| status | 1..1 | code | 1+ | active | cancelled | draft | entered-in-error |
| type | 1..1 | CodeableConcept | 1+ | More granular claim type |
| use | 1..1 | code | 1+ | claim | preauthorization | predetermination |
| patient | 1..1 | Reference | 1+ | The recipient of the products and services |
| created | 1..1 | dateTime | 1+ | Response creation date |
| insurer | 1..1 | Reference | 1+ | Party responsible for reimbursement |
| outcome | 1..1 | code | 1+ | queued | complete | error | partial |
| item.itemSequence | 1..1 | positiveInt | 1+ | Claim item instance identifier |
| item.adjudication | 1..* | BackboneElement | 1+ | Adjudication details |
| item.adjudication.category | 1..1 | CodeableConcept | 1+ | Type of adjudication information |
| item.detail.detailSequence | 1..1 | positiveInt | 1+ | Claim detail instance identifier |
| item.detail.adjudication | 1..* | | 1+ | Detail level adjudication details |
| item.detail.subDetail.subDetailSequence | 1..1 | positiveInt | 1+ | Claim sub-detail instance identifier |
| addItem.productOrService | 1..1 | CodeableConcept | 1+ | Billing, service, product, or drug code |
| addItem.adjudication | 1..* | | 1+ | Added items adjudication |
| addItem.detail.productOrService | 1..1 | CodeableConcept | 1+ | Billing, service, product, or drug code |
| addItem.detail.adjudication | 1..* | | 1+ | Added items detail adjudication |
| addItem.detail.subDetail.productOrService | 1..1 | CodeableConcept | 1+ | Billing, service, product, or drug code |
| addItem.detail.subDetail.adjudication | 1..* | | 1+ | Added items detail adjudication |
| total.category | 1..1 | CodeableConcept | 1+ | Type of adjudication information |
| total.amount | 1..1 | Money | 1+ | Financial total for the category |
| payment.type | 1..1 | CodeableConcept | 1+ | Partial or complete payment |
| payment.amount | 1..1 | Money | 1+ | Payable amount after adjustment |
| processNote.text | 1..1 | string | 1+ | Note explanatory text |
| insurance.sequence | 1..1 | positiveInt | 1+ | Insurance instance identifier |
| insurance.focal | 1..1 | boolean | 1+ | Coverage to be used for adjudication |
| insurance.coverage | 1..1 | Reference | 1+ | Insurance information |
| error.code | 1..1 | CodeableConcept | 1+ | Error code detailing processing issues |