| Name | Flags | Card. | Type |
Description & Constraints
|
|---|---|---|---|---|
ClaimResponse
|
ClaimResponse | |||
status
|
?! S Σ | 1..1 | code |
active | cancelled | draft | entered-in-error Binding: todo ( required ): A code specifying the state of the resource instance. Fixed Value: active |
type
|
S Σ | 1..1 | CodeableConcept |
More granular claim type Binding: Claim Type Codes ( extensible ): The type or discipline-style of the claim. |
|
use
|
S Σ | 1..1 | code |
claim | preauthorization | predetermination Binding: todo ( required ): Claim, preauthorization, predetermination. Fixed Value: preauthorization |
patient
|
S Σ | 1..1 | Reference (QICore Patient) | The recipient of the products and services |
|
created
|
S Σ | 1..1 | dateTime | Response creation date |
|
insurer
|
S Σ | 1..1 | Reference (QICore Organization) | Party responsible for reimbursement |
|
requestor
|
S | 0..1 | Reference (QICore Practitioner | QICore Organization | QICore PractitionerRole) | Party responsible for the claim |
|
request
|
S Σ | 0..1 | Reference (QICore Claim) | Id of resource triggering adjudication |
item
|
S | 0..* | BackboneElement |
Adjudication for claim line items |
adjudication
|
S | 1..* | BackboneElement |
Adjudication details |
category
|
S | 1..1 | CodeableConcept |
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 |
|
|
amount
|
S | 0..1 | Money | Monetary amount |
detail
|
||||
|
detailSequence
|
S | 1..1 | positiveInt | Claim detail instance identifier |
|
Documentation for this format
|
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