description: Base StructureDefinition for ClaimResponse Resource
package_name: hl7.fhir.r2b.examples
derivation: specialization
name: ClaimResponse
type: null
elements:
  requestOrganization:
    isModifier: false
    short: Responsible organization
    mustSupport: false
    choices: [requestOrganizationIdentifier, requestOrganizationReference]
    maxLength: 0
    base: {max: '1', min: 0, path: 'ClaimResponse.requestOrganization[x]'}
    isSummary: true
    index: 17
  payeeType:
    isModifier: false
    short: Party to be paid any benefits payable
    type: Coding
    mustSupport: false
    maxLength: 0
    base: {max: '1', min: 0, path: ClaimResponse.payeeType}
    isSummary: true
    index: 22
  requestProviderReference:
    isModifier: false
    short: Responsible practitioner
    index: 15
    type: Reference
    mustSupport: false
    maxLength: 0
    base: {max: '1', min: 0, path: 'ClaimResponse.requestProvider[x]'}
    choiceOf: requestProvider
    isSummary: true
  request:
    isModifier: false
    short: Id of resource triggering adjudication
    mustSupport: false
    choices: [requestIdentifier, requestReference]
    maxLength: 0
    base: {max: '1', min: 0, path: 'ClaimResponse.request[x]'}
    isSummary: true
    index: 2
  originalRuleset:
    isModifier: false
    short: Original version
    type: Coding
    mustSupport: false
    maxLength: 0
    base: {max: '1', min: 0, path: ClaimResponse.originalRuleset}
    isSummary: true
    index: 6
  requestProvider:
    isModifier: false
    short: Responsible practitioner
    mustSupport: false
    choices: [requestProviderIdentifier, requestProviderReference]
    maxLength: 0
    base: {max: '1', min: 0, path: 'ClaimResponse.requestProvider[x]'}
    isSummary: true
    index: 13
  paymentAmount:
    isModifier: false
    short: Payment amount
    type: Quantity
    mustSupport: false
    maxLength: 0
    base: {max: '1', min: 0, path: ClaimResponse.paymentAmount}
    isSummary: true
    index: 74
  organizationIdentifier:
    isModifier: false
    short: Insurer
    index: 10
    type: Identifier
    mustSupport: false
    maxLength: 0
    base: {max: '1', min: 0, path: 'ClaimResponse.organization[x]'}
    choiceOf: organization
    isSummary: true
  paymentAdjustmentReason:
    isModifier: false
    short: Reason for Payment adjustment
    type: Coding
    mustSupport: false
    maxLength: 0
    base: {max: '1', min: 0, path: ClaimResponse.paymentAdjustmentReason}
    isSummary: true
    index: 72
  requestOrganizationReference:
    isModifier: false
    short: Responsible organization
    index: 19
    type: Reference
    mustSupport: false
    maxLength: 0
    base: {max: '1', min: 0, path: 'ClaimResponse.requestOrganization[x]'}
    choiceOf: requestOrganization
    isSummary: true
  item:
    isModifier: false
    short: Line items
    index: 23
    type: BackboneElement
    mustSupport: false
    array: true
    elements:
      sequenceLinkId:
        isModifier: false
        short: Service instance
        index: 24
        type: positiveInt
        mustSupport: false
        maxLength: 0
        base: {max: '1', min: 0, path: ClaimResponse.item.sequenceLinkId}
        isSummary: true
      noteNumber:
        isModifier: false
        short: List of note numbers which apply
        index: 25
        type: positiveInt
        mustSupport: false
        array: true
        maxLength: 0
        base: {max: '*', min: 0, path: ClaimResponse.item.noteNumber}
        isSummary: true
      adjudication:
        isModifier: false
        short: Adjudication details
        index: 26
        type: BackboneElement
        mustSupport: false
        array: true
        elements:
          category:
            isModifier: false
            short: Adjudication category such as co-pay, eligible, benefit, etc.
            index: 27
            type: Coding
            mustSupport: false
            maxLength: 0
            base: {max: '1', min: 0, path: ClaimResponse.item.adjudication.category}
            isSummary: true
          reason:
            isModifier: false
            short: Adjudication reason
            type: Coding
            mustSupport: false
            maxLength: 0
            base: {max: '1', min: 0, path: ClaimResponse.item.adjudication.reason}
            isSummary: true
            index: 28
          amount:
            isModifier: false
            short: Monetary amount
            type: Quantity
            mustSupport: false
            maxLength: 0
            base: {max: '1', min: 0, path: ClaimResponse.item.adjudication.amount}
            isSummary: true
            index: 29
          value:
            isModifier: false
            short: Non-monetary value
            type: decimal
            mustSupport: false
            maxLength: 0
            base: {max: '1', min: 0, path: ClaimResponse.item.adjudication.value}
            isSummary: true
            index: 30
        maxLength: 0
        base: {max: '*', min: 0, path: ClaimResponse.item.adjudication}
        required: [category]
        isSummary: true
      detail:
        isModifier: false
        short: Detail line items
        index: 31
        type: BackboneElement
        mustSupport: false
        array: true
        elements:
          sequenceLinkId:
            isModifier: false
            short: Service instance
            index: 32
            type: positiveInt
            mustSupport: false
            maxLength: 0
            base: {max: '1', min: 0, path: ClaimResponse.item.detail.sequenceLinkId}
            isSummary: true
          adjudication:
            isModifier: false
            short: Detail adjudication
            index: 33
            type: BackboneElement
            mustSupport: false
            array: true
            elements:
              category:
                isModifier: false
                short: Adjudication category such as co-pay, eligible, benefit, etc.
                index: 34
                type: Coding
                mustSupport: false
                maxLength: 0
                base: {max: '1', min: 0, path: ClaimResponse.item.detail.adjudication.category}
                isSummary: true
              reason:
                isModifier: false
                short: Adjudication reason
                type: Coding
                mustSupport: false
                maxLength: 0
                base: {max: '1', min: 0, path: ClaimResponse.item.detail.adjudication.reason}
                isSummary: true
                index: 35
              amount:
                isModifier: false
                short: Monetary amount
                type: Quantity
                mustSupport: false
                maxLength: 0
                base: {max: '1', min: 0, path: ClaimResponse.item.detail.adjudication.amount}
                isSummary: true
                index: 36
              value:
                isModifier: false
                short: Non-monetary value
                type: decimal
                mustSupport: false
                maxLength: 0
                base: {max: '1', min: 0, path: ClaimResponse.item.detail.adjudication.value}
                isSummary: true
                index: 37
            maxLength: 0
            base: {max: '*', min: 0, path: ClaimResponse.item.detail.adjudication}
            required: [category]
            isSummary: true
          subDetail:
            isModifier: false
            short: Subdetail line items
            index: 38
            type: BackboneElement
            mustSupport: false
            array: true
            elements:
              sequenceLinkId:
                isModifier: false
                short: Service instance
                index: 39
                type: positiveInt
                mustSupport: false
                maxLength: 0
                base: {max: '1', min: 0, path: ClaimResponse.item.detail.subDetail.sequenceLinkId}
                isSummary: true
              adjudication:
                isModifier: false
                short: Subdetail adjudication
                index: 40
                type: BackboneElement
                mustSupport: false
                array: true
                elements:
                  category:
                    isModifier: false
                    short: Adjudication category such as co-pay, eligible, benefit, etc.
                    index: 41
                    type: Coding
                    mustSupport: false
                    maxLength: 0
                    base: {max: '1', min: 0, path: ClaimResponse.item.detail.subDetail.adjudication.category}
                    isSummary: true
                  reason:
                    isModifier: false
                    short: Adjudication reason
                    type: Coding
                    mustSupport: false
                    maxLength: 0
                    base: {max: '1', min: 0, path: ClaimResponse.item.detail.subDetail.adjudication.reason}
                    isSummary: true
                    index: 42
                  amount:
                    isModifier: false
                    short: Monetary amount
                    type: Quantity
                    mustSupport: false
                    maxLength: 0
                    base: {max: '1', min: 0, path: ClaimResponse.item.detail.subDetail.adjudication.amount}
                    isSummary: true
                    index: 43
                  value:
                    isModifier: false
                    short: Non-monetary value
                    type: decimal
                    mustSupport: false
                    maxLength: 0
                    base: {max: '1', min: 0, path: ClaimResponse.item.detail.subDetail.adjudication.value}
                    isSummary: true
                    index: 44
                maxLength: 0
                base: {max: '*', min: 0, path: ClaimResponse.item.detail.subDetail.adjudication}
                required: [category]
                isSummary: true
            maxLength: 0
            base: {max: '*', min: 0, path: ClaimResponse.item.detail.subDetail}
            required: [sequenceLinkId]
            isSummary: true
        maxLength: 0
        base: {max: '*', min: 0, path: ClaimResponse.item.detail}
        required: [sequenceLinkId]
        isSummary: true
    maxLength: 0
    base: {max: '*', min: 0, path: ClaimResponse.item}
    required: [sequenceLinkId]
    isSummary: true
  coverage:
    isModifier: false
    short: Insurance or medical plan
    index: 82
    type: BackboneElement
    mustSupport: false
    array: true
    elements:
      sequence:
        isModifier: false
        short: Service instance identifier
        index: 83
        type: positiveInt
        mustSupport: false
        maxLength: 0
        base: {max: '1', min: 0, path: ClaimResponse.coverage.sequence}
        isSummary: true
      focal:
        isModifier: false
        short: Is the focal Coverage
        index: 84
        type: boolean
        mustSupport: false
        maxLength: 0
        base: {max: '1', min: 0, path: ClaimResponse.coverage.focal}
        isSummary: true
      coverage:
        isModifier: false
        short: Insurance information
        index: 86
        mustSupport: false
        choices: [coverageIdentifier, coverageReference]
        maxLength: 0
        base: {max: '1', min: 0, path: 'ClaimResponse.coverage.coverage[x]'}
        isSummary: true
      coverageIdentifier:
        isModifier: false
        short: Insurance information
        index: 87
        type: Identifier
        mustSupport: false
        maxLength: 0
        base: {max: '1', min: 0, path: 'ClaimResponse.coverage.coverage[x]'}
        choiceOf: coverage
        isSummary: true
      coverageReference:
        isModifier: false
        short: Insurance information
        index: 88
        type: Reference
        mustSupport: false
        maxLength: 0
        base: {max: '1', min: 0, path: 'ClaimResponse.coverage.coverage[x]'}
        choiceOf: coverage
        isSummary: true
      businessArrangement:
        isModifier: false
        short: Business agreement
        type: string
        mustSupport: false
        maxLength: 0
        base: {max: '1', min: 0, path: ClaimResponse.coverage.businessArrangement}
        isSummary: true
        index: 89
      preAuthRef:
        isModifier: false
        short: Pre-Authorization/Determination Reference
        index: 90
        type: string
        mustSupport: false
        array: true
        maxLength: 0
        base: {max: '*', min: 0, path: ClaimResponse.coverage.preAuthRef}
        isSummary: true
      claimResponse:
        isModifier: false
        short: Adjudication results
        type: Reference
        mustSupport: false
        maxLength: 0
        base: {max: '1', min: 0, path: ClaimResponse.coverage.claimResponse}
        isSummary: true
        index: 91
    maxLength: 0
    base: {max: '*', min: 0, path: ClaimResponse.coverage}
    required: [coverageIdentifier, coverage, focal, sequence, coverageReference]
    isSummary: true
  created:
    isModifier: false
    short: Creation date
    type: dateTime
    mustSupport: false
    maxLength: 0
    base: {max: '1', min: 0, path: ClaimResponse.created}
    isSummary: true
    index: 7
  outcome:
    isModifier: false
    short: complete | error
    type: code
    mustSupport: false
    maxLength: 0
    base: {max: '1', min: 0, path: ClaimResponse.outcome}
    isSummary: true
    index: 20
  requestIdentifier:
    isModifier: false
    short: Id of resource triggering adjudication
    index: 3
    type: Identifier
    mustSupport: false
    maxLength: 0
    base: {max: '1', min: 0, path: 'ClaimResponse.request[x]'}
    choiceOf: request
    isSummary: true
  organization:
    isModifier: false
    short: Insurer
    mustSupport: false
    choices: [organizationIdentifier, organizationReference]
    maxLength: 0
    base: {max: '1', min: 0, path: 'ClaimResponse.organization[x]'}
    isSummary: true
    index: 9
  totalBenefit:
    isModifier: false
    short: Total benefit payable for the Claim
    type: Quantity
    mustSupport: false
    maxLength: 0
    base: {max: '1', min: 0, path: ClaimResponse.totalBenefit}
    isSummary: true
    index: 70
  unallocDeductable:
    isModifier: false
    short: Unallocated deductible
    type: Quantity
    mustSupport: false
    maxLength: 0
    base: {max: '1', min: 0, path: ClaimResponse.unallocDeductable}
    isSummary: true
    index: 69
  disposition:
    isModifier: false
    short: Disposition Message
    type: string
    mustSupport: false
    maxLength: 0
    base: {max: '1', min: 0, path: ClaimResponse.disposition}
    isSummary: true
    index: 21
  note:
    isModifier: false
    short: Processing notes
    index: 78
    type: BackboneElement
    mustSupport: false
    array: true
    elements:
      number:
        isModifier: false
        short: Note Number for this note
        type: positiveInt
        mustSupport: false
        maxLength: 0
        base: {max: '1', min: 0, path: ClaimResponse.note.number}
        isSummary: true
        index: 79
      type:
        isModifier: false
        short: display | print | printoper
        type: Coding
        mustSupport: false
        maxLength: 0
        base: {max: '1', min: 0, path: ClaimResponse.note.type}
        isSummary: true
        index: 80
      text:
        isModifier: false
        short: Note explanatory text
        type: string
        mustSupport: false
        maxLength: 0
        base: {max: '1', min: 0, path: ClaimResponse.note.text}
        isSummary: true
        index: 81
    maxLength: 0
    base: {max: '*', min: 0, path: ClaimResponse.note}
    isSummary: true
  requestProviderIdentifier:
    isModifier: false
    short: Responsible practitioner
    index: 14
    type: Identifier
    mustSupport: false
    maxLength: 0
    base: {max: '1', min: 0, path: 'ClaimResponse.requestProvider[x]'}
    choiceOf: requestProvider
    isSummary: true
  paymentDate:
    isModifier: false
    short: Expected data of Payment
    type: date
    mustSupport: false
    maxLength: 0
    base: {max: '1', min: 0, path: ClaimResponse.paymentDate}
    isSummary: true
    index: 73
  paymentRef:
    isModifier: false
    short: Payment identifier
    type: Identifier
    mustSupport: false
    maxLength: 0
    base: {max: '1', min: 0, path: ClaimResponse.paymentRef}
    isSummary: true
    index: 75
  identifier:
    isModifier: false
    short: Response  number
    index: 0
    type: Identifier
    mustSupport: false
    array: true
    maxLength: 0
    base: {max: '*', min: 0, path: ClaimResponse.identifier}
    isSummary: true
  reserved:
    isModifier: false
    short: Funds reserved status
    type: Coding
    mustSupport: false
    maxLength: 0
    base: {max: '1', min: 0, path: ClaimResponse.reserved}
    isSummary: true
    index: 76
  error:
    isModifier: false
    short: Processing errors
    index: 63
    type: BackboneElement
    mustSupport: false
    array: true
    elements:
      sequenceLinkId:
        isModifier: false
        short: Item sequence number
        type: positiveInt
        mustSupport: false
        maxLength: 0
        base: {max: '1', min: 0, path: ClaimResponse.error.sequenceLinkId}
        isSummary: true
        index: 64
      detailSequenceLinkId:
        isModifier: false
        short: Detail sequence number
        type: positiveInt
        mustSupport: false
        maxLength: 0
        base: {max: '1', min: 0, path: ClaimResponse.error.detailSequenceLinkId}
        isSummary: true
        index: 65
      subdetailSequenceLinkId:
        isModifier: false
        short: Subdetail sequence number
        type: positiveInt
        mustSupport: false
        maxLength: 0
        base: {max: '1', min: 0, path: ClaimResponse.error.subdetailSequenceLinkId}
        isSummary: true
        index: 66
      code:
        isModifier: false
        short: Error code detailing processing issues
        index: 67
        type: Coding
        mustSupport: false
        maxLength: 0
        base: {max: '1', min: 0, path: ClaimResponse.error.code}
        isSummary: true
    maxLength: 0
    base: {max: '*', min: 0, path: ClaimResponse.error}
    required: [code]
    isSummary: true
  form:
    isModifier: false
    short: Printed Form Identifier
    type: Coding
    mustSupport: false
    maxLength: 0
    base: {max: '1', min: 0, path: ClaimResponse.form}
    isSummary: true
    index: 77
  totalCost:
    isModifier: false
    short: Total Cost of service from the Claim
    type: Quantity
    mustSupport: false
    maxLength: 0
    base: {max: '1', min: 0, path: ClaimResponse.totalCost}
    isSummary: true
    index: 68
  paymentAdjustment:
    isModifier: false
    short: Payment adjustment for non-Claim issues
    type: Quantity
    mustSupport: false
    maxLength: 0
    base: {max: '1', min: 0, path: ClaimResponse.paymentAdjustment}
    isSummary: true
    index: 71
  requestReference:
    isModifier: false
    short: Id of resource triggering adjudication
    index: 4
    type: Reference
    mustSupport: false
    maxLength: 0
    base: {max: '1', min: 0, path: 'ClaimResponse.request[x]'}
    choiceOf: request
    isSummary: true
  ruleset:
    isModifier: false
    short: Resource version
    type: Coding
    mustSupport: false
    maxLength: 0
    base: {max: '1', min: 0, path: ClaimResponse.ruleset}
    isSummary: true
    index: 5
  addItem:
    isModifier: false
    short: Insurer added line items
    index: 45
    type: BackboneElement
    mustSupport: false
    array: true
    elements:
      sequenceLinkId:
        isModifier: false
        short: Service instances
        index: 46
        type: positiveInt
        mustSupport: false
        array: true
        maxLength: 0
        base: {max: '*', min: 0, path: ClaimResponse.addItem.sequenceLinkId}
        isSummary: true
      service:
        isModifier: false
        short: Group, Service or Product
        index: 47
        type: Coding
        mustSupport: false
        maxLength: 0
        base: {max: '1', min: 0, path: ClaimResponse.addItem.service}
        isSummary: true
      fee:
        isModifier: false
        short: Professional fee or Product charge
        type: Quantity
        mustSupport: false
        maxLength: 0
        base: {max: '1', min: 0, path: ClaimResponse.addItem.fee}
        isSummary: true
        index: 48
      noteNumberLinkId:
        isModifier: false
        short: List of note numbers which apply
        index: 49
        type: positiveInt
        mustSupport: false
        array: true
        maxLength: 0
        base: {max: '*', min: 0, path: ClaimResponse.addItem.noteNumberLinkId}
        isSummary: true
      adjudication:
        isModifier: false
        short: Added items adjudication
        index: 50
        type: BackboneElement
        mustSupport: false
        array: true
        elements:
          category:
            isModifier: false
            short: Adjudication category such as co-pay, eligible, benefit, etc.
            index: 51
            type: Coding
            mustSupport: false
            maxLength: 0
            base: {max: '1', min: 0, path: ClaimResponse.addItem.adjudication.category}
            isSummary: true
          reason:
            isModifier: false
            short: Adjudication reason
            type: Coding
            mustSupport: false
            maxLength: 0
            base: {max: '1', min: 0, path: ClaimResponse.addItem.adjudication.reason}
            isSummary: true
            index: 52
          amount:
            isModifier: false
            short: Monetary amount
            type: Quantity
            mustSupport: false
            maxLength: 0
            base: {max: '1', min: 0, path: ClaimResponse.addItem.adjudication.amount}
            isSummary: true
            index: 53
          value:
            isModifier: false
            short: Non-monetary value
            type: decimal
            mustSupport: false
            maxLength: 0
            base: {max: '1', min: 0, path: ClaimResponse.addItem.adjudication.value}
            isSummary: true
            index: 54
        maxLength: 0
        base: {max: '*', min: 0, path: ClaimResponse.addItem.adjudication}
        required: [category]
        isSummary: true
      detail:
        isModifier: false
        short: Added items details
        index: 55
        type: BackboneElement
        mustSupport: false
        array: true
        elements:
          service:
            isModifier: false
            short: Service or Product
            index: 56
            type: Coding
            mustSupport: false
            maxLength: 0
            base: {max: '1', min: 0, path: ClaimResponse.addItem.detail.service}
            isSummary: true
          fee:
            isModifier: false
            short: Professional fee or Product charge
            type: Quantity
            mustSupport: false
            maxLength: 0
            base: {max: '1', min: 0, path: ClaimResponse.addItem.detail.fee}
            isSummary: true
            index: 57
          adjudication:
            isModifier: false
            short: Added items detail adjudication
            index: 58
            type: BackboneElement
            mustSupport: false
            array: true
            elements:
              category:
                isModifier: false
                short: Adjudication category such as co-pay, eligible, benefit, etc.
                index: 59
                type: Coding
                mustSupport: false
                maxLength: 0
                base: {max: '1', min: 0, path: ClaimResponse.addItem.detail.adjudication.category}
                isSummary: true
              reason:
                isModifier: false
                short: Adjudication reason
                type: Coding
                mustSupport: false
                maxLength: 0
                base: {max: '1', min: 0, path: ClaimResponse.addItem.detail.adjudication.reason}
                isSummary: true
                index: 60
              amount:
                isModifier: false
                short: Monetary amount
                type: Quantity
                mustSupport: false
                maxLength: 0
                base: {max: '1', min: 0, path: ClaimResponse.addItem.detail.adjudication.amount}
                isSummary: true
                index: 61
              value:
                isModifier: false
                short: Non-monetary value
                type: decimal
                mustSupport: false
                maxLength: 0
                base: {max: '1', min: 0, path: ClaimResponse.addItem.detail.adjudication.value}
                isSummary: true
                index: 62
            maxLength: 0
            base: {max: '*', min: 0, path: ClaimResponse.addItem.detail.adjudication}
            required: [category]
            isSummary: true
        maxLength: 0
        base: {max: '*', min: 0, path: ClaimResponse.addItem.detail}
        required: [service]
        isSummary: true
    maxLength: 0
    base: {max: '*', min: 0, path: ClaimResponse.addItem}
    required: [service]
    isSummary: true
  requestOrganizationIdentifier:
    isModifier: false
    short: Responsible organization
    index: 18
    type: Identifier
    mustSupport: false
    maxLength: 0
    base: {max: '1', min: 0, path: 'ClaimResponse.requestOrganization[x]'}
    choiceOf: requestOrganization
    isSummary: true
  organizationReference:
    isModifier: false
    short: Insurer
    index: 11
    type: Reference
    mustSupport: false
    maxLength: 0
    base: {max: '1', min: 0, path: 'ClaimResponse.organization[x]'}
    choiceOf: organization
    isSummary: true
package_version: 1.4.0
class: resource
kind: resource
url: http://hl7.org/fhir/StructureDefinition/ClaimResponse
base: http://hl7.org/fhir/StructureDefinition/DomainResource
version: null