description: This resource provides the adjudication details from the processing of a Claim resource.
package_name: hl7.fhir.r6.core
derivation: specialization
name: ClaimResponse
type: ClaimResponse
elements:
  requestor:
    isModifier: false
    short: Party responsible for the claim
    refers: ['http://hl7.org/fhir/StructureDefinition/Organization', 'http://hl7.org/fhir/StructureDefinition/Practitioner', 'http://hl7.org/fhir/StructureDefinition/PractitionerRole']
    type: Reference
    mustSupport: false
    isSummary: false
    index: 10
  payeeType:
    isModifier: false
    short: Party to be paid any benefits payable
    type: CodeableConcept
    mustSupport: false
    binding: {strength: preferred, valueSet: 'http://hl7.org/fhir/ValueSet/payeetype'}
    isSummary: false
    index: 23
  insurance:
    isModifier: false
    short: Patient insurance information
    index: 206
    type: BackboneElement
    mustSupport: false
    array: true
    elements:
      sequence: {isModifier: false, short: Insurance instance identifier, type: positiveInt, mustSupport: false, isSummary: false, index: 207}
      focal: {isModifier: false, short: Coverage to be used for adjudication, type: boolean, mustSupport: false, isSummary: false, index: 208}
      coverage:
        isModifier: false
        short: Insurance information
        refers: ['http://hl7.org/fhir/StructureDefinition/Coverage']
        type: Reference
        mustSupport: false
        isSummary: false
        index: 209
      businessArrangement: {isModifier: false, short: Additional provider contract number, type: string, mustSupport: false, isSummary: false, index: 210}
      claimResponse:
        isModifier: false
        short: Adjudication results
        refers: ['http://hl7.org/fhir/StructureDefinition/ClaimResponse']
        type: Reference
        mustSupport: false
        isSummary: false
        index: 211
    required: [coverage, focal, sequence]
    isSummary: false
  request:
    isModifier: false
    short: Id of resource triggering adjudication
    refers: ['http://hl7.org/fhir/StructureDefinition/Claim']
    type: Reference
    mustSupport: false
    isSummary: true
    index: 11
  processNote:
    isModifier: false
    short: Note concerning adjudication
    index: 199
    type: BackboneElement
    mustSupport: false
    array: true
    elements:
      class: {isModifier: false, short: Business kind of note, type: CodeableConcept, mustSupport: false, isSummary: false, index: 200}
      number: {isModifier: false, short: Note instance identifier, type: positiveInt, mustSupport: false, isSummary: false, index: 201}
      type:
        isModifier: false
        short: Note purpose
        type: CodeableConcept
        mustSupport: false
        binding: {strength: extensible, valueSet: 'http://hl7.org/fhir/ValueSet/note-type'}
        isSummary: false
        index: 202
      text: {isModifier: false, short: Note explanatory text, type: markdown, mustSupport: false, isSummary: false, index: 203}
      language:
        isModifier: false
        short: Language of the text
        type: CodeableConcept
        mustSupport: false
        binding: {strength: required, valueSet: 'http://hl7.org/fhir/ValueSet/all-languages|6.0.0-ballot5'}
        isSummary: false
        index: 204
    required: [text]
    isSummary: false
  preAuthRef: {isModifier: false, short: Preauthorization reference, type: string, mustSupport: false, isSummary: false, index: 15}
  adjudication:
    elementReference: ['http://hl7.org/fhir/StructureDefinition/ClaimResponse', elements, item, elements, adjudication]
    isModifier: false
    short: Header-level adjudication
    mustSupport: false
    array: true
    isSummary: false
    index: 185
  supportingInfo:
    isModifier: false
    short: Supporting information
    index: 26
    type: BackboneElement
    mustSupport: false
    array: true
    elements:
      category:
        isModifier: false
        short: Classification of the supplied information
        type: CodeableConcept
        mustSupport: false
        binding: {strength: preferred, valueSet: 'http://hl7.org/fhir/ValueSet/claim-informationcategory'}
        isSummary: false
        index: 28
      valueBase64Binary: {isModifier: false, short: Data to be provided, type: base64Binary, mustSupport: false, choiceOf: value, isSummary: false, index: 38}
      valueAge: {isModifier: false, short: Data to be provided, type: Age, mustSupport: false, choiceOf: value, isSummary: false, index: 59}
      valueParameterDefinition: {isModifier: false, short: Data to be provided, type: ParameterDefinition, mustSupport: false, choiceOf: value, isSummary: false, index: 84}
      valueTiming: {isModifier: false, short: Data to be provided, type: Timing, mustSupport: false, choiceOf: value, isSummary: false, index: 80}
      valueCode: {isModifier: false, short: Data to be provided, type: code, mustSupport: false, choiceOf: value, isSummary: false, index: 41}
      valueReference: {isModifier: false, short: Data to be provided, type: Reference, mustSupport: false, choiceOf: value, isSummary: false, index: 77}
      valueContactDetail: {isModifier: false, short: Data to be provided, type: ContactDetail, mustSupport: false, choiceOf: value, isSummary: false, index: 81}
      valueVirtualServiceDetail: {isModifier: false, short: Data to be provided, type: VirtualServiceDetail, mustSupport: false, choiceOf: value, isSummary: false, index: 90}
      valueUri: {isModifier: false, short: Data to be provided, type: uri, mustSupport: false, choiceOf: value, isSummary: false, index: 55}
      valueUsageContext: {isModifier: false, short: Data to be provided, type: UsageContext, mustSupport: false, choiceOf: value, isSummary: false, index: 87}
      valueTime: {isModifier: false, short: Data to be provided, type: time, mustSupport: false, choiceOf: value, isSummary: false, index: 53}
      valueDecimal: {isModifier: false, short: Data to be provided, type: decimal, mustSupport: false, choiceOf: value, isSummary: false, index: 44}
      valueCanonical: {isModifier: false, short: Data to be provided, type: canonical, mustSupport: false, choiceOf: value, isSummary: false, index: 40}
      valueMarkdown: {isModifier: false, short: Data to be provided, type: markdown, mustSupport: false, choiceOf: value, isSummary: false, index: 49}
      valueIdentifier: {isModifier: false, short: Data to be provided, type: Identifier, mustSupport: false, choiceOf: value, isSummary: false, index: 70}
      valueTriggerDefinition: {isModifier: false, short: Data to be provided, type: TriggerDefinition, mustSupport: false, choiceOf: value, isSummary: false, index: 86}
      valueQuantity: {isModifier: false, short: Data to be provided, type: Quantity, mustSupport: false, choiceOf: value, isSummary: false, index: 73}
      timingPeriod: {isModifier: false, short: When it occurred, type: Period, mustSupport: false, choiceOf: timing, isSummary: false, index: 34}
      value:
        isModifier: false
        short: Data to be provided
        mustSupport: false
        choices: [valueBase64Binary, valueBoolean, valueCanonical, valueCode, valueDate, valueDateTime, valueDecimal, valueId, valueInstant, valueInteger, valueInteger64, valueMarkdown, valueOid, valuePositiveInt, valueString, valueTime, valueUnsignedInt, valueUri, valueUrl, valueUuid, valueAddress, valueAge, valueAnnotation, valueAttachment, valueCodeableConcept, valueCodeableReference, valueCoding, valueContactPoint, valueCount, valueDistance, valueDuration, valueHumanName, valueIdentifier, valueMoney, valuePeriod, valueQuantity, valueRange, valueRatio, valueRatioRange, valueReference, valueSampledData, valueSignature, valueTiming, valueContactDetail, valueDataRequirement, valueExpression, valueParameterDefinition, valueRelatedArtifact, valueTriggerDefinition, valueUsageContext, valueAvailability, valueExtendedContactDetail, valueVirtualServiceDetail, valueDosage, valueMeta]
        isSummary: false
        index: 37
      valueCount: {isModifier: false, short: Data to be provided, type: Count, mustSupport: false, choiceOf: value, isSummary: false, index: 66}
      valueString: {isModifier: false, short: Data to be provided, type: string, mustSupport: false, choiceOf: value, isSummary: false, index: 52}
      valueCodeableReference: {isModifier: false, short: Data to be provided, type: CodeableReference, mustSupport: false, choiceOf: value, isSummary: false, index: 63}
      valueRatio: {isModifier: false, short: Data to be provided, type: Ratio, mustSupport: false, choiceOf: value, isSummary: false, index: 75}
      valueBoolean: {isModifier: false, short: Data to be provided, type: boolean, mustSupport: false, choiceOf: value, isSummary: false, index: 39}
      valueInstant: {isModifier: false, short: Data to be provided, type: instant, mustSupport: false, choiceOf: value, isSummary: false, index: 46}
      valueDateTime: {isModifier: false, short: Data to be provided, type: dateTime, mustSupport: false, choiceOf: value, isSummary: false, index: 43}
      valueDate: {isModifier: false, short: Data to be provided, type: date, mustSupport: false, choiceOf: value, isSummary: false, index: 42}
      valueDuration: {isModifier: false, short: Data to be provided, type: Duration, mustSupport: false, choiceOf: value, isSummary: false, index: 68}
      valueDataRequirement: {isModifier: false, short: Data to be provided, type: DataRequirement, mustSupport: false, choiceOf: value, isSummary: false, index: 82}
      valueMeta: {isModifier: false, short: Data to be provided, type: Meta, mustSupport: false, choiceOf: value, isSummary: false, index: 92}
      valueMoney: {isModifier: false, short: Data to be provided, type: Money, mustSupport: false, choiceOf: value, isSummary: false, index: 71}
      valueCoding: {isModifier: false, short: Data to be provided, type: Coding, mustSupport: false, choiceOf: value, isSummary: false, index: 64}
      valueInteger64: {isModifier: false, short: Data to be provided, type: integer64, mustSupport: false, choiceOf: value, isSummary: false, index: 48}
      valueExpression: {isModifier: false, short: Data to be provided, type: Expression, mustSupport: false, choiceOf: value, isSummary: false, index: 83}
      reason:
        isModifier: false
        short: Explanation for the information
        type: CodeableConcept
        mustSupport: false
        binding: {strength: example, valueSet: 'http://hl7.org/fhir/ValueSet/missing-tooth-reason'}
        isSummary: false
        index: 93
      timingDateTime: {isModifier: false, short: When it occurred, type: dateTime, mustSupport: false, choiceOf: timing, isSummary: false, index: 33}
      timingTiming: {isModifier: false, short: When it occurred, type: Timing, mustSupport: false, choiceOf: timing, isSummary: false, index: 35}
      valueSampledData: {isModifier: false, short: Data to be provided, type: SampledData, mustSupport: false, choiceOf: value, isSummary: false, index: 78}
      timing:
        isModifier: false
        short: When it occurred
        mustSupport: false
        choices: [timingDateTime, timingPeriod, timingTiming]
        isSummary: false
        index: 32
      valueDosage: {isModifier: false, short: Data to be provided, type: Dosage, mustSupport: false, choiceOf: value, isSummary: false, index: 91}
      valueContactPoint: {isModifier: false, short: Data to be provided, type: ContactPoint, mustSupport: false, choiceOf: value, isSummary: false, index: 65}
      sequence: {isModifier: false, short: Information instance identifier, type: positiveInt, mustSupport: false, isSummary: false, index: 27}
      code:
        isModifier: false
        short: Type of information
        type: CodeableConcept
        mustSupport: false
        binding: {strength: example, valueSet: 'http://hl7.org/fhir/ValueSet/claim-exception'}
        isSummary: false
        index: 30
      subCategory: {isModifier: false, short: Finer-grained classification of the supplied information, type: CodeableConcept, mustSupport: false, isSummary: false, index: 29}
      valueCodeableConcept: {isModifier: false, short: Data to be provided, type: CodeableConcept, mustSupport: false, choiceOf: value, isSummary: false, index: 62}
      valueAnnotation: {isModifier: false, short: Data to be provided, type: Annotation, mustSupport: false, choiceOf: value, isSummary: false, index: 60}
      valueAvailability: {isModifier: false, short: Data to be provided, type: Availability, mustSupport: false, choiceOf: value, isSummary: false, index: 88}
      valuePeriod: {isModifier: false, short: Data to be provided, type: Period, mustSupport: false, choiceOf: value, isSummary: false, index: 72}
      valueDistance: {isModifier: false, short: Data to be provided, type: Distance, mustSupport: false, choiceOf: value, isSummary: false, index: 67}
      valueRange: {isModifier: false, short: Data to be provided, type: Range, mustSupport: false, choiceOf: value, isSummary: false, index: 74}
      valueSignature: {isModifier: false, short: Data to be provided, type: Signature, mustSupport: false, choiceOf: value, isSummary: false, index: 79}
      valueUuid: {isModifier: false, short: Data to be provided, type: uuid, mustSupport: false, choiceOf: value, isSummary: false, index: 57}
      valueInteger: {isModifier: false, short: Data to be provided, type: integer, mustSupport: false, choiceOf: value, isSummary: false, index: 47}
      valueHumanName: {isModifier: false, short: Data to be provided, type: HumanName, mustSupport: false, choiceOf: value, isSummary: false, index: 69}
      valueUnsignedInt: {isModifier: false, short: Data to be provided, type: unsignedInt, mustSupport: false, choiceOf: value, isSummary: false, index: 54}
      valueAttachment: {isModifier: false, short: Data to be provided, type: Attachment, mustSupport: false, choiceOf: value, isSummary: false, index: 61}
      valueOid: {isModifier: false, short: Data to be provided, type: oid, mustSupport: false, choiceOf: value, isSummary: false, index: 50}
      valueAddress: {isModifier: false, short: Data to be provided, type: Address, mustSupport: false, choiceOf: value, isSummary: false, index: 58}
      valueRelatedArtifact: {isModifier: false, short: Data to be provided, type: RelatedArtifact, mustSupport: false, choiceOf: value, isSummary: false, index: 85}
      valueRatioRange: {isModifier: false, short: Data to be provided, type: RatioRange, mustSupport: false, choiceOf: value, isSummary: false, index: 76}
      valuePositiveInt: {isModifier: false, short: Data to be provided, type: positiveInt, mustSupport: false, choiceOf: value, isSummary: false, index: 51}
      valueId: {isModifier: false, short: Data to be provided, type: id, mustSupport: false, choiceOf: value, isSummary: false, index: 45}
      valueUrl: {isModifier: false, short: Data to be provided, type: url, mustSupport: false, choiceOf: value, isSummary: false, index: 56}
      valueExtendedContactDetail: {isModifier: false, short: Data to be provided, type: ExtendedContactDetail, mustSupport: false, choiceOf: value, isSummary: false, index: 89}
    required: [sequence, category]
    isSummary: false
  encounter:
    isModifier: false
    short: Encounters associated with the listed treatments
    refers: ['http://hl7.org/fhir/StructureDefinition/Encounter']
    type: Reference
    mustSupport: false
    array: true
    isSummary: false
    index: 24
  use:
    isModifier: false
    short: claim | preauthorization | predetermination
    type: code
    mustSupport: false
    binding: {strength: required, valueSet: 'http://hl7.org/fhir/ValueSet/claim-use|6.0.0-ballot5'}
    isSummary: true
    index: 6
  payment:
    isModifier: false
    short: Payment Details
    type: BackboneElement
    mustSupport: false
    isSummary: false
    index: 189
    elements:
      type:
        isModifier: false
        short: Partial or complete payment
        type: CodeableConcept
        mustSupport: false
        binding: {strength: preferred, valueSet: 'http://hl7.org/fhir/ValueSet/ex-paymenttype'}
        isSummary: false
        index: 190
      adjustment: {isModifier: false, short: Payment adjustment for non-claim issues, type: Money, mustSupport: false, isSummary: false, index: 191}
      adjustmentReason:
        isModifier: false
        short: Explanation for the adjustment
        type: CodeableConcept
        mustSupport: false
        binding: {strength: preferred, valueSet: 'http://hl7.org/fhir/ValueSet/payment-adjustment-reason'}
        isSummary: false
        index: 192
      date: {isModifier: false, short: Expected date of payment, type: date, mustSupport: false, isSummary: false, index: 193}
      amount: {isModifier: false, short: Payable amount after adjustment, type: Money, mustSupport: false, isSummary: false, index: 194}
      identifier: {isModifier: false, short: Business identifier for the payment, type: Identifier, mustSupport: false, isSummary: false, index: 195}
    required: [type, amount]
  traceNumber: {isModifier: false, short: Number for tracking, type: Identifier, mustSupport: false, array: true, isSummary: false, index: 1}
  item:
    isModifier: false
    short: Adjudication for claim line items
    index: 94
    type: BackboneElement
    mustSupport: false
    array: true
    elements:
      itemSequence: {isModifier: false, short: Claim item instance identifier, type: positiveInt, mustSupport: false, isSummary: false, index: 95}
      traceNumber: {isModifier: false, short: Number for tracking, type: Identifier, mustSupport: false, array: true, isSummary: false, index: 96}
      informationSequence: {isModifier: false, short: Applicable exception and supporting information, type: positiveInt, mustSupport: false, array: true, isSummary: false, index: 97}
      noteNumber: {isModifier: false, short: Applicable note numbers, type: positiveInt, mustSupport: false, array: true, isSummary: false, index: 98}
      reviewOutcome:
        isModifier: false
        short: Adjudication results
        type: BackboneElement
        mustSupport: false
        isSummary: false
        index: 99
        elements:
          decision:
            isModifier: false
            short: Result of the adjudication
            type: CodeableConcept
            mustSupport: false
            binding: {strength: preferred, valueSet: 'http://hl7.org/fhir/ValueSet/claim-decision'}
            isSummary: false
            index: 100
          reason:
            isModifier: false
            short: Reason for result of the adjudication
            type: CodeableConcept
            mustSupport: false
            array: true
            binding: {strength: example, valueSet: 'http://hl7.org/fhir/ValueSet/claim-decision-reason'}
            isSummary: false
            index: 101
          preAuthRef: {isModifier: false, short: Preauthorization reference, type: string, mustSupport: false, isSummary: false, index: 102}
          preAuthPeriod: {isModifier: false, short: Preauthorization reference effective period, type: Period, mustSupport: false, isSummary: false, index: 103}
      adjudication:
        isModifier: false
        short: Adjudication details
        index: 104
        type: BackboneElement
        mustSupport: false
        array: true
        elements:
          category:
            isModifier: false
            short: Type of adjudication information
            type: CodeableConcept
            mustSupport: false
            binding: {strength: preferred, valueSet: 'http://hl7.org/fhir/ValueSet/adjudication'}
            isSummary: false
            index: 105
          reason:
            isModifier: false
            short: Explanation of adjudication outcome
            type: CodeableConcept
            mustSupport: false
            binding: {strength: example, valueSet: 'http://hl7.org/fhir/ValueSet/adjudication-reason'}
            isSummary: false
            index: 106
          amount: {isModifier: false, short: Monetary amount, type: Money, mustSupport: false, isSummary: false, index: 107}
          quantity: {isModifier: false, short: Non-monetary value, type: Quantity, mustSupport: false, isSummary: false, index: 108}
          decisionDate: {isModifier: false, short: When was adjudication performed, type: dateTime, mustSupport: false, isSummary: false, index: 109}
        required: [category]
        isSummary: false
      detail:
        isModifier: false
        short: Adjudication for claim details
        index: 110
        type: BackboneElement
        mustSupport: false
        array: true
        elements:
          detailSequence: {isModifier: false, short: Claim detail instance identifier, type: positiveInt, mustSupport: false, isSummary: false, index: 111}
          traceNumber: {isModifier: false, short: Number for tracking, type: Identifier, mustSupport: false, array: true, isSummary: false, index: 112}
          noteNumber: {isModifier: false, short: Applicable note numbers, type: positiveInt, mustSupport: false, array: true, isSummary: false, index: 113}
          reviewOutcome:
            elementReference: ['http://hl7.org/fhir/StructureDefinition/ClaimResponse', elements, item, elements, reviewOutcome]
            isModifier: false
            short: Detail level adjudication results
            mustSupport: false
            isSummary: false
            index: 114
          adjudication:
            elementReference: ['http://hl7.org/fhir/StructureDefinition/ClaimResponse', elements, item, elements, adjudication]
            isModifier: false
            short: Detail level adjudication details
            mustSupport: false
            array: true
            isSummary: false
            index: 115
          subDetail:
            isModifier: false
            short: Adjudication for claim sub-details
            index: 116
            type: BackboneElement
            mustSupport: false
            array: true
            elements:
              subDetailSequence: {isModifier: false, short: Claim sub-detail instance identifier, type: positiveInt, mustSupport: false, isSummary: false, index: 117}
              traceNumber: {isModifier: false, short: Number for tracking, type: Identifier, mustSupport: false, array: true, isSummary: false, index: 118}
              noteNumber: {isModifier: false, short: Applicable note numbers, type: positiveInt, mustSupport: false, array: true, isSummary: false, index: 119}
              reviewOutcome:
                elementReference: ['http://hl7.org/fhir/StructureDefinition/ClaimResponse', elements, item, elements, reviewOutcome]
                isModifier: false
                short: Subdetail level adjudication results
                mustSupport: false
                isSummary: false
                index: 120
              adjudication:
                elementReference: ['http://hl7.org/fhir/StructureDefinition/ClaimResponse', elements, item, elements, adjudication]
                isModifier: false
                short: Subdetail level adjudication details
                mustSupport: false
                array: true
                isSummary: false
                index: 121
            required: [subDetailSequence]
            isSummary: false
        required: [detailSequence]
        isSummary: false
    required: [itemSequence]
    isSummary: false
  type:
    isModifier: false
    short: More granular claim type
    type: CodeableConcept
    mustSupport: false
    binding: {strength: extensible, valueSet: 'http://hl7.org/fhir/ValueSet/claim-type'}
    isSummary: true
    index: 4
  created: {isModifier: false, short: Response creation date, type: dateTime, mustSupport: false, isSummary: true, index: 8}
  statusReason: {isModifier: false, short: Reason for status change, type: string, mustSupport: false, isSummary: true, index: 3}
  preAuthPeriod: {isModifier: false, short: Preauthorization reference effective period, type: Period, mustSupport: false, isSummary: false, index: 16}
  outcome:
    isModifier: false
    short: queued | complete | error | partial
    type: code
    mustSupport: false
    binding: {strength: required, valueSet: 'http://hl7.org/fhir/ValueSet/claim-outcome|6.0.0-ballot5'}
    isSummary: true
    index: 12
  disposition: {isModifier: false, short: Disposition Message, type: string, mustSupport: false, isSummary: false, index: 14}
  communicationRequest:
    isModifier: false
    short: Request for additional information
    refers: ['http://hl7.org/fhir/StructureDefinition/CommunicationRequest']
    type: Reference
    mustSupport: false
    array: true
    isSummary: false
    index: 205
  diagnosisRelatedGroup:
    isModifier: false
    short: Package billing code
    type: CodeableConcept
    mustSupport: false
    binding: {strength: example, valueSet: 'http://hl7.org/fhir/ValueSet/ex-diagnosisrelatedgroup'}
    isSummary: false
    index: 25
  total:
    isModifier: false
    short: Adjudication totals
    index: 186
    type: BackboneElement
    mustSupport: false
    array: true
    elements:
      category:
        isModifier: false
        short: Type of adjudication information
        type: CodeableConcept
        mustSupport: false
        binding: {strength: example, valueSet: 'http://hl7.org/fhir/ValueSet/adjudication'}
        isSummary: true
        index: 187
      amount: {isModifier: false, short: Financial total for the category, type: Money, mustSupport: false, isSummary: true, index: 188}
    required: [amount, category]
    isSummary: true
  event:
    isModifier: false
    short: Event information
    index: 17
    type: BackboneElement
    mustSupport: false
    array: true
    elements:
      type:
        isModifier: false
        short: Specific event
        type: CodeableConcept
        mustSupport: false
        binding: {strength: example, valueSet: 'http://hl7.org/fhir/ValueSet/datestype'}
        isSummary: false
        index: 18
      when:
        isModifier: false
        short: Occurance date or period
        mustSupport: false
        choices: [whenDateTime, whenPeriod]
        isSummary: false
        index: 20
      whenDateTime: {isModifier: false, short: Occurance date or period, type: dateTime, mustSupport: false, choiceOf: when, isSummary: false, index: 21}
      whenPeriod: {isModifier: false, short: Occurance date or period, type: Period, mustSupport: false, choiceOf: when, isSummary: false, index: 22}
    required: [when, type, whenDateTime, whenPeriod]
    isSummary: false
  insurer:
    isModifier: false
    short: Party responsible for reimbursement
    refers: ['http://hl7.org/fhir/StructureDefinition/Organization']
    type: Reference
    mustSupport: false
    isSummary: true
    index: 9
  fundsReserve:
    isModifier: false
    short: Funds reserved status
    type: CodeableConcept
    mustSupport: false
    binding: {strength: preferred, valueSet: 'http://hl7.org/fhir/ValueSet/fundsreserve'}
    isSummary: false
    index: 196
  status:
    isModifier: true
    short: active | cancelled | draft | entered-in-error
    index: 2
    type: code
    mustSupport: false
    binding: {strength: required, valueSet: 'http://hl7.org/fhir/ValueSet/fm-status|6.0.0-ballot5'}
    isModifierReason: This element is labeled as a modifier because it is a status element that contains status entered-in-error which means that the resource should not be treated as valid
    isSummary: true
  identifier: {isModifier: false, short: Business Identifier for a claim response, type: Identifier, mustSupport: false, array: true, isSummary: false, index: 0}
  error:
    isModifier: false
    short: Processing errors
    index: 212
    type: BackboneElement
    mustSupport: false
    array: true
    elements:
      itemSequence: {isModifier: false, short: Item sequence number, type: positiveInt, mustSupport: false, isSummary: false, index: 213}
      detailSequence: {isModifier: false, short: Detail sequence number, type: positiveInt, mustSupport: false, isSummary: false, index: 214}
      subDetailSequence: {isModifier: false, short: Subdetail sequence number, type: positiveInt, mustSupport: false, isSummary: false, index: 215}
      code:
        isModifier: false
        short: Error code detailing processing issues
        type: CodeableConcept
        mustSupport: false
        binding: {strength: example, valueSet: 'http://hl7.org/fhir/ValueSet/adjudication-error'}
        isSummary: true
        index: 216
      expression: {isModifier: false, short: FHIRPath of element(s) related to issue, type: string, mustSupport: false, array: true, isSummary: true, index: 217}
    required: [code]
    isSummary: false
  form: {isModifier: false, short: Printed reference or actual form, type: Attachment, mustSupport: false, isSummary: false, index: 198}
  subType:
    isModifier: false
    short: More granular claim type
    type: CodeableConcept
    mustSupport: false
    binding: {strength: example, valueSet: 'http://hl7.org/fhir/ValueSet/claim-subtype'}
    isSummary: false
    index: 5
  formCode:
    isModifier: false
    short: Printed form identifier
    type: CodeableConcept
    mustSupport: false
    binding: {strength: example, valueSet: 'http://hl7.org/fhir/ValueSet/forms'}
    isSummary: false
    index: 197
  addItem:
    isModifier: false
    short: Insurer added line items
    type: BackboneElement
    mustSupport: false
    array: true
    isSummary: false
    index: 122
    elements:
      category:
        isModifier: false
        short: Benefit classification
        type: CodeableConcept
        mustSupport: false
        binding: {strength: example, valueSet: 'http://hl7.org/fhir/ValueSet/ex-benefitcategory'}
        isSummary: false
        index: 131
      locationAddress: {isModifier: false, short: Place of service or where product was supplied, type: Address, mustSupport: false, choiceOf: location, isSummary: false, index: 144}
      request:
        isModifier: false
        short: Request or Referral for Service
        refers: ['http://hl7.org/fhir/StructureDefinition/DeviceRequest', 'http://hl7.org/fhir/StructureDefinition/MedicationRequest', 'http://hl7.org/fhir/StructureDefinition/NutritionOrder', 'http://hl7.org/fhir/StructureDefinition/ServiceRequest', 'http://hl7.org/fhir/StructureDefinition/VisionPrescription']
        type: Reference
        mustSupport: false
        array: true
        isSummary: false
        index: 134
      modifier:
        isModifier: false
        short: Service/Product billing modifiers
        type: CodeableConcept
        mustSupport: false
        array: true
        binding: {strength: example, valueSet: 'http://hl7.org/fhir/ValueSet/claim-modifiers'}
        isSummary: false
        index: 135
      revenue:
        isModifier: false
        short: Revenue or cost center code
        type: CodeableConcept
        mustSupport: false
        binding: {strength: example, valueSet: 'http://hl7.org/fhir/ValueSet/ex-revenue-center'}
        isSummary: false
        index: 130
      adjudication:
        elementReference: ['http://hl7.org/fhir/StructureDefinition/ClaimResponse', elements, item, elements, adjudication]
        isModifier: false
        short: Added items adjudication
        mustSupport: false
        array: true
        isSummary: false
        index: 156
      subdetailSequence: {isModifier: false, short: Subdetail sequence number, type: positiveInt, mustSupport: false, array: true, isSummary: false, index: 125}
      productOrServiceEnd:
        isModifier: false
        short: End of a range of codes
        type: CodeableConcept
        mustSupport: false
        binding: {strength: example, valueSet: 'http://hl7.org/fhir/ValueSet/service-uscls'}
        isSummary: false
        index: 133
      traceNumber: {isModifier: false, short: Number for tracking, type: Identifier, mustSupport: false, array: true, isSummary: false, index: 126}
      locationCodeableConcept: {isModifier: false, short: Place of service or where product was supplied, type: CodeableConcept, mustSupport: false, choiceOf: location, isSummary: false, index: 143}
      itemSequence: {isModifier: false, short: Item sequence number, type: positiveInt, mustSupport: false, array: true, isSummary: false, index: 123}
      net: {isModifier: false, short: Total item cost, type: Money, mustSupport: false, isSummary: false, index: 150}
      serviced:
        isModifier: false
        short: Date or dates of service or product delivery
        mustSupport: false
        choices: [servicedDate, servicedPeriod]
        isSummary: false
        index: 138
      detailSequence: {isModifier: false, short: Detail sequence number, type: positiveInt, mustSupport: false, array: true, isSummary: false, index: 124}
      tax: {isModifier: false, short: Total tax, type: Money, mustSupport: false, isSummary: false, index: 149}
      productOrService:
        isModifier: false
        short: Billing, service, product, or drug code
        type: CodeableConcept
        mustSupport: false
        binding: {strength: example, valueSet: 'http://hl7.org/fhir/ValueSet/service-uscls'}
        isSummary: false
        index: 132
      locationReference:
        isModifier: false
        short: Place of service or where product was supplied
        refers: ['http://hl7.org/fhir/StructureDefinition/Location']
        type: Reference
        mustSupport: false
        choiceOf: location
        isSummary: false
        index: 145
      informationSequence: {isModifier: false, short: Applicable exception and supporting information, type: positiveInt, mustSupport: false, array: true, isSummary: false, index: 128}
      programCode:
        isModifier: false
        short: Program the product or service is provided under
        type: CodeableConcept
        mustSupport: false
        array: true
        binding: {strength: example, valueSet: 'http://hl7.org/fhir/ValueSet/ex-program-code'}
        isSummary: false
        index: 136
      factor: {isModifier: false, short: Price scaling factor, type: decimal, mustSupport: false, isSummary: false, index: 148}
      servicedDate: {isModifier: false, short: Date or dates of service or product delivery, type: date, mustSupport: false, choiceOf: serviced, isSummary: false, index: 139}
      bodySite:
        isModifier: false
        short: Anatomical location
        index: 151
        type: BackboneElement
        mustSupport: false
        array: true
        elements:
          site:
            min: 1
            isModifier: false
            short: Location
            index: 152
            type: CodeableReference
            mustSupport: false
            array: true
            binding: {strength: example, valueSet: 'http://hl7.org/fhir/ValueSet/tooth'}
            isSummary: false
          subSite:
            isModifier: false
            short: Sub-location
            type: CodeableConcept
            mustSupport: false
            array: true
            binding: {strength: example, valueSet: 'http://hl7.org/fhir/ValueSet/surface'}
            isSummary: false
            index: 153
        required: [site]
        isSummary: false
      quantity: {isModifier: false, short: Count of products or services, type: Quantity, mustSupport: false, isSummary: false, index: 146}
      location:
        isModifier: false
        short: Place of service or where product was supplied
        mustSupport: false
        choices: [locationCodeableConcept, locationAddress, locationReference]
        isSummary: false
        index: 142
      provider:
        isModifier: false
        short: Authorized providers
        refers: ['http://hl7.org/fhir/StructureDefinition/Organization', 'http://hl7.org/fhir/StructureDefinition/Practitioner', 'http://hl7.org/fhir/StructureDefinition/PractitionerRole']
        type: Reference
        mustSupport: false
        array: true
        isSummary: false
        index: 129
      noteNumber: {isModifier: false, short: Applicable note numbers, type: positiveInt, mustSupport: false, array: true, isSummary: false, index: 154}
      unitPrice: {isModifier: false, short: 'Fee, charge or cost per item', type: Money, mustSupport: false, isSummary: false, index: 147}
      subject:
        isModifier: false
        short: The recipient of the products and services
        refers: ['http://hl7.org/fhir/StructureDefinition/Group', 'http://hl7.org/fhir/StructureDefinition/Patient']
        type: Reference
        mustSupport: false
        isSummary: false
        index: 127
      servicedPeriod: {isModifier: false, short: Date or dates of service or product delivery, type: Period, mustSupport: false, choiceOf: serviced, isSummary: false, index: 140}
      reviewOutcome:
        elementReference: ['http://hl7.org/fhir/StructureDefinition/ClaimResponse', elements, item, elements, reviewOutcome]
        isModifier: false
        short: Added items adjudication results
        mustSupport: false
        isSummary: false
        index: 155
      detail:
        isModifier: false
        short: Insurer added line details
        type: BackboneElement
        mustSupport: false
        array: true
        isSummary: false
        index: 157
        elements:
          modifier:
            isModifier: false
            short: Service/Product billing modifiers
            type: CodeableConcept
            mustSupport: false
            array: true
            binding: {strength: example, valueSet: 'http://hl7.org/fhir/ValueSet/claim-modifiers'}
            isSummary: false
            index: 162
          revenue:
            isModifier: false
            short: Revenue or cost center code
            type: CodeableConcept
            mustSupport: false
            binding: {strength: example, valueSet: 'http://hl7.org/fhir/ValueSet/ex-revenue-center'}
            isSummary: false
            index: 159
          adjudication:
            elementReference: ['http://hl7.org/fhir/StructureDefinition/ClaimResponse', elements, item, elements, adjudication]
            isModifier: false
            short: Added items detail adjudication
            mustSupport: false
            array: true
            isSummary: false
            index: 170
          productOrServiceEnd:
            isModifier: false
            short: End of a range of codes
            type: CodeableConcept
            mustSupport: false
            binding: {strength: example, valueSet: 'http://hl7.org/fhir/ValueSet/service-uscls'}
            isSummary: false
            index: 161
          traceNumber: {isModifier: false, short: Number for tracking, type: Identifier, mustSupport: false, array: true, isSummary: false, index: 158}
          net: {isModifier: false, short: Total item cost, type: Money, mustSupport: false, isSummary: false, index: 167}
          tax: {isModifier: false, short: Total tax, type: Money, mustSupport: false, isSummary: false, index: 166}
          productOrService:
            isModifier: false
            short: Billing, service, product, or drug code
            type: CodeableConcept
            mustSupport: false
            binding: {strength: example, valueSet: 'http://hl7.org/fhir/ValueSet/service-uscls'}
            isSummary: false
            index: 160
          factor: {isModifier: false, short: Price scaling factor, type: decimal, mustSupport: false, isSummary: false, index: 165}
          subDetail:
            isModifier: false
            short: Insurer added line items
            type: BackboneElement
            mustSupport: false
            array: true
            isSummary: false
            index: 171
            elements:
              modifier:
                isModifier: false
                short: Service/Product billing modifiers
                type: CodeableConcept
                mustSupport: false
                array: true
                binding: {strength: example, valueSet: 'http://hl7.org/fhir/ValueSet/claim-modifiers'}
                isSummary: false
                index: 176
              revenue:
                isModifier: false
                short: Revenue or cost center code
                type: CodeableConcept
                mustSupport: false
                binding: {strength: example, valueSet: 'http://hl7.org/fhir/ValueSet/ex-revenue-center'}
                isSummary: false
                index: 173
              adjudication:
                elementReference: ['http://hl7.org/fhir/StructureDefinition/ClaimResponse', elements, item, elements, adjudication]
                isModifier: false
                short: Added items subdetail adjudication
                mustSupport: false
                array: true
                isSummary: false
                index: 184
              productOrServiceEnd:
                isModifier: false
                short: End of a range of codes
                type: CodeableConcept
                mustSupport: false
                binding: {strength: example, valueSet: 'http://hl7.org/fhir/ValueSet/service-uscls'}
                isSummary: false
                index: 175
              traceNumber: {isModifier: false, short: Number for tracking, type: Identifier, mustSupport: false, array: true, isSummary: false, index: 172}
              net: {isModifier: false, short: Total item cost, type: Money, mustSupport: false, isSummary: false, index: 181}
              tax: {isModifier: false, short: Total tax, type: Money, mustSupport: false, isSummary: false, index: 180}
              productOrService:
                isModifier: false
                short: Billing, service, product, or drug code
                type: CodeableConcept
                mustSupport: false
                binding: {strength: example, valueSet: 'http://hl7.org/fhir/ValueSet/service-uscls'}
                isSummary: false
                index: 174
              factor: {isModifier: false, short: Price scaling factor, type: decimal, mustSupport: false, isSummary: false, index: 179}
              quantity: {isModifier: false, short: Count of products or services, type: Quantity, mustSupport: false, isSummary: false, index: 177}
              noteNumber: {isModifier: false, short: Applicable note numbers, type: positiveInt, mustSupport: false, array: true, isSummary: false, index: 182}
              unitPrice: {isModifier: false, short: 'Fee, charge or cost per item', type: Money, mustSupport: false, isSummary: false, index: 178}
              reviewOutcome:
                elementReference: ['http://hl7.org/fhir/StructureDefinition/ClaimResponse', elements, item, elements, reviewOutcome]
                isModifier: false
                short: Added items subdetail level adjudication results
                mustSupport: false
                isSummary: false
                index: 183
          quantity: {isModifier: false, short: Count of products or services, type: Quantity, mustSupport: false, isSummary: false, index: 163}
          noteNumber: {isModifier: false, short: Applicable note numbers, type: positiveInt, mustSupport: false, array: true, isSummary: false, index: 168}
          unitPrice: {isModifier: false, short: 'Fee, charge or cost per item', type: Money, mustSupport: false, isSummary: false, index: 164}
          reviewOutcome:
            elementReference: ['http://hl7.org/fhir/StructureDefinition/ClaimResponse', elements, item, elements, reviewOutcome]
            isModifier: false
            short: Added items detail level adjudication results
            mustSupport: false
            isSummary: false
            index: 169
  subject:
    isModifier: false
    short: The recipient(s) of the products and services
    refers: ['http://hl7.org/fhir/StructureDefinition/Group', 'http://hl7.org/fhir/StructureDefinition/Patient']
    type: Reference
    mustSupport: false
    isSummary: true
    index: 7
  decision:
    isModifier: false
    short: Result of the adjudication
    type: CodeableConcept
    mustSupport: false
    binding: {strength: preferred, valueSet: 'http://hl7.org/fhir/ValueSet/claim-decision'}
    isSummary: true
    index: 13
package_version: 6.0.0-ballot5
class: resource
kind: resource
url: http://hl7.org/fhir/StructureDefinition/ClaimResponse
base: http://hl7.org/fhir/StructureDefinition/DomainResource
version: 6.0.0-ballot5
required: [created, status, subject, type, use, outcome]