description: Base StructureDefinition for ClaimResponse Resource package_name: hl7.fhir.r3.examples derivation: specialization name: ClaimResponse type: ClaimResponse elements: patient: short: The subject of the Products and Services refers: ['http://hl7.org/fhir/StructureDefinition/Patient'] type: Reference index: 2 requestOrganization: short: Responsible organization refers: ['http://hl7.org/fhir/StructureDefinition/Organization'] type: Reference index: 6 payeeType: {type: CodeableConcept, short: Party to be paid any benefits payable, index: 10} insurance: short: Insurance or medical plan type: BackboneElement array: true index: 67 elements: sequence: {type: positiveInt, short: Service instance identifier, index: 68} focal: {type: boolean, short: Is the focal Coverage, index: 69} coverage: short: Insurance information refers: ['http://hl7.org/fhir/StructureDefinition/Coverage'] type: Reference index: 70 businessArrangement: {type: string, short: Business agreement, index: 71} preAuthRef: {short: Pre-Authorization/Determination Reference, type: string, array: true, index: 72} claimResponse: short: Adjudication results refers: ['http://hl7.org/fhir/StructureDefinition/ClaimResponse'] type: Reference index: 73 required: [coverage, focal, sequence] request: short: Id of resource triggering adjudication refers: ['http://hl7.org/fhir/StructureDefinition/Claim'] type: Reference index: 7 requestProvider: short: Responsible practitioner refers: ['http://hl7.org/fhir/StructureDefinition/Practitioner'] type: Reference index: 5 processNote: type: BackboneElement short: Processing notes array: true index: 61 elements: number: {type: positiveInt, short: Sequence Number for this note, index: 62} type: {type: CodeableConcept, short: display | print | printoper, index: 63} text: {type: string, short: Note explanatory text, index: 64} language: {type: CodeableConcept, short: Language if different from the resource, index: 65} payment: type: BackboneElement short: Payment details, if paid index: 52 elements: type: {type: CodeableConcept, short: Partial or Complete, index: 53} adjustment: {type: Money, short: Payment adjustment for non-Claim issues, index: 54} adjustmentReason: {type: CodeableConcept, short: Explanation for the non-claim adjustment, index: 55} date: {type: date, short: Expected data of Payment, index: 56} amount: {type: Money, short: Payable amount after adjustment, index: 57} identifier: {type: Identifier, short: Identifier of the payment instrument, index: 58} item: type: BackboneElement short: Line items array: true index: 11 elements: sequenceLinkId: {type: positiveInt, short: Service instance, index: 12} noteNumber: {type: positiveInt, short: List of note numbers which apply, array: true, index: 13} adjudication: type: BackboneElement short: Adjudication details array: true index: 14 elements: category: {type: CodeableConcept, short: 'Adjudication category such as co-pay, eligible, benefit, etc.', index: 15} reason: {type: CodeableConcept, short: Explanation of Adjudication outcome, index: 16} amount: {type: Money, short: Monetary amount, index: 17} value: {type: decimal, short: Non-monetary value, index: 18} required: [category] detail: type: BackboneElement short: Detail line items array: true index: 19 elements: sequenceLinkId: {type: positiveInt, short: Service instance, index: 20} noteNumber: {type: positiveInt, short: List of note numbers which apply, array: true, index: 21} adjudication: short: Detail level adjudication details elementReference: ['http://hl7.org/fhir/StructureDefinition/ClaimResponse', elements, item, elements, adjudication] array: true index: 22 subDetail: type: BackboneElement short: Subdetail line items array: true index: 23 elements: sequenceLinkId: {type: positiveInt, short: Service instance, index: 24} noteNumber: {type: positiveInt, short: List of note numbers which apply, array: true, index: 25} adjudication: short: Subdetail level adjudication details elementReference: ['http://hl7.org/fhir/StructureDefinition/ClaimResponse', elements, item, elements, adjudication] array: true index: 26 required: [sequenceLinkId] required: [sequenceLinkId] required: [sequenceLinkId] created: {type: dateTime, short: Creation date, index: 3} outcome: {type: CodeableConcept, short: complete | error | partial, index: 8} totalBenefit: {type: Money, short: Total benefit payable for the Claim, index: 51} unallocDeductable: {type: Money, short: Unallocated deductible, index: 50} disposition: {type: string, short: Disposition Message, index: 9} communicationRequest: type: Reference short: Request for additional information refers: ['http://hl7.org/fhir/StructureDefinition/CommunicationRequest'] array: true index: 66 insurer: short: Insurance issuing organization refers: ['http://hl7.org/fhir/StructureDefinition/Organization'] type: Reference index: 4 status: {isModifier: true, short: active | cancelled | draft | entered-in-error, type: code, isSummary: true, index: 1} identifier: {type: Identifier, short: Response number, array: true, index: 0} reserved: {type: Coding, short: Funds reserved status, index: 59} error: type: BackboneElement short: Processing errors array: true index: 44 elements: sequenceLinkId: {type: positiveInt, short: Item sequence number, index: 45} detailSequenceLinkId: {type: positiveInt, short: Detail sequence number, index: 46} subdetailSequenceLinkId: {type: positiveInt, short: Subdetail sequence number, index: 47} code: {type: CodeableConcept, short: Error code detailing processing issues, index: 48} required: [code] form: {short: Printed Form Identifier, type: CodeableConcept, index: 60} totalCost: {type: Money, short: Total Cost of service from the Claim, index: 49} addItem: type: BackboneElement short: Insurer added line items array: true index: 27 elements: category: {type: CodeableConcept, short: Type of service or product, index: 30} fee: {type: Money, short: Professional fee or Product charge, index: 33} service: {type: CodeableConcept, short: 'Group, Service or Product', index: 31} modifier: {short: Service/Product billing modifiers, type: CodeableConcept, array: true, index: 32} revenue: {type: CodeableConcept, short: Revenue or cost center code, index: 29} adjudication: short: Added items adjudication elementReference: ['http://hl7.org/fhir/StructureDefinition/ClaimResponse', elements, item, elements, adjudication] array: true index: 35 sequenceLinkId: {type: positiveInt, short: Service instances, array: true, index: 28} noteNumber: {type: positiveInt, short: List of note numbers which apply, array: true, index: 34} detail: type: BackboneElement short: Added items details array: true index: 36 elements: revenue: {type: CodeableConcept, short: Revenue or cost center code, index: 37} category: {type: CodeableConcept, short: Type of service or product, index: 38} service: {type: CodeableConcept, short: Service or Product, index: 39} modifier: {short: Service/Product billing modifiers, type: CodeableConcept, array: true, index: 40} fee: {type: Money, short: Professional fee or Product charge, index: 41} noteNumber: {type: positiveInt, short: List of note numbers which apply, array: true, index: 42} adjudication: short: Added items detail adjudication elementReference: ['http://hl7.org/fhir/StructureDefinition/ClaimResponse', elements, item, elements, adjudication] array: true index: 43 package_version: 3.0.2 class: resource kind: resource url: http://hl7.org/fhir/StructureDefinition/ClaimResponse base: http://hl7.org/fhir/StructureDefinition/DomainResource version: null