description: This profile represents application level adjudication outcomes, or an application level error, that occur as a result of processing a supplied Claim resource, which could be a functional corollary of a Claim, Predetermination, or Preauthorization.
package_name: rs/ndhm.in
derivation: constraint
name: ClaimResponse
type: ClaimResponse
elements:
  patient:
    type: Reference
    refers: ['https://nrces.in/ndhm/fhir/r4/StructureDefinition/Patient']
    index: 1
  requestor:
    type: Reference
    refers: ['https://nrces.in/ndhm/fhir/r4/StructureDefinition/Organization', 'https://nrces.in/ndhm/fhir/r4/StructureDefinition/Practitioner', 'https://nrces.in/ndhm/fhir/r4/StructureDefinition/PractitionerRole']
    index: 3
  insurance:
    mustSupport: true
    index: 15
    elements:
      coverage:
        type: Reference
        mustSupport: true
        refers: ['https://nrces.in/ndhm/fhir/r4/StructureDefinition/Coverage']
        index: 16
      claimResponse:
        type: Reference
        refers: ['https://nrces.in/ndhm/fhir/r4/StructureDefinition/ClaimResponse']
        index: 17
  request:
    type: Reference
    refers: ['https://nrces.in/ndhm/fhir/r4/StructureDefinition/Claim']
    index: 4
  item:
    mustSupport: true
    index: 7
    elements:
      adjudication:
        elements:
          reason: {index: 8}
        required: [reason]
  type:
    binding: {strength: extensible, valueSet: 'https://nrces.in/ndhm/fhir/r4/ValueSet/ndhm-claim-type'}
    index: 0
  outcome: {mustSupport: true, index: 5}
  disposition: {mustSupport: true, index: 6}
  total: {mustSupport: true, index: 14}
  insurer:
    type: Reference
    mustSupport: true
    refers: ['https://nrces.in/ndhm/fhir/r4/StructureDefinition/Organization']
    index: 2
  error: {mustSupport: true, index: 18}
  addItem:
    elements:
      provider:
        type: Reference
        refers: ['https://nrces.in/ndhm/fhir/r4/StructureDefinition/Organization', 'https://nrces.in/ndhm/fhir/r4/StructureDefinition/Practitioner', 'https://nrces.in/ndhm/fhir/r4/StructureDefinition/PractitionerRole']
        index: 9
      productOrService:
        binding: {strength: example, valueSet: 'https://nrces.in/ndhm/fhir/r4/ValueSet/ndhm-productorservice'}
        index: 10
      programCode:
        binding: {strength: example, valueSet: 'https://nrces.in/ndhm/fhir/r4/ValueSet/ndhm-program-code'}
        index: 11
      detail:
        elements:
          productOrService:
            binding: {strength: example, valueSet: 'https://nrces.in/ndhm/fhir/r4/ValueSet/ndhm-productorservice'}
            index: 12
          subDetail:
            elements:
              productOrService:
                binding: {strength: example, valueSet: 'https://nrces.in/ndhm/fhir/r4/ValueSet/ndhm-productorservice'}
                index: 13
package_version: 3.1.0
class: profile
kind: resource
url: https://nrces.in/ndhm/fhir/r4/StructureDefinition/ClaimResponse
base: http://hl7.org/fhir/StructureDefinition/ClaimResponse
version: 3.1.0