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