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

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Resource Profile: MOPED Claim Response

MOPED Profil der ClaimResponse Ressource für die Leistungsabrechnungsantwort.

Usage:

• This Resource Profile is not used by any profiles in this Implementation Guide

Formal Views of Profile Content

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

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

This structure is derived from ClaimResponse

Name	Flags	Card.	Type	Description & Constraints
ClaimResponse		0..*	ClaimResponse	Response to a claim predetermination or preauthorization
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
fehlerWarnung		0..*	(Complex)	Error/Warning URL: http://example.org/StructureDefinition/moped-ext-fehlerWarnung
diagnoseKnoten		0..1	Coding	"Abrechnung - Knoten:" Lukriert die Patient:innen über eine reguläre Gruppe Punkte, so ist in diesem Datenfeld die entsprechende Knotenbezeichnung einzutragen. URL: http://example.org/StructureDefinition/moped-ext-diagnoseKnoten Binding: LKF Abrechnungsknoten (required)
lkfPunkte		0..*	(Complex)	LKF Punkte URL: http://example.org/StructureDefinition/moped-ext-lkfPunkte
ldfPunktewertNetto		0..1	decimal	LDF-Punktewert Netto URL: http://example.org/StructureDefinition/moped-ext-ldfPunktewertNetto
ldfBetragNetto		0..1	decimal	LDF-Betrag Netto URL: http://example.org/StructureDefinition/moped-ext-ldfBetragNetto
patientenanteilAngehoerige		0..1	Money	Patientenanteil für Angehoerige URL: http://example.org/StructureDefinition/moped-ext-patientenanteilAngehoerige
patientenanteil		0..1	Money	Patientenanteil Netto URL: http://example.org/StructureDefinition/moped-ext-patientenanteil
beihilfenaequivalent		0..1	unsignedInt	Beihilfenaequivalent URL: http://example.org/StructureDefinition/moped-ext-beihilfenaequivalent
forderungsbetragAuslaenderverrechnungRegress		0..1	Money	Forderungsbetrag für Auslaenderverrechnung oder Regress URL: http://example.org/StructureDefinition/moped-ext-forderungsbetragAuslaenderverrechnungRegress
rechnungsnummerKHLGF		0..1	string	Rechnungsnummer der Krankenanstalt bzw. des Landesgesundheitsfonds URL: http://example.org/StructureDefinition/moped-ext-rechnungsnummerKHLGF
note		0..*	Annotation	A recorded sex or gender property for the individual URL: http://hl7.org/fhir/StructureDefinition/note
sonderleistungsnummer		0..1	Coding	Sonderleistungsnummer URL: http://example.org/StructureDefinition/moped-ext-sonderleistungsnummer Binding: Nummer für Sonderleistung (required)
anzahlSonderleistungen		0..1	unsignedInt	Anzahl Sonderleistungen URL: http://example.org/StructureDefinition/moped-ext-anzahlSonderleistungen
punkteLDFPauschale		0..1	decimal	Punkte LDF Pauschale URL: http://example.org/StructureDefinition/moped-ext-punkteLDFPauschale
konstenmeldungARK		0..1	Coding	Kostenmeldung für (A/R/K) URL: http://example.org/StructureDefinition/moped-ext-konstenmeldungARK Binding: Kostenmeldung für (A/R/K) (required)
status		1..1	code	active | cancelled | draft | entered-in-error Required Pattern: active
type
coding
code		0..1	code	Symbol in syntax defined by the system Required Pattern: institutional
use		1..1	code	claim | preauthorization | predetermination Required Pattern: claim
patient		1..1	Reference(HL7® AT Core Patient Profile)	The recipient of the products and services
insurer		1..1	Reference(HL7® AT Core Organization Profile)	Party responsible for reimbursement
requestor		1..1	Reference(HL7® AT Core Organization Profile)	Party responsible for the claim
request		1..1	Reference(MOPED Claim)	Id of resource triggering adjudication
diagnosisRelatedGroup		0..1	CodeableConcept	"Abrechnung - Gruppe:" Dieses Datenfeld ist mit der Codenummer der zutreffenden Abrechnungsgruppe zu befüllen. Bei Datensätzen von stationären Krankenhausaufenthalten, die keiner leistungsorientier- ten Diagnosenfallgruppe zugeordnet werden, erfolgt ein Eintrag entsprechend der jeweiligen Aufnahmeart. Binding: LKF Abrechnungsgruppe (required)
insurance
coverage		1..1	Reference(MOPED Coverage)	Insurance information
Documentation for this format

Terminology Bindings (Differential)

Path	Conformance	ValueSet	URI
ClaimResponse.diagnosisRelatedGroup	required	LKFAbrechnungsGruppe http://example.org/ValueSet/moped-LKFAbrechnungsGruppe-valueset from this IG

Name	Flags	Card.	Type	Description & Constraints
ClaimResponse		0..*	ClaimResponse	Response to a claim predetermination or preauthorization dom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources dom-3: If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource dom-4: If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated dom-5: If a resource is contained in another resource, it SHALL NOT have a security label dom-6: A resource should have narrative for robust management
implicitRules	?!Σ	0..1	uri	A set of rules under which this content was created ele-1: All FHIR elements must have a @value or children
contained		0..*	Resource	Contained, inline Resources
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
fehlerWarnung		0..*	(Complex)	Error/Warning URL: http://example.org/StructureDefinition/moped-ext-fehlerWarnung ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
diagnoseKnoten		0..1	Coding	"Abrechnung - Knoten:" Lukriert die Patient:innen über eine reguläre Gruppe Punkte, so ist in diesem Datenfeld die entsprechende Knotenbezeichnung einzutragen. URL: http://example.org/StructureDefinition/moped-ext-diagnoseKnoten Binding: LKF Abrechnungsknoten (required) ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
lkfPunkte		0..*	(Complex)	LKF Punkte URL: http://example.org/StructureDefinition/moped-ext-lkfPunkte ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
ldfPunktewertNetto		0..1	decimal	LDF-Punktewert Netto URL: http://example.org/StructureDefinition/moped-ext-ldfPunktewertNetto ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
ldfBetragNetto		0..1	decimal	LDF-Betrag Netto URL: http://example.org/StructureDefinition/moped-ext-ldfBetragNetto ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
patientenanteilAngehoerige		0..1	Money	Patientenanteil für Angehoerige URL: http://example.org/StructureDefinition/moped-ext-patientenanteilAngehoerige ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
patientenanteil		0..1	Money	Patientenanteil Netto URL: http://example.org/StructureDefinition/moped-ext-patientenanteil ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
beihilfenaequivalent		0..1	unsignedInt	Beihilfenaequivalent URL: http://example.org/StructureDefinition/moped-ext-beihilfenaequivalent ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
forderungsbetragAuslaenderverrechnungRegress		0..1	Money	Forderungsbetrag für Auslaenderverrechnung oder Regress URL: http://example.org/StructureDefinition/moped-ext-forderungsbetragAuslaenderverrechnungRegress ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
rechnungsnummerKHLGF		0..1	string	Rechnungsnummer der Krankenanstalt bzw. des Landesgesundheitsfonds URL: http://example.org/StructureDefinition/moped-ext-rechnungsnummerKHLGF ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
note		0..*	Annotation	A recorded sex or gender property for the individual URL: http://hl7.org/fhir/StructureDefinition/note ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
sonderleistungsnummer		0..1	Coding	Sonderleistungsnummer URL: http://example.org/StructureDefinition/moped-ext-sonderleistungsnummer Binding: Nummer für Sonderleistung (required) ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
anzahlSonderleistungen		0..1	unsignedInt	Anzahl Sonderleistungen URL: http://example.org/StructureDefinition/moped-ext-anzahlSonderleistungen ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
punkteLDFPauschale		0..1	decimal	Punkte LDF Pauschale URL: http://example.org/StructureDefinition/moped-ext-punkteLDFPauschale ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
konstenmeldungARK		0..1	Coding	Kostenmeldung für (A/R/K) URL: http://example.org/StructureDefinition/moped-ext-konstenmeldungARK Binding: Kostenmeldung für (A/R/K) (required) ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
status	?!Σ	1..1	code	active | cancelled | draft | entered-in-error Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance. ele-1: All FHIR elements must have a @value or children Required Pattern: active
type	Σ	1..1	CodeableConcept	More granular claim type Binding: ClaimTypeCodes (extensible): The type or discipline-style of the claim. ele-1: All FHIR elements must have a @value or children
use	Σ	1..1	code	claim | preauthorization | predetermination Binding: Use (required): Claim, preauthorization, predetermination. ele-1: All FHIR elements must have a @value or children Required Pattern: claim
patient	Σ	1..1	Reference(HL7® AT Core Patient Profile)	The recipient of the products and services ele-1: All FHIR elements must have a @value or children
created	Σ	1..1	dateTime	Response creation date ele-1: All FHIR elements must have a @value or children
insurer	Σ	1..1	Reference(HL7® AT Core Organization Profile)	Party responsible for reimbursement ele-1: All FHIR elements must have a @value or children
requestor		1..1	Reference(HL7® AT Core Organization Profile)	Party responsible for the claim ele-1: All FHIR elements must have a @value or children
request	Σ	1..1	Reference(MOPED Claim)	Id of resource triggering adjudication ele-1: All FHIR elements must have a @value or children
outcome	Σ	1..1	code	queued | complete | error | partial Binding: ClaimProcessingCodes (required): The result of the claim processing. ele-1: All FHIR elements must have a @value or children
diagnosisRelatedGroup		0..1	CodeableConcept	"Abrechnung - Gruppe:" Dieses Datenfeld ist mit der Codenummer der zutreffenden Abrechnungsgruppe zu befüllen. Bei Datensätzen von stationären Krankenhausaufenthalten, die keiner leistungsorientier- ten Diagnosenfallgruppe zugeordnet werden, erfolgt ein Eintrag entsprechend der jeweiligen Aufnahmeart. Binding: LKF Abrechnungsgruppe (required) ele-1: All FHIR elements must have a @value or children
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet / Code	URI
ClaimResponse.status	required	Pattern: active http://hl7.org/fhir/ValueSet/fm-status|5.0.0 from the FHIR Standard
ClaimResponse.type	extensible	ClaimTypeCodes http://hl7.org/fhir/ValueSet/claim-type from the FHIR Standard
ClaimResponse.use	required	Pattern: claim http://hl7.org/fhir/ValueSet/claim-use|5.0.0 from the FHIR Standard
ClaimResponse.outcome	required	ClaimProcessingCodes http://hl7.org/fhir/ValueSet/claim-outcome|5.0.0 from the FHIR Standard
ClaimResponse.diagnosisRelatedGroup	required	LKFAbrechnungsGruppe http://example.org/ValueSet/moped-LKFAbrechnungsGruppe-valueset from this IG

Constraints

Id	Grade	Path(s)	Details	Requirements
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()

Name	Flags	Card.	Type	Description & Constraints
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 Set
text		0..1	Narrative	Text summary of the resource, for human interpretation
contained		0..*	Resource	Contained, inline Resources
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
fehlerWarnung		0..*	(Complex)	Error/Warning URL: http://example.org/StructureDefinition/moped-ext-fehlerWarnung
diagnoseKnoten		0..1	Coding	"Abrechnung - Knoten:" Lukriert die Patient:innen über eine reguläre Gruppe Punkte, so ist in diesem Datenfeld die entsprechende Knotenbezeichnung einzutragen. URL: http://example.org/StructureDefinition/moped-ext-diagnoseKnoten Binding: LKF Abrechnungsknoten (required)
lkfPunkte		0..*	(Complex)	LKF Punkte URL: http://example.org/StructureDefinition/moped-ext-lkfPunkte
ldfPunktewertNetto		0..1	decimal	LDF-Punktewert Netto URL: http://example.org/StructureDefinition/moped-ext-ldfPunktewertNetto
ldfBetragNetto		0..1	decimal	LDF-Betrag Netto URL: http://example.org/StructureDefinition/moped-ext-ldfBetragNetto
patientenanteilAngehoerige		0..1	Money	Patientenanteil für Angehoerige URL: http://example.org/StructureDefinition/moped-ext-patientenanteilAngehoerige
patientenanteil		0..1	Money	Patientenanteil Netto URL: http://example.org/StructureDefinition/moped-ext-patientenanteil
beihilfenaequivalent		0..1	unsignedInt	Beihilfenaequivalent URL: http://example.org/StructureDefinition/moped-ext-beihilfenaequivalent
forderungsbetragAuslaenderverrechnungRegress		0..1	Money	Forderungsbetrag für Auslaenderverrechnung oder Regress URL: http://example.org/StructureDefinition/moped-ext-forderungsbetragAuslaenderverrechnungRegress
rechnungsnummerKHLGF		0..1	string	Rechnungsnummer der Krankenanstalt bzw. des Landesgesundheitsfonds URL: http://example.org/StructureDefinition/moped-ext-rechnungsnummerKHLGF
note		0..*	Annotation	A recorded sex or gender property for the individual URL: http://hl7.org/fhir/StructureDefinition/note
sonderleistungsnummer		0..1	Coding	Sonderleistungsnummer URL: http://example.org/StructureDefinition/moped-ext-sonderleistungsnummer Binding: Nummer für Sonderleistung (required)
anzahlSonderleistungen		0..1	unsignedInt	Anzahl Sonderleistungen URL: http://example.org/StructureDefinition/moped-ext-anzahlSonderleistungen
punkteLDFPauschale		0..1	decimal	Punkte LDF Pauschale URL: http://example.org/StructureDefinition/moped-ext-punkteLDFPauschale
konstenmeldungARK		0..1	Coding	Kostenmeldung für (A/R/K) URL: http://example.org/StructureDefinition/moped-ext-konstenmeldungARK Binding: Kostenmeldung für (A/R/K) (required)
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	?!Σ	1..1	code	active | cancelled | draft | entered-in-error Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance. Required Pattern: active
type	Σ	1..1	CodeableConcept	More granular claim type Binding: ClaimTypeCodes (extensible): The type or discipline-style of the claim.
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
id		0..1	id	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
system	Σ	0..1	uri	Identity of the terminology system
version	Σ	0..1	string	Version of the system - if relevant
code	ΣC	0..1	code	Symbol in syntax defined by the system Required Pattern: institutional
display	ΣC	0..1	string	Representation defined by the system
userSelected	Σ	0..1	boolean	If this coding was chosen directly by the user
text	Σ	0..1	string	Plain text representation of the concept
subType		0..1	CodeableConcept	More granular claim type Binding: ExampleClaimSubTypeCodes (example): A more granular claim typecode.
use	Σ	1..1	code	claim | preauthorization | predetermination Binding: Use (required): Claim, preauthorization, predetermination. Required Pattern: claim
patient	Σ	1..1	Reference(HL7® AT Core Patient Profile)	The recipient of the products and services
created	Σ	1..1	dateTime	Response creation date
insurer	Σ	1..1	Reference(HL7® AT Core Organization Profile)	Party responsible for reimbursement
requestor		1..1	Reference(HL7® AT Core Organization Profile)	Party responsible for the claim
request	Σ	1..1	Reference(MOPED Claim)	Id of resource triggering adjudication
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	"Abrechnung - Gruppe:" Dieses Datenfeld ist mit der Codenummer der zutreffenden Abrechnungsgruppe zu befüllen. Bei Datensätzen von stationären Krankenhausaufenthalten, die keiner leistungsorientier- ten Diagnosenfallgruppe zugeordnet werden, erfolgt ein Eintrag entsprechend der jeweiligen Aufnahmeart. Binding: LKF Abrechnungsgruppe (required)
item		0..*	BackboneElement	Adjudication for claim line items
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
itemSequence		1..1	positiveInt	Claim item instance identifier
traceNumber		0..*	Identifier	Number for tracking
noteNumber		0..*	positiveInt	Applicable note numbers
reviewOutcome		0..1	BackboneElement	Adjudication results
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
decision		0..1	CodeableConcept	Result of the adjudication Binding: ClaimAdjudicationDecisionsCodes (example)
reason		0..*	CodeableConcept	Reason for result of the adjudication Binding: ClaimAdjudicationDecisionReasonCodes (example)
preAuthRef		0..1	string	Preauthorization reference
preAuthPeriod		0..1	Period	Preauthorization reference effective period
adjudication		0..*	BackboneElement	Adjudication details
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
category		1..1	CodeableConcept	Type of adjudication information Binding: AdjudicationValueCodes (example): The adjudication codes.
reason		0..1	CodeableConcept	Explanation of adjudication outcome Binding: AdjudicationReasonCodes (example): The adjudication reason codes.
amount		0..1	Money	Monetary amount
quantity		0..1	Quantity	Non-monetary value
detail		0..*	BackboneElement	Adjudication for claim details
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
detailSequence		1..1	positiveInt	Claim detail instance identifier
traceNumber		0..*	Identifier	Number for tracking
noteNumber		0..*	positiveInt	Applicable note numbers
reviewOutcome		0..1	See reviewOutcome (ClaimResponse)	Detail level adjudication results
adjudication		0..*	See adjudication (ClaimResponse)	Detail level adjudication details
subDetail		0..*	BackboneElement	Adjudication for claim sub-details
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
subDetailSequence		1..1	positiveInt	Claim sub-detail instance identifier
traceNumber		0..*	Identifier	Number for tracking
noteNumber		0..*	positiveInt	Applicable note numbers
reviewOutcome		0..1	See reviewOutcome (ClaimResponse)	Subdetail level adjudication results
adjudication		0..*	See adjudication (ClaimResponse)	Subdetail level adjudication details
addItem		0..*	BackboneElement	Insurer added line items
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
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	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	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	Count of products or services
unitPrice		0..1	Money	Fee, charge or cost per item
factor		0..1	decimal	Price scaling factor
tax		0..1	Money	Total tax
net		0..1	Money	Total item cost
noteNumber		0..*	positiveInt	Applicable note numbers
reviewOutcome		0..1	See reviewOutcome (ClaimResponse)	Added items subdetail level adjudication results
adjudication		0..*	See adjudication (ClaimResponse)	Added items subdetail adjudication
adjudication		0..*	See adjudication (ClaimResponse)	Header-level adjudication
total	Σ	0..*	BackboneElement	Adjudication totals
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
category	Σ	1..1	CodeableConcept	Type of adjudication information Binding: AdjudicationValueCodes (example): The adjudication codes.
amount	Σ	1..1	Money	Financial total for the category
payment		0..1	BackboneElement	Payment Details
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
type		1..1	CodeableConcept	Partial or complete payment Binding: ExamplePaymentTypeCodes (example): The type (partial, complete) of the payment.
adjustment		0..1	Money	Payment adjustment for non-claim issues
adjustmentReason		0..1	CodeableConcept	Explanation for the adjustment Binding: PaymentAdjustmentReasonCodes (example): Payment Adjustment reason codes.
date		0..1	date	Expected date of payment
amount		1..1	Money	Payable amount after adjustment
identifier		0..1	Identifier	Business identifier for the payment
fundsReserve		0..1	CodeableConcept	Funds reserved status Binding: FundsReservationCodes (example): For whom funds are to be reserved: (Patient, Provider, None).
formCode		0..1	CodeableConcept	Printed form identifier Binding: FormCodes (example): The forms codes.
form		0..1	Attachment	Printed reference or actual form
processNote		0..*	BackboneElement	Note concerning adjudication
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
number		0..1	positiveInt	Note instance identifier
type		0..1	CodeableConcept	Note purpose Binding: NoteType (extensible): The presentation types of notes.
text		1..1	string	Note explanatory text
language		0..1	CodeableConcept	Language of the text Binding: AllLanguages (required): IETF language tag for a human language Additional Bindings Purpose CommonLanguages Starter Set
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(MOPED 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	Conformance	ValueSet / Code	URI
ClaimResponse.language	required	AllLanguages http://hl7.org/fhir/ValueSet/all-languages|5.0.0 from the FHIR Standard
ClaimResponse.status	required	Pattern: active http://hl7.org/fhir/ValueSet/fm-status|5.0.0 from the FHIR Standard
ClaimResponse.type	extensible	ClaimTypeCodes http://hl7.org/fhir/ValueSet/claim-type from the FHIR Standard
ClaimResponse.subType	example	ExampleClaimSubTypeCodes http://hl7.org/fhir/ValueSet/claim-subtype from the FHIR Standard
ClaimResponse.use	required	Pattern: claim http://hl7.org/fhir/ValueSet/claim-use|5.0.0 from the FHIR Standard
ClaimResponse.outcome	required	ClaimProcessingCodes http://hl7.org/fhir/ValueSet/claim-outcome|5.0.0 from the FHIR Standard
ClaimResponse.decision	example	ClaimAdjudicationDecisionsCodes http://hl7.org/fhir/ValueSet/claim-decision from the FHIR Standard
ClaimResponse.event.type	example	DatesTypeCodes http://hl7.org/fhir/ValueSet/datestype from the FHIR Standard
ClaimResponse.payeeType	example	ClaimPayeeTypeCodes http://hl7.org/fhir/ValueSet/payeetype from the FHIR Standard
ClaimResponse.diagnosisRelatedGroup	required	LKFAbrechnungsGruppe http://example.org/ValueSet/moped-LKFAbrechnungsGruppe-valueset from this IG
ClaimResponse.item.reviewOutcome.decision	example	ClaimAdjudicationDecisionsCodes http://hl7.org/fhir/ValueSet/claim-decision from the FHIR Standard
ClaimResponse.item.reviewOutcome.reason	example	ClaimAdjudicationDecisionReasonCodes http://hl7.org/fhir/ValueSet/claim-decision-reason from the FHIR Standard
ClaimResponse.item.adjudication.category	example	AdjudicationValueCodes http://hl7.org/fhir/ValueSet/adjudication from the FHIR Standard
ClaimResponse.item.adjudication.reason	example	AdjudicationReasonCodes http://hl7.org/fhir/ValueSet/adjudication-reason from the FHIR Standard
ClaimResponse.addItem.revenue	example	ExampleRevenueCenterCodes http://hl7.org/fhir/ValueSet/ex-revenue-center from the FHIR Standard
ClaimResponse.addItem.productOrService	example	USCLSCodes http://hl7.org/fhir/ValueSet/service-uscls from the FHIR Standard
ClaimResponse.addItem.productOrServiceEnd	example	USCLSCodes http://hl7.org/fhir/ValueSet/service-uscls from the FHIR Standard
ClaimResponse.addItem.modifier	example	ModifierTypeCodes http://hl7.org/fhir/ValueSet/claim-modifiers from the FHIR Standard
ClaimResponse.addItem.programCode	example	ExampleProgramReasonCodes http://hl7.org/fhir/ValueSet/ex-program-code from the FHIR Standard
ClaimResponse.addItem.location[x]	example	ExampleServicePlaceCodes http://hl7.org/fhir/ValueSet/service-place from the FHIR Standard
ClaimResponse.addItem.bodySite.site	example	OralSiteCodes http://hl7.org/fhir/ValueSet/tooth from the FHIR Standard
ClaimResponse.addItem.bodySite.subSite	example	SurfaceCodes http://hl7.org/fhir/ValueSet/surface from the FHIR Standard
ClaimResponse.addItem.detail.revenue	example	ExampleRevenueCenterCodes http://hl7.org/fhir/ValueSet/ex-revenue-center from the FHIR Standard
ClaimResponse.addItem.detail.productOrService	example	USCLSCodes http://hl7.org/fhir/ValueSet/service-uscls from the FHIR Standard
ClaimResponse.addItem.detail.productOrServiceEnd	example	USCLSCodes http://hl7.org/fhir/ValueSet/service-uscls from the FHIR Standard
ClaimResponse.addItem.detail.modifier	example	ModifierTypeCodes http://hl7.org/fhir/ValueSet/claim-modifiers from the FHIR Standard
ClaimResponse.addItem.detail.subDetail.revenue	example	ExampleRevenueCenterCodes http://hl7.org/fhir/ValueSet/ex-revenue-center from the FHIR Standard
ClaimResponse.addItem.detail.subDetail.productOrService	example	USCLSCodes http://hl7.org/fhir/ValueSet/service-uscls from the FHIR Standard
ClaimResponse.addItem.detail.subDetail.productOrServiceEnd	example	USCLSCodes http://hl7.org/fhir/ValueSet/service-uscls from the FHIR Standard
ClaimResponse.addItem.detail.subDetail.modifier	example	ModifierTypeCodes http://hl7.org/fhir/ValueSet/claim-modifiers from the FHIR Standard
ClaimResponse.total.category	example	AdjudicationValueCodes http://hl7.org/fhir/ValueSet/adjudication from the FHIR Standard
ClaimResponse.payment.type	example	ExamplePaymentTypeCodes http://hl7.org/fhir/ValueSet/ex-paymenttype from the FHIR Standard
ClaimResponse.payment.adjustmentReason	example	PaymentAdjustmentReasonCodes http://hl7.org/fhir/ValueSet/payment-adjustment-reason from the FHIR Standard
ClaimResponse.fundsReserve	example	FundsReservationCodes http://hl7.org/fhir/ValueSet/fundsreserve from the FHIR Standard
ClaimResponse.formCode	example	FormCodes http://hl7.org/fhir/ValueSet/forms from the FHIR Standard
ClaimResponse.processNote.type	extensible	NoteType http://hl7.org/fhir/ValueSet/note-type from the FHIR Standard
ClaimResponse.processNote.language	required	AllLanguages http://hl7.org/fhir/ValueSet/all-languages|5.0.0 from the FHIR Standard
ClaimResponse.error.code	example	AdjudicationErrorCodes http://hl7.org/fhir/ValueSet/adjudication-error from the FHIR Standard

Constraints

Id	Grade	Path(s)	Details	Requirements
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: 3 elements

Structures

This structure refers to these other structures:

• HL7® AT Core Patient Profile (http://hl7.at/fhir/HL7ATCoreProfiles/5.0.0/StructureDefinition/at-core-patient)
• HL7® AT Core Organization Profile (http://hl7.at/fhir/HL7ATCoreProfiles/5.0.0/StructureDefinition/at-core-organization)
• MOPED Claim (http://example.org/StructureDefinition/MOPEDClaim)
• MOPED Coverage (http://example.org/StructureDefinition/MOPEDCoverage)

Extensions

This structure refers to these extensions:

• http://example.org/StructureDefinition/moped-ext-fehlerWarnung
• http://example.org/StructureDefinition/moped-ext-diagnoseKnoten
• http://example.org/StructureDefinition/moped-ext-lkfPunkte
• http://example.org/StructureDefinition/moped-ext-ldfPunktewertNetto
• http://example.org/StructureDefinition/moped-ext-ldfBetragNetto
• http://example.org/StructureDefinition/moped-ext-patientenanteilAngehoerige
• http://example.org/StructureDefinition/moped-ext-patientenanteil
• http://example.org/StructureDefinition/moped-ext-beihilfenaequivalent
• http://example.org/StructureDefinition/moped-ext-forderungsbetragAuslaenderverrechnungRegress
• http://example.org/StructureDefinition/moped-ext-rechnungsnummerKHLGF
• http://hl7.org/fhir/StructureDefinition/note
• http://example.org/StructureDefinition/moped-ext-sonderleistungsnummer
• http://example.org/StructureDefinition/moped-ext-anzahlSonderleistungen
• http://example.org/StructureDefinition/moped-ext-punkteLDFPauschale
• http://example.org/StructureDefinition/moped-ext-konstenmeldungARK

Differential View

This structure is derived from ClaimResponse

Name	Flags	Card.	Type	Description & Constraints
ClaimResponse		0..*	ClaimResponse	Response to a claim predetermination or preauthorization
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
fehlerWarnung		0..*	(Complex)	Error/Warning URL: http://example.org/StructureDefinition/moped-ext-fehlerWarnung
diagnoseKnoten		0..1	Coding	"Abrechnung - Knoten:" Lukriert die Patient:innen über eine reguläre Gruppe Punkte, so ist in diesem Datenfeld die entsprechende Knotenbezeichnung einzutragen. URL: http://example.org/StructureDefinition/moped-ext-diagnoseKnoten Binding: LKF Abrechnungsknoten (required)
lkfPunkte		0..*	(Complex)	LKF Punkte URL: http://example.org/StructureDefinition/moped-ext-lkfPunkte
ldfPunktewertNetto		0..1	decimal	LDF-Punktewert Netto URL: http://example.org/StructureDefinition/moped-ext-ldfPunktewertNetto
ldfBetragNetto		0..1	decimal	LDF-Betrag Netto URL: http://example.org/StructureDefinition/moped-ext-ldfBetragNetto
patientenanteilAngehoerige		0..1	Money	Patientenanteil für Angehoerige URL: http://example.org/StructureDefinition/moped-ext-patientenanteilAngehoerige
patientenanteil		0..1	Money	Patientenanteil Netto URL: http://example.org/StructureDefinition/moped-ext-patientenanteil
beihilfenaequivalent		0..1	unsignedInt	Beihilfenaequivalent URL: http://example.org/StructureDefinition/moped-ext-beihilfenaequivalent
forderungsbetragAuslaenderverrechnungRegress		0..1	Money	Forderungsbetrag für Auslaenderverrechnung oder Regress URL: http://example.org/StructureDefinition/moped-ext-forderungsbetragAuslaenderverrechnungRegress
rechnungsnummerKHLGF		0..1	string	Rechnungsnummer der Krankenanstalt bzw. des Landesgesundheitsfonds URL: http://example.org/StructureDefinition/moped-ext-rechnungsnummerKHLGF
note		0..*	Annotation	A recorded sex or gender property for the individual URL: http://hl7.org/fhir/StructureDefinition/note
sonderleistungsnummer		0..1	Coding	Sonderleistungsnummer URL: http://example.org/StructureDefinition/moped-ext-sonderleistungsnummer Binding: Nummer für Sonderleistung (required)
anzahlSonderleistungen		0..1	unsignedInt	Anzahl Sonderleistungen URL: http://example.org/StructureDefinition/moped-ext-anzahlSonderleistungen
punkteLDFPauschale		0..1	decimal	Punkte LDF Pauschale URL: http://example.org/StructureDefinition/moped-ext-punkteLDFPauschale
konstenmeldungARK		0..1	Coding	Kostenmeldung für (A/R/K) URL: http://example.org/StructureDefinition/moped-ext-konstenmeldungARK Binding: Kostenmeldung für (A/R/K) (required)
status		1..1	code	active | cancelled | draft | entered-in-error Required Pattern: active
type
coding
code		0..1	code	Symbol in syntax defined by the system Required Pattern: institutional
use		1..1	code	claim | preauthorization | predetermination Required Pattern: claim
patient		1..1	Reference(HL7® AT Core Patient Profile)	The recipient of the products and services
insurer		1..1	Reference(HL7® AT Core Organization Profile)	Party responsible for reimbursement
requestor		1..1	Reference(HL7® AT Core Organization Profile)	Party responsible for the claim
request		1..1	Reference(MOPED Claim)	Id of resource triggering adjudication
diagnosisRelatedGroup		0..1	CodeableConcept	"Abrechnung - Gruppe:" Dieses Datenfeld ist mit der Codenummer der zutreffenden Abrechnungsgruppe zu befüllen. Bei Datensätzen von stationären Krankenhausaufenthalten, die keiner leistungsorientier- ten Diagnosenfallgruppe zugeordnet werden, erfolgt ein Eintrag entsprechend der jeweiligen Aufnahmeart. Binding: LKF Abrechnungsgruppe (required)
insurance
coverage		1..1	Reference(MOPED Coverage)	Insurance information
Documentation for this format

Terminology Bindings (Differential)

Path	Conformance	ValueSet	URI
ClaimResponse.diagnosisRelatedGroup	required	LKFAbrechnungsGruppe http://example.org/ValueSet/moped-LKFAbrechnungsGruppe-valueset from this IG

Key Elements View

Name	Flags	Card.	Type	Description & Constraints
ClaimResponse		0..*	ClaimResponse	Response to a claim predetermination or preauthorization dom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources dom-3: If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource dom-4: If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated dom-5: If a resource is contained in another resource, it SHALL NOT have a security label dom-6: A resource should have narrative for robust management
implicitRules	?!Σ	0..1	uri	A set of rules under which this content was created ele-1: All FHIR elements must have a @value or children
contained		0..*	Resource	Contained, inline Resources
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
fehlerWarnung		0..*	(Complex)	Error/Warning URL: http://example.org/StructureDefinition/moped-ext-fehlerWarnung ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
diagnoseKnoten		0..1	Coding	"Abrechnung - Knoten:" Lukriert die Patient:innen über eine reguläre Gruppe Punkte, so ist in diesem Datenfeld die entsprechende Knotenbezeichnung einzutragen. URL: http://example.org/StructureDefinition/moped-ext-diagnoseKnoten Binding: LKF Abrechnungsknoten (required) ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
lkfPunkte		0..*	(Complex)	LKF Punkte URL: http://example.org/StructureDefinition/moped-ext-lkfPunkte ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
ldfPunktewertNetto		0..1	decimal	LDF-Punktewert Netto URL: http://example.org/StructureDefinition/moped-ext-ldfPunktewertNetto ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
ldfBetragNetto		0..1	decimal	LDF-Betrag Netto URL: http://example.org/StructureDefinition/moped-ext-ldfBetragNetto ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
patientenanteilAngehoerige		0..1	Money	Patientenanteil für Angehoerige URL: http://example.org/StructureDefinition/moped-ext-patientenanteilAngehoerige ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
patientenanteil		0..1	Money	Patientenanteil Netto URL: http://example.org/StructureDefinition/moped-ext-patientenanteil ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
beihilfenaequivalent		0..1	unsignedInt	Beihilfenaequivalent URL: http://example.org/StructureDefinition/moped-ext-beihilfenaequivalent ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
forderungsbetragAuslaenderverrechnungRegress		0..1	Money	Forderungsbetrag für Auslaenderverrechnung oder Regress URL: http://example.org/StructureDefinition/moped-ext-forderungsbetragAuslaenderverrechnungRegress ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
rechnungsnummerKHLGF		0..1	string	Rechnungsnummer der Krankenanstalt bzw. des Landesgesundheitsfonds URL: http://example.org/StructureDefinition/moped-ext-rechnungsnummerKHLGF ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
note		0..*	Annotation	A recorded sex or gender property for the individual URL: http://hl7.org/fhir/StructureDefinition/note ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
sonderleistungsnummer		0..1	Coding	Sonderleistungsnummer URL: http://example.org/StructureDefinition/moped-ext-sonderleistungsnummer Binding: Nummer für Sonderleistung (required) ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
anzahlSonderleistungen		0..1	unsignedInt	Anzahl Sonderleistungen URL: http://example.org/StructureDefinition/moped-ext-anzahlSonderleistungen ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
punkteLDFPauschale		0..1	decimal	Punkte LDF Pauschale URL: http://example.org/StructureDefinition/moped-ext-punkteLDFPauschale ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
konstenmeldungARK		0..1	Coding	Kostenmeldung für (A/R/K) URL: http://example.org/StructureDefinition/moped-ext-konstenmeldungARK Binding: Kostenmeldung für (A/R/K) (required) ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
status	?!Σ	1..1	code	active | cancelled | draft | entered-in-error Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance. ele-1: All FHIR elements must have a @value or children Required Pattern: active
type	Σ	1..1	CodeableConcept	More granular claim type Binding: ClaimTypeCodes (extensible): The type or discipline-style of the claim. ele-1: All FHIR elements must have a @value or children
use	Σ	1..1	code	claim | preauthorization | predetermination Binding: Use (required): Claim, preauthorization, predetermination. ele-1: All FHIR elements must have a @value or children Required Pattern: claim
patient	Σ	1..1	Reference(HL7® AT Core Patient Profile)	The recipient of the products and services ele-1: All FHIR elements must have a @value or children
created	Σ	1..1	dateTime	Response creation date ele-1: All FHIR elements must have a @value or children
insurer	Σ	1..1	Reference(HL7® AT Core Organization Profile)	Party responsible for reimbursement ele-1: All FHIR elements must have a @value or children
requestor		1..1	Reference(HL7® AT Core Organization Profile)	Party responsible for the claim ele-1: All FHIR elements must have a @value or children
request	Σ	1..1	Reference(MOPED Claim)	Id of resource triggering adjudication ele-1: All FHIR elements must have a @value or children
outcome	Σ	1..1	code	queued | complete | error | partial Binding: ClaimProcessingCodes (required): The result of the claim processing. ele-1: All FHIR elements must have a @value or children
diagnosisRelatedGroup		0..1	CodeableConcept	"Abrechnung - Gruppe:" Dieses Datenfeld ist mit der Codenummer der zutreffenden Abrechnungsgruppe zu befüllen. Bei Datensätzen von stationären Krankenhausaufenthalten, die keiner leistungsorientier- ten Diagnosenfallgruppe zugeordnet werden, erfolgt ein Eintrag entsprechend der jeweiligen Aufnahmeart. Binding: LKF Abrechnungsgruppe (required) ele-1: All FHIR elements must have a @value or children
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet / Code	URI
ClaimResponse.status	required	Pattern: active http://hl7.org/fhir/ValueSet/fm-status|5.0.0 from the FHIR Standard
ClaimResponse.type	extensible	ClaimTypeCodes http://hl7.org/fhir/ValueSet/claim-type from the FHIR Standard
ClaimResponse.use	required	Pattern: claim http://hl7.org/fhir/ValueSet/claim-use|5.0.0 from the FHIR Standard
ClaimResponse.outcome	required	ClaimProcessingCodes http://hl7.org/fhir/ValueSet/claim-outcome|5.0.0 from the FHIR Standard
ClaimResponse.diagnosisRelatedGroup	required	LKFAbrechnungsGruppe http://example.org/ValueSet/moped-LKFAbrechnungsGruppe-valueset from this IG

Constraints

Id	Grade	Path(s)	Details	Requirements
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()

Snapshot View

Name	Flags	Card.	Type	Description & Constraints
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 Set
text		0..1	Narrative	Text summary of the resource, for human interpretation
contained		0..*	Resource	Contained, inline Resources
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
fehlerWarnung		0..*	(Complex)	Error/Warning URL: http://example.org/StructureDefinition/moped-ext-fehlerWarnung
diagnoseKnoten		0..1	Coding	"Abrechnung - Knoten:" Lukriert die Patient:innen über eine reguläre Gruppe Punkte, so ist in diesem Datenfeld die entsprechende Knotenbezeichnung einzutragen. URL: http://example.org/StructureDefinition/moped-ext-diagnoseKnoten Binding: LKF Abrechnungsknoten (required)
lkfPunkte		0..*	(Complex)	LKF Punkte URL: http://example.org/StructureDefinition/moped-ext-lkfPunkte
ldfPunktewertNetto		0..1	decimal	LDF-Punktewert Netto URL: http://example.org/StructureDefinition/moped-ext-ldfPunktewertNetto
ldfBetragNetto		0..1	decimal	LDF-Betrag Netto URL: http://example.org/StructureDefinition/moped-ext-ldfBetragNetto
patientenanteilAngehoerige		0..1	Money	Patientenanteil für Angehoerige URL: http://example.org/StructureDefinition/moped-ext-patientenanteilAngehoerige
patientenanteil		0..1	Money	Patientenanteil Netto URL: http://example.org/StructureDefinition/moped-ext-patientenanteil
beihilfenaequivalent		0..1	unsignedInt	Beihilfenaequivalent URL: http://example.org/StructureDefinition/moped-ext-beihilfenaequivalent
forderungsbetragAuslaenderverrechnungRegress		0..1	Money	Forderungsbetrag für Auslaenderverrechnung oder Regress URL: http://example.org/StructureDefinition/moped-ext-forderungsbetragAuslaenderverrechnungRegress
rechnungsnummerKHLGF		0..1	string	Rechnungsnummer der Krankenanstalt bzw. des Landesgesundheitsfonds URL: http://example.org/StructureDefinition/moped-ext-rechnungsnummerKHLGF
note		0..*	Annotation	A recorded sex or gender property for the individual URL: http://hl7.org/fhir/StructureDefinition/note
sonderleistungsnummer		0..1	Coding	Sonderleistungsnummer URL: http://example.org/StructureDefinition/moped-ext-sonderleistungsnummer Binding: Nummer für Sonderleistung (required)
anzahlSonderleistungen		0..1	unsignedInt	Anzahl Sonderleistungen URL: http://example.org/StructureDefinition/moped-ext-anzahlSonderleistungen
punkteLDFPauschale		0..1	decimal	Punkte LDF Pauschale URL: http://example.org/StructureDefinition/moped-ext-punkteLDFPauschale
konstenmeldungARK		0..1	Coding	Kostenmeldung für (A/R/K) URL: http://example.org/StructureDefinition/moped-ext-konstenmeldungARK Binding: Kostenmeldung für (A/R/K) (required)
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	?!Σ	1..1	code	active | cancelled | draft | entered-in-error Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance. Required Pattern: active
type	Σ	1..1	CodeableConcept	More granular claim type Binding: ClaimTypeCodes (extensible): The type or discipline-style of the claim.
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
id		0..1	id	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
system	Σ	0..1	uri	Identity of the terminology system
version	Σ	0..1	string	Version of the system - if relevant
code	ΣC	0..1	code	Symbol in syntax defined by the system Required Pattern: institutional
display	ΣC	0..1	string	Representation defined by the system
userSelected	Σ	0..1	boolean	If this coding was chosen directly by the user
text	Σ	0..1	string	Plain text representation of the concept
subType		0..1	CodeableConcept	More granular claim type Binding: ExampleClaimSubTypeCodes (example): A more granular claim typecode.
use	Σ	1..1	code	claim | preauthorization | predetermination Binding: Use (required): Claim, preauthorization, predetermination. Required Pattern: claim
patient	Σ	1..1	Reference(HL7® AT Core Patient Profile)	The recipient of the products and services
created	Σ	1..1	dateTime	Response creation date
insurer	Σ	1..1	Reference(HL7® AT Core Organization Profile)	Party responsible for reimbursement
requestor		1..1	Reference(HL7® AT Core Organization Profile)	Party responsible for the claim
request	Σ	1..1	Reference(MOPED Claim)	Id of resource triggering adjudication
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	"Abrechnung - Gruppe:" Dieses Datenfeld ist mit der Codenummer der zutreffenden Abrechnungsgruppe zu befüllen. Bei Datensätzen von stationären Krankenhausaufenthalten, die keiner leistungsorientier- ten Diagnosenfallgruppe zugeordnet werden, erfolgt ein Eintrag entsprechend der jeweiligen Aufnahmeart. Binding: LKF Abrechnungsgruppe (required)
item		0..*	BackboneElement	Adjudication for claim line items
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
itemSequence		1..1	positiveInt	Claim item instance identifier
traceNumber		0..*	Identifier	Number for tracking
noteNumber		0..*	positiveInt	Applicable note numbers
reviewOutcome		0..1	BackboneElement	Adjudication results
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
decision		0..1	CodeableConcept	Result of the adjudication Binding: ClaimAdjudicationDecisionsCodes (example)
reason		0..*	CodeableConcept	Reason for result of the adjudication Binding: ClaimAdjudicationDecisionReasonCodes (example)
preAuthRef		0..1	string	Preauthorization reference
preAuthPeriod		0..1	Period	Preauthorization reference effective period
adjudication		0..*	BackboneElement	Adjudication details
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
category		1..1	CodeableConcept	Type of adjudication information Binding: AdjudicationValueCodes (example): The adjudication codes.
reason		0..1	CodeableConcept	Explanation of adjudication outcome Binding: AdjudicationReasonCodes (example): The adjudication reason codes.
amount		0..1	Money	Monetary amount
quantity		0..1	Quantity	Non-monetary value
detail		0..*	BackboneElement	Adjudication for claim details
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
detailSequence		1..1	positiveInt	Claim detail instance identifier
traceNumber		0..*	Identifier	Number for tracking
noteNumber		0..*	positiveInt	Applicable note numbers
reviewOutcome		0..1	See reviewOutcome (ClaimResponse)	Detail level adjudication results
adjudication		0..*	See adjudication (ClaimResponse)	Detail level adjudication details
subDetail		0..*	BackboneElement	Adjudication for claim sub-details
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
subDetailSequence		1..1	positiveInt	Claim sub-detail instance identifier
traceNumber		0..*	Identifier	Number for tracking
noteNumber		0..*	positiveInt	Applicable note numbers
reviewOutcome		0..1	See reviewOutcome (ClaimResponse)	Subdetail level adjudication results
adjudication		0..*	See adjudication (ClaimResponse)	Subdetail level adjudication details
addItem		0..*	BackboneElement	Insurer added line items
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
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	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	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	Count of products or services
unitPrice		0..1	Money	Fee, charge or cost per item
factor		0..1	decimal	Price scaling factor
tax		0..1	Money	Total tax
net		0..1	Money	Total item cost
noteNumber		0..*	positiveInt	Applicable note numbers
reviewOutcome		0..1	See reviewOutcome (ClaimResponse)	Added items subdetail level adjudication results
adjudication		0..*	See adjudication (ClaimResponse)	Added items subdetail adjudication
adjudication		0..*	See adjudication (ClaimResponse)	Header-level adjudication
total	Σ	0..*	BackboneElement	Adjudication totals
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
category	Σ	1..1	CodeableConcept	Type of adjudication information Binding: AdjudicationValueCodes (example): The adjudication codes.
amount	Σ	1..1	Money	Financial total for the category
payment		0..1	BackboneElement	Payment Details
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
type		1..1	CodeableConcept	Partial or complete payment Binding: ExamplePaymentTypeCodes (example): The type (partial, complete) of the payment.
adjustment		0..1	Money	Payment adjustment for non-claim issues
adjustmentReason		0..1	CodeableConcept	Explanation for the adjustment Binding: PaymentAdjustmentReasonCodes (example): Payment Adjustment reason codes.
date		0..1	date	Expected date of payment
amount		1..1	Money	Payable amount after adjustment
identifier		0..1	Identifier	Business identifier for the payment
fundsReserve		0..1	CodeableConcept	Funds reserved status Binding: FundsReservationCodes (example): For whom funds are to be reserved: (Patient, Provider, None).
formCode		0..1	CodeableConcept	Printed form identifier Binding: FormCodes (example): The forms codes.
form		0..1	Attachment	Printed reference or actual form
processNote		0..*	BackboneElement	Note concerning adjudication
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
number		0..1	positiveInt	Note instance identifier
type		0..1	CodeableConcept	Note purpose Binding: NoteType (extensible): The presentation types of notes.
text		1..1	string	Note explanatory text
language		0..1	CodeableConcept	Language of the text Binding: AllLanguages (required): IETF language tag for a human language Additional Bindings Purpose CommonLanguages Starter Set
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(MOPED 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	Conformance	ValueSet / Code	URI
ClaimResponse.language	required	AllLanguages http://hl7.org/fhir/ValueSet/all-languages|5.0.0 from the FHIR Standard
ClaimResponse.status	required	Pattern: active http://hl7.org/fhir/ValueSet/fm-status|5.0.0 from the FHIR Standard
ClaimResponse.type	extensible	ClaimTypeCodes http://hl7.org/fhir/ValueSet/claim-type from the FHIR Standard
ClaimResponse.subType	example	ExampleClaimSubTypeCodes http://hl7.org/fhir/ValueSet/claim-subtype from the FHIR Standard
ClaimResponse.use	required	Pattern: claim http://hl7.org/fhir/ValueSet/claim-use|5.0.0 from the FHIR Standard
ClaimResponse.outcome	required	ClaimProcessingCodes http://hl7.org/fhir/ValueSet/claim-outcome|5.0.0 from the FHIR Standard
ClaimResponse.decision	example	ClaimAdjudicationDecisionsCodes http://hl7.org/fhir/ValueSet/claim-decision from the FHIR Standard
ClaimResponse.event.type	example	DatesTypeCodes http://hl7.org/fhir/ValueSet/datestype from the FHIR Standard
ClaimResponse.payeeType	example	ClaimPayeeTypeCodes http://hl7.org/fhir/ValueSet/payeetype from the FHIR Standard
ClaimResponse.diagnosisRelatedGroup	required	LKFAbrechnungsGruppe http://example.org/ValueSet/moped-LKFAbrechnungsGruppe-valueset from this IG
ClaimResponse.item.reviewOutcome.decision	example	ClaimAdjudicationDecisionsCodes http://hl7.org/fhir/ValueSet/claim-decision from the FHIR Standard
ClaimResponse.item.reviewOutcome.reason	example	ClaimAdjudicationDecisionReasonCodes http://hl7.org/fhir/ValueSet/claim-decision-reason from the FHIR Standard
ClaimResponse.item.adjudication.category	example	AdjudicationValueCodes http://hl7.org/fhir/ValueSet/adjudication from the FHIR Standard
ClaimResponse.item.adjudication.reason	example	AdjudicationReasonCodes http://hl7.org/fhir/ValueSet/adjudication-reason from the FHIR Standard
ClaimResponse.addItem.revenue	example	ExampleRevenueCenterCodes http://hl7.org/fhir/ValueSet/ex-revenue-center from the FHIR Standard
ClaimResponse.addItem.productOrService	example	USCLSCodes http://hl7.org/fhir/ValueSet/service-uscls from the FHIR Standard
ClaimResponse.addItem.productOrServiceEnd	example	USCLSCodes http://hl7.org/fhir/ValueSet/service-uscls from the FHIR Standard
ClaimResponse.addItem.modifier	example	ModifierTypeCodes http://hl7.org/fhir/ValueSet/claim-modifiers from the FHIR Standard
ClaimResponse.addItem.programCode	example	ExampleProgramReasonCodes http://hl7.org/fhir/ValueSet/ex-program-code from the FHIR Standard
ClaimResponse.addItem.location[x]	example	ExampleServicePlaceCodes http://hl7.org/fhir/ValueSet/service-place from the FHIR Standard
ClaimResponse.addItem.bodySite.site	example	OralSiteCodes http://hl7.org/fhir/ValueSet/tooth from the FHIR Standard
ClaimResponse.addItem.bodySite.subSite	example	SurfaceCodes http://hl7.org/fhir/ValueSet/surface from the FHIR Standard
ClaimResponse.addItem.detail.revenue	example	ExampleRevenueCenterCodes http://hl7.org/fhir/ValueSet/ex-revenue-center from the FHIR Standard
ClaimResponse.addItem.detail.productOrService	example	USCLSCodes http://hl7.org/fhir/ValueSet/service-uscls from the FHIR Standard
ClaimResponse.addItem.detail.productOrServiceEnd	example	USCLSCodes http://hl7.org/fhir/ValueSet/service-uscls from the FHIR Standard
ClaimResponse.addItem.detail.modifier	example	ModifierTypeCodes http://hl7.org/fhir/ValueSet/claim-modifiers from the FHIR Standard
ClaimResponse.addItem.detail.subDetail.revenue	example	ExampleRevenueCenterCodes http://hl7.org/fhir/ValueSet/ex-revenue-center from the FHIR Standard
ClaimResponse.addItem.detail.subDetail.productOrService	example	USCLSCodes http://hl7.org/fhir/ValueSet/service-uscls from the FHIR Standard
ClaimResponse.addItem.detail.subDetail.productOrServiceEnd	example	USCLSCodes http://hl7.org/fhir/ValueSet/service-uscls from the FHIR Standard
ClaimResponse.addItem.detail.subDetail.modifier	example	ModifierTypeCodes http://hl7.org/fhir/ValueSet/claim-modifiers from the FHIR Standard
ClaimResponse.total.category	example	AdjudicationValueCodes http://hl7.org/fhir/ValueSet/adjudication from the FHIR Standard
ClaimResponse.payment.type	example	ExamplePaymentTypeCodes http://hl7.org/fhir/ValueSet/ex-paymenttype from the FHIR Standard
ClaimResponse.payment.adjustmentReason	example	PaymentAdjustmentReasonCodes http://hl7.org/fhir/ValueSet/payment-adjustment-reason from the FHIR Standard
ClaimResponse.fundsReserve	example	FundsReservationCodes http://hl7.org/fhir/ValueSet/fundsreserve from the FHIR Standard
ClaimResponse.formCode	example	FormCodes http://hl7.org/fhir/ValueSet/forms from the FHIR Standard
ClaimResponse.processNote.type	extensible	NoteType http://hl7.org/fhir/ValueSet/note-type from the FHIR Standard
ClaimResponse.processNote.language	required	AllLanguages http://hl7.org/fhir/ValueSet/all-languages|5.0.0 from the FHIR Standard
ClaimResponse.error.code	example	AdjudicationErrorCodes http://hl7.org/fhir/ValueSet/adjudication-error from the FHIR Standard

Constraints

Id	Grade	Path(s)	Details	Requirements
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: 3 elements

Structures

This structure refers to these other structures:

• HL7® AT Core Patient Profile (http://hl7.at/fhir/HL7ATCoreProfiles/5.0.0/StructureDefinition/at-core-patient)
• HL7® AT Core Organization Profile (http://hl7.at/fhir/HL7ATCoreProfiles/5.0.0/StructureDefinition/at-core-organization)
• MOPED Claim (http://example.org/StructureDefinition/MOPEDClaim)
• MOPED Coverage (http://example.org/StructureDefinition/MOPEDCoverage)

Extensions

This structure refers to these extensions:

• http://example.org/StructureDefinition/moped-ext-fehlerWarnung
• http://example.org/StructureDefinition/moped-ext-diagnoseKnoten
• http://example.org/StructureDefinition/moped-ext-lkfPunkte
• http://example.org/StructureDefinition/moped-ext-ldfPunktewertNetto
• http://example.org/StructureDefinition/moped-ext-ldfBetragNetto
• http://example.org/StructureDefinition/moped-ext-patientenanteilAngehoerige
• http://example.org/StructureDefinition/moped-ext-patientenanteil
• http://example.org/StructureDefinition/moped-ext-beihilfenaequivalent
• http://example.org/StructureDefinition/moped-ext-forderungsbetragAuslaenderverrechnungRegress
• http://example.org/StructureDefinition/moped-ext-rechnungsnummerKHLGF
• http://hl7.org/fhir/StructureDefinition/note
• http://example.org/StructureDefinition/moped-ext-sonderleistungsnummer
• http://example.org/StructureDefinition/moped-ext-anzahlSonderleistungen
• http://example.org/StructureDefinition/moped-ext-punkteLDFPauschale
• http://example.org/StructureDefinition/moped-ext-konstenmeldungARK