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ClaimResponse

PropertyValue
Publisher
NameClaimResponse
URLhttp://hl7.org/fhir/StructureDefinition/ClaimResponse
Statusdraft
Description
Abstractfalse

Structure

PathCardinalityTypeDescription
ClaimResponse0..*ClaimResponseThis resource provides the adjudication details from the processing of a Claim resource.
ClaimResponse.id0..1http://hl7.org/fhirpath/System.StringThe logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes.
ClaimResponse.meta0..1MetaThe metadata about the resource. This is content that is maintained by the infrastructure. Changes to the content might not always be associated with version changes to the resource.
ClaimResponse.implicitRules0..1uriA reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content. Often, this is a reference to an implementation guide that defines the special rules along with other profiles etc.
ClaimResponse.language0..1codeThe base language in which the resource is written.
ClaimResponse.text0..1NarrativeA human-readable narrative that contains a summary of the resource and can be used to represent the content of the resource to a human. The narrative need not encode all the structured data, but is required to contain sufficient detail to make it "clinically safe" for a human to just read the narrative. Resource definitions may define what content should be represented in the narrative to ensure clinical safety.
ClaimResponse.contained0..*ResourceThese resources do not have an independent existence apart from the resource that contains them - they cannot be identified independently, and nor can they have their own independent transaction scope.
ClaimResponse.extension0..*ExtensionMay be used to represent additional information that is not part of the basic definition of the resource. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
ClaimResponse.modifierExtension0..*ExtensionMay be used to represent additional information that is not part of the basic definition of the resource and that modifies the understanding of the element that contains it and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).
ClaimResponse.identifier0..*IdentifierA unique identifier assigned to this claim response.
ClaimResponse.status1..1codeThe status of the resource instance.
ClaimResponse.type1..1CodeableConceptA finer grained suite of claim type codes which may convey additional information such as Inpatient vs Outpatient and/or a specialty service.
ClaimResponse.subType0..1CodeableConceptA finer grained suite of claim type codes which may convey additional information such as Inpatient vs Outpatient and/or a specialty service.
ClaimResponse.use1..1codeA code to indicate whether the nature of the request is: to request adjudication of products and services previously rendered; or requesting authorization and adjudication for provision in the future; or requesting the non-binding adjudication of the listed products and services which could be provided in the future.
ClaimResponse.patient1..1ReferenceThe party to whom the professional services and/or products have been supplied or are being considered and for whom actual for facast reimbursement is sought.
ClaimResponse.created1..1dateTimeThe date this resource was created.
ClaimResponse.insurer1..1ReferenceThe party responsible for authorization, adjudication and reimbursement.
ClaimResponse.requestor0..1ReferenceThe provider which is responsible for the claim, predetermination or preauthorization.
ClaimResponse.request0..1ReferenceOriginal request resource reference.
ClaimResponse.outcome1..1codeThe outcome of the claim, predetermination, or preauthorization processing.
ClaimResponse.disposition0..1stringA human readable description of the status of the adjudication.
ClaimResponse.preAuthRef0..1stringReference from the Insurer which is used in later communications which refers to this adjudication.
ClaimResponse.preAuthPeriod0..1PeriodThe time frame during which this authorization is effective.
ClaimResponse.payeeType0..1CodeableConceptType of Party to be reimbursed: subscriber, provider, other.
ClaimResponse.item0..*BackboneElementA claim line. Either a simple (a product or service) or a 'group' of details which can also be a simple items or groups of sub-details.
ClaimResponse.item.id0..1http://hl7.org/fhirpath/System.StringUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
ClaimResponse.item.extension0..*ExtensionMay be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
ClaimResponse.item.modifierExtension0..*ExtensionMay be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).
ClaimResponse.item.itemSequence1..1positiveIntA number to uniquely reference the claim item entries.
ClaimResponse.item.noteNumber0..*positiveIntThe numbers associated with notes below which apply to the adjudication of this item.
ClaimResponse.item.adjudication1..*BackboneElementIf this item is a group then the values here are a summary of the adjudication of the detail items. If this item is a simple product or service then this is the result of the adjudication of this item.
ClaimResponse.item.adjudication.id0..1http://hl7.org/fhirpath/System.StringUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
ClaimResponse.item.adjudication.extension0..*ExtensionMay be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
ClaimResponse.item.adjudication.modifierExtension0..*ExtensionMay be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).
ClaimResponse.item.adjudication.category1..1CodeableConceptA code to indicate the information type of this adjudication record. Information types may include the value submitted, maximum values or percentages allowed or payable under the plan, amounts that: the patient is responsible for in aggregate or pertaining to this item; amounts paid by other coverages; and, the benefit payable for this item.
ClaimResponse.item.adjudication.reason0..1CodeableConceptA code supporting the understanding of the adjudication result and explaining variance from expected amount.
ClaimResponse.item.adjudication.amount0..1MoneyMonetary amount associated with the category.
ClaimResponse.item.adjudication.value0..1decimalA non-monetary value associated with the category. Mutually exclusive to the amount element above.
ClaimResponse.item.detail0..*BackboneElementA claim detail. Either a simple (a product or service) or a 'group' of sub-details which are simple items.
ClaimResponse.item.detail.id0..1http://hl7.org/fhirpath/System.StringUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
ClaimResponse.item.detail.extension0..*ExtensionMay be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
ClaimResponse.item.detail.modifierExtension0..*ExtensionMay be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).
ClaimResponse.item.detail.detailSequence1..1positiveIntA number to uniquely reference the claim detail entry.
ClaimResponse.item.detail.noteNumber0..*positiveIntThe numbers associated with notes below which apply to the adjudication of this item.
ClaimResponse.item.detail.adjudication1..*ClaimResponseThe adjudication results.
ClaimResponse.item.detail.subDetail0..*BackboneElementA sub-detail adjudication of a simple product or service.
ClaimResponse.item.detail.subDetail.id0..1http://hl7.org/fhirpath/System.StringUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
ClaimResponse.item.detail.subDetail.extension0..*ExtensionMay be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
ClaimResponse.item.detail.subDetail.modifierExtension0..*ExtensionMay be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).
ClaimResponse.item.detail.subDetail.subDetailSequence1..1positiveIntA number to uniquely reference the claim sub-detail entry.
ClaimResponse.item.detail.subDetail.noteNumber0..*positiveIntThe numbers associated with notes below which apply to the adjudication of this item.
ClaimResponse.item.detail.subDetail.adjudication0..*ClaimResponseThe adjudication results.
ClaimResponse.addItem0..*BackboneElementThe first-tier service adjudications for payor added product or service lines.
ClaimResponse.addItem.id0..1http://hl7.org/fhirpath/System.StringUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
ClaimResponse.addItem.extension0..*ExtensionMay be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
ClaimResponse.addItem.modifierExtension0..*ExtensionMay be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).
ClaimResponse.addItem.itemSequence0..*positiveIntClaim items which this service line is intended to replace.
ClaimResponse.addItem.detailSequence0..*positiveIntThe sequence number of the details within the claim item which this line is intended to replace.
ClaimResponse.addItem.subdetailSequence0..*positiveIntThe sequence number of the sub-details within the details within the claim item which this line is intended to replace.
ClaimResponse.addItem.provider0..*ReferenceThe providers who are authorized for the services rendered to the patient.
ClaimResponse.addItem.productOrService1..1CodeableConceptWhen the value is a group code then this item collects a set of related claim details, otherwise this contains the product, service, drug or other billing code for the item.
ClaimResponse.addItem.modifier0..*CodeableConceptItem typification or modifiers codes to convey additional context for the product or service.
ClaimResponse.addItem.programCode0..*CodeableConceptIdentifies the program under which this may be recovered.
ClaimResponse.addItem.serviced[x]0..1dateThe date or dates when the service or product was supplied, performed or completed.
ClaimResponse.addItem.location[x]0..1CodeableConceptWhere the product or service was provided.
ClaimResponse.addItem.quantity0..1QuantityThe number of repetitions of a service or product.
ClaimResponse.addItem.unitPrice0..1MoneyIf the item is not a group then this is the fee for the product or service, otherwise this is the total of the fees for the details of the group.
ClaimResponse.addItem.factor0..1decimalA real number that represents a multiplier used in determining the overall value of services delivered and/or goods received. The concept of a Factor allows for a discount or surcharge multiplier to be applied to a monetary amount.
ClaimResponse.addItem.net0..1MoneyThe quantity times the unit price for an additional service or product or charge.
ClaimResponse.addItem.bodySite0..1CodeableConceptPhysical service site on the patient (limb, tooth, etc.).
ClaimResponse.addItem.subSite0..*CodeableConceptA region or surface of the bodySite, e.g. limb region or tooth surface(s).
ClaimResponse.addItem.noteNumber0..*positiveIntThe numbers associated with notes below which apply to the adjudication of this item.
ClaimResponse.addItem.adjudication1..*ClaimResponseThe adjudication results.
ClaimResponse.addItem.detail0..*BackboneElementThe second-tier service adjudications for payor added services.
ClaimResponse.addItem.detail.id0..1http://hl7.org/fhirpath/System.StringUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
ClaimResponse.addItem.detail.extension0..*ExtensionMay be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
ClaimResponse.addItem.detail.modifierExtension0..*ExtensionMay be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).
ClaimResponse.addItem.detail.productOrService1..1CodeableConceptWhen the value is a group code then this item collects a set of related claim details, otherwise this contains the product, service, drug or other billing code for the item.
ClaimResponse.addItem.detail.modifier0..*CodeableConceptItem typification or modifiers codes to convey additional context for the product or service.
ClaimResponse.addItem.detail.quantity0..1QuantityThe number of repetitions of a service or product.
ClaimResponse.addItem.detail.unitPrice0..1MoneyIf the item is not a group then this is the fee for the product or service, otherwise this is the total of the fees for the details of the group.
ClaimResponse.addItem.detail.factor0..1decimalA real number that represents a multiplier used in determining the overall value of services delivered and/or goods received. The concept of a Factor allows for a discount or surcharge multiplier to be applied to a monetary amount.
ClaimResponse.addItem.detail.net0..1MoneyThe quantity times the unit price for an additional service or product or charge.
ClaimResponse.addItem.detail.noteNumber0..*positiveIntThe numbers associated with notes below which apply to the adjudication of this item.
ClaimResponse.addItem.detail.adjudication1..*ClaimResponseThe adjudication results.
ClaimResponse.addItem.detail.subDetail0..*BackboneElementThe third-tier service adjudications for payor added services.
ClaimResponse.addItem.detail.subDetail.id0..1http://hl7.org/fhirpath/System.StringUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
ClaimResponse.addItem.detail.subDetail.extension0..*ExtensionMay be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
ClaimResponse.addItem.detail.subDetail.modifierExtension0..*ExtensionMay be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).
ClaimResponse.addItem.detail.subDetail.productOrService1..1CodeableConceptWhen the value is a group code then this item collects a set of related claim details, otherwise this contains the product, service, drug or other billing code for the item.
ClaimResponse.addItem.detail.subDetail.modifier0..*CodeableConceptItem typification or modifiers codes to convey additional context for the product or service.
ClaimResponse.addItem.detail.subDetail.quantity0..1QuantityThe number of repetitions of a service or product.
ClaimResponse.addItem.detail.subDetail.unitPrice0..1MoneyIf the item is not a group then this is the fee for the product or service, otherwise this is the total of the fees for the details of the group.
ClaimResponse.addItem.detail.subDetail.factor0..1decimalA real number that represents a multiplier used in determining the overall value of services delivered and/or goods received. The concept of a Factor allows for a discount or surcharge multiplier to be applied to a monetary amount.
ClaimResponse.addItem.detail.subDetail.net0..1MoneyThe quantity times the unit price for an additional service or product or charge.
ClaimResponse.addItem.detail.subDetail.noteNumber0..*positiveIntThe numbers associated with notes below which apply to the adjudication of this item.
ClaimResponse.addItem.detail.subDetail.adjudication1..*ClaimResponseThe adjudication results.
ClaimResponse.adjudication0..*ClaimResponseThe adjudication results which are presented at the header level rather than at the line-item or add-item levels.
ClaimResponse.total0..*BackboneElementCategorized monetary totals for the adjudication.
ClaimResponse.total.id0..1http://hl7.org/fhirpath/System.StringUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
ClaimResponse.total.extension0..*ExtensionMay be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
ClaimResponse.total.modifierExtension0..*ExtensionMay be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).
ClaimResponse.total.category1..1CodeableConceptA code to indicate the information type of this adjudication record. Information types may include: the value submitted, maximum values or percentages allowed or payable under the plan, amounts that the patient is responsible for in aggregate or pertaining to this item, amounts paid by other coverages, and the benefit payable for this item.
ClaimResponse.total.amount1..1MoneyMonetary total amount associated with the category.
ClaimResponse.payment0..1BackboneElementPayment details for the adjudication of the claim.
ClaimResponse.payment.id0..1http://hl7.org/fhirpath/System.StringUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
ClaimResponse.payment.extension0..*ExtensionMay be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
ClaimResponse.payment.modifierExtension0..*ExtensionMay be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).
ClaimResponse.payment.type1..1CodeableConceptWhether this represents partial or complete payment of the benefits payable.
ClaimResponse.payment.adjustment0..1MoneyTotal amount of all adjustments to this payment included in this transaction which are not related to this claim's adjudication.
ClaimResponse.payment.adjustmentReason0..1CodeableConceptReason for the payment adjustment.
ClaimResponse.payment.date0..1dateEstimated date the payment will be issued or the actual issue date of payment.
ClaimResponse.payment.amount1..1MoneyBenefits payable less any payment adjustment.
ClaimResponse.payment.identifier0..1IdentifierIssuer's unique identifier for the payment instrument.
ClaimResponse.fundsReserve0..1CodeableConceptA code, used only on a response to a preauthorization, to indicate whether the benefits payable have been reserved and for whom.
ClaimResponse.formCode0..1CodeableConceptA code for the form to be used for printing the content.
ClaimResponse.form0..1AttachmentThe actual form, by reference or inclusion, for printing the content or an EOB.
ClaimResponse.processNote0..*BackboneElementA note that describes or explains adjudication results in a human readable form.
ClaimResponse.processNote.id0..1http://hl7.org/fhirpath/System.StringUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
ClaimResponse.processNote.extension0..*ExtensionMay be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
ClaimResponse.processNote.modifierExtension0..*ExtensionMay be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).
ClaimResponse.processNote.number0..1positiveIntA number to uniquely identify a note entry.
ClaimResponse.processNote.type0..1codeThe business purpose of the note text.
ClaimResponse.processNote.text1..1stringThe explanation or description associated with the processing.
ClaimResponse.processNote.language0..1CodeableConceptA code to define the language used in the text of the note.
ClaimResponse.communicationRequest0..*ReferenceRequest for additional supporting or authorizing information.
ClaimResponse.insurance0..*BackboneElementFinancial instruments for reimbursement for the health care products and services specified on the claim.
ClaimResponse.insurance.id0..1http://hl7.org/fhirpath/System.StringUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
ClaimResponse.insurance.extension0..*ExtensionMay be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
ClaimResponse.insurance.modifierExtension0..*ExtensionMay be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).
ClaimResponse.insurance.sequence1..1positiveIntA number to uniquely identify insurance entries and provide a sequence of coverages to convey coordination of benefit order.
ClaimResponse.insurance.focal1..1booleanA flag to indicate that this Coverage is to be used for adjudication of this claim when set to true.
ClaimResponse.insurance.coverage1..1ReferenceReference to the insurance card level information contained in the Coverage resource. The coverage issuing insurer will use these details to locate the patient's actual coverage within the insurer's information system.
ClaimResponse.insurance.businessArrangement0..1stringA business agreement number established between the provider and the insurer for special business processing purposes.
ClaimResponse.insurance.claimResponse0..1ReferenceThe result of the adjudication of the line items for the Coverage specified in this insurance.
ClaimResponse.error0..*BackboneElementErrors encountered during the processing of the adjudication.
ClaimResponse.error.id0..1http://hl7.org/fhirpath/System.StringUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
ClaimResponse.error.extension0..*ExtensionMay be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
ClaimResponse.error.modifierExtension0..*ExtensionMay be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).
ClaimResponse.error.itemSequence0..1positiveIntThe sequence number of the line item submitted which contains the error. This value is omitted when the error occurs outside of the item structure.
ClaimResponse.error.detailSequence0..1positiveIntThe sequence number of the detail within the line item submitted which contains the error. This value is omitted when the error occurs outside of the item structure.
ClaimResponse.error.subDetailSequence0..1positiveIntThe sequence number of the sub-detail within the detail within the line item submitted which contains the error. This value is omitted when the error occurs outside of the item structure.
ClaimResponse.error.code1..1CodeableConceptAn error code, from a specified code system, which details why the claim could not be adjudicated.

Search Parameters

NameTypeDescriptionExpression
_textstringSearch on the narrative of the resource
_contentstringSearch on the entire content of the resource
_idtokenLogical id of this artifactResource.id
_lastUpdateddateWhen the resource version last changedResource.meta.lastUpdated
_profileuriProfiles this resource claims to conform toResource.meta.profile
_querytokenA custom search profile that describes a specific defined query operation
_securitytokenSecurity Labels applied to this resourceResource.meta.security
_sourceuriIdentifies where the resource comes fromResource.meta.source
_tagtokenTags applied to this resourceResource.meta.tag
createddateThe creation dateClaimResponse.created
dispositionstringThe contents of the disposition messageClaimResponse.disposition
identifiertokenThe identity of the ClaimResponseClaimResponse.identifier
insurerreferenceThe organization which generated this resourceClaimResponse.insurer
outcometokenThe processing outcomeClaimResponse.outcome
patientreferenceThe subject of careClaimResponse.patient
payment-datedateThe expected payment dateClaimResponse.payment.date
requestreferenceThe claim referenceClaimResponse.request
requestorreferenceThe Provider of the claimClaimResponse.requestor
statustokenThe status of the ClaimResponseClaimResponse.status
usetokenThe type of claimClaimResponse.use
_iguhealth-version-seqnumberThe version sequence of the resourceResource.meta.extension.where(url='https://iguhealth.app/version-sequence').value
_iguhealth-authorreferenceThe author of the resourceResource.meta.extension.where(url='https://iguhealth.app/author').value