Atrius India Core FHIR Implementation Guide
0.1.0 - ci-build

Atrius India Core FHIR Implementation Guide - Local Development build (v0.1.0) built by the FHIR (HL7® FHIR® Standard) Build Tools. See the Directory of published versions

Resource Profile: Atrius India Core ClaimResponse

Official URL: https://atrius.in/fhir/r4/atrius-in/StructureDefinition/atrius-in-claimresponse Version: 0.1.0
Draft as of 2026-07-24 Computable Name: AtriusInClaimResponse
Other Identifiers: OID:1.3.6.1.4.1.66219.1.42.27

Atrius India Core profile. Parent: FHIR R4. Structurally aligned with QI-Core. India terminology via NDHM ValueSets where noted. Legacy QI-Core projection: runtime-mapper.

Usages:

You can also check for usages in the FHIR IG Statistics

Formal Views of Profile Content

Description Differentials, Snapshots, and other representations.

NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
.. ClaimResponse 0..* ClaimResponse(4.0.1) Response to a claim predetermination or preauthorization
... implicitRules ?!Σ 0..1 uri A set of rules under which this content was created
... modifierExtension ?! 0..* Extension Extensions that cannot be ignored
Constraints: ext-1
... status ?!Σ 1..1 code active | cancelled | draft | entered-in-error
Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance.
... use Σ 1..1 code claim | preauthorization | predetermination
Binding: Use (required): Claim, preauthorization, predetermination.
... patient Σ 1..1 Reference(Atrius India Core Patient(0.1.0)) The recipient of the products and services
... created SΣ 1..1 dateTime Response creation date
... insurer SΣ 1..1 Reference(Atrius India Core Organization(0.1.0)) Party responsible for reimbursement
... requestor 0..1 Reference(Atrius India Core Practitioner(0.1.0) | Atrius India Core PractitionerRole(0.1.0) | Atrius India Core Organization(0.1.0)) Party responsible for the claim
... request SΣ 0..1 Reference(Atrius India Core Claim(0.1.0)) Id of resource triggering adjudication
... outcome SΣ 1..1 code queued | complete | error | partial
Binding: ClaimProcessingCodes (required): The result of the claim processing.
... disposition S 0..1 string Disposition Message
... item S 0..* BackboneElement Adjudication for claim line items
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
Constraints: ext-1
.... itemSequence 1..1 positiveInt Claim item instance identifier
.... adjudication 1..* BackboneElement Adjudication details
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
Constraints: ext-1
..... category 1..1 CodeableConcept Type of adjudication information
Binding: AdjudicationValueCodes (example): The adjudication codes.
..... reason 0..1 CodeableConcept Explanation of adjudication outcome
Binding: AdjudicationReason (6.5.0) (example)
... total SΣ 0..* BackboneElement Adjudication totals
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
Constraints: ext-1
.... category Σ 1..1 CodeableConcept Type of adjudication information
Binding: AdjudicationValueCodes (example): The adjudication codes.
.... amount Σ 1..1 Money Financial total for the category
... formCode 0..1 CodeableConcept Printed form identifier
Binding: FormCode (6.5.0) (example)
... communicationRequest 0..* Reference(Atrius India Core CommunicationRequest(0.1.0)) Request for additional information
... insurance S 0..* BackboneElement Patient insurance information
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
Constraints: ext-1
.... sequence 1..1 positiveInt Insurance instance identifier
.... focal 1..1 boolean Coverage to be used for adjudication
.... coverage S 1..1 Reference(Atrius India Core Coverage(0.1.0)) Insurance information
.... claimResponse 0..1 Reference(Atrius India Core ClaimResponse(0.1.0)) Adjudication results
... error S 0..* BackboneElement Processing errors
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
Constraints: ext-1
.... code 1..1 CodeableConcept Error code detailing processing issues
Binding: Adjudication Error Codes (example): The adjudication error codes.

doco Documentation for this format

Terminology Bindings

Path Status Usage ValueSet Version Source
ClaimResponse.status Base required Financial Resource Status Codes 📍4.0.1 FHIR Std.
ClaimResponse.type Base extensible Claim Type 📍6.5.0 FHIR Implementation Guide for ABDM v6.5
ClaimResponse.use Base required Use 📍4.0.1 FHIR Std.
ClaimResponse.outcome Base required Claim Processing Codes 📍4.0.1 FHIR Std.
ClaimResponse.item.adjudication.​category Base example Adjudication Value Codes 📍4.0.1 FHIR Std.
ClaimResponse.item.adjudication.​reason Base example Adjudication Reason 📍6.5.0 FHIR Implementation Guide for ABDM v6.5
ClaimResponse.total.​category Base example Adjudication Value Codes 📍4.0.1 FHIR Std.
ClaimResponse.formCode Base example Form Code 📍6.5.0 FHIR Implementation Guide for ABDM v6.5
ClaimResponse.error.​code Base example AdjudicationError 📍4.0.1 FHIR Std.

Constraints

Id Grade Path(s) Description Expression
dom-2 error ClaimResponse If the resource is contained in another resource, it SHALL NOT contain nested Resources contained.contained.empty()
dom-3 error ClaimResponse If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
dom-4 error ClaimResponse If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
dom-5 error ClaimResponse If a resource is contained in another resource, it SHALL NOT have a security label contained.meta.security.empty()
dom-6 best practice ClaimResponse A resource should have narrative for robust management text.`div`.exists()
ele-1 error ClaimResponse.implicitRules, ClaimResponse.modifierExtension, ClaimResponse.status, ClaimResponse.type, ClaimResponse.use, ClaimResponse.patient, ClaimResponse.created, ClaimResponse.insurer, ClaimResponse.requestor, ClaimResponse.request, ClaimResponse.outcome, ClaimResponse.disposition, ClaimResponse.item, ClaimResponse.item.modifierExtension, ClaimResponse.item.itemSequence, ClaimResponse.item.adjudication, ClaimResponse.item.adjudication.modifierExtension, ClaimResponse.item.adjudication.category, ClaimResponse.item.adjudication.reason, ClaimResponse.total, ClaimResponse.total.modifierExtension, ClaimResponse.total.category, ClaimResponse.total.amount, ClaimResponse.formCode, ClaimResponse.communicationRequest, ClaimResponse.insurance, ClaimResponse.insurance.modifierExtension, ClaimResponse.insurance.sequence, ClaimResponse.insurance.focal, ClaimResponse.insurance.coverage, ClaimResponse.insurance.claimResponse, ClaimResponse.error, ClaimResponse.error.modifierExtension, ClaimResponse.error.code All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
ext-1 error ClaimResponse.modifierExtension, ClaimResponse.item.modifierExtension, ClaimResponse.item.adjudication.modifierExtension, ClaimResponse.total.modifierExtension, ClaimResponse.insurance.modifierExtension, ClaimResponse.error.modifierExtension Must have either extensions or value[x], not both extension.exists() != value.exists()

NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
.. ClaimResponse ClaimResponse(4.0.1)
... type 1..1 CodeableConcept More granular claim type
Binding: ClaimType (6.5.0) (extensible)
... patient 1..1 Reference(Atrius India Core Patient(0.1.0)) The recipient of the products and services
... created S 1..1 dateTime Response creation date
... requestor 0..1 Reference(Atrius India Core Practitioner(0.1.0) | Atrius India Core PractitionerRole(0.1.0) | Atrius India Core Organization(0.1.0)) Party responsible for the claim
... request S 0..1 Reference(Atrius India Core Claim(0.1.0)) Id of resource triggering adjudication
... outcome S 1..1 code queued | complete | error | partial
... disposition S 0..1 string Disposition Message
... item S 0..* BackboneElement Adjudication for claim line items
.... adjudication
..... reason 0..1 CodeableConcept Explanation of adjudication outcome
Binding: AdjudicationReason (6.5.0) (example)
... addItem
.... provider 0..* Reference(Atrius India Core Practitioner(0.1.0) | Atrius India Core PractitionerRole(0.1.0) | Atrius India Core Organization(0.1.0)) Authorized providers
.... productOrService 1..1 CodeableConcept Billing, service, product, or drug code
Binding: ProductorService (6.5.0) (example)
.... programCode 0..* CodeableConcept Program the product or service is provided under
Binding: ProgramCode (6.5.0) (example)
.... detail
..... productOrService 1..1 CodeableConcept Billing, service, product, or drug code
Binding: ProductorService (6.5.0) (example)
..... subDetail
...... productOrService 1..1 CodeableConcept Billing, service, product, or drug code
Binding: ProductorService (6.5.0) (example)
... total S 0..* BackboneElement Adjudication totals
... formCode 0..1 CodeableConcept Printed form identifier
Binding: FormCode (6.5.0) (example)
... communicationRequest 0..* Reference(Atrius India Core CommunicationRequest(0.1.0)) Request for additional information
... insurance S 0..* BackboneElement Patient insurance information
.... coverage S 1..1 Reference(Atrius India Core Coverage(0.1.0)) Insurance information
.... claimResponse 0..1 Reference(Atrius India Core ClaimResponse(0.1.0)) Adjudication results
... error S 0..* BackboneElement Processing errors

doco Documentation for this format

Terminology Bindings (Differential)

Path Status Usage ValueSet Version Source
ClaimResponse.type Base extensible Claim Type 📍6.5.0 FHIR Implementation Guide for ABDM v6.5
ClaimResponse.item.adjudication.​reason Base example Adjudication Reason 📍6.5.0 FHIR Implementation Guide for ABDM v6.5
ClaimResponse.addItem.​productOrService Base example ProductorService 📍6.5.0 FHIR Implementation Guide for ABDM v6.5
ClaimResponse.addItem.​programCode Base example Program Code 📍6.5.0 FHIR Implementation Guide for ABDM v6.5
ClaimResponse.addItem.​detail.productOrService Base example ProductorService 📍6.5.0 FHIR Implementation Guide for ABDM v6.5
ClaimResponse.addItem.​detail.subDetail.productOrService Base example ProductorService 📍6.5.0 FHIR Implementation Guide for ABDM v6.5
ClaimResponse.formCode Base example Form Code 📍6.5.0 FHIR Implementation Guide for ABDM v6.5
NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
.. ClaimResponse 0..* ClaimResponse(4.0.1) Response to a claim predetermination or preauthorization
... id Σ 0..1 id Logical id of this artifact
... meta Σ 0..1 Meta Metadata about the resource
... implicitRules ?!Σ 0..1 uri A set of rules under which this content was created
... language 0..1 code Language of the resource content
Binding: CommonLanguages (preferred): A human language.
Additional BindingsPurpose
AllLanguages Max Binding
... text 0..1 Narrative Text summary of the resource, for human interpretation
This profile does not constrain the narrative in regard to content, language, or traceability to data elements
... contained 0..* Resource Contained, inline Resources
... extension 0..* Extension Additional content defined by implementations
Constraints: ext-1
... modifierExtension ?! 0..* Extension Extensions that cannot be ignored
Constraints: ext-1
... identifier 0..* Identifier Business Identifier for a claim response
... status ?!Σ 1..1 code active | cancelled | draft | entered-in-error
Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance.
... type Σ 1..1 CodeableConcept More granular claim type
Binding: ClaimType (6.5.0) (extensible)
... subType 0..1 CodeableConcept More granular claim type
Binding: ExampleClaimSubTypeCodes (example): A more granular claim typecode.
... use Σ 1..1 code claim | preauthorization | predetermination
Binding: Use (required): Claim, preauthorization, predetermination.
... patient Σ 1..1 Reference(Atrius India Core Patient(0.1.0)) The recipient of the products and services
... created SΣ 1..1 dateTime Response creation date
... insurer SΣ 1..1 Reference(Atrius India Core Organization(0.1.0)) Party responsible for reimbursement
... requestor 0..1 Reference(Atrius India Core Practitioner(0.1.0) | Atrius India Core PractitionerRole(0.1.0) | Atrius India Core Organization(0.1.0)) Party responsible for the claim
... request SΣ 0..1 Reference(Atrius India Core Claim(0.1.0)) Id of resource triggering adjudication
... outcome SΣ 1..1 code queued | complete | error | partial
Binding: ClaimProcessingCodes (required): The result of the claim processing.
... disposition S 0..1 string Disposition Message
... preAuthRef 0..1 string Preauthorization reference
... preAuthPeriod 0..1 Period Preauthorization reference effective period
... payeeType 0..1 CodeableConcept Party to be paid any benefits payable
Binding: Claim Payee Type Codes (example): A code for the party to be reimbursed.
... item S 0..* BackboneElement Adjudication for claim line items
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
Constraints: ext-1
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
Constraints: ext-1
.... itemSequence 1..1 positiveInt Claim item instance identifier
.... noteNumber 0..* positiveInt Applicable note numbers
.... adjudication 1..* BackboneElement Adjudication details
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
Constraints: ext-1
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
Constraints: ext-1
..... category 1..1 CodeableConcept Type of adjudication information
Binding: AdjudicationValueCodes (example): The adjudication codes.
..... reason 0..1 CodeableConcept Explanation of adjudication outcome
Binding: AdjudicationReason (6.5.0) (example)
..... amount 0..1 Money Monetary amount
..... value 0..1 decimal Non-monetary value
.... detail 0..* BackboneElement Adjudication for claim details
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
Constraints: ext-1
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
Constraints: ext-1
..... detailSequence 1..1 positiveInt Claim detail instance identifier
..... noteNumber 0..* positiveInt Applicable note numbers
..... adjudication 1..* See adjudication (ClaimResponse) Detail level adjudication details
..... subDetail 0..* BackboneElement Adjudication for claim sub-details
...... id 0..1 string Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
Constraints: ext-1
...... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
Constraints: ext-1
...... subDetailSequence 1..1 positiveInt Claim sub-detail instance identifier
...... noteNumber 0..* positiveInt Applicable note numbers
...... adjudication 0..* See adjudication (ClaimResponse) Subdetail level adjudication details
... addItem 0..* BackboneElement Insurer added line items
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
Constraints: ext-1
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
Constraints: ext-1
.... itemSequence 0..* positiveInt Item sequence number
.... detailSequence 0..* positiveInt Detail sequence number
.... subdetailSequence 0..* positiveInt Subdetail sequence number
.... provider 0..* Reference(Atrius India Core Practitioner(0.1.0) | Atrius India Core PractitionerRole(0.1.0) | Atrius India Core Organization(0.1.0)) Authorized providers
.... productOrService 1..1 CodeableConcept Billing, service, product, or drug code
Binding: ProductorService (6.5.0) (example)
.... modifier 0..* CodeableConcept Service/Product billing modifiers
Binding: ModifierTypeCodes (example): Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen.
.... programCode 0..* CodeableConcept Program the product or service is provided under
Binding: ProgramCode (6.5.0) (example)
.... serviced[x] 0..1 Date or dates of service or product delivery
..... servicedDate date
..... servicedPeriod Period
.... location[x] 0..1 Place of service or where product was supplied
Binding: ExampleServicePlaceCodes (example): Place of service: pharmacy, school, prison, etc.
..... locationCodeableConcept CodeableConcept
..... locationAddress Address
..... locationReference Reference(Location)
.... quantity 0..1 SimpleQuantity(4.0.1) Count of products or services
.... unitPrice 0..1 Money Fee, charge or cost per item
.... factor 0..1 decimal Price scaling factor
.... net 0..1 Money Total item cost
.... bodySite 0..1 CodeableConcept Anatomical location
Binding: OralSiteCodes (example): The code for the teeth, quadrant, sextant and arch.
.... subSite 0..* CodeableConcept Anatomical sub-location
Binding: SurfaceCodes (example): The code for the tooth surface and surface combinations.
.... noteNumber 0..* positiveInt Applicable note numbers
.... adjudication 1..* See adjudication (ClaimResponse) Added items adjudication
.... detail 0..* BackboneElement Insurer added line details
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
Constraints: ext-1
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
Constraints: ext-1
..... productOrService 1..1 CodeableConcept Billing, service, product, or drug code
Binding: ProductorService (6.5.0) (example)
..... modifier 0..* CodeableConcept Service/Product billing modifiers
Binding: ModifierTypeCodes (example): Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen.
..... quantity 0..1 SimpleQuantity(4.0.1) Count of products or services
..... unitPrice 0..1 Money Fee, charge or cost per item
..... factor 0..1 decimal Price scaling factor
..... net 0..1 Money Total item cost
..... noteNumber 0..* positiveInt Applicable note numbers
..... adjudication 1..* See adjudication (ClaimResponse) Added items detail adjudication
..... subDetail 0..* BackboneElement Insurer added line items
...... id 0..1 string Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
Constraints: ext-1
...... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
Constraints: ext-1
...... productOrService 1..1 CodeableConcept Billing, service, product, or drug code
Binding: ProductorService (6.5.0) (example)
...... modifier 0..* CodeableConcept Service/Product billing modifiers
Binding: ModifierTypeCodes (example): Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen.
...... quantity 0..1 SimpleQuantity(4.0.1) Count of products or services
...... unitPrice 0..1 Money Fee, charge or cost per item
...... factor 0..1 decimal Price scaling factor
...... net 0..1 Money Total item cost
...... noteNumber 0..* positiveInt Applicable note numbers
...... adjudication 1..* See adjudication (ClaimResponse) Added items detail adjudication
... adjudication 0..* See adjudication (ClaimResponse) Header-level adjudication
... total SΣ 0..* BackboneElement Adjudication totals
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
Constraints: ext-1
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
Constraints: ext-1
.... category Σ 1..1 CodeableConcept Type of adjudication information
Binding: AdjudicationValueCodes (example): The adjudication codes.
.... amount Σ 1..1 Money Financial total for the category
... payment 0..1 BackboneElement Payment Details
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
Constraints: ext-1
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
Constraints: ext-1
.... type 1..1 CodeableConcept Partial or complete payment
Binding: ExamplePaymentTypeCodes (example): The type (partial, complete) of the payment.
.... adjustment 0..1 Money Payment adjustment for non-claim issues
.... adjustmentReason 0..1 CodeableConcept Explanation for the adjustment
Binding: PaymentAdjustmentReasonCodes (example): Payment Adjustment reason codes.
.... date 0..1 date Expected date of payment
.... amount 1..1 Money Payable amount after adjustment
.... identifier 0..1 Identifier Business identifier for the payment
... fundsReserve 0..1 CodeableConcept Funds reserved status
Binding: Funds Reservation Codes (example): For whom funds are to be reserved: (Patient, Provider, None).
... formCode 0..1 CodeableConcept Printed form identifier
Binding: FormCode (6.5.0) (example)
... form 0..1 Attachment Printed reference or actual form
... processNote 0..* BackboneElement Note concerning adjudication
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
Constraints: ext-1
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
Constraints: ext-1
.... number 0..1 positiveInt Note instance identifier
.... type 0..1 code display | print | printoper
Binding: NoteType (required): The presentation types of notes.
.... text 1..1 string Note explanatory text
.... language 0..1 CodeableConcept Language of the text
Binding: CommonLanguages (preferred): A human language.
Additional BindingsPurpose
AllLanguages Max Binding
... communicationRequest 0..* Reference(Atrius India Core CommunicationRequest(0.1.0)) Request for additional information
... insurance S 0..* BackboneElement Patient insurance information
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
Constraints: ext-1
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
Constraints: ext-1
.... sequence 1..1 positiveInt Insurance instance identifier
.... focal 1..1 boolean Coverage to be used for adjudication
.... coverage S 1..1 Reference(Atrius India Core Coverage(0.1.0)) Insurance information
.... businessArrangement 0..1 string Additional provider contract number
.... claimResponse 0..1 Reference(Atrius India Core ClaimResponse(0.1.0)) Adjudication results
... error S 0..* BackboneElement Processing errors
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
Constraints: ext-1
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
Constraints: ext-1
.... itemSequence 0..1 positiveInt Item sequence number
.... detailSequence 0..1 positiveInt Detail sequence number
.... subDetailSequence 0..1 positiveInt Subdetail sequence number
.... code 1..1 CodeableConcept Error code detailing processing issues
Binding: Adjudication Error Codes (example): The adjudication error codes.

doco Documentation for this format

Terminology Bindings

Path Status Usage ValueSet Version Source
ClaimResponse.language Base preferred Common Languages 📍4.0.1 FHIR Std.
ClaimResponse.status Base required Financial Resource Status Codes 📍4.0.1 FHIR Std.
ClaimResponse.type Base extensible Claim Type 📍6.5.0 FHIR Implementation Guide for ABDM v6.5
ClaimResponse.subType Base example Example Claim SubType Codes 📍4.0.1 FHIR Std.
ClaimResponse.use Base required Use 📍4.0.1 FHIR Std.
ClaimResponse.outcome Base required Claim Processing Codes 📍4.0.1 FHIR Std.
ClaimResponse.payeeType Base example PayeeType 📍4.0.1 FHIR Std.
ClaimResponse.item.adjudication.​category Base example Adjudication Value Codes 📍4.0.1 FHIR Std.
ClaimResponse.item.adjudication.​reason Base example Adjudication Reason 📍6.5.0 FHIR Implementation Guide for ABDM v6.5
ClaimResponse.addItem.​productOrService Base example ProductorService 📍6.5.0 FHIR Implementation Guide for ABDM v6.5
ClaimResponse.addItem.​modifier Base example Modifier type Codes 📍4.0.1 FHIR Std.
ClaimResponse.addItem.​programCode Base example Program Code 📍6.5.0 FHIR Implementation Guide for ABDM v6.5
ClaimResponse.addItem.​location[x] Base example Example Service Place Codes 📍4.0.1 FHIR Std.
ClaimResponse.addItem.​bodySite Base example Oral Site Codes 📍4.0.1 FHIR Std.
ClaimResponse.addItem.​subSite Base example Surface Codes 📍4.0.1 FHIR Std.
ClaimResponse.addItem.​detail.productOrService Base example ProductorService 📍6.5.0 FHIR Implementation Guide for ABDM v6.5
ClaimResponse.addItem.​detail.modifier Base example Modifier type Codes 📍4.0.1 FHIR Std.
ClaimResponse.addItem.​detail.subDetail.productOrService Base example ProductorService 📍6.5.0 FHIR Implementation Guide for ABDM v6.5
ClaimResponse.addItem.​detail.subDetail.modifier Base example Modifier type Codes 📍4.0.1 FHIR Std.
ClaimResponse.total.​category Base example Adjudication Value Codes 📍4.0.1 FHIR Std.
ClaimResponse.payment.​type Base example Example Payment Type Codes 📍4.0.1 FHIR Std.
ClaimResponse.payment.​adjustmentReason Base example Payment Adjustment Reason Codes 📍4.0.1 FHIR Std.
ClaimResponse.fundsReserve Base example FundsReserve 📍4.0.1 FHIR Std.
ClaimResponse.formCode Base example Form Code 📍6.5.0 FHIR Implementation Guide for ABDM v6.5
ClaimResponse.processNote.​type Base required NoteType 📍4.0.1 FHIR Std.
ClaimResponse.processNote.​language Base preferred Common Languages 📍4.0.1 FHIR Std.
ClaimResponse.error.​code Base example AdjudicationError 📍4.0.1 FHIR Std.

Constraints

Id Grade Path(s) Description Expression
dom-2 error ClaimResponse If the resource is contained in another resource, it SHALL NOT contain nested Resources contained.contained.empty()
dom-3 error ClaimResponse If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
dom-4 error ClaimResponse If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
dom-5 error ClaimResponse If a resource is contained in another resource, it SHALL NOT have a security label contained.meta.security.empty()
dom-6 best practice ClaimResponse A resource should have narrative for robust management text.`div`.exists()
ele-1 error ClaimResponse.meta, ClaimResponse.implicitRules, ClaimResponse.language, ClaimResponse.text, ClaimResponse.extension, ClaimResponse.modifierExtension, ClaimResponse.identifier, ClaimResponse.status, ClaimResponse.type, ClaimResponse.subType, ClaimResponse.use, ClaimResponse.patient, ClaimResponse.created, ClaimResponse.insurer, ClaimResponse.requestor, ClaimResponse.request, ClaimResponse.outcome, ClaimResponse.disposition, ClaimResponse.preAuthRef, ClaimResponse.preAuthPeriod, ClaimResponse.payeeType, ClaimResponse.item, ClaimResponse.item.extension, ClaimResponse.item.modifierExtension, ClaimResponse.item.itemSequence, ClaimResponse.item.noteNumber, ClaimResponse.item.adjudication, ClaimResponse.item.adjudication.extension, ClaimResponse.item.adjudication.modifierExtension, ClaimResponse.item.adjudication.category, ClaimResponse.item.adjudication.reason, ClaimResponse.item.adjudication.amount, ClaimResponse.item.adjudication.value, ClaimResponse.item.detail, ClaimResponse.item.detail.extension, ClaimResponse.item.detail.modifierExtension, ClaimResponse.item.detail.detailSequence, ClaimResponse.item.detail.noteNumber, ClaimResponse.item.detail.adjudication, ClaimResponse.item.detail.subDetail, ClaimResponse.item.detail.subDetail.extension, ClaimResponse.item.detail.subDetail.modifierExtension, ClaimResponse.item.detail.subDetail.subDetailSequence, ClaimResponse.item.detail.subDetail.noteNumber, ClaimResponse.item.detail.subDetail.adjudication, ClaimResponse.addItem, ClaimResponse.addItem.extension, ClaimResponse.addItem.modifierExtension, ClaimResponse.addItem.itemSequence, ClaimResponse.addItem.detailSequence, ClaimResponse.addItem.subdetailSequence, ClaimResponse.addItem.provider, ClaimResponse.addItem.productOrService, ClaimResponse.addItem.modifier, ClaimResponse.addItem.programCode, ClaimResponse.addItem.serviced[x], ClaimResponse.addItem.location[x], ClaimResponse.addItem.quantity, ClaimResponse.addItem.unitPrice, ClaimResponse.addItem.factor, ClaimResponse.addItem.net, ClaimResponse.addItem.bodySite, ClaimResponse.addItem.subSite, ClaimResponse.addItem.noteNumber, ClaimResponse.addItem.adjudication, ClaimResponse.addItem.detail, ClaimResponse.addItem.detail.extension, ClaimResponse.addItem.detail.modifierExtension, ClaimResponse.addItem.detail.productOrService, ClaimResponse.addItem.detail.modifier, ClaimResponse.addItem.detail.quantity, ClaimResponse.addItem.detail.unitPrice, ClaimResponse.addItem.detail.factor, ClaimResponse.addItem.detail.net, ClaimResponse.addItem.detail.noteNumber, ClaimResponse.addItem.detail.adjudication, ClaimResponse.addItem.detail.subDetail, ClaimResponse.addItem.detail.subDetail.extension, ClaimResponse.addItem.detail.subDetail.modifierExtension, ClaimResponse.addItem.detail.subDetail.productOrService, ClaimResponse.addItem.detail.subDetail.modifier, ClaimResponse.addItem.detail.subDetail.quantity, ClaimResponse.addItem.detail.subDetail.unitPrice, ClaimResponse.addItem.detail.subDetail.factor, ClaimResponse.addItem.detail.subDetail.net, ClaimResponse.addItem.detail.subDetail.noteNumber, ClaimResponse.addItem.detail.subDetail.adjudication, ClaimResponse.adjudication, ClaimResponse.total, ClaimResponse.total.extension, ClaimResponse.total.modifierExtension, ClaimResponse.total.category, ClaimResponse.total.amount, ClaimResponse.payment, ClaimResponse.payment.extension, ClaimResponse.payment.modifierExtension, ClaimResponse.payment.type, ClaimResponse.payment.adjustment, ClaimResponse.payment.adjustmentReason, ClaimResponse.payment.date, ClaimResponse.payment.amount, ClaimResponse.payment.identifier, ClaimResponse.fundsReserve, ClaimResponse.formCode, ClaimResponse.form, ClaimResponse.processNote, ClaimResponse.processNote.extension, ClaimResponse.processNote.modifierExtension, ClaimResponse.processNote.number, ClaimResponse.processNote.type, ClaimResponse.processNote.text, ClaimResponse.processNote.language, ClaimResponse.communicationRequest, ClaimResponse.insurance, ClaimResponse.insurance.extension, ClaimResponse.insurance.modifierExtension, ClaimResponse.insurance.sequence, ClaimResponse.insurance.focal, ClaimResponse.insurance.coverage, ClaimResponse.insurance.businessArrangement, ClaimResponse.insurance.claimResponse, ClaimResponse.error, ClaimResponse.error.extension, ClaimResponse.error.modifierExtension, ClaimResponse.error.itemSequence, ClaimResponse.error.detailSequence, ClaimResponse.error.subDetailSequence, ClaimResponse.error.code All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
ext-1 error ClaimResponse.extension, ClaimResponse.modifierExtension, ClaimResponse.item.extension, ClaimResponse.item.modifierExtension, ClaimResponse.item.adjudication.extension, ClaimResponse.item.adjudication.modifierExtension, ClaimResponse.item.detail.extension, ClaimResponse.item.detail.modifierExtension, ClaimResponse.item.detail.subDetail.extension, ClaimResponse.item.detail.subDetail.modifierExtension, ClaimResponse.addItem.extension, ClaimResponse.addItem.modifierExtension, ClaimResponse.addItem.detail.extension, ClaimResponse.addItem.detail.modifierExtension, ClaimResponse.addItem.detail.subDetail.extension, ClaimResponse.addItem.detail.subDetail.modifierExtension, ClaimResponse.total.extension, ClaimResponse.total.modifierExtension, ClaimResponse.payment.extension, ClaimResponse.payment.modifierExtension, ClaimResponse.processNote.extension, ClaimResponse.processNote.modifierExtension, ClaimResponse.insurance.extension, ClaimResponse.insurance.modifierExtension, ClaimResponse.error.extension, ClaimResponse.error.modifierExtension Must have either extensions or value[x], not both extension.exists() != value.exists()

Key Elements View

NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
.. ClaimResponse 0..* ClaimResponse(4.0.1) Response to a claim predetermination or preauthorization
... implicitRules ?!Σ 0..1 uri A set of rules under which this content was created
... modifierExtension ?! 0..* Extension Extensions that cannot be ignored
Constraints: ext-1
... status ?!Σ 1..1 code active | cancelled | draft | entered-in-error
Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance.
... use Σ 1..1 code claim | preauthorization | predetermination
Binding: Use (required): Claim, preauthorization, predetermination.
... patient Σ 1..1 Reference(Atrius India Core Patient(0.1.0)) The recipient of the products and services
... created SΣ 1..1 dateTime Response creation date
... insurer SΣ 1..1 Reference(Atrius India Core Organization(0.1.0)) Party responsible for reimbursement
... requestor 0..1 Reference(Atrius India Core Practitioner(0.1.0) | Atrius India Core PractitionerRole(0.1.0) | Atrius India Core Organization(0.1.0)) Party responsible for the claim
... request SΣ 0..1 Reference(Atrius India Core Claim(0.1.0)) Id of resource triggering adjudication
... outcome SΣ 1..1 code queued | complete | error | partial
Binding: ClaimProcessingCodes (required): The result of the claim processing.
... disposition S 0..1 string Disposition Message
... item S 0..* BackboneElement Adjudication for claim line items
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
Constraints: ext-1
.... itemSequence 1..1 positiveInt Claim item instance identifier
.... adjudication 1..* BackboneElement Adjudication details
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
Constraints: ext-1
..... category 1..1 CodeableConcept Type of adjudication information
Binding: AdjudicationValueCodes (example): The adjudication codes.
..... reason 0..1 CodeableConcept Explanation of adjudication outcome
Binding: AdjudicationReason (6.5.0) (example)
... total SΣ 0..* BackboneElement Adjudication totals
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
Constraints: ext-1
.... category Σ 1..1 CodeableConcept Type of adjudication information
Binding: AdjudicationValueCodes (example): The adjudication codes.
.... amount Σ 1..1 Money Financial total for the category
... formCode 0..1 CodeableConcept Printed form identifier
Binding: FormCode (6.5.0) (example)
... communicationRequest 0..* Reference(Atrius India Core CommunicationRequest(0.1.0)) Request for additional information
... insurance S 0..* BackboneElement Patient insurance information
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
Constraints: ext-1
.... sequence 1..1 positiveInt Insurance instance identifier
.... focal 1..1 boolean Coverage to be used for adjudication
.... coverage S 1..1 Reference(Atrius India Core Coverage(0.1.0)) Insurance information
.... claimResponse 0..1 Reference(Atrius India Core ClaimResponse(0.1.0)) Adjudication results
... error S 0..* BackboneElement Processing errors
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
Constraints: ext-1
.... code 1..1 CodeableConcept Error code detailing processing issues
Binding: Adjudication Error Codes (example): The adjudication error codes.

doco Documentation for this format

Terminology Bindings

Path Status Usage ValueSet Version Source
ClaimResponse.status Base required Financial Resource Status Codes 📍4.0.1 FHIR Std.
ClaimResponse.type Base extensible Claim Type 📍6.5.0 FHIR Implementation Guide for ABDM v6.5
ClaimResponse.use Base required Use 📍4.0.1 FHIR Std.
ClaimResponse.outcome Base required Claim Processing Codes 📍4.0.1 FHIR Std.
ClaimResponse.item.adjudication.​category Base example Adjudication Value Codes 📍4.0.1 FHIR Std.
ClaimResponse.item.adjudication.​reason Base example Adjudication Reason 📍6.5.0 FHIR Implementation Guide for ABDM v6.5
ClaimResponse.total.​category Base example Adjudication Value Codes 📍4.0.1 FHIR Std.
ClaimResponse.formCode Base example Form Code 📍6.5.0 FHIR Implementation Guide for ABDM v6.5
ClaimResponse.error.​code Base example AdjudicationError 📍4.0.1 FHIR Std.

Constraints

Id Grade Path(s) Description Expression
dom-2 error ClaimResponse If the resource is contained in another resource, it SHALL NOT contain nested Resources contained.contained.empty()
dom-3 error ClaimResponse If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
dom-4 error ClaimResponse If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
dom-5 error ClaimResponse If a resource is contained in another resource, it SHALL NOT have a security label contained.meta.security.empty()
dom-6 best practice ClaimResponse A resource should have narrative for robust management text.`div`.exists()
ele-1 error ClaimResponse.implicitRules, ClaimResponse.modifierExtension, ClaimResponse.status, ClaimResponse.type, ClaimResponse.use, ClaimResponse.patient, ClaimResponse.created, ClaimResponse.insurer, ClaimResponse.requestor, ClaimResponse.request, ClaimResponse.outcome, ClaimResponse.disposition, ClaimResponse.item, ClaimResponse.item.modifierExtension, ClaimResponse.item.itemSequence, ClaimResponse.item.adjudication, ClaimResponse.item.adjudication.modifierExtension, ClaimResponse.item.adjudication.category, ClaimResponse.item.adjudication.reason, ClaimResponse.total, ClaimResponse.total.modifierExtension, ClaimResponse.total.category, ClaimResponse.total.amount, ClaimResponse.formCode, ClaimResponse.communicationRequest, ClaimResponse.insurance, ClaimResponse.insurance.modifierExtension, ClaimResponse.insurance.sequence, ClaimResponse.insurance.focal, ClaimResponse.insurance.coverage, ClaimResponse.insurance.claimResponse, ClaimResponse.error, ClaimResponse.error.modifierExtension, ClaimResponse.error.code All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
ext-1 error ClaimResponse.modifierExtension, ClaimResponse.item.modifierExtension, ClaimResponse.item.adjudication.modifierExtension, ClaimResponse.total.modifierExtension, ClaimResponse.insurance.modifierExtension, ClaimResponse.error.modifierExtension Must have either extensions or value[x], not both extension.exists() != value.exists()

Differential View

NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
.. ClaimResponse ClaimResponse(4.0.1)
... type 1..1 CodeableConcept More granular claim type
Binding: ClaimType (6.5.0) (extensible)
... patient 1..1 Reference(Atrius India Core Patient(0.1.0)) The recipient of the products and services
... created S 1..1 dateTime Response creation date
... requestor 0..1 Reference(Atrius India Core Practitioner(0.1.0) | Atrius India Core PractitionerRole(0.1.0) | Atrius India Core Organization(0.1.0)) Party responsible for the claim
... request S 0..1 Reference(Atrius India Core Claim(0.1.0)) Id of resource triggering adjudication
... outcome S 1..1 code queued | complete | error | partial
... disposition S 0..1 string Disposition Message
... item S 0..* BackboneElement Adjudication for claim line items
.... adjudication
..... reason 0..1 CodeableConcept Explanation of adjudication outcome
Binding: AdjudicationReason (6.5.0) (example)
... addItem
.... provider 0..* Reference(Atrius India Core Practitioner(0.1.0) | Atrius India Core PractitionerRole(0.1.0) | Atrius India Core Organization(0.1.0)) Authorized providers
.... productOrService 1..1 CodeableConcept Billing, service, product, or drug code
Binding: ProductorService (6.5.0) (example)
.... programCode 0..* CodeableConcept Program the product or service is provided under
Binding: ProgramCode (6.5.0) (example)
.... detail
..... productOrService 1..1 CodeableConcept Billing, service, product, or drug code
Binding: ProductorService (6.5.0) (example)
..... subDetail
...... productOrService 1..1 CodeableConcept Billing, service, product, or drug code
Binding: ProductorService (6.5.0) (example)
... total S 0..* BackboneElement Adjudication totals
... formCode 0..1 CodeableConcept Printed form identifier
Binding: FormCode (6.5.0) (example)
... communicationRequest 0..* Reference(Atrius India Core CommunicationRequest(0.1.0)) Request for additional information
... insurance S 0..* BackboneElement Patient insurance information
.... coverage S 1..1 Reference(Atrius India Core Coverage(0.1.0)) Insurance information
.... claimResponse 0..1 Reference(Atrius India Core ClaimResponse(0.1.0)) Adjudication results
... error S 0..* BackboneElement Processing errors

doco Documentation for this format

Terminology Bindings (Differential)

Path Status Usage ValueSet Version Source
ClaimResponse.type Base extensible Claim Type 📍6.5.0 FHIR Implementation Guide for ABDM v6.5
ClaimResponse.item.adjudication.​reason Base example Adjudication Reason 📍6.5.0 FHIR Implementation Guide for ABDM v6.5
ClaimResponse.addItem.​productOrService Base example ProductorService 📍6.5.0 FHIR Implementation Guide for ABDM v6.5
ClaimResponse.addItem.​programCode Base example Program Code 📍6.5.0 FHIR Implementation Guide for ABDM v6.5
ClaimResponse.addItem.​detail.productOrService Base example ProductorService 📍6.5.0 FHIR Implementation Guide for ABDM v6.5
ClaimResponse.addItem.​detail.subDetail.productOrService Base example ProductorService 📍6.5.0 FHIR Implementation Guide for ABDM v6.5
ClaimResponse.formCode Base example Form Code 📍6.5.0 FHIR Implementation Guide for ABDM v6.5

Snapshot ViewView

NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
.. ClaimResponse 0..* ClaimResponse(4.0.1) Response to a claim predetermination or preauthorization
... id Σ 0..1 id Logical id of this artifact
... meta Σ 0..1 Meta Metadata about the resource
... implicitRules ?!Σ 0..1 uri A set of rules under which this content was created
... language 0..1 code Language of the resource content
Binding: CommonLanguages (preferred): A human language.
Additional BindingsPurpose
AllLanguages Max Binding
... text 0..1 Narrative Text summary of the resource, for human interpretation
This profile does not constrain the narrative in regard to content, language, or traceability to data elements
... contained 0..* Resource Contained, inline Resources
... extension 0..* Extension Additional content defined by implementations
Constraints: ext-1
... modifierExtension ?! 0..* Extension Extensions that cannot be ignored
Constraints: ext-1
... identifier 0..* Identifier Business Identifier for a claim response
... status ?!Σ 1..1 code active | cancelled | draft | entered-in-error
Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance.
... type Σ 1..1 CodeableConcept More granular claim type
Binding: ClaimType (6.5.0) (extensible)
... subType 0..1 CodeableConcept More granular claim type
Binding: ExampleClaimSubTypeCodes (example): A more granular claim typecode.
... use Σ 1..1 code claim | preauthorization | predetermination
Binding: Use (required): Claim, preauthorization, predetermination.
... patient Σ 1..1 Reference(Atrius India Core Patient(0.1.0)) The recipient of the products and services
... created SΣ 1..1 dateTime Response creation date
... insurer SΣ 1..1 Reference(Atrius India Core Organization(0.1.0)) Party responsible for reimbursement
... requestor 0..1 Reference(Atrius India Core Practitioner(0.1.0) | Atrius India Core PractitionerRole(0.1.0) | Atrius India Core Organization(0.1.0)) Party responsible for the claim
... request SΣ 0..1 Reference(Atrius India Core Claim(0.1.0)) Id of resource triggering adjudication
... outcome SΣ 1..1 code queued | complete | error | partial
Binding: ClaimProcessingCodes (required): The result of the claim processing.
... disposition S 0..1 string Disposition Message
... preAuthRef 0..1 string Preauthorization reference
... preAuthPeriod 0..1 Period Preauthorization reference effective period
... payeeType 0..1 CodeableConcept Party to be paid any benefits payable
Binding: Claim Payee Type Codes (example): A code for the party to be reimbursed.
... item S 0..* BackboneElement Adjudication for claim line items
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
Constraints: ext-1
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
Constraints: ext-1
.... itemSequence 1..1 positiveInt Claim item instance identifier
.... noteNumber 0..* positiveInt Applicable note numbers
.... adjudication 1..* BackboneElement Adjudication details
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
Constraints: ext-1
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
Constraints: ext-1
..... category 1..1 CodeableConcept Type of adjudication information
Binding: AdjudicationValueCodes (example): The adjudication codes.
..... reason 0..1 CodeableConcept Explanation of adjudication outcome
Binding: AdjudicationReason (6.5.0) (example)
..... amount 0..1 Money Monetary amount
..... value 0..1 decimal Non-monetary value
.... detail 0..* BackboneElement Adjudication for claim details
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
Constraints: ext-1
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
Constraints: ext-1
..... detailSequence 1..1 positiveInt Claim detail instance identifier
..... noteNumber 0..* positiveInt Applicable note numbers
..... adjudication 1..* See adjudication (ClaimResponse) Detail level adjudication details
..... subDetail 0..* BackboneElement Adjudication for claim sub-details
...... id 0..1 string Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
Constraints: ext-1
...... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
Constraints: ext-1
...... subDetailSequence 1..1 positiveInt Claim sub-detail instance identifier
...... noteNumber 0..* positiveInt Applicable note numbers
...... adjudication 0..* See adjudication (ClaimResponse) Subdetail level adjudication details
... addItem 0..* BackboneElement Insurer added line items
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
Constraints: ext-1
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
Constraints: ext-1
.... itemSequence 0..* positiveInt Item sequence number
.... detailSequence 0..* positiveInt Detail sequence number
.... subdetailSequence 0..* positiveInt Subdetail sequence number
.... provider 0..* Reference(Atrius India Core Practitioner(0.1.0) | Atrius India Core PractitionerRole(0.1.0) | Atrius India Core Organization(0.1.0)) Authorized providers
.... productOrService 1..1 CodeableConcept Billing, service, product, or drug code
Binding: ProductorService (6.5.0) (example)
.... modifier 0..* CodeableConcept Service/Product billing modifiers
Binding: ModifierTypeCodes (example): Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen.
.... programCode 0..* CodeableConcept Program the product or service is provided under
Binding: ProgramCode (6.5.0) (example)
.... serviced[x] 0..1 Date or dates of service or product delivery
..... servicedDate date
..... servicedPeriod Period
.... location[x] 0..1 Place of service or where product was supplied
Binding: ExampleServicePlaceCodes (example): Place of service: pharmacy, school, prison, etc.
..... locationCodeableConcept CodeableConcept
..... locationAddress Address
..... locationReference Reference(Location)
.... quantity 0..1 SimpleQuantity(4.0.1) Count of products or services
.... unitPrice 0..1 Money Fee, charge or cost per item
.... factor 0..1 decimal Price scaling factor
.... net 0..1 Money Total item cost
.... bodySite 0..1 CodeableConcept Anatomical location
Binding: OralSiteCodes (example): The code for the teeth, quadrant, sextant and arch.
.... subSite 0..* CodeableConcept Anatomical sub-location
Binding: SurfaceCodes (example): The code for the tooth surface and surface combinations.
.... noteNumber 0..* positiveInt Applicable note numbers
.... adjudication 1..* See adjudication (ClaimResponse) Added items adjudication
.... detail 0..* BackboneElement Insurer added line details
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
Constraints: ext-1
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
Constraints: ext-1
..... productOrService 1..1 CodeableConcept Billing, service, product, or drug code
Binding: ProductorService (6.5.0) (example)
..... modifier 0..* CodeableConcept Service/Product billing modifiers
Binding: ModifierTypeCodes (example): Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen.
..... quantity 0..1 SimpleQuantity(4.0.1) Count of products or services
..... unitPrice 0..1 Money Fee, charge or cost per item
..... factor 0..1 decimal Price scaling factor
..... net 0..1 Money Total item cost
..... noteNumber 0..* positiveInt Applicable note numbers
..... adjudication 1..* See adjudication (ClaimResponse) Added items detail adjudication
..... subDetail 0..* BackboneElement Insurer added line items
...... id 0..1 string Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
Constraints: ext-1
...... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
Constraints: ext-1
...... productOrService 1..1 CodeableConcept Billing, service, product, or drug code
Binding: ProductorService (6.5.0) (example)
...... modifier 0..* CodeableConcept Service/Product billing modifiers
Binding: ModifierTypeCodes (example): Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen.
...... quantity 0..1 SimpleQuantity(4.0.1) Count of products or services
...... unitPrice 0..1 Money Fee, charge or cost per item
...... factor 0..1 decimal Price scaling factor
...... net 0..1 Money Total item cost
...... noteNumber 0..* positiveInt Applicable note numbers
...... adjudication 1..* See adjudication (ClaimResponse) Added items detail adjudication
... adjudication 0..* See adjudication (ClaimResponse) Header-level adjudication
... total SΣ 0..* BackboneElement Adjudication totals
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
Constraints: ext-1
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
Constraints: ext-1
.... category Σ 1..1 CodeableConcept Type of adjudication information
Binding: AdjudicationValueCodes (example): The adjudication codes.
.... amount Σ 1..1 Money Financial total for the category
... payment 0..1 BackboneElement Payment Details
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
Constraints: ext-1
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
Constraints: ext-1
.... type 1..1 CodeableConcept Partial or complete payment
Binding: ExamplePaymentTypeCodes (example): The type (partial, complete) of the payment.
.... adjustment 0..1 Money Payment adjustment for non-claim issues
.... adjustmentReason 0..1 CodeableConcept Explanation for the adjustment
Binding: PaymentAdjustmentReasonCodes (example): Payment Adjustment reason codes.
.... date 0..1 date Expected date of payment
.... amount 1..1 Money Payable amount after adjustment
.... identifier 0..1 Identifier Business identifier for the payment
... fundsReserve 0..1 CodeableConcept Funds reserved status
Binding: Funds Reservation Codes (example): For whom funds are to be reserved: (Patient, Provider, None).
... formCode 0..1 CodeableConcept Printed form identifier
Binding: FormCode (6.5.0) (example)
... form 0..1 Attachment Printed reference or actual form
... processNote 0..* BackboneElement Note concerning adjudication
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
Constraints: ext-1
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
Constraints: ext-1
.... number 0..1 positiveInt Note instance identifier
.... type 0..1 code display | print | printoper
Binding: NoteType (required): The presentation types of notes.
.... text 1..1 string Note explanatory text
.... language 0..1 CodeableConcept Language of the text
Binding: CommonLanguages (preferred): A human language.
Additional BindingsPurpose
AllLanguages Max Binding
... communicationRequest 0..* Reference(Atrius India Core CommunicationRequest(0.1.0)) Request for additional information
... insurance S 0..* BackboneElement Patient insurance information
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
Constraints: ext-1
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
Constraints: ext-1
.... sequence 1..1 positiveInt Insurance instance identifier
.... focal 1..1 boolean Coverage to be used for adjudication
.... coverage S 1..1 Reference(Atrius India Core Coverage(0.1.0)) Insurance information
.... businessArrangement 0..1 string Additional provider contract number
.... claimResponse 0..1 Reference(Atrius India Core ClaimResponse(0.1.0)) Adjudication results
... error S 0..* BackboneElement Processing errors
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
Constraints: ext-1
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
Constraints: ext-1
.... itemSequence 0..1 positiveInt Item sequence number
.... detailSequence 0..1 positiveInt Detail sequence number
.... subDetailSequence 0..1 positiveInt Subdetail sequence number
.... code 1..1 CodeableConcept Error code detailing processing issues
Binding: Adjudication Error Codes (example): The adjudication error codes.

doco Documentation for this format

Terminology Bindings

Path Status Usage ValueSet Version Source
ClaimResponse.language Base preferred Common Languages 📍4.0.1 FHIR Std.
ClaimResponse.status Base required Financial Resource Status Codes 📍4.0.1 FHIR Std.
ClaimResponse.type Base extensible Claim Type 📍6.5.0 FHIR Implementation Guide for ABDM v6.5
ClaimResponse.subType Base example Example Claim SubType Codes 📍4.0.1 FHIR Std.
ClaimResponse.use Base required Use 📍4.0.1 FHIR Std.
ClaimResponse.outcome Base required Claim Processing Codes 📍4.0.1 FHIR Std.
ClaimResponse.payeeType Base example PayeeType 📍4.0.1 FHIR Std.
ClaimResponse.item.adjudication.​category Base example Adjudication Value Codes 📍4.0.1 FHIR Std.
ClaimResponse.item.adjudication.​reason Base example Adjudication Reason 📍6.5.0 FHIR Implementation Guide for ABDM v6.5
ClaimResponse.addItem.​productOrService Base example ProductorService 📍6.5.0 FHIR Implementation Guide for ABDM v6.5
ClaimResponse.addItem.​modifier Base example Modifier type Codes 📍4.0.1 FHIR Std.
ClaimResponse.addItem.​programCode Base example Program Code 📍6.5.0 FHIR Implementation Guide for ABDM v6.5
ClaimResponse.addItem.​location[x] Base example Example Service Place Codes 📍4.0.1 FHIR Std.
ClaimResponse.addItem.​bodySite Base example Oral Site Codes 📍4.0.1 FHIR Std.
ClaimResponse.addItem.​subSite Base example Surface Codes 📍4.0.1 FHIR Std.
ClaimResponse.addItem.​detail.productOrService Base example ProductorService 📍6.5.0 FHIR Implementation Guide for ABDM v6.5
ClaimResponse.addItem.​detail.modifier Base example Modifier type Codes 📍4.0.1 FHIR Std.
ClaimResponse.addItem.​detail.subDetail.productOrService Base example ProductorService 📍6.5.0 FHIR Implementation Guide for ABDM v6.5
ClaimResponse.addItem.​detail.subDetail.modifier Base example Modifier type Codes 📍4.0.1 FHIR Std.
ClaimResponse.total.​category Base example Adjudication Value Codes 📍4.0.1 FHIR Std.
ClaimResponse.payment.​type Base example Example Payment Type Codes 📍4.0.1 FHIR Std.
ClaimResponse.payment.​adjustmentReason Base example Payment Adjustment Reason Codes 📍4.0.1 FHIR Std.
ClaimResponse.fundsReserve Base example FundsReserve 📍4.0.1 FHIR Std.
ClaimResponse.formCode Base example Form Code 📍6.5.0 FHIR Implementation Guide for ABDM v6.5
ClaimResponse.processNote.​type Base required NoteType 📍4.0.1 FHIR Std.
ClaimResponse.processNote.​language Base preferred Common Languages 📍4.0.1 FHIR Std.
ClaimResponse.error.​code Base example AdjudicationError 📍4.0.1 FHIR Std.

Constraints

Id Grade Path(s) Description Expression
dom-2 error ClaimResponse If the resource is contained in another resource, it SHALL NOT contain nested Resources contained.contained.empty()
dom-3 error ClaimResponse If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
dom-4 error ClaimResponse If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
dom-5 error ClaimResponse If a resource is contained in another resource, it SHALL NOT have a security label contained.meta.security.empty()
dom-6 best practice ClaimResponse A resource should have narrative for robust management text.`div`.exists()
ele-1 error ClaimResponse.meta, ClaimResponse.implicitRules, ClaimResponse.language, ClaimResponse.text, ClaimResponse.extension, ClaimResponse.modifierExtension, ClaimResponse.identifier, ClaimResponse.status, ClaimResponse.type, ClaimResponse.subType, ClaimResponse.use, ClaimResponse.patient, ClaimResponse.created, ClaimResponse.insurer, ClaimResponse.requestor, ClaimResponse.request, ClaimResponse.outcome, ClaimResponse.disposition, ClaimResponse.preAuthRef, ClaimResponse.preAuthPeriod, ClaimResponse.payeeType, ClaimResponse.item, ClaimResponse.item.extension, ClaimResponse.item.modifierExtension, ClaimResponse.item.itemSequence, ClaimResponse.item.noteNumber, ClaimResponse.item.adjudication, ClaimResponse.item.adjudication.extension, ClaimResponse.item.adjudication.modifierExtension, ClaimResponse.item.adjudication.category, ClaimResponse.item.adjudication.reason, ClaimResponse.item.adjudication.amount, ClaimResponse.item.adjudication.value, ClaimResponse.item.detail, ClaimResponse.item.detail.extension, ClaimResponse.item.detail.modifierExtension, ClaimResponse.item.detail.detailSequence, ClaimResponse.item.detail.noteNumber, ClaimResponse.item.detail.adjudication, ClaimResponse.item.detail.subDetail, ClaimResponse.item.detail.subDetail.extension, ClaimResponse.item.detail.subDetail.modifierExtension, ClaimResponse.item.detail.subDetail.subDetailSequence, ClaimResponse.item.detail.subDetail.noteNumber, ClaimResponse.item.detail.subDetail.adjudication, ClaimResponse.addItem, ClaimResponse.addItem.extension, ClaimResponse.addItem.modifierExtension, ClaimResponse.addItem.itemSequence, ClaimResponse.addItem.detailSequence, ClaimResponse.addItem.subdetailSequence, ClaimResponse.addItem.provider, ClaimResponse.addItem.productOrService, ClaimResponse.addItem.modifier, ClaimResponse.addItem.programCode, ClaimResponse.addItem.serviced[x], ClaimResponse.addItem.location[x], ClaimResponse.addItem.quantity, ClaimResponse.addItem.unitPrice, ClaimResponse.addItem.factor, ClaimResponse.addItem.net, ClaimResponse.addItem.bodySite, ClaimResponse.addItem.subSite, ClaimResponse.addItem.noteNumber, ClaimResponse.addItem.adjudication, ClaimResponse.addItem.detail, ClaimResponse.addItem.detail.extension, ClaimResponse.addItem.detail.modifierExtension, ClaimResponse.addItem.detail.productOrService, ClaimResponse.addItem.detail.modifier, ClaimResponse.addItem.detail.quantity, ClaimResponse.addItem.detail.unitPrice, ClaimResponse.addItem.detail.factor, ClaimResponse.addItem.detail.net, ClaimResponse.addItem.detail.noteNumber, ClaimResponse.addItem.detail.adjudication, ClaimResponse.addItem.detail.subDetail, ClaimResponse.addItem.detail.subDetail.extension, ClaimResponse.addItem.detail.subDetail.modifierExtension, ClaimResponse.addItem.detail.subDetail.productOrService, ClaimResponse.addItem.detail.subDetail.modifier, ClaimResponse.addItem.detail.subDetail.quantity, ClaimResponse.addItem.detail.subDetail.unitPrice, ClaimResponse.addItem.detail.subDetail.factor, ClaimResponse.addItem.detail.subDetail.net, ClaimResponse.addItem.detail.subDetail.noteNumber, ClaimResponse.addItem.detail.subDetail.adjudication, ClaimResponse.adjudication, ClaimResponse.total, ClaimResponse.total.extension, ClaimResponse.total.modifierExtension, ClaimResponse.total.category, ClaimResponse.total.amount, ClaimResponse.payment, ClaimResponse.payment.extension, ClaimResponse.payment.modifierExtension, ClaimResponse.payment.type, ClaimResponse.payment.adjustment, ClaimResponse.payment.adjustmentReason, ClaimResponse.payment.date, ClaimResponse.payment.amount, ClaimResponse.payment.identifier, ClaimResponse.fundsReserve, ClaimResponse.formCode, ClaimResponse.form, ClaimResponse.processNote, ClaimResponse.processNote.extension, ClaimResponse.processNote.modifierExtension, ClaimResponse.processNote.number, ClaimResponse.processNote.type, ClaimResponse.processNote.text, ClaimResponse.processNote.language, ClaimResponse.communicationRequest, ClaimResponse.insurance, ClaimResponse.insurance.extension, ClaimResponse.insurance.modifierExtension, ClaimResponse.insurance.sequence, ClaimResponse.insurance.focal, ClaimResponse.insurance.coverage, ClaimResponse.insurance.businessArrangement, ClaimResponse.insurance.claimResponse, ClaimResponse.error, ClaimResponse.error.extension, ClaimResponse.error.modifierExtension, ClaimResponse.error.itemSequence, ClaimResponse.error.detailSequence, ClaimResponse.error.subDetailSequence, ClaimResponse.error.code All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
ext-1 error ClaimResponse.extension, ClaimResponse.modifierExtension, ClaimResponse.item.extension, ClaimResponse.item.modifierExtension, ClaimResponse.item.adjudication.extension, ClaimResponse.item.adjudication.modifierExtension, ClaimResponse.item.detail.extension, ClaimResponse.item.detail.modifierExtension, ClaimResponse.item.detail.subDetail.extension, ClaimResponse.item.detail.subDetail.modifierExtension, ClaimResponse.addItem.extension, ClaimResponse.addItem.modifierExtension, ClaimResponse.addItem.detail.extension, ClaimResponse.addItem.detail.modifierExtension, ClaimResponse.addItem.detail.subDetail.extension, ClaimResponse.addItem.detail.subDetail.modifierExtension, ClaimResponse.total.extension, ClaimResponse.total.modifierExtension, ClaimResponse.payment.extension, ClaimResponse.payment.modifierExtension, ClaimResponse.processNote.extension, ClaimResponse.processNote.modifierExtension, ClaimResponse.insurance.extension, ClaimResponse.insurance.modifierExtension, ClaimResponse.error.extension, ClaimResponse.error.modifierExtension Must have either extensions or value[x], not both extension.exists() != value.exists()

 

Other representations of profile: CSV, Excel, Schematron