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<StructureDefinition xmlns="http://hl7.org/fhir">
  <id value="ClaimResponse" />
  <meta>
    <lastUpdated value="2021-01-02T08:58:31.578+11:00" />
  </meta>
  <extension url="http://hl7.org/fhir/StructureDefinition/structuredefinition-category">
    <valueString value="Financial.Billing" />
  </extension>
  <extension url="http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status">
    <valueCode value="trial-use" />
  </extension>
  <extension url="http://hl7.org/fhir/StructureDefinition/structuredefinition-fmm">
    <valueInteger value="2" />
  </extension>
  <extension url="http://hl7.org/fhir/StructureDefinition/structuredefinition-security-category">
    <valueCode value="patient" />
  </extension>
  <extension url="http://hl7.org/fhir/StructureDefinition/structuredefinition-wg">
    <valueCode value="fm" />
  </extension>
  <extension url="http://hl7.org/fhir/build/StructureDefinition/entered-in-error-status">
    <valueCode value=".status = entered-in-error" />
  </extension>
  <url value="http://hl7.org/fhir/StructureDefinition/ClaimResponse" />
  <version value="4.6.0" />
  <name value="ClaimResponse" />
  <status value="draft" />
  <date value="2021-01-02T08:58:31+11:00" />
  <publisher value="Health Level Seven International (Financial Management)" />
  <contact>
    <telecom>
      <system value="url" />
      <value value="http://hl7.org/fhir" />
    </telecom>
  </contact>
  <contact>
    <telecom>
      <system value="url" />
      <value value="http://www.hl7.org/Special/committees/fm/index.cfm" />
    </telecom>
  </contact>
  <description value="This resource provides the adjudication details from the processing of a Claim resource." />
  <fhirVersion value="4.6.0" />
  <mapping>
    <identity value="workflow" />
    <uri value="http://hl7.org/fhir/workflow" />
    <name value="Workflow Pattern" />
  </mapping>
  <mapping>
    <identity value="w5" />
    <uri value="http://hl7.org/fhir/fivews" />
    <name value="FiveWs Pattern Mapping" />
  </mapping>
  <mapping>
    <identity value="rim" />
    <uri value="http://hl7.org/v3" />
    <name value="RIM Mapping" />
  </mapping>
  <kind value="resource" />
  <abstract value="false" />
  <type value="ClaimResponse" />
  <baseDefinition value="http://hl7.org/fhir/StructureDefinition/DomainResource" />
  <derivation value="specialization" />
  <differential>
    <element id="ClaimResponse">
      <extension url="http://hl7.org/fhir/build/StructureDefinition/svg">
        <valueCode value="310,0" />
      </extension>
      <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="*" />
      <mapping>
        <identity value="workflow" />
        <map value="Event" />
      </mapping>
      <mapping>
        <identity value="w5" />
        <map value="financial.billing" />
      </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." />
      <requirements value="Allows claim responses to be distinguished and referenced." />
      <min value="0" />
      <max value="*" />
      <type>
        <code value="Identifier" />
      </type>
      <mapping>
        <identity value="workflow" />
        <map value="Event.identifier" />
      </mapping>
      <mapping>
        <identity value="w5" />
        <map value="FiveWs.identifier" />
      </mapping>
    </element>
    <element id="ClaimResponse.status">
      <path value="ClaimResponse.status" />
      <short value="active | cancelled | draft | entered-in-error" />
      <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" />
      <type>
        <code value="code" />
      </type>
      <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="http://hl7.org/fhir/ValueSet/fm-status" />
      </binding>
      <mapping>
        <identity value="workflow" />
        <map value="Event.status" />
      </mapping>
      <mapping>
        <identity value="w5" />
        <map value="FiveWs.status" />
      </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" />
      <type>
        <code value="CodeableConcept" />
      </type>
      <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="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" />
      <type>
        <code value="CodeableConcept" />
      </type>
      <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="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: to request adjudication of products and services previously rendered; or requesting authorization and adjudication for provision in the future; or requesting the non-binding adjudication of the listed products and services which could be provided in the future." />
      <requirements value="This element is required to understand the nature of the request for adjudication." />
      <min value="1" />
      <max value="1" />
      <type>
        <code value="code" />
      </type>
      <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" />
      </binding>
      <mapping>
        <identity value="w5" />
        <map value="FiveWs.class" />
      </mapping>
    </element>
    <element id="ClaimResponse.patient">
      <path value="ClaimResponse.patient" />
      <short value="The recipient of the products and services" />
      <definition value="The party to whom the professional services and/or products have been supplied or are being considered and for whom actual for facast reimbursement is sought." />
      <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" />
      <type>
        <code value="Reference" />
        <targetProfile value="http://hl7.org/fhir/StructureDefinition/Patient" />
      </type>
      <isSummary value="true" />
      <mapping>
        <identity value="w5" />
        <map value="FiveWs.subject[x]" />
      </mapping>
      <mapping>
        <identity value="w5" />
        <map value="FiveWs.subject" />
      </mapping>
    </element>
    <element id="ClaimResponse.created">
      <path value="ClaimResponse.created" />
      <short value="Response creation date" />
      <definition value="The date this resource was created." />
      <requirements value="Need to record a timestamp for use by both the recipient and the issuer." />
      <min value="1" />
      <max value="1" />
      <type>
        <code value="dateTime" />
      </type>
      <isSummary value="true" />
      <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." />
      <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="1" />
      <max value="1" />
      <type>
        <code value="Reference" />
        <targetProfile value="http://hl7.org/fhir/StructureDefinition/Organization" />
      </type>
      <isSummary value="true" />
      <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 responsible for the claim but not necessarily professionally responsible for the provision of the individual products and services listed below." />
      <min value="0" />
      <max value="1" />
      <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>
      <mapping>
        <identity value="w5" />
        <map value="FiveWs.source" />
      </mapping>
    </element>
    <element id="ClaimResponse.request">
      <path value="ClaimResponse.request" />
      <short value="Id of resource triggering adjudication" />
      <definition value="Original request resource reference." />
      <min value="0" />
      <max value="1" />
      <type>
        <code value="Reference" />
        <targetProfile value="http://hl7.org/fhir/StructureDefinition/Claim" />
      </type>
      <isSummary value="true" />
      <mapping>
        <identity value="workflow" />
        <map value="Event.basedOn" />
      </mapping>
      <mapping>
        <identity value="w5" />
        <map value="FiveWs.why[x]" />
      </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 request has been held (queued) for processing; that it has been processed and errors found (error); that no errors were found and that some of the adjudication has been undertaken (partial) or that all of the adjudication has been undertaken (complete)." />
      <requirements value="To advise the requestor of an overall processing outcome." />
      <min value="1" />
      <max value="1" />
      <type>
        <code value="code" />
      </type>
      <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" />
      </binding>
    </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." />
      <requirements value="Provided for user display." />
      <min value="0" />
      <max value="1" />
      <type>
        <code value="string" />
      </type>
      <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" />
      <type>
        <code value="string" />
      </type>
    </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." />
      <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" />
      <type>
        <code value="Period" />
      </type>
    </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." />
      <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" />
      <type>
        <code value="CodeableConcept" />
      </type>
      <binding>
        <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName">
          <valueString value="PayeeType" />
        </extension>
        <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-isCommonBinding">
          <valueBoolean value="true" />
        </extension>
        <strength value="example" />
        <description value="A code for the party to be reimbursed." />
        <valueSet value="http://hl7.org/fhir/ValueSet/payeetype" />
      </binding>
    </element>
    <element id="ClaimResponse.item">
      <extension url="http://hl7.org/fhir/StructureDefinition/structuredefinition-explicit-type-name">
        <valueString value="Item" />
      </extension>
      <extension url="http://hl7.org/fhir/build/StructureDefinition/svg">
        <valueCode value="0,390" />
      </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." />
      <requirements value="The adjudication for items provided on the claim." />
      <min value="0" />
      <max value="*" />
      <type>
        <code value="BackboneElement" />
      </type>
    </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." />
      <requirements value="Necessary to provide a mechanism to link the adjudication result to the submitted claim item." />
      <min value="1" />
      <max value="1" />
      <type>
        <code value="positiveInt" />
      </type>
    </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." />
      <requirements value="Provides a condensed manner for associating human readable descriptive explanations for adjudications on the line item." />
      <min value="0" />
      <max value="*" />
      <type>
        <code value="positiveInt" />
      </type>
    </element>
    <element id="ClaimResponse.item.adjudication">
      <extension url="http://hl7.org/fhir/StructureDefinition/structuredefinition-explicit-type-name">
        <valueString value="Adjudication" />
      </extension>
      <extension url="http://hl7.org/fhir/build/StructureDefinition/svg">
        <valueCode value="300,390" />
      </extension>
      <path value="ClaimResponse.item.adjudication" />
      <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="1" />
      <max value="*" />
      <type>
        <code value="BackboneElement" />
      </type>
    </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" />
      <type>
        <code value="CodeableConcept" />
      </type>
      <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>
    </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" />
      <type>
        <code value="CodeableConcept" />
      </type>
      <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>
    </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" />
      <type>
        <code value="Money" />
      </type>
    </element>
    <element id="ClaimResponse.item.adjudication.value">
      <path value="ClaimResponse.item.adjudication.value" />
      <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" />
      <type>
        <code value="decimal" />
      </type>
    </element>
    <element id="ClaimResponse.item.detail">
      <extension url="http://hl7.org/fhir/StructureDefinition/structuredefinition-explicit-type-name">
        <valueString value="ItemDetail" />
      </extension>
      <extension url="http://hl7.org/fhir/build/StructureDefinition/svg">
        <valueCode value="0,500" />
      </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="*" />
      <type>
        <code value="BackboneElement" />
      </type>
    </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." />
      <requirements value="Necessary to provide a mechanism to link the adjudication result to the submitted claim detail." />
      <min value="1" />
      <max value="1" />
      <type>
        <code value="positiveInt" />
      </type>
    </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." />
      <requirements value="Provides a condensed manner for associating human readable descriptive explanations for adjudications on the line item." />
      <min value="0" />
      <max value="*" />
      <type>
        <code value="positiveInt" />
      </type>
    </element>
    <element id="ClaimResponse.item.detail.adjudication">
      <extension url="http://hl7.org/fhir/build/StructureDefinition/svg">
        <valueCode value="0,450" />
      </extension>
      <path value="ClaimResponse.item.detail.adjudication" />
      <short value="Detail level adjudication details" />
      <definition value="The adjudication results." />
      <min value="1" />
      <max value="*" />
      <contentReference value="#ClaimResponse.item.adjudication" />
    </element>
    <element id="ClaimResponse.item.detail.subDetail">
      <extension url="http://hl7.org/fhir/StructureDefinition/structuredefinition-explicit-type-name">
        <valueString value="SubDetail" />
      </extension>
      <extension url="http://hl7.org/fhir/build/StructureDefinition/svg">
        <valueCode value="0,610" />
      </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="*" />
      <type>
        <code value="BackboneElement" />
      </type>
    </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." />
      <requirements value="Necessary to provide a mechanism to link the adjudication result to the submitted claim sub-detail." />
      <min value="1" />
      <max value="1" />
      <type>
        <code value="positiveInt" />
      </type>
    </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." />
      <requirements value="Provides a condensed manner for associating human readable descriptive explanations for adjudications on the line item." />
      <min value="0" />
      <max value="*" />
      <type>
        <code value="positiveInt" />
      </type>
    </element>
    <element id="ClaimResponse.item.detail.subDetail.adjudication">
      <extension url="http://hl7.org/fhir/build/StructureDefinition/svg">
        <valueCode value="0,560" />
      </extension>
      <path value="ClaimResponse.item.detail.subDetail.adjudication" />
      <short value="Subdetail level adjudication details" />
      <definition value="The adjudication results." />
      <min value="0" />
      <max value="*" />
      <contentReference value="#ClaimResponse.item.adjudication" />
    </element>
    <element id="ClaimResponse.addItem">
      <extension url="http://hl7.org/fhir/StructureDefinition/structuredefinition-explicit-type-name">
        <valueString value="AddedItem" />
      </extension>
      <extension url="http://hl7.org/fhir/build/StructureDefinition/svg">
        <valueCode value="620,390" />
      </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="*" />
      <type>
        <code value="BackboneElement" />
      </type>
    </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." />
      <requirements value="Provides references to the claim items." />
      <min value="0" />
      <max value="*" />
      <type>
        <code value="positiveInt" />
      </type>
    </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." />
      <requirements value="Provides references to the claim details within the claim item." />
      <min value="0" />
      <max value="*" />
      <type>
        <code value="positiveInt" />
      </type>
    </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." />
      <requirements value="Provides references to the claim sub-details within the claim detail." />
      <min value="0" />
      <max value="*" />
      <type>
        <code value="positiveInt" />
      </type>
    </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." />
      <requirements value="Insurer may provide authorization specifically to a restricted set of providers rather than an open authorization." />
      <min value="0" />
      <max value="*" />
      <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>
      <mapping>
        <identity value="w5" />
        <map value="FiveWs.source" />
      </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 claim details, otherwise this contains the product, service, drug or other billing code for the item." />
      <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="1" />
      <max value="1" />
      <type>
        <code value="CodeableConcept" />
      </type>
      <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>
    </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="*" />
      <type>
        <code value="CodeableConcept" />
      </type>
      <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="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="*" />
      <type>
        <code value="CodeableConcept" />
      </type>
      <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="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" />
      <type>
        <code value="date" />
      </type>
      <type>
        <code value="Period" />
      </type>
      <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" />
      <type>
        <code value="CodeableConcept" />
      </type>
      <type>
        <code value="Address" />
      </type>
      <type>
        <code value="Reference" />
        <targetProfile value="http://hl7.org/fhir/StructureDefinition/Location" />
      </type>
      <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="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." />
      <requirements value="Required when the product or service code does not convey the quantity provided." />
      <min value="0" />
      <max value="1" />
      <type>
        <code value="Quantity" />
        <profile value="http://hl7.org/fhir/StructureDefinition/SimpleQuantity" />
      </type>
      <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" />
      <type>
        <code value="Money" />
      </type>
    </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" />
      <type>
        <code value="decimal" />
      </type>
    </element>
    <element id="ClaimResponse.addItem.net">
      <path value="ClaimResponse.addItem.net" />
      <short value="Total item cost" />
      <definition value="The quantity times the unit price for an additional service or product or charge." />
      <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" />
      <type>
        <code value="Money" />
      </type>
      <mapping>
        <identity value="rim" />
        <map value="24.F" />
      </mapping>
    </element>
    <element id="ClaimResponse.addItem.bodySite">
      <path value="ClaimResponse.addItem.bodySite" />
      <short value="Anatomical 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="0" />
      <max value="1" />
      <type>
        <code value="CodeableConcept" />
      </type>
      <binding>
        <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName">
          <valueString value="OralSites" />
        </extension>
        <strength value="example" />
        <description value="The code for the teeth, quadrant, sextant and arch." />
        <valueSet value="http://hl7.org/fhir/ValueSet/tooth" />
      </binding>
    </element>
    <element id="ClaimResponse.addItem.subSite">
      <path value="ClaimResponse.addItem.subSite" />
      <short value="Anatomical sub-location" />
      <definition value="A region or surface of the bodySite, e.g. limb region or tooth surface(s)." />
      <requirements value="Allows insurer to validate specific procedures." />
      <min value="0" />
      <max value="*" />
      <type>
        <code value="CodeableConcept" />
      </type>
      <binding>
        <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName">
          <valueString value="Surface" />
        </extension>
        <strength value="example" />
        <description value="The code for the tooth surface and surface combinations." />
        <valueSet value="http://hl7.org/fhir/ValueSet/surface" />
      </binding>
    </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." />
      <requirements value="Provides a condensed manner for associating human readable descriptive explanations for adjudications on the line item." />
      <min value="0" />
      <max value="*" />
      <type>
        <code value="positiveInt" />
      </type>
    </element>
    <element id="ClaimResponse.addItem.adjudication">
      <extension url="http://hl7.org/fhir/build/StructureDefinition/svg">
        <valueCode value="500,0" />
      </extension>
      <path value="ClaimResponse.addItem.adjudication" />
      <short value="Added items adjudication" />
      <definition value="The adjudication results." />
      <min value="1" />
      <max value="*" />
      <contentReference value="#ClaimResponse.item.adjudication" />
    </element>
    <element id="ClaimResponse.addItem.detail">
      <extension url="http://hl7.org/fhir/StructureDefinition/structuredefinition-explicit-type-name">
        <valueString value="AddedItemDetail" />
      </extension>
      <extension url="http://hl7.org/fhir/build/StructureDefinition/svg">
        <valueCode value="620,710" />
      </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="*" />
      <type>
        <code value="BackboneElement" />
      </type>
    </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 claim details, otherwise this contains the product, service, drug or other billing code for the item." />
      <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="1" />
      <max value="1" />
      <type>
        <code value="CodeableConcept" />
      </type>
      <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>
    </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="*" />
      <type>
        <code value="CodeableConcept" />
      </type>
      <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="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." />
      <requirements value="Required when the product or service code does not convey the quantity provided." />
      <min value="0" />
      <max value="1" />
      <type>
        <code value="Quantity" />
        <profile value="http://hl7.org/fhir/StructureDefinition/SimpleQuantity" />
      </type>
      <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" />
      <type>
        <code value="Money" />
      </type>
    </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" />
      <type>
        <code value="decimal" />
      </type>
    </element>
    <element id="ClaimResponse.addItem.detail.net">
      <path value="ClaimResponse.addItem.detail.net" />
      <short value="Total item cost" />
      <definition value="The quantity times the unit price for an additional service or product or charge." />
      <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" />
      <type>
        <code value="Money" />
      </type>
      <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." />
      <requirements value="Provides a condensed manner for associating human readable descriptive explanations for adjudications on the line item." />
      <min value="0" />
      <max value="*" />
      <type>
        <code value="positiveInt" />
      </type>
    </element>
    <element id="ClaimResponse.addItem.detail.adjudication">
      <extension url="http://hl7.org/fhir/build/StructureDefinition/svg">
        <valueCode value="500,370" />
      </extension>
      <path value="ClaimResponse.addItem.detail.adjudication" />
      <short value="Added items detail adjudication" />
      <definition value="The adjudication results." />
      <min value="1" />
      <max value="*" />
      <contentReference value="#ClaimResponse.item.adjudication" />
    </element>
    <element id="ClaimResponse.addItem.detail.subDetail">
      <extension url="http://hl7.org/fhir/StructureDefinition/structuredefinition-explicit-type-name">
        <valueString value="AddedItemSubDetail" />
      </extension>
      <extension url="http://hl7.org/fhir/build/StructureDefinition/svg">
        <valueCode value="620,910" />
      </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="*" />
      <type>
        <code value="BackboneElement" />
      </type>
    </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 claim details, otherwise this contains the product, service, drug or other billing code for the item." />
      <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="1" />
      <max value="1" />
      <type>
        <code value="CodeableConcept" />
      </type>
      <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>
    </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="*" />
      <type>
        <code value="CodeableConcept" />
      </type>
      <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="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." />
      <requirements value="Required when the product or service code does not convey the quantity provided." />
      <min value="0" />
      <max value="1" />
      <type>
        <code value="Quantity" />
        <profile value="http://hl7.org/fhir/StructureDefinition/SimpleQuantity" />
      </type>
      <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" />
      <type>
        <code value="Money" />
      </type>
    </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" />
      <type>
        <code value="decimal" />
      </type>
    </element>
    <element id="ClaimResponse.addItem.detail.subDetail.net">
      <path value="ClaimResponse.addItem.detail.subDetail.net" />
      <short value="Total item cost" />
      <definition value="The quantity times the unit price for an additional service or product or charge." />
      <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" />
      <type>
        <code value="Money" />
      </type>
      <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." />
      <requirements value="Provides a condensed manner for associating human readable descriptive explanations for adjudications on the line item." />
      <min value="0" />
      <max value="*" />
      <type>
        <code value="positiveInt" />
      </type>
    </element>
    <element id="ClaimResponse.addItem.detail.subDetail.adjudication">
      <extension url="http://hl7.org/fhir/build/StructureDefinition/svg">
        <valueCode value="500,370" />
      </extension>
      <path value="ClaimResponse.addItem.detail.subDetail.adjudication" />
      <short value="Added items detail adjudication" />
      <definition value="The adjudication results." />
      <min value="1" />
      <max value="*" />
      <contentReference value="#ClaimResponse.item.adjudication" />
    </element>
    <element id="ClaimResponse.adjudication">
      <extension url="http://hl7.org/fhir/build/StructureDefinition/committee-notes">
        <valueString value="600;0." />
      </extension>
      <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="*" />
      <contentReference value="#ClaimResponse.item.adjudication" />
    </element>
    <element id="ClaimResponse.total">
      <extension url="http://hl7.org/fhir/StructureDefinition/structuredefinition-explicit-type-name">
        <valueString value="Total" />
      </extension>
      <extension url="http://hl7.org/fhir/build/StructureDefinition/committee-notes">
        <valueString value="780;600." />
      </extension>
      <extension url="http://hl7.org/fhir/build/StructureDefinition/svg">
        <valueCode value="0,230" />
      </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="*" />
      <type>
        <code value="BackboneElement" />
      </type>
      <isSummary value="true" />
    </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" />
      <type>
        <code value="CodeableConcept" />
      </type>
      <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>
    </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" />
      <type>
        <code value="Money" />
      </type>
      <isSummary value="true" />
    </element>
    <element id="ClaimResponse.payment">
      <extension url="http://hl7.org/fhir/StructureDefinition/structuredefinition-explicit-type-name">
        <valueString value="Payment" />
      </extension>
      <extension url="http://hl7.org/fhir/build/StructureDefinition/svg">
        <valueCode value="680,170" />
      </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" />
      <type>
        <code value="BackboneElement" />
      </type>
    </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." />
      <requirements value="To advise the requestor when the insurer believes all payments to have been completed." />
      <min value="1" />
      <max value="1" />
      <type>
        <code value="CodeableConcept" />
      </type>
      <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>
    </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" />
      <type>
        <code value="Money" />
      </type>
    </element>
    <element id="ClaimResponse.payment.adjustmentReason">
      <path value="ClaimResponse.payment.adjustmentReason" />
      <short value="Explanation for the adjustment" />
      <definition value="Reason for the payment adjustment." />
      <requirements value="Needed to clarify the monetary adjustment." />
      <min value="0" />
      <max value="1" />
      <type>
        <code value="CodeableConcept" />
      </type>
      <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>
    </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" />
      <type>
        <code value="date" />
      </type>
    </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" />
      <type>
        <code value="Money" />
      </type>
    </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" />
      <type>
        <code value="Identifier" />
      </type>
    </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" />
      <type>
        <code value="CodeableConcept" />
      </type>
      <binding>
        <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName">
          <valueString value="FundsReserve" />
        </extension>
        <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-isCommonBinding">
          <valueBoolean value="true" />
        </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>
    </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" />
      <type>
        <code value="CodeableConcept" />
      </type>
      <binding>
        <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName">
          <valueString value="Forms" />
        </extension>
        <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-isCommonBinding">
          <valueBoolean value="true" />
        </extension>
        <strength value="example" />
        <description value="The forms codes." />
        <valueSet value="http://hl7.org/fhir/ValueSet/forms" />
      </binding>
    </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" />
      <type>
        <code value="Attachment" />
      </type>
    </element>
    <element id="ClaimResponse.processNote">
      <extension url="http://hl7.org/fhir/StructureDefinition/structuredefinition-explicit-type-name">
        <valueString value="Note" />
      </extension>
      <extension url="http://hl7.org/fhir/build/StructureDefinition/svg">
        <valueCode value="0,110" />
      </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="*" />
      <type>
        <code value="BackboneElement" />
      </type>
    </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." />
      <requirements value="Necessary to provide a mechanism to link from adjudications." />
      <min value="0" />
      <max value="1" />
      <type>
        <code value="positiveInt" />
      </type>
    </element>
    <element id="ClaimResponse.processNote.type">
      <path value="ClaimResponse.processNote.type" />
      <short value="display | print | printoper" />
      <definition value="The business purpose of the note text." />
      <requirements value="To convey the expectation for when the text is used." />
      <min value="0" />
      <max value="1" />
      <type>
        <code value="code" />
      </type>
      <binding>
        <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName">
          <valueString value="NoteType" />
        </extension>
        <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-isCommonBinding">
          <valueBoolean value="true" />
        </extension>
        <strength value="required" />
        <description value="The presentation types of notes." />
        <valueSet value="http://hl7.org/fhir/ValueSet/note-type" />
      </binding>
    </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." />
      <requirements value="Required to provide human readable explanation." />
      <min value="1" />
      <max value="1" />
      <type>
        <code value="string" />
      </type>
    </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" />
      <type>
        <code value="CodeableConcept" />
      </type>
      <binding>
        <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName">
          <valueString value="Language" />
        </extension>
        <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-isCommonBinding">
          <valueBoolean value="true" />
        </extension>
        <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-maxValueSet">
          <valueCanonical value="http://hl7.org/fhir/ValueSet/all-languages" />
        </extension>
        <extension url="http://hl7.org/fhir/build/StructureDefinition/definition">
          <valueString value="A human language." />
        </extension>
        <strength value="preferred" />
        <description value="IETF language tag" />
        <valueSet value="http://hl7.org/fhir/ValueSet/languages" />
      </binding>
    </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="*" />
      <type>
        <code value="Reference" />
        <targetProfile value="http://hl7.org/fhir/StructureDefinition/CommunicationRequest" />
      </type>
    </element>
    <element id="ClaimResponse.insurance">
      <extension url="http://hl7.org/fhir/StructureDefinition/structuredefinition-explicit-type-name">
        <valueString value="Insurance" />
      </extension>
      <extension url="http://hl7.org/fhir/build/StructureDefinition/svg">
        <valueCode value="680,0" />
      </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="*" />
      <type>
        <code value="BackboneElement" />
      </type>
      <mapping>
        <identity value="rim" />
        <map value="Coverage" />
      </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." />
      <requirements value="To maintain order of the coverages." />
      <min value="1" />
      <max value="1" />
      <type>
        <code value="positiveInt" />
      </type>
    </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" />
      <type>
        <code value="boolean" />
      </type>
    </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." />
      <requirements value="Required to allow the adjudicator to locate the correct policy and history within their information system." />
      <min value="1" />
      <max value="1" />
      <type>
        <code value="Reference" />
        <targetProfile value="http://hl7.org/fhir/StructureDefinition/Coverage" />
      </type>
    </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." />
      <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" />
      <type>
        <code value="string" />
      </type>
    </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" />
      <type>
        <code value="Reference" />
        <targetProfile value="http://hl7.org/fhir/StructureDefinition/ClaimResponse" />
      </type>
    </element>
    <element id="ClaimResponse.error">
      <extension url="http://hl7.org/fhir/StructureDefinition/structuredefinition-explicit-type-name">
        <valueString value="Error" />
      </extension>
      <extension url="http://hl7.org/fhir/build/StructureDefinition/svg">
        <valueCode value="0,0" />
      </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="*" />
      <type>
        <code value="BackboneElement" />
      </type>
    </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." />
      <requirements value="Provides references to the claim items." />
      <min value="0" />
      <max value="1" />
      <type>
        <code value="positiveInt" />
      </type>
    </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." />
      <requirements value="Provides references to the claim details within the claim item." />
      <min value="0" />
      <max value="1" />
      <type>
        <code value="positiveInt" />
      </type>
    </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." />
      <requirements value="Provides references to the claim sub-details within the claim detail." />
      <min value="0" />
      <max value="1" />
      <type>
        <code value="positiveInt" />
      </type>
    </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." />
      <requirements value="Required to convey processing errors." />
      <min value="1" />
      <max value="1" />
      <type>
        <code value="CodeableConcept" />
      </type>
      <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>
    </element>
  </differential>
</StructureDefinition>

name : ClaimResponse

{

}

<name value="ClaimResponse" />