Name | Flags | Card. | Type | Description & Constraints![]() |
---|---|---|---|---|
DomainResource | Remittance resource Elements defined in Ancestors: id, meta, implicitRules, language, text, contained, extension, modifierExtension | |||
0..* | Identifier | Response number | ||
?!Σ | 0..1 | code | active | cancelled | draft | entered-in-error Financial Resource Status Codes (Required) | |
0..1 | Reference(Patient) | The subject of the Products and Services | ||
0..1 | dateTime | Creation date | ||
0..1 | Reference(Organization) | Insurance issuing organization | ||
0..1 | Reference(Practitioner) | Responsible practitioner | ||
0..1 | Reference(Organization) | Responsible organization | ||
0..1 | Reference(Claim) | Id of resource triggering adjudication | ||
0..1 | CodeableConcept | complete | error | partial Claim Processing Codes (Example) | ||
0..1 | string | Disposition Message | ||
0..1 | CodeableConcept | Party to be paid any benefits payable Claim Payee Type Codes (Example) | ||
0..* | BackboneElement | Line items | ||
1..1 | positiveInt | Service instance | ||
0..* | positiveInt | List of note numbers which apply | ||
0..* | BackboneElement | Adjudication details | ||
1..1 | CodeableConcept | Adjudication category such as co-pay, eligible, benefit, etc. Adjudication Value Codes (Example) | ||
0..1 | CodeableConcept | Explanation of Adjudication outcome Adjudication Reason Codes (Example) | ||
0..1 | Money | Monetary amount | ||
0..1 | decimal | Non-monetary value | ||
0..* | BackboneElement | Detail line items | ||
1..1 | positiveInt | Service instance | ||
0..* | positiveInt | List of note numbers which apply | ||
0..* | see adjudication | Detail level adjudication details | ||
0..* | BackboneElement | Subdetail line items | ||
1..1 | positiveInt | Service instance | ||
0..* | positiveInt | List of note numbers which apply | ||
0..* | see adjudication | Subdetail level adjudication details | ||
0..* | BackboneElement | Insurer added line items | ||
0..* | positiveInt | Service instances | ||
0..1 | CodeableConcept | Revenue or cost center code Example Revenue Center Codes (Example) | ||
0..1 | CodeableConcept | Type of service or product Benefit SubCategory Codes (Example) | ||
0..1 | CodeableConcept | Group, Service or Product USCLS Codes (Example) | ||
0..* | CodeableConcept | Service/Product billing modifiers Modifier type Codes (Example) | ||
0..1 | Money | Professional fee or Product charge | ||
0..* | positiveInt | List of note numbers which apply | ||
0..* | see adjudication | Added items adjudication | ||
0..* | BackboneElement | Added items details | ||
0..1 | CodeableConcept | Revenue or cost center code Example Revenue Center Codes (Example) | ||
0..1 | CodeableConcept | Type of service or product Benefit SubCategory Codes (Example) | ||
0..1 | CodeableConcept | Service or Product USCLS Codes (Example) | ||
0..* | CodeableConcept | Service/Product billing modifiers Modifier type Codes (Example) | ||
0..1 | Money | Professional fee or Product charge | ||
0..* | positiveInt | List of note numbers which apply | ||
0..* | see adjudication | Added items detail adjudication | ||
0..* | BackboneElement | Processing errors | ||
0..1 | positiveInt | Item sequence number | ||
0..1 | positiveInt | Detail sequence number | ||
0..1 | positiveInt | Subdetail sequence number | ||
1..1 | CodeableConcept | Error code detailing processing issues Adjudication Error Codes (Example) | ||
0..1 | Money | Total Cost of service from the Claim | ||
0..1 | Money | Unallocated deductible | ||
0..1 | Money | Total benefit payable for the Claim | ||
0..1 | BackboneElement | Payment details, if paid | ||
0..1 | CodeableConcept | Partial or Complete Example Payment Type Codes (Example) | ||
0..1 | Money | Payment adjustment for non-Claim issues | ||
0..1 | CodeableConcept | Explanation for the non-claim adjustment Payment Adjustment Reason Codes (Example) | ||
0..1 | date | Expected data of Payment | ||
0..1 | Money | Payable amount after adjustment | ||
0..1 | Identifier | Identifier of the payment instrument | ||
0..1 | Coding | Funds reserved status Funds Reservation Codes (Example) | ||
0..1 | CodeableConcept | Printed Form Identifier Form Codes (Example) | ||
0..* | BackboneElement | Processing notes | ||
0..1 | positiveInt | Sequence Number for this note | ||
0..1 | CodeableConcept | display | print | printoper NoteType (Required) | ||
0..1 | string | Note explanatory text | ||
0..1 | CodeableConcept | Language if different from the resource Common Languages (Extensible but limited to All Languages) | ||
0..* | Reference(CommunicationRequest) | Request for additional information | ||
0..* | BackboneElement | Insurance or medical plan | ||
1..1 | positiveInt | Service instance identifier | ||
1..1 | boolean | Is the focal Coverage | ||
1..1 | Reference(Coverage) | Insurance information | ||
0..1 | string | Business agreement | ||
0..* | string | Pre-Authorization/Determination Reference | ||
0..1 | Reference(ClaimResponse) | Adjudication results | ||
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