Moderne Patient:innenabrechnung und Datenkommunikation on FHIR (MOPED)
0.1.0 - ci-build
Moderne Patient:innenabrechnung und Datenkommunikation on FHIR (MOPED) - Local Development build (v0.1.0) built by the FHIR (HL7® FHIR® Standard) Build Tools. See the Directory of published versions
Draft as of 2024-11-04 |
Definitions for the MOPEDClaimResponse resource profile.
Guidance on how to interpret the contents of this table can be found here
Guidance on how to interpret the contents of this table can be found here
0. ClaimResponse | |
Definition | This resource provides the adjudication details from the processing of a Claim resource. |
Short | Response to a claim predetermination or preauthorization |
Control | 0..* |
Is Modifier | false |
Must Support | false |
Summary | false |
Alternate Names | Remittance Advice |
Invariants | dom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources (contained.contained.empty()) dom-3: If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource (contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().ofType(canonical) | %resource.descendants().ofType(uri) | %resource.descendants().ofType(url))) or descendants().where(reference = '#').exists() or descendants().where(ofType(canonical) = '#').exists() or descendants().where(ofType(canonical) = '#').exists()).not()).trace('unmatched', id).empty()) dom-4: If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated (contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()) dom-5: If a resource is contained in another resource, it SHALL NOT have a security label (contained.meta.security.empty()) dom-6: A resource should have narrative for robust management (text.`div`.exists()) |
2. ClaimResponse.implicitRules | |
Definition | A reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content. Often, this is a reference to an implementation guide that defines the special rules along with other profiles etc. |
Short | A set of rules under which this content was created |
Comments | Asserting this rule set restricts the content to be only understood by a limited set of trading partners. This inherently limits the usefulness of the data in the long term. However, the existing health eco-system is highly fractured, and not yet ready to define, collect, and exchange data in a generally computable sense. Wherever possible, implementers and/or specification writers should avoid using this element. Often, when used, the URL is a reference to an implementation guide that defines these special rules as part of its narrative along with other profiles, value sets, etc. |
Control | 0..1 |
Type | uri |
Is Modifier | true because This element is labeled as a modifier because the implicit rules may provide additional knowledge about the resource that modifies its meaning or interpretation |
Primitive Value | This primitive element may be present, or absent, or replaced by an extension |
Must Support | false |
Summary | true |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) |
4. ClaimResponse.contained | |
Definition | These resources do not have an independent existence apart from the resource that contains them - they cannot be identified independently, nor can they have their own independent transaction scope. This is allowed to be a Parameters resource if and only if it is referenced by a resource that provides context/meaning. |
Short | Contained, inline Resources |
Comments | This should never be done when the content can be identified properly, as once identification is lost, it is extremely difficult (and context dependent) to restore it again. Contained resources may have profiles and tags in their meta elements, but SHALL NOT have security labels. |
Control | 0..* This element is affected by the following invariants: dom-2, dom-4, dom-3, dom-5 |
Type | Resource |
Is Modifier | false |
Must Support | false |
Summary | false |
Alternate Names | inline resources, anonymous resources, contained resources |
6. ClaimResponse.extension | |
Definition | An Extension May be used to represent additional information that is not part of the basic definition of the resource. To make the use of extensions safe and managable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. |
Short | ExtensionAdditional content defined by implementations |
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. |
Control | 0..* |
Type | Extension |
Is Modifier | false |
Must Support | false |
Summary | false |
Alternate Names | extensions, user content |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists()) |
Slicing | This element introduces a set of slices on ClaimResponse.extension . The slices areUnordered and Open, and can be differentiated using the following discriminators: |
8. ClaimResponse.extension:fehlerWarnung | |
Slice Name | fehlerWarnung |
Definition | MOPED Extension für akzeptierte Errors und Warnings |
Short | Error/Warning |
Control | 0..* |
Type | Extension(Error/Warning) (Complex Extension) |
Is Modifier | false |
Must Support | false |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) )ext-1: Must have either extensions or value[x], not both ( extension.exists() != value.exists() ) |
10. ClaimResponse.extension:diagnoseKnoten | |
Slice Name | diagnoseKnoten |
Definition | "Abrechnung - Knoten:" Lukriert die Patient:innen über eine reguläre Gruppe Punkte, so ist in diesem Datenfeld die entsprechende Knotenbezeichnung einzutragen. |
Short | "Abrechnung - Knoten:" Lukriert die Patient:innen über eine reguläre Gruppe Punkte, so ist in diesem Datenfeld die entsprechende Knotenbezeichnung einzutragen. |
Control | 0..1 |
Type | Extension(Abrechnung - Knoten) (Extension Type: Coding) |
Is Modifier | false |
Must Support | false |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists()) |
12. ClaimResponse.extension:lkfPunkte | |
Slice Name | lkfPunkte |
Definition | In dieser Extension werden alle möglichen Punkteangaben im LKF zusammengefasst. |
Short | LKF Punkte |
Control | 0..* |
Type | Extension(LKF Punkte) (Complex Extension) |
Is Modifier | false |
Must Support | false |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) )ext-1: Must have either extensions or value[x], not both ( extension.exists() != value.exists() ) |
14. ClaimResponse.extension:ldfPunktewertNetto | |
Slice Name | ldfPunktewertNetto |
Definition | MOPED Extension für den LDF-Punktewert Netto |
Short | LDF-Punktewert Netto |
Control | 0..1 |
Type | Extension(LDF-Punktewert Netto) (Extension Type: Choice of: base64Binary, boolean, canonical, code, date, dateTime, decimal, id, instant, integer, integer64, markdown, oid, positiveInt, string, time, unsignedInt, uri, url, uuid, Address, Age, Annotation, Attachment, CodeableConcept, CodeableReference, Coding, ContactPoint, Count, Distance, Duration, HumanName, Identifier, Money, Period, Quantity, Range, Ratio, RatioRange, Reference, SampledData, Signature, Timing, ContactDetail, DataRequirement, Expression, ParameterDefinition, RelatedArtifact, TriggerDefinition, UsageContext, Availability, ExtendedContactDetail, Dosage, Meta) |
Is Modifier | false |
Must Support | false |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists()) |
16. ClaimResponse.extension:ldfBetragNetto | |
Slice Name | ldfBetragNetto |
Definition | MOPED Extension für den LDF-Punktewert Netto. Ergibt sich durch Punkteanzahl mal Punktewert Forderungsbasis ohne Berücksichtigung eines Patientenanteiles f. Angehörige bzw. eines Beihilfenäquivalentes |
Short | LDF-Betrag Netto |
Control | 0..1 |
Type | Extension(LDF-Betrag Netto) (Extension Type: Choice of: base64Binary, boolean, canonical, code, date, dateTime, decimal, id, instant, integer, integer64, markdown, oid, positiveInt, string, time, unsignedInt, uri, url, uuid, Address, Age, Annotation, Attachment, CodeableConcept, CodeableReference, Coding, ContactPoint, Count, Distance, Duration, HumanName, Identifier, Money, Period, Quantity, Range, Ratio, RatioRange, Reference, SampledData, Signature, Timing, ContactDetail, DataRequirement, Expression, ParameterDefinition, RelatedArtifact, TriggerDefinition, UsageContext, Availability, ExtendedContactDetail, Dosage, Meta) |
Is Modifier | false |
Must Support | false |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists()) |
18. ClaimResponse.extension:patientenanteilAngehoerige | |
Slice Name | patientenanteilAngehoerige |
Definition | MOPED Extension für den Patientenanteil für Angehörige (tägl. Satz) netto: Betrag in €, 2 Nachkommastellen |
Short | Patientenanteil für Angehoerige |
Control | 0..1 |
Type | Extension(Patientenanteil für Angehoerige) (Extension Type: Choice of: base64Binary, boolean, canonical, code, date, dateTime, decimal, id, instant, integer, integer64, markdown, oid, positiveInt, string, time, unsignedInt, uri, url, uuid, Address, Age, Annotation, Attachment, CodeableConcept, CodeableReference, Coding, ContactPoint, Count, Distance, Duration, HumanName, Identifier, Money, Period, Quantity, Range, Ratio, RatioRange, Reference, SampledData, Signature, Timing, ContactDetail, DataRequirement, Expression, ParameterDefinition, RelatedArtifact, TriggerDefinition, UsageContext, Availability, ExtendedContactDetail, Dosage, Meta) |
Is Modifier | false |
Must Support | false |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists()) |
20. ClaimResponse.extension:patientenanteil | |
Slice Name | patientenanteil |
Definition | MOPED Extension für den Patientenanteil netto: Betrag in €, 2 Nachkommastellen |
Short | Patientenanteil Netto |
Control | 0..1 |
Type | Extension(Patientenanteil Netto) (Extension Type: Choice of: base64Binary, boolean, canonical, code, date, dateTime, decimal, id, instant, integer, integer64, markdown, oid, positiveInt, string, time, unsignedInt, uri, url, uuid, Address, Age, Annotation, Attachment, CodeableConcept, CodeableReference, Coding, ContactPoint, Count, Distance, Duration, HumanName, Identifier, Money, Period, Quantity, Range, Ratio, RatioRange, Reference, SampledData, Signature, Timing, ContactDetail, DataRequirement, Expression, ParameterDefinition, RelatedArtifact, TriggerDefinition, UsageContext, Availability, ExtendedContactDetail, Dosage, Meta) |
Is Modifier | false |
Must Support | false |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists()) |
22. ClaimResponse.extension:beihilfenaequivalent | |
Slice Name | beihilfenaequivalent |
Definition | MOPED Extension für das Beihilfenaequivalent |
Short | Beihilfenaequivalent |
Control | 0..1 |
Type | Extension(Beihilfenaequivalent) (Extension Type: Choice of: base64Binary, boolean, canonical, code, date, dateTime, decimal, id, instant, integer, integer64, markdown, oid, positiveInt, string, time, unsignedInt, uri, url, uuid, Address, Age, Annotation, Attachment, CodeableConcept, CodeableReference, Coding, ContactPoint, Count, Distance, Duration, HumanName, Identifier, Money, Period, Quantity, Range, Ratio, RatioRange, Reference, SampledData, Signature, Timing, ContactDetail, DataRequirement, Expression, ParameterDefinition, RelatedArtifact, TriggerDefinition, UsageContext, Availability, ExtendedContactDetail, Dosage, Meta) |
Is Modifier | false |
Must Support | false |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists()) |
24. ClaimResponse.extension:forderungsbetragAuslaenderverrechnungRegress | |
Slice Name | forderungsbetragAuslaenderverrechnungRegress |
Definition | MOPED Extension für den Forderungsbetrag für Ausländerverrechnung oder Regress |
Short | Forderungsbetrag für Auslaenderverrechnung oder Regress |
Control | 0..1 |
Type | Extension(Forderungsbetrag für Auslaenderverrechnung oder Regress) (Extension Type: Choice of: base64Binary, boolean, canonical, code, date, dateTime, decimal, id, instant, integer, integer64, markdown, oid, positiveInt, string, time, unsignedInt, uri, url, uuid, Address, Age, Annotation, Attachment, CodeableConcept, CodeableReference, Coding, ContactPoint, Count, Distance, Duration, HumanName, Identifier, Money, Period, Quantity, Range, Ratio, RatioRange, Reference, SampledData, Signature, Timing, ContactDetail, DataRequirement, Expression, ParameterDefinition, RelatedArtifact, TriggerDefinition, UsageContext, Availability, ExtendedContactDetail, Dosage, Meta) |
Is Modifier | false |
Must Support | false |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists()) |
26. ClaimResponse.extension:rechnungsnummerKHLGF | |
Slice Name | rechnungsnummerKHLGF |
Definition | MOPED Extension für die Rechnungsnummer der Krankenanstalt bzw. des Landesgesundheitsfonds |
Short | Rechnungsnummer der Krankenanstalt bzw. des Landesgesundheitsfonds |
Control | 0..1 |
Type | Extension(Rechnungsnummer der Krankenanstalt bzw. des Landesgesundheitsfonds) (Extension Type: Choice of: base64Binary, boolean, canonical, code, date, dateTime, decimal, id, instant, integer, integer64, markdown, oid, positiveInt, string, time, unsignedInt, uri, url, uuid, Address, Age, Annotation, Attachment, CodeableConcept, CodeableReference, Coding, ContactPoint, Count, Distance, Duration, HumanName, Identifier, Money, Period, Quantity, Range, Ratio, RatioRange, Reference, SampledData, Signature, Timing, ContactDetail, DataRequirement, Expression, ParameterDefinition, RelatedArtifact, TriggerDefinition, UsageContext, Availability, ExtendedContactDetail, Dosage, Meta) |
Is Modifier | false |
Must Support | false |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists()) |
28. ClaimResponse.extension:note | |
Slice Name | note |
Definition | Additional notes that apply to this resource or element. |
Short | A recorded sex or gender property for the individual |
Comments | This extension SHALL NOT be used if the resource already has standard 'note' element (or equivalent) of type Annotation on the same element |
Control | 0..* |
Type | Extension(Note) (Extension Type: Annotation) |
Is Modifier | false |
Must Support | false |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists()) |
30. ClaimResponse.extension:sonderleistungsnummer | |
Slice Name | sonderleistungsnummer |
Definition | MOPED Extension für die Sonderleistungsnummer |
Short | Sonderleistungsnummer |
Control | 0..1 |
Type | Extension(Sonderleistungsnummer) (Extension Type: Coding) |
Is Modifier | false |
Must Support | false |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists()) |
32. ClaimResponse.extension:anzahlSonderleistungen | |
Slice Name | anzahlSonderleistungen |
Definition | MOPED Extension für die Anzahl der Sonderleistungen |
Short | Anzahl Sonderleistungen |
Control | 0..1 |
Type | Extension(Anzahl Sonderleistungen) (Extension Type: Choice of: base64Binary, boolean, canonical, code, date, dateTime, decimal, id, instant, integer, integer64, markdown, oid, positiveInt, string, time, unsignedInt, uri, url, uuid, Address, Age, Annotation, Attachment, CodeableConcept, CodeableReference, Coding, ContactPoint, Count, Distance, Duration, HumanName, Identifier, Money, Period, Quantity, Range, Ratio, RatioRange, Reference, SampledData, Signature, Timing, ContactDetail, DataRequirement, Expression, ParameterDefinition, RelatedArtifact, TriggerDefinition, UsageContext, Availability, ExtendedContactDetail, Dosage, Meta) |
Is Modifier | false |
Must Support | false |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists()) |
34. ClaimResponse.extension:punkteLDFPauschale | |
Slice Name | punkteLDFPauschale |
Definition | MOPED Extension für die LDF Punkte Pauschale |
Short | Punkte LDF Pauschale |
Control | 0..1 |
Type | Extension(Punkte LDF Pauschale) (Extension Type: Choice of: base64Binary, boolean, canonical, code, date, dateTime, decimal, id, instant, integer, integer64, markdown, oid, positiveInt, string, time, unsignedInt, uri, url, uuid, Address, Age, Annotation, Attachment, CodeableConcept, CodeableReference, Coding, ContactPoint, Count, Distance, Duration, HumanName, Identifier, Money, Period, Quantity, Range, Ratio, RatioRange, Reference, SampledData, Signature, Timing, ContactDetail, DataRequirement, Expression, ParameterDefinition, RelatedArtifact, TriggerDefinition, UsageContext, Availability, ExtendedContactDetail, Dosage, Meta) |
Is Modifier | false |
Must Support | false |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists()) |
36. ClaimResponse.extension:konstenmeldungARK | |
Slice Name | konstenmeldungARK |
Definition | MOPED Extension für die Kostenmeldung. Konstenmeldung für A = Ausländerverrechnung, R = Regressangelegenheiten oder K = Kosteninformation |
Short | Kostenmeldung für (A/R/K) |
Control | 0..1 |
Type | Extension(Kostenmeldung für (A/R/K)) (Extension Type: Coding) |
Is Modifier | false |
Must Support | false |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists()) |
38. ClaimResponse.modifierExtension | |
Definition | May be used to represent additional information that is not part of the basic definition of the resource and that modifies the understanding of the element that contains it and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and managable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). |
Short | Extensions that cannot be ignored |
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. |
Control | 0..* |
Type | Extension |
Is Modifier | true because Modifier extensions are expected to modify the meaning or interpretation of the resource that contains them |
Must Support | false |
Summary | true |
Requirements | Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions. |
Alternate Names | extensions, user content |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists()) |
40. ClaimResponse.status | |
Definition | The status of the resource instance. |
Short | active | cancelled | draft | entered-in-error |
Comments | This element is labeled as a modifier because the status contains codes that mark the resource as not currently valid. |
Control | 1..1 |
Binding | The codes SHALL be taken from FinancialResourceStatusCodeshttp://hl7.org/fhir/ValueSet/fm-status|5.0.0 (required to http://hl7.org/fhir/ValueSet/fm-status|5.0.0 )A code specifying the state of the resource instance. |
Type | code |
Is Modifier | true because This element is labeled as a modifier because it is a status element that contains status entered-in-error which means that the resource should not be treated as valid |
Primitive Value | This primitive element may be present, or absent, or replaced by an extension |
Must Support | false |
Summary | true |
Requirements | Need to track the status of the resource as 'draft' resources may undergo further edits while 'active' resources are immutable and may only have their status changed to 'cancelled'. |
Pattern Value | active |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) |
42. ClaimResponse.type | |
Definition | A finer grained suite of claim type codes which may convey additional information such as Inpatient vs Outpatient and/or a specialty service. |
Short | More granular claim type |
Comments | This may contain the local bill type codes, for example the US UB-04 bill type code or the CMS bill type. |
Control | 1..1 |
Binding | Unless not suitable, these codes SHALL be taken from ClaimTypeCodeshttp://hl7.org/fhir/ValueSet/claim-type (extensible to http://hl7.org/fhir/ValueSet/claim-type )The type or discipline-style of the claim. |
Type | CodeableConcept |
Is Modifier | false |
Must Support | false |
Summary | true |
Requirements | Some jurisdictions need a finer grained claim type for routing and adjudication. |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) |
44. ClaimResponse.use | |
Definition | A code to indicate whether the nature of the request is: Claim - A request to an Insurer to adjudicate the supplied charges for health care goods and services under the identified policy and to pay the determined Benefit amount, if any; Preauthorization - A request to an Insurer to adjudicate the supplied proposed future charges for health care goods and services under the identified policy and to approve the services and provide the expected benefit amounts and potentially to reserve funds to pay the benefits when Claims for the indicated services are later submitted; or, Pre-determination - A request to an Insurer to adjudicate the supplied 'what if' charges for health care goods and services under the identified policy and report back what the Benefit payable would be had the services actually been provided. |
Short | claim | preauthorization | predetermination |
Control | 1..1 |
Binding | The codes SHALL be taken from Usehttp://hl7.org/fhir/ValueSet/claim-use|5.0.0 (required to http://hl7.org/fhir/ValueSet/claim-use|5.0.0 )Claim, preauthorization, predetermination. |
Type | code |
Is Modifier | false |
Primitive Value | This primitive element may be present, or absent, or replaced by an extension |
Must Support | false |
Summary | true |
Requirements | This element is required to understand the nature of the request for adjudication. |
Pattern Value | claim |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) |
46. ClaimResponse.patient | |
Definition | The party to whom the professional services and/or products have been supplied or are being considered and for whom actual for facast reimbursement is sought. |
Short | The recipient of the products and services |
Control | 1..1 |
Type | Reference(HL7® AT Core Patient Profile, Patient) |
Is Modifier | false |
Must Support | false |
Summary | true |
Requirements | The patient must be supplied to the insurer so that confirmation of coverage and service hstory may be considered as part of the authorization and/or adjudiction. |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) |
48. ClaimResponse.created | |
Definition | The date this resource was created. |
Short | Response creation date |
Control | 1..1 |
Type | dateTime |
Is Modifier | false |
Primitive Value | This primitive element may be present, or absent, or replaced by an extension |
Must Support | false |
Summary | true |
Requirements | Need to record a timestamp for use by both the recipient and the issuer. |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) |
50. ClaimResponse.insurer | |
Definition | The party responsible for authorization, adjudication and reimbursement. |
Short | Party responsible for reimbursement |
Control | 10..1 |
Type | Reference(HL7® AT Core Organization Profile, Organization) |
Is Modifier | false |
Must Support | false |
Summary | true |
Requirements | To be a valid claim, preauthorization or predetermination there must be a party who is responsible for adjudicating the contents against a policy which provides benefits for the patient. |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) |
52. ClaimResponse.requestor | |
Definition | The provider which is responsible for the claim, predetermination or preauthorization. |
Short | Party responsible for the claim |
Comments | Typically this field would be 1..1 where this party is accountable for the data content within the claim but is not necessarily the facility, provider group or practitioner who provided the products and services listed within this claim resource. This field is the Billing Provider, for example, a facility, provider group, lab or practitioner.. |
Control | 10..1 |
Type | Reference(HL7® AT Core Organization Profile, Practitioner, PractitionerRole, Organization) |
Is Modifier | false |
Must Support | false |
Summary | false |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) |
54. ClaimResponse.request | |
Definition | Original request resource reference. |
Short | Id of resource triggering adjudication |
Control | 10..1 |
Type | Reference(MOPEDClaim, Claim) |
Is Modifier | false |
Must Support | false |
Summary | true |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) |
56. ClaimResponse.outcome | |
Definition | The outcome of the claim, predetermination, or preauthorization processing. |
Short | queued | complete | error | partial |
Comments | The resource may be used to indicate that the Claim/Preauthorization/Pre-determination has been received but processing has not begun (queued); that it has been processed and one or more errors have been detected (error); no errors were detected and some of the adjudication processing has been performed (partial); or all of the adjudication processing has completed without errors (complete). |
Control | 1..1 |
Binding | The codes SHALL be taken from ClaimProcessingCodeshttp://hl7.org/fhir/ValueSet/claim-outcome|5.0.0 (required to http://hl7.org/fhir/ValueSet/claim-outcome|5.0.0 )The result of the claim processing. |
Type | code |
Is Modifier | false |
Primitive Value | This primitive element may be present, or absent, or replaced by an extension |
Must Support | false |
Summary | true |
Requirements | To advise the requestor of an overall processing outcome. |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) |
58. ClaimResponse.diagnosisRelatedGroup | |
Definition | A package billing code or bundle code used to group products and services to a particular health condition (such as heart attack) which is based on a predetermined grouping code system. |
Short | "Abrechnung - Gruppe:" Dieses Datenfeld ist mit der Codenummer der zutreffenden Abrechnungsgruppe zu befüllen. Bei Datensätzen von stationären Krankenhausaufenthalten, die keiner leistungsorientier- ten Diagnosenfallgruppe zugeordnet werden, erfolgt ein Eintrag entsprechend der jeweiligen Aufnahmeart.Package billing code |
Comments | For example DRG (Diagnosis Related Group) or a bundled billing code. A patient may have a diagnosis of a Myocardial Infarction and a DRG for HeartAttack would be assigned. The Claim item (and possible subsequent claims) would refer to the DRG for those line items that were for services related to the heart attack event. |
Control | 0..1 |
Binding | The codes SHALL be taken from For example codes, see http://tbd.at/MOPED-LKFAbrechnungsGruppehttp://hl7.org/fhir/ValueSet/ex-diagnosisrelatedgroup (required to http://tbd.at/MOPED-LKFAbrechnungsGruppe ) |
Type | CodeableConcept |
Is Modifier | false |
Must Support | false |
Summary | false |
Requirements | Required to relate the current diagnosis to a package billing code that is then referenced on the individual claim items which are specific to the health condition covered by the package code. |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) |
Guidance on how to interpret the contents of this table can be found here
0. ClaimResponse | |
Definition | This resource provides the adjudication details from the processing of a Claim resource. |
Short | Response to a claim predetermination or preauthorization |
Control | 0..* |
Is Modifier | false |
Must Support | false |
Summary | false |
Alternate Names | Remittance Advice |
Invariants | dom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources (contained.contained.empty() )dom-3: If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource ( contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().ofType(canonical) | %resource.descendants().ofType(uri) | %resource.descendants().ofType(url))) or descendants().where(reference = '#').exists() or descendants().where(ofType(canonical) = '#').exists() or descendants().where(ofType(canonical) = '#').exists()).not()).trace('unmatched', id).empty() )dom-4: If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated ( contained.meta.versionId.empty() and contained.meta.lastUpdated.empty() )dom-5: If a resource is contained in another resource, it SHALL NOT have a security label ( contained.meta.security.empty() )dom-6: A resource should have narrative for robust management ( text.`div`.exists() ) |
2. ClaimResponse.id | |
Definition | The logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes. |
Short | Logical id of this artifact |
Comments | Within the context of the FHIR RESTful interactions, the resource has an id except for cases like the create and conditional update. Otherwise, the use of the resouce id depends on the given use case. |
Control | 0..1 |
Type | id |
Is Modifier | false |
Must Support | false |
Summary | true |
4. ClaimResponse.meta | |
Definition | The metadata about the resource. This is content that is maintained by the infrastructure. Changes to the content might not always be associated with version changes to the resource. |
Short | Metadata about the resource |
Control | 0..1 |
Type | Meta |
Is Modifier | false |
Must Support | false |
Summary | true |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) |
6. ClaimResponse.implicitRules | |
Definition | A reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content. Often, this is a reference to an implementation guide that defines the special rules along with other profiles etc. |
Short | A set of rules under which this content was created |
Comments | Asserting this rule set restricts the content to be only understood by a limited set of trading partners. This inherently limits the usefulness of the data in the long term. However, the existing health eco-system is highly fractured, and not yet ready to define, collect, and exchange data in a generally computable sense. Wherever possible, implementers and/or specification writers should avoid using this element. Often, when used, the URL is a reference to an implementation guide that defines these special rules as part of its narrative along with other profiles, value sets, etc. |
Control | 0..1 |
Type | uri |
Is Modifier | true because This element is labeled as a modifier because the implicit rules may provide additional knowledge about the resource that modifies its meaning or interpretation |
Primitive Value | This primitive element may be present, or absent, or replaced by an extension |
Must Support | false |
Summary | true |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) |
8. ClaimResponse.language | |
Definition | The base language in which the resource is written. |
Short | Language of the resource content |
Comments | Language is provided to support indexing and accessibility (typically, services such as text to speech use the language tag). The html language tag in the narrative applies to the narrative. The language tag on the resource may be used to specify the language of other presentations generated from the data in the resource. Not all the content has to be in the base language. The Resource.language should not be assumed to apply to the narrative automatically. If a language is specified, it should it also be specified on the div element in the html (see rules in HTML5 for information about the relationship between xml:lang and the html lang attribute). |
Control | 0..1 |
Binding | The codes SHALL be taken from AllLanguages (required to http://hl7.org/fhir/ValueSet/all-languages|5.0.0 )IETF language tag for a human language |
Type | code |
Is Modifier | false |
Primitive Value | This primitive element may be present, or absent, or replaced by an extension |
Must Support | false |
Summary | false |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) |
10. ClaimResponse.text | |
Definition | A human-readable narrative that contains a summary of the resource and can be used to represent the content of the resource to a human. The narrative need not encode all the structured data, but is required to contain sufficient detail to make it "clinically safe" for a human to just read the narrative. Resource definitions may define what content should be represented in the narrative to ensure clinical safety. |
Short | Text summary of the resource, for human interpretation |
Comments | Contained resources do not have a narrative. Resources that are not contained SHOULD have a narrative. In some cases, a resource may only have text with little or no additional discrete data (as long as all minOccurs=1 elements are satisfied). This may be necessary for data from legacy systems where information is captured as a "text blob" or where text is additionally entered raw or narrated and encoded information is added later. |
Control | 0..1 This element is affected by the following invariants: dom-6 |
Type | Narrative |
Is Modifier | false |
Must Support | false |
Summary | false |
Alternate Names | narrative, html, xhtml, display |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) |
12. ClaimResponse.contained | |
Definition | These resources do not have an independent existence apart from the resource that contains them - they cannot be identified independently, nor can they have their own independent transaction scope. This is allowed to be a Parameters resource if and only if it is referenced by a resource that provides context/meaning. |
Short | Contained, inline Resources |
Comments | This should never be done when the content can be identified properly, as once identification is lost, it is extremely difficult (and context dependent) to restore it again. Contained resources may have profiles and tags in their meta elements, but SHALL NOT have security labels. |
Control | 0..* This element is affected by the following invariants: dom-2, dom-4, dom-3, dom-5 |
Type | Resource |
Is Modifier | false |
Must Support | false |
Summary | false |
Alternate Names | inline resources, anonymous resources, contained resources |
14. ClaimResponse.extension | |
Definition | An Extension |
Short | Extension |
Control | 0..* |
Type | Extension |
Is Modifier | false |
Must Support | false |
Summary | false |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) )ext-1: Must have either extensions or value[x], not both ( extension.exists() != value.exists() ) |
Slicing | This element introduces a set of slices on ClaimResponse.extension . The slices areUnordered and Open, and can be differentiated using the following discriminators: |
16. ClaimResponse.extension:fehlerWarnung | |
Slice Name | fehlerWarnung |
Definition | MOPED Extension für akzeptierte Errors und Warnings |
Short | Error/Warning |
Control | 0..* |
Type | Extension(Error/Warning) (Complex Extension) |
Is Modifier | false |
Must Support | false |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) )ext-1: Must have either extensions or value[x], not both ( extension.exists() != value.exists() ) |
18. ClaimResponse.extension:diagnoseKnoten | |
Slice Name | diagnoseKnoten |
Definition | "Abrechnung - Knoten:" Lukriert die Patient:innen über eine reguläre Gruppe Punkte, so ist in diesem Datenfeld die entsprechende Knotenbezeichnung einzutragen. |
Short | "Abrechnung - Knoten:" Lukriert die Patient:innen über eine reguläre Gruppe Punkte, so ist in diesem Datenfeld die entsprechende Knotenbezeichnung einzutragen. |
Control | 0..1 |
Type | Extension(Abrechnung - Knoten) (Extension Type: Coding) |
Is Modifier | false |
Must Support | false |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) )ext-1: Must have either extensions or value[x], not both ( extension.exists() != value.exists() ) |
20. ClaimResponse.extension:lkfPunkte | |
Slice Name | lkfPunkte |
Definition | In dieser Extension werden alle möglichen Punkteangaben im LKF zusammengefasst. |
Short | LKF Punkte |
Control | 0..* |
Type | Extension(LKF Punkte) (Complex Extension) |
Is Modifier | false |
Must Support | false |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) )ext-1: Must have either extensions or value[x], not both ( extension.exists() != value.exists() ) |
22. ClaimResponse.extension:ldfPunktewertNetto | |
Slice Name | ldfPunktewertNetto |
Definition | MOPED Extension für den LDF-Punktewert Netto |
Short | LDF-Punktewert Netto |
Control | 0..1 |
Type | Extension(LDF-Punktewert Netto) (Extension Type: Choice of: base64Binary, boolean, canonical, code, date, dateTime, decimal, id, instant, integer, integer64, markdown, oid, positiveInt, string, time, unsignedInt, uri, url, uuid, Address, Age, Annotation, Attachment, CodeableConcept, CodeableReference, Coding, ContactPoint, Count, Distance, Duration, HumanName, Identifier, Money, Period, Quantity, Range, Ratio, RatioRange, Reference, SampledData, Signature, Timing, ContactDetail, DataRequirement, Expression, ParameterDefinition, RelatedArtifact, TriggerDefinition, UsageContext, Availability, ExtendedContactDetail, Dosage, Meta) |
Is Modifier | false |
Must Support | false |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) )ext-1: Must have either extensions or value[x], not both ( extension.exists() != value.exists() ) |
24. ClaimResponse.extension:ldfBetragNetto | |
Slice Name | ldfBetragNetto |
Definition | MOPED Extension für den LDF-Punktewert Netto. Ergibt sich durch Punkteanzahl mal Punktewert Forderungsbasis ohne Berücksichtigung eines Patientenanteiles f. Angehörige bzw. eines Beihilfenäquivalentes |
Short | LDF-Betrag Netto |
Control | 0..1 |
Type | Extension(LDF-Betrag Netto) (Extension Type: Choice of: base64Binary, boolean, canonical, code, date, dateTime, decimal, id, instant, integer, integer64, markdown, oid, positiveInt, string, time, unsignedInt, uri, url, uuid, Address, Age, Annotation, Attachment, CodeableConcept, CodeableReference, Coding, ContactPoint, Count, Distance, Duration, HumanName, Identifier, Money, Period, Quantity, Range, Ratio, RatioRange, Reference, SampledData, Signature, Timing, ContactDetail, DataRequirement, Expression, ParameterDefinition, RelatedArtifact, TriggerDefinition, UsageContext, Availability, ExtendedContactDetail, Dosage, Meta) |
Is Modifier | false |
Must Support | false |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) )ext-1: Must have either extensions or value[x], not both ( extension.exists() != value.exists() ) |
26. ClaimResponse.extension:patientenanteilAngehoerige | |
Slice Name | patientenanteilAngehoerige |
Definition | MOPED Extension für den Patientenanteil für Angehörige (tägl. Satz) netto: Betrag in €, 2 Nachkommastellen |
Short | Patientenanteil für Angehoerige |
Control | 0..1 |
Type | Extension(Patientenanteil für Angehoerige) (Extension Type: Choice of: base64Binary, boolean, canonical, code, date, dateTime, decimal, id, instant, integer, integer64, markdown, oid, positiveInt, string, time, unsignedInt, uri, url, uuid, Address, Age, Annotation, Attachment, CodeableConcept, CodeableReference, Coding, ContactPoint, Count, Distance, Duration, HumanName, Identifier, Money, Period, Quantity, Range, Ratio, RatioRange, Reference, SampledData, Signature, Timing, ContactDetail, DataRequirement, Expression, ParameterDefinition, RelatedArtifact, TriggerDefinition, UsageContext, Availability, ExtendedContactDetail, Dosage, Meta) |
Is Modifier | false |
Must Support | false |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) )ext-1: Must have either extensions or value[x], not both ( extension.exists() != value.exists() ) |
28. ClaimResponse.extension:patientenanteil | |
Slice Name | patientenanteil |
Definition | MOPED Extension für den Patientenanteil netto: Betrag in €, 2 Nachkommastellen |
Short | Patientenanteil Netto |
Control | 0..1 |
Type | Extension(Patientenanteil Netto) (Extension Type: Choice of: base64Binary, boolean, canonical, code, date, dateTime, decimal, id, instant, integer, integer64, markdown, oid, positiveInt, string, time, unsignedInt, uri, url, uuid, Address, Age, Annotation, Attachment, CodeableConcept, CodeableReference, Coding, ContactPoint, Count, Distance, Duration, HumanName, Identifier, Money, Period, Quantity, Range, Ratio, RatioRange, Reference, SampledData, Signature, Timing, ContactDetail, DataRequirement, Expression, ParameterDefinition, RelatedArtifact, TriggerDefinition, UsageContext, Availability, ExtendedContactDetail, Dosage, Meta) |
Is Modifier | false |
Must Support | false |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) )ext-1: Must have either extensions or value[x], not both ( extension.exists() != value.exists() ) |
30. ClaimResponse.extension:beihilfenaequivalent | |
Slice Name | beihilfenaequivalent |
Definition | MOPED Extension für das Beihilfenaequivalent |
Short | Beihilfenaequivalent |
Control | 0..1 |
Type | Extension(Beihilfenaequivalent) (Extension Type: Choice of: base64Binary, boolean, canonical, code, date, dateTime, decimal, id, instant, integer, integer64, markdown, oid, positiveInt, string, time, unsignedInt, uri, url, uuid, Address, Age, Annotation, Attachment, CodeableConcept, CodeableReference, Coding, ContactPoint, Count, Distance, Duration, HumanName, Identifier, Money, Period, Quantity, Range, Ratio, RatioRange, Reference, SampledData, Signature, Timing, ContactDetail, DataRequirement, Expression, ParameterDefinition, RelatedArtifact, TriggerDefinition, UsageContext, Availability, ExtendedContactDetail, Dosage, Meta) |
Is Modifier | false |
Must Support | false |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) )ext-1: Must have either extensions or value[x], not both ( extension.exists() != value.exists() ) |
32. ClaimResponse.extension:forderungsbetragAuslaenderverrechnungRegress | |
Slice Name | forderungsbetragAuslaenderverrechnungRegress |
Definition | MOPED Extension für den Forderungsbetrag für Ausländerverrechnung oder Regress |
Short | Forderungsbetrag für Auslaenderverrechnung oder Regress |
Control | 0..1 |
Type | Extension(Forderungsbetrag für Auslaenderverrechnung oder Regress) (Extension Type: Choice of: base64Binary, boolean, canonical, code, date, dateTime, decimal, id, instant, integer, integer64, markdown, oid, positiveInt, string, time, unsignedInt, uri, url, uuid, Address, Age, Annotation, Attachment, CodeableConcept, CodeableReference, Coding, ContactPoint, Count, Distance, Duration, HumanName, Identifier, Money, Period, Quantity, Range, Ratio, RatioRange, Reference, SampledData, Signature, Timing, ContactDetail, DataRequirement, Expression, ParameterDefinition, RelatedArtifact, TriggerDefinition, UsageContext, Availability, ExtendedContactDetail, Dosage, Meta) |
Is Modifier | false |
Must Support | false |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) )ext-1: Must have either extensions or value[x], not both ( extension.exists() != value.exists() ) |
34. ClaimResponse.extension:rechnungsnummerKHLGF | |
Slice Name | rechnungsnummerKHLGF |
Definition | MOPED Extension für die Rechnungsnummer der Krankenanstalt bzw. des Landesgesundheitsfonds |
Short | Rechnungsnummer der Krankenanstalt bzw. des Landesgesundheitsfonds |
Control | 0..1 |
Type | Extension(Rechnungsnummer der Krankenanstalt bzw. des Landesgesundheitsfonds) (Extension Type: Choice of: base64Binary, boolean, canonical, code, date, dateTime, decimal, id, instant, integer, integer64, markdown, oid, positiveInt, string, time, unsignedInt, uri, url, uuid, Address, Age, Annotation, Attachment, CodeableConcept, CodeableReference, Coding, ContactPoint, Count, Distance, Duration, HumanName, Identifier, Money, Period, Quantity, Range, Ratio, RatioRange, Reference, SampledData, Signature, Timing, ContactDetail, DataRequirement, Expression, ParameterDefinition, RelatedArtifact, TriggerDefinition, UsageContext, Availability, ExtendedContactDetail, Dosage, Meta) |
Is Modifier | false |
Must Support | false |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) )ext-1: Must have either extensions or value[x], not both ( extension.exists() != value.exists() ) |
36. ClaimResponse.extension:note | |
Slice Name | note |
Definition | Additional notes that apply to this resource or element. |
Short | A recorded sex or gender property for the individual |
Comments | This extension SHALL NOT be used if the resource already has standard 'note' element (or equivalent) of type Annotation on the same element |
Control | 0..* |
Type | Extension(Note) (Extension Type: Annotation) |
Is Modifier | false |
Must Support | false |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) )ext-1: Must have either extensions or value[x], not both ( extension.exists() != value.exists() ) |
38. ClaimResponse.extension:sonderleistungsnummer | |
Slice Name | sonderleistungsnummer |
Definition | MOPED Extension für die Sonderleistungsnummer |
Short | Sonderleistungsnummer |
Control | 0..1 |
Type | Extension(Sonderleistungsnummer) (Extension Type: Coding) |
Is Modifier | false |
Must Support | false |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) )ext-1: Must have either extensions or value[x], not both ( extension.exists() != value.exists() ) |
40. ClaimResponse.extension:anzahlSonderleistungen | |
Slice Name | anzahlSonderleistungen |
Definition | MOPED Extension für die Anzahl der Sonderleistungen |
Short | Anzahl Sonderleistungen |
Control | 0..1 |
Type | Extension(Anzahl Sonderleistungen) (Extension Type: Choice of: base64Binary, boolean, canonical, code, date, dateTime, decimal, id, instant, integer, integer64, markdown, oid, positiveInt, string, time, unsignedInt, uri, url, uuid, Address, Age, Annotation, Attachment, CodeableConcept, CodeableReference, Coding, ContactPoint, Count, Distance, Duration, HumanName, Identifier, Money, Period, Quantity, Range, Ratio, RatioRange, Reference, SampledData, Signature, Timing, ContactDetail, DataRequirement, Expression, ParameterDefinition, RelatedArtifact, TriggerDefinition, UsageContext, Availability, ExtendedContactDetail, Dosage, Meta) |
Is Modifier | false |
Must Support | false |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) )ext-1: Must have either extensions or value[x], not both ( extension.exists() != value.exists() ) |
42. ClaimResponse.extension:punkteLDFPauschale | |
Slice Name | punkteLDFPauschale |
Definition | MOPED Extension für die LDF Punkte Pauschale |
Short | Punkte LDF Pauschale |
Control | 0..1 |
Type | Extension(Punkte LDF Pauschale) (Extension Type: Choice of: base64Binary, boolean, canonical, code, date, dateTime, decimal, id, instant, integer, integer64, markdown, oid, positiveInt, string, time, unsignedInt, uri, url, uuid, Address, Age, Annotation, Attachment, CodeableConcept, CodeableReference, Coding, ContactPoint, Count, Distance, Duration, HumanName, Identifier, Money, Period, Quantity, Range, Ratio, RatioRange, Reference, SampledData, Signature, Timing, ContactDetail, DataRequirement, Expression, ParameterDefinition, RelatedArtifact, TriggerDefinition, UsageContext, Availability, ExtendedContactDetail, Dosage, Meta) |
Is Modifier | false |
Must Support | false |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) )ext-1: Must have either extensions or value[x], not both ( extension.exists() != value.exists() ) |
44. ClaimResponse.extension:konstenmeldungARK | |
Slice Name | konstenmeldungARK |
Definition | MOPED Extension für die Kostenmeldung. Konstenmeldung für A = Ausländerverrechnung, R = Regressangelegenheiten oder K = Kosteninformation |
Short | Kostenmeldung für (A/R/K) |
Control | 0..1 |
Type | Extension(Kostenmeldung für (A/R/K)) (Extension Type: Coding) |
Is Modifier | false |
Must Support | false |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) )ext-1: Must have either extensions or value[x], not both ( extension.exists() != value.exists() ) |
46. ClaimResponse.modifierExtension | |
Definition | May be used to represent additional information that is not part of the basic definition of the resource and that modifies the understanding of the element that contains it and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and managable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). |
Short | Extensions that cannot be ignored |
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. |
Control | 0..* |
Type | Extension |
Is Modifier | true because Modifier extensions are expected to modify the meaning or interpretation of the resource that contains them |
Must Support | false |
Summary | true |
Requirements | Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions. |
Alternate Names | extensions, user content |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) )ext-1: Must have either extensions or value[x], not both ( extension.exists() != value.exists() ) |
48. ClaimResponse.identifier | |
Definition | A unique identifier assigned to this claim response. |
Short | Business Identifier for a claim response |
Note | This is a business identifier, not a resource identifier (see discussion) |
Control | 0..* |
Type | Identifier |
Is Modifier | false |
Must Support | false |
Summary | false |
Requirements | Allows claim responses to be distinguished and referenced. |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) |
50. ClaimResponse.traceNumber | |
Definition | Trace number for tracking purposes. May be defined at the jurisdiction level or between trading partners. |
Short | Number for tracking |
Control | 0..* |
Type | Identifier |
Is Modifier | false |
Must Support | false |
Summary | false |
Requirements | Allows partners to uniquely identify components for tracking. |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) |
52. ClaimResponse.status | |
Definition | The status of the resource instance. |
Short | active | cancelled | draft | entered-in-error |
Comments | This element is labeled as a modifier because the status contains codes that mark the resource as not currently valid. |
Control | 1..1 |
Binding | The codes SHALL be taken from FinancialResourceStatusCodes (required to http://hl7.org/fhir/ValueSet/fm-status|5.0.0 )A code specifying the state of the resource instance. |
Type | code |
Is Modifier | true because This element is labeled as a modifier because it is a status element that contains status entered-in-error which means that the resource should not be treated as valid |
Primitive Value | This primitive element may be present, or absent, or replaced by an extension |
Must Support | false |
Summary | true |
Requirements | Need to track the status of the resource as 'draft' resources may undergo further edits while 'active' resources are immutable and may only have their status changed to 'cancelled'. |
Pattern Value | active |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) |
54. ClaimResponse.type | |
Definition | A finer grained suite of claim type codes which may convey additional information such as Inpatient vs Outpatient and/or a specialty service. |
Short | More granular claim type |
Comments | This may contain the local bill type codes, for example the US UB-04 bill type code or the CMS bill type. |
Control | 1..1 |
Binding | Unless not suitable, these codes SHALL be taken from ClaimTypeCodes (extensible to http://hl7.org/fhir/ValueSet/claim-type )The type or discipline-style of the claim. |
Type | CodeableConcept |
Is Modifier | false |
Must Support | false |
Summary | true |
Requirements | Some jurisdictions need a finer grained claim type for routing and adjudication. |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) |
56. ClaimResponse.type.id | |
Definition | Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. |
Short | Unique id for inter-element referencing |
Control | 0..1 This element is affected by the following invariants: ele-1 |
Type | id |
Is Modifier | false |
XML Format | In the XML format, this property is represented as an attribute. |
Summary | false |
58. ClaimResponse.type.extension | |
Definition | May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and managable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. |
Short | Additional content defined by implementations |
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. |
Control | 0..* |
Type | Extension |
Is Modifier | false |
Summary | false |
Alternate Names | extensions, user content |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) )ext-1: Must have either extensions or value[x], not both ( extension.exists() != value.exists() ) |
Slicing | This element introduces a set of slices on ClaimResponse.type.extension . The slices areUnordered and Open, and can be differentiated using the following discriminators: |
60. ClaimResponse.type.coding | |
Definition | A reference to a code defined by a terminology system. |
Short | Code defined by a terminology system |
Comments | Codes may be defined very casually in enumerations, or code lists, up to very formal definitions such as SNOMED CT - see the HL7 v3 Core Principles for more information. Ordering of codings is undefined and SHALL NOT be used to infer meaning. Generally, at most only one of the coding values will be labeled as UserSelected = true. |
Control | 0..* |
Type | Coding |
Is Modifier | false |
Summary | true |
Requirements | Allows for alternative encodings within a code system, and translations to other code systems. |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) |
62. ClaimResponse.type.coding.id | |
Definition | Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. |
Short | Unique id for inter-element referencing |
Control | 0..1 This element is affected by the following invariants: ele-1 |
Type | id |
Is Modifier | false |
XML Format | In the XML format, this property is represented as an attribute. |
Summary | false |
64. ClaimResponse.type.coding.extension | |
Definition | May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and managable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. |
Short | Additional content defined by implementations |
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. |
Control | 0..* |
Type | Extension |
Is Modifier | false |
Summary | false |
Alternate Names | extensions, user content |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) )ext-1: Must have either extensions or value[x], not both ( extension.exists() != value.exists() ) |
Slicing | This element introduces a set of slices on ClaimResponse.type.coding.extension . The slices areUnordered and Open, and can be differentiated using the following discriminators: |
66. ClaimResponse.type.coding.system | |
Definition | The identification of the code system that defines the meaning of the symbol in the code. |
Short | Identity of the terminology system |
Comments | The URI may be an OID (urn:oid:...) or a UUID (urn:uuid:...). OIDs and UUIDs SHALL be references to the HL7 OID registry. Otherwise, the URI should come from HL7's list of FHIR defined special URIs or it should be an absolute reference to some definition that establishes the system clearly and unambiguously. |
Control | 0..1 |
Type | uri |
Is Modifier | false |
Primitive Value | This primitive element may be present, or absent, or replaced by an extension |
Summary | true |
Requirements | Need to be unambiguous about the source of the definition of the symbol. |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) |
68. ClaimResponse.type.coding.version | |
Definition | The version of the code system which was used when choosing this code. Note that a well-maintained code system does not need the version reported, because the meaning of codes is consistent across versions. However this cannot consistently be assured, and when the meaning is not guaranteed to be consistent, the version SHOULD be exchanged. |
Short | Version of the system - if relevant |
Comments | Where the terminology does not clearly define what string should be used to identify code system versions, the recommendation is to use the date (expressed in FHIR date format) on which that version was officially published as the version date. |
Note | This is a business version Id, not a resource version Id (see discussion) |
Control | 0..1 |
Type | string |
Is Modifier | false |
Primitive Value | This primitive element may be present, or absent, or replaced by an extension |
Summary | true |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) |
70. ClaimResponse.type.coding.code | |
Definition | A symbol in syntax defined by the system. The symbol may be a predefined code or an expression in a syntax defined by the coding system (e.g. post-coordination). |
Short | Symbol in syntax defined by the system |
Control | 0..1 This element is affected by the following invariants: cod-1 |
Type | code |
Is Modifier | false |
Primitive Value | This primitive element may be present, or absent, or replaced by an extension |
Summary | true |
Requirements | Need to refer to a particular code in the system. |
Pattern Value | institutional |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) |
72. ClaimResponse.type.coding.display | |
Definition | A representation of the meaning of the code in the system, following the rules of the system. |
Short | Representation defined by the system |
Control | 0..1 This element is affected by the following invariants: cod-1 |
Type | string |
Is Modifier | false |
Primitive Value | This primitive element may be present, or absent, or replaced by an extension |
Summary | true |
Requirements | Need to be able to carry a human-readable meaning of the code for readers that do not know the system. |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) |
74. ClaimResponse.type.coding.userSelected | |
Definition | Indicates that this coding was chosen by a user directly - e.g. off a pick list of available items (codes or displays). |
Short | If this coding was chosen directly by the user |
Comments | Amongst a set of alternatives, a directly chosen code is the most appropriate starting point for new translations. There is some ambiguity about what exactly 'directly chosen' implies, and trading partner agreement may be needed to clarify the use of this element and its consequences more completely. |
Control | 0..1 |
Type | boolean |
Is Modifier | false |
Primitive Value | This primitive element may be present, or absent, or replaced by an extension |
Summary | true |
Requirements | This has been identified as a clinical safety criterium - that this exact system/code pair was chosen explicitly, rather than inferred by the system based on some rules or language processing. |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) |
76. ClaimResponse.type.text | |
Definition | A human language representation of the concept as seen/selected/uttered by the user who entered the data and/or which represents the intended meaning of the user. |
Short | Plain text representation of the concept |
Comments | Very often the text is the same as a displayName of one of the codings. |
Control | 0..1 |
Type | string |
Is Modifier | false |
Primitive Value | This primitive element may be present, or absent, or replaced by an extension |
Summary | true |
Requirements | The codes from the terminologies do not always capture the correct meaning with all the nuances of the human using them, or sometimes there is no appropriate code at all. In these cases, the text is used to capture the full meaning of the source. |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) |
78. ClaimResponse.subType | |
Definition | A finer grained suite of claim type codes which may convey additional information such as Inpatient vs Outpatient and/or a specialty service. |
Short | More granular claim type |
Comments | This may contain the local bill type codes, for example the US UB-04 bill type code or the CMS bill type. |
Control | 0..1 |
Binding | For example codes, see ExampleClaimSubTypeCodes (example to http://hl7.org/fhir/ValueSet/claim-subtype )A more granular claim typecode. |
Type | CodeableConcept |
Is Modifier | false |
Must Support | false |
Summary | false |
Requirements | Some jurisdictions need a finer grained claim type for routing and adjudication. |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) |
80. ClaimResponse.use | |
Definition | A code to indicate whether the nature of the request is: Claim - A request to an Insurer to adjudicate the supplied charges for health care goods and services under the identified policy and to pay the determined Benefit amount, if any; Preauthorization - A request to an Insurer to adjudicate the supplied proposed future charges for health care goods and services under the identified policy and to approve the services and provide the expected benefit amounts and potentially to reserve funds to pay the benefits when Claims for the indicated services are later submitted; or, Pre-determination - A request to an Insurer to adjudicate the supplied 'what if' charges for health care goods and services under the identified policy and report back what the Benefit payable would be had the services actually been provided. |
Short | claim | preauthorization | predetermination |
Control | 1..1 |
Binding | The codes SHALL be taken from Use (required to http://hl7.org/fhir/ValueSet/claim-use|5.0.0 )Claim, preauthorization, predetermination. |
Type | code |
Is Modifier | false |
Primitive Value | This primitive element may be present, or absent, or replaced by an extension |
Must Support | false |
Summary | true |
Requirements | This element is required to understand the nature of the request for adjudication. |
Pattern Value | claim |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) |
82. ClaimResponse.patient | |
Definition | The party to whom the professional services and/or products have been supplied or are being considered and for whom actual for facast reimbursement is sought. |
Short | The recipient of the products and services |
Control | 1..1 |
Type | Reference(HL7® AT Core Patient Profile) |
Is Modifier | false |
Must Support | false |
Summary | true |
Requirements | The patient must be supplied to the insurer so that confirmation of coverage and service hstory may be considered as part of the authorization and/or adjudiction. |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) |
84. ClaimResponse.created | |
Definition | The date this resource was created. |
Short | Response creation date |
Control | 1..1 |
Type | dateTime |
Is Modifier | false |
Primitive Value | This primitive element may be present, or absent, or replaced by an extension |
Must Support | false |
Summary | true |
Requirements | Need to record a timestamp for use by both the recipient and the issuer. |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) |
86. ClaimResponse.insurer | |
Definition | The party responsible for authorization, adjudication and reimbursement. |
Short | Party responsible for reimbursement |
Control | 1..1 |
Type | Reference(HL7® AT Core Organization Profile) |
Is Modifier | false |
Must Support | false |
Summary | true |
Requirements | To be a valid claim, preauthorization or predetermination there must be a party who is responsible for adjudicating the contents against a policy which provides benefits for the patient. |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) |
88. ClaimResponse.requestor | |
Definition | The provider which is responsible for the claim, predetermination or preauthorization. |
Short | Party responsible for the claim |
Comments | Typically this field would be 1..1 where this party is accountable for the data content within the claim but is not necessarily the facility, provider group or practitioner who provided the products and services listed within this claim resource. This field is the Billing Provider, for example, a facility, provider group, lab or practitioner.. |
Control | 1..1 |
Type | Reference(HL7® AT Core Organization Profile) |
Is Modifier | false |
Must Support | false |
Summary | false |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) |
90. ClaimResponse.request | |
Definition | Original request resource reference. |
Short | Id of resource triggering adjudication |
Control | 1..1 |
Type | Reference(MOPEDClaim) |
Is Modifier | false |
Must Support | false |
Summary | true |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) |
92. ClaimResponse.outcome | |
Definition | The outcome of the claim, predetermination, or preauthorization processing. |
Short | queued | complete | error | partial |
Comments | The resource may be used to indicate that the Claim/Preauthorization/Pre-determination has been received but processing has not begun (queued); that it has been processed and one or more errors have been detected (error); no errors were detected and some of the adjudication processing has been performed (partial); or all of the adjudication processing has completed without errors (complete). |
Control | 1..1 |
Binding | The codes SHALL be taken from ClaimProcessingCodes (required to http://hl7.org/fhir/ValueSet/claim-outcome|5.0.0 )The result of the claim processing. |
Type | code |
Is Modifier | false |
Primitive Value | This primitive element may be present, or absent, or replaced by an extension |
Must Support | false |
Summary | true |
Requirements | To advise the requestor of an overall processing outcome. |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) |
94. ClaimResponse.decision | |
Definition | The result of the claim, predetermination, or preauthorization adjudication. |
Short | Result of the adjudication |
Comments | The element is used to indicate the current state of the adjudication overall for the claim resource, for example: the request has been held (pended) for adjudication processing, for manual review or other reasons; that it has been processed and will be paid, or the outstanding paid, as submitted (approved); that no amount will be paid (denied); or that some amount between zero and the submitted amount will be paid (partial). |
Control | 0..1 |
Binding | For example codes, see ClaimAdjudicationDecisionsCodes (example to http://hl7.org/fhir/ValueSet/claim-decision )The overall result of the claim adjudication. |
Type | CodeableConcept |
Is Modifier | false |
Must Support | false |
Summary | true |
Requirements | To advise the requestor of the result of the adjudication process. |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) |
96. ClaimResponse.disposition | |
Definition | A human readable description of the status of the adjudication. |
Short | Disposition Message |
Control | 0..1 |
Type | string |
Is Modifier | false |
Primitive Value | This primitive element may be present, or absent, or replaced by an extension |
Must Support | false |
Summary | false |
Requirements | Provided for user display. |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) |
98. ClaimResponse.preAuthRef | |
Definition | Reference from the Insurer which is used in later communications which refers to this adjudication. |
Short | Preauthorization reference |
Comments | This value is only present on preauthorization adjudications. |
Control | 0..1 |
Type | string |
Is Modifier | false |
Primitive Value | This primitive element may be present, or absent, or replaced by an extension |
Must Support | false |
Summary | false |
Requirements | On subsequent claims, the insurer may require the provider to quote this value. |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) |
100. ClaimResponse.preAuthPeriod | |
Definition | The time frame during which this authorization is effective. |
Short | Preauthorization reference effective period |
Control | 0..1 |
Type | Period |
Is Modifier | false |
Must Support | false |
Summary | false |
Requirements | To convey to the provider when the authorized products and services must be supplied for the authorized adjudication to apply. |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) |
102. ClaimResponse.event | |
Definition | Information code for an event with a corresponding date or period. |
Short | Event information |
Control | 0..* |
Type | BackboneElement |
Is Modifier | false |
Must Support | false |
Summary | false |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) |
104. ClaimResponse.event.id | |
Definition | Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. |
Short | Unique id for inter-element referencing |
Control | 0..1 This element is affected by the following invariants: ele-1 |
Type | string |
Is Modifier | false |
XML Format | In the XML format, this property is represented as an attribute. |
Summary | false |
106. ClaimResponse.event.extension | |
Definition | May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and managable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. |
Short | Additional content defined by implementations |
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. |
Control | 0..* |
Type | Extension |
Is Modifier | false |
Summary | false |
Alternate Names | extensions, user content |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) )ext-1: Must have either extensions or value[x], not both ( extension.exists() != value.exists() ) |
108. ClaimResponse.event.modifierExtension | |
Definition | May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and managable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). |
Short | Extensions that cannot be ignored even if unrecognized |
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. |
Control | 0..* |
Type | Extension |
Is Modifier | true because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them |
Summary | true |
Requirements | Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions. |
Alternate Names | extensions, user content, modifiers |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) )ext-1: Must have either extensions or value[x], not both ( extension.exists() != value.exists() ) |
110. ClaimResponse.event.type | |
Definition | A coded event such as when a service is expected or a card printed. |
Short | Specific event |
Control | 1..1 |
Binding | For example codes, see DatesTypeCodes (example to http://hl7.org/fhir/ValueSet/datestype ) |
Type | CodeableConcept |
Is Modifier | false |
Must Support | false |
Summary | false |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) |
112. ClaimResponse.event.when[x] | |
Definition | A date or period in the past or future indicating when the event occurred or is expectd to occur. |
Short | Occurance date or period |
Control | 1..1 |
Type | Choice of: dateTime, Period |
[x] Note | SeeChoice of Data Typesfor further information about how to use [x] |
Is Modifier | false |
Primitive Value | This primitive element may be present, or absent, or replaced by an extension |
Must Support | false |
Summary | false |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) |
114. ClaimResponse.payeeType | |
Definition | Type of Party to be reimbursed: subscriber, provider, other. |
Short | Party to be paid any benefits payable |
Control | 0..1 |
Binding | For example codes, see ClaimPayeeTypeCodes (example to http://hl7.org/fhir/ValueSet/payeetype )A code for the party to be reimbursed. |
Type | CodeableConcept |
Is Modifier | false |
Must Support | false |
Summary | false |
Requirements | Need to know who should receive payment with the most common situations being the Provider (assignment of benefits) or the Subscriber. |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) |
116. ClaimResponse.encounter | |
Definition | Healthcare encounters related to this claim. |
Short | Encounters associated with the listed treatments |
Comments | This will typically be the encounter the event occurred within, but some activities may be initiated prior to or after the official completion of an encounter but still be tied to the context of the encounter. |
Control | 0..* |
Type | Reference(Encounter) |
Is Modifier | false |
Must Support | false |
Summary | false |
Requirements | Used in some jurisdictions to link clinical events to claim items. |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) |
118. ClaimResponse.diagnosisRelatedGroup | |
Definition | A package billing code or bundle code used to group products and services to a particular health condition (such as heart attack) which is based on a predetermined grouping code system. |
Short | "Abrechnung - Gruppe:" Dieses Datenfeld ist mit der Codenummer der zutreffenden Abrechnungsgruppe zu befüllen. Bei Datensätzen von stationären Krankenhausaufenthalten, die keiner leistungsorientier- ten Diagnosenfallgruppe zugeordnet werden, erfolgt ein Eintrag entsprechend der jeweiligen Aufnahmeart. |
Comments | For example DRG (Diagnosis Related Group) or a bundled billing code. A patient may have a diagnosis of a Myocardial Infarction and a DRG for HeartAttack would be assigned. The Claim item (and possible subsequent claims) would refer to the DRG for those line items that were for services related to the heart attack event. |
Control | 0..1 |
Binding | The codes SHALL be taken from http://tbd.at/MOPED-LKFAbrechnungsGruppe (required to http://tbd.at/MOPED-LKFAbrechnungsGruppe ) |
Type | CodeableConcept |
Is Modifier | false |
Must Support | false |
Summary | false |
Requirements | Required to relate the current diagnosis to a package billing code that is then referenced on the individual claim items which are specific to the health condition covered by the package code. |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) |
120. ClaimResponse.item | |
Definition | A claim line. Either a simple (a product or service) or a 'group' of details which can also be a simple items or groups of sub-details. |
Short | Adjudication for claim line items |
Control | 0..* |
Type | BackboneElement |
Is Modifier | false |
Must Support | false |
Summary | false |
Requirements | The adjudication for items provided on the claim. |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) |
122. ClaimResponse.item.id | |
Definition | Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. |
Short | Unique id for inter-element referencing |
Control | 0..1 This element is affected by the following invariants: ele-1 |
Type | string |
Is Modifier | false |
XML Format | In the XML format, this property is represented as an attribute. |
Summary | false |
124. ClaimResponse.item.extension | |
Definition | May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and managable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. |
Short | Additional content defined by implementations |
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. |
Control | 0..* |
Type | Extension |
Is Modifier | false |
Summary | false |
Alternate Names | extensions, user content |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) )ext-1: Must have either extensions or value[x], not both ( extension.exists() != value.exists() ) |
126. ClaimResponse.item.modifierExtension | |
Definition | May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and managable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). |
Short | Extensions that cannot be ignored even if unrecognized |
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. |
Control | 0..* |
Type | Extension |
Is Modifier | true because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them |
Summary | true |
Requirements | Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions. |
Alternate Names | extensions, user content, modifiers |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) )ext-1: Must have either extensions or value[x], not both ( extension.exists() != value.exists() ) |
128. ClaimResponse.item.itemSequence | |
Definition | A number to uniquely reference the claim item entries. |
Short | Claim item instance identifier |
Control | 1..1 |
Type | positiveInt |
Is Modifier | false |
Primitive Value | This primitive element may be present, or absent, or replaced by an extension |
Must Support | false |
Summary | false |
Requirements | Necessary to provide a mechanism to link the adjudication result to the submitted claim item. |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) |
130. ClaimResponse.item.traceNumber | |
Definition | Trace number for tracking purposes. May be defined at the jurisdiction level or between trading partners. |
Short | Number for tracking |
Control | 0..* |
Type | Identifier |
Is Modifier | false |
Must Support | false |
Summary | false |
Requirements | Allows partners to uniquely identify components for tracking. |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) |
132. ClaimResponse.item.noteNumber | |
Definition | The numbers associated with notes below which apply to the adjudication of this item. |
Short | Applicable note numbers |
Control | 0..* |
Type | positiveInt |
Is Modifier | false |
Primitive Value | This primitive element may be present, or absent, or replaced by an extension |
Must Support | false |
Summary | false |
Requirements | Provides a condensed manner for associating human readable descriptive explanations for adjudications on the line item. |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) |
134. ClaimResponse.item.reviewOutcome | |
Definition | The high-level results of the adjudication if adjudication has been performed. |
Short | Adjudication results |
Control | 0..1 |
Type | BackboneElement |
Is Modifier | false |
Must Support | false |
Summary | false |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) |
136. ClaimResponse.item.reviewOutcome.id | |
Definition | Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. |
Short | Unique id for inter-element referencing |
Control | 0..1 This element is affected by the following invariants: ele-1 |
Type | string |
Is Modifier | false |
XML Format | In the XML format, this property is represented as an attribute. |
Summary | false |
138. ClaimResponse.item.reviewOutcome.extension | |
Definition | May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and managable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. |
Short | Additional content defined by implementations |
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. |
Control | 0..* |
Type | Extension |
Is Modifier | false |
Summary | false |
Alternate Names | extensions, user content |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) )ext-1: Must have either extensions or value[x], not both ( extension.exists() != value.exists() ) |
140. ClaimResponse.item.reviewOutcome.modifierExtension | |
Definition | May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and managable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). |
Short | Extensions that cannot be ignored even if unrecognized |
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. |
Control | 0..* |
Type | Extension |
Is Modifier | true because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them |
Summary | true |
Requirements | Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions. |
Alternate Names | extensions, user content, modifiers |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) )ext-1: Must have either extensions or value[x], not both ( extension.exists() != value.exists() ) |
142. ClaimResponse.item.reviewOutcome.decision | |
Definition | The result of the claim, predetermination, or preauthorization adjudication. |
Short | Result of the adjudication |
Comments | The element is used to indicate the current state of the adjudication overall for the claim resource, for example: the request has been held (pended) for adjudication processing, for manual review or other reasons; that it has been processed and will be paid, or the outstanding paid, as submitted (approved); that no amount will be paid (denied); or that some amount between zero and the submitted amount will be paid (partial). |
Control | 0..1 |
Binding | For example codes, see ClaimAdjudicationDecisionsCodes (example to http://hl7.org/fhir/ValueSet/claim-decision ) |
Type | CodeableConcept |
Is Modifier | false |
Must Support | false |
Summary | false |
Requirements | To advise the requestor of the result of the adjudication process. |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) |
144. ClaimResponse.item.reviewOutcome.reason | |
Definition | The reasons for the result of the claim, predetermination, or preauthorization adjudication. |
Short | Reason for result of the adjudication |
Control | 0..* |
Binding | For example codes, see ClaimAdjudicationDecisionReasonCodes (example to http://hl7.org/fhir/ValueSet/claim-decision-reason ) |
Type | CodeableConcept |
Is Modifier | false |
Must Support | false |
Summary | false |
Requirements | To advise the requestor of the contributors to the result of the adjudication process. |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) |
146. ClaimResponse.item.reviewOutcome.preAuthRef | |
Definition | Reference from the Insurer which is used in later communications which refers to this adjudication. |
Short | Preauthorization reference |
Comments | This value is only present on preauthorization adjudications. |
Control | 0..1 |
Type | string |
Is Modifier | false |
Primitive Value | This primitive element may be present, or absent, or replaced by an extension |
Must Support | false |
Summary | false |
Requirements | On subsequent claims, the insurer may require the provider to quote this value. |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) |
148. ClaimResponse.item.reviewOutcome.preAuthPeriod | |
Definition | The time frame during which this authorization is effective. |
Short | Preauthorization reference effective period |
Control | 0..1 |
Type | Period |
Is Modifier | false |
Must Support | false |
Summary | false |
Requirements | To convey to the provider when the authorized products and services must be supplied for the authorized adjudication to apply. |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) |
150. ClaimResponse.item.adjudication | |
Definition | If this item is a group then the values here are a summary of the adjudication of the detail items. If this item is a simple product or service then this is the result of the adjudication of this item. |
Short | Adjudication details |
Control | 0..* |
Type | BackboneElement |
Is Modifier | false |
Must Support | false |
Summary | false |
Requirements | The adjudication results conveys the insurer's assessment of the item provided in the claim under the terms of the patient's insurance coverage. |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) |
152. ClaimResponse.item.adjudication.id | |
Definition | Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. |
Short | Unique id for inter-element referencing |
Control | 0..1 This element is affected by the following invariants: ele-1 |
Type | string |
Is Modifier | false |
XML Format | In the XML format, this property is represented as an attribute. |
Summary | false |
154. ClaimResponse.item.adjudication.extension | |
Definition | May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and managable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. |
Short | Additional content defined by implementations |
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. |
Control | 0..* |
Type | Extension |
Is Modifier | false |
Summary | false |
Alternate Names | extensions, user content |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) )ext-1: Must have either extensions or value[x], not both ( extension.exists() != value.exists() ) |
156. ClaimResponse.item.adjudication.modifierExtension | |
Definition | May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and managable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). |
Short | Extensions that cannot be ignored even if unrecognized |
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. |
Control | 0..* |
Type | Extension |
Is Modifier | true because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them |
Summary | true |
Requirements | Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions. |
Alternate Names | extensions, user content, modifiers |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) )ext-1: Must have either extensions or value[x], not both ( extension.exists() != value.exists() ) |
158. ClaimResponse.item.adjudication.category | |
Definition | A code to indicate the information type of this adjudication record. Information types may include the value submitted, maximum values or percentages allowed or payable under the plan, amounts that: the patient is responsible for in aggregate or pertaining to this item; amounts paid by other coverages; and, the benefit payable for this item. |
Short | Type of adjudication information |
Comments | For example codes indicating: Co-Pay, deductible, eligible, benefit, tax, etc. |
Control | 1..1 |
Binding | For example codes, see AdjudicationValueCodes (example to http://hl7.org/fhir/ValueSet/adjudication )The adjudication codes. |
Type | CodeableConcept |
Is Modifier | false |
Must Support | false |
Summary | false |
Requirements | Needed to enable understanding of the context of the other information in the adjudication. |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) |
160. ClaimResponse.item.adjudication.reason | |
Definition | A code supporting the understanding of the adjudication result and explaining variance from expected amount. |
Short | Explanation of adjudication outcome |
Comments | For example may indicate that the funds for this benefit type have been exhausted. |
Control | 0..1 |
Binding | For example codes, see AdjudicationReasonCodes (example to http://hl7.org/fhir/ValueSet/adjudication-reason )The adjudication reason codes. |
Type | CodeableConcept |
Is Modifier | false |
Must Support | false |
Summary | false |
Requirements | To support understanding of variance from adjudication expectations. |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) |
162. ClaimResponse.item.adjudication.amount | |
Definition | Monetary amount associated with the category. |
Short | Monetary amount |
Comments | For example: amount submitted, eligible amount, co-payment, and benefit payable. |
Control | 0..1 |
Type | Money |
Is Modifier | false |
Must Support | false |
Summary | false |
Requirements | Most adjudication categories convey a monetary amount. |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) |
164. ClaimResponse.item.adjudication.quantity | |
Definition | A non-monetary value associated with the category. Mutually exclusive to the amount element above. |
Short | Non-monetary value |
Comments | For example: eligible percentage or co-payment percentage. |
Control | 0..1 |
Type | Quantity |
Is Modifier | false |
Must Support | false |
Summary | false |
Requirements | Some adjudication categories convey a percentage or a fixed value. |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) |
166. ClaimResponse.item.detail | |
Definition | A claim detail. Either a simple (a product or service) or a 'group' of sub-details which are simple items. |
Short | Adjudication for claim details |
Control | 0..* |
Type | BackboneElement |
Is Modifier | false |
Must Support | false |
Summary | false |
Requirements | The adjudication for details provided on the claim. |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) |
168. ClaimResponse.item.detail.id | |
Definition | Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. |
Short | Unique id for inter-element referencing |
Control | 0..1 This element is affected by the following invariants: ele-1 |
Type | string |
Is Modifier | false |
XML Format | In the XML format, this property is represented as an attribute. |
Summary | false |
170. ClaimResponse.item.detail.extension | |
Definition | May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and managable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. |
Short | Additional content defined by implementations |
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. |
Control | 0..* |
Type | Extension |
Is Modifier | false |
Summary | false |
Alternate Names | extensions, user content |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) )ext-1: Must have either extensions or value[x], not both ( extension.exists() != value.exists() ) |
172. ClaimResponse.item.detail.modifierExtension | |
Definition | May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and managable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). |
Short | Extensions that cannot be ignored even if unrecognized |
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. |
Control | 0..* |
Type | Extension |
Is Modifier | true because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them |
Summary | true |
Requirements | Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions. |
Alternate Names | extensions, user content, modifiers |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) )ext-1: Must have either extensions or value[x], not both ( extension.exists() != value.exists() ) |
174. ClaimResponse.item.detail.detailSequence | |
Definition | A number to uniquely reference the claim detail entry. |
Short | Claim detail instance identifier |
Control | 1..1 |
Type | positiveInt |
Is Modifier | false |
Primitive Value | This primitive element may be present, or absent, or replaced by an extension |
Must Support | false |
Summary | false |
Requirements | Necessary to provide a mechanism to link the adjudication result to the submitted claim detail. |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) |
176. ClaimResponse.item.detail.traceNumber | |
Definition | Trace number for tracking purposes. May be defined at the jurisdiction level or between trading partners. |
Short | Number for tracking |
Control | 0..* |
Type | Identifier |
Is Modifier | false |
Must Support | false |
Summary | false |
Requirements | Allows partners to uniquely identify components for tracking. |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) |
178. ClaimResponse.item.detail.noteNumber | |
Definition | The numbers associated with notes below which apply to the adjudication of this item. |
Short | Applicable note numbers |
Control | 0..* |
Type | positiveInt |
Is Modifier | false |
Primitive Value | This primitive element may be present, or absent, or replaced by an extension |
Must Support | false |
Summary | false |
Requirements | Provides a condensed manner for associating human readable descriptive explanations for adjudications on the line item. |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) |
180. ClaimResponse.item.detail.reviewOutcome | |
Definition | The high-level results of the adjudication if adjudication has been performed. |
Short | Detail level adjudication results |
Control | 0..1 |
Type | Seettp://hl7.org/fhir/StructureDefinition/ClaimResponse#ClaimResponse.item.reviewOutcome |
Is Modifier | false |
Must Support | false |
Summary | false |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) |
182. ClaimResponse.item.detail.adjudication | |
Definition | The adjudication results. |
Short | Detail level adjudication details |
Control | 0..* |
Type | Seettp://hl7.org/fhir/StructureDefinition/ClaimResponse#ClaimResponse.item.adjudication |
Is Modifier | false |
Must Support | false |
Summary | false |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) |
184. ClaimResponse.item.detail.subDetail | |
Definition | A sub-detail adjudication of a simple product or service. |
Short | Adjudication for claim sub-details |
Control | 0..* |
Type | BackboneElement |
Is Modifier | false |
Must Support | false |
Summary | false |
Requirements | The adjudication for sub-details provided on the claim. |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) |
186. ClaimResponse.item.detail.subDetail.id | |
Definition | Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. |
Short | Unique id for inter-element referencing |
Control | 0..1 This element is affected by the following invariants: ele-1 |
Type | string |
Is Modifier | false |
XML Format | In the XML format, this property is represented as an attribute. |
Summary | false |
188. ClaimResponse.item.detail.subDetail.extension | |
Definition | May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and managable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. |
Short | Additional content defined by implementations |
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. |
Control | 0..* |
Type | Extension |
Is Modifier | false |
Summary | false |
Alternate Names | extensions, user content |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) )ext-1: Must have either extensions or value[x], not both ( extension.exists() != value.exists() ) |
190. ClaimResponse.item.detail.subDetail.modifierExtension | |
Definition | May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and managable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). |
Short | Extensions that cannot be ignored even if unrecognized |
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. |
Control | 0..* |
Type | Extension |
Is Modifier | true because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them |
Summary | true |
Requirements | Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions. |
Alternate Names | extensions, user content, modifiers |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) )ext-1: Must have either extensions or value[x], not both ( extension.exists() != value.exists() ) |
192. ClaimResponse.item.detail.subDetail.subDetailSequence | |
Definition | A number to uniquely reference the claim sub-detail entry. |
Short | Claim sub-detail instance identifier |
Control | 1..1 |
Type | positiveInt |
Is Modifier | false |
Primitive Value | This primitive element may be present, or absent, or replaced by an extension |
Must Support | false |
Summary | false |
Requirements | Necessary to provide a mechanism to link the adjudication result to the submitted claim sub-detail. |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) |
194. ClaimResponse.item.detail.subDetail.traceNumber | |
Definition | Trace number for tracking purposes. May be defined at the jurisdiction level or between trading partners. |
Short | Number for tracking |
Control | 0..* |
Type | Identifier |
Is Modifier | false |
Must Support | false |
Summary | false |
Requirements | Allows partners to uniquely identify components for tracking. |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) |
196. ClaimResponse.item.detail.subDetail.noteNumber | |
Definition | The numbers associated with notes below which apply to the adjudication of this item. |
Short | Applicable note numbers |
Control | 0..* |
Type | positiveInt |
Is Modifier | false |
Primitive Value | This primitive element may be present, or absent, or replaced by an extension |
Must Support | false |
Summary | false |
Requirements | Provides a condensed manner for associating human readable descriptive explanations for adjudications on the line item. |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) |
198. ClaimResponse.item.detail.subDetail.reviewOutcome | |
Definition | The high-level results of the adjudication if adjudication has been performed. |
Short | Subdetail level adjudication results |
Control | 0..1 |
Type | Seettp://hl7.org/fhir/StructureDefinition/ClaimResponse#ClaimResponse.item.reviewOutcome |
Is Modifier | false |
Must Support | false |
Summary | false |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) |
200. ClaimResponse.item.detail.subDetail.adjudication | |
Definition | The adjudication results. |
Short | Subdetail level adjudication details |
Control | 0..* |
Type | Seettp://hl7.org/fhir/StructureDefinition/ClaimResponse#ClaimResponse.item.adjudication |
Is Modifier | false |
Must Support | false |
Summary | false |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) |
202. ClaimResponse.addItem | |
Definition | The first-tier service adjudications for payor added product or service lines. |
Short | Insurer added line items |
Control | 0..* |
Type | BackboneElement |
Is Modifier | false |
Must Support | false |
Summary | false |
Requirements | Insurers may redefine the provided product or service or may package and/or decompose groups of products and services. The addItems allows the insurer to provide their line item list with linkage to the submitted items/details/sub-details. In a preauthorization the insurer may use the addItem structure to provide additional information on authorized products and services. |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) |
204. ClaimResponse.addItem.id | |
Definition | Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. |
Short | Unique id for inter-element referencing |
Control | 0..1 This element is affected by the following invariants: ele-1 |
Type | string |
Is Modifier | false |
XML Format | In the XML format, this property is represented as an attribute. |
Summary | false |
206. ClaimResponse.addItem.extension | |
Definition | May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and managable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. |
Short | Additional content defined by implementations |
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. |
Control | 0..* |
Type | Extension |
Is Modifier | false |
Summary | false |
Alternate Names | extensions, user content |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) )ext-1: Must have either extensions or value[x], not both ( extension.exists() != value.exists() ) |
208. ClaimResponse.addItem.modifierExtension | |
Definition | May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and managable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). |
Short | Extensions that cannot be ignored even if unrecognized |
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. |
Control | 0..* |
Type | Extension |
Is Modifier | true because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them |
Summary | true |
Requirements | Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions. |
Alternate Names | extensions, user content, modifiers |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) )ext-1: Must have either extensions or value[x], not both ( extension.exists() != value.exists() ) |
210. ClaimResponse.addItem.itemSequence | |
Definition | Claim items which this service line is intended to replace. |
Short | Item sequence number |
Control | 0..* |
Type | positiveInt |
Is Modifier | false |
Primitive Value | This primitive element may be present, or absent, or replaced by an extension |
Must Support | false |
Summary | false |
Requirements | Provides references to the claim items. |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) |
212. ClaimResponse.addItem.detailSequence | |
Definition | The sequence number of the details within the claim item which this line is intended to replace. |
Short | Detail sequence number |
Control | 0..* |
Type | positiveInt |
Is Modifier | false |
Primitive Value | This primitive element may be present, or absent, or replaced by an extension |
Must Support | false |
Summary | false |
Requirements | Provides references to the claim details within the claim item. |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) |
214. ClaimResponse.addItem.subdetailSequence | |
Definition | The sequence number of the sub-details within the details within the claim item which this line is intended to replace. |
Short | Subdetail sequence number |
Control | 0..* |
Type | positiveInt |
Is Modifier | false |
Primitive Value | This primitive element may be present, or absent, or replaced by an extension |
Must Support | false |
Summary | false |
Requirements | Provides references to the claim sub-details within the claim detail. |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) |
216. ClaimResponse.addItem.traceNumber | |
Definition | Trace number for tracking purposes. May be defined at the jurisdiction level or between trading partners. |
Short | Number for tracking |
Control | 0..* |
Type | Identifier |
Is Modifier | false |
Must Support | false |
Summary | false |
Requirements | Allows partners to uniquely identify components for tracking. |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) |
218. ClaimResponse.addItem.provider | |
Definition | The providers who are authorized for the services rendered to the patient. |
Short | Authorized providers |
Control | 0..* |
Type | Reference(Practitioner, PractitionerRole, Organization) |
Is Modifier | false |
Must Support | false |
Summary | false |
Requirements | Insurer may provide authorization specifically to a restricted set of providers rather than an open authorization. |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) |
220. ClaimResponse.addItem.revenue | |
Definition | The type of revenue or cost center providing the product and/or service. |
Short | Revenue or cost center code |
Control | 0..1 |
Binding | For example codes, see ExampleRevenueCenterCodes (example to http://hl7.org/fhir/ValueSet/ex-revenue-center )Codes for the revenue or cost centers supplying the service and/or products. |
Type | CodeableConcept |
Is Modifier | false |
Must Support | false |
Summary | false |
Requirements | Needed in the processing of institutional claims. |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) |
222. ClaimResponse.addItem.productOrService | |
Definition | When the value is a group code then this item collects a set of related item details, otherwise this contains the product, service, drug or other billing code for the item. This element may be the start of a range of .productOrService codes used in conjunction with .productOrServiceEnd or it may be a solo element where .productOrServiceEnd is not used. |
Short | Billing, service, product, or drug code |
Comments | If this is an actual service or product line, i.e. not a Group, then use code to indicate the Professional Service or Product supplied (e.g. CTP, HCPCS, USCLS, ICD10, NCPDP, DIN, RxNorm, ACHI, CCI). If a grouping item then use a group code to indicate the type of thing being grouped e.g. 'glasses' or 'compound'. |
Control | 0..1 |
Binding | For example codes, see USCLSCodes (example to http://hl7.org/fhir/ValueSet/service-uscls )Allowable service and product codes. |
Type | CodeableConcept |
Is Modifier | false |
Must Support | false |
Summary | false |
Requirements | Necessary to state what was provided or done. |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) |
224. ClaimResponse.addItem.productOrServiceEnd | |
Definition | This contains the end of a range of product, service, drug or other billing codes for the item. This element is not used when the .productOrService is a group code. This value may only be present when a .productOfService code has been provided to convey the start of the range. Typically this value may be used only with preauthorizations and not with claims. |
Short | End of a range of codes |
Control | 0..1 |
Binding | For example codes, see USCLSCodes (example to http://hl7.org/fhir/ValueSet/service-uscls ) |
Type | CodeableConcept |
Is Modifier | false |
Must Support | false |
Summary | false |
Alternate Names | End of a range of Drug Code; Bill Code; Service Cod |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) |
226. ClaimResponse.addItem.request | |
Definition | Request or Referral for Goods or Service to be rendered. |
Short | Request or Referral for Service |
Control | 0..* |
Type | Reference(DeviceRequest, MedicationRequest, NutritionOrder, ServiceRequest, SupplyRequest, VisionPrescription) |
Is Modifier | false |
Must Support | false |
Summary | false |
Requirements | May identify the service to be provided or provider authorization for the service. |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) |
228. ClaimResponse.addItem.modifier | |
Definition | Item typification or modifiers codes to convey additional context for the product or service. |
Short | Service/Product billing modifiers |
Comments | For example in Oral whether the treatment is cosmetic or associated with TMJ, or for Medical whether the treatment was outside the clinic or outside of office hours. |
Control | 0..* |
Binding | For example codes, see ModifierTypeCodes (example to http://hl7.org/fhir/ValueSet/claim-modifiers )Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen. |
Type | CodeableConcept |
Is Modifier | false |
Must Support | false |
Summary | false |
Requirements | To support inclusion of the item for adjudication or to charge an elevated fee. |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) |
230. ClaimResponse.addItem.programCode | |
Definition | Identifies the program under which this may be recovered. |
Short | Program the product or service is provided under |
Comments | For example: Neonatal program, child dental program or drug users recovery program. |
Control | 0..* |
Binding | For example codes, see ExampleProgramReasonCodes (example to http://hl7.org/fhir/ValueSet/ex-program-code )Program specific reason codes. |
Type | CodeableConcept |
Is Modifier | false |
Must Support | false |
Summary | false |
Requirements | Commonly used in in the identification of publicly provided program focused on population segments or disease classifications. |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) |
232. ClaimResponse.addItem.serviced[x] | |
Definition | The date or dates when the service or product was supplied, performed or completed. |
Short | Date or dates of service or product delivery |
Control | 0..1 |
Type | Choice of: date, Period |
[x] Note | SeeChoice of Data Typesfor further information about how to use [x] |
Is Modifier | false |
Primitive Value | This primitive element may be present, or absent, or replaced by an extension |
Must Support | false |
Summary | false |
Requirements | Needed to determine whether the service or product was provided during the term of the insurance coverage. |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) |
234. ClaimResponse.addItem.location[x] | |
Definition | Where the product or service was provided. |
Short | Place of service or where product was supplied |
Control | 0..1 |
Binding | For example codes, see ExampleServicePlaceCodes (example to http://hl7.org/fhir/ValueSet/service-place )Place of service: pharmacy, school, prison, etc. |
Type | Choice of: CodeableConcept, Address, Reference(Location) |
[x] Note | SeeChoice of Data Typesfor further information about how to use [x] |
Is Modifier | false |
Must Support | false |
Summary | false |
Requirements | The location can alter whether the item was acceptable for insurance purposes or impact the determination of the benefit amount. |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) |
236. ClaimResponse.addItem.quantity | |
Definition | The number of repetitions of a service or product. |
Short | Count of products or services |
Control | 0..1 |
Type | Quantity(SimpleQuantity) |
Is Modifier | false |
Must Support | false |
Summary | false |
Requirements | Required when the product or service code does not convey the quantity provided. |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) |
238. ClaimResponse.addItem.unitPrice | |
Definition | If the item is not a group then this is the fee for the product or service, otherwise this is the total of the fees for the details of the group. |
Short | Fee, charge or cost per item |
Control | 0..1 |
Type | Money |
Is Modifier | false |
Must Support | false |
Summary | false |
Requirements | The amount charged to the patient by the provider for a single unit. |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) |
240. ClaimResponse.addItem.factor | |
Definition | A real number that represents a multiplier used in determining the overall value of services delivered and/or goods received. The concept of a Factor allows for a discount or surcharge multiplier to be applied to a monetary amount. |
Short | Price scaling factor |
Comments | To show a 10% senior's discount, the value entered is: 0.90 (1.00 - 0.10). |
Control | 0..1 |
Type | decimal |
Is Modifier | false |
Primitive Value | This primitive element may be present, or absent, or replaced by an extension |
Must Support | false |
Summary | false |
Requirements | When discounts are provided to a patient (example: Senior's discount) then this must be documented for adjudication. |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) |
242. ClaimResponse.addItem.tax | |
Definition | The total of taxes applicable for this product or service. |
Short | Total tax |
Control | 0..1 |
Type | Money |
Is Modifier | false |
Must Support | false |
Summary | false |
Requirements | Required when taxes are not embedded in the unit price or provided as a separate service. |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) |
244. ClaimResponse.addItem.net | |
Definition | The total amount claimed for the group (if a grouper) or the addItem. Net = unit price * quantity * factor. |
Short | Total item cost |
Comments | For example, the formula: quantity * unitPrice * factor = net. Quantity and factor are assumed to be 1 if not supplied. |
Control | 0..1 |
Type | Money |
Is Modifier | false |
Must Support | false |
Summary | false |
Requirements | Provides the total amount claimed for the group (if a grouper) or the line item. |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) |
246. ClaimResponse.addItem.bodySite | |
Definition | Physical location where the service is performed or applies. |
Short | Anatomical location |
Control | 0..* |
Type | BackboneElement |
Is Modifier | false |
Must Support | false |
Summary | false |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) |
248. ClaimResponse.addItem.bodySite.id | |
Definition | Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. |
Short | Unique id for inter-element referencing |
Control | 0..1 This element is affected by the following invariants: ele-1 |
Type | string |
Is Modifier | false |
XML Format | In the XML format, this property is represented as an attribute. |
Summary | false |
250. ClaimResponse.addItem.bodySite.extension | |
Definition | May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and managable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. |
Short | Additional content defined by implementations |
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. |
Control | 0..* |
Type | Extension |
Is Modifier | false |
Summary | false |
Alternate Names | extensions, user content |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) )ext-1: Must have either extensions or value[x], not both ( extension.exists() != value.exists() ) |
252. ClaimResponse.addItem.bodySite.modifierExtension | |
Definition | May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and managable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). |
Short | Extensions that cannot be ignored even if unrecognized |
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. |
Control | 0..* |
Type | Extension |
Is Modifier | true because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them |
Summary | true |
Requirements | Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions. |
Alternate Names | extensions, user content, modifiers |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) )ext-1: Must have either extensions or value[x], not both ( extension.exists() != value.exists() ) |
254. ClaimResponse.addItem.bodySite.site | |
Definition | Physical service site on the patient (limb, tooth, etc.). |
Short | Location |
Comments | For example: Providing a tooth code allows an insurer to identify a provider performing a filling on a tooth that was previously removed. |
Control | 1..* |
Binding | For example codes, see OralSiteCodes (example to http://hl7.org/fhir/ValueSet/tooth ) |
Type | CodeableReference(BodyStructure) |
Is Modifier | false |
Must Support | false |
Summary | false |
Requirements | Allows insurer to validate specific procedures. |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) |
256. ClaimResponse.addItem.bodySite.subSite | |
Definition | A region or surface of the bodySite, e.g. limb region or tooth surface(s). |
Short | Sub-location |
Control | 0..* |
Binding | For example codes, see SurfaceCodes (example to http://hl7.org/fhir/ValueSet/surface ) |
Type | CodeableConcept |
Is Modifier | false |
Must Support | false |
Summary | false |
Requirements | Allows insurer to validate specific procedures. |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) |
258. ClaimResponse.addItem.noteNumber | |
Definition | The numbers associated with notes below which apply to the adjudication of this item. |
Short | Applicable note numbers |
Control | 0..* |
Type | positiveInt |
Is Modifier | false |
Primitive Value | This primitive element may be present, or absent, or replaced by an extension |
Must Support | false |
Summary | false |
Requirements | Provides a condensed manner for associating human readable descriptive explanations for adjudications on the line item. |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) |
260. ClaimResponse.addItem.reviewOutcome | |
Definition | The high-level results of the adjudication if adjudication has been performed. |
Short | Added items adjudication results |
Control | 0..1 |
Type | Seettp://hl7.org/fhir/StructureDefinition/ClaimResponse#ClaimResponse.item.reviewOutcome |
Is Modifier | false |
Must Support | false |
Summary | false |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) |
262. ClaimResponse.addItem.adjudication | |
Definition | The adjudication results. |
Short | Added items adjudication |
Control | 0..* |
Type | Seettp://hl7.org/fhir/StructureDefinition/ClaimResponse#ClaimResponse.item.adjudication |
Is Modifier | false |
Must Support | false |
Summary | false |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) |
264. ClaimResponse.addItem.detail | |
Definition | The second-tier service adjudications for payor added services. |
Short | Insurer added line details |
Control | 0..* |
Type | BackboneElement |
Is Modifier | false |
Must Support | false |
Summary | false |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) |
266. ClaimResponse.addItem.detail.id | |
Definition | Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. |
Short | Unique id for inter-element referencing |
Control | 0..1 This element is affected by the following invariants: ele-1 |
Type | string |
Is Modifier | false |
XML Format | In the XML format, this property is represented as an attribute. |
Summary | false |
268. ClaimResponse.addItem.detail.extension | |
Definition | May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and managable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. |
Short | Additional content defined by implementations |
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. |
Control | 0..* |
Type | Extension |
Is Modifier | false |
Summary | false |
Alternate Names | extensions, user content |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) )ext-1: Must have either extensions or value[x], not both ( extension.exists() != value.exists() ) |
270. ClaimResponse.addItem.detail.modifierExtension | |
Definition | May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and managable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). |
Short | Extensions that cannot be ignored even if unrecognized |
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. |
Control | 0..* |
Type | Extension |
Is Modifier | true because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them |
Summary | true |
Requirements | Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions. |
Alternate Names | extensions, user content, modifiers |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) )ext-1: Must have either extensions or value[x], not both ( extension.exists() != value.exists() ) |
272. ClaimResponse.addItem.detail.traceNumber | |
Definition | Trace number for tracking purposes. May be defined at the jurisdiction level or between trading partners. |
Short | Number for tracking |
Control | 0..* |
Type | Identifier |
Is Modifier | false |
Must Support | false |
Summary | false |
Requirements | Allows partners to uniquely identify components for tracking. |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) |
274. ClaimResponse.addItem.detail.revenue | |
Definition | The type of revenue or cost center providing the product and/or service. |
Short | Revenue or cost center code |
Control | 0..1 |
Binding | For example codes, see ExampleRevenueCenterCodes (example to http://hl7.org/fhir/ValueSet/ex-revenue-center )Codes for the revenue or cost centers supplying the service and/or products. |
Type | CodeableConcept |
Is Modifier | false |
Must Support | false |
Summary | false |
Requirements | Needed in the processing of institutional claims. |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) |
276. ClaimResponse.addItem.detail.productOrService | |
Definition | When the value is a group code then this item collects a set of related item details, otherwise this contains the product, service, drug or other billing code for the item. This element may be the start of a range of .productOrService codes used in conjunction with .productOrServiceEnd or it may be a solo element where .productOrServiceEnd is not used. |
Short | Billing, service, product, or drug code |
Comments | If this is an actual service or product line, i.e. not a Group, then use code to indicate the Professional Service or Product supplied (e.g. CTP, HCPCS, USCLS, ICD10, NCPDP, DIN, RxNorm, ACHI, CCI). If a grouping item then use a group code to indicate the type of thing being grouped e.g. 'glasses' or 'compound'. |
Control | 0..1 |
Binding | For example codes, see USCLSCodes (example to http://hl7.org/fhir/ValueSet/service-uscls )Allowable service and product codes. |
Type | CodeableConcept |
Is Modifier | false |
Must Support | false |
Summary | false |
Requirements | Necessary to state what was provided or done. |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) |
278. ClaimResponse.addItem.detail.productOrServiceEnd | |
Definition | This contains the end of a range of product, service, drug or other billing codes for the item. This element is not used when the .productOrService is a group code. This value may only be present when a .productOfService code has been provided to convey the start of the range. Typically this value may be used only with preauthorizations and not with claims. |
Short | End of a range of codes |
Control | 0..1 |
Binding | For example codes, see USCLSCodes (example to http://hl7.org/fhir/ValueSet/service-uscls ) |
Type | CodeableConcept |
Is Modifier | false |
Must Support | false |
Summary | false |
Alternate Names | End of a range of Drug Code; Bill Code; Service Cod |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) |
280. ClaimResponse.addItem.detail.modifier | |
Definition | Item typification or modifiers codes to convey additional context for the product or service. |
Short | Service/Product billing modifiers |
Comments | For example in Oral whether the treatment is cosmetic or associated with TMJ, or for Medical whether the treatment was outside the clinic or outside of office hours. |
Control | 0..* |
Binding | For example codes, see ModifierTypeCodes (example to http://hl7.org/fhir/ValueSet/claim-modifiers )Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen. |
Type | CodeableConcept |
Is Modifier | false |
Must Support | false |
Summary | false |
Requirements | To support inclusion of the item for adjudication or to charge an elevated fee. |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) |
282. ClaimResponse.addItem.detail.quantity | |
Definition | The number of repetitions of a service or product. |
Short | Count of products or services |
Control | 0..1 |
Type | Quantity(SimpleQuantity) |
Is Modifier | false |
Must Support | false |
Summary | false |
Requirements | Required when the product or service code does not convey the quantity provided. |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) |
284. ClaimResponse.addItem.detail.unitPrice | |
Definition | If the item is not a group then this is the fee for the product or service, otherwise this is the total of the fees for the details of the group. |
Short | Fee, charge or cost per item |
Control | 0..1 |
Type | Money |
Is Modifier | false |
Must Support | false |
Summary | false |
Requirements | The amount charged to the patient by the provider for a single unit. |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) |
286. ClaimResponse.addItem.detail.factor | |
Definition | A real number that represents a multiplier used in determining the overall value of services delivered and/or goods received. The concept of a Factor allows for a discount or surcharge multiplier to be applied to a monetary amount. |
Short | Price scaling factor |
Comments | To show a 10% senior's discount, the value entered is: 0.90 (1.00 - 0.10). |
Control | 0..1 |
Type | decimal |
Is Modifier | false |
Primitive Value | This primitive element may be present, or absent, or replaced by an extension |
Must Support | false |
Summary | false |
Requirements | When discounts are provided to a patient (example: Senior's discount) then this must be documented for adjudication. |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) |
288. ClaimResponse.addItem.detail.tax | |
Definition | The total of taxes applicable for this product or service. |
Short | Total tax |
Control | 0..1 |
Type | Money |
Is Modifier | false |
Must Support | false |
Summary | false |
Requirements | Required when taxes are not embedded in the unit price or provided as a separate service. |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) |
290. ClaimResponse.addItem.detail.net | |
Definition | The total amount claimed for the group (if a grouper) or the addItem.detail. Net = unit price * quantity * factor. |
Short | Total item cost |
Comments | For example, the formula: quantity * unitPrice * factor = net. Quantity and factor are assumed to be 1 if not supplied. |
Control | 0..1 |
Type | Money |
Is Modifier | false |
Must Support | false |
Summary | false |
Requirements | Provides the total amount claimed for the group (if a grouper) or the line item. |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) |
292. ClaimResponse.addItem.detail.noteNumber | |
Definition | The numbers associated with notes below which apply to the adjudication of this item. |
Short | Applicable note numbers |
Control | 0..* |
Type | positiveInt |
Is Modifier | false |
Primitive Value | This primitive element may be present, or absent, or replaced by an extension |
Must Support | false |
Summary | false |
Requirements | Provides a condensed manner for associating human readable descriptive explanations for adjudications on the line item. |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) |
294. ClaimResponse.addItem.detail.reviewOutcome | |
Definition | The high-level results of the adjudication if adjudication has been performed. |
Short | Added items detail level adjudication results |
Control | 0..1 |
Type | Seettp://hl7.org/fhir/StructureDefinition/ClaimResponse#ClaimResponse.item.reviewOutcome |
Is Modifier | false |
Must Support | false |
Summary | false |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) |
296. ClaimResponse.addItem.detail.adjudication | |
Definition | The adjudication results. |
Short | Added items detail adjudication |
Control | 0..* |
Type | Seettp://hl7.org/fhir/StructureDefinition/ClaimResponse#ClaimResponse.item.adjudication |
Is Modifier | false |
Must Support | false |
Summary | false |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) |
298. ClaimResponse.addItem.detail.subDetail | |
Definition | The third-tier service adjudications for payor added services. |
Short | Insurer added line items |
Control | 0..* |
Type | BackboneElement |
Is Modifier | false |
Must Support | false |
Summary | false |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) |
300. ClaimResponse.addItem.detail.subDetail.id | |
Definition | Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. |
Short | Unique id for inter-element referencing |
Control | 0..1 This element is affected by the following invariants: ele-1 |
Type | string |
Is Modifier | false |
XML Format | In the XML format, this property is represented as an attribute. |
Summary | false |
302. ClaimResponse.addItem.detail.subDetail.extension | |
Definition | May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and managable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. |
Short | Additional content defined by implementations |
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. |
Control | 0..* |
Type | Extension |
Is Modifier | false |
Summary | false |
Alternate Names | extensions, user content |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) )ext-1: Must have either extensions or value[x], not both ( extension.exists() != value.exists() ) |
304. ClaimResponse.addItem.detail.subDetail.modifierExtension | |
Definition | May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and managable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). |
Short | Extensions that cannot be ignored even if unrecognized |
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. |
Control | 0..* |
Type | Extension |
Is Modifier | true because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them |
Summary | true |
Requirements | Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions. |
Alternate Names | extensions, user content, modifiers |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) )ext-1: Must have either extensions or value[x], not both ( extension.exists() != value.exists() ) |
306. ClaimResponse.addItem.detail.subDetail.traceNumber | |
Definition | Trace number for tracking purposes. May be defined at the jurisdiction level or between trading partners. |
Short | Number for tracking |
Control | 0..* |
Type | Identifier |
Is Modifier | false |
Must Support | false |
Summary | false |
Requirements | Allows partners to uniquely identify components for tracking. |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) |
308. ClaimResponse.addItem.detail.subDetail.revenue | |
Definition | The type of revenue or cost center providing the product and/or service. |
Short | Revenue or cost center code |
Control | 0..1 |
Binding | For example codes, see ExampleRevenueCenterCodes (example to http://hl7.org/fhir/ValueSet/ex-revenue-center )Codes for the revenue or cost centers supplying the service and/or products. |
Type | CodeableConcept |
Is Modifier | false |
Must Support | false |
Summary | false |
Requirements | Needed in the processing of institutional claims. |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) |
310. ClaimResponse.addItem.detail.subDetail.productOrService | |
Definition | When the value is a group code then this item collects a set of related item details, otherwise this contains the product, service, drug or other billing code for the item. This element may be the start of a range of .productOrService codes used in conjunction with .productOrServiceEnd or it may be a solo element where .productOrServiceEnd is not used. |
Short | Billing, service, product, or drug code |
Comments | If this is an actual service or product line, i.e. not a Group, then use code to indicate the Professional Service or Product supplied (e.g. CTP, HCPCS, USCLS, ICD10, NCPDP, DIN, RxNorm, ACHI, CCI). If a grouping item then use a group code to indicate the type of thing being grouped e.g. 'glasses' or 'compound'. |
Control | 0..1 |
Binding | For example codes, see USCLSCodes (example to http://hl7.org/fhir/ValueSet/service-uscls )Allowable service and product codes. |
Type | CodeableConcept |
Is Modifier | false |
Must Support | false |
Summary | false |
Requirements | Necessary to state what was provided or done. |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) |
312. ClaimResponse.addItem.detail.subDetail.productOrServiceEnd | |
Definition | This contains the end of a range of product, service, drug or other billing codes for the item. This element is not used when the .productOrService is a group code. This value may only be present when a .productOfService code has been provided to convey the start of the range. Typically this value may be used only with preauthorizations and not with claims. |
Short | End of a range of codes |
Control | 0..1 |
Binding | For example codes, see USCLSCodes (example to http://hl7.org/fhir/ValueSet/service-uscls ) |
Type | CodeableConcept |
Is Modifier | false |
Must Support | false |
Summary | false |
Alternate Names | End of a range of Drug Code; Bill Code; Service Cod |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) |
314. ClaimResponse.addItem.detail.subDetail.modifier | |
Definition | Item typification or modifiers codes to convey additional context for the product or service. |
Short | Service/Product billing modifiers |
Comments | For example in Oral whether the treatment is cosmetic or associated with TMJ, or for Medical whether the treatment was outside the clinic or outside of office hours. |
Control | 0..* |
Binding | For example codes, see ModifierTypeCodes (example to http://hl7.org/fhir/ValueSet/claim-modifiers )Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen. |
Type | CodeableConcept |
Is Modifier | false |
Must Support | false |
Summary | false |
Requirements | To support inclusion of the item for adjudication or to charge an elevated fee. |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) |
316. ClaimResponse.addItem.detail.subDetail.quantity | |
Definition | The number of repetitions of a service or product. |
Short | Count of products or services |
Control | 0..1 |
Type | Quantity(SimpleQuantity) |
Is Modifier | false |
Must Support | false |
Summary | false |
Requirements | Required when the product or service code does not convey the quantity provided. |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) |
318. ClaimResponse.addItem.detail.subDetail.unitPrice | |
Definition | If the item is not a group then this is the fee for the product or service, otherwise this is the total of the fees for the details of the group. |
Short | Fee, charge or cost per item |
Control | 0..1 |
Type | Money |
Is Modifier | false |
Must Support | false |
Summary | false |
Requirements | The amount charged to the patient by the provider for a single unit. |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) |
320. ClaimResponse.addItem.detail.subDetail.factor | |
Definition | A real number that represents a multiplier used in determining the overall value of services delivered and/or goods received. The concept of a Factor allows for a discount or surcharge multiplier to be applied to a monetary amount. |
Short | Price scaling factor |
Comments | To show a 10% senior's discount, the value entered is: 0.90 (1.00 - 0.10). |
Control | 0..1 |
Type | decimal |
Is Modifier | false |
Primitive Value | This primitive element may be present, or absent, or replaced by an extension |
Must Support | false |
Summary | false |
Requirements | When discounts are provided to a patient (example: Senior's discount) then this must be documented for adjudication. |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) |
322. ClaimResponse.addItem.detail.subDetail.tax | |
Definition | The total of taxes applicable for this product or service. |
Short | Total tax |
Control | 0..1 |
Type | Money |
Is Modifier | false |
Must Support | false |
Summary | false |
Requirements | Required when taxes are not embedded in the unit price or provided as a separate service. |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) |
324. ClaimResponse.addItem.detail.subDetail.net | |
Definition | The total amount claimed for the addItem.detail.subDetail. Net = unit price * quantity * factor. |
Short | Total item cost |
Comments | For example, the formula: quantity * unitPrice * factor = net. Quantity and factor are assumed to be 1 if not supplied. |
Control | 0..1 |
Type | Money |
Is Modifier | false |
Must Support | false |
Summary | false |
Requirements | Provides the total amount claimed for the group (if a grouper) or the line item. |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) |
326. ClaimResponse.addItem.detail.subDetail.noteNumber | |
Definition | The numbers associated with notes below which apply to the adjudication of this item. |
Short | Applicable note numbers |
Control | 0..* |
Type | positiveInt |
Is Modifier | false |
Primitive Value | This primitive element may be present, or absent, or replaced by an extension |
Must Support | false |
Summary | false |
Requirements | Provides a condensed manner for associating human readable descriptive explanations for adjudications on the line item. |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) |
328. ClaimResponse.addItem.detail.subDetail.reviewOutcome | |
Definition | The high-level results of the adjudication if adjudication has been performed. |
Short | Added items subdetail level adjudication results |
Control | 0..1 |
Type | Seettp://hl7.org/fhir/StructureDefinition/ClaimResponse#ClaimResponse.item.reviewOutcome |
Is Modifier | false |
Must Support | false |
Summary | false |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) |
330. ClaimResponse.addItem.detail.subDetail.adjudication | |
Definition | The adjudication results. |
Short | Added items subdetail adjudication |
Control | 0..* |
Type | Seettp://hl7.org/fhir/StructureDefinition/ClaimResponse#ClaimResponse.item.adjudication |
Is Modifier | false |
Must Support | false |
Summary | false |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) |
332. ClaimResponse.adjudication | |
Definition | The adjudication results which are presented at the header level rather than at the line-item or add-item levels. |
Short | Header-level adjudication |
Control | 0..* |
Type | Seettp://hl7.org/fhir/StructureDefinition/ClaimResponse#ClaimResponse.item.adjudication |
Is Modifier | false |
Must Support | false |
Summary | false |
Requirements | Some insurers will receive line-items but provide the adjudication only at a summary or header-level. |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) |
334. ClaimResponse.total | |
Definition | Categorized monetary totals for the adjudication. |
Short | Adjudication totals |
Comments | Totals for amounts submitted, co-pays, benefits payable etc. |
Control | 0..* |
Type | BackboneElement |
Is Modifier | false |
Must Support | false |
Summary | true |
Requirements | To provide the requestor with financial totals by category for the adjudication. |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) |
336. ClaimResponse.total.id | |
Definition | Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. |
Short | Unique id for inter-element referencing |
Control | 0..1 This element is affected by the following invariants: ele-1 |
Type | string |
Is Modifier | false |
XML Format | In the XML format, this property is represented as an attribute. |
Summary | false |
338. ClaimResponse.total.extension | |
Definition | May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and managable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. |
Short | Additional content defined by implementations |
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. |
Control | 0..* |
Type | Extension |
Is Modifier | false |
Summary | false |
Alternate Names | extensions, user content |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) )ext-1: Must have either extensions or value[x], not both ( extension.exists() != value.exists() ) |
340. ClaimResponse.total.modifierExtension | |
Definition | May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and managable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). |
Short | Extensions that cannot be ignored even if unrecognized |
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. |
Control | 0..* |
Type | Extension |
Is Modifier | true because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them |
Summary | true |
Requirements | Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions. |
Alternate Names | extensions, user content, modifiers |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) )ext-1: Must have either extensions or value[x], not both ( extension.exists() != value.exists() ) |
342. ClaimResponse.total.category | |
Definition | A code to indicate the information type of this adjudication record. Information types may include: the value submitted, maximum values or percentages allowed or payable under the plan, amounts that the patient is responsible for in aggregate or pertaining to this item, amounts paid by other coverages, and the benefit payable for this item. |
Short | Type of adjudication information |
Comments | For example codes indicating: Co-Pay, deductible, eligible, benefit, tax, etc. |
Control | 1..1 |
Binding | For example codes, see AdjudicationValueCodes (example to http://hl7.org/fhir/ValueSet/adjudication )The adjudication codes. |
Type | CodeableConcept |
Is Modifier | false |
Must Support | false |
Summary | true |
Requirements | Needed to convey the type of total provided. |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) |
344. ClaimResponse.total.amount | |
Definition | Monetary total amount associated with the category. |
Short | Financial total for the category |
Control | 1..1 |
Type | Money |
Is Modifier | false |
Must Support | false |
Summary | true |
Requirements | Needed to convey the total monetary amount. |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) |
346. ClaimResponse.payment | |
Definition | Payment details for the adjudication of the claim. |
Short | Payment Details |
Control | 0..1 |
Type | BackboneElement |
Is Modifier | false |
Must Support | false |
Summary | false |
Requirements | Needed to convey references to the financial instrument that has been used if payment has been made. |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) |
348. ClaimResponse.payment.id | |
Definition | Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. |
Short | Unique id for inter-element referencing |
Control | 0..1 This element is affected by the following invariants: ele-1 |
Type | string |
Is Modifier | false |
XML Format | In the XML format, this property is represented as an attribute. |
Summary | false |
350. ClaimResponse.payment.extension | |
Definition | May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and managable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. |
Short | Additional content defined by implementations |
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. |
Control | 0..* |
Type | Extension |
Is Modifier | false |
Summary | false |
Alternate Names | extensions, user content |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) )ext-1: Must have either extensions or value[x], not both ( extension.exists() != value.exists() ) |
352. ClaimResponse.payment.modifierExtension | |
Definition | May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and managable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). |
Short | Extensions that cannot be ignored even if unrecognized |
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. |
Control | 0..* |
Type | Extension |
Is Modifier | true because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them |
Summary | true |
Requirements | Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions. |
Alternate Names | extensions, user content, modifiers |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) )ext-1: Must have either extensions or value[x], not both ( extension.exists() != value.exists() ) |
354. ClaimResponse.payment.type | |
Definition | Whether this represents partial or complete payment of the benefits payable. |
Short | Partial or complete payment |
Control | 1..1 |
Binding | For example codes, see ExamplePaymentTypeCodes (example to http://hl7.org/fhir/ValueSet/ex-paymenttype )The type (partial, complete) of the payment. |
Type | CodeableConcept |
Is Modifier | false |
Must Support | false |
Summary | false |
Requirements | To advise the requestor when the insurer believes all payments to have been completed. |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) |
356. ClaimResponse.payment.adjustment | |
Definition | Total amount of all adjustments to this payment included in this transaction which are not related to this claim's adjudication. |
Short | Payment adjustment for non-claim issues |
Comments | Insurers will deduct amounts owing from the provider (adjustment), such as a prior overpayment, from the amount owing to the provider (benefits payable) when payment is made to the provider. |
Control | 0..1 |
Type | Money |
Is Modifier | false |
Must Support | false |
Summary | false |
Requirements | To advise the requestor of adjustments applied to the payment. |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) |
358. ClaimResponse.payment.adjustmentReason | |
Definition | Reason for the payment adjustment. |
Short | Explanation for the adjustment |
Control | 0..1 |
Binding | For example codes, see PaymentAdjustmentReasonCodes (example to http://hl7.org/fhir/ValueSet/payment-adjustment-reason )Payment Adjustment reason codes. |
Type | CodeableConcept |
Is Modifier | false |
Must Support | false |
Summary | false |
Requirements | Needed to clarify the monetary adjustment. |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) |
360. ClaimResponse.payment.date | |
Definition | Estimated date the payment will be issued or the actual issue date of payment. |
Short | Expected date of payment |
Control | 0..1 |
Type | date |
Is Modifier | false |
Primitive Value | This primitive element may be present, or absent, or replaced by an extension |
Must Support | false |
Summary | false |
Requirements | To advise the payee when payment can be expected. |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) |
362. ClaimResponse.payment.amount | |
Definition | Benefits payable less any payment adjustment. |
Short | Payable amount after adjustment |
Control | 1..1 |
Type | Money |
Is Modifier | false |
Must Support | false |
Summary | false |
Requirements | Needed to provide the actual payment amount. |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) |
364. ClaimResponse.payment.identifier | |
Definition | Issuer's unique identifier for the payment instrument. |
Short | Business identifier for the payment |
Comments | For example: EFT number or check number. |
Note | This is a business identifier, not a resource identifier (see discussion) |
Control | 0..1 |
Type | Identifier |
Is Modifier | false |
Must Support | false |
Summary | false |
Requirements | Enable the receiver to reconcile when payment received. |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) |
366. ClaimResponse.fundsReserve | |
Definition | A code, used only on a response to a preauthorization, to indicate whether the benefits payable have been reserved and for whom. |
Short | Funds reserved status |
Comments | Fund would be release by a future claim quoting the preAuthRef of this response. Examples of values include: provider, patient, none. |
Control | 0..1 |
Binding | For example codes, see FundsReservationCodes (example to http://hl7.org/fhir/ValueSet/fundsreserve )For whom funds are to be reserved: (Patient, Provider, None). |
Type | CodeableConcept |
Is Modifier | false |
Must Support | false |
Summary | false |
Requirements | Needed to advise the submitting provider on whether the rquest for reservation of funds has been honored. |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) |
368. ClaimResponse.formCode | |
Definition | A code for the form to be used for printing the content. |
Short | Printed form identifier |
Comments | May be needed to identify specific jurisdictional forms. |
Control | 0..1 |
Binding | For example codes, see FormCodes (example to http://hl7.org/fhir/ValueSet/forms )The forms codes. |
Type | CodeableConcept |
Is Modifier | false |
Must Support | false |
Summary | false |
Requirements | Needed to specify the specific form used for producing output for this response. |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) |
370. ClaimResponse.form | |
Definition | The actual form, by reference or inclusion, for printing the content or an EOB. |
Short | Printed reference or actual form |
Comments | Needed to permit insurers to include the actual form. |
Control | 0..1 |
Type | Attachment |
Is Modifier | false |
Must Support | false |
Summary | false |
Requirements | Needed to include the specific form used for producing output for this response. |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) |
372. ClaimResponse.processNote | |
Definition | A note that describes or explains adjudication results in a human readable form. |
Short | Note concerning adjudication |
Control | 0..* |
Type | BackboneElement |
Is Modifier | false |
Must Support | false |
Summary | false |
Requirements | Provides the insurer specific textual explanations associated with the processing. |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) |
374. ClaimResponse.processNote.id | |
Definition | Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. |
Short | Unique id for inter-element referencing |
Control | 0..1 This element is affected by the following invariants: ele-1 |
Type | string |
Is Modifier | false |
XML Format | In the XML format, this property is represented as an attribute. |
Summary | false |
376. ClaimResponse.processNote.extension | |
Definition | May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and managable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. |
Short | Additional content defined by implementations |
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. |
Control | 0..* |
Type | Extension |
Is Modifier | false |
Summary | false |
Alternate Names | extensions, user content |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) )ext-1: Must have either extensions or value[x], not both ( extension.exists() != value.exists() ) |
378. ClaimResponse.processNote.modifierExtension | |
Definition | May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and managable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). |
Short | Extensions that cannot be ignored even if unrecognized |
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. |
Control | 0..* |
Type | Extension |
Is Modifier | true because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them |
Summary | true |
Requirements | Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions. |
Alternate Names | extensions, user content, modifiers |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) )ext-1: Must have either extensions or value[x], not both ( extension.exists() != value.exists() ) |
380. ClaimResponse.processNote.number | |
Definition | A number to uniquely identify a note entry. |
Short | Note instance identifier |
Control | 0..1 |
Type | positiveInt |
Is Modifier | false |
Primitive Value | This primitive element may be present, or absent, or replaced by an extension |
Must Support | false |
Summary | false |
Requirements | Necessary to provide a mechanism to link from adjudications. |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) |
382. ClaimResponse.processNote.type | |
Definition | The business purpose of the note text. |
Short | Note purpose |
Control | 0..1 |
Binding | Unless not suitable, these codes SHALL be taken from NoteType (extensible to http://hl7.org/fhir/ValueSet/note-type )The presentation types of notes. |
Type | CodeableConcept |
Is Modifier | false |
Must Support | false |
Summary | false |
Requirements | To convey the expectation for when the text is used. |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) |
384. ClaimResponse.processNote.text | |
Definition | The explanation or description associated with the processing. |
Short | Note explanatory text |
Control | 1..1 |
Type | string |
Is Modifier | false |
Primitive Value | This primitive element may be present, or absent, or replaced by an extension |
Must Support | false |
Summary | false |
Requirements | Required to provide human readable explanation. |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) |
386. ClaimResponse.processNote.language | |
Definition | A code to define the language used in the text of the note. |
Short | Language of the text |
Comments | Only required if the language is different from the resource language. |
Control | 0..1 |
Binding | The codes SHALL be taken from AllLanguages (required to http://hl7.org/fhir/ValueSet/all-languages|5.0.0 )IETF language tag for a human language |
Type | CodeableConcept |
Is Modifier | false |
Must Support | false |
Summary | false |
Requirements | Note text may vary from the resource defined language. |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) |
388. ClaimResponse.communicationRequest | |
Definition | Request for additional supporting or authorizing information. |
Short | Request for additional information |
Comments | For example: professional reports, documents, images, clinical resources, or accident reports. |
Control | 0..* |
Type | Reference(CommunicationRequest) |
Is Modifier | false |
Must Support | false |
Summary | false |
Requirements | Need to communicate insurer request for additional information required to support the adjudication. |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) |
390. ClaimResponse.insurance | |
Definition | Financial instruments for reimbursement for the health care products and services specified on the claim. |
Short | Patient insurance information |
Comments | All insurance coverages for the patient which may be applicable for reimbursement, of the products and services listed in the claim, are typically provided in the claim to allow insurers to confirm the ordering of the insurance coverages relative to local 'coordination of benefit' rules. One coverage (and only one) with 'focal=true' is to be used in the adjudication of this claim. Coverages appearing before the focal Coverage in the list, and where 'subrogation=false', should provide a reference to the ClaimResponse containing the adjudication results of the prior claim. |
Control | 0..* |
Type | BackboneElement |
Is Modifier | false |
Must Support | false |
Summary | false |
Requirements | At least one insurer is required for a claim to be a claim. |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) |
392. ClaimResponse.insurance.id | |
Definition | Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. |
Short | Unique id for inter-element referencing |
Control | 0..1 This element is affected by the following invariants: ele-1 |
Type | string |
Is Modifier | false |
XML Format | In the XML format, this property is represented as an attribute. |
Summary | false |
394. ClaimResponse.insurance.extension | |
Definition | May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and managable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. |
Short | Additional content defined by implementations |
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. |
Control | 0..* |
Type | Extension |
Is Modifier | false |
Summary | false |
Alternate Names | extensions, user content |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) )ext-1: Must have either extensions or value[x], not both ( extension.exists() != value.exists() ) |
396. ClaimResponse.insurance.modifierExtension | |
Definition | May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and managable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). |
Short | Extensions that cannot be ignored even if unrecognized |
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. |
Control | 0..* |
Type | Extension |
Is Modifier | true because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them |
Summary | true |
Requirements | Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions. |
Alternate Names | extensions, user content, modifiers |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) )ext-1: Must have either extensions or value[x], not both ( extension.exists() != value.exists() ) |
398. ClaimResponse.insurance.sequence | |
Definition | A number to uniquely identify insurance entries and provide a sequence of coverages to convey coordination of benefit order. |
Short | Insurance instance identifier |
Control | 1..1 |
Type | positiveInt |
Is Modifier | false |
Primitive Value | This primitive element may be present, or absent, or replaced by an extension |
Must Support | false |
Summary | false |
Requirements | To maintain order of the coverages. |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) |
400. ClaimResponse.insurance.focal | |
Definition | A flag to indicate that this Coverage is to be used for adjudication of this claim when set to true. |
Short | Coverage to be used for adjudication |
Comments | A patient may (will) have multiple insurance policies which provide reimbursement for healthcare services and products. For example a person may also be covered by their spouse's policy and both appear in the list (and may be from the same insurer). This flag will be set to true for only one of the listed policies and that policy will be used for adjudicating this claim. Other claims would be created to request adjudication against the other listed policies. |
Control | 1..1 |
Type | boolean |
Is Modifier | false |
Primitive Value | This primitive element may be present, or absent, or replaced by an extension |
Must Support | false |
Summary | false |
Requirements | To identify which coverage in the list is being used to adjudicate this claim. |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) |
402. ClaimResponse.insurance.coverage | |
Definition | Reference to the insurance card level information contained in the Coverage resource. The coverage issuing insurer will use these details to locate the patient's actual coverage within the insurer's information system. |
Short | Insurance information |
Control | 1..1 |
Type | Reference(SVCCoverage) |
Is Modifier | false |
Must Support | false |
Summary | false |
Requirements | Required to allow the adjudicator to locate the correct policy and history within their information system. |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) |
404. ClaimResponse.insurance.businessArrangement | |
Definition | A business agreement number established between the provider and the insurer for special business processing purposes. |
Short | Additional provider contract number |
Control | 0..1 |
Type | string |
Is Modifier | false |
Primitive Value | This primitive element may be present, or absent, or replaced by an extension |
Must Support | false |
Summary | false |
Requirements | Providers may have multiple business arrangements with a given insurer and must supply the specific contract number for adjudication. |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) |
406. ClaimResponse.insurance.claimResponse | |
Definition | The result of the adjudication of the line items for the Coverage specified in this insurance. |
Short | Adjudication results |
Comments | Must not be specified when 'focal=true' for this insurance. |
Control | 0..1 |
Type | Reference(ClaimResponse) |
Is Modifier | false |
Must Support | false |
Summary | false |
Requirements | An insurer need the adjudication results from prior insurers to determine the outstanding balance remaining by item for the items in the curent claim. |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) |
408. ClaimResponse.error | |
Definition | Errors encountered during the processing of the adjudication. |
Short | Processing errors |
Comments | If the request contains errors then an error element should be provided and no adjudication related sections (item, addItem, or payment) should be present. |
Control | 0..* |
Type | BackboneElement |
Is Modifier | false |
Must Support | false |
Summary | false |
Requirements | Need to communicate processing issues to the requestor. |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) |
410. ClaimResponse.error.id | |
Definition | Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. |
Short | Unique id for inter-element referencing |
Control | 0..1 This element is affected by the following invariants: ele-1 |
Type | string |
Is Modifier | false |
XML Format | In the XML format, this property is represented as an attribute. |
Summary | false |
412. ClaimResponse.error.extension | |
Definition | May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and managable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. |
Short | Additional content defined by implementations |
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. |
Control | 0..* |
Type | Extension |
Is Modifier | false |
Summary | false |
Alternate Names | extensions, user content |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) )ext-1: Must have either extensions or value[x], not both ( extension.exists() != value.exists() ) |
414. ClaimResponse.error.modifierExtension | |
Definition | May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and managable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). |
Short | Extensions that cannot be ignored even if unrecognized |
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. |
Control | 0..* |
Type | Extension |
Is Modifier | true because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them |
Summary | true |
Requirements | Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions. |
Alternate Names | extensions, user content, modifiers |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) )ext-1: Must have either extensions or value[x], not both ( extension.exists() != value.exists() ) |
416. ClaimResponse.error.itemSequence | |
Definition | The sequence number of the line item submitted which contains the error. This value is omitted when the error occurs outside of the item structure. |
Short | Item sequence number |
Control | 0..1 |
Type | positiveInt |
Is Modifier | false |
Primitive Value | This primitive element may be present, or absent, or replaced by an extension |
Must Support | false |
Summary | false |
Requirements | Provides references to the claim items. |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) |
418. ClaimResponse.error.detailSequence | |
Definition | The sequence number of the detail within the line item submitted which contains the error. This value is omitted when the error occurs outside of the item structure. |
Short | Detail sequence number |
Control | 0..1 |
Type | positiveInt |
Is Modifier | false |
Primitive Value | This primitive element may be present, or absent, or replaced by an extension |
Must Support | false |
Summary | false |
Requirements | Provides references to the claim details within the claim item. |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) |
420. ClaimResponse.error.subDetailSequence | |
Definition | The sequence number of the sub-detail within the detail within the line item submitted which contains the error. This value is omitted when the error occurs outside of the item structure. |
Short | Subdetail sequence number |
Control | 0..1 |
Type | positiveInt |
Is Modifier | false |
Primitive Value | This primitive element may be present, or absent, or replaced by an extension |
Must Support | false |
Summary | false |
Requirements | Provides references to the claim sub-details within the claim detail. |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) |
422. ClaimResponse.error.code | |
Definition | An error code, from a specified code system, which details why the claim could not be adjudicated. |
Short | Error code detailing processing issues |
Control | 1..1 |
Binding | For example codes, see AdjudicationErrorCodes (example to http://hl7.org/fhir/ValueSet/adjudication-error )The adjudication error codes. |
Type | CodeableConcept |
Is Modifier | false |
Must Support | false |
Summary | true |
Requirements | Required to convey processing errors. |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) |
424. ClaimResponse.error.expression | |
Definition | A simple subset of FHIRPath limited to element names, repetition indicators and the default child accessor that identifies one of the elements in the resource that caused this issue to be raised. |
Short | FHIRPath of element(s) related to issue |
Comments | The root of the FHIRPath is the resource or bundle that generated OperationOutcome. Each FHIRPath SHALL resolve to a single node. |
Control | 0..* |
Type | string |
Is Modifier | false |
Primitive Value | This primitive element may be present, or absent, or replaced by an extension |
Must Support | false |
Summary | true |
Requirements | Allows systems to highlight or otherwise guide users to elements implicated in issues to allow them to be fixed more easily. |
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()) ) |