description: This profile specifies constraints on ClaimResponse resource to reflect the contents of a pro-active prior authorization returned via a card
package_name: hl7.fhir.us.davinci
derivation: constraint
name: ClaimResponse
type: ClaimResponse
elements:
  payeeType: {mustSupport: true, index: 6}
  insurance:
    mustSupport: true
    index: 62
    elements:
      sequence: {mustSupport: true, index: 63}
      focal: {mustSupport: true, index: 64}
      coverage: {mustSupport: true, index: 65}
  processNote:
    mustSupport: true
    index: 57
    elements:
      number: {mustSupport: true, index: 58}
      type: {mustSupport: true, index: 59}
      text: {mustSupport: true, index: 60}
      language: {mustSupport: true, index: 61}
  preAuthRef: {mustSupport: true, index: 4}
  use:
    type: code
    pattern: {type: Code, value: preauthorization}
    mustSupport: true
    index: 2
  payment: {mustSupport: false, index: 55}
  type: {mustSupport: true, index: 1}
  preAuthPeriod: {mustSupport: true, index: 5}
  outcome:
    type: code
    pattern: {type: Code, value: complete}
    mustSupport: true
    index: 3
  total:
    mustSupport: true
    index: 52
    elements:
      category: {mustSupport: true, index: 53}
      amount: {mustSupport: true, index: 54}
  fundsReserve: {mustSupport: true, index: 56}
  status:
    type: code
    pattern: {type: Code, value: active}
    mustSupport: true
    index: 0
  error: {mustSupport: false, index: 66}
  addItem:
    mustSupport: true
    array: true
    min: 1
    index: 7
    elements:
      modifier: {mustSupport: true, index: 10}
      adjudication:
        mustSupport: true
        index: 21
        elements:
          category: {mustSupport: true, index: 22}
          reason: {mustSupport: true, index: 23}
          amount: {mustSupport: true, index: 24}
          value: {mustSupport: true, index: 25}
      net: {mustSupport: true, index: 17}
      subSite: {mustSupport: true, index: 19}
      productOrService: {mustSupport: true, index: 9}
      programCode: {mustSupport: true, index: 11}
      factor: {mustSupport: true, index: 16}
      bodySite: {mustSupport: true, index: 18}
      quantity: {mustSupport: true, index: 14}
      location:
        mustSupport: true
        choices: []
        index: 13
      provider: {mustSupport: true, index: 8}
      noteNumber: {mustSupport: true, index: 20}
      unitPrice: {mustSupport: true, index: 15}
      detail:
        mustSupport: true
        index: 26
        elements:
          modifier: {mustSupport: true, index: 28}
          adjudication:
            mustSupport: true
            index: 34
            elements:
              category: {mustSupport: true, index: 35}
              reason: {mustSupport: true, index: 36}
              amount: {mustSupport: true, index: 37}
              value: {mustSupport: true, index: 38}
          net: {mustSupport: true, index: 32}
          productOrService: {mustSupport: true, index: 27}
          factor: {mustSupport: true, index: 31}
          subDetail:
            mustSupport: true
            index: 39
            elements:
              productOrService: {mustSupport: true, index: 40}
              modifier: {mustSupport: true, index: 41}
              quantity: {mustSupport: true, index: 42}
              unitPrice: {mustSupport: true, index: 43}
              factor: {mustSupport: true, index: 44}
              net: {mustSupport: true, index: 45}
              noteNumber: {mustSupport: true, index: 46}
              adjudication:
                mustSupport: true
                index: 47
                elements:
                  category: {mustSupport: true, index: 48}
                  reason: {mustSupport: true, index: 49}
                  amount: {mustSupport: true, index: 50}
                  value: {mustSupport: true, index: 51}
          quantity: {mustSupport: true, index: 29}
          noteNumber: {mustSupport: true, index: 33}
          unitPrice: {mustSupport: true, index: 30}
package_version: crd-1.0.0
class: profile
kind: resource
url: http://hl7.org/fhir/us/davinci-crd/StructureDefinition/profile-claimresponse
base: http://hl7.org/fhir/StructureDefinition/ClaimResponse
version: 1.0.0
required: [addItem, preAuthRef]