| Left: | UZ Core ClaimResponse (https://dhp.uz/fhir/core/StructureDefinition/uz-core-claim-response) |
| Right: | UZ Core ClaimResponse (https://dhp.uz/fhir/core/StructureDefinition/uz-core-claim-response) |
| Error | StructureDefinition.version | Values for version differ: '0.9.0' vs '0.10.0' |
| Name | Value | Comments | |
|---|---|---|---|
abstract | false | ||
baseDefinition | http://hl7.org/fhir/StructureDefinition/ClaimResponse|5.0.0 | ||
copyright | |||
date | 2026-06-22 | ||
description | Uzbekistan Core ClaimResponse profile, used to represent claim adjudication and reimbursement responses | ||
experimental | true | ||
fhirVersion | 5.0.0 | ||
jurisdiction | |||
![]() jurisdiction[0] | urn:iso:std:iso:3166#UZ | ||
kind | resource | ||
name | UZCoreClaimResponse | ||
publisher | Ministry of Health of the Republic of Uzbekistan | ||
purpose | |||
status | active | ||
title | UZ Core ClaimResponse | ||
type | ClaimResponse | ||
url | https://dhp.uz/fhir/core/StructureDefinition/uz-core-claim-response | ||
version | 0.9.0 | 0.10.0 |
|
| Name | L Flags | L Card. | L Type | L Description & Constraints | R Flags | R Card. | R Type | R Description & Constraints | Comments![]() | ||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
![]() | 0..* | ClaimResponse(5.0.0) | Response to a claim predetermination or preauthorization | 0..* | ClaimResponse(5.0.0) | Response to a claim predetermination or preauthorization | |||||||||||
![]() ![]() | Σ | 0..1 | id | Logical id of this artifact | Σ | 0..1 | id | Logical id of this artifact | |||||||||
![]() ![]() | Σ | 0..1 | Meta | Metadata about the resource | Σ | 0..1 | Meta | Metadata about the resource | |||||||||
![]() ![]() | ?!Σ | 0..1 | uri | A set of rules under which this content was created | ?!Σ | 0..1 | uri | A set of rules under which this content was created | |||||||||
![]() ![]() | 0..1 | code | Language of the resource content Binding: ?? (required): IETF language tag for a human language
| 0..1 | code | Language of the resource content Binding: ?? (required): IETF language tag for a human language
| |||||||||||
![]() ![]() | 0..1 | Narrative | Text summary of the resource, for human interpretation This profile does not constrain the narrative in regard to content, language, or traceability to data elements | 0..1 | Narrative | Text summary of the resource, for human interpretation This profile does not constrain the narrative in regard to content, language, or traceability to data elements | |||||||||||
![]() ![]() | 0..* | Resource | Contained, inline Resources | 0..* | Resource | Contained, inline Resources | |||||||||||
![]() ![]() | 0..* | Extension | Extension Slice: Unordered, Open by value:url | 0..* | Extension | Extension Slice: Unordered, Open by value:url | |||||||||||
![]() ![]() | ?!Σ | 0..* | Extension | Extensions that cannot be ignored | ?!Σ | 0..* | Extension | Extensions that cannot be ignored | |||||||||
![]() ![]() | S | 0..* | Identifier | Business identifier for the claim response | S | 0..* | Identifier | Business identifier for the claim response | |||||||||
![]() ![]() | 0..* | Identifier | Number for tracking | 0..* | Identifier | Number for tracking | |||||||||||
![]() ![]() | ?!SΣ | 1..1 | code | Current status of the claim response Binding: ?? (required) | ?!SΣ | 1..1 | code | Current status of the claim response Binding: ?? (required) | |||||||||
![]() ![]() | SΣ | 1..1 | CodeableConcept | Category or discipline of the claim Binding: ?? (required) | SΣ | 1..1 | CodeableConcept | Category or discipline of the claim Binding: ?? (required) | |||||||||
![]() ![]() | 0..1 | CodeableConcept | More granular claim type Binding: ?? (example): A more granular claim typecode. | 0..1 | CodeableConcept | More granular claim type Binding: ?? (example): A more granular claim typecode. | |||||||||||
![]() ![]() | SΣ | 1..1 | code | Purpose of the claim response Binding: ?? (required) | SΣ | 1..1 | code | Purpose of the claim response Binding: ?? (required) | |||||||||
![]() ![]() | SΣ | 1..1 | Reference(UZ Core Patient(0.9.0)) | Patient associated with the claim | SΣ | 1..1 | Reference(UZ Core Patient(0.10.0)) | Patient associated with the claim | |||||||||
![]() ![]() | SΣ | 1..1 | dateTime | Date the claim response was created | SΣ | 1..1 | dateTime | Date the claim response was created | |||||||||
![]() ![]() | SΣ | 0..1 | Reference(UZ Core Organization(0.9.0)) | Organization responsible for reimbursement | SΣ | 0..1 | Reference(UZ Core Organization(0.10.0)) | Organization responsible for reimbursement | |||||||||
![]() ![]() | 0..1 | Reference(Practitioner | PractitionerRole | Organization) | Party responsible for the claim | 0..1 | Reference(Practitioner | PractitionerRole | Organization) | Party responsible for the claim | |||||||||||
![]() ![]() | SΣ | 0..1 | Reference(UZ Core Claim(0.9.0)) | Reference to the original claim | SΣ | 0..1 | Reference(UZ Core Claim(0.10.0)) | Reference to the original claim | |||||||||
![]() ![]() | SΣ | 1..1 | code | Processing outcome of the claim Binding: ?? (required) | SΣ | 1..1 | code | Processing outcome of the claim Binding: ?? (required) | |||||||||
![]() ![]() | SΣ | 0..1 | CodeableConcept | Adjudication decision Binding: ?? (required) | SΣ | 0..1 | CodeableConcept | Adjudication decision Binding: ?? (required) | |||||||||
![]() ![]() | 0..1 | string | Disposition Message | 0..1 | string | Disposition Message | |||||||||||
![]() ![]() | S | 0..1 | string | Reference to a prior authorization | S | 0..1 | string | Reference to a prior authorization | |||||||||
![]() ![]() | S | 0..1 | Period | Validity period of the prior authorization | S | 0..1 | Period | Validity period of the prior authorization | |||||||||
![]() ![]() ![]() | 0..1 | id | Unique id for inter-element referencing | 0..1 | id | Unique id for inter-element referencing | |||||||||||
![]() ![]() ![]() | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | |||||||||||
![]() ![]() ![]() | ΣC | 0..1 | dateTime | Authorization start date | ΣC | 0..1 | dateTime | Authorization start date | |||||||||
![]() ![]() ![]() | ΣC | 0..1 | dateTime | Authorization end date | ΣC | 0..1 | dateTime | Authorization end date | |||||||||
![]() ![]() | 0..* | BackboneElement | Event information | 0..* | BackboneElement | Event information | |||||||||||
![]() ![]() ![]() | 0..1 | string | Unique id for inter-element referencing | 0..1 | string | Unique id for inter-element referencing | |||||||||||
![]() ![]() ![]() | 0..* | Extension | Additional content defined by implementations | 0..* | Extension | Additional content defined by implementations | |||||||||||
![]() ![]() ![]() | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | |||||||||
![]() ![]() ![]() | 1..1 | CodeableConcept | Specific event Binding: ?? (example) | 1..1 | CodeableConcept | Specific event Binding: ?? (example) | |||||||||||
![]() ![]() ![]() | 1..1 | dateTime, Period | Occurance date or period | 1..1 | dateTime, Period | Occurance date or period | |||||||||||
![]() ![]() | 0..1 | CodeableConcept | Party to be paid any benefits payable Binding: ?? (example): A code for the party to be reimbursed. | 0..1 | CodeableConcept | Party to be paid any benefits payable Binding: ?? (example): A code for the party to be reimbursed. | |||||||||||
![]() ![]() | 0..* | Reference(Encounter) | Encounters associated with the listed treatments | 0..* | Reference(Encounter) | Encounters associated with the listed treatments | |||||||||||
![]() ![]() | 0..1 | CodeableConcept | Package billing code Binding: ?? (example) | 0..1 | CodeableConcept | Package billing code Binding: ?? (example) | |||||||||||
![]() ![]() | 0..* | BackboneElement | Adjudication for claim line items | 0..* | BackboneElement | Adjudication for claim line items | |||||||||||
![]() ![]() ![]() | 0..1 | string | Unique id for inter-element referencing | 0..1 | string | Unique id for inter-element referencing | |||||||||||
![]() ![]() ![]() | 0..* | Extension | Additional content defined by implementations | 0..* | Extension | Additional content defined by implementations | |||||||||||
![]() ![]() ![]() | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | |||||||||
![]() ![]() ![]() | 1..1 | positiveInt | Claim item instance identifier | 1..1 | positiveInt | Claim item instance identifier | |||||||||||
![]() ![]() ![]() | 0..* | Identifier | Number for tracking | 0..* | Identifier | Number for tracking | |||||||||||
![]() ![]() ![]() | 0..* | positiveInt | Applicable note numbers | 0..* | positiveInt | Applicable note numbers | |||||||||||
![]() ![]() ![]() | 0..1 | BackboneElement | Adjudication results | 0..1 | BackboneElement | Adjudication results | |||||||||||
![]() ![]() ![]() ![]() | 0..1 | string | Unique id for inter-element referencing | 0..1 | string | Unique id for inter-element referencing | |||||||||||
![]() ![]() ![]() ![]() | 0..* | Extension | Additional content defined by implementations | 0..* | Extension | Additional content defined by implementations | |||||||||||
![]() ![]() ![]() ![]() | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | |||||||||
![]() ![]() ![]() ![]() | 0..1 | CodeableConcept | Result of the adjudication Binding: ?? (example) | 0..1 | CodeableConcept | Result of the adjudication Binding: ?? (example) | |||||||||||
![]() ![]() ![]() ![]() | 0..* | CodeableConcept | Reason for result of the adjudication Binding: ?? (example) | 0..* | CodeableConcept | Reason for result of the adjudication Binding: ?? (example) | |||||||||||
![]() ![]() ![]() ![]() | 0..1 | string | Preauthorization reference | 0..1 | string | Preauthorization reference | |||||||||||
![]() ![]() ![]() ![]() | 0..1 | Period | Preauthorization reference effective period | 0..1 | Period | Preauthorization reference effective period | |||||||||||
![]() ![]() ![]() | 0..* | BackboneElement | Adjudication details | 0..* | BackboneElement | Adjudication details | |||||||||||
![]() ![]() ![]() ![]() | 0..1 | string | Unique id for inter-element referencing | 0..1 | string | Unique id for inter-element referencing | |||||||||||
![]() ![]() ![]() ![]() | 0..* | Extension | Additional content defined by implementations | 0..* | Extension | Additional content defined by implementations | |||||||||||
![]() ![]() ![]() ![]() | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | |||||||||
![]() ![]() ![]() ![]() | 1..1 | CodeableConcept | Type of adjudication information Binding: ?? (example): The adjudication codes. | 1..1 | CodeableConcept | Type of adjudication information Binding: ?? (example): The adjudication codes. | |||||||||||
![]() ![]() ![]() ![]() | 0..1 | CodeableConcept | Explanation of adjudication outcome Binding: ?? (example): The adjudication reason codes. | 0..1 | CodeableConcept | Explanation of adjudication outcome Binding: ?? (example): The adjudication reason codes. | |||||||||||
![]() ![]() ![]() ![]() | 0..1 | Money | Monetary amount | 0..1 | Money | Monetary amount | |||||||||||
![]() ![]() ![]() ![]() | 0..1 | Quantity | Non-monetary value | 0..1 | Quantity | Non-monetary value | |||||||||||
![]() ![]() ![]() | 0..* | BackboneElement | Adjudication for claim details | 0..* | BackboneElement | Adjudication for claim details | |||||||||||
![]() ![]() ![]() ![]() | 0..1 | string | Unique id for inter-element referencing | 0..1 | string | Unique id for inter-element referencing | |||||||||||
![]() ![]() ![]() ![]() | 0..* | Extension | Additional content defined by implementations | 0..* | Extension | Additional content defined by implementations | |||||||||||
![]() ![]() ![]() ![]() | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | |||||||||
![]() ![]() ![]() ![]() | 1..1 | positiveInt | Claim detail instance identifier | 1..1 | positiveInt | Claim detail instance identifier | |||||||||||
![]() ![]() ![]() ![]() | 0..* | Identifier | Number for tracking | 0..* | Identifier | Number for tracking | |||||||||||
![]() ![]() ![]() ![]() | 0..* | positiveInt | Applicable note numbers | 0..* | positiveInt | Applicable note numbers | |||||||||||
![]() ![]() ![]() ![]() | 0..1 | See reviewOutcome (ClaimResponse) | Detail level adjudication results | 0..1 | See reviewOutcome (ClaimResponse) | Detail level adjudication results | |||||||||||
![]() ![]() ![]() ![]() | 0..* | See adjudication (ClaimResponse) | Detail level adjudication details | 0..* | See adjudication (ClaimResponse) | Detail level adjudication details | |||||||||||
![]() ![]() ![]() ![]() | 0..* | BackboneElement | Adjudication for claim sub-details | 0..* | BackboneElement | Adjudication for claim sub-details | |||||||||||
![]() ![]() ![]() ![]() ![]() | 0..1 | string | Unique id for inter-element referencing | 0..1 | string | Unique id for inter-element referencing | |||||||||||
![]() ![]() ![]() ![]() ![]() | 0..* | Extension | Additional content defined by implementations | 0..* | Extension | Additional content defined by implementations | |||||||||||
![]() ![]() ![]() ![]() ![]() | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | |||||||||
![]() ![]() ![]() ![]() ![]() | 1..1 | positiveInt | Claim sub-detail instance identifier | 1..1 | positiveInt | Claim sub-detail instance identifier | |||||||||||
![]() ![]() ![]() ![]() ![]() | 0..* | Identifier | Number for tracking | 0..* | Identifier | Number for tracking | |||||||||||
![]() ![]() ![]() ![]() ![]() | 0..* | positiveInt | Applicable note numbers | 0..* | positiveInt | Applicable note numbers | |||||||||||
![]() ![]() ![]() ![]() ![]() | 0..1 | See reviewOutcome (ClaimResponse) | Subdetail level adjudication results | 0..1 | See reviewOutcome (ClaimResponse) | Subdetail level adjudication results | |||||||||||
![]() ![]() ![]() ![]() ![]() | 0..* | See adjudication (ClaimResponse) | Subdetail level adjudication details | 0..* | See adjudication (ClaimResponse) | Subdetail level adjudication details | |||||||||||
![]() ![]() | 0..* | BackboneElement | Insurer added line items | 0..* | BackboneElement | Insurer added line items | |||||||||||
![]() ![]() ![]() | 0..1 | string | Unique id for inter-element referencing | 0..1 | string | Unique id for inter-element referencing | |||||||||||
![]() ![]() ![]() | 0..* | Extension | Additional content defined by implementations | 0..* | Extension | Additional content defined by implementations | |||||||||||
![]() ![]() ![]() | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | |||||||||
![]() ![]() ![]() | 0..* | positiveInt | Item sequence number | 0..* | positiveInt | Item sequence number | |||||||||||
![]() ![]() ![]() | 0..* | positiveInt | Detail sequence number | 0..* | positiveInt | Detail sequence number | |||||||||||
![]() ![]() ![]() | 0..* | positiveInt | Subdetail sequence number | 0..* | positiveInt | Subdetail sequence number | |||||||||||
![]() ![]() ![]() | 0..* | Identifier | Number for tracking | 0..* | Identifier | Number for tracking | |||||||||||
![]() ![]() ![]() | 0..* | Reference(Practitioner | PractitionerRole | Organization) | Authorized providers | 0..* | Reference(Practitioner | PractitionerRole | Organization) | Authorized providers | |||||||||||
![]() ![]() ![]() | 0..1 | CodeableConcept | Revenue or cost center code Binding: ?? (example): Codes for the revenue or cost centers supplying the service and/or products. | 0..1 | CodeableConcept | Revenue or cost center code Binding: ?? (example): Codes for the revenue or cost centers supplying the service and/or products. | |||||||||||
![]() ![]() ![]() | 0..1 | CodeableConcept | Billing, service, product, or drug code Binding: ?? (example): Allowable service and product codes. | 0..1 | CodeableConcept | Billing, service, product, or drug code Binding: ?? (example): Allowable service and product codes. | |||||||||||
![]() ![]() ![]() | 0..1 | CodeableConcept | End of a range of codes Binding: ?? (example) | 0..1 | CodeableConcept | End of a range of codes Binding: ?? (example) | |||||||||||
![]() ![]() ![]() | 0..* | Reference(DeviceRequest | MedicationRequest | NutritionOrder | ServiceRequest | SupplyRequest | VisionPrescription) | Request or Referral for Service | 0..* | Reference(DeviceRequest | MedicationRequest | NutritionOrder | ServiceRequest | SupplyRequest | VisionPrescription) | Request or Referral for Service | |||||||||||
![]() ![]() ![]() | 0..* | CodeableConcept | Service/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. | 0..* | CodeableConcept | Service/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. | |||||||||||
![]() ![]() ![]() | 0..* | CodeableConcept | Program the product or service is provided under Binding: ?? (example): Program specific reason codes. | 0..* | CodeableConcept | Program the product or service is provided under Binding: ?? (example): Program specific reason codes. | |||||||||||
![]() ![]() ![]() | 0..1 | date, Period | Date or dates of service or product delivery | 0..1 | date, Period | Date or dates of service or product delivery | |||||||||||
![]() ![]() ![]() | 0..1 | CodeableConcept, Address, Reference(Location) | Place of service or where product was supplied Binding: ?? (example): Place of service: pharmacy, school, prison, etc. | 0..1 | CodeableConcept, Address, Reference(Location) | Place of service or where product was supplied Binding: ?? (example): Place of service: pharmacy, school, prison, etc. | |||||||||||
![]() ![]() ![]() | 0..1 | ?? | Count of products or services | 0..1 | ?? | Count of products or services | |||||||||||
![]() ![]() ![]() | 0..1 | Money | Fee, charge or cost per item | 0..1 | Money | Fee, charge or cost per item | |||||||||||
![]() ![]() ![]() | 0..1 | decimal | Price scaling factor | 0..1 | decimal | Price scaling factor | |||||||||||
![]() ![]() ![]() | 0..1 | Money | Total tax | 0..1 | Money | Total tax | |||||||||||
![]() ![]() ![]() | 0..1 | Money | Total item cost | 0..1 | Money | Total item cost | |||||||||||
![]() ![]() ![]() | 0..* | BackboneElement | Anatomical location | 0..* | BackboneElement | Anatomical location | |||||||||||
![]() ![]() ![]() ![]() | 0..1 | string | Unique id for inter-element referencing | 0..1 | string | Unique id for inter-element referencing | |||||||||||
![]() ![]() ![]() ![]() | 0..* | Extension | Additional content defined by implementations | 0..* | Extension | Additional content defined by implementations | |||||||||||
![]() ![]() ![]() ![]() | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | |||||||||
![]() ![]() ![]() ![]() | 1..* | CodeableReference(BodyStructure) | Location Binding: ?? (example) | 1..* | CodeableReference(BodyStructure) | Location Binding: ?? (example) | |||||||||||
![]() ![]() ![]() ![]() | 0..* | CodeableConcept | Sub-location Binding: ?? (example) | 0..* | CodeableConcept | Sub-location Binding: ?? (example) | |||||||||||
![]() ![]() ![]() | 0..* | positiveInt | Applicable note numbers | 0..* | positiveInt | Applicable note numbers | |||||||||||
![]() ![]() ![]() | 0..1 | See reviewOutcome (ClaimResponse) | Added items adjudication results | 0..1 | See reviewOutcome (ClaimResponse) | Added items adjudication results | |||||||||||
![]() ![]() ![]() | 0..* | See adjudication (ClaimResponse) | Added items adjudication | 0..* | See adjudication (ClaimResponse) | Added items adjudication | |||||||||||
![]() ![]() ![]() | 0..* | BackboneElement | Insurer added line details | 0..* | BackboneElement | Insurer added line details | |||||||||||
![]() ![]() ![]() ![]() | 0..1 | string | Unique id for inter-element referencing | 0..1 | string | Unique id for inter-element referencing | |||||||||||
![]() ![]() ![]() ![]() | 0..* | Extension | Additional content defined by implementations | 0..* | Extension | Additional content defined by implementations | |||||||||||
![]() ![]() ![]() ![]() | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | |||||||||
![]() ![]() ![]() ![]() | 0..* | Identifier | Number for tracking | 0..* | Identifier | Number for tracking | |||||||||||
![]() ![]() ![]() ![]() | 0..1 | CodeableConcept | Revenue or cost center code Binding: ?? (example): Codes for the revenue or cost centers supplying the service and/or products. | 0..1 | CodeableConcept | Revenue or cost center code Binding: ?? (example): Codes for the revenue or cost centers supplying the service and/or products. | |||||||||||
![]() ![]() ![]() ![]() | 0..1 | CodeableConcept | Billing, service, product, or drug code Binding: ?? (example): Allowable service and product codes. | 0..1 | CodeableConcept | Billing, service, product, or drug code Binding: ?? (example): Allowable service and product codes. | |||||||||||
![]() ![]() ![]() ![]() | 0..1 | CodeableConcept | End of a range of codes Binding: ?? (example) | 0..1 | CodeableConcept | End of a range of codes Binding: ?? (example) | |||||||||||
![]() ![]() ![]() ![]() | 0..* | CodeableConcept | Service/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. | 0..* | CodeableConcept | Service/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. | |||||||||||
![]() ![]() ![]() ![]() | 0..1 | ?? | Count of products or services | 0..1 | ?? | Count of products or services | |||||||||||
![]() ![]() ![]() ![]() | 0..1 | Money | Fee, charge or cost per item | 0..1 | Money | Fee, charge or cost per item | |||||||||||
![]() ![]() ![]() ![]() | 0..1 | decimal | Price scaling factor | 0..1 | decimal | Price scaling factor | |||||||||||
![]() ![]() ![]() ![]() | 0..1 | Money | Total tax | 0..1 | Money | Total tax | |||||||||||
![]() ![]() ![]() ![]() | 0..1 | Money | Total item cost | 0..1 | Money | Total item cost | |||||||||||
![]() ![]() ![]() ![]() | 0..* | positiveInt | Applicable note numbers | 0..* | positiveInt | Applicable note numbers | |||||||||||
![]() ![]() ![]() ![]() | 0..1 | See reviewOutcome (ClaimResponse) | Added items detail level adjudication results | 0..1 | See reviewOutcome (ClaimResponse) | Added items detail level adjudication results | |||||||||||
![]() ![]() ![]() ![]() | 0..* | See adjudication (ClaimResponse) | Added items detail adjudication | 0..* | See adjudication (ClaimResponse) | Added items detail adjudication | |||||||||||
![]() ![]() ![]() ![]() | 0..* | BackboneElement | Insurer added line items | 0..* | BackboneElement | Insurer added line items | |||||||||||
![]() ![]() ![]() ![]() ![]() | 0..1 | string | Unique id for inter-element referencing | 0..1 | string | Unique id for inter-element referencing | |||||||||||
![]() ![]() ![]() ![]() ![]() | 0..* | Extension | Additional content defined by implementations | 0..* | Extension | Additional content defined by implementations | |||||||||||
![]() ![]() ![]() ![]() ![]() | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | |||||||||
![]() ![]() ![]() ![]() ![]() | 0..* | Identifier | Number for tracking | 0..* | Identifier | Number for tracking | |||||||||||
![]() ![]() ![]() ![]() ![]() | 0..1 | CodeableConcept | Revenue or cost center code Binding: ?? (example): Codes for the revenue or cost centers supplying the service and/or products. | 0..1 | CodeableConcept | Revenue or cost center code Binding: ?? (example): Codes for the revenue or cost centers supplying the service and/or products. | |||||||||||
![]() ![]() ![]() ![]() ![]() | 0..1 | CodeableConcept | Billing, service, product, or drug code Binding: ?? (example): Allowable service and product codes. | 0..1 | CodeableConcept | Billing, service, product, or drug code Binding: ?? (example): Allowable service and product codes. | |||||||||||
![]() ![]() ![]() ![]() ![]() | 0..1 | CodeableConcept | End of a range of codes Binding: ?? (example) | 0..1 | CodeableConcept | End of a range of codes Binding: ?? (example) | |||||||||||
![]() ![]() ![]() ![]() ![]() | 0..* | CodeableConcept | Service/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. | 0..* | CodeableConcept | Service/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. | |||||||||||
![]() ![]() ![]() ![]() ![]() | 0..1 | ?? | Count of products or services | 0..1 | ?? | Count of products or services | |||||||||||
![]() ![]() ![]() ![]() ![]() | 0..1 | Money | Fee, charge or cost per item | 0..1 | Money | Fee, charge or cost per item | |||||||||||
![]() ![]() ![]() ![]() ![]() | 0..1 | decimal | Price scaling factor | 0..1 | decimal | Price scaling factor | |||||||||||
![]() ![]() ![]() ![]() ![]() | 0..1 | Money | Total tax | 0..1 | Money | Total tax | |||||||||||
![]() ![]() ![]() ![]() ![]() | 0..1 | Money | Total item cost | 0..1 | Money | Total item cost | |||||||||||
![]() ![]() ![]() ![]() ![]() | 0..* | positiveInt | Applicable note numbers | 0..* | positiveInt | Applicable note numbers | |||||||||||
![]() ![]() ![]() ![]() ![]() | 0..1 | See reviewOutcome (ClaimResponse) | Added items subdetail level adjudication results | 0..1 | See reviewOutcome (ClaimResponse) | Added items subdetail level adjudication results | |||||||||||
![]() ![]() ![]() ![]() ![]() | 0..* | See adjudication (ClaimResponse) | Added items subdetail adjudication | 0..* | See adjudication (ClaimResponse) | Added items subdetail adjudication | |||||||||||
![]() ![]() | 0..* | See adjudication (ClaimResponse) | Header-level adjudication | 0..* | See adjudication (ClaimResponse) | Header-level adjudication | |||||||||||
![]() ![]() | SΣ | 0..* | BackboneElement | Summary adjudication amounts | SΣ | 0..* | BackboneElement | Summary adjudication amounts | |||||||||
![]() ![]() ![]() | 0..1 | string | Unique id for inter-element referencing | 0..1 | string | Unique id for inter-element referencing | |||||||||||
![]() ![]() ![]() | 0..* | Extension | Additional content defined by implementations | 0..* | Extension | Additional content defined by implementations | |||||||||||
![]() ![]() ![]() | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | |||||||||
![]() ![]() ![]() | Σ | 1..1 | CodeableConcept | Type of adjudication information Binding: ?? (required) | Σ | 1..1 | CodeableConcept | Type of adjudication information Binding: ?? (required) | |||||||||
![]() ![]() ![]() | Σ | 1..1 | Money | Total amount for the category | Σ | 1..1 | Money | Total amount for the category | |||||||||
![]() ![]() | 0..1 | BackboneElement | Payment Details | 0..1 | BackboneElement | Payment Details | |||||||||||
![]() ![]() ![]() | 0..1 | string | Unique id for inter-element referencing | 0..1 | string | Unique id for inter-element referencing | |||||||||||
![]() ![]() ![]() | 0..* | Extension | Additional content defined by implementations | 0..* | Extension | Additional content defined by implementations | |||||||||||
![]() ![]() ![]() | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | |||||||||
![]() ![]() ![]() | 1..1 | CodeableConcept | Partial or complete payment Binding: ?? (example): The type (partial, complete) of the payment. | 1..1 | CodeableConcept | Partial or complete payment Binding: ?? (example): The type (partial, complete) of the payment. | |||||||||||
![]() ![]() ![]() | 0..1 | Money | Payment adjustment for non-claim issues | 0..1 | Money | Payment adjustment for non-claim issues | |||||||||||
![]() ![]() ![]() | 0..1 | CodeableConcept | Explanation for the adjustment Binding: ?? (example): Payment Adjustment reason codes. | 0..1 | CodeableConcept | Explanation for the adjustment Binding: ?? (example): Payment Adjustment reason codes. | |||||||||||
![]() ![]() ![]() | 0..1 | date | Expected date of payment | 0..1 | date | Expected date of payment | |||||||||||
![]() ![]() ![]() | 1..1 | Money | Payable amount after adjustment | 1..1 | Money | Payable amount after adjustment | |||||||||||
![]() ![]() ![]() | 0..1 | Identifier | Business identifier for the payment | 0..1 | Identifier | Business identifier for the payment | |||||||||||
![]() ![]() | 0..1 | CodeableConcept | Funds reserved status Binding: ?? (example): For whom funds are to be reserved: (Patient, Provider, None). | 0..1 | CodeableConcept | Funds reserved status Binding: ?? (example): For whom funds are to be reserved: (Patient, Provider, None). | |||||||||||
![]() ![]() | 0..1 | CodeableConcept | Printed form identifier Binding: ?? (example): The forms codes. | 0..1 | CodeableConcept | Printed form identifier Binding: ?? (example): The forms codes. | |||||||||||
![]() ![]() | 0..1 | Attachment | Printed reference or actual form | 0..1 | Attachment | Printed reference or actual form | |||||||||||
![]() ![]() | 0..* | BackboneElement | Note concerning adjudication | 0..* | BackboneElement | Note concerning adjudication | |||||||||||
![]() ![]() ![]() | 0..1 | string | Unique id for inter-element referencing | 0..1 | string | Unique id for inter-element referencing | |||||||||||
![]() ![]() ![]() | 0..* | Extension | Additional content defined by implementations | 0..* | Extension | Additional content defined by implementations | |||||||||||
![]() ![]() ![]() | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | |||||||||
![]() ![]() ![]() | 0..1 | positiveInt | Note instance identifier | 0..1 | positiveInt | Note instance identifier | |||||||||||
![]() ![]() ![]() | 0..1 | CodeableConcept | Note purpose Binding: ?? (extensible): The presentation types of notes. | 0..1 | CodeableConcept | Note purpose Binding: ?? (extensible): The presentation types of notes. | |||||||||||
![]() ![]() ![]() | 1..1 | string | Note explanatory text | 1..1 | string | Note explanatory text | |||||||||||
![]() ![]() ![]() | 0..1 | CodeableConcept | Language of the text Binding: ?? (required): IETF language tag for a human language
| 0..1 | CodeableConcept | Language of the text Binding: ?? (required): IETF language tag for a human language
| |||||||||||
![]() ![]() | 0..* | Reference(CommunicationRequest) | Request for additional information | 0..* | Reference(CommunicationRequest) | Request for additional information | |||||||||||
![]() ![]() | 0..* | BackboneElement | Patient insurance information | 0..* | BackboneElement | Patient insurance information | |||||||||||
![]() ![]() ![]() | 0..1 | string | Unique id for inter-element referencing | 0..1 | string | Unique id for inter-element referencing | |||||||||||
![]() ![]() ![]() | 0..* | Extension | Additional content defined by implementations | 0..* | Extension | Additional content defined by implementations | |||||||||||
![]() ![]() ![]() | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | |||||||||
![]() ![]() ![]() | 1..1 | positiveInt | Insurance instance identifier | 1..1 | positiveInt | Insurance instance identifier | |||||||||||
![]() ![]() ![]() | 1..1 | boolean | Coverage to be used for adjudication | 1..1 | boolean | Coverage to be used for adjudication | |||||||||||
![]() ![]() ![]() | 1..1 | Reference(Coverage) | Insurance information | 1..1 | Reference(Coverage) | Insurance information | |||||||||||
![]() ![]() ![]() | 0..1 | string | Additional provider contract number | 0..1 | string | Additional provider contract number | |||||||||||
![]() ![]() ![]() | 0..1 | Reference(ClaimResponse) | Adjudication results | 0..1 | Reference(ClaimResponse) | Adjudication results | |||||||||||
![]() ![]() | 0..* | BackboneElement | Processing errors | 0..* | BackboneElement | Processing errors | |||||||||||
![]() ![]() ![]() | 0..1 | string | Unique id for inter-element referencing | 0..1 | string | Unique id for inter-element referencing | |||||||||||
![]() ![]() ![]() | 0..* | Extension | Additional content defined by implementations | 0..* | Extension | Additional content defined by implementations | |||||||||||
![]() ![]() ![]() | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | |||||||||
![]() ![]() ![]() | 0..1 | positiveInt | Item sequence number | 0..1 | positiveInt | Item sequence number | |||||||||||
![]() ![]() ![]() | 0..1 | positiveInt | Detail sequence number | 0..1 | positiveInt | Detail sequence number | |||||||||||
![]() ![]() ![]() | 0..1 | positiveInt | Subdetail sequence number | 0..1 | positiveInt | Subdetail sequence number | |||||||||||
![]() ![]() ![]() | Σ | 1..1 | CodeableConcept | Error code detailing processing issues Binding: ?? (example): The adjudication error codes. | Σ | 1..1 | CodeableConcept | Error code detailing processing issues Binding: ?? (example): The adjudication error codes. | |||||||||
![]() ![]() ![]() | Σ | 0..* | string | FHIRPath of element(s) related to issue | Σ | 0..* | string | FHIRPath of element(s) related to issue | |||||||||
Documentation for this format | |||||||||||||||||