| Name | Flags | Card. | Type |
Description & Constraints
|
|---|---|---|---|---|
ClaimResponse
|
ClaimResponse | This is an abstract profile. Child profiles: ClaimResponse , ClaimResponse | ||
identifier
|
S | Identifier | ||
status
|
S | Required Pattern: active | ||
|
use
|
Required Pattern: preauthorization | |||
patient
|
S | Reference (PAS Beneficiary Patient) | ||
|
created
|
S | |||
|
insurer
|
S | Reference (PAS Insurer Organization) | ||
|
requestor
|
S | Reference (PAS Requestor Organization | PAS PractitionerRole) | ||
|
request
|
S | Reference (PAS Claim) | ||
|
outcome
|
S | |||
|
preAuthPeriod
|
S | |||
|
item
|
S | |||
Slices for extension
|
Slice: Unordered, Open by value:url | |||
itemTraceNumber
|
S | 0..* | Identifier |
Uniquely identifies this claim item. (2000F-TRN) URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-itemTraceNumber |
|
preAuthIssueDate
|
S | 0..1 | date |
The date when this item's preauthorization was issued. URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-itemPreAuthIssueDate |
|
preAuthPeriod
|
S | 0..1 | Period |
The date/period when this item's preauthorization is valid. URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-itemPreAuthPeriod |
|
previousAuthorizationNumber
|
S | 0..1 | string |
A string assigned by the UMO to an authorized review outcome associated with this service item. URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-authorizationNumber |
|
administrationReferenceNumber
|
S | 0..1 | string |
A string assigned by the UMO to the original disallowed review outcome associated with this service item. URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-administrationReferenceNumber |
|
requestedServiceDate
|
S | 0..1 | dateTime, Period |
The original date/period that was requested by the submitter for this item. URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-itemRequestedServiceDate |
|
authorizedItemDetail
|
S | 0..1 | (Complex) |
The details of what has been authorized for this item if different from what was requested. URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-itemAuthorizedDetail |
|
authorizedProvider
|
S | 0..* | (Complex) |
The specific provider who has been authorized to provide this item. URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-itemAuthorizedProvider |
adjudication
|
S | |||
Slices for extension
|
Slice: Unordered, Open by value:url | |||
|
reviewAction
|
S | 0..1 | (Complex) |
The details of the review action that is necessary for the authorization. URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-reviewAction |
|
category
|
This code is fixed to 'submitted' to indicate that the adjudication result is on what was submitted. Required Pattern: At least the following |
|||
coding
|
1..* | Coding |
Code defined by a terminology system Fixed Value: (complex) |
|
|
system
|
1..1 | uri |
Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/adjudication |
|
|
code
|
1..1 | code |
Symbol in syntax defined by the system Fixed Value: submitted |
|
|
error
|
S | |||
|
Slices for extension
|
Slice: Unordered, Open by value:url | |||
|
followupAction
|
S | 0..1 | CodeableConcept |
A code representing what action must occur to resolve this error. URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-errorFollowupAction Binding: X12 278 Follow Up Action Value Set ( required ) |
|
errorElement
|
S | 0..1 | string |
The specific X12 loop, segment, or element that this error information is about. URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-errorElement |
|
errorPath
|
S | 0..1 | string |
The FHIRPath expression that indicates which FHIR element that this error information is about. URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-errorPath |
|
code
|
S | Binding: X12 278 Reject Reason Value Set ( required ) | ||
|
Documentation for this format
|
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