{ "resourceType": "StructureDefinition", "id": "ClaimResponse", "meta": { "lastUpdated": "2017-04-18T21:44:43.294+00:00" }, "text": { "status": "generated", "div": "
NameFlagsCard.TypeDescription & Constraints\"doco\"
\".\"\".\"ClaimResponseDomainResourceRemittance resource\n
Elements defined in Ancestors: \n id, \n meta, \n implicitRules, \n language, \n text, \n contained, \n extension, \n modifierExtension
\".\"\".\"\".\"identifier0..*IdentifierResponse number\n
\".\"\".\"\".\"status?!Σ0..1codeactive | cancelled | draft | entered-in-error\n
Financial Resource Status Codes (\n Required)\n
\".\"\".\"\".\"patient0..1Reference(\n Patient)\n The subject of the Products and Services
\".\"\".\"\".\"created0..1dateTimeCreation date
\".\"\".\"\".\"insurer0..1Reference(\n Organization)\n Insurance issuing organization
\".\"\".\"\".\"requestProvider0..1Reference(\n Practitioner)\n Responsible practitioner
\".\"\".\"\".\"requestOrganization0..1Reference(\n Organization)\n Responsible organization
\".\"\".\"\".\"request0..1Reference(\n Claim)\n Id of resource triggering adjudication
\".\"\".\"\".\"outcome0..1CodeableConceptcomplete | error | partial\n
Claim Processing Codes (\n Example)\n
\".\"\".\"\".\"disposition0..1stringDisposition Message
\".\"\".\"\".\"payeeType0..1CodeableConceptParty to be paid any benefits payable\n
Claim Payee Type Codes (\n Example)\n
\".\"\".\"\".\"item0..*BackboneElementLine items\n
\".\"\".\"\".\"\".\"sequenceLinkId1..1positiveIntService instance
\".\"\".\"\".\"\".\"noteNumber0..*positiveIntList of note numbers which apply\n
\".\"\".\"\".\"\".\"adjudication0..*BackboneElementAdjudication details\n
\".\"\".\"\".\"\".\"\".\"category1..1CodeableConceptAdjudication category such as co-pay, eligible, benefit, etc.\n
Adjudication Value Codes (\n Example)\n
\".\"\".\"\".\"\".\"\".\"reason0..1CodeableConceptExplanation of Adjudication outcome\n
Adjudication Reason Codes (\n Example)\n
\".\"\".\"\".\"\".\"\".\"amount0..1MoneyMonetary amount
\".\"\".\"\".\"\".\"\".\"value0..1decimalNon-monetary value
\".\"\".\"\".\"\".\"detail0..*BackboneElementDetail line items\n
\".\"\".\"\".\"\".\"\".\"sequenceLinkId1..1positiveIntService instance
\".\"\".\"\".\"\".\"\".\"noteNumber0..*positiveIntList of note numbers which apply\n
\".\"\".\"\".\"\".\"\".\"adjudication0..*see \n adjudicationDetail level adjudication details\n
\".\"\".\"\".\"\".\"\".\"subDetail0..*BackboneElementSubdetail line items\n
\".\"\".\"\".\"\".\"\".\"\".\"sequenceLinkId1..1positiveIntService instance
\".\"\".\"\".\"\".\"\".\"\".\"noteNumber0..*positiveIntList of note numbers which apply\n
\".\"\".\"\".\"\".\"\".\"\".\"adjudication0..*see \n adjudicationSubdetail level adjudication details\n
\".\"\".\"\".\"addItem0..*BackboneElementInsurer added line items\n
\".\"\".\"\".\"\".\"sequenceLinkId0..*positiveIntService instances\n
\".\"\".\"\".\"\".\"revenue0..1CodeableConceptRevenue or cost center code\n
Example Revenue Center Codes (\n Example)\n
\".\"\".\"\".\"\".\"category0..1CodeableConceptType of service or product\n
Benefit SubCategory Codes (\n Example)\n
\".\"\".\"\".\"\".\"service0..1CodeableConceptGroup, Service or Product\n
USCLS Codes (\n Example)\n
\".\"\".\"\".\"\".\"modifier0..*CodeableConceptService/Product billing modifiers\n
Modifier type Codes (\n Example)\n
\".\"\".\"\".\"\".\"fee0..1MoneyProfessional fee or Product charge
\".\"\".\"\".\"\".\"noteNumber0..*positiveIntList of note numbers which apply\n
\".\"\".\"\".\"\".\"adjudication0..*see \n adjudicationAdded items adjudication\n
\".\"\".\"\".\"\".\"detail0..*BackboneElementAdded items details\n
\".\"\".\"\".\"\".\"\".\"revenue0..1CodeableConceptRevenue or cost center code\n
Example Revenue Center Codes (\n Example)\n
\".\"\".\"\".\"\".\"\".\"category0..1CodeableConceptType of service or product\n
Benefit SubCategory Codes (\n Example)\n
\".\"\".\"\".\"\".\"\".\"service0..1CodeableConceptService or Product\n
USCLS Codes (\n Example)\n
\".\"\".\"\".\"\".\"\".\"modifier0..*CodeableConceptService/Product billing modifiers\n
Modifier type Codes (\n Example)\n
\".\"\".\"\".\"\".\"\".\"fee0..1MoneyProfessional fee or Product charge
\".\"\".\"\".\"\".\"\".\"noteNumber0..*positiveIntList of note numbers which apply\n
\".\"\".\"\".\"\".\"\".\"adjudication0..*see \n adjudicationAdded items detail adjudication\n
\".\"\".\"\".\"error0..*BackboneElementProcessing errors\n
\".\"\".\"\".\"\".\"sequenceLinkId0..1positiveIntItem sequence number
\".\"\".\"\".\"\".\"detailSequenceLinkId0..1positiveIntDetail sequence number
\".\"\".\"\".\"\".\"subdetailSequenceLinkId0..1positiveIntSubdetail sequence number
\".\"\".\"\".\"\".\"code1..1CodeableConceptError code detailing processing issues\n
Adjudication Error Codes (\n Example)\n
\".\"\".\"\".\"totalCost0..1MoneyTotal Cost of service from the Claim
\".\"\".\"\".\"unallocDeductable0..1MoneyUnallocated deductible
\".\"\".\"\".\"totalBenefit0..1MoneyTotal benefit payable for the Claim
\".\"\".\"\".\"payment0..1BackboneElementPayment details, if paid
\".\"\".\"\".\"\".\"type0..1CodeableConceptPartial or Complete\n
Example Payment Type Codes (\n Example)\n
\".\"\".\"\".\"\".\"adjustment0..1MoneyPayment adjustment for non-Claim issues
\".\"\".\"\".\"\".\"adjustmentReason0..1CodeableConceptExplanation for the non-claim adjustment\n
Payment Adjustment Reason Codes (\n Example)\n
\".\"\".\"\".\"\".\"date0..1dateExpected data of Payment
\".\"\".\"\".\"\".\"amount0..1MoneyPayable amount after adjustment
\".\"\".\"\".\"\".\"identifier0..1IdentifierIdentifier of the payment instrument
\".\"\".\"\".\"reserved0..1CodingFunds reserved status\n
Funds Reservation Codes (\n Example)\n
\".\"\".\"\".\"form0..1CodeableConceptPrinted Form Identifier\n
Form Codes (\n Example)\n
\".\"\".\"\".\"processNote0..*BackboneElementProcessing notes\n
\".\"\".\"\".\"\".\"number0..1positiveIntSequence Number for this note
\".\"\".\"\".\"\".\"type0..1CodeableConceptdisplay | print | printoper\n
NoteType (\n Required)\n
\".\"\".\"\".\"\".\"text0..1stringNote explanatory text
\".\"\".\"\".\"\".\"language0..1CodeableConceptLanguage if different from the resource\n
Common Languages (\n Extensible but limited to \n All Languages)\n
\".\"\".\"\".\"communicationRequest0..*Reference(\n CommunicationRequest)\n Request for additional information\n
\".\"\".\"\".\"insurance0..*BackboneElementInsurance or medical plan\n
\".\"\".\"\".\"\".\"sequence1..1positiveIntService instance identifier
\".\"\".\"\".\"\".\"focal1..1booleanIs the focal Coverage
\".\"\".\"\".\"\".\"coverage1..1Reference(\n Coverage)\n Insurance information
\".\"\".\"\".\"\".\"businessArrangement0..1stringBusiness agreement
\".\"\".\"\".\"\".\"preAuthRef0..*stringPre-Authorization/Determination Reference\n
\".\"\".\"\".\"\".\"claimResponse0..1Reference(\n ClaimResponse)\n Adjudication results

\"doco\" Documentation for this format\n
" }, "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-fmm", "valueInteger": 2 }, { "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-wg", "valueCode": "fm" } ], "url": "http://hl7.org/fhir/StructureDefinition/ClaimResponse", "name": "ClaimResponse", "status": "draft", "date": "2017-04-18T21:44:43+00:00", "publisher": "Health Level Seven International (Financial Management)", "contact": [ { "telecom": [ { "system": "url", "value": "http://hl7.org/fhir" } ] }, { "telecom": [ { "system": "url", "value": "http://www.hl7.org/Special/committees/fm/index.cfm" } ] } ], "description": "Base StructureDefinition for ClaimResponse Resource", "fhirVersion": "3.0.1", "mapping": [ { "identity": "workflow", "uri": "http://hl7.org/fhir/workflow", "name": "Workflow Mapping" }, { "identity": "w5", "uri": "http://hl7.org/fhir/w5", "name": "W5 Mapping" }, { "identity": "cdanetv4", "uri": "http://www.cda-adc.ca/en/services/cdanet/", "name": "Canadian Dental Association eclaims standard" }, { "identity": "rim", "uri": "http://hl7.org/v3", "name": "RIM Mapping" } ], "kind": "resource", "abstract": false, "type": "ClaimResponse", "baseDefinition": "http://hl7.org/fhir/StructureDefinition/DomainResource", "derivation": "specialization", "snapshot": { "element": [ { "id": "ClaimResponse", "path": "ClaimResponse", "short": "Remittance resource", "definition": "This resource provides the adjudication details from the processing of a Claim resource.", "alias": [ "Remittance Advice" ], "min": 0, "max": "*", "base": { "path": "Resource", "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-1", "severity": "error", "human": "If the resource is contained in another resource, it SHALL NOT contain any narrative", "expression": "contained.text.empty()", "xpath": "not(parent::f:contained and f:text)", "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", "expression": "contained.where(('#'+id in %resource.descendants().reference).not()).empty()", "xpath": "not(exists(for $id in f:contained/*/@id return $id[not(ancestor::f:contained/parent::*/descendant::f:reference/@value=concat('#', $id))]))", "source": "http://hl7.org/fhir/StructureDefinition/DomainResource" } ], "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": [ { "code": "id" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() | (children().count() > id.count())", "xpath": "@value|f:*|h:div" } ], "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 may 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", "expression": "hasValue() | (children().count() > id.count())", "xpath": "@value|f:*|h:div" } ], "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.", "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. \n\nThis element is labelled as a modifier because the implicit rules may provide additional knowledge about the resource that modifies it's meaning or interpretation.", "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", "expression": "hasValue() | (children().count() > id.count())", "xpath": "@value|f:*|h:div" } ], "isModifier": true, "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", "expression": "hasValue() | (children().count() > id.count())", "xpath": "@value|f:*|h:div" } ], "binding": { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-maxValueSet", "valueReference": { "reference": "http://hl7.org/fhir/ValueSet/all-languages" } }, { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString": "Language" } ], "strength": "extensible", "description": "A human language.", "valueSetReference": { "reference": "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 may 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 in formation 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", "dom-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() | (children().count() > id.count())", "xpath": "@value|f:*|h:div" } ], "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.", "alias": [ "inline resources", "anonymous resources", "contained resources" ], "min": 0, "max": "*", "base": { "path": "DomainResource.contained", "min": 0, "max": "*" }, "type": [ { "code": "Resource" } ], "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. In order 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.", "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", "expression": "hasValue() | (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Extension" }, { "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.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. Usually modifier elements provide negation or qualification. In order 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.", "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.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", "expression": "hasValue() | (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Extension" }, { "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, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "rim", "map": "N/A" } ] }, { "id": "ClaimResponse.identifier", "path": "ClaimResponse.identifier", "short": "Response number", "definition": "The Response business 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", "expression": "hasValue() | (children().count() > id.count())", "xpath": "@value|f:*|h:div" } ], "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 - see see identifier pattern at http://wiki.hl7.org/index.php?title=Common_Design_Patterns#Identifier_Pattern for relevant discussion. 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": "id" } ] }, { "id": "ClaimResponse.status", "path": "ClaimResponse.status", "short": "active | cancelled | draft | entered-in-error", "definition": "The status of the resource instance.", "comment": "This element is labeled as a modifier because the status contains the code cancelled and entered-in-error that mark the response as not currently valid.", "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", "expression": "hasValue() | (children().count() > id.count())", "xpath": "@value|f:*|h:div" } ], "isModifier": true, "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.", "valueSetReference": { "reference": "http://hl7.org/fhir/ValueSet/fm-status" } }, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "workflow", "map": "Event.status" }, { "identity": "w5", "map": "status" } ] }, { "id": "ClaimResponse.patient", "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-display-hint", "valueString": "who.focus" } ], "path": "ClaimResponse.patient", "short": "The subject of the Products and Services", "definition": "Patient Resource.", "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", "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", "expression": "hasValue() | (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Reference" }, { "key": "ref-1", "severity": "error", "human": "SHALL have a contained resource if a local reference is provided", "expression": "reference.startsWith('#').not() or (reference.substring(1).trace('url') in %resource.contained.id.trace('ids'))", "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" } ], "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.created", "path": "ClaimResponse.created", "short": "Creation date", "definition": "The date when the enclosed suite of services were performed or completed.", "min": 0, "max": "1", "type": [ { "code": "dateTime" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() | (children().count() > id.count())", "xpath": "@value|f:*|h:div" } ], "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "workflow", "map": "Event.occurrence" }, { "identity": "w5", "map": "when.recorded" } ] }, { "id": "ClaimResponse.insurer", "path": "ClaimResponse.insurer", "short": "Insurance issuing organization", "definition": "The Insurer who produced this adjudicated response.", "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", "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", "expression": "hasValue() | (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Reference" }, { "key": "ref-1", "severity": "error", "human": "SHALL have a contained resource if a local reference is provided", "expression": "reference.startsWith('#').not() or (reference.substring(1).trace('url') in %resource.contained.id.trace('ids'))", "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" } ], "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.onBehalfOf" } ] }, { "id": "ClaimResponse.requestProvider", "path": "ClaimResponse.requestProvider", "short": "Responsible practitioner", "definition": "The practitioner who is responsible for the services rendered to the 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.", "min": 0, "max": "1", "type": [ { "code": "Reference", "targetProfile": "http://hl7.org/fhir/StructureDefinition/Practitioner" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() | (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Reference" }, { "key": "ref-1", "severity": "error", "human": "SHALL have a contained resource if a local reference is provided", "expression": "reference.startsWith('#').not() or (reference.substring(1).trace('url') in %resource.contained.id.trace('ids'))", "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" } ], "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": "cdanetv4", "map": "B01" }, { "identity": "w5", "map": "who.source" } ] }, { "id": "ClaimResponse.requestOrganization", "path": "ClaimResponse.requestOrganization", "short": "Responsible organization", "definition": "The organization which is responsible for the services rendered to the 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.", "min": 0, "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", "expression": "hasValue() | (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Reference" }, { "key": "ref-1", "severity": "error", "human": "SHALL have a contained resource if a local reference is provided", "expression": "reference.startsWith('#').not() or (reference.substring(1).trace('url') in %resource.contained.id.trace('ids'))", "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" } ], "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": "who.source" } ] }, { "id": "ClaimResponse.request", "path": "ClaimResponse.request", "short": "Id of resource triggering adjudication", "definition": "Original request resource referrence.", "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", "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", "expression": "hasValue() | (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Reference" }, { "key": "ref-1", "severity": "error", "human": "SHALL have a contained resource if a local reference is provided", "expression": "reference.startsWith('#').not() or (reference.substring(1).trace('url') in %resource.contained.id.trace('ids'))", "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" } ], "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": "cdanetv4", "map": "A02|G01" }, { "identity": "w5", "map": "why" } ] }, { "id": "ClaimResponse.outcome", "path": "ClaimResponse.outcome", "short": "complete | error | partial", "definition": "Processing outcome errror, partial or complete processing.", "comment": "Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination.", "min": 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", "expression": "hasValue() | (children().count() > id.count())", "xpath": "@value|f:*|h:div" } ], "binding": { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString": "RemittanceOutcome" } ], "strength": "example", "description": "The result of the claim processing", "valueSetReference": { "reference": "http://hl7.org/fhir/ValueSet/remittance-outcome" } }, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "v2", "map": "CE/CNE/CWE" }, { "identity": "rim", "map": "CD" }, { "identity": "orim", "map": "fhir:CodeableConcept rdfs:subClassOf dt:CD" } ] }, { "id": "ClaimResponse.disposition", "path": "ClaimResponse.disposition", "short": "Disposition Message", "definition": "A description of the status of the adjudication.", "comment": "Note that FHIR strings may not exceed 1MB in size", "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", "expression": "hasValue() | (children().count() > id.count())", "xpath": "@value|f:*|h:div" } ], "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "workflow", "map": "Event.note" } ] }, { "id": "ClaimResponse.payeeType", "path": "ClaimResponse.payeeType", "short": "Party to be paid any benefits payable", "definition": "Party to be reimbursed: Subscriber, provider, other.", "comment": "Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination.", "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", "expression": "hasValue() | (children().count() > id.count())", "xpath": "@value|f:*|h:div" } ], "binding": { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString": "PayeeType" }, { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-isCommonBinding", "valueBoolean": true } ], "strength": "example", "description": "A code for the party to be reimbursed.", "valueSetReference": { "reference": "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.item", "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-explicit-type-name", "valueString": "Item" } ], "path": "ClaimResponse.item", "short": "Line items", "definition": "The first tier service adjudications for submitted services.", "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", "expression": "hasValue() | (children().count() > id.count())", "xpath": "@value|f:*|h:div" } ], "mapping": [ { "identity": "rim", "map": "n/a" } ] }, { "id": "ClaimResponse.item.id", "path": "ClaimResponse.item.id", "representation": [ "xmlAttr" ], "short": "xml:id (or equivalent in JSON)", "definition": "unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.", "comment": "Note that FHIR strings may not exceed 1MB in size", "min": 0, "max": "1", "base": { "path": "Element.id", "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", "expression": "hasValue() | (children().count() > id.count())", "xpath": "@value|f:*|h:div" } ], "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. In order 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.", "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", "expression": "hasValue() | (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Extension" }, { "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", "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 that contains it. Usually modifier elements provide negation or qualification. In order 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.", "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", "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", "expression": "hasValue() | (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Extension" }, { "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, "isSummary": true, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "rim", "map": "N/A" } ] }, { "id": "ClaimResponse.item.sequenceLinkId", "path": "ClaimResponse.item.sequenceLinkId", "short": "Service instance", "definition": "A service line number.", "comment": "32 bit number; for values larger than this, use decimal", "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", "expression": "hasValue() | (children().count() > id.count())", "xpath": "@value|f:*|h:div" } ], "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "cdanetv4", "map": "F07" } ] }, { "id": "ClaimResponse.item.noteNumber", "path": "ClaimResponse.item.noteNumber", "short": "List of note numbers which apply", "definition": "A list of note references to the notes provided below.", "comment": "32 bit number; for values larger than this, use decimal", "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", "expression": "hasValue() | (children().count() > id.count())", "xpath": "@value|f:*|h:div" } ], "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": "The adjudication results.", "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", "expression": "hasValue() | (children().count() > id.count())", "xpath": "@value|f:*|h:div" } ], "mapping": [ { "identity": "rim", "map": "n/a" } ] }, { "id": "ClaimResponse.item.adjudication.id", "path": "ClaimResponse.item.adjudication.id", "representation": [ "xmlAttr" ], "short": "xml:id (or equivalent in JSON)", "definition": "unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.", "comment": "Note that FHIR strings may not exceed 1MB in size", "min": 0, "max": "1", "base": { "path": "Element.id", "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", "expression": "hasValue() | (children().count() > id.count())", "xpath": "@value|f:*|h:div" } ], "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. In order 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.", "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", "expression": "hasValue() | (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Extension" }, { "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", "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 that contains it. Usually modifier elements provide negation or qualification. In order 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.", "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", "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", "expression": "hasValue() | (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Extension" }, { "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, "isSummary": true, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "rim", "map": "N/A" } ] }, { "id": "ClaimResponse.item.adjudication.category", "path": "ClaimResponse.item.adjudication.category", "short": "Adjudication category such as co-pay, eligible, benefit, etc.", "definition": "Code indicating: Co-Pay, deductible, eligible, benefit, tax, etc.", "comment": "Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination.", "min": 1, "max": "1", "type": [ { "code": "CodeableConcept" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() | (children().count() > id.count())", "xpath": "@value|f:*|h:div" } ], "binding": { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString": "Adjudication" } ], "strength": "example", "description": "The adjudication codes.", "valueSetReference": { "reference": "http://hl7.org/fhir/ValueSet/adjudication" } }, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "v2", "map": "CE/CNE/CWE" }, { "identity": "rim", "map": "CD" }, { "identity": "orim", "map": "fhir:CodeableConcept rdfs:subClassOf dt:CD" } ] }, { "id": "ClaimResponse.item.adjudication.reason", "path": "ClaimResponse.item.adjudication.reason", "short": "Explanation of Adjudication outcome", "definition": "Adjudication reason such as limit reached.", "comment": "Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination.", "min": 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", "expression": "hasValue() | (children().count() > id.count())", "xpath": "@value|f:*|h:div" } ], "binding": { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString": "AdjudicationReason" } ], "strength": "example", "description": "The adjudication reason codes.", "valueSetReference": { "reference": "http://hl7.org/fhir/ValueSet/adjudication-reason" } }, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "v2", "map": "CE/CNE/CWE" }, { "identity": "rim", "map": "CD" }, { "identity": "orim", "map": "fhir:CodeableConcept rdfs:subClassOf dt:CD" } ] }, { "id": "ClaimResponse.item.adjudication.amount", "path": "ClaimResponse.item.adjudication.amount", "short": "Monetary amount", "definition": "Monetary amount associated with the code.", "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.", "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", "expression": "hasValue() | (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Quantity" }, { "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": "mny-1", "severity": "error", "human": "There SHALL be a code if there is a value and it SHALL be an expression of currency. If system is present, it SHALL be ISO 4217 (system = \"urn:iso:std:iso:4217\" - currency).", "expression": "(code or value.empty()) and (system.empty() or system = 'urn:iso:std:iso:4217')", "xpath": "(f:code or not(f:value)) and (not(exists(f:system)) or f:system/@value='urn:iso:std:iso:4217')", "source": "http://hl7.org/fhir/StructureDefinition/Money" } ], "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": "MO" } ] }, { "id": "ClaimResponse.item.adjudication.value", "path": "ClaimResponse.item.adjudication.value", "short": "Non-monetary value", "definition": "A non-monetary value for example a percentage. Mutually exclusive to the amount element above.", "comment": "Do not use a IEEE type floating point type, instead use something that works like a true decimal, with inbuilt precision (e.g. Java BigInteger)", "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", "expression": "hasValue() | (children().count() > id.count())", "xpath": "@value|f:*|h:div" } ], "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": "Detail line items", "definition": "The second tier service adjudications for submitted services.", "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", "expression": "hasValue() | (children().count() > id.count())", "xpath": "@value|f:*|h:div" } ], "mapping": [ { "identity": "rim", "map": "n/a" } ] }, { "id": "ClaimResponse.item.detail.id", "path": "ClaimResponse.item.detail.id", "representation": [ "xmlAttr" ], "short": "xml:id (or equivalent in JSON)", "definition": "unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.", "comment": "Note that FHIR strings may not exceed 1MB in size", "min": 0, "max": "1", "base": { "path": "Element.id", "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", "expression": "hasValue() | (children().count() > id.count())", "xpath": "@value|f:*|h:div" } ], "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. In order 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.", "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", "expression": "hasValue() | (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Extension" }, { "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", "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 that contains it. Usually modifier elements provide negation or qualification. In order 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.", "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", "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", "expression": "hasValue() | (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Extension" }, { "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, "isSummary": true, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "rim", "map": "N/A" } ] }, { "id": "ClaimResponse.item.detail.sequenceLinkId", "path": "ClaimResponse.item.detail.sequenceLinkId", "short": "Service instance", "definition": "A service line number.", "comment": "32 bit number; for values larger than this, use decimal", "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", "expression": "hasValue() | (children().count() > id.count())", "xpath": "@value|f:*|h:div" } ], "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "cdanetv4", "map": "F07" } ] }, { "id": "ClaimResponse.item.detail.noteNumber", "path": "ClaimResponse.item.detail.noteNumber", "short": "List of note numbers which apply", "definition": "A list of note references to the notes provided below.", "comment": "32 bit number; for values larger than this, use decimal", "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", "expression": "hasValue() | (children().count() > id.count())", "xpath": "@value|f:*|h:div" } ], "mapping": [ { "identity": "rim", "map": "n/a" } ] }, { "id": "ClaimResponse.item.detail.adjudication", "path": "ClaimResponse.item.detail.adjudication", "short": "Detail level adjudication details", "definition": "The adjudications results.", "min": 0, "max": "*", "contentReference": "#ClaimResponse.item.adjudication" }, { "id": "ClaimResponse.item.detail.subDetail", "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-explicit-type-name", "valueString": "SubDetail" } ], "path": "ClaimResponse.item.detail.subDetail", "short": "Subdetail line items", "definition": "The third tier service adjudications for submitted services.", "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", "expression": "hasValue() | (children().count() > id.count())", "xpath": "@value|f:*|h:div" } ], "mapping": [ { "identity": "rim", "map": "n/a" } ] }, { "id": "ClaimResponse.item.detail.subDetail.id", "path": "ClaimResponse.item.detail.subDetail.id", "representation": [ "xmlAttr" ], "short": "xml:id (or equivalent in JSON)", "definition": "unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.", "comment": "Note that FHIR strings may not exceed 1MB in size", "min": 0, "max": "1", "base": { "path": "Element.id", "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", "expression": "hasValue() | (children().count() > id.count())", "xpath": "@value|f:*|h:div" } ], "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. In order 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.", "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", "expression": "hasValue() | (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Extension" }, { "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", "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 that contains it. Usually modifier elements provide negation or qualification. In order 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.", "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", "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", "expression": "hasValue() | (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Extension" }, { "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, "isSummary": true, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "rim", "map": "N/A" } ] }, { "id": "ClaimResponse.item.detail.subDetail.sequenceLinkId", "path": "ClaimResponse.item.detail.subDetail.sequenceLinkId", "short": "Service instance", "definition": "A service line number.", "comment": "32 bit number; for values larger than this, use decimal", "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", "expression": "hasValue() | (children().count() > id.count())", "xpath": "@value|f:*|h:div" } ], "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "cdanetv4", "map": "F07" } ] }, { "id": "ClaimResponse.item.detail.subDetail.noteNumber", "path": "ClaimResponse.item.detail.subDetail.noteNumber", "short": "List of note numbers which apply", "definition": "A list of note references to the notes provided below.", "comment": "32 bit number; for values larger than this, use decimal", "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", "expression": "hasValue() | (children().count() > id.count())", "xpath": "@value|f:*|h:div" } ], "mapping": [ { "identity": "rim", "map": "n/a" } ] }, { "id": "ClaimResponse.item.detail.subDetail.adjudication", "path": "ClaimResponse.item.detail.subDetail.adjudication", "short": "Subdetail level adjudication details", "definition": "The adjudications results.", "min": 0, "max": "*", "contentReference": "#ClaimResponse.item.adjudication" }, { "id": "ClaimResponse.addItem", "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-explicit-type-name", "valueString": "AddedItem" } ], "path": "ClaimResponse.addItem", "short": "Insurer added line items", "definition": "The first tier service adjudications for payor added services.", "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", "expression": "hasValue() | (children().count() > id.count())", "xpath": "@value|f:*|h:div" } ], "mapping": [ { "identity": "rim", "map": "n/a" } ] }, { "id": "ClaimResponse.addItem.id", "path": "ClaimResponse.addItem.id", "representation": [ "xmlAttr" ], "short": "xml:id (or equivalent in JSON)", "definition": "unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.", "comment": "Note that FHIR strings may not exceed 1MB in size", "min": 0, "max": "1", "base": { "path": "Element.id", "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", "expression": "hasValue() | (children().count() > id.count())", "xpath": "@value|f:*|h:div" } ], "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. In order 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.", "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", "expression": "hasValue() | (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Extension" }, { "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", "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 that contains it. Usually modifier elements provide negation or qualification. In order 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.", "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", "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", "expression": "hasValue() | (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Extension" }, { "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, "isSummary": true, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "rim", "map": "N/A" } ] }, { "id": "ClaimResponse.addItem.sequenceLinkId", "path": "ClaimResponse.addItem.sequenceLinkId", "short": "Service instances", "definition": "List of input service items which this service line is intended to replace.", "comment": "32 bit number; for values larger than this, use decimal", "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", "expression": "hasValue() | (children().count() > id.count())", "xpath": "@value|f:*|h:div" } ], "mapping": [ { "identity": "rim", "map": "n/a" } ] }, { "id": "ClaimResponse.addItem.revenue", "path": "ClaimResponse.addItem.revenue", "short": "Revenue or cost center code", "definition": "The type of reveneu or cost center providing the product and/or service.", "comment": "Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination.", "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", "expression": "hasValue() | (children().count() > id.count())", "xpath": "@value|f:*|h:div" } ], "binding": { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString": "RevenueCenter" } ], "strength": "example", "description": "Codes for the revenue or cost centers supplying the service and/or products.", "valueSetReference": { "reference": "http://hl7.org/fhir/ValueSet/ex-revenue-center" } }, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "v2", "map": "CE/CNE/CWE" }, { "identity": "rim", "map": "CD" }, { "identity": "orim", "map": "fhir:CodeableConcept rdfs:subClassOf dt:CD" } ] }, { "id": "ClaimResponse.addItem.category", "path": "ClaimResponse.addItem.category", "short": "Type of service or product", "definition": "Health Care Service Type Codes to identify the classification of service or benefits.", "comment": "Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination.", "min": 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", "expression": "hasValue() | (children().count() > id.count())", "xpath": "@value|f:*|h:div" } ], "binding": { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString": "BenefitSubCategory" } ], "strength": "example", "description": "Benefit subcategories such as: oral-basic, major, glasses", "valueSetReference": { "reference": "http://hl7.org/fhir/ValueSet/benefit-subcategory" } }, "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.service", "path": "ClaimResponse.addItem.service", "short": "Group, Service or Product", "definition": "A code to indicate the Professional Service or Product supplied.", "comment": "Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination.", "min": 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", "expression": "hasValue() | (children().count() > id.count())", "xpath": "@value|f:*|h:div" } ], "binding": { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString": "ServiceProduct" } ], "strength": "example", "description": "Allowable service and product codes.", "valueSetReference": { "reference": "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.modifier", "path": "ClaimResponse.addItem.modifier", "short": "Service/Product billing modifiers", "definition": "Item typification or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or for medical whether the treatment was outside the clinic or out of office hours.", "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": "May impact on adjudication.", "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", "expression": "hasValue() | (children().count() > id.count())", "xpath": "@value|f:*|h:div" } ], "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.", "valueSetReference": { "reference": "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.fee", "path": "ClaimResponse.addItem.fee", "short": "Professional fee or Product charge", "definition": "The fee charged for the professional service or product..", "comment": "The context of use may frequently define what kind of quantity this is and therefore what kind of units can be used. The context of use may also restrict the values for the comparator.", "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", "expression": "hasValue() | (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Quantity" }, { "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": "mny-1", "severity": "error", "human": "There SHALL be a code if there is a value and it SHALL be an expression of currency. If system is present, it SHALL be ISO 4217 (system = \"urn:iso:std:iso:4217\" - currency).", "expression": "(code or value.empty()) and (system.empty() or system = 'urn:iso:std:iso:4217')", "xpath": "(f:code or not(f:value)) and (not(exists(f:system)) or f:system/@value='urn:iso:std:iso:4217')", "source": "http://hl7.org/fhir/StructureDefinition/Money" } ], "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": "MO" } ] }, { "id": "ClaimResponse.addItem.noteNumber", "path": "ClaimResponse.addItem.noteNumber", "short": "List of note numbers which apply", "definition": "A list of note references to the notes provided below.", "comment": "32 bit number; for values larger than this, use decimal", "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", "expression": "hasValue() | (children().count() > id.count())", "xpath": "@value|f:*|h:div" } ], "mapping": [ { "identity": "rim", "map": "n/a" } ] }, { "id": "ClaimResponse.addItem.adjudication", "path": "ClaimResponse.addItem.adjudication", "short": "Added items adjudication", "definition": "The adjudications results.", "min": 0, "max": "*", "contentReference": "#ClaimResponse.item.adjudication" }, { "id": "ClaimResponse.addItem.detail", "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-explicit-type-name", "valueString": "AddedItemsDetail" } ], "path": "ClaimResponse.addItem.detail", "short": "Added items details", "definition": "The second tier service adjudications for payor added services.", "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", "expression": "hasValue() | (children().count() > id.count())", "xpath": "@value|f:*|h:div" } ], "mapping": [ { "identity": "rim", "map": "n/a" } ] }, { "id": "ClaimResponse.addItem.detail.id", "path": "ClaimResponse.addItem.detail.id", "representation": [ "xmlAttr" ], "short": "xml:id (or equivalent in JSON)", "definition": "unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.", "comment": "Note that FHIR strings may not exceed 1MB in size", "min": 0, "max": "1", "base": { "path": "Element.id", "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", "expression": "hasValue() | (children().count() > id.count())", "xpath": "@value|f:*|h:div" } ], "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. In order 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.", "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", "expression": "hasValue() | (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Extension" }, { "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", "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 that contains it. Usually modifier elements provide negation or qualification. In order 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.", "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", "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", "expression": "hasValue() | (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Extension" }, { "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, "isSummary": true, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "rim", "map": "N/A" } ] }, { "id": "ClaimResponse.addItem.detail.revenue", "path": "ClaimResponse.addItem.detail.revenue", "short": "Revenue or cost center code", "definition": "The type of reveneu or cost center providing the product and/or service.", "comment": "Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination.", "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", "expression": "hasValue() | (children().count() > id.count())", "xpath": "@value|f:*|h:div" } ], "binding": { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString": "RevenueCenter" } ], "strength": "example", "description": "Codes for the revenue or cost centers supplying the service and/or products.", "valueSetReference": { "reference": "http://hl7.org/fhir/ValueSet/ex-revenue-center" } }, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "v2", "map": "CE/CNE/CWE" }, { "identity": "rim", "map": "CD" }, { "identity": "orim", "map": "fhir:CodeableConcept rdfs:subClassOf dt:CD" } ] }, { "id": "ClaimResponse.addItem.detail.category", "path": "ClaimResponse.addItem.detail.category", "short": "Type of service or product", "definition": "Health Care Service Type Codes to identify the classification of service or benefits.", "comment": "Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination.", "min": 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", "expression": "hasValue() | (children().count() > id.count())", "xpath": "@value|f:*|h:div" } ], "binding": { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString": "BenefitSubCategory" } ], "strength": "example", "description": "Benefit subcategories such as: oral-basic, major, glasses", "valueSetReference": { "reference": "http://hl7.org/fhir/ValueSet/benefit-subcategory" } }, "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.service", "path": "ClaimResponse.addItem.detail.service", "short": "Service or Product", "definition": "A code to indicate the Professional Service or Product supplied.", "comment": "Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination.", "min": 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", "expression": "hasValue() | (children().count() > id.count())", "xpath": "@value|f:*|h:div" } ], "binding": { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString": "ServiceProduct" } ], "strength": "example", "description": "Allowable service and product codes.", "valueSetReference": { "reference": "http://hl7.org/fhir/ValueSet/service-uscls" } }, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "v2", "map": "CE/CNE/CWE" }, { "identity": "rim", "map": "CD" }, { "identity": "orim", "map": "fhir:CodeableConcept rdfs:subClassOf dt:CD" } ] }, { "id": "ClaimResponse.addItem.detail.modifier", "path": "ClaimResponse.addItem.detail.modifier", "short": "Service/Product billing modifiers", "definition": "Item typification or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or for medical whether the treatment was outside the clinic or out of office hours.", "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": "May impact on adjudication.", "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", "expression": "hasValue() | (children().count() > id.count())", "xpath": "@value|f:*|h:div" } ], "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.", "valueSetReference": { "reference": "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.fee", "path": "ClaimResponse.addItem.detail.fee", "short": "Professional fee or Product charge", "definition": "The fee charged for the professional service or product..", "comment": "The context of use may frequently define what kind of quantity this is and therefore what kind of units can be used. The context of use may also restrict the values for the comparator.", "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", "expression": "hasValue() | (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Quantity" }, { "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": "mny-1", "severity": "error", "human": "There SHALL be a code if there is a value and it SHALL be an expression of currency. If system is present, it SHALL be ISO 4217 (system = \"urn:iso:std:iso:4217\" - currency).", "expression": "(code or value.empty()) and (system.empty() or system = 'urn:iso:std:iso:4217')", "xpath": "(f:code or not(f:value)) and (not(exists(f:system)) or f:system/@value='urn:iso:std:iso:4217')", "source": "http://hl7.org/fhir/StructureDefinition/Money" } ], "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": "MO" } ] }, { "id": "ClaimResponse.addItem.detail.noteNumber", "path": "ClaimResponse.addItem.detail.noteNumber", "short": "List of note numbers which apply", "definition": "A list of note references to the notes provided below.", "comment": "32 bit number; for values larger than this, use decimal", "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", "expression": "hasValue() | (children().count() > id.count())", "xpath": "@value|f:*|h:div" } ], "mapping": [ { "identity": "rim", "map": "n/a" } ] }, { "id": "ClaimResponse.addItem.detail.adjudication", "path": "ClaimResponse.addItem.detail.adjudication", "short": "Added items detail adjudication", "definition": "The adjudications results.", "min": 0, "max": "*", "contentReference": "#ClaimResponse.item.adjudication" }, { "id": "ClaimResponse.error", "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-explicit-type-name", "valueString": "Error" } ], "path": "ClaimResponse.error", "short": "Processing errors", "definition": "Mutually exclusive with Services Provided (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", "expression": "hasValue() | (children().count() > id.count())", "xpath": "@value|f:*|h:div" } ], "mapping": [ { "identity": "rim", "map": "n/a" } ] }, { "id": "ClaimResponse.error.id", "path": "ClaimResponse.error.id", "representation": [ "xmlAttr" ], "short": "xml:id (or equivalent in JSON)", "definition": "unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.", "comment": "Note that FHIR strings may not exceed 1MB in size", "min": 0, "max": "1", "base": { "path": "Element.id", "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", "expression": "hasValue() | (children().count() > id.count())", "xpath": "@value|f:*|h:div" } ], "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. In order 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.", "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", "expression": "hasValue() | (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Extension" }, { "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", "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 that contains it. Usually modifier elements provide negation or qualification. In order 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.", "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", "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", "expression": "hasValue() | (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Extension" }, { "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, "isSummary": true, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "rim", "map": "N/A" } ] }, { "id": "ClaimResponse.error.sequenceLinkId", "path": "ClaimResponse.error.sequenceLinkId", "short": "Item sequence number", "definition": "The sequence number of the line item submitted which contains the error. This value is omitted when the error is elsewhere.", "comment": "32 bit number; for values larger than this, use decimal", "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", "expression": "hasValue() | (children().count() > id.count())", "xpath": "@value|f:*|h:div" } ], "mapping": [ { "identity": "rim", "map": "n/a" } ] }, { "id": "ClaimResponse.error.detailSequenceLinkId", "path": "ClaimResponse.error.detailSequenceLinkId", "short": "Detail sequence number", "definition": "The sequence number of the addition within the line item submitted which contains the error. This value is omitted when the error is not related to an Addition.", "comment": "32 bit number; for values larger than this, use decimal", "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", "expression": "hasValue() | (children().count() > id.count())", "xpath": "@value|f:*|h:div" } ], "mapping": [ { "identity": "rim", "map": "n/a" } ] }, { "id": "ClaimResponse.error.subdetailSequenceLinkId", "path": "ClaimResponse.error.subdetailSequenceLinkId", "short": "Subdetail sequence number", "definition": "The sequence number of the addition within the line item submitted which contains the error. This value is omitted when the error is not related to an Addition.", "comment": "32 bit number; for values larger than this, use decimal", "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", "expression": "hasValue() | (children().count() > id.count())", "xpath": "@value|f:*|h:div" } ], "mapping": [ { "identity": "rim", "map": "n/a" } ] }, { "id": "ClaimResponse.error.code", "path": "ClaimResponse.error.code", "short": "Error code detailing processing issues", "definition": "An error code,from a specified code system, which details why the claim could not be adjudicated.", "comment": "Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination.", "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", "expression": "hasValue() | (children().count() > id.count())", "xpath": "@value|f:*|h:div" } ], "binding": { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString": "AdjudicationError" } ], "strength": "example", "description": "The adjudication error codes.", "valueSetReference": { "reference": "http://hl7.org/fhir/ValueSet/adjudication-error" } }, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "v2", "map": "CE/CNE/CWE" }, { "identity": "rim", "map": "CD" }, { "identity": "orim", "map": "fhir:CodeableConcept rdfs:subClassOf dt:CD" } ] }, { "id": "ClaimResponse.totalCost", "path": "ClaimResponse.totalCost", "short": "Total Cost of service from the Claim", "definition": "The total cost of the services reported.", "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": "This is a check value that the receiver calculates and returns.", "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", "expression": "hasValue() | (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Quantity" }, { "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": "mny-1", "severity": "error", "human": "There SHALL be a code if there is a value and it SHALL be an expression of currency. If system is present, it SHALL be ISO 4217 (system = \"urn:iso:std:iso:4217\" - currency).", "expression": "(code or value.empty()) and (system.empty() or system = 'urn:iso:std:iso:4217')", "xpath": "(f:code or not(f:value)) and (not(exists(f:system)) or f:system/@value='urn:iso:std:iso:4217')", "source": "http://hl7.org/fhir/StructureDefinition/Money" } ], "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": "MO" } ] }, { "id": "ClaimResponse.unallocDeductable", "path": "ClaimResponse.unallocDeductable", "short": "Unallocated deductible", "definition": "The amount of deductible applied which was not allocated to any particular service line.", "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.", "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", "expression": "hasValue() | (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Quantity" }, { "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": "mny-1", "severity": "error", "human": "There SHALL be a code if there is a value and it SHALL be an expression of currency. If system is present, it SHALL be ISO 4217 (system = \"urn:iso:std:iso:4217\" - currency).", "expression": "(code or value.empty()) and (system.empty() or system = 'urn:iso:std:iso:4217')", "xpath": "(f:code or not(f:value)) and (not(exists(f:system)) or f:system/@value='urn:iso:std:iso:4217')", "source": "http://hl7.org/fhir/StructureDefinition/Money" } ], "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": "MO" } ] }, { "id": "ClaimResponse.totalBenefit", "path": "ClaimResponse.totalBenefit", "short": "Total benefit payable for the Claim", "definition": "Total amount of benefit payable (Equal to sum of the Benefit amounts from all detail lines and additions less the Unallocated Deductible).", "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.", "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", "expression": "hasValue() | (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Quantity" }, { "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": "mny-1", "severity": "error", "human": "There SHALL be a code if there is a value and it SHALL be an expression of currency. If system is present, it SHALL be ISO 4217 (system = \"urn:iso:std:iso:4217\" - currency).", "expression": "(code or value.empty()) and (system.empty() or system = 'urn:iso:std:iso:4217')", "xpath": "(f:code or not(f:value)) and (not(exists(f:system)) or f:system/@value='urn:iso:std:iso:4217')", "source": "http://hl7.org/fhir/StructureDefinition/Money" } ], "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": "MO" } ] }, { "id": "ClaimResponse.payment", "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-explicit-type-name", "valueString": "Payment" } ], "path": "ClaimResponse.payment", "short": "Payment details, if paid", "definition": "Payment details for the claim if the claim has been paid.", "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", "expression": "hasValue() | (children().count() > id.count())", "xpath": "@value|f:*|h:div" } ], "mapping": [ { "identity": "rim", "map": "n/a" } ] }, { "id": "ClaimResponse.payment.id", "path": "ClaimResponse.payment.id", "representation": [ "xmlAttr" ], "short": "xml:id (or equivalent in JSON)", "definition": "unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.", "comment": "Note that FHIR strings may not exceed 1MB in size", "min": 0, "max": "1", "base": { "path": "Element.id", "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", "expression": "hasValue() | (children().count() > id.count())", "xpath": "@value|f:*|h:div" } ], "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. In order 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.", "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", "expression": "hasValue() | (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Extension" }, { "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", "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 that contains it. Usually modifier elements provide negation or qualification. In order 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.", "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", "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", "expression": "hasValue() | (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Extension" }, { "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, "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", "definition": "Whether this represents partial or complete payment of the claim.", "comment": "Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination.", "min": 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", "expression": "hasValue() | (children().count() > id.count())", "xpath": "@value|f:*|h:div" } ], "binding": { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString": "PaymentType" } ], "strength": "example", "description": "The type (partial, complete) of the payment", "valueSetReference": { "reference": "http://hl7.org/fhir/ValueSet/ex-paymenttype" } }, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "v2", "map": "CE/CNE/CWE" }, { "identity": "rim", "map": "CD" }, { "identity": "orim", "map": "fhir:CodeableConcept rdfs:subClassOf dt:CD" } ] }, { "id": "ClaimResponse.payment.adjustment", "path": "ClaimResponse.payment.adjustment", "short": "Payment adjustment for non-Claim issues", "definition": "Adjustment to the payment of this transaction which is not related to adjudication of this transaction.", "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.", "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", "expression": "hasValue() | (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Quantity" }, { "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": "mny-1", "severity": "error", "human": "There SHALL be a code if there is a value and it SHALL be an expression of currency. If system is present, it SHALL be ISO 4217 (system = \"urn:iso:std:iso:4217\" - currency).", "expression": "(code or value.empty()) and (system.empty() or system = 'urn:iso:std:iso:4217')", "xpath": "(f:code or not(f:value)) and (not(exists(f:system)) or f:system/@value='urn:iso:std:iso:4217')", "source": "http://hl7.org/fhir/StructureDefinition/Money" } ], "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": "MO" } ] }, { "id": "ClaimResponse.payment.adjustmentReason", "path": "ClaimResponse.payment.adjustmentReason", "short": "Explanation for the non-claim adjustment", "definition": "Reason for the payment adjustment.", "comment": "Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination.", "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", "expression": "hasValue() | (children().count() > id.count())", "xpath": "@value|f:*|h:div" } ], "binding": { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString": "PaymentAdjustmentReason" } ], "strength": "example", "description": "Payment Adjustment reason codes.", "valueSetReference": { "reference": "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 data of Payment", "definition": "Estimated payment data.", "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", "expression": "hasValue() | (children().count() > id.count())", "xpath": "@value|f:*|h:div" } ], "mapping": [ { "identity": "rim", "map": "n/a" } ] }, { "id": "ClaimResponse.payment.amount", "path": "ClaimResponse.payment.amount", "short": "Payable amount after adjustment", "definition": "Payable less any payment adjustment.", "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.", "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", "expression": "hasValue() | (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Quantity" }, { "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": "mny-1", "severity": "error", "human": "There SHALL be a code if there is a value and it SHALL be an expression of currency. If system is present, it SHALL be ISO 4217 (system = \"urn:iso:std:iso:4217\" - currency).", "expression": "(code or value.empty()) and (system.empty() or system = 'urn:iso:std:iso:4217')", "xpath": "(f:code or not(f:value)) and (not(exists(f:system)) or f:system/@value='urn:iso:std:iso:4217')", "source": "http://hl7.org/fhir/StructureDefinition/Money" } ], "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": "MO" } ] }, { "id": "ClaimResponse.payment.identifier", "path": "ClaimResponse.payment.identifier", "short": "Identifier of the payment instrument", "definition": "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", "expression": "hasValue() | (children().count() > id.count())", "xpath": "@value|f:*|h:div" } ], "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 - see see identifier pattern at http://wiki.hl7.org/index.php?title=Common_Design_Patterns#Identifier_Pattern for relevant discussion. 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.reserved", "path": "ClaimResponse.reserved", "short": "Funds reserved status", "definition": "Status of funds reservation (For provider, for Patient, None).", "comment": "Codes may be defined very casually in enumerations or code lists, up to very formal definitions such as SNOMED CT - see the HL7 v3 Core Principles for more information.", "min": 0, "max": "1", "type": [ { "code": "Coding" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() | (children().count() > id.count())", "xpath": "@value|f:*|h:div" } ], "binding": { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString": "FundsReserve" }, { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-isCommonBinding", "valueBoolean": true } ], "strength": "example", "description": "For whom funds are to be reserved: (Patient, Provider, None).", "valueSetReference": { "reference": "http://hl7.org/fhir/ValueSet/fundsreserve" } }, "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" } ] }, { "id": "ClaimResponse.form", "path": "ClaimResponse.form", "short": "Printed Form Identifier", "definition": "The form to be used for printing the content.", "comment": "Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination.", "min": 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", "expression": "hasValue() | (children().count() > id.count())", "xpath": "@value|f:*|h:div" } ], "binding": { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString": "Forms" }, { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-isCommonBinding", "valueBoolean": true } ], "strength": "example", "description": "The forms codes.", "valueSetReference": { "reference": "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" }, { "identity": "cdanetv4", "map": "G42" } ] }, { "id": "ClaimResponse.processNote", "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-explicit-type-name", "valueString": "Note" } ], "path": "ClaimResponse.processNote", "short": "Processing notes", "definition": "Note text.", "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", "expression": "hasValue() | (children().count() > id.count())", "xpath": "@value|f:*|h:div" } ], "mapping": [ { "identity": "rim", "map": "n/a" } ] }, { "id": "ClaimResponse.processNote.id", "path": "ClaimResponse.processNote.id", "representation": [ "xmlAttr" ], "short": "xml:id (or equivalent in JSON)", "definition": "unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.", "comment": "Note that FHIR strings may not exceed 1MB in size", "min": 0, "max": "1", "base": { "path": "Element.id", "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", "expression": "hasValue() | (children().count() > id.count())", "xpath": "@value|f:*|h:div" } ], "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. In order 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.", "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", "expression": "hasValue() | (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Extension" }, { "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", "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 that contains it. Usually modifier elements provide negation or qualification. In order 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.", "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", "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", "expression": "hasValue() | (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Extension" }, { "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, "isSummary": true, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "rim", "map": "N/A" } ] }, { "id": "ClaimResponse.processNote.number", "path": "ClaimResponse.processNote.number", "short": "Sequence Number for this note", "definition": "An integer associated with each note which may be referred to from each service line item.", "comment": "32 bit number; for values larger than this, use decimal", "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", "expression": "hasValue() | (children().count() > id.count())", "xpath": "@value|f:*|h:div" } ], "mapping": [ { "identity": "rim", "map": "n/a" } ] }, { "id": "ClaimResponse.processNote.type", "path": "ClaimResponse.processNote.type", "short": "display | print | printoper", "definition": "The note purpose: Print/Display.", "comment": "Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination.", "min": 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", "expression": "hasValue() | (children().count() > id.count())", "xpath": "@value|f:*|h:div" } ], "binding": { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString": "NoteType" }, { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-isCommonBinding", "valueBoolean": true } ], "strength": "required", "description": "The presentation types of notes.", "valueSetReference": { "reference": "http://hl7.org/fhir/ValueSet/note-type" } }, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "v2", "map": "CE/CNE/CWE" }, { "identity": "rim", "map": "CD" }, { "identity": "orim", "map": "fhir:CodeableConcept rdfs:subClassOf dt:CD" } ] }, { "id": "ClaimResponse.processNote.text", "path": "ClaimResponse.processNote.text", "short": "Note explanatory text", "definition": "The note text.", "comment": "Note that FHIR strings may not exceed 1MB in size", "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", "expression": "hasValue() | (children().count() > id.count())", "xpath": "@value|f:*|h:div" } ], "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "cdanetv4", "map": "G32" } ] }, { "id": "ClaimResponse.processNote.language", "path": "ClaimResponse.processNote.language", "short": "Language if different from the resource", "definition": "The ISO-639-1 alpha 2 code in lower case for the language, optionally followed by a hyphen and the ISO-3166-1 alpha 2 code for the region in upper case; e.g. \"en\" for English, or \"en-US\" for American English versus \"en-EN\" for England English.", "comment": "Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination.", "min": 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", "expression": "hasValue() | (children().count() > id.count())", "xpath": "@value|f:*|h:div" } ], "binding": { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-maxValueSet", "valueReference": { "reference": "http://hl7.org/fhir/ValueSet/all-languages" } }, { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString": "Language" }, { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-isCommonBinding", "valueBoolean": true } ], "strength": "extensible", "description": "A human language.", "valueSetReference": { "reference": "http://hl7.org/fhir/ValueSet/languages" } }, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "v2", "map": "CE/CNE/CWE" }, { "identity": "rim", "map": "CD" }, { "identity": "orim", "map": "fhir:CodeableConcept rdfs:subClassOf dt:CD" } ] }, { "id": "ClaimResponse.communicationRequest", "path": "ClaimResponse.communicationRequest", "short": "Request for additional information", "definition": "Request for additional supporting or authorizing information, such as: documents, images or resources.", "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": "*", "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", "expression": "hasValue() | (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Reference" }, { "key": "ref-1", "severity": "error", "human": "SHALL have a contained resource if a local reference is provided", "expression": "reference.startsWith('#').not() or (reference.substring(1).trace('url') in %resource.contained.id.trace('ids'))", "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" } ], "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": "Insurance or medical plan", "definition": "Financial instrument by which payment information for health care.", "requirements": "Health care programs and insurers are significant payors of health service costs.", "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", "expression": "hasValue() | (children().count() > id.count())", "xpath": "@value|f:*|h:div" } ], "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "rim", "map": "Coverage" } ] }, { "id": "ClaimResponse.insurance.id", "path": "ClaimResponse.insurance.id", "representation": [ "xmlAttr" ], "short": "xml:id (or equivalent in JSON)", "definition": "unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.", "comment": "Note that FHIR strings may not exceed 1MB in size", "min": 0, "max": "1", "base": { "path": "Element.id", "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", "expression": "hasValue() | (children().count() > id.count())", "xpath": "@value|f:*|h:div" } ], "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. In order 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.", "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", "expression": "hasValue() | (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Extension" }, { "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", "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 that contains it. Usually modifier elements provide negation or qualification. In order 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.", "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", "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", "expression": "hasValue() | (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Extension" }, { "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, "isSummary": true, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "rim", "map": "N/A" } ] }, { "id": "ClaimResponse.insurance.sequence", "path": "ClaimResponse.insurance.sequence", "short": "Service instance identifier", "definition": "A service line item.", "comment": "32 bit number; for values larger than this, use decimal", "requirements": "To maintain order of the coverages.", "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", "expression": "hasValue() | (children().count() > id.count())", "xpath": "@value|f:*|h:div" } ], "mapping": [ { "identity": "rim", "map": "n/a" } ] }, { "id": "ClaimResponse.insurance.focal", "path": "ClaimResponse.insurance.focal", "short": "Is the focal Coverage", "definition": "The instance number of the Coverage which is the focus for adjudication. The Coverage against which the claim is to be adjudicated.", "requirements": "To identify which coverage is being adjudicated.", "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", "expression": "hasValue() | (children().count() > id.count())", "xpath": "@value|f:*|h:div" } ], "mapping": [ { "identity": "rim", "map": "n/a" } ] }, { "id": "ClaimResponse.insurance.coverage", "path": "ClaimResponse.insurance.coverage", "short": "Insurance information", "definition": "Reference to the program or plan identification, underwriter or payor.", "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": "Need to identify the issuer to target for processing and for coordination of benefit processing.", "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", "expression": "hasValue() | (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Reference" }, { "key": "ref-1", "severity": "error", "human": "SHALL have a contained resource if a local reference is provided", "expression": "reference.startsWith('#').not() or (reference.substring(1).trace('url') in %resource.contained.id.trace('ids'))", "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" } ], "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": "Business agreement", "definition": "The contract number of a business agreement which describes the terms and conditions.", "comment": "Note that FHIR strings may not exceed 1MB in size", "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", "expression": "hasValue() | (children().count() > id.count())", "xpath": "@value|f:*|h:div" } ], "mapping": [ { "identity": "rim", "map": "n/a" } ] }, { "id": "ClaimResponse.insurance.preAuthRef", "path": "ClaimResponse.insurance.preAuthRef", "short": "Pre-Authorization/Determination Reference", "definition": "A list of references from the Insurer to which these services pertain.", "comment": "Note that FHIR strings may not exceed 1MB in size", "requirements": "To provide any pre-determination or prior authorization reference.", "min": 0, "max": "*", "type": [ { "code": "string" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() | (children().count() > id.count())", "xpath": "@value|f:*|h:div" } ], "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "cdanetv4", "map": "F03" } ] }, { "id": "ClaimResponse.insurance.claimResponse", "path": "ClaimResponse.insurance.claimResponse", "short": "Adjudication results", "definition": "The Coverages adjudication details.", "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": "Used by downstream payers to determine what balance remains and the net payable.", "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", "expression": "hasValue() | (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Reference" }, { "key": "ref-1", "severity": "error", "human": "SHALL have a contained resource if a local reference is provided", "expression": "reference.startsWith('#').not() or (reference.substring(1).trace('url') in %resource.contained.id.trace('ids'))", "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" } ], "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": "cdanetv4", "map": "EOB" } ] } ] }, "differential": { "element": [ { "id": "ClaimResponse", "path": "ClaimResponse", "short": "Remittance resource", "definition": "This resource provides the adjudication details from the processing of a Claim resource.", "alias": [ "Remittance Advice" ], "min": 0, "max": "*", "mapping": [ { "identity": "workflow", "map": "Event" }, { "identity": "w5", "map": "financial.billing" } ] }, { "id": "ClaimResponse.identifier", "path": "ClaimResponse.identifier", "short": "Response number", "definition": "The Response business identifier.", "min": 0, "max": "*", "type": [ { "code": "Identifier" } ], "mapping": [ { "identity": "workflow", "map": "Event.identifier" }, { "identity": "w5", "map": "id" } ] }, { "id": "ClaimResponse.status", "path": "ClaimResponse.status", "short": "active | cancelled | draft | entered-in-error", "definition": "The status of the resource instance.", "comment": "This element is labeled as a modifier because the status contains the code cancelled and entered-in-error that mark the response as not currently valid.", "min": 0, "max": "1", "type": [ { "code": "code" } ], "isModifier": true, "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.", "valueSetReference": { "reference": "http://hl7.org/fhir/ValueSet/fm-status" } }, "mapping": [ { "identity": "workflow", "map": "Event.status" }, { "identity": "w5", "map": "status" } ] }, { "id": "ClaimResponse.patient", "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-display-hint", "valueString": "who.focus" } ], "path": "ClaimResponse.patient", "short": "The subject of the Products and Services", "definition": "Patient Resource.", "min": 0, "max": "1", "type": [ { "code": "Reference", "targetProfile": "http://hl7.org/fhir/StructureDefinition/Patient" } ] }, { "id": "ClaimResponse.created", "path": "ClaimResponse.created", "short": "Creation date", "definition": "The date when the enclosed suite of services were performed or completed.", "min": 0, "max": "1", "type": [ { "code": "dateTime" } ], "mapping": [ { "identity": "workflow", "map": "Event.occurrence" }, { "identity": "w5", "map": "when.recorded" } ] }, { "id": "ClaimResponse.insurer", "path": "ClaimResponse.insurer", "short": "Insurance issuing organization", "definition": "The Insurer who produced this adjudicated response.", "min": 0, "max": "1", "type": [ { "code": "Reference", "targetProfile": "http://hl7.org/fhir/StructureDefinition/Organization" } ], "mapping": [ { "identity": "workflow", "map": "Event.performer.onBehalfOf" } ] }, { "id": "ClaimResponse.requestProvider", "path": "ClaimResponse.requestProvider", "short": "Responsible practitioner", "definition": "The practitioner who is responsible for the services rendered to the patient.", "min": 0, "max": "1", "type": [ { "code": "Reference", "targetProfile": "http://hl7.org/fhir/StructureDefinition/Practitioner" } ], "mapping": [ { "identity": "cdanetv4", "map": "B01" }, { "identity": "w5", "map": "who.source" } ] }, { "id": "ClaimResponse.requestOrganization", "path": "ClaimResponse.requestOrganization", "short": "Responsible organization", "definition": "The organization which is responsible for the services rendered to the patient.", "min": 0, "max": "1", "type": [ { "code": "Reference", "targetProfile": "http://hl7.org/fhir/StructureDefinition/Organization" } ], "mapping": [ { "identity": "w5", "map": "who.source" } ] }, { "id": "ClaimResponse.request", "path": "ClaimResponse.request", "short": "Id of resource triggering adjudication", "definition": "Original request resource referrence.", "min": 0, "max": "1", "type": [ { "code": "Reference", "targetProfile": "http://hl7.org/fhir/StructureDefinition/Claim" } ], "mapping": [ { "identity": "workflow", "map": "Event.basedOn" }, { "identity": "cdanetv4", "map": "A02|G01" }, { "identity": "w5", "map": "why" } ] }, { "id": "ClaimResponse.outcome", "path": "ClaimResponse.outcome", "short": "complete | error | partial", "definition": "Processing outcome errror, partial or complete processing.", "min": 0, "max": "1", "type": [ { "code": "CodeableConcept" } ], "binding": { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString": "RemittanceOutcome" } ], "strength": "example", "description": "The result of the claim processing", "valueSetReference": { "reference": "http://hl7.org/fhir/ValueSet/remittance-outcome" } } }, { "id": "ClaimResponse.disposition", "path": "ClaimResponse.disposition", "short": "Disposition Message", "definition": "A description of the status of the adjudication.", "min": 0, "max": "1", "type": [ { "code": "string" } ], "mapping": [ { "identity": "workflow", "map": "Event.note" } ] }, { "id": "ClaimResponse.payeeType", "path": "ClaimResponse.payeeType", "short": "Party to be paid any benefits payable", "definition": "Party to be reimbursed: Subscriber, provider, other.", "min": 0, "max": "1", "type": [ { "code": "CodeableConcept" } ], "binding": { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString": "PayeeType" }, { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-isCommonBinding", "valueBoolean": true } ], "strength": "example", "description": "A code for the party to be reimbursed.", "valueSetReference": { "reference": "http://hl7.org/fhir/ValueSet/payeetype" } } }, { "id": "ClaimResponse.item", "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-explicit-type-name", "valueString": "Item" } ], "path": "ClaimResponse.item", "short": "Line items", "definition": "The first tier service adjudications for submitted services.", "min": 0, "max": "*", "type": [ { "code": "BackboneElement" } ] }, { "id": "ClaimResponse.item.sequenceLinkId", "path": "ClaimResponse.item.sequenceLinkId", "short": "Service instance", "definition": "A service line number.", "min": 1, "max": "1", "type": [ { "code": "positiveInt" } ], "mapping": [ { "identity": "cdanetv4", "map": "F07" } ] }, { "id": "ClaimResponse.item.noteNumber", "path": "ClaimResponse.item.noteNumber", "short": "List of note numbers which apply", "definition": "A list of note references to the notes provided below.", "min": 0, "max": "*", "type": [ { "code": "positiveInt" } ] }, { "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": "The adjudication results.", "min": 0, "max": "*", "type": [ { "code": "BackboneElement" } ] }, { "id": "ClaimResponse.item.adjudication.category", "path": "ClaimResponse.item.adjudication.category", "short": "Adjudication category such as co-pay, eligible, benefit, etc.", "definition": "Code indicating: Co-Pay, deductible, eligible, benefit, tax, etc.", "min": 1, "max": "1", "type": [ { "code": "CodeableConcept" } ], "binding": { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString": "Adjudication" } ], "strength": "example", "description": "The adjudication codes.", "valueSetReference": { "reference": "http://hl7.org/fhir/ValueSet/adjudication" } } }, { "id": "ClaimResponse.item.adjudication.reason", "path": "ClaimResponse.item.adjudication.reason", "short": "Explanation of Adjudication outcome", "definition": "Adjudication reason such as limit reached.", "min": 0, "max": "1", "type": [ { "code": "CodeableConcept" } ], "binding": { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString": "AdjudicationReason" } ], "strength": "example", "description": "The adjudication reason codes.", "valueSetReference": { "reference": "http://hl7.org/fhir/ValueSet/adjudication-reason" } } }, { "id": "ClaimResponse.item.adjudication.amount", "path": "ClaimResponse.item.adjudication.amount", "short": "Monetary amount", "definition": "Monetary amount associated with the code.", "min": 0, "max": "1", "type": [ { "code": "Money" } ] }, { "id": "ClaimResponse.item.adjudication.value", "path": "ClaimResponse.item.adjudication.value", "short": "Non-monetary value", "definition": "A non-monetary value for example a percentage. Mutually exclusive to the amount element above.", "min": 0, "max": "1", "type": [ { "code": "decimal" } ] }, { "id": "ClaimResponse.item.detail", "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-explicit-type-name", "valueString": "ItemDetail" } ], "path": "ClaimResponse.item.detail", "short": "Detail line items", "definition": "The second tier service adjudications for submitted services.", "min": 0, "max": "*", "type": [ { "code": "BackboneElement" } ] }, { "id": "ClaimResponse.item.detail.sequenceLinkId", "path": "ClaimResponse.item.detail.sequenceLinkId", "short": "Service instance", "definition": "A service line number.", "min": 1, "max": "1", "type": [ { "code": "positiveInt" } ], "mapping": [ { "identity": "cdanetv4", "map": "F07" } ] }, { "id": "ClaimResponse.item.detail.noteNumber", "path": "ClaimResponse.item.detail.noteNumber", "short": "List of note numbers which apply", "definition": "A list of note references to the notes provided below.", "min": 0, "max": "*", "type": [ { "code": "positiveInt" } ] }, { "id": "ClaimResponse.item.detail.adjudication", "path": "ClaimResponse.item.detail.adjudication", "short": "Detail level adjudication details", "definition": "The adjudications results.", "min": 0, "max": "*", "contentReference": "#ClaimResponse.item.adjudication" }, { "id": "ClaimResponse.item.detail.subDetail", "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-explicit-type-name", "valueString": "SubDetail" } ], "path": "ClaimResponse.item.detail.subDetail", "short": "Subdetail line items", "definition": "The third tier service adjudications for submitted services.", "min": 0, "max": "*", "type": [ { "code": "BackboneElement" } ] }, { "id": "ClaimResponse.item.detail.subDetail.sequenceLinkId", "path": "ClaimResponse.item.detail.subDetail.sequenceLinkId", "short": "Service instance", "definition": "A service line number.", "min": 1, "max": "1", "type": [ { "code": "positiveInt" } ], "mapping": [ { "identity": "cdanetv4", "map": "F07" } ] }, { "id": "ClaimResponse.item.detail.subDetail.noteNumber", "path": "ClaimResponse.item.detail.subDetail.noteNumber", "short": "List of note numbers which apply", "definition": "A list of note references to the notes provided below.", "min": 0, "max": "*", "type": [ { "code": "positiveInt" } ] }, { "id": "ClaimResponse.item.detail.subDetail.adjudication", "path": "ClaimResponse.item.detail.subDetail.adjudication", "short": "Subdetail level adjudication details", "definition": "The adjudications results.", "min": 0, "max": "*", "contentReference": "#ClaimResponse.item.adjudication" }, { "id": "ClaimResponse.addItem", "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-explicit-type-name", "valueString": "AddedItem" } ], "path": "ClaimResponse.addItem", "short": "Insurer added line items", "definition": "The first tier service adjudications for payor added services.", "min": 0, "max": "*", "type": [ { "code": "BackboneElement" } ] }, { "id": "ClaimResponse.addItem.sequenceLinkId", "path": "ClaimResponse.addItem.sequenceLinkId", "short": "Service instances", "definition": "List of input service items which this service line is intended to replace.", "min": 0, "max": "*", "type": [ { "code": "positiveInt" } ] }, { "id": "ClaimResponse.addItem.revenue", "path": "ClaimResponse.addItem.revenue", "short": "Revenue or cost center code", "definition": "The type of reveneu or cost center providing the product and/or service.", "min": 0, "max": "1", "type": [ { "code": "CodeableConcept" } ], "binding": { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString": "RevenueCenter" } ], "strength": "example", "description": "Codes for the revenue or cost centers supplying the service and/or products.", "valueSetReference": { "reference": "http://hl7.org/fhir/ValueSet/ex-revenue-center" } } }, { "id": "ClaimResponse.addItem.category", "path": "ClaimResponse.addItem.category", "short": "Type of service or product", "definition": "Health Care Service Type Codes to identify the classification of service or benefits.", "min": 0, "max": "1", "type": [ { "code": "CodeableConcept" } ], "binding": { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString": "BenefitSubCategory" } ], "strength": "example", "description": "Benefit subcategories such as: oral-basic, major, glasses", "valueSetReference": { "reference": "http://hl7.org/fhir/ValueSet/benefit-subcategory" } } }, { "id": "ClaimResponse.addItem.service", "path": "ClaimResponse.addItem.service", "short": "Group, Service or Product", "definition": "A code to indicate the Professional Service or Product supplied.", "min": 0, "max": "1", "type": [ { "code": "CodeableConcept" } ], "binding": { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString": "ServiceProduct" } ], "strength": "example", "description": "Allowable service and product codes.", "valueSetReference": { "reference": "http://hl7.org/fhir/ValueSet/service-uscls" } } }, { "id": "ClaimResponse.addItem.modifier", "path": "ClaimResponse.addItem.modifier", "short": "Service/Product billing modifiers", "definition": "Item typification or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or for medical whether the treatment was outside the clinic or out of office hours.", "requirements": "May impact on adjudication.", "min": 0, "max": "*", "type": [ { "code": "CodeableConcept" } ], "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.", "valueSetReference": { "reference": "http://hl7.org/fhir/ValueSet/claim-modifiers" } }, "mapping": [ { "identity": "rim", "map": "24.C, 24.D mods" } ] }, { "id": "ClaimResponse.addItem.fee", "path": "ClaimResponse.addItem.fee", "short": "Professional fee or Product charge", "definition": "The fee charged for the professional service or product..", "min": 0, "max": "1", "type": [ { "code": "Money" } ] }, { "id": "ClaimResponse.addItem.noteNumber", "path": "ClaimResponse.addItem.noteNumber", "short": "List of note numbers which apply", "definition": "A list of note references to the notes provided below.", "min": 0, "max": "*", "type": [ { "code": "positiveInt" } ] }, { "id": "ClaimResponse.addItem.adjudication", "path": "ClaimResponse.addItem.adjudication", "short": "Added items adjudication", "definition": "The adjudications results.", "min": 0, "max": "*", "contentReference": "#ClaimResponse.item.adjudication" }, { "id": "ClaimResponse.addItem.detail", "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-explicit-type-name", "valueString": "AddedItemsDetail" } ], "path": "ClaimResponse.addItem.detail", "short": "Added items details", "definition": "The second tier service adjudications for payor added services.", "min": 0, "max": "*", "type": [ { "code": "BackboneElement" } ] }, { "id": "ClaimResponse.addItem.detail.revenue", "path": "ClaimResponse.addItem.detail.revenue", "short": "Revenue or cost center code", "definition": "The type of reveneu or cost center providing the product and/or service.", "min": 0, "max": "1", "type": [ { "code": "CodeableConcept" } ], "binding": { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString": "RevenueCenter" } ], "strength": "example", "description": "Codes for the revenue or cost centers supplying the service and/or products.", "valueSetReference": { "reference": "http://hl7.org/fhir/ValueSet/ex-revenue-center" } } }, { "id": "ClaimResponse.addItem.detail.category", "path": "ClaimResponse.addItem.detail.category", "short": "Type of service or product", "definition": "Health Care Service Type Codes to identify the classification of service or benefits.", "min": 0, "max": "1", "type": [ { "code": "CodeableConcept" } ], "binding": { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString": "BenefitSubCategory" } ], "strength": "example", "description": "Benefit subcategories such as: oral-basic, major, glasses", "valueSetReference": { "reference": "http://hl7.org/fhir/ValueSet/benefit-subcategory" } } }, { "id": "ClaimResponse.addItem.detail.service", "path": "ClaimResponse.addItem.detail.service", "short": "Service or Product", "definition": "A code to indicate the Professional Service or Product supplied.", "min": 0, "max": "1", "type": [ { "code": "CodeableConcept" } ], "binding": { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString": "ServiceProduct" } ], "strength": "example", "description": "Allowable service and product codes.", "valueSetReference": { "reference": "http://hl7.org/fhir/ValueSet/service-uscls" } } }, { "id": "ClaimResponse.addItem.detail.modifier", "path": "ClaimResponse.addItem.detail.modifier", "short": "Service/Product billing modifiers", "definition": "Item typification or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or for medical whether the treatment was outside the clinic or out of office hours.", "requirements": "May impact on adjudication.", "min": 0, "max": "*", "type": [ { "code": "CodeableConcept" } ], "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.", "valueSetReference": { "reference": "http://hl7.org/fhir/ValueSet/claim-modifiers" } }, "mapping": [ { "identity": "rim", "map": "24.C, 24.D mods" } ] }, { "id": "ClaimResponse.addItem.detail.fee", "path": "ClaimResponse.addItem.detail.fee", "short": "Professional fee or Product charge", "definition": "The fee charged for the professional service or product..", "min": 0, "max": "1", "type": [ { "code": "Money" } ] }, { "id": "ClaimResponse.addItem.detail.noteNumber", "path": "ClaimResponse.addItem.detail.noteNumber", "short": "List of note numbers which apply", "definition": "A list of note references to the notes provided below.", "min": 0, "max": "*", "type": [ { "code": "positiveInt" } ] }, { "id": "ClaimResponse.addItem.detail.adjudication", "path": "ClaimResponse.addItem.detail.adjudication", "short": "Added items detail adjudication", "definition": "The adjudications results.", "min": 0, "max": "*", "contentReference": "#ClaimResponse.item.adjudication" }, { "id": "ClaimResponse.error", "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-explicit-type-name", "valueString": "Error" } ], "path": "ClaimResponse.error", "short": "Processing errors", "definition": "Mutually exclusive with Services Provided (Item).", "min": 0, "max": "*", "type": [ { "code": "BackboneElement" } ] }, { "id": "ClaimResponse.error.sequenceLinkId", "path": "ClaimResponse.error.sequenceLinkId", "short": "Item sequence number", "definition": "The sequence number of the line item submitted which contains the error. This value is omitted when the error is elsewhere.", "min": 0, "max": "1", "type": [ { "code": "positiveInt" } ] }, { "id": "ClaimResponse.error.detailSequenceLinkId", "path": "ClaimResponse.error.detailSequenceLinkId", "short": "Detail sequence number", "definition": "The sequence number of the addition within the line item submitted which contains the error. This value is omitted when the error is not related to an Addition.", "min": 0, "max": "1", "type": [ { "code": "positiveInt" } ] }, { "id": "ClaimResponse.error.subdetailSequenceLinkId", "path": "ClaimResponse.error.subdetailSequenceLinkId", "short": "Subdetail sequence number", "definition": "The sequence number of the addition within the line item submitted which contains the error. This value is omitted when the error is not related to an Addition.", "min": 0, "max": "1", "type": [ { "code": "positiveInt" } ] }, { "id": "ClaimResponse.error.code", "path": "ClaimResponse.error.code", "short": "Error code detailing processing issues", "definition": "An error code,from a specified code system, which details why the claim could not be adjudicated.", "min": 1, "max": "1", "type": [ { "code": "CodeableConcept" } ], "binding": { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString": "AdjudicationError" } ], "strength": "example", "description": "The adjudication error codes.", "valueSetReference": { "reference": "http://hl7.org/fhir/ValueSet/adjudication-error" } } }, { "id": "ClaimResponse.totalCost", "path": "ClaimResponse.totalCost", "short": "Total Cost of service from the Claim", "definition": "The total cost of the services reported.", "requirements": "This is a check value that the receiver calculates and returns.", "min": 0, "max": "1", "type": [ { "code": "Money" } ] }, { "id": "ClaimResponse.unallocDeductable", "path": "ClaimResponse.unallocDeductable", "short": "Unallocated deductible", "definition": "The amount of deductible applied which was not allocated to any particular service line.", "min": 0, "max": "1", "type": [ { "code": "Money" } ] }, { "id": "ClaimResponse.totalBenefit", "path": "ClaimResponse.totalBenefit", "short": "Total benefit payable for the Claim", "definition": "Total amount of benefit payable (Equal to sum of the Benefit amounts from all detail lines and additions less the Unallocated Deductible).", "min": 0, "max": "1", "type": [ { "code": "Money" } ] }, { "id": "ClaimResponse.payment", "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-explicit-type-name", "valueString": "Payment" } ], "path": "ClaimResponse.payment", "short": "Payment details, if paid", "definition": "Payment details for the claim if the claim has been paid.", "min": 0, "max": "1", "type": [ { "code": "BackboneElement" } ] }, { "id": "ClaimResponse.payment.type", "path": "ClaimResponse.payment.type", "short": "Partial or Complete", "definition": "Whether this represents partial or complete payment of the claim.", "min": 0, "max": "1", "type": [ { "code": "CodeableConcept" } ], "binding": { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString": "PaymentType" } ], "strength": "example", "description": "The type (partial, complete) of the payment", "valueSetReference": { "reference": "http://hl7.org/fhir/ValueSet/ex-paymenttype" } } }, { "id": "ClaimResponse.payment.adjustment", "path": "ClaimResponse.payment.adjustment", "short": "Payment adjustment for non-Claim issues", "definition": "Adjustment to the payment of this transaction which is not related to adjudication of this transaction.", "min": 0, "max": "1", "type": [ { "code": "Money" } ] }, { "id": "ClaimResponse.payment.adjustmentReason", "path": "ClaimResponse.payment.adjustmentReason", "short": "Explanation for the non-claim adjustment", "definition": "Reason for the payment adjustment.", "min": 0, "max": "1", "type": [ { "code": "CodeableConcept" } ], "binding": { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString": "PaymentAdjustmentReason" } ], "strength": "example", "description": "Payment Adjustment reason codes.", "valueSetReference": { "reference": "http://hl7.org/fhir/ValueSet/payment-adjustment-reason" } } }, { "id": "ClaimResponse.payment.date", "path": "ClaimResponse.payment.date", "short": "Expected data of Payment", "definition": "Estimated payment data.", "min": 0, "max": "1", "type": [ { "code": "date" } ] }, { "id": "ClaimResponse.payment.amount", "path": "ClaimResponse.payment.amount", "short": "Payable amount after adjustment", "definition": "Payable less any payment adjustment.", "min": 0, "max": "1", "type": [ { "code": "Money" } ] }, { "id": "ClaimResponse.payment.identifier", "path": "ClaimResponse.payment.identifier", "short": "Identifier of the payment instrument", "definition": "Payment identifier.", "min": 0, "max": "1", "type": [ { "code": "Identifier" } ] }, { "id": "ClaimResponse.reserved", "path": "ClaimResponse.reserved", "short": "Funds reserved status", "definition": "Status of funds reservation (For provider, for Patient, None).", "min": 0, "max": "1", "type": [ { "code": "Coding" } ], "binding": { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString": "FundsReserve" }, { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-isCommonBinding", "valueBoolean": true } ], "strength": "example", "description": "For whom funds are to be reserved: (Patient, Provider, None).", "valueSetReference": { "reference": "http://hl7.org/fhir/ValueSet/fundsreserve" } } }, { "id": "ClaimResponse.form", "path": "ClaimResponse.form", "short": "Printed Form Identifier", "definition": "The form to be used for printing the content.", "min": 0, "max": "1", "type": [ { "code": "CodeableConcept" } ], "binding": { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString": "Forms" }, { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-isCommonBinding", "valueBoolean": true } ], "strength": "example", "description": "The forms codes.", "valueSetReference": { "reference": "http://hl7.org/fhir/ValueSet/forms" } }, "mapping": [ { "identity": "cdanetv4", "map": "G42" } ] }, { "id": "ClaimResponse.processNote", "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-explicit-type-name", "valueString": "Note" } ], "path": "ClaimResponse.processNote", "short": "Processing notes", "definition": "Note text.", "min": 0, "max": "*", "type": [ { "code": "BackboneElement" } ] }, { "id": "ClaimResponse.processNote.number", "path": "ClaimResponse.processNote.number", "short": "Sequence Number for this note", "definition": "An integer associated with each note which may be referred to from each service line item.", "min": 0, "max": "1", "type": [ { "code": "positiveInt" } ] }, { "id": "ClaimResponse.processNote.type", "path": "ClaimResponse.processNote.type", "short": "display | print | printoper", "definition": "The note purpose: Print/Display.", "min": 0, "max": "1", "type": [ { "code": "CodeableConcept" } ], "binding": { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString": "NoteType" }, { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-isCommonBinding", "valueBoolean": true } ], "strength": "required", "description": "The presentation types of notes.", "valueSetReference": { "reference": "http://hl7.org/fhir/ValueSet/note-type" } } }, { "id": "ClaimResponse.processNote.text", "path": "ClaimResponse.processNote.text", "short": "Note explanatory text", "definition": "The note text.", "min": 0, "max": "1", "type": [ { "code": "string" } ], "mapping": [ { "identity": "cdanetv4", "map": "G32" } ] }, { "id": "ClaimResponse.processNote.language", "path": "ClaimResponse.processNote.language", "short": "Language if different from the resource", "definition": "The ISO-639-1 alpha 2 code in lower case for the language, optionally followed by a hyphen and the ISO-3166-1 alpha 2 code for the region in upper case; e.g. \"en\" for English, or \"en-US\" for American English versus \"en-EN\" for England English.", "min": 0, "max": "1", "type": [ { "code": "CodeableConcept" } ], "binding": { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-maxValueSet", "valueReference": { "reference": "http://hl7.org/fhir/ValueSet/all-languages" } }, { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString": "Language" }, { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-isCommonBinding", "valueBoolean": true } ], "strength": "extensible", "description": "A human language.", "valueSetReference": { "reference": "http://hl7.org/fhir/ValueSet/languages" } } }, { "id": "ClaimResponse.communicationRequest", "path": "ClaimResponse.communicationRequest", "short": "Request for additional information", "definition": "Request for additional supporting or authorizing information, such as: documents, images or resources.", "min": 0, "max": "*", "type": [ { "code": "Reference", "targetProfile": "http://hl7.org/fhir/StructureDefinition/CommunicationRequest" } ] }, { "id": "ClaimResponse.insurance", "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-explicit-type-name", "valueString": "Insurance" } ], "path": "ClaimResponse.insurance", "short": "Insurance or medical plan", "definition": "Financial instrument by which payment information for health care.", "requirements": "Health care programs and insurers are significant payors of health service costs.", "min": 0, "max": "*", "type": [ { "code": "BackboneElement" } ], "mapping": [ { "identity": "rim", "map": "Coverage" } ] }, { "id": "ClaimResponse.insurance.sequence", "path": "ClaimResponse.insurance.sequence", "short": "Service instance identifier", "definition": "A service line item.", "requirements": "To maintain order of the coverages.", "min": 1, "max": "1", "type": [ { "code": "positiveInt" } ] }, { "id": "ClaimResponse.insurance.focal", "path": "ClaimResponse.insurance.focal", "short": "Is the focal Coverage", "definition": "The instance number of the Coverage which is the focus for adjudication. The Coverage against which the claim is to be adjudicated.", "requirements": "To identify which coverage is being adjudicated.", "min": 1, "max": "1", "type": [ { "code": "boolean" } ] }, { "id": "ClaimResponse.insurance.coverage", "path": "ClaimResponse.insurance.coverage", "short": "Insurance information", "definition": "Reference to the program or plan identification, underwriter or payor.", "requirements": "Need to identify the issuer to target for processing and for coordination of benefit processing.", "min": 1, "max": "1", "type": [ { "code": "Reference", "targetProfile": "http://hl7.org/fhir/StructureDefinition/Coverage" } ] }, { "id": "ClaimResponse.insurance.businessArrangement", "path": "ClaimResponse.insurance.businessArrangement", "short": "Business agreement", "definition": "The contract number of a business agreement which describes the terms and conditions.", "min": 0, "max": "1", "type": [ { "code": "string" } ] }, { "id": "ClaimResponse.insurance.preAuthRef", "path": "ClaimResponse.insurance.preAuthRef", "short": "Pre-Authorization/Determination Reference", "definition": "A list of references from the Insurer to which these services pertain.", "requirements": "To provide any pre-determination or prior authorization reference.", "min": 0, "max": "*", "type": [ { "code": "string" } ], "mapping": [ { "identity": "cdanetv4", "map": "F03" } ] }, { "id": "ClaimResponse.insurance.claimResponse", "path": "ClaimResponse.insurance.claimResponse", "short": "Adjudication results", "definition": "The Coverages adjudication details.", "requirements": "Used by downstream payers to determine what balance remains and the net payable.", "min": 0, "max": "1", "type": [ { "code": "Reference", "targetProfile": "http://hl7.org/fhir/StructureDefinition/ClaimResponse" } ], "mapping": [ { "identity": "cdanetv4", "map": "EOB" } ] } ] } }