Union of https://dhp.uz/fhir/core/StructureDefinition/uz-core-claim-response and https://dhp.uz/fhir/core/StructureDefinition/uz-core-claim-response

This is the set of resources that conform to either of the profiles UZ Core ClaimResponse (https://dhp.uz/fhir/core/StructureDefinition/uz-core-claim-response) and UZ Core ClaimResponse (https://dhp.uz/fhir/core/StructureDefinition/uz-core-claim-response). E.g. what you have to deal with if you get resources conforming to one of them

Structure

NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
.. ClaimResponse 0..*Response to a claim predetermination or preauthorization
... meta Σ0..1MetaMetadata about the resource
... implicitRules ?!Σ0..1uriA set of rules under which this content was created
... language 0..1codeLanguage of the resource content
Binding: ?? (required): IETF language tag for a human language
... text 0..1NarrativeText summary of the resource, for human interpretation
This profile does not constrain the narrative in regard to content, language, or traceability to data elements
... contained 0..*ResourceContained, inline Resources
... extension 0..*ExtensionExtension
Constraints: ext-1
... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored
Constraints: ext-1
... identifier S0..*IdentifierBusiness identifier for the claim response
... traceNumber 0..*IdentifierNumber for tracking
... status ?!SΣ1..1codeCurrent status of the claim response
Binding: ?? (required)
... type SΣ1..1CodeableConceptCategory or discipline of the claim
Binding: ?? (required)
... subType 0..1CodeableConceptMore granular claim type
Binding: ?? (example): A more granular claim typecode.
... use SΣ1..1codePurpose of the claim response
Binding: ?? (required)
... patient SΣ1..1Reference(UZ Core Patient(0.9.0) | #sd-808-uz-core-patient-uz-core-patient)Patient associated with the claim
... created SΣ1..1dateTimeDate the claim response was created
... insurer SΣ0..1Reference(UZ Core Organization(0.9.0) | #sd-810-uz-core-organization-uz-core-organization)Organization responsible for reimbursement
... requestor 0..1Reference(Practitioner | PractitionerRole | Organization)Party responsible for the claim
... request SΣ0..1Reference(UZ Core Claim(0.9.0) | #sd-907-uz-core-claim-uz-core-claim)Reference to the original claim
... outcome SΣ1..1codeProcessing outcome of the claim
Binding: ?? (required)
... decision SΣ0..1CodeableConceptAdjudication decision
Binding: ?? (required)
... disposition 0..1stringDisposition Message
... preAuthRef S0..1stringReference to a prior authorization
... preAuthPeriod S0..1PeriodValidity period of the prior authorization
.... extension 0..*ExtensionAdditional content defined by implementations
Constraints: ext-1
.... start Σ0..1dateTimeAuthorization start date
.... end Σ0..1dateTimeAuthorization end date
... event 0..*BackboneElementEvent information
.... extension 0..*ExtensionAdditional content defined by implementations
Constraints: ext-1
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
Constraints: ext-1
.... type 1..1CodeableConceptSpecific event
Binding: ?? (example)
.... when[x] 1..1Occurance date or period
..... whenDateTimedateTime
..... whenPeriodPeriod
... payeeType 0..1CodeableConceptParty to be paid any benefits payable
Binding: ?? (example): A code for the party to be reimbursed.
... encounter 0..*Reference(Encounter)Encounters associated with the listed treatments
... diagnosisRelatedGroup 0..1CodeableConceptPackage billing code
Binding: ?? (example)
... item 0..*BackboneElementAdjudication for claim line items
.... extension 0..*ExtensionAdditional content defined by implementations
Constraints: ext-1
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
Constraints: ext-1
.... itemSequence 1..1positiveIntClaim item instance identifier
.... traceNumber 0..*IdentifierNumber for tracking
.... noteNumber 0..*positiveIntApplicable note numbers
.... reviewOutcome 0..1BackboneElementAdjudication results
..... extension 0..*ExtensionAdditional content defined by implementations
Constraints: ext-1
..... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
Constraints: ext-1
..... decision 0..1CodeableConceptResult of the adjudication
Binding: ?? (example)
..... reason 0..*CodeableConceptReason for result of the adjudication
Binding: ?? (example)
..... preAuthRef 0..1stringPreauthorization reference
..... preAuthPeriod 0..1PeriodPreauthorization reference effective period
.... adjudication 0..*BackboneElementAdjudication details
..... extension 0..*ExtensionAdditional content defined by implementations
Constraints: ext-1
..... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
Constraints: ext-1
..... category 1..1CodeableConceptType of adjudication information
Binding: ?? (example): The adjudication codes.
..... reason 0..1CodeableConceptExplanation of adjudication outcome
Binding: ?? (example): The adjudication reason codes.
..... amount 0..1MoneyMonetary amount
..... quantity 0..1QuantityNon-monetary value
.... detail 0..*BackboneElementAdjudication for claim details
..... extension 0..*ExtensionAdditional content defined by implementations
Constraints: ext-1
..... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
Constraints: ext-1
..... detailSequence 1..1positiveIntClaim detail instance identifier
..... traceNumber 0..*IdentifierNumber for tracking
..... noteNumber 0..*positiveIntApplicable note numbers
..... reviewOutcome 0..1Detail level adjudication results
..... adjudication 0..*Detail level adjudication details
..... subDetail 0..*BackboneElementAdjudication for claim sub-details
...... extension 0..*ExtensionAdditional content defined by implementations
Constraints: ext-1
...... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
Constraints: ext-1
...... subDetailSequence 1..1positiveIntClaim sub-detail instance identifier
...... traceNumber 0..*IdentifierNumber for tracking
...... noteNumber 0..*positiveIntApplicable note numbers
...... reviewOutcome 0..1Subdetail level adjudication results
...... adjudication 0..*Subdetail level adjudication details
... addItem 0..*BackboneElementInsurer added line items
.... extension 0..*ExtensionAdditional content defined by implementations
Constraints: ext-1
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
Constraints: ext-1
.... itemSequence 0..*positiveIntItem sequence number
.... detailSequence 0..*positiveIntDetail sequence number
.... subdetailSequence 0..*positiveIntSubdetail sequence number
.... traceNumber 0..*IdentifierNumber for tracking
.... provider 0..*Reference(Practitioner | PractitionerRole | Organization)Authorized providers
.... revenue 0..1CodeableConceptRevenue or cost center code
Binding: ?? (example): Codes for the revenue or cost centers supplying the service and/or products.
.... productOrService 0..1CodeableConceptBilling, service, product, or drug code
Binding: ?? (example): Allowable service and product codes.
.... productOrServiceEnd 0..1CodeableConceptEnd of a range of codes
Binding: ?? (example)
.... request 0..*Reference(DeviceRequest | MedicationRequest | NutritionOrder | ServiceRequest | SupplyRequest | VisionPrescription)Request or Referral for Service
.... modifier 0..*CodeableConceptService/Product billing modifiers
Binding: ?? (example): Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen.
.... programCode 0..*CodeableConceptProgram the product or service is provided under
Binding: ?? (example): Program specific reason codes.
.... serviced[x] 0..1Date or dates of service or product delivery
..... servicedDatedate
..... servicedPeriodPeriod
.... location[x] 0..1Place of service or where product was supplied
Binding: ?? (example): Place of service: pharmacy, school, prison, etc.
..... locationCodeableConceptCodeableConcept
..... locationAddressAddress
..... locationReferenceReference(Location)
.... quantity 0..1??Count of products or services
.... unitPrice 0..1MoneyFee, charge or cost per item
.... factor 0..1decimalPrice scaling factor
.... tax 0..1MoneyTotal tax
.... net 0..1MoneyTotal item cost
.... bodySite 0..*BackboneElementAnatomical location
..... extension 0..*ExtensionAdditional content defined by implementations
Constraints: ext-1
..... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
Constraints: ext-1
..... site 1..*CodeableReference(BodyStructure)Location
Binding: ?? (example)
..... subSite 0..*CodeableConceptSub-location
Binding: ?? (example)
.... noteNumber 0..*positiveIntApplicable note numbers
.... reviewOutcome 0..1Added items adjudication results
.... adjudication 0..*Added items adjudication
.... detail 0..*BackboneElementInsurer added line details
..... extension 0..*ExtensionAdditional content defined by implementations
Constraints: ext-1
..... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
Constraints: ext-1
..... traceNumber 0..*IdentifierNumber for tracking
..... revenue 0..1CodeableConceptRevenue or cost center code
Binding: ?? (example): Codes for the revenue or cost centers supplying the service and/or products.
..... productOrService 0..1CodeableConceptBilling, service, product, or drug code
Binding: ?? (example): Allowable service and product codes.
..... productOrServiceEnd 0..1CodeableConceptEnd of a range of codes
Binding: ?? (example)
..... modifier 0..*CodeableConceptService/Product billing modifiers
Binding: ?? (example): Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen.
..... quantity 0..1??Count of products or services
..... unitPrice 0..1MoneyFee, charge or cost per item
..... factor 0..1decimalPrice scaling factor
..... tax 0..1MoneyTotal tax
..... net 0..1MoneyTotal item cost
..... noteNumber 0..*positiveIntApplicable note numbers
..... reviewOutcome 0..1Added items detail level adjudication results
..... adjudication 0..*Added items detail adjudication
..... subDetail 0..*BackboneElementInsurer added line items
...... extension 0..*ExtensionAdditional content defined by implementations
Constraints: ext-1
...... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
Constraints: ext-1
...... traceNumber 0..*IdentifierNumber for tracking
...... revenue 0..1CodeableConceptRevenue or cost center code
Binding: ?? (example): Codes for the revenue or cost centers supplying the service and/or products.
...... productOrService 0..1CodeableConceptBilling, service, product, or drug code
Binding: ?? (example): Allowable service and product codes.
...... productOrServiceEnd 0..1CodeableConceptEnd of a range of codes
Binding: ?? (example)
...... modifier 0..*CodeableConceptService/Product billing modifiers
Binding: ?? (example): Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen.
...... quantity 0..1??Count of products or services
...... unitPrice 0..1MoneyFee, charge or cost per item
...... factor 0..1decimalPrice scaling factor
...... tax 0..1MoneyTotal tax
...... net 0..1MoneyTotal item cost
...... noteNumber 0..*positiveIntApplicable note numbers
...... reviewOutcome 0..1Added items subdetail level adjudication results
...... adjudication 0..*Added items subdetail adjudication
... adjudication 0..*Header-level adjudication
... total SΣ0..*BackboneElementSummary adjudication amounts
.... extension 0..*ExtensionAdditional content defined by implementations
Constraints: ext-1
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
Constraints: ext-1
.... category Σ1..1CodeableConceptType of adjudication information
Binding: ?? (required)
.... amount Σ1..1MoneyTotal amount for the category
... payment 0..1BackboneElementPayment Details
.... extension 0..*ExtensionAdditional content defined by implementations
Constraints: ext-1
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
Constraints: ext-1
.... type 1..1CodeableConceptPartial or complete payment
Binding: ?? (example): The type (partial, complete) of the payment.
.... adjustment 0..1MoneyPayment adjustment for non-claim issues
.... adjustmentReason 0..1CodeableConceptExplanation for the adjustment
Binding: ?? (example): Payment Adjustment reason codes.
.... date 0..1dateExpected date of payment
.... amount 1..1MoneyPayable amount after adjustment
.... identifier 0..1IdentifierBusiness identifier for the payment
... fundsReserve 0..1CodeableConceptFunds reserved status
Binding: ?? (example): For whom funds are to be reserved: (Patient, Provider, None).
... formCode 0..1CodeableConceptPrinted form identifier
Binding: ?? (example): The forms codes.
... form 0..1AttachmentPrinted reference or actual form
... processNote 0..*BackboneElementNote concerning adjudication
.... extension 0..*ExtensionAdditional content defined by implementations
Constraints: ext-1
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
Constraints: ext-1
.... number 0..1positiveIntNote instance identifier
.... type 0..1CodeableConceptNote purpose
Binding: ?? (extensible): The presentation types of notes.
.... text 1..1stringNote explanatory text
.... language 0..1CodeableConceptLanguage of the text
Binding: ?? (required): IETF language tag for a human language
... communicationRequest 0..*Reference(CommunicationRequest)Request for additional information
... insurance 0..*BackboneElementPatient insurance information
.... extension 0..*ExtensionAdditional content defined by implementations
Constraints: ext-1
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
Constraints: ext-1
.... sequence 1..1positiveIntInsurance instance identifier
.... focal 1..1booleanCoverage to be used for adjudication
.... coverage 1..1Reference(Coverage)Insurance information
.... businessArrangement 0..1stringAdditional provider contract number
.... claimResponse 0..1Reference(ClaimResponse)Adjudication results
... error 0..*BackboneElementProcessing errors
.... extension 0..*ExtensionAdditional content defined by implementations
Constraints: ext-1
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
Constraints: ext-1
.... itemSequence 0..1positiveIntItem sequence number
.... detailSequence 0..1positiveIntDetail sequence number
.... subDetailSequence 0..1positiveIntSubdetail sequence number
.... code Σ1..1CodeableConceptError code detailing processing issues
Binding: ?? (example): The adjudication error codes.
.... expression Σ0..*stringFHIRPath of element(s) related to issue

doco Documentation for this format