| Name | Flags | Card. | Type |
Description & Constraints
|
|---|---|---|---|---|
ClaimResponse
|
ClaimResponse | Prior authorization | ||
status
|
Fixed Value: active | |||
|
type
|
S | |||
|
use
|
S | |||
patient
|
S | Reference (US Core Patient Profile) | ||
|
created
|
S | |||
|
insurer
|
S | Reference (US Core Organization Profile) | ||
|
outcome
|
S | |||
|
preAuthRef
|
S | 1.. | PA Number/Identifier | |
|
preAuthPeriod
|
S | Certification Effective Date and Certification End Date | ||
addItem
|
S | |||
Slices for extension
|
Slice: Unordered, Open by value:url | |||
itemTraceNumber
|
S | 0..* | Identifier |
Item Trace Number
URL: http://hl7.org/fhir/us/davinci-hrex/StructureDefinition/extension-itemTraceNumber |
|
preAuthIssueDate
|
S | 0..1 | date |
Pre Authorized Issue Date
URL: http://hl7.org/fhir/us/davinci-hrex/StructureDefinition/extension-itemPreAuthIssueDate |
|
authorizedDate
|
S | 0..1 | dateTime, Period |
Authorized Date
URL: http://hl7.org/fhir/us/davinci-hrex/StructureDefinition/extension-itemAuthorizedDate |
|
authorizedProvider
|
S | 0..1 | Reference (US Core Practitioner Profile | US Core Organization Profile) |
Authorized Provider
URL: http://hl7.org/fhir/us/davinci-hrex/StructureDefinition/extension-itemAuthorizedProvider |
|
productOrService
|
S | |||
|
modifier
|
S | |||
|
serviced[x]
|
S | |||
location[x]
|
S | CodeableConcept | ||
|
quantity
|
S | |||
|
unitPrice
|
S | |||
|
Documentation for this format
|
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