O‘zbekiston Raqamli sog‘liqni saqlash platformasi
0.7.0 - ci-build Uzbekistan bayroqcha

Uzbekistan Digital Health Platform - Local Development build (v0.7.0) built by the FHIR (HL7® FHIR® Standard) Build Tools. See the Directory of published versions

Resurss profili: UZ Core Claim Response ( Eksperimental )

Rasmiy URL: https://dhp.uz/fhir/core/StructureDefinition/uz-core-claim-response Versiya: 0.7.0
Active 2026-06-22 holatiga ko‘ra Kompyuterda qayta ishlanadigan nom: UZCoreClaimResponse

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

Usages:

You can also check for usages in the FHIR IG Statistics

Profil mazmunining rasmiy ko‘rinishlari

Profillar, differentsiyalar, snapshotlar va ularning tasvirlari ta’rifi.

NameFlagsCard.TypeDescription & Constraints    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
... Slices for extension 0..* Extension Extension
Slice: Unordered, Open by 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
Binding: 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
Binding: FMStatusVS (0.7.0) (required)
... type SΣ 1..1 CodeableConcept Category or discipline of the claim
Binding: ClaimTypeVS (0.7.0) (required)
... use SΣ 1..1 code Purpose of the claim response
Binding: 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
Binding: ClaimResponseOutcomeVS (0.7.0) (required)
... decision SΣ 0..1 CodeableConcept Adjudication decision
Binding: 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
Binding: ClaimResponseCategoryVS (0.7.0) (required)
.... amount Σ 1..1 Money Total amount for the category

doco Documentation for this format

Terminology Bindings

Path Status Usage ValueSet Version Source
ClaimResponse.status Base required Financial Management Status Value set 📍0.7.0 This IG
ClaimResponse.type Base required Claim Type VS 📍0.7.0 This IG
ClaimResponse.use Base required Claim Use Value set 📍0.7.0 This IG
ClaimResponse.outcome Base required Claim Response Outcome VS 📍0.7.0 This IG
ClaimResponse.decision Base required Claim Response Decision VS 📍0.7.0 This IG
ClaimResponse.total.​category Base required Claim Response Category VS 📍0.7.0 This IG

Constraints

Id Grade Path(s) Description Expression

NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
.. ClaimResponse 0..* ClaimResponse(5.0.0) Response to a claim predetermination or preauthorization
... Slices for extension 0..* Extension Extension
Slice: Unordered, Open by value:url
.... extension:cancellationReason S 0..1 CodeableConcept Reason for cancellation
URL: https://dhp.uz/fhir/core/StructureDefinition/claim-response-cancellation-reason
Binding: 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
Binding: FMStatusVS (0.7.0) (required)
... use S 1..1 code Purpose of the claim response
Binding: 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
Binding: ClaimResponseOutcomeVS (0.7.0) (required)
... decision S 0..1 CodeableConcept Adjudication decision
Binding: 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
Binding: ClaimResponseCategoryVS (0.7.0) (required)
.... amount 1..1 Money Total amount for the category

doco Documentation for this format

Terminology Bindings (Differential)

Path Status Usage ValueSet Version Source
ClaimResponse.status Base required Financial Management Status Value set 📍0.7.0 This IG
ClaimResponse.type Base required Claim Type VS 📍0.7.0 This IG
ClaimResponse.use Base required Claim Use Value set 📍0.7.0 This IG
ClaimResponse.outcome Base required Claim Response Outcome VS 📍0.7.0 This IG
ClaimResponse.decision Base required Claim Response Decision VS 📍0.7.0 This IG
ClaimResponse.total.​category Base required Claim Response Category VS 📍0.7.0 This IG
NameFlagsCard.TypeDescription & Constraints    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
Binding: AllLanguages (required): IETF language tag for a human language
Additional BindingsPurpose
CommonLanguages Starter
... 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
... Slices for extension 0..* Extension Extension
Slice: Unordered, Open by 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
Binding: 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
Binding: FMStatusVS (0.7.0) (required)
... type SΣ 1..1 CodeableConcept Category or discipline of the claim
Binding: ClaimTypeVS (0.7.0) (required)
... subType 0..1 CodeableConcept More granular claim type
Binding: ExampleClaimSubTypeCodes (example): A more granular claim typecode.
... use SΣ 1..1 code Purpose of the claim response
Binding: 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
Binding: ClaimResponseOutcomeVS (0.7.0) (required)
... decision SΣ 0..1 CodeableConcept Adjudication decision
Binding: 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
Slice: Unordered, Open by 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
Binding: 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
Binding: 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
Binding: 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
Binding: ClaimAdjudicationDecisionsCodes (example)
..... reason 0..* CodeableConcept Reason for result of the adjudication
Binding: 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
Binding: AdjudicationValueCodes (example): The adjudication codes.
..... reason 0..1 CodeableConcept Explanation of adjudication outcome
Binding: 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 See reviewOutcome (ClaimResponse) Detail level adjudication results
..... adjudication 0..* See 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 See reviewOutcome (ClaimResponse) Subdetail level adjudication results
...... adjudication 0..* See 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
Binding: 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
Binding: USCLSCodes (example): Allowable service and product codes.
.... productOrServiceEnd 0..1 CodeableConcept End of a range of codes
Binding: USCLSCodes (example)
.... request 0..* Reference(DeviceRequest | MedicationRequest | NutritionOrder | ServiceRequest | SupplyRequest | VisionPrescription) Request or Referral for Service
.... modifier 0..* CodeableConcept Service/Product billing modifiers
Binding: 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
Binding: 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
Binding: 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
Binding: OralSiteCodes (example)
..... subSite 0..* CodeableConcept Sub-location
Binding: SurfaceCodes (example)
.... noteNumber 0..* positiveInt Applicable note numbers
.... reviewOutcome 0..1 See reviewOutcome (ClaimResponse) Added items adjudication results
.... adjudication 0..* See 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
Binding: 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
Binding: USCLSCodes (example): Allowable service and product codes.
..... productOrServiceEnd 0..1 CodeableConcept End of a range of codes
Binding: USCLSCodes (example)
..... modifier 0..* CodeableConcept Service/Product billing modifiers
Binding: 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 See reviewOutcome (ClaimResponse) Added items detail level adjudication results
..... adjudication 0..* See 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
Binding: 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
Binding: USCLSCodes (example): Allowable service and product codes.
...... productOrServiceEnd 0..1 CodeableConcept End of a range of codes
Binding: USCLSCodes (example)
...... modifier 0..* CodeableConcept Service/Product billing modifiers
Binding: 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 See reviewOutcome (ClaimResponse) Added items subdetail level adjudication results
...... adjudication 0..* See adjudication (ClaimResponse) Added items subdetail adjudication
... adjudication 0..* See 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
Binding: 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
Binding: 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
Binding: 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
Binding: FundsReservationCodes (example): For whom funds are to be reserved: (Patient, Provider, None).
... formCode 0..1 CodeableConcept Printed form identifier
Binding: 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
Binding: NoteType (extensible): The presentation types of notes.
.... text 1..1 string Note explanatory text
.... language 0..1 CodeableConcept Language of the text
Binding: AllLanguages (required): IETF language tag for a human language
Additional BindingsPurpose
CommonLanguages Starter
... 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
Binding: AdjudicationErrorCodes (example): The adjudication error codes.
.... expression Σ 0..* string FHIRPath of element(s) related to issue

doco Documentation for this format

Terminology Bindings

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

Constraints

Id Grade Path(s) Description Expression

Asosiy elementlar ko'rinishi

NameFlagsCard.TypeDescription & Constraints    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
... Slices for extension 0..* Extension Extension
Slice: Unordered, Open by 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
Binding: 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
Binding: FMStatusVS (0.7.0) (required)
... type SΣ 1..1 CodeableConcept Category or discipline of the claim
Binding: ClaimTypeVS (0.7.0) (required)
... use SΣ 1..1 code Purpose of the claim response
Binding: 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
Binding: ClaimResponseOutcomeVS (0.7.0) (required)
... decision SΣ 0..1 CodeableConcept Adjudication decision
Binding: 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
Binding: ClaimResponseCategoryVS (0.7.0) (required)
.... amount Σ 1..1 Money Total amount for the category

doco Documentation for this format

Terminology Bindings

Path Status Usage ValueSet Version Source
ClaimResponse.status Base required Financial Management Status Value set 📍0.7.0 This IG
ClaimResponse.type Base required Claim Type VS 📍0.7.0 This IG
ClaimResponse.use Base required Claim Use Value set 📍0.7.0 This IG
ClaimResponse.outcome Base required Claim Response Outcome VS 📍0.7.0 This IG
ClaimResponse.decision Base required Claim Response Decision VS 📍0.7.0 This IG
ClaimResponse.total.​category Base required Claim Response Category VS 📍0.7.0 This IG

Constraints

Id Grade Path(s) Description Expression

Differensial ko‘rinish

NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
.. ClaimResponse 0..* ClaimResponse(5.0.0) Response to a claim predetermination or preauthorization
... Slices for extension 0..* Extension Extension
Slice: Unordered, Open by value:url
.... extension:cancellationReason S 0..1 CodeableConcept Reason for cancellation
URL: https://dhp.uz/fhir/core/StructureDefinition/claim-response-cancellation-reason
Binding: 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
Binding: FMStatusVS (0.7.0) (required)
... use S 1..1 code Purpose of the claim response
Binding: 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
Binding: ClaimResponseOutcomeVS (0.7.0) (required)
... decision S 0..1 CodeableConcept Adjudication decision
Binding: 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
Binding: ClaimResponseCategoryVS (0.7.0) (required)
.... amount 1..1 Money Total amount for the category

doco Documentation for this format

Terminology Bindings (Differential)

Path Status Usage ValueSet Version Source
ClaimResponse.status Base required Financial Management Status Value set 📍0.7.0 This IG
ClaimResponse.type Base required Claim Type VS 📍0.7.0 This IG
ClaimResponse.use Base required Claim Use Value set 📍0.7.0 This IG
ClaimResponse.outcome Base required Claim Response Outcome VS 📍0.7.0 This IG
ClaimResponse.decision Base required Claim Response Decision VS 📍0.7.0 This IG
ClaimResponse.total.​category Base required Claim Response Category VS 📍0.7.0 This IG

Snapshot ko‘rinishiView

NameFlagsCard.TypeDescription & Constraints    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
Binding: AllLanguages (required): IETF language tag for a human language
Additional BindingsPurpose
CommonLanguages Starter
... 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
... Slices for extension 0..* Extension Extension
Slice: Unordered, Open by 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
Binding: 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
Binding: FMStatusVS (0.7.0) (required)
... type SΣ 1..1 CodeableConcept Category or discipline of the claim
Binding: ClaimTypeVS (0.7.0) (required)
... subType 0..1 CodeableConcept More granular claim type
Binding: ExampleClaimSubTypeCodes (example): A more granular claim typecode.
... use SΣ 1..1 code Purpose of the claim response
Binding: 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
Binding: ClaimResponseOutcomeVS (0.7.0) (required)
... decision SΣ 0..1 CodeableConcept Adjudication decision
Binding: 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
Slice: Unordered, Open by 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
Binding: 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
Binding: 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
Binding: 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
Binding: ClaimAdjudicationDecisionsCodes (example)
..... reason 0..* CodeableConcept Reason for result of the adjudication
Binding: 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
Binding: AdjudicationValueCodes (example): The adjudication codes.
..... reason 0..1 CodeableConcept Explanation of adjudication outcome
Binding: 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 See reviewOutcome (ClaimResponse) Detail level adjudication results
..... adjudication 0..* See 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 See reviewOutcome (ClaimResponse) Subdetail level adjudication results
...... adjudication 0..* See 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
Binding: 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
Binding: USCLSCodes (example): Allowable service and product codes.
.... productOrServiceEnd 0..1 CodeableConcept End of a range of codes
Binding: USCLSCodes (example)
.... request 0..* Reference(DeviceRequest | MedicationRequest | NutritionOrder | ServiceRequest | SupplyRequest | VisionPrescription) Request or Referral for Service
.... modifier 0..* CodeableConcept Service/Product billing modifiers
Binding: 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
Binding: 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
Binding: 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
Binding: OralSiteCodes (example)
..... subSite 0..* CodeableConcept Sub-location
Binding: SurfaceCodes (example)
.... noteNumber 0..* positiveInt Applicable note numbers
.... reviewOutcome 0..1 See reviewOutcome (ClaimResponse) Added items adjudication results
.... adjudication 0..* See 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
Binding: 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
Binding: USCLSCodes (example): Allowable service and product codes.
..... productOrServiceEnd 0..1 CodeableConcept End of a range of codes
Binding: USCLSCodes (example)
..... modifier 0..* CodeableConcept Service/Product billing modifiers
Binding: 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 See reviewOutcome (ClaimResponse) Added items detail level adjudication results
..... adjudication 0..* See 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
Binding: 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
Binding: USCLSCodes (example): Allowable service and product codes.
...... productOrServiceEnd 0..1 CodeableConcept End of a range of codes
Binding: USCLSCodes (example)
...... modifier 0..* CodeableConcept Service/Product billing modifiers
Binding: 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 See reviewOutcome (ClaimResponse) Added items subdetail level adjudication results
...... adjudication 0..* See adjudication (ClaimResponse) Added items subdetail adjudication
... adjudication 0..* See 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
Binding: 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
Binding: 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
Binding: 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
Binding: FundsReservationCodes (example): For whom funds are to be reserved: (Patient, Provider, None).
... formCode 0..1 CodeableConcept Printed form identifier
Binding: 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
Binding: NoteType (extensible): The presentation types of notes.
.... text 1..1 string Note explanatory text
.... language 0..1 CodeableConcept Language of the text
Binding: AllLanguages (required): IETF language tag for a human language
Additional BindingsPurpose
CommonLanguages Starter
... 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
Binding: AdjudicationErrorCodes (example): The adjudication error codes.
.... expression Σ 0..* string FHIRPath of element(s) related to issue

doco Documentation for this format

Terminology Bindings

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

Constraints

Id Grade Path(s) Description Expression

 

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