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: MOPED ARKResponse

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

MOPED Profil der ClaimResponse Ressource für die Rückmeldung der SV für Ausländerverrechnung und Regresse.

Usages:

- Use this Profile: AT MOPED Bundle $antworten SV Profil
- Refer to this Profile: AT MOPED Composition generisches Profil

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 |  | 0..* | Extension | Extension Slice: Unordered, Open by value:url
extension:AbrechnungsartAuslaenderverrechnung | O | 0..1 | Coding | KaOrg: Abrechnungsart Ausländerverrechnung URL: https://elga.moped.at/StructureDefinition/moped-ext-AbrechnungsartAuslaenderverrechnung Binding: Abrechnungsart Ausländerverrechnung ValueSet (required)
Obligations | Actor
SHALL:populate | Moped SV Actor
extension:Betreuungsschein | O | 0..1 | string | KaOrg: Betreuungsschein bei Ausländerverrechnung URL: https://elga.moped.at/StructureDefinition/moped-ext-Betreuungsschein
Obligations | Actor
SHALL:populate | Moped SV Actor
extension:SupportingInfo | O | 0..* | (Complex) | Supporting Info Extension for ClaimResponse URL: https://elga.moped.at/StructureDefinition/MopedSupportingInfo
Obligations | Actor
SHALL:populate | Moped SV Actor
extension:MopedSupportingInfoFREMDRE | O | 0..1 | (Complex) | KaOrg: Rechnungsnummer der zwischenstaatlichen Abrechnung URL: https://elga.moped.at/StructureDefinition/MopedSupportingInfoFREMDRE
Obligations | Actor
SHALL:populate | Moped SV Actor
extension:MopedSupportingInfoOEGKELBNR | O | 0..1 | (Complex) | KaOrg: Forderungsnummer der ÖGK URL: https://elga.moped.at/StructureDefinition/MopedSupportingInfoOEGKELBNR
Obligations | Actor
SHALL:populate | Moped SV Actor
extension:Beihilfenaequivalent | O | 0..1 | decimal | KaOrg: Beihilfenäquivalent URL: https://elga.moped.at/StructureDefinition/moped-ext-Beihilfenaequivalent
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.
Obligations | Actor
SHALL:populate | Moped SV Actor
SHALL:handle | Moped Device Actor
type | O Σ | 1..1 | CodeableConcept | More granular claim type Binding: Claim Type ValueSet (required)
Obligations | Actor
SHALL:populate | Moped SV Actor
coding | Σ | 0..* | Coding | Code defined by a terminology system Fixed Value: As shown (ARK Response)
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: ARKRESP
display |  | 0..0 | string | Representation defined by the system
userSelected |  | 0..0 | boolean | If this coding was chosen directly by the user
subType | O | 1..1 | CodeableConcept | Kostenmeldung für Ausländerverrechnung, Regressangelegenheiten und Kosteninformation Binding: Kostenmeldung für (A/R/K) (required)
Obligations | Actor
SHALL:populate | Moped SV Actor
use | O Σ | 1..1 | code | claim | preauthorization | predetermination Binding: Use (required): Claim, preauthorization, predetermination. Required Pattern: claim
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 | Σ | 1..1 | dateTime | Response creation date
request | O Σ | 1..1 | Reference(MOPED ARKRequest) | Id of resource triggering adjudication
Obligations | Actor
SHALL:populate | Moped SV Actor
outcome | Σ | 1..1 | code | queued | complete | error | partial Binding: ClaimProcessingCodes (required): The result of the claim processing.
Slices for addItem |  | 0..* | BackboneElement | Insurer added line items Slice: Ordered, Open by value:extension('https://elga.moped.at/StructureDefinition/moped-ext-AddItemCategory').value.coding
addItem:All Slices |  |  |  | Content/Rules for all slices
Slices for extension |  | 0..* | Extension | Extension Slice: Unordered, Open by value:url
extension:AddItemCategory |  | 0..1 | CodeableConcept | AddItemCategory URL: https://elga.moped.at/StructureDefinition/moped-ext-AddItemCategory Binding: Moped Claim Item Category ValueSet (required)
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
addItem:Patientenanteil | O | 0..1 | BackboneElement | Insurer added line items
Obligations | Actor
SHALL:populate | Moped SV Actor
Slices for extension |  |  |  | Content/Rules for all slices
extension:AddItemCategory |  | 0..1 | (Complex) | AddItemCategory URL: https://elga.moped.at/StructureDefinition/moped-ext-AddItemCategory
extension |  | 0..0 |  | Extension Slice: Unordered, Open by value:url
url |  | 1..1 | uri | "https://elga.moped.at/StructureDefinition/moped-ext-AddItemCategory"
value[x] |  | 1..1 | CodeableConcept | Value of extension Binding: Moped Claim Item Category ValueSet (required)
coding | Σ | 0..* | Coding | Code defined by a terminology system Required Pattern: At least the following
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
unitPrice |  | 1..1 | Money | KaOrg: Patientenanteil für Angehörige (tägl. Satz) netto
factor |  | 0..1 | decimal | Price scaling factor Required Pattern: -1
net |  | 1..1 | Money | KaOrg: Patientenanteil
total | O Σ | 0..* | BackboneElement | Adjudication totals
Obligations | Actor
SHALL:populate | Moped SV Actor
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 | KaOrg: Betrag Ausländerverrechnung/Regress
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.subType | Base | required | Kostenmeldung für (A/R/K) | 📦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.addItem:Patientenanteil.​extension:AddItemCategory.​value[x] | Base | required | Moped Claim Item Category ValueSet | 📦0.1.0 | This IG
ClaimResponse.total.​category | Base | example | Adjudication Value 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

Name | Flags | Card. | Type | Description & Constraints Filter: Bindings Constraints Obligations
--- | --- | --- | --- | ---
ClaimResponse |  | 0..* | ClaimResponse | Response to a claim predetermination or preauthorization
Slices for extension |  | 0..* | Extension | Extension Slice: Unordered, Open by value:url
extension:AbrechnungsartAuslaenderverrechnung | O | 0..1 | Coding | KaOrg: Abrechnungsart Ausländerverrechnung URL: https://elga.moped.at/StructureDefinition/moped-ext-AbrechnungsartAuslaenderverrechnung Binding: Abrechnungsart Ausländerverrechnung ValueSet (required)
Obligations | Actor
SHALL:populate | Moped SV Actor
extension:Betreuungsschein | O | 0..1 | string | KaOrg: Betreuungsschein bei Ausländerverrechnung URL: https://elga.moped.at/StructureDefinition/moped-ext-Betreuungsschein
Obligations | Actor
SHALL:populate | Moped SV Actor
extension:SupportingInfo | O | 0..* | (Complex) | Supporting Info Extension for ClaimResponse URL: https://elga.moped.at/StructureDefinition/MopedSupportingInfo
Obligations | Actor
SHALL:populate | Moped SV Actor
extension:MopedSupportingInfoFREMDRE | O | 0..1 | (Complex) | KaOrg: Rechnungsnummer der zwischenstaatlichen Abrechnung URL: https://elga.moped.at/StructureDefinition/MopedSupportingInfoFREMDRE
Obligations | Actor
SHALL:populate | Moped SV Actor
extension:MopedSupportingInfoOEGKELBNR | O | 0..1 | (Complex) | KaOrg: Forderungsnummer der ÖGK URL: https://elga.moped.at/StructureDefinition/MopedSupportingInfoOEGKELBNR
Obligations | Actor
SHALL:populate | Moped SV Actor
extension:Beihilfenaequivalent | O | 0..1 | decimal | KaOrg: Beihilfenäquivalent URL: https://elga.moped.at/StructureDefinition/moped-ext-Beihilfenaequivalent
Obligations | Actor
SHALL:populate | Moped SV Actor
status | O | 1..1 | code | active | cancelled | draft | entered-in-error
Obligations | Actor
SHALL:populate | Moped SV Actor
SHALL:handle | Moped Device Actor
type | O | 1..1 | CodeableConcept | More granular claim type Binding: Claim Type ValueSet (required)
Obligations | Actor
SHALL:populate | Moped SV Actor
coding |  | 0..* | Coding | Code defined by a terminology system Fixed Value: As shown (ARK Response)
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: ARKRESP
subType | O | 1..1 | CodeableConcept | Kostenmeldung für Ausländerverrechnung, Regressangelegenheiten und Kosteninformation Binding: Kostenmeldung für (A/R/K) (required)
Obligations | Actor
SHALL:populate | Moped SV Actor
use | O | 1..1 | code | claim | preauthorization | predetermination Required Pattern: claim
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
request | O | 1..1 | Reference(MOPED ARKRequest) | Id of resource triggering adjudication
Obligations | Actor
SHALL:populate | Moped SV Actor
Slices for addItem |  | 0..* | BackboneElement | Insurer added line items Slice: Ordered, Open by value:extension('https://elga.moped.at/StructureDefinition/moped-ext-AddItemCategory').value.coding
addItem:All Slices |  |  |  | Content/Rules for all slices
Slices for extension |  | 0..* | Extension | Extension Slice: Unordered, Open by value:url
extension:AddItemCategory |  | 0..1 | CodeableConcept | AddItemCategory URL: https://elga.moped.at/StructureDefinition/moped-ext-AddItemCategory Binding: Moped Claim Item Category ValueSet (required)
addItem:Patientenanteil | O | 0..1 | BackboneElement | Insurer added line items
Obligations | Actor
SHALL:populate | Moped SV Actor
Slices for extension |  |  |  | Content/Rules for all slices
extension:AddItemCategory |  | 0..1 | (Complex) | AddItemCategory URL: https://elga.moped.at/StructureDefinition/moped-ext-AddItemCategory
value[x] |  |  |  |
coding |  | 0..* | Coding | Code defined by a terminology system Required Pattern: At least the following
unitPrice |  | 1..1 | Money | KaOrg: Patientenanteil für Angehörige (tägl. Satz) netto
factor |  | 0..1 | decimal | Price scaling factor Required Pattern: -1
net |  | 1..1 | Money | KaOrg: Patientenanteil
total | O | 0..* | BackboneElement | Adjudication totals
Obligations | Actor
SHALL:populate | Moped SV Actor
amount |  | 1..1 | Money | KaOrg: Betrag Ausländerverrechnung/Regress
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.subType | Base | required | Kostenmeldung für (A/R/K) | 📦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 |  | 0..* | Extension | Extension Slice: Unordered, Open by value:url
extension:AbrechnungsartAuslaenderverrechnung | O | 0..1 | Coding | KaOrg: Abrechnungsart Ausländerverrechnung URL: https://elga.moped.at/StructureDefinition/moped-ext-AbrechnungsartAuslaenderverrechnung Binding: Abrechnungsart Ausländerverrechnung ValueSet (required)
Obligations | Actor
SHALL:populate | Moped SV Actor
extension:Betreuungsschein | O | 0..1 | string | KaOrg: Betreuungsschein bei Ausländerverrechnung URL: https://elga.moped.at/StructureDefinition/moped-ext-Betreuungsschein
Obligations | Actor
SHALL:populate | Moped SV Actor
extension:SupportingInfo | O | 0..* | (Complex) | Supporting Info Extension for ClaimResponse URL: https://elga.moped.at/StructureDefinition/MopedSupportingInfo
Obligations | Actor
SHALL:populate | Moped SV Actor
extension:MopedSupportingInfoFREMDRE | O | 0..1 | (Complex) | KaOrg: Rechnungsnummer der zwischenstaatlichen Abrechnung URL: https://elga.moped.at/StructureDefinition/MopedSupportingInfoFREMDRE
Obligations | Actor
SHALL:populate | Moped SV Actor
extension:MopedSupportingInfoOEGKELBNR | O | 0..1 | (Complex) | KaOrg: Forderungsnummer der ÖGK URL: https://elga.moped.at/StructureDefinition/MopedSupportingInfoOEGKELBNR
Obligations | Actor
SHALL:populate | Moped SV Actor
extension:Beihilfenaequivalent | O | 0..1 | decimal | KaOrg: Beihilfenäquivalent URL: https://elga.moped.at/StructureDefinition/moped-ext-Beihilfenaequivalent
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.
Obligations | Actor
SHALL:populate | Moped SV Actor
SHALL:handle | Moped Device Actor
type | O Σ | 1..1 | CodeableConcept | More granular claim type Binding: Claim Type ValueSet (required)
Obligations | Actor
SHALL:populate | Moped SV Actor
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 | Σ | 0..* | Coding | Code defined by a terminology system Fixed Value: As shown (ARK Response)
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: ARKRESP
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 | O | 1..1 | CodeableConcept | Kostenmeldung für Ausländerverrechnung, Regressangelegenheiten und Kosteninformation Binding: Kostenmeldung für (A/R/K) (required)
Obligations | Actor
SHALL:populate | Moped SV Actor
use | O Σ | 1..1 | code | claim | preauthorization | predetermination Binding: Use (required): Claim, preauthorization, predetermination. Required Pattern: claim
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 | Σ | 1..1 | dateTime | Response creation date
insurer | Σ | 0..1 | Reference(Organization) | Party responsible for reimbursement
requestor |  | 0..1 | Reference(Practitioner | PractitionerRole | Organization) | Party responsible for the claim
request | O Σ | 1..1 | Reference(MOPED ARKRequest) | Id of resource triggering adjudication
Obligations | Actor
SHALL:populate | Moped SV Actor
outcome | Σ | 1..1 | code | queued | complete | error | partial Binding: ClaimProcessingCodes (required): The result of the claim processing.
decision | Σ | 0..1 | CodeableConcept | Result of the adjudication Binding: ClaimAdjudicationDecisionsCodes (example): The overall result of the claim adjudication.
disposition |  | 0..1 | string | Disposition Message
preAuthRef |  | 0..1 | string | Preauthorization reference
preAuthPeriod |  | 0..1 | Period | Preauthorization reference effective period
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
Slices for addItem |  | 0..* | BackboneElement | Insurer added line items Slice: Ordered, Open by value:extension('https://elga.moped.at/StructureDefinition/moped-ext-AddItemCategory').value.coding
addItem:All Slices |  |  |  | Content/Rules for all slices
id |  | 0..1 | string | Unique id for inter-element referencing
Slices for extension |  | 0..* | Extension | Extension Slice: Unordered, Open by value:url
extension:AddItemCategory |  | 0..1 | CodeableConcept | AddItemCategory URL: https://elga.moped.at/StructureDefinition/moped-ext-AddItemCategory Binding: Moped Claim Item Category ValueSet (required)
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
addItem:Patientenanteil | O | 0..1 | BackboneElement | Insurer added line items
Obligations | Actor
SHALL:populate | Moped SV Actor
id |  | 0..1 | string | Unique id for inter-element referencing
Slices for extension |  | 0..* | Extension | Extension Slice: Unordered, Open by value:url
extension:AddItemCategory |  | 0..1 | (Complex) | AddItemCategory URL: https://elga.moped.at/StructureDefinition/moped-ext-AddItemCategory
id |  | 0..1 | id | Unique id for inter-element referencing
extension |  | 0..0 |  | Extension Slice: Unordered, Open by value:url
url |  | 1..1 | uri | "https://elga.moped.at/StructureDefinition/moped-ext-AddItemCategory"
value[x] |  | 1..1 | CodeableConcept | Value of extension Binding: Moped Claim Item Category 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 | Σ | 0..* | Coding | Code defined by a terminology system Required Pattern: At least the following
text | Σ | 0..1 | string | Plain text representation of the concept
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 |  | 1..1 | Money | KaOrg: Patientenanteil für Angehörige (tägl. Satz) netto
factor |  | 0..1 | decimal | Price scaling factor Required Pattern: -1
tax |  | 0..1 | Money | Total tax
net |  | 1..1 | Money | KaOrg: Patientenanteil
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 | O Σ | 0..* | BackboneElement | Adjudication totals
Obligations | Actor
SHALL:populate | Moped SV Actor
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 | KaOrg: Betrag Ausländerverrechnung/Regress
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 | required | Kostenmeldung für (A/R/K) | 📦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 | example | Claim Adjudication Decision Codes | 📍5.0.0 | FHIR Std.
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.addItem:Patientenanteil.​extension:AddItemCategory.​value[x] | Base | required | Moped Claim Item Category ValueSet | 📦0.1.0 | This IG
ClaimResponse.addItem:Patientenanteil.​revenue | Base | example | Example Revenue Center Codes | 📍5.0.0 | FHIR Std.
ClaimResponse.addItem:Patientenanteil.​productOrService | Base | example | USCLS Codes | 📍5.0.0 | FHIR Std.
ClaimResponse.addItem:Patientenanteil.​productOrServiceEnd | Base | example | USCLS Codes | 📍5.0.0 | FHIR Std.
ClaimResponse.addItem:Patientenanteil.​modifier | Base | example | Modifier type Codes | 📍5.0.0 | FHIR Std.
ClaimResponse.addItem:Patientenanteil.​programCode | Base | example | Example Program Reason Codes | 📍5.0.0 | FHIR Std.
ClaimResponse.addItem:Patientenanteil.​location[x] | Base | example | Example Service Place Codes | 📍5.0.0 | FHIR Std.
ClaimResponse.addItem:Patientenanteil.​bodySite.site | Base | example | Oral Site Codes | 📍5.0.0 | FHIR Std.
ClaimResponse.addItem:Patientenanteil.​bodySite.subSite | Base | example | Surface Codes | 📍5.0.0 | FHIR Std.
ClaimResponse.addItem:Patientenanteil.​detail.revenue | Base | example | Example Revenue Center Codes | 📍5.0.0 | FHIR Std.
ClaimResponse.addItem:Patientenanteil.​detail.productOrService | Base | example | USCLS Codes | 📍5.0.0 | FHIR Std.
ClaimResponse.addItem:Patientenanteil.​detail.productOrServiceEnd | Base | example | USCLS Codes | 📍5.0.0 | FHIR Std.
ClaimResponse.addItem:Patientenanteil.​detail.modifier | Base | example | Modifier type Codes | 📍5.0.0 | FHIR Std.
ClaimResponse.addItem:Patientenanteil.​detail.subDetail.revenue | Base | example | Example Revenue Center Codes | 📍5.0.0 | FHIR Std.
ClaimResponse.addItem:Patientenanteil.​detail.subDetail.productOrService | Base | example | USCLS Codes | 📍5.0.0 | FHIR Std.
ClaimResponse.addItem:Patientenanteil.​detail.subDetail.productOrServiceEnd | Base | example | USCLS Codes | 📍5.0.0 | FHIR Std.
ClaimResponse.addItem:Patientenanteil.​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: 2 elements(2 nested mandatory 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)
- MOPED ARKRequest (https://elga.moped.at/StructureDefinition/MopedARKRequest)

Extensions

This structure refers to these extensions:

- https://elga.moped.at/StructureDefinition/moped-ext-AbrechnungsartAuslaenderverrechnung
- https://elga.moped.at/StructureDefinition/moped-ext-Betreuungsschein
- https://elga.moped.at/StructureDefinition/MopedSupportingInfo
- https://elga.moped.at/StructureDefinition/MopedSupportingInfoFREMDRE
- https://elga.moped.at/StructureDefinition/MopedSupportingInfoOEGKELBNR
- https://elga.moped.at/StructureDefinition/moped-ext-Beihilfenaequivalent
- https://elga.moped.at/StructureDefinition/moped-ext-AddItemCategory

Slices

This structure defines the following Slices:

- The element 1 is sliced based on the value of ClaimResponse.addItem (ordered)

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 |  | 0..* | Extension | Extension Slice: Unordered, Open by value:url
extension:AbrechnungsartAuslaenderverrechnung | O | 0..1 | Coding | KaOrg: Abrechnungsart Ausländerverrechnung URL: https://elga.moped.at/StructureDefinition/moped-ext-AbrechnungsartAuslaenderverrechnung Binding: Abrechnungsart Ausländerverrechnung ValueSet (required)
Obligations | Actor
SHALL:populate | Moped SV Actor
extension:Betreuungsschein | O | 0..1 | string | KaOrg: Betreuungsschein bei Ausländerverrechnung URL: https://elga.moped.at/StructureDefinition/moped-ext-Betreuungsschein
Obligations | Actor
SHALL:populate | Moped SV Actor
extension:SupportingInfo | O | 0..* | (Complex) | Supporting Info Extension for ClaimResponse URL: https://elga.moped.at/StructureDefinition/MopedSupportingInfo
Obligations | Actor
SHALL:populate | Moped SV Actor
extension:MopedSupportingInfoFREMDRE | O | 0..1 | (Complex) | KaOrg: Rechnungsnummer der zwischenstaatlichen Abrechnung URL: https://elga.moped.at/StructureDefinition/MopedSupportingInfoFREMDRE
Obligations | Actor
SHALL:populate | Moped SV Actor
extension:MopedSupportingInfoOEGKELBNR | O | 0..1 | (Complex) | KaOrg: Forderungsnummer der ÖGK URL: https://elga.moped.at/StructureDefinition/MopedSupportingInfoOEGKELBNR
Obligations | Actor
SHALL:populate | Moped SV Actor
extension:Beihilfenaequivalent | O | 0..1 | decimal | KaOrg: Beihilfenäquivalent URL: https://elga.moped.at/StructureDefinition/moped-ext-Beihilfenaequivalent
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.
Obligations | Actor
SHALL:populate | Moped SV Actor
SHALL:handle | Moped Device Actor
type | O Σ | 1..1 | CodeableConcept | More granular claim type Binding: Claim Type ValueSet (required)
Obligations | Actor
SHALL:populate | Moped SV Actor
coding | Σ | 0..* | Coding | Code defined by a terminology system Fixed Value: As shown (ARK Response)
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: ARKRESP
display |  | 0..0 | string | Representation defined by the system
userSelected |  | 0..0 | boolean | If this coding was chosen directly by the user
subType | O | 1..1 | CodeableConcept | Kostenmeldung für Ausländerverrechnung, Regressangelegenheiten und Kosteninformation Binding: Kostenmeldung für (A/R/K) (required)
Obligations | Actor
SHALL:populate | Moped SV Actor
use | O Σ | 1..1 | code | claim | preauthorization | predetermination Binding: Use (required): Claim, preauthorization, predetermination. Required Pattern: claim
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 | Σ | 1..1 | dateTime | Response creation date
request | O Σ | 1..1 | Reference(MOPED ARKRequest) | Id of resource triggering adjudication
Obligations | Actor
SHALL:populate | Moped SV Actor
outcome | Σ | 1..1 | code | queued | complete | error | partial Binding: ClaimProcessingCodes (required): The result of the claim processing.
Slices for addItem |  | 0..* | BackboneElement | Insurer added line items Slice: Ordered, Open by value:extension('https://elga.moped.at/StructureDefinition/moped-ext-AddItemCategory').value.coding
addItem:All Slices |  |  |  | Content/Rules for all slices
Slices for extension |  | 0..* | Extension | Extension Slice: Unordered, Open by value:url
extension:AddItemCategory |  | 0..1 | CodeableConcept | AddItemCategory URL: https://elga.moped.at/StructureDefinition/moped-ext-AddItemCategory Binding: Moped Claim Item Category ValueSet (required)
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
addItem:Patientenanteil | O | 0..1 | BackboneElement | Insurer added line items
Obligations | Actor
SHALL:populate | Moped SV Actor
Slices for extension |  |  |  | Content/Rules for all slices
extension:AddItemCategory |  | 0..1 | (Complex) | AddItemCategory URL: https://elga.moped.at/StructureDefinition/moped-ext-AddItemCategory
extension |  | 0..0 |  | Extension Slice: Unordered, Open by value:url
url |  | 1..1 | uri | "https://elga.moped.at/StructureDefinition/moped-ext-AddItemCategory"
value[x] |  | 1..1 | CodeableConcept | Value of extension Binding: Moped Claim Item Category ValueSet (required)
coding | Σ | 0..* | Coding | Code defined by a terminology system Required Pattern: At least the following
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
unitPrice |  | 1..1 | Money | KaOrg: Patientenanteil für Angehörige (tägl. Satz) netto
factor |  | 0..1 | decimal | Price scaling factor Required Pattern: -1
net |  | 1..1 | Money | KaOrg: Patientenanteil
total | O Σ | 0..* | BackboneElement | Adjudication totals
Obligations | Actor
SHALL:populate | Moped SV Actor
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 | KaOrg: Betrag Ausländerverrechnung/Regress
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.subType | Base | required | Kostenmeldung für (A/R/K) | 📦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.addItem:Patientenanteil.​extension:AddItemCategory.​value[x] | Base | required | Moped Claim Item Category ValueSet | 📦0.1.0 | This IG
ClaimResponse.total.​category | Base | example | Adjudication Value 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()`

Differential View

This structure is derived from ClaimResponse

Name | Flags | Card. | Type | Description & Constraints Filter: Bindings Constraints Obligations
--- | --- | --- | --- | ---
ClaimResponse |  | 0..* | ClaimResponse | Response to a claim predetermination or preauthorization
Slices for extension |  | 0..* | Extension | Extension Slice: Unordered, Open by value:url
extension:AbrechnungsartAuslaenderverrechnung | O | 0..1 | Coding | KaOrg: Abrechnungsart Ausländerverrechnung URL: https://elga.moped.at/StructureDefinition/moped-ext-AbrechnungsartAuslaenderverrechnung Binding: Abrechnungsart Ausländerverrechnung ValueSet (required)
Obligations | Actor
SHALL:populate | Moped SV Actor
extension:Betreuungsschein | O | 0..1 | string | KaOrg: Betreuungsschein bei Ausländerverrechnung URL: https://elga.moped.at/StructureDefinition/moped-ext-Betreuungsschein
Obligations | Actor
SHALL:populate | Moped SV Actor
extension:SupportingInfo | O | 0..* | (Complex) | Supporting Info Extension for ClaimResponse URL: https://elga.moped.at/StructureDefinition/MopedSupportingInfo
Obligations | Actor
SHALL:populate | Moped SV Actor
extension:MopedSupportingInfoFREMDRE | O | 0..1 | (Complex) | KaOrg: Rechnungsnummer der zwischenstaatlichen Abrechnung URL: https://elga.moped.at/StructureDefinition/MopedSupportingInfoFREMDRE
Obligations | Actor
SHALL:populate | Moped SV Actor
extension:MopedSupportingInfoOEGKELBNR | O | 0..1 | (Complex) | KaOrg: Forderungsnummer der ÖGK URL: https://elga.moped.at/StructureDefinition/MopedSupportingInfoOEGKELBNR
Obligations | Actor
SHALL:populate | Moped SV Actor
extension:Beihilfenaequivalent | O | 0..1 | decimal | KaOrg: Beihilfenäquivalent URL: https://elga.moped.at/StructureDefinition/moped-ext-Beihilfenaequivalent
Obligations | Actor
SHALL:populate | Moped SV Actor
status | O | 1..1 | code | active | cancelled | draft | entered-in-error
Obligations | Actor
SHALL:populate | Moped SV Actor
SHALL:handle | Moped Device Actor
type | O | 1..1 | CodeableConcept | More granular claim type Binding: Claim Type ValueSet (required)
Obligations | Actor
SHALL:populate | Moped SV Actor
coding |  | 0..* | Coding | Code defined by a terminology system Fixed Value: As shown (ARK Response)
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: ARKRESP
subType | O | 1..1 | CodeableConcept | Kostenmeldung für Ausländerverrechnung, Regressangelegenheiten und Kosteninformation Binding: Kostenmeldung für (A/R/K) (required)
Obligations | Actor
SHALL:populate | Moped SV Actor
use | O | 1..1 | code | claim | preauthorization | predetermination Required Pattern: claim
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
request | O | 1..1 | Reference(MOPED ARKRequest) | Id of resource triggering adjudication
Obligations | Actor
SHALL:populate | Moped SV Actor
Slices for addItem |  | 0..* | BackboneElement | Insurer added line items Slice: Ordered, Open by value:extension('https://elga.moped.at/StructureDefinition/moped-ext-AddItemCategory').value.coding
addItem:All Slices |  |  |  | Content/Rules for all slices
Slices for extension |  | 0..* | Extension | Extension Slice: Unordered, Open by value:url
extension:AddItemCategory |  | 0..1 | CodeableConcept | AddItemCategory URL: https://elga.moped.at/StructureDefinition/moped-ext-AddItemCategory Binding: Moped Claim Item Category ValueSet (required)
addItem:Patientenanteil | O | 0..1 | BackboneElement | Insurer added line items
Obligations | Actor
SHALL:populate | Moped SV Actor
Slices for extension |  |  |  | Content/Rules for all slices
extension:AddItemCategory |  | 0..1 | (Complex) | AddItemCategory URL: https://elga.moped.at/StructureDefinition/moped-ext-AddItemCategory
value[x] |  |  |  |
coding |  | 0..* | Coding | Code defined by a terminology system Required Pattern: At least the following
unitPrice |  | 1..1 | Money | KaOrg: Patientenanteil für Angehörige (tägl. Satz) netto
factor |  | 0..1 | decimal | Price scaling factor Required Pattern: -1
net |  | 1..1 | Money | KaOrg: Patientenanteil
total | O | 0..* | BackboneElement | Adjudication totals
Obligations | Actor
SHALL:populate | Moped SV Actor
amount |  | 1..1 | Money | KaOrg: Betrag Ausländerverrechnung/Regress
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.subType | Base | required | Kostenmeldung für (A/R/K) | 📦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 |  | 0..* | Extension | Extension Slice: Unordered, Open by value:url
extension:AbrechnungsartAuslaenderverrechnung | O | 0..1 | Coding | KaOrg: Abrechnungsart Ausländerverrechnung URL: https://elga.moped.at/StructureDefinition/moped-ext-AbrechnungsartAuslaenderverrechnung Binding: Abrechnungsart Ausländerverrechnung ValueSet (required)
Obligations | Actor
SHALL:populate | Moped SV Actor
extension:Betreuungsschein | O | 0..1 | string | KaOrg: Betreuungsschein bei Ausländerverrechnung URL: https://elga.moped.at/StructureDefinition/moped-ext-Betreuungsschein
Obligations | Actor
SHALL:populate | Moped SV Actor
extension:SupportingInfo | O | 0..* | (Complex) | Supporting Info Extension for ClaimResponse URL: https://elga.moped.at/StructureDefinition/MopedSupportingInfo
Obligations | Actor
SHALL:populate | Moped SV Actor
extension:MopedSupportingInfoFREMDRE | O | 0..1 | (Complex) | KaOrg: Rechnungsnummer der zwischenstaatlichen Abrechnung URL: https://elga.moped.at/StructureDefinition/MopedSupportingInfoFREMDRE
Obligations | Actor
SHALL:populate | Moped SV Actor
extension:MopedSupportingInfoOEGKELBNR | O | 0..1 | (Complex) | KaOrg: Forderungsnummer der ÖGK URL: https://elga.moped.at/StructureDefinition/MopedSupportingInfoOEGKELBNR
Obligations | Actor
SHALL:populate | Moped SV Actor
extension:Beihilfenaequivalent | O | 0..1 | decimal | KaOrg: Beihilfenäquivalent URL: https://elga.moped.at/StructureDefinition/moped-ext-Beihilfenaequivalent
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.
Obligations | Actor
SHALL:populate | Moped SV Actor
SHALL:handle | Moped Device Actor
type | O Σ | 1..1 | CodeableConcept | More granular claim type Binding: Claim Type ValueSet (required)
Obligations | Actor
SHALL:populate | Moped SV Actor
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 | Σ | 0..* | Coding | Code defined by a terminology system Fixed Value: As shown (ARK Response)
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: ARKRESP
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 | O | 1..1 | CodeableConcept | Kostenmeldung für Ausländerverrechnung, Regressangelegenheiten und Kosteninformation Binding: Kostenmeldung für (A/R/K) (required)
Obligations | Actor
SHALL:populate | Moped SV Actor
use | O Σ | 1..1 | code | claim | preauthorization | predetermination Binding: Use (required): Claim, preauthorization, predetermination. Required Pattern: claim
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 | Σ | 1..1 | dateTime | Response creation date
insurer | Σ | 0..1 | Reference(Organization) | Party responsible for reimbursement
requestor |  | 0..1 | Reference(Practitioner | PractitionerRole | Organization) | Party responsible for the claim
request | O Σ | 1..1 | Reference(MOPED ARKRequest) | Id of resource triggering adjudication
Obligations | Actor
SHALL:populate | Moped SV Actor
outcome | Σ | 1..1 | code | queued | complete | error | partial Binding: ClaimProcessingCodes (required): The result of the claim processing.
decision | Σ | 0..1 | CodeableConcept | Result of the adjudication Binding: ClaimAdjudicationDecisionsCodes (example): The overall result of the claim adjudication.
disposition |  | 0..1 | string | Disposition Message
preAuthRef |  | 0..1 | string | Preauthorization reference
preAuthPeriod |  | 0..1 | Period | Preauthorization reference effective period
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
Slices for addItem |  | 0..* | BackboneElement | Insurer added line items Slice: Ordered, Open by value:extension('https://elga.moped.at/StructureDefinition/moped-ext-AddItemCategory').value.coding
addItem:All Slices |  |  |  | Content/Rules for all slices
id |  | 0..1 | string | Unique id for inter-element referencing
Slices for extension |  | 0..* | Extension | Extension Slice: Unordered, Open by value:url
extension:AddItemCategory |  | 0..1 | CodeableConcept | AddItemCategory URL: https://elga.moped.at/StructureDefinition/moped-ext-AddItemCategory Binding: Moped Claim Item Category ValueSet (required)
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
addItem:Patientenanteil | O | 0..1 | BackboneElement | Insurer added line items
Obligations | Actor
SHALL:populate | Moped SV Actor
id |  | 0..1 | string | Unique id for inter-element referencing
Slices for extension |  | 0..* | Extension | Extension Slice: Unordered, Open by value:url
extension:AddItemCategory |  | 0..1 | (Complex) | AddItemCategory URL: https://elga.moped.at/StructureDefinition/moped-ext-AddItemCategory
id |  | 0..1 | id | Unique id for inter-element referencing
extension |  | 0..0 |  | Extension Slice: Unordered, Open by value:url
url |  | 1..1 | uri | "https://elga.moped.at/StructureDefinition/moped-ext-AddItemCategory"
value[x] |  | 1..1 | CodeableConcept | Value of extension Binding: Moped Claim Item Category 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 | Σ | 0..* | Coding | Code defined by a terminology system Required Pattern: At least the following
text | Σ | 0..1 | string | Plain text representation of the concept
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 |  | 1..1 | Money | KaOrg: Patientenanteil für Angehörige (tägl. Satz) netto
factor |  | 0..1 | decimal | Price scaling factor Required Pattern: -1
tax |  | 0..1 | Money | Total tax
net |  | 1..1 | Money | KaOrg: Patientenanteil
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 | O Σ | 0..* | BackboneElement | Adjudication totals
Obligations | Actor
SHALL:populate | Moped SV Actor
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 | KaOrg: Betrag Ausländerverrechnung/Regress
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 | required | Kostenmeldung für (A/R/K) | 📦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 | example | Claim Adjudication Decision Codes | 📍5.0.0 | FHIR Std.
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.addItem:Patientenanteil.​extension:AddItemCategory.​value[x] | Base | required | Moped Claim Item Category ValueSet | 📦0.1.0 | This IG
ClaimResponse.addItem:Patientenanteil.​revenue | Base | example | Example Revenue Center Codes | 📍5.0.0 | FHIR Std.
ClaimResponse.addItem:Patientenanteil.​productOrService | Base | example | USCLS Codes | 📍5.0.0 | FHIR Std.
ClaimResponse.addItem:Patientenanteil.​productOrServiceEnd | Base | example | USCLS Codes | 📍5.0.0 | FHIR Std.
ClaimResponse.addItem:Patientenanteil.​modifier | Base | example | Modifier type Codes | 📍5.0.0 | FHIR Std.
ClaimResponse.addItem:Patientenanteil.​programCode | Base | example | Example Program Reason Codes | 📍5.0.0 | FHIR Std.
ClaimResponse.addItem:Patientenanteil.​location[x] | Base | example | Example Service Place Codes | 📍5.0.0 | FHIR Std.
ClaimResponse.addItem:Patientenanteil.​bodySite.site | Base | example | Oral Site Codes | 📍5.0.0 | FHIR Std.
ClaimResponse.addItem:Patientenanteil.​bodySite.subSite | Base | example | Surface Codes | 📍5.0.0 | FHIR Std.
ClaimResponse.addItem:Patientenanteil.​detail.revenue | Base | example | Example Revenue Center Codes | 📍5.0.0 | FHIR Std.
ClaimResponse.addItem:Patientenanteil.​detail.productOrService | Base | example | USCLS Codes | 📍5.0.0 | FHIR Std.
ClaimResponse.addItem:Patientenanteil.​detail.productOrServiceEnd | Base | example | USCLS Codes | 📍5.0.0 | FHIR Std.
ClaimResponse.addItem:Patientenanteil.​detail.modifier | Base | example | Modifier type Codes | 📍5.0.0 | FHIR Std.
ClaimResponse.addItem:Patientenanteil.​detail.subDetail.revenue | Base | example | Example Revenue Center Codes | 📍5.0.0 | FHIR Std.
ClaimResponse.addItem:Patientenanteil.​detail.subDetail.productOrService | Base | example | USCLS Codes | 📍5.0.0 | FHIR Std.
ClaimResponse.addItem:Patientenanteil.​detail.subDetail.productOrServiceEnd | Base | example | USCLS Codes | 📍5.0.0 | FHIR Std.
ClaimResponse.addItem:Patientenanteil.​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: 2 elements(2 nested mandatory 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)
- MOPED ARKRequest (https://elga.moped.at/StructureDefinition/MopedARKRequest)

Extensions

This structure refers to these extensions:

- https://elga.moped.at/StructureDefinition/moped-ext-AbrechnungsartAuslaenderverrechnung
- https://elga.moped.at/StructureDefinition/moped-ext-Betreuungsschein
- https://elga.moped.at/StructureDefinition/MopedSupportingInfo
- https://elga.moped.at/StructureDefinition/MopedSupportingInfoFREMDRE
- https://elga.moped.at/StructureDefinition/MopedSupportingInfoOEGKELBNR
- https://elga.moped.at/StructureDefinition/moped-ext-Beihilfenaequivalent
- https://elga.moped.at/StructureDefinition/moped-ext-AddItemCategory

Slices

This structure defines the following Slices:

- The element 1 is sliced based on the value of ClaimResponse.addItem (ordered)

Other representations of profile: CSV, Excel, Schematron