{ "resourceType": "StructureDefinition", "id": "SatuSehatClaimResponse", "url": "https://fhir.kemkes.go.id/r4/StructureDefinition/ClaimResponse", "name": "SatuSehatClaimResponse", "title": "Satu Sehat Claim Response", "status": "active", "date": "2024-01-01", "description": "Defines the ID Core constraints and extensions on the ClaimResponse resource for the minimal set of data to query and retrieve claim information.", "fhirVersion": "4.0.1", "kind": "resource", "abstract": false, "type": "ClaimResponse", "baseDefinition": "http://hl7.org/fhir/StructureDefinition/ClaimResponse", "derivation": "constraint", "snapshot": { "element": [ { "id": "ClaimResponse", "path": "ClaimResponse", "short": "Response to a claim predetermination or preauthorization", "definition": "This resource provides the adjudication details from the processing of a Claim resource.", "alias": [ "Remittance Advice" ], "min": 0, "max": "*", "base": { "path": "ClaimResponse", "min": 0, "max": "*" }, "constraint": [ { "key": "dom-2", "severity": "error", "human": "If the resource is contained in another resource, it SHALL NOT contain nested Resources", "expression": "contained.contained.empty()", "xpath": "not(parent::f:contained and f:contained)", "source": "http://hl7.org/fhir/StructureDefinition/DomainResource" }, { "key": "dom-4", "severity": "error", "human": "If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated", "expression": "contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()", "xpath": "not(exists(f:contained/*/f:meta/f:versionId)) and not(exists(f:contained/*/f:meta/f:lastUpdated))", "source": "http://hl7.org/fhir/StructureDefinition/DomainResource" }, { "key": "dom-3", "severity": "error", "human": "If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource", "expression": "contained.where(((id.exists() and ('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url)))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(uri) = '#').exists()).not()).trace('unmatched', id).empty()", "xpath": "not(exists(for $contained in f:contained return $contained[not(exists(parent::*/descendant::f:reference/@value=concat('#', $contained/*/f:id/@value)) or exists(descendant::f:reference[@value='#']))]))", "source": "http://hl7.org/fhir/StructureDefinition/DomainResource" }, { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bestpractice", "valueBoolean": true }, { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bestpractice-explanation", "valueMarkdown": "When a resource has no narrative, only systems that fully understand the data can display the resource to a human safely. Including a human readable representation in the resource makes for a much more robust eco-system and cheaper handling of resources by intermediary systems. Some ecosystems restrict distribution of resources to only those systems that do fully understand the resources, and as a consequence implementers may believe that the narrative is superfluous. However experience shows that such eco-systems often open up to new participants over time." } ], "key": "dom-6", "severity": "warning", "human": "A resource should have narrative for robust management", "expression": "text.`div`.exists()", "xpath": "exists(f:text/h:div)", "source": "http://hl7.org/fhir/StructureDefinition/DomainResource" }, { "key": "dom-5", "severity": "error", "human": "If a resource is contained in another resource, it SHALL NOT have a security label", "expression": "contained.meta.security.empty()", "xpath": "not(exists(f:contained/*/f:meta/f:security))", "source": "http://hl7.org/fhir/StructureDefinition/DomainResource" } ], "mustSupport": false, "isModifier": false, "mapping": [ { "identity": "rim", "map": "Entity. Role, or Act" }, { "identity": "workflow", "map": "Event" }, { "identity": "w5", "map": "financial.billing" } ] }, { "id": "ClaimResponse.id", "path": "ClaimResponse.id", "short": "Logical id of this artifact", "definition": "The logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes.", "comment": "The only time that a resource does not have an id is when it is being submitted to the server using a create operation.", "min": 0, "max": "1", "base": { "path": "Resource.id", "min": 0, "max": "1" }, "type": [ { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type", "valueUrl": "id" } ], "code": "id" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children unless an empty Parameters resource", "expression": "hasValue() or (children().count() > id.count()) or $this is Parameters", "xpath": "@value|f:*|h:div|self::f:Parameters", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "mustSupport": false, "isModifier": false, "isSummary": true, "mapping": [ { "identity": "rim", "map": "n/a" } ] }, { "id": "ClaimResponse.meta", "path": "ClaimResponse.meta", "short": "Metadata about the resource", "definition": "The metadata about the resource. This is content that is maintained by the infrastructure. Changes to the content might not always be associated with version changes to the resource.", "min": 0, "max": "1", "base": { "path": "Resource.meta", "min": 0, "max": "1" }, "type": [ { "code": "Meta" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children unless an empty Parameters resource", "expression": "hasValue() or (children().count() > id.count()) or $this is Parameters", "xpath": "@value|f:*|h:div|self::f:Parameters", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "mustSupport": false, "isModifier": false, "isSummary": true, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "rim", "map": "N/A" } ] }, { "id": "ClaimResponse.implicitRules", "path": "ClaimResponse.implicitRules", "short": "A set of rules under which this content was created", "definition": "A reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content. Often, this is a reference to an implementation guide that defines the special rules along with other profiles etc.", "comment": "Asserting this rule set restricts the content to be only understood by a limited set of trading partners. This inherently limits the usefulness of the data in the long term. However, the existing health eco-system is highly fractured, and not yet ready to define, collect, and exchange data in a generally computable sense. Wherever possible, implementers and/or specification writers should avoid using this element. Often, when used, the URL is a reference to an implementation guide that defines these special rules as part of it's narrative along with other profiles, value sets, etc.", "min": 0, "max": "1", "base": { "path": "Resource.implicitRules", "min": 0, "max": "1" }, "type": [ { "code": "uri" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children unless an empty Parameters resource", "expression": "hasValue() or (children().count() > id.count()) or $this is Parameters", "xpath": "@value|f:*|h:div|self::f:Parameters", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "mustSupport": false, "isModifier": true, "isModifierReason": "This element is labeled as a modifier because the implicit rules may provide additional knowledge about the resource that modifies it's meaning or interpretation", "isSummary": true, "mapping": [ { "identity": "rim", "map": "n/a" } ] }, { "id": "ClaimResponse.language", "path": "ClaimResponse.language", "short": "Language of the resource content", "definition": "The base language in which the resource is written.", "comment": "Language is provided to support indexing and accessibility (typically, services such as text to speech use the language tag). The html language tag in the narrative applies to the narrative. The language tag on the resource may be used to specify the language of other presentations generated from the data in the resource. Not all the content has to be in the base language. The Resource.language should not be assumed to apply to the narrative automatically. If a language is specified, it should it also be specified on the div element in the html (see rules in HTML5 for information about the relationship between xml:lang and the html lang attribute).", "min": 0, "max": "1", "base": { "path": "Resource.language", "min": 0, "max": "1" }, "type": [ { "code": "code" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children unless an empty Parameters resource", "expression": "hasValue() or (children().count() > id.count()) or $this is Parameters", "xpath": "@value|f:*|h:div|self::f:Parameters", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "mustSupport": false, "isModifier": false, "isSummary": false, "binding": { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-maxValueSet", "valueCanonical": "http://hl7.org/fhir/ValueSet/all-languages" }, { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString": "Language" } ], "strength": "preferred", "description": "IETF language tag", "valueSet": "http://hl7.org/fhir/ValueSet/languages" }, "mapping": [ { "identity": "rim", "map": "n/a" } ] }, { "id": "ClaimResponse.text", "path": "ClaimResponse.text", "short": "Text summary of the resource, for human interpretation", "definition": "A human-readable narrative that contains a summary of the resource and can be used to represent the content of the resource to a human. The narrative need not encode all the structured data, but is required to contain sufficient detail to make it \"clinically safe\" for a human to just read the narrative. Resource definitions may define what content should be represented in the narrative to ensure clinical safety.", "comment": "Contained resources do not have narrative. Resources that are not contained SHOULD have a narrative. In some cases, a resource may only have text with little or no additional discrete data (as long as all minOccurs=1 elements are satisfied). This may be necessary for data from legacy systems where information is captured as a \"text blob\" or where text is additionally entered raw or narrated and encoded information is added later.", "alias": [ "narrative", "html", "xhtml", "display" ], "min": 0, "max": "1", "base": { "path": "DomainResource.text", "min": 0, "max": "1" }, "type": [ { "code": "Narrative" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children unless an empty Parameters resource", "expression": "hasValue() or (children().count() > id.count()) or $this is Parameters", "xpath": "@value|f:*|h:div|self::f:Parameters", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "mustSupport": false, "isModifier": false, "isSummary": false, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "rim", "map": "N/A" }, { "identity": "rim", "map": "Act.text?" } ] }, { "id": "ClaimResponse.contained", "path": "ClaimResponse.contained", "short": "Contained, inline Resources", "definition": "These resources do not have an independent existence apart from the resource that contains them - they cannot be identified independently, and nor can they have their own independent transaction scope.", "comment": "This should never be done when the content can be identified properly, as once identification is lost, it is extremely difficult (and context dependent) to restore it again. Contained resources may have profiles and tags In their meta elements, but SHALL NOT have security labels.", "alias": [ "inline resources", "anonymous resources", "contained resources" ], "min": 0, "max": "*", "base": { "path": "DomainResource.contained", "min": 0, "max": "*" }, "type": [ { "code": "Resource" } ], "constraint": [ { "key": "dom-r4b", "severity": "warning", "human": "Containing new R4B resources within R4 resources may cause interoperability issues if instances are shared with R4 systems", "expression": "($this is Citation or $this is Evidence or $this is EvidenceReport or $this is EvidenceVariable or $this is MedicinalProductDefinition or $this is PackagedProductDefinition or $this is AdministrableProductDefinition or $this is Ingredient or $this is ClinicalUseDefinition or $this is RegulatedAuthorization or $this is SubstanceDefinition or $this is SubscriptionStatus or $this is SubscriptionTopic) implies (%resource is Citation or %resource is Evidence or %resource is EvidenceReport or %resource is EvidenceVariable or %resource is MedicinalProductDefinition or %resource is PackagedProductDefinition or %resource is AdministrableProductDefinition or %resource is Ingredient or %resource is ClinicalUseDefinition or %resource is RegulatedAuthorization or %resource is SubstanceDefinition or %resource is SubscriptionStatus or %resource is SubscriptionTopic)", "xpath": "not(f:Citation|f:Evidence|f:EvidenceReport|f:EvidenceVariable|f:MedicinalProductDefinition|f:PackagedProductDefinition|f:AdministrableProductDefinition|f:Ingredient|f:ClinicalUseDefinition|f:RegulatedAuthorization|f:SubstanceDefinition|f:SubscriptionStatus|f:SubscriptionTopic) or not(parent::f:Citation|parent::f:Evidence|parent::f:EvidenceReport|parent::f:EvidenceVariable|parent::f:MedicinalProductDefinition|parent::f:PackagedProductDefinition|parent::f:AdministrableProductDefinition|parent::f:Ingredient|parent::f:ClinicalUseDefinition|parent::f:RegulatedAuthorization|parent::f:SubstanceDefinition|f:SubscriptionStatus|f:SubscriptionTopic)", "source": "http://hl7.org/fhir/StructureDefinition/DomainResource" } ], "mustSupport": false, "isModifier": false, "isSummary": false, "mapping": [ { "identity": "rim", "map": "Entity. Role, or Act" }, { "identity": "rim", "map": "N/A" } ] }, { "id": "ClaimResponse.extension", "path": "ClaimResponse.extension", "slicing": { "discriminator": [ { "type": "value", "path": "url" } ], "description": "Extensions are always sliced by (at least) url", "rules": "open" }, "short": "Additional content defined by implementations", "definition": "May be used to represent additional information that is not part of the basic definition of the resource. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.", "comment": "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.", "alias": [ "extensions", "user content" ], "min": 0, "max": "*", "base": { "path": "DomainResource.extension", "min": 0, "max": "*" }, "type": [ { "code": "Extension" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children unless an empty Parameters resource", "expression": "hasValue() or (children().count() > id.count()) or $this is Parameters", "xpath": "@value|f:*|h:div|self::f:Parameters", "source": "http://hl7.org/fhir/StructureDefinition/Element" }, { "key": "ext-1", "severity": "error", "human": "Must have either extensions or value[x], not both", "expression": "extension.exists() != value.exists()", "xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])", "source": "http://hl7.org/fhir/StructureDefinition/Extension" } ], "mustSupport": false, "isModifier": false, "isSummary": false, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "rim", "map": "N/A" } ] }, { "id": "ClaimResponse.modifierExtension", "path": "ClaimResponse.modifierExtension", "slicing": { "discriminator": [ { "type": "value", "path": "url" } ], "description": "Extensions are always sliced by (at least) url", "rules": "open" }, "short": "Extensions that cannot be ignored", "definition": "May be used to represent additional information that is not part of the basic definition of the resource and that modifies the understanding of the element that contains it and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.\n\nModifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).", "comment": "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.", "requirements": "Modifier extensions allow for extensions that *cannot* be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the [definition of modifier extensions](extensibility.html#modifierExtension).", "alias": [ "extensions", "user content" ], "min": 0, "max": "*", "base": { "path": "DomainResource.modifierExtension", "min": 0, "max": "*" }, "type": [ { "code": "Extension" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children unless an empty Parameters resource", "expression": "hasValue() or (children().count() > id.count()) or $this is Parameters", "xpath": "@value|f:*|h:div|self::f:Parameters", "source": "http://hl7.org/fhir/StructureDefinition/Element" }, { "key": "ext-1", "severity": "error", "human": "Must have either extensions or value[x], not both", "expression": "extension.exists() != value.exists()", "xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])", "source": "http://hl7.org/fhir/StructureDefinition/Extension" } ], "mustSupport": false, "isModifier": true, "isModifierReason": "Modifier extensions are expected to modify the meaning or interpretation of the resource that contains them", "isSummary": false, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "rim", "map": "N/A" } ] }, { "id": "ClaimResponse.identifier", "path": "ClaimResponse.identifier", "short": "Business Identifier for a claim response", "definition": "Berisi data ID lokal yang ditetapkan untuk respons klaim dengan tipe data Identifier.", "requirements": "Allows claim responses to be distinguished and referenced.", "min": 0, "max": "1", "base": { "path": "ClaimResponse.identifier", "min": 0, "max": "*" }, "type": [ { "code": "Identifier" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children unless an empty Parameters resource", "expression": "hasValue() or (children().count() > id.count()) or $this is Parameters", "xpath": "@value|f:*|h:div|self::f:Parameters", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "mustSupport": false, "isModifier": false, "isSummary": false, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "v2", "map": "CX / EI (occasionally, more often EI maps to a resource id or a URL)" }, { "identity": "rim", "map": "II - The Identifier class is a little looser than the v3 type II because it allows URIs as well as registered OIDs or GUIDs. Also maps to Role[classCode=IDENT]" }, { "identity": "servd", "map": "Identifier" }, { "identity": "workflow", "map": "Event.identifier" }, { "identity": "w5", "map": "FiveWs.identifier" } ] }, { "id": "ClaimResponse.status", "path": "ClaimResponse.status", "short": "active | cancelled | draft | entered-in-error", "definition": "Berisi data status respon klaim dengan tipe data code, yang nilainya mengacu pada data terminologi Financial Resource Status Code.", "comment": "This element is labeled as a modifier because the status contains codes that mark the resource as not currently valid.", "requirements": "Need to track the status of the resource as 'draft' resources may undergo further edits while 'active' resources are immutable and may only have their status changed to 'cancelled'.", "min": 1, "max": "1", "base": { "path": "ClaimResponse.status", "min": 1, "max": "1" }, "type": [ { "code": "code" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children unless an empty Parameters resource", "expression": "hasValue() or (children().count() > id.count()) or $this is Parameters", "xpath": "@value|f:*|h:div|self::f:Parameters", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "mustSupport": false, "isModifier": true, "isModifierReason": "This element is labeled as a modifier because it is a status element that contains status entered-in-error which means that the resource should not be treated as valid", "isSummary": true, "binding": { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString": "ClaimResponseStatus" } ], "strength": "required", "description": "A code specifying the state of the resource instance.", "valueSet": "http://hl7.org/fhir/ValueSet/fm-status|4.3.0" }, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "workflow", "map": "Event.status" }, { "identity": "w5", "map": "FiveWs.status" } ] }, { "id": "ClaimResponse.type", "path": "ClaimResponse.type", "short": "More granular claim type", "definition": "Berisi data kategori klaim dengan tipe data CodeableConcept.", "comment": "This may contain the local bill type codes, for example the US UB-04 bill type code or the CMS bill type.", "requirements": "Some jurisdictions need a finer grained claim type for routing and adjudication.", "min": 1, "max": "1", "base": { "path": "ClaimResponse.type", "min": 1, "max": "1" }, "type": [ { "code": "CodeableConcept" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children unless an empty Parameters resource", "expression": "hasValue() or (children().count() > id.count()) or $this is Parameters", "xpath": "@value|f:*|h:div|self::f:Parameters", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "mustSupport": false, "isModifier": false, "isSummary": true, "binding": { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString": "ClaimType" } ], "strength": "extensible", "description": "The type or discipline-style of the claim.", "valueSet": "http://hl7.org/fhir/ValueSet/claim-type" }, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "v2", "map": "CE/CNE/CWE" }, { "identity": "rim", "map": "CD" }, { "identity": "orim", "map": "fhir:CodeableConcept rdfs:subClassOf dt:CD" }, { "identity": "w5", "map": "FiveWs.class" } ] }, { "id": "ClaimResponse.type.id", "path": "ClaimResponse.type.id", "representation": [ "xmlAttr" ], "short": "Unique id for inter-element referencing", "definition": "Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.", "min": 0, "max": "1", "base": { "path": "Element.id", "min": 0, "max": "1" }, "type": [ { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type", "valueUrl": "id" } ], "code": "http://hl7.org/fhirpath/System.String" } ], "mapping": [ { "identity": "rim", "map": "n/a" } ] }, { "id": "ClaimResponse.type.extension", "path": "ClaimResponse.type.extension", "slicing": { "discriminator": [ { "type": "value", "path": "url" } ], "description": "Extensions are always sliced by (at least) url", "rules": "open" }, "short": "Additional content defined by implementations", "definition": "May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.", "comment": "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.", "alias": [ "extensions", "user content" ], "min": 0, "max": "*", "base": { "path": "Element.extension", "min": 0, "max": "*" }, "type": [ { "code": "Extension" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children unless an empty Parameters resource", "expression": "hasValue() or (children().count() > id.count()) or $this is Parameters", "xpath": "@value|f:*|h:div|self::f:Parameters", "source": "http://hl7.org/fhir/StructureDefinition/Element" }, { "key": "ext-1", "severity": "error", "human": "Must have either extensions or value[x], not both", "expression": "extension.exists() != value.exists()", "xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])", "source": "http://hl7.org/fhir/StructureDefinition/Extension" } ], "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "rim", "map": "N/A" } ] }, { "id": "ClaimResponse.type.coding", "path": "ClaimResponse.type.coding", "short": "Code defined by a terminology system", "definition": "Berisi data kategori klaim dengan tipe data Coding, yang nilainya mengacu pada data terminologi yang dapat diperluas yaitu Claim Type Codes.", "comment": "Codes may be defined very casually in enumerations, or code lists, up to very formal definitions such as SNOMED CT - see the HL7 v3 Core Principles for more information. Ordering of codings is undefined and SHALL NOT be used to infer meaning. Generally, at most only one of the coding values will be labeled as UserSelected = true.", "requirements": "Allows for alternative encodings within a code system, and translations to other code systems.", "min": 0, "max": "*", "base": { "path": "CodeableConcept.coding", "min": 0, "max": "*" }, "type": [ { "code": "Coding" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children unless an empty Parameters resource", "expression": "hasValue() or (children().count() > id.count()) or $this is Parameters", "xpath": "@value|f:*|h:div|self::f:Parameters", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "isSummary": true, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "v2", "map": "CE/CNE/CWE subset one of the sets of component 1-3 or 4-6" }, { "identity": "rim", "map": "CV" }, { "identity": "orim", "map": "fhir:Coding rdfs:subClassOf dt:CDCoding" }, { "identity": "v2", "map": "C*E.1-8, C*E.10-22" }, { "identity": "rim", "map": "union(., ./translation)" }, { "identity": "orim", "map": "fhir:CodeableConcept.coding rdfs:subPropertyOf dt:CD.coding" } ] }, { "id": "ClaimResponse.type.text", "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-translatable", "valueBoolean": true }, { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-translatable", "valueBoolean": true } ], "path": "ClaimResponse.type.text", "short": "Plain text representation of the concept", "definition": "A human language representation of the concept as seen/selected/uttered by the user who entered the data and/or which represents the intended meaning of the user.", "comment": "Very often the text is the same as a displayName of one of the codings.", "requirements": "The codes from the terminologies do not always capture the correct meaning with all the nuances of the human using them, or sometimes there is no appropriate code at all. In these cases, the text is used to capture the full meaning of the source.", "min": 0, "max": "1", "base": { "path": "CodeableConcept.text", "min": 0, "max": "1" }, "type": [ { "code": "string" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children unless an empty Parameters resource", "expression": "hasValue() or (children().count() > id.count()) or $this is Parameters", "xpath": "@value|f:*|h:div|self::f:Parameters", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "isSummary": true, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "v2", "map": "C*E.9. But note many systems use C*E.2 for this" }, { "identity": "rim", "map": "./originalText[mediaType/code=\"text/plain\"]/data" }, { "identity": "orim", "map": "fhir:CodeableConcept.text rdfs:subPropertyOf dt:CD.originalText" } ] }, { "id": "ClaimResponse.subType", "path": "ClaimResponse.subType", "short": "More granular claim type", "definition": "A finer grained suite of claim type codes which may convey additional information such as Inpatient vs Outpatient and/or a specialty service.", "comment": "This may contain the local bill type codes, for example the US UB-04 bill type code or the CMS bill type.", "requirements": "Some jurisdictions need a finer grained claim type for routing and adjudication.", "min": 0, "max": "1", "base": { "path": "ClaimResponse.subType", "min": 0, "max": "1" }, "type": [ { "code": "CodeableConcept" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children unless an empty Parameters resource", "expression": "hasValue() or (children().count() > id.count()) or $this is Parameters", "xpath": "@value|f:*|h:div|self::f:Parameters", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "mustSupport": false, "isModifier": false, "isSummary": false, "binding": { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString": "ClaimSubType" } ], "strength": "example", "description": "A more granular claim typecode.", "valueSet": "http://hl7.org/fhir/ValueSet/claim-subtype" }, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "v2", "map": "CE/CNE/CWE" }, { "identity": "rim", "map": "CD" }, { "identity": "orim", "map": "fhir:CodeableConcept rdfs:subClassOf dt:CD" }, { "identity": "w5", "map": "FiveWs.class" } ] }, { "id": "ClaimResponse.use", "path": "ClaimResponse.use", "short": "claim | preauthorization | predetermination", "definition": "Berisi data kode untuk menunjukkan apakah sifat dari permintaan tersebut adalah: untuk meminta keputusan atas produk dan layanan yang telah diberikan sebelumnya; atau meminta otorisasi dan ajudikasi untuk ketentuan di masa depan; atau meminta keputusan yang tidak mengikat atas produk dan layanan yang tercantum yang dapat disediakan di masa mendatang. Tipe data yang digunakan adalah code, yang nilainya mengacu pada data terminologi Use.", "comment": "Note that FHIR strings SHALL NOT exceed 1MB in size", "requirements": "This element is required to understand the nature of the request for adjudication.", "min": 1, "max": "1", "base": { "path": "ClaimResponse.use", "min": 1, "max": "1" }, "type": [ { "code": "code" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children unless an empty Parameters resource", "expression": "hasValue() or (children().count() > id.count()) or $this is Parameters", "xpath": "@value|f:*|h:div|self::f:Parameters", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "mustSupport": false, "isModifier": false, "isSummary": true, "binding": { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString": "Use" } ], "strength": "required", "description": "Claim, preauthorization, predetermination.", "valueSet": "http://hl7.org/fhir/ValueSet/claim-use|4.3.0" }, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "w5", "map": "FiveWs.class" } ] }, { "id": "ClaimResponse.patient", "path": "ClaimResponse.patient", "short": "The recipient of the products and services", "definition": "Berisi data terkait pihak kepada siapa layanan dan/atau produk profesional telah disediakan atau sedang dipertimbangkan dan untuk siapa penggantian aktual atau prakiraan dimintakan dengan tipe data Reference yang direferensikan ke data yang tersimpan di resource Patient.", "comment": "References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.", "requirements": "The patient must be supplied to the insurer so that confirmation of coverage and service hstory may be considered as part of the authorization and/or adjudiction.", "min": 1, "max": "1", "base": { "path": "ClaimResponse.patient", "min": 1, "max": "1" }, "type": [ { "code": "Reference", "targetProfile": [ "http://hl7.org/fhir/StructureDefinition/Patient" ] } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children unless an empty Parameters resource", "expression": "hasValue() or (children().count() > id.count()) or $this is Parameters", "xpath": "@value|f:*|h:div|self::f:Parameters", "source": "http://hl7.org/fhir/StructureDefinition/Element" }, { "key": "ref-1", "severity": "error", "human": "SHALL have a contained resource if a local reference is provided", "expression": "reference.exists() implies (reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids')) or (reference='#' and %rootResource!=%resource))", "xpath": "not(starts-with(f:reference/@value, '#')) or exists(ancestor::*[self::f:entry or self::f:parameter]/f:resource/f:*/f:contained/f:*[f:id/@value=substring-after(current()/f:reference/@value, '#')]|/*/f:contained/f:*[f:id/@value=substring-after(current()/f:reference/@value, '#')])", "source": "http://hl7.org/fhir/StructureDefinition/Reference" } ], "mustSupport": false, "isModifier": false, "isSummary": true, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "rim", "map": "The target of a resource reference is a RIM entry point (Act, Role, or Entity)" }, { "identity": "w5", "map": "FiveWs.subject[x]" }, { "identity": "w5", "map": "FiveWs.subject" } ] }, { "id": "ClaimResponse.created", "path": "ClaimResponse.created", "short": "Response creation date", "definition": "Berisi data tanggal ketika respon klaim dibuat dengan tipe data dateTime, dengan format yang diperbolehkan YYYY, YYYY-MM, YYYY-MM-DD atau YYYY-MM-DDThh:mm:ss+zz:zz.", "requirements": "Need to record a timestamp for use by both the recipient and the issuer.", "min": 1, "max": "1", "base": { "path": "ClaimResponse.created", "min": 1, "max": "1" }, "type": [ { "code": "dateTime" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children unless an empty Parameters resource", "expression": "hasValue() or (children().count() > id.count()) or $this is Parameters", "xpath": "@value|f:*|h:div|self::f:Parameters", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "mustSupport": false, "isModifier": false, "isSummary": true, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "workflow", "map": "Event.occurrence[x]" }, { "identity": "w5", "map": "FiveWs.recorded" } ] }, { "id": "ClaimResponse.insurer", "path": "ClaimResponse.insurer", "short": "Party responsible for reimbursement", "definition": "Berisi data pihak yang bertanggung jawab untuk otorisasi, ajudikasi dan penggantian dengan tipe data Reference yang direferensikan ke data yang tersimpan di resource Organization.", "comment": "References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.", "requirements": "To be a valid claim, preauthorization or predetermination there must be a party who is responsible for adjudicating the contents against a policy which provides benefits for the patient.", "min": 1, "max": "1", "base": { "path": "ClaimResponse.insurer", "min": 1, "max": "1" }, "type": [ { "code": "Reference", "targetProfile": [ "http://hl7.org/fhir/StructureDefinition/Organization" ] } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children unless an empty Parameters resource", "expression": "hasValue() or (children().count() > id.count()) or $this is Parameters", "xpath": "@value|f:*|h:div|self::f:Parameters", "source": "http://hl7.org/fhir/StructureDefinition/Element" }, { "key": "ref-1", "severity": "error", "human": "SHALL have a contained resource if a local reference is provided", "expression": "reference.exists() implies (reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids')) or (reference='#' and %rootResource!=%resource))", "xpath": "not(starts-with(f:reference/@value, '#')) or exists(ancestor::*[self::f:entry or self::f:parameter]/f:resource/f:*/f:contained/f:*[f:id/@value=substring-after(current()/f:reference/@value, '#')]|/*/f:contained/f:*[f:id/@value=substring-after(current()/f:reference/@value, '#')])", "source": "http://hl7.org/fhir/StructureDefinition/Reference" } ], "mustSupport": false, "isModifier": false, "isSummary": true, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "rim", "map": "The target of a resource reference is a RIM entry point (Act, Role, or Entity)" }, { "identity": "workflow", "map": "Event.performer" } ] }, { "id": "ClaimResponse.requestor", "path": "ClaimResponse.requestor", "short": "Party responsible for the claim", "definition": "Berisi data penyedia yang bertanggung jawab atas klaim, penentuan sebelumnya atau pra-otorisasi dengan tipe data Reference yang direferensikan ke data yang tersimpan di resource Practitioner | PractitionerRole | Organization.", "comment": "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": 0, "max": "1", "base": { "path": "ClaimResponse.requestor", "min": 0, "max": "1" }, "type": [ { "code": "Reference", "targetProfile": [ "http://hl7.org/fhir/StructureDefinition/Practitioner", "http://hl7.org/fhir/StructureDefinition/PractitionerRole", "http://hl7.org/fhir/StructureDefinition/Organization" ] } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children unless an empty Parameters resource", "expression": "hasValue() or (children().count() > id.count()) or $this is Parameters", "xpath": "@value|f:*|h:div|self::f:Parameters", "source": "http://hl7.org/fhir/StructureDefinition/Element" }, { "key": "ref-1", "severity": "error", "human": "SHALL have a contained resource if a local reference is provided", "expression": "reference.exists() implies (reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids')) or (reference='#' and %rootResource!=%resource))", "xpath": "not(starts-with(f:reference/@value, '#')) or exists(ancestor::*[self::f:entry or self::f:parameter]/f:resource/f:*/f:contained/f:*[f:id/@value=substring-after(current()/f:reference/@value, '#')]|/*/f:contained/f:*[f:id/@value=substring-after(current()/f:reference/@value, '#')])", "source": "http://hl7.org/fhir/StructureDefinition/Reference" } ], "mustSupport": false, "isModifier": false, "isSummary": false, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "rim", "map": "The target of a resource reference is a RIM entry point (Act, Role, or Entity)" }, { "identity": "w5", "map": "FiveWs.source" } ] }, { "id": "ClaimResponse.request", "path": "ClaimResponse.request", "short": "Id of resource triggering adjudication", "definition": "Berisi data referensi ke resource asli permintaan dengan tipe data Reference yang direferensikan ke data yang tersimpan di resource Claim.", "comment": "References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (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.", "min": 0, "max": "1", "base": { "path": "ClaimResponse.request", "min": 0, "max": "1" }, "type": [ { "code": "Reference", "targetProfile": [ "http://hl7.org/fhir/StructureDefinition/Claim" ] } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children unless an empty Parameters resource", "expression": "hasValue() or (children().count() > id.count()) or $this is Parameters", "xpath": "@value|f:*|h:div|self::f:Parameters", "source": "http://hl7.org/fhir/StructureDefinition/Element" }, { "key": "ref-1", "severity": "error", "human": "SHALL have a contained resource if a local reference is provided", "expression": "reference.exists() implies (reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids')) or (reference='#' and %rootResource!=%resource))", "xpath": "not(starts-with(f:reference/@value, '#')) or exists(ancestor::*[self::f:entry or self::f:parameter]/f:resource/f:*/f:contained/f:*[f:id/@value=substring-after(current()/f:reference/@value, '#')]|/*/f:contained/f:*[f:id/@value=substring-after(current()/f:reference/@value, '#')])", "source": "http://hl7.org/fhir/StructureDefinition/Reference" } ], "mustSupport": false, "isModifier": false, "isSummary": true, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "rim", "map": "The target of a resource reference is a RIM entry point (Act, Role, or Entity)" }, { "identity": "workflow", "map": "Event.basedOn" }, { "identity": "w5", "map": "FiveWs.why[x]" } ] }, { "id": "ClaimResponse.outcome", "path": "ClaimResponse.outcome", "short": "queued | complete | error | partial", "definition": "Berisi data hasil dari pemrosesan klaim, penentuan sebelumnya, atau praotorisasi dengan tipe data code, yang nilainya mengacu pada data terminologi Claim Processing Codes.", "comment": "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": "To advise the requestor of an overall processing outcome.", "min": 1, "max": "1", "base": { "path": "ClaimResponse.outcome", "min": 1, "max": "1" }, "type": [ { "code": "code" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children unless an empty Parameters resource", "expression": "hasValue() or (children().count() > id.count()) or $this is Parameters", "xpath": "@value|f:*|h:div|self::f:Parameters", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "mustSupport": false, "isModifier": false, "isSummary": true, "binding": { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString": "RemittanceOutcome" } ], "strength": "required", "description": "The result of the claim processing.", "valueSet": "http://hl7.org/fhir/ValueSet/remittance-outcome|4.3.0" }, "mapping": [ { "identity": "rim", "map": "n/a" } ] }, { "id": "ClaimResponse.disposition", "path": "ClaimResponse.disposition", "short": "Disposition Message", "definition": "Berisi data deskripsi status keputusan yang dapat dibaca manusia dengan tipe data string.", "comment": "Note that FHIR strings SHALL NOT exceed 1MB in size", "requirements": "Provided for user display.", "min": 0, "max": "1", "base": { "path": "ClaimResponse.disposition", "min": 0, "max": "1" }, "type": [ { "code": "string" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children unless an empty Parameters resource", "expression": "hasValue() or (children().count() > id.count()) or $this is Parameters", "xpath": "@value|f:*|h:div|self::f:Parameters", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "mustSupport": false, "isModifier": false, "isSummary": false, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "workflow", "map": "Event.note" } ] }, { "id": "ClaimResponse.preAuthRef", "path": "ClaimResponse.preAuthRef", "short": "Preauthorization reference", "definition": "Berisi data referensi dari penanggung yang digunakan dalam komunikasi selanjutnya yang mengacu pada keputusan dengan tipe data string.", "comment": "This value is only present on preauthorization adjudications.", "requirements": "On subsequent claims, the insurer may require the provider to quote this value.", "min": 0, "max": "1", "base": { "path": "ClaimResponse.preAuthRef", "min": 0, "max": "1" }, "type": [ { "code": "string" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children unless an empty Parameters resource", "expression": "hasValue() or (children().count() > id.count()) or $this is Parameters", "xpath": "@value|f:*|h:div|self::f:Parameters", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "mustSupport": false, "isModifier": false, "isSummary": false, "mapping": [ { "identity": "rim", "map": "n/a" } ] }, { "id": "ClaimResponse.preAuthPeriod", "path": "ClaimResponse.preAuthPeriod", "short": "Preauthorization reference effective period", "definition": "Berisi data jangka waktu selama otorisasi berlaku efektif dengan tipe data Period.", "comment": "A Period specifies a range of time; the context of use will specify whether the entire range applies (e.g. \"the patient was an inpatient of the hospital for this time range\") or one value from the range applies (e.g. \"give to the patient between these two times\").\n\nPeriod is not used for a duration (a measure of elapsed time). See [Duration](datatypes.html#Duration).", "requirements": "To convey to the provider when the authorized products and services must be supplied for the authorized adjudication to apply.", "min": 0, "max": "1", "base": { "path": "ClaimResponse.preAuthPeriod", "min": 0, "max": "1" }, "type": [ { "code": "Period" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children unless an empty Parameters resource", "expression": "hasValue() or (children().count() > id.count()) or $this is Parameters", "xpath": "@value|f:*|h:div|self::f:Parameters", "source": "http://hl7.org/fhir/StructureDefinition/Element" }, { "key": "per-1", "severity": "error", "human": "If present, start SHALL have a lower value than end", "expression": "start.hasValue().not() or end.hasValue().not() or (start <= end)", "xpath": "not(exists(f:start/@value)) or not(exists(f:end/@value)) or (xs:dateTime(f:start/@value) <= xs:dateTime(f:end/@value))", "source": "http://hl7.org/fhir/StructureDefinition/Period" } ], "mustSupport": false, "isModifier": false, "isSummary": false, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "v2", "map": "DR" }, { "identity": "rim", "map": "IVL[lowClosed=\"true\" and highClosed=\"true\"] or URG[lowClosed=\"true\" and highClosed=\"true\"]" } ] }, { "id": "ClaimResponse.payeeType", "path": "ClaimResponse.payeeType", "short": "Party to be paid any benefits payable", "definition": "Berisi data jenis pihak yang akan diberikan ganti: pelanggan, penyedia, lainnya dengan tipe data CodeableConcept.", "comment": "Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination.", "requirements": "Need to know who should receive payment with the most common situations being the Provider (assignment of benefits) or the Subscriber.", "min": 0, "max": "1", "base": { "path": "ClaimResponse.payeeType", "min": 0, "max": "1" }, "type": [ { "code": "CodeableConcept" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children unless an empty Parameters resource", "expression": "hasValue() or (children().count() > id.count()) or $this is Parameters", "xpath": "@value|f:*|h:div|self::f:Parameters", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "mustSupport": false, "isModifier": false, "isSummary": false, "binding": { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString": "PayeeType" } ], "strength": "example", "description": "A code for the party to be reimbursed.", "valueSet": "http://hl7.org/fhir/ValueSet/payeetype" }, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "v2", "map": "CE/CNE/CWE" }, { "identity": "rim", "map": "CD" }, { "identity": "orim", "map": "fhir:CodeableConcept rdfs:subClassOf dt:CD" } ] }, { "id": "ClaimResponse.payeeType.id", "path": "ClaimResponse.payeeType.id", "representation": [ "xmlAttr" ], "short": "Unique id for inter-element referencing", "definition": "Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.", "min": 0, "max": "1", "base": { "path": "Element.id", "min": 0, "max": "1" }, "type": [ { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type", "valueUrl": "id" } ], "code": "http://hl7.org/fhirpath/System.String" } ], "mapping": [ { "identity": "rim", "map": "n/a" } ] }, { "id": "ClaimResponse.payeeType.extension", "path": "ClaimResponse.payeeType.extension", "slicing": { "discriminator": [ { "type": "value", "path": "url" } ], "description": "Extensions are always sliced by (at least) url", "rules": "open" }, "short": "Additional content defined by implementations", "definition": "May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.", "comment": "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.", "alias": [ "extensions", "user content" ], "min": 0, "max": "*", "base": { "path": "Element.extension", "min": 0, "max": "*" }, "type": [ { "code": "Extension" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children unless an empty Parameters resource", "expression": "hasValue() or (children().count() > id.count()) or $this is Parameters", "xpath": "@value|f:*|h:div|self::f:Parameters", "source": "http://hl7.org/fhir/StructureDefinition/Element" }, { "key": "ext-1", "severity": "error", "human": "Must have either extensions or value[x], not both", "expression": "extension.exists() != value.exists()", "xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])", "source": "http://hl7.org/fhir/StructureDefinition/Extension" } ], "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "rim", "map": "N/A" } ] }, { "id": "ClaimResponse.payeeType.coding", "path": "ClaimResponse.payeeType.coding", "short": "Code defined by a terminology system", "definition": "Berisi data jenis pihak yang akan diberikan ganti: pelanggan, penyedia, lainnya dengan tipe data Coding, yang nilainya dapat mengacu pada contoh data terminologi PayeeType.", "comment": "Codes may be defined very casually in enumerations, or code lists, up to very formal definitions such as SNOMED CT - see the HL7 v3 Core Principles for more information. Ordering of codings is undefined and SHALL NOT be used to infer meaning. Generally, at most only one of the coding values will be labeled as UserSelected = true.", "requirements": "Allows for alternative encodings within a code system, and translations to other code systems.", "min": 0, "max": "*", "base": { "path": "CodeableConcept.coding", "min": 0, "max": "*" }, "type": [ { "code": "Coding" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children unless an empty Parameters resource", "expression": "hasValue() or (children().count() > id.count()) or $this is Parameters", "xpath": "@value|f:*|h:div|self::f:Parameters", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "isSummary": true, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "v2", "map": "CE/CNE/CWE subset one of the sets of component 1-3 or 4-6" }, { "identity": "rim", "map": "CV" }, { "identity": "orim", "map": "fhir:Coding rdfs:subClassOf dt:CDCoding" }, { "identity": "v2", "map": "C*E.1-8, C*E.10-22" }, { "identity": "rim", "map": "union(., ./translation)" }, { "identity": "orim", "map": "fhir:CodeableConcept.coding rdfs:subPropertyOf dt:CD.coding" } ] }, { "id": "ClaimResponse.payeeType.text", "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-translatable", "valueBoolean": true }, { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-translatable", "valueBoolean": true } ], "path": "ClaimResponse.payeeType.text", "short": "Plain text representation of the concept", "definition": "A human language representation of the concept as seen/selected/uttered by the user who entered the data and/or which represents the intended meaning of the user.", "comment": "Very often the text is the same as a displayName of one of the codings.", "requirements": "The codes from the terminologies do not always capture the correct meaning with all the nuances of the human using them, or sometimes there is no appropriate code at all. In these cases, the text is used to capture the full meaning of the source.", "min": 0, "max": "1", "base": { "path": "CodeableConcept.text", "min": 0, "max": "1" }, "type": [ { "code": "string" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children unless an empty Parameters resource", "expression": "hasValue() or (children().count() > id.count()) or $this is Parameters", "xpath": "@value|f:*|h:div|self::f:Parameters", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "isSummary": true, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "v2", "map": "C*E.9. But note many systems use C*E.2 for this" }, { "identity": "rim", "map": "./originalText[mediaType/code=\"text/plain\"]/data" }, { "identity": "orim", "map": "fhir:CodeableConcept.text rdfs:subPropertyOf dt:CD.originalText" } ] }, { "id": "ClaimResponse.item", "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-explicit-type-name", "valueString": "Item" } ], "path": "ClaimResponse.item", "short": "Adjudication for claim line items", "definition": "Berisi data baris klaim. Baik produk atau layanan sederhana atau 'grup' detail yang masing-masing dapat berupa item sederhana atau grup sub-detail dengan tipe data BackboneElement.", "requirements": "The adjudication for items provided on the claim.", "min": 0, "max": "*", "base": { "path": "ClaimResponse.item", "min": 0, "max": "*" }, "type": [ { "code": "BackboneElement" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children unless an empty Parameters resource", "expression": "hasValue() or (children().count() > id.count()) or $this is Parameters", "xpath": "@value|f:*|h:div|self::f:Parameters", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "mustSupport": false, "isModifier": false, "isSummary": false, "mapping": [ { "identity": "rim", "map": "n/a" } ] }, { "id": "ClaimResponse.item.id", "path": "ClaimResponse.item.id", "representation": [ "xmlAttr" ], "short": "Unique id for inter-element referencing", "definition": "Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.", "min": 0, "max": "1", "base": { "path": "Element.id", "min": 0, "max": "1" }, "type": [ { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type", "valueUrl": "id" } ], "code": "http://hl7.org/fhirpath/System.String" } ], "mapping": [ { "identity": "rim", "map": "n/a" } ] }, { "id": "ClaimResponse.item.extension", "path": "ClaimResponse.item.extension", "slicing": { "discriminator": [ { "type": "value", "path": "url" } ], "description": "Extensions are always sliced by (at least) url", "rules": "open" }, "short": "Additional content defined by implementations", "definition": "May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.", "comment": "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.", "alias": [ "extensions", "user content" ], "min": 0, "max": "*", "base": { "path": "Element.extension", "min": 0, "max": "*" }, "type": [ { "code": "Extension" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children unless an empty Parameters resource", "expression": "hasValue() or (children().count() > id.count()) or $this is Parameters", "xpath": "@value|f:*|h:div|self::f:Parameters", "source": "http://hl7.org/fhir/StructureDefinition/Element" }, { "key": "ext-1", "severity": "error", "human": "Must have either extensions or value[x], not both", "expression": "extension.exists() != value.exists()", "xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])", "source": "http://hl7.org/fhir/StructureDefinition/Extension" } ], "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "rim", "map": "N/A" } ] }, { "id": "ClaimResponse.item.modifierExtension", "path": "ClaimResponse.item.modifierExtension", "short": "Extensions that cannot be ignored even if unrecognized", "definition": "May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.\n\nModifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).", "comment": "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.", "requirements": "Modifier extensions allow for extensions that *cannot* be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the [definition of modifier extensions](extensibility.html#modifierExtension).", "alias": [ "extensions", "user content", "modifiers" ], "min": 0, "max": "*", "base": { "path": "BackboneElement.modifierExtension", "min": 0, "max": "*" }, "type": [ { "code": "Extension" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children unless an empty Parameters resource", "expression": "hasValue() or (children().count() > id.count()) or $this is Parameters", "xpath": "@value|f:*|h:div|self::f:Parameters", "source": "http://hl7.org/fhir/StructureDefinition/Element" }, { "key": "ext-1", "severity": "error", "human": "Must have either extensions or value[x], not both", "expression": "extension.exists() != value.exists()", "xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])", "source": "http://hl7.org/fhir/StructureDefinition/Extension" } ], "isModifier": true, "isModifierReason": "Modifier extensions are expected to modify the meaning or interpretation of the element that contains them", "isSummary": true, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "rim", "map": "N/A" } ] }, { "id": "ClaimResponse.item.itemSequence", "path": "ClaimResponse.item.itemSequence", "short": "Claim item instance identifier", "definition": "Berisi data nomor unik untuk mengidentifikasi entri item dengan tipe data positiveInt.", "comment": "32 bit number; for values larger than this, use decimal", "requirements": "Necessary to provide a mechanism to link the adjudication result to the submitted claim item.", "min": 1, "max": "1", "base": { "path": "ClaimResponse.item.itemSequence", "min": 1, "max": "1" }, "type": [ { "code": "positiveInt" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children unless an empty Parameters resource", "expression": "hasValue() or (children().count() > id.count()) or $this is Parameters", "xpath": "@value|f:*|h:div|self::f:Parameters", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "mustSupport": false, "isModifier": false, "isSummary": false, "mapping": [ { "identity": "rim", "map": "n/a" } ] }, { "id": "ClaimResponse.item.noteNumber", "path": "ClaimResponse.item.noteNumber", "short": "Applicable note numbers", "definition": "Berisi data angka-angka yang terkait dengan catatan yang ada di bawah yang berlaku untuk penilaian item dengan tipe data positiveInt.", "comment": "32 bit number; for values larger than this, use decimal", "requirements": "Provides a condensed manner for associating human readable descriptive explanations for adjudications on the line item.", "min": 0, "max": "*", "base": { "path": "ClaimResponse.item.noteNumber", "min": 0, "max": "*" }, "type": [ { "code": "positiveInt" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children unless an empty Parameters resource", "expression": "hasValue() or (children().count() > id.count()) or $this is Parameters", "xpath": "@value|f:*|h:div|self::f:Parameters", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "mustSupport": false, "isModifier": false, "isSummary": false, "mapping": [ { "identity": "rim", "map": "n/a" } ] }, { "id": "ClaimResponse.item.adjudication", "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-explicit-type-name", "valueString": "Adjudication" } ], "path": "ClaimResponse.item.adjudication", "short": "Adjudication details", "definition": "Berisi data penilaian item. Jika item ini adalah grup maka nilai-nilai di sini adalah ringkasan dari penilaian detail item. Jika item ini adalah produk atau layanan sederhana maka ini adalah hasil dari penilaian item ini. Hasil ajudikasi menyampaikan penilaian penanggung terhadap hal yang diberikan dalam klaim berdasarkan ketentuan pertanggungan asuransi pasien.", "requirements": "The adjudication results conveys the insurer's assessment of the item provided in the claim under the terms of the patient's insurance coverage.", "min": 1, "max": "*", "base": { "path": "ClaimResponse.item.adjudication", "min": 1, "max": "*" }, "type": [ { "code": "BackboneElement" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children unless an empty Parameters resource", "expression": "hasValue() or (children().count() > id.count()) or $this is Parameters", "xpath": "@value|f:*|h:div|self::f:Parameters", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "mustSupport": false, "isModifier": false, "isSummary": false, "mapping": [ { "identity": "rim", "map": "n/a" } ] }, { "id": "ClaimResponse.item.adjudication.id", "path": "ClaimResponse.item.adjudication.id", "representation": [ "xmlAttr" ], "short": "Unique id for inter-element referencing", "definition": "Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.", "min": 0, "max": "1", "base": { "path": "Element.id", "min": 0, "max": "1" }, "type": [ { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type", "valueUrl": "id" } ], "code": "http://hl7.org/fhirpath/System.String" } ], "mapping": [ { "identity": "rim", "map": "n/a" } ] }, { "id": "ClaimResponse.item.adjudication.extension", "path": "ClaimResponse.item.adjudication.extension", "slicing": { "discriminator": [ { "type": "value", "path": "url" } ], "description": "Extensions are always sliced by (at least) url", "rules": "open" }, "short": "Additional content defined by implementations", "definition": "May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.", "comment": "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.", "alias": [ "extensions", "user content" ], "min": 0, "max": "*", "base": { "path": "Element.extension", "min": 0, "max": "*" }, "type": [ { "code": "Extension" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children unless an empty Parameters resource", "expression": "hasValue() or (children().count() > id.count()) or $this is Parameters", "xpath": "@value|f:*|h:div|self::f:Parameters", "source": "http://hl7.org/fhir/StructureDefinition/Element" }, { "key": "ext-1", "severity": "error", "human": "Must have either extensions or value[x], not both", "expression": "extension.exists() != value.exists()", "xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])", "source": "http://hl7.org/fhir/StructureDefinition/Extension" } ], "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "rim", "map": "N/A" } ] }, { "id": "ClaimResponse.item.adjudication.modifierExtension", "path": "ClaimResponse.item.adjudication.modifierExtension", "short": "Extensions that cannot be ignored even if unrecognized", "definition": "May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.\n\nModifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).", "comment": "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.", "requirements": "Modifier extensions allow for extensions that *cannot* be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the [definition of modifier extensions](extensibility.html#modifierExtension).", "alias": [ "extensions", "user content", "modifiers" ], "min": 0, "max": "*", "base": { "path": "BackboneElement.modifierExtension", "min": 0, "max": "*" }, "type": [ { "code": "Extension" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children unless an empty Parameters resource", "expression": "hasValue() or (children().count() > id.count()) or $this is Parameters", "xpath": "@value|f:*|h:div|self::f:Parameters", "source": "http://hl7.org/fhir/StructureDefinition/Element" }, { "key": "ext-1", "severity": "error", "human": "Must have either extensions or value[x], not both", "expression": "extension.exists() != value.exists()", "xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])", "source": "http://hl7.org/fhir/StructureDefinition/Extension" } ], "isModifier": true, "isModifierReason": "Modifier extensions are expected to modify the meaning or interpretation of the element that contains them", "isSummary": true, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "rim", "map": "N/A" } ] }, { "id": "ClaimResponse.item.adjudication.category", "path": "ClaimResponse.item.adjudication.category", "short": "Type of adjudication information", "definition": "Berisi data kode untuk menunjukkan jenis informasi catatan keputusan. Jenis informasi dapat mencakup nilai yang diajukan, nilai maksimum atau persentase yang diperbolehkan atau dapat dibayarkan berdasarkan program, jumlah yang: pasien bertanggung jawab secara agregat atau berkaitan dengan item ini; jumlah yang dibayarkan oleh pertanggungan lain; dan, manfaat yang dibayarkan untuk item ini. Tipe data yang digunakan adalah CodeableConcept.", "comment": "For example codes indicating: Co-Pay, deductible, eligible, benefit, tax, etc.", "requirements": "Needed to enable understanding of the context of the other information in the adjudication.", "min": 1, "max": "1", "base": { "path": "ClaimResponse.item.adjudication.category", "min": 1, "max": "1" }, "type": [ { "code": "CodeableConcept" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children unless an empty Parameters resource", "expression": "hasValue() or (children().count() > id.count()) or $this is Parameters", "xpath": "@value|f:*|h:div|self::f:Parameters", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "mustSupport": false, "isModifier": false, "isSummary": false, "binding": { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString": "Adjudication" } ], "strength": "example", "description": "The adjudication codes.", "valueSet": "http://hl7.org/fhir/ValueSet/adjudication" }, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "v2", "map": "CE/CNE/CWE" }, { "identity": "rim", "map": "CD" }, { "identity": "orim", "map": "fhir:CodeableConcept rdfs:subClassOf dt:CD" } ] }, { "id": "ClaimResponse.item.adjudication.category.id", "path": "ClaimResponse.item.adjudication.category.id", "representation": [ "xmlAttr" ], "short": "Unique id for inter-element referencing", "definition": "Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.", "min": 0, "max": "1", "base": { "path": "Element.id", "min": 0, "max": "1" }, "type": [ { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type", "valueUrl": "id" } ], "code": "http://hl7.org/fhirpath/System.String" } ], "mapping": [ { "identity": "rim", "map": "n/a" } ] }, { "id": "ClaimResponse.item.adjudication.category.extension", "path": "ClaimResponse.item.adjudication.category.extension", "slicing": { "discriminator": [ { "type": "value", "path": "url" } ], "description": "Extensions are always sliced by (at least) url", "rules": "open" }, "short": "Additional content defined by implementations", "definition": "May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.", "comment": "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.", "alias": [ "extensions", "user content" ], "min": 0, "max": "*", "base": { "path": "Element.extension", "min": 0, "max": "*" }, "type": [ { "code": "Extension" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children unless an empty Parameters resource", "expression": "hasValue() or (children().count() > id.count()) or $this is Parameters", "xpath": "@value|f:*|h:div|self::f:Parameters", "source": "http://hl7.org/fhir/StructureDefinition/Element" }, { "key": "ext-1", "severity": "error", "human": "Must have either extensions or value[x], not both", "expression": "extension.exists() != value.exists()", "xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])", "source": "http://hl7.org/fhir/StructureDefinition/Extension" } ], "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "rim", "map": "N/A" } ] }, { "id": "ClaimResponse.item.adjudication.category.coding", "path": "ClaimResponse.item.adjudication.category.coding", "short": "Code defined by a terminology system", "definition": "Berisi data kode untuk menunjukkan jenis informasi catatan keputusan. Jenis informasi dapat mencakup nilai yang diajukan, nilai maksimum atau persentase yang diperbolehkan atau dapat dibayarkan berdasarkan program, jumlah yang: pasien bertanggung jawab secara agregat atau berkaitan dengan item ini; jumlah yang dibayarkan oleh pertanggungan lain; dan, manfaat yang dibayarkan untuk item ini. Tipe data yang digunakan adalah Coding, yang nilainya dapat mengacu pada contoh data terminologi Adjudication Value Codes.", "comment": "Codes may be defined very casually in enumerations, or code lists, up to very formal definitions such as SNOMED CT - see the HL7 v3 Core Principles for more information. Ordering of codings is undefined and SHALL NOT be used to infer meaning. Generally, at most only one of the coding values will be labeled as UserSelected = true.", "requirements": "Allows for alternative encodings within a code system, and translations to other code systems.", "min": 0, "max": "*", "base": { "path": "CodeableConcept.coding", "min": 0, "max": "*" }, "type": [ { "code": "Coding" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children unless an empty Parameters resource", "expression": "hasValue() or (children().count() > id.count()) or $this is Parameters", "xpath": "@value|f:*|h:div|self::f:Parameters", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "isSummary": true, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "v2", "map": "CE/CNE/CWE subset one of the sets of component 1-3 or 4-6" }, { "identity": "rim", "map": "CV" }, { "identity": "orim", "map": "fhir:Coding rdfs:subClassOf dt:CDCoding" }, { "identity": "v2", "map": "C*E.1-8, C*E.10-22" }, { "identity": "rim", "map": "union(., ./translation)" }, { "identity": "orim", "map": "fhir:CodeableConcept.coding rdfs:subPropertyOf dt:CD.coding" } ] }, { "id": "ClaimResponse.item.adjudication.category.text", "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-translatable", "valueBoolean": true }, { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-translatable", "valueBoolean": true } ], "path": "ClaimResponse.item.adjudication.category.text", "short": "Plain text representation of the concept", "definition": "A human language representation of the concept as seen/selected/uttered by the user who entered the data and/or which represents the intended meaning of the user.", "comment": "Very often the text is the same as a displayName of one of the codings.", "requirements": "The codes from the terminologies do not always capture the correct meaning with all the nuances of the human using them, or sometimes there is no appropriate code at all. In these cases, the text is used to capture the full meaning of the source.", "min": 0, "max": "1", "base": { "path": "CodeableConcept.text", "min": 0, "max": "1" }, "type": [ { "code": "string" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children unless an empty Parameters resource", "expression": "hasValue() or (children().count() > id.count()) or $this is Parameters", "xpath": "@value|f:*|h:div|self::f:Parameters", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "isSummary": true, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "v2", "map": "C*E.9. But note many systems use C*E.2 for this" }, { "identity": "rim", "map": "./originalText[mediaType/code=\"text/plain\"]/data" }, { "identity": "orim", "map": "fhir:CodeableConcept.text rdfs:subPropertyOf dt:CD.originalText" } ] }, { "id": "ClaimResponse.item.adjudication.reason", "path": "ClaimResponse.item.adjudication.reason", "short": "Explanation of adjudication outcome", "definition": "Berisi data kode yang mendukung pemahaman hasil keputusan dan menjelaskan perbedaan dari jumlah yang diharapkan dengan tipe data CodeableConcept.", "comment": "For example may indicate that the funds for this benefit type have been exhausted.", "requirements": "To support understanding of variance from adjudication expectations.", "min": 0, "max": "1", "base": { "path": "ClaimResponse.item.adjudication.reason", "min": 0, "max": "1" }, "type": [ { "code": "CodeableConcept" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children unless an empty Parameters resource", "expression": "hasValue() or (children().count() > id.count()) or $this is Parameters", "xpath": "@value|f:*|h:div|self::f:Parameters", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "mustSupport": false, "isModifier": false, "isSummary": false, "binding": { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString": "AdjudicationReason" } ], "strength": "example", "description": "The adjudication reason codes.", "valueSet": "http://hl7.org/fhir/ValueSet/adjudication-reason" }, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "v2", "map": "CE/CNE/CWE" }, { "identity": "rim", "map": "CD" }, { "identity": "orim", "map": "fhir:CodeableConcept rdfs:subClassOf dt:CD" } ] }, { "id": "ClaimResponse.item.adjudication.reason.id", "path": "ClaimResponse.item.adjudication.reason.id", "representation": [ "xmlAttr" ], "short": "Unique id for inter-element referencing", "definition": "Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.", "min": 0, "max": "1", "base": { "path": "Element.id", "min": 0, "max": "1" }, "type": [ { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type", "valueUrl": "id" } ], "code": "http://hl7.org/fhirpath/System.String" } ], "mapping": [ { "identity": "rim", "map": "n/a" } ] }, { "id": "ClaimResponse.item.adjudication.reason.extension", "path": "ClaimResponse.item.adjudication.reason.extension", "slicing": { "discriminator": [ { "type": "value", "path": "url" } ], "description": "Extensions are always sliced by (at least) url", "rules": "open" }, "short": "Additional content defined by implementations", "definition": "May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.", "comment": "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.", "alias": [ "extensions", "user content" ], "min": 0, "max": "*", "base": { "path": "Element.extension", "min": 0, "max": "*" }, "type": [ { "code": "Extension" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children unless an empty Parameters resource", "expression": "hasValue() or (children().count() > id.count()) or $this is Parameters", "xpath": "@value|f:*|h:div|self::f:Parameters", "source": "http://hl7.org/fhir/StructureDefinition/Element" }, { "key": "ext-1", "severity": "error", "human": "Must have either extensions or value[x], not both", "expression": "extension.exists() != value.exists()", "xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])", "source": "http://hl7.org/fhir/StructureDefinition/Extension" } ], "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "rim", "map": "N/A" } ] }, { "id": "ClaimResponse.item.adjudication.reason.coding", "path": "ClaimResponse.item.adjudication.reason.coding", "short": "Code defined by a terminology system", "definition": "Berisi data kode yang mendukung pemahaman hasil keputusan dan menjelaskan perbedaan dari jumlah yang diharapkan dengan tipe data Coding, yang nilainya dapat mengacu pada contoh data terminologi Adjudication Reason Codes.", "comment": "Codes may be defined very casually in enumerations, or code lists, up to very formal definitions such as SNOMED CT - see the HL7 v3 Core Principles for more information. Ordering of codings is undefined and SHALL NOT be used to infer meaning. Generally, at most only one of the coding values will be labeled as UserSelected = true.", "requirements": "Allows for alternative encodings within a code system, and translations to other code systems.", "min": 0, "max": "*", "base": { "path": "CodeableConcept.coding", "min": 0, "max": "*" }, "type": [ { "code": "Coding" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children unless an empty Parameters resource", "expression": "hasValue() or (children().count() > id.count()) or $this is Parameters", "xpath": "@value|f:*|h:div|self::f:Parameters", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "isSummary": true, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "v2", "map": "CE/CNE/CWE subset one of the sets of component 1-3 or 4-6" }, { "identity": "rim", "map": "CV" }, { "identity": "orim", "map": "fhir:Coding rdfs:subClassOf dt:CDCoding" }, { "identity": "v2", "map": "C*E.1-8, C*E.10-22" }, { "identity": "rim", "map": "union(., ./translation)" }, { "identity": "orim", "map": "fhir:CodeableConcept.coding rdfs:subPropertyOf dt:CD.coding" } ] }, { "id": "ClaimResponse.item.adjudication.reason.text", "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-translatable", "valueBoolean": true }, { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-translatable", "valueBoolean": true } ], "path": "ClaimResponse.item.adjudication.reason.text", "short": "Plain text representation of the concept", "definition": "A human language representation of the concept as seen/selected/uttered by the user who entered the data and/or which represents the intended meaning of the user.", "comment": "Very often the text is the same as a displayName of one of the codings.", "requirements": "The codes from the terminologies do not always capture the correct meaning with all the nuances of the human using them, or sometimes there is no appropriate code at all. In these cases, the text is used to capture the full meaning of the source.", "min": 0, "max": "1", "base": { "path": "CodeableConcept.text", "min": 0, "max": "1" }, "type": [ { "code": "string" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children unless an empty Parameters resource", "expression": "hasValue() or (children().count() > id.count()) or $this is Parameters", "xpath": "@value|f:*|h:div|self::f:Parameters", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "isSummary": true, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "v2", "map": "C*E.9. But note many systems use C*E.2 for this" }, { "identity": "rim", "map": "./originalText[mediaType/code=\"text/plain\"]/data" }, { "identity": "orim", "map": "fhir:CodeableConcept.text rdfs:subPropertyOf dt:CD.originalText" } ] }, { "id": "ClaimResponse.item.adjudication.amount", "path": "ClaimResponse.item.adjudication.amount", "short": "Monetary amount", "definition": "Berisi data jumlah uang yang terkait dengan kategori keputusan dengan tipe data Money.", "comment": "For example: amount submitted, eligible amount, co-payment, and benefit payable.", "requirements": "Most adjuciation categories convey a monetary amount.", "min": 0, "max": "1", "base": { "path": "ClaimResponse.item.adjudication.amount", "min": 0, "max": "1" }, "type": [ { "code": "Money" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children unless an empty Parameters resource", "expression": "hasValue() or (children().count() > id.count()) or $this is Parameters", "xpath": "@value|f:*|h:div|self::f:Parameters", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "mustSupport": false, "isModifier": false, "isSummary": false, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "rim", "map": "MO" } ] }, { "id": "ClaimResponse.item.adjudication.value", "path": "ClaimResponse.item.adjudication.value", "short": "Non-monetary value", "definition": "Berisi data nilai non-moneter yang terkait dengan kategori, beberapa kategori penilaian menyampaikan persentase atau nilai tetap, dapat berupa persentase yang memenuhi syarat atau persentase pembayaran bersama dengan tipe data decimal.", "comment": "For example: eligible percentage or co-payment percentage.", "requirements": "Some adjudication categories convey a percentage or a fixed value.", "min": 0, "max": "1", "base": { "path": "ClaimResponse.item.adjudication.value", "min": 0, "max": "1" }, "type": [ { "code": "decimal" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children unless an empty Parameters resource", "expression": "hasValue() or (children().count() > id.count()) or $this is Parameters", "xpath": "@value|f:*|h:div|self::f:Parameters", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "mustSupport": false, "isModifier": false, "isSummary": false, "mapping": [ { "identity": "rim", "map": "n/a" } ] }, { "id": "ClaimResponse.item.detail", "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-explicit-type-name", "valueString": "ItemDetail" } ], "path": "ClaimResponse.item.detail", "short": "Adjudication for claim details", "definition": "Berisi data detail klaim, baik yang sederhana (produk atau layanan) atau 'kelompok' sub-detail yang merupakan barang sederhana dengan tipe data BackboneElement.", "requirements": "The adjudication for details provided on the claim.", "min": 0, "max": "*", "base": { "path": "ClaimResponse.item.detail", "min": 0, "max": "*" }, "type": [ { "code": "BackboneElement" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children unless an empty Parameters resource", "expression": "hasValue() or (children().count() > id.count()) or $this is Parameters", "xpath": "@value|f:*|h:div|self::f:Parameters", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "mustSupport": false, "isModifier": false, "isSummary": false, "mapping": [ { "identity": "rim", "map": "n/a" } ] }, { "id": "ClaimResponse.item.detail.id", "path": "ClaimResponse.item.detail.id", "representation": [ "xmlAttr" ], "short": "Unique id for inter-element referencing", "definition": "Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.", "min": 0, "max": "1", "base": { "path": "Element.id", "min": 0, "max": "1" }, "type": [ { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type", "valueUrl": "id" } ], "code": "http://hl7.org/fhirpath/System.String" } ], "mapping": [ { "identity": "rim", "map": "n/a" } ] }, { "id": "ClaimResponse.item.detail.extension", "path": "ClaimResponse.item.detail.extension", "slicing": { "discriminator": [ { "type": "value", "path": "url" } ], "description": "Extensions are always sliced by (at least) url", "rules": "open" }, "short": "Additional content defined by implementations", "definition": "May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.", "comment": "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.", "alias": [ "extensions", "user content" ], "min": 0, "max": "*", "base": { "path": "Element.extension", "min": 0, "max": "*" }, "type": [ { "code": "Extension" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children unless an empty Parameters resource", "expression": "hasValue() or (children().count() > id.count()) or $this is Parameters", "xpath": "@value|f:*|h:div|self::f:Parameters", "source": "http://hl7.org/fhir/StructureDefinition/Element" }, { "key": "ext-1", "severity": "error", "human": "Must have either extensions or value[x], not both", "expression": "extension.exists() != value.exists()", "xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])", "source": "http://hl7.org/fhir/StructureDefinition/Extension" } ], "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "rim", "map": "N/A" } ] }, { "id": "ClaimResponse.item.detail.modifierExtension", "path": "ClaimResponse.item.detail.modifierExtension", "short": "Extensions that cannot be ignored even if unrecognized", "definition": "May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.\n\nModifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).", "comment": "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.", "requirements": "Modifier extensions allow for extensions that *cannot* be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the [definition of modifier extensions](extensibility.html#modifierExtension).", "alias": [ "extensions", "user content", "modifiers" ], "min": 0, "max": "*", "base": { "path": "BackboneElement.modifierExtension", "min": 0, "max": "*" }, "type": [ { "code": "Extension" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children unless an empty Parameters resource", "expression": "hasValue() or (children().count() > id.count()) or $this is Parameters", "xpath": "@value|f:*|h:div|self::f:Parameters", "source": "http://hl7.org/fhir/StructureDefinition/Element" }, { "key": "ext-1", "severity": "error", "human": "Must have either extensions or value[x], not both", "expression": "extension.exists() != value.exists()", "xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])", "source": "http://hl7.org/fhir/StructureDefinition/Extension" } ], "isModifier": true, "isModifierReason": "Modifier extensions are expected to modify the meaning or interpretation of the element that contains them", "isSummary": true, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "rim", "map": "N/A" } ] }, { "id": "ClaimResponse.item.detail.detailSequence", "path": "ClaimResponse.item.detail.detailSequence", "short": "Claim detail instance identifier", "definition": "Berisi data nomor unik untuk mereferensikan entri detail klaim dengan tipe data positiveInt.", "comment": "32 bit number; for values larger than this, use decimal", "requirements": "Necessary to provide a mechanism to link the adjudication result to the submitted claim detail.", "min": 1, "max": "1", "base": { "path": "ClaimResponse.item.detail.detailSequence", "min": 1, "max": "1" }, "type": [ { "code": "positiveInt" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children unless an empty Parameters resource", "expression": "hasValue() or (children().count() > id.count()) or $this is Parameters", "xpath": "@value|f:*|h:div|self::f:Parameters", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "mustSupport": false, "isModifier": false, "isSummary": false, "mapping": [ { "identity": "rim", "map": "n/a" } ] }, { "id": "ClaimResponse.item.detail.noteNumber", "path": "ClaimResponse.item.detail.noteNumber", "short": "Applicable note numbers", "definition": "Berisi data angka-angka yang terkait dengan catatan di bawah yang berlaku untuk penilaian item dengan tipe data positiveInt.", "comment": "32 bit number; for values larger than this, use decimal", "requirements": "Provides a condensed manner for associating human readable descriptive explanations for adjudications on the line item.", "min": 0, "max": "*", "base": { "path": "ClaimResponse.item.detail.noteNumber", "min": 0, "max": "*" }, "type": [ { "code": "positiveInt" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children unless an empty Parameters resource", "expression": "hasValue() or (children().count() > id.count()) or $this is Parameters", "xpath": "@value|f:*|h:div|self::f:Parameters", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "mustSupport": false, "isModifier": false, "isSummary": false, "mapping": [ { "identity": "rim", "map": "n/a" } ] }, { "id": "ClaimResponse.item.detail.adjudication", "path": "ClaimResponse.item.detail.adjudication", "short": "Detail level adjudication details", "definition": "Berisi data hasil keputusan dengan tipe data yang mengacu pada ClaimResponse.item.adjudication.", "min": 1, "max": "*", "base": { "path": "ClaimResponse.item.detail.adjudication", "min": 1, "max": "*" }, "contentReference": "http://hl7.org/fhir/StructureDefinition/ClaimResponse#ClaimResponse.item.adjudication", "mustSupport": false, "isModifier": false, "isSummary": false }, { "id": "ClaimResponse.item.detail.subDetail", "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-explicit-type-name", "valueString": "SubDetail" } ], "path": "ClaimResponse.item.detail.subDetail", "short": "Adjudication for claim sub-details", "definition": "Berisi data keputusan sub-detail dari produk atau layanan sederhana dengan tipe data BackboneElement.", "requirements": "The adjudication for sub-details provided on the claim.", "min": 0, "max": "*", "base": { "path": "ClaimResponse.item.detail.subDetail", "min": 0, "max": "*" }, "type": [ { "code": "BackboneElement" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children unless an empty Parameters resource", "expression": "hasValue() or (children().count() > id.count()) or $this is Parameters", "xpath": "@value|f:*|h:div|self::f:Parameters", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "mustSupport": false, "isModifier": false, "isSummary": false, "mapping": [ { "identity": "rim", "map": "n/a" } ] }, { "id": "ClaimResponse.item.detail.subDetail.id", "path": "ClaimResponse.item.detail.subDetail.id", "representation": [ "xmlAttr" ], "short": "Unique id for inter-element referencing", "definition": "Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.", "min": 0, "max": "1", "base": { "path": "Element.id", "min": 0, "max": "1" }, "type": [ { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type", "valueUrl": "id" } ], "code": "http://hl7.org/fhirpath/System.String" } ], "mapping": [ { "identity": "rim", "map": "n/a" } ] }, { "id": "ClaimResponse.item.detail.subDetail.extension", "path": "ClaimResponse.item.detail.subDetail.extension", "slicing": { "discriminator": [ { "type": "value", "path": "url" } ], "description": "Extensions are always sliced by (at least) url", "rules": "open" }, "short": "Additional content defined by implementations", "definition": "May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.", "comment": "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.", "alias": [ "extensions", "user content" ], "min": 0, "max": "*", "base": { "path": "Element.extension", "min": 0, "max": "*" }, "type": [ { "code": "Extension" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children unless an empty Parameters resource", "expression": "hasValue() or (children().count() > id.count()) or $this is Parameters", "xpath": "@value|f:*|h:div|self::f:Parameters", "source": "http://hl7.org/fhir/StructureDefinition/Element" }, { "key": "ext-1", "severity": "error", "human": "Must have either extensions or value[x], not both", "expression": "extension.exists() != value.exists()", "xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])", "source": "http://hl7.org/fhir/StructureDefinition/Extension" } ], "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "rim", "map": "N/A" } ] }, { "id": "ClaimResponse.item.detail.subDetail.modifierExtension", "path": "ClaimResponse.item.detail.subDetail.modifierExtension", "short": "Extensions that cannot be ignored even if unrecognized", "definition": "May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.\n\nModifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).", "comment": "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.", "requirements": "Modifier extensions allow for extensions that *cannot* be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the [definition of modifier extensions](extensibility.html#modifierExtension).", "alias": [ "extensions", "user content", "modifiers" ], "min": 0, "max": "*", "base": { "path": "BackboneElement.modifierExtension", "min": 0, "max": "*" }, "type": [ { "code": "Extension" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children unless an empty Parameters resource", "expression": "hasValue() or (children().count() > id.count()) or $this is Parameters", "xpath": "@value|f:*|h:div|self::f:Parameters", "source": "http://hl7.org/fhir/StructureDefinition/Element" }, { "key": "ext-1", "severity": "error", "human": "Must have either extensions or value[x], not both", "expression": "extension.exists() != value.exists()", "xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])", "source": "http://hl7.org/fhir/StructureDefinition/Extension" } ], "isModifier": true, "isModifierReason": "Modifier extensions are expected to modify the meaning or interpretation of the element that contains them", "isSummary": true, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "rim", "map": "N/A" } ] }, { "id": "ClaimResponse.item.detail.subDetail.subDetailSequence", "path": "ClaimResponse.item.detail.subDetail.subDetailSequence", "short": "Claim sub-detail instance identifier", "definition": "Berisi data nomor unik untuk mereferensikan entri sub-detail klaim dengan tipe data positiveInt.", "comment": "32 bit number; for values larger than this, use decimal", "requirements": "Necessary to provide a mechanism to link the adjudication result to the submitted claim sub-detail.", "min": 1, "max": "1", "base": { "path": "ClaimResponse.item.detail.subDetail.subDetailSequence", "min": 1, "max": "1" }, "type": [ { "code": "positiveInt" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children unless an empty Parameters resource", "expression": "hasValue() or (children().count() > id.count()) or $this is Parameters", "xpath": "@value|f:*|h:div|self::f:Parameters", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "mustSupport": false, "isModifier": false, "isSummary": false, "mapping": [ { "identity": "rim", "map": "n/a" } ] }, { "id": "ClaimResponse.item.detail.subDetail.noteNumber", "path": "ClaimResponse.item.detail.subDetail.noteNumber", "short": "Applicable note numbers", "definition": "Berisi data angka-angka yang terkait dengan catatan di bawah yang berlaku untuk penilaian item dengan tipe data positiveInt.", "comment": "32 bit number; for values larger than this, use decimal", "requirements": "Provides a condensed manner for associating human readable descriptive explanations for adjudications on the line item.", "min": 0, "max": "*", "base": { "path": "ClaimResponse.item.detail.subDetail.noteNumber", "min": 0, "max": "*" }, "type": [ { "code": "positiveInt" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children unless an empty Parameters resource", "expression": "hasValue() or (children().count() > id.count()) or $this is Parameters", "xpath": "@value|f:*|h:div|self::f:Parameters", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "mustSupport": false, "isModifier": false, "isSummary": false, "mapping": [ { "identity": "rim", "map": "n/a" } ] }, { "id": "ClaimResponse.item.detail.subDetail.adjudication", "path": "ClaimResponse.item.detail.subDetail.adjudication", "short": "Subdetail level adjudication details", "definition": "Berisi data hasil keputusan dengan tipe data yang mengacu pada ClaimResponse.item.adjudication.", "min": 1, "max": "*", "base": { "path": "ClaimResponse.item.detail.subDetail.adjudication", "min": 0, "max": "*" }, "contentReference": "http://hl7.org/fhir/StructureDefinition/ClaimResponse#ClaimResponse.item.adjudication", "mustSupport": false, "isModifier": false, "isSummary": false }, { "id": "ClaimResponse.addItem", "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-explicit-type-name", "valueString": "AddedItem" } ], "path": "ClaimResponse.addItem", "short": "Insurer added line items", "definition": "Berisi data keputusan layanan tingkat pertama untuk payor dapat menambahkan lini produk atau layanan. Penanggung dapat mendefinisikan kembali produk atau layanan yang disediakan atau dapat mengemas dan/atau menguraikan kelompok produk dan layanan. AddItems memungkinkan perusahaan asuransi untuk memberikan daftar item baris mereka dengan tautan ke item/detail/sub-detail yang dikirimkan. Dalam pra-otorisasi perusahaan asuransi dapat menggunakan struktur addItem untuk memberikan informasi tambahan tentang produk dan layanan resmi dengan tipe data BackboneElement.", "requirements": "Insurers may redefine the provided product or service or may package and/or decompose groups of products and services. The addItems allows the insurer to provide their line item list with linkage to the submitted items/details/sub-details. In a preauthorization the insurer may use the addItem structure to provide additional information on authorized products and services.", "min": 0, "max": "*", "base": { "path": "ClaimResponse.addItem", "min": 0, "max": "*" }, "type": [ { "code": "BackboneElement" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children unless an empty Parameters resource", "expression": "hasValue() or (children().count() > id.count()) or $this is Parameters", "xpath": "@value|f:*|h:div|self::f:Parameters", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "mustSupport": false, "isModifier": false, "isSummary": false, "mapping": [ { "identity": "rim", "map": "n/a" } ] }, { "id": "ClaimResponse.addItem.id", "path": "ClaimResponse.addItem.id", "representation": [ "xmlAttr" ], "short": "Unique id for inter-element referencing", "definition": "Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.", "min": 0, "max": "1", "base": { "path": "Element.id", "min": 0, "max": "1" }, "type": [ { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type", "valueUrl": "id" } ], "code": "http://hl7.org/fhirpath/System.String" } ], "mapping": [ { "identity": "rim", "map": "n/a" } ] }, { "id": "ClaimResponse.addItem.extension", "path": "ClaimResponse.addItem.extension", "slicing": { "discriminator": [ { "type": "value", "path": "url" } ], "description": "Extensions are always sliced by (at least) url", "rules": "open" }, "short": "Additional content defined by implementations", "definition": "May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.", "comment": "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.", "alias": [ "extensions", "user content" ], "min": 0, "max": "*", "base": { "path": "Element.extension", "min": 0, "max": "*" }, "type": [ { "code": "Extension" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children unless an empty Parameters resource", "expression": "hasValue() or (children().count() > id.count()) or $this is Parameters", "xpath": "@value|f:*|h:div|self::f:Parameters", "source": "http://hl7.org/fhir/StructureDefinition/Element" }, { "key": "ext-1", "severity": "error", "human": "Must have either extensions or value[x], not both", "expression": "extension.exists() != value.exists()", "xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])", "source": "http://hl7.org/fhir/StructureDefinition/Extension" } ], "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "rim", "map": "N/A" } ] }, { "id": "ClaimResponse.addItem.modifierExtension", "path": "ClaimResponse.addItem.modifierExtension", "short": "Extensions that cannot be ignored even if unrecognized", "definition": "May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.\n\nModifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).", "comment": "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.", "requirements": "Modifier extensions allow for extensions that *cannot* be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the [definition of modifier extensions](extensibility.html#modifierExtension).", "alias": [ "extensions", "user content", "modifiers" ], "min": 0, "max": "*", "base": { "path": "BackboneElement.modifierExtension", "min": 0, "max": "*" }, "type": [ { "code": "Extension" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children unless an empty Parameters resource", "expression": "hasValue() or (children().count() > id.count()) or $this is Parameters", "xpath": "@value|f:*|h:div|self::f:Parameters", "source": "http://hl7.org/fhir/StructureDefinition/Element" }, { "key": "ext-1", "severity": "error", "human": "Must have either extensions or value[x], not both", "expression": "extension.exists() != value.exists()", "xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])", "source": "http://hl7.org/fhir/StructureDefinition/Extension" } ], "isModifier": true, "isModifierReason": "Modifier extensions are expected to modify the meaning or interpretation of the element that contains them", "isSummary": true, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "rim", "map": "N/A" } ] }, { "id": "ClaimResponse.addItem.itemSequence", "path": "ClaimResponse.addItem.itemSequence", "short": "Item sequence number", "definition": "Berisi data klaim item yang ingin diganti oleh saluran layanan ini dengan tipe data positiveInt.", "comment": "32 bit number; for values larger than this, use decimal", "requirements": "Provides references to the claim items.", "min": 0, "max": "*", "base": { "path": "ClaimResponse.addItem.itemSequence", "min": 0, "max": "*" }, "type": [ { "code": "positiveInt" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children unless an empty Parameters resource", "expression": "hasValue() or (children().count() > id.count()) or $this is Parameters", "xpath": "@value|f:*|h:div|self::f:Parameters", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "mustSupport": false, "isModifier": false, "isSummary": false, "mapping": [ { "identity": "rim", "map": "n/a" } ] }, { "id": "ClaimResponse.addItem.detailSequence", "path": "ClaimResponse.addItem.detailSequence", "short": "Detail sequence number", "definition": "Berisi data nomor urut detail dalam item klaim yang ingin diganti oleh baris ini dengan tipe data positiveInt.", "comment": "32 bit number; for values larger than this, use decimal", "requirements": "Provides references to the claim details within the claim item.", "min": 0, "max": "*", "base": { "path": "ClaimResponse.addItem.detailSequence", "min": 0, "max": "*" }, "type": [ { "code": "positiveInt" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children unless an empty Parameters resource", "expression": "hasValue() or (children().count() > id.count()) or $this is Parameters", "xpath": "@value|f:*|h:div|self::f:Parameters", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "mustSupport": false, "isModifier": false, "isSummary": false, "mapping": [ { "identity": "rim", "map": "n/a" } ] }, { "id": "ClaimResponse.addItem.subdetailSequence", "path": "ClaimResponse.addItem.subdetailSequence", "short": "Subdetail sequence number", "definition": "Berisi data nomor urut sub-detail dalam detail pada item klaim yang dimaksudkan untuk diganti oleh baris ini dengan tipe data positiveInt.", "comment": "32 bit number; for values larger than this, use decimal", "requirements": "Provides references to the claim sub-details within the claim detail.", "min": 0, "max": "*", "base": { "path": "ClaimResponse.addItem.subdetailSequence", "min": 0, "max": "*" }, "type": [ { "code": "positiveInt" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children unless an empty Parameters resource", "expression": "hasValue() or (children().count() > id.count()) or $this is Parameters", "xpath": "@value|f:*|h:div|self::f:Parameters", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "mustSupport": false, "isModifier": false, "isSummary": false, "mapping": [ { "identity": "rim", "map": "n/a" } ] }, { "id": "ClaimResponse.addItem.provider", "path": "ClaimResponse.addItem.provider", "short": "Authorized providers", "definition": "Berisi data penyedia yang berwenang untuk layanan yang diberikan kepada pasien. dengan tipe data Reference yang direferensikan ke data yang tersimpan di resource Practitioner | PractitionerRole | Organization.", "comment": "References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.", "requirements": "Insurer may provide authorization specifically to a restricted set of providers rather than an open authorization.", "min": 0, "max": "*", "base": { "path": "ClaimResponse.addItem.provider", "min": 0, "max": "*" }, "type": [ { "code": "Reference", "targetProfile": [ "http://hl7.org/fhir/StructureDefinition/Practitioner", "http://hl7.org/fhir/StructureDefinition/PractitionerRole", "http://hl7.org/fhir/StructureDefinition/Organization" ] } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children unless an empty Parameters resource", "expression": "hasValue() or (children().count() > id.count()) or $this is Parameters", "xpath": "@value|f:*|h:div|self::f:Parameters", "source": "http://hl7.org/fhir/StructureDefinition/Element" }, { "key": "ref-1", "severity": "error", "human": "SHALL have a contained resource if a local reference is provided", "expression": "reference.exists() implies (reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids')) or (reference='#' and %rootResource!=%resource))", "xpath": "not(starts-with(f:reference/@value, '#')) or exists(ancestor::*[self::f:entry or self::f:parameter]/f:resource/f:*/f:contained/f:*[f:id/@value=substring-after(current()/f:reference/@value, '#')]|/*/f:contained/f:*[f:id/@value=substring-after(current()/f:reference/@value, '#')])", "source": "http://hl7.org/fhir/StructureDefinition/Reference" } ], "mustSupport": false, "isModifier": false, "isSummary": false, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "rim", "map": "The target of a resource reference is a RIM entry point (Act, Role, or Entity)" }, { "identity": "w5", "map": "FiveWs.source" } ] }, { "id": "ClaimResponse.addItem.productOrService", "path": "ClaimResponse.addItem.productOrService", "short": "Billing, service, product, or drug code", "definition": "Berisi data jika nilainya adalah kode grup maka item ini mengumpulkan serangkaian detail klaim terkait dan jika tidak maka berisi produk, layanan, obat, atau kode tagihan lainnya untuk item tersebut dengan tipe data CodeableConcept.", "comment": "If this is an actual service or product line, i.e. not a Group, then use code to indicate the Professional Service or Product supplied (e.g. CTP, HCPCS, USCLS, ICD10, NCPDP, DIN, RxNorm, ACHI, CCI). If a grouping item then use a group code to indicate the type of thing being grouped e.g. 'glasses' or 'compound'.", "requirements": "Necessary to state what was provided or done.", "min": 1, "max": "1", "base": { "path": "ClaimResponse.addItem.productOrService", "min": 1, "max": "1" }, "type": [ { "code": "CodeableConcept" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children unless an empty Parameters resource", "expression": "hasValue() or (children().count() > id.count()) or $this is Parameters", "xpath": "@value|f:*|h:div|self::f:Parameters", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "mustSupport": false, "isModifier": false, "isSummary": false, "binding": { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString": "ServiceProduct" } ], "strength": "example", "description": "Allowable service and product codes.", "valueSet": "http://hl7.org/fhir/ValueSet/service-uscls" }, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "v2", "map": "CE/CNE/CWE" }, { "identity": "rim", "map": "CD" }, { "identity": "orim", "map": "fhir:CodeableConcept rdfs:subClassOf dt:CD" } ] }, { "id": "ClaimResponse.addItem.productOrService.id", "path": "ClaimResponse.addItem.productOrService.id", "representation": [ "xmlAttr" ], "short": "Unique id for inter-element referencing", "definition": "Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.", "min": 0, "max": "1", "base": { "path": "Element.id", "min": 0, "max": "1" }, "type": [ { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type", "valueUrl": "id" } ], "code": "http://hl7.org/fhirpath/System.String" } ], "mapping": [ { "identity": "rim", "map": "n/a" } ] }, { "id": "ClaimResponse.addItem.productOrService.extension", "path": "ClaimResponse.addItem.productOrService.extension", "slicing": { "discriminator": [ { "type": "value", "path": "url" } ], "description": "Extensions are always sliced by (at least) url", "rules": "open" }, "short": "Additional content defined by implementations", "definition": "May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.", "comment": "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.", "alias": [ "extensions", "user content" ], "min": 0, "max": "*", "base": { "path": "Element.extension", "min": 0, "max": "*" }, "type": [ { "code": "Extension" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children unless an empty Parameters resource", "expression": "hasValue() or (children().count() > id.count()) or $this is Parameters", "xpath": "@value|f:*|h:div|self::f:Parameters", "source": "http://hl7.org/fhir/StructureDefinition/Element" }, { "key": "ext-1", "severity": "error", "human": "Must have either extensions or value[x], not both", "expression": "extension.exists() != value.exists()", "xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])", "source": "http://hl7.org/fhir/StructureDefinition/Extension" } ], "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "rim", "map": "N/A" } ] }, { "id": "ClaimResponse.addItem.productOrService.coding", "path": "ClaimResponse.addItem.productOrService.coding", "short": "Code defined by a terminology system", "definition": "Berisi data jika nilainya adalah kode grup maka item ini mengumpulkan serangkaian detail klaim terkait dan jika tidak maka berisi produk, layanan, obat, atau kode tagihan lainnya untuk item tersebut dengan tipe data Coding yang nilainya dapat mengacu pada contoh data terminologi USCLS Codes.", "comment": "Codes may be defined very casually in enumerations, or code lists, up to very formal definitions such as SNOMED CT - see the HL7 v3 Core Principles for more information. Ordering of codings is undefined and SHALL NOT be used to infer meaning. Generally, at most only one of the coding values will be labeled as UserSelected = true.", "requirements": "Allows for alternative encodings within a code system, and translations to other code systems.", "min": 0, "max": "*", "base": { "path": "CodeableConcept.coding", "min": 0, "max": "*" }, "type": [ { "code": "Coding" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children unless an empty Parameters resource", "expression": "hasValue() or (children().count() > id.count()) or $this is Parameters", "xpath": "@value|f:*|h:div|self::f:Parameters", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "isSummary": true, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "v2", "map": "CE/CNE/CWE subset one of the sets of component 1-3 or 4-6" }, { "identity": "rim", "map": "CV" }, { "identity": "orim", "map": "fhir:Coding rdfs:subClassOf dt:CDCoding" }, { "identity": "v2", "map": "C*E.1-8, C*E.10-22" }, { "identity": "rim", "map": "union(., ./translation)" }, { "identity": "orim", "map": "fhir:CodeableConcept.coding rdfs:subPropertyOf dt:CD.coding" } ] }, { "id": "ClaimResponse.addItem.productOrService.text", "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-translatable", "valueBoolean": true }, { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-translatable", "valueBoolean": true } ], "path": "ClaimResponse.addItem.productOrService.text", "short": "Plain text representation of the concept", "definition": "A human language representation of the concept as seen/selected/uttered by the user who entered the data and/or which represents the intended meaning of the user.", "comment": "Very often the text is the same as a displayName of one of the codings.", "requirements": "The codes from the terminologies do not always capture the correct meaning with all the nuances of the human using them, or sometimes there is no appropriate code at all. In these cases, the text is used to capture the full meaning of the source.", "min": 0, "max": "1", "base": { "path": "CodeableConcept.text", "min": 0, "max": "1" }, "type": [ { "code": "string" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children unless an empty Parameters resource", "expression": "hasValue() or (children().count() > id.count()) or $this is Parameters", "xpath": "@value|f:*|h:div|self::f:Parameters", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "isSummary": true, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "v2", "map": "C*E.9. But note many systems use C*E.2 for this" }, { "identity": "rim", "map": "./originalText[mediaType/code=\"text/plain\"]/data" }, { "identity": "orim", "map": "fhir:CodeableConcept.text rdfs:subPropertyOf dt:CD.originalText" } ] }, { "id": "ClaimResponse.addItem.modifier", "path": "ClaimResponse.addItem.modifier", "short": "Service/Product billing modifiers", "definition": "Berisi data kode tipifikasi atau pengubah item untuk menyampaikan konteks tambahan untuk produk atau layanan dengan tipe data CodeableConcept.", "comment": "For example in Oral whether the treatment is cosmetic or associated with TMJ, or for Medical whether the treatment was outside the clinic or outside of office hours.", "requirements": "To support inclusion of the item for adjudication or to charge an elevated fee.", "min": 0, "max": "*", "base": { "path": "ClaimResponse.addItem.modifier", "min": 0, "max": "*" }, "type": [ { "code": "CodeableConcept" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children unless an empty Parameters resource", "expression": "hasValue() or (children().count() > id.count()) or $this is Parameters", "xpath": "@value|f:*|h:div|self::f:Parameters", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "mustSupport": false, "isModifier": false, "isSummary": false, "binding": { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString": "Modifiers" } ], "strength": "example", "description": "Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen.", "valueSet": "http://hl7.org/fhir/ValueSet/claim-modifiers" }, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "v2", "map": "CE/CNE/CWE" }, { "identity": "rim", "map": "CD" }, { "identity": "orim", "map": "fhir:CodeableConcept rdfs:subClassOf dt:CD" }, { "identity": "rim", "map": "24.C, 24.D mods" } ] }, { "id": "ClaimResponse.addItem.modifier.id", "path": "ClaimResponse.addItem.modifier.id", "representation": [ "xmlAttr" ], "short": "Unique id for inter-element referencing", "definition": "Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.", "min": 0, "max": "1", "base": { "path": "Element.id", "min": 0, "max": "1" }, "type": [ { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type", "valueUrl": "id" } ], "code": "http://hl7.org/fhirpath/System.String" } ], "mapping": [ { "identity": "rim", "map": "n/a" } ] }, { "id": "ClaimResponse.addItem.modifier.extension", "path": "ClaimResponse.addItem.modifier.extension", "slicing": { "discriminator": [ { "type": "value", "path": "url" } ], "description": "Extensions are always sliced by (at least) url", "rules": "open" }, "short": "Additional content defined by implementations", "definition": "May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.", "comment": "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.", "alias": [ "extensions", "user content" ], "min": 0, "max": "*", "base": { "path": "Element.extension", "min": 0, "max": "*" }, "type": [ { "code": "Extension" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children unless an empty Parameters resource", "expression": "hasValue() or (children().count() > id.count()) or $this is Parameters", "xpath": "@value|f:*|h:div|self::f:Parameters", "source": "http://hl7.org/fhir/StructureDefinition/Element" }, { "key": "ext-1", "severity": "error", "human": "Must have either extensions or value[x], not both", "expression": "extension.exists() != value.exists()", "xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])", "source": "http://hl7.org/fhir/StructureDefinition/Extension" } ], "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "rim", "map": "N/A" } ] }, { "id": "ClaimResponse.addItem.modifier.coding", "path": "ClaimResponse.addItem.modifier.coding", "short": "Code defined by a terminology system", "definition": "Berisi data kode tipifikasi atau pengubah item untuk menyampaikan konteks tambahan untuk produk atau layanan dengan tipe data Coding yang nilainya dapat mengacu pada contoh data terminologi Modifier types Codes.", "comment": "Codes may be defined very casually in enumerations, or code lists, up to very formal definitions such as SNOMED CT - see the HL7 v3 Core Principles for more information. Ordering of codings is undefined and SHALL NOT be used to infer meaning. Generally, at most only one of the coding values will be labeled as UserSelected = true.", "requirements": "Allows for alternative encodings within a code system, and translations to other code systems.", "min": 0, "max": "*", "base": { "path": "CodeableConcept.coding", "min": 0, "max": "*" }, "type": [ { "code": "Coding" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children unless an empty Parameters resource", "expression": "hasValue() or (children().count() > id.count()) or $this is Parameters", "xpath": "@value|f:*|h:div|self::f:Parameters", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "isSummary": true, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "v2", "map": "CE/CNE/CWE subset one of the sets of component 1-3 or 4-6" }, { "identity": "rim", "map": "CV" }, { "identity": "orim", "map": "fhir:Coding rdfs:subClassOf dt:CDCoding" }, { "identity": "v2", "map": "C*E.1-8, C*E.10-22" }, { "identity": "rim", "map": "union(., ./translation)" }, { "identity": "orim", "map": "fhir:CodeableConcept.coding rdfs:subPropertyOf dt:CD.coding" } ] }, { "id": "ClaimResponse.addItem.modifier.text", "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-translatable", "valueBoolean": true }, { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-translatable", "valueBoolean": true } ], "path": "ClaimResponse.addItem.modifier.text", "short": "Plain text representation of the concept", "definition": "A human language representation of the concept as seen/selected/uttered by the user who entered the data and/or which represents the intended meaning of the user.", "comment": "Very often the text is the same as a displayName of one of the codings.", "requirements": "The codes from the terminologies do not always capture the correct meaning with all the nuances of the human using them, or sometimes there is no appropriate code at all. In these cases, the text is used to capture the full meaning of the source.", "min": 0, "max": "1", "base": { "path": "CodeableConcept.text", "min": 0, "max": "1" }, "type": [ { "code": "string" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children unless an empty Parameters resource", "expression": "hasValue() or (children().count() > id.count()) or $this is Parameters", "xpath": "@value|f:*|h:div|self::f:Parameters", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "isSummary": true, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "v2", "map": "C*E.9. But note many systems use C*E.2 for this" }, { "identity": "rim", "map": "./originalText[mediaType/code=\"text/plain\"]/data" }, { "identity": "orim", "map": "fhir:CodeableConcept.text rdfs:subPropertyOf dt:CD.originalText" } ] }, { "id": "ClaimResponse.addItem.programCode", "path": "ClaimResponse.addItem.programCode", "short": "Program the product or service is provided under", "definition": "Berisi data untuk mengidentifikasi program yang memungkinkan pemulihan dengan tipe data CodeableConcept.", "comment": "For example: Neonatal program, child dental program or drug users recovery program.", "requirements": "Commonly used in in the identification of publicly provided program focused on population segments or disease classifications.", "min": 0, "max": "*", "base": { "path": "ClaimResponse.addItem.programCode", "min": 0, "max": "*" }, "type": [ { "code": "CodeableConcept" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children unless an empty Parameters resource", "expression": "hasValue() or (children().count() > id.count()) or $this is Parameters", "xpath": "@value|f:*|h:div|self::f:Parameters", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "mustSupport": false, "isModifier": false, "isSummary": false, "binding": { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString": "ProgramCode" } ], "strength": "example", "description": "Program specific reason codes.", "valueSet": "http://hl7.org/fhir/ValueSet/ex-program-code" }, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "v2", "map": "CE/CNE/CWE" }, { "identity": "rim", "map": "CD" }, { "identity": "orim", "map": "fhir:CodeableConcept rdfs:subClassOf dt:CD" }, { "identity": "rim", "map": "24.H" } ] }, { "id": "ClaimResponse.addItem.programCode.id", "path": "ClaimResponse.addItem.programCode.id", "representation": [ "xmlAttr" ], "short": "Unique id for inter-element referencing", "definition": "Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.", "min": 0, "max": "1", "base": { "path": "Element.id", "min": 0, "max": "1" }, "type": [ { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type", "valueUrl": "id" } ], "code": "http://hl7.org/fhirpath/System.String" } ], "mapping": [ { "identity": "rim", "map": "n/a" } ] }, { "id": "ClaimResponse.addItem.programCode.extension", "path": "ClaimResponse.addItem.programCode.extension", "slicing": { "discriminator": [ { "type": "value", "path": "url" } ], "description": "Extensions are always sliced by (at least) url", "rules": "open" }, "short": "Additional content defined by implementations", "definition": "May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.", "comment": "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.", "alias": [ "extensions", "user content" ], "min": 0, "max": "*", "base": { "path": "Element.extension", "min": 0, "max": "*" }, "type": [ { "code": "Extension" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children unless an empty Parameters resource", "expression": "hasValue() or (children().count() > id.count()) or $this is Parameters", "xpath": "@value|f:*|h:div|self::f:Parameters", "source": "http://hl7.org/fhir/StructureDefinition/Element" }, { "key": "ext-1", "severity": "error", "human": "Must have either extensions or value[x], not both", "expression": "extension.exists() != value.exists()", "xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])", "source": "http://hl7.org/fhir/StructureDefinition/Extension" } ], "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "rim", "map": "N/A" } ] }, { "id": "ClaimResponse.addItem.programCode.coding", "path": "ClaimResponse.addItem.programCode.coding", "short": "Code defined by a terminology system", "definition": "Berisi data untuk mengidentifikasi program yang memungkinkan pemulihan dengan tipe data Coding yang nilainya dapat mengacu pada contoh data terminologi Example Program Reason Codes.", "comment": "Codes may be defined very casually in enumerations, or code lists, up to very formal definitions such as SNOMED CT - see the HL7 v3 Core Principles for more information. Ordering of codings is undefined and SHALL NOT be used to infer meaning. Generally, at most only one of the coding values will be labeled as UserSelected = true.", "requirements": "Allows for alternative encodings within a code system, and translations to other code systems.", "min": 0, "max": "*", "base": { "path": "CodeableConcept.coding", "min": 0, "max": "*" }, "type": [ { "code": "Coding" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children unless an empty Parameters resource", "expression": "hasValue() or (children().count() > id.count()) or $this is Parameters", "xpath": "@value|f:*|h:div|self::f:Parameters", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "isSummary": true, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "v2", "map": "CE/CNE/CWE subset one of the sets of component 1-3 or 4-6" }, { "identity": "rim", "map": "CV" }, { "identity": "orim", "map": "fhir:Coding rdfs:subClassOf dt:CDCoding" }, { "identity": "v2", "map": "C*E.1-8, C*E.10-22" }, { "identity": "rim", "map": "union(., ./translation)" }, { "identity": "orim", "map": "fhir:CodeableConcept.coding rdfs:subPropertyOf dt:CD.coding" } ] }, { "id": "ClaimResponse.addItem.programCode.text", "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-translatable", "valueBoolean": true }, { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-translatable", "valueBoolean": true } ], "path": "ClaimResponse.addItem.programCode.text", "short": "Plain text representation of the concept", "definition": "A human language representation of the concept as seen/selected/uttered by the user who entered the data and/or which represents the intended meaning of the user.", "comment": "Very often the text is the same as a displayName of one of the codings.", "requirements": "The codes from the terminologies do not always capture the correct meaning with all the nuances of the human using them, or sometimes there is no appropriate code at all. In these cases, the text is used to capture the full meaning of the source.", "min": 0, "max": "1", "base": { "path": "CodeableConcept.text", "min": 0, "max": "1" }, "type": [ { "code": "string" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children unless an empty Parameters resource", "expression": "hasValue() or (children().count() > id.count()) or $this is Parameters", "xpath": "@value|f:*|h:div|self::f:Parameters", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "isSummary": true, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "v2", "map": "C*E.9. But note many systems use C*E.2 for this" }, { "identity": "rim", "map": "./originalText[mediaType/code=\"text/plain\"]/data" }, { "identity": "orim", "map": "fhir:CodeableConcept.text rdfs:subPropertyOf dt:CD.originalText" } ] }, { "id": "ClaimResponse.addItem.serviced[x]", "path": "ClaimResponse.addItem.serviced[x]", "short": "Date or dates of service or product delivery", "definition": "Berisi data tanggal atau tanggal ketika layanan atau produk dipasok, dilaksanakan, atau diselesaikan.", "requirements": "Needed to determine whether the service or product was provided during the term of the insurance coverage.", "min": 0, "max": "1", "base": { "path": "ClaimResponse.addItem.serviced[x]", "min": 0, "max": "1" }, "type": [ { "code": "date" }, { "code": "Period" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children unless an empty Parameters resource", "expression": "hasValue() or (children().count() > id.count()) or $this is Parameters", "xpath": "@value|f:*|h:div|self::f:Parameters", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "mustSupport": false, "isModifier": false, "isSummary": false, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "w5", "map": "FiveWs.done[x]" }, { "identity": "rim", "map": "24.A" } ] }, { "id": "ClaimResponse.addItem.location[x]", "path": "ClaimResponse.addItem.location[x]", "short": "Place of service or where product was supplied", "definition": "Berisi data lokasi produk atau layanan disediakan.", "requirements": "The location can alter whether the item was acceptable for insurance purposes or impact the determination of the benefit amount.", "min": 0, "max": "1", "base": { "path": "ClaimResponse.addItem.location[x]", "min": 0, "max": "1" }, "type": [ { "code": "CodeableConcept" }, { "code": "Address" }, { "code": "Reference", "targetProfile": [ "http://hl7.org/fhir/StructureDefinition/Location" ] } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children unless an empty Parameters resource", "expression": "hasValue() or (children().count() > id.count()) or $this is Parameters", "xpath": "@value|f:*|h:div|self::f:Parameters", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "mustSupport": false, "isModifier": false, "isSummary": false, "binding": { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString": "ServicePlace" } ], "strength": "example", "description": "Place of service: pharmacy, school, prison, etc.", "valueSet": "http://hl7.org/fhir/ValueSet/service-place" }, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "w5", "map": "FiveWs.where[x]" }, { "identity": "rim", "map": "24.B" } ] }, { "id": "ClaimResponse.addItem.quantity", "path": "ClaimResponse.addItem.quantity", "short": "Count of products or services", "definition": "Berisi data jumlah pengulangan layanan atau produk dengan tipe data SimpleQuantity.", "comment": "The context of use may frequently define what kind of quantity this is and therefore what kind of units can be used. The context of use may also restrict the values for the comparator.", "requirements": "Required when the product or service code does not convey the quantity provided.", "min": 0, "max": "1", "base": { "path": "ClaimResponse.addItem.quantity", "min": 0, "max": "1" }, "type": [ { "code": "Quantity", "profile": [ "http://hl7.org/fhir/StructureDefinition/SimpleQuantity" ] } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children unless an empty Parameters resource", "expression": "hasValue() or (children().count() > id.count()) or $this is Parameters", "xpath": "@value|f:*|h:div|self::f:Parameters", "source": "http://hl7.org/fhir/StructureDefinition/Element" }, { "key": "qty-3", "severity": "error", "human": "If a code for the unit is present, the system SHALL also be present", "expression": "code.empty() or system.exists()", "xpath": "not(exists(f:code)) or exists(f:system)", "source": "http://hl7.org/fhir/StructureDefinition/Quantity" }, { "key": "sqty-1", "severity": "error", "human": "The comparator is not used on a SimpleQuantity", "expression": "comparator.empty()", "xpath": "not(exists(f:comparator))", "source": "http://hl7.org/fhir/StructureDefinition/SimpleQuantity" } ], "mustSupport": false, "isModifier": false, "isSummary": false, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "v2", "map": "SN (see also Range) or CQ" }, { "identity": "rim", "map": "PQ, IVL, MO, CO, depending on the values" }, { "identity": "rim", "map": "24.G" } ] }, { "id": "ClaimResponse.addItem.unitPrice", "path": "ClaimResponse.addItem.unitPrice", "short": "Fee, charge or cost per item", "definition": "Berisi data jika item tersebut bukan grup maka ini adalah biaya untuk produk atau layanan, jika tidak, ini adalah total biaya untuk perincian grup dengan tipe data Money.", "requirements": "The amount charged to the patient by the provider for a single unit.", "min": 0, "max": "1", "base": { "path": "ClaimResponse.addItem.unitPrice", "min": 0, "max": "1" }, "type": [ { "code": "Money" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children unless an empty Parameters resource", "expression": "hasValue() or (children().count() > id.count()) or $this is Parameters", "xpath": "@value|f:*|h:div|self::f:Parameters", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "mustSupport": false, "isModifier": false, "isSummary": false, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "rim", "map": "MO" } ] }, { "id": "ClaimResponse.addItem.factor", "path": "ClaimResponse.addItem.factor", "short": "Price scaling factor", "definition": "Berisi data bilangan real yang mewakili pengali yang digunakan dalam menentukan nilai keseluruhan dari layanan yang diberikan dan/atau barang yang diterima. Konsep Faktor memungkinkan pengganda diskon atau biaya tambahan untuk diterapkan pada jumlah uang dengan tipe data decimal.", "comment": "To show a 10% senior's discount, the value entered is: 0.90 (1.00 - 0.10).", "requirements": "When discounts are provided to a patient (example: Senior's discount) then this must be documented for adjudication.", "min": 0, "max": "1", "base": { "path": "ClaimResponse.addItem.factor", "min": 0, "max": "1" }, "type": [ { "code": "decimal" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children unless an empty Parameters resource", "expression": "hasValue() or (children().count() > id.count()) or $this is Parameters", "xpath": "@value|f:*|h:div|self::f:Parameters", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "mustSupport": false, "isModifier": false, "isSummary": false, "mapping": [ { "identity": "rim", "map": "n/a" } ] }, { "id": "ClaimResponse.addItem.net", "path": "ClaimResponse.addItem.net", "short": "Total item cost", "definition": "Berisi data kuantitas dikalikan harga satuan untuk layanan atau produk atau biaya tambahan dengan tipe data Money.", "comment": "For example, the formula: quantity * unitPrice * factor = net. Quantity and factor are assumed to be 1 if not supplied.", "requirements": "Provides the total amount claimed for the group (if a grouper) or the line item.", "min": 0, "max": "1", "base": { "path": "ClaimResponse.addItem.net", "min": 0, "max": "1" }, "type": [ { "code": "Money" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children unless an empty Parameters resource", "expression": "hasValue() or (children().count() > id.count()) or $this is Parameters", "xpath": "@value|f:*|h:div|self::f:Parameters", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "mustSupport": false, "isModifier": false, "isSummary": false, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "rim", "map": "MO" }, { "identity": "rim", "map": "24.F" } ] }, { "id": "ClaimResponse.addItem.bodySite", "path": "ClaimResponse.addItem.bodySite", "short": "Anatomical location", "definition": "Berisi data lokasi pelayanan fisik pada pasien (tungkai, gigi, dan lainnya) dengan tipe data CodeableConcept.", "comment": "For example: Providing a tooth code allows an insurer to identify a provider performing a filling on a tooth that was previously removed.", "requirements": "Allows insurer to validate specific procedures.", "min": 0, "max": "1", "base": { "path": "ClaimResponse.addItem.bodySite", "min": 0, "max": "1" }, "type": [ { "code": "CodeableConcept" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children unless an empty Parameters resource", "expression": "hasValue() or (children().count() > id.count()) or $this is Parameters", "xpath": "@value|f:*|h:div|self::f:Parameters", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "mustSupport": false, "isModifier": false, "isSummary": false, "binding": { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString": "OralSites" } ], "strength": "example", "description": "The code for the teeth, quadrant, sextant and arch.", "valueSet": "http://hl7.org/fhir/ValueSet/tooth" }, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "v2", "map": "CE/CNE/CWE" }, { "identity": "rim", "map": "CD" }, { "identity": "orim", "map": "fhir:CodeableConcept rdfs:subClassOf dt:CD" } ] }, { "id": "ClaimResponse.addItem.bodySite.id", "path": "ClaimResponse.addItem.bodySite.id", "representation": [ "xmlAttr" ], "short": "Unique id for inter-element referencing", "definition": "Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.", "min": 0, "max": "1", "base": { "path": "Element.id", "min": 0, "max": "1" }, "type": [ { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type", "valueUrl": "id" } ], "code": "http://hl7.org/fhirpath/System.String" } ], "mapping": [ { "identity": "rim", "map": "n/a" } ] }, { "id": "ClaimResponse.addItem.bodySite.extension", "path": "ClaimResponse.addItem.bodySite.extension", "slicing": { "discriminator": [ { "type": "value", "path": "url" } ], "description": "Extensions are always sliced by (at least) url", "rules": "open" }, "short": "Additional content defined by implementations", "definition": "May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.", "comment": "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.", "alias": [ "extensions", "user content" ], "min": 0, "max": "*", "base": { "path": "Element.extension", "min": 0, "max": "*" }, "type": [ { "code": "Extension" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children unless an empty Parameters resource", "expression": "hasValue() or (children().count() > id.count()) or $this is Parameters", "xpath": "@value|f:*|h:div|self::f:Parameters", "source": "http://hl7.org/fhir/StructureDefinition/Element" }, { "key": "ext-1", "severity": "error", "human": "Must have either extensions or value[x], not both", "expression": "extension.exists() != value.exists()", "xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])", "source": "http://hl7.org/fhir/StructureDefinition/Extension" } ], "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "rim", "map": "N/A" } ] }, { "id": "ClaimResponse.addItem.bodySite.coding", "path": "ClaimResponse.addItem.bodySite.coding", "short": "Code defined by a terminology system", "definition": "Berisi data lokasi pelayanan fisik pada pasien (tungkai, gigi, dan lainnya) dengan tipe data Coding yang nilainya dapat mengacu pada contoh data terminologi Oral Site Codes.", "comment": "Codes may be defined very casually in enumerations, or code lists, up to very formal definitions such as SNOMED CT - see the HL7 v3 Core Principles for more information. Ordering of codings is undefined and SHALL NOT be used to infer meaning. Generally, at most only one of the coding values will be labeled as UserSelected = true.", "requirements": "Allows for alternative encodings within a code system, and translations to other code systems.", "min": 0, "max": "*", "base": { "path": "CodeableConcept.coding", "min": 0, "max": "*" }, "type": [ { "code": "Coding" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children unless an empty Parameters resource", "expression": "hasValue() or (children().count() > id.count()) or $this is Parameters", "xpath": "@value|f:*|h:div|self::f:Parameters", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "isSummary": true, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "v2", "map": "CE/CNE/CWE subset one of the sets of component 1-3 or 4-6" }, { "identity": "rim", "map": "CV" }, { "identity": "orim", "map": "fhir:Coding rdfs:subClassOf dt:CDCoding" }, { "identity": "v2", "map": "C*E.1-8, C*E.10-22" }, { "identity": "rim", "map": "union(., ./translation)" }, { "identity": "orim", "map": "fhir:CodeableConcept.coding rdfs:subPropertyOf dt:CD.coding" } ] }, { "id": "ClaimResponse.addItem.bodySite.text", "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-translatable", "valueBoolean": true }, { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-translatable", "valueBoolean": true } ], "path": "ClaimResponse.addItem.bodySite.text", "short": "Plain text representation of the concept", "definition": "A human language representation of the concept as seen/selected/uttered by the user who entered the data and/or which represents the intended meaning of the user.", "comment": "Very often the text is the same as a displayName of one of the codings.", "requirements": "The codes from the terminologies do not always capture the correct meaning with all the nuances of the human using them, or sometimes there is no appropriate code at all. In these cases, the text is used to capture the full meaning of the source.", "min": 0, "max": "1", "base": { "path": "CodeableConcept.text", "min": 0, "max": "1" }, "type": [ { "code": "string" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children unless an empty Parameters resource", "expression": "hasValue() or (children().count() > id.count()) or $this is Parameters", "xpath": "@value|f:*|h:div|self::f:Parameters", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "isSummary": true, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "v2", "map": "C*E.9. But note many systems use C*E.2 for this" }, { "identity": "rim", "map": "./originalText[mediaType/code=\"text/plain\"]/data" }, { "identity": "orim", "map": "fhir:CodeableConcept.text rdfs:subPropertyOf dt:CD.originalText" } ] }, { "id": "ClaimResponse.addItem.subSite", "path": "ClaimResponse.addItem.subSite", "short": "Anatomical sub-location", "definition": "Berisi data wilayah atau permukaan bodySite, seperti daerah anggota gerak atau permukaan gigi dengan tipe data CodeableConcept.", "comment": "Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination.", "requirements": "Allows insurer to validate specific procedures.", "min": 0, "max": "*", "base": { "path": "ClaimResponse.addItem.subSite", "min": 0, "max": "*" }, "type": [ { "code": "CodeableConcept" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children unless an empty Parameters resource", "expression": "hasValue() or (children().count() > id.count()) or $this is Parameters", "xpath": "@value|f:*|h:div|self::f:Parameters", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "mustSupport": false, "isModifier": false, "isSummary": false, "binding": { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString": "Surface" } ], "strength": "example", "description": "The code for the tooth surface and surface combinations.", "valueSet": "http://hl7.org/fhir/ValueSet/surface" }, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "v2", "map": "CE/CNE/CWE" }, { "identity": "rim", "map": "CD" }, { "identity": "orim", "map": "fhir:CodeableConcept rdfs:subClassOf dt:CD" } ] }, { "id": "ClaimResponse.addItem.subSite.id", "path": "ClaimResponse.addItem.subSite.id", "representation": [ "xmlAttr" ], "short": "Unique id for inter-element referencing", "definition": "Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.", "min": 0, "max": "1", "base": { "path": "Element.id", "min": 0, "max": "1" }, "type": [ { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type", "valueUrl": "id" } ], "code": "http://hl7.org/fhirpath/System.String" } ], "mapping": [ { "identity": "rim", "map": "n/a" } ] }, { "id": "ClaimResponse.addItem.subSite.extension", "path": "ClaimResponse.addItem.subSite.extension", "slicing": { "discriminator": [ { "type": "value", "path": "url" } ], "description": "Extensions are always sliced by (at least) url", "rules": "open" }, "short": "Additional content defined by implementations", "definition": "May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.", "comment": "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.", "alias": [ "extensions", "user content" ], "min": 0, "max": "*", "base": { "path": "Element.extension", "min": 0, "max": "*" }, "type": [ { "code": "Extension" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children unless an empty Parameters resource", "expression": "hasValue() or (children().count() > id.count()) or $this is Parameters", "xpath": "@value|f:*|h:div|self::f:Parameters", "source": "http://hl7.org/fhir/StructureDefinition/Element" }, { "key": "ext-1", "severity": "error", "human": "Must have either extensions or value[x], not both", "expression": "extension.exists() != value.exists()", "xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])", "source": "http://hl7.org/fhir/StructureDefinition/Extension" } ], "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "rim", "map": "N/A" } ] }, { "id": "ClaimResponse.addItem.subSite.coding", "path": "ClaimResponse.addItem.subSite.coding", "short": "Code defined by a terminology system", "definition": "Berisi data wilayah atau permukaan bodySite, seperti daerah anggota gerak atau permukaan gigi dengan tipe data Coding yang nilainya dapat mengacu pada contoh data terminologi Surface Codes.", "comment": "Codes may be defined very casually in enumerations, or code lists, up to very formal definitions such as SNOMED CT - see the HL7 v3 Core Principles for more information. Ordering of codings is undefined and SHALL NOT be used to infer meaning. Generally, at most only one of the coding values will be labeled as UserSelected = true.", "requirements": "Allows for alternative encodings within a code system, and translations to other code systems.", "min": 0, "max": "*", "base": { "path": "CodeableConcept.coding", "min": 0, "max": "*" }, "type": [ { "code": "Coding" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children unless an empty Parameters resource", "expression": "hasValue() or (children().count() > id.count()) or $this is Parameters", "xpath": "@value|f:*|h:div|self::f:Parameters", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "isSummary": true, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "v2", "map": "CE/CNE/CWE subset one of the sets of component 1-3 or 4-6" }, { "identity": "rim", "map": "CV" }, { "identity": "orim", "map": "fhir:Coding rdfs:subClassOf dt:CDCoding" }, { "identity": "v2", "map": "C*E.1-8, C*E.10-22" }, { "identity": "rim", "map": "union(., ./translation)" }, { "identity": "orim", "map": "fhir:CodeableConcept.coding rdfs:subPropertyOf dt:CD.coding" } ] }, { "id": "ClaimResponse.addItem.subSite.text", "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-translatable", "valueBoolean": true }, { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-translatable", "valueBoolean": true } ], "path": "ClaimResponse.addItem.subSite.text", "short": "Plain text representation of the concept", "definition": "A human language representation of the concept as seen/selected/uttered by the user who entered the data and/or which represents the intended meaning of the user.", "comment": "Very often the text is the same as a displayName of one of the codings.", "requirements": "The codes from the terminologies do not always capture the correct meaning with all the nuances of the human using them, or sometimes there is no appropriate code at all. In these cases, the text is used to capture the full meaning of the source.", "min": 0, "max": "1", "base": { "path": "CodeableConcept.text", "min": 0, "max": "1" }, "type": [ { "code": "string" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children unless an empty Parameters resource", "expression": "hasValue() or (children().count() > id.count()) or $this is Parameters", "xpath": "@value|f:*|h:div|self::f:Parameters", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "isSummary": true, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "v2", "map": "C*E.9. But note many systems use C*E.2 for this" }, { "identity": "rim", "map": "./originalText[mediaType/code=\"text/plain\"]/data" }, { "identity": "orim", "map": "fhir:CodeableConcept.text rdfs:subPropertyOf dt:CD.originalText" } ] }, { "id": "ClaimResponse.addItem.noteNumber", "path": "ClaimResponse.addItem.noteNumber", "short": "Applicable note numbers", "definition": "Berisi data angka-angka yang terkait dengan catatan yang ada di bawah yang berlaku untuk penilaian item dengan tipe data positiveInt.", "comment": "32 bit number; for values larger than this, use decimal", "requirements": "Provides a condensed manner for associating human readable descriptive explanations for adjudications on the line item.", "min": 0, "max": "*", "base": { "path": "ClaimResponse.addItem.noteNumber", "min": 0, "max": "*" }, "type": [ { "code": "positiveInt" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children unless an empty Parameters resource", "expression": "hasValue() or (children().count() > id.count()) or $this is Parameters", "xpath": "@value|f:*|h:div|self::f:Parameters", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "mustSupport": false, "isModifier": false, "isSummary": false, "mapping": [ { "identity": "rim", "map": "n/a" } ] }, { "id": "ClaimResponse.addItem.adjudication", "path": "ClaimResponse.addItem.adjudication", "short": "Added items adjudication", "definition": "Berisi data hasil keputusan dengan tipe data yang mengacu pada ClaimResponse.item.adjudication.", "min": 1, "max": "*", "base": { "path": "ClaimResponse.addItem.adjudication", "min": 1, "max": "*" }, "contentReference": "http://hl7.org/fhir/StructureDefinition/ClaimResponse#ClaimResponse.item.adjudication", "mustSupport": false, "isModifier": false, "isSummary": false }, { "id": "ClaimResponse.addItem.detail", "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-explicit-type-name", "valueString": "AddedItemDetail" } ], "path": "ClaimResponse.addItem.detail", "short": "Insurer added line details", "definition": "Berisi data keputusan layanan tingkat kedua untuk pembayar menambahkan layanan dengan tipe data BackboneElement.", "min": 0, "max": "*", "base": { "path": "ClaimResponse.addItem.detail", "min": 0, "max": "*" }, "type": [ { "code": "BackboneElement" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children unless an empty Parameters resource", "expression": "hasValue() or (children().count() > id.count()) or $this is Parameters", "xpath": "@value|f:*|h:div|self::f:Parameters", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "mustSupport": false, "isModifier": false, "isSummary": false, "mapping": [ { "identity": "rim", "map": "n/a" } ] }, { "id": "ClaimResponse.addItem.detail.id", "path": "ClaimResponse.addItem.detail.id", "representation": [ "xmlAttr" ], "short": "Unique id for inter-element referencing", "definition": "Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.", "min": 0, "max": "1", "base": { "path": "Element.id", "min": 0, "max": "1" }, "type": [ { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type", "valueUrl": "id" } ], "code": "http://hl7.org/fhirpath/System.String" } ], "mapping": [ { "identity": "rim", "map": "n/a" } ] }, { "id": "ClaimResponse.addItem.detail.extension", "path": "ClaimResponse.addItem.detail.extension", "slicing": { "discriminator": [ { "type": "value", "path": "url" } ], "description": "Extensions are always sliced by (at least) url", "rules": "open" }, "short": "Additional content defined by implementations", "definition": "May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.", "comment": "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.", "alias": [ "extensions", "user content" ], "min": 0, "max": "*", "base": { "path": "Element.extension", "min": 0, "max": "*" }, "type": [ { "code": "Extension" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children unless an empty Parameters resource", "expression": "hasValue() or (children().count() > id.count()) or $this is Parameters", "xpath": "@value|f:*|h:div|self::f:Parameters", "source": "http://hl7.org/fhir/StructureDefinition/Element" }, { "key": "ext-1", "severity": "error", "human": "Must have either extensions or value[x], not both", "expression": "extension.exists() != value.exists()", "xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])", "source": "http://hl7.org/fhir/StructureDefinition/Extension" } ], "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "rim", "map": "N/A" } ] }, { "id": "ClaimResponse.addItem.detail.modifierExtension", "path": "ClaimResponse.addItem.detail.modifierExtension", "short": "Extensions that cannot be ignored even if unrecognized", "definition": "May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.\n\nModifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).", "comment": "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.", "requirements": "Modifier extensions allow for extensions that *cannot* be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the [definition of modifier extensions](extensibility.html#modifierExtension).", "alias": [ "extensions", "user content", "modifiers" ], "min": 0, "max": "*", "base": { "path": "BackboneElement.modifierExtension", "min": 0, "max": "*" }, "type": [ { "code": "Extension" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children unless an empty Parameters resource", "expression": "hasValue() or (children().count() > id.count()) or $this is Parameters", "xpath": "@value|f:*|h:div|self::f:Parameters", "source": "http://hl7.org/fhir/StructureDefinition/Element" }, { "key": "ext-1", "severity": "error", "human": "Must have either extensions or value[x], not both", "expression": "extension.exists() != value.exists()", "xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])", "source": "http://hl7.org/fhir/StructureDefinition/Extension" } ], "isModifier": true, "isModifierReason": "Modifier extensions are expected to modify the meaning or interpretation of the element that contains them", "isSummary": true, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "rim", "map": "N/A" } ] }, { "id": "ClaimResponse.addItem.detail.productOrService", "path": "ClaimResponse.addItem.detail.productOrService", "short": "Billing, service, product, or drug code", "definition": "Berisi data jika nilainya adalah kode grup maka item ini mengumpulkan serangkaian detail klaim terkait dan jika tidak maka berisi produk, layanan, obat, atau kode tagihan lainnya untuk item tersebut dengan tipe data CodeableConcept.", "comment": "If this is an actual service or product line, i.e. not a Group, then use code to indicate the Professional Service or Product supplied (e.g. CTP, HCPCS, USCLS, ICD10, NCPDP, DIN, RxNorm, ACHI, CCI). If a grouping item then use a group code to indicate the type of thing being grouped e.g. 'glasses' or 'compound'.", "requirements": "Necessary to state what was provided or done.", "min": 1, "max": "1", "base": { "path": "ClaimResponse.addItem.detail.productOrService", "min": 1, "max": "1" }, "type": [ { "code": "CodeableConcept" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children unless an empty Parameters resource", "expression": "hasValue() or (children().count() > id.count()) or $this is Parameters", "xpath": "@value|f:*|h:div|self::f:Parameters", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "mustSupport": false, "isModifier": false, "isSummary": false, "binding": { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString": "ServiceProduct" } ], "strength": "example", "description": "Allowable service and product codes.", "valueSet": "http://hl7.org/fhir/ValueSet/service-uscls" }, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "v2", "map": "CE/CNE/CWE" }, { "identity": "rim", "map": "CD" }, { "identity": "orim", "map": "fhir:CodeableConcept rdfs:subClassOf dt:CD" } ] }, { "id": "ClaimResponse.addItem.detail.productOrService.id", "path": "ClaimResponse.addItem.detail.productOrService.id", "representation": [ "xmlAttr" ], "short": "Unique id for inter-element referencing", "definition": "Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.", "min": 0, "max": "1", "base": { "path": "Element.id", "min": 0, "max": "1" }, "type": [ { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type", "valueUrl": "id" } ], "code": "http://hl7.org/fhirpath/System.String" } ], "mapping": [ { "identity": "rim", "map": "n/a" } ] }, { "id": "ClaimResponse.addItem.detail.productOrService.extension", "path": "ClaimResponse.addItem.detail.productOrService.extension", "slicing": { "discriminator": [ { "type": "value", "path": "url" } ], "description": "Extensions are always sliced by (at least) url", "rules": "open" }, "short": "Additional content defined by implementations", "definition": "May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.", "comment": "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.", "alias": [ "extensions", "user content" ], "min": 0, "max": "*", "base": { "path": "Element.extension", "min": 0, "max": "*" }, "type": [ { "code": "Extension" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children unless an empty Parameters resource", "expression": "hasValue() or (children().count() > id.count()) or $this is Parameters", "xpath": "@value|f:*|h:div|self::f:Parameters", "source": "http://hl7.org/fhir/StructureDefinition/Element" }, { "key": "ext-1", "severity": "error", "human": "Must have either extensions or value[x], not both", "expression": "extension.exists() != value.exists()", "xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])", "source": "http://hl7.org/fhir/StructureDefinition/Extension" } ], "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "rim", "map": "N/A" } ] }, { "id": "ClaimResponse.addItem.detail.productOrService.coding", "path": "ClaimResponse.addItem.detail.productOrService.coding", "short": "Code defined by a terminology system", "definition": "Berisi data jika nilainya adalah kode grup maka item ini mengumpulkan serangkaian detail klaim terkait dan jika tidak maka berisi produk, layanan, obat, atau kode tagihan lainnya untuk item tersebut dengan tipe data Coding yang nilainya dapat mengacu pada contoh data terminologi USCLS Codes.", "comment": "Codes may be defined very casually in enumerations, or code lists, up to very formal definitions such as SNOMED CT - see the HL7 v3 Core Principles for more information. Ordering of codings is undefined and SHALL NOT be used to infer meaning. Generally, at most only one of the coding values will be labeled as UserSelected = true.", "requirements": "Allows for alternative encodings within a code system, and translations to other code systems.", "min": 0, "max": "*", "base": { "path": "CodeableConcept.coding", "min": 0, "max": "*" }, "type": [ { "code": "Coding" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children unless an empty Parameters resource", "expression": "hasValue() or (children().count() > id.count()) or $this is Parameters", "xpath": "@value|f:*|h:div|self::f:Parameters", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "isSummary": true, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "v2", "map": "CE/CNE/CWE subset one of the sets of component 1-3 or 4-6" }, { "identity": "rim", "map": "CV" }, { "identity": "orim", "map": "fhir:Coding rdfs:subClassOf dt:CDCoding" }, { "identity": "v2", "map": "C*E.1-8, C*E.10-22" }, { "identity": "rim", "map": "union(., ./translation)" }, { "identity": "orim", "map": "fhir:CodeableConcept.coding rdfs:subPropertyOf dt:CD.coding" } ] }, { "id": "ClaimResponse.addItem.detail.productOrService.text", "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-translatable", "valueBoolean": true }, { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-translatable", "valueBoolean": true } ], "path": "ClaimResponse.addItem.detail.productOrService.text", "short": "Plain text representation of the concept", "definition": "A human language representation of the concept as seen/selected/uttered by the user who entered the data and/or which represents the intended meaning of the user.", "comment": "Very often the text is the same as a displayName of one of the codings.", "requirements": "The codes from the terminologies do not always capture the correct meaning with all the nuances of the human using them, or sometimes there is no appropriate code at all. In these cases, the text is used to capture the full meaning of the source.", "min": 0, "max": "1", "base": { "path": "CodeableConcept.text", "min": 0, "max": "1" }, "type": [ { "code": "string" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children unless an empty Parameters resource", "expression": "hasValue() or (children().count() > id.count()) or $this is Parameters", "xpath": "@value|f:*|h:div|self::f:Parameters", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "isSummary": true, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "v2", "map": "C*E.9. But note many systems use C*E.2 for this" }, { "identity": "rim", "map": "./originalText[mediaType/code=\"text/plain\"]/data" }, { "identity": "orim", "map": "fhir:CodeableConcept.text rdfs:subPropertyOf dt:CD.originalText" } ] }, { "id": "ClaimResponse.addItem.detail.modifier", "path": "ClaimResponse.addItem.detail.modifier", "short": "Service/Product billing modifiers", "definition": "Berisi data kode tipifikasi atau pengubah item untuk menyampaikan konteks tambahan untuk produk atau layanan dengan tipe data CodeableConcept.", "comment": "For example in Oral whether the treatment is cosmetic or associated with TMJ, or for Medical whether the treatment was outside the clinic or outside of office hours.", "requirements": "To support inclusion of the item for adjudication or to charge an elevated fee.", "min": 0, "max": "*", "base": { "path": "ClaimResponse.addItem.detail.modifier", "min": 0, "max": "*" }, "type": [ { "code": "CodeableConcept" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children unless an empty Parameters resource", "expression": "hasValue() or (children().count() > id.count()) or $this is Parameters", "xpath": "@value|f:*|h:div|self::f:Parameters", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "mustSupport": false, "isModifier": false, "isSummary": false, "binding": { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString": "Modifiers" } ], "strength": "example", "description": "Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen.", "valueSet": "http://hl7.org/fhir/ValueSet/claim-modifiers" }, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "v2", "map": "CE/CNE/CWE" }, { "identity": "rim", "map": "CD" }, { "identity": "orim", "map": "fhir:CodeableConcept rdfs:subClassOf dt:CD" }, { "identity": "rim", "map": "24.C, 24.D mods" } ] }, { "id": "ClaimResponse.addItem.detail.modifier.id", "path": "ClaimResponse.addItem.detail.modifier.id", "representation": [ "xmlAttr" ], "short": "Unique id for inter-element referencing", "definition": "Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.", "min": 0, "max": "1", "base": { "path": "Element.id", "min": 0, "max": "1" }, "type": [ { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type", "valueUrl": "id" } ], "code": "http://hl7.org/fhirpath/System.String" } ], "mapping": [ { "identity": "rim", "map": "n/a" } ] }, { "id": "ClaimResponse.addItem.detail.modifier.extension", "path": "ClaimResponse.addItem.detail.modifier.extension", "slicing": { "discriminator": [ { "type": "value", "path": "url" } ], "description": "Extensions are always sliced by (at least) url", "rules": "open" }, "short": "Additional content defined by implementations", "definition": "May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.", "comment": "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.", "alias": [ "extensions", "user content" ], "min": 0, "max": "*", "base": { "path": "Element.extension", "min": 0, "max": "*" }, "type": [ { "code": "Extension" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children unless an empty Parameters resource", "expression": "hasValue() or (children().count() > id.count()) or $this is Parameters", "xpath": "@value|f:*|h:div|self::f:Parameters", "source": "http://hl7.org/fhir/StructureDefinition/Element" }, { "key": "ext-1", "severity": "error", "human": "Must have either extensions or value[x], not both", "expression": "extension.exists() != value.exists()", "xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])", "source": "http://hl7.org/fhir/StructureDefinition/Extension" } ], "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "rim", "map": "N/A" } ] }, { "id": "ClaimResponse.addItem.detail.modifier.coding", "path": "ClaimResponse.addItem.detail.modifier.coding", "short": "Code defined by a terminology system", "definition": "Berisi data kode tipifikasi atau pengubah item untuk menyampaikan konteks tambahan untuk produk atau layanan dengan tipe data Coding yang nilainya dapat mengacu pada contoh data terminologi Modifier types Codes.", "comment": "Codes may be defined very casually in enumerations, or code lists, up to very formal definitions such as SNOMED CT - see the HL7 v3 Core Principles for more information. Ordering of codings is undefined and SHALL NOT be used to infer meaning. Generally, at most only one of the coding values will be labeled as UserSelected = true.", "requirements": "Allows for alternative encodings within a code system, and translations to other code systems.", "min": 0, "max": "*", "base": { "path": "CodeableConcept.coding", "min": 0, "max": "*" }, "type": [ { "code": "Coding" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children unless an empty Parameters resource", "expression": "hasValue() or (children().count() > id.count()) or $this is Parameters", "xpath": "@value|f:*|h:div|self::f:Parameters", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "isSummary": true, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "v2", "map": "CE/CNE/CWE subset one of the sets of component 1-3 or 4-6" }, { "identity": "rim", "map": "CV" }, { "identity": "orim", "map": "fhir:Coding rdfs:subClassOf dt:CDCoding" }, { "identity": "v2", "map": "C*E.1-8, C*E.10-22" }, { "identity": "rim", "map": "union(., ./translation)" }, { "identity": "orim", "map": "fhir:CodeableConcept.coding rdfs:subPropertyOf dt:CD.coding" } ] }, { "id": "ClaimResponse.addItem.detail.modifier.text", "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-translatable", "valueBoolean": true }, { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-translatable", "valueBoolean": true } ], "path": "ClaimResponse.addItem.detail.modifier.text", "short": "Plain text representation of the concept", "definition": "A human language representation of the concept as seen/selected/uttered by the user who entered the data and/or which represents the intended meaning of the user.", "comment": "Very often the text is the same as a displayName of one of the codings.", "requirements": "The codes from the terminologies do not always capture the correct meaning with all the nuances of the human using them, or sometimes there is no appropriate code at all. In these cases, the text is used to capture the full meaning of the source.", "min": 0, "max": "1", "base": { "path": "CodeableConcept.text", "min": 0, "max": "1" }, "type": [ { "code": "string" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children unless an empty Parameters resource", "expression": "hasValue() or (children().count() > id.count()) or $this is Parameters", "xpath": "@value|f:*|h:div|self::f:Parameters", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "isSummary": true, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "v2", "map": "C*E.9. But note many systems use C*E.2 for this" }, { "identity": "rim", "map": "./originalText[mediaType/code=\"text/plain\"]/data" }, { "identity": "orim", "map": "fhir:CodeableConcept.text rdfs:subPropertyOf dt:CD.originalText" } ] }, { "id": "ClaimResponse.addItem.detail.quantity", "path": "ClaimResponse.addItem.detail.quantity", "short": "Count of products or services", "definition": "Berisi data jumlah pengulangan layanan atau produk dengan tipe data SimpleQuantity.", "comment": "The context of use may frequently define what kind of quantity this is and therefore what kind of units can be used. The context of use may also restrict the values for the comparator.", "requirements": "Required when the product or service code does not convey the quantity provided.", "min": 0, "max": "1", "base": { "path": "ClaimResponse.addItem.detail.quantity", "min": 0, "max": "1" }, "type": [ { "code": "Quantity", "profile": [ "http://hl7.org/fhir/StructureDefinition/SimpleQuantity" ] } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children unless an empty Parameters resource", "expression": "hasValue() or (children().count() > id.count()) or $this is Parameters", "xpath": "@value|f:*|h:div|self::f:Parameters", "source": "http://hl7.org/fhir/StructureDefinition/Element" }, { "key": "qty-3", "severity": "error", "human": "If a code for the unit is present, the system SHALL also be present", "expression": "code.empty() or system.exists()", "xpath": "not(exists(f:code)) or exists(f:system)", "source": "http://hl7.org/fhir/StructureDefinition/Quantity" }, { "key": "sqty-1", "severity": "error", "human": "The comparator is not used on a SimpleQuantity", "expression": "comparator.empty()", "xpath": "not(exists(f:comparator))", "source": "http://hl7.org/fhir/StructureDefinition/SimpleQuantity" } ], "mustSupport": false, "isModifier": false, "isSummary": false, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "v2", "map": "SN (see also Range) or CQ" }, { "identity": "rim", "map": "PQ, IVL, MO, CO, depending on the values" }, { "identity": "rim", "map": "24.G" } ] }, { "id": "ClaimResponse.addItem.detail.unitPrice", "path": "ClaimResponse.addItem.detail.unitPrice", "short": "Fee, charge or cost per item", "definition": "Berisi data biaya di mana jika item yang tersebut bukan grup maka ini adalah biaya untuk produk atau layanan, jika tidak maka ini adalah total biaya untuk perincian grup dengan tipe data Money.", "requirements": "The amount charged to the patient by the provider for a single unit.", "min": 0, "max": "1", "base": { "path": "ClaimResponse.addItem.detail.unitPrice", "min": 0, "max": "1" }, "type": [ { "code": "Money" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children unless an empty Parameters resource", "expression": "hasValue() or (children().count() > id.count()) or $this is Parameters", "xpath": "@value|f:*|h:div|self::f:Parameters", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "mustSupport": false, "isModifier": false, "isSummary": false, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "rim", "map": "MO" } ] }, { "id": "ClaimResponse.addItem.detail.factor", "path": "ClaimResponse.addItem.detail.factor", "short": "Price scaling factor", "definition": "Berisi data bilangan real yang mewakili pengali yang digunakan dalam menentukan nilai keseluruhan dari layanan yang diberikan dan/atau barang yang diterima. Konsep Faktor memungkinkan pengganda diskon atau biaya tambahan untuk diterapkan pada jumlah uang. Tipe data yang digunakan adalah decimal.", "comment": "To show a 10% senior's discount, the value entered is: 0.90 (1.00 - 0.10).", "requirements": "When discounts are provided to a patient (example: Senior's discount) then this must be documented for adjudication.", "min": 0, "max": "1", "base": { "path": "ClaimResponse.addItem.detail.factor", "min": 0, "max": "1" }, "type": [ { "code": "decimal" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children unless an empty Parameters resource", "expression": "hasValue() or (children().count() > id.count()) or $this is Parameters", "xpath": "@value|f:*|h:div|self::f:Parameters", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "mustSupport": false, "isModifier": false, "isSummary": false, "mapping": [ { "identity": "rim", "map": "n/a" } ] }, { "id": "ClaimResponse.addItem.detail.net", "path": "ClaimResponse.addItem.detail.net", "short": "Total item cost", "definition": "Berisi data kuantitas dikalikan harga satuan untuk layanan atau produk atau biaya tambahan dengan tipe data Money.", "comment": "For example, the formula: quantity * unitPrice * factor = net. Quantity and factor are assumed to be 1 if not supplied.", "requirements": "Provides the total amount claimed for the group (if a grouper) or the line item.", "min": 0, "max": "1", "base": { "path": "ClaimResponse.addItem.detail.net", "min": 0, "max": "1" }, "type": [ { "code": "Money" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children unless an empty Parameters resource", "expression": "hasValue() or (children().count() > id.count()) or $this is Parameters", "xpath": "@value|f:*|h:div|self::f:Parameters", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "mustSupport": false, "isModifier": false, "isSummary": false, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "rim", "map": "MO" }, { "identity": "rim", "map": "24.F" } ] }, { "id": "ClaimResponse.addItem.detail.noteNumber", "path": "ClaimResponse.addItem.detail.noteNumber", "short": "Applicable note numbers", "definition": "Berisi data angka-angka yang terkait dengan catatan yang ada di bawah yang berlaku untuk penilaian item dengan tipe data positiveInt.", "comment": "32 bit number; for values larger than this, use decimal", "requirements": "Provides a condensed manner for associating human readable descriptive explanations for adjudications on the line item.", "min": 0, "max": "*", "base": { "path": "ClaimResponse.addItem.detail.noteNumber", "min": 0, "max": "*" }, "type": [ { "code": "positiveInt" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children unless an empty Parameters resource", "expression": "hasValue() or (children().count() > id.count()) or $this is Parameters", "xpath": "@value|f:*|h:div|self::f:Parameters", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "mustSupport": false, "isModifier": false, "isSummary": false, "mapping": [ { "identity": "rim", "map": "n/a" } ] }, { "id": "ClaimResponse.addItem.detail.adjudication", "path": "ClaimResponse.addItem.detail.adjudication", "short": "Added items detail adjudication", "definition": "Berisi data hasil keputusan dengan tipe data yang mengacu pada ClaimResponse.item.adjudication.", "min": 1, "max": "*", "base": { "path": "ClaimResponse.addItem.detail.adjudication", "min": 1, "max": "*" }, "contentReference": "http://hl7.org/fhir/StructureDefinition/ClaimResponse#ClaimResponse.item.adjudication", "mustSupport": false, "isModifier": false, "isSummary": false }, { "id": "ClaimResponse.addItem.detail.subDetail", "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-explicit-type-name", "valueString": "AddedItemSubDetail" } ], "path": "ClaimResponse.addItem.detail.subDetail", "short": "Insurer added line items", "definition": "Berisi data keputusan layanan tingkat ketiga untuk pembayar menambahkan layanan dengan tipe data BackboneElement.", "min": 0, "max": "*", "base": { "path": "ClaimResponse.addItem.detail.subDetail", "min": 0, "max": "*" }, "type": [ { "code": "BackboneElement" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children unless an empty Parameters resource", "expression": "hasValue() or (children().count() > id.count()) or $this is Parameters", "xpath": "@value|f:*|h:div|self::f:Parameters", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "mustSupport": false, "isModifier": false, "isSummary": false, "mapping": [ { "identity": "rim", "map": "n/a" } ] }, { "id": "ClaimResponse.addItem.detail.subDetail.id", "path": "ClaimResponse.addItem.detail.subDetail.id", "representation": [ "xmlAttr" ], "short": "Unique id for inter-element referencing", "definition": "Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.", "min": 0, "max": "1", "base": { "path": "Element.id", "min": 0, "max": "1" }, "type": [ { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type", "valueUrl": "id" } ], "code": "http://hl7.org/fhirpath/System.String" } ], "mapping": [ { "identity": "rim", "map": "n/a" } ] }, { "id": "ClaimResponse.addItem.detail.subDetail.extension", "path": "ClaimResponse.addItem.detail.subDetail.extension", "slicing": { "discriminator": [ { "type": "value", "path": "url" } ], "description": "Extensions are always sliced by (at least) url", "rules": "open" }, "short": "Additional content defined by implementations", "definition": "May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.", "comment": "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.", "alias": [ "extensions", "user content" ], "min": 0, "max": "*", "base": { "path": "Element.extension", "min": 0, "max": "*" }, "type": [ { "code": "Extension" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children unless an empty Parameters resource", "expression": "hasValue() or (children().count() > id.count()) or $this is Parameters", "xpath": "@value|f:*|h:div|self::f:Parameters", "source": "http://hl7.org/fhir/StructureDefinition/Element" }, { "key": "ext-1", "severity": "error", "human": "Must have either extensions or value[x], not both", "expression": "extension.exists() != value.exists()", "xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])", "source": "http://hl7.org/fhir/StructureDefinition/Extension" } ], "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "rim", "map": "N/A" } ] }, { "id": "ClaimResponse.addItem.detail.subDetail.modifierExtension", "path": "ClaimResponse.addItem.detail.subDetail.modifierExtension", "short": "Extensions that cannot be ignored even if unrecognized", "definition": "May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.\n\nModifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).", "comment": "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.", "requirements": "Modifier extensions allow for extensions that *cannot* be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the [definition of modifier extensions](extensibility.html#modifierExtension).", "alias": [ "extensions", "user content", "modifiers" ], "min": 0, "max": "*", "base": { "path": "BackboneElement.modifierExtension", "min": 0, "max": "*" }, "type": [ { "code": "Extension" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children unless an empty Parameters resource", "expression": "hasValue() or (children().count() > id.count()) or $this is Parameters", "xpath": "@value|f:*|h:div|self::f:Parameters", "source": "http://hl7.org/fhir/StructureDefinition/Element" }, { "key": "ext-1", "severity": "error", "human": "Must have either extensions or value[x], not both", "expression": "extension.exists() != value.exists()", "xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])", "source": "http://hl7.org/fhir/StructureDefinition/Extension" } ], "isModifier": true, "isModifierReason": "Modifier extensions are expected to modify the meaning or interpretation of the element that contains them", "isSummary": true, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "rim", "map": "N/A" } ] }, { "id": "ClaimResponse.addItem.detail.subDetail.productOrService", "path": "ClaimResponse.addItem.detail.subDetail.productOrService", "short": "Billing, service, product, or drug code", "definition": "Berisi data jika nilainya adalah kode grup maka item ini mengumpulkan serangkaian detail klaim terkait dan jika tidak maka berisi produk, layanan, obat, atau kode tagihan lainnya untuk item tersebut dengan tipe data CodeableConcept.", "comment": "If this is an actual service or product line, i.e. not a Group, then use code to indicate the Professional Service or Product supplied (e.g. CTP, HCPCS, USCLS, ICD10, NCPDP, DIN, RxNorm, ACHI, CCI). If a grouping item then use a group code to indicate the type of thing being grouped e.g. 'glasses' or 'compound'.", "requirements": "Necessary to state what was provided or done.", "min": 1, "max": "1", "base": { "path": "ClaimResponse.addItem.detail.subDetail.productOrService", "min": 1, "max": "1" }, "type": [ { "code": "CodeableConcept" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children unless an empty Parameters resource", "expression": "hasValue() or (children().count() > id.count()) or $this is Parameters", "xpath": "@value|f:*|h:div|self::f:Parameters", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "mustSupport": false, "isModifier": false, "isSummary": false, "binding": { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString": "ServiceProduct" } ], "strength": "example", "description": "Allowable service and product codes.", "valueSet": "http://hl7.org/fhir/ValueSet/service-uscls" }, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "v2", "map": "CE/CNE/CWE" }, { "identity": "rim", "map": "CD" }, { "identity": "orim", "map": "fhir:CodeableConcept rdfs:subClassOf dt:CD" } ] }, { "id": "ClaimResponse.addItem.detail.subDetail.productOrService.id", "path": "ClaimResponse.addItem.detail.subDetail.productOrService.id", "representation": [ "xmlAttr" ], "short": "Unique id for inter-element referencing", "definition": "Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.", "min": 0, "max": "1", "base": { "path": "Element.id", "min": 0, "max": "1" }, "type": [ { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type", "valueUrl": "id" } ], "code": "http://hl7.org/fhirpath/System.String" } ], "mapping": [ { "identity": "rim", "map": "n/a" } ] }, { "id": "ClaimResponse.addItem.detail.subDetail.productOrService.extension", "path": "ClaimResponse.addItem.detail.subDetail.productOrService.extension", "slicing": { "discriminator": [ { "type": "value", "path": "url" } ], "description": "Extensions are always sliced by (at least) url", "rules": "open" }, "short": "Additional content defined by implementations", "definition": "May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.", "comment": "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.", "alias": [ "extensions", "user content" ], "min": 0, "max": "*", "base": { "path": "Element.extension", "min": 0, "max": "*" }, "type": [ { "code": "Extension" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children unless an empty Parameters resource", "expression": "hasValue() or (children().count() > id.count()) or $this is Parameters", "xpath": "@value|f:*|h:div|self::f:Parameters", "source": "http://hl7.org/fhir/StructureDefinition/Element" }, { "key": "ext-1", "severity": "error", "human": "Must have either extensions or value[x], not both", "expression": "extension.exists() != value.exists()", "xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])", "source": "http://hl7.org/fhir/StructureDefinition/Extension" } ], "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "rim", "map": "N/A" } ] }, { "id": "ClaimResponse.addItem.detail.subDetail.productOrService.coding", "path": "ClaimResponse.addItem.detail.subDetail.productOrService.coding", "short": "Code defined by a terminology system", "definition": "Berisi data jika nilainya adalah kode grup maka item ini mengumpulkan serangkaian detail klaim terkait dan jika tidak maka berisi produk, layanan, obat, atau kode tagihan lainnya untuk item tersebut dengan tipe data Coding yang nilainya dapat mengacu pada contoh data terminologi USCLS Codes.", "comment": "Codes may be defined very casually in enumerations, or code lists, up to very formal definitions such as SNOMED CT - see the HL7 v3 Core Principles for more information. Ordering of codings is undefined and SHALL NOT be used to infer meaning. Generally, at most only one of the coding values will be labeled as UserSelected = true.", "requirements": "Allows for alternative encodings within a code system, and translations to other code systems.", "min": 0, "max": "*", "base": { "path": "CodeableConcept.coding", "min": 0, "max": "*" }, "type": [ { "code": "Coding" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children unless an empty Parameters resource", "expression": "hasValue() or (children().count() > id.count()) or $this is Parameters", "xpath": "@value|f:*|h:div|self::f:Parameters", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "isSummary": true, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "v2", "map": "CE/CNE/CWE subset one of the sets of component 1-3 or 4-6" }, { "identity": "rim", "map": "CV" }, { "identity": "orim", "map": "fhir:Coding rdfs:subClassOf dt:CDCoding" }, { "identity": "v2", "map": "C*E.1-8, C*E.10-22" }, { "identity": "rim", "map": "union(., ./translation)" }, { "identity": "orim", "map": "fhir:CodeableConcept.coding rdfs:subPropertyOf dt:CD.coding" } ] }, { "id": "ClaimResponse.addItem.detail.subDetail.productOrService.text", "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-translatable", "valueBoolean": true }, { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-translatable", "valueBoolean": true } ], "path": "ClaimResponse.addItem.detail.subDetail.productOrService.text", "short": "Plain text representation of the concept", "definition": "A human language representation of the concept as seen/selected/uttered by the user who entered the data and/or which represents the intended meaning of the user.", "comment": "Very often the text is the same as a displayName of one of the codings.", "requirements": "The codes from the terminologies do not always capture the correct meaning with all the nuances of the human using them, or sometimes there is no appropriate code at all. In these cases, the text is used to capture the full meaning of the source.", "min": 0, "max": "1", "base": { "path": "CodeableConcept.text", "min": 0, "max": "1" }, "type": [ { "code": "string" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children unless an empty Parameters resource", "expression": "hasValue() or (children().count() > id.count()) or $this is Parameters", "xpath": "@value|f:*|h:div|self::f:Parameters", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "isSummary": true, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "v2", "map": "C*E.9. But note many systems use C*E.2 for this" }, { "identity": "rim", "map": "./originalText[mediaType/code=\"text/plain\"]/data" }, { "identity": "orim", "map": "fhir:CodeableConcept.text rdfs:subPropertyOf dt:CD.originalText" } ] }, { "id": "ClaimResponse.addItem.detail.subDetail.modifier", "path": "ClaimResponse.addItem.detail.subDetail.modifier", "short": "Service/Product billing modifiers", "definition": "Berisi data kode tipifikasi atau pengubah item untuk menyampaikan konteks tambahan untuk produk atau layanan dengan tipe data CodeableConcept.", "comment": "For example in Oral whether the treatment is cosmetic or associated with TMJ, or for Medical whether the treatment was outside the clinic or outside of office hours.", "requirements": "To support inclusion of the item for adjudication or to charge an elevated fee.", "min": 0, "max": "*", "base": { "path": "ClaimResponse.addItem.detail.subDetail.modifier", "min": 0, "max": "*" }, "type": [ { "code": "CodeableConcept" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children unless an empty Parameters resource", "expression": "hasValue() or (children().count() > id.count()) or $this is Parameters", "xpath": "@value|f:*|h:div|self::f:Parameters", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "mustSupport": false, "isModifier": false, "isSummary": false, "binding": { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString": "Modifiers" } ], "strength": "example", "description": "Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen.", "valueSet": "http://hl7.org/fhir/ValueSet/claim-modifiers" }, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "v2", "map": "CE/CNE/CWE" }, { "identity": "rim", "map": "CD" }, { "identity": "orim", "map": "fhir:CodeableConcept rdfs:subClassOf dt:CD" }, { "identity": "rim", "map": "24.C, 24.D mods" } ] }, { "id": "ClaimResponse.addItem.detail.subDetail.modifier.id", "path": "ClaimResponse.addItem.detail.subDetail.modifier.id", "representation": [ "xmlAttr" ], "short": "Unique id for inter-element referencing", "definition": "Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.", "min": 0, "max": "1", "base": { "path": "Element.id", "min": 0, "max": "1" }, "type": [ { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type", "valueUrl": "id" } ], "code": "http://hl7.org/fhirpath/System.String" } ], "mapping": [ { "identity": "rim", "map": "n/a" } ] }, { "id": "ClaimResponse.addItem.detail.subDetail.modifier.extension", "path": "ClaimResponse.addItem.detail.subDetail.modifier.extension", "slicing": { "discriminator": [ { "type": "value", "path": "url" } ], "description": "Extensions are always sliced by (at least) url", "rules": "open" }, "short": "Additional content defined by implementations", "definition": "May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.", "comment": "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.", "alias": [ "extensions", "user content" ], "min": 0, "max": "*", "base": { "path": "Element.extension", "min": 0, "max": "*" }, "type": [ { "code": "Extension" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children unless an empty Parameters resource", "expression": "hasValue() or (children().count() > id.count()) or $this is Parameters", "xpath": "@value|f:*|h:div|self::f:Parameters", "source": "http://hl7.org/fhir/StructureDefinition/Element" }, { "key": "ext-1", "severity": "error", "human": "Must have either extensions or value[x], not both", "expression": "extension.exists() != value.exists()", "xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])", "source": "http://hl7.org/fhir/StructureDefinition/Extension" } ], "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "rim", "map": "N/A" } ] }, { "id": "ClaimResponse.addItem.detail.subDetail.modifier.coding", "path": "ClaimResponse.addItem.detail.subDetail.modifier.coding", "short": "Code defined by a terminology system", "definition": "Berisi data kode tipifikasi atau pengubah item untuk menyampaikan konteks tambahan untuk produk atau layanan dengan tipe data Coding yang nilainya dapat mengacu pada contoh data terminologi Modifier types Codes.", "comment": "Codes may be defined very casually in enumerations, or code lists, up to very formal definitions such as SNOMED CT - see the HL7 v3 Core Principles for more information. Ordering of codings is undefined and SHALL NOT be used to infer meaning. Generally, at most only one of the coding values will be labeled as UserSelected = true.", "requirements": "Allows for alternative encodings within a code system, and translations to other code systems.", "min": 0, "max": "*", "base": { "path": "CodeableConcept.coding", "min": 0, "max": "*" }, "type": [ { "code": "Coding" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children unless an empty Parameters resource", "expression": "hasValue() or (children().count() > id.count()) or $this is Parameters", "xpath": "@value|f:*|h:div|self::f:Parameters", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "isSummary": true, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "v2", "map": "CE/CNE/CWE subset one of the sets of component 1-3 or 4-6" }, { "identity": "rim", "map": "CV" }, { "identity": "orim", "map": "fhir:Coding rdfs:subClassOf dt:CDCoding" }, { "identity": "v2", "map": "C*E.1-8, C*E.10-22" }, { "identity": "rim", "map": "union(., ./translation)" }, { "identity": "orim", "map": "fhir:CodeableConcept.coding rdfs:subPropertyOf dt:CD.coding" } ] }, { "id": "ClaimResponse.addItem.detail.subDetail.modifier.text", "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-translatable", "valueBoolean": true }, { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-translatable", "valueBoolean": true } ], "path": "ClaimResponse.addItem.detail.subDetail.modifier.text", "short": "Plain text representation of the concept", "definition": "A human language representation of the concept as seen/selected/uttered by the user who entered the data and/or which represents the intended meaning of the user.", "comment": "Very often the text is the same as a displayName of one of the codings.", "requirements": "The codes from the terminologies do not always capture the correct meaning with all the nuances of the human using them, or sometimes there is no appropriate code at all. In these cases, the text is used to capture the full meaning of the source.", "min": 0, "max": "1", "base": { "path": "CodeableConcept.text", "min": 0, "max": "1" }, "type": [ { "code": "string" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children unless an empty Parameters resource", "expression": "hasValue() or (children().count() > id.count()) or $this is Parameters", "xpath": "@value|f:*|h:div|self::f:Parameters", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "isSummary": true, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "v2", "map": "C*E.9. But note many systems use C*E.2 for this" }, { "identity": "rim", "map": "./originalText[mediaType/code=\"text/plain\"]/data" }, { "identity": "orim", "map": "fhir:CodeableConcept.text rdfs:subPropertyOf dt:CD.originalText" } ] }, { "id": "ClaimResponse.addItem.detail.subDetail.quantity", "path": "ClaimResponse.addItem.detail.subDetail.quantity", "short": "Count of products or services", "definition": "Berisi data jumlah pengulangan layanan atau produk dengan tipe data SimpleQuantity.", "comment": "The context of use may frequently define what kind of quantity this is and therefore what kind of units can be used. The context of use may also restrict the values for the comparator.", "requirements": "Required when the product or service code does not convey the quantity provided.", "min": 0, "max": "1", "base": { "path": "ClaimResponse.addItem.detail.subDetail.quantity", "min": 0, "max": "1" }, "type": [ { "code": "Quantity", "profile": [ "http://hl7.org/fhir/StructureDefinition/SimpleQuantity" ] } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children unless an empty Parameters resource", "expression": "hasValue() or (children().count() > id.count()) or $this is Parameters", "xpath": "@value|f:*|h:div|self::f:Parameters", "source": "http://hl7.org/fhir/StructureDefinition/Element" }, { "key": "qty-3", "severity": "error", "human": "If a code for the unit is present, the system SHALL also be present", "expression": "code.empty() or system.exists()", "xpath": "not(exists(f:code)) or exists(f:system)", "source": "http://hl7.org/fhir/StructureDefinition/Quantity" }, { "key": "sqty-1", "severity": "error", "human": "The comparator is not used on a SimpleQuantity", "expression": "comparator.empty()", "xpath": "not(exists(f:comparator))", "source": "http://hl7.org/fhir/StructureDefinition/SimpleQuantity" } ], "mustSupport": false, "isModifier": false, "isSummary": false, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "v2", "map": "SN (see also Range) or CQ" }, { "identity": "rim", "map": "PQ, IVL, MO, CO, depending on the values" }, { "identity": "rim", "map": "24.G" } ] }, { "id": "ClaimResponse.addItem.detail.subDetail.unitPrice", "path": "ClaimResponse.addItem.detail.subDetail.unitPrice", "short": "Fee, charge or cost per item", "definition": "Berisi data biaya di mana jika item yang tersebut bukan grup maka ini adalah biaya untuk produk atau layanan, jika tidak maka ini adalah total biaya untuk perincian grup dengan tipe data Money.", "requirements": "The amount charged to the patient by the provider for a single unit.", "min": 0, "max": "1", "base": { "path": "ClaimResponse.addItem.detail.subDetail.unitPrice", "min": 0, "max": "1" }, "type": [ { "code": "Money" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children unless an empty Parameters resource", "expression": "hasValue() or (children().count() > id.count()) or $this is Parameters", "xpath": "@value|f:*|h:div|self::f:Parameters", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "mustSupport": false, "isModifier": false, "isSummary": false, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "rim", "map": "MO" } ] }, { "id": "ClaimResponse.addItem.detail.subDetail.factor", "path": "ClaimResponse.addItem.detail.subDetail.factor", "short": "Price scaling factor", "definition": "Berisi data bilangan real yang mewakili pengali yang digunakan dalam menentukan nilai keseluruhan dari layanan yang diberikan dan/atau barang yang diterima. Konsep Faktor memungkinkan pengganda diskon atau biaya tambahan untuk diterapkan pada jumlah uang. Tipe data yang digunakan adalah decimal.", "comment": "To show a 10% senior's discount, the value entered is: 0.90 (1.00 - 0.10).", "requirements": "When discounts are provided to a patient (example: Senior's discount) then this must be documented for adjudication.", "min": 0, "max": "1", "base": { "path": "ClaimResponse.addItem.detail.subDetail.factor", "min": 0, "max": "1" }, "type": [ { "code": "decimal" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children unless an empty Parameters resource", "expression": "hasValue() or (children().count() > id.count()) or $this is Parameters", "xpath": "@value|f:*|h:div|self::f:Parameters", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "mustSupport": false, "isModifier": false, "isSummary": false, "mapping": [ { "identity": "rim", "map": "n/a" } ] }, { "id": "ClaimResponse.addItem.detail.subDetail.net", "path": "ClaimResponse.addItem.detail.subDetail.net", "short": "Total item cost", "definition": "Berisi data kuantitas dikalikan harga satuan untuk layanan atau produk atau biaya tambahan dengan tipe data Money.", "comment": "For example, the formula: quantity * unitPrice * factor = net. Quantity and factor are assumed to be 1 if not supplied.", "requirements": "Provides the total amount claimed for the group (if a grouper) or the line item.", "min": 0, "max": "1", "base": { "path": "ClaimResponse.addItem.detail.subDetail.net", "min": 0, "max": "1" }, "type": [ { "code": "Money" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children unless an empty Parameters resource", "expression": "hasValue() or (children().count() > id.count()) or $this is Parameters", "xpath": "@value|f:*|h:div|self::f:Parameters", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "mustSupport": false, "isModifier": false, "isSummary": false, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "rim", "map": "MO" }, { "identity": "rim", "map": "24.F" } ] }, { "id": "ClaimResponse.addItem.detail.subDetail.noteNumber", "path": "ClaimResponse.addItem.detail.subDetail.noteNumber", "short": "Applicable note numbers", "definition": "Berisi data angka-angka yang terkait dengan catatan yang ada di bawah yang berlaku untuk penilaian item dengan tipe data positiveInt.", "comment": "32 bit number; for values larger than this, use decimal", "requirements": "Provides a condensed manner for associating human readable descriptive explanations for adjudications on the line item.", "min": 0, "max": "*", "base": { "path": "ClaimResponse.addItem.detail.subDetail.noteNumber", "min": 0, "max": "*" }, "type": [ { "code": "positiveInt" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children unless an empty Parameters resource", "expression": "hasValue() or (children().count() > id.count()) or $this is Parameters", "xpath": "@value|f:*|h:div|self::f:Parameters", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "mustSupport": false, "isModifier": false, "isSummary": false, "mapping": [ { "identity": "rim", "map": "n/a" } ] }, { "id": "ClaimResponse.addItem.detail.subDetail.adjudication", "path": "ClaimResponse.addItem.detail.subDetail.adjudication", "short": "Added items detail adjudication", "definition": "Berisi data hasil ajudikasi dengan tipe data yang mengacu pada ClaimResponse.item.adjudication.", "min": 1, "max": "*", "base": { "path": "ClaimResponse.addItem.detail.subDetail.adjudication", "min": 1, "max": "*" }, "contentReference": "http://hl7.org/fhir/StructureDefinition/ClaimResponse#ClaimResponse.item.adjudication", "mustSupport": false, "isModifier": false, "isSummary": false }, { "id": "ClaimResponse.adjudication", "path": "ClaimResponse.adjudication", "short": "Header-level adjudication", "definition": "The adjudication results which are presented at the header level rather than at the line-item or add-item levels.", "requirements": "Some insurers will receive line-items but provide the adjudication only at a summary or header-level.", "min": 0, "max": "*", "base": { "path": "ClaimResponse.adjudication", "min": 0, "max": "*" }, "contentReference": "http://hl7.org/fhir/StructureDefinition/ClaimResponse#ClaimResponse.item.adjudication", "mustSupport": false, "isModifier": false, "isSummary": false }, { "id": "ClaimResponse.total", "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-explicit-type-name", "valueString": "Total" } ], "path": "ClaimResponse.total", "short": "Adjudication totals", "definition": "Berisi data total moneter yang dikategorikan untuk ajudikasi dengan tipe data Money.", "comment": "Totals for amounts submitted, co-pays, benefits payable etc.", "requirements": "To provide the requestor with financial totals by category for the adjudication.", "min": 0, "max": "*", "base": { "path": "ClaimResponse.total", "min": 0, "max": "*" }, "type": [ { "code": "BackboneElement" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children unless an empty Parameters resource", "expression": "hasValue() or (children().count() > id.count()) or $this is Parameters", "xpath": "@value|f:*|h:div|self::f:Parameters", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "mustSupport": false, "isModifier": false, "isSummary": true, "mapping": [ { "identity": "rim", "map": "n/a" } ] }, { "id": "ClaimResponse.total.id", "path": "ClaimResponse.total.id", "representation": [ "xmlAttr" ], "short": "Unique id for inter-element referencing", "definition": "Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.", "min": 0, "max": "1", "base": { "path": "Element.id", "min": 0, "max": "1" }, "type": [ { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type", "valueUrl": "id" } ], "code": "http://hl7.org/fhirpath/System.String" } ], "mapping": [ { "identity": "rim", "map": "n/a" } ] }, { "id": "ClaimResponse.total.extension", "path": "ClaimResponse.total.extension", "slicing": { "discriminator": [ { "type": "value", "path": "url" } ], "description": "Extensions are always sliced by (at least) url", "rules": "open" }, "short": "Additional content defined by implementations", "definition": "May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.", "comment": "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.", "alias": [ "extensions", "user content" ], "min": 0, "max": "*", "base": { "path": "Element.extension", "min": 0, "max": "*" }, "type": [ { "code": "Extension" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children unless an empty Parameters resource", "expression": "hasValue() or (children().count() > id.count()) or $this is Parameters", "xpath": "@value|f:*|h:div|self::f:Parameters", "source": "http://hl7.org/fhir/StructureDefinition/Element" }, { "key": "ext-1", "severity": "error", "human": "Must have either extensions or value[x], not both", "expression": "extension.exists() != value.exists()", "xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])", "source": "http://hl7.org/fhir/StructureDefinition/Extension" } ], "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "rim", "map": "N/A" } ] }, { "id": "ClaimResponse.total.modifierExtension", "path": "ClaimResponse.total.modifierExtension", "short": "Extensions that cannot be ignored even if unrecognized", "definition": "May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.\n\nModifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).", "comment": "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.", "requirements": "Modifier extensions allow for extensions that *cannot* be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the [definition of modifier extensions](extensibility.html#modifierExtension).", "alias": [ "extensions", "user content", "modifiers" ], "min": 0, "max": "*", "base": { "path": "BackboneElement.modifierExtension", "min": 0, "max": "*" }, "type": [ { "code": "Extension" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children unless an empty Parameters resource", "expression": "hasValue() or (children().count() > id.count()) or $this is Parameters", "xpath": "@value|f:*|h:div|self::f:Parameters", "source": "http://hl7.org/fhir/StructureDefinition/Element" }, { "key": "ext-1", "severity": "error", "human": "Must have either extensions or value[x], not both", "expression": "extension.exists() != value.exists()", "xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])", "source": "http://hl7.org/fhir/StructureDefinition/Extension" } ], "isModifier": true, "isModifierReason": "Modifier extensions are expected to modify the meaning or interpretation of the element that contains them", "isSummary": true, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "rim", "map": "N/A" } ] }, { "id": "ClaimResponse.total.category", "path": "ClaimResponse.total.category", "short": "Type of adjudication information", "definition": "Berisi data Kode untuk menunjukkan jenis informasi catatan ajudikasi ini. Jenis informasi dapat mencakup: nilai yang diajukan, nilai maksimum atau persentase yang diperbolehkan atau dibayarkan berdasarkan program, jumlah yang menjadi tanggung jawab pasien secara keseluruhan atau berkaitan dengan item ini, jumlah yang dibayarkan oleh pertanggungan lain, dan manfaat yang dibayarkan untuk item ini. Tipe data yang digunakan adalah CodeableConcept.", "comment": "For example codes indicating: Co-Pay, deductible, eligible, benefit, tax, etc.", "requirements": "Needed to convey the type of total provided.", "min": 1, "max": "1", "base": { "path": "ClaimResponse.total.category", "min": 1, "max": "1" }, "type": [ { "code": "CodeableConcept" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children unless an empty Parameters resource", "expression": "hasValue() or (children().count() > id.count()) or $this is Parameters", "xpath": "@value|f:*|h:div|self::f:Parameters", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "mustSupport": false, "isModifier": false, "isSummary": true, "binding": { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString": "Adjudication" } ], "strength": "example", "description": "The adjudication codes.", "valueSet": "http://hl7.org/fhir/ValueSet/adjudication" }, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "v2", "map": "CE/CNE/CWE" }, { "identity": "rim", "map": "CD" }, { "identity": "orim", "map": "fhir:CodeableConcept rdfs:subClassOf dt:CD" } ] }, { "id": "ClaimResponse.total.category.id", "path": "ClaimResponse.total.category.id", "representation": [ "xmlAttr" ], "short": "Unique id for inter-element referencing", "definition": "Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.", "min": 0, "max": "1", "base": { "path": "Element.id", "min": 0, "max": "1" }, "type": [ { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type", "valueUrl": "id" } ], "code": "http://hl7.org/fhirpath/System.String" } ], "mapping": [ { "identity": "rim", "map": "n/a" } ] }, { "id": "ClaimResponse.total.category.extension", "path": "ClaimResponse.total.category.extension", "slicing": { "discriminator": [ { "type": "value", "path": "url" } ], "description": "Extensions are always sliced by (at least) url", "rules": "open" }, "short": "Additional content defined by implementations", "definition": "May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.", "comment": "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.", "alias": [ "extensions", "user content" ], "min": 0, "max": "*", "base": { "path": "Element.extension", "min": 0, "max": "*" }, "type": [ { "code": "Extension" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children unless an empty Parameters resource", "expression": "hasValue() or (children().count() > id.count()) or $this is Parameters", "xpath": "@value|f:*|h:div|self::f:Parameters", "source": "http://hl7.org/fhir/StructureDefinition/Element" }, { "key": "ext-1", "severity": "error", "human": "Must have either extensions or value[x], not both", "expression": "extension.exists() != value.exists()", "xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])", "source": "http://hl7.org/fhir/StructureDefinition/Extension" } ], "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "rim", "map": "N/A" } ] }, { "id": "ClaimResponse.total.category.coding", "path": "ClaimResponse.total.category.coding", "short": "Code defined by a terminology system", "definition": "Berisi data Kode untuk menunjukkan jenis informasi catatan ajudikasi ini. Jenis informasi dapat mencakup: nilai yang diajukan, nilai maksimum atau persentase yang diperbolehkan atau dibayarkan berdasarkan program, jumlah yang menjadi tanggung jawab pasien secara keseluruhan atau berkaitan dengan item ini, jumlah yang dibayarkan oleh pertanggungan lain, dan manfaat yang dibayarkan untuk item ini. Tipe data yang digunakan adalah Coding yang nilainya dapat mengacu pada contoh data terminologi Adjudication Value Codes.", "comment": "Codes may be defined very casually in enumerations, or code lists, up to very formal definitions such as SNOMED CT - see the HL7 v3 Core Principles for more information. Ordering of codings is undefined and SHALL NOT be used to infer meaning. Generally, at most only one of the coding values will be labeled as UserSelected = true.", "requirements": "Allows for alternative encodings within a code system, and translations to other code systems.", "min": 0, "max": "*", "base": { "path": "CodeableConcept.coding", "min": 0, "max": "*" }, "type": [ { "code": "Coding" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children unless an empty Parameters resource", "expression": "hasValue() or (children().count() > id.count()) or $this is Parameters", "xpath": "@value|f:*|h:div|self::f:Parameters", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "isSummary": true, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "v2", "map": "CE/CNE/CWE subset one of the sets of component 1-3 or 4-6" }, { "identity": "rim", "map": "CV" }, { "identity": "orim", "map": "fhir:Coding rdfs:subClassOf dt:CDCoding" }, { "identity": "v2", "map": "C*E.1-8, C*E.10-22" }, { "identity": "rim", "map": "union(., ./translation)" }, { "identity": "orim", "map": "fhir:CodeableConcept.coding rdfs:subPropertyOf dt:CD.coding" } ] }, { "id": "ClaimResponse.total.category.text", "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-translatable", "valueBoolean": true }, { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-translatable", "valueBoolean": true } ], "path": "ClaimResponse.total.category.text", "short": "Plain text representation of the concept", "definition": "A human language representation of the concept as seen/selected/uttered by the user who entered the data and/or which represents the intended meaning of the user.", "comment": "Very often the text is the same as a displayName of one of the codings.", "requirements": "The codes from the terminologies do not always capture the correct meaning with all the nuances of the human using them, or sometimes there is no appropriate code at all. In these cases, the text is used to capture the full meaning of the source.", "min": 0, "max": "1", "base": { "path": "CodeableConcept.text", "min": 0, "max": "1" }, "type": [ { "code": "string" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children unless an empty Parameters resource", "expression": "hasValue() or (children().count() > id.count()) or $this is Parameters", "xpath": "@value|f:*|h:div|self::f:Parameters", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "isSummary": true, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "v2", "map": "C*E.9. But note many systems use C*E.2 for this" }, { "identity": "rim", "map": "./originalText[mediaType/code=\"text/plain\"]/data" }, { "identity": "orim", "map": "fhir:CodeableConcept.text rdfs:subPropertyOf dt:CD.originalText" } ] }, { "id": "ClaimResponse.total.amount", "path": "ClaimResponse.total.amount", "short": "Financial total for the category", "definition": "Berisi data jumlah total biaya yang terkait dengan kategori dengan tipe data Money.", "requirements": "Needed to convey the total monetary amount.", "min": 1, "max": "1", "base": { "path": "ClaimResponse.total.amount", "min": 1, "max": "1" }, "type": [ { "code": "Money" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children unless an empty Parameters resource", "expression": "hasValue() or (children().count() > id.count()) or $this is Parameters", "xpath": "@value|f:*|h:div|self::f:Parameters", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "mustSupport": false, "isModifier": false, "isSummary": true, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "rim", "map": "MO" } ] }, { "id": "ClaimResponse.payment", "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-explicit-type-name", "valueString": "Payment" } ], "path": "ClaimResponse.payment", "short": "Payment Details", "definition": "Berisi data rincian pembayaran untuk ajudikasi klaim dengan tipe data BackboneElement.", "requirements": "Needed to convey references to the financial instrument that has been used if payment has been made.", "min": 0, "max": "1", "base": { "path": "ClaimResponse.payment", "min": 0, "max": "1" }, "type": [ { "code": "BackboneElement" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children unless an empty Parameters resource", "expression": "hasValue() or (children().count() > id.count()) or $this is Parameters", "xpath": "@value|f:*|h:div|self::f:Parameters", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "mustSupport": false, "isModifier": false, "isSummary": false, "mapping": [ { "identity": "rim", "map": "n/a" } ] }, { "id": "ClaimResponse.payment.id", "path": "ClaimResponse.payment.id", "representation": [ "xmlAttr" ], "short": "Unique id for inter-element referencing", "definition": "Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.", "min": 0, "max": "1", "base": { "path": "Element.id", "min": 0, "max": "1" }, "type": [ { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type", "valueUrl": "id" } ], "code": "http://hl7.org/fhirpath/System.String" } ], "mapping": [ { "identity": "rim", "map": "n/a" } ] }, { "id": "ClaimResponse.payment.extension", "path": "ClaimResponse.payment.extension", "slicing": { "discriminator": [ { "type": "value", "path": "url" } ], "description": "Extensions are always sliced by (at least) url", "rules": "open" }, "short": "Additional content defined by implementations", "definition": "May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.", "comment": "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.", "alias": [ "extensions", "user content" ], "min": 0, "max": "*", "base": { "path": "Element.extension", "min": 0, "max": "*" }, "type": [ { "code": "Extension" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children unless an empty Parameters resource", "expression": "hasValue() or (children().count() > id.count()) or $this is Parameters", "xpath": "@value|f:*|h:div|self::f:Parameters", "source": "http://hl7.org/fhir/StructureDefinition/Element" }, { "key": "ext-1", "severity": "error", "human": "Must have either extensions or value[x], not both", "expression": "extension.exists() != value.exists()", "xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])", "source": "http://hl7.org/fhir/StructureDefinition/Extension" } ], "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "rim", "map": "N/A" } ] }, { "id": "ClaimResponse.payment.modifierExtension", "path": "ClaimResponse.payment.modifierExtension", "short": "Extensions that cannot be ignored even if unrecognized", "definition": "May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.\n\nModifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).", "comment": "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.", "requirements": "Modifier extensions allow for extensions that *cannot* be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the [definition of modifier extensions](extensibility.html#modifierExtension).", "alias": [ "extensions", "user content", "modifiers" ], "min": 0, "max": "*", "base": { "path": "BackboneElement.modifierExtension", "min": 0, "max": "*" }, "type": [ { "code": "Extension" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children unless an empty Parameters resource", "expression": "hasValue() or (children().count() > id.count()) or $this is Parameters", "xpath": "@value|f:*|h:div|self::f:Parameters", "source": "http://hl7.org/fhir/StructureDefinition/Element" }, { "key": "ext-1", "severity": "error", "human": "Must have either extensions or value[x], not both", "expression": "extension.exists() != value.exists()", "xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])", "source": "http://hl7.org/fhir/StructureDefinition/Extension" } ], "isModifier": true, "isModifierReason": "Modifier extensions are expected to modify the meaning or interpretation of the element that contains them", "isSummary": true, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "rim", "map": "N/A" } ] }, { "id": "ClaimResponse.payment.type", "path": "ClaimResponse.payment.type", "short": "Partial or complete payment", "definition": "Berisi data jenis pembayaran untuk membedakan apakah merupakan pembayaran sebagian atau seluruhnya dari manfaat yang dibayarkan dengan tipe data CodeableConcept.", "comment": "Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination.", "requirements": "To advise the requestor when the insurer believes all payments to have been completed.", "min": 1, "max": "1", "base": { "path": "ClaimResponse.payment.type", "min": 1, "max": "1" }, "type": [ { "code": "CodeableConcept" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children unless an empty Parameters resource", "expression": "hasValue() or (children().count() > id.count()) or $this is Parameters", "xpath": "@value|f:*|h:div|self::f:Parameters", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "mustSupport": false, "isModifier": false, "isSummary": false, "binding": { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString": "PaymentType" } ], "strength": "example", "description": "The type (partial, complete) of the payment.", "valueSet": "http://hl7.org/fhir/ValueSet/ex-paymenttype" }, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "v2", "map": "CE/CNE/CWE" }, { "identity": "rim", "map": "CD" }, { "identity": "orim", "map": "fhir:CodeableConcept rdfs:subClassOf dt:CD" } ] }, { "id": "ClaimResponse.payment.type.id", "path": "ClaimResponse.payment.type.id", "representation": [ "xmlAttr" ], "short": "Unique id for inter-element referencing", "definition": "Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.", "min": 0, "max": "1", "base": { "path": "Element.id", "min": 0, "max": "1" }, "type": [ { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type", "valueUrl": "id" } ], "code": "http://hl7.org/fhirpath/System.String" } ], "mapping": [ { "identity": "rim", "map": "n/a" } ] }, { "id": "ClaimResponse.payment.type.extension", "path": "ClaimResponse.payment.type.extension", "slicing": { "discriminator": [ { "type": "value", "path": "url" } ], "description": "Extensions are always sliced by (at least) url", "rules": "open" }, "short": "Additional content defined by implementations", "definition": "May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.", "comment": "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.", "alias": [ "extensions", "user content" ], "min": 0, "max": "*", "base": { "path": "Element.extension", "min": 0, "max": "*" }, "type": [ { "code": "Extension" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children unless an empty Parameters resource", "expression": "hasValue() or (children().count() > id.count()) or $this is Parameters", "xpath": "@value|f:*|h:div|self::f:Parameters", "source": "http://hl7.org/fhir/StructureDefinition/Element" }, { "key": "ext-1", "severity": "error", "human": "Must have either extensions or value[x], not both", "expression": "extension.exists() != value.exists()", "xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])", "source": "http://hl7.org/fhir/StructureDefinition/Extension" } ], "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "rim", "map": "N/A" } ] }, { "id": "ClaimResponse.payment.type.coding", "path": "ClaimResponse.payment.type.coding", "short": "Code defined by a terminology system", "definition": "Berisi data jenis pembayaran untuk membedakan apakah merupakan pembayaran sebagian atau seluruhnya dari manfaat yang dibayarkan dengan tipe data Coding yang nilainya dapat mengacu pada contoh data terminologi Example Payment Type Codes.", "comment": "Codes may be defined very casually in enumerations, or code lists, up to very formal definitions such as SNOMED CT - see the HL7 v3 Core Principles for more information. Ordering of codings is undefined and SHALL NOT be used to infer meaning. Generally, at most only one of the coding values will be labeled as UserSelected = true.", "requirements": "Allows for alternative encodings within a code system, and translations to other code systems.", "min": 0, "max": "*", "base": { "path": "CodeableConcept.coding", "min": 0, "max": "*" }, "type": [ { "code": "Coding" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children unless an empty Parameters resource", "expression": "hasValue() or (children().count() > id.count()) or $this is Parameters", "xpath": "@value|f:*|h:div|self::f:Parameters", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "isSummary": true, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "v2", "map": "CE/CNE/CWE subset one of the sets of component 1-3 or 4-6" }, { "identity": "rim", "map": "CV" }, { "identity": "orim", "map": "fhir:Coding rdfs:subClassOf dt:CDCoding" }, { "identity": "v2", "map": "C*E.1-8, C*E.10-22" }, { "identity": "rim", "map": "union(., ./translation)" }, { "identity": "orim", "map": "fhir:CodeableConcept.coding rdfs:subPropertyOf dt:CD.coding" } ] }, { "id": "ClaimResponse.payment.type.text", "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-translatable", "valueBoolean": true }, { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-translatable", "valueBoolean": true } ], "path": "ClaimResponse.payment.type.text", "short": "Plain text representation of the concept", "definition": "A human language representation of the concept as seen/selected/uttered by the user who entered the data and/or which represents the intended meaning of the user.", "comment": "Very often the text is the same as a displayName of one of the codings.", "requirements": "The codes from the terminologies do not always capture the correct meaning with all the nuances of the human using them, or sometimes there is no appropriate code at all. In these cases, the text is used to capture the full meaning of the source.", "min": 0, "max": "1", "base": { "path": "CodeableConcept.text", "min": 0, "max": "1" }, "type": [ { "code": "string" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children unless an empty Parameters resource", "expression": "hasValue() or (children().count() > id.count()) or $this is Parameters", "xpath": "@value|f:*|h:div|self::f:Parameters", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "isSummary": true, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "v2", "map": "C*E.9. But note many systems use C*E.2 for this" }, { "identity": "rim", "map": "./originalText[mediaType/code=\"text/plain\"]/data" }, { "identity": "orim", "map": "fhir:CodeableConcept.text rdfs:subPropertyOf dt:CD.originalText" } ] }, { "id": "ClaimResponse.payment.adjustment", "path": "ClaimResponse.payment.adjustment", "short": "Payment adjustment for non-claim issues", "definition": "Berisi data jumlah total dari semua penyesuaian untuk pembayaran yang termasuk dalam transaksi yang tidak terkait dengan ajudikasi klaim dengan tipe data Money.", "comment": "Insurers will deduct amounts owing from the provider (adjustment), such as a prior overpayment, from the amount owing to the provider (benefits payable) when payment is made to the provider.", "requirements": "To advise the requestor of adjustments applied to the payment.", "min": 0, "max": "1", "base": { "path": "ClaimResponse.payment.adjustment", "min": 0, "max": "1" }, "type": [ { "code": "Money" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children unless an empty Parameters resource", "expression": "hasValue() or (children().count() > id.count()) or $this is Parameters", "xpath": "@value|f:*|h:div|self::f:Parameters", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "mustSupport": false, "isModifier": false, "isSummary": false, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "rim", "map": "MO" } ] }, { "id": "ClaimResponse.payment.adjustmentReason", "path": "ClaimResponse.payment.adjustmentReason", "short": "Explanation for the adjustment", "definition": "Berisi data alasan penyesuaian pembayaran dengan tipe data CodeableConcept.", "comment": "Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination.", "requirements": "Needed to clarify the monetary adjustment.", "min": 0, "max": "1", "base": { "path": "ClaimResponse.payment.adjustmentReason", "min": 0, "max": "1" }, "type": [ { "code": "CodeableConcept" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children unless an empty Parameters resource", "expression": "hasValue() or (children().count() > id.count()) or $this is Parameters", "xpath": "@value|f:*|h:div|self::f:Parameters", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "mustSupport": false, "isModifier": false, "isSummary": false, "binding": { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString": "PaymentAdjustmentReason" } ], "strength": "example", "description": "Payment Adjustment reason codes.", "valueSet": "http://hl7.org/fhir/ValueSet/payment-adjustment-reason" }, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "v2", "map": "CE/CNE/CWE" }, { "identity": "rim", "map": "CD" }, { "identity": "orim", "map": "fhir:CodeableConcept rdfs:subClassOf dt:CD" } ] }, { "id": "ClaimResponse.payment.date", "path": "ClaimResponse.payment.date", "short": "Expected date of payment", "definition": "Berisi data perkiraan tanggal pembayaran akan dikeluarkan atau tanggal penerbitan pembayaran yang sebenarnya dengan tipe data date.", "requirements": "To advise the payee when payment can be expected.", "min": 0, "max": "1", "base": { "path": "ClaimResponse.payment.date", "min": 0, "max": "1" }, "type": [ { "code": "date" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children unless an empty Parameters resource", "expression": "hasValue() or (children().count() > id.count()) or $this is Parameters", "xpath": "@value|f:*|h:div|self::f:Parameters", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "mustSupport": false, "isModifier": false, "isSummary": false, "mapping": [ { "identity": "rim", "map": "n/a" } ] }, { "id": "ClaimResponse.payment.amount", "path": "ClaimResponse.payment.amount", "short": "Payable amount after adjustment", "definition": "Berisi data manfaat yang dibayarkan dikurangi penyesuaian pembayaran dengan tipe data Money.", "requirements": "Needed to provide the actual payment amount.", "min": 1, "max": "1", "base": { "path": "ClaimResponse.payment.amount", "min": 1, "max": "1" }, "type": [ { "code": "Money" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children unless an empty Parameters resource", "expression": "hasValue() or (children().count() > id.count()) or $this is Parameters", "xpath": "@value|f:*|h:div|self::f:Parameters", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "mustSupport": false, "isModifier": false, "isSummary": false, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "rim", "map": "MO" } ] }, { "id": "ClaimResponse.payment.identifier", "path": "ClaimResponse.payment.identifier", "short": "Business identifier for the payment", "definition": "Berisi data pengidentifikasi unik penerbit untuk instrumen pembayaran dengan tipe data Identifier.", "comment": "For example: EFT number or check number.", "requirements": "Enable the receiver to reconcile when payment received.", "min": 0, "max": "1", "base": { "path": "ClaimResponse.payment.identifier", "min": 0, "max": "1" }, "type": [ { "code": "Identifier" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children unless an empty Parameters resource", "expression": "hasValue() or (children().count() > id.count()) or $this is Parameters", "xpath": "@value|f:*|h:div|self::f:Parameters", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "mustSupport": false, "isModifier": false, "isSummary": false, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "v2", "map": "CX / EI (occasionally, more often EI maps to a resource id or a URL)" }, { "identity": "rim", "map": "II - The Identifier class is a little looser than the v3 type II because it allows URIs as well as registered OIDs or GUIDs. Also maps to Role[classCode=IDENT]" }, { "identity": "servd", "map": "Identifier" } ] }, { "id": "ClaimResponse.fundsReserve", "path": "ClaimResponse.fundsReserve", "short": "Funds reserved status", "definition": "Berisi data sebuah kode, yang digunakan hanya sebagai tanggapan atas pra-otorisasi, untuk menunjukkan apakah tunjangan yang dibayarkan telah dipesan dan untuk siapa dengan tipe data CodeableConcept.", "comment": "Fund would be release by a future claim quoting the preAuthRef of this response. Examples of values include: provider, patient, none.", "requirements": "Needed to advise the submitting provider on whether the rquest for reservation of funds has been honored.", "min": 0, "max": "1", "base": { "path": "ClaimResponse.fundsReserve", "min": 0, "max": "1" }, "type": [ { "code": "CodeableConcept" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children unless an empty Parameters resource", "expression": "hasValue() or (children().count() > id.count()) or $this is Parameters", "xpath": "@value|f:*|h:div|self::f:Parameters", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "mustSupport": false, "isModifier": false, "isSummary": false, "binding": { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString": "FundsReserve" } ], "strength": "example", "description": "For whom funds are to be reserved: (Patient, Provider, None).", "valueSet": "http://hl7.org/fhir/ValueSet/fundsreserve" }, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "v2", "map": "CE/CNE/CWE" }, { "identity": "rim", "map": "CD" }, { "identity": "orim", "map": "fhir:CodeableConcept rdfs:subClassOf dt:CD" } ] }, { "id": "ClaimResponse.fundsReserve.id", "path": "ClaimResponse.fundsReserve.id", "representation": [ "xmlAttr" ], "short": "Unique id for inter-element referencing", "definition": "Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.", "min": 0, "max": "1", "base": { "path": "Element.id", "min": 0, "max": "1" }, "type": [ { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type", "valueUrl": "id" } ], "code": "http://hl7.org/fhirpath/System.String" } ], "mapping": [ { "identity": "rim", "map": "n/a" } ] }, { "id": "ClaimResponse.fundsReserve.extension", "path": "ClaimResponse.fundsReserve.extension", "slicing": { "discriminator": [ { "type": "value", "path": "url" } ], "description": "Extensions are always sliced by (at least) url", "rules": "open" }, "short": "Additional content defined by implementations", "definition": "May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.", "comment": "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.", "alias": [ "extensions", "user content" ], "min": 0, "max": "*", "base": { "path": "Element.extension", "min": 0, "max": "*" }, "type": [ { "code": "Extension" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children unless an empty Parameters resource", "expression": "hasValue() or (children().count() > id.count()) or $this is Parameters", "xpath": "@value|f:*|h:div|self::f:Parameters", "source": "http://hl7.org/fhir/StructureDefinition/Element" }, { "key": "ext-1", "severity": "error", "human": "Must have either extensions or value[x], not both", "expression": "extension.exists() != value.exists()", "xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])", "source": "http://hl7.org/fhir/StructureDefinition/Extension" } ], "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "rim", "map": "N/A" } ] }, { "id": "ClaimResponse.fundsReserve.coding", "path": "ClaimResponse.fundsReserve.coding", "short": "Code defined by a terminology system", "definition": "Berisi data sebuah kode, yang digunakan hanya sebagai tanggapan atas pra-otorisasi, untuk menunjukkan apakah tunjangan yang dibayarkan telah dipesan dan untuk siapa dengan tipe data Coding yang nilainya dapat mengacu pada contoh data terminologi FundsReserve.", "comment": "Codes may be defined very casually in enumerations, or code lists, up to very formal definitions such as SNOMED CT - see the HL7 v3 Core Principles for more information. Ordering of codings is undefined and SHALL NOT be used to infer meaning. Generally, at most only one of the coding values will be labeled as UserSelected = true.", "requirements": "Allows for alternative encodings within a code system, and translations to other code systems.", "min": 0, "max": "*", "base": { "path": "CodeableConcept.coding", "min": 0, "max": "*" }, "type": [ { "code": "Coding" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children unless an empty Parameters resource", "expression": "hasValue() or (children().count() > id.count()) or $this is Parameters", "xpath": "@value|f:*|h:div|self::f:Parameters", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "isSummary": true, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "v2", "map": "CE/CNE/CWE subset one of the sets of component 1-3 or 4-6" }, { "identity": "rim", "map": "CV" }, { "identity": "orim", "map": "fhir:Coding rdfs:subClassOf dt:CDCoding" }, { "identity": "v2", "map": "C*E.1-8, C*E.10-22" }, { "identity": "rim", "map": "union(., ./translation)" }, { "identity": "orim", "map": "fhir:CodeableConcept.coding rdfs:subPropertyOf dt:CD.coding" } ] }, { "id": "ClaimResponse.fundsReserve.text", "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-translatable", "valueBoolean": true }, { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-translatable", "valueBoolean": true } ], "path": "ClaimResponse.fundsReserve.text", "short": "Plain text representation of the concept", "definition": "A human language representation of the concept as seen/selected/uttered by the user who entered the data and/or which represents the intended meaning of the user.", "comment": "Very often the text is the same as a displayName of one of the codings.", "requirements": "The codes from the terminologies do not always capture the correct meaning with all the nuances of the human using them, or sometimes there is no appropriate code at all. In these cases, the text is used to capture the full meaning of the source.", "min": 0, "max": "1", "base": { "path": "CodeableConcept.text", "min": 0, "max": "1" }, "type": [ { "code": "string" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children unless an empty Parameters resource", "expression": "hasValue() or (children().count() > id.count()) or $this is Parameters", "xpath": "@value|f:*|h:div|self::f:Parameters", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "isSummary": true, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "v2", "map": "C*E.9. But note many systems use C*E.2 for this" }, { "identity": "rim", "map": "./originalText[mediaType/code=\"text/plain\"]/data" }, { "identity": "orim", "map": "fhir:CodeableConcept.text rdfs:subPropertyOf dt:CD.originalText" } ] }, { "id": "ClaimResponse.formCode", "path": "ClaimResponse.formCode", "short": "Printed form identifier", "definition": "Berisi data kode untuk formulir yang akan digunakan untuk mencetak konten dengan tipe data CodeableConcept.", "comment": "May be needed to identify specific jurisdictional forms.", "requirements": "Needed to specify the specific form used for producing output for this response.", "min": 0, "max": "1", "base": { "path": "ClaimResponse.formCode", "min": 0, "max": "1" }, "type": [ { "code": "CodeableConcept" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children unless an empty Parameters resource", "expression": "hasValue() or (children().count() > id.count()) or $this is Parameters", "xpath": "@value|f:*|h:div|self::f:Parameters", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "mustSupport": false, "isModifier": false, "isSummary": false, "binding": { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString": "Forms" } ], "strength": "example", "description": "The forms codes.", "valueSet": "http://hl7.org/fhir/ValueSet/forms" }, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "v2", "map": "CE/CNE/CWE" }, { "identity": "rim", "map": "CD" }, { "identity": "orim", "map": "fhir:CodeableConcept rdfs:subClassOf dt:CD" } ] }, { "id": "ClaimResponse.formCode.id", "path": "ClaimResponse.formCode.id", "representation": [ "xmlAttr" ], "short": "Unique id for inter-element referencing", "definition": "Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.", "min": 0, "max": "1", "base": { "path": "Element.id", "min": 0, "max": "1" }, "type": [ { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type", "valueUrl": "id" } ], "code": "http://hl7.org/fhirpath/System.String" } ], "mapping": [ { "identity": "rim", "map": "n/a" } ] }, { "id": "ClaimResponse.formCode.extension", "path": "ClaimResponse.formCode.extension", "slicing": { "discriminator": [ { "type": "value", "path": "url" } ], "description": "Extensions are always sliced by (at least) url", "rules": "open" }, "short": "Additional content defined by implementations", "definition": "May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.", "comment": "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.", "alias": [ "extensions", "user content" ], "min": 0, "max": "*", "base": { "path": "Element.extension", "min": 0, "max": "*" }, "type": [ { "code": "Extension" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children unless an empty Parameters resource", "expression": "hasValue() or (children().count() > id.count()) or $this is Parameters", "xpath": "@value|f:*|h:div|self::f:Parameters", "source": "http://hl7.org/fhir/StructureDefinition/Element" }, { "key": "ext-1", "severity": "error", "human": "Must have either extensions or value[x], not both", "expression": "extension.exists() != value.exists()", "xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])", "source": "http://hl7.org/fhir/StructureDefinition/Extension" } ], "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "rim", "map": "N/A" } ] }, { "id": "ClaimResponse.formCode.coding", "path": "ClaimResponse.formCode.coding", "short": "Code defined by a terminology system", "definition": "Berisi data kode untuk formulir yang akan digunakan untuk mencetak konten dengan tipe data Coding yang nilainya dapat mengacu pada contoh data terminologi Forms.", "comment": "Codes may be defined very casually in enumerations, or code lists, up to very formal definitions such as SNOMED CT - see the HL7 v3 Core Principles for more information. Ordering of codings is undefined and SHALL NOT be used to infer meaning. Generally, at most only one of the coding values will be labeled as UserSelected = true.", "requirements": "Allows for alternative encodings within a code system, and translations to other code systems.", "min": 0, "max": "*", "base": { "path": "CodeableConcept.coding", "min": 0, "max": "*" }, "type": [ { "code": "Coding" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children unless an empty Parameters resource", "expression": "hasValue() or (children().count() > id.count()) or $this is Parameters", "xpath": "@value|f:*|h:div|self::f:Parameters", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "isSummary": true, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "v2", "map": "CE/CNE/CWE subset one of the sets of component 1-3 or 4-6" }, { "identity": "rim", "map": "CV" }, { "identity": "orim", "map": "fhir:Coding rdfs:subClassOf dt:CDCoding" }, { "identity": "v2", "map": "C*E.1-8, C*E.10-22" }, { "identity": "rim", "map": "union(., ./translation)" }, { "identity": "orim", "map": "fhir:CodeableConcept.coding rdfs:subPropertyOf dt:CD.coding" } ] }, { "id": "ClaimResponse.formCode.text", "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-translatable", "valueBoolean": true }, { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-translatable", "valueBoolean": true } ], "path": "ClaimResponse.formCode.text", "short": "Plain text representation of the concept", "definition": "A human language representation of the concept as seen/selected/uttered by the user who entered the data and/or which represents the intended meaning of the user.", "comment": "Very often the text is the same as a displayName of one of the codings.", "requirements": "The codes from the terminologies do not always capture the correct meaning with all the nuances of the human using them, or sometimes there is no appropriate code at all. In these cases, the text is used to capture the full meaning of the source.", "min": 0, "max": "1", "base": { "path": "CodeableConcept.text", "min": 0, "max": "1" }, "type": [ { "code": "string" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children unless an empty Parameters resource", "expression": "hasValue() or (children().count() > id.count()) or $this is Parameters", "xpath": "@value|f:*|h:div|self::f:Parameters", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "isSummary": true, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "v2", "map": "C*E.9. But note many systems use C*E.2 for this" }, { "identity": "rim", "map": "./originalText[mediaType/code=\"text/plain\"]/data" }, { "identity": "orim", "map": "fhir:CodeableConcept.text rdfs:subPropertyOf dt:CD.originalText" } ] }, { "id": "ClaimResponse.form", "path": "ClaimResponse.form", "short": "Printed reference or actual form", "definition": "Berisi data bentuk sebenarnya, dengan referensi atau penyertaan, untuk mencetak konten atau EOB dengan tipe data Attachment.", "comment": "Needed to permit insurers to include the actual form.", "requirements": "Needed to include the specific form used for producing output for this response.", "min": 0, "max": "1", "base": { "path": "ClaimResponse.form", "min": 0, "max": "1" }, "type": [ { "code": "Attachment" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children unless an empty Parameters resource", "expression": "hasValue() or (children().count() > id.count()) or $this is Parameters", "xpath": "@value|f:*|h:div|self::f:Parameters", "source": "http://hl7.org/fhir/StructureDefinition/Element" }, { "key": "att-1", "severity": "error", "human": "If the Attachment has data, it SHALL have a contentType", "expression": "data.empty() or contentType.exists()", "xpath": "not(exists(f:data)) or exists(f:contentType)", "source": "http://hl7.org/fhir/StructureDefinition/Attachment" } ], "mustSupport": false, "isModifier": false, "isSummary": false, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "v2", "map": "ED/RP" }, { "identity": "rim", "map": "ED" } ] }, { "id": "ClaimResponse.processNote", "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-explicit-type-name", "valueString": "Note" } ], "path": "ClaimResponse.processNote", "short": "Note concerning adjudication", "definition": "Berisi data catatan yang menggambarkan atau menjelaskan hasil ajudikasi dalam bentuk yang dapat dibaca manusia dengan tipe data BackboneElement.", "requirements": "Provides the insurer specific textual explanations associated with the processing.", "min": 0, "max": "*", "base": { "path": "ClaimResponse.processNote", "min": 0, "max": "*" }, "type": [ { "code": "BackboneElement" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children unless an empty Parameters resource", "expression": "hasValue() or (children().count() > id.count()) or $this is Parameters", "xpath": "@value|f:*|h:div|self::f:Parameters", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "mustSupport": false, "isModifier": false, "isSummary": false, "mapping": [ { "identity": "rim", "map": "n/a" } ] }, { "id": "ClaimResponse.processNote.id", "path": "ClaimResponse.processNote.id", "representation": [ "xmlAttr" ], "short": "Unique id for inter-element referencing", "definition": "Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.", "min": 0, "max": "1", "base": { "path": "Element.id", "min": 0, "max": "1" }, "type": [ { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type", "valueUrl": "id" } ], "code": "http://hl7.org/fhirpath/System.String" } ], "mapping": [ { "identity": "rim", "map": "n/a" } ] }, { "id": "ClaimResponse.processNote.extension", "path": "ClaimResponse.processNote.extension", "slicing": { "discriminator": [ { "type": "value", "path": "url" } ], "description": "Extensions are always sliced by (at least) url", "rules": "open" }, "short": "Additional content defined by implementations", "definition": "May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.", "comment": "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.", "alias": [ "extensions", "user content" ], "min": 0, "max": "*", "base": { "path": "Element.extension", "min": 0, "max": "*" }, "type": [ { "code": "Extension" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children unless an empty Parameters resource", "expression": "hasValue() or (children().count() > id.count()) or $this is Parameters", "xpath": "@value|f:*|h:div|self::f:Parameters", "source": "http://hl7.org/fhir/StructureDefinition/Element" }, { "key": "ext-1", "severity": "error", "human": "Must have either extensions or value[x], not both", "expression": "extension.exists() != value.exists()", "xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])", "source": "http://hl7.org/fhir/StructureDefinition/Extension" } ], "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "rim", "map": "N/A" } ] }, { "id": "ClaimResponse.processNote.modifierExtension", "path": "ClaimResponse.processNote.modifierExtension", "short": "Extensions that cannot be ignored even if unrecognized", "definition": "May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.\n\nModifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).", "comment": "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.", "requirements": "Modifier extensions allow for extensions that *cannot* be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the [definition of modifier extensions](extensibility.html#modifierExtension).", "alias": [ "extensions", "user content", "modifiers" ], "min": 0, "max": "*", "base": { "path": "BackboneElement.modifierExtension", "min": 0, "max": "*" }, "type": [ { "code": "Extension" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children unless an empty Parameters resource", "expression": "hasValue() or (children().count() > id.count()) or $this is Parameters", "xpath": "@value|f:*|h:div|self::f:Parameters", "source": "http://hl7.org/fhir/StructureDefinition/Element" }, { "key": "ext-1", "severity": "error", "human": "Must have either extensions or value[x], not both", "expression": "extension.exists() != value.exists()", "xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])", "source": "http://hl7.org/fhir/StructureDefinition/Extension" } ], "isModifier": true, "isModifierReason": "Modifier extensions are expected to modify the meaning or interpretation of the element that contains them", "isSummary": true, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "rim", "map": "N/A" } ] }, { "id": "ClaimResponse.processNote.number", "path": "ClaimResponse.processNote.number", "short": "Note instance identifier", "definition": "Berisi data nomor unik untuk mengidentifikasi entri catatan dengan tipe data positiveInt.", "comment": "32 bit number; for values larger than this, use decimal", "requirements": "Necessary to provide a mechanism to link from adjudications.", "min": 1, "max": "1", "base": { "path": "ClaimResponse.processNote.number", "min": 0, "max": "1" }, "type": [ { "code": "positiveInt" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children unless an empty Parameters resource", "expression": "hasValue() or (children().count() > id.count()) or $this is Parameters", "xpath": "@value|f:*|h:div|self::f:Parameters", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "mustSupport": false, "isModifier": false, "isSummary": false, "mapping": [ { "identity": "rim", "map": "n/a" } ] }, { "id": "ClaimResponse.processNote.type", "path": "ClaimResponse.processNote.type", "short": "display | print | printoper", "definition": "Berisi data tujuan bisnis dari teks catatan dengan tipe data code yang nilainya mengacu pada data terminologi NoteType.", "comment": "Note that FHIR strings SHALL NOT exceed 1MB in size", "requirements": "To convey the expectation for when the text is used.", "min": 0, "max": "1", "base": { "path": "ClaimResponse.processNote.type", "min": 0, "max": "1" }, "type": [ { "code": "code" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children unless an empty Parameters resource", "expression": "hasValue() or (children().count() > id.count()) or $this is Parameters", "xpath": "@value|f:*|h:div|self::f:Parameters", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "mustSupport": false, "isModifier": false, "isSummary": false, "binding": { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString": "NoteType" } ], "strength": "required", "description": "The presentation types of notes.", "valueSet": "http://hl7.org/fhir/ValueSet/note-type|4.3.0" }, "mapping": [ { "identity": "rim", "map": "n/a" } ] }, { "id": "ClaimResponse.processNote.text", "path": "ClaimResponse.processNote.text", "short": "Note explanatory text", "definition": "Berisi data penjelasan atau deskripsi yang terkait dengan pemrosesan dengan tipe data string.", "comment": "Note that FHIR strings SHALL NOT exceed 1MB in size", "requirements": "Required to provide human readable explanation.", "min": 1, "max": "1", "base": { "path": "ClaimResponse.processNote.text", "min": 1, "max": "1" }, "type": [ { "code": "string" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children unless an empty Parameters resource", "expression": "hasValue() or (children().count() > id.count()) or $this is Parameters", "xpath": "@value|f:*|h:div|self::f:Parameters", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "mustSupport": false, "isModifier": false, "isSummary": false, "mapping": [ { "identity": "rim", "map": "n/a" } ] }, { "id": "ClaimResponse.processNote.language", "path": "ClaimResponse.processNote.language", "short": "Language of the text", "definition": "Berisi data kode untuk menentukan bahasa yang digunakan dalam teks catatan dengan tipe data CodeableConcept yang nilainya lebih baik mengacu pada contoh data terminologi urn:ietf:bcp:47[Common Languages].", "comment": "Only required if the language is different from the resource language.", "requirements": "Note text may vary from the resource defined language.", "min": 0, "max": "1", "base": { "path": "ClaimResponse.processNote.language", "min": 0, "max": "1" }, "type": [ { "code": "CodeableConcept" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children unless an empty Parameters resource", "expression": "hasValue() or (children().count() > id.count()) or $this is Parameters", "xpath": "@value|f:*|h:div|self::f:Parameters", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "mustSupport": false, "isModifier": false, "isSummary": false, "binding": { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-maxValueSet", "valueCanonical": "http://hl7.org/fhir/ValueSet/all-languages" }, { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString": "Language" } ], "strength": "preferred", "description": "IETF language tag", "valueSet": "http://hl7.org/fhir/ValueSet/languages" }, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "v2", "map": "CE/CNE/CWE" }, { "identity": "rim", "map": "CD" }, { "identity": "orim", "map": "fhir:CodeableConcept rdfs:subClassOf dt:CD" } ] }, { "id": "ClaimResponse.communicationRequest", "path": "ClaimResponse.communicationRequest", "short": "Request for additional information", "definition": "Berisi data permintaan informasi pendukung atau otorisasi tambahan dengan tipe data Reference yang direferensikan ke data yang tersimpan di resource CommunicationRequest.", "comment": "For example: professional reports, documents, images, clinical resources, or accident reports.", "requirements": "Need to communicate insurer request for additional information required to support the adjudication.", "min": 0, "max": "*", "base": { "path": "ClaimResponse.communicationRequest", "min": 0, "max": "*" }, "type": [ { "code": "Reference", "targetProfile": [ "http://hl7.org/fhir/StructureDefinition/CommunicationRequest" ] } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children unless an empty Parameters resource", "expression": "hasValue() or (children().count() > id.count()) or $this is Parameters", "xpath": "@value|f:*|h:div|self::f:Parameters", "source": "http://hl7.org/fhir/StructureDefinition/Element" }, { "key": "ref-1", "severity": "error", "human": "SHALL have a contained resource if a local reference is provided", "expression": "reference.exists() implies (reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids')) or (reference='#' and %rootResource!=%resource))", "xpath": "not(starts-with(f:reference/@value, '#')) or exists(ancestor::*[self::f:entry or self::f:parameter]/f:resource/f:*/f:contained/f:*[f:id/@value=substring-after(current()/f:reference/@value, '#')]|/*/f:contained/f:*[f:id/@value=substring-after(current()/f:reference/@value, '#')])", "source": "http://hl7.org/fhir/StructureDefinition/Reference" } ], "mustSupport": false, "isModifier": false, "isSummary": false, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "rim", "map": "The target of a resource reference is a RIM entry point (Act, Role, or Entity)" } ] }, { "id": "ClaimResponse.insurance", "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-explicit-type-name", "valueString": "Insurance" } ], "path": "ClaimResponse.insurance", "short": "Patient insurance information", "definition": "Berisi data instrumen keuangan untuk penggantian produk dan layanan perawatan kesehatan yang ditentukan pada klaim. Semua pertanggungan asuransi untuk pasien yang mungkin berlaku untuk penggantian, dari produk dan layanan yang tercantum dalam klaim, biasanya diberikan dalam klaim untuk memungkinkan perusahaan asuransi mengkonfirmasi pemesanan pertanggungan asuransi relatif terhadap aturan 'koordinasi manfaat' setempat. Satu liputan (dan hanya satu) dengan 'focal=true' akan digunakan dalam putusan klaim ini. Cakupan muncul sebelum Cakupan fokus dalam daftar, dan di mana 'subrogasi = salah', harus memberikan referensi ke ClaimResponse berisi hasil ajudikasi dari klaim sebelumnya dengan tipe data BackboneElement.", "comment": "All insurance coverages for the patient which may be applicable for reimbursement, of the products and services listed in the claim, are typically provided in the claim to allow insurers to confirm the ordering of the insurance coverages relative to local 'coordination of benefit' rules. One coverage (and only one) with 'focal=true' is to be used in the adjudication of this claim. Coverages appearing before the focal Coverage in the list, and where 'subrogation=false', should provide a reference to the ClaimResponse containing the adjudication results of the prior claim.", "requirements": "At least one insurer is required for a claim to be a claim.", "min": 0, "max": "*", "base": { "path": "ClaimResponse.insurance", "min": 0, "max": "*" }, "type": [ { "code": "BackboneElement" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children unless an empty Parameters resource", "expression": "hasValue() or (children().count() > id.count()) or $this is Parameters", "xpath": "@value|f:*|h:div|self::f:Parameters", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "mustSupport": false, "isModifier": false, "isSummary": false, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "rim", "map": "Coverage" } ] }, { "id": "ClaimResponse.insurance.id", "path": "ClaimResponse.insurance.id", "representation": [ "xmlAttr" ], "short": "Unique id for inter-element referencing", "definition": "Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.", "min": 0, "max": "1", "base": { "path": "Element.id", "min": 0, "max": "1" }, "type": [ { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type", "valueUrl": "id" } ], "code": "http://hl7.org/fhirpath/System.String" } ], "mapping": [ { "identity": "rim", "map": "n/a" } ] }, { "id": "ClaimResponse.insurance.extension", "path": "ClaimResponse.insurance.extension", "slicing": { "discriminator": [ { "type": "value", "path": "url" } ], "description": "Extensions are always sliced by (at least) url", "rules": "open" }, "short": "Additional content defined by implementations", "definition": "May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.", "comment": "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.", "alias": [ "extensions", "user content" ], "min": 0, "max": "*", "base": { "path": "Element.extension", "min": 0, "max": "*" }, "type": [ { "code": "Extension" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children unless an empty Parameters resource", "expression": "hasValue() or (children().count() > id.count()) or $this is Parameters", "xpath": "@value|f:*|h:div|self::f:Parameters", "source": "http://hl7.org/fhir/StructureDefinition/Element" }, { "key": "ext-1", "severity": "error", "human": "Must have either extensions or value[x], not both", "expression": "extension.exists() != value.exists()", "xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])", "source": "http://hl7.org/fhir/StructureDefinition/Extension" } ], "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "rim", "map": "N/A" } ] }, { "id": "ClaimResponse.insurance.modifierExtension", "path": "ClaimResponse.insurance.modifierExtension", "short": "Extensions that cannot be ignored even if unrecognized", "definition": "May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.\n\nModifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).", "comment": "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.", "requirements": "Modifier extensions allow for extensions that *cannot* be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the [definition of modifier extensions](extensibility.html#modifierExtension).", "alias": [ "extensions", "user content", "modifiers" ], "min": 0, "max": "*", "base": { "path": "BackboneElement.modifierExtension", "min": 0, "max": "*" }, "type": [ { "code": "Extension" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children unless an empty Parameters resource", "expression": "hasValue() or (children().count() > id.count()) or $this is Parameters", "xpath": "@value|f:*|h:div|self::f:Parameters", "source": "http://hl7.org/fhir/StructureDefinition/Element" }, { "key": "ext-1", "severity": "error", "human": "Must have either extensions or value[x], not both", "expression": "extension.exists() != value.exists()", "xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])", "source": "http://hl7.org/fhir/StructureDefinition/Extension" } ], "isModifier": true, "isModifierReason": "Modifier extensions are expected to modify the meaning or interpretation of the element that contains them", "isSummary": true, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "rim", "map": "N/A" } ] }, { "id": "ClaimResponse.insurance.sequence", "path": "ClaimResponse.insurance.sequence", "short": "Insurance instance identifier", "definition": "Berisi nomor unik untuk mengidentifikasi entri asuransi dan memberikan urutan pertanggungan untuk menyampaikan koordinasi urutan manfaat dengan tipe data positiveInt.", "comment": "32 bit number; for values larger than this, use decimal", "requirements": "To maintain order of the coverages.", "min": 1, "max": "1", "base": { "path": "ClaimResponse.insurance.sequence", "min": 1, "max": "1" }, "type": [ { "code": "positiveInt" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children unless an empty Parameters resource", "expression": "hasValue() or (children().count() > id.count()) or $this is Parameters", "xpath": "@value|f:*|h:div|self::f:Parameters", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "mustSupport": false, "isModifier": false, "isSummary": false, "mapping": [ { "identity": "rim", "map": "n/a" } ] }, { "id": "ClaimResponse.insurance.focal", "path": "ClaimResponse.insurance.focal", "short": "Coverage to be used for adjudication", "definition": "Berisi data penanda untuk menunjukkan bahwa cakupan yang tersebut akan digunakan untuk keputusan klaim bila disetel ke true dengan tipe data booelan.", "comment": "A patient may (will) have multiple insurance policies which provide reimbursement for healthcare services and products. For example a person may also be covered by their spouse's policy and both appear in the list (and may be from the same insurer). This flag will be set to true for only one of the listed policies and that policy will be used for adjudicating this claim. Other claims would be created to request adjudication against the other listed policies.", "requirements": "To identify which coverage in the list is being used to adjudicate this claim.", "min": 1, "max": "1", "base": { "path": "ClaimResponse.insurance.focal", "min": 1, "max": "1" }, "type": [ { "code": "boolean" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children unless an empty Parameters resource", "expression": "hasValue() or (children().count() > id.count()) or $this is Parameters", "xpath": "@value|f:*|h:div|self::f:Parameters", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "mustSupport": false, "isModifier": false, "isSummary": false, "mapping": [ { "identity": "rim", "map": "n/a" } ] }, { "id": "ClaimResponse.insurance.coverage", "path": "ClaimResponse.insurance.coverage", "short": "Insurance information", "definition": "Berisi data referensi ke informasi tingkat kartu asuransi yang terdapat pada resource Coverage. Perusahaan asuransi yang mengeluarkan pertanggungan akan menggunakan perincian ini untuk menemukan pertanggungan aktual pasien dalam sistem informasi perusahaan asuransi. Tipe data yang digunakan adalah Reference yang direferensikan ke data yang tersimpan di resource Coverage.", "comment": "References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.", "requirements": "Required to allow the adjudicator to locate the correct policy and history within their information system.", "min": 1, "max": "1", "base": { "path": "ClaimResponse.insurance.coverage", "min": 1, "max": "1" }, "type": [ { "code": "Reference", "targetProfile": [ "http://hl7.org/fhir/StructureDefinition/Coverage" ] } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children unless an empty Parameters resource", "expression": "hasValue() or (children().count() > id.count()) or $this is Parameters", "xpath": "@value|f:*|h:div|self::f:Parameters", "source": "http://hl7.org/fhir/StructureDefinition/Element" }, { "key": "ref-1", "severity": "error", "human": "SHALL have a contained resource if a local reference is provided", "expression": "reference.exists() implies (reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids')) or (reference='#' and %rootResource!=%resource))", "xpath": "not(starts-with(f:reference/@value, '#')) or exists(ancestor::*[self::f:entry or self::f:parameter]/f:resource/f:*/f:contained/f:*[f:id/@value=substring-after(current()/f:reference/@value, '#')]|/*/f:contained/f:*[f:id/@value=substring-after(current()/f:reference/@value, '#')])", "source": "http://hl7.org/fhir/StructureDefinition/Reference" } ], "mustSupport": false, "isModifier": false, "isSummary": false, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "rim", "map": "The target of a resource reference is a RIM entry point (Act, Role, or Entity)" } ] }, { "id": "ClaimResponse.insurance.businessArrangement", "path": "ClaimResponse.insurance.businessArrangement", "short": "Additional provider contract number", "definition": "Berisi data nomor perjanjian bisnis yang dibuat antara penyedia dan perusahaan asuransi untuk tujuan pemrosesan bisnis khusus dengan tipe data string.", "comment": "Note that FHIR strings SHALL NOT exceed 1MB in size", "requirements": "Providers may have multiple business arrangements with a given insurer and must supply the specific contract number for adjudication.", "min": 0, "max": "1", "base": { "path": "ClaimResponse.insurance.businessArrangement", "min": 0, "max": "1" }, "type": [ { "code": "string" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children unless an empty Parameters resource", "expression": "hasValue() or (children().count() > id.count()) or $this is Parameters", "xpath": "@value|f:*|h:div|self::f:Parameters", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "mustSupport": false, "isModifier": false, "isSummary": false, "mapping": [ { "identity": "rim", "map": "n/a" } ] }, { "id": "ClaimResponse.insurance.claimResponse", "path": "ClaimResponse.insurance.claimResponse", "short": "Adjudication results", "definition": "Berisi data hasil ajudikasi item baris untuk pertanggungan yang ditentukan dalam asuransi dengan tipe data Reference yang direferensikan ke data yang tersimpan di resource ClaimResponse.", "comment": "Must not be specified when 'focal=true' for this insurance.", "requirements": "An insurer need the adjudication results from prior insurers to determine the outstanding balance remaining by item for the items in the curent claim.", "min": 0, "max": "1", "base": { "path": "ClaimResponse.insurance.claimResponse", "min": 0, "max": "1" }, "type": [ { "code": "Reference", "targetProfile": [ "http://hl7.org/fhir/StructureDefinition/ClaimResponse" ] } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children unless an empty Parameters resource", "expression": "hasValue() or (children().count() > id.count()) or $this is Parameters", "xpath": "@value|f:*|h:div|self::f:Parameters", "source": "http://hl7.org/fhir/StructureDefinition/Element" }, { "key": "ref-1", "severity": "error", "human": "SHALL have a contained resource if a local reference is provided", "expression": "reference.exists() implies (reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids')) or (reference='#' and %rootResource!=%resource))", "xpath": "not(starts-with(f:reference/@value, '#')) or exists(ancestor::*[self::f:entry or self::f:parameter]/f:resource/f:*/f:contained/f:*[f:id/@value=substring-after(current()/f:reference/@value, '#')]|/*/f:contained/f:*[f:id/@value=substring-after(current()/f:reference/@value, '#')])", "source": "http://hl7.org/fhir/StructureDefinition/Reference" } ], "mustSupport": false, "isModifier": false, "isSummary": false, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "rim", "map": "The target of a resource reference is a RIM entry point (Act, Role, or Entity)" } ] }, { "id": "ClaimResponse.error", "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-explicit-type-name", "valueString": "Error" } ], "path": "ClaimResponse.error", "short": "Processing errors", "definition": "Berisi data kesalahan yang ditemui selama proses ajudikasi dengan tipe data BackboneElement.", "comment": "If the request contains errors then an error element should be provided and no adjudication related sections (item, addItem, or payment) should be present.", "requirements": "Need to communicate processing issues to the requestor.", "min": 0, "max": "*", "base": { "path": "ClaimResponse.error", "min": 0, "max": "*" }, "type": [ { "code": "BackboneElement" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children unless an empty Parameters resource", "expression": "hasValue() or (children().count() > id.count()) or $this is Parameters", "xpath": "@value|f:*|h:div|self::f:Parameters", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "mustSupport": false, "isModifier": false, "isSummary": false, "mapping": [ { "identity": "rim", "map": "n/a" } ] }, { "id": "ClaimResponse.error.id", "path": "ClaimResponse.error.id", "representation": [ "xmlAttr" ], "short": "Unique id for inter-element referencing", "definition": "Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.", "min": 0, "max": "1", "base": { "path": "Element.id", "min": 0, "max": "1" }, "type": [ { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type", "valueUrl": "id" } ], "code": "http://hl7.org/fhirpath/System.String" } ], "mapping": [ { "identity": "rim", "map": "n/a" } ] }, { "id": "ClaimResponse.error.extension", "path": "ClaimResponse.error.extension", "slicing": { "discriminator": [ { "type": "value", "path": "url" } ], "description": "Extensions are always sliced by (at least) url", "rules": "open" }, "short": "Additional content defined by implementations", "definition": "May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.", "comment": "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.", "alias": [ "extensions", "user content" ], "min": 0, "max": "*", "base": { "path": "Element.extension", "min": 0, "max": "*" }, "type": [ { "code": "Extension" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children unless an empty Parameters resource", "expression": "hasValue() or (children().count() > id.count()) or $this is Parameters", "xpath": "@value|f:*|h:div|self::f:Parameters", "source": "http://hl7.org/fhir/StructureDefinition/Element" }, { "key": "ext-1", "severity": "error", "human": "Must have either extensions or value[x], not both", "expression": "extension.exists() != value.exists()", "xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])", "source": "http://hl7.org/fhir/StructureDefinition/Extension" } ], "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "rim", "map": "N/A" } ] }, { "id": "ClaimResponse.error.modifierExtension", "path": "ClaimResponse.error.modifierExtension", "short": "Extensions that cannot be ignored even if unrecognized", "definition": "May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.\n\nModifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).", "comment": "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.", "requirements": "Modifier extensions allow for extensions that *cannot* be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the [definition of modifier extensions](extensibility.html#modifierExtension).", "alias": [ "extensions", "user content", "modifiers" ], "min": 0, "max": "*", "base": { "path": "BackboneElement.modifierExtension", "min": 0, "max": "*" }, "type": [ { "code": "Extension" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children unless an empty Parameters resource", "expression": "hasValue() or (children().count() > id.count()) or $this is Parameters", "xpath": "@value|f:*|h:div|self::f:Parameters", "source": "http://hl7.org/fhir/StructureDefinition/Element" }, { "key": "ext-1", "severity": "error", "human": "Must have either extensions or value[x], not both", "expression": "extension.exists() != value.exists()", "xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])", "source": "http://hl7.org/fhir/StructureDefinition/Extension" } ], "isModifier": true, "isModifierReason": "Modifier extensions are expected to modify the meaning or interpretation of the element that contains them", "isSummary": true, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "rim", "map": "N/A" } ] }, { "id": "ClaimResponse.error.itemSequence", "path": "ClaimResponse.error.itemSequence", "short": "Item sequence number", "definition": "Berisi data nomor urut item baris yang dikirimkan yang berisi kesalahan. Nilai ini dihilangkan ketika kesalahan terjadi di luar struktur item. Tipe data yang digunakan adalah positiveInt.", "comment": "32 bit number; for values larger than this, use decimal", "requirements": "Provides references to the claim items.", "min": 0, "max": "1", "base": { "path": "ClaimResponse.error.itemSequence", "min": 0, "max": "1" }, "type": [ { "code": "positiveInt" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children unless an empty Parameters resource", "expression": "hasValue() or (children().count() > id.count()) or $this is Parameters", "xpath": "@value|f:*|h:div|self::f:Parameters", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "mustSupport": false, "isModifier": false, "isSummary": false, "mapping": [ { "identity": "rim", "map": "n/a" } ] }, { "id": "ClaimResponse.error.detailSequence", "path": "ClaimResponse.error.detailSequence", "short": "Detail sequence number", "definition": "Berisi data nomor urut detail dalam item baris yang dikirimkan yang berisi kesalahan. Nilai ini dihilangkan ketika kesalahan terjadi di luar struktur item. Tipe data yang digunakan adalah positiveInt.", "comment": "32 bit number; for values larger than this, use decimal", "requirements": "Provides references to the claim details within the claim item.", "min": 0, "max": "1", "base": { "path": "ClaimResponse.error.detailSequence", "min": 0, "max": "1" }, "type": [ { "code": "positiveInt" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children unless an empty Parameters resource", "expression": "hasValue() or (children().count() > id.count()) or $this is Parameters", "xpath": "@value|f:*|h:div|self::f:Parameters", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "mustSupport": false, "isModifier": false, "isSummary": false, "mapping": [ { "identity": "rim", "map": "n/a" } ] }, { "id": "ClaimResponse.error.subDetailSequence", "path": "ClaimResponse.error.subDetailSequence", "short": "Subdetail sequence number", "definition": "Berisi data nomor urut sub-detail dalam detail dalam item baris yang dikirimkan yang berisi kesalahan. Nilai ini dihilangkan ketika kesalahan terjadi di luar struktur item. Tipe data yang digunakan adalah positiveInt.", "comment": "32 bit number; for values larger than this, use decimal", "requirements": "Provides references to the claim sub-details within the claim detail.", "min": 0, "max": "1", "base": { "path": "ClaimResponse.error.subDetailSequence", "min": 0, "max": "1" }, "type": [ { "code": "positiveInt" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children unless an empty Parameters resource", "expression": "hasValue() or (children().count() > id.count()) or $this is Parameters", "xpath": "@value|f:*|h:div|self::f:Parameters", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "mustSupport": false, "isModifier": false, "isSummary": false, "mapping": [ { "identity": "rim", "map": "n/a" } ] }, { "id": "ClaimResponse.error.code", "path": "ClaimResponse.error.code", "short": "Error code detailing processing issues", "definition": "Berisi data kode kesalahan, dari sistem kode tertentu, yang merinci mengapa klaim tidak dapat diajudikasi dengan tipe data CodeableConcept yang nilainya dapat mengacu pada contoh data terminologi AdjudicationError.", "comment": "Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination.", "requirements": "Required to convey processing errors.", "min": 1, "max": "1", "base": { "path": "ClaimResponse.error.code", "min": 1, "max": "1" }, "type": [ { "code": "CodeableConcept" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children unless an empty Parameters resource", "expression": "hasValue() or (children().count() > id.count()) or $this is Parameters", "xpath": "@value|f:*|h:div|self::f:Parameters", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "mustSupport": false, "isModifier": false, "isSummary": false, "binding": { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString": "AdjudicationError" } ], "strength": "example", "description": "The adjudication error codes.", "valueSet": "http://hl7.org/fhir/ValueSet/adjudication-error" }, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "v2", "map": "CE/CNE/CWE" }, { "identity": "rim", "map": "CD" }, { "identity": "orim", "map": "fhir:CodeableConcept rdfs:subClassOf dt:CD" } ] } ] }, "differential": { "element": [ { "id": "ClaimResponse.identifier", "path": "ClaimResponse.identifier", "definition": "Berisi data ID lokal yang ditetapkan untuk respons klaim dengan tipe data Identifier.", "max": "1" }, { "id": "ClaimResponse.status", "path": "ClaimResponse.status", "definition": "Berisi data status respon klaim dengan tipe data code, yang nilainya mengacu pada data terminologi Financial Resource Status Code." }, { "id": "ClaimResponse.type", "path": "ClaimResponse.type", "definition": "Berisi data kategori klaim dengan tipe data CodeableConcept." }, { "id": "ClaimResponse.type.coding", "path": "ClaimResponse.type.coding", "definition": "Berisi data kategori klaim dengan tipe data Coding, yang nilainya mengacu pada data terminologi yang dapat diperluas yaitu Claim Type Codes." }, { "id": "ClaimResponse.use", "path": "ClaimResponse.use", "definition": "Berisi data kode untuk menunjukkan apakah sifat dari permintaan tersebut adalah: untuk meminta keputusan atas produk dan layanan yang telah diberikan sebelumnya; atau meminta otorisasi dan ajudikasi untuk ketentuan di masa depan; atau meminta keputusan yang tidak mengikat atas produk dan layanan yang tercantum yang dapat disediakan di masa mendatang. Tipe data yang digunakan adalah code, yang nilainya mengacu pada data terminologi Use." }, { "id": "ClaimResponse.patient", "path": "ClaimResponse.patient", "definition": "Berisi data terkait pihak kepada siapa layanan dan/atau produk profesional telah disediakan atau sedang dipertimbangkan dan untuk siapa penggantian aktual atau prakiraan dimintakan dengan tipe data Reference yang direferensikan ke data yang tersimpan di resource Patient." }, { "id": "ClaimResponse.created", "path": "ClaimResponse.created", "definition": "Berisi data tanggal ketika respon klaim dibuat dengan tipe data dateTime, dengan format yang diperbolehkan YYYY, YYYY-MM, YYYY-MM-DD atau YYYY-MM-DDThh:mm:ss+zz:zz." }, { "id": "ClaimResponse.insurer", "path": "ClaimResponse.insurer", "definition": "Berisi data pihak yang bertanggung jawab untuk otorisasi, ajudikasi dan penggantian dengan tipe data Reference yang direferensikan ke data yang tersimpan di resource Organization." }, { "id": "ClaimResponse.requestor", "path": "ClaimResponse.requestor", "definition": "Berisi data penyedia yang bertanggung jawab atas klaim, penentuan sebelumnya atau pra-otorisasi dengan tipe data Reference yang direferensikan ke data yang tersimpan di resource Practitioner | PractitionerRole | Organization." }, { "id": "ClaimResponse.request", "path": "ClaimResponse.request", "definition": "Berisi data referensi ke resource asli permintaan dengan tipe data Reference yang direferensikan ke data yang tersimpan di resource Claim." }, { "id": "ClaimResponse.outcome", "path": "ClaimResponse.outcome", "definition": "Berisi data hasil dari pemrosesan klaim, penentuan sebelumnya, atau praotorisasi dengan tipe data code, yang nilainya mengacu pada data terminologi Claim Processing Codes." }, { "id": "ClaimResponse.disposition", "path": "ClaimResponse.disposition", "definition": "Berisi data deskripsi status keputusan yang dapat dibaca manusia dengan tipe data string." }, { "id": "ClaimResponse.preAuthRef", "path": "ClaimResponse.preAuthRef", "definition": "Berisi data referensi dari penanggung yang digunakan dalam komunikasi selanjutnya yang mengacu pada keputusan dengan tipe data string." }, { "id": "ClaimResponse.preAuthPeriod", "path": "ClaimResponse.preAuthPeriod", "definition": "Berisi data jangka waktu selama otorisasi berlaku efektif dengan tipe data Period." }, { "id": "ClaimResponse.payeeType", "path": "ClaimResponse.payeeType", "definition": "Berisi data jenis pihak yang akan diberikan ganti: pelanggan, penyedia, lainnya dengan tipe data CodeableConcept." }, { "id": "ClaimResponse.payeeType.coding", "path": "ClaimResponse.payeeType.coding", "definition": "Berisi data jenis pihak yang akan diberikan ganti: pelanggan, penyedia, lainnya dengan tipe data Coding, yang nilainya dapat mengacu pada contoh data terminologi PayeeType." }, { "id": "ClaimResponse.item", "path": "ClaimResponse.item", "definition": "Berisi data baris klaim. Baik produk atau layanan sederhana atau 'grup' detail yang masing-masing dapat berupa item sederhana atau grup sub-detail dengan tipe data BackboneElement." }, { "id": "ClaimResponse.item.itemSequence", "path": "ClaimResponse.item.itemSequence", "definition": "Berisi data nomor unik untuk mengidentifikasi entri item dengan tipe data positiveInt." }, { "id": "ClaimResponse.item.noteNumber", "path": "ClaimResponse.item.noteNumber", "definition": "Berisi data angka-angka yang terkait dengan catatan yang ada di bawah yang berlaku untuk penilaian item dengan tipe data positiveInt." }, { "id": "ClaimResponse.item.adjudication", "path": "ClaimResponse.item.adjudication", "definition": "Berisi data penilaian item. Jika item ini adalah grup maka nilai-nilai di sini adalah ringkasan dari penilaian detail item. Jika item ini adalah produk atau layanan sederhana maka ini adalah hasil dari penilaian item ini. Hasil ajudikasi menyampaikan penilaian penanggung terhadap hal yang diberikan dalam klaim berdasarkan ketentuan pertanggungan asuransi pasien." }, { "id": "ClaimResponse.item.adjudication.category", "path": "ClaimResponse.item.adjudication.category", "definition": "Berisi data kode untuk menunjukkan jenis informasi catatan keputusan. Jenis informasi dapat mencakup nilai yang diajukan, nilai maksimum atau persentase yang diperbolehkan atau dapat dibayarkan berdasarkan program, jumlah yang: pasien bertanggung jawab secara agregat atau berkaitan dengan item ini; jumlah yang dibayarkan oleh pertanggungan lain; dan, manfaat yang dibayarkan untuk item ini. Tipe data yang digunakan adalah CodeableConcept." }, { "id": "ClaimResponse.item.adjudication.category.coding", "path": "ClaimResponse.item.adjudication.category.coding", "definition": "Berisi data kode untuk menunjukkan jenis informasi catatan keputusan. Jenis informasi dapat mencakup nilai yang diajukan, nilai maksimum atau persentase yang diperbolehkan atau dapat dibayarkan berdasarkan program, jumlah yang: pasien bertanggung jawab secara agregat atau berkaitan dengan item ini; jumlah yang dibayarkan oleh pertanggungan lain; dan, manfaat yang dibayarkan untuk item ini. Tipe data yang digunakan adalah Coding, yang nilainya dapat mengacu pada contoh data terminologi Adjudication Value Codes." }, { "id": "ClaimResponse.item.adjudication.reason", "path": "ClaimResponse.item.adjudication.reason", "definition": "Berisi data kode yang mendukung pemahaman hasil keputusan dan menjelaskan perbedaan dari jumlah yang diharapkan dengan tipe data CodeableConcept." }, { "id": "ClaimResponse.item.adjudication.reason.coding", "path": "ClaimResponse.item.adjudication.reason.coding", "definition": "Berisi data kode yang mendukung pemahaman hasil keputusan dan menjelaskan perbedaan dari jumlah yang diharapkan dengan tipe data Coding, yang nilainya dapat mengacu pada contoh data terminologi Adjudication Reason Codes." }, { "id": "ClaimResponse.item.adjudication.amount", "path": "ClaimResponse.item.adjudication.amount", "definition": "Berisi data jumlah uang yang terkait dengan kategori keputusan dengan tipe data Money." }, { "id": "ClaimResponse.item.adjudication.value", "path": "ClaimResponse.item.adjudication.value", "definition": "Berisi data nilai non-moneter yang terkait dengan kategori, beberapa kategori penilaian menyampaikan persentase atau nilai tetap, dapat berupa persentase yang memenuhi syarat atau persentase pembayaran bersama dengan tipe data decimal." }, { "id": "ClaimResponse.item.detail", "path": "ClaimResponse.item.detail", "definition": "Berisi data detail klaim, baik yang sederhana (produk atau layanan) atau 'kelompok' sub-detail yang merupakan barang sederhana dengan tipe data BackboneElement." }, { "id": "ClaimResponse.item.detail.detailSequence", "path": "ClaimResponse.item.detail.detailSequence", "definition": "Berisi data nomor unik untuk mereferensikan entri detail klaim dengan tipe data positiveInt." }, { "id": "ClaimResponse.item.detail.noteNumber", "path": "ClaimResponse.item.detail.noteNumber", "definition": "Berisi data angka-angka yang terkait dengan catatan di bawah yang berlaku untuk penilaian item dengan tipe data positiveInt." }, { "id": "ClaimResponse.item.detail.adjudication", "path": "ClaimResponse.item.detail.adjudication", "definition": "Berisi data hasil keputusan dengan tipe data yang mengacu pada ClaimResponse.item.adjudication." }, { "id": "ClaimResponse.item.detail.subDetail", "path": "ClaimResponse.item.detail.subDetail", "definition": "Berisi data keputusan sub-detail dari produk atau layanan sederhana dengan tipe data BackboneElement." }, { "id": "ClaimResponse.item.detail.subDetail.subDetailSequence", "path": "ClaimResponse.item.detail.subDetail.subDetailSequence", "definition": "Berisi data nomor unik untuk mereferensikan entri sub-detail klaim dengan tipe data positiveInt." }, { "id": "ClaimResponse.item.detail.subDetail.noteNumber", "path": "ClaimResponse.item.detail.subDetail.noteNumber", "definition": "Berisi data angka-angka yang terkait dengan catatan di bawah yang berlaku untuk penilaian item dengan tipe data positiveInt." }, { "id": "ClaimResponse.item.detail.subDetail.adjudication", "path": "ClaimResponse.item.detail.subDetail.adjudication", "definition": "Berisi data hasil keputusan dengan tipe data yang mengacu pada ClaimResponse.item.adjudication.", "min": 1 }, { "id": "ClaimResponse.addItem", "path": "ClaimResponse.addItem", "definition": "Berisi data keputusan layanan tingkat pertama untuk payor dapat menambahkan lini produk atau layanan. Penanggung dapat mendefinisikan kembali produk atau layanan yang disediakan atau dapat mengemas dan/atau menguraikan kelompok produk dan layanan. AddItems memungkinkan perusahaan asuransi untuk memberikan daftar item baris mereka dengan tautan ke item/detail/sub-detail yang dikirimkan. Dalam pra-otorisasi perusahaan asuransi dapat menggunakan struktur addItem untuk memberikan informasi tambahan tentang produk dan layanan resmi dengan tipe data BackboneElement." }, { "id": "ClaimResponse.addItem.itemSequence", "path": "ClaimResponse.addItem.itemSequence", "definition": "Berisi data klaim item yang ingin diganti oleh saluran layanan ini dengan tipe data positiveInt." }, { "id": "ClaimResponse.addItem.detailSequence", "path": "ClaimResponse.addItem.detailSequence", "definition": "Berisi data nomor urut detail dalam item klaim yang ingin diganti oleh baris ini dengan tipe data positiveInt." }, { "id": "ClaimResponse.addItem.subdetailSequence", "path": "ClaimResponse.addItem.subdetailSequence", "definition": "Berisi data nomor urut sub-detail dalam detail pada item klaim yang dimaksudkan untuk diganti oleh baris ini dengan tipe data positiveInt." }, { "id": "ClaimResponse.addItem.provider", "path": "ClaimResponse.addItem.provider", "definition": "Berisi data penyedia yang berwenang untuk layanan yang diberikan kepada pasien. dengan tipe data Reference yang direferensikan ke data yang tersimpan di resource Practitioner | PractitionerRole | Organization." }, { "id": "ClaimResponse.addItem.productOrService", "path": "ClaimResponse.addItem.productOrService", "definition": "Berisi data jika nilainya adalah kode grup maka item ini mengumpulkan serangkaian detail klaim terkait dan jika tidak maka berisi produk, layanan, obat, atau kode tagihan lainnya untuk item tersebut dengan tipe data CodeableConcept." }, { "id": "ClaimResponse.addItem.productOrService.coding", "path": "ClaimResponse.addItem.productOrService.coding", "definition": "Berisi data jika nilainya adalah kode grup maka item ini mengumpulkan serangkaian detail klaim terkait dan jika tidak maka berisi produk, layanan, obat, atau kode tagihan lainnya untuk item tersebut dengan tipe data Coding yang nilainya dapat mengacu pada contoh data terminologi USCLS Codes." }, { "id": "ClaimResponse.addItem.modifier", "path": "ClaimResponse.addItem.modifier", "definition": "Berisi data kode tipifikasi atau pengubah item untuk menyampaikan konteks tambahan untuk produk atau layanan dengan tipe data CodeableConcept." }, { "id": "ClaimResponse.addItem.modifier.coding", "path": "ClaimResponse.addItem.modifier.coding", "definition": "Berisi data kode tipifikasi atau pengubah item untuk menyampaikan konteks tambahan untuk produk atau layanan dengan tipe data Coding yang nilainya dapat mengacu pada contoh data terminologi Modifier types Codes." }, { "id": "ClaimResponse.addItem.programCode", "path": "ClaimResponse.addItem.programCode", "definition": "Berisi data untuk mengidentifikasi program yang memungkinkan pemulihan dengan tipe data CodeableConcept." }, { "id": "ClaimResponse.addItem.programCode.coding", "path": "ClaimResponse.addItem.programCode.coding", "definition": "Berisi data untuk mengidentifikasi program yang memungkinkan pemulihan dengan tipe data Coding yang nilainya dapat mengacu pada contoh data terminologi Example Program Reason Codes." }, { "id": "ClaimResponse.addItem.serviced[x]", "path": "ClaimResponse.addItem.serviced[x]", "definition": "Berisi data tanggal atau tanggal ketika layanan atau produk dipasok, dilaksanakan, atau diselesaikan." }, { "id": "ClaimResponse.addItem.location[x]", "path": "ClaimResponse.addItem.location[x]", "definition": "Berisi data lokasi produk atau layanan disediakan." }, { "id": "ClaimResponse.addItem.quantity", "path": "ClaimResponse.addItem.quantity", "definition": "Berisi data jumlah pengulangan layanan atau produk dengan tipe data SimpleQuantity." }, { "id": "ClaimResponse.addItem.unitPrice", "path": "ClaimResponse.addItem.unitPrice", "definition": "Berisi data jika item tersebut bukan grup maka ini adalah biaya untuk produk atau layanan, jika tidak, ini adalah total biaya untuk perincian grup dengan tipe data Money." }, { "id": "ClaimResponse.addItem.factor", "path": "ClaimResponse.addItem.factor", "definition": "Berisi data bilangan real yang mewakili pengali yang digunakan dalam menentukan nilai keseluruhan dari layanan yang diberikan dan/atau barang yang diterima. Konsep Faktor memungkinkan pengganda diskon atau biaya tambahan untuk diterapkan pada jumlah uang dengan tipe data decimal." }, { "id": "ClaimResponse.addItem.net", "path": "ClaimResponse.addItem.net", "definition": "Berisi data kuantitas dikalikan harga satuan untuk layanan atau produk atau biaya tambahan dengan tipe data Money." }, { "id": "ClaimResponse.addItem.bodySite", "path": "ClaimResponse.addItem.bodySite", "definition": "Berisi data lokasi pelayanan fisik pada pasien (tungkai, gigi, dan lainnya) dengan tipe data CodeableConcept." }, { "id": "ClaimResponse.addItem.bodySite.coding", "path": "ClaimResponse.addItem.bodySite.coding", "definition": "Berisi data lokasi pelayanan fisik pada pasien (tungkai, gigi, dan lainnya) dengan tipe data Coding yang nilainya dapat mengacu pada contoh data terminologi Oral Site Codes." }, { "id": "ClaimResponse.addItem.subSite", "path": "ClaimResponse.addItem.subSite", "definition": "Berisi data wilayah atau permukaan bodySite, seperti daerah anggota gerak atau permukaan gigi dengan tipe data CodeableConcept." }, { "id": "ClaimResponse.addItem.subSite.coding", "path": "ClaimResponse.addItem.subSite.coding", "definition": "Berisi data wilayah atau permukaan bodySite, seperti daerah anggota gerak atau permukaan gigi dengan tipe data Coding yang nilainya dapat mengacu pada contoh data terminologi Surface Codes." }, { "id": "ClaimResponse.addItem.noteNumber", "path": "ClaimResponse.addItem.noteNumber", "definition": "Berisi data angka-angka yang terkait dengan catatan yang ada di bawah yang berlaku untuk penilaian item dengan tipe data positiveInt." }, { "id": "ClaimResponse.addItem.adjudication", "path": "ClaimResponse.addItem.adjudication", "definition": "Berisi data hasil keputusan dengan tipe data yang mengacu pada ClaimResponse.item.adjudication." }, { "id": "ClaimResponse.addItem.detail", "path": "ClaimResponse.addItem.detail", "definition": "Berisi data keputusan layanan tingkat kedua untuk pembayar menambahkan layanan dengan tipe data BackboneElement." }, { "id": "ClaimResponse.addItem.detail.productOrService", "path": "ClaimResponse.addItem.detail.productOrService", "definition": "Berisi data jika nilainya adalah kode grup maka item ini mengumpulkan serangkaian detail klaim terkait dan jika tidak maka berisi produk, layanan, obat, atau kode tagihan lainnya untuk item tersebut dengan tipe data CodeableConcept." }, { "id": "ClaimResponse.addItem.detail.productOrService.coding", "path": "ClaimResponse.addItem.detail.productOrService.coding", "definition": "Berisi data jika nilainya adalah kode grup maka item ini mengumpulkan serangkaian detail klaim terkait dan jika tidak maka berisi produk, layanan, obat, atau kode tagihan lainnya untuk item tersebut dengan tipe data Coding yang nilainya dapat mengacu pada contoh data terminologi USCLS Codes." }, { "id": "ClaimResponse.addItem.detail.modifier", "path": "ClaimResponse.addItem.detail.modifier", "definition": "Berisi data kode tipifikasi atau pengubah item untuk menyampaikan konteks tambahan untuk produk atau layanan dengan tipe data CodeableConcept." }, { "id": "ClaimResponse.addItem.detail.modifier.coding", "path": "ClaimResponse.addItem.detail.modifier.coding", "definition": "Berisi data kode tipifikasi atau pengubah item untuk menyampaikan konteks tambahan untuk produk atau layanan dengan tipe data Coding yang nilainya dapat mengacu pada contoh data terminologi Modifier types Codes." }, { "id": "ClaimResponse.addItem.detail.quantity", "path": "ClaimResponse.addItem.detail.quantity", "definition": "Berisi data jumlah pengulangan layanan atau produk dengan tipe data SimpleQuantity." }, { "id": "ClaimResponse.addItem.detail.unitPrice", "path": "ClaimResponse.addItem.detail.unitPrice", "definition": "Berisi data biaya di mana jika item yang tersebut bukan grup maka ini adalah biaya untuk produk atau layanan, jika tidak maka ini adalah total biaya untuk perincian grup dengan tipe data Money." }, { "id": "ClaimResponse.addItem.detail.factor", "path": "ClaimResponse.addItem.detail.factor", "definition": "Berisi data bilangan real yang mewakili pengali yang digunakan dalam menentukan nilai keseluruhan dari layanan yang diberikan dan/atau barang yang diterima. Konsep Faktor memungkinkan pengganda diskon atau biaya tambahan untuk diterapkan pada jumlah uang. Tipe data yang digunakan adalah decimal." }, { "id": "ClaimResponse.addItem.detail.net", "path": "ClaimResponse.addItem.detail.net", "definition": "Berisi data kuantitas dikalikan harga satuan untuk layanan atau produk atau biaya tambahan dengan tipe data Money." }, { "id": "ClaimResponse.addItem.detail.noteNumber", "path": "ClaimResponse.addItem.detail.noteNumber", "definition": "Berisi data angka-angka yang terkait dengan catatan yang ada di bawah yang berlaku untuk penilaian item dengan tipe data positiveInt." }, { "id": "ClaimResponse.addItem.detail.adjudication", "path": "ClaimResponse.addItem.detail.adjudication", "definition": "Berisi data hasil keputusan dengan tipe data yang mengacu pada ClaimResponse.item.adjudication." }, { "id": "ClaimResponse.addItem.detail.subDetail", "path": "ClaimResponse.addItem.detail.subDetail", "definition": "Berisi data keputusan layanan tingkat ketiga untuk pembayar menambahkan layanan dengan tipe data BackboneElement." }, { "id": "ClaimResponse.addItem.detail.subDetail.productOrService", "path": "ClaimResponse.addItem.detail.subDetail.productOrService", "definition": "Berisi data jika nilainya adalah kode grup maka item ini mengumpulkan serangkaian detail klaim terkait dan jika tidak maka berisi produk, layanan, obat, atau kode tagihan lainnya untuk item tersebut dengan tipe data CodeableConcept." }, { "id": "ClaimResponse.addItem.detail.subDetail.productOrService.coding", "path": "ClaimResponse.addItem.detail.subDetail.productOrService.coding", "definition": "Berisi data jika nilainya adalah kode grup maka item ini mengumpulkan serangkaian detail klaim terkait dan jika tidak maka berisi produk, layanan, obat, atau kode tagihan lainnya untuk item tersebut dengan tipe data Coding yang nilainya dapat mengacu pada contoh data terminologi USCLS Codes." }, { "id": "ClaimResponse.addItem.detail.subDetail.modifier", "path": "ClaimResponse.addItem.detail.subDetail.modifier", "definition": "Berisi data kode tipifikasi atau pengubah item untuk menyampaikan konteks tambahan untuk produk atau layanan dengan tipe data CodeableConcept." }, { "id": "ClaimResponse.addItem.detail.subDetail.modifier.coding", "path": "ClaimResponse.addItem.detail.subDetail.modifier.coding", "definition": "Berisi data kode tipifikasi atau pengubah item untuk menyampaikan konteks tambahan untuk produk atau layanan dengan tipe data Coding yang nilainya dapat mengacu pada contoh data terminologi Modifier types Codes." }, { "id": "ClaimResponse.addItem.detail.subDetail.quantity", "path": "ClaimResponse.addItem.detail.subDetail.quantity", "definition": "Berisi data jumlah pengulangan layanan atau produk dengan tipe data SimpleQuantity." }, { "id": "ClaimResponse.addItem.detail.subDetail.unitPrice", "path": "ClaimResponse.addItem.detail.subDetail.unitPrice", "definition": "Berisi data biaya di mana jika item yang tersebut bukan grup maka ini adalah biaya untuk produk atau layanan, jika tidak maka ini adalah total biaya untuk perincian grup dengan tipe data Money." }, { "id": "ClaimResponse.addItem.detail.subDetail.factor", "path": "ClaimResponse.addItem.detail.subDetail.factor", "definition": "Berisi data bilangan real yang mewakili pengali yang digunakan dalam menentukan nilai keseluruhan dari layanan yang diberikan dan/atau barang yang diterima. Konsep Faktor memungkinkan pengganda diskon atau biaya tambahan untuk diterapkan pada jumlah uang. Tipe data yang digunakan adalah decimal." }, { "id": "ClaimResponse.addItem.detail.subDetail.net", "path": "ClaimResponse.addItem.detail.subDetail.net", "definition": "Berisi data kuantitas dikalikan harga satuan untuk layanan atau produk atau biaya tambahan dengan tipe data Money." }, { "id": "ClaimResponse.addItem.detail.subDetail.noteNumber", "path": "ClaimResponse.addItem.detail.subDetail.noteNumber", "definition": "Berisi data angka-angka yang terkait dengan catatan yang ada di bawah yang berlaku untuk penilaian item dengan tipe data positiveInt." }, { "id": "ClaimResponse.addItem.detail.subDetail.adjudication", "path": "ClaimResponse.addItem.detail.subDetail.adjudication", "definition": "Berisi data hasil ajudikasi dengan tipe data yang mengacu pada ClaimResponse.item.adjudication." }, { "id": "ClaimResponse.total", "path": "ClaimResponse.total", "definition": "Berisi data total moneter yang dikategorikan untuk ajudikasi dengan tipe data Money." }, { "id": "ClaimResponse.total.category", "path": "ClaimResponse.total.category", "definition": "Berisi data Kode untuk menunjukkan jenis informasi catatan ajudikasi ini. Jenis informasi dapat mencakup: nilai yang diajukan, nilai maksimum atau persentase yang diperbolehkan atau dibayarkan berdasarkan program, jumlah yang menjadi tanggung jawab pasien secara keseluruhan atau berkaitan dengan item ini, jumlah yang dibayarkan oleh pertanggungan lain, dan manfaat yang dibayarkan untuk item ini. Tipe data yang digunakan adalah CodeableConcept." }, { "id": "ClaimResponse.total.category.coding", "path": "ClaimResponse.total.category.coding", "definition": "Berisi data Kode untuk menunjukkan jenis informasi catatan ajudikasi ini. Jenis informasi dapat mencakup: nilai yang diajukan, nilai maksimum atau persentase yang diperbolehkan atau dibayarkan berdasarkan program, jumlah yang menjadi tanggung jawab pasien secara keseluruhan atau berkaitan dengan item ini, jumlah yang dibayarkan oleh pertanggungan lain, dan manfaat yang dibayarkan untuk item ini. Tipe data yang digunakan adalah Coding yang nilainya dapat mengacu pada contoh data terminologi Adjudication Value Codes." }, { "id": "ClaimResponse.total.amount", "path": "ClaimResponse.total.amount", "definition": "Berisi data jumlah total biaya yang terkait dengan kategori dengan tipe data Money." }, { "id": "ClaimResponse.payment", "path": "ClaimResponse.payment", "definition": "Berisi data rincian pembayaran untuk ajudikasi klaim dengan tipe data BackboneElement." }, { "id": "ClaimResponse.payment.type", "path": "ClaimResponse.payment.type", "definition": "Berisi data jenis pembayaran untuk membedakan apakah merupakan pembayaran sebagian atau seluruhnya dari manfaat yang dibayarkan dengan tipe data CodeableConcept." }, { "id": "ClaimResponse.payment.type.coding", "path": "ClaimResponse.payment.type.coding", "definition": "Berisi data jenis pembayaran untuk membedakan apakah merupakan pembayaran sebagian atau seluruhnya dari manfaat yang dibayarkan dengan tipe data Coding yang nilainya dapat mengacu pada contoh data terminologi Example Payment Type Codes." }, { "id": "ClaimResponse.payment.adjustment", "path": "ClaimResponse.payment.adjustment", "definition": "Berisi data jumlah total dari semua penyesuaian untuk pembayaran yang termasuk dalam transaksi yang tidak terkait dengan ajudikasi klaim dengan tipe data Money." }, { "id": "ClaimResponse.payment.adjustmentReason", "path": "ClaimResponse.payment.adjustmentReason", "definition": "Berisi data alasan penyesuaian pembayaran dengan tipe data CodeableConcept." }, { "id": "ClaimResponse.payment.date", "path": "ClaimResponse.payment.date", "definition": "Berisi data perkiraan tanggal pembayaran akan dikeluarkan atau tanggal penerbitan pembayaran yang sebenarnya dengan tipe data date." }, { "id": "ClaimResponse.payment.amount", "path": "ClaimResponse.payment.amount", "definition": "Berisi data manfaat yang dibayarkan dikurangi penyesuaian pembayaran dengan tipe data Money." }, { "id": "ClaimResponse.payment.identifier", "path": "ClaimResponse.payment.identifier", "definition": "Berisi data pengidentifikasi unik penerbit untuk instrumen pembayaran dengan tipe data Identifier." }, { "id": "ClaimResponse.fundsReserve", "path": "ClaimResponse.fundsReserve", "definition": "Berisi data sebuah kode, yang digunakan hanya sebagai tanggapan atas pra-otorisasi, untuk menunjukkan apakah tunjangan yang dibayarkan telah dipesan dan untuk siapa dengan tipe data CodeableConcept." }, { "id": "ClaimResponse.fundsReserve.coding", "path": "ClaimResponse.fundsReserve.coding", "definition": "Berisi data sebuah kode, yang digunakan hanya sebagai tanggapan atas pra-otorisasi, untuk menunjukkan apakah tunjangan yang dibayarkan telah dipesan dan untuk siapa dengan tipe data Coding yang nilainya dapat mengacu pada contoh data terminologi FundsReserve." }, { "id": "ClaimResponse.formCode", "path": "ClaimResponse.formCode", "definition": "Berisi data kode untuk formulir yang akan digunakan untuk mencetak konten dengan tipe data CodeableConcept." }, { "id": "ClaimResponse.formCode.coding", "path": "ClaimResponse.formCode.coding", "definition": "Berisi data kode untuk formulir yang akan digunakan untuk mencetak konten dengan tipe data Coding yang nilainya dapat mengacu pada contoh data terminologi Forms." }, { "id": "ClaimResponse.form", "path": "ClaimResponse.form", "definition": "Berisi data bentuk sebenarnya, dengan referensi atau penyertaan, untuk mencetak konten atau EOB dengan tipe data Attachment." }, { "id": "ClaimResponse.processNote", "path": "ClaimResponse.processNote", "definition": "Berisi data catatan yang menggambarkan atau menjelaskan hasil ajudikasi dalam bentuk yang dapat dibaca manusia dengan tipe data BackboneElement." }, { "id": "ClaimResponse.processNote.number", "path": "ClaimResponse.processNote.number", "definition": "Berisi data nomor unik untuk mengidentifikasi entri catatan dengan tipe data positiveInt.", "min": 1 }, { "id": "ClaimResponse.processNote.type", "path": "ClaimResponse.processNote.type", "definition": "Berisi data tujuan bisnis dari teks catatan dengan tipe data code yang nilainya mengacu pada data terminologi NoteType." }, { "id": "ClaimResponse.processNote.text", "path": "ClaimResponse.processNote.text", "definition": "Berisi data penjelasan atau deskripsi yang terkait dengan pemrosesan dengan tipe data string." }, { "id": "ClaimResponse.processNote.language", "path": "ClaimResponse.processNote.language", "definition": "Berisi data kode untuk menentukan bahasa yang digunakan dalam teks catatan dengan tipe data CodeableConcept yang nilainya lebih baik mengacu pada contoh data terminologi urn:ietf:bcp:47[Common Languages]." }, { "id": "ClaimResponse.communicationRequest", "path": "ClaimResponse.communicationRequest", "definition": "Berisi data permintaan informasi pendukung atau otorisasi tambahan dengan tipe data Reference yang direferensikan ke data yang tersimpan di resource CommunicationRequest." }, { "id": "ClaimResponse.insurance", "path": "ClaimResponse.insurance", "definition": "Berisi data instrumen keuangan untuk penggantian produk dan layanan perawatan kesehatan yang ditentukan pada klaim. Semua pertanggungan asuransi untuk pasien yang mungkin berlaku untuk penggantian, dari produk dan layanan yang tercantum dalam klaim, biasanya diberikan dalam klaim untuk memungkinkan perusahaan asuransi mengkonfirmasi pemesanan pertanggungan asuransi relatif terhadap aturan 'koordinasi manfaat' setempat. Satu liputan (dan hanya satu) dengan 'focal=true' akan digunakan dalam putusan klaim ini. Cakupan muncul sebelum Cakupan fokus dalam daftar, dan di mana 'subrogasi = salah', harus memberikan referensi ke ClaimResponse berisi hasil ajudikasi dari klaim sebelumnya dengan tipe data BackboneElement." }, { "id": "ClaimResponse.insurance.sequence", "path": "ClaimResponse.insurance.sequence", "definition": "Berisi nomor unik untuk mengidentifikasi entri asuransi dan memberikan urutan pertanggungan untuk menyampaikan koordinasi urutan manfaat dengan tipe data positiveInt." }, { "id": "ClaimResponse.insurance.focal", "path": "ClaimResponse.insurance.focal", "definition": "Berisi data penanda untuk menunjukkan bahwa cakupan yang tersebut akan digunakan untuk keputusan klaim bila disetel ke true dengan tipe data booelan." }, { "id": "ClaimResponse.insurance.coverage", "path": "ClaimResponse.insurance.coverage", "definition": "Berisi data referensi ke informasi tingkat kartu asuransi yang terdapat pada resource Coverage. Perusahaan asuransi yang mengeluarkan pertanggungan akan menggunakan perincian ini untuk menemukan pertanggungan aktual pasien dalam sistem informasi perusahaan asuransi. Tipe data yang digunakan adalah Reference yang direferensikan ke data yang tersimpan di resource Coverage." }, { "id": "ClaimResponse.insurance.businessArrangement", "path": "ClaimResponse.insurance.businessArrangement", "definition": "Berisi data nomor perjanjian bisnis yang dibuat antara penyedia dan perusahaan asuransi untuk tujuan pemrosesan bisnis khusus dengan tipe data string." }, { "id": "ClaimResponse.insurance.claimResponse", "path": "ClaimResponse.insurance.claimResponse", "definition": "Berisi data hasil ajudikasi item baris untuk pertanggungan yang ditentukan dalam asuransi dengan tipe data Reference yang direferensikan ke data yang tersimpan di resource ClaimResponse." }, { "id": "ClaimResponse.error", "path": "ClaimResponse.error", "definition": "Berisi data kesalahan yang ditemui selama proses ajudikasi dengan tipe data BackboneElement." }, { "id": "ClaimResponse.error.itemSequence", "path": "ClaimResponse.error.itemSequence", "definition": "Berisi data nomor urut item baris yang dikirimkan yang berisi kesalahan. Nilai ini dihilangkan ketika kesalahan terjadi di luar struktur item. Tipe data yang digunakan adalah positiveInt." }, { "id": "ClaimResponse.error.detailSequence", "path": "ClaimResponse.error.detailSequence", "definition": "Berisi data nomor urut detail dalam item baris yang dikirimkan yang berisi kesalahan. Nilai ini dihilangkan ketika kesalahan terjadi di luar struktur item. Tipe data yang digunakan adalah positiveInt." }, { "id": "ClaimResponse.error.subDetailSequence", "path": "ClaimResponse.error.subDetailSequence", "definition": "Berisi data nomor urut sub-detail dalam detail dalam item baris yang dikirimkan yang berisi kesalahan. Nilai ini dihilangkan ketika kesalahan terjadi di luar struktur item. Tipe data yang digunakan adalah positiveInt." }, { "id": "ClaimResponse.error.code", "path": "ClaimResponse.error.code", "definition": "Berisi data kode kesalahan, dari sistem kode tertentu, yang merinci mengapa klaim tidak dapat diajudikasi dengan tipe data CodeableConcept yang nilainya dapat mengacu pada contoh data terminologi AdjudicationError." } ] } }