binding> <mapping> <identity value="rim" /> <map value="n/a" /> </mapping> <mapping> <identity value="w5" /> <map value="FiveWs.class" /> </mapping> </element> <element id="ClaimResponse.patient"> <path value="ClaimResponse.patient" /> <short value="A reference from one resource to another" /> <definition value="A reference from one resource to another." /> <comment value="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 value="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 value="1" /> <max value="1" /> <base> <path value="ClaimResponse.patient" /> <min value="1" /> <max value="1" /> </base> <type> <code value="Reference" /> <profile value="https://bpcs.exchange/fhir/StructureDefinition/profile-Reference-group-or-patient" /> <targetProfile value="https://bpcs.exchange/fhir/StructureDefinition/profile-Patient-create" /> </type> <constraint> <key value="ele-1" /> <severity value="error" /> <human value="All FHIR elements must have a @value or children" /> <expression value="hasValue() or (children().count() > id.count())" /> <source value="http://hl7.org/fhir/StructureDefinition/Element" /> </constraint> <constraint> <key value="ref-1" /> <severity value="error" /> <human value="SHALL have a contained resource if a local reference is provided" /> <expression value="reference.exists() implies (reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids')) or (reference='#' and %rootResource!=%resource))" /> <source value="http://hl7.org/fhir/StructureDefinition/Reference" /> </constraint> <constraint> <key value="ref-2" /> <severity value="error" /> <human value="At least one of reference, identifier and display SHALL be present (unless an extension is provided)." /> <expression value="reference.exists() or identifier.exists() or display.exists() or extension.exists()" /> <source value="http://hl7.org/fhir/StructureDefinition/Reference" /> </constraint> <constraint> <key value="bpcs-reference-1" /> <severity value="error" /> <human value="Must have either a reference or a subject extension, but not both" /> <expression value="reference.exists() != extension('https://bpcs.exchange/fhir/StructureDefinition/ext-Resource-Subject').exists()" /> <source value="https://bpcs.exchange/fhir/StructureDefinition/profile-Reference-group-or-patient" /> </constraint> <constraint> <key value="bpcs-reference-2" /> <severity value="error" /> <human value="If reference is not present, must have display" /> <expression value="reference.exists().not() implies display.exists()" /> <source value="https://bpcs.exchange/fhir/StructureDefinition/profile-Reference-group-or-patient" /> </constraint> <mustSupport value="true" /> <isModifier value="false" /> <isSummary value="true" /> <mapping> <identity value="rim" /> <map value="n/a" /> </mapping> <mapping> <identity value="rim" /> <map value="The target of a resource reference is a RIM entry point (Act, Role, or Entity)" /> </mapping> <mapping> <identity value="w5" /> <map value="FiveWs.subject[x]" /> </mapping> </element> <element id="ClaimResponse.created"> <path value="ClaimResponse.created" /> <short value="Response creation date" /> <definition value="The date this resource was created." /> <comment value="This is the 'current' date when the ClaimResponse is produced" /> <requirements value="Need to record a timestamp for use by both the recipient and the issuer." /> <min value="1" /> <max value="1" /> <base> <path value="ClaimResponse.created" /> <min value="1" /> <max value="1" /> </base> <type> <code value="dateTime" /> </type> <constraint> <key value="ele-1" /> <severity value="error" /> <human value="All FHIR elements must have a @value or children" /> <expression value="hasValue() or (children().count() > id.count())" /> <source value="http://hl7.org/fhir/StructureDefinition/Element" /> </constraint> <mustSupport value="true" /> <isModifier value="false" /> <isSummary value="true" /> <mapping> <identity value="rim" /> <map value="n/a" /> </mapping> <mapping> <identity value="workflow" /> <map value="Event.occurrence[x]" /> </mapping> <mapping> <identity value="w5" /> <map value="FiveWs.recorded" /> </mapping> </element> <element id="ClaimResponse.insurer"> <path value="ClaimResponse.insurer" /> <short value="Party responsible for reimbursement" /> <definition value="The party responsible for authorization, adjudication and reimbursement." /> <comment value="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 value="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 value="0" /> <max value="1" /> <base> <path value="ClaimResponse.insurer" /> <min value="0" /> <max value="1" /> </base> <type> <code value="Reference" /> <targetProfile value="http://hl7.org/fhir/StructureDefinition/Organization" /> </type> <patternReference> <reference value="Organization/bpcs" /> </patternReference> <constraint> <key value="ele-1" /> <severity value="error" /> <human value="All FHIR elements must have a @value or children" /> <expression value="hasValue() or (children().count() > id.count())" /> <source value="http://hl7.org/fhir/StructureDefinition/Element" /> </constraint> <constraint> <key value="ref-1" /> <severity value="error" /> <human value="SHALL have a contained resource if a local reference is provided" /> <expression value="reference.exists() implies (reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids')) or (reference='#' and %rootResource!=%resource))" /> <source value="http://hl7.org/fhir/StructureDefinition/Reference" /> </constraint> <constraint> <key value="ref-2" /> <severity value="error" /> <human value="At least one of reference, identifier and display SHALL be present (unless an extension is provided)." /> <expression value="reference.exists() or identifier.exists() or display.exists() or extension.exists()" /> <source value="http://hl7.org/fhir/StructureDefinition/Reference" /> </constraint> <mustSupport value="false" /> <isModifier value="false" /> <isSummary value="true" /> <mapping> <identity value="rim" /> <map value="n/a" /> </mapping> <mapping> <identity value="rim" /> <map value="The target of a resource reference is a RIM entry point (Act, Role, or Entity)" /> </mapping> <mapping> <identity value="workflow" /> <map value="Event.performer" /> </mapping> </element> <element id="ClaimResponse.requestor"> <path value="ClaimResponse.requestor" /> <short value="Party responsible for the claim" /> <definition value="The provider which is responsible for the claim, predetermination or preauthorization." /> <comment value="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 value="0" /> <max value="1" /> <base> <path value="ClaimResponse.requestor" /> <min value="0" /> <max value="1" /> </base> <type> <code value="Reference" /> <targetProfile value="http://hl7.org/fhir/StructureDefinition/Practitioner" /> <targetProfile value="http://hl7.org/fhir/StructureDefinition/PractitionerRole" /> <targetProfile value="http://hl7.org/fhir/StructureDefinition/Organization" /> </type> <constraint> <key value="ele-1" /> <severity value="error" /> <human value="All FHIR elements must have a @value or children" /> <expression value="hasValue() or (children().count() > id.count())" /> <source value="http://hl7.org/fhir/StructureDefinition/Element" /> </constraint> <constraint> <key value="ref-1" /> <severity value="error" /> <human value="SHALL have a contained resource if a local reference is provided" /> <expression value="reference.exists() implies (reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids')) or (reference='#' and %rootResource!=%resource))" /> <source value="http://hl7.org/fhir/StructureDefinition/Reference" /> </constraint> <constraint> <key value="ref-2" /> <severity value="error" /> <human value="At least one of reference, identifier and display SHALL be present (unless an extension is provided)." /> <expression value="reference.exists() or identifier.exists() or display.exists() or extension.exists()" /> <source value="http://hl7.org/fhir/StructureDefinition/Reference" /> </constraint> <mustSupport value="false" /> <isModifier value="false" /> <isSummary value="false" /> <mapping> <identity value="rim" /> <map value="n/a" /> </mapping> <mapping> <identity value="rim" /> <map value="The target of a resource reference is a RIM entry point (Act, Role, or Entity)" /> </mapping> <mapping> <identity value="w5" /> <map value="FiveWs.source" /> </mapping> </element> <element id="ClaimResponse.request"> <path value="ClaimResponse.request" /> <short value="A reference from one resource to another" /> <definition value="A reference from one resource to another." /> <comment value="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. This will only be present if the submitted Claim has an id (because the Claim has previously been held)" /> <min value="0" /> <max value="1" /> <base> <path value="ClaimResponse.request" /> <min value="0" /> <max value="1" /> </base> <type> <code value="Reference" /> <profile value="https://bpcs.exchange/fhir/StructureDefinition/profile-Reference-rest" /> <targetProfile value="https://bpcs.exchange/fhir/StructureDefinition/profile-Claim-create" /> </type> <constraint> <key value="ele-1" /> <severity value="error" /> <human value="All FHIR elements must have a @value or children" /> <expression value="hasValue() or (children().count() > id.count())" /> <source value="http://hl7.org/fhir/StructureDefinition/Element" /> </constraint> <constraint> <key value="ref-1" /> <severity value="error" /> <human value="SHALL have a contained resource if a local reference is provided" /> <expression value="reference.exists() implies (reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids')) or (reference='#' and %rootResource!=%resource))" /> <source value="http://hl7.org/fhir/StructureDefinition/Reference" /> </constraint> <constraint> <key value="ref-2" /> <severity value="error" /> <human value="At least one of reference, identifier and display SHALL be present (unless an extension is provided)." /> <expression value="reference.exists() or identifier.exists() or display.exists() or extension.exists()" /> <source value="http://hl7.org/fhir/StructureDefinition/Reference" /> </constraint> <mustSupport value="true" /> <isModifier value="false" /> <isSummary value="true" /> <mapping> <identity value="rim" /> <map value="n/a" /> </mapping> <mapping> <identity value="rim" /> <map value="The target of a resource reference is a RIM entry point (Act, Role, or Entity)" /> </mapping> <mapping> <identity value="workflow" /> <map value="Event.basedOn" /> </mapping> <mapping> <identity value="w5" /> <map value="FiveWs.why[x]" /> </mapping> <mapping> <identity value="BPCS" /> <map value="BatchRecordDTO.dateReceived (second-last component of id), BatchRecordDTO.batchSeqNum (last component of id)" /> </mapping> </element> <element id="ClaimResponse.outcome"> <path value="ClaimResponse.outcome" /> <short value="queued | complete | error | partial" /> <definition value="The outcome of the claim, predetermination, or preauthorization processing." /> <comment value="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 value="To advise the requestor of an overall processing outcome." /> <min value="1" /> <max value="1" /> <base> <path value="ClaimResponse.outcome" /> <min value="1" /> <max value="1" /> </base> <type> <code value="code" /> </type> <constraint> <key value="ele-1" /> <severity value="error" /> <human value="All FHIR elements must have a @value or children" /> <expression value="hasValue() or (children().count() > id.count())" /> <source value="http://hl7.org/fhir/StructureDefinition/Element" /> </constraint> <mustSupport value="true" /> <isModifier value="false" /> <isSummary value="true" /> <binding> <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName"> <valueString value="RemittanceOutcome" /> </extension> <strength value="required" /> <description value="The result of the claim processing." /> <valueSet value="http://hl7.org/fhir/ValueSet/claim-outcome|5.0.0" /> </binding> <mapping> <identity value="rim" /> <map value="n/a" /> </mapping> </element> <element id="ClaimResponse.decision"> <path value="ClaimResponse.decision" /> <short value="Result of the adjudication" /> <definition value="The result of the claim, predetermination, or preauthorization adjudication." /> <comment value="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 value="To advise the requestor of the result of the adjudication process." /> <min value="0" /> <max value="1" /> <base> <path value="ClaimResponse.decision" /> <min value="0" /> <max value="1" /> </base> <type> <code value="CodeableConcept" /> </type> <constraint> <key value="ele-1" /> <severity value="error" /> <human value="All FHIR elements must have a @value or children" /> <expression value="hasValue() or (children().count() > id.count())" /> <source value="http://hl7.org/fhir/StructureDefinition/Element" /> </constraint> <mustSupport value="false" /> <isModifier value="false" /> <isSummary value="true" /> <binding> <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName"> <valueString value="AdjudicationDecision" /> </extension> <strength value="example" /> <description value="The overall result of the claim adjudication." /> <valueSet value="http://hl7.org/fhir/ValueSet/claim-decision" /> </binding> <mapping> <identity value="rim" /> <map value="n/a" /> </mapping> <mapping> <identity value="v2" /> <map value="CE/CNE/CWE" /> </mapping> <mapping> <identity value="rim" /> <map value="CD" /> </mapping> <mapping> <identity value="orim" /> <map value="fhir:CodeableConcept rdfs:subClassOf dt:CD" /> </mapping> </element> <element id="ClaimResponse.disposition"> <path value="ClaimResponse.disposition" /> <short value="Disposition Message" /> <definition value="A human readable description of the status of the adjudication." /> <comment value="Note that FHIR strings SHALL NOT exceed 1,048,576 (1024*1024) characters in size" /> <requirements value="Provided for user display." /> <min value="0" /> <max value="1" /> <base> <path value="ClaimResponse.disposition" /> <min value="0" /> <max value="1" /> </base> <type> <code value="string" /> </type> <constraint> <key value="ele-1" /> <severity value="error" /> <human value="All FHIR elements must have a @value or children" /> <expression value="hasValue() or (children().count() > id.count())" /> <source value="http://hl7.org/fhir/StructureDefinition/Element" /> </constraint> <mustSupport value="false" /> <isModifier value="false" /> <isSummary value="false" /> <mapping> <identity value="rim" /> <map value="n/a" /> </mapping> <mapping> <identity value="workflow" /> <map value="Event.note" /> </mapping> </element> <element id="ClaimResponse.preAuthRef"> <path value="ClaimResponse.preAuthRef" /> <short value="Preauthorization reference" /> <definition value="Reference from the Insurer which is used in later communications which refers to this adjudication." /> <comment value="This value is only present on preauthorization adjudications." /> <requirements value="On subsequent claims, the insurer may require the provider to quote this value." /> <min value="0" /> <max value="1" /> <base> <path value="ClaimResponse.preAuthRef" /> <min value="0" /> <max value="1" /> </base> <type> <code value="string" /> </type> <constraint> <key value="ele-1" /> <severity value="error" /> <human value="All FHIR elements must have a @value or children" /> <expression value="hasValue() or (children().count() > id.count())" /> <source value="http://hl7.org/fhir/StructureDefinition/Element" /> </constraint> <mustSupport value="false" /> <isModifier value="false" /> <isSummary value="false" /> <mapping> <identity value="rim" /> <map value="n/a" /> </mapping> </element> <element id="ClaimResponse.preAuthPeriod"> <path value="ClaimResponse.preAuthPeriod" /> <short value="Preauthorization reference effective period" /> <definition value="The time frame during which this authorization is effective." /> <comment value="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"). Period is not used for a duration (a measure of elapsed time). See [Duration](datatypes.html#Duration)." /> <requirements value="To convey to the provider when the authorized products and services must be supplied for the authorized adjudication to apply." /> <min value="0" /> <max value="1" /> <base> <path value="ClaimResponse.preAuthPeriod" /> <min value="0" /> <max value="1" /> </base> <type> <code value="Period" /> </type> <constraint> <key value="ele-1" /> <severity value="error" /> <human value="All FHIR elements must have a @value or children" /> <expression value="hasValue() or (children().count() > id.count())" /> <source value="http://hl7.org/fhir/StructureDefinition/Element" /> </constraint> <constraint> <key value="per-1" /> <severity value="error" /> <human value="If present, start SHALL have a lower or equal value than end" /> <expression value="start.hasValue().not() or end.hasValue().not() or (start.lowBoundary() <= end.highBoundary())" /> <source value="http://hl7.org/fhir/StructureDefinition/Period" /> </constraint> <mustSupport value="false" /> <isModifier value="false" /> <isSummary value="false" /> <mapping> <identity value="rim" /> <map value="n/a" /> </mapping> <mapping> <identity value="v2" /> <map value="DR" /> </mapping> <mapping> <identity value="rim" /> <map value="IVL<TS>[lowClosed="true" and highClosed="true"] or URG<TS>[lowClosed="true" and highClosed="true"]" /> </mapping> </element> <element id="ClaimResponse.event"> <path value="ClaimResponse.event" /> <short value="Event information" /> <definition value="Information code for an event with a corresponding date or period." /> <min value="0" /> <max value="*" /> <base> <path value="ClaimResponse.event" /> <min value="0" /> <max value="*" /> </base> <type> <code value="BackboneElement" /> </type> <constraint> <key value="ele-1" /> <severity value="error" /> <human value="All FHIR elements must have a @value or children" /> <expression value="hasValue() or (children().count() > id.count())" /> <source value="http://hl7.org/fhir/StructureDefinition/Element" /> </constraint> <mustSupport value="false" /> <isModifier value="false" /> <isSummary value="false" /> <mapping> <identity value="rim" /> <map value="n/a" /> </mapping> </element> <element id="ClaimResponse.event.id"> <path value="ClaimResponse.event.id" /> <representation value="xmlAttr" /> <short value="Unique id for inter-element referencing" /> <definition value="Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces." /> <min value="0" /> <max value="1" /> <base> <path value="Element.id" /> <min value="0" /> <max value="1" /> </base> <type> <extension url="http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type"> <valueUrl value="string" /> </extension> <code value="http://hl7.org/fhirpath/System.String" /> </type> <condition value="ele-1" /> <mapping> <identity value="rim" /> <map value="n/a" /> </mapping> </element> <element id="ClaimResponse.event.extension"> <path value="ClaimResponse.event.extension" /> <slicing> <discriminator> <type value="value" /> <path value="url" /> </discriminator> <description value="Extensions are always sliced by (at least) url" /> <rules value="open" /> </slicing> <short value="Additional content defined by implementations" /> <definition value="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 value="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 value="extensions" /> <alias value="user content" /> <min value="0" /> <max value="*" /> <base> <path value="Element.extension" /> <min value="0" /> <max value="*" /> </base> <type> <code value="Extension" /> </type> <constraint> <key value="ele-1" /> <severity value="error" /> <human value="All FHIR elements must have a @value or children" /> <expression value="hasValue() or (children().count() > id.count())" /> <source value="http://hl7.org/fhir/StructureDefinition/Element" /> </constraint> <constraint> <key value="ext-1" /> <severity value="error" /> <human value="Must have either extensions or value[x], not both" /> <expression value="extension.exists() != value.exists()" /> <source value="http://hl7.org/fhir/StructureDefinition/Extension" /> </constraint> <mapping> <identity value="rim" /> <map value="n/a" /> </mapping> <mapping> <identity value="rim" /> <map value="N/A" /> </mapping> </element> <element id="ClaimResponse.event.modifierExtension"> <path value="ClaimResponse.event.modifierExtension" /> <short value="Extensions that cannot be ignored even if unrecognized" /> <definition value="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. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself)." /> <comment value="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 value="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 value="extensions" /> <alias value="user content" /> <alias value="modifiers" /> <min value="0" /> <max value="*" /> <base> <path value="BackboneElement.modifierExtension" /> <min value="0" /> <max value="*" /> </base> <type> <code value="Extension" /> </type> <constraint> <key value="ele-1" /> <severity value="error" /> <human value="All FHIR elements must have a @value or children" /> <expression value="hasValue() or (children().count() > id.count())" /> <source value="http://hl7.org/fhir/StructureDefinition/Element" /> </constraint> <constraint> <key value="ext-1" /> <severity value="error" /> <human value="Must have either extensions or value[x], not both" /> <expression value="extension.exists() != value.exists()" /> <source value="http://hl7.org/fhir/StructureDefinition/Extension" /> </constraint> <isModifier value="true" /> <isModifierReason value="Modifier extensions are expected to modify the meaning or interpretation of the element that contains them" /> <isSummary value="true" /> <mapping> <identity value="rim" /> <map value="n/a" /> </mapping> <mapping> <identity value="rim" /> <map value="N/A" /> </mapping> </element> <element id="ClaimResponse.event.type"> <path value="ClaimResponse.event.type" /> <short value="Specific event" /> <definition value="A coded event such as when a service is expected or a card printed." /> <comment value="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 value="1" /> <max value="1" /> <base> <path value="ClaimResponse.event.type" /> <min value="1" /> <max value="1" /> </base> <type> <code value="CodeableConcept" /> </type> <constraint> <key value="ele-1" /> <severity value="error" /> <human value="All FHIR elements must have a @value or children" /> <expression value="hasValue() or (children().count() > id.count())" /> <source value="http://hl7.org/fhir/StructureDefinition/Element" /> </constraint> <mustSupport value="false" /> <isModifier value="false" /> <isSummary value="false" /> <binding> <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName"> <valueString value="DatesType" /> </extension> <strength value="example" /> <valueSet value="http://hl7.org/fhir/ValueSet/datestype" /> </binding> <mapping> <identity value="rim" /> <map value="n/a" /> </mapping> <mapping> <identity value="v2" /> <map value="CE/CNE/CWE" /> </mapping> <mapping> <identity value="rim" /> <map value="CD" /> </mapping> <mapping> <identity value="orim" /> <map value="fhir:CodeableConcept rdfs:subClassOf dt:CD" /> </mapping> </element> <element id="ClaimResponse.event.when[x]"> <path value="ClaimResponse.event.when[x]" /> <short value="Occurance date or period" /> <definition value="A date or period in the past or future indicating when the event occurred or is expectd to occur." /> <min value="1" /> <max value="1" /> <base> <path value="ClaimResponse.event.when[x]" /> <min value="1" /> <max value="1" /> </base> <type> <code value="dateTime" /> </type> <type> <code value="Period" /> </type> <constraint> <key value="ele-1" /> <severity value="error" /> <human value="All FHIR elements must have a @value or children" /> <expression value="hasValue() or (children().count() > id.count())" /> <source value="http://hl7.org/fhir/StructureDefinition/Element" /> </constraint> <mustSupport value="false" /> <isModifier value="false" /> <isSummary value="false" /> <mapping> <identity value="rim" /> <map value="n/a" /> </mapping> </element> <element id="ClaimResponse.payeeType"> <path value="ClaimResponse.payeeType" /> <short value="Party to be paid any benefits payable" /> <definition value="Type of Party to be reimbursed: subscriber, provider, other." /> <comment value="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 value="Need to know who should receive payment with the most common situations being the Provider (assignment of benefits) or the Subscriber." /> <min value="0" /> <max value="1" /> <base> <path value="ClaimResponse.payeeType" /> <min value="0" /> <max value="1" /> </base> <type> <code value="CodeableConcept" /> </type> <constraint> <key value="ele-1" /> <severity value="error" /> <human value="All FHIR elements must have a @value or children" /> <expression value="hasValue() or (children().count() > id.count())" /> <source value="http://hl7.org/fhir/StructureDefinition/Element" /> </constraint> <mustSupport value="false" /> <isModifier value="false" /> <isSummary value="false" /> <binding> <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName"> <valueString value="PayeeType" /> </extension> <strength value="example" /> <description value="A code for the party to be reimbursed." /> <valueSet value="http://hl7.org/fhir/ValueSet/payeetype" /> </binding> <mapping> <identity value="rim" /> <map value="n/a" /> </mapping> <mapping> <identity value="v2" /> <map value="CE/CNE/CWE" /> </mapping> <mapping> <identity value="rim" /> <map value="CD" /> </mapping> <mapping> <identity value="orim" /> <map value="fhir:CodeableConcept rdfs:subClassOf dt:CD" /> </mapping> </element> <element id="ClaimResponse.encounter"> <path value="ClaimResponse.encounter" /> <short value="Encounters associated with the listed treatments" /> <definition value="Healthcare encounters related to this claim." /> <comment value="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 value="Used in some jurisdictions to link clinical events to claim items." /> <min value="0" /> <max value="*" /> <base> <path value="ClaimResponse.encounter" /> <min value="0" /> <max value="*" /> </base> <type> <code value="Reference" /> <targetProfile value="http://hl7.org/fhir/StructureDefinition/Encounter" /> </type> <constraint> <key value="ele-1" /> <severity value="error" /> <human value="All FHIR elements must have a @value or children" /> <expression value="hasValue() or (children().count() > id.count())" /> <source value="http://hl7.org/fhir/StructureDefinition/Element" /> </constraint> <constraint> <key value="ref-1" /> <severity value="error" /> <human value="SHALL have a contained resource if a local reference is provided" /> <expression value="reference.exists() implies (reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids')) or (reference='#' and %rootResource!=%resource))" /> <source value="http://hl7.org/fhir/StructureDefinition/Reference" /> </constraint> <constraint> <key value="ref-2" /> <severity value="error" /> <human value="At least one of reference, identifier and display SHALL be present (unless an extension is provided)." /> <expression value="reference.exists() or identifier.exists() or display.exists() or extension.exists()" /> <source value="http://hl7.org/fhir/StructureDefinition/Reference" /> </constraint> <mustSupport value="false" /> <isModifier value="false" /> <isSummary value="false" /> <mapping> <identity value="rim" /> <map value="n/a" /> </mapping> <mapping> <identity value="rim" /> <map value="The target of a resource reference is a RIM entry point (Act, Role, or Entity)" /> </mapping> </element> <element id="ClaimResponse.diagnosisRelatedGroup"> <path value="ClaimResponse.diagnosisRelatedGroup" /> <short value="Package billing code" /> <definition value="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 value="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 value="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 value="0" /> <max value="1" /> <base> <path value="ClaimResponse.diagnosisRelatedGroup" /> <min value="0" /> <max value="1" /> </base> <type> <code value="CodeableConcept" /> </type> <constraint> <key value="ele-1" /> <severity value="error" /> <human value="All FHIR elements must have a @value or children" /> <expression value="hasValue() or (children().count() > id.count())" /> <source value="http://hl7.org/fhir/StructureDefinition/Element" /> </constraint> <mustSupport value="false" /> <isModifier value="false" /> <isSummary value="false" /> <binding> <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName"> <valueString value="DiagnosisRelatedGroup" /> </extension> <strength value="example" /> <valueSet value="http://hl7.org/fhir/ValueSet/ex-diagnosisrelatedgroup" /> </binding> <mapping> <identity value="rim" /> <map value="n/a" /> </mapping> <mapping> <identity value="v2" /> <map value="CE/CNE/CWE" /> </mapping> <mapping> <identity value="rim" /> <map value="CD" /> </mapping> <mapping> <identity value="orim" /> <map value="fhir:CodeableConcept rdfs:subClassOf dt:CD" /> </mapping> </element> <element id="ClaimResponse.item"> <extension url="http://hl7.org/fhir/StructureDefinition/structuredefinition-explicit-type-name"> <valueString value="Item" /> </extension> <path value="ClaimResponse.item" /> <short value="Adjudication for claim line items" /> <definition value="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 value="There will be a ClaimResponse.item for each item in the associated claim submission" /> <requirements value="The adjudication for items provided on the claim." /> <min value="1" /> <max value="*" /> <base> <path value="ClaimResponse.item" /> <min value="0" /> <max value="*" /> </base> <type> <code value="BackboneElement" /> </type> <constraint> <key value="ele-1" /> <severity value="error" /> <human value="All FHIR elements must have a @value or children" /> <expression value="hasValue() or (children().count() > id.count())" /> <source value="http://hl7.org/fhir/StructureDefinition/Element" /> </constraint> <mustSupport value="true" /> <isModifier value="false" /> <isSummary value="false" /> <mapping> <identity value="rim" /> <map value="n/a" /> </mapping> </element> <element id="ClaimResponse.item.id"> <path value="ClaimResponse.item.id" /> <representation value="xmlAttr" /> <short value="Unique id for inter-element referencing" /> <definition value="Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces." /> <min value="0" /> <max value="1" /> <base> <path value="Element.id" /> <min value="0" /> <max value="1" /> </base> <type> <extension url="http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type"> <valueUrl value="string" /> </extension> <code value="http://hl7.org/fhirpath/System.String" /> </type> <condition value="ele-1" /> <mapping> <identity value="rim" /> <map value="n/a" /> </mapping> </element> <element id="ClaimResponse.item.extension"> <path value="ClaimResponse.item.extension" /> <slicing> <discriminator> <type value="value" /> <path value="url" /> </discriminator> <description value="Extensions are always sliced by (at least) url" /> <rules value="open" /> </slicing> <short value="Additional content defined by implementations" /> <definition value="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 value="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 value="extensions" /> <alias value="user content" /> <min value="1" /> <max value="*" /> <base> <path value="Element.extension" /> <min value="0" /> <max value="*" /> </base> <type> <code value="Extension" /> </type> <constraint> <key value="ele-1" /> <severity value="error" /> <human value="All FHIR elements must have a @value or children" /> <expression value="hasValue() or (children().count() > id.count())" /> <source value="http://hl7.org/fhir/StructureDefinition/Element" /> </constraint> <constraint> <key value="ext-1" /> <severity value="error" /> <human value="Must have either extensions or value[x], not both" /> <expression value="extension.exists() != value.exists()" /> <source value="http://hl7.org/fhir/StructureDefinition/Extension" /> </constraint> <mustSupport value="true" /> <mapping> <identity value="rim" /> <map value="n/a" /> </mapping> <mapping> <identity value="rim" /> <map value="N/A" /> </mapping> </element> <element id="ClaimResponse.item.extension:receiptPlan"> <path value="ClaimResponse.item.extension" /> <sliceName value="receiptPlan" /> <short value="Insurance Plan" /> <definition value="The insurance plan under which the receipt was adjudicated" /> <comment value="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 value="extensions" /> <alias value="user content" /> <min value="1" /> <max value="1" /> <base> <path value="Element.extension" /> <min value="0" /> <max value="*" /> </base> <type> <code value="Extension" /> <profile value="https://bpcs.exchange/fhir/StructureDefinition/ext-Resource-ReceiptPlan" /> </type> <constraint> <key value="ele-1" /> <severity value="error" /> <human value="All FHIR elements must have a @value or children" /> <expression value="hasValue() or (children().count() > id.count())" /> <source value="http://hl7.org/fhir/StructureDefinition/Element" /> </constraint> <constraint> <key value="ext-1" /> <severity value="error" /> <human value="Must have either extensions or value[x], not both" /> <expression value="extension.exists() != value.exists()" /> <source value="http://hl7.org/fhir/StructureDefinition/Extension" /> </constraint> <mustSupport value="true" /> <mapping> <identity value="rim" /> <map value="n/a" /> </mapping> <mapping> <identity value="rim" /> <map value="N/A" /> </mapping> </element> <element id="ClaimResponse.item.extension:presetModifier"> <path value="ClaimResponse.item.extension" /> <sliceName value="presetModifier" /> <short value="Preset modifier" /> <definition value="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 value="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 value="extensions" /> <alias value="user content" /> <min value="0" /> <max value="*" /> <base> <path value="Element.extension" /> <min value="0" /> <max value="*" /> </base> <type> <code value="Extension" /> <profile value="https://bpcs.exchange/fhir/StructureDefinition/ext-ClaimResponse-PresetModifier" /> </type> <constraint> <key value="ele-1" /> <severity value="error" /> <human value="All FHIR elements must have a @value or children" /> <expression value="hasValue() or (children().count() > id.count())" /> <source value="http://hl7.org/fhir/StructureDefinition/Element" /> </constraint> <constraint> <key value="ext-1" /> <severity value="error" /> <human value="Must have either extensions or value[x], not both" /> <expression value="extension.exists() != value.exists()" /> <source value="http://hl7.org/fhir/StructureDefinition/Extension" /> </constraint> <mustSupport value="true" /> <mapping> <identity value="rim" /> <map value="n/a" /> </mapping> <mapping> <identity value="rim" /> <map value="N/A" /> </mapping> </element> <element id="ClaimResponse.item.modifierExtension"> <path value="ClaimResponse.item.modifierExtension" /> <short value="Extensions that cannot be ignored even if unrecognized" /> <definition value="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. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself)." /> <comment value="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 value="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 value="extensions" /> <alias value="user content" /> <alias value="modifiers" /> <min value="0" /> <max value="*" /> <base> <path value="BackboneElement.modifierExtension" /> <min value="0" /> <max value="*" /> </base> <type> <code value="Extension" /> </type> <constraint> <key value="ele-1" /> <severity value="error" /> <human value="All FHIR elements must have a @value or children" /> <expression value="hasValue() or (children().count() > id.count())" /> <source value="http://hl7.org/fhir/StructureDefinition/Element" /> </constraint> <constraint> <key value="ext-1" /> <severity value="error" /> <human value="Must have either extensions or value[x], not both" /> <expression value="extension.exists() != value.exists()" /> <source value="http://hl7.org/fhir/StructureDefinition/Extension" /> </constraint> <isModifier value="true" /> <isModifierReason value="Modifier extensions are expected to modify the meaning or interpretation of the element that contains them" /> <isSummary value="true" /> <mapping> <identity value="rim" /> <map value="n/a" /> </mapping> <mapping> <identity value="rim" /> <map value="N/A" /> </mapping> </element> <element id="ClaimResponse.item.itemSequence"> <path value="ClaimResponse.item.itemSequence" /> <short value="Claim item instance identifier" /> <definition value="A number to uniquely reference the claim item entries." /> <comment value="This will match the Claim.item.sequence of the corresponding repetition in the associated Claim submission" /> <requirements value="Necessary to provide a mechanism to link the adjudication result to the submitted claim item." /> <min value="1" /> <max value="1" /> <base> <path value="ClaimResponse.item.itemSequence" /> <min value="1" /> <max value="1" /> </base> <type> <code value="positiveInt" /> </type> <constraint> <key value="ele-1" /> <severity value="error" /> <human value="All FHIR elements must have a @value or children" /> <expression value="hasValue() or (children().count() > id.count())" /> <source value="http://hl7.org/fhir/StructureDefinition/Element" /> </constraint> <mustSupport value="true" /> <isModifier value="false" /> <isSummary value="false" /> <mapping> <identity value="rim" /> <map value="n/a" /> </mapping> </element> <element id="ClaimResponse.item.traceNumber"> <path value="ClaimResponse.item.traceNumber" /> <short value="Number for tracking" /> <definition value="Trace number for tracking purposes. May be defined at the jurisdiction level or between trading partners." /> <comment value="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 value="Allows partners to uniquely identify components for tracking." /> <min value="0" /> <max value="*" /> <base> <path value="ClaimResponse.item.traceNumber" /> <min value="0" /> <max value="*" /> </base> <type> <code value="Identifier" /> </type> <constraint> <key value="ele-1" /> <severity value="error" /> <human value="All FHIR elements must have a @value or children" /> <expression value="hasValue() or (children().count() > id.count())" /> <source value="http://hl7.org/fhir/StructureDefinition/Element" /> </constraint> <constraint> <key value="ident-1" /> <severity value="warning" /> <human value="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="value.exists()" /> <source value="http://hl7.org/fhir/StructureDefinition/Identifier" /> </constraint> <mustSupport value="false" /> <isModifier value="false" /> <isSummary value="false" /> <mapping> <identity value="rim" /> <map value="n/a" /> </mapping> <mapping> <identity value="v2" /> <map value="CX / EI (occasionally, more often EI maps to a resource id or a URL)" /> </mapping> <mapping> <identity value="rim" /> <map value="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]" /> </mapping> <mapping> <identity value="servd" /> <map value="Identifier" /> </mapping> </element> <element id="ClaimResponse.item.noteNumber"> <path value="ClaimResponse.item.noteNumber" /> <short value="Applicable note numbers" /> <definition value="The numbers associated with notes below which apply to the adjudication of this item." /> <comment value="32 bit number; for values larger than this, use decimal" /> <requirements value="Provides a condensed manner for associating human readable descriptive explanations for adjudications on the line item." /> <min value="0" /> <max value="*" /> <base> <path value="ClaimResponse.item.noteNumber" /> <min value="0" /> <max value="*" /> </base> <type> <code value="positiveInt" /> </type> <constraint> <key value="ele-1" /> <severity value="error" /> <human value="All FHIR elements must have a @value or children" /> <expression value="hasValue() or (children().count() > id.count())" /> <source value="http://hl7.org/fhir/StructureDefinition/Element" /> </constraint> <mustSupport value="false" /> <isModifier value="false" /> <isSummary value="false" /> <mapping> <identity value="rim" /> <map value="n/a" /> </mapping> </element> <element id="ClaimResponse.item.reviewOutcome"> <extension url="http://hl7.org/fhir/StructureDefinition/structuredefinition-explicit-type-name"> <valueString value="ReviewOutcome" /> </extension> <path value="ClaimResponse.item.reviewOutcome" /> <short value="Adjudication results" /> <definition value="The high-level results of the adjudication if adjudication has been performed." /> <min value="1" /> <max value="1" /> <base> <path value="ClaimResponse.item.reviewOutcome" /> <min value="0" /> <max value="1" /> </base> <type> <code value="BackboneElement" /> </type> <constraint> <key value="ele-1" /> <severity value="error" /> <human value="All FHIR elements must have a @value or children" /> <expression value="hasValue() or (children().count() > id.count())" /> <source value="http://hl7.org/fhir/StructureDefinition/Element" /> </constraint> <mustSupport value="true" /> <isModifier value="false" /> <isSummary value="false" /> <mapping> <identity value="rim" /> <map value="n/a" /> </mapping> </element> <element id="ClaimResponse.item.reviewOutcome.id"> <path value="ClaimResponse.item.reviewOutcome.id" /> <representation value="xmlAttr" /> <short value="Unique id for inter-element referencing" /> <definition value="Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces." /> <min value="0" /> <max value="1" /> <base> <path value="Element.id" /> <min value="0" /> <max value="1" /> </base> <type> <extension url="http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type"> <valueUrl value="string" /> </extension> <code value="http://hl7.org/fhirpath/System.String" /> </type> <condition value="ele-1" /> <mapping> <identity value="rim" /> <map value="n/a" /> </mapping> </element> <element id="ClaimResponse.item.reviewOutcome.extension"> <path value="ClaimResponse.item.reviewOutcome.extension" /> <slicing> <discriminator> <type value="value" /> <path value="url" /> </discriminator> <description value="Extensions are always sliced by (at least) url" /> <rules value="open" /> </slicing> <short value="Additional content defined by implementations" /> <definition value="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 value="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 value="extensions" /> <alias value="user content" /> <min value="0" /> <max value="*" /> <base> <path value="Element.extension" /> <min value="0" /> <max value="*" /> </base> <type> <code value="Extension" /> </type> <constraint> <key value="ele-1" /> <severity value="error" /> <human value="All FHIR elements must have a @value or children" /> <expression value="hasValue() or (children().count() > id.count())" /> <source value="http://hl7.org/fhir/StructureDefinition/Element" /> </constraint> <constraint> <key value="ext-1" /> <severity value="error" /> <human value="Must have either extensions or value[x], not both" /> <expression value="extension.exists() != value.exists()" /> <source value="http://hl7.org/fhir/StructureDefinition/Extension" /> </constraint> <mapping> <identity value="rim" /> <map value="n/a" /> </mapping> <mapping> <identity value="rim" /> <map value="N/A" /> </mapping> </element> <element id="ClaimResponse.item.reviewOutcome.extension:info"> <path value="ClaimResponse.item.reviewOutcome.extension" /> <sliceName value="info" /> <short value="Information Message" /> <definition value="Allows a claim response to provide an 'information' message as part of its response to a claim" /> <comment value="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 value="extensions" /> <alias value="user content" /> <min value="0" /> <max value="*" /> <base> <path value="Element.extension" /> <min value="0" /> <max value="*" /> </base> <type> <code value="Extension" /> <profile value="https://bpcs.exchange/fhir/StructureDefinition/ext-ClaimResponse-Info" /> </type> <constraint> <key value="ele-1" /> <severity value="error" /> <human value="All FHIR elements must have a @value or children" /> <expression value="hasValue() or (children().count() > id.count())" /> <source value="http://hl7.org/fhir/StructureDefinition/Element" /> </constraint> <constraint> <key value="ext-1" /> <severity value="error" /> <human value="Must have either extensions or value[x], not both" /> <expression value="extension.exists() != value.exists()" /> <source value="http://hl7.org/fhir/StructureDefinition/Extension" /> </constraint> <mustSupport value="true" /> <mapping> <identity value="rim" /> <map value="n/a" /> </mapping> <mapping> <identity value="rim" /> <map value="N/A" /> </mapping> </element> <element id="ClaimResponse.item.reviewOutcome.modifierExtension"> <path value="ClaimResponse.item.reviewOutcome.modifierExtension" /> <short value="Extensions that cannot be ignored even if unrecognized" /> <definition value="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. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself)." /> <comment value="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 value="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 value="extensions" /> <alias value="user content" /> <alias value="modifiers" /> <min value="0" /> <max value="*" /> <base> <path value="BackboneElement.modifierExtension" /> <min value="0" /> <max value="*" /> </base> <type> <code value="Extension" /> </type> <constraint> <key value="ele-1" /> <severity value="error" /> <human value="All FHIR elements must have a @value or children" /> <expression value="hasValue() or (children().count() > id.count())" /> <source value="http://hl7.org/fhir/StructureDefinition/Element" /> </constraint> <constraint> <key value="ext-1" /> <severity value="error" /> <human value="Must have either extensions or value[x], not both" /> <expression value="extension.exists() != value.exists()" /> <source value="http://hl7.org/fhir/StructureDefinition/Extension" /> </constraint> <isModifier value="true" /> <isModifierReason value="Modifier extensions are expected to modify the meaning or interpretation of the element that contains them" /> <isSummary value="true" /> <mapping> <identity value="rim" /> <map value="n/a" /> </mapping> <mapping> <identity value="rim" /> <map value="N/A" /> </mapping> </element> <element id="ClaimResponse.item.reviewOutcome.decision"> <path value="ClaimResponse.item.reviewOutcome.decision" /> <short value="Result of the adjudication" /> <definition value="The result of the claim, predetermination, or preauthorization adjudication." /> <comment value="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 value="To advise the requestor of the result of the adjudication process." /> <min value="1" /> <max value="1" /> <base> <path value="ClaimResponse.item.reviewOutcome.decision" /> <min value="0" /> <max value="1" /> </base> <type> <code value="CodeableConcept" /> </type> <constraint> <key value="ele-1" /> <severity value="error" /> <human value="All FHIR elements must have a @value or children" /> <expression value="hasValue() or (children().count() > id.count())" /> <source value="http://hl7.org/fhir/StructureDefinition/Element" /> </constraint> <mustSupport value="true" /> <isModifier value="false" /> <isSummary value="false" /> <binding> <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName"> <valueString value="AdjudicationDecision" /> </extension> <strength value="required" /> <valueSet value="https://bpcs.exchange/fhir/ValueSet/vs-Receipt-status" /> </binding> <mapping> <identity value="rim" /> <map value="n/a" /> </mapping> <mapping> <identity value="v2" /> <map value="CE/CNE/CWE" /> </mapping> <mapping> <identity value="rim" /> <map value="CD" /> </mapping> <mapping> <identity value="orim" /> <map value="fhir:CodeableConcept rdfs:subClassOf dt:CD" /> </mapping> </element> <element id="ClaimResponse.item.reviewOutcome.reason"> <path value="ClaimResponse.item.reviewOutcome.reason" /> <short value="Reason for result of the adjudication" /> <definition value="The reasons for the result of the claim, predetermination, or preauthorization adjudication." /> <comment value="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 value="To advise the requestor of the contributors to the result of the adjudication process." /> <min value="0" /> <max value="*" /> <base> <path value="ClaimResponse.item.reviewOutcome.reason" /> <min value="0" /> <max value="*" /> </base> <type> <code value="CodeableConcept" /> </type> <constraint> <key value="ele-1" /> <severity value="error" /> <human value="All FHIR elements must have a @value or children" /> <expression value="hasValue() or (children().count() > id.count())" /> <source value="http://hl7.org/fhir/StructureDefinition/Element" /> </constraint> <mustSupport value="true" /> <isModifier value="false" /> <isSummary value="false" /> <binding> <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName"> <valueString value="AdjudicationDecisionReason" /> </extension> <strength value="extensible" /> <valueSet value="https://bpcs.exchange/fhir/ValueSet/vs-ClaimResponse" /> </binding> <mapping> <identity value="rim" /> <map value="n/a" /> </mapping> <mapping> <identity value="v2" /> <map value="CE/CNE/CWE" /> </mapping> <mapping> <identity value="rim" /> <map value="CD" /> </mapping> <mapping> <identity value="orim" /> <map value="fhir:CodeableConcept rdfs:subClassOf dt:CD" /> </mapping> <mapping> <identity value="BPCS" /> <map value="AssessContext.responseCodes, AssessmentFlag.(various EFlags)" /> </mapping> </element> <element id="ClaimResponse.item.reviewOutcome.reason.id"> <path value="ClaimResponse.item.reviewOutcome.reason.id" /> <representation value="xmlAttr" /> <short value="Unique id for inter-element referencing" /> <definition value="Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces." /> <min value="0" /> <max value="1" /> <base> <path value="Element.id" /> <min value="0" /> <max value="1" /> </base> <type> <extension url="http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type"> <valueUrl value="string" /> </extension> <code value="http://hl7.org/fhirpath/System.String" /> </type> <condition value="ele-1" /> <mapping> <identity value="rim" /> <map value="n/a" /> </mapping> </element> <element id="ClaimResponse.item.reviewOutcome.reason.extension"> <path value="ClaimResponse.item.reviewOutcome.reason.extension" /> <slicing> <discriminator> <type value="value" /> <path value="url" /> </discriminator> <description value="Extensions are always sliced by (at least) url" /> <rules value="open" /> </slicing> <short value="Additional content defined by implementations" /> <definition value="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 value="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 value="extensions" /> <alias value="user content" /> <min value="0" /> <max value="*" /> <base> <path value="Element.extension" /> <min value="0" /> <max value="*" /> </base> <type> <code value="Extension" /> </type> <constraint> <key value="ele-1" /> <severity value="error" /> <human value="All FHIR elements must have a @value or children" /> <expression value="hasValue() or (children().count() > id.count())" /> <source value="http://hl7.org/fhir/StructureDefinition/Element" /> </constraint> <constraint> <key value="ext-1" /> <severity value="error" /> <human value="Must have either extensions or value[x], not both" /> <expression value="extension.exists() != value.exists()" /> <source value="http://hl7.org/fhir/StructureDefinition/Extension" /> </constraint> <mapping> <identity value="rim" /> <map value="n/a" /> </mapping> <mapping> <identity value="rim" /> <map value="N/A" /> </mapping> </element> <element id="ClaimResponse.item.reviewOutcome.reason.extension:allowedModifier"> <path value="ClaimResponse.item.reviewOutcome.reason.extension" /> <sliceName value="allowedModifier" /> <short value="Allowed modifier" /> <definition value="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 value="Indicates modifier codes permitted to override for this response code (if any)." /> <alias value="extensions" /> <alias value="user content" /> <min value="0" /> <max value="*" /> <base> <path value="Element.extension" /> <min value="0" /> <max value="*" /> </base> <type> <code value="Extension" /> <profile value="https://bpcs.exchange/fhir/StructureDefinition/ext-ClaimResponse-AllowedModifier" /> </type> <constraint> <key value="ele-1" /> <severity value="error" /> <human value="All FHIR elements must have a @value or children" /> <expression value="hasValue() or (children().count() > id.count())" /> <source value="http://hl7.org/fhir/StructureDefinition/Element" /> </constraint> <constraint> <key value="ext-1" /> <severity value="error" /> <human value="Must have either extensions or value[x], not both" /> <expression value="extension.exists() != value.exists()" /> <source value="http://hl7.org/fhir/StructureDefinition/Extension" /> </constraint> <mustSupport value="true" /> <mapping> <identity value="rim" /> <map value="n/a" /> </mapping> <mapping> <identity value="rim" /> <map value="N/A" /> </mapping> </element> <element id="ClaimResponse.item.reviewOutcome.reason.extension:allowedModifier.id"> <path value="ClaimResponse.item.reviewOutcome.reason.extension.id" /> <representation value="xmlAttr" /> <short value="Unique id for inter-element referencing" /> <definition value="Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces." /> <min value="0" /> <max value="1" /> <base> <path value="Element.id" /> <min value="0" /> <max value="1" /> </base> <type> <extension url="http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type"> <valueUrl value="string" /> </extension> <code value="http://hl7.org/fhirpath/System.String" /> </type> <condition value="ele-1" /> <mapping> <identity value="rim" /> <map value="n/a" /> </mapping> </element> <element id="ClaimResponse.item.reviewOutcome.reason.extension:allowedModifier.extension"> <path value="ClaimResponse.item.reviewOutcome.reason.extension.extension" /> <slicing> <discriminator> <type value="value" /> <path value="url" /> </discriminator> <description value="Extensions are always sliced by (at least) url" /> <rules value="open" /> </slicing> <short value="Additional content defined by implementations" /> <definition value="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 value="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 value="extensions" /> <alias value="user content" /> <min value="0" /> <max value="*" /> <base> <path value="Element.extension" /> <min value="0" /> <max value="*" /> </base> <type> <code value="Extension" /> </type> <constraint> <key value="ele-1" /> <severity value="error" /> <human value="All FHIR elements must have a @value or children" /> <expression value="hasValue() or (children().count() > id.count())" /> <source value="http://hl7.org/fhir/StructureDefinition/Element" /> </constraint> <constraint> <key value="ext-1" /> <severity value="error" /> <human value="Must have either extensions or value[x], not both" /> <expression value="extension.exists() != value.exists()" /> <source value="http://hl7.org/fhir/StructureDefinition/Extension" /> </constraint> <mapping> <identity value="rim" /> <map value="n/a" /> </mapping> <mapping> <identity value="rim" /> <map value="N/A" /> </mapping> </element> <element id="ClaimResponse.item.reviewOutcome.reason.extension:allowedModifier.url"> <path value="ClaimResponse.item.reviewOutcome.reason.extension.url" /> <representation value="xmlAttr" /> <short value="identifies the meaning of the extension" /> <definition value="Source of the definition for the extension code - a logical name or a URL." /> <comment value="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 value="1" /> <max value="1" /> <base> <path value="Extension.url" /> <min value="1" /> <max value="1" /> </base> <type> <extension url="http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type"> <valueUrl value="uri" /> </extension> <code value="http://hl7.org/fhirpath/System.String" /> </type> <fixedUri value="https://bpcs.exchange/fhir/StructureDefinition/ext-ClaimResponse-AllowedModifier" /> <mapping> <identity value="rim" /> <map value="N/A" /> </mapping> </element> <element id="ClaimResponse.item.reviewOutcome.reason.extension:allowedModifier.value[x]"> <path value="ClaimResponse.item.reviewOutcome.reason.extension.value[x]" /> <short value="A reference to a code defined by a terminology system" /> <definition value="A reference to a code defined by a terminology system." /> <comment value="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 value="0" /> <max value="1" /> <base> <path value="Extension.value[x]" /> <min value="0" /> <max value="1" /> </base> <type> <code value="Coding" /> <profile value="https://bpcs.exchange/fhir/StructureDefinition/profile-Coding-simple" /> </type> <condition value="ext-1" /> <constraint> <key value="ele-1" /> <severity value="error" /> <human value="All FHIR elements must have a @value or children" /> <expression value="hasValue() or (children().count() > id.count())" /> <source value="http://hl7.org/fhir/StructureDefinition/Element" /> </constraint> <constraint> <key value="cod-1" /> <severity value="warning" /> <human value="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 value="code.exists().not() implies display.exists().not()" /> <source value="http://hl7.org/fhir/StructureDefinition/Coding" /> </constraint> <mustSupport value="true" /> <binding> <strength value="extensible" /> <valueSet value="https://bpcs.exchange/fhir/ValueSet/vs-ClaimResponse-AllowedModifier" /> </binding> <mapping> <identity value="rim" /> <map value="n/a" /> </mapping> <mapping> <identity value="rim" /> <map value="N/A" /> </mapping> <mapping> <identity value="v2" /> <map value="CE/CNE/CWE subset one of the sets of component 1-3 or 4-6" /> </mapping> <mapping> <identity value="rim" /> <map value="CV" /> </mapping> <mapping> <identity value="orim" /> <map value="fhir:Coding rdfs:subClassOf dt:CDCoding" /> </mapping> <mapping> <identity value="BPCS" /> <map value="AssessmentFlag.reasnUseCd, other override codes populated by intermediary based on what overrides are permitted for a given response code or EFlag" /> </mapping> </element> <element id="ClaimResponse.item.reviewOutcome.reason.extension:allowedModifier.value[x].id"> <path value="ClaimResponse.item.reviewOutcome.reason.extension.value[x].id" /> <representation value="xmlAttr" /> <short value="Unique id for inter-element referencing" /> <definition value="Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces." /> <min value="0" /> <max value="1" /> <base> <path value="Element.id" /> <min value="0" /> <max value="1" /> </base> <type> <extension url="http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type"> <valueUrl value="string" /> </extension> <code value="http://hl7.org/fhirpath/System.String" /> </type> <condition value="ele-1" /> <mapping> <identity value="rim" /> <map value="n/a" /> </mapping> </element> <element id="ClaimResponse.item.reviewOutcome.reason.extension:allowedModifier.value[x].extension"> <path value="ClaimResponse.item.reviewOutcome.reason.extension.value[x].extension" /> <slicing> <discriminator> <type value="value" /> <path value="url" /> </discriminator> <description value="Extensions are always sliced by (at least) url" /> <rules value="open" /> </slicing> <short value="Additional content defined by implementations" /> <definition value="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 value="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 value="extensions" /> <alias value="user content" /> <min value="0" /> <max value="*" /> <base> <path value="Element.extension" /> <min value="0" /> <max value="*" /> </base> <type> <code value="Extension" /> </type> <constraint> <key value="ele-1" /> <severity value="error" /> <human value="All FHIR elements must have a @value or children" /> <expression value="hasValue() or (children().count() > id.count())" /> <source value="http://hl7.org/fhir/StructureDefinition/Element" /> </constraint> <constraint> <key value="ext-1" /> <severity value="error" /> <human value="Must have either extensions or value[x], not both" /> <expression value="extension.exists() != value.exists()" /> <source value="http://hl7.org/fhir/StructureDefinition/Extension" /> </constraint> <mapping> <identity value="rim" /> <map value="n/a" /> </mapping> <mapping> <identity value="rim" /> <map value="N/A" /> </mapping> </element> <element id="ClaimResponse.item.reviewOutcome.reason.extension:allowedModifier.value[x].extension:default"> <path value="ClaimResponse.item.reviewOutcome.reason.extension.value[x].extension" /> <sliceName value="default" /> <short value="Default Modifier" /> <definition value="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 value="May only be present on one modifier within a reason." /> <alias value="extensions" /> <alias value="user content" /> <min value="0" /> <max value="*" /> <base> <path value="Element.extension" /> <min value="0" /> <max value="*" /> </base> <type> <code value="Extension" /> <profile value="https://bpcs.exchange/fhir/StructureDefinition/ext-ClaimResponse-AllowedModifierDefault" /> </type> <meaningWhenMissing value="If not present, allowedModifier is not a 'default' value." /> <constraint> <key value="ele-1" /> <severity value="error" /> <human value="All FHIR elements must have a @value or children" /> <expression value="hasValue() or (children().count() > id.count())" /> <source value="http://hl7.org/fhir/StructureDefinition/Element" /> </constraint> <constraint> <key value="ext-1" /> <severity value="error" /> <human value="Must have either extensions or value[x], not both" /> <expression value="extension.exists() != value.exists()" /> <source value="http://hl7.org/fhir/StructureDefinition/Extension" /> </constraint> <mustSupport value="true" /> <mapping> <identity value="rim" /> <map value="n/a" /> </mapping> <mapping> <identity value="rim" /> <map value="N/A" /> </mapping> </element> <element id="ClaimResponse.item.reviewOutcome.reason.extension:allowedModifier.value[x].extension:preExistingCondition"> <path value="ClaimResponse.item.reviewOutcome.reason.extension.value[x].extension" /> <sliceName value="preExistingCondition" /> <short value="Pre-existing condition" /> <definition value="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 value="Only allowed where an 'allowed modifier' is a health condition." /> <alias value="extensions" /> <alias value="user content" /> <min value="0" /> <max value="*" /> <base> <path value="Element.extension" /> <min value="0" /> <max value="*" /> </base> <type> <code value="Extension" /> <profile value="https://bpcs.exchange/fhir/StructureDefinition/ext-ClaimResponse-PreExistingCondition" /> </type> <constraint> <key value="ele-1" /> <severity value="error" /> <human value="All FHIR elements must have a @value or children" /> <expression value="hasValue() or (children().count() > id.count())" /> <source value="http://hl7.org/fhir/StructureDefinition/Element" /> </constraint> <constraint> <key value="ext-1" /> <severity value="error" /> <human value="Must have either extensions or value[x], not both" /> <expression value="extension.exists() != value.exists()" /> <source value="http://hl7.org/fhir/StructureDefinition/Extension" /> </constraint> <mustSupport value="true" /> <mapping> <identity value="rim" /> <map value="n/a" /> </mapping> <mapping> <identity value="rim" /> <map value="N/A" /> </mapping> </element> <element id="ClaimResponse.item.reviewOutcome.reason.extension:allowedModifier.value[x].system"> <path value="ClaimResponse.item.reviewOutcome.reason.extension.value[x].system" /> <short value="Identity of the terminology system" /> <definition value="The identification of the code system that defines the meaning of the symbol in the code." /> <comment value="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 value="Need to be unambiguous about the source of the definition of the symbol." /> <min value="1" /> <max value="1" /> <base> <path value="Coding.system" /> <min value="0" /> <max value="1" /> </base> <type> <code value="uri" /> </type> <constraint> <key value="ele-1" /> <severity value="error" /> <human value="All FHIR elements must have a @value or children" /> <expression value="hasValue() or (children().count() > id.count())" /> <source value="http://hl7.org/fhir/StructureDefinition/Element" /> </constraint> <mustSupport value="true" /> <isSummary value="true" /> <mapping> <identity value="rim" /> <map value="n/a" /> </mapping> <mapping> <identity value="v2" /> <map value="C*E.3" /> </mapping> <mapping> <identity value="rim" /> <map value="./codeSystem" /> </mapping> <mapping> <identity value="orim" /> <map value="fhir:Coding.system rdfs:subPropertyOf dt:CDCoding.codeSystem" /> </mapping> </element> <element id="ClaimResponse.item.reviewOutcome.reason.extension:allowedModifier.value[x].version"> <path value="ClaimResponse.item.reviewOutcome.reason.extension.value[x].version" /> <short value="Version of the system - if relevant" /> <definition value="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 value="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 value="0" /> <max value="1" /> <base> <path value="Coding.version" /> <min value="0" /> <max value="1" /> </base> <type> <code value="string" /> </type> <constraint> <key value="ele-1" /> <severity value="error" /> <human value="All FHIR elements must have a @value or children" /> <expression value="hasValue() or (children().count() > id.count())" /> <source value="http://hl7.org/fhir/StructureDefinition/Element" /> </constraint> <isSummary value="true" /> <mapping> <identity value="rim" /> <map value="n/a" /> </mapping> <mapping> <identity value="v2" /> <map value="C*E.7" /> </mapping> <mapping> <identity value="rim" /> <map value="./codeSystemVersion" /> </mapping> <mapping> <identity value="orim" /> <map value="fhir:Coding.version rdfs:subPropertyOf dt:CDCoding.codeSystemVersion" /> </mapping> </element> <element id="ClaimResponse.item.reviewOutcome.reason.extension:allowedModifier.value[x].code"> <extension url="http://hl7.org/fhir/tools/StructureDefinition/no-binding"> <valueBoolean value="true" /> </extension> <path value="ClaimResponse.item.reviewOutcome.reason.extension.value[x].code" /> <short value="Symbol in syntax defined by the system" /> <definition value="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 value="Note that FHIR strings SHALL NOT exceed 1,048,576 (1024*1024) characters in size" /> <requirements value="Need to refer to a particular code in the system." /> <min value="1" /> <max value="1" /> <base> <path value="Coding.code" /> <min value="0" /> <max value="1" /> </base> <type> <code value="code" /> </type> <condition value="cod-1" /> <constraint> <key value="ele-1" /> <severity value="error" /> <human value="All FHIR elements must have a @value or children" /> <expression value="hasValue() or (children().count() > id.count())" /> <source value="http://hl7.org/fhir/StructureDefinition/Element" /> </constraint> <mustSupport value="true" /> <isSummary value="true" /> <mapping> <identity value="rim" /> <map value="n/a" /> </mapping> <mapping> <identity value="v2" /> <map value="C*E.1" /> </mapping> <mapping> <identity value="rim" /> <map value="./code" /> </mapping> <mapping> <identity value="orim" /> <map value="fhir:Coding.code rdfs:subPropertyOf dt:CDCoding.code" /> </mapping> </element> <element id="ClaimResponse.item.reviewOutcome.reason.extension:allowedModifier.value[x].display"> <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-translatable"> <valueBoolean value="true" /> </extension> <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-translatable"> <valueBoolean value="true" /> </extension> <path value="ClaimResponse.item.reviewOutcome.reason.extension.value[x].display" /> <short value="Representation defined by the system" /> <definition value="A representation of the meaning of the code in the system, following the rules of the system." /> <comment value="Note that FHIR strings SHALL NOT exceed 1,048,576 (1024*1024) characters in size" /> <requirements value="Need to be able to carry a human-readable meaning of the code for readers that do not know the system." /> <min value="0" /> <max value="1" /> <base> <path value="Coding.display" /> <min value="0" /> <max value="1" /> </base> <type> <code value="string" /> </type> <condition value="cod-1" /> <constraint> <key value="ele-1" /> <severity value="error" /> <human value="All FHIR elements must have a @value or children" /> <expression value="hasValue() or (children().count() > id.count())" /> <source value="http://hl7.org/fhir/StructureDefinition/Element" /> </constraint> <mustSupport value="true" /> <isSummary value="true" /> <mapping> <identity value="rim" /> <map value="n/a" /> </mapping> <mapping> <identity value="v2" /> <map value="C*E.2 - but note this is not well followed" /> </mapping> <mapping> <identity value="rim" /> <map value="CV.displayName" /> </mapping> <mapping> <identity value="orim" /> <map value="fhir:Coding.display rdfs:subPropertyOf dt:CDCoding.displayName" /> </mapping> </element> <element id="ClaimResponse.item.reviewOutcome.reason.extension:allowedModifier.value[x].userSelected"> <path value="ClaimResponse.item.reviewOutcome.reason.extension.value[x].userSelected" /> <short value="If this coding was chosen directly by the user" /> <definition value="Indicates that this coding was chosen by a user directly - e.g. off a pick list of available items (codes or displays)." /> <comment value="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 value="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 value="0" /> <max value="1" /> <base> <path value="Coding.userSelected" /> <min value="0" /> <max value="1" /> </base> <type> <code value="boolean" /> </type> <constraint> <key value="ele-1" /> <severity value="error" /> <human value="All FHIR elements must have a @value or children" /> <expression value="hasValue() or (children().count() > id.count())" /> <source value="http://hl7.org/fhir/StructureDefinition/Element" /> </constraint> <isSummary value="true" /> <mapping> <identity value="rim" /> <map value="n/a" /> </mapping> <mapping> <identity value="v2" /> <map value="Sometimes implied by being first" /> </mapping> <mapping> <identity value="rim" /> <map value="CD.codingRationale" /> </mapping> <mapping> <identity value="orim" /> <map value="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 ]" /> </mapping> </element> <element id="ClaimResponse.item.reviewOutcome.reason.extension:duplicate"> <path value="ClaimResponse.item.reviewOutcome.reason.extension" /> <sliceName value="duplicate" /> <short value="Duplicate receipts" /> <definition value="Allows an adjudicationResponse to indicate one or more duplicate receipts associated with a particular claim item" /> <comment value="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 value="extensions" /> <alias value="user content" /> <min value="0" /> <max value="1" /> <base> <path value="Element.extension" /> <min value="0" /> <max value="*" /> </base> <type> <code value="Extension" /> <profile value="https://bpcs.exchange/fhir/StructureDefinition/ext-ClaimResponse-DuplicateReceipts" /> </type> <constraint> <key value="ele-1" /> <severity value="error" /> <human value="All FHIR elements must have a @value or children" /> <expression value="hasValue() or (children().count() > id.count())" /> <source value="http://hl7.org/fhir/StructureDefinition/Element" /> </constraint> <constraint> <key value="ext-1" /> <severity value="error" /> <human value="Must have either extensions or value[x], not both" /> <expression value="extension.exists() != value.exists()" /> <source value="http://hl7.org/fhir/StructureDefinition/Extension" /> </constraint> <mustSupport value="true" /> <mapping> <identity value="rim" /> <map value="n/a" /> </mapping> <mapping> <identity value="rim" /> <map value="N/A" /> </mapping> </element> <element id="ClaimResponse.item.reviewOutcome.reason.coding"> <path value="ClaimResponse.item.reviewOutcome.reason.coding" /> <short value="Code defined by a terminology system" /> <definition value="A reference to a code defined by a terminology system." /> <comment value="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 value="Allows for alternative encodings within a code system, and translations to other code systems." /> <min value="0" /> <max value="*" /> <base> <path value="CodeableConcept.coding" /> <min value="0" /> <max value="*" /> </base> <type> <code value="Coding" /> </type> <constraint> <key value="ele-1" /> <severity value="error" /> <human value="All FHIR elements must have a @value or children" /> <expression value="hasValue() or (children().count() > id.count())" /> <source value="http://hl7.org/fhir/StructureDefinition/Element" /> </constraint> <constraint> <key value="cod-1" /> <severity value="warning" /> <human value="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 value="code.exists().not() implies display.exists().not()" /> <source value="http://hl7.org/fhir/StructureDefinition/Coding" /> </constraint> <isSummary value="true" /> <mapping> <identity value="rim" /> <map value="n/a" /> </mapping> <mapping> <identity value="v2" /> <map value="CE/CNE/CWE subset one of the sets of component 1-3 or 4-6" /> </mapping> <mapping> <identity value="rim" /> <map value="CV" /> </mapping> <mapping> <identity value="orim" /> <map value="fhir:Coding rdfs:subClassOf dt:CDCoding" /> </mapping> <mapping> <identity value="v2" /> <map value="C*E.1-8, C*E.10-22" /> </mapping> <mapping> <identity value="rim" /> <map value="union(., ./translation)" /> </mapping> <mapping> <identity value="orim" /> <map value="fhir:CodeableConcept.coding rdfs:subPropertyOf dt:CD.coding" /> </mapping> </element> <element id="ClaimResponse.item.reviewOutcome.reason.text"> <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-translatable"> <valueBoolean value="true" /> </extension> <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-translatable"> <valueBoolean value="true" /> </extension> <path value="ClaimResponse.item.reviewOutcome.reason.text" /> <short value="Plain text representation of the concept" /> <definition value="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 value="Very often the text is the same as a displayName of one of the codings." /> <requirements value="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 value="0" /> <max value="1" /> <base> <path value="CodeableConcept.text" /> <min value="0" /> <max value="1" /> </base> <type> <code value="string" /> </type> <constraint> <key value="ele-1" /> <severity value="error" /> <human value="All FHIR elements must have a @value or children" /> <expression value="hasValue() or (children().count() > id.count())" /> <source value="http://hl7.org/fhir/StructureDefinition/Element" /> </constraint> <isSummary value="true" /> <mapping> <identity value="rim" /> <map value="n/a" /> </mapping> <mapping> <identity value="v2" /> <map value="C*E.9. But note many systems use C*E.2 for this" /> </mapping> <mapping> <identity value="rim" /> <map value="./originalText[mediaType/code="text/plain"]/data" /> </mapping> <mapping> <identity value="orim" /> <map value="fhir:CodeableConcept.text rdfs:subPropertyOf dt:CD.originalText" /> </mapping> </element> <element id="ClaimResponse.item.reviewOutcome.preAuthRef"> <path value="ClaimResponse.item.reviewOutcome.preAuthRef" /> <short value="Preauthorization reference" /> <definition value="Reference from the Insurer which is used in later communications which refers to this adjudication." /> <comment value="This value is only present on preauthorization adjudications." /> <requirements value="On subsequent claims, the insurer may require the provider to quote this value." /> <min value="0" /> <max value="1" /> <base> <path value="ClaimResponse.item.reviewOutcome.preAuthRef" /> <min value="0" /> <max value="1" /> </base> <type> <code value="string" /> </type> <constraint> <key value="ele-1" /> <severity value="error" /> <human value="All FHIR elements must have a @value or children" /> <expression value="hasValue() or (children().count() > id.count())" /> <source value="http://hl7.org/fhir/StructureDefinition/Element" /> </constraint> <mustSupport value="false" /> <isModifier value="false" /> <isSummary value="false" /> <mapping> <identity value="rim" /> <map value="n/a" /> </mapping> </element> <element id="ClaimResponse.item.reviewOutcome.preAuthPeriod"> <path value="ClaimResponse.item.reviewOutcome.preAuthPeriod" /> <short value="Preauthorization reference effective period" /> <definition value="The time frame during which this authorization is effective." /> <comment value="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"). Period is not used for a duration (a measure of elapsed time). See [Duration](datatypes.html#Duration)." /> <requirements value="To convey to the provider when the authorized products and services must be supplied for the authorized adjudication to apply." /> <min value="0" /> <max value="1" /> <base> <path value="ClaimResponse.item.reviewOutcome.preAuthPeriod" /> <min value="0" /> <max value="1" /> </base> <type> <code value="Period" /> </type> <constraint> <key value="ele-1" /> <severity value="error" /> <human value="All FHIR elements must have a @value or children" /> <expression value="hasValue() or (children().count() > id.count())" /> <source value="http://hl7.org/fhir/StructureDefinition/Element" /> </constraint> <constraint> <key value="per-1" /> <severity value="error" /> <human value="If present, start SHALL have a lower or equal value than end" /> <expression value="start.hasValue().not() or end.hasValue().not() or (start.lowBoundary() <= end.highBoundary())" /> <source value="http://hl7.org/fhir/StructureDefinition/Period" /> </constraint> <mustSupport value="false" /> <isModifier value="false" /> <isSummary value="false" /> <mapping> <identity value="rim" /> <map value="n/a" /> </mapping> <mapping> <identity value="v2" /> <map value="DR" /> </mapping> <mapping> <identity value="rim" /> <map value="IVL<TS>[lowClosed="true" and highClosed="true"] or URG<TS>[lowClosed="true" and highClosed="true"]" /> </mapping> </element> <element id="ClaimResponse.item.adjudication"> <extension url="http://hl7.org/fhir/StructureDefinition/structuredefinition-explicit-type-name"> <valueString value="Adjudication" /> </extension> <path value="ClaimResponse.item.adjudication" /> <slicing> <discriminator> <type value="value" /> <path value="category" /> </discriminator> <rules value="open" /> </slicing> <short value="Adjudication details" /> <definition value="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 value="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 value="2" /> <max value="*" /> <base> <path value="ClaimResponse.item.adjudication" /> <min value="0" /> <max value="*" /> </base> <type> <code value="BackboneElement" /> </type> <constraint> <key value="ele-1" /> <severity value="error" /> <human value="All FHIR elements must have a @value or children" /> <expression value="hasValue() or (children().count() > id.count())" /> <source value="http://hl7.org/fhir/StructureDefinition/Element" /> </constraint> <mustSupport value="true" /> <isModifier value="false" /> <isSummary value="false" /> <mapping> <identity value="rim" /> <map value="n/a" /> </mapping> </element> <element id="ClaimResponse.item.adjudication.id"> <path value="ClaimResponse.item.adjudication.id" /> <representation value="xmlAttr" /> <short value="Unique id for inter-element referencing" /> <definition value="Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces." /> <min value="0" /> <max value="1" /> <base> <path value="Element.id" /> <min value="0" /> <max value="1" /> </base> <type> <extension url="http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type"> <valueUrl value="string" /> </extension> <code value="http://hl7.org/fhirpath/System.String" /> </type> <condition value="ele-1" /> <mapping> <identity value="rim" /> <map value="n/a" /> </mapping> </element> <element id="ClaimResponse.item.adjudication.extension"> <path value="ClaimResponse.item.adjudication.extension" /> <slicing> <discriminator> <type value="value" /> <path value="url" /> </discriminator> <description value="Extensions are always sliced by (at least) url" /> <rules value="open" /> </slicing> <short value="Additional content defined by implementations" /> <definition value="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 value="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 value="extensions" /> <alias value="user content" /> <min value="0" /> <max value="*" /> <base> <path value="Element.extension" /> <min value="0" /> <max value="*" /> </base> <type> <code value="Extension" /> </type> <constraint> <key value="ele-1" /> <severity value="error" /> <human value="All FHIR elements must have a @value or children" /> <expression value="hasValue() or (children().count() > id.count())" /> <source value="http://hl7.org/fhir/StructureDefinition/Element" /> </constraint> <constraint> <key value="ext-1" /> <severity value="error" /> <human value="Must have either extensions or value[x], not both" /> <expression value="extension.exists() != value.exists()" /> <source value="http://hl7.org/fhir/StructureDefinition/Extension" /> </constraint> <mapping> <identity value="rim" /> <map value="n/a" /> </mapping> <mapping> <identity value="rim" /> <map value="N/A" /> </mapping> </element> <element id="ClaimResponse.item.adjudication.modifierExtension"> <path value="ClaimResponse.item.adjudication.modifierExtension" /> <short value="Extensions that cannot be ignored even if unrecognized" /> <definition value="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. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself)." /> <comment value="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 value="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 value="extensions" /> <alias value="user content" /> <alias value="modifiers" /> <min value="0" /> <max value="*" /> <base> <path value="BackboneElement.modifierExtension" /> <min value="0" /> <max value="*" /> </base> <type> <code value="Extension" /> </type> <constraint> <key value="ele-1" /> <severity value="error" /> <human value="All FHIR elements must have a @value or children" /> <expression value="hasValue() or (children().count() > id.count())" /> <source value="http://hl7.org/fhir/StructureDefinition/Element" /> </constraint> <constraint> <key value="ext-1" /> <severity value="error" /> <human value="Must have either extensions or value[x], not both" /> <expression value="extension.exists() != value.exists()" /> <source value="http://hl7.org/fhir/StructureDefinition/Extension" /> </constraint> <isModifier value="true" /> <isModifierReason value="Modifier extensions are expected to modify the meaning or interpretation of the element that contains them" /> <isSummary value="true" /> <mapping> <identity value="rim" /> <map value="n/a" /> </mapping> <mapping> <identity value="rim" /> <map value="N/A" /> </mapping> </element> <element id="ClaimResponse.item.adjudication.category"> <path value="ClaimResponse.item.adjudication.category" /> <short value="Type of adjudication information" /> <definition value="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 value="For example codes indicating: Co-Pay, deductible, eligible, benefit, tax, etc." /> <requirements value="Needed to enable understanding of the context of the other information in the adjudication." /> <min value="1" /> <max value="1" /> <base> <path value="ClaimResponse.item.adjudication.category" /> <min value="1" /> <max value="1" /> </base> <type> <code value="CodeableConcept" /> </type> <constraint> <key value="ele-1" /> <severity value="error" /> <human value="All FHIR elements must have a @value or children" /> <expression value="hasValue() or (children().count() > id.count())" /> <source value="http://hl7.org/fhir/StructureDefinition/Element" /> </constraint> <mustSupport value="false" /> <isModifier value="false" /> <isSummary value="false" /> <binding> <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName"> <valueString value="Adjudication" /> </extension> <strength value="example" /> <description value="The adjudication codes." /> <valueSet value="http://hl7.org/fhir/ValueSet/adjudication" /> </binding> <mapping> <identity value="rim" /> <map value="n/a" /> </mapping> <mapping> <identity value="v2" /> <map value="CE/CNE/CWE" /> </mapping> <mapping> <identity value="rim" /> <map value="CD" /> </mapping> <mapping> <identity value="orim" /> <map value="fhir:CodeableConcept rdfs:subClassOf dt:CD" /> </mapping> </element> <element id="ClaimResponse.item.adjudication.reason"> <path value="ClaimResponse.item.adjudication.reason" /> <short value="Explanation of adjudication outcome" /> <definition value="A code supporting the understanding of the adjudication result and explaining variance from expected amount." /> <comment value="For example may indicate that the funds for this benefit type have been exhausted." /> <requirements value="To support understanding of variance from adjudication expectations." /> <min value="0" /> <max value="1" /> <base> <path value="ClaimResponse.item.adjudication.reason" /> <min value="0" /> <max value="1" /> </base> <type> <code value="CodeableConcept" /> </type> <constraint> <key value="ele-1" /> <severity value="error" /> <human value="All FHIR elements must have a @value or children" /> <expression value="hasValue() or (children().count() > id.count())" /> <source value="http://hl7.org/fhir/StructureDefinition/Element" /> </constraint> <mustSupport value="false" /> <isModifier value="false" /> <isSummary value="false" /> <binding> <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName"> <valueString value="AdjudicationReason" /> </extension> <strength value="example" /> <description value="The adjudication reason codes." /> <valueSet value="http://hl7.org/fhir/ValueSet/adjudication-reason" /> </binding> <mapping> <identity value="rim" /> <map value="n/a" /> </mapping> <mapping> <identity value="v2" /> <map value="CE/CNE/CWE" /> </mapping> <mapping> <identity value="rim" /> <map value="CD" /> </mapping> <mapping> <identity value="orim" /> <map value="fhir:CodeableConcept rdfs:subClassOf dt:CD" /> </mapping> </element> <element id="ClaimResponse.item.adjudication.amount"> <path value="ClaimResponse.item.adjudication.amount" /> <short value="Monetary amount" /> <definition value="Monetary amount associated with the category." /> <comment value="For example: amount submitted, eligible amount, co-payment, and benefit payable." /> <requirements value="Most adjudication categories convey a monetary amount." /> <min value="0" /> <max value="1" /> <base> <path value="ClaimResponse.item.adjudication.amount" /> <min value="0" /> <max value="1" /> </base> <type> <code value="Money" /> </type> <constraint> <key value="ele-1" /> <severity value="error" /> <human value="All FHIR elements must have a @value or children" /> <expression value="hasValue() or (children().count() > id.count())" /> <source value="http://hl7.org/fhir/StructureDefinition/Element" /> </constraint> <mustSupport value="false" /> <isModifier value="false" /> <isSummary value="false" /> <mapping> <identity value="rim" /> <map value="n/a" /> </mapping> <mapping> <identity value="rim" /> <map value="MO" /> </mapping> </element> <element id="ClaimResponse.item.adjudication.quantity"> <path value="ClaimResponse.item.adjudication.quantity" /> <short value="Non-monetary value" /> <definition value="A non-monetary value associated with the category. Mutually exclusive to the amount element above." /> <comment value="For example: eligible percentage or co-payment percentage." /> <requirements value="Some adjudication categories convey a percentage or a fixed value." /> <min value="0" /> <max value="1" /> <base> <path value="ClaimResponse.item.adjudication.quantity" /> <min value="0" /> <max value="1" /> </base> <type> <code value="Quantity" /> </type> <constraint> <key value="ele-1" /> <severity value="error" /> <human value="All FHIR elements must have a @value or children" /> <expression value="hasValue() or (children().count() > id.count())" /> <source value="http://hl7.org/fhir/StructureDefinition/Element" /> </constraint> <constraint> <key value="qty-3" /> <severity value="error" /> <human value="If a code for the unit is present, the system SHALL also be present" /> <expression value="code.empty() or system.exists()" /> <source value="http://hl7.org/fhir/StructureDefinition/Quantity" /> </constraint> <mustSupport value="false" /> <isModifier value="false" /> <isSummary value="false" /> <mapping> <identity value="rim" /> <map value="n/a" /> </mapping> <mapping> <identity value="v2" /> <map value="SN (see also Range) or CQ" /> </mapping> <mapping> <identity value="rim" /> <map value="PQ, IVL<PQ>, MO, CO, depending on the values" /> </mapping> </element> <element id="ClaimResponse.item.adjudication:eligible"> <extension url="http://hl7.org/fhir/StructureDefinition/structuredefinition-explicit-type-name"> <valueString value="Adjudication" /> </extension> <path value="ClaimResponse.item.adjudication" /> <sliceName value="eligible" /> <short value="Eligible amount" /> <definition value="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 value="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 value="1" /> <max value="1" /> <base> <path value="ClaimResponse.item.adjudication" /> <min value="0" /> <max value="*" /> </base> <type> <code value="BackboneElement" /> </type> <constraint> <key value="ele-1" /> <severity value="error" /> <human value="All FHIR elements must have a @value or children" /> <expression value="hasValue() or (children().count() > id.count())" /> <source value="http://hl7.org/fhir/StructureDefinition/Element" /> </constraint> <mustSupport value="true" /> <isModifier value="false" /> <isSummary value="false" /> <mapping> <identity value="rim" /> <map value="n/a" /> </mapping> </element> <element id="ClaimResponse.item.adjudication:eligible.id"> <path value="ClaimResponse.item.adjudication.id" /> <representation value="xmlAttr" /> <short value="Unique id for inter-element referencing" /> <definition value="Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces." /> <min value="0" /> <max value="1" /> <base> <path value="Element.id" /> <min value="0" /> <max value="1" /> </base> <type> <extension url="http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type"> <valueUrl value="string" /> </extension> <code value="http://hl7.org/fhirpath/System.String" /> </type> <condition value="ele-1" /> <mapping> <identity value="rim" /> <map value="n/a" /> </mapping> </element> <element id="ClaimResponse.item.adjudication:eligible.extension"> <path value="ClaimResponse.item.adjudication.extension" /> <slicing> <discriminator> <type value="value" /> <path value="url" /> </discriminator> <description value="Extensions are always sliced by (at least) url" /> <rules value="open" /> </slicing> <short value="Additional content defined by implementations" /> <definition value="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 value="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 value="extensions" /> <alias value="user content" /> <min value="0" /> <max value="*" /> <base> <path value="Element.extension" /> <min value="0" /> <max value="*" /> </base> <type> <code value="Extension" /> </type> <constraint> <key value="ele-1" /> <severity value="error" /> <human value="All FHIR elements must have a @value or children" /> <expression value="hasValue() or (children().count() > id.count())" /> <source value="http://hl7.org/fhir/StructureDefinition/Element" /> </constraint> <constraint> <key value="ext-1" /> <severity value="error" /> <human value="Must have either extensions or value[x], not both" /> <expression value="extension.exists() != value.exists()" /> <source value="http://hl7.org/fhir/StructureDefinition/Extension" /> </constraint> <mapping> <identity value="rim" /> <map value="n/a" /> </mapping> <mapping> <identity value="rim" /> <map value="N/A" /> </mapping> </element> <element id="ClaimResponse.item.adjudication:eligible.modifierExtension"> <path value="ClaimResponse.item.adjudication.modifierExtension" /> <short value="Extensions that cannot be ignored even if unrecognized" /> <definition value="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. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself)." /> <comment value="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 value="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 value="extensions" /> <alias value="user content" /> <alias value="modifiers" /> <min value="0" /> <max value="*" /> <base> <path value="BackboneElement.modifierExtension" /> <min value="0" /> <max value="*" /> </base> <type> <code value="Extension" /> </type> <constraint> <key value="ele-1" /> <severity value="error" /> <human value="All FHIR elements must have a @value or children" /> <expression value="hasValue() or (children().count() > id.count())" /> <source value="http://hl7.org/fhir/StructureDefinition/Element" /> </constraint> <constraint> <key value="ext-1" /> <severity value="error" /> <human value="Must have either extensions or value[x], not both" /> <expression value="extension.exists() != value.exists()" /> <source value="http://hl7.org/fhir/StructureDefinition/Extension" /> </constraint> <isModifier value="true" /> <isModifierReason value="Modifier extensions are expected to modify the meaning or interpretation of the element that contains them" /> <isSummary value="true" /> <mapping> <identity value="rim" /> <map value="n/a" /> </mapping> <mapping> <identity value="rim" /> <map value="N/A" /> </mapping> </element> <element id="ClaimResponse.item.adjudication:eligible.category"> <path value="ClaimResponse.item.adjudication.category" /> <short value="Type of adjudication information" /> <definition value="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 value="For example codes indicating: Co-Pay, deductible, eligible, benefit, tax, etc." /> <requirements value="Needed to enable understanding of the context of the other information in the adjudication." /> <min value="1" /> <max value="1" /> <base> <path value="ClaimResponse.item.adjudication.category" /> <min value="1" /> <max value="1" /> </base> <type> <code value="CodeableConcept" /> </type> <patternCodeableConcept> <coding> <system value="http://terminology.hl7.org/CodeSystem/adjudication" /> <code value="eligible" /> </coding> </patternCodeableConcept> <constraint> <key value="ele-1" /> <severity value="error" /> <human value="All FHIR elements must have a @value or children" /> <expression value="hasValue() or (children().count() > id.count())" /> <source value="http://hl7.org/fhir/StructureDefinition/Element" /> </constraint> <mustSupport value="false" /> <isModifier value="false" /> <isSummary value="false" /> <binding> <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName"> <valueString value="Adjudication" /> </extension> <strength value="example" /> <description value="The adjudication codes." /> <valueSet value="http://hl7.org/fhir/ValueSet/adjudication" /> </binding> <mapping> <identity value="rim" /> <map value="n/a" /> </mapping> <mapping> <identity value="v2" /> <map value="CE/CNE/CWE" /> </mapping> <mapping> <identity value="rim" /> <map value="CD" /> </mapping> <mapping> <identity value="orim" /> <map value="fhir:CodeableConcept rdfs:subClassOf dt:CD" /> </mapping> </element> <element id="ClaimResponse.item.adjudication:eligible.reason"> <path value="ClaimResponse.item.adjudication.reason" /> <short value="Explanation of adjudication outcome" /> <definition value="A code supporting the understanding of the adjudication result and explaining variance from expected amount." /> <comment value="For example may indicate that the funds for this benefit type have been exhausted." /> <requirements value="To support understanding of variance from adjudication expectations." /> <min value="0" /> <max value="1" /> <base> <path value="ClaimResponse.item.adjudication.reason" /> <min value="0" /> <max value="1" /> </base> <type> <code value="CodeableConcept" /> </type> <constraint> <key value="ele-1" /> <severity value="error" /> <human value="All FHIR elements must have a @value or children" /> <expression value="hasValue() or (children().count() > id.count())" /> <source value="http://hl7.org/fhir/StructureDefinition/Element" /> </constraint> <mustSupport value="false" /> <isModifier value="false" /> <isSummary value="false" /> <binding> <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName"> <valueString value="AdjudicationReason" /> </extension> <strength value="example" /> <description value="The adjudication reason codes." /> <valueSet value="http://hl7.org/fhir/ValueSet/adjudication-reason" /> </binding> <mapping> <identity value="rim" /> <map value="n/a" /> </mapping> <mapping> <identity value="v2" /> <map value="CE/CNE/CWE" /> </mapping> <mapping> <identity value="rim" /> <map value="CD" /> </mapping> <mapping> <identity value="orim" /> <map value="fhir:CodeableConcept rdfs:subClassOf dt:CD" /> </mapping> </element> <element id="ClaimResponse.item.adjudication:eligible.amount"> <path value="ClaimResponse.item.adjudication.amount" /> <short value="An amount of economic utility in some recognized currency" /> <definition value="An amount of economic utility in some recognized currency." /> <comment value="For example: amount submitted, eligible amount, co-payment, and benefit payable." /> <requirements value="Most adjudication categories convey a monetary amount." /> <min value="1" /> <max value="1" /> <base> <path value="ClaimResponse.item.adjudication.amount" /> <min value="0" /> <max value="1" /> </base> <type> <code value="Money" /> <profile value="https://bpcs.exchange/fhir/StructureDefinition/profile-Money-CAD-NonNeg" /> </type> <constraint> <key value="ele-1" /> <severity value="error" /> <human value="All FHIR elements must have a @value or children" /> <expression value="hasValue() or (children().count() > id.count())" /> <source value="http://hl7.org/fhir/StructureDefinition/Element" /> </constraint> <mustSupport value="true" /> <isModifier value="false" /> <isSummary value="false" /> <mapping> <identity value="rim" /> <map value="n/a" /> </mapping> <mapping> <identity value="rim" /> <map value="MO" /> </mapping> <mapping> <identity value="BPCS" /> <map value="ReceiptDTO.allowedRxExp" /> </mapping> </element> <element id="ClaimResponse.item.adjudication:eligible.quantity"> <path value="ClaimResponse.item.adjudication.quantity" /> <short value="Non-monetary value" /> <definition value="A non-monetary value associated with the category. Mutually exclusive to the amount element above." /> <comment value="For example: eligible percentage or co-payment percentage." /> <requirements value="Some adjudication categories convey a percentage or a fixed value." /> <min value="0" /> <max value="1" /> <base> <path value="ClaimResponse.item.adjudication.quantity" /> <min value="0" /> <max value="1" /> </base> <type> <code value="Quantity" /> </type> <constraint> <key value="ele-1" /> <severity value="error" /> <human value="All FHIR elements must have a @value or children" /> <expression value="hasValue() or (children().count() > id.count())" /> <source value="http://hl7.org/fhir/StructureDefinition/Element" /> </constraint> <constraint> <key value="qty-3" /> <severity value="error" /> <human value="If a code for the unit is present, the system SHALL also be present" /> <expression value="code.empty() or system.exists()" /> <source value="http://hl7.org/fhir/StructureDefinition/Quantity" /> </constraint> <mustSupport value="false" /> <isModifier value="false" /> <isSummary value="false" /> <mapping> <identity value="rim" /> <map value="n/a" /> </mapping> <mapping> <identity value="v2" /> <map value="SN (see also Range) or CQ" /> </mapping> <mapping> <identity value="rim" /> <map value="PQ, IVL<PQ>, MO, CO, depending on the values" /> </mapping> </element> <element id="ClaimResponse.item.adjudication:benefit"> <extension url="http://hl7.org/fhir/StructureDefinition/structuredefinition-explicit-type-name"> <valueString value="Adjudication" /> </extension> <path value="ClaimResponse.item.adjudication" /> <sliceName value="benefit" /> <short value="Benefit amount" /> <definition value="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 value="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 value="1" /> <max value="1" /> <base> <path value="ClaimResponse.item.adjudication" /> <min value="0" /> <max value="*" /> </base> <type> <code value="BackboneElement" /> </type> <constraint> <key value="ele-1" /> <severity value="error" /> <human value="All FHIR elements must have a @value or children" /> <expression value="hasValue() or (children().count() > id.count())" /> <source value="http://hl7.org/fhir/StructureDefinition/Element" /> </constraint> <mustSupport value="true" /> <isModifier value="false" /> <isSummary value="false" /> <mapping> <identity value="rim" /> <map value="n/a" /> </mapping> </element> <element id="ClaimResponse.item.adjudication:benefit.id"> <path value="ClaimResponse.item.adjudication.id" /> <representation value="xmlAttr" /> <short value="Unique id for inter-element referencing" /> <definition value="Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces." /> <min value="0" /> <max value="1" /> <base> <path value="Element.id" /> <min value="0" /> <max value="1" /> </base> <type> <extension url="http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type"> <valueUrl value="string" /> </extension> <code value="http://hl7.org/fhirpath/System.String" /> </type> <condition value="ele-1" /> <mapping> <identity value="rim" /> <map value="n/a" /> </mapping> </element> <element id="ClaimResponse.item.adjudication:benefit.extension"> <path value="ClaimResponse.item.adjudication.extension" /> <slicing> <discriminator> <type value="value" /> <path value="url" /> </discriminator> <description value="Extensions are always sliced by (at least) url" /> <rules value="open" /> </slicing> <short value="Additional content defined by implementations" /> <definition value="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 value="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 value="extensions" /> <alias value="user content" /> <min value="0" /> <max value="*" /> <base> <path value="Element.extension" /> <min value="0" /> <max value="*" /> </base> <type> <code value="Extension" /> </type> <constraint> <key value="ele-1" /> <severity value="error" /> <human value="All FHIR elements must have a @value or children" /> <expression value="hasValue() or (children().count() > id.count())" /> <source value="http://hl7.org/fhir/StructureDefinition/Element" /> </constraint> <constraint> <key value="ext-1" /> <severity value="error" /> <human value="Must have either extensions or value[x], not both" /> <expression value="extension.exists() != value.exists()" /> <source value="http://hl7.org/fhir/StructureDefinition/Extension" /> </constraint> <mapping> <identity value="rim" /> <map value="n/a" /> </mapping> <mapping> <identity value="rim" /> <map value="N/A" /> </mapping> </element> <element id="ClaimResponse.item.adjudication:benefit.modifierExtension"> <path value="ClaimResponse.item.adjudication.modifierExtension" /> <short value="Extensions that cannot be ignored even if unrecognized" /> <definition value="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. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself)." /> <comment value="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 value="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 value="extensions" /> <alias value="user content" /> <alias value="modifiers" /> <min value="0" /> <max value="*" /> <base> <path value="BackboneElement.modifierExtension" /> <min value="0" /> <max value="*" /> </base> <type> <code value="Extension" /> </type> <constraint> <key value="ele-1" /> <severity value="error" /> <human value="All FHIR elements must have a @value or children" /> <expression value="hasValue() or (children().count() > id.count())" /> <source value="http://hl7.org/fhir/StructureDefinition/Element" /> </constraint> <constraint> <key value="ext-1" /> <severity value="error" /> <human value="Must have either extensions or value[x], not both" /> <expression value="extension.exists() != value.exists()" /> <source value="http://hl7.org/fhir/StructureDefinition/Extension" /> </constraint> <isModifier value="true" /> <isModifierReason value="Modifier extensions are expected to modify the meaning or interpretation of the element that contains them" /> <isSummary value="true" /> <mapping> <identity value="rim" /> <map value="n/a" /> </mapping> <mapping> <identity value="rim" /> <map value="N/A" /> </mapping> </element> <element id="ClaimResponse.item.adjudication:benefit.category"> <path value="ClaimResponse.item.adjudication.category" /> <short value="Type of adjudication information" /> <definition value="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 value="For example codes indicating: Co-Pay, deductible, eligible, benefit, tax, etc." /> <requirements value="Needed to enable understanding of the context of the other information in the adjudication." /> <min value="1" /> <max value="1" /> <base> <path value="ClaimResponse.item.adjudication.category" /> <min value="1" /> <max value="1" /> </base> <type> <code value="CodeableConcept" /> </type> <patternCodeableConcept> <coding> <system value="http://terminology.hl7.org/CodeSystem/adjudication" /> <code value="benefit" /> </coding> </patternCodeableConcept> <constraint> <key value="ele-1" /> <severity value="error" /> <human value="All FHIR elements must have a @value or children" /> <expression value="hasValue() or (children().count() > id.count())" /> <source value="http://hl7.org/fhir/StructureDefinition/Element" /> </constraint> <mustSupport value="false" /> <isModifier value="false" /> <isSummary value="false" /> <binding> <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName"> <valueString value="Adjudication" /> </extension> <strength value="example" /> <description value="The adjudication codes." /> <valueSet value="http://hl7.org/fhir/ValueSet/adjudication" /> </binding> <mapping> <identity value="rim" /> <map value="n/a" /> </mapping> <mapping> <identity value="v2" /> <map value="CE/CNE/CWE" /> </mapping> <mapping> <identity value="rim" /> <map value="CD" /> </mapping> <mapping> <identity value="orim" /> <map value="fhir:CodeableConcept rdfs:subClassOf dt:CD" /> </mapping> </element> <element id="ClaimResponse.item.adjudication:benefit.reason"> <path value="ClaimResponse.item.adjudication.reason" /> <short value="Explanation of adjudication outcome" /> <definition value="A code supporting the understanding of the adjudication result and explaining variance from expected amount." /> <comment value="For example may indicate that the funds for this benefit type have been exhausted." /> <requirements value="To support understanding of variance from adjudication expectations." /> <min value="0" /> <max value="1" /> <base> <path value="ClaimResponse.item.adjudication.reason" /> <min value="0" /> <max value="1" /> </base> <type> <code value="CodeableConcept" /> </type> <constraint> <key value="ele-1" /> <severity value="error" /> <human value="All FHIR elements must have a @value or children" /> <expression value="hasValue() or (children().count() > id.count())" /> <source value="http://hl7.org/fhir/StructureDefinition/Element" /> </constraint> <mustSupport value="false" /> <isModifier value="false" /> <isSummary value="false" /> <binding> <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName"> <valueString value="AdjudicationReason" /> </extension> <strength value="example" /> <description value="The adjudication reason codes." /> <valueSet value="http://hl7.org/fhir/ValueSet/adjudication-reason" /> </binding> <mapping> <identity value="rim" /> <map value="n/a" /> </mapping> <mapping> <identity value="v2" /> <map value="CE/CNE/CWE" /> </mapping> <mapping> <identity value="rim" /> <map value="CD" /> </mapping> <mapping> <identity value="orim" /> <map value="fhir:CodeableConcept rdfs:subClassOf dt:CD" /> </mapping> </element> <element id="ClaimResponse.item.adjudication:benefit.amount"> <path value="ClaimResponse.item.adjudication.amount" /> <short value="An amount of economic utility in some recognized currency" /> <definition value="An amount of economic utility in some recognized currency." /> <comment value="For example: amount submitted, eligible amount, co-payment, and benefit payable." /> <requirements value="Most adjudication categories convey a monetary amount." /> <min value="1" /> <max value="1" /> <base> <path value="ClaimResponse.item.adjudication.amount" /> <min value="0" /> <max value="1" /> </base> <type> <code value="Money" /> <profile value="https://bpcs.exchange/fhir/StructureDefinition/profile-Money-CAD-NonNeg" /> </type> <constraint> <key value="ele-1" /> <severity value="error" /> <human value="All FHIR elements must have a @value or children" /> <expression value="hasValue() or (children().count() > id.count())" /> <source value="http://hl7.org/fhir/StructureDefinition/Element" /> </constraint> <mustSupport value="true" /> <isModifier value="false" /> <isSummary value="false" /> <mapping> <identity value="rim" /> <map value="n/a" /> </mapping> <mapping> <identity value="rim" /> <map value="MO" /> </mapping> <mapping> <identity value="BPCS" /> <map value="ReceiptDTO.reimbAmt" /> </mapping> </element> <element id="ClaimResponse.item.adjudication:benefit.quantity"> <path value="ClaimResponse.item.adjudication.quantity" /> <short value="Non-monetary value" /> <definition value="A non-monetary value associated with the category. Mutually exclusive to the amount element above." /> <comment value="For example: eligible percentage or co-payment percentage." /> <requirements value="Some adjudication categories convey a percentage or a fixed value." /> <min value="0" /> <max value="1" /> <base> <path value="ClaimResponse.item.adjudication.quantity" /> <min value="0" /> <max value="1" /> </base> <type> <code value="Quantity" /> </type> <constraint> <key value="ele-1" /> <severity value="error" /> <human value="All FHIR elements must have a @value or children" /> <expression value="hasValue() or (children().count() > id.count())" /> <source value="http://hl7.org/fhir/StructureDefinition/Element" /> </constraint> <constraint> <key value="qty-3" /> <severity value="error" /> <human value="If a code for the unit is present, the system SHALL also be present" /> <expression value="code.empty() or system.exists()" /> <source value="http://hl7.org/fhir/StructureDefinition/Quantity" /> </constraint> <mustSupport value="false" /> <isModifier value="false" /> <isSummary value="false" /> <mapping> <identity value="rim" /> <map value="n/a" /> </mapping> <mapping> <identity value="v2" /> <map value="SN (see also Range) or CQ" /> </mapping> <mapping> <identity value="rim" /> <map value="PQ, IVL<PQ>, MO, CO, depending on the values" /> </mapping> </element> <element id="ClaimResponse.item.detail"> <extension url="http://hl7.org/fhir/StructureDefinition/structuredefinition-explicit-type-name"> <valueString value="ItemDetail" /> </extension> <path value="ClaimResponse.item.detail" /> <short value="Adjudication for claim details" /> <definition value="A claim detail. Either a simple (a product or service) or a 'group' of sub-details which are simple items." /> <requirements value="The adjudication for details provided on the claim." /> <min value="0" /> <max value="*" /> <base> <path value="ClaimResponse.item.detail" /> <min value="0" /> <max value="*" /> </base> <type> <code value="BackboneElement" /> </type> <constraint> <key value="ele-1" /> <severity value="error" /> <human value="All FHIR elements must have a @value or children" /> <expression value="hasValue() or (children().count() > id.count())" /> <source value="http://hl7.org/fhir/StructureDefinition/Element" /> </constraint> <mustSupport value="false" /> <isModifier value="false" /> <isSummary value="false" /> <mapping> <identity value="rim" /> <map value="n/a" /> </mapping> </element> <element id="ClaimResponse.item.detail.id"> <path value="ClaimResponse.item.detail.id" /> <representation value="xmlAttr" /> <short value="Unique id for inter-element referencing" /> <definition value="Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces." /> <min value="0" /> <max value="1" /> <base> <path value="Element.id" /> <min value="0" /> <max value="1" /> </base> <type> <extension url="http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type"> <valueUrl value="string" /> </extension> <code value="http://hl7.org/fhirpath/System.String" /> </type> <condition value="ele-1" /> <mapping> <identity value="rim" /> <map value="n/a" /> </mapping> </element> <element id="ClaimResponse.item.detail.extension"> <path value="ClaimResponse.item.detail.extension" /> <slicing> <discriminator> <type value="value" /> <path value="url" /> </discriminator> <description value="Extensions are always sliced by (at least) url" /> <rules value="open" /> </slicing> <short value="Additional content defined by implementations" /> <definition value="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 value="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 value="extensions" /> <alias value="user content" /> <min value="0" /> <max value="*" /> <base> <path value="Element.extension" /> <min value="0" /> <max value="*" /> </base> <type> <code value="Extension" /> </type> <constraint> <key value="ele-1" /> <severity value="error" /> <human value="All FHIR elements must have a @value or children" /> <expression value="hasValue() or (children().count() > id.count())" /> <source value="http://hl7.org/fhir/StructureDefinition/Element" /> </constraint> <constraint> <key value="ext-1" /> <severity value="error" /> <human value="Must have either extensions or value[x], not both" /> <expression value="extension.exists() != value.exists()" /> <source value="http://hl7.org/fhir/StructureDefinition/Extension" /> </constraint> <mapping> <identity value="rim" /> <map value="n/a" /> </mapping> <mapping> <identity value="rim" /> <map value="N/A" /> </mapping> </element> <element id="ClaimResponse.item.detail.modifierExtension"> <path value="ClaimResponse.item.detail.modifierExtension" /> <short value="Extensions that cannot be ignored even if unrecognized" /> <definition value="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. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself)." /> <comment value="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 value="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 value="extensions" /> <alias value="user content" /> <alias value="modifiers" /> <min value="0" /> <max value="*" /> <base> <path value="BackboneElement.modifierExtension" /> <min value="0" /> <max value="*" /> </base> <type> <code value="Extension" /> </type> <constraint> <key value="ele-1" /> <severity value="error" /> <human value="All FHIR elements must have a @value or children" /> <expression value="hasValue() or (children().count() > id.count())" /> <source value="http://hl7.org/fhir/StructureDefinition/Element" /> </constraint> <constraint> <key value="ext-1" /> <severity value="error" /> <human value="Must have either extensions or value[x], not both" /> <expression value="extension.exists() != value.exists()" /> <source value="http://hl7.org/fhir/StructureDefinition/Extension" /> </constraint> <isModifier value="true" /> <isModifierReason value="Modifier extensions are expected to modify the meaning or interpretation of the element that contains them" /> <isSummary value="true" /> <mapping> <identity value="rim" /> <map value="n/a" /> </mapping> <mapping> <identity value="rim" /> <map value="N/A" /> </mapping> </element> <element id="ClaimResponse.item.detail.detailSequence"> <path value="ClaimResponse.item.detail.detailSequence" /> <short value="Claim detail instance identifier" /> <definition value="A number to uniquely reference the claim detail entry." /> <comment value="32 bit number; for values larger than this, use decimal" /> <requirements value="Necessary to provide a mechanism to link the adjudication result to the submitted claim detail." /> <min value="1" /> <max value="1" /> <base> <path value="ClaimResponse.item.detail.detailSequence" /> <min value="1" /> <max value="1" /> </base> <type> <code value="positiveInt" /> </type> <constraint> <key value="ele-1" /> <severity value="error" /> <human value="All FHIR elements must have a @value or children" /> <expression value="hasValue() or (children().count() > id.count())" /> <source value="http://hl7.org/fhir/StructureDefinition/Element" /> </constraint> <mustSupport value="false" /> <isModifier value="false" /> <isSummary value="false" /> <mapping> <identity value="rim" /> <map value="n/a" /> </mapping> </element> <element id="ClaimResponse.item.detail.traceNumber"> <path value="ClaimResponse.item.detail.traceNumber" /> <short value="Number for tracking" /> <definition value="Trace number for tracking purposes. May be defined at the jurisdiction level or between trading partners." /> <comment value="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 value="Allows partners to uniquely identify components for tracking." /> <min value="0" /> <max value="*" /> <base> <path value="ClaimResponse.item.detail.traceNumber" /> <min value="0" /> <max value="*" /> </base> <type> <code value="Identifier" /> </type> <constraint> <key value="ele-1" /> <severity value="error" /> <human value="All FHIR elements must have a @value or children" /> <expression value="hasValue() or (children().count() > id.count())" /> <source value="http://hl7.org/fhir/StructureDefinition/Element" /> </constraint> <constraint> <key value="ident-1" /> <severity value="warning" /> <human value="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="value.exists()" /> <source value="http://hl7.org/fhir/StructureDefinition/Identifier" /> </constraint> <mustSupport value="false" /> <isModifier value="false" /> <isSummary value="false" /> <mapping> <identity value="rim" /> <map value="n/a" /> </mapping> <mapping> <identity value="v2" /> <map value="CX / EI (occasionally, more often EI maps to a resource id or a URL)" /> </mapping> <mapping> <identity value="rim" /> <map value="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]" /> </mapping> <mapping> <identity value="servd" /> <map value="Identifier" /> </mapping> </element> <element id="ClaimResponse.item.detail.noteNumber"> <path value="ClaimResponse.item.detail.noteNumber" /> <short value="Applicable note numbers" /> <definition value="The numbers associated with notes below which apply to the adjudication of this item." /> <comment value="32 bit number; for values larger than this, use decimal" /> <requirements value="Provides a condensed manner for associating human readable descriptive explanations for adjudications on the line item." /> <min value="0" /> <max value="*" /> <base> <path value="ClaimResponse.item.detail.noteNumber" /> <min value="0" /> <max value="*" /> </base> <type> <code value="positiveInt" /> </type> <constraint> <key value="ele-1" /> <severity value="error" /> <human value="All FHIR elements must have a @value or children" /> <expression value="hasValue() or (children().count() > id.count())" /> <source value="http://hl7.org/fhir/StructureDefinition/Element" /> </constraint> <mustSupport value="false" /> <isModifier value="false" /> <isSummary value="false" /> <mapping> <identity value="rim" /> <map value="n/a" /> </mapping> </element> <element id="ClaimResponse.item.detail.reviewOutcome"> <path value="ClaimResponse.item.detail.reviewOutcome" /> <short value="Detail level adjudication results" /> <definition value="The high-level results of the adjudication if adjudication has been performed." /> <min value="0" /> <max value="1" /> <base> <path value="ClaimResponse.item.detail.reviewOutcome" /> <min value="0" /> <max value="1" /> </base> <contentReference value="#ClaimResponse.item.reviewOutcome" /> <mustSupport value="false" /> <isModifier value="false" /> <isSummary value="false" /> </element> <element id="ClaimResponse.item.detail.adjudication"> <path value="ClaimResponse.item.detail.adjudication" /> <short value="Detail level adjudication details" /> <definition value="The adjudication results." /> <min value="0" /> <max value="*" /> <base> <path value="ClaimResponse.item.detail.adjudication" /> <min value="0" /> <max value="*" /> </base> <contentReference value="#ClaimResponse.item.adjudication" /> <mustSupport value="false" /> <isModifier value="false" /> <isSummary value="false" /> </element> <element id="ClaimResponse.item.detail.subDetail"> <extension url="http://hl7.org/fhir/StructureDefinition/structuredefinition-explicit-type-name"> <valueString value="SubDetail" /> </extension> <path value="ClaimResponse.item.detail.subDetail" /> <short value="Adjudication for claim sub-details" /> <definition value="A sub-detail adjudication of a simple product or service." /> <requirements value="The adjudication for sub-details provided on the claim." /> <min value="0" /> <max value="*" /> <base> <path value="ClaimResponse.item.detail.subDetail" /> <min value="0" /> <max value="*" /> </base> <type> <code value="BackboneElement" /> </type> <constraint> <key value="ele-1" /> <severity value="error" /> <human value="All FHIR elements must have a @value or children" /> <expression value="hasValue() or (children().count() > id.count())" /> <source value="http://hl7.org/fhir/StructureDefinition/Element" /> </constraint> <mustSupport value="false" /> <isModifier value="false" /> <isSummary value="false" /> <mapping> <identity value="rim" /> <map value="n/a" /> </mapping> </element> <element id="ClaimResponse.item.detail.subDetail.id"> <path value="ClaimResponse.item.detail.subDetail.id" /> <representation value="xmlAttr" /> <short value="Unique id for inter-element referencing" /> <definition value="Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces." /> <min value="0" /> <max value="1" /> <base> <path value="Element.id" /> <min value="0" /> <max value="1" /> </base> <type> <extension url="http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type"> <valueUrl value="string" /> </extension> <code value="http://hl7.org/fhirpath/System.String" /> </type> <condition value="ele-1" /> <mapping> <identity value="rim" /> <map value="n/a" /> </mapping> </element> <element id="ClaimResponse.item.detail.subDetail.extension"> <path value="ClaimResponse.item.detail.subDetail.extension" /> <slicing> <discriminator> <type value="value" /> <path value="url" /> </discriminator> <description value="Extensions are always sliced by (at least) url" /> <rules value="open" /> </slicing> <short value="Additional content defined by implementations" /> <definition value="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 value="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 value="extensions" /> <alias value="user content" /> <min value="0" /> <max value="*" /> <base> <path value="Element.extension" /> <min value="0" /> <max value="*" /> </base> <type> <code value="Extension" /> </type> <constraint> <key value="ele-1" /> <severity value="error" /> <human value="All FHIR elements must have a @value or children" /> <expression value="hasValue() or (children().count() > id.count())" /> <source value="http://hl7.org/fhir/StructureDefinition/Element" /> </constraint> <constraint> <key value="ext-1" /> <severity value="error" /> <human value="Must have either extensions or value[x], not both" /> <expression value="extension.exists() != value.exists()" /> <source value="http://hl7.org/fhir/StructureDefinition/Extension" /> </constraint> <mapping> <identity value="rim" /> <map value="n/a" /> </mapping> <mapping> <identity value="rim" /> <map value="N/A" /> </mapping> </element> <element id="ClaimResponse.item.detail.subDetail.modifierExtension"> <path value="ClaimResponse.item.detail.subDetail.modifierExtension" /> <short value="Extensions that cannot be ignored even if unrecognized" /> <definition value="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. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself)." /> <comment value="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 value="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 value="extensions" /> <alias value="user content" /> <alias value="modifiers" /> <min value="0" /> <max value="*" /> <base> <path value="BackboneElement.modifierExtension" /> <min value="0" /> <max value="*" /> </base> <type> <code value="Extension" /> </type> <constraint> <key value="ele-1" /> <severity value="error" /> <human value="All FHIR elements must have a @value or children" /> <expression value="hasValue() or (children().count() > id.count())" /> <source value="http://hl7.org/fhir/StructureDefinition/Element" /> </constraint> <constraint> <key value="ext-1" /> <severity value="error" /> <human value="Must have either extensions or value[x], not both" /> <expression value="extension.exists() != value.exists()" /> <source value="http://hl7.org/fhir/StructureDefinition/Extension" /> </constraint> <isModifier value="true" /> <isModifierReason value="Modifier extensions are expected to modify the meaning or interpretation of the element that contains them" /> <isSummary value="true" /> <mapping> <identity value="rim" /> <map value="n/a" /> </mapping> <mapping> <identity value="rim" /> <map value="N/A" /> </mapping> </element> <element id="ClaimResponse.item.detail.subDetail.subDetailSequence"> <path value="ClaimResponse.item.detail.subDetail.subDetailSequence" /> <short value="Claim sub-detail instance identifier" /> <definition value="A number to uniquely reference the claim sub-detail entry." /> <comment value="32 bit number; for values larger than this, use decimal" /> <requirements value="Necessary to provide a mechanism to link the adjudication result to the submitted claim sub-detail." /> <min value="1" /> <max value="1" /> <base> <path value="ClaimResponse.item.detail.subDetail.subDetailSequence" /> <min value="1" /> <max value="1" /> </base> <type> <code value="positiveInt" /> </type> <constraint> <key value="ele-1" /> <severity value="error" /> <human value="All FHIR elements must have a @value or children" /> <expression value="hasValue() or (children().count() > id.count())" /> <source value="http://hl7.org/fhir/StructureDefinition/Element" /> </constraint> <mustSupport value="false" /> <isModifier value="false" /> <isSummary value="false" /> <mapping> <identity value="rim" /> <map value="n/a" /> </mapping> </element> <element id="ClaimResponse.item.detail.subDetail.traceNumber"> <path value="ClaimResponse.item.detail.subDetail.traceNumber" /> <short value="Number for tracking" /> <definition value="Trace number for tracking purposes. May be defined at the jurisdiction level or between trading partners." /> <comment value="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 value="Allows partners to uniquely identify components for tracking." /> <min value="0" /> <max value="*" /> <base> <path value="ClaimResponse.item.detail.subDetail.traceNumber" /> <min value="0" /> <max value="*" /> </base> <type> <code value="Identifier" /> </type> <constraint> <key value="ele-1" /> <severity value="error" /> <human value="All FHIR elements must have a @value or children" /> <expression value="hasValue() or (children().count() > id.count())" /> <source value="http://hl7.org/fhir/StructureDefinition/Element" /> </constraint> <constraint> <key value="ident-1" /> <severity value="warning" /> <human value="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="value.exists()" /> <source value="http://hl7.org/fhir/StructureDefinition/Identifier" /> </constraint> <mustSupport value="false" /> <isModifier value="false" /> <isSummary value="false" /> <mapping> <identity value="rim" /> <map value="n/a" /> </mapping> <mapping> <identity value="v2" /> <map value="CX / EI (occasionally, more often EI maps to a resource id or a URL)" /> </mapping> <mapping> <identity value="rim" /> <map value="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]" /> </mapping> <mapping> <identity value="servd" /> <map value="Identifier" /> </mapping> </element> <element id="ClaimResponse.item.detail.subDetail.noteNumber"> <path value="ClaimResponse.item.detail.subDetail.noteNumber" /> <short value="Applicable note numbers" /> <definition value="The numbers associated with notes below which apply to the adjudication of this item." /> <comment value="32 bit number; for values larger than this, use decimal" /> <requirements value="Provides a condensed manner for associating human readable descriptive explanations for adjudications on the line item." /> <min value="0" /> <max value="*" /> <base> <path value="ClaimResponse.item.detail.subDetail.noteNumber" /> <min value="0" /> <max value="*" /> </base> <type> <code value="positiveInt" /> </type> <constraint> <key value="ele-1" /> <severity value="error" /> <human value="All FHIR elements must have a @value or children" /> <expression value="hasValue() or (children().count() > id.count())" /> <source value="http://hl7.org/fhir/StructureDefinition/Element" /> </constraint> <mustSupport value="false" /> <isModifier value="false" /> <isSummary value="false" /> <mapping> <identity value="rim" /> <map value="n/a" /> </mapping> </element> <element id="ClaimResponse.item.detail.subDetail.reviewOutcome"> <path value="ClaimResponse.item.detail.subDetail.reviewOutcome" /> <short value="Subdetail level adjudication results" /> <definition value="The high-level results of the adjudication if adjudication has been performed." /> <min value="0" /> <max value="1" /> <base> <path value="ClaimResponse.item.detail.subDetail.reviewOutcome" /> <min value="0" /> <max value="1" /> </base> <contentReference value="#ClaimResponse.item.reviewOutcome" /> <mustSupport value="false" /> <isModifier value="false" /> <isSummary value="false" /> </element> <element id="ClaimResponse.item.detail.subDetail.adjudication"> <path value="ClaimResponse.item.detail.subDetail.adjudication" /> <short value="Subdetail level adjudication details" /> <definition value="The adjudication results." /> <min value="0" /> <max value="*" /> <base> <path value="ClaimResponse.item.detail.subDetail.adjudication" /> <min value="0" /> <max value="*" /> </base> <contentReference value="#ClaimResponse.item.adjudication" /> <mustSupport value="false" /> <isModifier value="false" /> <isSummary value="false" /> </element> <element id="ClaimResponse.addItem"> <extension url="http://hl7.org/fhir/StructureDefinition/structuredefinition-explicit-type-name"> <valueString value="AddedItem" /> </extension> <path value="ClaimResponse.addItem" /> <short value="Insurer added line items" /> <definition value="The first-tier service adjudications for payor added product or service lines." /> <requirements value="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 value="0" /> <max value="*" /> <base> <path value="ClaimResponse.addItem" /> <min value="0" /> <max value="*" /> </base> <type> <code value="BackboneElement" /> </type> <constraint> <key value="ele-1" /> <severity value="error" /> <human value="All FHIR elements must have a @value or children" /> <expression value="hasValue() or (children().count() > id.count())" /> <source value="http://hl7.org/fhir/StructureDefinition/Element" /> </constraint> <mustSupport value="false" /> <isModifier value="false" /> <isSummary value="false" /> <mapping> <identity value="rim" /> <map value="n/a" /> </mapping> </element> <element id="ClaimResponse.addItem.id"> <path value="ClaimResponse.addItem.id" /> <representation value="xmlAttr" /> <short value="Unique id for inter-element referencing" /> <definition value="Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces." /> <min value="0" /> <max value="1" /> <base> <path value="Element.id" /> <min value="0" /> <max value="1" /> </base> <type> <extension url="http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type"> <valueUrl value="string" /> </extension> <code value="http://hl7.org/fhirpath/System.String" /> </type> <condition value="ele-1" /> <mapping> <identity value="rim" /> <map value="n/a" /> </mapping> </element> <element id="ClaimResponse.addItem.extension"> <path value="ClaimResponse.addItem.extension" /> <slicing> <discriminator> <type value="value" /> <path value="url" /> </discriminator> <description value="Extensions are always sliced by (at least) url" /> <rules value="open" /> </slicing> <short value="Additional content defined by implementations" /> <definition value="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 value="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 value="extensions" /> <alias value="user content" /> <min value="0" /> <max value="*" /> <base> <path value="Element.extension" /> <min value="0" /> <max value="*" /> </base> <type> <code value="Extension" /> </type> <constraint> <key value="ele-1" /> <severity value="error" /> <human value="All FHIR elements must have a @value or children" /> <expression value="hasValue() or (children().count() > id.count())" /> <source value="http://hl7.org/fhir/StructureDefinition/Element" /> </constraint> <constraint> <key value="ext-1" /> <severity value="error" /> <human value="Must have either extensions or value[x], not both" /> <expression value="extension.exists() != value.exists()" /> <source value="http://hl7.org/fhir/StructureDefinition/Extension" /> </constraint> <mapping> <identity value="rim" /> <map value="n/a" /> </mapping> <mapping> <identity value="rim" /> <map value="N/A" /> </mapping> </element> <element id="ClaimResponse.addItem.modifierExtension"> <path value="ClaimResponse.addItem.modifierExtension" /> <short value="Extensions that cannot be ignored even if unrecognized" /> <definition value="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. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself)." /> <comment value="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 value="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 value="extensions" /> <alias value="user content" /> <alias value="modifiers" /> <min value="0" /> <max value="*" /> <base> <path value="BackboneElement.modifierExtension" /> <min value="0" /> <max value="*" /> </base> <type> <code value="Extension" /> </type> <constraint> <key value="ele-1" /> <severity value="error" /> <human value="All FHIR elements must have a @value or children" /> <expression value="hasValue() or (children().count() > id.count())" /> <source value="http://hl7.org/fhir/StructureDefinition/Element" /> </constraint> <constraint> <key value="ext-1" /> <severity value="error" /> <human value="Must have either extensions or value[x], not both" /> <expression value="extension.exists() != value.exists()" /> <source value="http://hl7.org/fhir/StructureDefinition/Extension" /> </constraint> <isModifier value="true" /> <isModifierReason value="Modifier extensions are expected to modify the meaning or interpretation of the element that contains them" /> <isSummary value="true" /> <mapping> <identity value="rim" /> <map value="n/a" /> </mapping> <mapping> <identity value="rim" /> <map value="N/A" /> </mapping> </element> <element id="ClaimResponse.addItem.itemSequence"> <path value="ClaimResponse.addItem.itemSequence" /> <short value="Item sequence number" /> <definition value="Claim items which this service line is intended to replace." /> <comment value="32 bit number; for values larger than this, use decimal" /> <requirements value="Provides references to the claim items." /> <min value="0" /> <max value="*" /> <base> <path value="ClaimResponse.addItem.itemSequence" /> <min value="0" /> <max value="*" /> </base> <type> <code value="positiveInt" /> </type> <constraint> <key value="ele-1" /> <severity value="error" /> <human value="All FHIR elements must have a @value or children" /> <expression value="hasValue() or (children().count() > id.count())" /> <source value="http://hl7.org/fhir/StructureDefinition/Element" /> </constraint> <mustSupport value="false" /> <isModifier value="false" /> <isSummary value="false" /> <mapping> <identity value="rim" /> <map value="n/a" /> </mapping> </element> <element id="ClaimResponse.addItem.detailSequence"> <path value="ClaimResponse.addItem.detailSequence" /> <short value="Detail sequence number" /> <definition value="The sequence number of the details within the claim item which this line is intended to replace." /> <comment value="32 bit number; for values larger than this, use decimal" /> <requirements value="Provides references to the claim details within the claim item." /> <min value="0" /> <max value="*" /> <base> <path value="ClaimResponse.addItem.detailSequence" /> <min value="0" /> <max value="*" /> </base> <type> <code value="positiveInt" /> </type> <constraint> <key value="ele-1" /> <severity value="error" /> <human value="All FHIR elements must have a @value or children" /> <expression value="hasValue() or (children().count() > id.count())" /> <source value="http://hl7.org/fhir/StructureDefinition/Element" /> </constraint> <mustSupport value="false" /> <isModifier value="false" /> <isSummary value="false" /> <mapping> <identity value="rim" /> <map value="n/a" /> </mapping> </element> <element id="ClaimResponse.addItem.subdetailSequence"> <path value="ClaimResponse.addItem.subdetailSequence" /> <short value="Subdetail sequence number" /> <definition value="The sequence number of the sub-details within the details within the claim item which this line is intended to replace." /> <comment value="32 bit number; for values larger than this, use decimal" /> <requirements value="Provides references to the claim sub-details within the claim detail." /> <min value="0" /> <max value="*" /> <base> <path value="ClaimResponse.addItem.subdetailSequence" /> <min value="0" /> <max value="*" /> </base> <type> <code value="positiveInt" /> </type> <constraint> <key value="ele-1" /> <severity value="error" /> <human value="All FHIR elements must have a @value or children" /> <expression value="hasValue() or (children().count() > id.count())" /> <source value="http://hl7.org/fhir/StructureDefinition/Element" /> </constraint> <mustSupport value="false" /> <isModifier value="false" /> <isSummary value="false" /> <mapping> <identity value="rim" /> <map value="n/a" /> </mapping> </element> <element id="ClaimResponse.addItem.traceNumber"> <path value="ClaimResponse.addItem.traceNumber" /> <short value="Number for tracking" /> <definition value="Trace number for tracking purposes. May be defined at the jurisdiction level or between trading partners." /> <comment value="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 value="Allows partners to uniquely identify components for tracking." /> <min value="0" /> <max value="*" /> <base> <path value="ClaimResponse.addItem.traceNumber" /> <min value="0" /> <max value="*" /> </base> <type> <code value="Identifier" /> </type> <constraint> <key value="ele-1" /> <severity value="error" /> <human value="All FHIR elements must have a @value or children" /> <expression value="hasValue() or (children().count() > id.count())" /> <source value="http://hl7.org/fhir/StructureDefinition/Element" /> </constraint> <constraint> <key value="ident-1" /> <severity value="warning" /> <human value="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="value.exists()" /> <source value="http://hl7.org/fhir/StructureDefinition/Identifier" /> </constraint> <mustSupport value="false" /> <isModifier value="false" /> <isSummary value="false" /> <mapping> <identity value="rim" /> <map value="n/a" /> </mapping> <mapping> <identity value="v2" /> <map value="CX / EI (occasionally, more often EI maps to a resource id or a URL)" /> </mapping> <mapping> <identity value="rim" /> <map value="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]" /> </mapping> <mapping> <identity value="servd" /> <map value="Identifier" /> </mapping> </element> <element id="ClaimResponse.addItem.provider"> <path value="ClaimResponse.addItem.provider" /> <short value="Authorized providers" /> <definition value="The providers who are authorized for the services rendered to the patient." /> <comment value="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 value="Insurer may provide authorization specifically to a restricted set of providers rather than an open authorization." /> <min value="0" /> <max value="*" /> <base> <path value="ClaimResponse.addItem.provider" /> <min value="0" /> <max value="*" /> </base> <type> <code value="Reference" /> <targetProfile value="http://hl7.org/fhir/StructureDefinition/Practitioner" /> <targetProfile value="http://hl7.org/fhir/StructureDefinition/PractitionerRole" /> <targetProfile value="http://hl7.org/fhir/StructureDefinition/Organization" /> </type> <constraint> <key value="ele-1" /> <severity value="error" /> <human value="All FHIR elements must have a @value or children" /> <expression value="hasValue() or (children().count() > id.count())" /> <source value="http://hl7.org/fhir/StructureDefinition/Element" /> </constraint> <constraint> <key value="ref-1" /> <severity value="error" /> <human value="SHALL have a contained resource if a local reference is provided" /> <expression value="reference.exists() implies (reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids')) or (reference='#' and %rootResource!=%resource))" /> <source value="http://hl7.org/fhir/StructureDefinition/Reference" /> </constraint> <constraint> <key value="ref-2" /> <severity value="error" /> <human value="At least one of reference, identifier and display SHALL be present (unless an extension is provided)." /> <expression value="reference.exists() or identifier.exists() or display.exists() or extension.exists()" /> <source value="http://hl7.org/fhir/StructureDefinition/Reference" /> </constraint> <mustSupport value="false" /> <isModifier value="false" /> <isSummary value="false" /> <mapping> <identity value="rim" /> <map value="n/a" /> </mapping> <mapping> <identity value="rim" /> <map value="The target of a resource reference is a RIM entry point (Act, Role, or Entity)" /> </mapping> <mapping> <identity value="w5" /> <map value="FiveWs.source" /> </mapping> </element> <element id="ClaimResponse.addItem.revenue"> <path value="ClaimResponse.addItem.revenue" /> <short value="Revenue or cost center code" /> <definition value="The type of revenue or cost center providing the product and/or service." /> <comment value="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 value="Needed in the processing of institutional claims." /> <min value="0" /> <max value="1" /> <base> <path value="ClaimResponse.addItem.revenue" /> <min value="0" /> <max value="1" /> </base> <type> <code value="CodeableConcept" /> </type> <constraint> <key value="ele-1" /> <severity value="error" /> <human value="All FHIR elements must have a @value or children" /> <expression value="hasValue() or (children().count() > id.count())" /> <source value="http://hl7.org/fhir/StructureDefinition/Element" /> </constraint> <mustSupport value="false" /> <isModifier value="false" /> <isSummary value="false" /> <binding> <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName"> <valueString value="RevenueCenter" /> </extension> <strength value="example" /> <description value="Codes for the revenue or cost centers supplying the service and/or products." /> <valueSet value="http://hl7.org/fhir/ValueSet/ex-revenue-center" /> </binding> <mapping> <identity value="rim" /> <map value="n/a" /> </mapping> <mapping> <identity value="v2" /> <map value="CE/CNE/CWE" /> </mapping> <mapping> <identity value="rim" /> <map value="CD" /> </mapping> <mapping> <identity value="orim" /> <map value="fhir:CodeableConcept rdfs:subClassOf dt:CD" /> </mapping> </element> <element id="ClaimResponse.addItem.productOrService"> <path value="ClaimResponse.addItem.productOrService" /> <short value="Billing, service, product, or drug code" /> <definition value="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 value="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 value="Necessary to state what was provided or done." /> <min value="0" /> <max value="1" /> <base> <path value="ClaimResponse.addItem.productOrService" /> <min value="0" /> <max value="1" /> </base> <type> <code value="CodeableConcept" /> </type> <constraint> <key value="ele-1" /> <severity value="error" /> <human value="All FHIR elements must have a @value or children" /> <expression value="hasValue() or (children().count() > id.count())" /> <source value="http://hl7.org/fhir/StructureDefinition/Element" /> </constraint> <mustSupport value="false" /> <isModifier value="false" /> <isSummary value="false" /> <binding> <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName"> <valueString value="ServiceProduct" /> </extension> <strength value="example" /> <description value="Allowable service and product codes." /> <valueSet value="http://hl7.org/fhir/ValueSet/service-uscls" /> </binding> <mapping> <identity value="rim" /> <map value="n/a" /> </mapping> <mapping> <identity value="v2" /> <map value="CE/CNE/CWE" /> </mapping> <mapping> <identity value="rim" /> <map value="CD" /> </mapping> <mapping> <identity value="orim" /> <map value="fhir:CodeableConcept rdfs:subClassOf dt:CD" /> </mapping> </element> <element id="ClaimResponse.addItem.productOrServiceEnd"> <path value="ClaimResponse.addItem.productOrServiceEnd" /> <short value="End of a range of codes" /> <definition value="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 value="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 value="End of a range of Drug Code; Bill Code; Service Cod" /> <min value="0" /> <max value="1" /> <base> <path value="ClaimResponse.addItem.productOrServiceEnd" /> <min value="0" /> <max value="1" /> </base> <type> <code value="CodeableConcept" /> </type> <constraint> <key value="ele-1" /> <severity value="error" /> <human value="All FHIR elements must have a @value or children" /> <expression value="hasValue() or (children().count() > id.count())" /> <source value="http://hl7.org/fhir/StructureDefinition/Element" /> </constraint> <mustSupport value="false" /> <isModifier value="false" /> <isSummary value="false" /> <binding> <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName"> <valueString value="ServiceProduct" /> </extension> <strength value="example" /> <valueSet value="http://hl7.org/fhir/ValueSet/service-uscls" /> </binding> <mapping> <identity value="rim" /> <map value="n/a" /> </mapping> <mapping> <identity value="v2" /> <map value="CE/CNE/CWE" /> </mapping> <mapping> <identity value="rim" /> <map value="CD" /> </mapping> <mapping> <identity value="orim" /> <map value="fhir:CodeableConcept rdfs:subClassOf dt:CD" /> </mapping> </element> <element id="ClaimResponse.addItem.request"> <path value="ClaimResponse.addItem.request" /> <short value="Request or Referral for Service" /> <definition value="Request or Referral for Goods or Service to be rendered." /> <comment value="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 value="May identify the service to be provided or provider authorization for the service." /> <min value="0" /> <max value="*" /> <base> <path value="ClaimResponse.addItem.request" /> <min value="0" /> <max value="*" /> </base> <type> <code value="Reference" /> <targetProfile value="http://hl7.org/fhir/StructureDefinition/DeviceRequest" /> <targetProfile value="http://hl7.org/fhir/StructureDefinition/MedicationRequest" /> <targetProfile value="http://hl7.org/fhir/StructureDefinition/NutritionOrder" /> <targetProfile value="http://hl7.org/fhir/StructureDefinition/ServiceRequest" /> <targetProfile value="http://hl7.org/fhir/StructureDefinition/SupplyRequest" /> <targetProfile value="http://hl7.org/fhir/StructureDefinition/VisionPrescription" /> </type> <constraint> <key value="ele-1" /> <severity value="error" /> <human value="All FHIR elements must have a @value or children" /> <expression value="hasValue() or (children().count() > id.count())" /> <source value="http://hl7.org/fhir/StructureDefinition/Element" /> </constraint> <constraint> <key value="ref-1" /> <severity value="error" /> <human value="SHALL have a contained resource if a local reference is provided" /> <expression value="reference.exists() implies (reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids')) or (reference='#' and %rootResource!=%resource))" /> <source value="http://hl7.org/fhir/StructureDefinition/Reference" /> </constraint> <constraint> <key value="ref-2" /> <severity value="error" /> <human value="At least one of reference, identifier and display SHALL be present (unless an extension is provided)." /> <expression value="reference.exists() or identifier.exists() or display.exists() or extension.exists()" /> <source value="http://hl7.org/fhir/StructureDefinition/Reference" /> </constraint> <mustSupport value="false" /> <isModifier value="false" /> <isSummary value="false" /> <mapping> <identity value="rim" /> <map value="n/a" /> </mapping> <mapping> <identity value="rim" /> <map value="The target of a resource reference is a RIM entry point (Act, Role, or Entity)" /> </mapping> </element> <element id="ClaimResponse.addItem.modifier"> <path value="ClaimResponse.addItem.modifier" /> <short value="Service/Product billing modifiers" /> <definition value="Item typification or modifiers codes to convey additional context for the product or service." /> <comment value="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 value="To support inclusion of the item for adjudication or to charge an elevated fee." /> <min value="0" /> <max value="*" /> <base> <path value="ClaimResponse.addItem.modifier" /> <min value="0" /> <max value="*" /> </base> <type> <code value="CodeableConcept" /> </type> <constraint> <key value="ele-1" /> <severity value="error" /> <human value="All FHIR elements must have a @value or children" /> <expression value="hasValue() or (children().count() > id.count())" /> <source value="http://hl7.org/fhir/StructureDefinition/Element" /> </constraint> <mustSupport value="false" /> <isModifier value="false" /> <isSummary value="false" /> <binding> <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName"> <valueString value="Modifiers" /> </extension> <strength value="example" /> <description value="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 value="http://hl7.org/fhir/ValueSet/claim-modifiers" /> </binding> <mapping> <identity value="rim" /> <map value="n/a" /> </mapping> <mapping> <identity value="v2" /> <map value="CE/CNE/CWE" /> </mapping> <mapping> <identity value="rim" /> <map value="CD" /> </mapping> <mapping> <identity value="orim" /> <map value="fhir:CodeableConcept rdfs:subClassOf dt:CD" /> </mapping> <mapping> <identity value="rim" /> <map value="24.C, 24.D mods" /> </mapping> </element> <element id="ClaimResponse.addItem.programCode"> <path value="ClaimResponse.addItem.programCode" /> <short value="Program the product or service is provided under" /> <definition value="Identifies the program under which this may be recovered." /> <comment value="For example: Neonatal program, child dental program or drug users recovery program." /> <requirements value="Commonly used in in the identification of publicly provided program focused on population segments or disease classifications." /> <min value="0" /> <max value="*" /> <base> <path value="ClaimResponse.addItem.programCode" /> <min value="0" /> <max value="*" /> </base> <type> <code value="CodeableConcept" /> </type> <constraint> <key value="ele-1" /> <severity value="error" /> <human value="All FHIR elements must have a @value or children" /> <expression value="hasValue() or (children().count() > id.count())" /> <source value="http://hl7.org/fhir/StructureDefinition/Element" /> </constraint> <mustSupport value="false" /> <isModifier value="false" /> <isSummary value="false" /> <binding> <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName"> <valueString value="ProgramCode" /> </extension> <strength value="example" /> <description value="Program specific reason codes." /> <valueSet value="http://hl7.org/fhir/ValueSet/ex-program-code" /> </binding> <mapping> <identity value="rim" /> <map value="n/a" /> </mapping> <mapping> <identity value="v2" /> <map value="CE/CNE/CWE" /> </mapping> <mapping> <identity value="rim" /> <map value="CD" /> </mapping> <mapping> <identity value="orim" /> <map value="fhir:CodeableConcept rdfs:subClassOf dt:CD" /> </mapping> <mapping> <identity value="rim" /> <map value="24.H" /> </mapping> </element> <element id="ClaimResponse.addItem.serviced[x]"> <path value="ClaimResponse.addItem.serviced[x]" /> <short value="Date or dates of service or product delivery" /> <definition value="The date or dates when the service or product was supplied, performed or completed." /> <requirements value="Needed to determine whether the service or product was provided during the term of the insurance coverage." /> <min value="0" /> <max value="1" /> <base> <path value="ClaimResponse.addItem.serviced[x]" /> <min value="0" /> <max value="1" /> </base> <type> <code value="date" /> </type> <type> <code value="Period" /> </type> <constraint> <key value="ele-1" /> <severity value="error" /> <human value="All FHIR elements must have a @value or children" /> <expression value="hasValue() or (children().count() > id.count())" /> <source value="http://hl7.org/fhir/StructureDefinition/Element" /> </constraint> <mustSupport value="false" /> <isModifier value="false" /> <isSummary value="false" /> <mapping> <identity value="rim" /> <map value="n/a" /> </mapping> <mapping> <identity value="w5" /> <map value="FiveWs.done[x]" /> </mapping> <mapping> <identity value="rim" /> <map value="24.A" /> </mapping> </element> <element id="ClaimResponse.addItem.location[x]"> <path value="ClaimResponse.addItem.location[x]" /> <short value="Place of service or where product was supplied" /> <definition value="Where the product or service was provided." /> <requirements value="The location can alter whether the item was acceptable for insurance purposes or impact the determination of the benefit amount." /> <min value="0" /> <max value="1" /> <base> <path value="ClaimResponse.addItem.location[x]" /> <min value="0" /> <max value="1" /> </base> <type> <code value="CodeableConcept" /> </type> <type> <code value="Address" /> </type> <type> <code value="Reference" /> <targetProfile value="http://hl7.org/fhir/StructureDefinition/Location" /> </type> <constraint> <key value="ele-1" /> <severity value="error" /> <human value="All FHIR elements must have a @value or children" /> <expression value="hasValue() or (children().count() > id.count())" /> <source value="http://hl7.org/fhir/StructureDefinition/Element" /> </constraint> <mustSupport value="false" /> <isModifier value="false" /> <isSummary value="false" /> <binding> <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName"> <valueString value="ServicePlace" /> </extension> <strength value="example" /> <description value="Place of service: pharmacy, school, prison, etc." /> <valueSet value="http://hl7.org/fhir/ValueSet/service-place" /> </binding> <mapping> <identity value="rim" /> <map value="n/a" /> </mapping> <mapping> <identity value="w5" /> <map value="FiveWs.where[x]" /> </mapping> <mapping> <identity value="rim" /> <map value="24.B" /> </mapping> </element> <element id="ClaimResponse.addItem.quantity"> <path value="ClaimResponse.addItem.quantity" /> <short value="Count of products or services" /> <definition value="The number of repetitions of a service or product." /> <comment value="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 value="Required when the product or service code does not convey the quantity provided." /> <min value="0" /> <max value="1" /> <base> <path value="ClaimResponse.addItem.quantity" /> <min value="0" /> <max value="1" /> </base> <type> <code value="Quantity" /> <profile value="http://hl7.org/fhir/StructureDefinition/SimpleQuantity" /> </type> <constraint> <key value="ele-1" /> <severity value="error" /> <human value="All FHIR elements must have a @value or children" /> <expression value="hasValue() or (children().count() > id.count())" /> <source value="http://hl7.org/fhir/StructureDefinition/Element" /> </constraint> <constraint> <key value="qty-3" /> <severity value="error" /> <human value="If a code for the unit is present, the system SHALL also be present" /> <expression value="code.empty() or system.exists()" /> <source value="http://hl7.org/fhir/StructureDefinition/Quantity" /> </constraint> <constraint> <key value="sqty-1" /> <severity value="error" /> <human value="The comparator is not used on a SimpleQuantity" /> <expression value="comparator.empty()" /> <source value="http://hl7.org/fhir/StructureDefinition/SimpleQuantity" /> </constraint> <mustSupport value="false" /> <isModifier value="false" /> <isSummary value="false" /> <mapping> <identity value="rim" /> <map value="n/a" /> </mapping> <mapping> <identity value="v2" /> <map value="SN (see also Range) or CQ" /> </mapping> <mapping> <identity value="rim" /> <map value="PQ, IVL<PQ>, MO, CO, depending on the values" /> </mapping> <mapping> <identity value="rim" /> <map value="24.G" /> </mapping> </element> <element id="ClaimResponse.addItem.unitPrice"> <path value="ClaimResponse.addItem.unitPrice" /> <short value="Fee, charge or cost per item" /> <definition value="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 value="The amount charged to the patient by the provider for a single unit." /> <min value="0" /> <max value="1" /> <base> <path value="ClaimResponse.addItem.unitPrice" /> <min value="0" /> <max value="1" /> </base> <type> <code value="Money" /> </type> <constraint> <key value="ele-1" /> <severity value="error" /> <human value="All FHIR elements must have a @value or children" /> <expression value="hasValue() or (children().count() > id.count())" /> <source value="http://hl7.org/fhir/StructureDefinition/Element" /> </constraint> <mustSupport value="false" /> <isModifier value="false" /> <isSummary value="false" /> <mapping> <identity value="rim" /> <map value="n/a" /> </mapping> <mapping> <identity value="rim" /> <map value="MO" /> </mapping> </element> <element id="ClaimResponse.addItem.factor"> <path value="ClaimResponse.addItem.factor" /> <short value="Price scaling factor" /> <definition value="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 value="To show a 10% senior's discount, the value entered is: 0.90 (1.00 - 0.10)." /> <requirements value="When discounts are provided to a patient (example: Senior's discount) then this must be documented for adjudication." /> <min value="0" /> <max value="1" /> <base> <path value="ClaimResponse.addItem.factor" /> <min value="0" /> <max value="1" /> </base> <type> <code value="decimal" /> </type> <constraint> <key value="ele-1" /> <severity value="error" /> <human value="All FHIR elements must have a @value or children" /> <expression value="hasValue() or (children().count() > id.count())" /> <source value="http://hl7.org/fhir/StructureDefinition/Element" /> </constraint> <mustSupport value="false" /> <isModifier value="false" /> <isSummary value="false" /> <mapping> <identity value="rim" /> <map value="n/a" /> </mapping> </element> <element id="ClaimResponse.addItem.tax"> <path value="ClaimResponse.addItem.tax" /> <short value="Total tax" /> <definition value="The total of taxes applicable for this product or service." /> <requirements value="Required when taxes are not embedded in the unit price or provided as a separate service." /> <min value="0" /> <max value="1" /> <base> <path value="ClaimResponse.addItem.tax" /> <min value="0" /> <max value="1" /> </base> <type> <code value="Money" /> </type> <constraint> <key value="ele-1" /> <severity value="error" /> <human value="All FHIR elements must have a @value or children" /> <expression value="hasValue() or (children().count() > id.count())" /> <source value="http://hl7.org/fhir/StructureDefinition/Element" /> </constraint> <mustSupport value="false" /> <isModifier value="false" /> <isSummary value="false" /> <mapping> <identity value="rim" /> <map value="n/a" /> </mapping> <mapping> <identity value="rim" /> <map value="MO" /> </mapping> </element> <element id="ClaimResponse.addItem.net"> <path value="ClaimResponse.addItem.net" /> <short value="Total item cost" /> <definition value="The total amount claimed for the group (if a grouper) or the addItem. Net = unit price * quantity * factor." /> <comment value="For example, the formula: quantity * unitPrice * factor = net. Quantity and factor are assumed to be 1 if not supplied." /> <requirements value="Provides the total amount claimed for the group (if a grouper) or the line item." /> <min value="0" /> <max value="1" /> <base> <path value="ClaimResponse.addItem.net" /> <min value="0" /> <max value="1" /> </base> <type> <code value="Money" /> </type> <constraint> <key value="ele-1" /> <severity value="error" /> <human value="All FHIR elements must have a @value or children" /> <expression value="hasValue() or (children().count() > id.count())" /> <source value="http://hl7.org/fhir/StructureDefinition/Element" /> </constraint> <mustSupport value="false" /> <isModifier value="false" /> <isSummary value="false" /> <mapping> <identity value="rim" /> <map value="n/a" /> </mapping> <mapping> <identity value="rim" /> <map value="MO" /> </mapping> <mapping> <identity value="rim" /> <map value="24.F" /> </mapping> </element> <element id="ClaimResponse.addItem.bodySite"> <extension url="http://hl7.org/fhir/StructureDefinition/structuredefinition-explicit-type-name"> <valueString value="BodySite" /> </extension> <path value="ClaimResponse.addItem.bodySite" /> <short value="Anatomical location" /> <definition value="Physical location where the service is performed or applies." /> <min value="0" /> <max value="*" /> <base> <path value="ClaimResponse.addItem.bodySite" /> <min value="0" /> <max value="*" /> </base> <type> <code value="BackboneElement" /> </type> <constraint> <key value="ele-1" /> <severity value="error" /> <human value="All FHIR elements must have a @value or children" /> <expression value="hasValue() or (children().count() > id.count())" /> <source value="http://hl7.org/fhir/StructureDefinition/Element" /> </constraint> <mustSupport value="false" /> <isModifier value="false" /> <isSummary value="false" /> <mapping> <identity value="rim" /> <map value="n/a" /> </mapping> </element> <element id="ClaimResponse.addItem.bodySite.id"> <path value="ClaimResponse.addItem.bodySite.id" /> <representation value="xmlAttr" /> <short value="Unique id for inter-element referencing" /> <definition value="Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces." /> <min value="0" /> <max value="1" /> <base> <path value="Element.id" /> <min value="0" /> <max value="1" /> </base> <type> <extension url="http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type"> <valueUrl value="string" /> </extension> <code value="http://hl7.org/fhirpath/System.String" /> </type> <condition value="ele-1" /> <mapping> <identity value="rim" /> <map value="n/a" /> </mapping> </element> <element id="ClaimResponse.addItem.bodySite.extension"> <path value="ClaimResponse.addItem.bodySite.extension" /> <slicing> <discriminator> <type value="value" /> <path value="url" /> </discriminator> <description value="Extensions are always sliced by (at least) url" /> <rules value="open" /> </slicing> <short value="Additional content defined by implementations" /> <definition value="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 value="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 value="extensions" /> <alias value="user content" /> <min value="0" /> <max value="*" /> <base> <path value="Element.extension" /> <min value="0" /> <max value="*" /> </base> <type> <code value="Extension" /> </type> <constraint> <key value="ele-1" /> <severity value="error" /> <human value="All FHIR elements must have a @value or children" /> <expression value="hasValue() or (children().count() > id.count())" /> <source value="http://hl7.org/fhir/StructureDefinition/Element" /> </constraint> <constraint> <key value="ext-1" /> <severity value="error" /> <human value="Must have either extensions or value[x], not both" /> <expression value="extension.exists() != value.exists()" /> <source value="http://hl7.org/fhir/StructureDefinition/Extension" /> </constraint> <mapping> <identity value="rim" /> <map value="n/a" /> </mapping> <mapping> <identity value="rim" /> <map value="N/A" /> </mapping> </element> <element id="ClaimResponse.addItem.bodySite.modifierExtension"> <path value="ClaimResponse.addItem.bodySite.modifierExtension" /> <short value="Extensions that cannot be ignored even if unrecognized" /> <definition value="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. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself)." /> <comment value="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 value="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 value="extensions" /> <alias value="user content" /> <alias value="modifiers" /> <min value="0" /> <max value="*" /> <base> <path value="BackboneElement.modifierExtension" /> <min value="0" /> <max value="*" /> </base> <type> <code value="Extension" /> </type> <constraint> <key value="ele-1" /> <severity value="error" /> <human value="All FHIR elements must have a @value or children" /> <expression value="hasValue() or (children().count() > id.count())" /> <source value="http://hl7.org/fhir/StructureDefinition/Element" /> </constraint> <constraint> <key value="ext-1" /> <severity value="error" /> <human value="Must have either extensions or value[x], not both" /> <expression value="extension.exists() != value.exists()" /> <source value="http://hl7.org/fhir/StructureDefinition/Extension" /> </constraint> <isModifier value="true" /> <isModifierReason value="Modifier extensions are expected to modify the meaning or interpretation of the element that contains them" /> <isSummary value="true" /> <mapping> <identity value="rim" /> <map value="n/a" /> </mapping> <mapping> <identity value="rim" /> <map value="N/A" /> </mapping> </element> <element id="ClaimResponse.addItem.bodySite.site"> <path value="ClaimResponse.addItem.bodySite.site" /> <short value="Location" /> <definition value="Physical service site on the patient (limb, tooth, etc.)." /> <comment value="For example: Providing a tooth code allows an insurer to identify a provider performing a filling on a tooth that was previously removed." /> <requirements value="Allows insurer to validate specific procedures." /> <min value="1" /> <max value="*" /> <base> <path value="ClaimResponse.addItem.bodySite.site" /> <min value="1" /> <max value="*" /> </base> <type> <code value="CodeableReference" /> <targetProfile value="http://hl7.org/fhir/StructureDefinition/BodyStructure" /> </type> <constraint> <key value="ele-1" /> <severity value="error" /> <human value="All FHIR elements must have a @value or children" /> <expression value="hasValue() or (children().count() > id.count())" /> <source value="http://hl7.org/fhir/StructureDefinition/Element" /> </constraint> <mustSupport value="false" /> <isModifier value="false" /> <isSummary value="false" /> <binding> <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName"> <valueString value="OralSites" /> </extension> <strength value="example" /> <valueSet value="http://hl7.org/fhir/ValueSet/tooth" /> </binding> <mapping> <identity value="rim" /> <map value="n/a" /> </mapping> </element> <element id="ClaimResponse.addItem.bodySite.subSite"> <path value="ClaimResponse.addItem.bodySite.subSite" /> <short value="Sub-location" /> <definition value="A region or surface of the bodySite, e.g. limb region or tooth surface(s)." /> <comment value="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 value="Allows insurer to validate specific procedures." /> <min value="0" /> <max value="*" /> <base> <path value="ClaimResponse.addItem.bodySite.subSite" /> <min value="0" /> <max value="*" /> </base> <type> <code value="CodeableConcept" /> </type> <constraint> <key value="ele-1" /> <severity value="error" /> <human value="All FHIR elements must have a @value or children" /> <expression value="hasValue() or (children().count() > id.count())" /> <source value="http://hl7.org/fhir/StructureDefinition/Element" /> </constraint> <mustSupport value="false" /> <isModifier value="false" /> <isSummary value="false" /> <binding> <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName"> <valueString value="Surface" /> </extension> <strength value="example" /> <valueSet value="http://hl7.org/fhir/ValueSet/surface" /> </binding> <mapping> <identity value="rim" /> <map value="n/a" /> </mapping> <mapping> <identity value="v2" /> <map value="CE/CNE/CWE" /> </mapping> <mapping> <identity value="rim" /> <map value="CD" /> </mapping> <mapping> <identity value="orim" /> <map value="fhir:CodeableConcept rdfs:subClassOf dt:CD" /> </mapping> </element> <element id="ClaimResponse.addItem.noteNumber"> <path value="ClaimResponse.addItem.noteNumber" /> <short value="Applicable note numbers" /> <definition value="The numbers associated with notes below which apply to the adjudication of this item." /> <comment value="32 bit number; for values larger than this, use decimal" /> <requirements value="Provides a condensed manner for associating human readable descriptive explanations for adjudications on the line item." /> <min value="0" /> <max value="*" /> <base> <path value="ClaimResponse.addItem.noteNumber" /> <min value="0" /> <max value="*" /> </base> <type> <code value="positiveInt" /> </type> <constraint> <key value="ele-1" /> <severity value="error" /> <human value="All FHIR elements must have a @value or children" /> <expression value="hasValue() or (children().count() > id.count())" /> <source value="http://hl7.org/fhir/StructureDefinition/Element" /> </constraint> <mustSupport value="false" /> <isModifier value="false" /> <isSummary value="false" /> <mapping> <identity value="rim" /> <map value="n/a" /> </mapping> </element> <element id="ClaimResponse.addItem.reviewOutcome"> <path value="ClaimResponse.addItem.reviewOutcome" /> <short value="Added items adjudication results" /> <definition value="The high-level results of the adjudication if adjudication has been performed." /> <min value="0" /> <max value="1" /> <base> <path value="ClaimResponse.addItem.reviewOutcome" /> <min value="0" /> <max value="1" /> </base> <contentReference value="#ClaimResponse.item.reviewOutcome" /> <mustSupport value="false" /> <isModifier value="false" /> <isSummary value="false" /> </element> <element id="ClaimResponse.addItem.adjudication"> <path value="ClaimResponse.addItem.adjudication" /> <short value="Added items adjudication" /> <definition value="The adjudication results." /> <min value="0" /> <max value="*" /> <base> <path value="ClaimResponse.addItem.adjudication" /> <min value="0" /> <max value="*" /> </base> <contentReference value="#ClaimResponse.item.adjudication" /> <mustSupport value="false" /> <isModifier value="false" /> <isSummary value="false" /> </element> <element id="ClaimResponse.addItem.detail"> <extension url="http://hl7.org/fhir/StructureDefinition/structuredefinition-explicit-type-name"> <valueString value="AddedItemDetail" /> </extension> <path value="ClaimResponse.addItem.detail" /> <short value="Insurer added line details" /> <definition value="The second-tier service adjudications for payor added services." /> <min value="0" /> <max value="*" /> <base> <path value="ClaimResponse.addItem.detail" /> <min value="0" /> <max value="*" /> </base> <type> <code value="BackboneElement" /> </type> <constraint> <key value="ele-1" /> <severity value="error" /> <human value="All FHIR elements must have a @value or children" /> <expression value="hasValue() or (children().count() > id.count())" /> <source value="http://hl7.org/fhir/StructureDefinition/Element" /> </constraint> <mustSupport value="false" /> <isModifier value="false" /> <isSummary value="false" /> <mapping> <identity value="rim" /> <map value="n/a" /> </mapping> </element> <element id="ClaimResponse.addItem.detail.id"> <path value="ClaimResponse.addItem.detail.id" /> <representation value="xmlAttr" /> <short value="Unique id for inter-element referencing" /> <definition value="Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces." /> <min value="0" /> <max value="1" /> <base> <path value="Element.id" /> <min value="0" /> <max value="1" /> </base> <type> <extension url="http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type"> <valueUrl value="string" /> </extension> <code value="http://hl7.org/fhirpath/System.String" /> </type> <condition value="ele-1" /> <mapping> <identity value="rim" /> <map value="n/a" /> </mapping> </element> <element id="ClaimResponse.addItem.detail.extension"> <path value="ClaimResponse.addItem.detail.extension" /> <slicing> <discriminator> <type value="value" /> <path value="url" /> </discriminator> <description value="Extensions are always sliced by (at least) url" /> <rules value="open" /> </slicing> <short value="Additional content defined by implementations" /> <definition value="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 value="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 value="extensions" /> <alias value="user content" /> <min value="0" /> <max value="*" /> <base> <path value="Element.extension" /> <min value="0" /> <max value="*" /> </base> <type> <code value="Extension" /> </type> <constraint> <key value="ele-1" /> <severity value="error" /> <human value="All FHIR elements must have a @value or children" /> <expression value="hasValue() or (children().count() > id.count())" /> <source value="http://hl7.org/fhir/StructureDefinition/Element" /> </constraint> <constraint> <key value="ext-1" /> <severity value="error" /> <human value="Must have either extensions or value[x], not both" /> <expression value="extension.exists() != value.exists()" /> <source value="http://hl7.org/fhir/StructureDefinition/Extension" /> </constraint> <mapping> <identity value="rim" /> <map value="n/a" /> </mapping> <mapping> <identity value="rim" /> <map value="N/A" /> </mapping> </element> <element id="ClaimResponse.addItem.detail.modifierExtension"> <path value="ClaimResponse.addItem.detail.modifierExtension" /> <short value="Extensions that cannot be ignored even if unrecognized" /> <definition value="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. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself)." /> <comment value="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 value="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 value="extensions" /> <alias value="user content" /> <alias value="modifiers" /> <min value="0" /> <max value="*" /> <base> <path value="BackboneElement.modifierExtension" /> <min value="0" /> <max value="*" /> </base> <type> <code value="Extension" /> </type> <constraint> <key value="ele-1" /> <severity value="error" /> <human value="All FHIR elements must have a @value or children" /> <expression value="hasValue() or (children().count() > id.count())" /> <source value="http://hl7.org/fhir/StructureDefinition/Element" /> </constraint> <constraint> <key value="ext-1" /> <severity value="error" /> <human value="Must have either extensions or value[x], not both" /> <expression value="extension.exists() != value.exists()" /> <source value="http://hl7.org/fhir/StructureDefinition/Extension" /> </constraint> <isModifier value="true" /> <isModifierReason value="Modifier extensions are expected to modify the meaning or interpretation of the element that contains them" /> <isSummary value="true" /> <mapping> <identity value="rim" /> <map value="n/a" /> </mapping> <mapping> <identity value="rim" /> <map value="N/A" /> </mapping> </element> <element id="ClaimResponse.addItem.detail.traceNumber"> <path value="ClaimResponse.addItem.detail.traceNumber" /> <short value="Number for tracking" /> <definition value="Trace number for tracking purposes. May be defined at the jurisdiction level or between trading partners." /> <comment value="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 value="Allows partners to uniquely identify components for tracking." /> <min value="0" /> <max value="*" /> <base> <path value="ClaimResponse.addItem.detail.traceNumber" /> <min value="0" /> <max value="*" /> </base> <type> <code value="Identifier" /> </type> <constraint> <key value="ele-1" /> <severity value="error" /> <human value="All FHIR elements must have a @value or children" /> <expression value="hasValue() or (children().count() > id.count())" /> <source value="http://hl7.org/fhir/StructureDefinition/Element" /> </constraint> <constraint> <key value="ident-1" /> <severity value="warning" /> <human value="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="value.exists()" /> <source value="http://hl7.org/fhir/StructureDefinition/Identifier" /> </constraint> <mustSupport value="false" /> <isModifier value="false" /> <isSummary value="false" /> <mapping> <identity value="rim" /> <map value="n/a" /> </mapping> <mapping> <identity value="v2" /> <map value="CX / EI (occasionally, more often EI maps to a resource id or a URL)" /> </mapping> <mapping> <identity value="rim" /> <map value="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]" /> </mapping> <mapping> <identity value="servd" /> <map value="Identifier" /> </mapping> </element> <element id="ClaimResponse.addItem.detail.revenue"> <path value="ClaimResponse.addItem.detail.revenue" /> <short value="Revenue or cost center code" /> <definition value="The type of revenue or cost center providing the product and/or service." /> <comment value="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 value="Needed in the processing of institutional claims." /> <min value="0" /> <max value="1" /> <base> <path value="ClaimResponse.addItem.detail.revenue" /> <min value="0" /> <max value="1" /> </base> <type> <code value="CodeableConcept" /> </type> <constraint> <key value="ele-1" /> <severity value="error" /> <human value="All FHIR elements must have a @value or children" /> <expression value="hasValue() or (children().count() > id.count())" /> <source value="http://hl7.org/fhir/StructureDefinition/Element" /> </constraint> <mustSupport value="false" /> <isModifier value="false" /> <isSummary value="false" /> <binding> <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName"> <valueString value="RevenueCenter" /> </extension> <strength value="example" /> <description value="Codes for the revenue or cost centers supplying the service and/or products." /> <valueSet value="http://hl7.org/fhir/ValueSet/ex-revenue-center" /> </binding> <mapping> <identity value="rim" /> <map value="n/a" /> </mapping> <mapping> <identity value="v2" /> <map value="CE/CNE/CWE" /> </mapping> <mapping> <identity value="rim" /> <map value="CD" /> </mapping> <mapping> <identity value="orim" /> <map value="fhir:CodeableConcept rdfs:subClassOf dt:CD" /> </mapping> </element> <element id="ClaimResponse.addItem.detail.productOrService"> <path value="ClaimResponse.addItem.detail.productOrService" /> <short value="Billing, service, product, or drug code" /> <definition value="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 value="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 value="Necessary to state what was provided or done." /> <min value="0" /> <max value="1" /> <base> <path value="ClaimResponse.addItem.detail.productOrService" /> <min value="0" /> <max value="1" /> </base> <type> <code value="CodeableConcept" /> </type> <constraint> <key value="ele-1" /> <severity value="error" /> <human value="All FHIR elements must have a @value or children" /> <expression value="hasValue() or (children().count() > id.count())" /> <source value="http://hl7.org/fhir/StructureDefinition/Element" /> </constraint> <mustSupport value="false" /> <isModifier value="false" /> <isSummary value="false" /> <binding> <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName"> <valueString value="ServiceProduct" /> </extension> <strength value="example" /> <description value="Allowable service and product codes." /> <valueSet value="http://hl7.org/fhir/ValueSet/service-uscls" /> </binding> <mapping> <identity value="rim" /> <map value="n/a" /> </mapping> <mapping> <identity value="v2" /> <map value="CE/CNE/CWE" /> </mapping> <mapping> <identity value="rim" /> <map value="CD" /> </mapping> <mapping> <identity value="orim" /> <map value="fhir:CodeableConcept rdfs:subClassOf dt:CD" /> </mapping> </element> <element id="ClaimResponse.addItem.detail.productOrServiceEnd"> <path value="ClaimResponse.addItem.detail.productOrServiceEnd" /> <short value="End of a range of codes" /> <definition value="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 value="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 value="End of a range of Drug Code; Bill Code; Service Cod" /> <min value="0" /> <max value="1" /> <base> <path value="ClaimResponse.addItem.detail.productOrServiceEnd" /> <min value="0" /> <max value="1" /> </base> <type> <code value="CodeableConcept" /> </type> <constraint> <key value="ele-1" /> <severity value="error" /> <human value="All FHIR elements must have a @value or children" /> <expression value="hasValue() or (children().count() > id.count())" /> <source value="http://hl7.org/fhir/StructureDefinition/Element" /> </constraint> <mustSupport value="false" /> <isModifier value="false" /> <isSummary value="false" /> <binding> <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName"> <valueString value="ServiceProduct" /> </extension> <strength value="example" /> <valueSet value="http://hl7.org/fhir/ValueSet/service-uscls" /> </binding> <mapping> <identity value="rim" /> <map value="n/a" /> </mapping> <mapping> <identity value="v2" /> <map value="CE/CNE/CWE" /> </mapping> <mapping> <identity value="rim" /> <map value="CD" /> </mapping> <mapping> <identity value="orim" /> <map value="fhir:CodeableConcept rdfs:subClassOf dt:CD" /> </mapping> </element> <element id="ClaimResponse.addItem.detail.modifier"> <path value="ClaimResponse.addItem.detail.modifier" /> <short value="Service/Product billing modifiers" /> <definition value="Item typification or modifiers codes to convey additional context for the product or service." /> <comment value="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 value="To support inclusion of the item for adjudication or to charge an elevated fee." /> <min value="0" /> <max value="*" /> <base> <path value="ClaimResponse.addItem.detail.modifier" /> <min value="0" /> <max value="*" /> </base> <type> <code value="CodeableConcept" /> </type> <constraint> <key value="ele-1" /> <severity value="error" /> <human value="All FHIR elements must have a @value or children" /> <expression value="hasValue() or (children().count() > id.count())" /> <source value="http://hl7.org/fhir/StructureDefinition/Element" /> </constraint> <mustSupport value="false" /> <isModifier value="false" /> <isSummary value="false" /> <binding> <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName"> <valueString value="Modifiers" /> </extension> <strength value="example" /> <description value="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 value="http://hl7.org/fhir/ValueSet/claim-modifiers" /> </binding> <mapping> <identity value="rim" /> <map value="n/a" /> </mapping> <mapping> <identity value="v2" /> <map value="CE/CNE/CWE" /> </mapping> <mapping> <identity value="rim" /> <map value="CD" /> </mapping> <mapping> <identity value="orim" /> <map value="fhir:CodeableConcept rdfs:subClassOf dt:CD" /> </mapping> <mapping> <identity value="rim" /> <map value="24.C, 24.D mods" /> </mapping> </element> <element id="ClaimResponse.addItem.detail.quantity"> <path value="ClaimResponse.addItem.detail.quantity" /> <short value="Count of products or services" /> <definition value="The number of repetitions of a service or product." /> <comment value="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 value="Required when the product or service code does not convey the quantity provided." /> <min value="0" /> <max value="1" /> <base> <path value="ClaimResponse.addItem.detail.quantity" /> <min value="0" /> <max value="1" /> </base> <type> <code value="Quantity" /> <profile value="http://hl7.org/fhir/StructureDefinition/SimpleQuantity" /> </type> <constraint> <key value="ele-1" /> <severity value="error" /> <human value="All FHIR elements must have a @value or children" /> <expression value="hasValue() or (children().count() > id.count())" /> <source value="http://hl7.org/fhir/StructureDefinition/Element" /> </constraint> <constraint> <key value="qty-3" /> <severity value="error" /> <human value="If a code for the unit is present, the system SHALL also be present" /> <expression value="code.empty() or system.exists()" /> <source value="http://hl7.org/fhir/StructureDefinition/Quantity" /> </constraint> <constraint> <key value="sqty-1" /> <severity value="error" /> <human value="The comparator is not used on a SimpleQuantity" /> <expression value="comparator.empty()" /> <source value="http://hl7.org/fhir/StructureDefinition/SimpleQuantity" /> </constraint> <mustSupport value="false" /> <isModifier value="false" /> <isSummary value="false" /> <mapping> <identity value="rim" /> <map value="n/a" /> </mapping> <mapping> <identity value="v2" /> <map value="SN (see also Range) or CQ" /> </mapping> <mapping> <identity value="rim" /> <map value="PQ, IVL<PQ>, MO, CO, depending on the values" /> </mapping> <mapping> <identity value="rim" /> <map value="24.G" /> </mapping> </element> <element id="ClaimResponse.addItem.detail.unitPrice"> <path value="ClaimResponse.addItem.detail.unitPrice" /> <short value="Fee, charge or cost per item" /> <definition value="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 value="The amount charged to the patient by the provider for a single unit." /> <min value="0" /> <max value="1" /> <base> <path value="ClaimResponse.addItem.detail.unitPrice" /> <min value="0" /> <max value="1" /> </base> <type> <code value="Money" /> </type> <constraint> <key value="ele-1" /> <severity value="error" /> <human value="All FHIR elements must have a @value or children" /> <expression value="hasValue() or (children().count() > id.count())" /> <source value="http://hl7.org/fhir/StructureDefinition/Element" /> </constraint> <mustSupport value="false" /> <isModifier value="false" /> <isSummary value="false" /> <mapping> <identity value="rim" /> <map value="n/a" /> </mapping> <mapping> <identity value="rim" /> <map value="MO" /> </mapping> </element> <element id="ClaimResponse.addItem.detail.factor"> <path value="ClaimResponse.addItem.detail.factor" /> <short value="Price scaling factor" /> <definition value="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 value="To show a 10% senior's discount, the value entered is: 0.90 (1.00 - 0.10)." /> <requirements value="When discounts are provided to a patient (example: Senior's discount) then this must be documented for adjudication." /> <min value="0" /> <max value="1" /> <base> <path value="ClaimResponse.addItem.detail.factor" /> <min value="0" /> <max value="1" /> </base> <type> <code value="decimal" /> </type> <constraint> <key value="ele-1" /> <severity value="error" /> <human value="All FHIR elements must have a @value or children" /> <expression value="hasValue() or (children().count() > id.count())" /> <source value="http://hl7.org/fhir/StructureDefinition/Element" /> </constraint> <mustSupport value="false" /> <isModifier value="false" /> <isSummary value="false" /> <mapping> <identity value="rim" /> <map value="n/a" /> </mapping> </element> <element id="ClaimResponse.addItem.detail.tax"> <path value="ClaimResponse.addItem.detail.tax" /> <short value="Total tax" /> <definition value="The total of taxes applicable for this product or service." /> <requirements value="Required when taxes are not embedded in the unit price or provided as a separate service." /> <min value="0" /> <max value="1" /> <base> <path value="ClaimResponse.addItem.detail.tax" /> <min value="0" /> <max value="1" /> </base> <type> <code value="Money" /> </type> <constraint> <key value="ele-1" /> <severity value="error" /> <human value="All FHIR elements must have a @value or children" /> <expression value="hasValue() or (children().count() > id.count())" /> <source value="http://hl7.org/fhir/StructureDefinition/Element" /> </constraint> <mustSupport value="false" /> <isModifier value="false" /> <isSummary value="false" /> <mapping> <identity value="rim" /> <map value="n/a" /> </mapping> <mapping> <identity value="rim" /> <map value="MO" /> </mapping> </element> <element id="ClaimResponse.addItem.detail.net"> <path value="ClaimResponse.addItem.detail.net" /> <short value="Total item cost" /> <definition value="The total amount claimed for the group (if a grouper) or the addItem.detail. Net = unit price * quantity * factor." /> <comment value="For example, the formula: quantity * unitPrice * factor = net. Quantity and factor are assumed to be 1 if not supplied." /> <requirements value="Provides the total amount claimed for the group (if a grouper) or the line item." /> <min value="0" /> <max value="1" /> <base> <path value="ClaimResponse.addItem.detail.net" /> <min value="0" /> <max value="1" /> </base> <type> <code value="Money" /> </type> <constraint> <key value="ele-1" /> <severity value="error" /> <human value="All FHIR elements must have a @value or children" /> <expression value="hasValue() or (children().count() > id.count())" /> <source value="http://hl7.org/fhir/StructureDefinition/Element" /> </constraint> <mustSupport value="false" /> <isModifier value="false" /> <isSummary value="false" /> <mapping> <identity value="rim" /> <map value="n/a" /> </mapping> <mapping> <identity value="rim" /> <map value="MO" /> </mapping> <mapping> <identity value="rim" /> <map value="24.F" /> </mapping> </element> <element id="ClaimResponse.addItem.detail.noteNumber"> <path value="ClaimResponse.addItem.detail.noteNumber" /> <short value="Applicable note numbers" /> <definition value="The numbers associated with notes below which apply to the adjudication of this item." /> <comment value="32 bit number; for values larger than this, use decimal" /> <requirements value="Provides a condensed manner for associating human readable descriptive explanations for adjudications on the line item." /> <min value="0" /> <max value="*" /> <base> <path value="ClaimResponse.addItem.detail.noteNumber" /> <min value="0" /> <max value="*" /> </base> <type> <code value="positiveInt" /> </type> <constraint> <key value="ele-1" /> <severity value="error" /> <human value="All FHIR elements must have a @value or children" /> <expression value="hasValue() or (children().count() > id.count())" /> <source value="http://hl7.org/fhir/StructureDefinition/Element" /> </constraint> <mustSupport value="false" /> <isModifier value="false" /> <isSummary value="false" /> <mapping> <identity value="rim" /> <map value="n/a" /> </mapping> </element> <element id="ClaimResponse.addItem.detail.reviewOutcome"> <path value="ClaimResponse.addItem.detail.reviewOutcome" /> <short value="Added items detail level adjudication results" /> <definition value="The high-level results of the adjudication if adjudication has been performed." /> <min value="0" /> <max value="1" /> <base> <path value="ClaimResponse.addItem.detail.reviewOutcome" /> <min value="0" /> <max value="1" /> </base> <contentReference value="#ClaimResponse.item.reviewOutcome" /> <mustSupport value="false" /> <isModifier value="false" /> <isSummary value="false" /> </element> <element id="ClaimResponse.addItem.detail.adjudication"> <path value="ClaimResponse.addItem.detail.adjudication" /> <short value="Added items detail adjudication" /> <definition value="The adjudication results." /> <min value="0" /> <max value="*" /> <base> <path value="ClaimResponse.addItem.detail.adjudication" /> <min value="0" /> <max value="*" /> </base> <contentReference value="#ClaimResponse.item.adjudication" /> <mustSupport value="false" /> <isModifier value="false" /> <isSummary value="false" /> </element> <element id="ClaimResponse.addItem.detail.subDetail"> <extension url="http://hl7.org/fhir/StructureDefinition/structuredefinition-explicit-type-name"> <valueString value="AddedItemSubDetail" /> </extension> <path value="ClaimResponse.addItem.detail.subDetail" /> <short value="Insurer added line items" /> <definition value="The third-tier service adjudications for payor added services." /> <min value="0" /> <max value="*" /> <base> <path value="ClaimResponse.addItem.detail.subDetail" /> <min value="0" /> <max value="*" /> </base> <type> <code value="BackboneElement" /> </type> <constraint> <key value="ele-1" /> <severity value="error" /> <human value="All FHIR elements must have a @value or children" /> <expression value="hasValue() or (children().count() > id.count())" /> <source value="http://hl7.org/fhir/StructureDefinition/Element" /> </constraint> <mustSupport value="false" /> <isModifier value="false" /> <isSummary value="false" /> <mapping> <identity value="rim" /> <map value="n/a" /> </mapping> </element> <element id="ClaimResponse.addItem.detail.subDetail.id"> <path value="ClaimResponse.addItem.detail.subDetail.id" /> <representation value="xmlAttr" /> <short value="Unique id for inter-element referencing" /> <definition value="Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces." /> <min value="0" /> <max value="1" /> <base> <path value="Element.id" /> <min value="0" /> <max value="1" /> </base> <type> <extension url="http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type"> <valueUrl value="string" /> </extension> <code value="http://hl7.org/fhirpath/System.String" /> </type> <condition value="ele-1" /> <mapping> <identity value="rim" /> <map value="n/a" /> </mapping> </element> <element id="ClaimResponse.addItem.detail.subDetail.extension"> <path value="ClaimResponse.addItem.detail.subDetail.extension" /> <slicing> <discriminator> <type value="value" /> <path value="url" /> </discriminator> <description value="Extensions are always sliced by (at least) url" /> <rules value="open" /> </slicing> <short value="Additional content defined by implementations" /> <definition value="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 value="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 value="extensions" /> <alias value="user content" /> <min value="0" /> <max value="*" /> <base> <path value="Element.extension" /> <min value="0" /> <max value="*" /> </base> <type> <code value="Extension" /> </type> <constraint> <key value="ele-1" /> <severity value="error" /> <human value="All FHIR elements must have a @value or children" /> <expression value="hasValue() or (children().count() > id.count())" /> <source value="http://hl7.org/fhir/StructureDefinition/Element" /> </constraint> <constraint> <key value="ext-1" /> <severity value="error" /> <human value="Must have either extensions or value[x], not both" /> <expression value="extension.exists() != value.exists()" /> <source value="http://hl7.org/fhir/StructureDefinition/Extension" /> </constraint> <mapping> <identity value="rim" /> <map value="n/a" /> </mapping> <mapping> <identity value="rim" /> <map value="N/A" /> </mapping> </element> <element id="ClaimResponse.addItem.detail.subDetail.modifierExtension"> <path value="ClaimResponse.addItem.detail.subDetail.modifierExtension" /> <short value="Extensions that cannot be ignored even if unrecognized" /> <definition value="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. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself)." /> <comment value="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 value="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 value="extensions" /> <alias value="user content" /> <alias value="modifiers" /> <min value="0" /> <max value="*" /> <base> <path value="BackboneElement.modifierExtension" /> <min value="0" /> <max value="*" /> </base> <type> <code value="Extension" /> </type> <constraint> <key value="ele-1" /> <severity value="error" /> <human value="All FHIR elements must have a @value or children" /> <expression value="hasValue() or (children().count() > id.count())" /> <source value="http://hl7.org/fhir/StructureDefinition/Element" /> </constraint> <constraint> <key value="ext-1" /> <severity value="error" /> <human value="Must have either extensions or value[x], not both" /> <expression value="extension.exists() != value.exists()" /> <source value="http://hl7.org/fhir/StructureDefinition/Extension" /> </constraint> <isModifier value="true" /> <isModifierReason value="Modifier extensions are expected to modify the meaning or interpretation of the element that contains them" /> <isSummary value="true" /> <mapping> <identity value="rim" /> <map value="n/a" /> </mapping> <mapping> <identity value="rim" /> <map value="N/A" /> </mapping> </element> <element id="ClaimResponse.addItem.detail.subDetail.traceNumber"> <path value="ClaimResponse.addItem.detail.subDetail.traceNumber" /> <short value="Number for tracking" /> <definition value="Trace number for tracking purposes. May be defined at the jurisdiction level or between trading partners." /> <comment value="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 value="Allows partners to uniquely identify components for tracking." /> <min value="0" /> <max value="*" /> <base> <path value="ClaimResponse.addItem.detail.subDetail.traceNumber" /> <min value="0" /> <max value="*" /> </base> <type> <code value="Identifier" /> </type> <constraint> <key value="ele-1" /> <severity value="error" /> <human value="All FHIR elements must have a @value or children" /> <expression value="hasValue() or (children().count() > id.count())" /> <source value="http://hl7.org/fhir/StructureDefinition/Element" /> </constraint> <constraint> <key value="ident-1" /> <severity value="warning" /> <human value="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="value.exists()" /> <source value="http://hl7.org/fhir/StructureDefinition/Identifier" /> </constraint> <mustSupport value="false" /> <isModifier value="false" /> <isSummary value="false" /> <mapping> <identity value="rim" /> <map value="n/a" /> </mapping> <mapping> <identity value="v2" /> <map value="CX / EI (occasionally, more often EI maps to a resource id or a URL)" /> </mapping> <mapping> <identity value="rim" /> <map value="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]" /> </mapping> <mapping> <identity value="servd" /> <map value="Identifier" /> </mapping> </element> <element id="ClaimResponse.addItem.detail.subDetail.revenue"> <path value="ClaimResponse.addItem.detail.subDetail.revenue" /> <short value="Revenue or cost center code" /> <definition value="The type of revenue or cost center providing the product and/or service." /> <comment value="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 value="Needed in the processing of institutional claims." /> <min value="0" /> <max value="1" /> <base> <path value="ClaimResponse.addItem.detail.subDetail.revenue" /> <min value="0" /> <max value="1" /> </base> <type> <code value="CodeableConcept" /> </type> <constraint> <key value="ele-1" /> <severity value="error" /> <human value="All FHIR elements must have a @value or children" /> <expression value="hasValue() or (children().count() > id.count())" /> <source value="http://hl7.org/fhir/StructureDefinition/Element" /> </constraint> <mustSupport value="false" /> <isModifier value="false" /> <isSummary value="false" /> <binding> <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName"> <valueString value="RevenueCenter" /> </extension> <strength value="example" /> <description value="Codes for the revenue or cost centers supplying the service and/or products." /> <valueSet value="http://hl7.org/fhir/ValueSet/ex-revenue-center" /> </binding> <mapping> <identity value="rim" /> <map value="n/a" /> </mapping> <mapping> <identity value="v2" /> <map value="CE/CNE/CWE" /> </mapping> <mapping> <identity value="rim" /> <map value="CD" /> </mapping> <mapping> <identity value="orim" /> <map value="fhir:CodeableConcept rdfs:subClassOf dt:CD" /> </mapping> </element> <element id="ClaimResponse.addItem.detail.subDetail.productOrService"> <path value="ClaimResponse.addItem.detail.subDetail.productOrService" /> <short value="Billing, service, product, or drug code" /> <definition value="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 value="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 value="Necessary to state what was provided or done." /> <min value="0" /> <max value="1" /> <base> <path value="ClaimResponse.addItem.detail.subDetail.productOrService" /> <min value="0" /> <max value="1" /> </base> <type> <code value="CodeableConcept" /> </type> <constraint> <key value="ele-1" /> <severity value="error" /> <human value="All FHIR elements must have a @value or children" /> <expression value="hasValue() or (children().count() > id.count())" /> <source value="http://hl7.org/fhir/StructureDefinition/Element" /> </constraint> <mustSupport value="false" /> <isModifier value="false" /> <isSummary value="false" /> <binding> <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName"> <valueString value="ServiceProduct" /> </extension> <strength value="example" /> <description value="Allowable service and product codes." /> <valueSet value="http://hl7.org/fhir/ValueSet/service-uscls" /> </binding> <mapping> <identity value="rim" /> <map value="n/a" /> </mapping> <mapping> <identity value="v2" /> <map value="CE/CNE/CWE" /> </mapping> <mapping> <identity value="rim" /> <map value="CD" /> </mapping> <mapping> <identity value="orim" /> <map value="fhir:CodeableConcept rdfs:subClassOf dt:CD" /> </mapping> </element> <element id="ClaimResponse.addItem.detail.subDetail.productOrServiceEnd"> <path value="ClaimResponse.addItem.detail.subDetail.productOrServiceEnd" /> <short value="End of a range of codes" /> <definition value="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 value="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 value="End of a range of Drug Code; Bill Code; Service Cod" /> <min value="0" /> <max value="1" /> <base> <path value="ClaimResponse.addItem.detail.subDetail.productOrServiceEnd" /> <min value="0" /> <max value="1" /> </base> <type> <code value="CodeableConcept" /> </type> <constraint> <key value="ele-1" /> <severity value="error" /> <human value="All FHIR elements must have a @value or children" /> <expression value="hasValue() or (children().count() > id.count())" /> <source value="http://hl7.org/fhir/StructureDefinition/Element" /> </constraint> <mustSupport value="false" /> <isModifier value="false" /> <isSummary value="false" /> <binding> <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName"> <valueString value="ServiceProduct" /> </extension> <strength value="example" /> <valueSet value="http://hl7.org/fhir/ValueSet/service-uscls" /> </binding> <mapping> <identity value="rim" /> <map value="n/a" /> </mapping> <mapping> <identity value="v2" /> <map value="CE/CNE/CWE" /> </mapping> <mapping> <identity value="rim" /> <map value="CD" /> </mapping> <mapping> <identity value="orim" /> <map value="fhir:CodeableConcept rdfs:subClassOf dt:CD" /> </mapping> </element> <element id="ClaimResponse.addItem.detail.subDetail.modifier"> <path value="ClaimResponse.addItem.detail.subDetail.modifier" /> <short value="Service/Product billing modifiers" /> <definition value="Item typification or modifiers codes to convey additional context for the product or service." /> <comment value="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 value="To support inclusion of the item for adjudication or to charge an elevated fee." /> <min value="0" /> <max value="*" /> <base> <path value="ClaimResponse.addItem.detail.subDetail.modifier" /> <min value="0" /> <max value="*" /> </base> <type> <code value="CodeableConcept" /> </type> <constraint> <key value="ele-1" /> <severity value="error" /> <human value="All FHIR elements must have a @value or children" /> <expression value="hasValue() or (children().count() > id.count())" /> <source value="http://hl7.org/fhir/StructureDefinition/Element" /> </constraint> <mustSupport value="false" /> <isModifier value="false" /> <isSummary value="false" /> <binding> <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName"> <valueString value="Modifiers" /> </extension> <strength value="example" /> <description value="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 value="http://hl7.org/fhir/ValueSet/claim-modifiers" /> </binding> <mapping> <identity value="rim" /> <map value="n/a" /> </mapping> <mapping> <identity value="v2" /> <map value="CE/CNE/CWE" /> </mapping> <mapping> <identity value="rim" /> <map value="CD" /> </mapping> <mapping> <identity value="orim" /> <map value="fhir:CodeableConcept rdfs:subClassOf dt:CD" /> </mapping> <mapping> <identity value="rim" /> <map value="24.C, 24.D mods" /> </mapping> </element> <element id="ClaimResponse.addItem.detail.subDetail.quantity"> <path value="ClaimResponse.addItem.detail.subDetail.quantity" /> <short value="Count of products or services" /> <definition value="The number of repetitions of a service or product." /> <comment value="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 value="Required when the product or service code does not convey the quantity provided." /> <min value="0" /> <max value="1" /> <base> <path value="ClaimResponse.addItem.detail.subDetail.quantity" /> <min value="0" /> <max value="1" /> </base> <type> <code value="Quantity" /> <profile value="http://hl7.org/fhir/StructureDefinition/SimpleQuantity" /> </type> <constraint> <key value="ele-1" /> <severity value="error" /> <human value="All FHIR elements must have a @value or children" /> <expression value="hasValue() or (children().count() > id.count())" /> <source value="http://hl7.org/fhir/StructureDefinition/Element" /> </constraint> <constraint> <key value="qty-3" /> <severity value="error" /> <human value="If a code for the unit is present, the system SHALL also be present" /> <expression value="code.empty() or system.exists()" /> <source value="http://hl7.org/fhir/StructureDefinition/Quantity" /> </constraint> <constraint> <key value="sqty-1" /> <severity value="error" /> <human value="The comparator is not used on a SimpleQuantity" /> <expression value="comparator.empty()" /> <source value="http://hl7.org/fhir/StructureDefinition/SimpleQuantity" /> </constraint> <mustSupport value="false" /> <isModifier value="false" /> <isSummary value="false" /> <mapping> <identity value="rim" /> <map value="n/a" /> </mapping> <mapping> <identity value="v2" /> <map value="SN (see also Range) or CQ" /> </mapping> <mapping> <identity value="rim" /> <map value="PQ, IVL<PQ>, MO, CO, depending on the values" /> </mapping> <mapping> <identity value="rim" /> <map value="24.G" /> </mapping> </element> <element id="ClaimResponse.addItem.detail.subDetail.unitPrice"> <path value="ClaimResponse.addItem.detail.subDetail.unitPrice" /> <short value="Fee, charge or cost per item" /> <definition value="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 value="The amount charged to the patient by the provider for a single unit." /> <min value="0" /> <max value="1" /> <base> <path value="ClaimResponse.addItem.detail.subDetail.unitPrice" /> <min value="0" /> <max value="1" /> </base> <type> <code value="Money" /> </type> <constraint> <key value="ele-1" /> <severity value="error" /> <human value="All FHIR elements must have a @value or children" /> <expression value="hasValue() or (children().count() > id.count())" /> <source value="http://hl7.org/fhir/StructureDefinition/Element" /> </constraint> <mustSupport value="false" /> <isModifier value="false" /> <isSummary value="false" /> <mapping> <identity value="rim" /> <map value="n/a" /> </mapping> <mapping> <identity value="rim" /> <map value="MO" /> </mapping> </element> <element id="ClaimResponse.addItem.detail.subDetail.factor"> <path value="ClaimResponse.addItem.detail.subDetail.factor" /> <short value="Price scaling factor" /> <definition value="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 value="To show a 10% senior's discount, the value entered is: 0.90 (1.00 - 0.10)." /> <requirements value="When discounts are provided to a patient (example: Senior's discount) then this must be documented for adjudication." /> <min value="0" /> <max value="1" /> <base> <path value="ClaimResponse.addItem.detail.subDetail.factor" /> <min value="0" /> <max value="1" /> </base> <type> <code value="decimal" /> </type> <constraint> <key value="ele-1" /> <severity value="error" /> <human value="All FHIR elements must have a @value or children" /> <expression value="hasValue() or (children().count() > id.count())" /> <source value="http://hl7.org/fhir/StructureDefinition/Element" /> </constraint> <mustSupport value="false" /> <isModifier value="false" /> <isSummary value="false" /> <mapping> <identity value="rim" /> <map value="n/a" /> </mapping> </element> <element id="ClaimResponse.addItem.detail.subDetail.tax"> <path value="ClaimResponse.addItem.detail.subDetail.tax" /> <short value="Total tax" /> <definition value="The total of taxes applicable for this product or service." /> <requirements value="Required when taxes are not embedded in the unit price or provided as a separate service." /> <min value="0" /> <max value="1" /> <base> <path value="ClaimResponse.addItem.detail.subDetail.tax" /> <min value="0" /> <max value="1" /> </base> <type> <code value="Money" /> </type> <constraint> <key value="ele-1" /> <severity value="error" /> <human value="All FHIR elements must have a @value or children" /> <expression value="hasValue() or (children().count() > id.count())" /> <source value="http://hl7.org/fhir/StructureDefinition/Element" /> </constraint> <mustSupport value="false" /> <isModifier value="false" /> <isSummary value="false" /> <mapping> <identity value="rim" /> <map value="n/a" /> </mapping> <mapping> <identity value="rim" /> <map value="MO" /> </mapping> </element> <element id="ClaimResponse.addItem.detail.subDetail.net"> <path value="ClaimResponse.addItem.detail.subDetail.net" /> <short value="Total item cost" /> <definition value="The total amount claimed for the addItem.detail.subDetail. Net = unit price * quantity * factor." /> <comment value="For example, the formula: quantity * unitPrice * factor = net. Quantity and factor are assumed to be 1 if not supplied." /> <requirements value="Provides the total amount claimed for the group (if a grouper) or the line item." /> <min value="0" /> <max value="1" /> <base> <path value="ClaimResponse.addItem.detail.subDetail.net" /> <min value="0" /> <max value="1" /> </base> <type> <code value="Money" /> </type> <constraint> <key value="ele-1" /> <severity value="error" /> <human value="All FHIR elements must have a @value or children" /> <expression value="hasValue() or (children().count() > id.count())" /> <source value="http://hl7.org/fhir/StructureDefinition/Element" /> </constraint> <mustSupport value="false" /> <isModifier value="false" /> <isSummary value="false" /> <mapping> <identity value="rim" /> <map value="n/a" /> </mapping> <mapping> <identity value="rim" /> <map value="MO" /> </mapping> <mapping> <identity value="rim" /> <map value="24.F" /> </mapping> </element> <element id="ClaimResponse.addItem.detail.subDetail.noteNumber"> <path value="ClaimResponse.addItem.detail.subDetail.noteNumber" /> <short value="Applicable note numbers" /> <definition value="The numbers associated with notes below which apply to the adjudication of this item." /> <comment value="32 bit number; for values larger than this, use decimal" /> <requirements value="Provides a condensed manner for associating human readable descriptive explanations for adjudications on the line item." /> <min value="0" /> <max value="*" /> <base> <path value="ClaimResponse.addItem.detail.subDetail.noteNumber" /> <min value="0" /> <max value="*" /> </base> <type> <code value="positiveInt" /> </type> <constraint> <key value="ele-1" /> <severity value="error" /> <human value="All FHIR elements must have a @value or children" /> <expression value="hasValue() or (children().count() > id.count())" /> <source value="http://hl7.org/fhir/StructureDefinition/Element" /> </constraint> <mustSupport value="false" /> <isModifier value="false" /> <isSummary value="false" /> <mapping> <identity value="rim" /> <map value="n/a" /> </mapping> </element> <element id="ClaimResponse.addItem.detail.subDetail.reviewOutcome"> <path value="ClaimResponse.addItem.detail.subDetail.reviewOutcome" /> <short value="Added items subdetail level adjudication results" /> <definition value="The high-level results of the adjudication if adjudication has been performed." /> <min value="0" /> <max value="1" /> <base> <path value="ClaimResponse.addItem.detail.subDetail.reviewOutcome" /> <min value="0" /> <max value="1" /> </base> <contentReference value="#ClaimResponse.item.reviewOutcome" /> <mustSupport value="false" /> <isModifier value="false" /> <isSummary value="false" /> </element> <element id="ClaimResponse.addItem.detail.subDetail.adjudication"> <path value="ClaimResponse.addItem.detail.subDetail.adjudication" /> <short value="Added items subdetail adjudication" /> <definition value="The adjudication results." /> <min value="0" /> <max value="*" /> <base> <path value="ClaimResponse.addItem.detail.subDetail.adjudication" /> <min value="0" /> <max value="*" /> </base> <contentReference value="#ClaimResponse.item.adjudication" /> <mustSupport value="false" /> <isModifier value="false" /> <isSummary value="false" /> </element> <element id="ClaimResponse.adjudication"> <path value="ClaimResponse.adjudication" /> <short value="Header-level adjudication" /> <definition value="The adjudication results which are presented at the header level rather than at the line-item or add-item levels." /> <requirements value="Some insurers will receive line-items but provide the adjudication only at a summary or header-level." /> <min value="0" /> <max value="*" /> <base> <path value="ClaimResponse.adjudication" /> <min value="0" /> <max value="*" /> </base> <contentReference value="http://hl7.org/fhir/StructureDefinition/ClaimResponse#ClaimResponse.item.adjudication" /> <mustSupport value="false" /> <isModifier value="false" /> <isSummary value="false" /> </element> <element id="ClaimResponse.total"> <extension url="http://hl7.org/fhir/StructureDefinition/structuredefinition-explicit-type-name"> <valueString value="Total" /> </extension> <path value="ClaimResponse.total" /> <short value="Adjudication totals" /> <definition value="Categorized monetary totals for the adjudication." /> <comment value="Totals for amounts submitted, co-pays, benefits payable etc." /> <requirements value="To provide the requestor with financial totals by category for the adjudication." /> <min value="0" /> <max value="*" /> <base> <path value="ClaimResponse.total" /> <min value="0" /> <max value="*" /> </base> <type> <code value="BackboneElement" /> </type> <constraint> <key value="ele-1" /> <severity value="error" /> <human value="All FHIR elements must have a @value or children" /> <expression value="hasValue() or (children().count() > id.count())" /> <source value="http://hl7.org/fhir/StructureDefinition/Element" /> </constraint> <mustSupport value="false" /> <isModifier value="false" /> <isSummary value="true" /> <mapping> <identity value="rim" /> <map value="n/a" /> </mapping> </element> <element id="ClaimResponse.total.id"> <path value="ClaimResponse.total.id" /> <representation value="xmlAttr" /> <short value="Unique id for inter-element referencing" /> <definition value="Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces." /> <min value="0" /> <max value="1" /> <base> <path value="Element.id" /> <min value="0" /> <max value="1" /> </base> <type> <extension url="http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type"> <valueUrl value="string" /> </extension> <code value="http://hl7.org/fhirpath/System.String" /> </type> <condition value="ele-1" /> <mapping> <identity value="rim" /> <map value="n/a" /> </mapping> </element> <element id="ClaimResponse.total.extension"> <path value="ClaimResponse.total.extension" /> <slicing> <discriminator> <type value="value" /> <path value="url" /> </discriminator> <description value="Extensions are always sliced by (at least) url" /> <rules value="open" /> </slicing> <short value="Additional content defined by implementations" /> <definition value="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 value="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 value="extensions" /> <alias value="user content" /> <min value="0" /> <max value="*" /> <base> <path value="Element.extension" /> <min value="0" /> <max value="*" /> </base> <type> <code value="Extension" /> </type> <constraint> <key value="ele-1" /> <severity value="error" /> <human value="All FHIR elements must have a @value or children" /> <expression value="hasValue() or (children().count() > id.count())" /> <source value="http://hl7.org/fhir/StructureDefinition/Element" /> </constraint> <constraint> <key value="ext-1" /> <severity value="error" /> <human value="Must have either extensions or value[x], not both" /> <expression value="extension.exists() != value.exists()" /> <source value="http://hl7.org/fhir/StructureDefinition/Extension" /> </constraint> <mapping> <identity value="rim" /> <map value="n/a" /> </mapping> <mapping> <identity value="rim" /> <map value="N/A" /> </mapping> </element> <element id="ClaimResponse.total.modifierExtension"> <path value="ClaimResponse.total.modifierExtension" /> <short value="Extensions that cannot be ignored even if unrecognized" /> <definition value="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. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself)." /> <comment value="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 value="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 value="extensions" /> <alias value="user content" /> <alias value="modifiers" /> <min value="0" /> <max value="*" /> <base> <path value="BackboneElement.modifierExtension" /> <min value="0" /> <max value="*" /> </base> <type> <code value="Extension" /> </type> <constraint> <key value="ele-1" /> <severity value="error" /> <human value="All FHIR elements must have a @value or children" /> <expression value="hasValue() or (children().count() > id.count())" /> <source value="http://hl7.org/fhir/StructureDefinition/Element" /> </constraint> <constraint> <key value="ext-1" /> <severity value="error" /> <human value="Must have either extensions or value[x], not both" /> <expression value="extension.exists() != value.exists()" /> <source value="http://hl7.org/fhir/StructureDefinition/Extension" /> </constraint> <isModifier value="true" /> <isModifierReason value="Modifier extensions are expected to modify the meaning or interpretation of the element that contains them" /> <isSummary value="true" /> <mapping> <identity value="rim" /> <map value="n/a" /> </mapping> <mapping> <identity value="rim" /> <map value="N/A" /> </mapping> </element> <element id="ClaimResponse.total.category"> <path value="ClaimResponse.total.category" /> <short value="Type of adjudication information" /> <definition value="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 value="For example codes indicating: Co-Pay, deductible, eligible, benefit, tax, etc." /> <requirements value="Needed to convey the type of total provided." /> <min value="1" /> <max value="1" /> <base> <path value="ClaimResponse.total.category" /> <min value="1" /> <max value="1" /> </base> <type> <code value="CodeableConcept" /> </type> <constraint> <key value="ele-1" /> <severity value="error" /> <human value="All FHIR elements must have a @value or children" /> <expression value="hasValue() or (children().count() > id.count())" /> <source value="http://hl7.org/fhir/StructureDefinition/Element" /> </constraint> <mustSupport value="false" /> <isModifier value="false" /> <isSummary value="true" /> <binding> <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName"> <valueString value="Adjudication" /> </extension> <strength value="example" /> <description value="The adjudication codes." /> <valueSet value="http://hl7.org/fhir/ValueSet/adjudication" /> </binding> <mapping> <identity value="rim" /> <map value="n/a" /> </mapping> <mapping> <identity value="v2" /> <map value="CE/CNE/CWE" /> </mapping> <mapping> <identity value="rim" /> <map value="CD" /> </mapping> <mapping> <identity value="orim" /> <map value="fhir:CodeableConcept rdfs:subClassOf dt:CD" /> </mapping> </element> <element id="ClaimResponse.total.amount"> <path value="ClaimResponse.total.amount" /> <short value="Financial total for the category" /> <definition value="Monetary total amount associated with the category." /> <requirements value="Needed to convey the total monetary amount." /> <min value="1" /> <max value="1" /> <base> <path value="ClaimResponse.total.amount" /> <min value="1" /> <max value="1" /> </base> <type> <code value="Money" /> </type> <constraint> <key value="ele-1" /> <severity value="error" /> <human value="All FHIR elements must have a @value or children" /> <expression value="hasValue() or (children().count() > id.count())" /> <source value="http://hl7.org/fhir/StructureDefinition/Element" /> </constraint> <mustSupport value="false" /> <isModifier value="false" /> <isSummary value="true" /> <mapping> <identity value="rim" /> <map value="n/a" /> </mapping> <mapping> <identity value="rim" /> <map value="MO" /> </mapping> </element> <element id="ClaimResponse.payment"> <extension url="http://hl7.org/fhir/StructureDefinition/structuredefinition-explicit-type-name"> <valueString value="Payment" /> </extension> <path value="ClaimResponse.payment" /> <short value="Payment Details" /> <definition value="Payment details for the adjudication of the claim." /> <requirements value="Needed to convey references to the financial instrument that has been used if payment has been made." /> <min value="0" /> <max value="1" /> <base> <path value="ClaimResponse.payment" /> <min value="0" /> <max value="1" /> </base> <type> <code value="BackboneElement" /> </type> <constraint> <key value="ele-1" /> <severity value="error" /> <human value="All FHIR elements must have a @value or children" /> <expression value="hasValue() or (children().count() > id.count())" /> <source value="http://hl7.org/fhir/StructureDefinition/Element" /> </constraint> <mustSupport value="false" /> <isModifier value="false" /> <isSummary value="false" /> <mapping> <identity value="rim" /> <map value="n/a" /> </mapping> </element> <element id="ClaimResponse.payment.id"> <path value="ClaimResponse.payment.id" /> <representation value="xmlAttr" /> <short value="Unique id for inter-element referencing" /> <definition value="Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces." /> <min value="0" /> <max value="1" /> <base> <path value="Element.id" /> <min value="0" /> <max value="1" /> </base> <type> <extension url="http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type"> <valueUrl value="string" /> </extension> <code value="http://hl7.org/fhirpath/System.String" /> </type> <condition value="ele-1" /> <mapping> <identity value="rim" /> <map value="n/a" /> </mapping> </element> <element id="ClaimResponse.payment.extension"> <path value="ClaimResponse.payment.extension" /> <slicing> <discriminator> <type value="value" /> <path value="url" /> </discriminator> <description value="Extensions are always sliced by (at least) url" /> <rules value="open" /> </slicing> <short value="Additional content defined by implementations" /> <definition value="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 value="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 value="extensions" /> <alias value="user content" /> <min value="0" /> <max value="*" /> <base> <path value="Element.extension" /> <min value="0" /> <max value="*" /> </base> <type> <code value="Extension" /> </type> <constraint> <key value="ele-1" /> <severity value="error" /> <human value="All FHIR elements must have a @value or children" /> <expression value="hasValue() or (children().count() > id.count())" /> <source value="http://hl7.org/fhir/StructureDefinition/Element" /> </constraint> <constraint> <key value="ext-1" /> <severity value="error" /> <human value="Must have either extensions or value[x], not both" /> <expression value="extension.exists() != value.exists()" /> <source value="http://hl7.org/fhir/StructureDefinition/Extension" /> </constraint> <mapping> <identity value="rim" /> <map value="n/a" /> </mapping> <mapping> <identity value="rim" /> <map value="N/A" /> </mapping> </element> <element id="ClaimResponse.payment.modifierExtension"> <path value="ClaimResponse.payment.modifierExtension" /> <short value="Extensions that cannot be ignored even if unrecognized" /> <definition value="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. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself)." /> <comment value="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 value="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 value="extensions" /> <alias value="user content" /> <alias value="modifiers" /> <min value="0" /> <max value="*" /> <base> <path value="BackboneElement.modifierExtension" /> <min value="0" /> <max value="*" /> </base> <type> <code value="Extension" /> </type> <constraint> <key value="ele-1" /> <severity value="error" /> <human value="All FHIR elements must have a @value or children" /> <expression value="hasValue() or (children().count() > id.count())" /> <source value="http://hl7.org/fhir/StructureDefinition/Element" /> </constraint> <constraint> <key value="ext-1" /> <severity value="error" /> <human value="Must have either extensions or value[x], not both" /> <expression value="extension.exists() != value.exists()" /> <source value="http://hl7.org/fhir/StructureDefinition/Extension" /> </constraint> <isModifier value="true" /> <isModifierReason value="Modifier extensions are expected to modify the meaning or interpretation of the element that contains them" /> <isSummary value="true" /> <mapping> <identity value="rim" /> <map value="n/a" /> </mapping> <mapping> <identity value="rim" /> <map value="N/A" /> </mapping> </element> <element id="ClaimResponse.payment.type"> <path value="ClaimResponse.payment.type" /> <short value="Partial or complete payment" /> <definition value="Whether this represents partial or complete payment of the benefits payable." /> <comment value="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 value="To advise the requestor when the insurer believes all payments to have been completed." /> <min value="1" /> <max value="1" /> <base> <path value="ClaimResponse.payment.type" /> <min value="1" /> <max value="1" /> </base> <type> <code value="CodeableConcept" /> </type> <constraint> <key value="ele-1" /> <severity value="error" /> <human value="All FHIR elements must have a @value or children" /> <expression value="hasValue() or (children().count() > id.count())" /> <source value="http://hl7.org/fhir/StructureDefinition/Element" /> </constraint> <mustSupport value="false" /> <isModifier value="false" /> <isSummary value="false" /> <binding> <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName"> <valueString value="PaymentType" /> </extension> <strength value="example" /> <description value="The type (partial, complete) of the payment." /> <valueSet value="http://hl7.org/fhir/ValueSet/ex-paymenttype" /> </binding> <mapping> <identity value="rim" /> <map value="n/a" /> </mapping> <mapping> <identity value="v2" /> <map value="CE/CNE/CWE" /> </mapping> <mapping> <identity value="rim" /> <map value="CD" /> </mapping> <mapping> <identity value="orim" /> <map value="fhir:CodeableConcept rdfs:subClassOf dt:CD" /> </mapping> </element> <element id="ClaimResponse.payment.adjustment"> <path value="ClaimResponse.payment.adjustment" /> <short value="Payment adjustment for non-claim issues" /> <definition value="Total amount of all adjustments to this payment included in this transaction which are not related to this claim's adjudication." /> <comment value="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 value="To advise the requestor of adjustments applied to the payment." /> <min value="0" /> <max value="1" /> <base> <path value="ClaimResponse.payment.adjustment" /> <min value="0" /> <max value="1" /> </base> <type> <code value="Money" /> </type> <constraint> <key value="ele-1" /> <severity value="error" /> <human value="All FHIR elements must have a @value or children" /> <expression value="hasValue() or (children().count() > id.count())" /> <source value="http://hl7.org/fhir/StructureDefinition/Element" /> </constraint> <mustSupport value="false" /> <isModifier value="false" /> <isSummary value="false" /> <mapping> <identity value="rim" /> <map value="n/a" /> </mapping> <mapping> <identity value="rim" /> <map value="MO" /> </mapping> </element> <element id="ClaimResponse.payment.adjustmentReason"> <path value="ClaimResponse.payment.adjustmentReason" /> <short value="Explanation for the adjustment" /> <definition value="Reason for the payment adjustment." /> <comment value="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 value="Needed to clarify the monetary adjustment." /> <min value="0" /> <max value="1" /> <base> <path value="ClaimResponse.payment.adjustmentReason" /> <min value="0" /> <max value="1" /> </base> <type> <code value="CodeableConcept" /> </type> <constraint> <key value="ele-1" /> <severity value="error" /> <human value="All FHIR elements must have a @value or children" /> <expression value="hasValue() or (children().count() > id.count())" /> <source value="http://hl7.org/fhir/StructureDefinition/Element" /> </constraint> <mustSupport value="false" /> <isModifier value="false" /> <isSummary value="false" /> <binding> <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName"> <valueString value="PaymentAdjustmentReason" /> </extension> <strength value="example" /> <description value="Payment Adjustment reason codes." /> <valueSet value="http://hl7.org/fhir/ValueSet/payment-adjustment-reason" /> </binding> <mapping> <identity value="rim" /> <map value="n/a" /> </mapping> <mapping> <identity value="v2" /> <map value="CE/CNE/CWE" /> </mapping> <mapping> <identity value="rim" /> <map value="CD" /> </mapping> <mapping> <identity value="orim" /> <map value="fhir:CodeableConcept rdfs:subClassOf dt:CD" /> </mapping> </element> <element id="ClaimResponse.payment.date"> <path value="ClaimResponse.payment.date" /> <short value="Expected date of payment" /> <definition value="Estimated date the payment will be issued or the actual issue date of payment." /> <requirements value="To advise the payee when payment can be expected." /> <min value="0" /> <max value="1" /> <base> <path value="ClaimResponse.payment.date" /> <min value="0" /> <max value="1" /> </base> <type> <code value="date" /> </type> <constraint> <key value="ele-1" /> <severity value="error" /> <human value="All FHIR elements must have a @value or children" /> <expression value="hasValue() or (children().count() > id.count())" /> <source value="http://hl7.org/fhir/StructureDefinition/Element" /> </constraint> <mustSupport value="false" /> <isModifier value="false" /> <isSummary value="false" /> <mapping> <identity value="rim" /> <map value="n/a" /> </mapping> </element> <element id="ClaimResponse.payment.amount"> <path value="ClaimResponse.payment.amount" /> <short value="Payable amount after adjustment" /> <definition value="Benefits payable less any payment adjustment." /> <requirements value="Needed to provide the actual payment amount." /> <min value="1" /> <max value="1" /> <base> <path value="ClaimResponse.payment.amount" /> <min value="1" /> <max value="1" /> </base> <type> <code value="Money" /> </type> <constraint> <key value="ele-1" /> <severity value="error" /> <human value="All FHIR elements must have a @value or children" /> <expression value="hasValue() or (children().count() > id.count())" /> <source value="http://hl7.org/fhir/StructureDefinition/Element" /> </constraint> <mustSupport value="false" /> <isModifier value="false" /> <isSummary value="false" /> <mapping> <identity value="rim" /> <map value="n/a" /> </mapping> <mapping> <identity value="rim" /> <map value="MO" /> </mapping> </element> <element id="ClaimResponse.payment.identifier"> <path value="ClaimResponse.payment.identifier" /> <short value="Business identifier for the payment" /> <definition value="Issuer's unique identifier for the payment instrument." /> <comment value="For example: EFT number or check number." /> <requirements value="Enable the receiver to reconcile when payment received." /> <min value="0" /> <max value="1" /> <base> <path value="ClaimResponse.payment.identifier" /> <min value="0" /> <max value="1" /> </base> <type> <code value="Identifier" /> </type> <constraint> <key value="ele-1" /> <severity value="error" /> <human value="All FHIR elements must have a @value or children" /> <expression value="hasValue() or (children().count() > id.count())" /> <source value="http://hl7.org/fhir/StructureDefinition/Element" /> </constraint> <constraint> <key value="ident-1" /> <severity value="warning" /> <human value="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="value.exists()" /> <source value="http://hl7.org/fhir/StructureDefinition/Identifier" /> </constraint> <mustSupport value="false" /> <isModifier value="false" /> <isSummary value="false" /> <mapping> <identity value="rim" /> <map value="n/a" /> </mapping> <mapping> <identity value="v2" /> <map value="CX / EI (occasionally, more often EI maps to a resource id or a URL)" /> </mapping> <mapping> <identity value="rim" /> <map value="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]" /> </mapping> <mapping> <identity value="servd" /> <map value="Identifier" /> </mapping> </element> <element id="ClaimResponse.fundsReserve"> <path value="ClaimResponse.fundsReserve" /> <short value="Funds reserved status" /> <definition value="A code, used only on a response to a preauthorization, to indicate whether the benefits payable have been reserved and for whom." /> <comment value="Fund would be release by a future claim quoting the preAuthRef of this response. Examples of values include: provider, patient, none." /> <requirements value="Needed to advise the submitting provider on whether the rquest for reservation of funds has been honored." /> <min value="0" /> <max value="1" /> <base> <path value="ClaimResponse.fundsReserve" /> <min value="0" /> <max value="1" /> </base> <type> <code value="CodeableConcept" /> </type> <constraint> <key value="ele-1" /> <severity value="error" /> <human value="All FHIR elements must have a @value or children" /> <expression value="hasValue() or (children().count() > id.count())" /> <source value="http://hl7.org/fhir/StructureDefinition/Element" /> </constraint> <mustSupport value="false" /> <isModifier value="false" /> <isSummary value="false" /> <binding> <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName"> <valueString value="FundsReserve" /> </extension> <strength value="example" /> <description value="For whom funds are to be reserved: (Patient, Provider, None)." /> <valueSet value="http://hl7.org/fhir/ValueSet/fundsreserve" /> </binding> <mapping> <identity value="rim" /> <map value="n/a" /> </mapping> <mapping> <identity value="v2" /> <map value="CE/CNE/CWE" /> </mapping> <mapping> <identity value="rim" /> <map value="CD" /> </mapping> <mapping> <identity value="orim" /> <map value="fhir:CodeableConcept rdfs:subClassOf dt:CD" /> </mapping> </element> <element id="ClaimResponse.formCode"> <path value="ClaimResponse.formCode" /> <short value="Printed form identifier" /> <definition value="A code for the form to be used for printing the content." /> <comment value="May be needed to identify specific jurisdictional forms." /> <requirements value="Needed to specify the specific form used for producing output for this response." /> <min value="0" /> <max value="1" /> <base> <path value="ClaimResponse.formCode" /> <min value="0" /> <max value="1" /> </base> <type> <code value="CodeableConcept" /> </type> <constraint> <key value="ele-1" /> <severity value="error" /> <human value="All FHIR elements must have a @value or children" /> <expression value="hasValue() or (children().count() > id.count())" /> <source value="http://hl7.org/fhir/StructureDefinition/Element" /> </constraint> <mustSupport value="false" /> <isModifier value="false" /> <isSummary value="false" /> <binding> <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName"> <valueString value="Forms" /> </extension> <strength value="example" /> <description value="The forms codes." /> <valueSet value="http://hl7.org/fhir/ValueSet/forms" /> </binding> <mapping> <identity value="rim" /> <map value="n/a" /> </mapping> <mapping> <identity value="v2" /> <map value="CE/CNE/CWE" /> </mapping> <mapping> <identity value="rim" /> <map value="CD" /> </mapping> <mapping> <identity value="orim" /> <map value="fhir:CodeableConcept rdfs:subClassOf dt:CD" /> </mapping> </element> <element id="ClaimResponse.form"> <path value="ClaimResponse.form" /> <short value="Printed reference or actual form" /> <definition value="The actual form, by reference or inclusion, for printing the content or an EOB." /> <comment value="Needed to permit insurers to include the actual form." /> <requirements value="Needed to include the specific form used for producing output for this response." /> <min value="0" /> <max value="1" /> <base> <path value="ClaimResponse.form" /> <min value="0" /> <max value="1" /> </base> <type> <code value="Attachment" /> </type> <constraint> <key value="ele-1" /> <severity value="error" /> <human value="All FHIR elements must have a @value or children" /> <expression value="hasValue() or (children().count() > id.count())" /> <source value="http://hl7.org/fhir/StructureDefinition/Element" /> </constraint> <constraint> <key value="att-1" /> <severity value="error" /> <human value="If the Attachment has data, it SHALL have a contentType" /> <expression value="data.empty() or contentType.exists()" /> <source value="http://hl7.org/fhir/StructureDefinition/Attachment" /> </constraint> <mustSupport value="false" /> <isModifier value="false" /> <isSummary value="false" /> <mapping> <identity value="rim" /> <map value="n/a" /> </mapping> <mapping> <identity value="v2" /> <map value="ED/RP" /> </mapping> <mapping> <identity value="rim" /> <map value="ED" /> </mapping> </element> <element id="ClaimResponse.processNote"> <extension url="http://hl7.org/fhir/StructureDefinition/structuredefinition-explicit-type-name"> <valueString value="Note" /> </extension> <path value="ClaimResponse.processNote" /> <short value="Note concerning adjudication" /> <definition value="A note that describes or explains adjudication results in a human readable form." /> <requirements value="Provides the insurer specific textual explanations associated with the processing." /> <min value="0" /> <max value="*" /> <base> <path value="ClaimResponse.processNote" /> <min value="0" /> <max value="*" /> </base> <type> <code value="BackboneElement" /> </type> <constraint> <key value="ele-1" /> <severity value="error" /> <human value="All FHIR elements must have a @value or children" /> <expression value="hasValue() or (children().count() > id.count())" /> <source value="http://hl7.org/fhir/StructureDefinition/Element" /> </constraint> <mustSupport value="false" /> <isModifier value="false" /> <isSummary value="false" /> <mapping> <identity value="rim" /> <map value="n/a" /> </mapping> </element> <element id="ClaimResponse.processNote.id"> <path value="ClaimResponse.processNote.id" /> <representation value="xmlAttr" /> <short value="Unique id for inter-element referencing" /> <definition value="Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces." /> <min value="0" /> <max value="1" /> <base> <path value="Element.id" /> <min value="0" /> <max value="1" /> </base> <type> <extension url="http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type"> <valueUrl value="string" /> </extension> <code value="http://hl7.org/fhirpath/System.String" /> </type> <condition value="ele-1" /> <mapping> <identity value="rim" /> <map value="n/a" /> </mapping> </element> <element id="ClaimResponse.processNote.extension"> <path value="ClaimResponse.processNote.extension" /> <slicing> <discriminator> <type value="value" /> <path value="url" /> </discriminator> <description value="Extensions are always sliced by (at least) url" /> <rules value="open" /> </slicing> <short value="Additional content defined by implementations" /> <definition value="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 value="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 value="extensions" /> <alias value="user content" /> <min value="0" /> <max value="*" /> <base> <path value="Element.extension" /> <min value="0" /> <max value="*" /> </base> <type> <code value="Extension" /> </type> <constraint> <key value="ele-1" /> <severity value="error" /> <human value="All FHIR elements must have a @value or children" /> <expression value="hasValue() or (children().count() > id.count())" /> <source value="http://hl7.org/fhir/StructureDefinition/Element" /> </constraint> <constraint> <key value="ext-1" /> <severity value="error" /> <human value="Must have either extensions or value[x], not both" /> <expression value="extension.exists() != value.exists()" /> <source value="http://hl7.org/fhir/StructureDefinition/Extension" /> </constraint> <mapping> <identity value="rim" /> <map value="n/a" /> </mapping> <mapping> <identity value="rim" /> <map value="N/A" /> </mapping> </element> <element id="ClaimResponse.processNote.modifierExtension"> <path value="ClaimResponse.processNote.modifierExtension" /> <short value="Extensions that cannot be ignored even if unrecognized" /> <definition value="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. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself)." /> <comment value="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 value="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 value="extensions" /> <alias value="user content" /> <alias value="modifiers" /> <min value="0" /> <max value="*" /> <base> <path value="BackboneElement.modifierExtension" /> <min value="0" /> <max value="*" /> </base> <type> <code value="Extension" /> </type> <constraint> <key value="ele-1" /> <severity value="error" /> <human value="All FHIR elements must have a @value or children" /> <expression value="hasValue() or (children().count() > id.count())" /> <source value="http://hl7.org/fhir/StructureDefinition/Element" /> </constraint> <constraint> <key value="ext-1" /> <severity value="error" /> <human value="Must have either extensions or value[x], not both" /> <expression value="extension.exists() != value.exists()" /> <source value="http://hl7.org/fhir/StructureDefinition/Extension" /> </constraint> <isModifier value="true" /> <isModifierReason value="Modifier extensions are expected to modify the meaning or interpretation of the element that contains them" /> <isSummary value="true" /> <mapping> <identity value="rim" /> <map value="n/a" /> </mapping> <mapping> <identity value="rim" /> <map value="N/A" /> </mapping> </element> <element id="ClaimResponse.processNote.number"> <path value="ClaimResponse.processNote.number" /> <short value="Note instance identifier" /> <definition value="A number to uniquely identify a note entry." /> <comment value="32 bit number; for values larger than this, use decimal" /> <requirements value="Necessary to provide a mechanism to link from adjudications." /> <min value="0" /> <max value="1" /> <base> <path value="ClaimResponse.processNote.number" /> <min value="0" /> <max value="1" /> </base> <type> <code value="positiveInt" /> </type> <constraint> <key value="ele-1" /> <severity value="error" /> <human value="All FHIR elements must have a @value or children" /> <expression value="hasValue() or (children().count() > id.count())" /> <source value="http://hl7.org/fhir/StructureDefinition/Element" /> </constraint> <mustSupport value="false" /> <isModifier value="false" /> <isSummary value="false" /> <mapping> <identity value="rim" /> <map value="n/a" /> </mapping> </element> <element id="ClaimResponse.processNote.type"> <path value="ClaimResponse.processNote.type" /> <short value="Note purpose" /> <definition value="The business purpose of the note text." /> <comment value="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 value="To convey the expectation for when the text is used." /> <min value="0" /> <max value="1" /> <base> <path value="ClaimResponse.processNote.type" /> <min value="0" /> <max value="1" /> </base> <type> <code value="CodeableConcept" /> </type> <constraint> <key value="ele-1" /> <severity value="error" /> <human value="All FHIR elements must have a @value or children" /> <expression value="hasValue() or (children().count() > id.count())" /> <source value="http://hl7.org/fhir/StructureDefinition/Element" /> </constraint> <mustSupport value="false" /> <isModifier value="false" /> <isSummary value="false" /> <binding> <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName"> <valueString value="NoteType" /> </extension> <strength value="extensible" /> <description value="The presentation types of notes." /> <valueSet value="http://hl7.org/fhir/ValueSet/note-type" /> </binding> <mapping> <identity value="rim" /> <map value="n/a" /> </mapping> <mapping> <identity value="v2" /> <map value="CE/CNE/CWE" /> </mapping> <mapping> <identity value="rim" /> <map value="CD" /> </mapping> <mapping> <identity value="orim" /> <map value="fhir:CodeableConcept rdfs:subClassOf dt:CD" /> </mapping> </element> <element id="ClaimResponse.processNote.text"> <path value="ClaimResponse.processNote.text" /> <short value="Note explanatory text" /> <definition value="The explanation or description associated with the processing." /> <comment value="Note that FHIR strings SHALL NOT exceed 1,048,576 (1024*1024) characters in size" /> <requirements value="Required to provide human readable explanation." /> <min value="1" /> <max value="1" /> <base> <path value="ClaimResponse.processNote.text" /> <min value="1" /> <max value="1" /> </base> <type> <code value="string" /> </type> <constraint> <key value="ele-1" /> <severity value="error" /> <human value="All FHIR elements must have a @value or children" /> <expression value="hasValue() or (children().count() > id.count())" /> <source value="http://hl7.org/fhir/StructureDefinition/Element" /> </constraint> <mustSupport value="false" /> <isModifier value="false" /> <isSummary value="false" /> <mapping> <identity value="rim" /> <map value="n/a" /> </mapping> </element> <element id="ClaimResponse.processNote.language"> <path value="ClaimResponse.processNote.language" /> <short value="Language of the text" /> <definition value="A code to define the language used in the text of the note." /> <comment value="Only required if the language is different from the resource language." /> <requirements value="Note text may vary from the resource defined language." /> <min value="0" /> <max value="1" /> <base> <path value="ClaimResponse.processNote.language" /> <min value="0" /> <max value="1" /> </base> <type> <code value="CodeableConcept" /> </type> <constraint> <key value="ele-1" /> <severity value="error" /> <human value="All FHIR elements must have a @value or children" /> <expression value="hasValue() or (children().count() > id.count())" /> <source value="http://hl7.org/fhir/StructureDefinition/Element" /> </constraint> <mustSupport value="false" /> <isModifier value="false" /> <isSummary value="false" /> <binding> <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName"> <valueString value="Language" /> </extension> <strength value="required" /> <description value="IETF language tag for a human language" /> <valueSet value="http://hl7.org/fhir/ValueSet/all-languages|5.0.0" /> <additional> <purpose value="starter" /> <valueSet value="http://hl7.org/fhir/ValueSet/languages" /> </additional> </binding> <mapping> <identity value="rim" /> <map value="n/a" /> </mapping> <mapping> <identity value="v2" /> <map value="CE/CNE/CWE" /> </mapping> <mapping> <identity value="rim" /> <map value="CD" /> </mapping> <mapping> <identity value="orim" /> <map value="fhir:CodeableConcept rdfs:subClassOf dt:CD" /> </mapping> </element> <element id="ClaimResponse.communicationRequest"> <path value="ClaimResponse.communicationRequest" /> <short value="Request for additional information" /> <definition value="Request for additional supporting or authorizing information." /> <comment value="For example: professional reports, documents, images, clinical resources, or accident reports." /> <requirements value="Need to communicate insurer request for additional information required to support the adjudication." /> <min value="0" /> <max value="*" /> <base> <path value="ClaimResponse.communicationRequest" /> <min value="0" /> <max value="*" /> </base> <type> <code value="Reference" /> <targetProfile value="http://hl7.org/fhir/StructureDefinition/CommunicationRequest" /> </type> <constraint> <key value="ele-1" /> <severity value="error" /> <human value="All FHIR elements must have a @value or children" /> <expression value="hasValue() or (children().count() > id.count())" /> <source value="http://hl7.org/fhir/StructureDefinition/Element" /> </constraint> <constraint> <key value="ref-1" /> <severity value="error" /> <human value="SHALL have a contained resource if a local reference is provided" /> <expression value="reference.exists() implies (reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids')) or (reference='#' and %rootResource!=%resource))" /> <source value="http://hl7.org/fhir/StructureDefinition/Reference" /> </constraint> <constraint> <key value="ref-2" /> <severity value="error" /> <human value="At least one of reference, identifier and display SHALL be present (unless an extension is provided)." /> <expression value="reference.exists() or identifier.exists() or display.exists() or extension.exists()" /> <source value="http://hl7.org/fhir/StructureDefinition/Reference" /> </constraint> <mustSupport value="false" /> <isModifier value="false" /> <isSummary value="false" /> <mapping> <identity value="rim" /> <map value="n/a" /> </mapping> <mapping> <identity value="rim" /> <map value="The target of a resource reference is a RIM entry point (Act, Role, or Entity)" /> </mapping> </element> <element id="ClaimResponse.insurance"> <extension url="http://hl7.org/fhir/StructureDefinition/structuredefinition-explicit-type-name"> <valueString value="Insurance" /> </extension> <path value="ClaimResponse.insurance" /> <short value="Patient insurance information" /> <definition value="Financial instruments for reimbursement for the health care products and services specified on the claim." /> <comment value="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 value="At least one insurer is required for a claim to be a claim." /> <min value="0" /> <max value="*" /> <base> <path value="ClaimResponse.insurance" /> <min value="0" /> <max value="*" /> </base> <type> <code value="BackboneElement" /> </type> <constraint> <key value="ele-1" /> <severity value="error" /> <human value="All FHIR elements must have a @value or children" /> <expression value="hasValue() or (children().count() > id.count())" /> <source value="http://hl7.org/fhir/StructureDefinition/Element" /> </constraint> <mustSupport value="false" /> <isModifier value="false" /> <isSummary value="false" /> <mapping> <identity value="rim" /> <map value="n/a" /> </mapping> <mapping> <identity value="rim" /> <map value="Coverage" /> </mapping> </element> <element id="ClaimResponse.insurance.id"> <path value="ClaimResponse.insurance.id" /> <representation value="xmlAttr" /> <short value="Unique id for inter-element referencing" /> <definition value="Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces." /> <min value="0" /> <max value="1" /> <base> <path value="Element.id" /> <min value="0" /> <max value="1" /> </base> <type> <extension url="http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type"> <valueUrl value="string" /> </extension> <code value="http://hl7.org/fhirpath/System.String" /> </type> <condition value="ele-1" /> <mapping> <identity value="rim" /> <map value="n/a" /> </mapping> </element> <element id="ClaimResponse.insurance.extension"> <path value="ClaimResponse.insurance.extension" /> <slicing> <discriminator> <type value="value" /> <path value="url" /> </discriminator> <description value="Extensions are always sliced by (at least) url" /> <rules value="open" /> </slicing> <short value="Additional content defined by implementations" /> <definition value="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 value="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 value="extensions" /> <alias value="user content" /> <min value="0" /> <max value="*" /> <base> <path value="Element.extension" /> <min value="0" /> <max value="*" /> </base> <type> <code value="Extension" /> </type> <constraint> <key value="ele-1" /> <severity value="error" /> <human value="All FHIR elements must have a @value or children" /> <expression value="hasValue() or (children().count() > id.count())" /> <source value="http://hl7.org/fhir/StructureDefinition/Element" /> </constraint> <constraint> <key value="ext-1" /> <severity value="error" /> <human value="Must have either extensions or value[x], not both" /> <expression value="extension.exists() != value.exists()" /> <source value="http://hl7.org/fhir/StructureDefinition/Extension" /> </constraint> <mapping> <identity value="rim" /> <map value="n/a" /> </mapping> <mapping> <identity value="rim" /> <map value="N/A" /> </mapping> </element> <element id="ClaimResponse.insurance.modifierExtension"> <path value="ClaimResponse.insurance.modifierExtension" /> <short value="Extensions that cannot be ignored even if unrecognized" /> <definition value="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. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself)." /> <comment value="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 value="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 value="extensions" /> <alias value="user content" /> <alias value="modifiers" /> <min value="0" /> <max value="*" /> <base> <path value="BackboneElement.modifierExtension" /> <min value="0" /> <max value="*" /> </base> <type> <code value="Extension" /> </type> <constraint> <key value="ele-1" /> <severity value="error" /> <human value="All FHIR elements must have a @value or children" /> <expression value="hasValue() or (children().count() > id.count())" /> <source value="http://hl7.org/fhir/StructureDefinition/Element" /> </constraint> <constraint> <key value="ext-1" /> <severity value="error" /> <human value="Must have either extensions or value[x], not both" /> <expression value="extension.exists() != value.exists()" /> <source value="http://hl7.org/fhir/StructureDefinition/Extension" /> </constraint> <isModifier value="true" /> <isModifierReason value="Modifier extensions are expected to modify the meaning or interpretation of the element that contains them" /> <isSummary value="true" /> <mapping> <identity value="rim" /> <map value="n/a" /> </mapping> <mapping> <identity value="rim" /> <map value="N/A" /> </mapping> </element> <element id="ClaimResponse.insurance.sequence"> <path value="ClaimResponse.insurance.sequence" /> <short value="Insurance instance identifier" /> <definition value="A number to uniquely identify insurance entries and provide a sequence of coverages to convey coordination of benefit order." /> <comment value="32 bit number; for values larger than this, use decimal" /> <requirements value="To maintain order of the coverages." /> <min value="1" /> <max value="1" /> <base> <path value="ClaimResponse.insurance.sequence" /> <min value="1" /> <max value="1" /> </base> <type> <code value="positiveInt" /> </type> <constraint> <key value="ele-1" /> <severity value="error" /> <human value="All FHIR elements must have a @value or children" /> <expression value="hasValue() or (children().count() > id.count())" /> <source value="http://hl7.org/fhir/StructureDefinition/Element" /> </constraint> <mustSupport value="false" /> <isModifier value="false" /> <isSummary value="false" /> <mapping> <identity value="rim" /> <map value="n/a" /> </mapping> </element> <element id="ClaimResponse.insurance.focal"> <path value="ClaimResponse.insurance.focal" /> <short value="Coverage to be used for adjudication" /> <definition value="A flag to indicate that this Coverage is to be used for adjudication of this claim when set to true." /> <comment value="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 value="To identify which coverage in the list is being used to adjudicate this claim." /> <min value="1" /> <max value="1" /> <base> <path value="ClaimResponse.insurance.focal" /> <min value="1" /> <max value="1" /> </base> <type> <code value="boolean" /> </type> <constraint> <key value="ele-1" /> <severity value="error" /> <human value="All FHIR elements must have a @value or children" /> <expression value="hasValue() or (children().count() > id.count())" /> <source value="http://hl7.org/fhir/StructureDefinition/Element" /> </constraint> <mustSupport value="false" /> <isModifier value="false" /> <isSummary value="false" /> <mapping> <identity value="rim" /> <map value="n/a" /> </mapping> </element> <element id="ClaimResponse.insurance.coverage"> <path value="ClaimResponse.insurance.coverage" /> <short value="Insurance information" /> <definition value="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 value="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 value="Required to allow the adjudicator to locate the correct policy and history within their information system." /> <min value="1" /> <max value="1" /> <base> <path value="ClaimResponse.insurance.coverage" /> <min value="1" /> <max value="1" /> </base> <type> <code value="Reference" /> <targetProfile value="http://hl7.org/fhir/StructureDefinition/Coverage" /> </type> <constraint> <key value="ele-1" /> <severity value="error" /> <human value="All FHIR elements must have a @value or children" /> <expression value="hasValue() or (children().count() > id.count())" /> <source value="http://hl7.org/fhir/StructureDefinition/Element" /> </constraint> <constraint> <key value="ref-1" /> <severity value="error" /> <human value="SHALL have a contained resource if a local reference is provided" /> <expression value="reference.exists() implies (reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids')) or (reference='#' and %rootResource!=%resource))" /> <source value="http://hl7.org/fhir/StructureDefinition/Reference" /> </constraint> <constraint> <key value="ref-2" /> <severity value="error" /> <human value="At least one of reference, identifier and display SHALL be present (unless an extension is provided)." /> <expression value="reference.exists() or identifier.exists() or display.exists() or extension.exists()" /> <source value="http://hl7.org/fhir/StructureDefinition/Reference" /> </constraint> <mustSupport value="false" /> <isModifier value="false" /> <isSummary value="false" /> <mapping> <identity value="rim" /> <map value="n/a" /> </mapping> <mapping> <identity value="rim" /> <map value="The target of a resource reference is a RIM entry point (Act, Role, or Entity)" /> </mapping> </element> <element id="ClaimResponse.insurance.businessArrangement"> <path value="ClaimResponse.insurance.businessArrangement" /> <short value="Additional provider contract number" /> <definition value="A business agreement number established between the provider and the insurer for special business processing purposes." /> <comment value="Note that FHIR strings SHALL NOT exceed 1,048,576 (1024*1024) characters in size" /> <requirements value="Providers may have multiple business arrangements with a given insurer and must supply the specific contract number for adjudication." /> <min value="0" /> <max value="1" /> <base> <path value="ClaimResponse.insurance.businessArrangement" /> <min value="0" /> <max value="1" /> </base> <type> <code value="string" /> </type> <constraint> <key value="ele-1" /> <severity value="error" /> <human value="All FHIR elements must have a @value or children" /> <expression value="hasValue() or (children().count() > id.count())" /> <source value="http://hl7.org/fhir/StructureDefinition/Element" /> </constraint> <mustSupport value="false" /> <isModifier value="false" /> <isSummary value="false" /> <mapping> <identity value="rim" /> <map value="n/a" /> </mapping> </element> <element id="ClaimResponse.insurance.claimResponse"> <path value="ClaimResponse.insurance.claimResponse" /> <short value="Adjudication results" /> <definition value="The result of the adjudication of the line items for the Coverage specified in this insurance." /> <comment value="Must not be specified when 'focal=true' for this insurance." /> <requirements value="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 value="0" /> <max value="1" /> <base> <path value="ClaimResponse.insurance.claimResponse" /> <min value="0" /> <max value="1" /> </base> <type> <code value="Reference" /> <targetProfile value="http://hl7.org/fhir/StructureDefinition/ClaimResponse" /> </type> <constraint> <key value="ele-1" /> <severity value="error" /> <human value="All FHIR elements must have a @value or children" /> <expression value="hasValue() or (children().count() > id.count())" /> <source value="http://hl7.org/fhir/StructureDefinition/Element" /> </constraint> <constraint> <key value="ref-1" /> <severity value="error" /> <human value="SHALL have a contained resource if a local reference is provided" /> <expression value="reference.exists() implies (reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids')) or (reference='#' and %rootResource!=%resource))" /> <source value="http://hl7.org/fhir/StructureDefinition/Reference" /> </constraint> <constraint> <key value="ref-2" /> <severity value="error" /> <human value="At least one of reference, identifier and display SHALL be present (unless an extension is provided)." /> <expression value="reference.exists() or identifier.exists() or display.exists() or extension.exists()" /> <source value="http://hl7.org/fhir/StructureDefinition/Reference" /> </constraint> <mustSupport value="false" /> <isModifier value="false" /> <isSummary value="false" /> <mapping> <identity value="rim" /> <map value="n/a" /> </mapping> <mapping> <identity value="rim" /> <map value="The target of a resource reference is a RIM entry point (Act, Role, or Entity)" /> </mapping> </element> <element id="ClaimResponse.error"> <extension url="http://hl7.org/fhir/StructureDefinition/structuredefinition-explicit-type-name"> <valueString value="Error" /> </extension> <path value="ClaimResponse.error" /> <short value="Processing errors" /> <definition value="Errors encountered during the processing of the adjudication." /> <comment value="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 value="Need to communicate processing issues to the requestor." /> <min value="0" /> <max value="*" /> <base> <path value="ClaimResponse.error" /> <min value="0" /> <max value="*" /> </base> <type> <code value="BackboneElement" /> </type> <constraint> <key value="ele-1" /> <severity value="error" /> <human value="All FHIR elements must have a @value or children" /> <expression value="hasValue() or (children().count() > id.count())" /> <source value="http://hl7.org/fhir/StructureDefinition/Element" /> </constraint> <mustSupport value="false" /> <isModifier value="false" /> <isSummary value="false" /> <mapping> <identity value="rim" /> <map value="n/a" /> </mapping> </element> <element id="ClaimResponse.error.id"> <path value="ClaimResponse.error.id" /> <representation value="xmlAttr" /> <short value="Unique id for inter-element referencing" /> <definition value="Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces." /> <min value="0" /> <max value="1" /> <base> <path value="Element.id" /> <min value="0" /> <max value="1" /> </base> <type> <extension url="http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type"> <valueUrl value="string" /> </extension> <code value="http://hl7.org/fhirpath/System.String" /> </type> <condition value="ele-1" /> <mapping> <identity value="rim" /> <map value="n/a" /> </mapping> </element> <element id="ClaimResponse.error.extension"> <path value="ClaimResponse.error.extension" /> <slicing> <discriminator> <type value="value" /> <path value="url" /> </discriminator> <description value="Extensions are always sliced by (at least) url" /> <rules value="open" /> </slicing> <short value="Additional content defined by implementations" /> <definition value="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 value="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 value="extensions" /> <alias value="user content" /> <min value="0" /> <max value="*" /> <base> <path value="Element.extension" /> <min value="0" /> <max value="*" /> </base> <type> <code value="Extension" /> </type> <constraint> <key value="ele-1" /> <severity value="error" /> <human value="All FHIR elements must have a @value or children" /> <expression value="hasValue() or (children().count() > id.count())" /> <source value="http://hl7.org/fhir/StructureDefinition/Element" /> </constraint> <constraint> <key value="ext-1" /> <severity value="error" /> <human value="Must have either extensions or value[x], not both" /> <expression value="extension.exists() != value.exists()" /> <source value="http://hl7.org/fhir/StructureDefinition/Extension" /> </constraint> <mapping> <identity value="rim" /> <map value="n/a" /> </mapping> <mapping> <identity value="rim" /> <map value="N/A" /> </mapping> </element> <element id="ClaimResponse.error.modifierExtension"> <path value="ClaimResponse.error.modifierExtension" /> <short value="Extensions that cannot be ignored even if unrecognized" /> <definition value="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. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself)." /> <comment value="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 value="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 value="extensions" /> <alias value="user content" /> <alias value="modifiers" /> <min value="0" /> <max value="*" /> <base> <path value="BackboneElement.modifierExtension" /> <min value="0" /> <max value="*" /> </base> <type> <code value="Extension" /> </type> <constraint> <key value="ele-1" /> <severity value="error" /> <human value="All FHIR elements must have a @value or children" /> <expression value="hasValue() or (children().count() > id.count())" /> <source value="http://hl7.org/fhir/StructureDefinition/Element" /> </constraint> <constraint> <key value="ext-1" /> <severity value="error" /> <human value="Must have either extensions or value[x], not both" /> <expression value="extension.exists() != value.exists()" /> <source value="http://hl7.org/fhir/StructureDefinition/Extension" /> </constraint> <isModifier value="true" /> <isModifierReason value="Modifier extensions are expected to modify the meaning or interpretation of the element that contains them" /> <isSummary value="true" /> <mapping> <identity value="rim" /> <map value="n/a" /> </mapping> <mapping> <identity value="rim" /> <map value="N/A" /> </mapping> </element> <element id="ClaimResponse.error.itemSequence"> <path value="ClaimResponse.error.itemSequence" /> <short value="Item sequence number" /> <definition value="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 value="32 bit number; for values larger than this, use decimal" /> <requirements value="Provides references to the claim items." /> <min value="0" /> <max value="1" /> <base> <path value="ClaimResponse.error.itemSequence" /> <min value="0" /> <max value="1" /> </base> <type> <code value="positiveInt" /> </type> <constraint> <key value="ele-1" /> <severity value="error" /> <human value="All FHIR elements must have a @value or children" /> <expression value="hasValue() or (children().count() > id.count())" /> <source value="http://hl7.org/fhir/StructureDefinition/Element" /> </constraint> <mustSupport value="false" /> <isModifier value="false" /> <isSummary value="false" /> <mapping> <identity value="rim" /> <map value="n/a" /> </mapping> </element> <element id="ClaimResponse.error.detailSequence"> <path value="ClaimResponse.error.detailSequence" /> <short value="Detail sequence number" /> <definition value="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 value="32 bit number; for values larger than this, use decimal" /> <requirements value="Provides references to the claim details within the claim item." /> <min value="0" /> <max value="1" /> <base> <path value="ClaimResponse.error.detailSequence" /> <min value="0" /> <max value="1" /> </base> <type> <code value="positiveInt" /> </type> <constraint> <key value="ele-1" /> <severity value="error" /> <human value="All FHIR elements must have a @value or children" /> <expression value="hasValue() or (children().count() > id.count())" /> <source value="http://hl7.org/fhir/StructureDefinition/Element" /> </constraint> <mustSupport value="false" /> <isModifier value="false" /> <isSummary value="false" /> <mapping> <identity value="rim" /> <map value="n/a" /> </mapping> </element> <element id="ClaimResponse.error.subDetailSequence"> <path value="ClaimResponse.error.subDetailSequence" /> <short value="Subdetail sequence number" /> <definition value="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 value="32 bit number; for values larger than this, use decimal" /> <requirements value="Provides references to the claim sub-details within the claim detail." /> <min value="0" /> <max value="1" /> <base> <path value="ClaimResponse.error.subDetailSequence" /> <min value="0" /> <max value="1" /> </base> <type> <code value="positiveInt" /> </type> <constraint> <key value="ele-1" /> <severity value="error" /> <human value="All FHIR elements must have a @value or children" /> <expression value="hasValue() or (children().count() > id.count())" /> <source value="http://hl7.org/fhir/StructureDefinition/Element" /> </constraint> <mustSupport value="false" /> <isModifier value="false" /> <isSummary value="false" /> <mapping> <identity value="rim" /> <map value="n/a" /> </mapping> </element> <element id="ClaimResponse.error.code"> <path value="ClaimResponse.error.code" /> <short value="Error code detailing processing issues" /> <definition value="An error code, from a specified code system, which details why the claim could not be adjudicated." /> <comment value="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 value="Required to convey processing errors." /> <min value="1" /> <max value="1" /> <base> <path value="ClaimResponse.error.code" /> <min value="1" /> <max value="1" /> </base> <type> <code value="CodeableConcept" /> </type> <constraint> <key value="ele-1" /> <severity value="error" /> <human value="All FHIR elements must have a @value or children" /> <expression value="hasValue() or (children().count() > id.count())" /> <source value="http://hl7.org/fhir/StructureDefinition/Element" /> </constraint> <mustSupport value="false" /> <isModifier value="false" /> <isSummary value="true" /> <binding> <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName"> <valueString value="AdjudicationError" /> </extension> <strength value="example" /> <description value="The adjudication error codes." /> <valueSet value="http://hl7.org/fhir/ValueSet/adjudication-error" /> </binding> <mapping> <identity value="rim" /> <map value="n/a" /> </mapping> <mapping> <identity value="v2" /> <map value="CE/CNE/CWE" /> </mapping> <mapping> <identity value="rim" /> <map value="CD" /> </mapping> <mapping> <identity value="orim" /> <map value="fhir:CodeableConcept rdfs:subClassOf dt:CD" /> </mapping> </element> <element id="ClaimResponse.error.expression"> <path value="ClaimResponse.error.expression" /> <short value="FHIRPath of element(s) related to issue" /> <definition value="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 value="The root of the FHIRPath is the resource or bundle that generated OperationOutcome. Each FHIRPath SHALL resolve to a single node." /> <requirements value="Allows systems to highlight or otherwise guide users to elements implicated in issues to allow them to be fixed more easily." /> <min value="0" /> <max value="*" /> <base> <path value="ClaimResponse.error.expression" /> <min value="0" /> <max value="*" /> </base> <type> <code value="string" /> </type> <constraint> <key value="ele-1" /> <severity value="error" /> <human value="All FHIR elements must have a @value or children" /> <expression value="hasValue() or (children().count() > id.count())" /> <source value="http://hl7.org/fhir/StructureDefinition/Element" /> </constraint> <mustSupport value="false" /> <isModifier value="false" /> <isSummary value="true" /> <mapping> <identity value="rim" /> <map value="n/a" /> </mapping> </element> </snapshot> <differential> <element id="ClaimResponse.contained"> <path value="ClaimResponse.contained" /> <slicing> <discriminator> <type value="profile" /> <path value="$this" /> </discriminator> <rules value="open" /> </slicing> </element> <element id="ClaimResponse.contained:duplicates"> <path value="ClaimResponse.contained" /> <sliceName value="duplicates" /> <max value="1" /> <type> <code value="ExplanationOfBenefit" /> <profile value="https://bpcs.exchange/fhir/StructureDefinition/profile-ExplanationOfBenefit-duplicate" /> </type> <mustSupport value="true" /> </element> <element id="ClaimResponse.contained:dispenses"> <path value="ClaimResponse.contained" /> <sliceName value="dispenses" /> <type> <code value="MedicationDispense" /> <profile value="https://bpcs.exchange/fhir/StructureDefinition/profile-MedicationDispense" /> </type> <mustSupport value="true" /> </element> <element id="ClaimResponse.status"> <path value="ClaimResponse.status" /> <short value="draft | active" /> <mustSupport value="true" /> <binding> <strength value="required" /> <valueSet value="https://bpcs.exchange/fhir/ValueSet/vs-FinancialStatus" /> </binding> <mapping> <identity value="BPCS" /> <map value="BatchRecordDTO.batchStatus" /> </mapping> </element> <element id="ClaimResponse.type"> <path value="ClaimResponse.type" /> <patternCodeableConcept> <coding> <system value="http://terminology.hl7.org/CodeSystem/claim-type" /> <code value="pharmacy" /> </coding> </patternCodeableConcept> </element> <element id="ClaimResponse.use"> <path value="ClaimResponse.use" /> <patternCode value="claim" /> </element> <element id="ClaimResponse.patient"> <path value="ClaimResponse.patient" /> <type> <code value="Reference" /> <profile value="https://bpcs.exchange/fhir/StructureDefinition/profile-Reference-group-or-patient" /> <targetProfile value="https://bpcs.exchange/fhir/StructureDefinition/profile-Patient-create" /> </type> <mustSupport value="true" /> </element> <element id="ClaimResponse.created"> <path value="ClaimResponse.created" /> <comment value="This is the 'current' date when the ClaimResponse is produced" /> <mustSupport value="true" /> </element> <element id="ClaimResponse.insurer"> <path value="ClaimResponse.insurer" /> <patternReference> <reference value="Organization/bpcs" /> </patternReference> </element> <element id="ClaimResponse.request"> <path value="ClaimResponse.request" /> <comment value="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. This will only be present if the submitted Claim has an id (because the Claim has previously been held)" /> <type> <code value="Reference" /> <profile value="https://bpcs.exchange/fhir/StructureDefinition/profile-Reference-rest" /> <targetProfile value="https://bpcs.exchange/fhir/StructureDefinition/profile-Claim-create" /> </type> <mustSupport value="true" /> <mapping> <identity value="BPCS" /> <map value="BatchRecordDTO.dateReceived (second-last component of id), BatchRecordDTO.batchSeqNum (last component of id)" /> </mapping> </element> <element id="ClaimResponse.outcome"> <path value="ClaimResponse.outcome" /> <mustSupport value="true" /> </element> <element id="ClaimResponse.item"> <path value="ClaimResponse.item" /> <comment value="There will be a ClaimResponse.item for each item in the associated claim submission" /> <min value="1" /> <mustSupport value="true" /> </element> <element id="ClaimResponse.item.extension"> <path value="ClaimResponse.item.extension" /> <min value="1" /> <mustSupport value="true" /> </element> <element id="ClaimResponse.item.extension:receiptPlan"> <path value="ClaimResponse.item.extension" /> <sliceName value="receiptPlan" /> <min value="1" /> <type> <code value="Extension" /> <profile value="https://bpcs.exchange/fhir/StructureDefinition/ext-Resource-ReceiptPlan" /> </type> <mustSupport value="true" /> </element> <element id="ClaimResponse.item.extension:presetModifier"> <path value="ClaimResponse.item.extension" /> <sliceName value="presetModifier" /> <type> <code value="Extension" /> <profile value="https://bpcs.exchange/fhir/StructureDefinition/ext-ClaimResponse-PresetModifier" /> </type> <mustSupport value="true" /> </element> <element id="ClaimResponse.item.itemSequence"> <path value="ClaimResponse.item.itemSequence" /> <comment value="This will match the Claim.item.sequence of the corresponding repetition in the associated Claim submission" /> <mustSupport value="true" /> </element> <element id="ClaimResponse.item.reviewOutcome"> <path value="ClaimResponse.item.reviewOutcome" /> <min value="1" /> <mustSupport value="true" /> </element> <element id="ClaimResponse.item.reviewOutcome.extension:info"> <path value="ClaimResponse.item.reviewOutcome.extension" /> <sliceName value="info" /> <type> <code value="Extension" /> <profile value="https://bpcs.exchange/fhir/StructureDefinition/ext-ClaimResponse-Info" /> </type> <mustSupport value="true" /> </element> <element id="ClaimResponse.item.reviewOutcome.decision"> <path value="ClaimResponse.item.reviewOutcome.decision" /> <min value="1" /> <mustSupport value="true" /> <binding> <strength value="required" /> <valueSet value="https://bpcs.exchange/fhir/ValueSet/vs-Receipt-status" /> </binding> </element> <element id="ClaimResponse.item.reviewOutcome.reason"> <path value="ClaimResponse.item.reviewOutcome.reason" /> <comment value="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 value="true" /> <binding> <strength value="extensible" /> <valueSet value="https://bpcs.exchange/fhir/ValueSet/vs-ClaimResponse" /> </binding> <mapping> <identity value="BPCS" /> <map value="AssessContext.responseCodes, AssessmentFlag.(various EFlags)" /> </mapping> </element> <element id="ClaimResponse.item.reviewOutcome.reason.extension:allowedModifier"> <path value="ClaimResponse.item.reviewOutcome.reason.extension" /> <sliceName value="allowedModifier" /> <comment value="Indicates modifier codes permitted to override for this response code (if any)." /> <type> <code value="Extension" /> <profile value="https://bpcs.exchange/fhir/StructureDefinition/ext-ClaimResponse-AllowedModifier" /> </type> <mustSupport value="true" /> </element> <element id="ClaimResponse.item.reviewOutcome.reason.extension:allowedModifier.value[x]"> <path value="ClaimResponse.item.reviewOutcome.reason.extension.value[x]" /> </element> <element id="ClaimResponse.item.reviewOutcome.reason.extension:allowedModifier.value[x].extension:default"> <path value="ClaimResponse.item.reviewOutcome.reason.extension.value[x].extension" /> <sliceName value="default" /> <comment value="May only be present on one modifier within a reason." /> <type> <code value="Extension" /> <profile value="https://bpcs.exchange/fhir/StructureDefinition/ext-ClaimResponse-AllowedModifierDefault" /> </type> <mustSupport value="true" /> </element> <element id="ClaimResponse.item.reviewOutcome.reason.extension:allowedModifier.value[x].extension:preExistingCondition"> <path value="ClaimResponse.item.reviewOutcome.reason.extension.value[x].extension" /> <sliceName value="preExistingCondition" /> <comment value="Only allowed where an 'allowed modifier' is a health condition." /> <type> <code value="Extension" /> <profile value="https://bpcs.exchange/fhir/StructureDefinition/ext-ClaimResponse-PreExistingCondition" /> </type> <mustSupport value="true" /> </element> <element id="ClaimResponse.item.reviewOutcome.reason.extension:duplicate"> <path value="ClaimResponse.item.reviewOutcome.reason.extension" /> <sliceName value="duplicate" /> <comment value="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 value="Extension" /> <profile value="https://bpcs.exchange/fhir/StructureDefinition/ext-ClaimResponse-DuplicateReceipts" /> </type> <mustSupport value="true" /> </element> <element id="ClaimResponse.item.adjudication"> <path value="ClaimResponse.item.adjudication" /> <slicing> <discriminator> <type value="value" /> <path value="category" /> </discriminator> <rules value="open" /> </slicing> <min value="2" /> <mustSupport value="true" /> </element> <element id="ClaimResponse.item.adjudication:eligible"> <path value="ClaimResponse.item.adjudication" /> <sliceName value="eligible" /> <short value="Eligible amount" /> <min value="1" /> <max value="1" /> <mustSupport value="true" /> </element> <element id="ClaimResponse.item.adjudication:eligible.category"> <path value="ClaimResponse.item.adjudication.category" /> <patternCodeableConcept> <coding> <system value="http://terminology.hl7.org/CodeSystem/adjudication" /> <code value="eligible" /> </coding> </patternCodeableConcept> </element> <element id="ClaimResponse.item.adjudication:eligible.amount"> <path value="ClaimResponse.item.adjudication.amount" /> <min value="1" /> <type> <code value="Money" /> <profile value="https://bpcs.exchange/fhir/StructureDefinition/profile-Money-CAD-NonNeg" /> </type> <mustSupport value="true" /> <mapping> <identity value="BPCS" /> <map value="ReceiptDTO.allowedRxExp" /> </mapping> </element> <element id="ClaimResponse.item.adjudication:benefit"> <path value="ClaimResponse.item.adjudication" /> <sliceName value="benefit" /> <short value="Benefit amount" /> <min value="1" /> <max value="1" /> <mustSupport value="true" /> </element> <element id="ClaimResponse.item.adjudication:benefit.category"> <path value="ClaimResponse.item.adjudication.category" /> <patternCodeableConcept> <coding> <system value="http://terminology.hl7.org/CodeSystem/adjudication" /> <code value="benefit" /> </coding> </patternCodeableConcept> </element> <element id="ClaimResponse.item.adjudication:benefit.amount"> <path value="ClaimResponse.item.adjudication.amount" /> <min value="1" /> <type> <code value="Money" /> <profile value="https://bpcs.exchange/fhir/StructureDefinition/profile-Money-CAD-NonNeg" /> </type> <mustSupport value="true" /> <mapping> <identity value="BPCS" /> <map value="ReceiptDTO.reimbAmt" /> </mapping> </element> </differential> </StructureDefinition>