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
<?xml version="1.0" encoding="UTF-8"?> <Questionnaire xmlns="http://hl7.org/fhir"> <id value="qs1"/> <identifier> <system value="urn:ietf:rfc:3986"/> </identifier> <status value="draft"/> <date value="2019-10-24T11:53:00+11:00"/> <publisher value="Health Level Seven International (Financial Management)"/> <item> <linkId value="ClaimResponse"/> <text value="Remittance resource"/> <type value="group"/> <required value="false"/> <repeats value="true"/> <item> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl"> <valueCodeableConcept> <coding> <system value="http://hl7.org/fhir/questionnaire-item-control"/> <code value="flyover"/> <display value="Fly-over"/> </coding> </valueCodeableConcept> </extension> <text value="This resource provides the adjudication details from the processing of a Claim resource."/> <type value="display"/> </item> <item> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs"> <valueInteger value="1"/> </extension> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType"> <valueString value="string"/> </extension> <linkId value="ClaimResponse.id"/> <type value="group"/> <required value="false"/> <repeats value="true"/> <item> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl"> <valueCodeableConcept> <coding> <system value="http://hl7.org/fhir/questionnaire-item-control"/> <code value="flyover"/> <display value="Fly-over"/> </coding> </valueCodeableConcept> </extension> <text value="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 value="display"/> </item> <item> <linkId value="ClaimResponse.id.value"/> <text value="Logical id of this artifact"/> <type value="string"/> <required value="false"/> <repeats value="false"/> </item> </item> <item> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs"> <valueInteger value="1"/> </extension> <linkId value="ClaimResponse.meta"/> <text value="Metadata about the resource"/> <type value="group"/> <required value="false"/> <repeats value="true"/> <item> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl"> <valueCodeableConcept> <coding> <system value="http://hl7.org/fhir/questionnaire-item-control"/> <code value="flyover"/> <display value="Fly-over"/> </coding> </valueCodeableConcept> </extension> <text value="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 value="display"/> </item> </item> <item> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs"> <valueInteger value="1"/> </extension> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType"> <valueString value="uri"/> </extension> <linkId value="ClaimResponse.implicitRules"/> <type value="group"/> <required value="false"/> <repeats value="true"/> <item> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl"> <valueCodeableConcept> <coding> <system value="http://hl7.org/fhir/questionnaire-item-control"/> <code value="flyover"/> <display value="Fly-over"/> </coding> </valueCodeableConcept> </extension> <text value="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. 

This 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 value="display"/> </item> <item> <linkId value="ClaimResponse.implicitRules.value"/> <text value="A set of rules under which this content was created"/> <type value="string"/> <required value="false"/> <repeats value="false"/> </item> </item> <item> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs"> <valueInteger value="1"/> </extension> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType"> <valueString value="code"/> </extension> <linkId value="ClaimResponse.language"/> <type value="group"/> <required value="false"/> <repeats value="true"/> <item> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl"> <valueCodeableConcept> <coding> <system value="http://hl7.org/fhir/questionnaire-item-control"/> <code value="flyover"/> <display value="Fly-over"/> </coding> </valueCodeableConcept> </extension> <text value="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 value="display"/> </item> <item> <linkId value="ClaimResponse.language.value"/> <text value="language"/> <type value="choice"/> <required value="false"/> <repeats value="false"/> </item> </item> <item> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs"> <valueInteger value="1"/> </extension> <linkId value="ClaimResponse.text"/> <text value="Text summary of the resource, for human interpretation"/> <type value="group"/> <required value="false"/> <repeats value="true"/> <item> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl"> <valueCodeableConcept> <coding> <system value="http://hl7.org/fhir/questionnaire-item-control"/> <code value="flyover"/> <display value="Fly-over"/> </coding> </valueCodeableConcept> </extension> <text value="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 value="display"/> </item> </item> <item> <linkId value="ClaimResponse.contained"/> <text value="Contained, inline Resources"/> <type value="group"/> <required value="false"/> <repeats value="true"/> <item> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl"> <valueCodeableConcept> <coding> <system value="http://hl7.org/fhir/questionnaire-item-control"/> <code value="flyover"/> <display value="Fly-over"/> </coding> </valueCodeableConcept> </extension> <text value="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 value="display"/> </item> </item> <item> <linkId value="ClaimResponse.extension"/> <text value="Additional Content defined by implementations"/> <type value="group"/> <required value="false"/> <repeats value="true"/> <item> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl"> <valueCodeableConcept> <coding> <system value="http://hl7.org/fhir/questionnaire-item-control"/> <code value="flyover"/> <display value="Fly-over"/> </coding> </valueCodeableConcept> </extension> <text value="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 value="display"/> </item> </item> <item> <linkId value="ClaimResponse.modifierExtension"/> <text value="Extensions that cannot be ignored"/> <type value="group"/> <required value="false"/> <repeats value="true"/> <item> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl"> <valueCodeableConcept> <coding> <system value="http://hl7.org/fhir/questionnaire-item-control"/> <code value="flyover"/> <display value="Fly-over"/> </coding> </valueCodeableConcept> </extension> <text value="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 value="display"/> </item> </item> <item> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType"> <valueString value="Identifier"/> </extension> <linkId value="ClaimResponse.identifier"/> <text value="Response number"/> <type value="group"/> <required value="false"/> <repeats value="true"/> <item> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl"> <valueCodeableConcept> <coding> <system value="http://hl7.org/fhir/questionnaire-item-control"/> <code value="flyover"/> <display value="Fly-over"/> </coding> </valueCodeableConcept> </extension> <text value="The Response business identifier."/> <type value="display"/> </item> <item> <linkId value="ClaimResponse.identifier.label"/> <text value="label:"/> <type value="string"/> <required value="false"/> <repeats value="false"/> </item> <item> <linkId value="ClaimResponse.identifier.system"/> <text value="system:"/> <type value="string"/> <required value="false"/> <repeats value="false"/> </item> <item> <linkId value="ClaimResponse.identifier.value"/> <text value="value:"/> <type value="string"/> <required value="false"/> <repeats value="false"/> </item> </item> <item> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs"> <valueInteger value="1"/> </extension> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType"> <valueString value="code"/> </extension> <linkId value="ClaimResponse.status"/> <type value="group"/> <required value="false"/> <repeats value="true"/> <item> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl"> <valueCodeableConcept> <coding> <system value="http://hl7.org/fhir/questionnaire-item-control"/> <code value="flyover"/> <display value="Fly-over"/> </coding> </valueCodeableConcept> </extension> <text value="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 value="display"/> </item> <item> <linkId value="ClaimResponse.status.value"/> <text value="status"/> <type value="choice"/> <required value="false"/> <repeats value="false"/> </item> </item> <item> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs"> <valueInteger value="1"/> </extension> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType"> <valueString value="Reference"/> </extension> <linkId value="ClaimResponse.patient"/> <type value="group"/> <required value="false"/> <repeats value="true"/> <item> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl"> <valueCodeableConcept> <coding> <system value="http://hl7.org/fhir/questionnaire-item-control"/> <code value="flyover"/> <display value="Fly-over"/> </coding> </valueCodeableConcept> </extension> <text value="Patient Resource."/> <type value="display"/> </item> <item> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-allowedResource"> <valueCode value="Patient"/> </extension> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-referenceFilter"> <valueString value="subject=$subj&patient=$subj&encounter=$encounter"/> </extension> <linkId value="ClaimResponse.patient.value"/> <text value="The subject of the Products and Services"/> <type value="reference"/> <required value="false"/> <repeats value="false"/> </item> </item> <item> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs"> <valueInteger value="1"/> </extension> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType"> <valueString value="datetime"/> </extension> <linkId value="ClaimResponse.created"/> <type value="group"/> <required value="false"/> <repeats value="true"/> <item> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl"> <valueCodeableConcept> <coding> <system value="http://hl7.org/fhir/questionnaire-item-control"/> <code value="flyover"/> <display value="Fly-over"/> </coding> </valueCodeableConcept> </extension> <text value="The date when the enclosed suite of services were performed or completed."/> <type value="display"/> </item> <item> <linkId value="ClaimResponse.created.value"/> <text value="Creation date"/> <type value="dateTime"/> <required value="false"/> <repeats value="false"/> </item> </item> <item> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs"> <valueInteger value="1"/> </extension> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType"> <valueString value="Reference"/> </extension> <linkId value="ClaimResponse.insurer"/> <type value="group"/> <required value="false"/> <repeats value="true"/> <item> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl"> <valueCodeableConcept> <coding> <system value="http://hl7.org/fhir/questionnaire-item-control"/> <code value="flyover"/> <display value="Fly-over"/> </coding> </valueCodeableConcept> </extension> <text value="The Insurer who produced this adjudicated response."/> <type value="display"/> </item> <item> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-allowedResource"> <valueCode value="Organization"/> </extension> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-referenceFilter"> <valueString value="subject=$subj&patient=$subj&encounter=$encounter"/> </extension> <linkId value="ClaimResponse.insurer.value"/> <text value="Insurance issuing organization"/> <type value="reference"/> <required value="false"/> <repeats value="false"/> </item> </item> <item> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs"> <valueInteger value="1"/> </extension> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType"> <valueString value="Reference"/> </extension> <linkId value="ClaimResponse.requestProvider"/> <type value="group"/> <required value="false"/> <repeats value="true"/> <item> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl"> <valueCodeableConcept> <coding> <system value="http://hl7.org/fhir/questionnaire-item-control"/> <code value="flyover"/> <display value="Fly-over"/> </coding> </valueCodeableConcept> </extension> <text value="The practitioner who is responsible for the services rendered to the patient."/> <type value="display"/> </item> <item> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-allowedResource"> <valueCode value="Practitioner"/> </extension> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-referenceFilter"> <valueString value="subject=$subj&patient=$subj&encounter=$encounter"/> </extension> <linkId value="ClaimResponse.requestProvider.value"/> <text value="Responsible practitioner"/> <type value="reference"/> <required value="false"/> <repeats value="false"/> </item> </item> <item> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs"> <valueInteger value="1"/> </extension> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType"> <valueString value="Reference"/> </extension> <linkId value="ClaimResponse.requestOrganization"/> <type value="group"/> <required value="false"/> <repeats value="true"/> <item> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl"> <valueCodeableConcept> <coding> <system value="http://hl7.org/fhir/questionnaire-item-control"/> <code value="flyover"/> <display value="Fly-over"/> </coding> </valueCodeableConcept> </extension> <text value="The organization which is responsible for the services rendered to the patient."/> <type value="display"/> </item> <item> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-allowedResource"> <valueCode value="Organization"/> </extension> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-referenceFilter"> <valueString value="subject=$subj&patient=$subj&encounter=$encounter"/> </extension> <linkId value="ClaimResponse.requestOrganization.value"/> <text value="Responsible organization"/> <type value="reference"/> <required value="false"/> <repeats value="false"/> </item> </item> <item> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs"> <valueInteger value="1"/> </extension> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType"> <valueString value="Reference"/> </extension> <linkId value="ClaimResponse.request"/> <type value="group"/> <required value="false"/> <repeats value="true"/> <item> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl"> <valueCodeableConcept> <coding> <system value="http://hl7.org/fhir/questionnaire-item-control"/> <code value="flyover"/> <display value="Fly-over"/> </coding> </valueCodeableConcept> </extension> <text value="Original request resource referrence."/> <type value="display"/> </item> <item> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-allowedResource"> <valueCode value="Claim"/> </extension> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-referenceFilter"> <valueString value="subject=$subj&patient=$subj&encounter=$encounter"/> </extension> <linkId value="ClaimResponse.request.value"/> <text value="Id of resource triggering adjudication"/> <type value="reference"/> <required value="false"/> <repeats value="false"/> </item> </item> <item> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs"> <valueInteger value="1"/> </extension> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType"> <valueString value="CodeableConcept"/> </extension> <linkId value="ClaimResponse.outcome"/> <text value="complete | error | partial"/> <type value="group"/> <required value="false"/> <repeats value="true"/> <item> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl"> <valueCodeableConcept> <coding> <system value="http://hl7.org/fhir/questionnaire-item-control"/> <code value="flyover"/> <display value="Fly-over"/> </coding> </valueCodeableConcept> </extension> <text value="Processing outcome errror, partial or complete processing."/> <type value="display"/> </item> <item> <linkId value="ClaimResponse.outcome.coding"/> <text value="code:"/> <type value="open-choice"/> <required value="false"/> <repeats value="false"/> </item> <item> <linkId value="ClaimResponse.outcome.text"/> <text value="text:"/> <type value="string"/> <required value="false"/> <repeats value="false"/> </item> </item> <item> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs"> <valueInteger value="1"/> </extension> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType"> <valueString value="string"/> </extension> <linkId value="ClaimResponse.disposition"/> <type value="group"/> <required value="false"/> <repeats value="true"/> <item> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl"> <valueCodeableConcept> <coding> <system value="http://hl7.org/fhir/questionnaire-item-control"/> <code value="flyover"/> <display value="Fly-over"/> </coding> </valueCodeableConcept> </extension> <text value="A description of the status of the adjudication."/> <type value="display"/> </item> <item> <linkId value="ClaimResponse.disposition.value"/> <text value="Disposition Message"/> <type value="string"/> <required value="false"/> <repeats value="false"/> </item> </item> <item> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs"> <valueInteger value="1"/> </extension> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType"> <valueString value="CodeableConcept"/> </extension> <linkId value="ClaimResponse.payeeType"/> <text value="Party to be paid any benefits payable"/> <type value="group"/> <required value="false"/> <repeats value="true"/> <item> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl"> <valueCodeableConcept> <coding> <system value="http://hl7.org/fhir/questionnaire-item-control"/> <code value="flyover"/> <display value="Fly-over"/> </coding> </valueCodeableConcept> </extension> <text value="Party to be reimbursed: Subscriber, provider, other."/> <type value="display"/> </item> <item> <linkId value="ClaimResponse.payeeType.coding"/> <text value="code:"/> <type value="open-choice"/> <required value="false"/> <repeats value="false"/> </item> <item> <linkId value="ClaimResponse.payeeType.text"/> <text value="text:"/> <type value="string"/> <required value="false"/> <repeats value="false"/> </item> </item> <item> <linkId value="ClaimResponse.item"/> <text value="Line items"/> <type value="group"/> <required value="false"/> <repeats value="true"/> <item> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl"> <valueCodeableConcept> <coding> <system value="http://hl7.org/fhir/questionnaire-item-control"/> <code value="flyover"/> <display value="Fly-over"/> </coding> </valueCodeableConcept> </extension> <text value="The first tier service adjudications for submitted services."/> <type value="display"/> </item> <item> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs"> <valueInteger value="1"/> </extension> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType"> <valueString value="string"/> </extension> <linkId value="ClaimResponse.item.id"/> <type value="group"/> <required value="false"/> <repeats value="true"/> <item> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl"> <valueCodeableConcept> <coding> <system value="http://hl7.org/fhir/questionnaire-item-control"/> <code value="flyover"/> <display value="Fly-over"/> </coding> </valueCodeableConcept> </extension> <text value="unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces."/> <type value="display"/> </item> <item> <linkId value="ClaimResponse.item.id.value"/> <text value="xml:id (or equivalent in JSON)"/> <type value="string"/> <required value="false"/> <repeats value="false"/> </item> </item> <item> <linkId value="ClaimResponse.item.extension"/> <text value="Additional Content defined by implementations"/> <type value="group"/> <required value="false"/> <repeats value="true"/> <item> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl"> <valueCodeableConcept> <coding> <system value="http://hl7.org/fhir/questionnaire-item-control"/> <code value="flyover"/> <display value="Fly-over"/> </coding> </valueCodeableConcept> </extension> <text value="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 value="display"/> </item> </item> <item> <linkId value="ClaimResponse.item.modifierExtension"/> <text value="Extensions that cannot be ignored"/> <type value="group"/> <required value="false"/> <repeats value="true"/> <item> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl"> <valueCodeableConcept> <coding> <system value="http://hl7.org/fhir/questionnaire-item-control"/> <code value="flyover"/> <display value="Fly-over"/> </coding> </valueCodeableConcept> </extension> <text value="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 value="display"/> </item> </item> <item> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-minOccurs"> <valueInteger value="1"/> </extension> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs"> <valueInteger value="1"/> </extension> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType"> <valueString value="integer"/> </extension> <linkId value="ClaimResponse.item.sequenceLinkId"/> <type value="group"/> <required value="true"/> <repeats value="true"/> <item> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl"> <valueCodeableConcept> <coding> <system value="http://hl7.org/fhir/questionnaire-item-control"/> <code value="flyover"/> <display value="Fly-over"/> </coding> </valueCodeableConcept> </extension> <text value="A service line number."/> <type value="display"/> </item> <item> <linkId value="ClaimResponse.item.sequenceLinkId.value"/> <text value="Service instance"/> <type value="integer"/> <required value="false"/> <repeats value="false"/> </item> </item> <item> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType"> <valueString value="integer"/> </extension> <linkId value="ClaimResponse.item.noteNumber"/> <type value="group"/> <required value="false"/> <repeats value="true"/> <item> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl"> <valueCodeableConcept> <coding> <system value="http://hl7.org/fhir/questionnaire-item-control"/> <code value="flyover"/> <display value="Fly-over"/> </coding> </valueCodeableConcept> </extension> <text value="A list of note references to the notes provided below."/> <type value="display"/> </item> <item> <linkId value="ClaimResponse.item.noteNumber.value"/> <text value="List of note numbers which apply"/> <type value="integer"/> <required value="false"/> <repeats value="false"/> </item> </item> <item> <linkId value="ClaimResponse.item.adjudication"/> <text value="Adjudication details"/> <type value="group"/> <required value="false"/> <repeats value="true"/> <item> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl"> <valueCodeableConcept> <coding> <system value="http://hl7.org/fhir/questionnaire-item-control"/> <code value="flyover"/> <display value="Fly-over"/> </coding> </valueCodeableConcept> </extension> <text value="The adjudication results."/> <type value="display"/> </item> <item> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs"> <valueInteger value="1"/> </extension> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType"> <valueString value="string"/> </extension> <linkId value="ClaimResponse.item.adjudication.id"/> <type value="group"/> <required value="false"/> <repeats value="true"/> <item> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl"> <valueCodeableConcept> <coding> <system value="http://hl7.org/fhir/questionnaire-item-control"/> <code value="flyover"/> <display value="Fly-over"/> </coding> </valueCodeableConcept> </extension> <text value="unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces."/> <type value="display"/> </item> <item> <linkId value="ClaimResponse.item.adjudication.id.value"/> <text value="xml:id (or equivalent in JSON)"/> <type value="string"/> <required value="false"/> <repeats value="false"/> </item> </item> <item> <linkId value="ClaimResponse.item.adjudication.extension"/> <text value="Additional Content defined by implementations"/> <type value="group"/> <required value="false"/> <repeats value="true"/> <item> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl"> <valueCodeableConcept> <coding> <system value="http://hl7.org/fhir/questionnaire-item-control"/> <code value="flyover"/> <display value="Fly-over"/> </coding> </valueCodeableConcept> </extension> <text value="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 value="display"/> </item> </item> <item> <linkId value="ClaimResponse.item.adjudication.modifierExtension"/> <text value="Extensions that cannot be ignored"/> <type value="group"/> <required value="false"/> <repeats value="true"/> <item> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl"> <valueCodeableConcept> <coding> <system value="http://hl7.org/fhir/questionnaire-item-control"/> <code value="flyover"/> <display value="Fly-over"/> </coding> </valueCodeableConcept> </extension> <text value="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 value="display"/> </item> </item> <item> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-minOccurs"> <valueInteger value="1"/> </extension> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs"> <valueInteger value="1"/> </extension> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType"> <valueString value="CodeableConcept"/> </extension> <linkId value="ClaimResponse.item.adjudication.category"/> <text value="Adjudication category such as co-pay, eligible, benefit, etc."/> <type value="group"/> <required value="true"/> <repeats value="true"/> <item> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl"> <valueCodeableConcept> <coding> <system value="http://hl7.org/fhir/questionnaire-item-control"/> <code value="flyover"/> <display value="Fly-over"/> </coding> </valueCodeableConcept> </extension> <text value="Code indicating: Co-Pay, deductible, eligible, benefit, tax, etc."/> <type value="display"/> </item> <item> <linkId value="ClaimResponse.item.adjudication.category.coding"/> <text value="code:"/> <type value="open-choice"/> <required value="false"/> <repeats value="false"/> </item> <item> <linkId value="ClaimResponse.item.adjudication.category.text"/> <text value="text:"/> <type value="string"/> <required value="false"/> <repeats value="false"/> </item> </item> <item> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs"> <valueInteger value="1"/> </extension> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType"> <valueString value="CodeableConcept"/> </extension> <linkId value="ClaimResponse.item.adjudication.reason"/> <text value="Explanation of Adjudication outcome"/> <type value="group"/> <required value="false"/> <repeats value="true"/> <item> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl"> <valueCodeableConcept> <coding> <system value="http://hl7.org/fhir/questionnaire-item-control"/> <code value="flyover"/> <display value="Fly-over"/> </coding> </valueCodeableConcept> </extension> <text value="Adjudication reason such as limit reached."/> <type value="display"/> </item> <item> <linkId value="ClaimResponse.item.adjudication.reason.coding"/> <text value="code:"/> <type value="open-choice"/> <required value="false"/> <repeats value="false"/> </item> <item> <linkId value="ClaimResponse.item.adjudication.reason.text"/> <text value="text:"/> <type value="string"/> <required value="false"/> <repeats value="false"/> </item> </item> <item> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs"> <valueInteger value="1"/> </extension> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType"> <valueString value="Quantity"/> </extension> <linkId value="ClaimResponse.item.adjudication.amount"/> <text value="Monetary amount"/> <type value="group"/> <required value="false"/> <repeats value="true"/> <item> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl"> <valueCodeableConcept> <coding> <system value="http://hl7.org/fhir/questionnaire-item-control"/> <code value="flyover"/> <display value="Fly-over"/> </coding> </valueCodeableConcept> </extension> <text value="Monetary amount associated with the code."/> <type value="display"/> </item> <item> <linkId value="ClaimResponse.item.adjudication.amount.comparator"/> <text value="comp:"/> <type value="choice"/> <required value="false"/> <repeats value="false"/> </item> <item> <linkId value="ClaimResponse.item.adjudication.amount.value"/> <text value="value:"/> <type value="decimal"/> <required value="false"/> <repeats value="false"/> </item> <item> <linkId value="ClaimResponse.item.adjudication.amount.units"/> <text value="units:"/> <type value="string"/> <required value="false"/> <repeats value="false"/> </item> <item> <linkId value="ClaimResponse.item.adjudication.amount.code"/> <text value="coded units:"/> <type value="string"/> <required value="false"/> <repeats value="false"/> </item> <item> <linkId value="ClaimResponse.item.adjudication.amount.system"/> <text value="units system:"/> <type value="string"/> <required value="false"/> <repeats value="false"/> </item> </item> <item> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs"> <valueInteger value="1"/> </extension> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType"> <valueString value="decimal"/> </extension> <linkId value="ClaimResponse.item.adjudication.value"/> <type value="group"/> <required value="false"/> <repeats value="true"/> <item> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl"> <valueCodeableConcept> <coding> <system value="http://hl7.org/fhir/questionnaire-item-control"/> <code value="flyover"/> <display value="Fly-over"/> </coding> </valueCodeableConcept> </extension> <text value="A non-monetary value for example a percentage. Mutually exclusive to the amount element above."/> <type value="display"/> </item> <item> <linkId value="ClaimResponse.item.adjudication.value.value"/> <text value="Non-monetary value"/> <type value="decimal"/> <required value="false"/> <repeats value="false"/> </item> </item> </item> <item> <linkId value="ClaimResponse.item.detail"/> <text value="Detail line items"/> <type value="group"/> <required value="false"/> <repeats value="true"/> <item> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl"> <valueCodeableConcept> <coding> <system value="http://hl7.org/fhir/questionnaire-item-control"/> <code value="flyover"/> <display value="Fly-over"/> </coding> </valueCodeableConcept> </extension> <text value="The second tier service adjudications for submitted services."/> <type value="display"/> </item> <item> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs"> <valueInteger value="1"/> </extension> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType"> <valueString value="string"/> </extension> <linkId value="ClaimResponse.item.detail.id"/> <type value="group"/> <required value="false"/> <repeats value="true"/> <item> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl"> <valueCodeableConcept> <coding> <system value="http://hl7.org/fhir/questionnaire-item-control"/> <code value="flyover"/> <display value="Fly-over"/> </coding> </valueCodeableConcept> </extension> <text value="unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces."/> <type value="display"/> </item> <item> <linkId value="ClaimResponse.item.detail.id.value"/> <text value="xml:id (or equivalent in JSON)"/> <type value="string"/> <required value="false"/> <repeats value="false"/> </item> </item> <item> <linkId value="ClaimResponse.item.detail.extension"/> <text value="Additional Content defined by implementations"/> <type value="group"/> <required value="false"/> <repeats value="true"/> <item> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl"> <valueCodeableConcept> <coding> <system value="http://hl7.org/fhir/questionnaire-item-control"/> <code value="flyover"/> <display value="Fly-over"/> </coding> </valueCodeableConcept> </extension> <text value="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 value="display"/> </item> </item> <item> <linkId value="ClaimResponse.item.detail.modifierExtension"/> <text value="Extensions that cannot be ignored"/> <type value="group"/> <required value="false"/> <repeats value="true"/> <item> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl"> <valueCodeableConcept> <coding> <system value="http://hl7.org/fhir/questionnaire-item-control"/> <code value="flyover"/> <display value="Fly-over"/> </coding> </valueCodeableConcept> </extension> <text value="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 value="display"/> </item> </item> <item> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-minOccurs"> <valueInteger value="1"/> </extension> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs"> <valueInteger value="1"/> </extension> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType"> <valueString value="integer"/> </extension> <linkId value="ClaimResponse.item.detail.sequenceLinkId"/> <type value="group"/> <required value="true"/> <repeats value="true"/> <item> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl"> <valueCodeableConcept> <coding> <system value="http://hl7.org/fhir/questionnaire-item-control"/> <code value="flyover"/> <display value="Fly-over"/> </coding> </valueCodeableConcept> </extension> <text value="A service line number."/> <type value="display"/> </item> <item> <linkId value="ClaimResponse.item.detail.sequenceLinkId.value"/> <text value="Service instance"/> <type value="integer"/> <required value="false"/> <repeats value="false"/> </item> </item> <item> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType"> <valueString value="integer"/> </extension> <linkId value="ClaimResponse.item.detail.noteNumber"/> <type value="group"/> <required value="false"/> <repeats value="true"/> <item> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl"> <valueCodeableConcept> <coding> <system value="http://hl7.org/fhir/questionnaire-item-control"/> <code value="flyover"/> <display value="Fly-over"/> </coding> </valueCodeableConcept> </extension> <text value="A list of note references to the notes provided below."/> <type value="display"/> </item> <item> <linkId value="ClaimResponse.item.detail.noteNumber.value"/> <text value="List of note numbers which apply"/> <type value="integer"/> <required value="false"/> <repeats value="false"/> </item> </item> <item> <linkId value="ClaimResponse.item.detail.adjudication"/> <text value="Detail level adjudication details"/> <type value="group"/> <required value="false"/> <repeats value="true"/> <item> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl"> <valueCodeableConcept> <coding> <system value="http://hl7.org/fhir/questionnaire-item-control"/> <code value="flyover"/> <display value="Fly-over"/> </coding> </valueCodeableConcept> </extension> <text value="The adjudications results."/> <type value="display"/> </item> </item> <item> <linkId value="ClaimResponse.item.detail.subDetail"/> <text value="Subdetail line items"/> <type value="group"/> <required value="false"/> <repeats value="true"/> <item> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl"> <valueCodeableConcept> <coding> <system value="http://hl7.org/fhir/questionnaire-item-control"/> <code value="flyover"/> <display value="Fly-over"/> </coding> </valueCodeableConcept> </extension> <text value="The third tier service adjudications for submitted services."/> <type value="display"/> </item> <item> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs"> <valueInteger value="1"/> </extension> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType"> <valueString value="string"/> </extension> <linkId value="ClaimResponse.item.detail.subDetail.id"/> <type value="group"/> <required value="false"/> <repeats value="true"/> <item> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl"> <valueCodeableConcept> <coding> <system value="http://hl7.org/fhir/questionnaire-item-control"/> <code value="flyover"/> <display value="Fly-over"/> </coding> </valueCodeableConcept> </extension> <text value="unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces."/> <type value="display"/> </item> <item> <linkId value="ClaimResponse.item.detail.subDetail.id.value"/> <text value="xml:id (or equivalent in JSON)"/> <type value="string"/> <required value="false"/> <repeats value="false"/> </item> </item> <item> <linkId value="ClaimResponse.item.detail.subDetail.extension"/> <text value="Additional Content defined by implementations"/> <type value="group"/> <required value="false"/> <repeats value="true"/> <item> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl"> <valueCodeableConcept> <coding> <system value="http://hl7.org/fhir/questionnaire-item-control"/> <code value="flyover"/> <display value="Fly-over"/> </coding> </valueCodeableConcept> </extension> <text value="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 value="display"/> </item> </item> <item> <linkId value="ClaimResponse.item.detail.subDetail.modifierExtension"/> <text value="Extensions that cannot be ignored"/> <type value="group"/> <required value="false"/> <repeats value="true"/> <item> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl"> <valueCodeableConcept> <coding> <system value="http://hl7.org/fhir/questionnaire-item-control"/> <code value="flyover"/> <display value="Fly-over"/> </coding> </valueCodeableConcept> </extension> <text value="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 value="display"/> </item> </item> <item> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-minOccurs"> <valueInteger value="1"/> </extension> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs"> <valueInteger value="1"/> </extension> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType"> <valueString value="integer"/> </extension> <linkId value="ClaimResponse.item.detail.subDetail.sequenceLinkId"/> <type value="group"/> <required value="true"/> <repeats value="true"/> <item> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl"> <valueCodeableConcept> <coding> <system value="http://hl7.org/fhir/questionnaire-item-control"/> <code value="flyover"/> <display value="Fly-over"/> </coding> </valueCodeableConcept> </extension> <text value="A service line number."/> <type value="display"/> </item> <item> <linkId value="ClaimResponse.item.detail.subDetail.sequenceLinkId.value"/> <text value="Service instance"/> <type value="integer"/> <required value="false"/> <repeats value="false"/> </item> </item> <item> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType"> <valueString value="integer"/> </extension> <linkId value="ClaimResponse.item.detail.subDetail.noteNumber"/> <type value="group"/> <required value="false"/> <repeats value="true"/> <item> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl"> <valueCodeableConcept> <coding> <system value="http://hl7.org/fhir/questionnaire-item-control"/> <code value="flyover"/> <display value="Fly-over"/> </coding> </valueCodeableConcept> </extension> <text value="A list of note references to the notes provided below."/> <type value="display"/> </item> <item> <linkId value="ClaimResponse.item.detail.subDetail.noteNumber.value"/> <text value="List of note numbers which apply"/> <type value="integer"/> <required value="false"/> <repeats value="false"/> </item> </item> <item> <linkId value="ClaimResponse.item.detail.subDetail.adjudication"/> <text value="Subdetail level adjudication details"/> <type value="group"/> <required value="false"/> <repeats value="true"/> <item> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl"> <valueCodeableConcept> <coding> <system value="http://hl7.org/fhir/questionnaire-item-control"/> <code value="flyover"/> <display value="Fly-over"/> </coding> </valueCodeableConcept> </extension> <text value="The adjudications results."/> <type value="display"/> </item> </item> </item> </item> </item> <item> <linkId value="ClaimResponse.addItem"/> <text value="Insurer added line items"/> <type value="group"/> <required value="false"/> <repeats value="true"/> <item> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl"> <valueCodeableConcept> <coding> <system value="http://hl7.org/fhir/questionnaire-item-control"/> <code value="flyover"/> <display value="Fly-over"/> </coding> </valueCodeableConcept> </extension> <text value="The first tier service adjudications for payor added services."/> <type value="display"/> </item> <item> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs"> <valueInteger value="1"/> </extension> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType"> <valueString value="string"/> </extension> <linkId value="ClaimResponse.addItem.id"/> <type value="group"/> <required value="false"/> <repeats value="true"/> <item> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl"> <valueCodeableConcept> <coding> <system value="http://hl7.org/fhir/questionnaire-item-control"/> <code value="flyover"/> <display value="Fly-over"/> </coding> </valueCodeableConcept> </extension> <text value="unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces."/> <type value="display"/> </item> <item> <linkId value="ClaimResponse.addItem.id.value"/> <text value="xml:id (or equivalent in JSON)"/> <type value="string"/> <required value="false"/> <repeats value="false"/> </item> </item> <item> <linkId value="ClaimResponse.addItem.extension"/> <text value="Additional Content defined by implementations"/> <type value="group"/> <required value="false"/> <repeats value="true"/> <item> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl"> <valueCodeableConcept> <coding> <system value="http://hl7.org/fhir/questionnaire-item-control"/> <code value="flyover"/> <display value="Fly-over"/> </coding> </valueCodeableConcept> </extension> <text value="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 value="display"/> </item> </item> <item> <linkId value="ClaimResponse.addItem.modifierExtension"/> <text value="Extensions that cannot be ignored"/> <type value="group"/> <required value="false"/> <repeats value="true"/> <item> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl"> <valueCodeableConcept> <coding> <system value="http://hl7.org/fhir/questionnaire-item-control"/> <code value="flyover"/> <display value="Fly-over"/> </coding> </valueCodeableConcept> </extension> <text value="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 value="display"/> </item> </item> <item> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType"> <valueString value="integer"/> </extension> <linkId value="ClaimResponse.addItem.sequenceLinkId"/> <type value="group"/> <required value="false"/> <repeats value="true"/> <item> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl"> <valueCodeableConcept> <coding> <system value="http://hl7.org/fhir/questionnaire-item-control"/> <code value="flyover"/> <display value="Fly-over"/> </coding> </valueCodeableConcept> </extension> <text value="List of input service items which this service line is intended to replace."/> <type value="display"/> </item> <item> <linkId value="ClaimResponse.addItem.sequenceLinkId.value"/> <text value="Service instances"/> <type value="integer"/> <required value="false"/> <repeats value="false"/> </item> </item> <item> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs"> <valueInteger value="1"/> </extension> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType"> <valueString value="CodeableConcept"/> </extension> <linkId value="ClaimResponse.addItem.revenue"/> <text value="Revenue or cost center code"/> <type value="group"/> <required value="false"/> <repeats value="true"/> <item> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl"> <valueCodeableConcept> <coding> <system value="http://hl7.org/fhir/questionnaire-item-control"/> <code value="flyover"/> <display value="Fly-over"/> </coding> </valueCodeableConcept> </extension> <text value="The type of reveneu or cost center providing the product and/or service."/> <type value="display"/> </item> <item> <linkId value="ClaimResponse.addItem.revenue.coding"/> <text value="code:"/> <type value="open-choice"/> <required value="false"/> <repeats value="false"/> </item> <item> <linkId value="ClaimResponse.addItem.revenue.text"/> <text value="text:"/> <type value="string"/> <required value="false"/> <repeats value="false"/> </item> </item> <item> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs"> <valueInteger value="1"/> </extension> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType"> <valueString value="CodeableConcept"/> </extension> <linkId value="ClaimResponse.addItem.category"/> <text value="Type of service or product"/> <type value="group"/> <required value="false"/> <repeats value="true"/> <item> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl"> <valueCodeableConcept> <coding> <system value="http://hl7.org/fhir/questionnaire-item-control"/> <code value="flyover"/> <display value="Fly-over"/> </coding> </valueCodeableConcept> </extension> <text value="Health Care Service Type Codes to identify the classification of service or benefits."/> <type value="display"/> </item> <item> <linkId value="ClaimResponse.addItem.category.coding"/> <text value="code:"/> <type value="open-choice"/> <required value="false"/> <repeats value="false"/> </item> <item> <linkId value="ClaimResponse.addItem.category.text"/> <text value="text:"/> <type value="string"/> <required value="false"/> <repeats value="false"/> </item> </item> <item> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs"> <valueInteger value="1"/> </extension> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType"> <valueString value="CodeableConcept"/> </extension> <linkId value="ClaimResponse.addItem.service"/> <text value="Group, Service or Product"/> <type value="group"/> <required value="false"/> <repeats value="true"/> <item> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl"> <valueCodeableConcept> <coding> <system value="http://hl7.org/fhir/questionnaire-item-control"/> <code value="flyover"/> <display value="Fly-over"/> </coding> </valueCodeableConcept> </extension> <text value="A code to indicate the Professional Service or Product supplied."/> <type value="display"/> </item> <item> <linkId value="ClaimResponse.addItem.service.coding"/> <text value="code:"/> <type value="open-choice"/> <required value="false"/> <repeats value="false"/> </item> <item> <linkId value="ClaimResponse.addItem.service.text"/> <text value="text:"/> <type value="string"/> <required value="false"/> <repeats value="false"/> </item> </item> <item> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType"> <valueString value="CodeableConcept"/> </extension> <linkId value="ClaimResponse.addItem.modifier"/> <text value="Service/Product billing modifiers"/> <type value="group"/> <required value="false"/> <repeats value="true"/> <item> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl"> <valueCodeableConcept> <coding> <system value="http://hl7.org/fhir/questionnaire-item-control"/> <code value="flyover"/> <display value="Fly-over"/> </coding> </valueCodeableConcept> </extension> <text value="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 value="display"/> </item> <item> <linkId value="ClaimResponse.addItem.modifier.coding"/> <text value="code:"/> <type value="open-choice"/> <required value="false"/> <repeats value="false"/> </item> <item> <linkId value="ClaimResponse.addItem.modifier.text"/> <text value="text:"/> <type value="string"/> <required value="false"/> <repeats value="false"/> </item> </item> <item> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs"> <valueInteger value="1"/> </extension> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType"> <valueString value="Quantity"/> </extension> <linkId value="ClaimResponse.addItem.fee"/> <text value="Professional fee or Product charge"/> <type value="group"/> <required value="false"/> <repeats value="true"/> <item> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl"> <valueCodeableConcept> <coding> <system value="http://hl7.org/fhir/questionnaire-item-control"/> <code value="flyover"/> <display value="Fly-over"/> </coding> </valueCodeableConcept> </extension> <text value="The fee charged for the professional service or product.."/> <type value="display"/> </item> <item> <linkId value="ClaimResponse.addItem.fee.comparator"/> <text value="comp:"/> <type value="choice"/> <required value="false"/> <repeats value="false"/> </item> <item> <linkId value="ClaimResponse.addItem.fee.value"/> <text value="value:"/> <type value="decimal"/> <required value="false"/> <repeats value="false"/> </item> <item> <linkId value="ClaimResponse.addItem.fee.units"/> <text value="units:"/> <type value="string"/> <required value="false"/> <repeats value="false"/> </item> <item> <linkId value="ClaimResponse.addItem.fee.code"/> <text value="coded units:"/> <type value="string"/> <required value="false"/> <repeats value="false"/> </item> <item> <linkId value="ClaimResponse.addItem.fee.system"/> <text value="units system:"/> <type value="string"/> <required value="false"/> <repeats value="false"/> </item> </item> <item> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType"> <valueString value="integer"/> </extension> <linkId value="ClaimResponse.addItem.noteNumber"/> <type value="group"/> <required value="false"/> <repeats value="true"/> <item> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl"> <valueCodeableConcept> <coding> <system value="http://hl7.org/fhir/questionnaire-item-control"/> <code value="flyover"/> <display value="Fly-over"/> </coding> </valueCodeableConcept> </extension> <text value="A list of note references to the notes provided below."/> <type value="display"/> </item> <item> <linkId value="ClaimResponse.addItem.noteNumber.value"/> <text value="List of note numbers which apply"/> <type value="integer"/> <required value="false"/> <repeats value="false"/> </item> </item> <item> <linkId value="ClaimResponse.addItem.adjudication"/> <text value="Added items adjudication"/> <type value="group"/> <required value="false"/> <repeats value="true"/> <item> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl"> <valueCodeableConcept> <coding> <system value="http://hl7.org/fhir/questionnaire-item-control"/> <code value="flyover"/> <display value="Fly-over"/> </coding> </valueCodeableConcept> </extension> <text value="The adjudications results."/> <type value="display"/> </item> </item> <item> <linkId value="ClaimResponse.addItem.detail"/> <text value="Added items details"/> <type value="group"/> <required value="false"/> <repeats value="true"/> <item> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl"> <valueCodeableConcept> <coding> <system value="http://hl7.org/fhir/questionnaire-item-control"/> <code value="flyover"/> <display value="Fly-over"/> </coding> </valueCodeableConcept> </extension> <text value="The second tier service adjudications for payor added services."/> <type value="display"/> </item> <item> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs"> <valueInteger value="1"/> </extension> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType"> <valueString value="string"/> </extension> <linkId value="ClaimResponse.addItem.detail.id"/> <type value="group"/> <required value="false"/> <repeats value="true"/> <item> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl"> <valueCodeableConcept> <coding> <system value="http://hl7.org/fhir/questionnaire-item-control"/> <code value="flyover"/> <display value="Fly-over"/> </coding> </valueCodeableConcept> </extension> <text value="unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces."/> <type value="display"/> </item> <item> <linkId value="ClaimResponse.addItem.detail.id.value"/> <text value="xml:id (or equivalent in JSON)"/> <type value="string"/> <required value="false"/> <repeats value="false"/> </item> </item> <item> <linkId value="ClaimResponse.addItem.detail.extension"/> <text value="Additional Content defined by implementations"/> <type value="group"/> <required value="false"/> <repeats value="true"/> <item> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl"> <valueCodeableConcept> <coding> <system value="http://hl7.org/fhir/questionnaire-item-control"/> <code value="flyover"/> <display value="Fly-over"/> </coding> </valueCodeableConcept> </extension> <text value="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 value="display"/> </item> </item> <item> <linkId value="ClaimResponse.addItem.detail.modifierExtension"/> <text value="Extensions that cannot be ignored"/> <type value="group"/> <required value="false"/> <repeats value="true"/> <item> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl"> <valueCodeableConcept> <coding> <system value="http://hl7.org/fhir/questionnaire-item-control"/> <code value="flyover"/> <display value="Fly-over"/> </coding> </valueCodeableConcept> </extension> <text value="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 value="display"/> </item> </item> <item> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs"> <valueInteger value="1"/> </extension> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType"> <valueString value="CodeableConcept"/> </extension> <linkId value="ClaimResponse.addItem.detail.revenue"/> <text value="Revenue or cost center code"/> <type value="group"/> <required value="false"/> <repeats value="true"/> <item> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl"> <valueCodeableConcept> <coding> <system value="http://hl7.org/fhir/questionnaire-item-control"/> <code value="flyover"/> <display value="Fly-over"/> </coding> </valueCodeableConcept> </extension> <text value="The type of reveneu or cost center providing the product and/or service."/> <type value="display"/> </item> <item> <linkId value="ClaimResponse.addItem.detail.revenue.coding"/> <text value="code:"/> <type value="open-choice"/> <required value="false"/> <repeats value="false"/> </item> <item> <linkId value="ClaimResponse.addItem.detail.revenue.text"/> <text value="text:"/> <type value="string"/> <required value="false"/> <repeats value="false"/> </item> </item> <item> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs"> <valueInteger value="1"/> </extension> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType"> <valueString value="CodeableConcept"/> </extension> <linkId value="ClaimResponse.addItem.detail.category"/> <text value="Type of service or product"/> <type value="group"/> <required value="false"/> <repeats value="true"/> <item> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl"> <valueCodeableConcept> <coding> <system value="http://hl7.org/fhir/questionnaire-item-control"/> <code value="flyover"/> <display value="Fly-over"/> </coding> </valueCodeableConcept> </extension> <text value="Health Care Service Type Codes to identify the classification of service or benefits."/> <type value="display"/> </item> <item> <linkId value="ClaimResponse.addItem.detail.category.coding"/> <text value="code:"/> <type value="open-choice"/> <required value="false"/> <repeats value="false"/> </item> <item> <linkId value="ClaimResponse.addItem.detail.category.text"/> <text value="text:"/> <type value="string"/> <required value="false"/> <repeats value="false"/> </item> </item> <item> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs"> <valueInteger value="1"/> </extension> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType"> <valueString value="CodeableConcept"/> </extension> <linkId value="ClaimResponse.addItem.detail.service"/> <text value="Service or Product"/> <type value="group"/> <required value="false"/> <repeats value="true"/> <item> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl"> <valueCodeableConcept> <coding> <system value="http://hl7.org/fhir/questionnaire-item-control"/> <code value="flyover"/> <display value="Fly-over"/> </coding> </valueCodeableConcept> </extension> <text value="A code to indicate the Professional Service or Product supplied."/> <type value="display"/> </item> <item> <linkId value="ClaimResponse.addItem.detail.service.coding"/> <text value="code:"/> <type value="open-choice"/> <required value="false"/> <repeats value="false"/> </item> <item> <linkId value="ClaimResponse.addItem.detail.service.text"/> <text value="text:"/> <type value="string"/> <required value="false"/> <repeats value="false"/> </item> </item> <item> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType"> <valueString value="CodeableConcept"/> </extension> <linkId value="ClaimResponse.addItem.detail.modifier"/> <text value="Service/Product billing modifiers"/> <type value="group"/> <required value="false"/> <repeats value="true"/> <item> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl"> <valueCodeableConcept> <coding> <system value="http://hl7.org/fhir/questionnaire-item-control"/> <code value="flyover"/> <display value="Fly-over"/> </coding> </valueCodeableConcept> </extension> <text value="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 value="display"/> </item> <item> <linkId value="ClaimResponse.addItem.detail.modifier.coding"/> <text value="code:"/> <type value="open-choice"/> <required value="false"/> <repeats value="false"/> </item> <item> <linkId value="ClaimResponse.addItem.detail.modifier.text"/> <text value="text:"/> <type value="string"/> <required value="false"/> <repeats value="false"/> </item> </item> <item> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs"> <valueInteger value="1"/> </extension> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType"> <valueString value="Quantity"/> </extension> <linkId value="ClaimResponse.addItem.detail.fee"/> <text value="Professional fee or Product charge"/> <type value="group"/> <required value="false"/> <repeats value="true"/> <item> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl"> <valueCodeableConcept> <coding> <system value="http://hl7.org/fhir/questionnaire-item-control"/> <code value="flyover"/> <display value="Fly-over"/> </coding> </valueCodeableConcept> </extension> <text value="The fee charged for the professional service or product.."/> <type value="display"/> </item> <item> <linkId value="ClaimResponse.addItem.detail.fee.comparator"/> <text value="comp:"/> <type value="choice"/> <required value="false"/> <repeats value="false"/> </item> <item> <linkId value="ClaimResponse.addItem.detail.fee.value"/> <text value="value:"/> <type value="decimal"/> <required value="false"/> <repeats value="false"/> </item> <item> <linkId value="ClaimResponse.addItem.detail.fee.units"/> <text value="units:"/> <type value="string"/> <required value="false"/> <repeats value="false"/> </item> <item> <linkId value="ClaimResponse.addItem.detail.fee.code"/> <text value="coded units:"/> <type value="string"/> <required value="false"/> <repeats value="false"/> </item> <item> <linkId value="ClaimResponse.addItem.detail.fee.system"/> <text value="units system:"/> <type value="string"/> <required value="false"/> <repeats value="false"/> </item> </item> <item> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType"> <valueString value="integer"/> </extension> <linkId value="ClaimResponse.addItem.detail.noteNumber"/> <type value="group"/> <required value="false"/> <repeats value="true"/> <item> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl"> <valueCodeableConcept> <coding> <system value="http://hl7.org/fhir/questionnaire-item-control"/> <code value="flyover"/> <display value="Fly-over"/> </coding> </valueCodeableConcept> </extension> <text value="A list of note references to the notes provided below."/> <type value="display"/> </item> <item> <linkId value="ClaimResponse.addItem.detail.noteNumber.value"/> <text value="List of note numbers which apply"/> <type value="integer"/> <required value="false"/> <repeats value="false"/> </item> </item> <item> <linkId value="ClaimResponse.addItem.detail.adjudication"/> <text value="Added items detail adjudication"/> <type value="group"/> <required value="false"/> <repeats value="true"/> <item> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl"> <valueCodeableConcept> <coding> <system value="http://hl7.org/fhir/questionnaire-item-control"/> <code value="flyover"/> <display value="Fly-over"/> </coding> </valueCodeableConcept> </extension> <text value="The adjudications results."/> <type value="display"/> </item> </item> </item> </item> <item> <linkId value="ClaimResponse.error"/> <text value="Processing errors"/> <type value="group"/> <required value="false"/> <repeats value="true"/> <item> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl"> <valueCodeableConcept> <coding> <system value="http://hl7.org/fhir/questionnaire-item-control"/> <code value="flyover"/> <display value="Fly-over"/> </coding> </valueCodeableConcept> </extension> <text value="Mutually exclusive with Services Provided (Item)."/> <type value="display"/> </item> <item> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs"> <valueInteger value="1"/> </extension> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType"> <valueString value="string"/> </extension> <linkId value="ClaimResponse.error.id"/> <type value="group"/> <required value="false"/> <repeats value="true"/> <item> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl"> <valueCodeableConcept> <coding> <system value="http://hl7.org/fhir/questionnaire-item-control"/> <code value="flyover"/> <display value="Fly-over"/> </coding> </valueCodeableConcept> </extension> <text value="unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces."/> <type value="display"/> </item> <item> <linkId value="ClaimResponse.error.id.value"/> <text value="xml:id (or equivalent in JSON)"/> <type value="string"/> <required value="false"/> <repeats value="false"/> </item> </item> <item> <linkId value="ClaimResponse.error.extension"/> <text value="Additional Content defined by implementations"/> <type value="group"/> <required value="false"/> <repeats value="true"/> <item> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl"> <valueCodeableConcept> <coding> <system value="http://hl7.org/fhir/questionnaire-item-control"/> <code value="flyover"/> <display value="Fly-over"/> </coding> </valueCodeableConcept> </extension> <text value="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 value="display"/> </item> </item> <item> <linkId value="ClaimResponse.error.modifierExtension"/> <text value="Extensions that cannot be ignored"/> <type value="group"/> <required value="false"/> <repeats value="true"/> <item> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl"> <valueCodeableConcept> <coding> <system value="http://hl7.org/fhir/questionnaire-item-control"/> <code value="flyover"/> <display value="Fly-over"/> </coding> </valueCodeableConcept> </extension> <text value="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 value="display"/> </item> </item> <item> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs"> <valueInteger value="1"/> </extension> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType"> <valueString value="integer"/> </extension> <linkId value="ClaimResponse.error.sequenceLinkId"/> <type value="group"/> <required value="false"/> <repeats value="true"/> <item> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl"> <valueCodeableConcept> <coding> <system value="http://hl7.org/fhir/questionnaire-item-control"/> <code value="flyover"/> <display value="Fly-over"/> </coding> </valueCodeableConcept> </extension> <text value="The sequence number of the line item submitted which contains the error. This value is omitted when the error is elsewhere."/> <type value="display"/> </item> <item> <linkId value="ClaimResponse.error.sequenceLinkId.value"/> <text value="Item sequence number"/> <type value="integer"/> <required value="false"/> <repeats value="false"/> </item> </item> <item> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs"> <valueInteger value="1"/> </extension> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType"> <valueString value="integer"/> </extension> <linkId value="ClaimResponse.error.detailSequenceLinkId"/> <type value="group"/> <required value="false"/> <repeats value="true"/> <item> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl"> <valueCodeableConcept> <coding> <system value="http://hl7.org/fhir/questionnaire-item-control"/> <code value="flyover"/> <display value="Fly-over"/> </coding> </valueCodeableConcept> </extension> <text value="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 value="display"/> </item> <item> <linkId value="ClaimResponse.error.detailSequenceLinkId.value"/> <text value="Detail sequence number"/> <type value="integer"/> <required value="false"/> <repeats value="false"/> </item> </item> <item> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs"> <valueInteger value="1"/> </extension> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType"> <valueString value="integer"/> </extension> <linkId value="ClaimResponse.error.subdetailSequenceLinkId"/> <type value="group"/> <required value="false"/> <repeats value="true"/> <item> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl"> <valueCodeableConcept> <coding> <system value="http://hl7.org/fhir/questionnaire-item-control"/> <code value="flyover"/> <display value="Fly-over"/> </coding> </valueCodeableConcept> </extension> <text value="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 value="display"/> </item> <item> <linkId value="ClaimResponse.error.subdetailSequenceLinkId.value"/> <text value="Subdetail sequence number"/> <type value="integer"/> <required value="false"/> <repeats value="false"/> </item> </item> <item> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-minOccurs"> <valueInteger value="1"/> </extension> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs"> <valueInteger value="1"/> </extension> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType"> <valueString value="CodeableConcept"/> </extension> <linkId value="ClaimResponse.error.code"/> <text value="Error code detailing processing issues"/> <type value="group"/> <required value="true"/> <repeats value="true"/> <item> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl"> <valueCodeableConcept> <coding> <system value="http://hl7.org/fhir/questionnaire-item-control"/> <code value="flyover"/> <display value="Fly-over"/> </coding> </valueCodeableConcept> </extension> <text value="An error code,from a specified code system, which details why the claim could not be adjudicated."/> <type value="display"/> </item> <item> <linkId value="ClaimResponse.error.code.coding"/> <text value="code:"/> <type value="open-choice"/> <required value="false"/> <repeats value="false"/> </item> <item> <linkId value="ClaimResponse.error.code.text"/> <text value="text:"/> <type value="string"/> <required value="false"/> <repeats value="false"/> </item> </item> </item> <item> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs"> <valueInteger value="1"/> </extension> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType"> <valueString value="Quantity"/> </extension> <linkId value="ClaimResponse.totalCost"/> <text value="Total Cost of service from the Claim"/> <type value="group"/> <required value="false"/> <repeats value="true"/> <item> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl"> <valueCodeableConcept> <coding> <system value="http://hl7.org/fhir/questionnaire-item-control"/> <code value="flyover"/> <display value="Fly-over"/> </coding> </valueCodeableConcept> </extension> <text value="The total cost of the services reported."/> <type value="display"/> </item> <item> <linkId value="ClaimResponse.totalCost.comparator"/> <text value="comp:"/> <type value="choice"/> <required value="false"/> <repeats value="false"/> </item> <item> <linkId value="ClaimResponse.totalCost.value"/> <text value="value:"/> <type value="decimal"/> <required value="false"/> <repeats value="false"/> </item> <item> <linkId value="ClaimResponse.totalCost.units"/> <text value="units:"/> <type value="string"/> <required value="false"/> <repeats value="false"/> </item> <item> <linkId value="ClaimResponse.totalCost.code"/> <text value="coded units:"/> <type value="string"/> <required value="false"/> <repeats value="false"/> </item> <item> <linkId value="ClaimResponse.totalCost.system"/> <text value="units system:"/> <type value="string"/> <required value="false"/> <repeats value="false"/> </item> </item> <item> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs"> <valueInteger value="1"/> </extension> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType"> <valueString value="Quantity"/> </extension> <linkId value="ClaimResponse.unallocDeductable"/> <text value="Unallocated deductible"/> <type value="group"/> <required value="false"/> <repeats value="true"/> <item> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl"> <valueCodeableConcept> <coding> <system value="http://hl7.org/fhir/questionnaire-item-control"/> <code value="flyover"/> <display value="Fly-over"/> </coding> </valueCodeableConcept> </extension> <text value="The amount of deductible applied which was not allocated to any particular service line."/> <type value="display"/> </item> <item> <linkId value="ClaimResponse.unallocDeductable.comparator"/> <text value="comp:"/> <type value="choice"/> <required value="false"/> <repeats value="false"/> </item> <item> <linkId value="ClaimResponse.unallocDeductable.value"/> <text value="value:"/> <type value="decimal"/> <required value="false"/> <repeats value="false"/> </item> <item> <linkId value="ClaimResponse.unallocDeductable.units"/> <text value="units:"/> <type value="string"/> <required value="false"/> <repeats value="false"/> </item> <item> <linkId value="ClaimResponse.unallocDeductable.code"/> <text value="coded units:"/> <type value="string"/> <required value="false"/> <repeats value="false"/> </item> <item> <linkId value="ClaimResponse.unallocDeductable.system"/> <text value="units system:"/> <type value="string"/> <required value="false"/> <repeats value="false"/> </item> </item> <item> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs"> <valueInteger value="1"/> </extension> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType"> <valueString value="Quantity"/> </extension> <linkId value="ClaimResponse.totalBenefit"/> <text value="Total benefit payable for the Claim"/> <type value="group"/> <required value="false"/> <repeats value="true"/> <item> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl"> <valueCodeableConcept> <coding> <system value="http://hl7.org/fhir/questionnaire-item-control"/> <code value="flyover"/> <display value="Fly-over"/> </coding> </valueCodeableConcept> </extension> <text value="Total amount of benefit payable (Equal to sum of the Benefit amounts from all detail lines and additions less the Unallocated Deductible)."/> <type value="display"/> </item> <item> <linkId value="ClaimResponse.totalBenefit.comparator"/> <text value="comp:"/> <type value="choice"/> <required value="false"/> <repeats value="false"/> </item> <item> <linkId value="ClaimResponse.totalBenefit.value"/> <text value="value:"/> <type value="decimal"/> <required value="false"/> <repeats value="false"/> </item> <item> <linkId value="ClaimResponse.totalBenefit.units"/> <text value="units:"/> <type value="string"/> <required value="false"/> <repeats value="false"/> </item> <item> <linkId value="ClaimResponse.totalBenefit.code"/> <text value="coded units:"/> <type value="string"/> <required value="false"/> <repeats value="false"/> </item> <item> <linkId value="ClaimResponse.totalBenefit.system"/> <text value="units system:"/> <type value="string"/> <required value="false"/> <repeats value="false"/> </item> </item> <item> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs"> <valueInteger value="1"/> </extension> <linkId value="ClaimResponse.payment"/> <text value="Payment details, if paid"/> <type value="group"/> <required value="false"/> <repeats value="false"/> <item> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl"> <valueCodeableConcept> <coding> <system value="http://hl7.org/fhir/questionnaire-item-control"/> <code value="flyover"/> <display value="Fly-over"/> </coding> </valueCodeableConcept> </extension> <text value="Payment details for the claim if the claim has been paid."/> <type value="display"/> </item> <item> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs"> <valueInteger value="1"/> </extension> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType"> <valueString value="string"/> </extension> <linkId value="ClaimResponse.payment.id"/> <type value="group"/> <required value="false"/> <repeats value="true"/> <item> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl"> <valueCodeableConcept> <coding> <system value="http://hl7.org/fhir/questionnaire-item-control"/> <code value="flyover"/> <display value="Fly-over"/> </coding> </valueCodeableConcept> </extension> <text value="unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces."/> <type value="display"/> </item> <item> <linkId value="ClaimResponse.payment.id.value"/> <text value="xml:id (or equivalent in JSON)"/> <type value="string"/> <required value="false"/> <repeats value="false"/> </item> </item> <item> <linkId value="ClaimResponse.payment.extension"/> <text value="Additional Content defined by implementations"/> <type value="group"/> <required value="false"/> <repeats value="true"/> <item> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl"> <valueCodeableConcept> <coding> <system value="http://hl7.org/fhir/questionnaire-item-control"/> <code value="flyover"/> <display value="Fly-over"/> </coding> </valueCodeableConcept> </extension> <text value="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 value="display"/> </item> </item> <item> <linkId value="ClaimResponse.payment.modifierExtension"/> <text value="Extensions that cannot be ignored"/> <type value="group"/> <required value="false"/> <repeats value="true"/> <item> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl"> <valueCodeableConcept> <coding> <system value="http://hl7.org/fhir/questionnaire-item-control"/> <code value="flyover"/> <display value="Fly-over"/> </coding> </valueCodeableConcept> </extension> <text value="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 value="display"/> </item> </item> <item> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs"> <valueInteger value="1"/> </extension> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType"> <valueString value="CodeableConcept"/> </extension> <linkId value="ClaimResponse.payment.type"/> <text value="Partial or Complete"/> <type value="group"/> <required value="false"/> <repeats value="true"/> <item> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl"> <valueCodeableConcept> <coding> <system value="http://hl7.org/fhir/questionnaire-item-control"/> <code value="flyover"/> <display value="Fly-over"/> </coding> </valueCodeableConcept> </extension> <text value="Whether this represents partial or complete payment of the claim."/> <type value="display"/> </item> <item> <linkId value="ClaimResponse.payment.type.coding"/> <text value="code:"/> <type value="open-choice"/> <required value="false"/> <repeats value="false"/> </item> <item> <linkId value="ClaimResponse.payment.type.text"/> <text value="text:"/> <type value="string"/> <required value="false"/> <repeats value="false"/> </item> </item> <item> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs"> <valueInteger value="1"/> </extension> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType"> <valueString value="Quantity"/> </extension> <linkId value="ClaimResponse.payment.adjustment"/> <text value="Payment adjustment for non-Claim issues"/> <type value="group"/> <required value="false"/> <repeats value="true"/> <item> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl"> <valueCodeableConcept> <coding> <system value="http://hl7.org/fhir/questionnaire-item-control"/> <code value="flyover"/> <display value="Fly-over"/> </coding> </valueCodeableConcept> </extension> <text value="Adjustment to the payment of this transaction which is not related to adjudication of this transaction."/> <type value="display"/> </item> <item> <linkId value="ClaimResponse.payment.adjustment.comparator"/> <text value="comp:"/> <type value="choice"/> <required value="false"/> <repeats value="false"/> </item> <item> <linkId value="ClaimResponse.payment.adjustment.value"/> <text value="value:"/> <type value="decimal"/> <required value="false"/> <repeats value="false"/> </item> <item> <linkId value="ClaimResponse.payment.adjustment.units"/> <text value="units:"/> <type value="string"/> <required value="false"/> <repeats value="false"/> </item> <item> <linkId value="ClaimResponse.payment.adjustment.code"/> <text value="coded units:"/> <type value="string"/> <required value="false"/> <repeats value="false"/> </item> <item> <linkId value="ClaimResponse.payment.adjustment.system"/> <text value="units system:"/> <type value="string"/> <required value="false"/> <repeats value="false"/> </item> </item> <item> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs"> <valueInteger value="1"/> </extension> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType"> <valueString value="CodeableConcept"/> </extension> <linkId value="ClaimResponse.payment.adjustmentReason"/> <text value="Explanation for the non-claim adjustment"/> <type value="group"/> <required value="false"/> <repeats value="true"/> <item> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl"> <valueCodeableConcept> <coding> <system value="http://hl7.org/fhir/questionnaire-item-control"/> <code value="flyover"/> <display value="Fly-over"/> </coding> </valueCodeableConcept> </extension> <text value="Reason for the payment adjustment."/> <type value="display"/> </item> <item> <linkId value="ClaimResponse.payment.adjustmentReason.coding"/> <text value="code:"/> <type value="open-choice"/> <required value="false"/> <repeats value="false"/> </item> <item> <linkId value="ClaimResponse.payment.adjustmentReason.text"/> <text value="text:"/> <type value="string"/> <required value="false"/> <repeats value="false"/> </item> </item> <item> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs"> <valueInteger value="1"/> </extension> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType"> <valueString value="datetime"/> </extension> <linkId value="ClaimResponse.payment.date"/> <type value="group"/> <required value="false"/> <repeats value="true"/> <item> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl"> <valueCodeableConcept> <coding> <system value="http://hl7.org/fhir/questionnaire-item-control"/> <code value="flyover"/> <display value="Fly-over"/> </coding> </valueCodeableConcept> </extension> <text value="Estimated payment data."/> <type value="display"/> </item> <item> <linkId value="ClaimResponse.payment.date.value"/> <text value="Expected data of Payment"/> <type value="dateTime"/> <required value="false"/> <repeats value="false"/> </item> </item> <item> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs"> <valueInteger value="1"/> </extension> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType"> <valueString value="Quantity"/> </extension> <linkId value="ClaimResponse.payment.amount"/> <text value="Payable amount after adjustment"/> <type value="group"/> <required value="false"/> <repeats value="true"/> <item> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl"> <valueCodeableConcept> <coding> <system value="http://hl7.org/fhir/questionnaire-item-control"/> <code value="flyover"/> <display value="Fly-over"/> </coding> </valueCodeableConcept> </extension> <text value="Payable less any payment adjustment."/> <type value="display"/> </item> <item> <linkId value="ClaimResponse.payment.amount.comparator"/> <text value="comp:"/> <type value="choice"/> <required value="false"/> <repeats value="false"/> </item> <item> <linkId value="ClaimResponse.payment.amount.value"/> <text value="value:"/> <type value="decimal"/> <required value="false"/> <repeats value="false"/> </item> <item> <linkId value="ClaimResponse.payment.amount.units"/> <text value="units:"/> <type value="string"/> <required value="false"/> <repeats value="false"/> </item> <item> <linkId value="ClaimResponse.payment.amount.code"/> <text value="coded units:"/> <type value="string"/> <required value="false"/> <repeats value="false"/> </item> <item> <linkId value="ClaimResponse.payment.amount.system"/> <text value="units system:"/> <type value="string"/> <required value="false"/> <repeats value="false"/> </item> </item> <item> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs"> <valueInteger value="1"/> </extension> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType"> <valueString value="Identifier"/> </extension> <linkId value="ClaimResponse.payment.identifier"/> <text value="Identifier of the payment instrument"/> <type value="group"/> <required value="false"/> <repeats value="true"/> <item> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl"> <valueCodeableConcept> <coding> <system value="http://hl7.org/fhir/questionnaire-item-control"/> <code value="flyover"/> <display value="Fly-over"/> </coding> </valueCodeableConcept> </extension> <text value="Payment identifier."/> <type value="display"/> </item> <item> <linkId value="ClaimResponse.payment.identifier.label"/> <text value="label:"/> <type value="string"/> <required value="false"/> <repeats value="false"/> </item> <item> <linkId value="ClaimResponse.payment.identifier.system"/> <text value="system:"/> <type value="string"/> <required value="false"/> <repeats value="false"/> </item> <item> <linkId value="ClaimResponse.payment.identifier.value"/> <text value="value:"/> <type value="string"/> <required value="false"/> <repeats value="false"/> </item> </item> </item> <item> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs"> <valueInteger value="1"/> </extension> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType"> <valueString value="Coding"/> </extension> <linkId value="ClaimResponse.reserved"/> <type value="group"/> <required value="false"/> <repeats value="true"/> <item> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl"> <valueCodeableConcept> <coding> <system value="http://hl7.org/fhir/questionnaire-item-control"/> <code value="flyover"/> <display value="Fly-over"/> </coding> </valueCodeableConcept> </extension> <text value="Status of funds reservation (For provider, for Patient, None)."/> <type value="display"/> </item> <item> <linkId value="ClaimResponse.reserved.value"/> <text value="Funds reserved status"/> <type value="open-choice"/> <required value="false"/> <repeats value="false"/> </item> </item> <item> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs"> <valueInteger value="1"/> </extension> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType"> <valueString value="CodeableConcept"/> </extension> <linkId value="ClaimResponse.form"/> <text value="Printed Form Identifier"/> <type value="group"/> <required value="false"/> <repeats value="true"/> <item> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl"> <valueCodeableConcept> <coding> <system value="http://hl7.org/fhir/questionnaire-item-control"/> <code value="flyover"/> <display value="Fly-over"/> </coding> </valueCodeableConcept> </extension> <text value="The form to be used for printing the content."/> <type value="display"/> </item> <item> <linkId value="ClaimResponse.form.coding"/> <text value="code:"/> <type value="open-choice"/> <required value="false"/> <repeats value="false"/> </item> <item> <linkId value="ClaimResponse.form.text"/> <text value="text:"/> <type value="string"/> <required value="false"/> <repeats value="false"/> </item> </item> <item> <linkId value="ClaimResponse.processNote"/> <text value="Processing notes"/> <type value="group"/> <required value="false"/> <repeats value="true"/> <item> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl"> <valueCodeableConcept> <coding> <system value="http://hl7.org/fhir/questionnaire-item-control"/> <code value="flyover"/> <display value="Fly-over"/> </coding> </valueCodeableConcept> </extension> <text value="Note text."/> <type value="display"/> </item> <item> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs"> <valueInteger value="1"/> </extension> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType"> <valueString value="string"/> </extension> <linkId value="ClaimResponse.processNote.id"/> <type value="group"/> <required value="false"/> <repeats value="true"/> <item> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl"> <valueCodeableConcept> <coding> <system value="http://hl7.org/fhir/questionnaire-item-control"/> <code value="flyover"/> <display value="Fly-over"/> </coding> </valueCodeableConcept> </extension> <text value="unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces."/> <type value="display"/> </item> <item> <linkId value="ClaimResponse.processNote.id.value"/> <text value="xml:id (or equivalent in JSON)"/> <type value="string"/> <required value="false"/> <repeats value="false"/> </item> </item> <item> <linkId value="ClaimResponse.processNote.extension"/> <text value="Additional Content defined by implementations"/> <type value="group"/> <required value="false"/> <repeats value="true"/> <item> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl"> <valueCodeableConcept> <coding> <system value="http://hl7.org/fhir/questionnaire-item-control"/> <code value="flyover"/> <display value="Fly-over"/> </coding> </valueCodeableConcept> </extension> <text value="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 value="display"/> </item> </item> <item> <linkId value="ClaimResponse.processNote.modifierExtension"/> <text value="Extensions that cannot be ignored"/> <type value="group"/> <required value="false"/> <repeats value="true"/> <item> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl"> <valueCodeableConcept> <coding> <system value="http://hl7.org/fhir/questionnaire-item-control"/> <code value="flyover"/> <display value="Fly-over"/> </coding> </valueCodeableConcept> </extension> <text value="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 value="display"/> </item> </item> <item> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs"> <valueInteger value="1"/> </extension> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType"> <valueString value="integer"/> </extension> <linkId value="ClaimResponse.processNote.number"/> <type value="group"/> <required value="false"/> <repeats value="true"/> <item> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl"> <valueCodeableConcept> <coding> <system value="http://hl7.org/fhir/questionnaire-item-control"/> <code value="flyover"/> <display value="Fly-over"/> </coding> </valueCodeableConcept> </extension> <text value="An integer associated with each note which may be referred to from each service line item."/> <type value="display"/> </item> <item> <linkId value="ClaimResponse.processNote.number.value"/> <text value="Sequence Number for this note"/> <type value="integer"/> <required value="false"/> <repeats value="false"/> </item> </item> <item> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs"> <valueInteger value="1"/> </extension> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType"> <valueString value="CodeableConcept"/> </extension> <linkId value="ClaimResponse.processNote.type"/> <text value="display | print | printoper"/> <type value="group"/> <required value="false"/> <repeats value="true"/> <item> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl"> <valueCodeableConcept> <coding> <system value="http://hl7.org/fhir/questionnaire-item-control"/> <code value="flyover"/> <display value="Fly-over"/> </coding> </valueCodeableConcept> </extension> <text value="The note purpose: Print/Display."/> <type value="display"/> </item> <item> <linkId value="ClaimResponse.processNote.type.coding"/> <text value="code:"/> <type value="choice"/> <required value="false"/> <repeats value="false"/> </item> <item> <linkId value="ClaimResponse.processNote.type.text"/> <text value="text:"/> <type value="string"/> <required value="false"/> <repeats value="false"/> </item> </item> <item> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs"> <valueInteger value="1"/> </extension> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType"> <valueString value="string"/> </extension> <linkId value="ClaimResponse.processNote.text"/> <type value="group"/> <required value="false"/> <repeats value="true"/> <item> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl"> <valueCodeableConcept> <coding> <system value="http://hl7.org/fhir/questionnaire-item-control"/> <code value="flyover"/> <display value="Fly-over"/> </coding> </valueCodeableConcept> </extension> <text value="The note text."/> <type value="display"/> </item> <item> <linkId value="ClaimResponse.processNote.text.value"/> <text value="Note explanatory text"/> <type value="string"/> <required value="false"/> <repeats value="false"/> </item> </item> <item> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs"> <valueInteger value="1"/> </extension> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType"> <valueString value="CodeableConcept"/> </extension> <linkId value="ClaimResponse.processNote.language"/> <text value="Language if different from the resource"/> <type value="group"/> <required value="false"/> <repeats value="true"/> <item> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl"> <valueCodeableConcept> <coding> <system value="http://hl7.org/fhir/questionnaire-item-control"/> <code value="flyover"/> <display value="Fly-over"/> </coding> </valueCodeableConcept> </extension> <text value="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 value="display"/> </item> <item> <linkId value="ClaimResponse.processNote.language.coding"/> <text value="code:"/> <type value="open-choice"/> <required value="false"/> <repeats value="false"/> </item> <item> <linkId value="ClaimResponse.processNote.language.text"/> <text value="text:"/> <type value="string"/> <required value="false"/> <repeats value="false"/> </item> </item> </item> <item> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType"> <valueString value="Reference"/> </extension> <linkId value="ClaimResponse.communicationRequest"/> <type value="group"/> <required value="false"/> <repeats value="true"/> <item> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl"> <valueCodeableConcept> <coding> <system value="http://hl7.org/fhir/questionnaire-item-control"/> <code value="flyover"/> <display value="Fly-over"/> </coding> </valueCodeableConcept> </extension> <text value="Request for additional supporting or authorizing information, such as: documents, images or resources."/> <type value="display"/> </item> <item> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-allowedResource"> <valueCode value="CommunicationRequest"/> </extension> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-referenceFilter"> <valueString value="subject=$subj&patient=$subj&encounter=$encounter"/> </extension> <linkId value="ClaimResponse.communicationRequest.value"/> <text value="Request for additional information"/> <type value="reference"/> <required value="false"/> <repeats value="false"/> </item> </item> <item> <linkId value="ClaimResponse.insurance"/> <text value="Insurance or medical plan"/> <type value="group"/> <required value="false"/> <repeats value="true"/> <item> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl"> <valueCodeableConcept> <coding> <system value="http://hl7.org/fhir/questionnaire-item-control"/> <code value="flyover"/> <display value="Fly-over"/> </coding> </valueCodeableConcept> </extension> <text value="Financial instrument by which payment information for health care."/> <type value="display"/> </item> <item> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs"> <valueInteger value="1"/> </extension> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType"> <valueString value="string"/> </extension> <linkId value="ClaimResponse.insurance.id"/> <type value="group"/> <required value="false"/> <repeats value="true"/> <item> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl"> <valueCodeableConcept> <coding> <system value="http://hl7.org/fhir/questionnaire-item-control"/> <code value="flyover"/> <display value="Fly-over"/> </coding> </valueCodeableConcept> </extension> <text value="unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces."/> <type value="display"/> </item> <item> <linkId value="ClaimResponse.insurance.id.value"/> <text value="xml:id (or equivalent in JSON)"/> <type value="string"/> <required value="false"/> <repeats value="false"/> </item> </item> <item> <linkId value="ClaimResponse.insurance.extension"/> <text value="Additional Content defined by implementations"/> <type value="group"/> <required value="false"/> <repeats value="true"/> <item> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl"> <valueCodeableConcept> <coding> <system value="http://hl7.org/fhir/questionnaire-item-control"/> <code value="flyover"/> <display value="Fly-over"/> </coding> </valueCodeableConcept> </extension> <text value="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 value="display"/> </item> </item> <item> <linkId value="ClaimResponse.insurance.modifierExtension"/> <text value="Extensions that cannot be ignored"/> <type value="group"/> <required value="false"/> <repeats value="true"/> <item> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl"> <valueCodeableConcept> <coding> <system value="http://hl7.org/fhir/questionnaire-item-control"/> <code value="flyover"/> <display value="Fly-over"/> </coding> </valueCodeableConcept> </extension> <text value="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 value="display"/> </item> </item> <item> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-minOccurs"> <valueInteger value="1"/> </extension> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs"> <valueInteger value="1"/> </extension> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType"> <valueString value="integer"/> </extension> <linkId value="ClaimResponse.insurance.sequence"/> <type value="group"/> <required value="true"/> <repeats value="true"/> <item> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl"> <valueCodeableConcept> <coding> <system value="http://hl7.org/fhir/questionnaire-item-control"/> <code value="flyover"/> <display value="Fly-over"/> </coding> </valueCodeableConcept> </extension> <text value="A service line item."/> <type value="display"/> </item> <item> <linkId value="ClaimResponse.insurance.sequence.value"/> <text value="Service instance identifier"/> <type value="integer"/> <required value="false"/> <repeats value="false"/> </item> </item> <item> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-minOccurs"> <valueInteger value="1"/> </extension> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs"> <valueInteger value="1"/> </extension> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType"> <valueString value="boolean"/> </extension> <linkId value="ClaimResponse.insurance.focal"/> <type value="group"/> <required value="true"/> <repeats value="true"/> <item> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl"> <valueCodeableConcept> <coding> <system value="http://hl7.org/fhir/questionnaire-item-control"/> <code value="flyover"/> <display value="Fly-over"/> </coding> </valueCodeableConcept> </extension> <text value="The instance number of the Coverage which is the focus for adjudication. The Coverage against which the claim is to be adjudicated."/> <type value="display"/> </item> <item> <linkId value="ClaimResponse.insurance.focal.value"/> <text value="Is the focal Coverage"/> <type value="boolean"/> <required value="false"/> <repeats value="false"/> </item> </item> <item> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-minOccurs"> <valueInteger value="1"/> </extension> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs"> <valueInteger value="1"/> </extension> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType"> <valueString value="Reference"/> </extension> <linkId value="ClaimResponse.insurance.coverage"/> <type value="group"/> <required value="true"/> <repeats value="true"/> <item> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl"> <valueCodeableConcept> <coding> <system value="http://hl7.org/fhir/questionnaire-item-control"/> <code value="flyover"/> <display value="Fly-over"/> </coding> </valueCodeableConcept> </extension> <text value="Reference to the program or plan identification, underwriter or payor."/> <type value="display"/> </item> <item> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-allowedResource"> <valueCode value="Coverage"/> </extension> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-referenceFilter"> <valueString value="subject=$subj&patient=$subj&encounter=$encounter"/> </extension> <linkId value="ClaimResponse.insurance.coverage.value"/> <text value="Insurance information"/> <type value="reference"/> <required value="false"/> <repeats value="false"/> </item> </item> <item> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs"> <valueInteger value="1"/> </extension> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType"> <valueString value="string"/> </extension> <linkId value="ClaimResponse.insurance.businessArrangement"/> <type value="group"/> <required value="false"/> <repeats value="true"/> <item> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl"> <valueCodeableConcept> <coding> <system value="http://hl7.org/fhir/questionnaire-item-control"/> <code value="flyover"/> <display value="Fly-over"/> </coding> </valueCodeableConcept> </extension> <text value="The contract number of a business agreement which describes the terms and conditions."/> <type value="display"/> </item> <item> <linkId value="ClaimResponse.insurance.businessArrangement.value"/> <text value="Business agreement"/> <type value="string"/> <required value="false"/> <repeats value="false"/> </item> </item> <item> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType"> <valueString value="string"/> </extension> <linkId value="ClaimResponse.insurance.preAuthRef"/> <type value="group"/> <required value="false"/> <repeats value="true"/> <item> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl"> <valueCodeableConcept> <coding> <system value="http://hl7.org/fhir/questionnaire-item-control"/> <code value="flyover"/> <display value="Fly-over"/> </coding> </valueCodeableConcept> </extension> <text value="A list of references from the Insurer to which these services pertain."/> <type value="display"/> </item> <item> <linkId value="ClaimResponse.insurance.preAuthRef.value"/> <text value="Pre-Authorization/Determination Reference"/> <type value="string"/> <required value="false"/> <repeats value="false"/> </item> </item> <item> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs"> <valueInteger value="1"/> </extension> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType"> <valueString value="Reference"/> </extension> <linkId value="ClaimResponse.insurance.claimResponse"/> <type value="group"/> <required value="false"/> <repeats value="true"/> <item> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl"> <valueCodeableConcept> <coding> <system value="http://hl7.org/fhir/questionnaire-item-control"/> <code value="flyover"/> <display value="Fly-over"/> </coding> </valueCodeableConcept> </extension> <text value="The Coverages adjudication details."/> <type value="display"/> </item> <item> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-allowedResource"> <valueCode value="ClaimResponse"/> </extension> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-referenceFilter"> <valueString value="subject=$subj&patient=$subj&encounter=$encounter"/> </extension> <linkId value="ClaimResponse.insurance.claimResponse.value"/> <text value="Adjudication results"/> <type value="reference"/> <required value="false"/> <repeats value="false"/> </item> </item> </item> </item> </Questionnaire>
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.