This page is part of the FHIR Specification (v3.0.2: STU 3). The current version which supercedes this version is 4.0.1. For a full list of available versions, see the Directory of published versions
Financial Management Work Group | Maturity Level: N/A | Ballot Status: Informative | Compartments: Patient, Practitioner |
Generated Questionnaire for ClaimResponse
{ "resourceType": "Questionnaire", "id": "qs1", "identifier": [ { "system": "urn:ietf:rfc:3986" } ], "status": "draft", "date": "2019-10-24T11:53:00+11:00", "publisher": "Health Level Seven International (Financial Management)", "item": [ { "linkId": "ClaimResponse", "text": "Remittance resource", "type": "group", "required": false, "repeats": true, "item": [ { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl", "valueCodeableConcept": { "coding": [ { "system": "http://hl7.org/fhir/questionnaire-item-control", "code": "flyover", "display": "Fly-over" } ] } } ], "text": "This resource provides the adjudication details from the processing of a Claim resource.", "type": "display" }, { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs", "valueInteger": 1 }, { "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType", "valueString": "string" } ], "linkId": "ClaimResponse.id", "type": "group", "required": false, "repeats": true, "item": [ { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl", "valueCodeableConcept": { "coding": [ { "system": "http://hl7.org/fhir/questionnaire-item-control", "code": "flyover", "display": "Fly-over" } ] } } ], "text": "The logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes. The only time that a resource does not have an id is when it is being submitted to the server using a create operation.", "type": "display" }, { "linkId": "ClaimResponse.id.value", "text": "Logical id of this artifact", "type": "string", "required": false, "repeats": false } ] }, { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs", "valueInteger": 1 } ], "linkId": "ClaimResponse.meta", "text": "Metadata about the resource", "type": "group", "required": false, "repeats": true, "item": [ { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl", "valueCodeableConcept": { "coding": [ { "system": "http://hl7.org/fhir/questionnaire-item-control", "code": "flyover", "display": "Fly-over" } ] } } ], "text": "The metadata about the resource. This is content that is maintained by the infrastructure. Changes to the content may not always be associated with version changes to the resource.", "type": "display" } ] }, { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs", "valueInteger": 1 }, { "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType", "valueString": "uri" } ], "linkId": "ClaimResponse.implicitRules", "type": "group", "required": false, "repeats": true, "item": [ { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl", "valueCodeableConcept": { "coding": [ { "system": "http://hl7.org/fhir/questionnaire-item-control", "code": "flyover", "display": "Fly-over" } ] } } ], "text": "A reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content. Asserting this rule set restricts the content to be only understood by a limited set of trading partners. This inherently limits the usefulness of the data in the long term. However, the existing health eco-system is highly fractured, and not yet ready to define, collect, and exchange data in a generally computable sense. Wherever possible, implementers and/or specification writers should avoid using this element. \n\nThis element is labelled as a modifier because the implicit rules may provide additional knowledge about the resource that modifies it's meaning or interpretation.", "type": "display" }, { "linkId": "ClaimResponse.implicitRules.value", "text": "A set of rules under which this content was created", "type": "string", "required": false, "repeats": false } ] }, { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs", "valueInteger": 1 }, { "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType", "valueString": "code" } ], "linkId": "ClaimResponse.language", "type": "group", "required": false, "repeats": true, "item": [ { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl", "valueCodeableConcept": { "coding": [ { "system": "http://hl7.org/fhir/questionnaire-item-control", "code": "flyover", "display": "Fly-over" } ] } } ], "text": "The base language in which the resource is written. Language is provided to support indexing and accessibility (typically, services such as text to speech use the language tag). The html language tag in the narrative applies to the narrative. The language tag on the resource may be used to specify the language of other presentations generated from the data in the resource Not all the content has to be in the base language. The Resource.language should not be assumed to apply to the narrative automatically. If a language is specified, it should it also be specified on the div element in the html (see rules in HTML5 for information about the relationship between xml:lang and the html lang attribute).", "type": "display" }, { "linkId": "ClaimResponse.language.value", "text": "language", "type": "choice", "required": false, "repeats": false } ] }, { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs", "valueInteger": 1 } ], "linkId": "ClaimResponse.text", "text": "Text summary of the resource, for human interpretation", "type": "group", "required": false, "repeats": true, "item": [ { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl", "valueCodeableConcept": { "coding": [ { "system": "http://hl7.org/fhir/questionnaire-item-control", "code": "flyover", "display": "Fly-over" } ] } } ], "text": "A human-readable narrative that contains a summary of the resource, and may 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. Contained resources do not have narrative. Resources that are not contained SHOULD have a narrative. In some cases, a resource may only have text with little or no additional discrete data (as long as all minOccurs=1 elements are satisfied). This may be necessary for data from legacy systems where information is captured as a \"text blob\" or where text is additionally entered raw or narrated and encoded in formation is added later.", "type": "display" } ] }, { "linkId": "ClaimResponse.contained", "text": "Contained, inline Resources", "type": "group", "required": false, "repeats": true, "item": [ { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl", "valueCodeableConcept": { "coding": [ { "system": "http://hl7.org/fhir/questionnaire-item-control", "code": "flyover", "display": "Fly-over" } ] } } ], "text": "These 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. This should never be done when the content can be identified properly, as once identification is lost, it is extremely difficult (and context dependent) to restore it again.", "type": "display" } ] }, { "linkId": "ClaimResponse.extension", "text": "Additional Content defined by implementations", "type": "group", "required": false, "repeats": true, "item": [ { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl", "valueCodeableConcept": { "coding": [ { "system": "http://hl7.org/fhir/questionnaire-item-control", "code": "flyover", "display": "Fly-over" } ] } } ], "text": "May be used to represent additional information that is not part of the basic definition of the resource. In order 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. There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.", "type": "display" } ] }, { "linkId": "ClaimResponse.modifierExtension", "text": "Extensions that cannot be ignored", "type": "group", "required": false, "repeats": true, "item": [ { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl", "valueCodeableConcept": { "coding": [ { "system": "http://hl7.org/fhir/questionnaire-item-control", "code": "flyover", "display": "Fly-over" } ] } } ], "text": "May 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. Usually modifier elements provide negation or qualification. In order 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. There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.", "type": "display" } ] }, { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType", "valueString": "Identifier" } ], "linkId": "ClaimResponse.identifier", "text": "Response number", "type": "group", "required": false, "repeats": true, "item": [ { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl", "valueCodeableConcept": { "coding": [ { "system": "http://hl7.org/fhir/questionnaire-item-control", "code": "flyover", "display": "Fly-over" } ] } } ], "text": "The Response business identifier.", "type": "display" }, { "linkId": "ClaimResponse.identifier.label", "text": "label:", "type": "string", "required": false, "repeats": false }, { "linkId": "ClaimResponse.identifier.system", "text": "system:", "type": "string", "required": false, "repeats": false }, { "linkId": "ClaimResponse.identifier.value", "text": "value:", "type": "string", "required": false, "repeats": false } ] }, { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs", "valueInteger": 1 }, { "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType", "valueString": "code" } ], "linkId": "ClaimResponse.status", "type": "group", "required": false, "repeats": true, "item": [ { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl", "valueCodeableConcept": { "coding": [ { "system": "http://hl7.org/fhir/questionnaire-item-control", "code": "flyover", "display": "Fly-over" } ] } } ], "text": "The status of the resource instance. This element is labeled as a modifier because the status contains the code cancelled and entered-in-error that mark the response as not currently valid.", "type": "display" }, { "linkId": "ClaimResponse.status.value", "text": "status", "type": "choice", "required": false, "repeats": false } ] }, { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs", "valueInteger": 1 }, { "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType", "valueString": "Reference" } ], "linkId": "ClaimResponse.patient", "type": "group", "required": false, "repeats": true, "item": [ { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl", "valueCodeableConcept": { "coding": [ { "system": "http://hl7.org/fhir/questionnaire-item-control", "code": "flyover", "display": "Fly-over" } ] } } ], "text": "Patient Resource.", "type": "display" }, { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-allowedResource", "valueCode": "Patient" }, { "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-referenceFilter", "valueString": "subject=$subj&patient=$subj&encounter=$encounter" } ], "linkId": "ClaimResponse.patient.value", "text": "The subject of the Products and Services", "type": "reference", "required": false, "repeats": false } ] }, { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs", "valueInteger": 1 }, { "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType", "valueString": "datetime" } ], "linkId": "ClaimResponse.created", "type": "group", "required": false, "repeats": true, "item": [ { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl", "valueCodeableConcept": { "coding": [ { "system": "http://hl7.org/fhir/questionnaire-item-control", "code": "flyover", "display": "Fly-over" } ] } } ], "text": "The date when the enclosed suite of services were performed or completed.", "type": "display" }, { "linkId": "ClaimResponse.created.value", "text": "Creation date", "type": "dateTime", "required": false, "repeats": false } ] }, { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs", "valueInteger": 1 }, { "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType", "valueString": "Reference" } ], "linkId": "ClaimResponse.insurer", "type": "group", "required": false, "repeats": true, "item": [ { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl", "valueCodeableConcept": { "coding": [ { "system": "http://hl7.org/fhir/questionnaire-item-control", "code": "flyover", "display": "Fly-over" } ] } } ], "text": "The Insurer who produced this adjudicated response.", "type": "display" }, { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-allowedResource", "valueCode": "Organization" }, { "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-referenceFilter", "valueString": "subject=$subj&patient=$subj&encounter=$encounter" } ], "linkId": "ClaimResponse.insurer.value", "text": "Insurance issuing organization", "type": "reference", "required": false, "repeats": false } ] }, { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs", "valueInteger": 1 }, { "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType", "valueString": "Reference" } ], "linkId": "ClaimResponse.requestProvider", "type": "group", "required": false, "repeats": true, "item": [ { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl", "valueCodeableConcept": { "coding": [ { "system": "http://hl7.org/fhir/questionnaire-item-control", "code": "flyover", "display": "Fly-over" } ] } } ], "text": "The practitioner who is responsible for the services rendered to the patient.", "type": "display" }, { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-allowedResource", "valueCode": "Practitioner" }, { "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-referenceFilter", "valueString": "subject=$subj&patient=$subj&encounter=$encounter" } ], "linkId": "ClaimResponse.requestProvider.value", "text": "Responsible practitioner", "type": "reference", "required": false, "repeats": false } ] }, { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs", "valueInteger": 1 }, { "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType", "valueString": "Reference" } ], "linkId": "ClaimResponse.requestOrganization", "type": "group", "required": false, "repeats": true, "item": [ { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl", "valueCodeableConcept": { "coding": [ { "system": "http://hl7.org/fhir/questionnaire-item-control", "code": "flyover", "display": "Fly-over" } ] } } ], "text": "The organization which is responsible for the services rendered to the patient.", "type": "display" }, { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-allowedResource", "valueCode": "Organization" }, { "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-referenceFilter", "valueString": "subject=$subj&patient=$subj&encounter=$encounter" } ], "linkId": "ClaimResponse.requestOrganization.value", "text": "Responsible organization", "type": "reference", "required": false, "repeats": false } ] }, { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs", "valueInteger": 1 }, { "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType", "valueString": "Reference" } ], "linkId": "ClaimResponse.request", "type": "group", "required": false, "repeats": true, "item": [ { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl", "valueCodeableConcept": { "coding": [ { "system": "http://hl7.org/fhir/questionnaire-item-control", "code": "flyover", "display": "Fly-over" } ] } } ], "text": "Original request resource referrence.", "type": "display" }, { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-allowedResource", "valueCode": "Claim" }, { "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-referenceFilter", "valueString": "subject=$subj&patient=$subj&encounter=$encounter" } ], "linkId": "ClaimResponse.request.value", "text": "Id of resource triggering adjudication", "type": "reference", "required": false, "repeats": false } ] }, { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs", "valueInteger": 1 }, { "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType", "valueString": "CodeableConcept" } ], "linkId": "ClaimResponse.outcome", "text": "complete | error | partial", "type": "group", "required": false, "repeats": true, "item": [ { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl", "valueCodeableConcept": { "coding": [ { "system": "http://hl7.org/fhir/questionnaire-item-control", "code": "flyover", "display": "Fly-over" } ] } } ], "text": "Processing outcome errror, partial or complete processing.", "type": "display" }, { "linkId": "ClaimResponse.outcome.coding", "text": "code:", "type": "open-choice", "required": false, "repeats": false }, { "linkId": "ClaimResponse.outcome.text", "text": "text:", "type": "string", "required": false, "repeats": false } ] }, { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs", "valueInteger": 1 }, { "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType", "valueString": "string" } ], "linkId": "ClaimResponse.disposition", "type": "group", "required": false, "repeats": true, "item": [ { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl", "valueCodeableConcept": { "coding": [ { "system": "http://hl7.org/fhir/questionnaire-item-control", "code": "flyover", "display": "Fly-over" } ] } } ], "text": "A description of the status of the adjudication.", "type": "display" }, { "linkId": "ClaimResponse.disposition.value", "text": "Disposition Message", "type": "string", "required": false, "repeats": false } ] }, { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs", "valueInteger": 1 }, { "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType", "valueString": "CodeableConcept" } ], "linkId": "ClaimResponse.payeeType", "text": "Party to be paid any benefits payable", "type": "group", "required": false, "repeats": true, "item": [ { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl", "valueCodeableConcept": { "coding": [ { "system": "http://hl7.org/fhir/questionnaire-item-control", "code": "flyover", "display": "Fly-over" } ] } } ], "text": "Party to be reimbursed: Subscriber, provider, other.", "type": "display" }, { "linkId": "ClaimResponse.payeeType.coding", "text": "code:", "type": "open-choice", "required": false, "repeats": false }, { "linkId": "ClaimResponse.payeeType.text", "text": "text:", "type": "string", "required": false, "repeats": false } ] }, { "linkId": "ClaimResponse.item", "text": "Line items", "type": "group", "required": false, "repeats": true, "item": [ { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl", "valueCodeableConcept": { "coding": [ { "system": "http://hl7.org/fhir/questionnaire-item-control", "code": "flyover", "display": "Fly-over" } ] } } ], "text": "The first tier service adjudications for submitted services.", "type": "display" }, { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs", "valueInteger": 1 }, { "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType", "valueString": "string" } ], "linkId": "ClaimResponse.item.id", "type": "group", "required": false, "repeats": true, "item": [ { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl", "valueCodeableConcept": { "coding": [ { "system": "http://hl7.org/fhir/questionnaire-item-control", "code": "flyover", "display": "Fly-over" } ] } } ], "text": "unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.", "type": "display" }, { "linkId": "ClaimResponse.item.id.value", "text": "xml:id (or equivalent in JSON)", "type": "string", "required": false, "repeats": false } ] }, { "linkId": "ClaimResponse.item.extension", "text": "Additional Content defined by implementations", "type": "group", "required": false, "repeats": true, "item": [ { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl", "valueCodeableConcept": { "coding": [ { "system": "http://hl7.org/fhir/questionnaire-item-control", "code": "flyover", "display": "Fly-over" } ] } } ], "text": "May be used to represent additional information that is not part of the basic definition of the element. In order 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. There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.", "type": "display" } ] }, { "linkId": "ClaimResponse.item.modifierExtension", "text": "Extensions that cannot be ignored", "type": "group", "required": false, "repeats": true, "item": [ { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl", "valueCodeableConcept": { "coding": [ { "system": "http://hl7.org/fhir/questionnaire-item-control", "code": "flyover", "display": "Fly-over" } ] } } ], "text": "May 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 that contains it. Usually modifier elements provide negation or qualification. In order 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. There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.", "type": "display" } ] }, { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-minOccurs", "valueInteger": 1 }, { "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs", "valueInteger": 1 }, { "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType", "valueString": "integer" } ], "linkId": "ClaimResponse.item.sequenceLinkId", "type": "group", "required": true, "repeats": true, "item": [ { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl", "valueCodeableConcept": { "coding": [ { "system": "http://hl7.org/fhir/questionnaire-item-control", "code": "flyover", "display": "Fly-over" } ] } } ], "text": "A service line number.", "type": "display" }, { "linkId": "ClaimResponse.item.sequenceLinkId.value", "text": "Service instance", "type": "integer", "required": false, "repeats": false } ] }, { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType", "valueString": "integer" } ], "linkId": "ClaimResponse.item.noteNumber", "type": "group", "required": false, "repeats": true, "item": [ { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl", "valueCodeableConcept": { "coding": [ { "system": "http://hl7.org/fhir/questionnaire-item-control", "code": "flyover", "display": "Fly-over" } ] } } ], "text": "A list of note references to the notes provided below.", "type": "display" }, { "linkId": "ClaimResponse.item.noteNumber.value", "text": "List of note numbers which apply", "type": "integer", "required": false, "repeats": false } ] }, { "linkId": "ClaimResponse.item.adjudication", "text": "Adjudication details", "type": "group", "required": false, "repeats": true, "item": [ { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl", "valueCodeableConcept": { "coding": [ { "system": "http://hl7.org/fhir/questionnaire-item-control", "code": "flyover", "display": "Fly-over" } ] } } ], "text": "The adjudication results.", "type": "display" }, { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs", "valueInteger": 1 }, { "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType", "valueString": "string" } ], "linkId": "ClaimResponse.item.adjudication.id", "type": "group", "required": false, "repeats": true, "item": [ { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl", "valueCodeableConcept": { "coding": [ { "system": "http://hl7.org/fhir/questionnaire-item-control", "code": "flyover", "display": "Fly-over" } ] } } ], "text": "unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.", "type": "display" }, { "linkId": "ClaimResponse.item.adjudication.id.value", "text": "xml:id (or equivalent in JSON)", "type": "string", "required": false, "repeats": false } ] }, { "linkId": "ClaimResponse.item.adjudication.extension", "text": "Additional Content defined by implementations", "type": "group", "required": false, "repeats": true, "item": [ { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl", "valueCodeableConcept": { "coding": [ { "system": "http://hl7.org/fhir/questionnaire-item-control", "code": "flyover", "display": "Fly-over" } ] } } ], "text": "May be used to represent additional information that is not part of the basic definition of the element. In order 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. There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.", "type": "display" } ] }, { "linkId": "ClaimResponse.item.adjudication.modifierExtension", "text": "Extensions that cannot be ignored", "type": "group", "required": false, "repeats": true, "item": [ { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl", "valueCodeableConcept": { "coding": [ { "system": "http://hl7.org/fhir/questionnaire-item-control", "code": "flyover", "display": "Fly-over" } ] } } ], "text": "May 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 that contains it. Usually modifier elements provide negation or qualification. In order 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. There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.", "type": "display" } ] }, { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-minOccurs", "valueInteger": 1 }, { "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs", "valueInteger": 1 }, { "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType", "valueString": "CodeableConcept" } ], "linkId": "ClaimResponse.item.adjudication.category", "text": "Adjudication category such as co-pay, eligible, benefit, etc.", "type": "group", "required": true, "repeats": true, "item": [ { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl", "valueCodeableConcept": { "coding": [ { "system": "http://hl7.org/fhir/questionnaire-item-control", "code": "flyover", "display": "Fly-over" } ] } } ], "text": "Code indicating: Co-Pay, deductible, eligible, benefit, tax, etc.", "type": "display" }, { "linkId": "ClaimResponse.item.adjudication.category.coding", "text": "code:", "type": "open-choice", "required": false, "repeats": false }, { "linkId": "ClaimResponse.item.adjudication.category.text", "text": "text:", "type": "string", "required": false, "repeats": false } ] }, { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs", "valueInteger": 1 }, { "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType", "valueString": "CodeableConcept" } ], "linkId": "ClaimResponse.item.adjudication.reason", "text": "Explanation of Adjudication outcome", "type": "group", "required": false, "repeats": true, "item": [ { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl", "valueCodeableConcept": { "coding": [ { "system": "http://hl7.org/fhir/questionnaire-item-control", "code": "flyover", "display": "Fly-over" } ] } } ], "text": "Adjudication reason such as limit reached.", "type": "display" }, { "linkId": "ClaimResponse.item.adjudication.reason.coding", "text": "code:", "type": "open-choice", "required": false, "repeats": false }, { "linkId": "ClaimResponse.item.adjudication.reason.text", "text": "text:", "type": "string", "required": false, "repeats": false } ] }, { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs", "valueInteger": 1 }, { "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType", "valueString": "Quantity" } ], "linkId": "ClaimResponse.item.adjudication.amount", "text": "Monetary amount", "type": "group", "required": false, "repeats": true, "item": [ { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl", "valueCodeableConcept": { "coding": [ { "system": "http://hl7.org/fhir/questionnaire-item-control", "code": "flyover", "display": "Fly-over" } ] } } ], "text": "Monetary amount associated with the code.", "type": "display" }, { "linkId": "ClaimResponse.item.adjudication.amount.comparator", "text": "comp:", "type": "choice", "required": false, "repeats": false }, { "linkId": "ClaimResponse.item.adjudication.amount.value", "text": "value:", "type": "decimal", "required": false, "repeats": false }, { "linkId": "ClaimResponse.item.adjudication.amount.units", "text": "units:", "type": "string", "required": false, "repeats": false }, { "linkId": "ClaimResponse.item.adjudication.amount.code", "text": "coded units:", "type": "string", "required": false, "repeats": false }, { "linkId": "ClaimResponse.item.adjudication.amount.system", "text": "units system:", "type": "string", "required": false, "repeats": false } ] }, { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs", "valueInteger": 1 }, { "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType", "valueString": "decimal" } ], "linkId": "ClaimResponse.item.adjudication.value", "type": "group", "required": false, "repeats": true, "item": [ { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl", "valueCodeableConcept": { "coding": [ { "system": "http://hl7.org/fhir/questionnaire-item-control", "code": "flyover", "display": "Fly-over" } ] } } ], "text": "A non-monetary value for example a percentage. Mutually exclusive to the amount element above.", "type": "display" }, { "linkId": "ClaimResponse.item.adjudication.value.value", "text": "Non-monetary value", "type": "decimal", "required": false, "repeats": false } ] } ] }, { "linkId": "ClaimResponse.item.detail", "text": "Detail line items", "type": "group", "required": false, "repeats": true, "item": [ { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl", "valueCodeableConcept": { "coding": [ { "system": "http://hl7.org/fhir/questionnaire-item-control", "code": "flyover", "display": "Fly-over" } ] } } ], "text": "The second tier service adjudications for submitted services.", "type": "display" }, { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs", "valueInteger": 1 }, { "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType", "valueString": "string" } ], "linkId": "ClaimResponse.item.detail.id", "type": "group", "required": false, "repeats": true, "item": [ { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl", "valueCodeableConcept": { "coding": [ { "system": "http://hl7.org/fhir/questionnaire-item-control", "code": "flyover", "display": "Fly-over" } ] } } ], "text": "unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.", "type": "display" }, { "linkId": "ClaimResponse.item.detail.id.value", "text": "xml:id (or equivalent in JSON)", "type": "string", "required": false, "repeats": false } ] }, { "linkId": "ClaimResponse.item.detail.extension", "text": "Additional Content defined by implementations", "type": "group", "required": false, "repeats": true, "item": [ { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl", "valueCodeableConcept": { "coding": [ { "system": "http://hl7.org/fhir/questionnaire-item-control", "code": "flyover", "display": "Fly-over" } ] } } ], "text": "May be used to represent additional information that is not part of the basic definition of the element. In order 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. There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.", "type": "display" } ] }, { "linkId": "ClaimResponse.item.detail.modifierExtension", "text": "Extensions that cannot be ignored", "type": "group", "required": false, "repeats": true, "item": [ { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl", "valueCodeableConcept": { "coding": [ { "system": "http://hl7.org/fhir/questionnaire-item-control", "code": "flyover", "display": "Fly-over" } ] } } ], "text": "May 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 that contains it. Usually modifier elements provide negation or qualification. In order 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. There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.", "type": "display" } ] }, { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-minOccurs", "valueInteger": 1 }, { "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs", "valueInteger": 1 }, { "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType", "valueString": "integer" } ], "linkId": "ClaimResponse.item.detail.sequenceLinkId", "type": "group", "required": true, "repeats": true, "item": [ { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl", "valueCodeableConcept": { "coding": [ { "system": "http://hl7.org/fhir/questionnaire-item-control", "code": "flyover", "display": "Fly-over" } ] } } ], "text": "A service line number.", "type": "display" }, { "linkId": "ClaimResponse.item.detail.sequenceLinkId.value", "text": "Service instance", "type": "integer", "required": false, "repeats": false } ] }, { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType", "valueString": "integer" } ], "linkId": "ClaimResponse.item.detail.noteNumber", "type": "group", "required": false, "repeats": true, "item": [ { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl", "valueCodeableConcept": { "coding": [ { "system": "http://hl7.org/fhir/questionnaire-item-control", "code": "flyover", "display": "Fly-over" } ] } } ], "text": "A list of note references to the notes provided below.", "type": "display" }, { "linkId": "ClaimResponse.item.detail.noteNumber.value", "text": "List of note numbers which apply", "type": "integer", "required": false, "repeats": false } ] }, { "linkId": "ClaimResponse.item.detail.adjudication", "text": "Detail level adjudication details", "type": "group", "required": false, "repeats": true, "item": [ { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl", "valueCodeableConcept": { "coding": [ { "system": "http://hl7.org/fhir/questionnaire-item-control", "code": "flyover", "display": "Fly-over" } ] } } ], "text": "The adjudications results.", "type": "display" } ] }, { "linkId": "ClaimResponse.item.detail.subDetail", "text": "Subdetail line items", "type": "group", "required": false, "repeats": true, "item": [ { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl", "valueCodeableConcept": { "coding": [ { "system": "http://hl7.org/fhir/questionnaire-item-control", "code": "flyover", "display": "Fly-over" } ] } } ], "text": "The third tier service adjudications for submitted services.", "type": "display" }, { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs", "valueInteger": 1 }, { "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType", "valueString": "string" } ], "linkId": "ClaimResponse.item.detail.subDetail.id", "type": "group", "required": false, "repeats": true, "item": [ { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl", "valueCodeableConcept": { "coding": [ { "system": "http://hl7.org/fhir/questionnaire-item-control", "code": "flyover", "display": "Fly-over" } ] } } ], "text": "unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.", "type": "display" }, { "linkId": "ClaimResponse.item.detail.subDetail.id.value", "text": "xml:id (or equivalent in JSON)", "type": "string", "required": false, "repeats": false } ] }, { "linkId": "ClaimResponse.item.detail.subDetail.extension", "text": "Additional Content defined by implementations", "type": "group", "required": false, "repeats": true, "item": [ { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl", "valueCodeableConcept": { "coding": [ { "system": "http://hl7.org/fhir/questionnaire-item-control", "code": "flyover", "display": "Fly-over" } ] } } ], "text": "May be used to represent additional information that is not part of the basic definition of the element. In order 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. There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.", "type": "display" } ] }, { "linkId": "ClaimResponse.item.detail.subDetail.modifierExtension", "text": "Extensions that cannot be ignored", "type": "group", "required": false, "repeats": true, "item": [ { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl", "valueCodeableConcept": { "coding": [ { "system": "http://hl7.org/fhir/questionnaire-item-control", "code": "flyover", "display": "Fly-over" } ] } } ], "text": "May 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 that contains it. Usually modifier elements provide negation or qualification. In order 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. There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.", "type": "display" } ] }, { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-minOccurs", "valueInteger": 1 }, { "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs", "valueInteger": 1 }, { "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType", "valueString": "integer" } ], "linkId": "ClaimResponse.item.detail.subDetail.sequenceLinkId", "type": "group", "required": true, "repeats": true, "item": [ { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl", "valueCodeableConcept": { "coding": [ { "system": "http://hl7.org/fhir/questionnaire-item-control", "code": "flyover", "display": "Fly-over" } ] } } ], "text": "A service line number.", "type": "display" }, { "linkId": "ClaimResponse.item.detail.subDetail.sequenceLinkId.value", "text": "Service instance", "type": "integer", "required": false, "repeats": false } ] }, { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType", "valueString": "integer" } ], "linkId": "ClaimResponse.item.detail.subDetail.noteNumber", "type": "group", "required": false, "repeats": true, "item": [ { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl", "valueCodeableConcept": { "coding": [ { "system": "http://hl7.org/fhir/questionnaire-item-control", "code": "flyover", "display": "Fly-over" } ] } } ], "text": "A list of note references to the notes provided below.", "type": "display" }, { "linkId": "ClaimResponse.item.detail.subDetail.noteNumber.value", "text": "List of note numbers which apply", "type": "integer", "required": false, "repeats": false } ] }, { "linkId": "ClaimResponse.item.detail.subDetail.adjudication", "text": "Subdetail level adjudication details", "type": "group", "required": false, "repeats": true, "item": [ { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl", "valueCodeableConcept": { "coding": [ { "system": "http://hl7.org/fhir/questionnaire-item-control", "code": "flyover", "display": "Fly-over" } ] } } ], "text": "The adjudications results.", "type": "display" } ] } ] } ] } ] }, { "linkId": "ClaimResponse.addItem", "text": "Insurer added line items", "type": "group", "required": false, "repeats": true, "item": [ { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl", "valueCodeableConcept": { "coding": [ { "system": "http://hl7.org/fhir/questionnaire-item-control", "code": "flyover", "display": "Fly-over" } ] } } ], "text": "The first tier service adjudications for payor added services.", "type": "display" }, { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs", "valueInteger": 1 }, { "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType", "valueString": "string" } ], "linkId": "ClaimResponse.addItem.id", "type": "group", "required": false, "repeats": true, "item": [ { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl", "valueCodeableConcept": { "coding": [ { "system": "http://hl7.org/fhir/questionnaire-item-control", "code": "flyover", "display": "Fly-over" } ] } } ], "text": "unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.", "type": "display" }, { "linkId": "ClaimResponse.addItem.id.value", "text": "xml:id (or equivalent in JSON)", "type": "string", "required": false, "repeats": false } ] }, { "linkId": "ClaimResponse.addItem.extension", "text": "Additional Content defined by implementations", "type": "group", "required": false, "repeats": true, "item": [ { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl", "valueCodeableConcept": { "coding": [ { "system": "http://hl7.org/fhir/questionnaire-item-control", "code": "flyover", "display": "Fly-over" } ] } } ], "text": "May be used to represent additional information that is not part of the basic definition of the element. In order 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. There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.", "type": "display" } ] }, { "linkId": "ClaimResponse.addItem.modifierExtension", "text": "Extensions that cannot be ignored", "type": "group", "required": false, "repeats": true, "item": [ { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl", "valueCodeableConcept": { "coding": [ { "system": "http://hl7.org/fhir/questionnaire-item-control", "code": "flyover", "display": "Fly-over" } ] } } ], "text": "May 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 that contains it. Usually modifier elements provide negation or qualification. In order 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. There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.", "type": "display" } ] }, { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType", "valueString": "integer" } ], "linkId": "ClaimResponse.addItem.sequenceLinkId", "type": "group", "required": false, "repeats": true, "item": [ { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl", "valueCodeableConcept": { "coding": [ { "system": "http://hl7.org/fhir/questionnaire-item-control", "code": "flyover", "display": "Fly-over" } ] } } ], "text": "List of input service items which this service line is intended to replace.", "type": "display" }, { "linkId": "ClaimResponse.addItem.sequenceLinkId.value", "text": "Service instances", "type": "integer", "required": false, "repeats": false } ] }, { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs", "valueInteger": 1 }, { "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType", "valueString": "CodeableConcept" } ], "linkId": "ClaimResponse.addItem.revenue", "text": "Revenue or cost center code", "type": "group", "required": false, "repeats": true, "item": [ { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl", "valueCodeableConcept": { "coding": [ { "system": "http://hl7.org/fhir/questionnaire-item-control", "code": "flyover", "display": "Fly-over" } ] } } ], "text": "The type of reveneu or cost center providing the product and/or service.", "type": "display" }, { "linkId": "ClaimResponse.addItem.revenue.coding", "text": "code:", "type": "open-choice", "required": false, "repeats": false }, { "linkId": "ClaimResponse.addItem.revenue.text", "text": "text:", "type": "string", "required": false, "repeats": false } ] }, { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs", "valueInteger": 1 }, { "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType", "valueString": "CodeableConcept" } ], "linkId": "ClaimResponse.addItem.category", "text": "Type of service or product", "type": "group", "required": false, "repeats": true, "item": [ { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl", "valueCodeableConcept": { "coding": [ { "system": "http://hl7.org/fhir/questionnaire-item-control", "code": "flyover", "display": "Fly-over" } ] } } ], "text": "Health Care Service Type Codes to identify the classification of service or benefits.", "type": "display" }, { "linkId": "ClaimResponse.addItem.category.coding", "text": "code:", "type": "open-choice", "required": false, "repeats": false }, { "linkId": "ClaimResponse.addItem.category.text", "text": "text:", "type": "string", "required": false, "repeats": false } ] }, { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs", "valueInteger": 1 }, { "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType", "valueString": "CodeableConcept" } ], "linkId": "ClaimResponse.addItem.service", "text": "Group, Service or Product", "type": "group", "required": false, "repeats": true, "item": [ { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl", "valueCodeableConcept": { "coding": [ { "system": "http://hl7.org/fhir/questionnaire-item-control", "code": "flyover", "display": "Fly-over" } ] } } ], "text": "A code to indicate the Professional Service or Product supplied.", "type": "display" }, { "linkId": "ClaimResponse.addItem.service.coding", "text": "code:", "type": "open-choice", "required": false, "repeats": false }, { "linkId": "ClaimResponse.addItem.service.text", "text": "text:", "type": "string", "required": false, "repeats": false } ] }, { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType", "valueString": "CodeableConcept" } ], "linkId": "ClaimResponse.addItem.modifier", "text": "Service/Product billing modifiers", "type": "group", "required": false, "repeats": true, "item": [ { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl", "valueCodeableConcept": { "coding": [ { "system": "http://hl7.org/fhir/questionnaire-item-control", "code": "flyover", "display": "Fly-over" } ] } } ], "text": "Item typification or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or for medical whether the treatment was outside the clinic or out of office hours.", "type": "display" }, { "linkId": "ClaimResponse.addItem.modifier.coding", "text": "code:", "type": "open-choice", "required": false, "repeats": false }, { "linkId": "ClaimResponse.addItem.modifier.text", "text": "text:", "type": "string", "required": false, "repeats": false } ] }, { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs", "valueInteger": 1 }, { "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType", "valueString": "Quantity" } ], "linkId": "ClaimResponse.addItem.fee", "text": "Professional fee or Product charge", "type": "group", "required": false, "repeats": true, "item": [ { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl", "valueCodeableConcept": { "coding": [ { "system": "http://hl7.org/fhir/questionnaire-item-control", "code": "flyover", "display": "Fly-over" } ] } } ], "text": "The fee charged for the professional service or product..", "type": "display" }, { "linkId": "ClaimResponse.addItem.fee.comparator", "text": "comp:", "type": "choice", "required": false, "repeats": false }, { "linkId": "ClaimResponse.addItem.fee.value", "text": "value:", "type": "decimal", "required": false, "repeats": false }, { "linkId": "ClaimResponse.addItem.fee.units", "text": "units:", "type": "string", "required": false, "repeats": false }, { "linkId": "ClaimResponse.addItem.fee.code", "text": "coded units:", "type": "string", "required": false, "repeats": false }, { "linkId": "ClaimResponse.addItem.fee.system", "text": "units system:", "type": "string", "required": false, "repeats": false } ] }, { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType", "valueString": "integer" } ], "linkId": "ClaimResponse.addItem.noteNumber", "type": "group", "required": false, "repeats": true, "item": [ { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl", "valueCodeableConcept": { "coding": [ { "system": "http://hl7.org/fhir/questionnaire-item-control", "code": "flyover", "display": "Fly-over" } ] } } ], "text": "A list of note references to the notes provided below.", "type": "display" }, { "linkId": "ClaimResponse.addItem.noteNumber.value", "text": "List of note numbers which apply", "type": "integer", "required": false, "repeats": false } ] }, { "linkId": "ClaimResponse.addItem.adjudication", "text": "Added items adjudication", "type": "group", "required": false, "repeats": true, "item": [ { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl", "valueCodeableConcept": { "coding": [ { "system": "http://hl7.org/fhir/questionnaire-item-control", "code": "flyover", "display": "Fly-over" } ] } } ], "text": "The adjudications results.", "type": "display" } ] }, { "linkId": "ClaimResponse.addItem.detail", "text": "Added items details", "type": "group", "required": false, "repeats": true, "item": [ { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl", "valueCodeableConcept": { "coding": [ { "system": "http://hl7.org/fhir/questionnaire-item-control", "code": "flyover", "display": "Fly-over" } ] } } ], "text": "The second tier service adjudications for payor added services.", "type": "display" }, { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs", "valueInteger": 1 }, { "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType", "valueString": "string" } ], "linkId": "ClaimResponse.addItem.detail.id", "type": "group", "required": false, "repeats": true, "item": [ { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl", "valueCodeableConcept": { "coding": [ { "system": "http://hl7.org/fhir/questionnaire-item-control", "code": "flyover", "display": "Fly-over" } ] } } ], "text": "unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.", "type": "display" }, { "linkId": "ClaimResponse.addItem.detail.id.value", "text": "xml:id (or equivalent in JSON)", "type": "string", "required": false, "repeats": false } ] }, { "linkId": "ClaimResponse.addItem.detail.extension", "text": "Additional Content defined by implementations", "type": "group", "required": false, "repeats": true, "item": [ { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl", "valueCodeableConcept": { "coding": [ { "system": "http://hl7.org/fhir/questionnaire-item-control", "code": "flyover", "display": "Fly-over" } ] } } ], "text": "May be used to represent additional information that is not part of the basic definition of the element. In order 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. There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.", "type": "display" } ] }, { "linkId": "ClaimResponse.addItem.detail.modifierExtension", "text": "Extensions that cannot be ignored", "type": "group", "required": false, "repeats": true, "item": [ { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl", "valueCodeableConcept": { "coding": [ { "system": "http://hl7.org/fhir/questionnaire-item-control", "code": "flyover", "display": "Fly-over" } ] } } ], "text": "May 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 that contains it. Usually modifier elements provide negation or qualification. In order 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. There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.", "type": "display" } ] }, { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs", "valueInteger": 1 }, { "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType", "valueString": "CodeableConcept" } ], "linkId": "ClaimResponse.addItem.detail.revenue", "text": "Revenue or cost center code", "type": "group", "required": false, "repeats": true, "item": [ { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl", "valueCodeableConcept": { "coding": [ { "system": "http://hl7.org/fhir/questionnaire-item-control", "code": "flyover", "display": "Fly-over" } ] } } ], "text": "The type of reveneu or cost center providing the product and/or service.", "type": "display" }, { "linkId": "ClaimResponse.addItem.detail.revenue.coding", "text": "code:", "type": "open-choice", "required": false, "repeats": false }, { "linkId": "ClaimResponse.addItem.detail.revenue.text", "text": "text:", "type": "string", "required": false, "repeats": false } ] }, { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs", "valueInteger": 1 }, { "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType", "valueString": "CodeableConcept" } ], "linkId": "ClaimResponse.addItem.detail.category", "text": "Type of service or product", "type": "group", "required": false, "repeats": true, "item": [ { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl", "valueCodeableConcept": { "coding": [ { "system": "http://hl7.org/fhir/questionnaire-item-control", "code": "flyover", "display": "Fly-over" } ] } } ], "text": "Health Care Service Type Codes to identify the classification of service or benefits.", "type": "display" }, { "linkId": "ClaimResponse.addItem.detail.category.coding", "text": "code:", "type": "open-choice", "required": false, "repeats": false }, { "linkId": "ClaimResponse.addItem.detail.category.text", "text": "text:", "type": "string", "required": false, "repeats": false } ] }, { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs", "valueInteger": 1 }, { "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType", "valueString": "CodeableConcept" } ], "linkId": "ClaimResponse.addItem.detail.service", "text": "Service or Product", "type": "group", "required": false, "repeats": true, "item": [ { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl", "valueCodeableConcept": { "coding": [ { "system": "http://hl7.org/fhir/questionnaire-item-control", "code": "flyover", "display": "Fly-over" } ] } } ], "text": "A code to indicate the Professional Service or Product supplied.", "type": "display" }, { "linkId": "ClaimResponse.addItem.detail.service.coding", "text": "code:", "type": "open-choice", "required": false, "repeats": false }, { "linkId": "ClaimResponse.addItem.detail.service.text", "text": "text:", "type": "string", "required": false, "repeats": false } ] }, { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType", "valueString": "CodeableConcept" } ], "linkId": "ClaimResponse.addItem.detail.modifier", "text": "Service/Product billing modifiers", "type": "group", "required": false, "repeats": true, "item": [ { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl", "valueCodeableConcept": { "coding": [ { "system": "http://hl7.org/fhir/questionnaire-item-control", "code": "flyover", "display": "Fly-over" } ] } } ], "text": "Item typification or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or for medical whether the treatment was outside the clinic or out of office hours.", "type": "display" }, { "linkId": "ClaimResponse.addItem.detail.modifier.coding", "text": "code:", "type": "open-choice", "required": false, "repeats": false }, { "linkId": "ClaimResponse.addItem.detail.modifier.text", "text": "text:", "type": "string", "required": false, "repeats": false } ] }, { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs", "valueInteger": 1 }, { "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType", "valueString": "Quantity" } ], "linkId": "ClaimResponse.addItem.detail.fee", "text": "Professional fee or Product charge", "type": "group", "required": false, "repeats": true, "item": [ { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl", "valueCodeableConcept": { "coding": [ { "system": "http://hl7.org/fhir/questionnaire-item-control", "code": "flyover", "display": "Fly-over" } ] } } ], "text": "The fee charged for the professional service or product..", "type": "display" }, { "linkId": "ClaimResponse.addItem.detail.fee.comparator", "text": "comp:", "type": "choice", "required": false, "repeats": false }, { "linkId": "ClaimResponse.addItem.detail.fee.value", "text": "value:", "type": "decimal", "required": false, "repeats": false }, { "linkId": "ClaimResponse.addItem.detail.fee.units", "text": "units:", "type": "string", "required": false, "repeats": false }, { "linkId": "ClaimResponse.addItem.detail.fee.code", "text": "coded units:", "type": "string", "required": false, "repeats": false }, { "linkId": "ClaimResponse.addItem.detail.fee.system", "text": "units system:", "type": "string", "required": false, "repeats": false } ] }, { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType", "valueString": "integer" } ], "linkId": "ClaimResponse.addItem.detail.noteNumber", "type": "group", "required": false, "repeats": true, "item": [ { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl", "valueCodeableConcept": { "coding": [ { "system": "http://hl7.org/fhir/questionnaire-item-control", "code": "flyover", "display": "Fly-over" } ] } } ], "text": "A list of note references to the notes provided below.", "type": "display" }, { "linkId": "ClaimResponse.addItem.detail.noteNumber.value", "text": "List of note numbers which apply", "type": "integer", "required": false, "repeats": false } ] }, { "linkId": "ClaimResponse.addItem.detail.adjudication", "text": "Added items detail adjudication", "type": "group", "required": false, "repeats": true, "item": [ { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl", "valueCodeableConcept": { "coding": [ { "system": "http://hl7.org/fhir/questionnaire-item-control", "code": "flyover", "display": "Fly-over" } ] } } ], "text": "The adjudications results.", "type": "display" } ] } ] } ] }, { "linkId": "ClaimResponse.error", "text": "Processing errors", "type": "group", "required": false, "repeats": true, "item": [ { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl", "valueCodeableConcept": { "coding": [ { "system": "http://hl7.org/fhir/questionnaire-item-control", "code": "flyover", "display": "Fly-over" } ] } } ], "text": "Mutually exclusive with Services Provided (Item).", "type": "display" }, { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs", "valueInteger": 1 }, { "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType", "valueString": "string" } ], "linkId": "ClaimResponse.error.id", "type": "group", "required": false, "repeats": true, "item": [ { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl", "valueCodeableConcept": { "coding": [ { "system": "http://hl7.org/fhir/questionnaire-item-control", "code": "flyover", "display": "Fly-over" } ] } } ], "text": "unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.", "type": "display" }, { "linkId": "ClaimResponse.error.id.value", "text": "xml:id (or equivalent in JSON)", "type": "string", "required": false, "repeats": false } ] }, { "linkId": "ClaimResponse.error.extension", "text": "Additional Content defined by implementations", "type": "group", "required": false, "repeats": true, "item": [ { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl", "valueCodeableConcept": { "coding": [ { "system": "http://hl7.org/fhir/questionnaire-item-control", "code": "flyover", "display": "Fly-over" } ] } } ], "text": "May be used to represent additional information that is not part of the basic definition of the element. In order 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. There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.", "type": "display" } ] }, { "linkId": "ClaimResponse.error.modifierExtension", "text": "Extensions that cannot be ignored", "type": "group", "required": false, "repeats": true, "item": [ { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl", "valueCodeableConcept": { "coding": [ { "system": "http://hl7.org/fhir/questionnaire-item-control", "code": "flyover", "display": "Fly-over" } ] } } ], "text": "May 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 that contains it. Usually modifier elements provide negation or qualification. In order 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. There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.", "type": "display" } ] }, { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs", "valueInteger": 1 }, { "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType", "valueString": "integer" } ], "linkId": "ClaimResponse.error.sequenceLinkId", "type": "group", "required": false, "repeats": true, "item": [ { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl", "valueCodeableConcept": { "coding": [ { "system": "http://hl7.org/fhir/questionnaire-item-control", "code": "flyover", "display": "Fly-over" } ] } } ], "text": "The sequence number of the line item submitted which contains the error. This value is omitted when the error is elsewhere.", "type": "display" }, { "linkId": "ClaimResponse.error.sequenceLinkId.value", "text": "Item sequence number", "type": "integer", "required": false, "repeats": false } ] }, { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs", "valueInteger": 1 }, { "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType", "valueString": "integer" } ], "linkId": "ClaimResponse.error.detailSequenceLinkId", "type": "group", "required": false, "repeats": true, "item": [ { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl", "valueCodeableConcept": { "coding": [ { "system": "http://hl7.org/fhir/questionnaire-item-control", "code": "flyover", "display": "Fly-over" } ] } } ], "text": "The sequence number of the addition within the line item submitted which contains the error. This value is omitted when the error is not related to an Addition.", "type": "display" }, { "linkId": "ClaimResponse.error.detailSequenceLinkId.value", "text": "Detail sequence number", "type": "integer", "required": false, "repeats": false } ] }, { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs", "valueInteger": 1 }, { "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType", "valueString": "integer" } ], "linkId": "ClaimResponse.error.subdetailSequenceLinkId", "type": "group", "required": false, "repeats": true, "item": [ { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl", "valueCodeableConcept": { "coding": [ { "system": "http://hl7.org/fhir/questionnaire-item-control", "code": "flyover", "display": "Fly-over" } ] } } ], "text": "The sequence number of the addition within the line item submitted which contains the error. This value is omitted when the error is not related to an Addition.", "type": "display" }, { "linkId": "ClaimResponse.error.subdetailSequenceLinkId.value", "text": "Subdetail sequence number", "type": "integer", "required": false, "repeats": false } ] }, { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-minOccurs", "valueInteger": 1 }, { "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs", "valueInteger": 1 }, { "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType", "valueString": "CodeableConcept" } ], "linkId": "ClaimResponse.error.code", "text": "Error code detailing processing issues", "type": "group", "required": true, "repeats": true, "item": [ { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl", "valueCodeableConcept": { "coding": [ { "system": "http://hl7.org/fhir/questionnaire-item-control", "code": "flyover", "display": "Fly-over" } ] } } ], "text": "An error code,from a specified code system, which details why the claim could not be adjudicated.", "type": "display" }, { "linkId": "ClaimResponse.error.code.coding", "text": "code:", "type": "open-choice", "required": false, "repeats": false }, { "linkId": "ClaimResponse.error.code.text", "text": "text:", "type": "string", "required": false, "repeats": false } ] } ] }, { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs", "valueInteger": 1 }, { "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType", "valueString": "Quantity" } ], "linkId": "ClaimResponse.totalCost", "text": "Total Cost of service from the Claim", "type": "group", "required": false, "repeats": true, "item": [ { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl", "valueCodeableConcept": { "coding": [ { "system": "http://hl7.org/fhir/questionnaire-item-control", "code": "flyover", "display": "Fly-over" } ] } } ], "text": "The total cost of the services reported.", "type": "display" }, { "linkId": "ClaimResponse.totalCost.comparator", "text": "comp:", "type": "choice", "required": false, "repeats": false }, { "linkId": "ClaimResponse.totalCost.value", "text": "value:", "type": "decimal", "required": false, "repeats": false }, { "linkId": "ClaimResponse.totalCost.units", "text": "units:", "type": "string", "required": false, "repeats": false }, { "linkId": "ClaimResponse.totalCost.code", "text": "coded units:", "type": "string", "required": false, "repeats": false }, { "linkId": "ClaimResponse.totalCost.system", "text": "units system:", "type": "string", "required": false, "repeats": false } ] }, { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs", "valueInteger": 1 }, { "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType", "valueString": "Quantity" } ], "linkId": "ClaimResponse.unallocDeductable", "text": "Unallocated deductible", "type": "group", "required": false, "repeats": true, "item": [ { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl", "valueCodeableConcept": { "coding": [ { "system": "http://hl7.org/fhir/questionnaire-item-control", "code": "flyover", "display": "Fly-over" } ] } } ], "text": "The amount of deductible applied which was not allocated to any particular service line.", "type": "display" }, { "linkId": "ClaimResponse.unallocDeductable.comparator", "text": "comp:", "type": "choice", "required": false, "repeats": false }, { "linkId": "ClaimResponse.unallocDeductable.value", "text": "value:", "type": "decimal", "required": false, "repeats": false }, { "linkId": "ClaimResponse.unallocDeductable.units", "text": "units:", "type": "string", "required": false, "repeats": false }, { "linkId": "ClaimResponse.unallocDeductable.code", "text": "coded units:", "type": "string", "required": false, "repeats": false }, { "linkId": "ClaimResponse.unallocDeductable.system", "text": "units system:", "type": "string", "required": false, "repeats": false } ] }, { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs", "valueInteger": 1 }, { "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType", "valueString": "Quantity" } ], "linkId": "ClaimResponse.totalBenefit", "text": "Total benefit payable for the Claim", "type": "group", "required": false, "repeats": true, "item": [ { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl", "valueCodeableConcept": { "coding": [ { "system": "http://hl7.org/fhir/questionnaire-item-control", "code": "flyover", "display": "Fly-over" } ] } } ], "text": "Total amount of benefit payable (Equal to sum of the Benefit amounts from all detail lines and additions less the Unallocated Deductible).", "type": "display" }, { "linkId": "ClaimResponse.totalBenefit.comparator", "text": "comp:", "type": "choice", "required": false, "repeats": false }, { "linkId": "ClaimResponse.totalBenefit.value", "text": "value:", "type": "decimal", "required": false, "repeats": false }, { "linkId": "ClaimResponse.totalBenefit.units", "text": "units:", "type": "string", "required": false, "repeats": false }, { "linkId": "ClaimResponse.totalBenefit.code", "text": "coded units:", "type": "string", "required": false, "repeats": false }, { "linkId": "ClaimResponse.totalBenefit.system", "text": "units system:", "type": "string", "required": false, "repeats": false } ] }, { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs", "valueInteger": 1 } ], "linkId": "ClaimResponse.payment", "text": "Payment details, if paid", "type": "group", "required": false, "repeats": false, "item": [ { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl", "valueCodeableConcept": { "coding": [ { "system": "http://hl7.org/fhir/questionnaire-item-control", "code": "flyover", "display": "Fly-over" } ] } } ], "text": "Payment details for the claim if the claim has been paid.", "type": "display" }, { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs", "valueInteger": 1 }, { "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType", "valueString": "string" } ], "linkId": "ClaimResponse.payment.id", "type": "group", "required": false, "repeats": true, "item": [ { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl", "valueCodeableConcept": { "coding": [ { "system": "http://hl7.org/fhir/questionnaire-item-control", "code": "flyover", "display": "Fly-over" } ] } } ], "text": "unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.", "type": "display" }, { "linkId": "ClaimResponse.payment.id.value", "text": "xml:id (or equivalent in JSON)", "type": "string", "required": false, "repeats": false } ] }, { "linkId": "ClaimResponse.payment.extension", "text": "Additional Content defined by implementations", "type": "group", "required": false, "repeats": true, "item": [ { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl", "valueCodeableConcept": { "coding": [ { "system": "http://hl7.org/fhir/questionnaire-item-control", "code": "flyover", "display": "Fly-over" } ] } } ], "text": "May be used to represent additional information that is not part of the basic definition of the element. In order 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. There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.", "type": "display" } ] }, { "linkId": "ClaimResponse.payment.modifierExtension", "text": "Extensions that cannot be ignored", "type": "group", "required": false, "repeats": true, "item": [ { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl", "valueCodeableConcept": { "coding": [ { "system": "http://hl7.org/fhir/questionnaire-item-control", "code": "flyover", "display": "Fly-over" } ] } } ], "text": "May 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 that contains it. Usually modifier elements provide negation or qualification. In order 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. There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.", "type": "display" } ] }, { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs", "valueInteger": 1 }, { "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType", "valueString": "CodeableConcept" } ], "linkId": "ClaimResponse.payment.type", "text": "Partial or Complete", "type": "group", "required": false, "repeats": true, "item": [ { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl", "valueCodeableConcept": { "coding": [ { "system": "http://hl7.org/fhir/questionnaire-item-control", "code": "flyover", "display": "Fly-over" } ] } } ], "text": "Whether this represents partial or complete payment of the claim.", "type": "display" }, { "linkId": "ClaimResponse.payment.type.coding", "text": "code:", "type": "open-choice", "required": false, "repeats": false }, { "linkId": "ClaimResponse.payment.type.text", "text": "text:", "type": "string", "required": false, "repeats": false } ] }, { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs", "valueInteger": 1 }, { "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType", "valueString": "Quantity" } ], "linkId": "ClaimResponse.payment.adjustment", "text": "Payment adjustment for non-Claim issues", "type": "group", "required": false, "repeats": true, "item": [ { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl", "valueCodeableConcept": { "coding": [ { "system": "http://hl7.org/fhir/questionnaire-item-control", "code": "flyover", "display": "Fly-over" } ] } } ], "text": "Adjustment to the payment of this transaction which is not related to adjudication of this transaction.", "type": "display" }, { "linkId": "ClaimResponse.payment.adjustment.comparator", "text": "comp:", "type": "choice", "required": false, "repeats": false }, { "linkId": "ClaimResponse.payment.adjustment.value", "text": "value:", "type": "decimal", "required": false, "repeats": false }, { "linkId": "ClaimResponse.payment.adjustment.units", "text": "units:", "type": "string", "required": false, "repeats": false }, { "linkId": "ClaimResponse.payment.adjustment.code", "text": "coded units:", "type": "string", "required": false, "repeats": false }, { "linkId": "ClaimResponse.payment.adjustment.system", "text": "units system:", "type": "string", "required": false, "repeats": false } ] }, { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs", "valueInteger": 1 }, { "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType", "valueString": "CodeableConcept" } ], "linkId": "ClaimResponse.payment.adjustmentReason", "text": "Explanation for the non-claim adjustment", "type": "group", "required": false, "repeats": true, "item": [ { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl", "valueCodeableConcept": { "coding": [ { "system": "http://hl7.org/fhir/questionnaire-item-control", "code": "flyover", "display": "Fly-over" } ] } } ], "text": "Reason for the payment adjustment.", "type": "display" }, { "linkId": "ClaimResponse.payment.adjustmentReason.coding", "text": "code:", "type": "open-choice", "required": false, "repeats": false }, { "linkId": "ClaimResponse.payment.adjustmentReason.text", "text": "text:", "type": "string", "required": false, "repeats": false } ] }, { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs", "valueInteger": 1 }, { "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType", "valueString": "datetime" } ], "linkId": "ClaimResponse.payment.date", "type": "group", "required": false, "repeats": true, "item": [ { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl", "valueCodeableConcept": { "coding": [ { "system": "http://hl7.org/fhir/questionnaire-item-control", "code": "flyover", "display": "Fly-over" } ] } } ], "text": "Estimated payment data.", "type": "display" }, { "linkId": "ClaimResponse.payment.date.value", "text": "Expected data of Payment", "type": "dateTime", "required": false, "repeats": false } ] }, { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs", "valueInteger": 1 }, { "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType", "valueString": "Quantity" } ], "linkId": "ClaimResponse.payment.amount", "text": "Payable amount after adjustment", "type": "group", "required": false, "repeats": true, "item": [ { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl", "valueCodeableConcept": { "coding": [ { "system": "http://hl7.org/fhir/questionnaire-item-control", "code": "flyover", "display": "Fly-over" } ] } } ], "text": "Payable less any payment adjustment.", "type": "display" }, { "linkId": "ClaimResponse.payment.amount.comparator", "text": "comp:", "type": "choice", "required": false, "repeats": false }, { "linkId": "ClaimResponse.payment.amount.value", "text": "value:", "type": "decimal", "required": false, "repeats": false }, { "linkId": "ClaimResponse.payment.amount.units", "text": "units:", "type": "string", "required": false, "repeats": false }, { "linkId": "ClaimResponse.payment.amount.code", "text": "coded units:", "type": "string", "required": false, "repeats": false }, { "linkId": "ClaimResponse.payment.amount.system", "text": "units system:", "type": "string", "required": false, "repeats": false } ] }, { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs", "valueInteger": 1 }, { "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType", "valueString": "Identifier" } ], "linkId": "ClaimResponse.payment.identifier", "text": "Identifier of the payment instrument", "type": "group", "required": false, "repeats": true, "item": [ { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl", "valueCodeableConcept": { "coding": [ { "system": "http://hl7.org/fhir/questionnaire-item-control", "code": "flyover", "display": "Fly-over" } ] } } ], "text": "Payment identifier.", "type": "display" }, { "linkId": "ClaimResponse.payment.identifier.label", "text": "label:", "type": "string", "required": false, "repeats": false }, { "linkId": "ClaimResponse.payment.identifier.system", "text": "system:", "type": "string", "required": false, "repeats": false }, { "linkId": "ClaimResponse.payment.identifier.value", "text": "value:", "type": "string", "required": false, "repeats": false } ] } ] }, { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs", "valueInteger": 1 }, { "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType", "valueString": "Coding" } ], "linkId": "ClaimResponse.reserved", "type": "group", "required": false, "repeats": true, "item": [ { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl", "valueCodeableConcept": { "coding": [ { "system": "http://hl7.org/fhir/questionnaire-item-control", "code": "flyover", "display": "Fly-over" } ] } } ], "text": "Status of funds reservation (For provider, for Patient, None).", "type": "display" }, { "linkId": "ClaimResponse.reserved.value", "text": "Funds reserved status", "type": "open-choice", "required": false, "repeats": false } ] }, { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs", "valueInteger": 1 }, { "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType", "valueString": "CodeableConcept" } ], "linkId": "ClaimResponse.form", "text": "Printed Form Identifier", "type": "group", "required": false, "repeats": true, "item": [ { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl", "valueCodeableConcept": { "coding": [ { "system": "http://hl7.org/fhir/questionnaire-item-control", "code": "flyover", "display": "Fly-over" } ] } } ], "text": "The form to be used for printing the content.", "type": "display" }, { "linkId": "ClaimResponse.form.coding", "text": "code:", "type": "open-choice", "required": false, "repeats": false }, { "linkId": "ClaimResponse.form.text", "text": "text:", "type": "string", "required": false, "repeats": false } ] }, { "linkId": "ClaimResponse.processNote", "text": "Processing notes", "type": "group", "required": false, "repeats": true, "item": [ { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl", "valueCodeableConcept": { "coding": [ { "system": "http://hl7.org/fhir/questionnaire-item-control", "code": "flyover", "display": "Fly-over" } ] } } ], "text": "Note text.", "type": "display" }, { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs", "valueInteger": 1 }, { "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType", "valueString": "string" } ], "linkId": "ClaimResponse.processNote.id", "type": "group", "required": false, "repeats": true, "item": [ { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl", "valueCodeableConcept": { "coding": [ { "system": "http://hl7.org/fhir/questionnaire-item-control", "code": "flyover", "display": "Fly-over" } ] } } ], "text": "unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.", "type": "display" }, { "linkId": "ClaimResponse.processNote.id.value", "text": "xml:id (or equivalent in JSON)", "type": "string", "required": false, "repeats": false } ] }, { "linkId": "ClaimResponse.processNote.extension", "text": "Additional Content defined by implementations", "type": "group", "required": false, "repeats": true, "item": [ { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl", "valueCodeableConcept": { "coding": [ { "system": "http://hl7.org/fhir/questionnaire-item-control", "code": "flyover", "display": "Fly-over" } ] } } ], "text": "May be used to represent additional information that is not part of the basic definition of the element. In order 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. There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.", "type": "display" } ] }, { "linkId": "ClaimResponse.processNote.modifierExtension", "text": "Extensions that cannot be ignored", "type": "group", "required": false, "repeats": true, "item": [ { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl", "valueCodeableConcept": { "coding": [ { "system": "http://hl7.org/fhir/questionnaire-item-control", "code": "flyover", "display": "Fly-over" } ] } } ], "text": "May 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 that contains it. Usually modifier elements provide negation or qualification. In order 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. There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.", "type": "display" } ] }, { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs", "valueInteger": 1 }, { "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType", "valueString": "integer" } ], "linkId": "ClaimResponse.processNote.number", "type": "group", "required": false, "repeats": true, "item": [ { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl", "valueCodeableConcept": { "coding": [ { "system": "http://hl7.org/fhir/questionnaire-item-control", "code": "flyover", "display": "Fly-over" } ] } } ], "text": "An integer associated with each note which may be referred to from each service line item.", "type": "display" }, { "linkId": "ClaimResponse.processNote.number.value", "text": "Sequence Number for this note", "type": "integer", "required": false, "repeats": false } ] }, { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs", "valueInteger": 1 }, { "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType", "valueString": "CodeableConcept" } ], "linkId": "ClaimResponse.processNote.type", "text": "display | print | printoper", "type": "group", "required": false, "repeats": true, "item": [ { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl", "valueCodeableConcept": { "coding": [ { "system": "http://hl7.org/fhir/questionnaire-item-control", "code": "flyover", "display": "Fly-over" } ] } } ], "text": "The note purpose: Print/Display.", "type": "display" }, { "linkId": "ClaimResponse.processNote.type.coding", "text": "code:", "type": "choice", "required": false, "repeats": false }, { "linkId": "ClaimResponse.processNote.type.text", "text": "text:", "type": "string", "required": false, "repeats": false } ] }, { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs", "valueInteger": 1 }, { "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType", "valueString": "string" } ], "linkId": "ClaimResponse.processNote.text", "type": "group", "required": false, "repeats": true, "item": [ { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl", "valueCodeableConcept": { "coding": [ { "system": "http://hl7.org/fhir/questionnaire-item-control", "code": "flyover", "display": "Fly-over" } ] } } ], "text": "The note text.", "type": "display" }, { "linkId": "ClaimResponse.processNote.text.value", "text": "Note explanatory text", "type": "string", "required": false, "repeats": false } ] }, { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs", "valueInteger": 1 }, { "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType", "valueString": "CodeableConcept" } ], "linkId": "ClaimResponse.processNote.language", "text": "Language if different from the resource", "type": "group", "required": false, "repeats": true, "item": [ { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl", "valueCodeableConcept": { "coding": [ { "system": "http://hl7.org/fhir/questionnaire-item-control", "code": "flyover", "display": "Fly-over" } ] } } ], "text": "The ISO-639-1 alpha 2 code in lower case for the language, optionally followed by a hyphen and the ISO-3166-1 alpha 2 code for the region in upper case; e.g. \"en\" for English, or \"en-US\" for American English versus \"en-EN\" for England English.", "type": "display" }, { "linkId": "ClaimResponse.processNote.language.coding", "text": "code:", "type": "open-choice", "required": false, "repeats": false }, { "linkId": "ClaimResponse.processNote.language.text", "text": "text:", "type": "string", "required": false, "repeats": false } ] } ] }, { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType", "valueString": "Reference" } ], "linkId": "ClaimResponse.communicationRequest", "type": "group", "required": false, "repeats": true, "item": [ { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl", "valueCodeableConcept": { "coding": [ { "system": "http://hl7.org/fhir/questionnaire-item-control", "code": "flyover", "display": "Fly-over" } ] } } ], "text": "Request for additional supporting or authorizing information, such as: documents, images or resources.", "type": "display" }, { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-allowedResource", "valueCode": "CommunicationRequest" }, { "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-referenceFilter", "valueString": "subject=$subj&patient=$subj&encounter=$encounter" } ], "linkId": "ClaimResponse.communicationRequest.value", "text": "Request for additional information", "type": "reference", "required": false, "repeats": false } ] }, { "linkId": "ClaimResponse.insurance", "text": "Insurance or medical plan", "type": "group", "required": false, "repeats": true, "item": [ { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl", "valueCodeableConcept": { "coding": [ { "system": "http://hl7.org/fhir/questionnaire-item-control", "code": "flyover", "display": "Fly-over" } ] } } ], "text": "Financial instrument by which payment information for health care.", "type": "display" }, { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs", "valueInteger": 1 }, { "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType", "valueString": "string" } ], "linkId": "ClaimResponse.insurance.id", "type": "group", "required": false, "repeats": true, "item": [ { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl", "valueCodeableConcept": { "coding": [ { "system": "http://hl7.org/fhir/questionnaire-item-control", "code": "flyover", "display": "Fly-over" } ] } } ], "text": "unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.", "type": "display" }, { "linkId": "ClaimResponse.insurance.id.value", "text": "xml:id (or equivalent in JSON)", "type": "string", "required": false, "repeats": false } ] }, { "linkId": "ClaimResponse.insurance.extension", "text": "Additional Content defined by implementations", "type": "group", "required": false, "repeats": true, "item": [ { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl", "valueCodeableConcept": { "coding": [ { "system": "http://hl7.org/fhir/questionnaire-item-control", "code": "flyover", "display": "Fly-over" } ] } } ], "text": "May be used to represent additional information that is not part of the basic definition of the element. In order 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. There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.", "type": "display" } ] }, { "linkId": "ClaimResponse.insurance.modifierExtension", "text": "Extensions that cannot be ignored", "type": "group", "required": false, "repeats": true, "item": [ { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl", "valueCodeableConcept": { "coding": [ { "system": "http://hl7.org/fhir/questionnaire-item-control", "code": "flyover", "display": "Fly-over" } ] } } ], "text": "May 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 that contains it. Usually modifier elements provide negation or qualification. In order 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. There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.", "type": "display" } ] }, { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-minOccurs", "valueInteger": 1 }, { "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs", "valueInteger": 1 }, { "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType", "valueString": "integer" } ], "linkId": "ClaimResponse.insurance.sequence", "type": "group", "required": true, "repeats": true, "item": [ { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl", "valueCodeableConcept": { "coding": [ { "system": "http://hl7.org/fhir/questionnaire-item-control", "code": "flyover", "display": "Fly-over" } ] } } ], "text": "A service line item.", "type": "display" }, { "linkId": "ClaimResponse.insurance.sequence.value", "text": "Service instance identifier", "type": "integer", "required": false, "repeats": false } ] }, { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-minOccurs", "valueInteger": 1 }, { "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs", "valueInteger": 1 }, { "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType", "valueString": "boolean" } ], "linkId": "ClaimResponse.insurance.focal", "type": "group", "required": true, "repeats": true, "item": [ { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl", "valueCodeableConcept": { "coding": [ { "system": "http://hl7.org/fhir/questionnaire-item-control", "code": "flyover", "display": "Fly-over" } ] } } ], "text": "The instance number of the Coverage which is the focus for adjudication. The Coverage against which the claim is to be adjudicated.", "type": "display" }, { "linkId": "ClaimResponse.insurance.focal.value", "text": "Is the focal Coverage", "type": "boolean", "required": false, "repeats": false } ] }, { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-minOccurs", "valueInteger": 1 }, { "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs", "valueInteger": 1 }, { "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType", "valueString": "Reference" } ], "linkId": "ClaimResponse.insurance.coverage", "type": "group", "required": true, "repeats": true, "item": [ { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl", "valueCodeableConcept": { "coding": [ { "system": "http://hl7.org/fhir/questionnaire-item-control", "code": "flyover", "display": "Fly-over" } ] } } ], "text": "Reference to the program or plan identification, underwriter or payor.", "type": "display" }, { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-allowedResource", "valueCode": "Coverage" }, { "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-referenceFilter", "valueString": "subject=$subj&patient=$subj&encounter=$encounter" } ], "linkId": "ClaimResponse.insurance.coverage.value", "text": "Insurance information", "type": "reference", "required": false, "repeats": false } ] }, { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs", "valueInteger": 1 }, { "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType", "valueString": "string" } ], "linkId": "ClaimResponse.insurance.businessArrangement", "type": "group", "required": false, "repeats": true, "item": [ { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl", "valueCodeableConcept": { "coding": [ { "system": "http://hl7.org/fhir/questionnaire-item-control", "code": "flyover", "display": "Fly-over" } ] } } ], "text": "The contract number of a business agreement which describes the terms and conditions.", "type": "display" }, { "linkId": "ClaimResponse.insurance.businessArrangement.value", "text": "Business agreement", "type": "string", "required": false, "repeats": false } ] }, { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType", "valueString": "string" } ], "linkId": "ClaimResponse.insurance.preAuthRef", "type": "group", "required": false, "repeats": true, "item": [ { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl", "valueCodeableConcept": { "coding": [ { "system": "http://hl7.org/fhir/questionnaire-item-control", "code": "flyover", "display": "Fly-over" } ] } } ], "text": "A list of references from the Insurer to which these services pertain.", "type": "display" }, { "linkId": "ClaimResponse.insurance.preAuthRef.value", "text": "Pre-Authorization/Determination Reference", "type": "string", "required": false, "repeats": false } ] }, { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs", "valueInteger": 1 }, { "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType", "valueString": "Reference" } ], "linkId": "ClaimResponse.insurance.claimResponse", "type": "group", "required": false, "repeats": true, "item": [ { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl", "valueCodeableConcept": { "coding": [ { "system": "http://hl7.org/fhir/questionnaire-item-control", "code": "flyover", "display": "Fly-over" } ] } } ], "text": "The Coverages adjudication details.", "type": "display" }, { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-allowedResource", "valueCode": "ClaimResponse" }, { "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-referenceFilter", "valueString": "subject=$subj&patient=$subj&encounter=$encounter" } ], "linkId": "ClaimResponse.insurance.claimResponse.value", "text": "Adjudication results", "type": "reference", "required": false, "repeats": false } ] } ] } ] } ] }
Usage note: every effort has been made to ensure that the examples are correct and useful, but they are not a normative part of the specification.