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

## Resource Profile: AT MOPED ClaimResponse VAEResponse generisches Profil

Official URL: https://elga.moped.at/StructureDefinition/at-moped-claimresponse-vaeresponse-generisch | Version: 0.1.0
Draft as of 2026-06-09 | Responsible: ELGA GmbH | Computable Name: AtMopedClaimResponseVAEResponseGenerisch

MOPED generisches Profil der ClaimResponse Ressource für die Beantwortung der Versichertenanspruchserklärung VAE.

Usages:

- Derived from this Profile: AT MOPED ClaimResponse VAEResponse Basis Profil
- Use this Profile: AT MOPED Bundle $antworten SV Profil
- Refer to this Profile: AT MOPED Composition generisches Profil
- Examples for this Profile: ClaimResponse/PJ1VAEResponse1 and ClaimResponse/PJ2VAEResponse1

You can also check for usages in the FHIR IG Statistics

### Formal Views of Profile Content

Description of Profiles, Differentials, Snapshots and how the different presentations work.

- Key Elements Table
- Differential Table
- Snapshot Table
- Statistics/References
- All

Name | Flags | Card. | Type | Description & Constraints Filter: Bindings Constraints Obligations
--- | --- | --- | --- | ---
ClaimResponse |  | 0..* | ClaimResponse | Response to a claim predetermination or preauthorization
implicitRules | ?!Σ | 0..1 | uri | A set of rules under which this content was created
contained |  | 0..* | Resource | Contained, inline Resources
Slices for extension |  | 2..* | Extension | Extension Slice: Unordered, Open by value:url
extension:VerpflegskostenBeitragsbefreiung | O | 1..* | (Complex) | KaOrg: Verpflegskosten-Beitragsbefreiung URL: https://elga.moped.at/StructureDefinition/moped-ext-verpflegskostenBeitragsbefreiung
Obligations | Actor
SHALL:populate | Moped SV Actor
extension:MopedSupportingInfoVortageanzahlAufKostenbeitrag | O | 1..1 | (Complex) | KaOrg: Vortageanzahl auf Kostenbeitrag URL: https://elga.moped.at/StructureDefinition/MopedSupportingInfoVortageanzahlAufKostenbeitrag
Obligations | Actor
SHALL:populate | Moped SV Actor
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored
status | ?!O Σ | 1..1 | code | active | cancelled | draft | entered-in-error Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance. Required Pattern: active
Obligations | Actor
SHALL:populate | Moped SV Actor
SHALL:handle | Moped Device Actor
type | Σ | 1..1 | CodeableConcept | More granular claim type Binding: Claim Type ValueSet (required)
coding | O Σ | 1..* | Coding | Code defined by a terminology system Fixed Value: As shown (VAE Response)
Obligations | Actor
SHALL:populate | Moped SV Actor
id |  | 0..0 | string | Unique id for inter-element referencing
extension |  | 0..0 | Extension | Additional content defined by implementations
system |  | 1..1 | uri | Identity of the terminology system Fixed Value: https://elga.moped.at/CodeSystem/MopedClaimTypeCS
version |  | 0..0 | string | Version of the system - if relevant
code |  | 1..1 | code | Symbol in syntax defined by the system Fixed Value: VAERESP
display |  | 0..0 | string | Representation defined by the system
userSelected |  | 0..0 | boolean | If this coding was chosen directly by the user
use | O Σ | 1..1 | code | claim | preauthorization | predetermination Binding: Use (required): Claim, preauthorization, predetermination. Required Pattern: preauthorization
Obligations | Actor
SHALL:populate | Moped SV Actor
patient | O Σ | 1..1 | Reference(AT MOPED Patient vbPK Basis Profil | AT MOPED Patient Klarname Basis Profil) | The recipient of the products and services
Obligations | Actor
SHALL:handle | Moped Device Actor
created | O Σ | 1..1 | dateTime | Response creation date
Obligations | Actor
SHALL:populate | Moped SV Actor
insurer | O Σ | 1..1 | Reference(AT MOPED Organization SV Profil) | Party responsible for reimbursement
Obligations | Actor
SHALL:populate | Moped SV Actor
requestor | O | 1..1 | Reference(AT MOPED Organization KA Profil) | Party responsible for the claim
Obligations | Actor
SHALL:handle | Moped Device Actor
request | O Σ | 1..1 | Reference(AT MOPED Claim VAERequest Initiales Profil | AT MOPED Claim VAERequest Verlängerungs Profil) | Id of resource triggering adjudication
Obligations | Actor
SHALL:populate | Moped SV Actor
outcome | O Σ | 1..1 | code | VAE Bewilligung/Ablehnung Binding: ClaimProcessingCodes (required): The result of the claim processing.
Obligations | Actor
SHALL:populate | Moped SV Actor
decision | O Σ | 1..1 | CodeableConcept | KaOrg: Status der VAE Binding: Status der Versichertenanspruchserklärung (required)
Obligations | Actor
SHALL:populate | Moped SV Actor
preAuthPeriod |  | 1..1 | Period | Preauthorization reference effective period
start | O Σ C | 1..1 | dateTime | KaOrg: VAE Beginndatum
Obligations | Actor
SHALL:populate | Moped SV Actor
end | O Σ C | 0..1 | dateTime | KaOrg: Fristende; KaOrg: VAE Endedatum; VAE Enddatum und Indikator, ob es ein Fristende gibt
Obligations | Actor
SHALL:populate | Moped SV Actor
Documentation for this format

#### Terminology Bindings

Path | Status | Usage | ValueSet | Version | Source
ClaimResponse.status | Base | required | Financial Resource Status Codes | 📍5.0.0 | FHIR Std.
ClaimResponse.type | Base | required | Claim Type ValueSet | 📦0.1.0 | This IG
ClaimResponse.use | Base | required | Use | 📍5.0.0 | FHIR Std.
ClaimResponse.outcome | Base | required | Claim Processing Codes | 📍5.0.0 | FHIR Std.
ClaimResponse.decision | Base | required | Status der Versichertenanspruchserklärung | 📦0.1.0 | This IG

#### Constraints

Id | Grade | Path(s) | Description | Expression
dom-2 | error | ClaimResponse | If the resource is contained in another resource, it SHALL NOT contain nested Resources | `contained.contained.empty()`
dom-3 | error | ClaimResponse | 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 | error | ClaimResponse | 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 | error | ClaimResponse | If a resource is contained in another resource, it SHALL NOT have a security label | `contained.meta.security.empty()`
dom-6 | best practice | ClaimResponse | A resource should have narrative for robust management | `text.`div`.exists()`
ele-1 | error | **ALL** elements | All FHIR elements must have a @value or children | `hasValue() or (children().count() > id.count())`
ext-1 | error | **ALL** extensions | Must have either extensions or value[x], not both | `extension.exists() != value.exists()`

This structure is derived from ClaimResponse

Name | Flags | Card. | Type | Description & Constraints Filter: Bindings Constraints Obligations
--- | --- | --- | --- | ---
ClaimResponse |  |  | ClaimResponse |
Slices for extension |  | 2..* | Extension | Extension Slice: Unordered, Open by value:url
extension:VerpflegskostenBeitragsbefreiung | O | 1..* | (Complex) | KaOrg: Verpflegskosten-Beitragsbefreiung URL: https://elga.moped.at/StructureDefinition/moped-ext-verpflegskostenBeitragsbefreiung
Obligations | Actor
SHALL:populate | Moped SV Actor
extension:MopedSupportingInfoVortageanzahlAufKostenbeitrag | O | 1..1 | (Complex) | KaOrg: Vortageanzahl auf Kostenbeitrag URL: https://elga.moped.at/StructureDefinition/MopedSupportingInfoVortageanzahlAufKostenbeitrag
Obligations | Actor
SHALL:populate | Moped SV Actor
status | O | 1..1 | code | active | cancelled | draft | entered-in-error Required Pattern: active
Obligations | Actor
SHALL:populate | Moped SV Actor
SHALL:handle | Moped Device Actor
type |  | 1..1 | CodeableConcept | More granular claim type Binding: Claim Type ValueSet (required)
coding | O | 1..* | Coding | Code defined by a terminology system Fixed Value: As shown (VAE Response)
Obligations | Actor
SHALL:populate | Moped SV Actor
system |  | 1..1 | uri | Identity of the terminology system Fixed Value: https://elga.moped.at/CodeSystem/MopedClaimTypeCS
code |  | 1..1 | code | Symbol in syntax defined by the system Fixed Value: VAERESP
use | O | 1..1 | code | claim | preauthorization | predetermination Required Pattern: preauthorization
Obligations | Actor
SHALL:populate | Moped SV Actor
patient | O | 1..1 | Reference(AT MOPED Patient vbPK Basis Profil | AT MOPED Patient Klarname Basis Profil) | The recipient of the products and services
Obligations | Actor
SHALL:handle | Moped Device Actor
created | O | 1..1 | dateTime | Response creation date
Obligations | Actor
SHALL:populate | Moped SV Actor
insurer | O | 1..1 | Reference(AT MOPED Organization SV Profil) | Party responsible for reimbursement
Obligations | Actor
SHALL:populate | Moped SV Actor
requestor | O | 1..1 | Reference(AT MOPED Organization KA Profil) | Party responsible for the claim
Obligations | Actor
SHALL:handle | Moped Device Actor
request | O | 1..1 | Reference(AT MOPED Claim VAERequest Initiales Profil | AT MOPED Claim VAERequest Verlängerungs Profil) | Id of resource triggering adjudication
Obligations | Actor
SHALL:populate | Moped SV Actor
outcome | O | 1..1 | code | VAE Bewilligung/Ablehnung
Obligations | Actor
SHALL:populate | Moped SV Actor
decision | O | 1..1 | CodeableConcept | KaOrg: Status der VAE Binding: Status der Versichertenanspruchserklärung (required)
Obligations | Actor
SHALL:populate | Moped SV Actor
preAuthPeriod |  | 1..1 | Period | Preauthorization reference effective period
start | O | 1..1 | dateTime | KaOrg: VAE Beginndatum
Obligations | Actor
SHALL:populate | Moped SV Actor
end | O | 0..1 | dateTime | KaOrg: Fristende; KaOrg: VAE Endedatum; VAE Enddatum und Indikator, ob es ein Fristende gibt
Obligations | Actor
SHALL:populate | Moped SV Actor
addItem |  |  |  |
Slices for extension |  | 0..* | Extension | Extension Slice: Unordered, Open by value:url
extension:AddItemCategory | O | 0..1 | CodeableConcept | AddItemCategory URL: https://elga.moped.at/StructureDefinition/moped-ext-AddItemCategory Binding: Moped Claim Item Category ValueSet (required)
Obligations | Actor
SHALL:populate | Moped SV Actor
Documentation for this format

#### Terminology Bindings (Differential)

Path | Status | Usage | ValueSet | Version | Source
ClaimResponse.type | Base | required | Claim Type ValueSet | 📦0.1.0 | This IG
ClaimResponse.decision | Base | required | Status der Versichertenanspruchserklärung | 📦0.1.0 | This IG

Name | Flags | Card. | Type | Description & Constraints Filter: Bindings Constraints Obligations
--- | --- | --- | --- | ---
ClaimResponse |  | 0..* | ClaimResponse | Response to a claim predetermination or preauthorization
id | Σ | 0..1 | id | Logical id of this artifact
meta | Σ | 0..1 | Meta | Metadata about the resource
implicitRules | ?!Σ | 0..1 | uri | A set of rules under which this content was created
language |  | 0..1 | code | Language of the resource content Binding: AllLanguages (required): IETF language tag for a human language
Additional Bindings | Purpose
CommonLanguages | Starter
text |  | 0..1 | Narrative | Text summary of the resource, for human interpretation This profile does not constrain the narrative in regard to content, language, or traceability to data elements
contained |  | 0..* | Resource | Contained, inline Resources
Slices for extension |  | 2..* | Extension | Extension Slice: Unordered, Open by value:url
extension:VerpflegskostenBeitragsbefreiung | O | 1..* | (Complex) | KaOrg: Verpflegskosten-Beitragsbefreiung URL: https://elga.moped.at/StructureDefinition/moped-ext-verpflegskostenBeitragsbefreiung
Obligations | Actor
SHALL:populate | Moped SV Actor
extension:MopedSupportingInfoVortageanzahlAufKostenbeitrag | O | 1..1 | (Complex) | KaOrg: Vortageanzahl auf Kostenbeitrag URL: https://elga.moped.at/StructureDefinition/MopedSupportingInfoVortageanzahlAufKostenbeitrag
Obligations | Actor
SHALL:populate | Moped SV Actor
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored
identifier |  | 0..* | Identifier | Business Identifier for a claim response
traceNumber |  | 0..* | Identifier | Number for tracking
status | ?!O Σ | 1..1 | code | active | cancelled | draft | entered-in-error Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance. Required Pattern: active
Obligations | Actor
SHALL:populate | Moped SV Actor
SHALL:handle | Moped Device Actor
type | Σ | 1..1 | CodeableConcept | More granular claim type Binding: Claim Type ValueSet (required)
id |  | 0..1 | id | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url
coding | O Σ | 1..* | Coding | Code defined by a terminology system Fixed Value: As shown (VAE Response)
Obligations | Actor
SHALL:populate | Moped SV Actor
id |  | 0..0 | string | Unique id for inter-element referencing
extension |  | 0..0 | Extension | Additional content defined by implementations
system |  | 1..1 | uri | Identity of the terminology system Fixed Value: https://elga.moped.at/CodeSystem/MopedClaimTypeCS
version |  | 0..0 | string | Version of the system - if relevant
code |  | 1..1 | code | Symbol in syntax defined by the system Fixed Value: VAERESP
display |  | 0..0 | string | Representation defined by the system
userSelected |  | 0..0 | boolean | If this coding was chosen directly by the user
text | Σ | 0..1 | string | Plain text representation of the concept
subType |  | 0..1 | CodeableConcept | More granular claim type Binding: ExampleClaimSubTypeCodes (example): A more granular claim typecode.
use | O Σ | 1..1 | code | claim | preauthorization | predetermination Binding: Use (required): Claim, preauthorization, predetermination. Required Pattern: preauthorization
Obligations | Actor
SHALL:populate | Moped SV Actor
patient | O Σ | 1..1 | Reference(AT MOPED Patient vbPK Basis Profil | AT MOPED Patient Klarname Basis Profil) | The recipient of the products and services
Obligations | Actor
SHALL:handle | Moped Device Actor
created | O Σ | 1..1 | dateTime | Response creation date
Obligations | Actor
SHALL:populate | Moped SV Actor
insurer | O Σ | 1..1 | Reference(AT MOPED Organization SV Profil) | Party responsible for reimbursement
Obligations | Actor
SHALL:populate | Moped SV Actor
requestor | O | 1..1 | Reference(AT MOPED Organization KA Profil) | Party responsible for the claim
Obligations | Actor
SHALL:handle | Moped Device Actor
request | O Σ | 1..1 | Reference(AT MOPED Claim VAERequest Initiales Profil | AT MOPED Claim VAERequest Verlängerungs Profil) | Id of resource triggering adjudication
Obligations | Actor
SHALL:populate | Moped SV Actor
outcome | O Σ | 1..1 | code | VAE Bewilligung/Ablehnung Binding: ClaimProcessingCodes (required): The result of the claim processing.
Obligations | Actor
SHALL:populate | Moped SV Actor
decision | O Σ | 1..1 | CodeableConcept | KaOrg: Status der VAE Binding: Status der Versichertenanspruchserklärung (required)
Obligations | Actor
SHALL:populate | Moped SV Actor
disposition |  | 0..1 | string | Disposition Message
preAuthRef |  | 0..1 | string | Preauthorization reference
preAuthPeriod |  | 1..1 | Period | Preauthorization reference effective period
id |  | 0..1 | id | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url
start | O Σ C | 1..1 | dateTime | KaOrg: VAE Beginndatum
Obligations | Actor
SHALL:populate | Moped SV Actor
end | O Σ C | 0..1 | dateTime | KaOrg: Fristende; KaOrg: VAE Endedatum; VAE Enddatum und Indikator, ob es ein Fristende gibt
Obligations | Actor
SHALL:populate | Moped SV Actor
event |  | 0..* | BackboneElement | Event information
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
type |  | 1..1 | CodeableConcept | Specific event Binding: DatesTypeCodes (example)
when[x] |  | 1..1 |  | Occurance date or period
whenDateTime |  |  | dateTime |
whenPeriod |  |  | Period |
payeeType |  | 0..1 | CodeableConcept | Party to be paid any benefits payable Binding: ClaimPayeeTypeCodes (example): A code for the party to be reimbursed.
encounter |  | 0..* | Reference(Encounter) | Encounters associated with the listed treatments
diagnosisRelatedGroup |  | 0..1 | CodeableConcept | Package billing code Binding: ExampleDiagnosisRelatedGroupCodes (example)
item |  | 0..* | BackboneElement | Adjudication for claim line items
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
itemSequence |  | 1..1 | positiveInt | Claim item instance identifier
traceNumber |  | 0..* | Identifier | Number for tracking
noteNumber |  | 0..* | positiveInt | Applicable note numbers
reviewOutcome |  | 0..1 | BackboneElement | Adjudication results
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
decision |  | 0..1 | CodeableConcept | Result of the adjudication Binding: ClaimAdjudicationDecisionsCodes (example)
reason |  | 0..* | CodeableConcept | Reason for result of the adjudication Binding: ClaimAdjudicationDecisionReasonCodes (example)
preAuthRef |  | 0..1 | string | Preauthorization reference
preAuthPeriod |  | 0..1 | Period | Preauthorization reference effective period
adjudication |  | 0..* | BackboneElement | Adjudication details
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
category |  | 1..1 | CodeableConcept | Type of adjudication information Binding: AdjudicationValueCodes (example): The adjudication codes.
reason |  | 0..1 | CodeableConcept | Explanation of adjudication outcome Binding: AdjudicationReasonCodes (example): The adjudication reason codes.
amount |  | 0..1 | Money | Monetary amount
quantity |  | 0..1 | Quantity | Non-monetary value
detail |  | 0..* | BackboneElement | Adjudication for claim details
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
detailSequence |  | 1..1 | positiveInt | Claim detail instance identifier
traceNumber |  | 0..* | Identifier | Number for tracking
noteNumber |  | 0..* | positiveInt | Applicable note numbers
reviewOutcome |  | 0..1 | See reviewOutcome (ClaimResponse) | Detail level adjudication results
adjudication |  | 0..* | See adjudication (ClaimResponse) | Detail level adjudication details
subDetail |  | 0..* | BackboneElement | Adjudication for claim sub-details
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
subDetailSequence |  | 1..1 | positiveInt | Claim sub-detail instance identifier
traceNumber |  | 0..* | Identifier | Number for tracking
noteNumber |  | 0..* | positiveInt | Applicable note numbers
reviewOutcome |  | 0..1 | See reviewOutcome (ClaimResponse) | Subdetail level adjudication results
adjudication |  | 0..* | See adjudication (ClaimResponse) | Subdetail level adjudication details
addItem |  | 0..* | BackboneElement | Insurer added line items
id |  | 0..1 | string | Unique id for inter-element referencing
Slices for extension |  | 0..* | Extension | Extension Slice: Unordered, Open by value:url
extension:AddItemCategory | O | 0..1 | CodeableConcept | AddItemCategory URL: https://elga.moped.at/StructureDefinition/moped-ext-AddItemCategory Binding: Moped Claim Item Category ValueSet (required)
Obligations | Actor
SHALL:populate | Moped SV Actor
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
itemSequence |  | 0..* | positiveInt | Item sequence number
detailSequence |  | 0..* | positiveInt | Detail sequence number
subdetailSequence |  | 0..* | positiveInt | Subdetail sequence number
traceNumber |  | 0..* | Identifier | Number for tracking
provider |  | 0..* | Reference(Practitioner | PractitionerRole | Organization) | Authorized providers
revenue |  | 0..1 | CodeableConcept | Revenue or cost center code Binding: ExampleRevenueCenterCodes (example): Codes for the revenue or cost centers supplying the service and/or products.
productOrService |  | 0..1 | CodeableConcept | Billing, service, product, or drug code Binding: USCLSCodes (example): Allowable service and product codes.
productOrServiceEnd |  | 0..1 | CodeableConcept | End of a range of codes Binding: USCLSCodes (example)
request |  | 0..* | Reference(DeviceRequest | MedicationRequest | NutritionOrder | ServiceRequest | SupplyRequest | VisionPrescription) | Request or Referral for Service
modifier |  | 0..* | CodeableConcept | Service/Product billing modifiers Binding: ModifierTypeCodes (example): Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen.
programCode |  | 0..* | CodeableConcept | Program the product or service is provided under Binding: ExampleProgramReasonCodes (example): Program specific reason codes.
serviced[x] |  | 0..1 |  | Date or dates of service or product delivery
servicedDate |  |  | date |
servicedPeriod |  |  | Period |
location[x] |  | 0..1 |  | Place of service or where product was supplied Binding: ExampleServicePlaceCodes (example): Place of service: pharmacy, school, prison, etc.
locationCodeableConcept |  |  | CodeableConcept |
locationAddress |  |  | Address |
locationReference |  |  | Reference(Location) |
quantity |  | 0..1 | SimpleQuantity(5.0.0) | Count of products or services
unitPrice |  | 0..1 | Money | Fee, charge or cost per item
factor |  | 0..1 | decimal | Price scaling factor
tax |  | 0..1 | Money | Total tax
net |  | 0..1 | Money | Total item cost
bodySite |  | 0..* | BackboneElement | Anatomical location
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
site |  | 1..* | CodeableReference(BodyStructure) | Location Binding: OralSiteCodes (example)
subSite |  | 0..* | CodeableConcept | Sub-location Binding: SurfaceCodes (example)
noteNumber |  | 0..* | positiveInt | Applicable note numbers
reviewOutcome |  | 0..1 | See reviewOutcome (ClaimResponse) | Added items adjudication results
adjudication |  | 0..* | See adjudication (ClaimResponse) | Added items adjudication
detail |  | 0..* | BackboneElement | Insurer added line details
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
traceNumber |  | 0..* | Identifier | Number for tracking
revenue |  | 0..1 | CodeableConcept | Revenue or cost center code Binding: ExampleRevenueCenterCodes (example): Codes for the revenue or cost centers supplying the service and/or products.
productOrService |  | 0..1 | CodeableConcept | Billing, service, product, or drug code Binding: USCLSCodes (example): Allowable service and product codes.
productOrServiceEnd |  | 0..1 | CodeableConcept | End of a range of codes Binding: USCLSCodes (example)
modifier |  | 0..* | CodeableConcept | Service/Product billing modifiers Binding: ModifierTypeCodes (example): Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen.
quantity |  | 0..1 | SimpleQuantity(5.0.0) | Count of products or services
unitPrice |  | 0..1 | Money | Fee, charge or cost per item
factor |  | 0..1 | decimal | Price scaling factor
tax |  | 0..1 | Money | Total tax
net |  | 0..1 | Money | Total item cost
noteNumber |  | 0..* | positiveInt | Applicable note numbers
reviewOutcome |  | 0..1 | See reviewOutcome (ClaimResponse) | Added items detail level adjudication results
adjudication |  | 0..* | See adjudication (ClaimResponse) | Added items detail adjudication
subDetail |  | 0..* | BackboneElement | Insurer added line items
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
traceNumber |  | 0..* | Identifier | Number for tracking
revenue |  | 0..1 | CodeableConcept | Revenue or cost center code Binding: ExampleRevenueCenterCodes (example): Codes for the revenue or cost centers supplying the service and/or products.
productOrService |  | 0..1 | CodeableConcept | Billing, service, product, or drug code Binding: USCLSCodes (example): Allowable service and product codes.
productOrServiceEnd |  | 0..1 | CodeableConcept | End of a range of codes Binding: USCLSCodes (example)
modifier |  | 0..* | CodeableConcept | Service/Product billing modifiers Binding: ModifierTypeCodes (example): Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen.
quantity |  | 0..1 | SimpleQuantity(5.0.0) | Count of products or services
unitPrice |  | 0..1 | Money | Fee, charge or cost per item
factor |  | 0..1 | decimal | Price scaling factor
tax |  | 0..1 | Money | Total tax
net |  | 0..1 | Money | Total item cost
noteNumber |  | 0..* | positiveInt | Applicable note numbers
reviewOutcome |  | 0..1 | See reviewOutcome (ClaimResponse) | Added items subdetail level adjudication results
adjudication |  | 0..* | See adjudication (ClaimResponse) | Added items subdetail adjudication
adjudication |  | 0..* | See adjudication (ClaimResponse) | Header-level adjudication
total | Σ | 0..* | BackboneElement | Adjudication totals
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
category | Σ | 1..1 | CodeableConcept | Type of adjudication information Binding: AdjudicationValueCodes (example): The adjudication codes.
amount | Σ | 1..1 | Money | Financial total for the category
payment |  | 0..1 | BackboneElement | Payment Details
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
type |  | 1..1 | CodeableConcept | Partial or complete payment Binding: ExamplePaymentTypeCodes (example): The type (partial, complete) of the payment.
adjustment |  | 0..1 | Money | Payment adjustment for non-claim issues
adjustmentReason |  | 0..1 | CodeableConcept | Explanation for the adjustment Binding: PaymentAdjustmentReasonCodes (example): Payment Adjustment reason codes.
date |  | 0..1 | date | Expected date of payment
amount |  | 1..1 | Money | Payable amount after adjustment
identifier |  | 0..1 | Identifier | Business identifier for the payment
fundsReserve |  | 0..1 | CodeableConcept | Funds reserved status Binding: FundsReservationCodes (example): For whom funds are to be reserved: (Patient, Provider, None).
formCode |  | 0..1 | CodeableConcept | Printed form identifier Binding: FormCodes (example): The forms codes.
form |  | 0..1 | Attachment | Printed reference or actual form
processNote |  | 0..* | BackboneElement | Note concerning adjudication
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
number |  | 0..1 | positiveInt | Note instance identifier
type |  | 0..1 | CodeableConcept | Note purpose Binding: NoteType (extensible): The presentation types of notes.
text |  | 1..1 | string | Note explanatory text
language |  | 0..1 | CodeableConcept | Language of the text Binding: AllLanguages (required): IETF language tag for a human language
Additional Bindings | Purpose
CommonLanguages | Starter
communicationRequest |  | 0..* | Reference(CommunicationRequest) | Request for additional information
insurance |  | 0..* | BackboneElement | Patient insurance information
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
sequence |  | 1..1 | positiveInt | Insurance instance identifier
focal |  | 1..1 | boolean | Coverage to be used for adjudication
coverage |  | 1..1 | Reference(Coverage) | Insurance information
businessArrangement |  | 0..1 | string | Additional provider contract number
claimResponse |  | 0..1 | Reference(ClaimResponse) | Adjudication results
error |  | 0..* | BackboneElement | Processing errors
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
itemSequence |  | 0..1 | positiveInt | Item sequence number
detailSequence |  | 0..1 | positiveInt | Detail sequence number
subDetailSequence |  | 0..1 | positiveInt | Subdetail sequence number
code | Σ | 1..1 | CodeableConcept | Error code detailing processing issues Binding: AdjudicationErrorCodes (example): The adjudication error codes.
expression | Σ | 0..* | string | FHIRPath of element(s) related to issue
Documentation for this format

#### Terminology Bindings

Path | Status | Usage | ValueSet | Version | Source
ClaimResponse.language | Base | required | All Languages | 📍5.0.0 | FHIR Std.
ClaimResponse.status | Base | required | Financial Resource Status Codes | 📍5.0.0 | FHIR Std.
ClaimResponse.type | Base | required | Claim Type ValueSet | 📦0.1.0 | This IG
ClaimResponse.subType | Base | example | Example Claim SubType Codes | 📍5.0.0 | FHIR Std.
ClaimResponse.use | Base | required | Use | 📍5.0.0 | FHIR Std.
ClaimResponse.outcome | Base | required | Claim Processing Codes | 📍5.0.0 | FHIR Std.
ClaimResponse.decision | Base | required | Status der Versichertenanspruchserklärung | 📦0.1.0 | This IG
ClaimResponse.event.​type | Base | example | Dates Type Codes | 📍5.0.0 | FHIR Std.
ClaimResponse.payeeType | Base | example | Claim Payee Type Codes | 📍5.0.0 | FHIR Std.
ClaimResponse.diagnosisRelatedGroup | Base | example | Example Diagnosis Related Group Codes | 📍5.0.0 | FHIR Std.
ClaimResponse.item.reviewOutcome.​decision | Base | example | Claim Adjudication Decision Codes | 📍5.0.0 | FHIR Std.
ClaimResponse.item.reviewOutcome.​reason | Base | example | Claim Adjudication Decision Reason Codes | 📍5.0.0 | FHIR Std.
ClaimResponse.item.adjudication.​category | Base | example | Adjudication Value Codes | 📍5.0.0 | FHIR Std.
ClaimResponse.item.adjudication.​reason | Base | example | Adjudication Reason Codes | 📍5.0.0 | FHIR Std.
ClaimResponse.addItem.​revenue | Base | example | Example Revenue Center Codes | 📍5.0.0 | FHIR Std.
ClaimResponse.addItem.​productOrService | Base | example | USCLS Codes | 📍5.0.0 | FHIR Std.
ClaimResponse.addItem.​productOrServiceEnd | Base | example | USCLS Codes | 📍5.0.0 | FHIR Std.
ClaimResponse.addItem.​modifier | Base | example | Modifier type Codes | 📍5.0.0 | FHIR Std.
ClaimResponse.addItem.​programCode | Base | example | Example Program Reason Codes | 📍5.0.0 | FHIR Std.
ClaimResponse.addItem.​location[x] | Base | example | Example Service Place Codes | 📍5.0.0 | FHIR Std.
ClaimResponse.addItem.​bodySite.site | Base | example | Oral Site Codes | 📍5.0.0 | FHIR Std.
ClaimResponse.addItem.​bodySite.subSite | Base | example | Surface Codes | 📍5.0.0 | FHIR Std.
ClaimResponse.addItem.​detail.revenue | Base | example | Example Revenue Center Codes | 📍5.0.0 | FHIR Std.
ClaimResponse.addItem.​detail.productOrService | Base | example | USCLS Codes | 📍5.0.0 | FHIR Std.
ClaimResponse.addItem.​detail.productOrServiceEnd | Base | example | USCLS Codes | 📍5.0.0 | FHIR Std.
ClaimResponse.addItem.​detail.modifier | Base | example | Modifier type Codes | 📍5.0.0 | FHIR Std.
ClaimResponse.addItem.​detail.subDetail.revenue | Base | example | Example Revenue Center Codes | 📍5.0.0 | FHIR Std.
ClaimResponse.addItem.​detail.subDetail.productOrService | Base | example | USCLS Codes | 📍5.0.0 | FHIR Std.
ClaimResponse.addItem.​detail.subDetail.productOrServiceEnd | Base | example | USCLS Codes | 📍5.0.0 | FHIR Std.
ClaimResponse.addItem.​detail.subDetail.modifier | Base | example | Modifier type Codes | 📍5.0.0 | FHIR Std.
ClaimResponse.total.​category | Base | example | Adjudication Value Codes | 📍5.0.0 | FHIR Std.
ClaimResponse.payment.​type | Base | example | Example Payment Type Codes | 📍5.0.0 | FHIR Std.
ClaimResponse.payment.​adjustmentReason | Base | example | Payment Adjustment Reason Codes | 📍5.0.0 | FHIR Std.
ClaimResponse.fundsReserve | Base | example | Funds Reservation Codes | 📍5.0.0 | FHIR Std.
ClaimResponse.formCode | Base | example | Form Codes | 📍5.0.0 | FHIR Std.
ClaimResponse.processNote.​type | Base | extensible | NoteType | 📍5.0.0 | FHIR Std.
ClaimResponse.processNote.​language | Base | required | All Languages | 📍5.0.0 | FHIR Std.
ClaimResponse.error.​code | Base | example | Adjudication Error Codes | 📍5.0.0 | FHIR Std.

#### Constraints

Id | Grade | Path(s) | Description | Expression
dom-2 | error | ClaimResponse | If the resource is contained in another resource, it SHALL NOT contain nested Resources | `contained.contained.empty()`
dom-3 | error | ClaimResponse | 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 | error | ClaimResponse | 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 | error | ClaimResponse | If a resource is contained in another resource, it SHALL NOT have a security label | `contained.meta.security.empty()`
dom-6 | best practice | ClaimResponse | A resource should have narrative for robust management | `text.`div`.exists()`
ele-1 | error | **ALL** elements | All FHIR elements must have a @value or children | `hasValue() or (children().count() > id.count())`
ext-1 | error | **ALL** extensions | Must have either extensions or value[x], not both | `extension.exists() != value.exists()`

This structure is derived from ClaimResponse

Summary

Mandatory: 9 elements
Fixed: 1 element

Structures

This structure refers to these other structures:

- AT MOPED Patient vbPK Basis Profil (https://elga.moped.at/StructureDefinition/at-moped-patient-vbPK-basis)
- AT MOPED Patient Klarname Basis Profil (https://elga.moped.at/StructureDefinition/at-moped-patient-klarname-basis)
- AT MOPED Organization SV Profil (https://elga.moped.at/StructureDefinition/at-moped-organization-SV)
- AT MOPED Organization KA Profil (https://elga.moped.at/StructureDefinition/at-moped-organization-KA)
- AT MOPED Claim VAERequest Initiales Profil (https://elga.moped.at/StructureDefinition/at-moped-claim-VAE-request-initial)
- AT MOPED Claim VAERequest Verlängerungs Profil (https://elga.moped.at/StructureDefinition/at-moped-claim-vaerequest-verlaengerung)

Extensions

This structure refers to these extensions:

- https://elga.moped.at/StructureDefinition/moped-ext-verpflegskostenBeitragsbefreiung
- https://elga.moped.at/StructureDefinition/MopedSupportingInfoVortageanzahlAufKostenbeitrag
- https://elga.moped.at/StructureDefinition/moped-ext-AddItemCategory

Key Elements View

Name | Flags | Card. | Type | Description & Constraints Filter: Bindings Constraints Obligations
--- | --- | --- | --- | ---
ClaimResponse |  | 0..* | ClaimResponse | Response to a claim predetermination or preauthorization
implicitRules | ?!Σ | 0..1 | uri | A set of rules under which this content was created
contained |  | 0..* | Resource | Contained, inline Resources
Slices for extension |  | 2..* | Extension | Extension Slice: Unordered, Open by value:url
extension:VerpflegskostenBeitragsbefreiung | O | 1..* | (Complex) | KaOrg: Verpflegskosten-Beitragsbefreiung URL: https://elga.moped.at/StructureDefinition/moped-ext-verpflegskostenBeitragsbefreiung
Obligations | Actor
SHALL:populate | Moped SV Actor
extension:MopedSupportingInfoVortageanzahlAufKostenbeitrag | O | 1..1 | (Complex) | KaOrg: Vortageanzahl auf Kostenbeitrag URL: https://elga.moped.at/StructureDefinition/MopedSupportingInfoVortageanzahlAufKostenbeitrag
Obligations | Actor
SHALL:populate | Moped SV Actor
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored
status | ?!O Σ | 1..1 | code | active | cancelled | draft | entered-in-error Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance. Required Pattern: active
Obligations | Actor
SHALL:populate | Moped SV Actor
SHALL:handle | Moped Device Actor
type | Σ | 1..1 | CodeableConcept | More granular claim type Binding: Claim Type ValueSet (required)
coding | O Σ | 1..* | Coding | Code defined by a terminology system Fixed Value: As shown (VAE Response)
Obligations | Actor
SHALL:populate | Moped SV Actor
id |  | 0..0 | string | Unique id for inter-element referencing
extension |  | 0..0 | Extension | Additional content defined by implementations
system |  | 1..1 | uri | Identity of the terminology system Fixed Value: https://elga.moped.at/CodeSystem/MopedClaimTypeCS
version |  | 0..0 | string | Version of the system - if relevant
code |  | 1..1 | code | Symbol in syntax defined by the system Fixed Value: VAERESP
display |  | 0..0 | string | Representation defined by the system
userSelected |  | 0..0 | boolean | If this coding was chosen directly by the user
use | O Σ | 1..1 | code | claim | preauthorization | predetermination Binding: Use (required): Claim, preauthorization, predetermination. Required Pattern: preauthorization
Obligations | Actor
SHALL:populate | Moped SV Actor
patient | O Σ | 1..1 | Reference(AT MOPED Patient vbPK Basis Profil | AT MOPED Patient Klarname Basis Profil) | The recipient of the products and services
Obligations | Actor
SHALL:handle | Moped Device Actor
created | O Σ | 1..1 | dateTime | Response creation date
Obligations | Actor
SHALL:populate | Moped SV Actor
insurer | O Σ | 1..1 | Reference(AT MOPED Organization SV Profil) | Party responsible for reimbursement
Obligations | Actor
SHALL:populate | Moped SV Actor
requestor | O | 1..1 | Reference(AT MOPED Organization KA Profil) | Party responsible for the claim
Obligations | Actor
SHALL:handle | Moped Device Actor
request | O Σ | 1..1 | Reference(AT MOPED Claim VAERequest Initiales Profil | AT MOPED Claim VAERequest Verlängerungs Profil) | Id of resource triggering adjudication
Obligations | Actor
SHALL:populate | Moped SV Actor
outcome | O Σ | 1..1 | code | VAE Bewilligung/Ablehnung Binding: ClaimProcessingCodes (required): The result of the claim processing.
Obligations | Actor
SHALL:populate | Moped SV Actor
decision | O Σ | 1..1 | CodeableConcept | KaOrg: Status der VAE Binding: Status der Versichertenanspruchserklärung (required)
Obligations | Actor
SHALL:populate | Moped SV Actor
preAuthPeriod |  | 1..1 | Period | Preauthorization reference effective period
start | O Σ C | 1..1 | dateTime | KaOrg: VAE Beginndatum
Obligations | Actor
SHALL:populate | Moped SV Actor
end | O Σ C | 0..1 | dateTime | KaOrg: Fristende; KaOrg: VAE Endedatum; VAE Enddatum und Indikator, ob es ein Fristende gibt
Obligations | Actor
SHALL:populate | Moped SV Actor
Documentation for this format

#### Terminology Bindings

Path | Status | Usage | ValueSet | Version | Source
ClaimResponse.status | Base | required | Financial Resource Status Codes | 📍5.0.0 | FHIR Std.
ClaimResponse.type | Base | required | Claim Type ValueSet | 📦0.1.0 | This IG
ClaimResponse.use | Base | required | Use | 📍5.0.0 | FHIR Std.
ClaimResponse.outcome | Base | required | Claim Processing Codes | 📍5.0.0 | FHIR Std.
ClaimResponse.decision | Base | required | Status der Versichertenanspruchserklärung | 📦0.1.0 | This IG

#### Constraints

Id | Grade | Path(s) | Description | Expression
dom-2 | error | ClaimResponse | If the resource is contained in another resource, it SHALL NOT contain nested Resources | `contained.contained.empty()`
dom-3 | error | ClaimResponse | 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 | error | ClaimResponse | 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 | error | ClaimResponse | If a resource is contained in another resource, it SHALL NOT have a security label | `contained.meta.security.empty()`
dom-6 | best practice | ClaimResponse | A resource should have narrative for robust management | `text.`div`.exists()`
ele-1 | error | **ALL** elements | All FHIR elements must have a @value or children | `hasValue() or (children().count() > id.count())`
ext-1 | error | **ALL** extensions | Must have either extensions or value[x], not both | `extension.exists() != value.exists()`

Differential View

This structure is derived from ClaimResponse

Name | Flags | Card. | Type | Description & Constraints Filter: Bindings Constraints Obligations
--- | --- | --- | --- | ---
ClaimResponse |  |  | ClaimResponse |
Slices for extension |  | 2..* | Extension | Extension Slice: Unordered, Open by value:url
extension:VerpflegskostenBeitragsbefreiung | O | 1..* | (Complex) | KaOrg: Verpflegskosten-Beitragsbefreiung URL: https://elga.moped.at/StructureDefinition/moped-ext-verpflegskostenBeitragsbefreiung
Obligations | Actor
SHALL:populate | Moped SV Actor
extension:MopedSupportingInfoVortageanzahlAufKostenbeitrag | O | 1..1 | (Complex) | KaOrg: Vortageanzahl auf Kostenbeitrag URL: https://elga.moped.at/StructureDefinition/MopedSupportingInfoVortageanzahlAufKostenbeitrag
Obligations | Actor
SHALL:populate | Moped SV Actor
status | O | 1..1 | code | active | cancelled | draft | entered-in-error Required Pattern: active
Obligations | Actor
SHALL:populate | Moped SV Actor
SHALL:handle | Moped Device Actor
type |  | 1..1 | CodeableConcept | More granular claim type Binding: Claim Type ValueSet (required)
coding | O | 1..* | Coding | Code defined by a terminology system Fixed Value: As shown (VAE Response)
Obligations | Actor
SHALL:populate | Moped SV Actor
system |  | 1..1 | uri | Identity of the terminology system Fixed Value: https://elga.moped.at/CodeSystem/MopedClaimTypeCS
code |  | 1..1 | code | Symbol in syntax defined by the system Fixed Value: VAERESP
use | O | 1..1 | code | claim | preauthorization | predetermination Required Pattern: preauthorization
Obligations | Actor
SHALL:populate | Moped SV Actor
patient | O | 1..1 | Reference(AT MOPED Patient vbPK Basis Profil | AT MOPED Patient Klarname Basis Profil) | The recipient of the products and services
Obligations | Actor
SHALL:handle | Moped Device Actor
created | O | 1..1 | dateTime | Response creation date
Obligations | Actor
SHALL:populate | Moped SV Actor
insurer | O | 1..1 | Reference(AT MOPED Organization SV Profil) | Party responsible for reimbursement
Obligations | Actor
SHALL:populate | Moped SV Actor
requestor | O | 1..1 | Reference(AT MOPED Organization KA Profil) | Party responsible for the claim
Obligations | Actor
SHALL:handle | Moped Device Actor
request | O | 1..1 | Reference(AT MOPED Claim VAERequest Initiales Profil | AT MOPED Claim VAERequest Verlängerungs Profil) | Id of resource triggering adjudication
Obligations | Actor
SHALL:populate | Moped SV Actor
outcome | O | 1..1 | code | VAE Bewilligung/Ablehnung
Obligations | Actor
SHALL:populate | Moped SV Actor
decision | O | 1..1 | CodeableConcept | KaOrg: Status der VAE Binding: Status der Versichertenanspruchserklärung (required)
Obligations | Actor
SHALL:populate | Moped SV Actor
preAuthPeriod |  | 1..1 | Period | Preauthorization reference effective period
start | O | 1..1 | dateTime | KaOrg: VAE Beginndatum
Obligations | Actor
SHALL:populate | Moped SV Actor
end | O | 0..1 | dateTime | KaOrg: Fristende; KaOrg: VAE Endedatum; VAE Enddatum und Indikator, ob es ein Fristende gibt
Obligations | Actor
SHALL:populate | Moped SV Actor
addItem |  |  |  |
Slices for extension |  | 0..* | Extension | Extension Slice: Unordered, Open by value:url
extension:AddItemCategory | O | 0..1 | CodeableConcept | AddItemCategory URL: https://elga.moped.at/StructureDefinition/moped-ext-AddItemCategory Binding: Moped Claim Item Category ValueSet (required)
Obligations | Actor
SHALL:populate | Moped SV Actor
Documentation for this format

#### Terminology Bindings (Differential)

Path | Status | Usage | ValueSet | Version | Source
ClaimResponse.type | Base | required | Claim Type ValueSet | 📦0.1.0 | This IG
ClaimResponse.decision | Base | required | Status der Versichertenanspruchserklärung | 📦0.1.0 | This IG

Snapshot View

Name | Flags | Card. | Type | Description & Constraints Filter: Bindings Constraints Obligations
--- | --- | --- | --- | ---
ClaimResponse |  | 0..* | ClaimResponse | Response to a claim predetermination or preauthorization
id | Σ | 0..1 | id | Logical id of this artifact
meta | Σ | 0..1 | Meta | Metadata about the resource
implicitRules | ?!Σ | 0..1 | uri | A set of rules under which this content was created
language |  | 0..1 | code | Language of the resource content Binding: AllLanguages (required): IETF language tag for a human language
Additional Bindings | Purpose
CommonLanguages | Starter
text |  | 0..1 | Narrative | Text summary of the resource, for human interpretation This profile does not constrain the narrative in regard to content, language, or traceability to data elements
contained |  | 0..* | Resource | Contained, inline Resources
Slices for extension |  | 2..* | Extension | Extension Slice: Unordered, Open by value:url
extension:VerpflegskostenBeitragsbefreiung | O | 1..* | (Complex) | KaOrg: Verpflegskosten-Beitragsbefreiung URL: https://elga.moped.at/StructureDefinition/moped-ext-verpflegskostenBeitragsbefreiung
Obligations | Actor
SHALL:populate | Moped SV Actor
extension:MopedSupportingInfoVortageanzahlAufKostenbeitrag | O | 1..1 | (Complex) | KaOrg: Vortageanzahl auf Kostenbeitrag URL: https://elga.moped.at/StructureDefinition/MopedSupportingInfoVortageanzahlAufKostenbeitrag
Obligations | Actor
SHALL:populate | Moped SV Actor
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored
identifier |  | 0..* | Identifier | Business Identifier for a claim response
traceNumber |  | 0..* | Identifier | Number for tracking
status | ?!O Σ | 1..1 | code | active | cancelled | draft | entered-in-error Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance. Required Pattern: active
Obligations | Actor
SHALL:populate | Moped SV Actor
SHALL:handle | Moped Device Actor
type | Σ | 1..1 | CodeableConcept | More granular claim type Binding: Claim Type ValueSet (required)
id |  | 0..1 | id | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url
coding | O Σ | 1..* | Coding | Code defined by a terminology system Fixed Value: As shown (VAE Response)
Obligations | Actor
SHALL:populate | Moped SV Actor
id |  | 0..0 | string | Unique id for inter-element referencing
extension |  | 0..0 | Extension | Additional content defined by implementations
system |  | 1..1 | uri | Identity of the terminology system Fixed Value: https://elga.moped.at/CodeSystem/MopedClaimTypeCS
version |  | 0..0 | string | Version of the system - if relevant
code |  | 1..1 | code | Symbol in syntax defined by the system Fixed Value: VAERESP
display |  | 0..0 | string | Representation defined by the system
userSelected |  | 0..0 | boolean | If this coding was chosen directly by the user
text | Σ | 0..1 | string | Plain text representation of the concept
subType |  | 0..1 | CodeableConcept | More granular claim type Binding: ExampleClaimSubTypeCodes (example): A more granular claim typecode.
use | O Σ | 1..1 | code | claim | preauthorization | predetermination Binding: Use (required): Claim, preauthorization, predetermination. Required Pattern: preauthorization
Obligations | Actor
SHALL:populate | Moped SV Actor
patient | O Σ | 1..1 | Reference(AT MOPED Patient vbPK Basis Profil | AT MOPED Patient Klarname Basis Profil) | The recipient of the products and services
Obligations | Actor
SHALL:handle | Moped Device Actor
created | O Σ | 1..1 | dateTime | Response creation date
Obligations | Actor
SHALL:populate | Moped SV Actor
insurer | O Σ | 1..1 | Reference(AT MOPED Organization SV Profil) | Party responsible for reimbursement
Obligations | Actor
SHALL:populate | Moped SV Actor
requestor | O | 1..1 | Reference(AT MOPED Organization KA Profil) | Party responsible for the claim
Obligations | Actor
SHALL:handle | Moped Device Actor
request | O Σ | 1..1 | Reference(AT MOPED Claim VAERequest Initiales Profil | AT MOPED Claim VAERequest Verlängerungs Profil) | Id of resource triggering adjudication
Obligations | Actor
SHALL:populate | Moped SV Actor
outcome | O Σ | 1..1 | code | VAE Bewilligung/Ablehnung Binding: ClaimProcessingCodes (required): The result of the claim processing.
Obligations | Actor
SHALL:populate | Moped SV Actor
decision | O Σ | 1..1 | CodeableConcept | KaOrg: Status der VAE Binding: Status der Versichertenanspruchserklärung (required)
Obligations | Actor
SHALL:populate | Moped SV Actor
disposition |  | 0..1 | string | Disposition Message
preAuthRef |  | 0..1 | string | Preauthorization reference
preAuthPeriod |  | 1..1 | Period | Preauthorization reference effective period
id |  | 0..1 | id | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url
start | O Σ C | 1..1 | dateTime | KaOrg: VAE Beginndatum
Obligations | Actor
SHALL:populate | Moped SV Actor
end | O Σ C | 0..1 | dateTime | KaOrg: Fristende; KaOrg: VAE Endedatum; VAE Enddatum und Indikator, ob es ein Fristende gibt
Obligations | Actor
SHALL:populate | Moped SV Actor
event |  | 0..* | BackboneElement | Event information
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
type |  | 1..1 | CodeableConcept | Specific event Binding: DatesTypeCodes (example)
when[x] |  | 1..1 |  | Occurance date or period
whenDateTime |  |  | dateTime |
whenPeriod |  |  | Period |
payeeType |  | 0..1 | CodeableConcept | Party to be paid any benefits payable Binding: ClaimPayeeTypeCodes (example): A code for the party to be reimbursed.
encounter |  | 0..* | Reference(Encounter) | Encounters associated with the listed treatments
diagnosisRelatedGroup |  | 0..1 | CodeableConcept | Package billing code Binding: ExampleDiagnosisRelatedGroupCodes (example)
item |  | 0..* | BackboneElement | Adjudication for claim line items
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
itemSequence |  | 1..1 | positiveInt | Claim item instance identifier
traceNumber |  | 0..* | Identifier | Number for tracking
noteNumber |  | 0..* | positiveInt | Applicable note numbers
reviewOutcome |  | 0..1 | BackboneElement | Adjudication results
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
decision |  | 0..1 | CodeableConcept | Result of the adjudication Binding: ClaimAdjudicationDecisionsCodes (example)
reason |  | 0..* | CodeableConcept | Reason for result of the adjudication Binding: ClaimAdjudicationDecisionReasonCodes (example)
preAuthRef |  | 0..1 | string | Preauthorization reference
preAuthPeriod |  | 0..1 | Period | Preauthorization reference effective period
adjudication |  | 0..* | BackboneElement | Adjudication details
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
category |  | 1..1 | CodeableConcept | Type of adjudication information Binding: AdjudicationValueCodes (example): The adjudication codes.
reason |  | 0..1 | CodeableConcept | Explanation of adjudication outcome Binding: AdjudicationReasonCodes (example): The adjudication reason codes.
amount |  | 0..1 | Money | Monetary amount
quantity |  | 0..1 | Quantity | Non-monetary value
detail |  | 0..* | BackboneElement | Adjudication for claim details
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
detailSequence |  | 1..1 | positiveInt | Claim detail instance identifier
traceNumber |  | 0..* | Identifier | Number for tracking
noteNumber |  | 0..* | positiveInt | Applicable note numbers
reviewOutcome |  | 0..1 | See reviewOutcome (ClaimResponse) | Detail level adjudication results
adjudication |  | 0..* | See adjudication (ClaimResponse) | Detail level adjudication details
subDetail |  | 0..* | BackboneElement | Adjudication for claim sub-details
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
subDetailSequence |  | 1..1 | positiveInt | Claim sub-detail instance identifier
traceNumber |  | 0..* | Identifier | Number for tracking
noteNumber |  | 0..* | positiveInt | Applicable note numbers
reviewOutcome |  | 0..1 | See reviewOutcome (ClaimResponse) | Subdetail level adjudication results
adjudication |  | 0..* | See adjudication (ClaimResponse) | Subdetail level adjudication details
addItem |  | 0..* | BackboneElement | Insurer added line items
id |  | 0..1 | string | Unique id for inter-element referencing
Slices for extension |  | 0..* | Extension | Extension Slice: Unordered, Open by value:url
extension:AddItemCategory | O | 0..1 | CodeableConcept | AddItemCategory URL: https://elga.moped.at/StructureDefinition/moped-ext-AddItemCategory Binding: Moped Claim Item Category ValueSet (required)
Obligations | Actor
SHALL:populate | Moped SV Actor
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
itemSequence |  | 0..* | positiveInt | Item sequence number
detailSequence |  | 0..* | positiveInt | Detail sequence number
subdetailSequence |  | 0..* | positiveInt | Subdetail sequence number
traceNumber |  | 0..* | Identifier | Number for tracking
provider |  | 0..* | Reference(Practitioner | PractitionerRole | Organization) | Authorized providers
revenue |  | 0..1 | CodeableConcept | Revenue or cost center code Binding: ExampleRevenueCenterCodes (example): Codes for the revenue or cost centers supplying the service and/or products.
productOrService |  | 0..1 | CodeableConcept | Billing, service, product, or drug code Binding: USCLSCodes (example): Allowable service and product codes.
productOrServiceEnd |  | 0..1 | CodeableConcept | End of a range of codes Binding: USCLSCodes (example)
request |  | 0..* | Reference(DeviceRequest | MedicationRequest | NutritionOrder | ServiceRequest | SupplyRequest | VisionPrescription) | Request or Referral for Service
modifier |  | 0..* | CodeableConcept | Service/Product billing modifiers Binding: ModifierTypeCodes (example): Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen.
programCode |  | 0..* | CodeableConcept | Program the product or service is provided under Binding: ExampleProgramReasonCodes (example): Program specific reason codes.
serviced[x] |  | 0..1 |  | Date or dates of service or product delivery
servicedDate |  |  | date |
servicedPeriod |  |  | Period |
location[x] |  | 0..1 |  | Place of service or where product was supplied Binding: ExampleServicePlaceCodes (example): Place of service: pharmacy, school, prison, etc.
locationCodeableConcept |  |  | CodeableConcept |
locationAddress |  |  | Address |
locationReference |  |  | Reference(Location) |
quantity |  | 0..1 | SimpleQuantity(5.0.0) | Count of products or services
unitPrice |  | 0..1 | Money | Fee, charge or cost per item
factor |  | 0..1 | decimal | Price scaling factor
tax |  | 0..1 | Money | Total tax
net |  | 0..1 | Money | Total item cost
bodySite |  | 0..* | BackboneElement | Anatomical location
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
site |  | 1..* | CodeableReference(BodyStructure) | Location Binding: OralSiteCodes (example)
subSite |  | 0..* | CodeableConcept | Sub-location Binding: SurfaceCodes (example)
noteNumber |  | 0..* | positiveInt | Applicable note numbers
reviewOutcome |  | 0..1 | See reviewOutcome (ClaimResponse) | Added items adjudication results
adjudication |  | 0..* | See adjudication (ClaimResponse) | Added items adjudication
detail |  | 0..* | BackboneElement | Insurer added line details
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
traceNumber |  | 0..* | Identifier | Number for tracking
revenue |  | 0..1 | CodeableConcept | Revenue or cost center code Binding: ExampleRevenueCenterCodes (example): Codes for the revenue or cost centers supplying the service and/or products.
productOrService |  | 0..1 | CodeableConcept | Billing, service, product, or drug code Binding: USCLSCodes (example): Allowable service and product codes.
productOrServiceEnd |  | 0..1 | CodeableConcept | End of a range of codes Binding: USCLSCodes (example)
modifier |  | 0..* | CodeableConcept | Service/Product billing modifiers Binding: ModifierTypeCodes (example): Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen.
quantity |  | 0..1 | SimpleQuantity(5.0.0) | Count of products or services
unitPrice |  | 0..1 | Money | Fee, charge or cost per item
factor |  | 0..1 | decimal | Price scaling factor
tax |  | 0..1 | Money | Total tax
net |  | 0..1 | Money | Total item cost
noteNumber |  | 0..* | positiveInt | Applicable note numbers
reviewOutcome |  | 0..1 | See reviewOutcome (ClaimResponse) | Added items detail level adjudication results
adjudication |  | 0..* | See adjudication (ClaimResponse) | Added items detail adjudication
subDetail |  | 0..* | BackboneElement | Insurer added line items
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
traceNumber |  | 0..* | Identifier | Number for tracking
revenue |  | 0..1 | CodeableConcept | Revenue or cost center code Binding: ExampleRevenueCenterCodes (example): Codes for the revenue or cost centers supplying the service and/or products.
productOrService |  | 0..1 | CodeableConcept | Billing, service, product, or drug code Binding: USCLSCodes (example): Allowable service and product codes.
productOrServiceEnd |  | 0..1 | CodeableConcept | End of a range of codes Binding: USCLSCodes (example)
modifier |  | 0..* | CodeableConcept | Service/Product billing modifiers Binding: ModifierTypeCodes (example): Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen.
quantity |  | 0..1 | SimpleQuantity(5.0.0) | Count of products or services
unitPrice |  | 0..1 | Money | Fee, charge or cost per item
factor |  | 0..1 | decimal | Price scaling factor
tax |  | 0..1 | Money | Total tax
net |  | 0..1 | Money | Total item cost
noteNumber |  | 0..* | positiveInt | Applicable note numbers
reviewOutcome |  | 0..1 | See reviewOutcome (ClaimResponse) | Added items subdetail level adjudication results
adjudication |  | 0..* | See adjudication (ClaimResponse) | Added items subdetail adjudication
adjudication |  | 0..* | See adjudication (ClaimResponse) | Header-level adjudication
total | Σ | 0..* | BackboneElement | Adjudication totals
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
category | Σ | 1..1 | CodeableConcept | Type of adjudication information Binding: AdjudicationValueCodes (example): The adjudication codes.
amount | Σ | 1..1 | Money | Financial total for the category
payment |  | 0..1 | BackboneElement | Payment Details
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
type |  | 1..1 | CodeableConcept | Partial or complete payment Binding: ExamplePaymentTypeCodes (example): The type (partial, complete) of the payment.
adjustment |  | 0..1 | Money | Payment adjustment for non-claim issues
adjustmentReason |  | 0..1 | CodeableConcept | Explanation for the adjustment Binding: PaymentAdjustmentReasonCodes (example): Payment Adjustment reason codes.
date |  | 0..1 | date | Expected date of payment
amount |  | 1..1 | Money | Payable amount after adjustment
identifier |  | 0..1 | Identifier | Business identifier for the payment
fundsReserve |  | 0..1 | CodeableConcept | Funds reserved status Binding: FundsReservationCodes (example): For whom funds are to be reserved: (Patient, Provider, None).
formCode |  | 0..1 | CodeableConcept | Printed form identifier Binding: FormCodes (example): The forms codes.
form |  | 0..1 | Attachment | Printed reference or actual form
processNote |  | 0..* | BackboneElement | Note concerning adjudication
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
number |  | 0..1 | positiveInt | Note instance identifier
type |  | 0..1 | CodeableConcept | Note purpose Binding: NoteType (extensible): The presentation types of notes.
text |  | 1..1 | string | Note explanatory text
language |  | 0..1 | CodeableConcept | Language of the text Binding: AllLanguages (required): IETF language tag for a human language
Additional Bindings | Purpose
CommonLanguages | Starter
communicationRequest |  | 0..* | Reference(CommunicationRequest) | Request for additional information
insurance |  | 0..* | BackboneElement | Patient insurance information
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
sequence |  | 1..1 | positiveInt | Insurance instance identifier
focal |  | 1..1 | boolean | Coverage to be used for adjudication
coverage |  | 1..1 | Reference(Coverage) | Insurance information
businessArrangement |  | 0..1 | string | Additional provider contract number
claimResponse |  | 0..1 | Reference(ClaimResponse) | Adjudication results
error |  | 0..* | BackboneElement | Processing errors
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
itemSequence |  | 0..1 | positiveInt | Item sequence number
detailSequence |  | 0..1 | positiveInt | Detail sequence number
subDetailSequence |  | 0..1 | positiveInt | Subdetail sequence number
code | Σ | 1..1 | CodeableConcept | Error code detailing processing issues Binding: AdjudicationErrorCodes (example): The adjudication error codes.
expression | Σ | 0..* | string | FHIRPath of element(s) related to issue
Documentation for this format

#### Terminology Bindings

Path | Status | Usage | ValueSet | Version | Source
ClaimResponse.language | Base | required | All Languages | 📍5.0.0 | FHIR Std.
ClaimResponse.status | Base | required | Financial Resource Status Codes | 📍5.0.0 | FHIR Std.
ClaimResponse.type | Base | required | Claim Type ValueSet | 📦0.1.0 | This IG
ClaimResponse.subType | Base | example | Example Claim SubType Codes | 📍5.0.0 | FHIR Std.
ClaimResponse.use | Base | required | Use | 📍5.0.0 | FHIR Std.
ClaimResponse.outcome | Base | required | Claim Processing Codes | 📍5.0.0 | FHIR Std.
ClaimResponse.decision | Base | required | Status der Versichertenanspruchserklärung | 📦0.1.0 | This IG
ClaimResponse.event.​type | Base | example | Dates Type Codes | 📍5.0.0 | FHIR Std.
ClaimResponse.payeeType | Base | example | Claim Payee Type Codes | 📍5.0.0 | FHIR Std.
ClaimResponse.diagnosisRelatedGroup | Base | example | Example Diagnosis Related Group Codes | 📍5.0.0 | FHIR Std.
ClaimResponse.item.reviewOutcome.​decision | Base | example | Claim Adjudication Decision Codes | 📍5.0.0 | FHIR Std.
ClaimResponse.item.reviewOutcome.​reason | Base | example | Claim Adjudication Decision Reason Codes | 📍5.0.0 | FHIR Std.
ClaimResponse.item.adjudication.​category | Base | example | Adjudication Value Codes | 📍5.0.0 | FHIR Std.
ClaimResponse.item.adjudication.​reason | Base | example | Adjudication Reason Codes | 📍5.0.0 | FHIR Std.
ClaimResponse.addItem.​revenue | Base | example | Example Revenue Center Codes | 📍5.0.0 | FHIR Std.
ClaimResponse.addItem.​productOrService | Base | example | USCLS Codes | 📍5.0.0 | FHIR Std.
ClaimResponse.addItem.​productOrServiceEnd | Base | example | USCLS Codes | 📍5.0.0 | FHIR Std.
ClaimResponse.addItem.​modifier | Base | example | Modifier type Codes | 📍5.0.0 | FHIR Std.
ClaimResponse.addItem.​programCode | Base | example | Example Program Reason Codes | 📍5.0.0 | FHIR Std.
ClaimResponse.addItem.​location[x] | Base | example | Example Service Place Codes | 📍5.0.0 | FHIR Std.
ClaimResponse.addItem.​bodySite.site | Base | example | Oral Site Codes | 📍5.0.0 | FHIR Std.
ClaimResponse.addItem.​bodySite.subSite | Base | example | Surface Codes | 📍5.0.0 | FHIR Std.
ClaimResponse.addItem.​detail.revenue | Base | example | Example Revenue Center Codes | 📍5.0.0 | FHIR Std.
ClaimResponse.addItem.​detail.productOrService | Base | example | USCLS Codes | 📍5.0.0 | FHIR Std.
ClaimResponse.addItem.​detail.productOrServiceEnd | Base | example | USCLS Codes | 📍5.0.0 | FHIR Std.
ClaimResponse.addItem.​detail.modifier | Base | example | Modifier type Codes | 📍5.0.0 | FHIR Std.
ClaimResponse.addItem.​detail.subDetail.revenue | Base | example | Example Revenue Center Codes | 📍5.0.0 | FHIR Std.
ClaimResponse.addItem.​detail.subDetail.productOrService | Base | example | USCLS Codes | 📍5.0.0 | FHIR Std.
ClaimResponse.addItem.​detail.subDetail.productOrServiceEnd | Base | example | USCLS Codes | 📍5.0.0 | FHIR Std.
ClaimResponse.addItem.​detail.subDetail.modifier | Base | example | Modifier type Codes | 📍5.0.0 | FHIR Std.
ClaimResponse.total.​category | Base | example | Adjudication Value Codes | 📍5.0.0 | FHIR Std.
ClaimResponse.payment.​type | Base | example | Example Payment Type Codes | 📍5.0.0 | FHIR Std.
ClaimResponse.payment.​adjustmentReason | Base | example | Payment Adjustment Reason Codes | 📍5.0.0 | FHIR Std.
ClaimResponse.fundsReserve | Base | example | Funds Reservation Codes | 📍5.0.0 | FHIR Std.
ClaimResponse.formCode | Base | example | Form Codes | 📍5.0.0 | FHIR Std.
ClaimResponse.processNote.​type | Base | extensible | NoteType | 📍5.0.0 | FHIR Std.
ClaimResponse.processNote.​language | Base | required | All Languages | 📍5.0.0 | FHIR Std.
ClaimResponse.error.​code | Base | example | Adjudication Error Codes | 📍5.0.0 | FHIR Std.

#### Constraints

Id | Grade | Path(s) | Description | Expression
dom-2 | error | ClaimResponse | If the resource is contained in another resource, it SHALL NOT contain nested Resources | `contained.contained.empty()`
dom-3 | error | ClaimResponse | 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 | error | ClaimResponse | 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 | error | ClaimResponse | If a resource is contained in another resource, it SHALL NOT have a security label | `contained.meta.security.empty()`
dom-6 | best practice | ClaimResponse | A resource should have narrative for robust management | `text.`div`.exists()`
ele-1 | error | **ALL** elements | All FHIR elements must have a @value or children | `hasValue() or (children().count() > id.count())`
ext-1 | error | **ALL** extensions | Must have either extensions or value[x], not both | `extension.exists() != value.exists()`

This structure is derived from ClaimResponse

Summary

Mandatory: 9 elements
Fixed: 1 element

Structures

This structure refers to these other structures:

- AT MOPED Patient vbPK Basis Profil (https://elga.moped.at/StructureDefinition/at-moped-patient-vbPK-basis)
- AT MOPED Patient Klarname Basis Profil (https://elga.moped.at/StructureDefinition/at-moped-patient-klarname-basis)
- AT MOPED Organization SV Profil (https://elga.moped.at/StructureDefinition/at-moped-organization-SV)
- AT MOPED Organization KA Profil (https://elga.moped.at/StructureDefinition/at-moped-organization-KA)
- AT MOPED Claim VAERequest Initiales Profil (https://elga.moped.at/StructureDefinition/at-moped-claim-VAE-request-initial)
- AT MOPED Claim VAERequest Verlängerungs Profil (https://elga.moped.at/StructureDefinition/at-moped-claim-vaerequest-verlaengerung)

Extensions

This structure refers to these extensions:

- https://elga.moped.at/StructureDefinition/moped-ext-verpflegskostenBeitragsbefreiung
- https://elga.moped.at/StructureDefinition/MopedSupportingInfoVortageanzahlAufKostenbeitrag
- https://elga.moped.at/StructureDefinition/moped-ext-AddItemCategory

Other representations of profile: CSV, Excel, Schematron