ClaimResponse (9)

#NameSourceVerDescription
1HRex Prior authorizationhl7.fhir.us.davinci-hrex#currentR4This profile specifies constraints on ClaimResponse resource to reflect the contents of a pro-active prior authorization returned via a card
2MyCareNet eAgreement Claim Response BE profilehl7.fhir.be.mycarenet#currentR4Claimresponse profile for use in the different eAgreement flows from MyCareNet.
3MyCareNet eAttestation Claim Response BE profilehl7.fhir.be.eattestation#currentR4Claimresponse profile for use in the different eAttestation flows from MyCareNet.
4MyCareNet Etariff Claim Response BE profilehl7.fhir.be.etariff#currentR4Claimresponse profile for use in the different Etariff flows from MyCareNet.
5PAS Claim Inquiry Responsehl7.fhir.us.davinci-pas#currentR4PAS constraints on Claim resource mandating support for elements relevant to the response of an inquiry for details of previous authorizations.
6PAS Claim Responsehl7.fhir.us.davinci-pas#currentR4PAS constraints on Claim resource mandating support for elements relevant to the response of a prior authorization request
7PAS Claim Response Basehl7.fhir.us.davinci-pas#currentR4PAS constraints on ClaimResponse resource that are common to both the request and the inquiry.
8QICore ClaimResponsehl7.fhir.us.qicore#currentR4The QI Core ClaimResponse profile is used to provide the results of the adjudication and/or authorization of a set of healthcare-related products and services for a patient against the patient's insurance coverages, or to respond with what the adjudication would be for a supplied set of products or services should they be actually supplied to the patient.It identifies the mandatory core elements, extensions, vocabularies and value sets which SHALL be present in the ClaimResponse resource when using this profile
9RTPBC Response Using ClaimResponsehl7.fhir.us.carin-rtpbc#1.0.0R4This profile constrains the ClaimResponse resource to serve as the RTPBC Response in the consumer real-time pharmacy benefit check process. It uses the ClaimResponse's "predetermination" processing mode
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ClaimResponse I
ClaimResponse.id C C C C D
ClaimResponse.meta C
ClaimResponse.meta.profile C
ClaimResponse.implicitRules
ClaimResponse.language
ClaimResponse.text
ClaimResponse.contained
ClaimResponse.extension
ClaimResponse.modifierExtension
ClaimResponse.identifier S C (2) C
ClaimResponse.identifier.value C C D
ClaimResponse.identifier.system C F
ClaimResponse.traceNumber
ClaimResponse.status F F C F D B M C F D
ClaimResponse.type C D B M D
ClaimResponse.type.coding C C C C
ClaimResponse.type.coding.display C F
ClaimResponse.type.coding.code C C C C F
ClaimResponse.type.coding.system C C C C F
ClaimResponse.subType C C B M C B M
ClaimResponse.subType.coding C C
ClaimResponse.subType.coding.code C C
ClaimResponse.subType.coding.system C F C
ClaimResponse.use F F F C F D B M F D
ClaimResponse.patient C D D
ClaimResponse.created C D
ClaimResponse.insurer C D
ClaimResponse.insurer.identifier C
ClaimResponse.insurer.identifier.value C
ClaimResponse.requestor C C C D
ClaimResponse.requestor.reference C C C
ClaimResponse.request C D C D
ClaimResponse.request.identifier C
ClaimResponse.request.identifier.value C D
ClaimResponse.outcome D
ClaimResponse.decision
ClaimResponse.disposition D
ClaimResponse.preAuthRef C C
ClaimResponse.preAuthPeriod
ClaimResponse.preAuthPeriod.start C
ClaimResponse.event
ClaimResponse.event.extension
ClaimResponse.event.modifierExtension
ClaimResponse.event.type
ClaimResponse.event.when[x]
ClaimResponse.payeeType
ClaimResponse.encounter
ClaimResponse.diagnosisRelatedGroup
ClaimResponse.item C D D
ClaimResponse.item.extension S C S C S C (9) S C D
ClaimResponse.item.modifierExtension
ClaimResponse.item.itemSequence D
ClaimResponse.item.traceNumber
ClaimResponse.item.noteNumber D
ClaimResponse.item.reviewOutcome
ClaimResponse.item.reviewOutcome.extension
ClaimResponse.item.reviewOutcome.modifierExtension
ClaimResponse.item.reviewOutcome.decision
ClaimResponse.item.reviewOutcome.reason
ClaimResponse.item.reviewOutcome.preAuthRef
ClaimResponse.item.reviewOutcome.preAuthPeriod
ClaimResponse.item.adjudication C C D D
ClaimResponse.item.adjudication.extension S C (2)
ClaimResponse.item.adjudication.modifierExtension
ClaimResponse.item.adjudication.category F C F D D B M
ClaimResponse.item.adjudication.category.coding C
ClaimResponse.item.adjudication.category.coding.code C
ClaimResponse.item.adjudication.category.coding.system C F
ClaimResponse.item.adjudication.reason
ClaimResponse.item.adjudication.reason.coding C B M
ClaimResponse.item.adjudication.reason.coding.code C
ClaimResponse.item.adjudication.reason.coding.system C
ClaimResponse.item.adjudication.amount C D C D
ClaimResponse.item.adjudication.amount.currency C B M
ClaimResponse.item.adjudication.amount.value C D
ClaimResponse.item.adjudication.quantity
ClaimResponse.item.detail
ClaimResponse.item.detail.extension
ClaimResponse.item.detail.modifierExtension
ClaimResponse.item.detail.detailSequence C D
ClaimResponse.item.detail.traceNumber
ClaimResponse.item.detail.noteNumber
ClaimResponse.item.detail.reviewOutcome
ClaimResponse.item.detail.adjudication
ClaimResponse.item.detail.subDetail
ClaimResponse.item.detail.subDetail.extension
ClaimResponse.item.detail.subDetail.modifierExtension
ClaimResponse.item.detail.subDetail.subDetailSequence
ClaimResponse.item.detail.subDetail.traceNumber
ClaimResponse.item.detail.subDetail.noteNumber
ClaimResponse.item.detail.subDetail.reviewOutcome
ClaimResponse.item.detail.subDetail.adjudication
ClaimResponse.addItem C
ClaimResponse.addItem.extension S C (5) S C (4) S C D (2)
ClaimResponse.addItem.extension.value[x]
ClaimResponse.addItem.extension.value[x].currency C (2)
ClaimResponse.addItem.extension.value[x].value C (2)
ClaimResponse.addItem.modifierExtension
ClaimResponse.addItem.itemSequence C C C C D
ClaimResponse.addItem.detailSequence
ClaimResponse.addItem.subdetailSequence
ClaimResponse.addItem.traceNumber
ClaimResponse.addItem.provider C C C D
ClaimResponse.addItem.provider.reference C
ClaimResponse.addItem.revenue
ClaimResponse.addItem.productOrService B M D B M
ClaimResponse.addItem.productOrService.coding C C C C
ClaimResponse.addItem.productOrService.coding.display C D
ClaimResponse.addItem.productOrService.coding.code C C C C
ClaimResponse.addItem.productOrService.coding.system C C F C F C
ClaimResponse.addItem.productOrServiceEnd
ClaimResponse.addItem.request
ClaimResponse.addItem.modifier
ClaimResponse.addItem.programCode
ClaimResponse.addItem.serviced[x] S C (2) S C (2)
ClaimResponse.addItem.location[x]
ClaimResponse.addItem.quantity C C
ClaimResponse.addItem.quantity.unit C D B M
ClaimResponse.addItem.quantity.value C C D
ClaimResponse.addItem.unitPrice C
ClaimResponse.addItem.unitPrice.currency C
ClaimResponse.addItem.unitPrice.value C
ClaimResponse.addItem.factor
ClaimResponse.addItem.tax
ClaimResponse.addItem.net C
ClaimResponse.addItem.net.currency C
ClaimResponse.addItem.net.value C
ClaimResponse.addItem.bodySite
ClaimResponse.addItem.bodySite.extension
ClaimResponse.addItem.bodySite.modifierExtension
ClaimResponse.addItem.bodySite.site
ClaimResponse.addItem.bodySite.subSite
ClaimResponse.addItem.noteNumber D
ClaimResponse.addItem.reviewOutcome
ClaimResponse.addItem.adjudication C D
ClaimResponse.addItem.adjudication.amount C D
ClaimResponse.addItem.adjudication.amount.currency C B M
ClaimResponse.addItem.adjudication.amount.value C D
ClaimResponse.addItem.adjudication.category B M D B M
ClaimResponse.addItem.adjudication.category.coding C
ClaimResponse.addItem.adjudication.category.coding.code C
ClaimResponse.addItem.adjudication.category.coding.system C
ClaimResponse.addItem.adjudication.extension S C (3)
ClaimResponse.addItem.adjudication.extension.value[x] S
ClaimResponse.addItem.adjudication.extension.value[x].coding C
ClaimResponse.addItem.adjudication.extension.value[x].coding.code C
ClaimResponse.addItem.adjudication.extension.value[x].coding.system C
ClaimResponse.addItem.adjudication.reason B M B M
ClaimResponse.addItem.detail
ClaimResponse.addItem.detail.extension
ClaimResponse.addItem.detail.modifierExtension
ClaimResponse.addItem.detail.traceNumber
ClaimResponse.addItem.detail.revenue
ClaimResponse.addItem.detail.productOrService
ClaimResponse.addItem.detail.productOrServiceEnd
ClaimResponse.addItem.detail.modifier
ClaimResponse.addItem.detail.quantity
ClaimResponse.addItem.detail.unitPrice
ClaimResponse.addItem.detail.factor
ClaimResponse.addItem.detail.tax
ClaimResponse.addItem.detail.net
ClaimResponse.addItem.detail.noteNumber
ClaimResponse.addItem.detail.reviewOutcome
ClaimResponse.addItem.detail.adjudication
ClaimResponse.addItem.detail.subDetail
ClaimResponse.addItem.detail.subDetail.extension
ClaimResponse.addItem.detail.subDetail.modifierExtension
ClaimResponse.addItem.detail.subDetail.traceNumber
ClaimResponse.addItem.detail.subDetail.revenue
ClaimResponse.addItem.detail.subDetail.productOrService
ClaimResponse.addItem.detail.subDetail.productOrServiceEnd
ClaimResponse.addItem.detail.subDetail.modifier
ClaimResponse.addItem.detail.subDetail.quantity
ClaimResponse.addItem.detail.subDetail.unitPrice
ClaimResponse.addItem.detail.subDetail.factor
ClaimResponse.addItem.detail.subDetail.tax
ClaimResponse.addItem.detail.subDetail.net
ClaimResponse.addItem.detail.subDetail.noteNumber
ClaimResponse.addItem.detail.subDetail.reviewOutcome
ClaimResponse.addItem.detail.subDetail.adjudication
ClaimResponse.adjudication
ClaimResponse.total
ClaimResponse.total.extension
ClaimResponse.total.modifierExtension
ClaimResponse.total.category
ClaimResponse.total.amount
ClaimResponse.payment
ClaimResponse.payment.extension
ClaimResponse.payment.modifierExtension
ClaimResponse.payment.type
ClaimResponse.payment.adjustment
ClaimResponse.payment.adjustmentReason
ClaimResponse.payment.date
ClaimResponse.payment.amount
ClaimResponse.payment.identifier
ClaimResponse.fundsReserve
ClaimResponse.formCode
ClaimResponse.form
ClaimResponse.processNote D
ClaimResponse.processNote.extension
ClaimResponse.processNote.modifierExtension
ClaimResponse.processNote.number C D
ClaimResponse.processNote.type
ClaimResponse.processNote.text C
ClaimResponse.processNote.language
ClaimResponse.communicationRequest
ClaimResponse.insurance C
ClaimResponse.insurance.extension
ClaimResponse.insurance.modifierExtension
ClaimResponse.insurance.sequence
ClaimResponse.insurance.focal
ClaimResponse.insurance.coverage
ClaimResponse.insurance.businessArrangement
ClaimResponse.insurance.claimResponse
ClaimResponse.error D
ClaimResponse.error.extension S C (4)
ClaimResponse.error.modifierExtension
ClaimResponse.error.itemSequence
ClaimResponse.error.detailSequence
ClaimResponse.error.subDetailSequence
ClaimResponse.error.code B M D B M
ClaimResponse.error.code.text D
ClaimResponse.error.code.coding C
ClaimResponse.error.code.coding.display C
ClaimResponse.error.code.coding.code C
ClaimResponse.error.code.coding.system C
ClaimResponse.error.expression
S: There is slicing defined in the element(s)
C: There is cardinality erstrictions defined in the element(s)
I: There is invariants defined in the element(s)
F: There is a fixed or pattern value defined in the element(s)
D: There is document provided in the element(s)
B: There is terminology bindings defined in the element(s)
M: At least one of the element(s) has must-support = true
(N): The number of elements if > 1

Produced 08 Sep 2023