QICoreClaimResponse

QICore ClaimResponse

draftQI-Core7.0.2resource9 key elements

The QI-Core ClaimResponse profile is used to provide the results of the adjudication and/or authorization of a set of healthcare-related products and services for a patient against the patient's insurance coverages, or to respond with what the adjudication would be for a supplied set of products or services should they be actually supplied to the patient. It identifies the mandatory core elements, extensions, vocabularies and value sets which SHALL be present in the ClaimResponse resource when using this profile

Metadata

hl7.org/fhir
Canonical URL
http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-claimresponse
ID
qicore-claimresponse
Type
Base Definition
Derivation
constraint
Mandatory and Must-Support Elements

Elements with cardinality > 0 or marked as Must Support (S)

PathCard.TypeFlagsDescription
status1..1
code
1+
(QI) active | cancelled | draft | entered-in-error
type1..1
CodeableConcept
1+
(QI) More granular claim type
use1..1
code
1+
(QI) claim | preauthorization | predetermination
patient1..1
Reference
1+
(QI) The recipient of the products and services
created1..1
dateTime
1+
(QI) Response creation date
insurer1..1
Reference
1+
(QI) Party responsible for reimbursement
item.adjudication1..*
BackboneElement
1+
(QI) Adjudication details
item.adjudication.category1..1
CodeableConcept
1+
(QI) This code is fixed to 'submitted' to indicate that the adjudication result is on what was submitted.
item.detail.detailSequence1..1
positiveInt
1+
(QI) Claim detail instance identifier