| status | 1..1 | code | 1+ | active | cancelled | draft | entered-in-error |
| type | 1..1 | CodeableConcept | 1+ | Category or discipline |
| 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 |
| provider | 1..1 | Reference | 1+ | Party responsible for the claim |
| outcome | 1..1 | code | 1+ | queued | complete | error | partial |
| careTeam.sequence | 1..1 | positiveInt | 1+ | Order of care team |
| careTeam.provider | 1..1 | Reference | 1+ | Practitioner or organization |
| supportingInfo.sequence | 1..1 | positiveInt | 1+ | Information instance identifier |
| supportingInfo.category | 1..1 | CodeableConcept | 1+ | Classification of the supplied information |
| diagnosis.sequence | 1..1 | positiveInt | 1+ | Diagnosis instance identifier |
| diagnosis.diagnosis[x] | 1..1 | CodeableConceptReference | 1+ | Nature of illness or problem |
| procedure.sequence | 1..1 | positiveInt | 1+ | Procedure instance identifier |
| procedure.procedure[x] | 1..1 | CodeableConceptReference | 1+ | Specific clinical procedure |
| insurance | 1..* | BackboneElement | 1+ | Patient insurance information |
| insurance.focal | 1..1 | boolean | 1+ | Coverage to be used for adjudication |
| insurance.coverage | 1..1 | Reference | 1+ | Insurance information |
| item.sequence | 1..1 | positiveInt | 1+ | Item instance identifier |
| item.productOrService | 1..1 | CodeableConcept | 1+ | Billing, service, product, or drug code |
| item.adjudication.category | 1..1 | CodeableConcept | 1+ | Type of adjudication information |
| item.detail.sequence | 1..1 | positiveInt | 1+ | Product or service provided |
| item.detail.productOrService | 1..1 | CodeableConcept | 1+ | Billing, service, product, or drug code |
| item.detail.subDetail.sequence | 1..1 | positiveInt | 1+ | Product or service provided |
| item.detail.subDetail.productOrService | 1..1 | CodeableConcept | 1+ | Billing, service, product, or drug code |
| addItem.productOrService | 1..1 | CodeableConcept | 1+ | Billing, service, product, or drug code |
| addItem.detail.productOrService | 1..1 | CodeableConcept | 1+ | Billing, service, product, or drug code |
| addItem.detail.subDetail.productOrService | 1..1 | CodeableConcept | 1+ | Billing, service, product, or drug code |
| total.category | 1..1 | CodeableConcept | 1+ | Type of adjudication information |
| total.amount | 1..1 | Money | 1+ | Financial total for the category |
| benefitBalance.category | 1..1 | CodeableConcept | 1+ | Benefit classification |
| benefitBalance.financial.type | 1..1 | CodeableConcept | 1+ | Benefit classification |