Единая платформа цифрового здравоохранения Узбекистана
0.7.0 - ci-build Uzbekistan флаг

Uzbekistan Digital Health Platform - Локальная сборка (v0.7.0), построенная FHIR (HL7® FHIR® Стандартные инструменты сборки. Смотрите каталог опубликованных версий

Профиль ресурса: UZ Core Claim Response ( Экспериментальный )

Официальный URL: https://dhp.uz/fhir/core/StructureDefinition/uz-core-claim-response Версия: 0.7.0
Active по состоянию на 2026-06-22 Вычисляемое имя: UZCoreClaimResponse

Uzbekistan Core Claim Response profile, used to represent claim adjudication and reimbursement responses

Использование:

You can also check for usages in the FHIR IG Statistics

Формальные представления содержимого профиля

Описание профилей, дифференциалов, снимков и их представлений.

НаименованиеФлагиКарта.ТипОписание и ограничения    Filter: Filtersdoco
.. ClaimResponse 0..* ClaimResponse(5.0.0) Response to a claim predetermination or preauthorization
... implicitRules ?!Σ 0..1 uri A set of rules under which this content was created
... contained 0..* Resource Contained, inline Resources
... Разрезы для extension 0..* Extension Extension
Разрез: Не упорядочено, Открыто от value:url
Constraints: ext-1
.... extension:cancellationReason S 0..1 CodeableConcept Reason for cancellation
URL: https://dhp.uz/fhir/core/StructureDefinition/claim-response-cancellation-reason
Привязка: CancellationReasonVS (0.7.0) (required)
Constraints: ext-1
... identifier S 0..* Identifier Business identifier for the claim response
... status ?!SΣ 1..1 code Current status of the claim response
Привязка: FMStatusVS (0.7.0) (required)
... type SΣ 1..1 CodeableConcept Category or discipline of the claim
Привязка: ClaimTypeVS (0.7.0) (required)
... use SΣ 1..1 code Purpose of the claim response
Привязка: ClaimUseVS (0.7.0) (required)
... patient SΣ 1..1 Reference(UZ Core Patient(0.7.0)) Patient associated with the claim
... created SΣ 1..1 dateTime Date the claim response was created
... insurer SΣ 0..1 Reference(UZ Core Organization(0.7.0)) Organization responsible for reimbursement
... request SΣ 0..1 Reference(UZ Core Claim(0.7.0)) Reference to the original claim
... outcome SΣ 1..1 code Processing outcome of the claim
Привязка: ClaimResponseOutcomeVS (0.7.0) (required)
... decision SΣ 0..1 CodeableConcept Adjudication decision
Привязка: ClaimResponseDecisionVS (0.7.0) (required)
... preAuthRef S 0..1 string Reference to a prior authorization
... preAuthPeriod S 0..1 Period Validity period of the prior authorization
.... start ΣC 0..1 dateTime Authorization start date
.... end ΣC 0..1 dateTime Authorization end date
... total SΣ 0..* BackboneElement Summary adjudication amounts
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
Constraints: ext-1
.... category Σ 1..1 CodeableConcept Type of adjudication information
Привязка: ClaimResponseCategoryVS (0.7.0) (required)
.... amount Σ 1..1 Money Total amount for the category

doco Документация для этого формата

Привязки к терминологии

Путь Статус Использование ValueSet Версия Источник
ClaimResponse.status Base required Financial Management Status Value set 📍0.7.0 этот IG
ClaimResponse.type Base required Claim Type VS 📍0.7.0 этот IG
ClaimResponse.use Base required Claim Use Value set 📍0.7.0 этот IG
ClaimResponse.outcome Base required Claim Response Outcome VS 📍0.7.0 этот IG
ClaimResponse.decision Base required Claim Response Decision VS 📍0.7.0 этот IG
ClaimResponse.total.​category Base required Claim Response Category VS 📍0.7.0 этот IG

Ограничения

Id Градация Путь(и) Описание Выражение

НаименованиеФлагиКарта.ТипОписание и ограничения    Filter: Filtersdoco
.. ClaimResponse 0..* ClaimResponse(5.0.0) Response to a claim predetermination or preauthorization
... Разрезы для extension 0..* Extension Extension
Разрез: Не упорядочено, Открыто от value:url
.... extension:cancellationReason S 0..1 CodeableConcept Reason for cancellation
URL: https://dhp.uz/fhir/core/StructureDefinition/claim-response-cancellation-reason
Привязка: CancellationReasonVS (0.7.0) (required)
... identifier S 0..* Identifier Business identifier for the claim response
... status S 1..1 code Current status of the claim response
Привязка: FMStatusVS (0.7.0) (required)
... use S 1..1 code Purpose of the claim response
Привязка: ClaimUseVS (0.7.0) (required)
... patient S 1..1 Reference(UZ Core Patient(0.7.0)) Patient associated with the claim
... created S 1..1 dateTime Date the claim response was created
... insurer S 0..1 Reference(UZ Core Organization(0.7.0)) Organization responsible for reimbursement
... request S 0..1 Reference(UZ Core Claim(0.7.0)) Reference to the original claim
... outcome S 1..1 code Processing outcome of the claim
Привязка: ClaimResponseOutcomeVS (0.7.0) (required)
... decision S 0..1 CodeableConcept Adjudication decision
Привязка: ClaimResponseDecisionVS (0.7.0) (required)
... preAuthRef S 0..1 string Reference to a prior authorization
... preAuthPeriod S 0..1 Period Validity period of the prior authorization
.... start 0..1 dateTime Authorization start date
.... end 0..1 dateTime Authorization end date
... total S 0..* BackboneElement Summary adjudication amounts
.... category 1..1 CodeableConcept Type of adjudication information
Привязка: ClaimResponseCategoryVS (0.7.0) (required)
.... amount 1..1 Money Total amount for the category

doco Документация для этого формата

Терминологические привязки (дифференциал)

Путь Статус Использование ValueSet Версия Источник
ClaimResponse.status Base required Financial Management Status Value set 📍0.7.0 этот IG
ClaimResponse.type Base required Claim Type VS 📍0.7.0 этот IG
ClaimResponse.use Base required Claim Use Value set 📍0.7.0 этот IG
ClaimResponse.outcome Base required Claim Response Outcome VS 📍0.7.0 этот IG
ClaimResponse.decision Base required Claim Response Decision VS 📍0.7.0 этот IG
ClaimResponse.total.​category Base required Claim Response Category VS 📍0.7.0 этот IG
НаименованиеФлагиКарта.ТипОписание и ограничения    Filter: Filtersdoco
.. ClaimResponse 0..* ClaimResponse(5.0.0) Response to a claim predetermination or preauthorization
... id Σ 0..1 id Logical id of this artifact
... meta Σ 0..1 Meta Metadata about the resource
... implicitRules ?!Σ 0..1 uri A set of rules under which this content was created
... language 0..1 code Language of the resource content
Привязка: AllLanguages (required): IETF language tag for a human language
Дополнительные привязкиЦель
CommonLanguages Старт
... text 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
... contained 0..* Resource Contained, inline Resources
... Разрезы для extension 0..* Extension Extension
Разрез: Не упорядочено, Открыто от value:url
Constraints: ext-1
.... extension:cancellationReason S 0..1 CodeableConcept Reason for cancellation
URL: https://dhp.uz/fhir/core/StructureDefinition/claim-response-cancellation-reason
Привязка: CancellationReasonVS (0.7.0) (required)
Constraints: ext-1
... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored
Constraints: ext-1
... identifier S 0..* Identifier Business identifier for the claim response
... traceNumber 0..* Identifier Number for tracking
... status ?!SΣ 1..1 code Current status of the claim response
Привязка: FMStatusVS (0.7.0) (required)
... type SΣ 1..1 CodeableConcept Category or discipline of the claim
Привязка: ClaimTypeVS (0.7.0) (required)
... subType 0..1 CodeableConcept More granular claim type
Привязка: ExampleClaimSubTypeCodes (example): A more granular claim typecode.
... use SΣ 1..1 code Purpose of the claim response
Привязка: ClaimUseVS (0.7.0) (required)
... patient SΣ 1..1 Reference(UZ Core Patient(0.7.0)) Patient associated with the claim
... created SΣ 1..1 dateTime Date the claim response was created
... insurer SΣ 0..1 Reference(UZ Core Organization(0.7.0)) Organization responsible for reimbursement
... requestor 0..1 Reference(Practitioner | PractitionerRole | Organization) Party responsible for the claim
... request SΣ 0..1 Reference(UZ Core Claim(0.7.0)) Reference to the original claim
... outcome SΣ 1..1 code Processing outcome of the claim
Привязка: ClaimResponseOutcomeVS (0.7.0) (required)
... decision SΣ 0..1 CodeableConcept Adjudication decision
Привязка: ClaimResponseDecisionVS (0.7.0) (required)
... disposition 0..1 string Disposition Message
... preAuthRef S 0..1 string Reference to a prior authorization
... preAuthPeriod S 0..1 Period Validity period of the prior authorization
.... id 0..1 id Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
Разрез: Не упорядочено, Открыто от value:url
Constraints: ext-1
.... start ΣC 0..1 dateTime Authorization start date
.... end ΣC 0..1 dateTime Authorization end date
... event 0..* BackboneElement Event information
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
Constraints: ext-1
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
Constraints: ext-1
.... type 1..1 CodeableConcept Specific event
Привязка: DatesTypeCodes (example)
.... when[x] 1..1 Occurance date or period
..... whenDateTime dateTime
..... whenPeriod Period
... payeeType 0..1 CodeableConcept Party to be paid any benefits payable
Привязка: ClaimPayeeTypeCodes (example): A code for the party to be reimbursed.
... encounter 0..* Reference(Encounter) Encounters associated with the listed treatments
... diagnosisRelatedGroup 0..1 CodeableConcept Package billing code
Привязка: ExampleDiagnosisRelatedGroupCodes (example)
... item 0..* BackboneElement Adjudication for claim line items
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
Constraints: ext-1
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
Constraints: ext-1
.... itemSequence 1..1 positiveInt Claim item instance identifier
.... traceNumber 0..* Identifier Number for tracking
.... noteNumber 0..* positiveInt Applicable note numbers
.... reviewOutcome 0..1 BackboneElement Adjudication results
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
Constraints: ext-1
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
Constraints: ext-1
..... decision 0..1 CodeableConcept Result of the adjudication
Привязка: ClaimAdjudicationDecisionsCodes (example)
..... reason 0..* CodeableConcept Reason for result of the adjudication
Привязка: ClaimAdjudicationDecisionReasonCodes (example)
..... preAuthRef 0..1 string Preauthorization reference
..... preAuthPeriod 0..1 Period Preauthorization reference effective period
.... adjudication 0..* BackboneElement Adjudication details
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
Constraints: ext-1
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
Constraints: ext-1
..... category 1..1 CodeableConcept Type of adjudication information
Привязка: AdjudicationValueCodes (example): The adjudication codes.
..... reason 0..1 CodeableConcept Explanation of adjudication outcome
Привязка: AdjudicationReasonCodes (example): The adjudication reason codes.
..... amount 0..1 Money Monetary amount
..... quantity 0..1 Quantity Non-monetary value
.... detail 0..* BackboneElement Adjudication for claim details
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
Constraints: ext-1
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
Constraints: ext-1
..... detailSequence 1..1 positiveInt Claim detail instance identifier
..... traceNumber 0..* Identifier Number for tracking
..... noteNumber 0..* positiveInt Applicable note numbers
..... reviewOutcome 0..1 Смотреть reviewOutcome (ClaimResponse) Detail level adjudication results
..... adjudication 0..* Смотреть adjudication (ClaimResponse) Detail level adjudication details
..... subDetail 0..* BackboneElement Adjudication for claim sub-details
...... id 0..1 string Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
Constraints: ext-1
...... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
Constraints: ext-1
...... subDetailSequence 1..1 positiveInt Claim sub-detail instance identifier
...... traceNumber 0..* Identifier Number for tracking
...... noteNumber 0..* positiveInt Applicable note numbers
...... reviewOutcome 0..1 Смотреть reviewOutcome (ClaimResponse) Subdetail level adjudication results
...... adjudication 0..* Смотреть adjudication (ClaimResponse) Subdetail level adjudication details
... addItem 0..* BackboneElement Insurer added line items
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
Constraints: ext-1
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
Constraints: ext-1
.... itemSequence 0..* positiveInt Item sequence number
.... detailSequence 0..* positiveInt Detail sequence number
.... subdetailSequence 0..* positiveInt Subdetail sequence number
.... traceNumber 0..* Identifier Number for tracking
.... provider 0..* Reference(Practitioner | PractitionerRole | Organization) Authorized providers
.... revenue 0..1 CodeableConcept Revenue or cost center code
Привязка: ExampleRevenueCenterCodes (example): Codes for the revenue or cost centers supplying the service and/or products.
.... productOrService 0..1 CodeableConcept Billing, service, product, or drug code
Привязка: USCLSCodes (example): Allowable service and product codes.
.... productOrServiceEnd 0..1 CodeableConcept End of a range of codes
Привязка: USCLSCodes (example)
.... request 0..* Reference(DeviceRequest | MedicationRequest | NutritionOrder | ServiceRequest | SupplyRequest | VisionPrescription) Request or Referral for Service
.... modifier 0..* CodeableConcept Service/Product billing modifiers
Привязка: ModifierTypeCodes (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..* CodeableConcept Program the product or service is provided under
Привязка: ExampleProgramReasonCodes (example): Program specific reason codes.
.... serviced[x] 0..1 Date or dates of service or product delivery
..... servicedDate date
..... servicedPeriod Period
.... location[x] 0..1 Place of service or where product was supplied
Привязка: ExampleServicePlaceCodes (example): Place of service: pharmacy, school, prison, etc.
..... locationCodeableConcept CodeableConcept
..... locationAddress Address
..... locationReference Reference(Location)
.... quantity 0..1 SimpleQuantity(5.0.0) Count of products or services
.... unitPrice 0..1 Money Fee, charge or cost per item
.... factor 0..1 decimal Price scaling factor
.... tax 0..1 Money Total tax
.... net 0..1 Money Total item cost
.... bodySite 0..* BackboneElement Anatomical location
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
Constraints: ext-1
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
Constraints: ext-1
..... site 1..* CodeableReference(BodyStructure) Location
Привязка: OralSiteCodes (example)
..... subSite 0..* CodeableConcept Sub-location
Привязка: SurfaceCodes (example)
.... noteNumber 0..* positiveInt Applicable note numbers
.... reviewOutcome 0..1 Смотреть reviewOutcome (ClaimResponse) Added items adjudication results
.... adjudication 0..* Смотреть adjudication (ClaimResponse) Added items adjudication
.... detail 0..* BackboneElement Insurer added line details
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
Constraints: ext-1
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
Constraints: ext-1
..... traceNumber 0..* Identifier Number for tracking
..... revenue 0..1 CodeableConcept Revenue or cost center code
Привязка: ExampleRevenueCenterCodes (example): Codes for the revenue or cost centers supplying the service and/or products.
..... productOrService 0..1 CodeableConcept Billing, service, product, or drug code
Привязка: USCLSCodes (example): Allowable service and product codes.
..... productOrServiceEnd 0..1 CodeableConcept End of a range of codes
Привязка: USCLSCodes (example)
..... modifier 0..* CodeableConcept Service/Product billing modifiers
Привязка: ModifierTypeCodes (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 SimpleQuantity(5.0.0) Count of products or services
..... unitPrice 0..1 Money Fee, charge or cost per item
..... factor 0..1 decimal Price scaling factor
..... tax 0..1 Money Total tax
..... net 0..1 Money Total item cost
..... noteNumber 0..* positiveInt Applicable note numbers
..... reviewOutcome 0..1 Смотреть reviewOutcome (ClaimResponse) Added items detail level adjudication results
..... adjudication 0..* Смотреть adjudication (ClaimResponse) Added items detail adjudication
..... subDetail 0..* BackboneElement Insurer added line items
...... id 0..1 string Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
Constraints: ext-1
...... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
Constraints: ext-1
...... traceNumber 0..* Identifier Number for tracking
...... revenue 0..1 CodeableConcept Revenue or cost center code
Привязка: ExampleRevenueCenterCodes (example): Codes for the revenue or cost centers supplying the service and/or products.
...... productOrService 0..1 CodeableConcept Billing, service, product, or drug code
Привязка: USCLSCodes (example): Allowable service and product codes.
...... productOrServiceEnd 0..1 CodeableConcept End of a range of codes
Привязка: USCLSCodes (example)
...... modifier 0..* CodeableConcept Service/Product billing modifiers
Привязка: ModifierTypeCodes (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 SimpleQuantity(5.0.0) Count of products or services
...... unitPrice 0..1 Money Fee, charge or cost per item
...... factor 0..1 decimal Price scaling factor
...... tax 0..1 Money Total tax
...... net 0..1 Money Total item cost
...... noteNumber 0..* positiveInt Applicable note numbers
...... reviewOutcome 0..1 Смотреть reviewOutcome (ClaimResponse) Added items subdetail level adjudication results
...... adjudication 0..* Смотреть adjudication (ClaimResponse) Added items subdetail adjudication
... adjudication 0..* Смотреть adjudication (ClaimResponse) Header-level adjudication
... total SΣ 0..* BackboneElement Summary adjudication amounts
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
Constraints: ext-1
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
Constraints: ext-1
.... category Σ 1..1 CodeableConcept Type of adjudication information
Привязка: ClaimResponseCategoryVS (0.7.0) (required)
.... amount Σ 1..1 Money Total amount for the category
... payment 0..1 BackboneElement Payment Details
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
Constraints: ext-1
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
Constraints: ext-1
.... type 1..1 CodeableConcept Partial or complete payment
Привязка: ExamplePaymentTypeCodes (example): The type (partial, complete) of the payment.
.... adjustment 0..1 Money Payment adjustment for non-claim issues
.... adjustmentReason 0..1 CodeableConcept Explanation for the adjustment
Привязка: PaymentAdjustmentReasonCodes (example): Payment Adjustment reason codes.
.... date 0..1 date Expected date of payment
.... amount 1..1 Money Payable amount after adjustment
.... identifier 0..1 Identifier Business identifier for the payment
... fundsReserve 0..1 CodeableConcept Funds reserved status
Привязка: FundsReservationCodes (example): For whom funds are to be reserved: (Patient, Provider, None).
... formCode 0..1 CodeableConcept Printed form identifier
Привязка: FormCodes (example): The forms codes.
... form 0..1 Attachment Printed reference or actual form
... processNote 0..* BackboneElement Note concerning adjudication
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
Constraints: ext-1
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
Constraints: ext-1
.... number 0..1 positiveInt Note instance identifier
.... type 0..1 CodeableConcept Note purpose
Привязка: NoteType (extensible): The presentation types of notes.
.... text 1..1 string Note explanatory text
.... language 0..1 CodeableConcept Language of the text
Привязка: AllLanguages (required): IETF language tag for a human language
Дополнительные привязкиЦель
CommonLanguages Старт
... communicationRequest 0..* Reference(CommunicationRequest) Request for additional information
... insurance 0..* BackboneElement Patient insurance information
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
Constraints: ext-1
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
Constraints: ext-1
.... sequence 1..1 positiveInt Insurance instance identifier
.... focal 1..1 boolean Coverage to be used for adjudication
.... coverage 1..1 Reference(Coverage) Insurance information
.... businessArrangement 0..1 string Additional provider contract number
.... claimResponse 0..1 Reference(ClaimResponse) Adjudication results
... error 0..* BackboneElement Processing errors
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
Constraints: ext-1
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
Constraints: ext-1
.... itemSequence 0..1 positiveInt Item sequence number
.... detailSequence 0..1 positiveInt Detail sequence number
.... subDetailSequence 0..1 positiveInt Subdetail sequence number
.... code Σ 1..1 CodeableConcept Error code detailing processing issues
Привязка: AdjudicationErrorCodes (example): The adjudication error codes.
.... expression Σ 0..* string FHIRPath of element(s) related to issue

doco Документация для этого формата

Привязки к терминологии

Путь Статус Использование ValueSet Версия Источник
ClaimResponse.language Base required All Languages 📍5.0.0 Стандарт FHIR
ClaimResponse.status Base required Financial Management Status Value set 📍0.7.0 этот IG
ClaimResponse.type Base required Claim Type VS 📍0.7.0 этот IG
ClaimResponse.subType Base example Example Claim SubType Codes 📍5.0.0 Стандарт FHIR
ClaimResponse.use Base required Claim Use Value set 📍0.7.0 этот IG
ClaimResponse.outcome Base required Claim Response Outcome VS 📍0.7.0 этот IG
ClaimResponse.decision Base required Claim Response Decision VS 📍0.7.0 этот IG
ClaimResponse.event.​type Base example Dates Type Codes 📍5.0.0 Стандарт FHIR
ClaimResponse.payeeType Base example Claim Payee Type Codes 📍5.0.0 Стандарт FHIR
ClaimResponse.diagnosisRelatedGroup Base example Example Diagnosis Related Group Codes 📍5.0.0 Стандарт FHIR
ClaimResponse.item.reviewOutcome.​decision Base example Claim Adjudication Decision Codes 📍5.0.0 Стандарт FHIR
ClaimResponse.item.reviewOutcome.​reason Base example Claim Adjudication Decision Reason Codes 📍5.0.0 Стандарт FHIR
ClaimResponse.item.adjudication.​category Base example Adjudication Value Codes 📍5.0.0 Стандарт FHIR
ClaimResponse.item.adjudication.​reason Base example Adjudication Reason Codes 📍5.0.0 Стандарт FHIR
ClaimResponse.addItem.​revenue Base example Example Revenue Center Codes 📍5.0.0 Стандарт FHIR
ClaimResponse.addItem.​productOrService Base example USCLS Codes 📍5.0.0 Стандарт FHIR
ClaimResponse.addItem.​productOrServiceEnd Base example USCLS Codes 📍5.0.0 Стандарт FHIR
ClaimResponse.addItem.​modifier Base example Modifier type Codes 📍5.0.0 Стандарт FHIR
ClaimResponse.addItem.​programCode Base example Example Program Reason Codes 📍5.0.0 Стандарт FHIR
ClaimResponse.addItem.​location[x] Base example Example Service Place Codes 📍5.0.0 Стандарт FHIR
ClaimResponse.addItem.​bodySite.site Base example Oral Site Codes 📍5.0.0 Стандарт FHIR
ClaimResponse.addItem.​bodySite.subSite Base example Surface Codes 📍5.0.0 Стандарт FHIR
ClaimResponse.addItem.​detail.revenue Base example Example Revenue Center Codes 📍5.0.0 Стандарт FHIR
ClaimResponse.addItem.​detail.productOrService Base example USCLS Codes 📍5.0.0 Стандарт FHIR
ClaimResponse.addItem.​detail.productOrServiceEnd Base example USCLS Codes 📍5.0.0 Стандарт FHIR
ClaimResponse.addItem.​detail.modifier Base example Modifier type Codes 📍5.0.0 Стандарт FHIR
ClaimResponse.addItem.​detail.subDetail.revenue Base example Example Revenue Center Codes 📍5.0.0 Стандарт FHIR
ClaimResponse.addItem.​detail.subDetail.productOrService Base example USCLS Codes 📍5.0.0 Стандарт FHIR
ClaimResponse.addItem.​detail.subDetail.productOrServiceEnd Base example USCLS Codes 📍5.0.0 Стандарт FHIR
ClaimResponse.addItem.​detail.subDetail.modifier Base example Modifier type Codes 📍5.0.0 Стандарт FHIR
ClaimResponse.total.​category Base required Claim Response Category VS 📍0.7.0 этот IG
ClaimResponse.payment.​type Base example Example Payment Type Codes 📍5.0.0 Стандарт FHIR
ClaimResponse.payment.​adjustmentReason Base example Payment Adjustment Reason Codes 📍5.0.0 Стандарт FHIR
ClaimResponse.fundsReserve Base example Funds Reservation Codes 📍5.0.0 Стандарт FHIR
ClaimResponse.formCode Base example Form Codes 📍5.0.0 Стандарт FHIR
ClaimResponse.processNote.​type Base extensible NoteType 📍5.0.0 Стандарт FHIR
ClaimResponse.processNote.​language Base required All Languages 📍5.0.0 Стандарт FHIR
ClaimResponse.error.​code Base example Adjudication Error Codes 📍5.0.0 Стандарт FHIR

Ограничения

Id Градация Путь(и) Описание Выражение

Summary

Обязательная поддержка: 14 элементs

Структуры

Эта структура относится к этим другим структурам:

Расширения

Эта структура ссылается на эти расширения:

Просмотр ключевых элементов

НаименованиеФлагиКарта.ТипОписание и ограничения    Filter: Filtersdoco
.. ClaimResponse 0..* ClaimResponse(5.0.0) Response to a claim predetermination or preauthorization
... implicitRules ?!Σ 0..1 uri A set of rules under which this content was created
... contained 0..* Resource Contained, inline Resources
... Разрезы для extension 0..* Extension Extension
Разрез: Не упорядочено, Открыто от value:url
Constraints: ext-1
.... extension:cancellationReason S 0..1 CodeableConcept Reason for cancellation
URL: https://dhp.uz/fhir/core/StructureDefinition/claim-response-cancellation-reason
Привязка: CancellationReasonVS (0.7.0) (required)
Constraints: ext-1
... identifier S 0..* Identifier Business identifier for the claim response
... status ?!SΣ 1..1 code Current status of the claim response
Привязка: FMStatusVS (0.7.0) (required)
... type SΣ 1..1 CodeableConcept Category or discipline of the claim
Привязка: ClaimTypeVS (0.7.0) (required)
... use SΣ 1..1 code Purpose of the claim response
Привязка: ClaimUseVS (0.7.0) (required)
... patient SΣ 1..1 Reference(UZ Core Patient(0.7.0)) Patient associated with the claim
... created SΣ 1..1 dateTime Date the claim response was created
... insurer SΣ 0..1 Reference(UZ Core Organization(0.7.0)) Organization responsible for reimbursement
... request SΣ 0..1 Reference(UZ Core Claim(0.7.0)) Reference to the original claim
... outcome SΣ 1..1 code Processing outcome of the claim
Привязка: ClaimResponseOutcomeVS (0.7.0) (required)
... decision SΣ 0..1 CodeableConcept Adjudication decision
Привязка: ClaimResponseDecisionVS (0.7.0) (required)
... preAuthRef S 0..1 string Reference to a prior authorization
... preAuthPeriod S 0..1 Period Validity period of the prior authorization
.... start ΣC 0..1 dateTime Authorization start date
.... end ΣC 0..1 dateTime Authorization end date
... total SΣ 0..* BackboneElement Summary adjudication amounts
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
Constraints: ext-1
.... category Σ 1..1 CodeableConcept Type of adjudication information
Привязка: ClaimResponseCategoryVS (0.7.0) (required)
.... amount Σ 1..1 Money Total amount for the category

doco Документация для этого формата

Привязки к терминологии

Путь Статус Использование ValueSet Версия Источник
ClaimResponse.status Base required Financial Management Status Value set 📍0.7.0 этот IG
ClaimResponse.type Base required Claim Type VS 📍0.7.0 этот IG
ClaimResponse.use Base required Claim Use Value set 📍0.7.0 этот IG
ClaimResponse.outcome Base required Claim Response Outcome VS 📍0.7.0 этот IG
ClaimResponse.decision Base required Claim Response Decision VS 📍0.7.0 этот IG
ClaimResponse.total.​category Base required Claim Response Category VS 📍0.7.0 этот IG

Ограничения

Id Градация Путь(и) Описание Выражение

Дифференциальный вид

НаименованиеФлагиКарта.ТипОписание и ограничения    Filter: Filtersdoco
.. ClaimResponse 0..* ClaimResponse(5.0.0) Response to a claim predetermination or preauthorization
... Разрезы для extension 0..* Extension Extension
Разрез: Не упорядочено, Открыто от value:url
.... extension:cancellationReason S 0..1 CodeableConcept Reason for cancellation
URL: https://dhp.uz/fhir/core/StructureDefinition/claim-response-cancellation-reason
Привязка: CancellationReasonVS (0.7.0) (required)
... identifier S 0..* Identifier Business identifier for the claim response
... status S 1..1 code Current status of the claim response
Привязка: FMStatusVS (0.7.0) (required)
... use S 1..1 code Purpose of the claim response
Привязка: ClaimUseVS (0.7.0) (required)
... patient S 1..1 Reference(UZ Core Patient(0.7.0)) Patient associated with the claim
... created S 1..1 dateTime Date the claim response was created
... insurer S 0..1 Reference(UZ Core Organization(0.7.0)) Organization responsible for reimbursement
... request S 0..1 Reference(UZ Core Claim(0.7.0)) Reference to the original claim
... outcome S 1..1 code Processing outcome of the claim
Привязка: ClaimResponseOutcomeVS (0.7.0) (required)
... decision S 0..1 CodeableConcept Adjudication decision
Привязка: ClaimResponseDecisionVS (0.7.0) (required)
... preAuthRef S 0..1 string Reference to a prior authorization
... preAuthPeriod S 0..1 Period Validity period of the prior authorization
.... start 0..1 dateTime Authorization start date
.... end 0..1 dateTime Authorization end date
... total S 0..* BackboneElement Summary adjudication amounts
.... category 1..1 CodeableConcept Type of adjudication information
Привязка: ClaimResponseCategoryVS (0.7.0) (required)
.... amount 1..1 Money Total amount for the category

doco Документация для этого формата

Терминологические привязки (дифференциал)

Путь Статус Использование ValueSet Версия Источник
ClaimResponse.status Base required Financial Management Status Value set 📍0.7.0 этот IG
ClaimResponse.type Base required Claim Type VS 📍0.7.0 этот IG
ClaimResponse.use Base required Claim Use Value set 📍0.7.0 этот IG
ClaimResponse.outcome Base required Claim Response Outcome VS 📍0.7.0 этот IG
ClaimResponse.decision Base required Claim Response Decision VS 📍0.7.0 этот IG
ClaimResponse.total.​category Base required Claim Response Category VS 📍0.7.0 этот IG

Обзор моментальных снимковView

НаименованиеФлагиКарта.ТипОписание и ограничения    Filter: Filtersdoco
.. ClaimResponse 0..* ClaimResponse(5.0.0) Response to a claim predetermination or preauthorization
... id Σ 0..1 id Logical id of this artifact
... meta Σ 0..1 Meta Metadata about the resource
... implicitRules ?!Σ 0..1 uri A set of rules under which this content was created
... language 0..1 code Language of the resource content
Привязка: AllLanguages (required): IETF language tag for a human language
Дополнительные привязкиЦель
CommonLanguages Старт
... text 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
... contained 0..* Resource Contained, inline Resources
... Разрезы для extension 0..* Extension Extension
Разрез: Не упорядочено, Открыто от value:url
Constraints: ext-1
.... extension:cancellationReason S 0..1 CodeableConcept Reason for cancellation
URL: https://dhp.uz/fhir/core/StructureDefinition/claim-response-cancellation-reason
Привязка: CancellationReasonVS (0.7.0) (required)
Constraints: ext-1
... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored
Constraints: ext-1
... identifier S 0..* Identifier Business identifier for the claim response
... traceNumber 0..* Identifier Number for tracking
... status ?!SΣ 1..1 code Current status of the claim response
Привязка: FMStatusVS (0.7.0) (required)
... type SΣ 1..1 CodeableConcept Category or discipline of the claim
Привязка: ClaimTypeVS (0.7.0) (required)
... subType 0..1 CodeableConcept More granular claim type
Привязка: ExampleClaimSubTypeCodes (example): A more granular claim typecode.
... use SΣ 1..1 code Purpose of the claim response
Привязка: ClaimUseVS (0.7.0) (required)
... patient SΣ 1..1 Reference(UZ Core Patient(0.7.0)) Patient associated with the claim
... created SΣ 1..1 dateTime Date the claim response was created
... insurer SΣ 0..1 Reference(UZ Core Organization(0.7.0)) Organization responsible for reimbursement
... requestor 0..1 Reference(Practitioner | PractitionerRole | Organization) Party responsible for the claim
... request SΣ 0..1 Reference(UZ Core Claim(0.7.0)) Reference to the original claim
... outcome SΣ 1..1 code Processing outcome of the claim
Привязка: ClaimResponseOutcomeVS (0.7.0) (required)
... decision SΣ 0..1 CodeableConcept Adjudication decision
Привязка: ClaimResponseDecisionVS (0.7.0) (required)
... disposition 0..1 string Disposition Message
... preAuthRef S 0..1 string Reference to a prior authorization
... preAuthPeriod S 0..1 Period Validity period of the prior authorization
.... id 0..1 id Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
Разрез: Не упорядочено, Открыто от value:url
Constraints: ext-1
.... start ΣC 0..1 dateTime Authorization start date
.... end ΣC 0..1 dateTime Authorization end date
... event 0..* BackboneElement Event information
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
Constraints: ext-1
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
Constraints: ext-1
.... type 1..1 CodeableConcept Specific event
Привязка: DatesTypeCodes (example)
.... when[x] 1..1 Occurance date or period
..... whenDateTime dateTime
..... whenPeriod Period
... payeeType 0..1 CodeableConcept Party to be paid any benefits payable
Привязка: ClaimPayeeTypeCodes (example): A code for the party to be reimbursed.
... encounter 0..* Reference(Encounter) Encounters associated with the listed treatments
... diagnosisRelatedGroup 0..1 CodeableConcept Package billing code
Привязка: ExampleDiagnosisRelatedGroupCodes (example)
... item 0..* BackboneElement Adjudication for claim line items
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
Constraints: ext-1
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
Constraints: ext-1
.... itemSequence 1..1 positiveInt Claim item instance identifier
.... traceNumber 0..* Identifier Number for tracking
.... noteNumber 0..* positiveInt Applicable note numbers
.... reviewOutcome 0..1 BackboneElement Adjudication results
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
Constraints: ext-1
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
Constraints: ext-1
..... decision 0..1 CodeableConcept Result of the adjudication
Привязка: ClaimAdjudicationDecisionsCodes (example)
..... reason 0..* CodeableConcept Reason for result of the adjudication
Привязка: ClaimAdjudicationDecisionReasonCodes (example)
..... preAuthRef 0..1 string Preauthorization reference
..... preAuthPeriod 0..1 Period Preauthorization reference effective period
.... adjudication 0..* BackboneElement Adjudication details
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
Constraints: ext-1
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
Constraints: ext-1
..... category 1..1 CodeableConcept Type of adjudication information
Привязка: AdjudicationValueCodes (example): The adjudication codes.
..... reason 0..1 CodeableConcept Explanation of adjudication outcome
Привязка: AdjudicationReasonCodes (example): The adjudication reason codes.
..... amount 0..1 Money Monetary amount
..... quantity 0..1 Quantity Non-monetary value
.... detail 0..* BackboneElement Adjudication for claim details
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
Constraints: ext-1
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
Constraints: ext-1
..... detailSequence 1..1 positiveInt Claim detail instance identifier
..... traceNumber 0..* Identifier Number for tracking
..... noteNumber 0..* positiveInt Applicable note numbers
..... reviewOutcome 0..1 Смотреть reviewOutcome (ClaimResponse) Detail level adjudication results
..... adjudication 0..* Смотреть adjudication (ClaimResponse) Detail level adjudication details
..... subDetail 0..* BackboneElement Adjudication for claim sub-details
...... id 0..1 string Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
Constraints: ext-1
...... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
Constraints: ext-1
...... subDetailSequence 1..1 positiveInt Claim sub-detail instance identifier
...... traceNumber 0..* Identifier Number for tracking
...... noteNumber 0..* positiveInt Applicable note numbers
...... reviewOutcome 0..1 Смотреть reviewOutcome (ClaimResponse) Subdetail level adjudication results
...... adjudication 0..* Смотреть adjudication (ClaimResponse) Subdetail level adjudication details
... addItem 0..* BackboneElement Insurer added line items
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
Constraints: ext-1
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
Constraints: ext-1
.... itemSequence 0..* positiveInt Item sequence number
.... detailSequence 0..* positiveInt Detail sequence number
.... subdetailSequence 0..* positiveInt Subdetail sequence number
.... traceNumber 0..* Identifier Number for tracking
.... provider 0..* Reference(Practitioner | PractitionerRole | Organization) Authorized providers
.... revenue 0..1 CodeableConcept Revenue or cost center code
Привязка: ExampleRevenueCenterCodes (example): Codes for the revenue or cost centers supplying the service and/or products.
.... productOrService 0..1 CodeableConcept Billing, service, product, or drug code
Привязка: USCLSCodes (example): Allowable service and product codes.
.... productOrServiceEnd 0..1 CodeableConcept End of a range of codes
Привязка: USCLSCodes (example)
.... request 0..* Reference(DeviceRequest | MedicationRequest | NutritionOrder | ServiceRequest | SupplyRequest | VisionPrescription) Request or Referral for Service
.... modifier 0..* CodeableConcept Service/Product billing modifiers
Привязка: ModifierTypeCodes (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..* CodeableConcept Program the product or service is provided under
Привязка: ExampleProgramReasonCodes (example): Program specific reason codes.
.... serviced[x] 0..1 Date or dates of service or product delivery
..... servicedDate date
..... servicedPeriod Period
.... location[x] 0..1 Place of service or where product was supplied
Привязка: ExampleServicePlaceCodes (example): Place of service: pharmacy, school, prison, etc.
..... locationCodeableConcept CodeableConcept
..... locationAddress Address
..... locationReference Reference(Location)
.... quantity 0..1 SimpleQuantity(5.0.0) Count of products or services
.... unitPrice 0..1 Money Fee, charge or cost per item
.... factor 0..1 decimal Price scaling factor
.... tax 0..1 Money Total tax
.... net 0..1 Money Total item cost
.... bodySite 0..* BackboneElement Anatomical location
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
Constraints: ext-1
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
Constraints: ext-1
..... site 1..* CodeableReference(BodyStructure) Location
Привязка: OralSiteCodes (example)
..... subSite 0..* CodeableConcept Sub-location
Привязка: SurfaceCodes (example)
.... noteNumber 0..* positiveInt Applicable note numbers
.... reviewOutcome 0..1 Смотреть reviewOutcome (ClaimResponse) Added items adjudication results
.... adjudication 0..* Смотреть adjudication (ClaimResponse) Added items adjudication
.... detail 0..* BackboneElement Insurer added line details
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
Constraints: ext-1
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
Constraints: ext-1
..... traceNumber 0..* Identifier Number for tracking
..... revenue 0..1 CodeableConcept Revenue or cost center code
Привязка: ExampleRevenueCenterCodes (example): Codes for the revenue or cost centers supplying the service and/or products.
..... productOrService 0..1 CodeableConcept Billing, service, product, or drug code
Привязка: USCLSCodes (example): Allowable service and product codes.
..... productOrServiceEnd 0..1 CodeableConcept End of a range of codes
Привязка: USCLSCodes (example)
..... modifier 0..* CodeableConcept Service/Product billing modifiers
Привязка: ModifierTypeCodes (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 SimpleQuantity(5.0.0) Count of products or services
..... unitPrice 0..1 Money Fee, charge or cost per item
..... factor 0..1 decimal Price scaling factor
..... tax 0..1 Money Total tax
..... net 0..1 Money Total item cost
..... noteNumber 0..* positiveInt Applicable note numbers
..... reviewOutcome 0..1 Смотреть reviewOutcome (ClaimResponse) Added items detail level adjudication results
..... adjudication 0..* Смотреть adjudication (ClaimResponse) Added items detail adjudication
..... subDetail 0..* BackboneElement Insurer added line items
...... id 0..1 string Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
Constraints: ext-1
...... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
Constraints: ext-1
...... traceNumber 0..* Identifier Number for tracking
...... revenue 0..1 CodeableConcept Revenue or cost center code
Привязка: ExampleRevenueCenterCodes (example): Codes for the revenue or cost centers supplying the service and/or products.
...... productOrService 0..1 CodeableConcept Billing, service, product, or drug code
Привязка: USCLSCodes (example): Allowable service and product codes.
...... productOrServiceEnd 0..1 CodeableConcept End of a range of codes
Привязка: USCLSCodes (example)
...... modifier 0..* CodeableConcept Service/Product billing modifiers
Привязка: ModifierTypeCodes (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 SimpleQuantity(5.0.0) Count of products or services
...... unitPrice 0..1 Money Fee, charge or cost per item
...... factor 0..1 decimal Price scaling factor
...... tax 0..1 Money Total tax
...... net 0..1 Money Total item cost
...... noteNumber 0..* positiveInt Applicable note numbers
...... reviewOutcome 0..1 Смотреть reviewOutcome (ClaimResponse) Added items subdetail level adjudication results
...... adjudication 0..* Смотреть adjudication (ClaimResponse) Added items subdetail adjudication
... adjudication 0..* Смотреть adjudication (ClaimResponse) Header-level adjudication
... total SΣ 0..* BackboneElement Summary adjudication amounts
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
Constraints: ext-1
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
Constraints: ext-1
.... category Σ 1..1 CodeableConcept Type of adjudication information
Привязка: ClaimResponseCategoryVS (0.7.0) (required)
.... amount Σ 1..1 Money Total amount for the category
... payment 0..1 BackboneElement Payment Details
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
Constraints: ext-1
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
Constraints: ext-1
.... type 1..1 CodeableConcept Partial or complete payment
Привязка: ExamplePaymentTypeCodes (example): The type (partial, complete) of the payment.
.... adjustment 0..1 Money Payment adjustment for non-claim issues
.... adjustmentReason 0..1 CodeableConcept Explanation for the adjustment
Привязка: PaymentAdjustmentReasonCodes (example): Payment Adjustment reason codes.
.... date 0..1 date Expected date of payment
.... amount 1..1 Money Payable amount after adjustment
.... identifier 0..1 Identifier Business identifier for the payment
... fundsReserve 0..1 CodeableConcept Funds reserved status
Привязка: FundsReservationCodes (example): For whom funds are to be reserved: (Patient, Provider, None).
... formCode 0..1 CodeableConcept Printed form identifier
Привязка: FormCodes (example): The forms codes.
... form 0..1 Attachment Printed reference or actual form
... processNote 0..* BackboneElement Note concerning adjudication
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
Constraints: ext-1
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
Constraints: ext-1
.... number 0..1 positiveInt Note instance identifier
.... type 0..1 CodeableConcept Note purpose
Привязка: NoteType (extensible): The presentation types of notes.
.... text 1..1 string Note explanatory text
.... language 0..1 CodeableConcept Language of the text
Привязка: AllLanguages (required): IETF language tag for a human language
Дополнительные привязкиЦель
CommonLanguages Старт
... communicationRequest 0..* Reference(CommunicationRequest) Request for additional information
... insurance 0..* BackboneElement Patient insurance information
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
Constraints: ext-1
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
Constraints: ext-1
.... sequence 1..1 positiveInt Insurance instance identifier
.... focal 1..1 boolean Coverage to be used for adjudication
.... coverage 1..1 Reference(Coverage) Insurance information
.... businessArrangement 0..1 string Additional provider contract number
.... claimResponse 0..1 Reference(ClaimResponse) Adjudication results
... error 0..* BackboneElement Processing errors
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
Constraints: ext-1
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
Constraints: ext-1
.... itemSequence 0..1 positiveInt Item sequence number
.... detailSequence 0..1 positiveInt Detail sequence number
.... subDetailSequence 0..1 positiveInt Subdetail sequence number
.... code Σ 1..1 CodeableConcept Error code detailing processing issues
Привязка: AdjudicationErrorCodes (example): The adjudication error codes.
.... expression Σ 0..* string FHIRPath of element(s) related to issue

doco Документация для этого формата

Привязки к терминологии

Путь Статус Использование ValueSet Версия Источник
ClaimResponse.language Base required All Languages 📍5.0.0 Стандарт FHIR
ClaimResponse.status Base required Financial Management Status Value set 📍0.7.0 этот IG
ClaimResponse.type Base required Claim Type VS 📍0.7.0 этот IG
ClaimResponse.subType Base example Example Claim SubType Codes 📍5.0.0 Стандарт FHIR
ClaimResponse.use Base required Claim Use Value set 📍0.7.0 этот IG
ClaimResponse.outcome Base required Claim Response Outcome VS 📍0.7.0 этот IG
ClaimResponse.decision Base required Claim Response Decision VS 📍0.7.0 этот IG
ClaimResponse.event.​type Base example Dates Type Codes 📍5.0.0 Стандарт FHIR
ClaimResponse.payeeType Base example Claim Payee Type Codes 📍5.0.0 Стандарт FHIR
ClaimResponse.diagnosisRelatedGroup Base example Example Diagnosis Related Group Codes 📍5.0.0 Стандарт FHIR
ClaimResponse.item.reviewOutcome.​decision Base example Claim Adjudication Decision Codes 📍5.0.0 Стандарт FHIR
ClaimResponse.item.reviewOutcome.​reason Base example Claim Adjudication Decision Reason Codes 📍5.0.0 Стандарт FHIR
ClaimResponse.item.adjudication.​category Base example Adjudication Value Codes 📍5.0.0 Стандарт FHIR
ClaimResponse.item.adjudication.​reason Base example Adjudication Reason Codes 📍5.0.0 Стандарт FHIR
ClaimResponse.addItem.​revenue Base example Example Revenue Center Codes 📍5.0.0 Стандарт FHIR
ClaimResponse.addItem.​productOrService Base example USCLS Codes 📍5.0.0 Стандарт FHIR
ClaimResponse.addItem.​productOrServiceEnd Base example USCLS Codes 📍5.0.0 Стандарт FHIR
ClaimResponse.addItem.​modifier Base example Modifier type Codes 📍5.0.0 Стандарт FHIR
ClaimResponse.addItem.​programCode Base example Example Program Reason Codes 📍5.0.0 Стандарт FHIR
ClaimResponse.addItem.​location[x] Base example Example Service Place Codes 📍5.0.0 Стандарт FHIR
ClaimResponse.addItem.​bodySite.site Base example Oral Site Codes 📍5.0.0 Стандарт FHIR
ClaimResponse.addItem.​bodySite.subSite Base example Surface Codes 📍5.0.0 Стандарт FHIR
ClaimResponse.addItem.​detail.revenue Base example Example Revenue Center Codes 📍5.0.0 Стандарт FHIR
ClaimResponse.addItem.​detail.productOrService Base example USCLS Codes 📍5.0.0 Стандарт FHIR
ClaimResponse.addItem.​detail.productOrServiceEnd Base example USCLS Codes 📍5.0.0 Стандарт FHIR
ClaimResponse.addItem.​detail.modifier Base example Modifier type Codes 📍5.0.0 Стандарт FHIR
ClaimResponse.addItem.​detail.subDetail.revenue Base example Example Revenue Center Codes 📍5.0.0 Стандарт FHIR
ClaimResponse.addItem.​detail.subDetail.productOrService Base example USCLS Codes 📍5.0.0 Стандарт FHIR
ClaimResponse.addItem.​detail.subDetail.productOrServiceEnd Base example USCLS Codes 📍5.0.0 Стандарт FHIR
ClaimResponse.addItem.​detail.subDetail.modifier Base example Modifier type Codes 📍5.0.0 Стандарт FHIR
ClaimResponse.total.​category Base required Claim Response Category VS 📍0.7.0 этот IG
ClaimResponse.payment.​type Base example Example Payment Type Codes 📍5.0.0 Стандарт FHIR
ClaimResponse.payment.​adjustmentReason Base example Payment Adjustment Reason Codes 📍5.0.0 Стандарт FHIR
ClaimResponse.fundsReserve Base example Funds Reservation Codes 📍5.0.0 Стандарт FHIR
ClaimResponse.formCode Base example Form Codes 📍5.0.0 Стандарт FHIR
ClaimResponse.processNote.​type Base extensible NoteType 📍5.0.0 Стандарт FHIR
ClaimResponse.processNote.​language Base required All Languages 📍5.0.0 Стандарт FHIR
ClaimResponse.error.​code Base example Adjudication Error Codes 📍5.0.0 Стандарт FHIR

Ограничения

Id Градация Путь(и) Описание Выражение

Summary

Обязательная поддержка: 14 элементs

Структуры

Эта структура относится к этим другим структурам:

Расширения

Эта структура ссылается на эти расширения:

 

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