ClaimResponse
ClaimResponse
draftResource187 elementsv5.0.0
This resource provides the adjudication details from the processing of a Claim resource.
Metadata
hl7.org/fhir- Canonical URL
- http://hl7.org/fhir/StructureDefinition/ClaimResponse
- ID
- ClaimResponse
- Type
- Base Definition
- Derivation
- specialization
- Publisher
- Health Level Seven International (Financial Management)
- Version
- 5.0.0
| Path | Card. | Type | Description |
|---|---|---|---|
ClaimResponse | 0..* | Response to a claim predetermination or preauthorization | |
id | 0..1 | string | Logical id of this artifact |
meta | 0..1 | Metadata about the resource | |
implicitRules | 0..1 | uri | A set of rules under which this content was created |
language | 0..1 | code | Language of the resource contentrequired: all-languages |
text | 0..1 | Text summary of the resource, for human interpretation | |
contained | 0..* | Resource | Contained, inline Resources |
extension | 0..* | Additional content defined by implementations | |
modifierExtension | 0..* | Extensions that cannot be ignored | |
identifier | 0..* | Business Identifier for a claim response | |
traceNumber | 0..* | Number for tracking | |
status | 1..1 | code | active | cancelled | draft | entered-in-errorrequired: fm-status |
type | 1..1 | More granular claim typeextensible: claim-type | |
subType | 0..1 | More granular claim typeexample: claim-subtype | |
use | 1..1 | code | claim | preauthorization | predeterminationrequired: claim-use |
patient | 1..1 | The recipient of the products and services | |
created | 1..1 | dateTime | Response creation date |
insurer | 0..1 | Party responsible for reimbursement | |
requestor | 0..1 | Party responsible for the claim | |
request | 0..1 | Id of resource triggering adjudication | |
outcome | 1..1 | code | queued | complete | error | partialrequired: claim-outcome |
decision | 0..1 | Result of the adjudicationexample: claim-decision | |
disposition | 0..1 | string | Disposition Message |
preAuthRef | 0..1 | string | Preauthorization reference |
preAuthPeriod | 0..1 | Preauthorization reference effective period | |
event | 0..* | BackboneElement | Event information |
payeeType | 0..1 | Party to be paid any benefits payableexample: payeetype | |
encounter | 0..* | Encounters associated with the listed treatments | |
diagnosisRelatedGroup | 0..1 | Package billing codeexample: ex-diagnosisrelatedgroup | |
item | 0..* | BackboneElement | Adjudication for claim line items |
addItem | 0..* | BackboneElement | Insurer added line items |
adjudication | 0..* | see adjudication | Header-level adjudication |
total | 0..* | BackboneElement | Adjudication totals |
payment | 0..1 | BackboneElement | Payment Details |
fundsReserve | 0..1 | Funds reserved statusexample: fundsreserve | |
formCode | 0..1 | Printed form identifierexample: forms | |
form | 0..1 | Printed reference or actual form | |
processNote | 0..* | BackboneElement | Note concerning adjudication |
communicationRequest | 0..* | Request for additional information | |
insurance | 0..* | BackboneElement | Patient insurance information |
error | 0..* | BackboneElement | Processing errors |