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: 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: 27
    elements:
      coverage:
        type: Reference
        mustSupport: true
        refers: ['https://nrces.in/ndhm/fhir/r4/StructureDefinition/Coverage']
        index: 28
      claimResponse:
        type: Reference
        refers: ['https://nrces.in/ndhm/fhir/r4/StructureDefinition/ClaimResponse']
        index: 29
  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: 26}
  insurer:
    type: Reference
    mustSupport: true
    refers: ['https://nrces.in/ndhm/fhir/r4/StructureDefinition/Organization']
    index: 2
  error: {mustSupport: true, index: 30}
  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
        elements:
          coding:
            elements:
              system: {index: 11}
              code: {index: 12}
              display: {index: 13}
            required: [display, system, code]
      programCode:
        binding: {strength: example, valueSet: 'https://nrces.in/ndhm/fhir/r4/ValueSet/ndhm-program-code'}
        index: 14
        elements:
          coding:
            elements:
              system: {index: 15}
              code: {index: 16}
              display: {index: 17}
            required: [display, system, code]
      detail:
        elements:
          productOrService:
            binding: {strength: example, valueSet: 'https://nrces.in/ndhm/fhir/r4/ValueSet/ndhm-productorservice'}
            index: 18
            elements:
              coding:
                elements:
                  system: {index: 19}
                  code: {index: 20}
                  display: {index: 21}
                required: [display, system, code]
          subDetail:
            elements:
              productOrService:
                binding: {strength: example, valueSet: 'https://nrces.in/ndhm/fhir/r4/ValueSet/ndhm-productorservice'}
                index: 22
                elements:
                  coding:
                    elements:
                      system: {index: 23}
                      code: {index: 24}
                      display: {index: 25}
                    required: [display, system, code]
package_version: 5.0.0
class: profile
kind: resource
url: https://nrces.in/ndhm/fhir/r4/StructureDefinition/ClaimResponse
base: http://hl7.org/fhir/StructureDefinition/ClaimResponse
version: 5.0.0