NameFlagsCard.TypeDescription & Constraintsdoco
.. ClaimResponse DomainResourceRemittance resource
Elements defined in Ancestors: id, meta, implicitRules, language, text, contained, extension, modifierExtension
... identifier 0..*IdentifierResponse number
... status ?!Σ0..1codeactive | cancelled | draft | entered-in-error
Financial Resource Status Codes (Required)
... patient 0..1Reference(Patient)The subject of the Products and Services
... created 0..1dateTimeCreation date
... insurer 0..1Reference(Organization)Insurance issuing organization
... requestProvider 0..1Reference(Practitioner)Responsible practitioner
... requestOrganization 0..1Reference(Organization)Responsible organization
... request 0..1Reference(Claim)Id of resource triggering adjudication
... outcome 0..1CodeableConceptcomplete | error | partial
Claim Processing Codes (Example)
... disposition 0..1stringDisposition Message
... payeeType 0..1CodeableConceptParty to be paid any benefits payable
Claim Payee Type Codes (Example)
... item 0..*BackboneElementLine items
.... sequenceLinkId 1..1positiveIntService instance
.... noteNumber 0..*positiveIntList of note numbers which apply
.... adjudication 0..*BackboneElementAdjudication details
..... category 1..1CodeableConceptAdjudication category such as co-pay, eligible, benefit, etc.
Adjudication Value Codes (Example)
..... reason 0..1CodeableConceptExplanation of Adjudication outcome
Adjudication Reason Codes (Example)
..... amount 0..1MoneyMonetary amount
..... value 0..1decimalNon-monetary value
.... detail 0..*BackboneElementDetail line items
..... sequenceLinkId 1..1positiveIntService instance
..... noteNumber 0..*positiveIntList of note numbers which apply
..... adjudication 0..*see adjudicationDetail level adjudication details
..... subDetail 0..*BackboneElementSubdetail line items
...... sequenceLinkId 1..1positiveIntService instance
...... noteNumber 0..*positiveIntList of note numbers which apply
...... adjudication 0..*see adjudicationSubdetail level adjudication details
... addItem 0..*BackboneElementInsurer added line items
.... sequenceLinkId 0..*positiveIntService instances
.... revenue 0..1CodeableConceptRevenue or cost center code
Example Revenue Center Codes (Example)
.... category 0..1CodeableConceptType of service or product
Benefit SubCategory Codes (Example)
.... service 0..1CodeableConceptGroup, Service or Product
USCLS Codes (Example)
.... modifier 0..*CodeableConceptService/Product billing modifiers
Modifier type Codes (Example)
.... fee 0..1MoneyProfessional fee or Product charge
.... noteNumber 0..*positiveIntList of note numbers which apply
.... adjudication 0..*see adjudicationAdded items adjudication
.... detail 0..*BackboneElementAdded items details
..... revenue 0..1CodeableConceptRevenue or cost center code
Example Revenue Center Codes (Example)
..... category 0..1CodeableConceptType of service or product
Benefit SubCategory Codes (Example)
..... service 0..1CodeableConceptService or Product
USCLS Codes (Example)
..... modifier 0..*CodeableConceptService/Product billing modifiers
Modifier type Codes (Example)
..... fee 0..1MoneyProfessional fee or Product charge
..... noteNumber 0..*positiveIntList of note numbers which apply
..... adjudication 0..*see adjudicationAdded items detail adjudication
... error 0..*BackboneElementProcessing errors
.... sequenceLinkId 0..1positiveIntItem sequence number
.... detailSequenceLinkId 0..1positiveIntDetail sequence number
.... subdetailSequenceLinkId 0..1positiveIntSubdetail sequence number
.... code 1..1CodeableConceptError code detailing processing issues
Adjudication Error Codes (Example)
... totalCost 0..1MoneyTotal Cost of service from the Claim
... unallocDeductable 0..1MoneyUnallocated deductible
... totalBenefit 0..1MoneyTotal benefit payable for the Claim
... payment 0..1BackboneElementPayment details, if paid
.... type 0..1CodeableConceptPartial or Complete
Example Payment Type Codes (Example)
.... adjustment 0..1MoneyPayment adjustment for non-Claim issues
.... adjustmentReason 0..1CodeableConceptExplanation for the non-claim adjustment
Payment Adjustment Reason Codes (Example)
.... date 0..1dateExpected data of Payment
.... amount 0..1MoneyPayable amount after adjustment
.... identifier 0..1IdentifierIdentifier of the payment instrument
... reserved 0..1CodingFunds reserved status
Funds Reservation Codes (Example)
... form 0..1CodeableConceptPrinted Form Identifier
Form Codes (Example)
... processNote 0..*BackboneElementProcessing notes
.... number 0..1positiveIntSequence Number for this note
.... type 0..1CodeableConceptdisplay | print | printoper
NoteType (Required)
.... text 0..1stringNote explanatory text
.... language 0..1CodeableConceptLanguage if different from the resource
Common Languages (Extensible but limited to All Languages)
... communicationRequest 0..*Reference(CommunicationRequest)Request for additional information
... insurance 0..*BackboneElementInsurance or medical plan
.... sequence 1..1positiveIntService instance identifier
.... focal 1..1booleanIs the focal Coverage
.... coverage 1..1Reference(Coverage)Insurance information
.... businessArrangement 0..1stringBusiness agreement
.... preAuthRef 0..*stringPre-Authorization/Determination Reference
.... claimResponse 0..1Reference(ClaimResponse)Adjudication results

doco Documentation for this format