Release 5
FinancialThis page is part of the FHIR Specification (v5.0.0: R5 - STU). This is a downloaded copy of the specification. For a full list of available versions, see the Directory of published versions 
. Page versions: R5 R4B R4 R3 R2
| Financial Management Work Group | Maturity Level: N/A | Standards Status: Informative | Compartments: Patient, Practitioner |
Raw JSON (canonical form + also see JSON Format Specification)
Generated Questionnaire for ClaimResponse
{
"resourceType" : "Questionnaire",
"id" : "qgen-ClaimResponse1",
"contained" : [{
"resourceType" : "ValueSet",
"id" : "vs2",
"name" : "Type options for ClaimResponse.event.when[x]",
"status" : "active",
"description" : "Type options for ClaimResponse.event.when[x]",
"expansion" : {
"identifier" : "urn:uuid:4cbf4041-1161-4c98-b98d-2cad872d76d7",
"timestamp" : "2023-03-26T15:24:20+11:00",
"contains" : [{
"system" : "http://hl7.org/fhir/fhir-types",
"code" : "dateTime",
"display" : "dateTime"
},
{
"system" : "http://hl7.org/fhir/fhir-types",
"code" : "Period",
"display" : "Period"
}]
}
},
{
"resourceType" : "ValueSet",
"id" : "vs3",
"name" : "Type options for ClaimResponse.addItem.serviced[x]",
"status" : "active",
"description" : "Type options for ClaimResponse.addItem.serviced[x]",
"expansion" : {
"identifier" : "urn:uuid:fae9e771-8195-4fe8-a535-e1ad4a54349c",
"timestamp" : "2023-03-26T15:24:20+11:00",
"contains" : [{
"system" : "http://hl7.org/fhir/fhir-types",
"code" : "date",
"display" : "date"
},
{
"system" : "http://hl7.org/fhir/fhir-types",
"code" : "Period",
"display" : "Period"
}]
}
},
{
"resourceType" : "ValueSet",
"id" : "vs4",
"name" : "Type options for ClaimResponse.addItem.location[x]",
"status" : "active",
"description" : "Type options for ClaimResponse.addItem.location[x]",
"expansion" : {
"identifier" : "urn:uuid:74e2613a-858c-43de-bbc0-f6153a2d2761",
"timestamp" : "2023-03-26T15:24:20+11:00",
"contains" : [{
"system" : "http://hl7.org/fhir/fhir-types",
"code" : "CodeableConcept",
"display" : "CodeableConcept"
},
{
"system" : "http://hl7.org/fhir/fhir-types",
"code" : "Address",
"display" : "Address"
},
{
"system" : "http://hl7.org/fhir/fhir-types",
"code" : "Location",
"display" : "Location"
}]
}
}],
"url" : "http://hl7.org/fhir/Questionnaire/qgen-ClaimResponse1",
"identifier" : [{
"system" : "urn:ietf:rfc:3986"
}],
"version" : "5.0.0",
"status" : "draft",
"experimental" : false,
"date" : "2023-03-26T15:21:02+11:00",
"publisher" : "Health Level Seven International (Financial Management)",
"item" : [{
"linkId" : "ClaimResponse",
"text" : "Response to a claim predetermination or preauthorization",
"type" : "group",
"required" : false,
"repeats" : true,
"item" : [{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept" : {
"coding" : [{
"system" : "http://hl7.org/fhir/questionnaire-item-control",
"code" : "flyover",
"display" : "Fly-over"
}]
}
}],
"linkId" : "ClaimResponse-flyover",
"text" : "This resource provides the adjudication details from the processing of a Claim resource.",
"type" : "display"
},
{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs",
"valueInteger" : 1
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType",
"valueString" : "string"
}],
"linkId" : "ClaimResponse.id",
"type" : "group",
"required" : false,
"repeats" : true,
"item" : [{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept" : {
"coding" : [{
"system" : "http://hl7.org/fhir/questionnaire-item-control",
"code" : "flyover",
"display" : "Fly-over"
}]
}
}],
"linkId" : "ClaimResponse.id-flyover",
"text" : "The logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes. Within the context of the FHIR RESTful interactions, the resource has an id except for cases like the create and conditional update. Otherwise, the use of the resouce id depends on the given use case.",
"type" : "display"
},
{
"linkId" : "ClaimResponse.id.value",
"text" : "Logical id of this artifact",
"type" : "string",
"required" : false,
"repeats" : false
}]
},
{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs",
"valueInteger" : 1
}],
"linkId" : "ClaimResponse.meta",
"text" : "Metadata about the resource",
"type" : "group",
"required" : false,
"repeats" : true,
"item" : [{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept" : {
"coding" : [{
"system" : "http://hl7.org/fhir/questionnaire-item-control",
"code" : "flyover",
"display" : "Fly-over"
}]
}
}],
"linkId" : "ClaimResponse.meta-flyover",
"text" : "The metadata about the resource. This is content that is maintained by the infrastructure. Changes to the content might not always be associated with version changes to the resource.",
"type" : "display"
}]
},
{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs",
"valueInteger" : 1
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType",
"valueString" : "uri"
}],
"linkId" : "ClaimResponse.implicitRules",
"type" : "group",
"required" : false,
"repeats" : true,
"item" : [{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept" : {
"coding" : [{
"system" : "http://hl7.org/fhir/questionnaire-item-control",
"code" : "flyover",
"display" : "Fly-over"
}]
}
}],
"linkId" : "ClaimResponse.implicitRules-flyover",
"text" : "A reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content. Often, this is a reference to an implementation guide that defines the special rules along with other profiles etc. 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. Often, when used, the URL is a reference to an implementation guide that defines these special rules as part of its narrative along with other profiles, value sets, etc.",
"type" : "display"
},
{
"linkId" : "ClaimResponse.implicitRules.value",
"text" : "A set of rules under which this content was created",
"type" : "string",
"required" : false,
"repeats" : false
}]
},
{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs",
"valueInteger" : 1
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType",
"valueString" : "code"
}],
"linkId" : "ClaimResponse.language",
"type" : "group",
"required" : false,
"repeats" : true,
"item" : [{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept" : {
"coding" : [{
"system" : "http://hl7.org/fhir/questionnaire-item-control",
"code" : "flyover",
"display" : "Fly-over"
}]
}
}],
"linkId" : "ClaimResponse.language-flyover",
"text" : "The base language in which the resource is written. Language is provided to support indexing and accessibility (typically, services such as text to speech use the language tag). The html language tag in the narrative applies to the narrative. The language tag on the resource may be used to specify the language of other presentations generated from the data in the resource. Not all the content has to be in the base language. The Resource.language should not be assumed to apply to the narrative automatically. If a language is specified, it should it also be specified on the div element in the html (see rules in HTML5 for information about the relationship between xml:lang and the html lang attribute).",
"type" : "display"
},
{
"linkId" : "ClaimResponse.language.value",
"text" : "language",
"type" : "coding",
"required" : false,
"repeats" : false,
"answerConstraint" : "optionsOrType"
}]
},
{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs",
"valueInteger" : 1
}],
"linkId" : "ClaimResponse.text",
"text" : "Text summary of the resource, for human interpretation",
"type" : "group",
"required" : false,
"repeats" : true,
"item" : [{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept" : {
"coding" : [{
"system" : "http://hl7.org/fhir/questionnaire-item-control",
"code" : "flyover",
"display" : "Fly-over"
}]
}
}],
"linkId" : "ClaimResponse.text-flyover",
"text" : "A human-readable narrative that contains a summary of the resource and can 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 a 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 information is added later.",
"type" : "display"
}]
},
{
"linkId" : "ClaimResponse.contained",
"text" : "Contained, inline Resources",
"type" : "group",
"required" : false,
"repeats" : true,
"item" : [{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept" : {
"coding" : [{
"system" : "http://hl7.org/fhir/questionnaire-item-control",
"code" : "flyover",
"display" : "Fly-over"
}]
}
}],
"linkId" : "ClaimResponse.contained-flyover",
"text" : "These resources do not have an independent existence apart from the resource that contains them - they cannot be identified independently, nor can they have their own independent transaction scope. This is allowed to be a Parameters resource if and only if it is referenced by a resource that provides context/meaning. 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. Contained resources may have profiles and tags in their meta elements, but SHALL NOT have security labels.",
"type" : "display"
}]
},
{
"linkId" : "ClaimResponse.extension",
"text" : "Additional content defined by implementations",
"type" : "group",
"required" : false,
"repeats" : true,
"item" : [{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept" : {
"coding" : [{
"system" : "http://hl7.org/fhir/questionnaire-item-control",
"code" : "flyover",
"display" : "Fly-over"
}]
}
}],
"linkId" : "ClaimResponse.extension-flyover",
"text" : "May be used to represent additional information that is not part of the basic definition of the resource. To make the use of extensions safe and managable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.",
"type" : "display"
}]
},
{
"linkId" : "ClaimResponse.modifierExtension",
"text" : "Extensions that cannot be ignored",
"type" : "group",
"required" : false,
"repeats" : true,
"item" : [{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept" : {
"coding" : [{
"system" : "http://hl7.org/fhir/questionnaire-item-control",
"code" : "flyover",
"display" : "Fly-over"
}]
}
}],
"linkId" : "ClaimResponse.modifierExtension-flyover",
"text" : "May be used to represent additional information that is not part of the basic definition of the resource and that modifies the understanding of the element that contains it and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and managable, 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.\n\nModifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.",
"type" : "display"
}]
},
{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType",
"valueString" : "Identifier"
}],
"linkId" : "ClaimResponse.identifier",
"text" : "Business Identifier for a claim response",
"type" : "group",
"required" : false,
"repeats" : true,
"item" : [{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept" : {
"coding" : [{
"system" : "http://hl7.org/fhir/questionnaire-item-control",
"code" : "flyover",
"display" : "Fly-over"
}]
}
}],
"linkId" : "ClaimResponse.identifier-flyover",
"text" : "A unique identifier assigned to this claim response.",
"type" : "display"
},
{
"linkId" : "ClaimResponse.identifier.label",
"text" : "label:",
"type" : "string",
"required" : false,
"repeats" : false
},
{
"linkId" : "ClaimResponse.identifier.system",
"text" : "system:",
"type" : "string",
"required" : false,
"repeats" : false
},
{
"linkId" : "ClaimResponse.identifier.value",
"text" : "value:",
"type" : "string",
"required" : false,
"repeats" : false
}]
},
{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType",
"valueString" : "Identifier"
}],
"linkId" : "ClaimResponse.traceNumber",
"text" : "Number for tracking",
"type" : "group",
"required" : false,
"repeats" : true,
"item" : [{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept" : {
"coding" : [{
"system" : "http://hl7.org/fhir/questionnaire-item-control",
"code" : "flyover",
"display" : "Fly-over"
}]
}
}],
"linkId" : "ClaimResponse.traceNumber-flyover",
"text" : "Trace number for tracking purposes. May be defined at the jurisdiction level or between trading partners.",
"type" : "display"
},
{
"linkId" : "ClaimResponse.traceNumber.label",
"text" : "label:",
"type" : "string",
"required" : false,
"repeats" : false
},
{
"linkId" : "ClaimResponse.traceNumber.system",
"text" : "system:",
"type" : "string",
"required" : false,
"repeats" : false
},
{
"linkId" : "ClaimResponse.traceNumber.value",
"text" : "value:",
"type" : "string",
"required" : false,
"repeats" : false
}]
},
{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-minOccurs",
"valueInteger" : 1
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs",
"valueInteger" : 1
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType",
"valueString" : "code"
}],
"linkId" : "ClaimResponse.status",
"type" : "group",
"required" : true,
"repeats" : true,
"item" : [{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept" : {
"coding" : [{
"system" : "http://hl7.org/fhir/questionnaire-item-control",
"code" : "flyover",
"display" : "Fly-over"
}]
}
}],
"linkId" : "ClaimResponse.status-flyover",
"text" : "The status of the resource instance. This element is labeled as a modifier because the status contains codes that mark the resource as not currently valid.",
"type" : "display"
},
{
"linkId" : "ClaimResponse.status.value",
"text" : "status",
"type" : "coding",
"required" : false,
"repeats" : false,
"answerConstraint" : "optionsOrType"
}]
},
{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-minOccurs",
"valueInteger" : 1
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs",
"valueInteger" : 1
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType",
"valueString" : "CodeableConcept"
}],
"linkId" : "ClaimResponse.type",
"text" : "More granular claim type",
"type" : "group",
"required" : true,
"repeats" : true,
"item" : [{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept" : {
"coding" : [{
"system" : "http://hl7.org/fhir/questionnaire-item-control",
"code" : "flyover",
"display" : "Fly-over"
}]
}
}],
"linkId" : "ClaimResponse.type-flyover",
"text" : "A finer grained suite of claim type codes which may convey additional information such as Inpatient vs Outpatient and/or a specialty service. This may contain the local bill type codes, for example the US UB-04 bill type code or the CMS bill type.",
"type" : "display"
},
{
"linkId" : "ClaimResponse.type.coding",
"text" : "code:",
"type" : "coding",
"required" : false,
"repeats" : false,
"answerConstraint" : "optionsOnly"
},
{
"linkId" : "ClaimResponse.type.text",
"text" : "text:",
"type" : "string",
"required" : false,
"repeats" : false
}]
},
{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs",
"valueInteger" : 1
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType",
"valueString" : "CodeableConcept"
}],
"linkId" : "ClaimResponse.subType",
"text" : "More granular claim type",
"type" : "group",
"required" : false,
"repeats" : true,
"item" : [{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept" : {
"coding" : [{
"system" : "http://hl7.org/fhir/questionnaire-item-control",
"code" : "flyover",
"display" : "Fly-over"
}]
}
}],
"linkId" : "ClaimResponse.subType-flyover",
"text" : "A finer grained suite of claim type codes which may convey additional information such as Inpatient vs Outpatient and/or a specialty service. This may contain the local bill type codes, for example the US UB-04 bill type code or the CMS bill type.",
"type" : "display"
},
{
"linkId" : "ClaimResponse.subType.coding",
"text" : "code:",
"type" : "coding",
"required" : false,
"repeats" : false,
"answerConstraint" : "optionsOnly"
},
{
"linkId" : "ClaimResponse.subType.text",
"text" : "text:",
"type" : "string",
"required" : false,
"repeats" : false
}]
},
{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-minOccurs",
"valueInteger" : 1
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs",
"valueInteger" : 1
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType",
"valueString" : "code"
}],
"linkId" : "ClaimResponse.use",
"type" : "group",
"required" : true,
"repeats" : true,
"item" : [{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept" : {
"coding" : [{
"system" : "http://hl7.org/fhir/questionnaire-item-control",
"code" : "flyover",
"display" : "Fly-over"
}]
}
}],
"linkId" : "ClaimResponse.use-flyover",
"text" : "A code to indicate whether the nature of the request is: Claim - A request to an Insurer to adjudicate the supplied charges for health care goods and services under the identified policy and to pay the determined Benefit amount, if any; Preauthorization - A request to an Insurer to adjudicate the supplied proposed future charges for health care goods and services under the identified policy and to approve the services and provide the expected benefit amounts and potentially to reserve funds to pay the benefits when Claims for the indicated services are later submitted; or, Pre-determination - A request to an Insurer to adjudicate the supplied 'what if' charges for health care goods and services under the identified policy and report back what the Benefit payable would be had the services actually been provided.",
"type" : "display"
},
{
"linkId" : "ClaimResponse.use.value",
"text" : "use",
"type" : "coding",
"required" : false,
"repeats" : false,
"answerConstraint" : "optionsOrType"
}]
},
{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-minOccurs",
"valueInteger" : 1
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs",
"valueInteger" : 1
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType",
"valueString" : "Reference"
}],
"linkId" : "ClaimResponse.patient",
"type" : "group",
"required" : true,
"repeats" : true,
"item" : [{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept" : {
"coding" : [{
"system" : "http://hl7.org/fhir/questionnaire-item-control",
"code" : "flyover",
"display" : "Fly-over"
}]
}
}],
"linkId" : "ClaimResponse.patient-flyover",
"text" : "The party to whom the professional services and/or products have been supplied or are being considered and for whom actual for facast reimbursement is sought.",
"type" : "display"
},
{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-referenceResource",
"valueCode" : "Patient"
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-referenceFilter",
"valueString" : "subject=$subj&patient=$subj&encounter=$encounter"
}],
"linkId" : "ClaimResponse.patient.value",
"text" : "The recipient of the products and services",
"type" : "reference",
"required" : false,
"repeats" : false
}]
},
{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-minOccurs",
"valueInteger" : 1
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs",
"valueInteger" : 1
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType",
"valueString" : "datetime"
}],
"linkId" : "ClaimResponse.created",
"type" : "group",
"required" : true,
"repeats" : true,
"item" : [{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept" : {
"coding" : [{
"system" : "http://hl7.org/fhir/questionnaire-item-control",
"code" : "flyover",
"display" : "Fly-over"
}]
}
}],
"linkId" : "ClaimResponse.created-flyover",
"text" : "The date this resource was created.",
"type" : "display"
},
{
"linkId" : "ClaimResponse.created.value",
"text" : "Response creation date",
"type" : "dateTime",
"required" : false,
"repeats" : false
}]
},
{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs",
"valueInteger" : 1
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType",
"valueString" : "Reference"
}],
"linkId" : "ClaimResponse.insurer",
"type" : "group",
"required" : false,
"repeats" : true,
"item" : [{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept" : {
"coding" : [{
"system" : "http://hl7.org/fhir/questionnaire-item-control",
"code" : "flyover",
"display" : "Fly-over"
}]
}
}],
"linkId" : "ClaimResponse.insurer-flyover",
"text" : "The party responsible for authorization, adjudication and reimbursement.",
"type" : "display"
},
{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-referenceResource",
"valueCode" : "Organization"
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-referenceFilter",
"valueString" : "subject=$subj&patient=$subj&encounter=$encounter"
}],
"linkId" : "ClaimResponse.insurer.value",
"text" : "Party responsible for reimbursement",
"type" : "reference",
"required" : false,
"repeats" : false
}]
},
{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs",
"valueInteger" : 1
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType",
"valueString" : "Reference"
}],
"linkId" : "ClaimResponse.requestor",
"type" : "group",
"required" : false,
"repeats" : true,
"item" : [{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept" : {
"coding" : [{
"system" : "http://hl7.org/fhir/questionnaire-item-control",
"code" : "flyover",
"display" : "Fly-over"
}]
}
}],
"linkId" : "ClaimResponse.requestor-flyover",
"text" : "The provider which is responsible for the claim, predetermination or preauthorization. Typically this field would be 1..1 where this party is accountable for the data content within the claim but is not necessarily the facility, provider group or practitioner who provided the products and services listed within this claim resource. This field is the Billing Provider, for example, a facility, provider group, lab or practitioner..",
"type" : "display"
},
{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-referenceResource",
"valueCode" : "Practitioner, PractitionerRole, Organization"
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-referenceFilter",
"valueString" : "subject=$subj&patient=$subj&encounter=$encounter"
}],
"linkId" : "ClaimResponse.requestor.value",
"text" : "Party responsible for the claim",
"type" : "reference",
"required" : false,
"repeats" : false
}]
},
{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs",
"valueInteger" : 1
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType",
"valueString" : "Reference"
}],
"linkId" : "ClaimResponse.request",
"type" : "group",
"required" : false,
"repeats" : true,
"item" : [{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept" : {
"coding" : [{
"system" : "http://hl7.org/fhir/questionnaire-item-control",
"code" : "flyover",
"display" : "Fly-over"
}]
}
}],
"linkId" : "ClaimResponse.request-flyover",
"text" : "Original request resource reference.",
"type" : "display"
},
{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-referenceResource",
"valueCode" : "Claim"
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-referenceFilter",
"valueString" : "subject=$subj&patient=$subj&encounter=$encounter"
}],
"linkId" : "ClaimResponse.request.value",
"text" : "Id of resource triggering adjudication",
"type" : "reference",
"required" : false,
"repeats" : false
}]
},
{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-minOccurs",
"valueInteger" : 1
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs",
"valueInteger" : 1
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType",
"valueString" : "code"
}],
"linkId" : "ClaimResponse.outcome",
"type" : "group",
"required" : true,
"repeats" : true,
"item" : [{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept" : {
"coding" : [{
"system" : "http://hl7.org/fhir/questionnaire-item-control",
"code" : "flyover",
"display" : "Fly-over"
}]
}
}],
"linkId" : "ClaimResponse.outcome-flyover",
"text" : "The outcome of the claim, predetermination, or preauthorization processing. The resource may be used to indicate that the Claim/Preauthorization/Pre-determination has been received but processing has not begun (queued); that it has been processed and one or more errors have been detected (error); no errors were detected and some of the adjudication processing has been performed (partial); or all of the adjudication processing has completed without errors (complete).",
"type" : "display"
},
{
"linkId" : "ClaimResponse.outcome.value",
"text" : "outcome",
"type" : "coding",
"required" : false,
"repeats" : false,
"answerConstraint" : "optionsOrType"
}]
},
{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs",
"valueInteger" : 1
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType",
"valueString" : "CodeableConcept"
}],
"linkId" : "ClaimResponse.decision",
"text" : "Result of the adjudication",
"type" : "group",
"required" : false,
"repeats" : true,
"item" : [{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept" : {
"coding" : [{
"system" : "http://hl7.org/fhir/questionnaire-item-control",
"code" : "flyover",
"display" : "Fly-over"
}]
}
}],
"linkId" : "ClaimResponse.decision-flyover",
"text" : "The result of the claim, predetermination, or preauthorization adjudication. The element is used to indicate the current state of the adjudication overall for the claim resource, for example: the request has been held (pended) for adjudication processing, for manual review or other reasons; that it has been processed and will be paid, or the outstanding paid, as submitted (approved); that no amount will be paid (denied); or that some amount between zero and the submitted amount will be paid (partial).",
"type" : "display"
},
{
"linkId" : "ClaimResponse.decision.coding",
"text" : "code:",
"type" : "coding",
"required" : false,
"repeats" : false,
"answerConstraint" : "optionsOnly"
},
{
"linkId" : "ClaimResponse.decision.text",
"text" : "text:",
"type" : "string",
"required" : false,
"repeats" : false
}]
},
{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs",
"valueInteger" : 1
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType",
"valueString" : "string"
}],
"linkId" : "ClaimResponse.disposition",
"type" : "group",
"required" : false,
"repeats" : true,
"item" : [{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept" : {
"coding" : [{
"system" : "http://hl7.org/fhir/questionnaire-item-control",
"code" : "flyover",
"display" : "Fly-over"
}]
}
}],
"linkId" : "ClaimResponse.disposition-flyover",
"text" : "A human readable description of the status of the adjudication.",
"type" : "display"
},
{
"linkId" : "ClaimResponse.disposition.value",
"text" : "Disposition Message",
"type" : "string",
"required" : false,
"repeats" : false
}]
},
{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs",
"valueInteger" : 1
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType",
"valueString" : "string"
}],
"linkId" : "ClaimResponse.preAuthRef",
"type" : "group",
"required" : false,
"repeats" : true,
"item" : [{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept" : {
"coding" : [{
"system" : "http://hl7.org/fhir/questionnaire-item-control",
"code" : "flyover",
"display" : "Fly-over"
}]
}
}],
"linkId" : "ClaimResponse.preAuthRef-flyover",
"text" : "Reference from the Insurer which is used in later communications which refers to this adjudication. This value is only present on preauthorization adjudications.",
"type" : "display"
},
{
"linkId" : "ClaimResponse.preAuthRef.value",
"text" : "Preauthorization reference",
"type" : "string",
"required" : false,
"repeats" : false
}]
},
{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs",
"valueInteger" : 1
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType",
"valueString" : "Period"
}],
"linkId" : "ClaimResponse.preAuthPeriod",
"text" : "Preauthorization reference effective period",
"type" : "group",
"required" : false,
"repeats" : true,
"item" : [{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept" : {
"coding" : [{
"system" : "http://hl7.org/fhir/questionnaire-item-control",
"code" : "flyover",
"display" : "Fly-over"
}]
}
}],
"linkId" : "ClaimResponse.preAuthPeriod-flyover",
"text" : "The time frame during which this authorization is effective.",
"type" : "display"
},
{
"linkId" : "ClaimResponse.preAuthPeriod.low",
"text" : "start:",
"type" : "dateTime",
"required" : false,
"repeats" : false
},
{
"linkId" : "ClaimResponse.preAuthPeriod.end",
"text" : "end:",
"type" : "dateTime",
"required" : false,
"repeats" : false
}]
},
{
"linkId" : "ClaimResponse.event",
"text" : "Event information",
"type" : "group",
"required" : false,
"repeats" : true,
"item" : [{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept" : {
"coding" : [{
"system" : "http://hl7.org/fhir/questionnaire-item-control",
"code" : "flyover",
"display" : "Fly-over"
}]
}
}],
"linkId" : "ClaimResponse.event-flyover",
"text" : "Information code for an event with a corresponding date or period.",
"type" : "display"
},
{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs",
"valueInteger" : 1
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType",
"valueString" : "string"
}],
"linkId" : "ClaimResponse.event.id",
"type" : "group",
"required" : false,
"repeats" : true,
"item" : [{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept" : {
"coding" : [{
"system" : "http://hl7.org/fhir/questionnaire-item-control",
"code" : "flyover",
"display" : "Fly-over"
}]
}
}],
"linkId" : "ClaimResponse.event.id-flyover",
"text" : "Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.",
"type" : "display"
},
{
"linkId" : "ClaimResponse.event.id.value",
"text" : "Unique id for inter-element referencing",
"type" : "string",
"required" : false,
"repeats" : false
}]
},
{
"linkId" : "ClaimResponse.event.extension",
"text" : "Additional content defined by implementations",
"type" : "group",
"required" : false,
"repeats" : true,
"item" : [{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept" : {
"coding" : [{
"system" : "http://hl7.org/fhir/questionnaire-item-control",
"code" : "flyover",
"display" : "Fly-over"
}]
}
}],
"linkId" : "ClaimResponse.event.extension-flyover",
"text" : "May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and managable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.",
"type" : "display"
}]
},
{
"linkId" : "ClaimResponse.event.modifierExtension",
"text" : "Extensions that cannot be ignored even if unrecognized",
"type" : "group",
"required" : false,
"repeats" : true,
"item" : [{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept" : {
"coding" : [{
"system" : "http://hl7.org/fhir/questionnaire-item-control",
"code" : "flyover",
"display" : "Fly-over"
}]
}
}],
"linkId" : "ClaimResponse.event.modifierExtension-flyover",
"text" : "May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and managable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can 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.\n\nModifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.",
"type" : "display"
}]
},
{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-minOccurs",
"valueInteger" : 1
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs",
"valueInteger" : 1
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType",
"valueString" : "CodeableConcept"
}],
"linkId" : "ClaimResponse.event.type",
"text" : "Specific event",
"type" : "group",
"required" : true,
"repeats" : true,
"item" : [{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept" : {
"coding" : [{
"system" : "http://hl7.org/fhir/questionnaire-item-control",
"code" : "flyover",
"display" : "Fly-over"
}]
}
}],
"linkId" : "ClaimResponse.event.type-flyover",
"text" : "A coded event such as when a service is expected or a card printed.",
"type" : "display"
},
{
"linkId" : "ClaimResponse.event.type.coding",
"text" : "code:",
"type" : "coding",
"required" : false,
"repeats" : false,
"answerConstraint" : "optionsOnly"
},
{
"linkId" : "ClaimResponse.event.type.text",
"text" : "text:",
"type" : "string",
"required" : false,
"repeats" : false
}]
},
{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-minOccurs",
"valueInteger" : 1
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs",
"valueInteger" : 1
}],
"linkId" : "ClaimResponse.event.when[x]",
"text" : "Occurance date or period",
"type" : "group",
"required" : true,
"repeats" : true,
"item" : [{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept" : {
"coding" : [{
"system" : "http://hl7.org/fhir/questionnaire-item-control",
"code" : "flyover",
"display" : "Fly-over"
}]
}
}],
"linkId" : "ClaimResponse.event.when[x]-flyover",
"text" : "A date or period in the past or future indicating when the event occurred or is expectd to occur.",
"type" : "display"
},
{
"linkId" : "ClaimResponse.event.when[x]._type",
"text" : "type",
"type" : "coding",
"required" : false,
"repeats" : false,
"answerConstraint" : "optionsOnly",
"answerValueSet" : "#vs2",
"item" : [{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType",
"valueString" : "datetime"
}],
"linkId" : "ClaimResponse.event.when[x]._null",
"type" : "group",
"item" : [{
"linkId" : "ClaimResponse.event.when[x]._null.value",
"type" : "dateTime",
"required" : false,
"repeats" : false
}]
},
{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType",
"valueString" : "Period"
}],
"linkId" : "ClaimResponse.event.when[x]._null",
"type" : "group",
"item" : [{
"linkId" : "ClaimResponse.event.when[x]._null.low",
"text" : "start:",
"type" : "dateTime",
"required" : false,
"repeats" : false
},
{
"linkId" : "ClaimResponse.event.when[x]._null.end",
"text" : "end:",
"type" : "dateTime",
"required" : false,
"repeats" : false
}]
}]
}]
}]
},
{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs",
"valueInteger" : 1
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType",
"valueString" : "CodeableConcept"
}],
"linkId" : "ClaimResponse.payeeType",
"text" : "Party to be paid any benefits payable",
"type" : "group",
"required" : false,
"repeats" : true,
"item" : [{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept" : {
"coding" : [{
"system" : "http://hl7.org/fhir/questionnaire-item-control",
"code" : "flyover",
"display" : "Fly-over"
}]
}
}],
"linkId" : "ClaimResponse.payeeType-flyover",
"text" : "Type of Party to be reimbursed: subscriber, provider, other.",
"type" : "display"
},
{
"linkId" : "ClaimResponse.payeeType.coding",
"text" : "code:",
"type" : "coding",
"required" : false,
"repeats" : false,
"answerConstraint" : "optionsOnly"
},
{
"linkId" : "ClaimResponse.payeeType.text",
"text" : "text:",
"type" : "string",
"required" : false,
"repeats" : false
}]
},
{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType",
"valueString" : "Reference"
}],
"linkId" : "ClaimResponse.encounter",
"type" : "group",
"required" : false,
"repeats" : true,
"item" : [{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept" : {
"coding" : [{
"system" : "http://hl7.org/fhir/questionnaire-item-control",
"code" : "flyover",
"display" : "Fly-over"
}]
}
}],
"linkId" : "ClaimResponse.encounter-flyover",
"text" : "Healthcare encounters related to this claim. This will typically be the encounter the event occurred within, but some activities may be initiated prior to or after the official completion of an encounter but still be tied to the context of the encounter.",
"type" : "display"
},
{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-referenceResource",
"valueCode" : "Encounter"
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-referenceFilter",
"valueString" : "subject=$subj&patient=$subj&encounter=$encounter"
}],
"linkId" : "ClaimResponse.encounter.value",
"text" : "Encounters associated with the listed treatments",
"type" : "reference",
"required" : false,
"repeats" : false
}]
},
{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs",
"valueInteger" : 1
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType",
"valueString" : "CodeableConcept"
}],
"linkId" : "ClaimResponse.diagnosisRelatedGroup",
"text" : "Package billing code",
"type" : "group",
"required" : false,
"repeats" : true,
"item" : [{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept" : {
"coding" : [{
"system" : "http://hl7.org/fhir/questionnaire-item-control",
"code" : "flyover",
"display" : "Fly-over"
}]
}
}],
"linkId" : "ClaimResponse.diagnosisRelatedGroup-flyover",
"text" : "A package billing code or bundle code used to group products and services to a particular health condition (such as heart attack) which is based on a predetermined grouping code system. For example DRG (Diagnosis Related Group) or a bundled billing code. A patient may have a diagnosis of a Myocardial Infarction and a DRG for HeartAttack would be assigned. The Claim item (and possible subsequent claims) would refer to the DRG for those line items that were for services related to the heart attack event.",
"type" : "display"
},
{
"linkId" : "ClaimResponse.diagnosisRelatedGroup.coding",
"text" : "code:",
"type" : "coding",
"required" : false,
"repeats" : false,
"answerConstraint" : "optionsOnly"
},
{
"linkId" : "ClaimResponse.diagnosisRelatedGroup.text",
"text" : "text:",
"type" : "string",
"required" : false,
"repeats" : false
}]
},
{
"linkId" : "ClaimResponse.item",
"text" : "Adjudication for claim line items",
"type" : "group",
"required" : false,
"repeats" : true,
"item" : [{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept" : {
"coding" : [{
"system" : "http://hl7.org/fhir/questionnaire-item-control",
"code" : "flyover",
"display" : "Fly-over"
}]
}
}],
"linkId" : "ClaimResponse.item-flyover",
"text" : "A claim line. Either a simple (a product or service) or a 'group' of details which can also be a simple items or groups of sub-details.",
"type" : "display"
},
{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs",
"valueInteger" : 1
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType",
"valueString" : "string"
}],
"linkId" : "ClaimResponse.item.id",
"type" : "group",
"required" : false,
"repeats" : true,
"item" : [{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept" : {
"coding" : [{
"system" : "http://hl7.org/fhir/questionnaire-item-control",
"code" : "flyover",
"display" : "Fly-over"
}]
}
}],
"linkId" : "ClaimResponse.item.id-flyover",
"text" : "Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.",
"type" : "display"
},
{
"linkId" : "ClaimResponse.item.id.value",
"text" : "Unique id for inter-element referencing",
"type" : "string",
"required" : false,
"repeats" : false
}]
},
{
"linkId" : "ClaimResponse.item.extension",
"text" : "Additional content defined by implementations",
"type" : "group",
"required" : false,
"repeats" : true,
"item" : [{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept" : {
"coding" : [{
"system" : "http://hl7.org/fhir/questionnaire-item-control",
"code" : "flyover",
"display" : "Fly-over"
}]
}
}],
"linkId" : "ClaimResponse.item.extension-flyover",
"text" : "May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and managable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.",
"type" : "display"
}]
},
{
"linkId" : "ClaimResponse.item.modifierExtension",
"text" : "Extensions that cannot be ignored even if unrecognized",
"type" : "group",
"required" : false,
"repeats" : true,
"item" : [{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept" : {
"coding" : [{
"system" : "http://hl7.org/fhir/questionnaire-item-control",
"code" : "flyover",
"display" : "Fly-over"
}]
}
}],
"linkId" : "ClaimResponse.item.modifierExtension-flyover",
"text" : "May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and managable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can 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.\n\nModifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.",
"type" : "display"
}]
},
{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-minOccurs",
"valueInteger" : 1
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs",
"valueInteger" : 1
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType",
"valueString" : "integer"
}],
"linkId" : "ClaimResponse.item.itemSequence",
"type" : "group",
"required" : true,
"repeats" : true,
"item" : [{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept" : {
"coding" : [{
"system" : "http://hl7.org/fhir/questionnaire-item-control",
"code" : "flyover",
"display" : "Fly-over"
}]
}
}],
"linkId" : "ClaimResponse.item.itemSequence-flyover",
"text" : "A number to uniquely reference the claim item entries.",
"type" : "display"
},
{
"linkId" : "ClaimResponse.item.itemSequence.value",
"text" : "Claim item instance identifier",
"type" : "integer",
"required" : false,
"repeats" : false
}]
},
{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType",
"valueString" : "Identifier"
}],
"linkId" : "ClaimResponse.item.traceNumber",
"text" : "Number for tracking",
"type" : "group",
"required" : false,
"repeats" : true,
"item" : [{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept" : {
"coding" : [{
"system" : "http://hl7.org/fhir/questionnaire-item-control",
"code" : "flyover",
"display" : "Fly-over"
}]
}
}],
"linkId" : "ClaimResponse.item.traceNumber-flyover",
"text" : "Trace number for tracking purposes. May be defined at the jurisdiction level or between trading partners.",
"type" : "display"
},
{
"linkId" : "ClaimResponse.item.traceNumber.label",
"text" : "label:",
"type" : "string",
"required" : false,
"repeats" : false
},
{
"linkId" : "ClaimResponse.item.traceNumber.system",
"text" : "system:",
"type" : "string",
"required" : false,
"repeats" : false
},
{
"linkId" : "ClaimResponse.item.traceNumber.value",
"text" : "value:",
"type" : "string",
"required" : false,
"repeats" : false
}]
},
{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType",
"valueString" : "integer"
}],
"linkId" : "ClaimResponse.item.noteNumber",
"type" : "group",
"required" : false,
"repeats" : true,
"item" : [{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept" : {
"coding" : [{
"system" : "http://hl7.org/fhir/questionnaire-item-control",
"code" : "flyover",
"display" : "Fly-over"
}]
}
}],
"linkId" : "ClaimResponse.item.noteNumber-flyover",
"text" : "The numbers associated with notes below which apply to the adjudication of this item.",
"type" : "display"
},
{
"linkId" : "ClaimResponse.item.noteNumber.value",
"text" : "Applicable note numbers",
"type" : "integer",
"required" : false,
"repeats" : false
}]
},
{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs",
"valueInteger" : 1
}],
"linkId" : "ClaimResponse.item.reviewOutcome",
"text" : "Adjudication results",
"type" : "group",
"required" : false,
"repeats" : false,
"item" : [{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept" : {
"coding" : [{
"system" : "http://hl7.org/fhir/questionnaire-item-control",
"code" : "flyover",
"display" : "Fly-over"
}]
}
}],
"linkId" : "ClaimResponse.item.reviewOutcome-flyover",
"text" : "The high-level results of the adjudication if adjudication has been performed.",
"type" : "display"
},
{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs",
"valueInteger" : 1
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType",
"valueString" : "string"
}],
"linkId" : "ClaimResponse.item.reviewOutcome.id",
"type" : "group",
"required" : false,
"repeats" : true,
"item" : [{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept" : {
"coding" : [{
"system" : "http://hl7.org/fhir/questionnaire-item-control",
"code" : "flyover",
"display" : "Fly-over"
}]
}
}],
"linkId" : "ClaimResponse.item.reviewOutcome.id-flyover",
"text" : "Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.",
"type" : "display"
},
{
"linkId" : "ClaimResponse.item.reviewOutcome.id.value",
"text" : "Unique id for inter-element referencing",
"type" : "string",
"required" : false,
"repeats" : false
}]
},
{
"linkId" : "ClaimResponse.item.reviewOutcome.extension",
"text" : "Additional content defined by implementations",
"type" : "group",
"required" : false,
"repeats" : true,
"item" : [{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept" : {
"coding" : [{
"system" : "http://hl7.org/fhir/questionnaire-item-control",
"code" : "flyover",
"display" : "Fly-over"
}]
}
}],
"linkId" : "ClaimResponse.item.reviewOutcome.extension-flyover",
"text" : "May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and managable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.",
"type" : "display"
}]
},
{
"linkId" : "ClaimResponse.item.reviewOutcome.modifierExtension",
"text" : "Extensions that cannot be ignored even if unrecognized",
"type" : "group",
"required" : false,
"repeats" : true,
"item" : [{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept" : {
"coding" : [{
"system" : "http://hl7.org/fhir/questionnaire-item-control",
"code" : "flyover",
"display" : "Fly-over"
}]
}
}],
"linkId" : "ClaimResponse.item.reviewOutcome.modifierExtension-flyover",
"text" : "May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and managable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can 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.\n\nModifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.",
"type" : "display"
}]
},
{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs",
"valueInteger" : 1
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType",
"valueString" : "CodeableConcept"
}],
"linkId" : "ClaimResponse.item.reviewOutcome.decision",
"text" : "Result of the adjudication",
"type" : "group",
"required" : false,
"repeats" : true,
"item" : [{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept" : {
"coding" : [{
"system" : "http://hl7.org/fhir/questionnaire-item-control",
"code" : "flyover",
"display" : "Fly-over"
}]
}
}],
"linkId" : "ClaimResponse.item.reviewOutcome.decision-flyover",
"text" : "The result of the claim, predetermination, or preauthorization adjudication. The element is used to indicate the current state of the adjudication overall for the claim resource, for example: the request has been held (pended) for adjudication processing, for manual review or other reasons; that it has been processed and will be paid, or the outstanding paid, as submitted (approved); that no amount will be paid (denied); or that some amount between zero and the submitted amount will be paid (partial).",
"type" : "display"
},
{
"linkId" : "ClaimResponse.item.reviewOutcome.decision.coding",
"text" : "code:",
"type" : "coding",
"required" : false,
"repeats" : false,
"answerConstraint" : "optionsOnly"
},
{
"linkId" : "ClaimResponse.item.reviewOutcome.decision.text",
"text" : "text:",
"type" : "string",
"required" : false,
"repeats" : false
}]
},
{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType",
"valueString" : "CodeableConcept"
}],
"linkId" : "ClaimResponse.item.reviewOutcome.reason",
"text" : "Reason for result of the adjudication",
"type" : "group",
"required" : false,
"repeats" : true,
"item" : [{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept" : {
"coding" : [{
"system" : "http://hl7.org/fhir/questionnaire-item-control",
"code" : "flyover",
"display" : "Fly-over"
}]
}
}],
"linkId" : "ClaimResponse.item.reviewOutcome.reason-flyover",
"text" : "The reasons for the result of the claim, predetermination, or preauthorization adjudication.",
"type" : "display"
},
{
"linkId" : "ClaimResponse.item.reviewOutcome.reason.coding",
"text" : "code:",
"type" : "coding",
"required" : false,
"repeats" : false,
"answerConstraint" : "optionsOnly"
},
{
"linkId" : "ClaimResponse.item.reviewOutcome.reason.text",
"text" : "text:",
"type" : "string",
"required" : false,
"repeats" : false
}]
},
{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs",
"valueInteger" : 1
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType",
"valueString" : "string"
}],
"linkId" : "ClaimResponse.item.reviewOutcome.preAuthRef",
"type" : "group",
"required" : false,
"repeats" : true,
"item" : [{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept" : {
"coding" : [{
"system" : "http://hl7.org/fhir/questionnaire-item-control",
"code" : "flyover",
"display" : "Fly-over"
}]
}
}],
"linkId" : "ClaimResponse.item.reviewOutcome.preAuthRef-flyover",
"text" : "Reference from the Insurer which is used in later communications which refers to this adjudication. This value is only present on preauthorization adjudications.",
"type" : "display"
},
{
"linkId" : "ClaimResponse.item.reviewOutcome.preAuthRef.value",
"text" : "Preauthorization reference",
"type" : "string",
"required" : false,
"repeats" : false
}]
},
{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs",
"valueInteger" : 1
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType",
"valueString" : "Period"
}],
"linkId" : "ClaimResponse.item.reviewOutcome.preAuthPeriod",
"text" : "Preauthorization reference effective period",
"type" : "group",
"required" : false,
"repeats" : true,
"item" : [{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept" : {
"coding" : [{
"system" : "http://hl7.org/fhir/questionnaire-item-control",
"code" : "flyover",
"display" : "Fly-over"
}]
}
}],
"linkId" : "ClaimResponse.item.reviewOutcome.preAuthPeriod-flyover",
"text" : "The time frame during which this authorization is effective.",
"type" : "display"
},
{
"linkId" : "ClaimResponse.item.reviewOutcome.preAuthPeriod.low",
"text" : "start:",
"type" : "dateTime",
"required" : false,
"repeats" : false
},
{
"linkId" : "ClaimResponse.item.reviewOutcome.preAuthPeriod.end",
"text" : "end:",
"type" : "dateTime",
"required" : false,
"repeats" : false
}]
}]
},
{
"linkId" : "ClaimResponse.item.adjudication",
"text" : "Adjudication details",
"type" : "group",
"required" : false,
"repeats" : true,
"item" : [{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept" : {
"coding" : [{
"system" : "http://hl7.org/fhir/questionnaire-item-control",
"code" : "flyover",
"display" : "Fly-over"
}]
}
}],
"linkId" : "ClaimResponse.item.adjudication-flyover",
"text" : "If this item is a group then the values here are a summary of the adjudication of the detail items. If this item is a simple product or service then this is the result of the adjudication of this item.",
"type" : "display"
},
{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs",
"valueInteger" : 1
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType",
"valueString" : "string"
}],
"linkId" : "ClaimResponse.item.adjudication.id",
"type" : "group",
"required" : false,
"repeats" : true,
"item" : [{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept" : {
"coding" : [{
"system" : "http://hl7.org/fhir/questionnaire-item-control",
"code" : "flyover",
"display" : "Fly-over"
}]
}
}],
"linkId" : "ClaimResponse.item.adjudication.id-flyover",
"text" : "Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.",
"type" : "display"
},
{
"linkId" : "ClaimResponse.item.adjudication.id.value",
"text" : "Unique id for inter-element referencing",
"type" : "string",
"required" : false,
"repeats" : false
}]
},
{
"linkId" : "ClaimResponse.item.adjudication.extension",
"text" : "Additional content defined by implementations",
"type" : "group",
"required" : false,
"repeats" : true,
"item" : [{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept" : {
"coding" : [{
"system" : "http://hl7.org/fhir/questionnaire-item-control",
"code" : "flyover",
"display" : "Fly-over"
}]
}
}],
"linkId" : "ClaimResponse.item.adjudication.extension-flyover",
"text" : "May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and managable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.",
"type" : "display"
}]
},
{
"linkId" : "ClaimResponse.item.adjudication.modifierExtension",
"text" : "Extensions that cannot be ignored even if unrecognized",
"type" : "group",
"required" : false,
"repeats" : true,
"item" : [{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept" : {
"coding" : [{
"system" : "http://hl7.org/fhir/questionnaire-item-control",
"code" : "flyover",
"display" : "Fly-over"
}]
}
}],
"linkId" : "ClaimResponse.item.adjudication.modifierExtension-flyover",
"text" : "May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and managable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can 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.\n\nModifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.",
"type" : "display"
}]
},
{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-minOccurs",
"valueInteger" : 1
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs",
"valueInteger" : 1
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType",
"valueString" : "CodeableConcept"
}],
"linkId" : "ClaimResponse.item.adjudication.category",
"text" : "Type of adjudication information",
"type" : "group",
"required" : true,
"repeats" : true,
"item" : [{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept" : {
"coding" : [{
"system" : "http://hl7.org/fhir/questionnaire-item-control",
"code" : "flyover",
"display" : "Fly-over"
}]
}
}],
"linkId" : "ClaimResponse.item.adjudication.category-flyover",
"text" : "A code to indicate the information type of this adjudication record. Information types may include the value submitted, maximum values or percentages allowed or payable under the plan, amounts that: the patient is responsible for in aggregate or pertaining to this item; amounts paid by other coverages; and, the benefit payable for this item. For example codes indicating: Co-Pay, deductible, eligible, benefit, tax, etc.",
"type" : "display"
},
{
"linkId" : "ClaimResponse.item.adjudication.category.coding",
"text" : "code:",
"type" : "coding",
"required" : false,
"repeats" : false,
"answerConstraint" : "optionsOnly"
},
{
"linkId" : "ClaimResponse.item.adjudication.category.text",
"text" : "text:",
"type" : "string",
"required" : false,
"repeats" : false
}]
},
{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs",
"valueInteger" : 1
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType",
"valueString" : "CodeableConcept"
}],
"linkId" : "ClaimResponse.item.adjudication.reason",
"text" : "Explanation of adjudication outcome",
"type" : "group",
"required" : false,
"repeats" : true,
"item" : [{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept" : {
"coding" : [{
"system" : "http://hl7.org/fhir/questionnaire-item-control",
"code" : "flyover",
"display" : "Fly-over"
}]
}
}],
"linkId" : "ClaimResponse.item.adjudication.reason-flyover",
"text" : "A code supporting the understanding of the adjudication result and explaining variance from expected amount. For example may indicate that the funds for this benefit type have been exhausted.",
"type" : "display"
},
{
"linkId" : "ClaimResponse.item.adjudication.reason.coding",
"text" : "code:",
"type" : "coding",
"required" : false,
"repeats" : false,
"answerConstraint" : "optionsOnly"
},
{
"linkId" : "ClaimResponse.item.adjudication.reason.text",
"text" : "text:",
"type" : "string",
"required" : false,
"repeats" : false
}]
},
{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs",
"valueInteger" : 1
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType",
"valueString" : "Quantity"
}],
"linkId" : "ClaimResponse.item.adjudication.amount",
"text" : "Monetary amount",
"type" : "group",
"required" : false,
"repeats" : true,
"item" : [{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept" : {
"coding" : [{
"system" : "http://hl7.org/fhir/questionnaire-item-control",
"code" : "flyover",
"display" : "Fly-over"
}]
}
}],
"linkId" : "ClaimResponse.item.adjudication.amount-flyover",
"text" : "Monetary amount associated with the category. For example: amount submitted, eligible amount, co-payment, and benefit payable.",
"type" : "display"
},
{
"linkId" : "ClaimResponse.item.adjudication.amount.comparator",
"text" : "comp:",
"type" : "coding",
"required" : false,
"repeats" : false,
"answerConstraint" : "optionsOnly"
},
{
"linkId" : "ClaimResponse.item.adjudication.amount.value",
"text" : "value:",
"type" : "decimal",
"required" : false,
"repeats" : false
},
{
"linkId" : "ClaimResponse.item.adjudication.amount.units",
"text" : "units:",
"type" : "string",
"required" : false,
"repeats" : false
},
{
"linkId" : "ClaimResponse.item.adjudication.amount.code",
"text" : "coded units:",
"type" : "string",
"required" : false,
"repeats" : false
},
{
"linkId" : "ClaimResponse.item.adjudication.amount.system",
"text" : "units system:",
"type" : "string",
"required" : false,
"repeats" : false
}]
},
{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs",
"valueInteger" : 1
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType",
"valueString" : "Quantity"
}],
"linkId" : "ClaimResponse.item.adjudication.quantity",
"text" : "Non-monetary value",
"type" : "group",
"required" : false,
"repeats" : true,
"item" : [{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept" : {
"coding" : [{
"system" : "http://hl7.org/fhir/questionnaire-item-control",
"code" : "flyover",
"display" : "Fly-over"
}]
}
}],
"linkId" : "ClaimResponse.item.adjudication.quantity-flyover",
"text" : "A non-monetary value associated with the category. Mutually exclusive to the amount element above. For example: eligible percentage or co-payment percentage.",
"type" : "display"
},
{
"linkId" : "ClaimResponse.item.adjudication.quantity.comparator",
"text" : "comp:",
"type" : "coding",
"required" : false,
"repeats" : false,
"answerConstraint" : "optionsOnly"
},
{
"linkId" : "ClaimResponse.item.adjudication.quantity.value",
"text" : "value:",
"type" : "decimal",
"required" : false,
"repeats" : false
},
{
"linkId" : "ClaimResponse.item.adjudication.quantity.units",
"text" : "units:",
"type" : "string",
"required" : false,
"repeats" : false
},
{
"linkId" : "ClaimResponse.item.adjudication.quantity.code",
"text" : "coded units:",
"type" : "string",
"required" : false,
"repeats" : false
},
{
"linkId" : "ClaimResponse.item.adjudication.quantity.system",
"text" : "units system:",
"type" : "string",
"required" : false,
"repeats" : false
}]
}]
},
{
"linkId" : "ClaimResponse.item.detail",
"text" : "Adjudication for claim details",
"type" : "group",
"required" : false,
"repeats" : true,
"item" : [{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept" : {
"coding" : [{
"system" : "http://hl7.org/fhir/questionnaire-item-control",
"code" : "flyover",
"display" : "Fly-over"
}]
}
}],
"linkId" : "ClaimResponse.item.detail-flyover",
"text" : "A claim detail. Either a simple (a product or service) or a 'group' of sub-details which are simple items.",
"type" : "display"
},
{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs",
"valueInteger" : 1
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType",
"valueString" : "string"
}],
"linkId" : "ClaimResponse.item.detail.id",
"type" : "group",
"required" : false,
"repeats" : true,
"item" : [{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept" : {
"coding" : [{
"system" : "http://hl7.org/fhir/questionnaire-item-control",
"code" : "flyover",
"display" : "Fly-over"
}]
}
}],
"linkId" : "ClaimResponse.item.detail.id-flyover",
"text" : "Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.",
"type" : "display"
},
{
"linkId" : "ClaimResponse.item.detail.id.value",
"text" : "Unique id for inter-element referencing",
"type" : "string",
"required" : false,
"repeats" : false
}]
},
{
"linkId" : "ClaimResponse.item.detail.extension",
"text" : "Additional content defined by implementations",
"type" : "group",
"required" : false,
"repeats" : true,
"item" : [{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept" : {
"coding" : [{
"system" : "http://hl7.org/fhir/questionnaire-item-control",
"code" : "flyover",
"display" : "Fly-over"
}]
}
}],
"linkId" : "ClaimResponse.item.detail.extension-flyover",
"text" : "May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and managable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.",
"type" : "display"
}]
},
{
"linkId" : "ClaimResponse.item.detail.modifierExtension",
"text" : "Extensions that cannot be ignored even if unrecognized",
"type" : "group",
"required" : false,
"repeats" : true,
"item" : [{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept" : {
"coding" : [{
"system" : "http://hl7.org/fhir/questionnaire-item-control",
"code" : "flyover",
"display" : "Fly-over"
}]
}
}],
"linkId" : "ClaimResponse.item.detail.modifierExtension-flyover",
"text" : "May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and managable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can 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.\n\nModifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.",
"type" : "display"
}]
},
{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-minOccurs",
"valueInteger" : 1
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs",
"valueInteger" : 1
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType",
"valueString" : "integer"
}],
"linkId" : "ClaimResponse.item.detail.detailSequence",
"type" : "group",
"required" : true,
"repeats" : true,
"item" : [{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept" : {
"coding" : [{
"system" : "http://hl7.org/fhir/questionnaire-item-control",
"code" : "flyover",
"display" : "Fly-over"
}]
}
}],
"linkId" : "ClaimResponse.item.detail.detailSequence-flyover",
"text" : "A number to uniquely reference the claim detail entry.",
"type" : "display"
},
{
"linkId" : "ClaimResponse.item.detail.detailSequence.value",
"text" : "Claim detail instance identifier",
"type" : "integer",
"required" : false,
"repeats" : false
}]
},
{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType",
"valueString" : "Identifier"
}],
"linkId" : "ClaimResponse.item.detail.traceNumber",
"text" : "Number for tracking",
"type" : "group",
"required" : false,
"repeats" : true,
"item" : [{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept" : {
"coding" : [{
"system" : "http://hl7.org/fhir/questionnaire-item-control",
"code" : "flyover",
"display" : "Fly-over"
}]
}
}],
"linkId" : "ClaimResponse.item.detail.traceNumber-flyover",
"text" : "Trace number for tracking purposes. May be defined at the jurisdiction level or between trading partners.",
"type" : "display"
},
{
"linkId" : "ClaimResponse.item.detail.traceNumber.label",
"text" : "label:",
"type" : "string",
"required" : false,
"repeats" : false
},
{
"linkId" : "ClaimResponse.item.detail.traceNumber.system",
"text" : "system:",
"type" : "string",
"required" : false,
"repeats" : false
},
{
"linkId" : "ClaimResponse.item.detail.traceNumber.value",
"text" : "value:",
"type" : "string",
"required" : false,
"repeats" : false
}]
},
{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType",
"valueString" : "integer"
}],
"linkId" : "ClaimResponse.item.detail.noteNumber",
"type" : "group",
"required" : false,
"repeats" : true,
"item" : [{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept" : {
"coding" : [{
"system" : "http://hl7.org/fhir/questionnaire-item-control",
"code" : "flyover",
"display" : "Fly-over"
}]
}
}],
"linkId" : "ClaimResponse.item.detail.noteNumber-flyover",
"text" : "The numbers associated with notes below which apply to the adjudication of this item.",
"type" : "display"
},
{
"linkId" : "ClaimResponse.item.detail.noteNumber.value",
"text" : "Applicable note numbers",
"type" : "integer",
"required" : false,
"repeats" : false
}]
},
{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs",
"valueInteger" : 1
}],
"linkId" : "ClaimResponse.item.detail.reviewOutcome",
"text" : "Detail level adjudication results",
"type" : "group",
"required" : false,
"repeats" : false,
"item" : [{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept" : {
"coding" : [{
"system" : "http://hl7.org/fhir/questionnaire-item-control",
"code" : "flyover",
"display" : "Fly-over"
}]
}
}],
"linkId" : "ClaimResponse.item.detail.reviewOutcome-flyover",
"text" : "The high-level results of the adjudication if adjudication has been performed.",
"type" : "display"
},
{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs",
"valueInteger" : 1
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType",
"valueString" : "string"
}],
"linkId" : "ClaimResponse.item.reviewOutcome.id",
"type" : "group",
"required" : false,
"repeats" : true,
"item" : [{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept" : {
"coding" : [{
"system" : "http://hl7.org/fhir/questionnaire-item-control",
"code" : "flyover",
"display" : "Fly-over"
}]
}
}],
"linkId" : "ClaimResponse.item.reviewOutcome.id-flyover",
"text" : "Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.",
"type" : "display"
},
{
"linkId" : "ClaimResponse.item.reviewOutcome.id.value",
"text" : "Unique id for inter-element referencing",
"type" : "string",
"required" : false,
"repeats" : false
}]
},
{
"linkId" : "ClaimResponse.item.reviewOutcome.extension",
"text" : "Additional content defined by implementations",
"type" : "group",
"required" : false,
"repeats" : true,
"item" : [{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept" : {
"coding" : [{
"system" : "http://hl7.org/fhir/questionnaire-item-control",
"code" : "flyover",
"display" : "Fly-over"
}]
}
}],
"linkId" : "ClaimResponse.item.reviewOutcome.extension-flyover",
"text" : "May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and managable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.",
"type" : "display"
}]
},
{
"linkId" : "ClaimResponse.item.reviewOutcome.modifierExtension",
"text" : "Extensions that cannot be ignored even if unrecognized",
"type" : "group",
"required" : false,
"repeats" : true,
"item" : [{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept" : {
"coding" : [{
"system" : "http://hl7.org/fhir/questionnaire-item-control",
"code" : "flyover",
"display" : "Fly-over"
}]
}
}],
"linkId" : "ClaimResponse.item.reviewOutcome.modifierExtension-flyover",
"text" : "May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and managable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can 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.\n\nModifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.",
"type" : "display"
}]
},
{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs",
"valueInteger" : 1
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType",
"valueString" : "CodeableConcept"
}],
"linkId" : "ClaimResponse.item.reviewOutcome.decision",
"text" : "Result of the adjudication",
"type" : "group",
"required" : false,
"repeats" : true,
"item" : [{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept" : {
"coding" : [{
"system" : "http://hl7.org/fhir/questionnaire-item-control",
"code" : "flyover",
"display" : "Fly-over"
}]
}
}],
"linkId" : "ClaimResponse.item.reviewOutcome.decision-flyover",
"text" : "The result of the claim, predetermination, or preauthorization adjudication. The element is used to indicate the current state of the adjudication overall for the claim resource, for example: the request has been held (pended) for adjudication processing, for manual review or other reasons; that it has been processed and will be paid, or the outstanding paid, as submitted (approved); that no amount will be paid (denied); or that some amount between zero and the submitted amount will be paid (partial).",
"type" : "display"
},
{
"linkId" : "ClaimResponse.item.reviewOutcome.decision.coding",
"text" : "code:",
"type" : "coding",
"required" : false,
"repeats" : false,
"answerConstraint" : "optionsOnly"
},
{
"linkId" : "ClaimResponse.item.reviewOutcome.decision.text",
"text" : "text:",
"type" : "string",
"required" : false,
"repeats" : false
}]
},
{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType",
"valueString" : "CodeableConcept"
}],
"linkId" : "ClaimResponse.item.reviewOutcome.reason",
"text" : "Reason for result of the adjudication",
"type" : "group",
"required" : false,
"repeats" : true,
"item" : [{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept" : {
"coding" : [{
"system" : "http://hl7.org/fhir/questionnaire-item-control",
"code" : "flyover",
"display" : "Fly-over"
}]
}
}],
"linkId" : "ClaimResponse.item.reviewOutcome.reason-flyover",
"text" : "The reasons for the result of the claim, predetermination, or preauthorization adjudication.",
"type" : "display"
},
{
"linkId" : "ClaimResponse.item.reviewOutcome.reason.coding",
"text" : "code:",
"type" : "coding",
"required" : false,
"repeats" : false,
"answerConstraint" : "optionsOnly"
},
{
"linkId" : "ClaimResponse.item.reviewOutcome.reason.text",
"text" : "text:",
"type" : "string",
"required" : false,
"repeats" : false
}]
},
{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs",
"valueInteger" : 1
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType",
"valueString" : "string"
}],
"linkId" : "ClaimResponse.item.reviewOutcome.preAuthRef",
"type" : "group",
"required" : false,
"repeats" : true,
"item" : [{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept" : {
"coding" : [{
"system" : "http://hl7.org/fhir/questionnaire-item-control",
"code" : "flyover",
"display" : "Fly-over"
}]
}
}],
"linkId" : "ClaimResponse.item.reviewOutcome.preAuthRef-flyover",
"text" : "Reference from the Insurer which is used in later communications which refers to this adjudication. This value is only present on preauthorization adjudications.",
"type" : "display"
},
{
"linkId" : "ClaimResponse.item.reviewOutcome.preAuthRef.value",
"text" : "Preauthorization reference",
"type" : "string",
"required" : false,
"repeats" : false
}]
},
{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs",
"valueInteger" : 1
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType",
"valueString" : "Period"
}],
"linkId" : "ClaimResponse.item.reviewOutcome.preAuthPeriod",
"text" : "Preauthorization reference effective period",
"type" : "group",
"required" : false,
"repeats" : true,
"item" : [{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept" : {
"coding" : [{
"system" : "http://hl7.org/fhir/questionnaire-item-control",
"code" : "flyover",
"display" : "Fly-over"
}]
}
}],
"linkId" : "ClaimResponse.item.reviewOutcome.preAuthPeriod-flyover",
"text" : "The time frame during which this authorization is effective.",
"type" : "display"
},
{
"linkId" : "ClaimResponse.item.reviewOutcome.preAuthPeriod.low",
"text" : "start:",
"type" : "dateTime",
"required" : false,
"repeats" : false
},
{
"linkId" : "ClaimResponse.item.reviewOutcome.preAuthPeriod.end",
"text" : "end:",
"type" : "dateTime",
"required" : false,
"repeats" : false
}]
}]
},
{
"linkId" : "ClaimResponse.item.detail.adjudication",
"text" : "Detail level adjudication details",
"type" : "group",
"required" : false,
"repeats" : true,
"item" : [{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept" : {
"coding" : [{
"system" : "http://hl7.org/fhir/questionnaire-item-control",
"code" : "flyover",
"display" : "Fly-over"
}]
}
}],
"linkId" : "ClaimResponse.item.detail.adjudication-flyover",
"text" : "The adjudication results.",
"type" : "display"
},
{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs",
"valueInteger" : 1
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType",
"valueString" : "string"
}],
"linkId" : "ClaimResponse.item.adjudication.id",
"type" : "group",
"required" : false,
"repeats" : true,
"item" : [{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept" : {
"coding" : [{
"system" : "http://hl7.org/fhir/questionnaire-item-control",
"code" : "flyover",
"display" : "Fly-over"
}]
}
}],
"linkId" : "ClaimResponse.item.adjudication.id-flyover",
"text" : "Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.",
"type" : "display"
},
{
"linkId" : "ClaimResponse.item.adjudication.id.value",
"text" : "Unique id for inter-element referencing",
"type" : "string",
"required" : false,
"repeats" : false
}]
},
{
"linkId" : "ClaimResponse.item.adjudication.extension",
"text" : "Additional content defined by implementations",
"type" : "group",
"required" : false,
"repeats" : true,
"item" : [{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept" : {
"coding" : [{
"system" : "http://hl7.org/fhir/questionnaire-item-control",
"code" : "flyover",
"display" : "Fly-over"
}]
}
}],
"linkId" : "ClaimResponse.item.adjudication.extension-flyover",
"text" : "May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and managable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.",
"type" : "display"
}]
},
{
"linkId" : "ClaimResponse.item.adjudication.modifierExtension",
"text" : "Extensions that cannot be ignored even if unrecognized",
"type" : "group",
"required" : false,
"repeats" : true,
"item" : [{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept" : {
"coding" : [{
"system" : "http://hl7.org/fhir/questionnaire-item-control",
"code" : "flyover",
"display" : "Fly-over"
}]
}
}],
"linkId" : "ClaimResponse.item.adjudication.modifierExtension-flyover",
"text" : "May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and managable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can 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.\n\nModifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.",
"type" : "display"
}]
},
{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-minOccurs",
"valueInteger" : 1
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs",
"valueInteger" : 1
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType",
"valueString" : "CodeableConcept"
}],
"linkId" : "ClaimResponse.item.adjudication.category",
"text" : "Type of adjudication information",
"type" : "group",
"required" : true,
"repeats" : true,
"item" : [{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept" : {
"coding" : [{
"system" : "http://hl7.org/fhir/questionnaire-item-control",
"code" : "flyover",
"display" : "Fly-over"
}]
}
}],
"linkId" : "ClaimResponse.item.adjudication.category-flyover",
"text" : "A code to indicate the information type of this adjudication record. Information types may include the value submitted, maximum values or percentages allowed or payable under the plan, amounts that: the patient is responsible for in aggregate or pertaining to this item; amounts paid by other coverages; and, the benefit payable for this item. For example codes indicating: Co-Pay, deductible, eligible, benefit, tax, etc.",
"type" : "display"
},
{
"linkId" : "ClaimResponse.item.adjudication.category.coding",
"text" : "code:",
"type" : "coding",
"required" : false,
"repeats" : false,
"answerConstraint" : "optionsOnly"
},
{
"linkId" : "ClaimResponse.item.adjudication.category.text",
"text" : "text:",
"type" : "string",
"required" : false,
"repeats" : false
}]
},
{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs",
"valueInteger" : 1
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType",
"valueString" : "CodeableConcept"
}],
"linkId" : "ClaimResponse.item.adjudication.reason",
"text" : "Explanation of adjudication outcome",
"type" : "group",
"required" : false,
"repeats" : true,
"item" : [{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept" : {
"coding" : [{
"system" : "http://hl7.org/fhir/questionnaire-item-control",
"code" : "flyover",
"display" : "Fly-over"
}]
}
}],
"linkId" : "ClaimResponse.item.adjudication.reason-flyover",
"text" : "A code supporting the understanding of the adjudication result and explaining variance from expected amount. For example may indicate that the funds for this benefit type have been exhausted.",
"type" : "display"
},
{
"linkId" : "ClaimResponse.item.adjudication.reason.coding",
"text" : "code:",
"type" : "coding",
"required" : false,
"repeats" : false,
"answerConstraint" : "optionsOnly"
},
{
"linkId" : "ClaimResponse.item.adjudication.reason.text",
"text" : "text:",
"type" : "string",
"required" : false,
"repeats" : false
}]
},
{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs",
"valueInteger" : 1
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType",
"valueString" : "Quantity"
}],
"linkId" : "ClaimResponse.item.adjudication.amount",
"text" : "Monetary amount",
"type" : "group",
"required" : false,
"repeats" : true,
"item" : [{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept" : {
"coding" : [{
"system" : "http://hl7.org/fhir/questionnaire-item-control",
"code" : "flyover",
"display" : "Fly-over"
}]
}
}],
"linkId" : "ClaimResponse.item.adjudication.amount-flyover",
"text" : "Monetary amount associated with the category. For example: amount submitted, eligible amount, co-payment, and benefit payable.",
"type" : "display"
},
{
"linkId" : "ClaimResponse.item.adjudication.amount.comparator",
"text" : "comp:",
"type" : "coding",
"required" : false,
"repeats" : false,
"answerConstraint" : "optionsOnly"
},
{
"linkId" : "ClaimResponse.item.adjudication.amount.value",
"text" : "value:",
"type" : "decimal",
"required" : false,
"repeats" : false
},
{
"linkId" : "ClaimResponse.item.adjudication.amount.units",
"text" : "units:",
"type" : "string",
"required" : false,
"repeats" : false
},
{
"linkId" : "ClaimResponse.item.adjudication.amount.code",
"text" : "coded units:",
"type" : "string",
"required" : false,
"repeats" : false
},
{
"linkId" : "ClaimResponse.item.adjudication.amount.system",
"text" : "units system:",
"type" : "string",
"required" : false,
"repeats" : false
}]
},
{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs",
"valueInteger" : 1
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType",
"valueString" : "Quantity"
}],
"linkId" : "ClaimResponse.item.adjudication.quantity",
"text" : "Non-monetary value",
"type" : "group",
"required" : false,
"repeats" : true,
"item" : [{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept" : {
"coding" : [{
"system" : "http://hl7.org/fhir/questionnaire-item-control",
"code" : "flyover",
"display" : "Fly-over"
}]
}
}],
"linkId" : "ClaimResponse.item.adjudication.quantity-flyover",
"text" : "A non-monetary value associated with the category. Mutually exclusive to the amount element above. For example: eligible percentage or co-payment percentage.",
"type" : "display"
},
{
"linkId" : "ClaimResponse.item.adjudication.quantity.comparator",
"text" : "comp:",
"type" : "coding",
"required" : false,
"repeats" : false,
"answerConstraint" : "optionsOnly"
},
{
"linkId" : "ClaimResponse.item.adjudication.quantity.value",
"text" : "value:",
"type" : "decimal",
"required" : false,
"repeats" : false
},
{
"linkId" : "ClaimResponse.item.adjudication.quantity.units",
"text" : "units:",
"type" : "string",
"required" : false,
"repeats" : false
},
{
"linkId" : "ClaimResponse.item.adjudication.quantity.code",
"text" : "coded units:",
"type" : "string",
"required" : false,
"repeats" : false
},
{
"linkId" : "ClaimResponse.item.adjudication.quantity.system",
"text" : "units system:",
"type" : "string",
"required" : false,
"repeats" : false
}]
}]
},
{
"linkId" : "ClaimResponse.item.detail.subDetail",
"text" : "Adjudication for claim sub-details",
"type" : "group",
"required" : false,
"repeats" : true,
"item" : [{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept" : {
"coding" : [{
"system" : "http://hl7.org/fhir/questionnaire-item-control",
"code" : "flyover",
"display" : "Fly-over"
}]
}
}],
"linkId" : "ClaimResponse.item.detail.subDetail-flyover",
"text" : "A sub-detail adjudication of a simple product or service.",
"type" : "display"
},
{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs",
"valueInteger" : 1
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType",
"valueString" : "string"
}],
"linkId" : "ClaimResponse.item.detail.subDetail.id",
"type" : "group",
"required" : false,
"repeats" : true,
"item" : [{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept" : {
"coding" : [{
"system" : "http://hl7.org/fhir/questionnaire-item-control",
"code" : "flyover",
"display" : "Fly-over"
}]
}
}],
"linkId" : "ClaimResponse.item.detail.subDetail.id-flyover",
"text" : "Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.",
"type" : "display"
},
{
"linkId" : "ClaimResponse.item.detail.subDetail.id.value",
"text" : "Unique id for inter-element referencing",
"type" : "string",
"required" : false,
"repeats" : false
}]
},
{
"linkId" : "ClaimResponse.item.detail.subDetail.extension",
"text" : "Additional content defined by implementations",
"type" : "group",
"required" : false,
"repeats" : true,
"item" : [{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept" : {
"coding" : [{
"system" : "http://hl7.org/fhir/questionnaire-item-control",
"code" : "flyover",
"display" : "Fly-over"
}]
}
}],
"linkId" : "ClaimResponse.item.detail.subDetail.extension-flyover",
"text" : "May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and managable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.",
"type" : "display"
}]
},
{
"linkId" : "ClaimResponse.item.detail.subDetail.modifierExtension",
"text" : "Extensions that cannot be ignored even if unrecognized",
"type" : "group",
"required" : false,
"repeats" : true,
"item" : [{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept" : {
"coding" : [{
"system" : "http://hl7.org/fhir/questionnaire-item-control",
"code" : "flyover",
"display" : "Fly-over"
}]
}
}],
"linkId" : "ClaimResponse.item.detail.subDetail.modifierExtension-flyover",
"text" : "May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and managable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can 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.\n\nModifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.",
"type" : "display"
}]
},
{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-minOccurs",
"valueInteger" : 1
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs",
"valueInteger" : 1
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType",
"valueString" : "integer"
}],
"linkId" : "ClaimResponse.item.detail.subDetail.subDetailSequence",
"type" : "group",
"required" : true,
"repeats" : true,
"item" : [{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept" : {
"coding" : [{
"system" : "http://hl7.org/fhir/questionnaire-item-control",
"code" : "flyover",
"display" : "Fly-over"
}]
}
}],
"linkId" : "ClaimResponse.item.detail.subDetail.subDetailSequence-flyover",
"text" : "A number to uniquely reference the claim sub-detail entry.",
"type" : "display"
},
{
"linkId" : "ClaimResponse.item.detail.subDetail.subDetailSequence.value",
"text" : "Claim sub-detail instance identifier",
"type" : "integer",
"required" : false,
"repeats" : false
}]
},
{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType",
"valueString" : "Identifier"
}],
"linkId" : "ClaimResponse.item.detail.subDetail.traceNumber",
"text" : "Number for tracking",
"type" : "group",
"required" : false,
"repeats" : true,
"item" : [{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept" : {
"coding" : [{
"system" : "http://hl7.org/fhir/questionnaire-item-control",
"code" : "flyover",
"display" : "Fly-over"
}]
}
}],
"linkId" : "ClaimResponse.item.detail.subDetail.traceNumber-flyover",
"text" : "Trace number for tracking purposes. May be defined at the jurisdiction level or between trading partners.",
"type" : "display"
},
{
"linkId" : "ClaimResponse.item.detail.subDetail.traceNumber.label",
"text" : "label:",
"type" : "string",
"required" : false,
"repeats" : false
},
{
"linkId" : "ClaimResponse.item.detail.subDetail.traceNumber.system",
"text" : "system:",
"type" : "string",
"required" : false,
"repeats" : false
},
{
"linkId" : "ClaimResponse.item.detail.subDetail.traceNumber.value",
"text" : "value:",
"type" : "string",
"required" : false,
"repeats" : false
}]
},
{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType",
"valueString" : "integer"
}],
"linkId" : "ClaimResponse.item.detail.subDetail.noteNumber",
"type" : "group",
"required" : false,
"repeats" : true,
"item" : [{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept" : {
"coding" : [{
"system" : "http://hl7.org/fhir/questionnaire-item-control",
"code" : "flyover",
"display" : "Fly-over"
}]
}
}],
"linkId" : "ClaimResponse.item.detail.subDetail.noteNumber-flyover",
"text" : "The numbers associated with notes below which apply to the adjudication of this item.",
"type" : "display"
},
{
"linkId" : "ClaimResponse.item.detail.subDetail.noteNumber.value",
"text" : "Applicable note numbers",
"type" : "integer",
"required" : false,
"repeats" : false
}]
},
{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs",
"valueInteger" : 1
}],
"linkId" : "ClaimResponse.item.detail.subDetail.reviewOutcome",
"text" : "Subdetail level adjudication results",
"type" : "group",
"required" : false,
"repeats" : false,
"item" : [{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept" : {
"coding" : [{
"system" : "http://hl7.org/fhir/questionnaire-item-control",
"code" : "flyover",
"display" : "Fly-over"
}]
}
}],
"linkId" : "ClaimResponse.item.detail.subDetail.reviewOutcome-flyover",
"text" : "The high-level results of the adjudication if adjudication has been performed.",
"type" : "display"
},
{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs",
"valueInteger" : 1
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType",
"valueString" : "string"
}],
"linkId" : "ClaimResponse.item.reviewOutcome.id",
"type" : "group",
"required" : false,
"repeats" : true,
"item" : [{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept" : {
"coding" : [{
"system" : "http://hl7.org/fhir/questionnaire-item-control",
"code" : "flyover",
"display" : "Fly-over"
}]
}
}],
"linkId" : "ClaimResponse.item.reviewOutcome.id-flyover",
"text" : "Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.",
"type" : "display"
},
{
"linkId" : "ClaimResponse.item.reviewOutcome.id.value",
"text" : "Unique id for inter-element referencing",
"type" : "string",
"required" : false,
"repeats" : false
}]
},
{
"linkId" : "ClaimResponse.item.reviewOutcome.extension",
"text" : "Additional content defined by implementations",
"type" : "group",
"required" : false,
"repeats" : true,
"item" : [{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept" : {
"coding" : [{
"system" : "http://hl7.org/fhir/questionnaire-item-control",
"code" : "flyover",
"display" : "Fly-over"
}]
}
}],
"linkId" : "ClaimResponse.item.reviewOutcome.extension-flyover",
"text" : "May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and managable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.",
"type" : "display"
}]
},
{
"linkId" : "ClaimResponse.item.reviewOutcome.modifierExtension",
"text" : "Extensions that cannot be ignored even if unrecognized",
"type" : "group",
"required" : false,
"repeats" : true,
"item" : [{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept" : {
"coding" : [{
"system" : "http://hl7.org/fhir/questionnaire-item-control",
"code" : "flyover",
"display" : "Fly-over"
}]
}
}],
"linkId" : "ClaimResponse.item.reviewOutcome.modifierExtension-flyover",
"text" : "May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and managable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can 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.\n\nModifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.",
"type" : "display"
}]
},
{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs",
"valueInteger" : 1
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType",
"valueString" : "CodeableConcept"
}],
"linkId" : "ClaimResponse.item.reviewOutcome.decision",
"text" : "Result of the adjudication",
"type" : "group",
"required" : false,
"repeats" : true,
"item" : [{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept" : {
"coding" : [{
"system" : "http://hl7.org/fhir/questionnaire-item-control",
"code" : "flyover",
"display" : "Fly-over"
}]
}
}],
"linkId" : "ClaimResponse.item.reviewOutcome.decision-flyover",
"text" : "The result of the claim, predetermination, or preauthorization adjudication. The element is used to indicate the current state of the adjudication overall for the claim resource, for example: the request has been held (pended) for adjudication processing, for manual review or other reasons; that it has been processed and will be paid, or the outstanding paid, as submitted (approved); that no amount will be paid (denied); or that some amount between zero and the submitted amount will be paid (partial).",
"type" : "display"
},
{
"linkId" : "ClaimResponse.item.reviewOutcome.decision.coding",
"text" : "code:",
"type" : "coding",
"required" : false,
"repeats" : false,
"answerConstraint" : "optionsOnly"
},
{
"linkId" : "ClaimResponse.item.reviewOutcome.decision.text",
"text" : "text:",
"type" : "string",
"required" : false,
"repeats" : false
}]
},
{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType",
"valueString" : "CodeableConcept"
}],
"linkId" : "ClaimResponse.item.reviewOutcome.reason",
"text" : "Reason for result of the adjudication",
"type" : "group",
"required" : false,
"repeats" : true,
"item" : [{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept" : {
"coding" : [{
"system" : "http://hl7.org/fhir/questionnaire-item-control",
"code" : "flyover",
"display" : "Fly-over"
}]
}
}],
"linkId" : "ClaimResponse.item.reviewOutcome.reason-flyover",
"text" : "The reasons for the result of the claim, predetermination, or preauthorization adjudication.",
"type" : "display"
},
{
"linkId" : "ClaimResponse.item.reviewOutcome.reason.coding",
"text" : "code:",
"type" : "coding",
"required" : false,
"repeats" : false,
"answerConstraint" : "optionsOnly"
},
{
"linkId" : "ClaimResponse.item.reviewOutcome.reason.text",
"text" : "text:",
"type" : "string",
"required" : false,
"repeats" : false
}]
},
{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs",
"valueInteger" : 1
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType",
"valueString" : "string"
}],
"linkId" : "ClaimResponse.item.reviewOutcome.preAuthRef",
"type" : "group",
"required" : false,
"repeats" : true,
"item" : [{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept" : {
"coding" : [{
"system" : "http://hl7.org/fhir/questionnaire-item-control",
"code" : "flyover",
"display" : "Fly-over"
}]
}
}],
"linkId" : "ClaimResponse.item.reviewOutcome.preAuthRef-flyover",
"text" : "Reference from the Insurer which is used in later communications which refers to this adjudication. This value is only present on preauthorization adjudications.",
"type" : "display"
},
{
"linkId" : "ClaimResponse.item.reviewOutcome.preAuthRef.value",
"text" : "Preauthorization reference",
"type" : "string",
"required" : false,
"repeats" : false
}]
},
{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs",
"valueInteger" : 1
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType",
"valueString" : "Period"
}],
"linkId" : "ClaimResponse.item.reviewOutcome.preAuthPeriod",
"text" : "Preauthorization reference effective period",
"type" : "group",
"required" : false,
"repeats" : true,
"item" : [{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept" : {
"coding" : [{
"system" : "http://hl7.org/fhir/questionnaire-item-control",
"code" : "flyover",
"display" : "Fly-over"
}]
}
}],
"linkId" : "ClaimResponse.item.reviewOutcome.preAuthPeriod-flyover",
"text" : "The time frame during which this authorization is effective.",
"type" : "display"
},
{
"linkId" : "ClaimResponse.item.reviewOutcome.preAuthPeriod.low",
"text" : "start:",
"type" : "dateTime",
"required" : false,
"repeats" : false
},
{
"linkId" : "ClaimResponse.item.reviewOutcome.preAuthPeriod.end",
"text" : "end:",
"type" : "dateTime",
"required" : false,
"repeats" : false
}]
}]
},
{
"linkId" : "ClaimResponse.item.detail.subDetail.adjudication",
"text" : "Subdetail level adjudication details",
"type" : "group",
"required" : false,
"repeats" : true,
"item" : [{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept" : {
"coding" : [{
"system" : "http://hl7.org/fhir/questionnaire-item-control",
"code" : "flyover",
"display" : "Fly-over"
}]
}
}],
"linkId" : "ClaimResponse.item.detail.subDetail.adjudication-flyover",
"text" : "The adjudication results.",
"type" : "display"
},
{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs",
"valueInteger" : 1
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType",
"valueString" : "string"
}],
"linkId" : "ClaimResponse.item.adjudication.id",
"type" : "group",
"required" : false,
"repeats" : true,
"item" : [{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept" : {
"coding" : [{
"system" : "http://hl7.org/fhir/questionnaire-item-control",
"code" : "flyover",
"display" : "Fly-over"
}]
}
}],
"linkId" : "ClaimResponse.item.adjudication.id-flyover",
"text" : "Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.",
"type" : "display"
},
{
"linkId" : "ClaimResponse.item.adjudication.id.value",
"text" : "Unique id for inter-element referencing",
"type" : "string",
"required" : false,
"repeats" : false
}]
},
{
"linkId" : "ClaimResponse.item.adjudication.extension",
"text" : "Additional content defined by implementations",
"type" : "group",
"required" : false,
"repeats" : true,
"item" : [{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept" : {
"coding" : [{
"system" : "http://hl7.org/fhir/questionnaire-item-control",
"code" : "flyover",
"display" : "Fly-over"
}]
}
}],
"linkId" : "ClaimResponse.item.adjudication.extension-flyover",
"text" : "May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and managable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.",
"type" : "display"
}]
},
{
"linkId" : "ClaimResponse.item.adjudication.modifierExtension",
"text" : "Extensions that cannot be ignored even if unrecognized",
"type" : "group",
"required" : false,
"repeats" : true,
"item" : [{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept" : {
"coding" : [{
"system" : "http://hl7.org/fhir/questionnaire-item-control",
"code" : "flyover",
"display" : "Fly-over"
}]
}
}],
"linkId" : "ClaimResponse.item.adjudication.modifierExtension-flyover",
"text" : "May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and managable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can 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.\n\nModifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.",
"type" : "display"
}]
},
{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-minOccurs",
"valueInteger" : 1
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs",
"valueInteger" : 1
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType",
"valueString" : "CodeableConcept"
}],
"linkId" : "ClaimResponse.item.adjudication.category",
"text" : "Type of adjudication information",
"type" : "group",
"required" : true,
"repeats" : true,
"item" : [{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept" : {
"coding" : [{
"system" : "http://hl7.org/fhir/questionnaire-item-control",
"code" : "flyover",
"display" : "Fly-over"
}]
}
}],
"linkId" : "ClaimResponse.item.adjudication.category-flyover",
"text" : "A code to indicate the information type of this adjudication record. Information types may include the value submitted, maximum values or percentages allowed or payable under the plan, amounts that: the patient is responsible for in aggregate or pertaining to this item; amounts paid by other coverages; and, the benefit payable for this item. For example codes indicating: Co-Pay, deductible, eligible, benefit, tax, etc.",
"type" : "display"
},
{
"linkId" : "ClaimResponse.item.adjudication.category.coding",
"text" : "code:",
"type" : "coding",
"required" : false,
"repeats" : false,
"answerConstraint" : "optionsOnly"
},
{
"linkId" : "ClaimResponse.item.adjudication.category.text",
"text" : "text:",
"type" : "string",
"required" : false,
"repeats" : false
}]
},
{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs",
"valueInteger" : 1
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType",
"valueString" : "CodeableConcept"
}],
"linkId" : "ClaimResponse.item.adjudication.reason",
"text" : "Explanation of adjudication outcome",
"type" : "group",
"required" : false,
"repeats" : true,
"item" : [{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept" : {
"coding" : [{
"system" : "http://hl7.org/fhir/questionnaire-item-control",
"code" : "flyover",
"display" : "Fly-over"
}]
}
}],
"linkId" : "ClaimResponse.item.adjudication.reason-flyover",
"text" : "A code supporting the understanding of the adjudication result and explaining variance from expected amount. For example may indicate that the funds for this benefit type have been exhausted.",
"type" : "display"
},
{
"linkId" : "ClaimResponse.item.adjudication.reason.coding",
"text" : "code:",
"type" : "coding",
"required" : false,
"repeats" : false,
"answerConstraint" : "optionsOnly"
},
{
"linkId" : "ClaimResponse.item.adjudication.reason.text",
"text" : "text:",
"type" : "string",
"required" : false,
"repeats" : false
}]
},
{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs",
"valueInteger" : 1
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType",
"valueString" : "Quantity"
}],
"linkId" : "ClaimResponse.item.adjudication.amount",
"text" : "Monetary amount",
"type" : "group",
"required" : false,
"repeats" : true,
"item" : [{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept" : {
"coding" : [{
"system" : "http://hl7.org/fhir/questionnaire-item-control",
"code" : "flyover",
"display" : "Fly-over"
}]
}
}],
"linkId" : "ClaimResponse.item.adjudication.amount-flyover",
"text" : "Monetary amount associated with the category. For example: amount submitted, eligible amount, co-payment, and benefit payable.",
"type" : "display"
},
{
"linkId" : "ClaimResponse.item.adjudication.amount.comparator",
"text" : "comp:",
"type" : "coding",
"required" : false,
"repeats" : false,
"answerConstraint" : "optionsOnly"
},
{
"linkId" : "ClaimResponse.item.adjudication.amount.value",
"text" : "value:",
"type" : "decimal",
"required" : false,
"repeats" : false
},
{
"linkId" : "ClaimResponse.item.adjudication.amount.units",
"text" : "units:",
"type" : "string",
"required" : false,
"repeats" : false
},
{
"linkId" : "ClaimResponse.item.adjudication.amount.code",
"text" : "coded units:",
"type" : "string",
"required" : false,
"repeats" : false
},
{
"linkId" : "ClaimResponse.item.adjudication.amount.system",
"text" : "units system:",
"type" : "string",
"required" : false,
"repeats" : false
}]
},
{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs",
"valueInteger" : 1
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType",
"valueString" : "Quantity"
}],
"linkId" : "ClaimResponse.item.adjudication.quantity",
"text" : "Non-monetary value",
"type" : "group",
"required" : false,
"repeats" : true,
"item" : [{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept" : {
"coding" : [{
"system" : "http://hl7.org/fhir/questionnaire-item-control",
"code" : "flyover",
"display" : "Fly-over"
}]
}
}],
"linkId" : "ClaimResponse.item.adjudication.quantity-flyover",
"text" : "A non-monetary value associated with the category. Mutually exclusive to the amount element above. For example: eligible percentage or co-payment percentage.",
"type" : "display"
},
{
"linkId" : "ClaimResponse.item.adjudication.quantity.comparator",
"text" : "comp:",
"type" : "coding",
"required" : false,
"repeats" : false,
"answerConstraint" : "optionsOnly"
},
{
"linkId" : "ClaimResponse.item.adjudication.quantity.value",
"text" : "value:",
"type" : "decimal",
"required" : false,
"repeats" : false
},
{
"linkId" : "ClaimResponse.item.adjudication.quantity.units",
"text" : "units:",
"type" : "string",
"required" : false,
"repeats" : false
},
{
"linkId" : "ClaimResponse.item.adjudication.quantity.code",
"text" : "coded units:",
"type" : "string",
"required" : false,
"repeats" : false
},
{
"linkId" : "ClaimResponse.item.adjudication.quantity.system",
"text" : "units system:",
"type" : "string",
"required" : false,
"repeats" : false
}]
}]
}]
}]
}]
},
{
"linkId" : "ClaimResponse.addItem",
"text" : "Insurer added line items",
"type" : "group",
"required" : false,
"repeats" : true,
"item" : [{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept" : {
"coding" : [{
"system" : "http://hl7.org/fhir/questionnaire-item-control",
"code" : "flyover",
"display" : "Fly-over"
}]
}
}],
"linkId" : "ClaimResponse.addItem-flyover",
"text" : "The first-tier service adjudications for payor added product or service lines.",
"type" : "display"
},
{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs",
"valueInteger" : 1
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType",
"valueString" : "string"
}],
"linkId" : "ClaimResponse.addItem.id",
"type" : "group",
"required" : false,
"repeats" : true,
"item" : [{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept" : {
"coding" : [{
"system" : "http://hl7.org/fhir/questionnaire-item-control",
"code" : "flyover",
"display" : "Fly-over"
}]
}
}],
"linkId" : "ClaimResponse.addItem.id-flyover",
"text" : "Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.",
"type" : "display"
},
{
"linkId" : "ClaimResponse.addItem.id.value",
"text" : "Unique id for inter-element referencing",
"type" : "string",
"required" : false,
"repeats" : false
}]
},
{
"linkId" : "ClaimResponse.addItem.extension",
"text" : "Additional content defined by implementations",
"type" : "group",
"required" : false,
"repeats" : true,
"item" : [{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept" : {
"coding" : [{
"system" : "http://hl7.org/fhir/questionnaire-item-control",
"code" : "flyover",
"display" : "Fly-over"
}]
}
}],
"linkId" : "ClaimResponse.addItem.extension-flyover",
"text" : "May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and managable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.",
"type" : "display"
}]
},
{
"linkId" : "ClaimResponse.addItem.modifierExtension",
"text" : "Extensions that cannot be ignored even if unrecognized",
"type" : "group",
"required" : false,
"repeats" : true,
"item" : [{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept" : {
"coding" : [{
"system" : "http://hl7.org/fhir/questionnaire-item-control",
"code" : "flyover",
"display" : "Fly-over"
}]
}
}],
"linkId" : "ClaimResponse.addItem.modifierExtension-flyover",
"text" : "May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and managable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can 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.\n\nModifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.",
"type" : "display"
}]
},
{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType",
"valueString" : "integer"
}],
"linkId" : "ClaimResponse.addItem.itemSequence",
"type" : "group",
"required" : false,
"repeats" : true,
"item" : [{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept" : {
"coding" : [{
"system" : "http://hl7.org/fhir/questionnaire-item-control",
"code" : "flyover",
"display" : "Fly-over"
}]
}
}],
"linkId" : "ClaimResponse.addItem.itemSequence-flyover",
"text" : "Claim items which this service line is intended to replace.",
"type" : "display"
},
{
"linkId" : "ClaimResponse.addItem.itemSequence.value",
"text" : "Item sequence number",
"type" : "integer",
"required" : false,
"repeats" : false
}]
},
{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType",
"valueString" : "integer"
}],
"linkId" : "ClaimResponse.addItem.detailSequence",
"type" : "group",
"required" : false,
"repeats" : true,
"item" : [{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept" : {
"coding" : [{
"system" : "http://hl7.org/fhir/questionnaire-item-control",
"code" : "flyover",
"display" : "Fly-over"
}]
}
}],
"linkId" : "ClaimResponse.addItem.detailSequence-flyover",
"text" : "The sequence number of the details within the claim item which this line is intended to replace.",
"type" : "display"
},
{
"linkId" : "ClaimResponse.addItem.detailSequence.value",
"text" : "Detail sequence number",
"type" : "integer",
"required" : false,
"repeats" : false
}]
},
{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType",
"valueString" : "integer"
}],
"linkId" : "ClaimResponse.addItem.subdetailSequence",
"type" : "group",
"required" : false,
"repeats" : true,
"item" : [{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept" : {
"coding" : [{
"system" : "http://hl7.org/fhir/questionnaire-item-control",
"code" : "flyover",
"display" : "Fly-over"
}]
}
}],
"linkId" : "ClaimResponse.addItem.subdetailSequence-flyover",
"text" : "The sequence number of the sub-details within the details within the claim item which this line is intended to replace.",
"type" : "display"
},
{
"linkId" : "ClaimResponse.addItem.subdetailSequence.value",
"text" : "Subdetail sequence number",
"type" : "integer",
"required" : false,
"repeats" : false
}]
},
{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType",
"valueString" : "Identifier"
}],
"linkId" : "ClaimResponse.addItem.traceNumber",
"text" : "Number for tracking",
"type" : "group",
"required" : false,
"repeats" : true,
"item" : [{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept" : {
"coding" : [{
"system" : "http://hl7.org/fhir/questionnaire-item-control",
"code" : "flyover",
"display" : "Fly-over"
}]
}
}],
"linkId" : "ClaimResponse.addItem.traceNumber-flyover",
"text" : "Trace number for tracking purposes. May be defined at the jurisdiction level or between trading partners.",
"type" : "display"
},
{
"linkId" : "ClaimResponse.addItem.traceNumber.label",
"text" : "label:",
"type" : "string",
"required" : false,
"repeats" : false
},
{
"linkId" : "ClaimResponse.addItem.traceNumber.system",
"text" : "system:",
"type" : "string",
"required" : false,
"repeats" : false
},
{
"linkId" : "ClaimResponse.addItem.traceNumber.value",
"text" : "value:",
"type" : "string",
"required" : false,
"repeats" : false
}]
},
{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType",
"valueString" : "Reference"
}],
"linkId" : "ClaimResponse.addItem.provider",
"type" : "group",
"required" : false,
"repeats" : true,
"item" : [{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept" : {
"coding" : [{
"system" : "http://hl7.org/fhir/questionnaire-item-control",
"code" : "flyover",
"display" : "Fly-over"
}]
}
}],
"linkId" : "ClaimResponse.addItem.provider-flyover",
"text" : "The providers who are authorized for the services rendered to the patient.",
"type" : "display"
},
{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-referenceResource",
"valueCode" : "Practitioner, PractitionerRole, Organization"
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-referenceFilter",
"valueString" : "subject=$subj&patient=$subj&encounter=$encounter"
}],
"linkId" : "ClaimResponse.addItem.provider.value",
"text" : "Authorized providers",
"type" : "reference",
"required" : false,
"repeats" : false
}]
},
{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs",
"valueInteger" : 1
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType",
"valueString" : "CodeableConcept"
}],
"linkId" : "ClaimResponse.addItem.revenue",
"text" : "Revenue or cost center code",
"type" : "group",
"required" : false,
"repeats" : true,
"item" : [{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept" : {
"coding" : [{
"system" : "http://hl7.org/fhir/questionnaire-item-control",
"code" : "flyover",
"display" : "Fly-over"
}]
}
}],
"linkId" : "ClaimResponse.addItem.revenue-flyover",
"text" : "The type of revenue or cost center providing the product and/or service.",
"type" : "display"
},
{
"linkId" : "ClaimResponse.addItem.revenue.coding",
"text" : "code:",
"type" : "coding",
"required" : false,
"repeats" : false,
"answerConstraint" : "optionsOnly"
},
{
"linkId" : "ClaimResponse.addItem.revenue.text",
"text" : "text:",
"type" : "string",
"required" : false,
"repeats" : false
}]
},
{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs",
"valueInteger" : 1
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType",
"valueString" : "CodeableConcept"
}],
"linkId" : "ClaimResponse.addItem.productOrService",
"text" : "Billing, service, product, or drug code",
"type" : "group",
"required" : false,
"repeats" : true,
"item" : [{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept" : {
"coding" : [{
"system" : "http://hl7.org/fhir/questionnaire-item-control",
"code" : "flyover",
"display" : "Fly-over"
}]
}
}],
"linkId" : "ClaimResponse.addItem.productOrService-flyover",
"text" : "When the value is a group code then this item collects a set of related item details, otherwise this contains the product, service, drug or other billing code for the item. This element may be the start of a range of .productOrService codes used in conjunction with .productOrServiceEnd or it may be a solo element where .productOrServiceEnd is not used. If this is an actual service or product line, i.e. not a Group, then use code to indicate the Professional Service or Product supplied (e.g. CTP, HCPCS, USCLS, ICD10, NCPDP, DIN, RxNorm, ACHI, CCI). If a grouping item then use a group code to indicate the type of thing being grouped e.g. 'glasses' or 'compound'.",
"type" : "display"
},
{
"linkId" : "ClaimResponse.addItem.productOrService.coding",
"text" : "code:",
"type" : "coding",
"required" : false,
"repeats" : false,
"answerConstraint" : "optionsOnly"
},
{
"linkId" : "ClaimResponse.addItem.productOrService.text",
"text" : "text:",
"type" : "string",
"required" : false,
"repeats" : false
}]
},
{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs",
"valueInteger" : 1
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType",
"valueString" : "CodeableConcept"
}],
"linkId" : "ClaimResponse.addItem.productOrServiceEnd",
"text" : "End of a range of codes",
"type" : "group",
"required" : false,
"repeats" : true,
"item" : [{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept" : {
"coding" : [{
"system" : "http://hl7.org/fhir/questionnaire-item-control",
"code" : "flyover",
"display" : "Fly-over"
}]
}
}],
"linkId" : "ClaimResponse.addItem.productOrServiceEnd-flyover",
"text" : "This contains the end of a range of product, service, drug or other billing codes for the item. This element is not used when the .productOrService is a group code. This value may only be present when a .productOfService code has been provided to convey the start of the range. Typically this value may be used only with preauthorizations and not with claims.",
"type" : "display"
},
{
"linkId" : "ClaimResponse.addItem.productOrServiceEnd.coding",
"text" : "code:",
"type" : "coding",
"required" : false,
"repeats" : false,
"answerConstraint" : "optionsOnly"
},
{
"linkId" : "ClaimResponse.addItem.productOrServiceEnd.text",
"text" : "text:",
"type" : "string",
"required" : false,
"repeats" : false
}]
},
{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType",
"valueString" : "Reference"
}],
"linkId" : "ClaimResponse.addItem.request",
"type" : "group",
"required" : false,
"repeats" : true,
"item" : [{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept" : {
"coding" : [{
"system" : "http://hl7.org/fhir/questionnaire-item-control",
"code" : "flyover",
"display" : "Fly-over"
}]
}
}],
"linkId" : "ClaimResponse.addItem.request-flyover",
"text" : "Request or Referral for Goods or Service to be rendered.",
"type" : "display"
},
{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-referenceResource",
"valueCode" : "DeviceRequest, MedicationRequest, NutritionOrder, ServiceRequest, SupplyRequest, VisionPrescription"
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-referenceFilter",
"valueString" : "subject=$subj&patient=$subj&encounter=$encounter"
}],
"linkId" : "ClaimResponse.addItem.request.value",
"text" : "Request or Referral for Service",
"type" : "reference",
"required" : false,
"repeats" : false
}]
},
{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType",
"valueString" : "CodeableConcept"
}],
"linkId" : "ClaimResponse.addItem.modifier",
"text" : "Service/Product billing modifiers",
"type" : "group",
"required" : false,
"repeats" : true,
"item" : [{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept" : {
"coding" : [{
"system" : "http://hl7.org/fhir/questionnaire-item-control",
"code" : "flyover",
"display" : "Fly-over"
}]
}
}],
"linkId" : "ClaimResponse.addItem.modifier-flyover",
"text" : "Item typification or modifiers codes to convey additional context for the product or service. For example in Oral whether the treatment is cosmetic or associated with TMJ, or for Medical whether the treatment was outside the clinic or outside of office hours.",
"type" : "display"
},
{
"linkId" : "ClaimResponse.addItem.modifier.coding",
"text" : "code:",
"type" : "coding",
"required" : false,
"repeats" : false,
"answerConstraint" : "optionsOnly"
},
{
"linkId" : "ClaimResponse.addItem.modifier.text",
"text" : "text:",
"type" : "string",
"required" : false,
"repeats" : false
}]
},
{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType",
"valueString" : "CodeableConcept"
}],
"linkId" : "ClaimResponse.addItem.programCode",
"text" : "Program the product or service is provided under",
"type" : "group",
"required" : false,
"repeats" : true,
"item" : [{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept" : {
"coding" : [{
"system" : "http://hl7.org/fhir/questionnaire-item-control",
"code" : "flyover",
"display" : "Fly-over"
}]
}
}],
"linkId" : "ClaimResponse.addItem.programCode-flyover",
"text" : "Identifies the program under which this may be recovered. For example: Neonatal program, child dental program or drug users recovery program.",
"type" : "display"
},
{
"linkId" : "ClaimResponse.addItem.programCode.coding",
"text" : "code:",
"type" : "coding",
"required" : false,
"repeats" : false,
"answerConstraint" : "optionsOnly"
},
{
"linkId" : "ClaimResponse.addItem.programCode.text",
"text" : "text:",
"type" : "string",
"required" : false,
"repeats" : false
}]
},
{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs",
"valueInteger" : 1
}],
"linkId" : "ClaimResponse.addItem.serviced[x]",
"text" : "Date or dates of service or product delivery",
"type" : "group",
"required" : false,
"repeats" : true,
"item" : [{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept" : {
"coding" : [{
"system" : "http://hl7.org/fhir/questionnaire-item-control",
"code" : "flyover",
"display" : "Fly-over"
}]
}
}],
"linkId" : "ClaimResponse.addItem.serviced[x]-flyover",
"text" : "The date or dates when the service or product was supplied, performed or completed.",
"type" : "display"
},
{
"linkId" : "ClaimResponse.addItem.serviced[x]._type",
"text" : "type",
"type" : "coding",
"required" : false,
"repeats" : false,
"answerConstraint" : "optionsOnly",
"answerValueSet" : "#vs3",
"item" : [{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType",
"valueString" : "datetime"
}],
"linkId" : "ClaimResponse.addItem.serviced[x]._null",
"type" : "group",
"item" : [{
"linkId" : "ClaimResponse.addItem.serviced[x]._null.value",
"type" : "dateTime",
"required" : false,
"repeats" : false
}]
},
{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType",
"valueString" : "Period"
}],
"linkId" : "ClaimResponse.addItem.serviced[x]._null",
"type" : "group",
"item" : [{
"linkId" : "ClaimResponse.addItem.serviced[x]._null.low",
"text" : "start:",
"type" : "dateTime",
"required" : false,
"repeats" : false
},
{
"linkId" : "ClaimResponse.addItem.serviced[x]._null.end",
"text" : "end:",
"type" : "dateTime",
"required" : false,
"repeats" : false
}]
}]
}]
},
{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs",
"valueInteger" : 1
}],
"linkId" : "ClaimResponse.addItem.location[x]",
"text" : "Place of service or where product was supplied",
"type" : "group",
"required" : false,
"repeats" : true,
"item" : [{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept" : {
"coding" : [{
"system" : "http://hl7.org/fhir/questionnaire-item-control",
"code" : "flyover",
"display" : "Fly-over"
}]
}
}],
"linkId" : "ClaimResponse.addItem.location[x]-flyover",
"text" : "Where the product or service was provided.",
"type" : "display"
},
{
"linkId" : "ClaimResponse.addItem.location[x]._type",
"text" : "type",
"type" : "coding",
"required" : false,
"repeats" : false,
"answerConstraint" : "optionsOnly",
"answerValueSet" : "#vs4",
"item" : [{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType",
"valueString" : "CodeableConcept"
}],
"linkId" : "ClaimResponse.addItem.location[x]._null",
"type" : "group",
"item" : [{
"linkId" : "ClaimResponse.addItem.location[x]._null.coding",
"text" : "code:",
"type" : "coding",
"required" : false,
"repeats" : false,
"answerConstraint" : "optionsOnly"
},
{
"linkId" : "ClaimResponse.addItem.location[x]._null.text",
"text" : "text:",
"type" : "string",
"required" : false,
"repeats" : false
}]
},
{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType",
"valueString" : "Address"
}],
"linkId" : "ClaimResponse.addItem.location[x]._null",
"type" : "group",
"item" : [{
"linkId" : "ClaimResponse.addItem.location[x]._null.text",
"text" : "text:",
"type" : "string",
"required" : false,
"repeats" : false
},
{
"linkId" : "ClaimResponse.addItem.location[x]._null.line",
"text" : "line:",
"type" : "string",
"required" : false,
"repeats" : true
},
{
"linkId" : "ClaimResponse.addItem.location[x]._null.city",
"text" : "city:",
"type" : "string",
"required" : false,
"repeats" : false
},
{
"linkId" : "ClaimResponse.addItem.location[x]._null.state",
"text" : "state:",
"type" : "string",
"required" : false,
"repeats" : false
},
{
"linkId" : "ClaimResponse.addItem.location[x]._null.postalCode",
"text" : "post code:",
"type" : "string",
"required" : false,
"repeats" : false
},
{
"linkId" : "ClaimResponse.addItem.location[x]._null.country",
"text" : "country:",
"type" : "string",
"required" : false,
"repeats" : false
},
{
"linkId" : "ClaimResponse.addItem.location[x]._null.use",
"text" : "use:",
"type" : "coding",
"required" : false,
"repeats" : false,
"answerConstraint" : "optionsOnly"
}]
},
{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType",
"valueString" : "Reference"
}],
"linkId" : "ClaimResponse.addItem.location[x]._null",
"type" : "group",
"item" : [{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-referenceResource",
"valueCode" : "Location"
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-referenceFilter",
"valueString" : "subject=$subj&patient=$subj&encounter=$encounter"
}],
"linkId" : "ClaimResponse.addItem.location[x]._null.value",
"type" : "reference",
"required" : false,
"repeats" : false
}]
}]
}]
},
{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs",
"valueInteger" : 1
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType",
"valueString" : "Quantity"
}],
"linkId" : "ClaimResponse.addItem.quantity",
"text" : "Count of products or services",
"type" : "group",
"required" : false,
"repeats" : true,
"item" : [{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept" : {
"coding" : [{
"system" : "http://hl7.org/fhir/questionnaire-item-control",
"code" : "flyover",
"display" : "Fly-over"
}]
}
}],
"linkId" : "ClaimResponse.addItem.quantity-flyover",
"text" : "The number of repetitions of a service or product.",
"type" : "display"
},
{
"linkId" : "ClaimResponse.addItem.quantity.comparator",
"text" : "comp:",
"type" : "coding",
"required" : false,
"repeats" : false,
"answerConstraint" : "optionsOnly"
},
{
"linkId" : "ClaimResponse.addItem.quantity.value",
"text" : "value:",
"type" : "decimal",
"required" : false,
"repeats" : false
},
{
"linkId" : "ClaimResponse.addItem.quantity.units",
"text" : "units:",
"type" : "string",
"required" : false,
"repeats" : false
},
{
"linkId" : "ClaimResponse.addItem.quantity.code",
"text" : "coded units:",
"type" : "string",
"required" : false,
"repeats" : false
},
{
"linkId" : "ClaimResponse.addItem.quantity.system",
"text" : "units system:",
"type" : "string",
"required" : false,
"repeats" : false
}]
},
{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs",
"valueInteger" : 1
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType",
"valueString" : "Quantity"
}],
"linkId" : "ClaimResponse.addItem.unitPrice",
"text" : "Fee, charge or cost per item",
"type" : "group",
"required" : false,
"repeats" : true,
"item" : [{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept" : {
"coding" : [{
"system" : "http://hl7.org/fhir/questionnaire-item-control",
"code" : "flyover",
"display" : "Fly-over"
}]
}
}],
"linkId" : "ClaimResponse.addItem.unitPrice-flyover",
"text" : "If the item is not a group then this is the fee for the product or service, otherwise this is the total of the fees for the details of the group.",
"type" : "display"
},
{
"linkId" : "ClaimResponse.addItem.unitPrice.comparator",
"text" : "comp:",
"type" : "coding",
"required" : false,
"repeats" : false,
"answerConstraint" : "optionsOnly"
},
{
"linkId" : "ClaimResponse.addItem.unitPrice.value",
"text" : "value:",
"type" : "decimal",
"required" : false,
"repeats" : false
},
{
"linkId" : "ClaimResponse.addItem.unitPrice.units",
"text" : "units:",
"type" : "string",
"required" : false,
"repeats" : false
},
{
"linkId" : "ClaimResponse.addItem.unitPrice.code",
"text" : "coded units:",
"type" : "string",
"required" : false,
"repeats" : false
},
{
"linkId" : "ClaimResponse.addItem.unitPrice.system",
"text" : "units system:",
"type" : "string",
"required" : false,
"repeats" : false
}]
},
{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs",
"valueInteger" : 1
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType",
"valueString" : "decimal"
}],
"linkId" : "ClaimResponse.addItem.factor",
"type" : "group",
"required" : false,
"repeats" : true,
"item" : [{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept" : {
"coding" : [{
"system" : "http://hl7.org/fhir/questionnaire-item-control",
"code" : "flyover",
"display" : "Fly-over"
}]
}
}],
"linkId" : "ClaimResponse.addItem.factor-flyover",
"text" : "A real number that represents a multiplier used in determining the overall value of services delivered and/or goods received. The concept of a Factor allows for a discount or surcharge multiplier to be applied to a monetary amount. To show a 10% senior's discount, the value entered is: 0.90 (1.00 - 0.10).",
"type" : "display"
},
{
"linkId" : "ClaimResponse.addItem.factor.value",
"text" : "Price scaling factor",
"type" : "decimal",
"required" : false,
"repeats" : false
}]
},
{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs",
"valueInteger" : 1
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType",
"valueString" : "Quantity"
}],
"linkId" : "ClaimResponse.addItem.tax",
"text" : "Total tax",
"type" : "group",
"required" : false,
"repeats" : true,
"item" : [{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept" : {
"coding" : [{
"system" : "http://hl7.org/fhir/questionnaire-item-control",
"code" : "flyover",
"display" : "Fly-over"
}]
}
}],
"linkId" : "ClaimResponse.addItem.tax-flyover",
"text" : "The total of taxes applicable for this product or service.",
"type" : "display"
},
{
"linkId" : "ClaimResponse.addItem.tax.comparator",
"text" : "comp:",
"type" : "coding",
"required" : false,
"repeats" : false,
"answerConstraint" : "optionsOnly"
},
{
"linkId" : "ClaimResponse.addItem.tax.value",
"text" : "value:",
"type" : "decimal",
"required" : false,
"repeats" : false
},
{
"linkId" : "ClaimResponse.addItem.tax.units",
"text" : "units:",
"type" : "string",
"required" : false,
"repeats" : false
},
{
"linkId" : "ClaimResponse.addItem.tax.code",
"text" : "coded units:",
"type" : "string",
"required" : false,
"repeats" : false
},
{
"linkId" : "ClaimResponse.addItem.tax.system",
"text" : "units system:",
"type" : "string",
"required" : false,
"repeats" : false
}]
},
{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs",
"valueInteger" : 1
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType",
"valueString" : "Quantity"
}],
"linkId" : "ClaimResponse.addItem.net",
"text" : "Total item cost",
"type" : "group",
"required" : false,
"repeats" : true,
"item" : [{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept" : {
"coding" : [{
"system" : "http://hl7.org/fhir/questionnaire-item-control",
"code" : "flyover",
"display" : "Fly-over"
}]
}
}],
"linkId" : "ClaimResponse.addItem.net-flyover",
"text" : "The total amount claimed for the group (if a grouper) or the addItem. Net = unit price * quantity * factor. For example, the formula: quantity * unitPrice * factor = net. Quantity and factor are assumed to be 1 if not supplied.",
"type" : "display"
},
{
"linkId" : "ClaimResponse.addItem.net.comparator",
"text" : "comp:",
"type" : "coding",
"required" : false,
"repeats" : false,
"answerConstraint" : "optionsOnly"
},
{
"linkId" : "ClaimResponse.addItem.net.value",
"text" : "value:",
"type" : "decimal",
"required" : false,
"repeats" : false
},
{
"linkId" : "ClaimResponse.addItem.net.units",
"text" : "units:",
"type" : "string",
"required" : false,
"repeats" : false
},
{
"linkId" : "ClaimResponse.addItem.net.code",
"text" : "coded units:",
"type" : "string",
"required" : false,
"repeats" : false
},
{
"linkId" : "ClaimResponse.addItem.net.system",
"text" : "units system:",
"type" : "string",
"required" : false,
"repeats" : false
}]
},
{
"linkId" : "ClaimResponse.addItem.bodySite",
"text" : "Anatomical location",
"type" : "group",
"required" : false,
"repeats" : true,
"item" : [{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept" : {
"coding" : [{
"system" : "http://hl7.org/fhir/questionnaire-item-control",
"code" : "flyover",
"display" : "Fly-over"
}]
}
}],
"linkId" : "ClaimResponse.addItem.bodySite-flyover",
"text" : "Physical location where the service is performed or applies.",
"type" : "display"
},
{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs",
"valueInteger" : 1
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType",
"valueString" : "string"
}],
"linkId" : "ClaimResponse.addItem.bodySite.id",
"type" : "group",
"required" : false,
"repeats" : true,
"item" : [{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept" : {
"coding" : [{
"system" : "http://hl7.org/fhir/questionnaire-item-control",
"code" : "flyover",
"display" : "Fly-over"
}]
}
}],
"linkId" : "ClaimResponse.addItem.bodySite.id-flyover",
"text" : "Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.",
"type" : "display"
},
{
"linkId" : "ClaimResponse.addItem.bodySite.id.value",
"text" : "Unique id for inter-element referencing",
"type" : "string",
"required" : false,
"repeats" : false
}]
},
{
"linkId" : "ClaimResponse.addItem.bodySite.extension",
"text" : "Additional content defined by implementations",
"type" : "group",
"required" : false,
"repeats" : true,
"item" : [{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept" : {
"coding" : [{
"system" : "http://hl7.org/fhir/questionnaire-item-control",
"code" : "flyover",
"display" : "Fly-over"
}]
}
}],
"linkId" : "ClaimResponse.addItem.bodySite.extension-flyover",
"text" : "May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and managable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.",
"type" : "display"
}]
},
{
"linkId" : "ClaimResponse.addItem.bodySite.modifierExtension",
"text" : "Extensions that cannot be ignored even if unrecognized",
"type" : "group",
"required" : false,
"repeats" : true,
"item" : [{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept" : {
"coding" : [{
"system" : "http://hl7.org/fhir/questionnaire-item-control",
"code" : "flyover",
"display" : "Fly-over"
}]
}
}],
"linkId" : "ClaimResponse.addItem.bodySite.modifierExtension-flyover",
"text" : "May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and managable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can 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.\n\nModifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.",
"type" : "display"
}]
},
{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-minOccurs",
"valueInteger" : 1
}],
"linkId" : "ClaimResponse.addItem.bodySite.site",
"text" : "Location",
"type" : "group",
"required" : true,
"repeats" : true,
"item" : [{
"linkId" : "ClaimResponse.addItem.bodySite.site-display",
"text" : "For example: Providing a tooth code allows an insurer to identify a provider performing a filling on a tooth that was previously removed.",
"type" : "display"
},
{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept" : {
"coding" : [{
"system" : "http://hl7.org/fhir/questionnaire-item-control",
"code" : "flyover",
"display" : "Fly-over"
}]
}
}],
"linkId" : "ClaimResponse.addItem.bodySite.site-flyover",
"text" : "Physical service site on the patient (limb, tooth, etc.).",
"type" : "display"
}]
},
{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType",
"valueString" : "CodeableConcept"
}],
"linkId" : "ClaimResponse.addItem.bodySite.subSite",
"text" : "Sub-location",
"type" : "group",
"required" : false,
"repeats" : true,
"item" : [{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept" : {
"coding" : [{
"system" : "http://hl7.org/fhir/questionnaire-item-control",
"code" : "flyover",
"display" : "Fly-over"
}]
}
}],
"linkId" : "ClaimResponse.addItem.bodySite.subSite-flyover",
"text" : "A region or surface of the bodySite, e.g. limb region or tooth surface(s).",
"type" : "display"
},
{
"linkId" : "ClaimResponse.addItem.bodySite.subSite.coding",
"text" : "code:",
"type" : "coding",
"required" : false,
"repeats" : false,
"answerConstraint" : "optionsOnly"
},
{
"linkId" : "ClaimResponse.addItem.bodySite.subSite.text",
"text" : "text:",
"type" : "string",
"required" : false,
"repeats" : false
}]
}]
},
{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType",
"valueString" : "integer"
}],
"linkId" : "ClaimResponse.addItem.noteNumber",
"type" : "group",
"required" : false,
"repeats" : true,
"item" : [{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept" : {
"coding" : [{
"system" : "http://hl7.org/fhir/questionnaire-item-control",
"code" : "flyover",
"display" : "Fly-over"
}]
}
}],
"linkId" : "ClaimResponse.addItem.noteNumber-flyover",
"text" : "The numbers associated with notes below which apply to the adjudication of this item.",
"type" : "display"
},
{
"linkId" : "ClaimResponse.addItem.noteNumber.value",
"text" : "Applicable note numbers",
"type" : "integer",
"required" : false,
"repeats" : false
}]
},
{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs",
"valueInteger" : 1
}],
"linkId" : "ClaimResponse.addItem.reviewOutcome",
"text" : "Added items adjudication results",
"type" : "group",
"required" : false,
"repeats" : false,
"item" : [{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept" : {
"coding" : [{
"system" : "http://hl7.org/fhir/questionnaire-item-control",
"code" : "flyover",
"display" : "Fly-over"
}]
}
}],
"linkId" : "ClaimResponse.addItem.reviewOutcome-flyover",
"text" : "The high-level results of the adjudication if adjudication has been performed.",
"type" : "display"
},
{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs",
"valueInteger" : 1
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType",
"valueString" : "string"
}],
"linkId" : "ClaimResponse.item.reviewOutcome.id",
"type" : "group",
"required" : false,
"repeats" : true,
"item" : [{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept" : {
"coding" : [{
"system" : "http://hl7.org/fhir/questionnaire-item-control",
"code" : "flyover",
"display" : "Fly-over"
}]
}
}],
"linkId" : "ClaimResponse.item.reviewOutcome.id-flyover",
"text" : "Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.",
"type" : "display"
},
{
"linkId" : "ClaimResponse.item.reviewOutcome.id.value",
"text" : "Unique id for inter-element referencing",
"type" : "string",
"required" : false,
"repeats" : false
}]
},
{
"linkId" : "ClaimResponse.item.reviewOutcome.extension",
"text" : "Additional content defined by implementations",
"type" : "group",
"required" : false,
"repeats" : true,
"item" : [{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept" : {
"coding" : [{
"system" : "http://hl7.org/fhir/questionnaire-item-control",
"code" : "flyover",
"display" : "Fly-over"
}]
}
}],
"linkId" : "ClaimResponse.item.reviewOutcome.extension-flyover",
"text" : "May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and managable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.",
"type" : "display"
}]
},
{
"linkId" : "ClaimResponse.item.reviewOutcome.modifierExtension",
"text" : "Extensions that cannot be ignored even if unrecognized",
"type" : "group",
"required" : false,
"repeats" : true,
"item" : [{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept" : {
"coding" : [{
"system" : "http://hl7.org/fhir/questionnaire-item-control",
"code" : "flyover",
"display" : "Fly-over"
}]
}
}],
"linkId" : "ClaimResponse.item.reviewOutcome.modifierExtension-flyover",
"text" : "May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and managable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can 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.\n\nModifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.",
"type" : "display"
}]
},
{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs",
"valueInteger" : 1
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType",
"valueString" : "CodeableConcept"
}],
"linkId" : "ClaimResponse.item.reviewOutcome.decision",
"text" : "Result of the adjudication",
"type" : "group",
"required" : false,
"repeats" : true,
"item" : [{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept" : {
"coding" : [{
"system" : "http://hl7.org/fhir/questionnaire-item-control",
"code" : "flyover",
"display" : "Fly-over"
}]
}
}],
"linkId" : "ClaimResponse.item.reviewOutcome.decision-flyover",
"text" : "The result of the claim, predetermination, or preauthorization adjudication. The element is used to indicate the current state of the adjudication overall for the claim resource, for example: the request has been held (pended) for adjudication processing, for manual review or other reasons; that it has been processed and will be paid, or the outstanding paid, as submitted (approved); that no amount will be paid (denied); or that some amount between zero and the submitted amount will be paid (partial).",
"type" : "display"
},
{
"linkId" : "ClaimResponse.item.reviewOutcome.decision.coding",
"text" : "code:",
"type" : "coding",
"required" : false,
"repeats" : false,
"answerConstraint" : "optionsOnly"
},
{
"linkId" : "ClaimResponse.item.reviewOutcome.decision.text",
"text" : "text:",
"type" : "string",
"required" : false,
"repeats" : false
}]
},
{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType",
"valueString" : "CodeableConcept"
}],
"linkId" : "ClaimResponse.item.reviewOutcome.reason",
"text" : "Reason for result of the adjudication",
"type" : "group",
"required" : false,
"repeats" : true,
"item" : [{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept" : {
"coding" : [{
"system" : "http://hl7.org/fhir/questionnaire-item-control",
"code" : "flyover",
"display" : "Fly-over"
}]
}
}],
"linkId" : "ClaimResponse.item.reviewOutcome.reason-flyover",
"text" : "The reasons for the result of the claim, predetermination, or preauthorization adjudication.",
"type" : "display"
},
{
"linkId" : "ClaimResponse.item.reviewOutcome.reason.coding",
"text" : "code:",
"type" : "coding",
"required" : false,
"repeats" : false,
"answerConstraint" : "optionsOnly"
},
{
"linkId" : "ClaimResponse.item.reviewOutcome.reason.text",
"text" : "text:",
"type" : "string",
"required" : false,
"repeats" : false
}]
},
{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs",
"valueInteger" : 1
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType",
"valueString" : "string"
}],
"linkId" : "ClaimResponse.item.reviewOutcome.preAuthRef",
"type" : "group",
"required" : false,
"repeats" : true,
"item" : [{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept" : {
"coding" : [{
"system" : "http://hl7.org/fhir/questionnaire-item-control",
"code" : "flyover",
"display" : "Fly-over"
}]
}
}],
"linkId" : "ClaimResponse.item.reviewOutcome.preAuthRef-flyover",
"text" : "Reference from the Insurer which is used in later communications which refers to this adjudication. This value is only present on preauthorization adjudications.",
"type" : "display"
},
{
"linkId" : "ClaimResponse.item.reviewOutcome.preAuthRef.value",
"text" : "Preauthorization reference",
"type" : "string",
"required" : false,
"repeats" : false
}]
},
{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs",
"valueInteger" : 1
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType",
"valueString" : "Period"
}],
"linkId" : "ClaimResponse.item.reviewOutcome.preAuthPeriod",
"text" : "Preauthorization reference effective period",
"type" : "group",
"required" : false,
"repeats" : true,
"item" : [{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept" : {
"coding" : [{
"system" : "http://hl7.org/fhir/questionnaire-item-control",
"code" : "flyover",
"display" : "Fly-over"
}]
}
}],
"linkId" : "ClaimResponse.item.reviewOutcome.preAuthPeriod-flyover",
"text" : "The time frame during which this authorization is effective.",
"type" : "display"
},
{
"linkId" : "ClaimResponse.item.reviewOutcome.preAuthPeriod.low",
"text" : "start:",
"type" : "dateTime",
"required" : false,
"repeats" : false
},
{
"linkId" : "ClaimResponse.item.reviewOutcome.preAuthPeriod.end",
"text" : "end:",
"type" : "dateTime",
"required" : false,
"repeats" : false
}]
}]
},
{
"linkId" : "ClaimResponse.addItem.adjudication",
"text" : "Added items adjudication",
"type" : "group",
"required" : false,
"repeats" : true,
"item" : [{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept" : {
"coding" : [{
"system" : "http://hl7.org/fhir/questionnaire-item-control",
"code" : "flyover",
"display" : "Fly-over"
}]
}
}],
"linkId" : "ClaimResponse.addItem.adjudication-flyover",
"text" : "The adjudication results.",
"type" : "display"
},
{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs",
"valueInteger" : 1
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType",
"valueString" : "string"
}],
"linkId" : "ClaimResponse.item.adjudication.id",
"type" : "group",
"required" : false,
"repeats" : true,
"item" : [{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept" : {
"coding" : [{
"system" : "http://hl7.org/fhir/questionnaire-item-control",
"code" : "flyover",
"display" : "Fly-over"
}]
}
}],
"linkId" : "ClaimResponse.item.adjudication.id-flyover",
"text" : "Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.",
"type" : "display"
},
{
"linkId" : "ClaimResponse.item.adjudication.id.value",
"text" : "Unique id for inter-element referencing",
"type" : "string",
"required" : false,
"repeats" : false
}]
},
{
"linkId" : "ClaimResponse.item.adjudication.extension",
"text" : "Additional content defined by implementations",
"type" : "group",
"required" : false,
"repeats" : true,
"item" : [{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept" : {
"coding" : [{
"system" : "http://hl7.org/fhir/questionnaire-item-control",
"code" : "flyover",
"display" : "Fly-over"
}]
}
}],
"linkId" : "ClaimResponse.item.adjudication.extension-flyover",
"text" : "May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and managable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.",
"type" : "display"
}]
},
{
"linkId" : "ClaimResponse.item.adjudication.modifierExtension",
"text" : "Extensions that cannot be ignored even if unrecognized",
"type" : "group",
"required" : false,
"repeats" : true,
"item" : [{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept" : {
"coding" : [{
"system" : "http://hl7.org/fhir/questionnaire-item-control",
"code" : "flyover",
"display" : "Fly-over"
}]
}
}],
"linkId" : "ClaimResponse.item.adjudication.modifierExtension-flyover",
"text" : "May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and managable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can 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.\n\nModifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.",
"type" : "display"
}]
},
{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-minOccurs",
"valueInteger" : 1
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs",
"valueInteger" : 1
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType",
"valueString" : "CodeableConcept"
}],
"linkId" : "ClaimResponse.item.adjudication.category",
"text" : "Type of adjudication information",
"type" : "group",
"required" : true,
"repeats" : true,
"item" : [{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept" : {
"coding" : [{
"system" : "http://hl7.org/fhir/questionnaire-item-control",
"code" : "flyover",
"display" : "Fly-over"
}]
}
}],
"linkId" : "ClaimResponse.item.adjudication.category-flyover",
"text" : "A code to indicate the information type of this adjudication record. Information types may include the value submitted, maximum values or percentages allowed or payable under the plan, amounts that: the patient is responsible for in aggregate or pertaining to this item; amounts paid by other coverages; and, the benefit payable for this item. For example codes indicating: Co-Pay, deductible, eligible, benefit, tax, etc.",
"type" : "display"
},
{
"linkId" : "ClaimResponse.item.adjudication.category.coding",
"text" : "code:",
"type" : "coding",
"required" : false,
"repeats" : false,
"answerConstraint" : "optionsOnly"
},
{
"linkId" : "ClaimResponse.item.adjudication.category.text",
"text" : "text:",
"type" : "string",
"required" : false,
"repeats" : false
}]
},
{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs",
"valueInteger" : 1
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType",
"valueString" : "CodeableConcept"
}],
"linkId" : "ClaimResponse.item.adjudication.reason",
"text" : "Explanation of adjudication outcome",
"type" : "group",
"required" : false,
"repeats" : true,
"item" : [{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept" : {
"coding" : [{
"system" : "http://hl7.org/fhir/questionnaire-item-control",
"code" : "flyover",
"display" : "Fly-over"
}]
}
}],
"linkId" : "ClaimResponse.item.adjudication.reason-flyover",
"text" : "A code supporting the understanding of the adjudication result and explaining variance from expected amount. For example may indicate that the funds for this benefit type have been exhausted.",
"type" : "display"
},
{
"linkId" : "ClaimResponse.item.adjudication.reason.coding",
"text" : "code:",
"type" : "coding",
"required" : false,
"repeats" : false,
"answerConstraint" : "optionsOnly"
},
{
"linkId" : "ClaimResponse.item.adjudication.reason.text",
"text" : "text:",
"type" : "string",
"required" : false,
"repeats" : false
}]
},
{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs",
"valueInteger" : 1
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType",
"valueString" : "Quantity"
}],
"linkId" : "ClaimResponse.item.adjudication.amount",
"text" : "Monetary amount",
"type" : "group",
"required" : false,
"repeats" : true,
"item" : [{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept" : {
"coding" : [{
"system" : "http://hl7.org/fhir/questionnaire-item-control",
"code" : "flyover",
"display" : "Fly-over"
}]
}
}],
"linkId" : "ClaimResponse.item.adjudication.amount-flyover",
"text" : "Monetary amount associated with the category. For example: amount submitted, eligible amount, co-payment, and benefit payable.",
"type" : "display"
},
{
"linkId" : "ClaimResponse.item.adjudication.amount.comparator",
"text" : "comp:",
"type" : "coding",
"required" : false,
"repeats" : false,
"answerConstraint" : "optionsOnly"
},
{
"linkId" : "ClaimResponse.item.adjudication.amount.value",
"text" : "value:",
"type" : "decimal",
"required" : false,
"repeats" : false
},
{
"linkId" : "ClaimResponse.item.adjudication.amount.units",
"text" : "units:",
"type" : "string",
"required" : false,
"repeats" : false
},
{
"linkId" : "ClaimResponse.item.adjudication.amount.code",
"text" : "coded units:",
"type" : "string",
"required" : false,
"repeats" : false
},
{
"linkId" : "ClaimResponse.item.adjudication.amount.system",
"text" : "units system:",
"type" : "string",
"required" : false,
"repeats" : false
}]
},
{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs",
"valueInteger" : 1
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType",
"valueString" : "Quantity"
}],
"linkId" : "ClaimResponse.item.adjudication.quantity",
"text" : "Non-monetary value",
"type" : "group",
"required" : false,
"repeats" : true,
"item" : [{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept" : {
"coding" : [{
"system" : "http://hl7.org/fhir/questionnaire-item-control",
"code" : "flyover",
"display" : "Fly-over"
}]
}
}],
"linkId" : "ClaimResponse.item.adjudication.quantity-flyover",
"text" : "A non-monetary value associated with the category. Mutually exclusive to the amount element above. For example: eligible percentage or co-payment percentage.",
"type" : "display"
},
{
"linkId" : "ClaimResponse.item.adjudication.quantity.comparator",
"text" : "comp:",
"type" : "coding",
"required" : false,
"repeats" : false,
"answerConstraint" : "optionsOnly"
},
{
"linkId" : "ClaimResponse.item.adjudication.quantity.value",
"text" : "value:",
"type" : "decimal",
"required" : false,
"repeats" : false
},
{
"linkId" : "ClaimResponse.item.adjudication.quantity.units",
"text" : "units:",
"type" : "string",
"required" : false,
"repeats" : false
},
{
"linkId" : "ClaimResponse.item.adjudication.quantity.code",
"text" : "coded units:",
"type" : "string",
"required" : false,
"repeats" : false
},
{
"linkId" : "ClaimResponse.item.adjudication.quantity.system",
"text" : "units system:",
"type" : "string",
"required" : false,
"repeats" : false
}]
}]
},
{
"linkId" : "ClaimResponse.addItem.detail",
"text" : "Insurer added line details",
"type" : "group",
"required" : false,
"repeats" : true,
"item" : [{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept" : {
"coding" : [{
"system" : "http://hl7.org/fhir/questionnaire-item-control",
"code" : "flyover",
"display" : "Fly-over"
}]
}
}],
"linkId" : "ClaimResponse.addItem.detail-flyover",
"text" : "The second-tier service adjudications for payor added services.",
"type" : "display"
},
{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs",
"valueInteger" : 1
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType",
"valueString" : "string"
}],
"linkId" : "ClaimResponse.addItem.detail.id",
"type" : "group",
"required" : false,
"repeats" : true,
"item" : [{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept" : {
"coding" : [{
"system" : "http://hl7.org/fhir/questionnaire-item-control",
"code" : "flyover",
"display" : "Fly-over"
}]
}
}],
"linkId" : "ClaimResponse.addItem.detail.id-flyover",
"text" : "Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.",
"type" : "display"
},
{
"linkId" : "ClaimResponse.addItem.detail.id.value",
"text" : "Unique id for inter-element referencing",
"type" : "string",
"required" : false,
"repeats" : false
}]
},
{
"linkId" : "ClaimResponse.addItem.detail.extension",
"text" : "Additional content defined by implementations",
"type" : "group",
"required" : false,
"repeats" : true,
"item" : [{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept" : {
"coding" : [{
"system" : "http://hl7.org/fhir/questionnaire-item-control",
"code" : "flyover",
"display" : "Fly-over"
}]
}
}],
"linkId" : "ClaimResponse.addItem.detail.extension-flyover",
"text" : "May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and managable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.",
"type" : "display"
}]
},
{
"linkId" : "ClaimResponse.addItem.detail.modifierExtension",
"text" : "Extensions that cannot be ignored even if unrecognized",
"type" : "group",
"required" : false,
"repeats" : true,
"item" : [{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept" : {
"coding" : [{
"system" : "http://hl7.org/fhir/questionnaire-item-control",
"code" : "flyover",
"display" : "Fly-over"
}]
}
}],
"linkId" : "ClaimResponse.addItem.detail.modifierExtension-flyover",
"text" : "May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and managable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can 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.\n\nModifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.",
"type" : "display"
}]
},
{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType",
"valueString" : "Identifier"
}],
"linkId" : "ClaimResponse.addItem.detail.traceNumber",
"text" : "Number for tracking",
"type" : "group",
"required" : false,
"repeats" : true,
"item" : [{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept" : {
"coding" : [{
"system" : "http://hl7.org/fhir/questionnaire-item-control",
"code" : "flyover",
"display" : "Fly-over"
}]
}
}],
"linkId" : "ClaimResponse.addItem.detail.traceNumber-flyover",
"text" : "Trace number for tracking purposes. May be defined at the jurisdiction level or between trading partners.",
"type" : "display"
},
{
"linkId" : "ClaimResponse.addItem.detail.traceNumber.label",
"text" : "label:",
"type" : "string",
"required" : false,
"repeats" : false
},
{
"linkId" : "ClaimResponse.addItem.detail.traceNumber.system",
"text" : "system:",
"type" : "string",
"required" : false,
"repeats" : false
},
{
"linkId" : "ClaimResponse.addItem.detail.traceNumber.value",
"text" : "value:",
"type" : "string",
"required" : false,
"repeats" : false
}]
},
{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs",
"valueInteger" : 1
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType",
"valueString" : "CodeableConcept"
}],
"linkId" : "ClaimResponse.addItem.detail.revenue",
"text" : "Revenue or cost center code",
"type" : "group",
"required" : false,
"repeats" : true,
"item" : [{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept" : {
"coding" : [{
"system" : "http://hl7.org/fhir/questionnaire-item-control",
"code" : "flyover",
"display" : "Fly-over"
}]
}
}],
"linkId" : "ClaimResponse.addItem.detail.revenue-flyover",
"text" : "The type of revenue or cost center providing the product and/or service.",
"type" : "display"
},
{
"linkId" : "ClaimResponse.addItem.detail.revenue.coding",
"text" : "code:",
"type" : "coding",
"required" : false,
"repeats" : false,
"answerConstraint" : "optionsOnly"
},
{
"linkId" : "ClaimResponse.addItem.detail.revenue.text",
"text" : "text:",
"type" : "string",
"required" : false,
"repeats" : false
}]
},
{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs",
"valueInteger" : 1
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType",
"valueString" : "CodeableConcept"
}],
"linkId" : "ClaimResponse.addItem.detail.productOrService",
"text" : "Billing, service, product, or drug code",
"type" : "group",
"required" : false,
"repeats" : true,
"item" : [{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept" : {
"coding" : [{
"system" : "http://hl7.org/fhir/questionnaire-item-control",
"code" : "flyover",
"display" : "Fly-over"
}]
}
}],
"linkId" : "ClaimResponse.addItem.detail.productOrService-flyover",
"text" : "When the value is a group code then this item collects a set of related item details, otherwise this contains the product, service, drug or other billing code for the item. This element may be the start of a range of .productOrService codes used in conjunction with .productOrServiceEnd or it may be a solo element where .productOrServiceEnd is not used. If this is an actual service or product line, i.e. not a Group, then use code to indicate the Professional Service or Product supplied (e.g. CTP, HCPCS, USCLS, ICD10, NCPDP, DIN, RxNorm, ACHI, CCI). If a grouping item then use a group code to indicate the type of thing being grouped e.g. 'glasses' or 'compound'.",
"type" : "display"
},
{
"linkId" : "ClaimResponse.addItem.detail.productOrService.coding",
"text" : "code:",
"type" : "coding",
"required" : false,
"repeats" : false,
"answerConstraint" : "optionsOnly"
},
{
"linkId" : "ClaimResponse.addItem.detail.productOrService.text",
"text" : "text:",
"type" : "string",
"required" : false,
"repeats" : false
}]
},
{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs",
"valueInteger" : 1
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType",
"valueString" : "CodeableConcept"
}],
"linkId" : "ClaimResponse.addItem.detail.productOrServiceEnd",
"text" : "End of a range of codes",
"type" : "group",
"required" : false,
"repeats" : true,
"item" : [{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept" : {
"coding" : [{
"system" : "http://hl7.org/fhir/questionnaire-item-control",
"code" : "flyover",
"display" : "Fly-over"
}]
}
}],
"linkId" : "ClaimResponse.addItem.detail.productOrServiceEnd-flyover",
"text" : "This contains the end of a range of product, service, drug or other billing codes for the item. This element is not used when the .productOrService is a group code. This value may only be present when a .productOfService code has been provided to convey the start of the range. Typically this value may be used only with preauthorizations and not with claims.",
"type" : "display"
},
{
"linkId" : "ClaimResponse.addItem.detail.productOrServiceEnd.coding",
"text" : "code:",
"type" : "coding",
"required" : false,
"repeats" : false,
"answerConstraint" : "optionsOnly"
},
{
"linkId" : "ClaimResponse.addItem.detail.productOrServiceEnd.text",
"text" : "text:",
"type" : "string",
"required" : false,
"repeats" : false
}]
},
{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType",
"valueString" : "CodeableConcept"
}],
"linkId" : "ClaimResponse.addItem.detail.modifier",
"text" : "Service/Product billing modifiers",
"type" : "group",
"required" : false,
"repeats" : true,
"item" : [{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept" : {
"coding" : [{
"system" : "http://hl7.org/fhir/questionnaire-item-control",
"code" : "flyover",
"display" : "Fly-over"
}]
}
}],
"linkId" : "ClaimResponse.addItem.detail.modifier-flyover",
"text" : "Item typification or modifiers codes to convey additional context for the product or service. For example in Oral whether the treatment is cosmetic or associated with TMJ, or for Medical whether the treatment was outside the clinic or outside of office hours.",
"type" : "display"
},
{
"linkId" : "ClaimResponse.addItem.detail.modifier.coding",
"text" : "code:",
"type" : "coding",
"required" : false,
"repeats" : false,
"answerConstraint" : "optionsOnly"
},
{
"linkId" : "ClaimResponse.addItem.detail.modifier.text",
"text" : "text:",
"type" : "string",
"required" : false,
"repeats" : false
}]
},
{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs",
"valueInteger" : 1
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType",
"valueString" : "Quantity"
}],
"linkId" : "ClaimResponse.addItem.detail.quantity",
"text" : "Count of products or services",
"type" : "group",
"required" : false,
"repeats" : true,
"item" : [{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept" : {
"coding" : [{
"system" : "http://hl7.org/fhir/questionnaire-item-control",
"code" : "flyover",
"display" : "Fly-over"
}]
}
}],
"linkId" : "ClaimResponse.addItem.detail.quantity-flyover",
"text" : "The number of repetitions of a service or product.",
"type" : "display"
},
{
"linkId" : "ClaimResponse.addItem.detail.quantity.comparator",
"text" : "comp:",
"type" : "coding",
"required" : false,
"repeats" : false,
"answerConstraint" : "optionsOnly"
},
{
"linkId" : "ClaimResponse.addItem.detail.quantity.value",
"text" : "value:",
"type" : "decimal",
"required" : false,
"repeats" : false
},
{
"linkId" : "ClaimResponse.addItem.detail.quantity.units",
"text" : "units:",
"type" : "string",
"required" : false,
"repeats" : false
},
{
"linkId" : "ClaimResponse.addItem.detail.quantity.code",
"text" : "coded units:",
"type" : "string",
"required" : false,
"repeats" : false
},
{
"linkId" : "ClaimResponse.addItem.detail.quantity.system",
"text" : "units system:",
"type" : "string",
"required" : false,
"repeats" : false
}]
},
{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs",
"valueInteger" : 1
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType",
"valueString" : "Quantity"
}],
"linkId" : "ClaimResponse.addItem.detail.unitPrice",
"text" : "Fee, charge or cost per item",
"type" : "group",
"required" : false,
"repeats" : true,
"item" : [{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept" : {
"coding" : [{
"system" : "http://hl7.org/fhir/questionnaire-item-control",
"code" : "flyover",
"display" : "Fly-over"
}]
}
}],
"linkId" : "ClaimResponse.addItem.detail.unitPrice-flyover",
"text" : "If the item is not a group then this is the fee for the product or service, otherwise this is the total of the fees for the details of the group.",
"type" : "display"
},
{
"linkId" : "ClaimResponse.addItem.detail.unitPrice.comparator",
"text" : "comp:",
"type" : "coding",
"required" : false,
"repeats" : false,
"answerConstraint" : "optionsOnly"
},
{
"linkId" : "ClaimResponse.addItem.detail.unitPrice.value",
"text" : "value:",
"type" : "decimal",
"required" : false,
"repeats" : false
},
{
"linkId" : "ClaimResponse.addItem.detail.unitPrice.units",
"text" : "units:",
"type" : "string",
"required" : false,
"repeats" : false
},
{
"linkId" : "ClaimResponse.addItem.detail.unitPrice.code",
"text" : "coded units:",
"type" : "string",
"required" : false,
"repeats" : false
},
{
"linkId" : "ClaimResponse.addItem.detail.unitPrice.system",
"text" : "units system:",
"type" : "string",
"required" : false,
"repeats" : false
}]
},
{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs",
"valueInteger" : 1
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType",
"valueString" : "decimal"
}],
"linkId" : "ClaimResponse.addItem.detail.factor",
"type" : "group",
"required" : false,
"repeats" : true,
"item" : [{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept" : {
"coding" : [{
"system" : "http://hl7.org/fhir/questionnaire-item-control",
"code" : "flyover",
"display" : "Fly-over"
}]
}
}],
"linkId" : "ClaimResponse.addItem.detail.factor-flyover",
"text" : "A real number that represents a multiplier used in determining the overall value of services delivered and/or goods received. The concept of a Factor allows for a discount or surcharge multiplier to be applied to a monetary amount. To show a 10% senior's discount, the value entered is: 0.90 (1.00 - 0.10).",
"type" : "display"
},
{
"linkId" : "ClaimResponse.addItem.detail.factor.value",
"text" : "Price scaling factor",
"type" : "decimal",
"required" : false,
"repeats" : false
}]
},
{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs",
"valueInteger" : 1
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType",
"valueString" : "Quantity"
}],
"linkId" : "ClaimResponse.addItem.detail.tax",
"text" : "Total tax",
"type" : "group",
"required" : false,
"repeats" : true,
"item" : [{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept" : {
"coding" : [{
"system" : "http://hl7.org/fhir/questionnaire-item-control",
"code" : "flyover",
"display" : "Fly-over"
}]
}
}],
"linkId" : "ClaimResponse.addItem.detail.tax-flyover",
"text" : "The total of taxes applicable for this product or service.",
"type" : "display"
},
{
"linkId" : "ClaimResponse.addItem.detail.tax.comparator",
"text" : "comp:",
"type" : "coding",
"required" : false,
"repeats" : false,
"answerConstraint" : "optionsOnly"
},
{
"linkId" : "ClaimResponse.addItem.detail.tax.value",
"text" : "value:",
"type" : "decimal",
"required" : false,
"repeats" : false
},
{
"linkId" : "ClaimResponse.addItem.detail.tax.units",
"text" : "units:",
"type" : "string",
"required" : false,
"repeats" : false
},
{
"linkId" : "ClaimResponse.addItem.detail.tax.code",
"text" : "coded units:",
"type" : "string",
"required" : false,
"repeats" : false
},
{
"linkId" : "ClaimResponse.addItem.detail.tax.system",
"text" : "units system:",
"type" : "string",
"required" : false,
"repeats" : false
}]
},
{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs",
"valueInteger" : 1
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType",
"valueString" : "Quantity"
}],
"linkId" : "ClaimResponse.addItem.detail.net",
"text" : "Total item cost",
"type" : "group",
"required" : false,
"repeats" : true,
"item" : [{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept" : {
"coding" : [{
"system" : "http://hl7.org/fhir/questionnaire-item-control",
"code" : "flyover",
"display" : "Fly-over"
}]
}
}],
"linkId" : "ClaimResponse.addItem.detail.net-flyover",
"text" : "The total amount claimed for the group (if a grouper) or the addItem.detail. Net = unit price * quantity * factor. For example, the formula: quantity * unitPrice * factor = net. Quantity and factor are assumed to be 1 if not supplied.",
"type" : "display"
},
{
"linkId" : "ClaimResponse.addItem.detail.net.comparator",
"text" : "comp:",
"type" : "coding",
"required" : false,
"repeats" : false,
"answerConstraint" : "optionsOnly"
},
{
"linkId" : "ClaimResponse.addItem.detail.net.value",
"text" : "value:",
"type" : "decimal",
"required" : false,
"repeats" : false
},
{
"linkId" : "ClaimResponse.addItem.detail.net.units",
"text" : "units:",
"type" : "string",
"required" : false,
"repeats" : false
},
{
"linkId" : "ClaimResponse.addItem.detail.net.code",
"text" : "coded units:",
"type" : "string",
"required" : false,
"repeats" : false
},
{
"linkId" : "ClaimResponse.addItem.detail.net.system",
"text" : "units system:",
"type" : "string",
"required" : false,
"repeats" : false
}]
},
{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType",
"valueString" : "integer"
}],
"linkId" : "ClaimResponse.addItem.detail.noteNumber",
"type" : "group",
"required" : false,
"repeats" : true,
"item" : [{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept" : {
"coding" : [{
"system" : "http://hl7.org/fhir/questionnaire-item-control",
"code" : "flyover",
"display" : "Fly-over"
}]
}
}],
"linkId" : "ClaimResponse.addItem.detail.noteNumber-flyover",
"text" : "The numbers associated with notes below which apply to the adjudication of this item.",
"type" : "display"
},
{
"linkId" : "ClaimResponse.addItem.detail.noteNumber.value",
"text" : "Applicable note numbers",
"type" : "integer",
"required" : false,
"repeats" : false
}]
},
{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs",
"valueInteger" : 1
}],
"linkId" : "ClaimResponse.addItem.detail.reviewOutcome",
"text" : "Added items detail level adjudication results",
"type" : "group",
"required" : false,
"repeats" : false,
"item" : [{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept" : {
"coding" : [{
"system" : "http://hl7.org/fhir/questionnaire-item-control",
"code" : "flyover",
"display" : "Fly-over"
}]
}
}],
"linkId" : "ClaimResponse.addItem.detail.reviewOutcome-flyover",
"text" : "The high-level results of the adjudication if adjudication has been performed.",
"type" : "display"
},
{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs",
"valueInteger" : 1
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType",
"valueString" : "string"
}],
"linkId" : "ClaimResponse.item.reviewOutcome.id",
"type" : "group",
"required" : false,
"repeats" : true,
"item" : [{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept" : {
"coding" : [{
"system" : "http://hl7.org/fhir/questionnaire-item-control",
"code" : "flyover",
"display" : "Fly-over"
}]
}
}],
"linkId" : "ClaimResponse.item.reviewOutcome.id-flyover",
"text" : "Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.",
"type" : "display"
},
{
"linkId" : "ClaimResponse.item.reviewOutcome.id.value",
"text" : "Unique id for inter-element referencing",
"type" : "string",
"required" : false,
"repeats" : false
}]
},
{
"linkId" : "ClaimResponse.item.reviewOutcome.extension",
"text" : "Additional content defined by implementations",
"type" : "group",
"required" : false,
"repeats" : true,
"item" : [{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept" : {
"coding" : [{
"system" : "http://hl7.org/fhir/questionnaire-item-control",
"code" : "flyover",
"display" : "Fly-over"
}]
}
}],
"linkId" : "ClaimResponse.item.reviewOutcome.extension-flyover",
"text" : "May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and managable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.",
"type" : "display"
}]
},
{
"linkId" : "ClaimResponse.item.reviewOutcome.modifierExtension",
"text" : "Extensions that cannot be ignored even if unrecognized",
"type" : "group",
"required" : false,
"repeats" : true,
"item" : [{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept" : {
"coding" : [{
"system" : "http://hl7.org/fhir/questionnaire-item-control",
"code" : "flyover",
"display" : "Fly-over"
}]
}
}],
"linkId" : "ClaimResponse.item.reviewOutcome.modifierExtension-flyover",
"text" : "May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and managable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can 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.\n\nModifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.",
"type" : "display"
}]
},
{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs",
"valueInteger" : 1
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType",
"valueString" : "CodeableConcept"
}],
"linkId" : "ClaimResponse.item.reviewOutcome.decision",
"text" : "Result of the adjudication",
"type" : "group",
"required" : false,
"repeats" : true,
"item" : [{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept" : {
"coding" : [{
"system" : "http://hl7.org/fhir/questionnaire-item-control",
"code" : "flyover",
"display" : "Fly-over"
}]
}
}],
"linkId" : "ClaimResponse.item.reviewOutcome.decision-flyover",
"text" : "The result of the claim, predetermination, or preauthorization adjudication. The element is used to indicate the current state of the adjudication overall for the claim resource, for example: the request has been held (pended) for adjudication processing, for manual review or other reasons; that it has been processed and will be paid, or the outstanding paid, as submitted (approved); that no amount will be paid (denied); or that some amount between zero and the submitted amount will be paid (partial).",
"type" : "display"
},
{
"linkId" : "ClaimResponse.item.reviewOutcome.decision.coding",
"text" : "code:",
"type" : "coding",
"required" : false,
"repeats" : false,
"answerConstraint" : "optionsOnly"
},
{
"linkId" : "ClaimResponse.item.reviewOutcome.decision.text",
"text" : "text:",
"type" : "string",
"required" : false,
"repeats" : false
}]
},
{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType",
"valueString" : "CodeableConcept"
}],
"linkId" : "ClaimResponse.item.reviewOutcome.reason",
"text" : "Reason for result of the adjudication",
"type" : "group",
"required" : false,
"repeats" : true,
"item" : [{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept" : {
"coding" : [{
"system" : "http://hl7.org/fhir/questionnaire-item-control",
"code" : "flyover",
"display" : "Fly-over"
}]
}
}],
"linkId" : "ClaimResponse.item.reviewOutcome.reason-flyover",
"text" : "The reasons for the result of the claim, predetermination, or preauthorization adjudication.",
"type" : "display"
},
{
"linkId" : "ClaimResponse.item.reviewOutcome.reason.coding",
"text" : "code:",
"type" : "coding",
"required" : false,
"repeats" : false,
"answerConstraint" : "optionsOnly"
},
{
"linkId" : "ClaimResponse.item.reviewOutcome.reason.text",
"text" : "text:",
"type" : "string",
"required" : false,
"repeats" : false
}]
},
{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs",
"valueInteger" : 1
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType",
"valueString" : "string"
}],
"linkId" : "ClaimResponse.item.reviewOutcome.preAuthRef",
"type" : "group",
"required" : false,
"repeats" : true,
"item" : [{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept" : {
"coding" : [{
"system" : "http://hl7.org/fhir/questionnaire-item-control",
"code" : "flyover",
"display" : "Fly-over"
}]
}
}],
"linkId" : "ClaimResponse.item.reviewOutcome.preAuthRef-flyover",
"text" : "Reference from the Insurer which is used in later communications which refers to this adjudication. This value is only present on preauthorization adjudications.",
"type" : "display"
},
{
"linkId" : "ClaimResponse.item.reviewOutcome.preAuthRef.value",
"text" : "Preauthorization reference",
"type" : "string",
"required" : false,
"repeats" : false
}]
},
{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs",
"valueInteger" : 1
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType",
"valueString" : "Period"
}],
"linkId" : "ClaimResponse.item.reviewOutcome.preAuthPeriod",
"text" : "Preauthorization reference effective period",
"type" : "group",
"required" : false,
"repeats" : true,
"item" : [{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept" : {
"coding" : [{
"system" : "http://hl7.org/fhir/questionnaire-item-control",
"code" : "flyover",
"display" : "Fly-over"
}]
}
}],
"linkId" : "ClaimResponse.item.reviewOutcome.preAuthPeriod-flyover",
"text" : "The time frame during which this authorization is effective.",
"type" : "display"
},
{
"linkId" : "ClaimResponse.item.reviewOutcome.preAuthPeriod.low",
"text" : "start:",
"type" : "dateTime",
"required" : false,
"repeats" : false
},
{
"linkId" : "ClaimResponse.item.reviewOutcome.preAuthPeriod.end",
"text" : "end:",
"type" : "dateTime",
"required" : false,
"repeats" : false
}]
}]
},
{
"linkId" : "ClaimResponse.addItem.detail.adjudication",
"text" : "Added items detail adjudication",
"type" : "group",
"required" : false,
"repeats" : true,
"item" : [{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept" : {
"coding" : [{
"system" : "http://hl7.org/fhir/questionnaire-item-control",
"code" : "flyover",
"display" : "Fly-over"
}]
}
}],
"linkId" : "ClaimResponse.addItem.detail.adjudication-flyover",
"text" : "The adjudication results.",
"type" : "display"
},
{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs",
"valueInteger" : 1
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType",
"valueString" : "string"
}],
"linkId" : "ClaimResponse.item.adjudication.id",
"type" : "group",
"required" : false,
"repeats" : true,
"item" : [{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept" : {
"coding" : [{
"system" : "http://hl7.org/fhir/questionnaire-item-control",
"code" : "flyover",
"display" : "Fly-over"
}]
}
}],
"linkId" : "ClaimResponse.item.adjudication.id-flyover",
"text" : "Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.",
"type" : "display"
},
{
"linkId" : "ClaimResponse.item.adjudication.id.value",
"text" : "Unique id for inter-element referencing",
"type" : "string",
"required" : false,
"repeats" : false
}]
},
{
"linkId" : "ClaimResponse.item.adjudication.extension",
"text" : "Additional content defined by implementations",
"type" : "group",
"required" : false,
"repeats" : true,
"item" : [{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept" : {
"coding" : [{
"system" : "http://hl7.org/fhir/questionnaire-item-control",
"code" : "flyover",
"display" : "Fly-over"
}]
}
}],
"linkId" : "ClaimResponse.item.adjudication.extension-flyover",
"text" : "May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and managable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.",
"type" : "display"
}]
},
{
"linkId" : "ClaimResponse.item.adjudication.modifierExtension",
"text" : "Extensions that cannot be ignored even if unrecognized",
"type" : "group",
"required" : false,
"repeats" : true,
"item" : [{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept" : {
"coding" : [{
"system" : "http://hl7.org/fhir/questionnaire-item-control",
"code" : "flyover",
"display" : "Fly-over"
}]
}
}],
"linkId" : "ClaimResponse.item.adjudication.modifierExtension-flyover",
"text" : "May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and managable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can 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.\n\nModifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.",
"type" : "display"
}]
},
{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-minOccurs",
"valueInteger" : 1
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs",
"valueInteger" : 1
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType",
"valueString" : "CodeableConcept"
}],
"linkId" : "ClaimResponse.item.adjudication.category",
"text" : "Type of adjudication information",
"type" : "group",
"required" : true,
"repeats" : true,
"item" : [{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept" : {
"coding" : [{
"system" : "http://hl7.org/fhir/questionnaire-item-control",
"code" : "flyover",
"display" : "Fly-over"
}]
}
}],
"linkId" : "ClaimResponse.item.adjudication.category-flyover",
"text" : "A code to indicate the information type of this adjudication record. Information types may include the value submitted, maximum values or percentages allowed or payable under the plan, amounts that: the patient is responsible for in aggregate or pertaining to this item; amounts paid by other coverages; and, the benefit payable for this item. For example codes indicating: Co-Pay, deductible, eligible, benefit, tax, etc.",
"type" : "display"
},
{
"linkId" : "ClaimResponse.item.adjudication.category.coding",
"text" : "code:",
"type" : "coding",
"required" : false,
"repeats" : false,
"answerConstraint" : "optionsOnly"
},
{
"linkId" : "ClaimResponse.item.adjudication.category.text",
"text" : "text:",
"type" : "string",
"required" : false,
"repeats" : false
}]
},
{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs",
"valueInteger" : 1
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType",
"valueString" : "CodeableConcept"
}],
"linkId" : "ClaimResponse.item.adjudication.reason",
"text" : "Explanation of adjudication outcome",
"type" : "group",
"required" : false,
"repeats" : true,
"item" : [{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept" : {
"coding" : [{
"system" : "http://hl7.org/fhir/questionnaire-item-control",
"code" : "flyover",
"display" : "Fly-over"
}]
}
}],
"linkId" : "ClaimResponse.item.adjudication.reason-flyover",
"text" : "A code supporting the understanding of the adjudication result and explaining variance from expected amount. For example may indicate that the funds for this benefit type have been exhausted.",
"type" : "display"
},
{
"linkId" : "ClaimResponse.item.adjudication.reason.coding",
"text" : "code:",
"type" : "coding",
"required" : false,
"repeats" : false,
"answerConstraint" : "optionsOnly"
},
{
"linkId" : "ClaimResponse.item.adjudication.reason.text",
"text" : "text:",
"type" : "string",
"required" : false,
"repeats" : false
}]
},
{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs",
"valueInteger" : 1
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType",
"valueString" : "Quantity"
}],
"linkId" : "ClaimResponse.item.adjudication.amount",
"text" : "Monetary amount",
"type" : "group",
"required" : false,
"repeats" : true,
"item" : [{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept" : {
"coding" : [{
"system" : "http://hl7.org/fhir/questionnaire-item-control",
"code" : "flyover",
"display" : "Fly-over"
}]
}
}],
"linkId" : "ClaimResponse.item.adjudication.amount-flyover",
"text" : "Monetary amount associated with the category. For example: amount submitted, eligible amount, co-payment, and benefit payable.",
"type" : "display"
},
{
"linkId" : "ClaimResponse.item.adjudication.amount.comparator",
"text" : "comp:",
"type" : "coding",
"required" : false,
"repeats" : false,
"answerConstraint" : "optionsOnly"
},
{
"linkId" : "ClaimResponse.item.adjudication.amount.value",
"text" : "value:",
"type" : "decimal",
"required" : false,
"repeats" : false
},
{
"linkId" : "ClaimResponse.item.adjudication.amount.units",
"text" : "units:",
"type" : "string",
"required" : false,
"repeats" : false
},
{
"linkId" : "ClaimResponse.item.adjudication.amount.code",
"text" : "coded units:",
"type" : "string",
"required" : false,
"repeats" : false
},
{
"linkId" : "ClaimResponse.item.adjudication.amount.system",
"text" : "units system:",
"type" : "string",
"required" : false,
"repeats" : false
}]
},
{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs",
"valueInteger" : 1
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType",
"valueString" : "Quantity"
}],
"linkId" : "ClaimResponse.item.adjudication.quantity",
"text" : "Non-monetary value",
"type" : "group",
"required" : false,
"repeats" : true,
"item" : [{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept" : {
"coding" : [{
"system" : "http://hl7.org/fhir/questionnaire-item-control",
"code" : "flyover",
"display" : "Fly-over"
}]
}
}],
"linkId" : "ClaimResponse.item.adjudication.quantity-flyover",
"text" : "A non-monetary value associated with the category. Mutually exclusive to the amount element above. For example: eligible percentage or co-payment percentage.",
"type" : "display"
},
{
"linkId" : "ClaimResponse.item.adjudication.quantity.comparator",
"text" : "comp:",
"type" : "coding",
"required" : false,
"repeats" : false,
"answerConstraint" : "optionsOnly"
},
{
"linkId" : "ClaimResponse.item.adjudication.quantity.value",
"text" : "value:",
"type" : "decimal",
"required" : false,
"repeats" : false
},
{
"linkId" : "ClaimResponse.item.adjudication.quantity.units",
"text" : "units:",
"type" : "string",
"required" : false,
"repeats" : false
},
{
"linkId" : "ClaimResponse.item.adjudication.quantity.code",
"text" : "coded units:",
"type" : "string",
"required" : false,
"repeats" : false
},
{
"linkId" : "ClaimResponse.item.adjudication.quantity.system",
"text" : "units system:",
"type" : "string",
"required" : false,
"repeats" : false
}]
}]
},
{
"linkId" : "ClaimResponse.addItem.detail.subDetail",
"text" : "Insurer added line items",
"type" : "group",
"required" : false,
"repeats" : true,
"item" : [{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept" : {
"coding" : [{
"system" : "http://hl7.org/fhir/questionnaire-item-control",
"code" : "flyover",
"display" : "Fly-over"
}]
}
}],
"linkId" : "ClaimResponse.addItem.detail.subDetail-flyover",
"text" : "The third-tier service adjudications for payor added services.",
"type" : "display"
},
{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs",
"valueInteger" : 1
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType",
"valueString" : "string"
}],
"linkId" : "ClaimResponse.addItem.detail.subDetail.id",
"type" : "group",
"required" : false,
"repeats" : true,
"item" : [{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept" : {
"coding" : [{
"system" : "http://hl7.org/fhir/questionnaire-item-control",
"code" : "flyover",
"display" : "Fly-over"
}]
}
}],
"linkId" : "ClaimResponse.addItem.detail.subDetail.id-flyover",
"text" : "Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.",
"type" : "display"
},
{
"linkId" : "ClaimResponse.addItem.detail.subDetail.id.value",
"text" : "Unique id for inter-element referencing",
"type" : "string",
"required" : false,
"repeats" : false
}]
},
{
"linkId" : "ClaimResponse.addItem.detail.subDetail.extension",
"text" : "Additional content defined by implementations",
"type" : "group",
"required" : false,
"repeats" : true,
"item" : [{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept" : {
"coding" : [{
"system" : "http://hl7.org/fhir/questionnaire-item-control",
"code" : "flyover",
"display" : "Fly-over"
}]
}
}],
"linkId" : "ClaimResponse.addItem.detail.subDetail.extension-flyover",
"text" : "May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and managable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.",
"type" : "display"
}]
},
{
"linkId" : "ClaimResponse.addItem.detail.subDetail.modifierExtension",
"text" : "Extensions that cannot be ignored even if unrecognized",
"type" : "group",
"required" : false,
"repeats" : true,
"item" : [{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept" : {
"coding" : [{
"system" : "http://hl7.org/fhir/questionnaire-item-control",
"code" : "flyover",
"display" : "Fly-over"
}]
}
}],
"linkId" : "ClaimResponse.addItem.detail.subDetail.modifierExtension-flyover",
"text" : "May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and managable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can 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.\n\nModifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.",
"type" : "display"
}]
},
{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType",
"valueString" : "Identifier"
}],
"linkId" : "ClaimResponse.addItem.detail.subDetail.traceNumber",
"text" : "Number for tracking",
"type" : "group",
"required" : false,
"repeats" : true,
"item" : [{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept" : {
"coding" : [{
"system" : "http://hl7.org/fhir/questionnaire-item-control",
"code" : "flyover",
"display" : "Fly-over"
}]
}
}],
"linkId" : "ClaimResponse.addItem.detail.subDetail.traceNumber-flyover",
"text" : "Trace number for tracking purposes. May be defined at the jurisdiction level or between trading partners.",
"type" : "display"
},
{
"linkId" : "ClaimResponse.addItem.detail.subDetail.traceNumber.label",
"text" : "label:",
"type" : "string",
"required" : false,
"repeats" : false
},
{
"linkId" : "ClaimResponse.addItem.detail.subDetail.traceNumber.system",
"text" : "system:",
"type" : "string",
"required" : false,
"repeats" : false
},
{
"linkId" : "ClaimResponse.addItem.detail.subDetail.traceNumber.value",
"text" : "value:",
"type" : "string",
"required" : false,
"repeats" : false
}]
},
{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs",
"valueInteger" : 1
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType",
"valueString" : "CodeableConcept"
}],
"linkId" : "ClaimResponse.addItem.detail.subDetail.revenue",
"text" : "Revenue or cost center code",
"type" : "group",
"required" : false,
"repeats" : true,
"item" : [{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept" : {
"coding" : [{
"system" : "http://hl7.org/fhir/questionnaire-item-control",
"code" : "flyover",
"display" : "Fly-over"
}]
}
}],
"linkId" : "ClaimResponse.addItem.detail.subDetail.revenue-flyover",
"text" : "The type of revenue or cost center providing the product and/or service.",
"type" : "display"
},
{
"linkId" : "ClaimResponse.addItem.detail.subDetail.revenue.coding",
"text" : "code:",
"type" : "coding",
"required" : false,
"repeats" : false,
"answerConstraint" : "optionsOnly"
},
{
"linkId" : "ClaimResponse.addItem.detail.subDetail.revenue.text",
"text" : "text:",
"type" : "string",
"required" : false,
"repeats" : false
}]
},
{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs",
"valueInteger" : 1
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType",
"valueString" : "CodeableConcept"
}],
"linkId" : "ClaimResponse.addItem.detail.subDetail.productOrService",
"text" : "Billing, service, product, or drug code",
"type" : "group",
"required" : false,
"repeats" : true,
"item" : [{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept" : {
"coding" : [{
"system" : "http://hl7.org/fhir/questionnaire-item-control",
"code" : "flyover",
"display" : "Fly-over"
}]
}
}],
"linkId" : "ClaimResponse.addItem.detail.subDetail.productOrService-flyover",
"text" : "When the value is a group code then this item collects a set of related item details, otherwise this contains the product, service, drug or other billing code for the item. This element may be the start of a range of .productOrService codes used in conjunction with .productOrServiceEnd or it may be a solo element where .productOrServiceEnd is not used. If this is an actual service or product line, i.e. not a Group, then use code to indicate the Professional Service or Product supplied (e.g. CTP, HCPCS, USCLS, ICD10, NCPDP, DIN, RxNorm, ACHI, CCI). If a grouping item then use a group code to indicate the type of thing being grouped e.g. 'glasses' or 'compound'.",
"type" : "display"
},
{
"linkId" : "ClaimResponse.addItem.detail.subDetail.productOrService.coding",
"text" : "code:",
"type" : "coding",
"required" : false,
"repeats" : false,
"answerConstraint" : "optionsOnly"
},
{
"linkId" : "ClaimResponse.addItem.detail.subDetail.productOrService.text",
"text" : "text:",
"type" : "string",
"required" : false,
"repeats" : false
}]
},
{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs",
"valueInteger" : 1
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType",
"valueString" : "CodeableConcept"
}],
"linkId" : "ClaimResponse.addItem.detail.subDetail.productOrServiceEnd",
"text" : "End of a range of codes",
"type" : "group",
"required" : false,
"repeats" : true,
"item" : [{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept" : {
"coding" : [{
"system" : "http://hl7.org/fhir/questionnaire-item-control",
"code" : "flyover",
"display" : "Fly-over"
}]
}
}],
"linkId" : "ClaimResponse.addItem.detail.subDetail.productOrServiceEnd-flyover",
"text" : "This contains the end of a range of product, service, drug or other billing codes for the item. This element is not used when the .productOrService is a group code. This value may only be present when a .productOfService code has been provided to convey the start of the range. Typically this value may be used only with preauthorizations and not with claims.",
"type" : "display"
},
{
"linkId" : "ClaimResponse.addItem.detail.subDetail.productOrServiceEnd.coding",
"text" : "code:",
"type" : "coding",
"required" : false,
"repeats" : false,
"answerConstraint" : "optionsOnly"
},
{
"linkId" : "ClaimResponse.addItem.detail.subDetail.productOrServiceEnd.text",
"text" : "text:",
"type" : "string",
"required" : false,
"repeats" : false
}]
},
{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType",
"valueString" : "CodeableConcept"
}],
"linkId" : "ClaimResponse.addItem.detail.subDetail.modifier",
"text" : "Service/Product billing modifiers",
"type" : "group",
"required" : false,
"repeats" : true,
"item" : [{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept" : {
"coding" : [{
"system" : "http://hl7.org/fhir/questionnaire-item-control",
"code" : "flyover",
"display" : "Fly-over"
}]
}
}],
"linkId" : "ClaimResponse.addItem.detail.subDetail.modifier-flyover",
"text" : "Item typification or modifiers codes to convey additional context for the product or service. For example in Oral whether the treatment is cosmetic or associated with TMJ, or for Medical whether the treatment was outside the clinic or outside of office hours.",
"type" : "display"
},
{
"linkId" : "ClaimResponse.addItem.detail.subDetail.modifier.coding",
"text" : "code:",
"type" : "coding",
"required" : false,
"repeats" : false,
"answerConstraint" : "optionsOnly"
},
{
"linkId" : "ClaimResponse.addItem.detail.subDetail.modifier.text",
"text" : "text:",
"type" : "string",
"required" : false,
"repeats" : false
}]
},
{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs",
"valueInteger" : 1
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType",
"valueString" : "Quantity"
}],
"linkId" : "ClaimResponse.addItem.detail.subDetail.quantity",
"text" : "Count of products or services",
"type" : "group",
"required" : false,
"repeats" : true,
"item" : [{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept" : {
"coding" : [{
"system" : "http://hl7.org/fhir/questionnaire-item-control",
"code" : "flyover",
"display" : "Fly-over"
}]
}
}],
"linkId" : "ClaimResponse.addItem.detail.subDetail.quantity-flyover",
"text" : "The number of repetitions of a service or product.",
"type" : "display"
},
{
"linkId" : "ClaimResponse.addItem.detail.subDetail.quantity.comparator",
"text" : "comp:",
"type" : "coding",
"required" : false,
"repeats" : false,
"answerConstraint" : "optionsOnly"
},
{
"linkId" : "ClaimResponse.addItem.detail.subDetail.quantity.value",
"text" : "value:",
"type" : "decimal",
"required" : false,
"repeats" : false
},
{
"linkId" : "ClaimResponse.addItem.detail.subDetail.quantity.units",
"text" : "units:",
"type" : "string",
"required" : false,
"repeats" : false
},
{
"linkId" : "ClaimResponse.addItem.detail.subDetail.quantity.code",
"text" : "coded units:",
"type" : "string",
"required" : false,
"repeats" : false
},
{
"linkId" : "ClaimResponse.addItem.detail.subDetail.quantity.system",
"text" : "units system:",
"type" : "string",
"required" : false,
"repeats" : false
}]
},
{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs",
"valueInteger" : 1
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType",
"valueString" : "Quantity"
}],
"linkId" : "ClaimResponse.addItem.detail.subDetail.unitPrice",
"text" : "Fee, charge or cost per item",
"type" : "group",
"required" : false,
"repeats" : true,
"item" : [{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept" : {
"coding" : [{
"system" : "http://hl7.org/fhir/questionnaire-item-control",
"code" : "flyover",
"display" : "Fly-over"
}]
}
}],
"linkId" : "ClaimResponse.addItem.detail.subDetail.unitPrice-flyover",
"text" : "If the item is not a group then this is the fee for the product or service, otherwise this is the total of the fees for the details of the group.",
"type" : "display"
},
{
"linkId" : "ClaimResponse.addItem.detail.subDetail.unitPrice.comparator",
"text" : "comp:",
"type" : "coding",
"required" : false,
"repeats" : false,
"answerConstraint" : "optionsOnly"
},
{
"linkId" : "ClaimResponse.addItem.detail.subDetail.unitPrice.value",
"text" : "value:",
"type" : "decimal",
"required" : false,
"repeats" : false
},
{
"linkId" : "ClaimResponse.addItem.detail.subDetail.unitPrice.units",
"text" : "units:",
"type" : "string",
"required" : false,
"repeats" : false
},
{
"linkId" : "ClaimResponse.addItem.detail.subDetail.unitPrice.code",
"text" : "coded units:",
"type" : "string",
"required" : false,
"repeats" : false
},
{
"linkId" : "ClaimResponse.addItem.detail.subDetail.unitPrice.system",
"text" : "units system:",
"type" : "string",
"required" : false,
"repeats" : false
}]
},
{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs",
"valueInteger" : 1
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType",
"valueString" : "decimal"
}],
"linkId" : "ClaimResponse.addItem.detail.subDetail.factor",
"type" : "group",
"required" : false,
"repeats" : true,
"item" : [{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept" : {
"coding" : [{
"system" : "http://hl7.org/fhir/questionnaire-item-control",
"code" : "flyover",
"display" : "Fly-over"
}]
}
}],
"linkId" : "ClaimResponse.addItem.detail.subDetail.factor-flyover",
"text" : "A real number that represents a multiplier used in determining the overall value of services delivered and/or goods received. The concept of a Factor allows for a discount or surcharge multiplier to be applied to a monetary amount. To show a 10% senior's discount, the value entered is: 0.90 (1.00 - 0.10).",
"type" : "display"
},
{
"linkId" : "ClaimResponse.addItem.detail.subDetail.factor.value",
"text" : "Price scaling factor",
"type" : "decimal",
"required" : false,
"repeats" : false
}]
},
{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs",
"valueInteger" : 1
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType",
"valueString" : "Quantity"
}],
"linkId" : "ClaimResponse.addItem.detail.subDetail.tax",
"text" : "Total tax",
"type" : "group",
"required" : false,
"repeats" : true,
"item" : [{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept" : {
"coding" : [{
"system" : "http://hl7.org/fhir/questionnaire-item-control",
"code" : "flyover",
"display" : "Fly-over"
}]
}
}],
"linkId" : "ClaimResponse.addItem.detail.subDetail.tax-flyover",
"text" : "The total of taxes applicable for this product or service.",
"type" : "display"
},
{
"linkId" : "ClaimResponse.addItem.detail.subDetail.tax.comparator",
"text" : "comp:",
"type" : "coding",
"required" : false,
"repeats" : false,
"answerConstraint" : "optionsOnly"
},
{
"linkId" : "ClaimResponse.addItem.detail.subDetail.tax.value",
"text" : "value:",
"type" : "decimal",
"required" : false,
"repeats" : false
},
{
"linkId" : "ClaimResponse.addItem.detail.subDetail.tax.units",
"text" : "units:",
"type" : "string",
"required" : false,
"repeats" : false
},
{
"linkId" : "ClaimResponse.addItem.detail.subDetail.tax.code",
"text" : "coded units:",
"type" : "string",
"required" : false,
"repeats" : false
},
{
"linkId" : "ClaimResponse.addItem.detail.subDetail.tax.system",
"text" : "units system:",
"type" : "string",
"required" : false,
"repeats" : false
}]
},
{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs",
"valueInteger" : 1
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType",
"valueString" : "Quantity"
}],
"linkId" : "ClaimResponse.addItem.detail.subDetail.net",
"text" : "Total item cost",
"type" : "group",
"required" : false,
"repeats" : true,
"item" : [{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept" : {
"coding" : [{
"system" : "http://hl7.org/fhir/questionnaire-item-control",
"code" : "flyover",
"display" : "Fly-over"
}]
}
}],
"linkId" : "ClaimResponse.addItem.detail.subDetail.net-flyover",
"text" : "The total amount claimed for the addItem.detail.subDetail. Net = unit price * quantity * factor. For example, the formula: quantity * unitPrice * factor = net. Quantity and factor are assumed to be 1 if not supplied.",
"type" : "display"
},
{
"linkId" : "ClaimResponse.addItem.detail.subDetail.net.comparator",
"text" : "comp:",
"type" : "coding",
"required" : false,
"repeats" : false,
"answerConstraint" : "optionsOnly"
},
{
"linkId" : "ClaimResponse.addItem.detail.subDetail.net.value",
"text" : "value:",
"type" : "decimal",
"required" : false,
"repeats" : false
},
{
"linkId" : "ClaimResponse.addItem.detail.subDetail.net.units",
"text" : "units:",
"type" : "string",
"required" : false,
"repeats" : false
},
{
"linkId" : "ClaimResponse.addItem.detail.subDetail.net.code",
"text" : "coded units:",
"type" : "string",
"required" : false,
"repeats" : false
},
{
"linkId" : "ClaimResponse.addItem.detail.subDetail.net.system",
"text" : "units system:",
"type" : "string",
"required" : false,
"repeats" : false
}]
},
{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType",
"valueString" : "integer"
}],
"linkId" : "ClaimResponse.addItem.detail.subDetail.noteNumber",
"type" : "group",
"required" : false,
"repeats" : true,
"item" : [{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept" : {
"coding" : [{
"system" : "http://hl7.org/fhir/questionnaire-item-control",
"code" : "flyover",
"display" : "Fly-over"
}]
}
}],
"linkId" : "ClaimResponse.addItem.detail.subDetail.noteNumber-flyover",
"text" : "The numbers associated with notes below which apply to the adjudication of this item.",
"type" : "display"
},
{
"linkId" : "ClaimResponse.addItem.detail.subDetail.noteNumber.value",
"text" : "Applicable note numbers",
"type" : "integer",
"required" : false,
"repeats" : false
}]
},
{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs",
"valueInteger" : 1
}],
"linkId" : "ClaimResponse.addItem.detail.subDetail.reviewOutcome",
"text" : "Added items subdetail level adjudication results",
"type" : "group",
"required" : false,
"repeats" : false,
"item" : [{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept" : {
"coding" : [{
"system" : "http://hl7.org/fhir/questionnaire-item-control",
"code" : "flyover",
"display" : "Fly-over"
}]
}
}],
"linkId" : "ClaimResponse.addItem.detail.subDetail.reviewOutcome-flyover",
"text" : "The high-level results of the adjudication if adjudication has been performed.",
"type" : "display"
},
{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs",
"valueInteger" : 1
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType",
"valueString" : "string"
}],
"linkId" : "ClaimResponse.item.reviewOutcome.id",
"type" : "group",
"required" : false,
"repeats" : true,
"item" : [{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept" : {
"coding" : [{
"system" : "http://hl7.org/fhir/questionnaire-item-control",
"code" : "flyover",
"display" : "Fly-over"
}]
}
}],
"linkId" : "ClaimResponse.item.reviewOutcome.id-flyover",
"text" : "Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.",
"type" : "display"
},
{
"linkId" : "ClaimResponse.item.reviewOutcome.id.value",
"text" : "Unique id for inter-element referencing",
"type" : "string",
"required" : false,
"repeats" : false
}]
},
{
"linkId" : "ClaimResponse.item.reviewOutcome.extension",
"text" : "Additional content defined by implementations",
"type" : "group",
"required" : false,
"repeats" : true,
"item" : [{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept" : {
"coding" : [{
"system" : "http://hl7.org/fhir/questionnaire-item-control",
"code" : "flyover",
"display" : "Fly-over"
}]
}
}],
"linkId" : "ClaimResponse.item.reviewOutcome.extension-flyover",
"text" : "May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and managable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.",
"type" : "display"
}]
},
{
"linkId" : "ClaimResponse.item.reviewOutcome.modifierExtension",
"text" : "Extensions that cannot be ignored even if unrecognized",
"type" : "group",
"required" : false,
"repeats" : true,
"item" : [{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept" : {
"coding" : [{
"system" : "http://hl7.org/fhir/questionnaire-item-control",
"code" : "flyover",
"display" : "Fly-over"
}]
}
}],
"linkId" : "ClaimResponse.item.reviewOutcome.modifierExtension-flyover",
"text" : "May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and managable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can 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.\n\nModifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.",
"type" : "display"
}]
},
{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs",
"valueInteger" : 1
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType",
"valueString" : "CodeableConcept"
}],
"linkId" : "ClaimResponse.item.reviewOutcome.decision",
"text" : "Result of the adjudication",
"type" : "group",
"required" : false,
"repeats" : true,
"item" : [{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept" : {
"coding" : [{
"system" : "http://hl7.org/fhir/questionnaire-item-control",
"code" : "flyover",
"display" : "Fly-over"
}]
}
}],
"linkId" : "ClaimResponse.item.reviewOutcome.decision-flyover",
"text" : "The result of the claim, predetermination, or preauthorization adjudication. The element is used to indicate the current state of the adjudication overall for the claim resource, for example: the request has been held (pended) for adjudication processing, for manual review or other reasons; that it has been processed and will be paid, or the outstanding paid, as submitted (approved); that no amount will be paid (denied); or that some amount between zero and the submitted amount will be paid (partial).",
"type" : "display"
},
{
"linkId" : "ClaimResponse.item.reviewOutcome.decision.coding",
"text" : "code:",
"type" : "coding",
"required" : false,
"repeats" : false,
"answerConstraint" : "optionsOnly"
},
{
"linkId" : "ClaimResponse.item.reviewOutcome.decision.text",
"text" : "text:",
"type" : "string",
"required" : false,
"repeats" : false
}]
},
{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType",
"valueString" : "CodeableConcept"
}],
"linkId" : "ClaimResponse.item.reviewOutcome.reason",
"text" : "Reason for result of the adjudication",
"type" : "group",
"required" : false,
"repeats" : true,
"item" : [{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept" : {
"coding" : [{
"system" : "http://hl7.org/fhir/questionnaire-item-control",
"code" : "flyover",
"display" : "Fly-over"
}]
}
}],
"linkId" : "ClaimResponse.item.reviewOutcome.reason-flyover",
"text" : "The reasons for the result of the claim, predetermination, or preauthorization adjudication.",
"type" : "display"
},
{
"linkId" : "ClaimResponse.item.reviewOutcome.reason.coding",
"text" : "code:",
"type" : "coding",
"required" : false,
"repeats" : false,
"answerConstraint" : "optionsOnly"
},
{
"linkId" : "ClaimResponse.item.reviewOutcome.reason.text",
"text" : "text:",
"type" : "string",
"required" : false,
"repeats" : false
}]
},
{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs",
"valueInteger" : 1
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType",
"valueString" : "string"
}],
"linkId" : "ClaimResponse.item.reviewOutcome.preAuthRef",
"type" : "group",
"required" : false,
"repeats" : true,
"item" : [{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept" : {
"coding" : [{
"system" : "http://hl7.org/fhir/questionnaire-item-control",
"code" : "flyover",
"display" : "Fly-over"
}]
}
}],
"linkId" : "ClaimResponse.item.reviewOutcome.preAuthRef-flyover",
"text" : "Reference from the Insurer which is used in later communications which refers to this adjudication. This value is only present on preauthorization adjudications.",
"type" : "display"
},
{
"linkId" : "ClaimResponse.item.reviewOutcome.preAuthRef.value",
"text" : "Preauthorization reference",
"type" : "string",
"required" : false,
"repeats" : false
}]
},
{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs",
"valueInteger" : 1
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType",
"valueString" : "Period"
}],
"linkId" : "ClaimResponse.item.reviewOutcome.preAuthPeriod",
"text" : "Preauthorization reference effective period",
"type" : "group",
"required" : false,
"repeats" : true,
"item" : [{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept" : {
"coding" : [{
"system" : "http://hl7.org/fhir/questionnaire-item-control",
"code" : "flyover",
"display" : "Fly-over"
}]
}
}],
"linkId" : "ClaimResponse.item.reviewOutcome.preAuthPeriod-flyover",
"text" : "The time frame during which this authorization is effective.",
"type" : "display"
},
{
"linkId" : "ClaimResponse.item.reviewOutcome.preAuthPeriod.low",
"text" : "start:",
"type" : "dateTime",
"required" : false,
"repeats" : false
},
{
"linkId" : "ClaimResponse.item.reviewOutcome.preAuthPeriod.end",
"text" : "end:",
"type" : "dateTime",
"required" : false,
"repeats" : false
}]
}]
},
{
"linkId" : "ClaimResponse.addItem.detail.subDetail.adjudication",
"text" : "Added items subdetail adjudication",
"type" : "group",
"required" : false,
"repeats" : true,
"item" : [{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept" : {
"coding" : [{
"system" : "http://hl7.org/fhir/questionnaire-item-control",
"code" : "flyover",
"display" : "Fly-over"
}]
}
}],
"linkId" : "ClaimResponse.addItem.detail.subDetail.adjudication-flyover",
"text" : "The adjudication results.",
"type" : "display"
},
{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs",
"valueInteger" : 1
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType",
"valueString" : "string"
}],
"linkId" : "ClaimResponse.item.adjudication.id",
"type" : "group",
"required" : false,
"repeats" : true,
"item" : [{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept" : {
"coding" : [{
"system" : "http://hl7.org/fhir/questionnaire-item-control",
"code" : "flyover",
"display" : "Fly-over"
}]
}
}],
"linkId" : "ClaimResponse.item.adjudication.id-flyover",
"text" : "Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.",
"type" : "display"
},
{
"linkId" : "ClaimResponse.item.adjudication.id.value",
"text" : "Unique id for inter-element referencing",
"type" : "string",
"required" : false,
"repeats" : false
}]
},
{
"linkId" : "ClaimResponse.item.adjudication.extension",
"text" : "Additional content defined by implementations",
"type" : "group",
"required" : false,
"repeats" : true,
"item" : [{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept" : {
"coding" : [{
"system" : "http://hl7.org/fhir/questionnaire-item-control",
"code" : "flyover",
"display" : "Fly-over"
}]
}
}],
"linkId" : "ClaimResponse.item.adjudication.extension-flyover",
"text" : "May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and managable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.",
"type" : "display"
}]
},
{
"linkId" : "ClaimResponse.item.adjudication.modifierExtension",
"text" : "Extensions that cannot be ignored even if unrecognized",
"type" : "group",
"required" : false,
"repeats" : true,
"item" : [{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept" : {
"coding" : [{
"system" : "http://hl7.org/fhir/questionnaire-item-control",
"code" : "flyover",
"display" : "Fly-over"
}]
}
}],
"linkId" : "ClaimResponse.item.adjudication.modifierExtension-flyover",
"text" : "May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and managable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can 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.\n\nModifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.",
"type" : "display"
}]
},
{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-minOccurs",
"valueInteger" : 1
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs",
"valueInteger" : 1
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType",
"valueString" : "CodeableConcept"
}],
"linkId" : "ClaimResponse.item.adjudication.category",
"text" : "Type of adjudication information",
"type" : "group",
"required" : true,
"repeats" : true,
"item" : [{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept" : {
"coding" : [{
"system" : "http://hl7.org/fhir/questionnaire-item-control",
"code" : "flyover",
"display" : "Fly-over"
}]
}
}],
"linkId" : "ClaimResponse.item.adjudication.category-flyover",
"text" : "A code to indicate the information type of this adjudication record. Information types may include the value submitted, maximum values or percentages allowed or payable under the plan, amounts that: the patient is responsible for in aggregate or pertaining to this item; amounts paid by other coverages; and, the benefit payable for this item. For example codes indicating: Co-Pay, deductible, eligible, benefit, tax, etc.",
"type" : "display"
},
{
"linkId" : "ClaimResponse.item.adjudication.category.coding",
"text" : "code:",
"type" : "coding",
"required" : false,
"repeats" : false,
"answerConstraint" : "optionsOnly"
},
{
"linkId" : "ClaimResponse.item.adjudication.category.text",
"text" : "text:",
"type" : "string",
"required" : false,
"repeats" : false
}]
},
{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs",
"valueInteger" : 1
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType",
"valueString" : "CodeableConcept"
}],
"linkId" : "ClaimResponse.item.adjudication.reason",
"text" : "Explanation of adjudication outcome",
"type" : "group",
"required" : false,
"repeats" : true,
"item" : [{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept" : {
"coding" : [{
"system" : "http://hl7.org/fhir/questionnaire-item-control",
"code" : "flyover",
"display" : "Fly-over"
}]
}
}],
"linkId" : "ClaimResponse.item.adjudication.reason-flyover",
"text" : "A code supporting the understanding of the adjudication result and explaining variance from expected amount. For example may indicate that the funds for this benefit type have been exhausted.",
"type" : "display"
},
{
"linkId" : "ClaimResponse.item.adjudication.reason.coding",
"text" : "code:",
"type" : "coding",
"required" : false,
"repeats" : false,
"answerConstraint" : "optionsOnly"
},
{
"linkId" : "ClaimResponse.item.adjudication.reason.text",
"text" : "text:",
"type" : "string",
"required" : false,
"repeats" : false
}]
},
{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs",
"valueInteger" : 1
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType",
"valueString" : "Quantity"
}],
"linkId" : "ClaimResponse.item.adjudication.amount",
"text" : "Monetary amount",
"type" : "group",
"required" : false,
"repeats" : true,
"item" : [{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept" : {
"coding" : [{
"system" : "http://hl7.org/fhir/questionnaire-item-control",
"code" : "flyover",
"display" : "Fly-over"
}]
}
}],
"linkId" : "ClaimResponse.item.adjudication.amount-flyover",
"text" : "Monetary amount associated with the category. For example: amount submitted, eligible amount, co-payment, and benefit payable.",
"type" : "display"
},
{
"linkId" : "ClaimResponse.item.adjudication.amount.comparator",
"text" : "comp:",
"type" : "coding",
"required" : false,
"repeats" : false,
"answerConstraint" : "optionsOnly"
},
{
"linkId" : "ClaimResponse.item.adjudication.amount.value",
"text" : "value:",
"type" : "decimal",
"required" : false,
"repeats" : false
},
{
"linkId" : "ClaimResponse.item.adjudication.amount.units",
"text" : "units:",
"type" : "string",
"required" : false,
"repeats" : false
},
{
"linkId" : "ClaimResponse.item.adjudication.amount.code",
"text" : "coded units:",
"type" : "string",
"required" : false,
"repeats" : false
},
{
"linkId" : "ClaimResponse.item.adjudication.amount.system",
"text" : "units system:",
"type" : "string",
"required" : false,
"repeats" : false
}]
},
{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs",
"valueInteger" : 1
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType",
"valueString" : "Quantity"
}],
"linkId" : "ClaimResponse.item.adjudication.quantity",
"text" : "Non-monetary value",
"type" : "group",
"required" : false,
"repeats" : true,
"item" : [{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept" : {
"coding" : [{
"system" : "http://hl7.org/fhir/questionnaire-item-control",
"code" : "flyover",
"display" : "Fly-over"
}]
}
}],
"linkId" : "ClaimResponse.item.adjudication.quantity-flyover",
"text" : "A non-monetary value associated with the category. Mutually exclusive to the amount element above. For example: eligible percentage or co-payment percentage.",
"type" : "display"
},
{
"linkId" : "ClaimResponse.item.adjudication.quantity.comparator",
"text" : "comp:",
"type" : "coding",
"required" : false,
"repeats" : false,
"answerConstraint" : "optionsOnly"
},
{
"linkId" : "ClaimResponse.item.adjudication.quantity.value",
"text" : "value:",
"type" : "decimal",
"required" : false,
"repeats" : false
},
{
"linkId" : "ClaimResponse.item.adjudication.quantity.units",
"text" : "units:",
"type" : "string",
"required" : false,
"repeats" : false
},
{
"linkId" : "ClaimResponse.item.adjudication.quantity.code",
"text" : "coded units:",
"type" : "string",
"required" : false,
"repeats" : false
},
{
"linkId" : "ClaimResponse.item.adjudication.quantity.system",
"text" : "units system:",
"type" : "string",
"required" : false,
"repeats" : false
}]
}]
}]
}]
}]
},
{
"linkId" : "ClaimResponse.adjudication",
"text" : "Header-level adjudication",
"type" : "group",
"required" : false,
"repeats" : true,
"item" : [{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept" : {
"coding" : [{
"system" : "http://hl7.org/fhir/questionnaire-item-control",
"code" : "flyover",
"display" : "Fly-over"
}]
}
}],
"linkId" : "ClaimResponse.adjudication-flyover",
"text" : "The adjudication results which are presented at the header level rather than at the line-item or add-item levels.",
"type" : "display"
},
{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs",
"valueInteger" : 1
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType",
"valueString" : "string"
}],
"linkId" : "ClaimResponse.item.adjudication.id",
"type" : "group",
"required" : false,
"repeats" : true,
"item" : [{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept" : {
"coding" : [{
"system" : "http://hl7.org/fhir/questionnaire-item-control",
"code" : "flyover",
"display" : "Fly-over"
}]
}
}],
"linkId" : "ClaimResponse.item.adjudication.id-flyover",
"text" : "Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.",
"type" : "display"
},
{
"linkId" : "ClaimResponse.item.adjudication.id.value",
"text" : "Unique id for inter-element referencing",
"type" : "string",
"required" : false,
"repeats" : false
}]
},
{
"linkId" : "ClaimResponse.item.adjudication.extension",
"text" : "Additional content defined by implementations",
"type" : "group",
"required" : false,
"repeats" : true,
"item" : [{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept" : {
"coding" : [{
"system" : "http://hl7.org/fhir/questionnaire-item-control",
"code" : "flyover",
"display" : "Fly-over"
}]
}
}],
"linkId" : "ClaimResponse.item.adjudication.extension-flyover",
"text" : "May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and managable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.",
"type" : "display"
}]
},
{
"linkId" : "ClaimResponse.item.adjudication.modifierExtension",
"text" : "Extensions that cannot be ignored even if unrecognized",
"type" : "group",
"required" : false,
"repeats" : true,
"item" : [{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept" : {
"coding" : [{
"system" : "http://hl7.org/fhir/questionnaire-item-control",
"code" : "flyover",
"display" : "Fly-over"
}]
}
}],
"linkId" : "ClaimResponse.item.adjudication.modifierExtension-flyover",
"text" : "May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and managable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can 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.\n\nModifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.",
"type" : "display"
}]
},
{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-minOccurs",
"valueInteger" : 1
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs",
"valueInteger" : 1
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType",
"valueString" : "CodeableConcept"
}],
"linkId" : "ClaimResponse.item.adjudication.category",
"text" : "Type of adjudication information",
"type" : "group",
"required" : true,
"repeats" : true,
"item" : [{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept" : {
"coding" : [{
"system" : "http://hl7.org/fhir/questionnaire-item-control",
"code" : "flyover",
"display" : "Fly-over"
}]
}
}],
"linkId" : "ClaimResponse.item.adjudication.category-flyover",
"text" : "A code to indicate the information type of this adjudication record. Information types may include the value submitted, maximum values or percentages allowed or payable under the plan, amounts that: the patient is responsible for in aggregate or pertaining to this item; amounts paid by other coverages; and, the benefit payable for this item. For example codes indicating: Co-Pay, deductible, eligible, benefit, tax, etc.",
"type" : "display"
},
{
"linkId" : "ClaimResponse.item.adjudication.category.coding",
"text" : "code:",
"type" : "coding",
"required" : false,
"repeats" : false,
"answerConstraint" : "optionsOnly"
},
{
"linkId" : "ClaimResponse.item.adjudication.category.text",
"text" : "text:",
"type" : "string",
"required" : false,
"repeats" : false
}]
},
{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs",
"valueInteger" : 1
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType",
"valueString" : "CodeableConcept"
}],
"linkId" : "ClaimResponse.item.adjudication.reason",
"text" : "Explanation of adjudication outcome",
"type" : "group",
"required" : false,
"repeats" : true,
"item" : [{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept" : {
"coding" : [{
"system" : "http://hl7.org/fhir/questionnaire-item-control",
"code" : "flyover",
"display" : "Fly-over"
}]
}
}],
"linkId" : "ClaimResponse.item.adjudication.reason-flyover",
"text" : "A code supporting the understanding of the adjudication result and explaining variance from expected amount. For example may indicate that the funds for this benefit type have been exhausted.",
"type" : "display"
},
{
"linkId" : "ClaimResponse.item.adjudication.reason.coding",
"text" : "code:",
"type" : "coding",
"required" : false,
"repeats" : false,
"answerConstraint" : "optionsOnly"
},
{
"linkId" : "ClaimResponse.item.adjudication.reason.text",
"text" : "text:",
"type" : "string",
"required" : false,
"repeats" : false
}]
},
{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs",
"valueInteger" : 1
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType",
"valueString" : "Quantity"
}],
"linkId" : "ClaimResponse.item.adjudication.amount",
"text" : "Monetary amount",
"type" : "group",
"required" : false,
"repeats" : true,
"item" : [{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept" : {
"coding" : [{
"system" : "http://hl7.org/fhir/questionnaire-item-control",
"code" : "flyover",
"display" : "Fly-over"
}]
}
}],
"linkId" : "ClaimResponse.item.adjudication.amount-flyover",
"text" : "Monetary amount associated with the category. For example: amount submitted, eligible amount, co-payment, and benefit payable.",
"type" : "display"
},
{
"linkId" : "ClaimResponse.item.adjudication.amount.comparator",
"text" : "comp:",
"type" : "coding",
"required" : false,
"repeats" : false,
"answerConstraint" : "optionsOnly"
},
{
"linkId" : "ClaimResponse.item.adjudication.amount.value",
"text" : "value:",
"type" : "decimal",
"required" : false,
"repeats" : false
},
{
"linkId" : "ClaimResponse.item.adjudication.amount.units",
"text" : "units:",
"type" : "string",
"required" : false,
"repeats" : false
},
{
"linkId" : "ClaimResponse.item.adjudication.amount.code",
"text" : "coded units:",
"type" : "string",
"required" : false,
"repeats" : false
},
{
"linkId" : "ClaimResponse.item.adjudication.amount.system",
"text" : "units system:",
"type" : "string",
"required" : false,
"repeats" : false
}]
},
{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs",
"valueInteger" : 1
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType",
"valueString" : "Quantity"
}],
"linkId" : "ClaimResponse.item.adjudication.quantity",
"text" : "Non-monetary value",
"type" : "group",
"required" : false,
"repeats" : true,
"item" : [{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept" : {
"coding" : [{
"system" : "http://hl7.org/fhir/questionnaire-item-control",
"code" : "flyover",
"display" : "Fly-over"
}]
}
}],
"linkId" : "ClaimResponse.item.adjudication.quantity-flyover",
"text" : "A non-monetary value associated with the category. Mutually exclusive to the amount element above. For example: eligible percentage or co-payment percentage.",
"type" : "display"
},
{
"linkId" : "ClaimResponse.item.adjudication.quantity.comparator",
"text" : "comp:",
"type" : "coding",
"required" : false,
"repeats" : false,
"answerConstraint" : "optionsOnly"
},
{
"linkId" : "ClaimResponse.item.adjudication.quantity.value",
"text" : "value:",
"type" : "decimal",
"required" : false,
"repeats" : false
},
{
"linkId" : "ClaimResponse.item.adjudication.quantity.units",
"text" : "units:",
"type" : "string",
"required" : false,
"repeats" : false
},
{
"linkId" : "ClaimResponse.item.adjudication.quantity.code",
"text" : "coded units:",
"type" : "string",
"required" : false,
"repeats" : false
},
{
"linkId" : "ClaimResponse.item.adjudication.quantity.system",
"text" : "units system:",
"type" : "string",
"required" : false,
"repeats" : false
}]
}]
},
{
"linkId" : "ClaimResponse.total",
"text" : "Adjudication totals",
"type" : "group",
"required" : false,
"repeats" : true,
"item" : [{
"linkId" : "ClaimResponse.total-display",
"text" : "Totals for amounts submitted, co-pays, benefits payable etc.",
"type" : "display"
},
{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept" : {
"coding" : [{
"system" : "http://hl7.org/fhir/questionnaire-item-control",
"code" : "flyover",
"display" : "Fly-over"
}]
}
}],
"linkId" : "ClaimResponse.total-flyover",
"text" : "Categorized monetary totals for the adjudication.",
"type" : "display"
},
{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs",
"valueInteger" : 1
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType",
"valueString" : "string"
}],
"linkId" : "ClaimResponse.total.id",
"type" : "group",
"required" : false,
"repeats" : true,
"item" : [{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept" : {
"coding" : [{
"system" : "http://hl7.org/fhir/questionnaire-item-control",
"code" : "flyover",
"display" : "Fly-over"
}]
}
}],
"linkId" : "ClaimResponse.total.id-flyover",
"text" : "Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.",
"type" : "display"
},
{
"linkId" : "ClaimResponse.total.id.value",
"text" : "Unique id for inter-element referencing",
"type" : "string",
"required" : false,
"repeats" : false
}]
},
{
"linkId" : "ClaimResponse.total.extension",
"text" : "Additional content defined by implementations",
"type" : "group",
"required" : false,
"repeats" : true,
"item" : [{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept" : {
"coding" : [{
"system" : "http://hl7.org/fhir/questionnaire-item-control",
"code" : "flyover",
"display" : "Fly-over"
}]
}
}],
"linkId" : "ClaimResponse.total.extension-flyover",
"text" : "May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and managable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.",
"type" : "display"
}]
},
{
"linkId" : "ClaimResponse.total.modifierExtension",
"text" : "Extensions that cannot be ignored even if unrecognized",
"type" : "group",
"required" : false,
"repeats" : true,
"item" : [{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept" : {
"coding" : [{
"system" : "http://hl7.org/fhir/questionnaire-item-control",
"code" : "flyover",
"display" : "Fly-over"
}]
}
}],
"linkId" : "ClaimResponse.total.modifierExtension-flyover",
"text" : "May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and managable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can 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.\n\nModifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.",
"type" : "display"
}]
},
{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-minOccurs",
"valueInteger" : 1
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs",
"valueInteger" : 1
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType",
"valueString" : "CodeableConcept"
}],
"linkId" : "ClaimResponse.total.category",
"text" : "Type of adjudication information",
"type" : "group",
"required" : true,
"repeats" : true,
"item" : [{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept" : {
"coding" : [{
"system" : "http://hl7.org/fhir/questionnaire-item-control",
"code" : "flyover",
"display" : "Fly-over"
}]
}
}],
"linkId" : "ClaimResponse.total.category-flyover",
"text" : "A code to indicate the information type of this adjudication record. Information types may include: the value submitted, maximum values or percentages allowed or payable under the plan, amounts that the patient is responsible for in aggregate or pertaining to this item, amounts paid by other coverages, and the benefit payable for this item. For example codes indicating: Co-Pay, deductible, eligible, benefit, tax, etc.",
"type" : "display"
},
{
"linkId" : "ClaimResponse.total.category.coding",
"text" : "code:",
"type" : "coding",
"required" : false,
"repeats" : false,
"answerConstraint" : "optionsOnly"
},
{
"linkId" : "ClaimResponse.total.category.text",
"text" : "text:",
"type" : "string",
"required" : false,
"repeats" : false
}]
},
{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-minOccurs",
"valueInteger" : 1
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs",
"valueInteger" : 1
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType",
"valueString" : "Quantity"
}],
"linkId" : "ClaimResponse.total.amount",
"text" : "Financial total for the category",
"type" : "group",
"required" : true,
"repeats" : true,
"item" : [{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept" : {
"coding" : [{
"system" : "http://hl7.org/fhir/questionnaire-item-control",
"code" : "flyover",
"display" : "Fly-over"
}]
}
}],
"linkId" : "ClaimResponse.total.amount-flyover",
"text" : "Monetary total amount associated with the category.",
"type" : "display"
},
{
"linkId" : "ClaimResponse.total.amount.comparator",
"text" : "comp:",
"type" : "coding",
"required" : false,
"repeats" : false,
"answerConstraint" : "optionsOnly"
},
{
"linkId" : "ClaimResponse.total.amount.value",
"text" : "value:",
"type" : "decimal",
"required" : false,
"repeats" : false
},
{
"linkId" : "ClaimResponse.total.amount.units",
"text" : "units:",
"type" : "string",
"required" : false,
"repeats" : false
},
{
"linkId" : "ClaimResponse.total.amount.code",
"text" : "coded units:",
"type" : "string",
"required" : false,
"repeats" : false
},
{
"linkId" : "ClaimResponse.total.amount.system",
"text" : "units system:",
"type" : "string",
"required" : false,
"repeats" : false
}]
}]
},
{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs",
"valueInteger" : 1
}],
"linkId" : "ClaimResponse.payment",
"text" : "Payment Details",
"type" : "group",
"required" : false,
"repeats" : false,
"item" : [{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept" : {
"coding" : [{
"system" : "http://hl7.org/fhir/questionnaire-item-control",
"code" : "flyover",
"display" : "Fly-over"
}]
}
}],
"linkId" : "ClaimResponse.payment-flyover",
"text" : "Payment details for the adjudication of the claim.",
"type" : "display"
},
{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs",
"valueInteger" : 1
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType",
"valueString" : "string"
}],
"linkId" : "ClaimResponse.payment.id",
"type" : "group",
"required" : false,
"repeats" : true,
"item" : [{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept" : {
"coding" : [{
"system" : "http://hl7.org/fhir/questionnaire-item-control",
"code" : "flyover",
"display" : "Fly-over"
}]
}
}],
"linkId" : "ClaimResponse.payment.id-flyover",
"text" : "Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.",
"type" : "display"
},
{
"linkId" : "ClaimResponse.payment.id.value",
"text" : "Unique id for inter-element referencing",
"type" : "string",
"required" : false,
"repeats" : false
}]
},
{
"linkId" : "ClaimResponse.payment.extension",
"text" : "Additional content defined by implementations",
"type" : "group",
"required" : false,
"repeats" : true,
"item" : [{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept" : {
"coding" : [{
"system" : "http://hl7.org/fhir/questionnaire-item-control",
"code" : "flyover",
"display" : "Fly-over"
}]
}
}],
"linkId" : "ClaimResponse.payment.extension-flyover",
"text" : "May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and managable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.",
"type" : "display"
}]
},
{
"linkId" : "ClaimResponse.payment.modifierExtension",
"text" : "Extensions that cannot be ignored even if unrecognized",
"type" : "group",
"required" : false,
"repeats" : true,
"item" : [{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept" : {
"coding" : [{
"system" : "http://hl7.org/fhir/questionnaire-item-control",
"code" : "flyover",
"display" : "Fly-over"
}]
}
}],
"linkId" : "ClaimResponse.payment.modifierExtension-flyover",
"text" : "May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and managable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can 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.\n\nModifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.",
"type" : "display"
}]
},
{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-minOccurs",
"valueInteger" : 1
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs",
"valueInteger" : 1
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType",
"valueString" : "CodeableConcept"
}],
"linkId" : "ClaimResponse.payment.type",
"text" : "Partial or complete payment",
"type" : "group",
"required" : true,
"repeats" : true,
"item" : [{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept" : {
"coding" : [{
"system" : "http://hl7.org/fhir/questionnaire-item-control",
"code" : "flyover",
"display" : "Fly-over"
}]
}
}],
"linkId" : "ClaimResponse.payment.type-flyover",
"text" : "Whether this represents partial or complete payment of the benefits payable.",
"type" : "display"
},
{
"linkId" : "ClaimResponse.payment.type.coding",
"text" : "code:",
"type" : "coding",
"required" : false,
"repeats" : false,
"answerConstraint" : "optionsOnly"
},
{
"linkId" : "ClaimResponse.payment.type.text",
"text" : "text:",
"type" : "string",
"required" : false,
"repeats" : false
}]
},
{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs",
"valueInteger" : 1
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType",
"valueString" : "Quantity"
}],
"linkId" : "ClaimResponse.payment.adjustment",
"text" : "Payment adjustment for non-claim issues",
"type" : "group",
"required" : false,
"repeats" : true,
"item" : [{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept" : {
"coding" : [{
"system" : "http://hl7.org/fhir/questionnaire-item-control",
"code" : "flyover",
"display" : "Fly-over"
}]
}
}],
"linkId" : "ClaimResponse.payment.adjustment-flyover",
"text" : "Total amount of all adjustments to this payment included in this transaction which are not related to this claim's adjudication. Insurers will deduct amounts owing from the provider (adjustment), such as a prior overpayment, from the amount owing to the provider (benefits payable) when payment is made to the provider.",
"type" : "display"
},
{
"linkId" : "ClaimResponse.payment.adjustment.comparator",
"text" : "comp:",
"type" : "coding",
"required" : false,
"repeats" : false,
"answerConstraint" : "optionsOnly"
},
{
"linkId" : "ClaimResponse.payment.adjustment.value",
"text" : "value:",
"type" : "decimal",
"required" : false,
"repeats" : false
},
{
"linkId" : "ClaimResponse.payment.adjustment.units",
"text" : "units:",
"type" : "string",
"required" : false,
"repeats" : false
},
{
"linkId" : "ClaimResponse.payment.adjustment.code",
"text" : "coded units:",
"type" : "string",
"required" : false,
"repeats" : false
},
{
"linkId" : "ClaimResponse.payment.adjustment.system",
"text" : "units system:",
"type" : "string",
"required" : false,
"repeats" : false
}]
},
{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs",
"valueInteger" : 1
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType",
"valueString" : "CodeableConcept"
}],
"linkId" : "ClaimResponse.payment.adjustmentReason",
"text" : "Explanation for the adjustment",
"type" : "group",
"required" : false,
"repeats" : true,
"item" : [{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept" : {
"coding" : [{
"system" : "http://hl7.org/fhir/questionnaire-item-control",
"code" : "flyover",
"display" : "Fly-over"
}]
}
}],
"linkId" : "ClaimResponse.payment.adjustmentReason-flyover",
"text" : "Reason for the payment adjustment.",
"type" : "display"
},
{
"linkId" : "ClaimResponse.payment.adjustmentReason.coding",
"text" : "code:",
"type" : "coding",
"required" : false,
"repeats" : false,
"answerConstraint" : "optionsOnly"
},
{
"linkId" : "ClaimResponse.payment.adjustmentReason.text",
"text" : "text:",
"type" : "string",
"required" : false,
"repeats" : false
}]
},
{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs",
"valueInteger" : 1
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType",
"valueString" : "datetime"
}],
"linkId" : "ClaimResponse.payment.date",
"type" : "group",
"required" : false,
"repeats" : true,
"item" : [{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept" : {
"coding" : [{
"system" : "http://hl7.org/fhir/questionnaire-item-control",
"code" : "flyover",
"display" : "Fly-over"
}]
}
}],
"linkId" : "ClaimResponse.payment.date-flyover",
"text" : "Estimated date the payment will be issued or the actual issue date of payment.",
"type" : "display"
},
{
"linkId" : "ClaimResponse.payment.date.value",
"text" : "Expected date of payment",
"type" : "dateTime",
"required" : false,
"repeats" : false
}]
},
{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-minOccurs",
"valueInteger" : 1
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs",
"valueInteger" : 1
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType",
"valueString" : "Quantity"
}],
"linkId" : "ClaimResponse.payment.amount",
"text" : "Payable amount after adjustment",
"type" : "group",
"required" : true,
"repeats" : true,
"item" : [{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept" : {
"coding" : [{
"system" : "http://hl7.org/fhir/questionnaire-item-control",
"code" : "flyover",
"display" : "Fly-over"
}]
}
}],
"linkId" : "ClaimResponse.payment.amount-flyover",
"text" : "Benefits payable less any payment adjustment.",
"type" : "display"
},
{
"linkId" : "ClaimResponse.payment.amount.comparator",
"text" : "comp:",
"type" : "coding",
"required" : false,
"repeats" : false,
"answerConstraint" : "optionsOnly"
},
{
"linkId" : "ClaimResponse.payment.amount.value",
"text" : "value:",
"type" : "decimal",
"required" : false,
"repeats" : false
},
{
"linkId" : "ClaimResponse.payment.amount.units",
"text" : "units:",
"type" : "string",
"required" : false,
"repeats" : false
},
{
"linkId" : "ClaimResponse.payment.amount.code",
"text" : "coded units:",
"type" : "string",
"required" : false,
"repeats" : false
},
{
"linkId" : "ClaimResponse.payment.amount.system",
"text" : "units system:",
"type" : "string",
"required" : false,
"repeats" : false
}]
},
{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs",
"valueInteger" : 1
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType",
"valueString" : "Identifier"
}],
"linkId" : "ClaimResponse.payment.identifier",
"text" : "Business identifier for the payment",
"type" : "group",
"required" : false,
"repeats" : true,
"item" : [{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept" : {
"coding" : [{
"system" : "http://hl7.org/fhir/questionnaire-item-control",
"code" : "flyover",
"display" : "Fly-over"
}]
}
}],
"linkId" : "ClaimResponse.payment.identifier-flyover",
"text" : "Issuer's unique identifier for the payment instrument. For example: EFT number or check number.",
"type" : "display"
},
{
"linkId" : "ClaimResponse.payment.identifier.label",
"text" : "label:",
"type" : "string",
"required" : false,
"repeats" : false
},
{
"linkId" : "ClaimResponse.payment.identifier.system",
"text" : "system:",
"type" : "string",
"required" : false,
"repeats" : false
},
{
"linkId" : "ClaimResponse.payment.identifier.value",
"text" : "value:",
"type" : "string",
"required" : false,
"repeats" : false
}]
}]
},
{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs",
"valueInteger" : 1
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType",
"valueString" : "CodeableConcept"
}],
"linkId" : "ClaimResponse.fundsReserve",
"text" : "Funds reserved status",
"type" : "group",
"required" : false,
"repeats" : true,
"item" : [{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept" : {
"coding" : [{
"system" : "http://hl7.org/fhir/questionnaire-item-control",
"code" : "flyover",
"display" : "Fly-over"
}]
}
}],
"linkId" : "ClaimResponse.fundsReserve-flyover",
"text" : "A code, used only on a response to a preauthorization, to indicate whether the benefits payable have been reserved and for whom. Fund would be release by a future claim quoting the preAuthRef of this response. Examples of values include: provider, patient, none.",
"type" : "display"
},
{
"linkId" : "ClaimResponse.fundsReserve.coding",
"text" : "code:",
"type" : "coding",
"required" : false,
"repeats" : false,
"answerConstraint" : "optionsOnly"
},
{
"linkId" : "ClaimResponse.fundsReserve.text",
"text" : "text:",
"type" : "string",
"required" : false,
"repeats" : false
}]
},
{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs",
"valueInteger" : 1
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType",
"valueString" : "CodeableConcept"
}],
"linkId" : "ClaimResponse.formCode",
"text" : "Printed form identifier",
"type" : "group",
"required" : false,
"repeats" : true,
"item" : [{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept" : {
"coding" : [{
"system" : "http://hl7.org/fhir/questionnaire-item-control",
"code" : "flyover",
"display" : "Fly-over"
}]
}
}],
"linkId" : "ClaimResponse.formCode-flyover",
"text" : "A code for the form to be used for printing the content. May be needed to identify specific jurisdictional forms.",
"type" : "display"
},
{
"linkId" : "ClaimResponse.formCode.coding",
"text" : "code:",
"type" : "coding",
"required" : false,
"repeats" : false,
"answerConstraint" : "optionsOnly"
},
{
"linkId" : "ClaimResponse.formCode.text",
"text" : "text:",
"type" : "string",
"required" : false,
"repeats" : false
}]
},
{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs",
"valueInteger" : 1
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType",
"valueString" : "Attachment"
}],
"linkId" : "ClaimResponse.form",
"text" : "Printed reference or actual form",
"type" : "group",
"required" : false,
"repeats" : true,
"item" : [{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept" : {
"coding" : [{
"system" : "http://hl7.org/fhir/questionnaire-item-control",
"code" : "flyover",
"display" : "Fly-over"
}]
}
}],
"linkId" : "ClaimResponse.form-flyover",
"text" : "The actual form, by reference or inclusion, for printing the content or an EOB. Needed to permit insurers to include the actual form.",
"type" : "display"
}]
},
{
"linkId" : "ClaimResponse.processNote",
"text" : "Note concerning adjudication",
"type" : "group",
"required" : false,
"repeats" : true,
"item" : [{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept" : {
"coding" : [{
"system" : "http://hl7.org/fhir/questionnaire-item-control",
"code" : "flyover",
"display" : "Fly-over"
}]
}
}],
"linkId" : "ClaimResponse.processNote-flyover",
"text" : "A note that describes or explains adjudication results in a human readable form.",
"type" : "display"
},
{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs",
"valueInteger" : 1
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType",
"valueString" : "string"
}],
"linkId" : "ClaimResponse.processNote.id",
"type" : "group",
"required" : false,
"repeats" : true,
"item" : [{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept" : {
"coding" : [{
"system" : "http://hl7.org/fhir/questionnaire-item-control",
"code" : "flyover",
"display" : "Fly-over"
}]
}
}],
"linkId" : "ClaimResponse.processNote.id-flyover",
"text" : "Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.",
"type" : "display"
},
{
"linkId" : "ClaimResponse.processNote.id.value",
"text" : "Unique id for inter-element referencing",
"type" : "string",
"required" : false,
"repeats" : false
}]
},
{
"linkId" : "ClaimResponse.processNote.extension",
"text" : "Additional content defined by implementations",
"type" : "group",
"required" : false,
"repeats" : true,
"item" : [{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept" : {
"coding" : [{
"system" : "http://hl7.org/fhir/questionnaire-item-control",
"code" : "flyover",
"display" : "Fly-over"
}]
}
}],
"linkId" : "ClaimResponse.processNote.extension-flyover",
"text" : "May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and managable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.",
"type" : "display"
}]
},
{
"linkId" : "ClaimResponse.processNote.modifierExtension",
"text" : "Extensions that cannot be ignored even if unrecognized",
"type" : "group",
"required" : false,
"repeats" : true,
"item" : [{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept" : {
"coding" : [{
"system" : "http://hl7.org/fhir/questionnaire-item-control",
"code" : "flyover",
"display" : "Fly-over"
}]
}
}],
"linkId" : "ClaimResponse.processNote.modifierExtension-flyover",
"text" : "May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and managable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can 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.\n\nModifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.",
"type" : "display"
}]
},
{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs",
"valueInteger" : 1
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType",
"valueString" : "integer"
}],
"linkId" : "ClaimResponse.processNote.number",
"type" : "group",
"required" : false,
"repeats" : true,
"item" : [{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept" : {
"coding" : [{
"system" : "http://hl7.org/fhir/questionnaire-item-control",
"code" : "flyover",
"display" : "Fly-over"
}]
}
}],
"linkId" : "ClaimResponse.processNote.number-flyover",
"text" : "A number to uniquely identify a note entry.",
"type" : "display"
},
{
"linkId" : "ClaimResponse.processNote.number.value",
"text" : "Note instance identifier",
"type" : "integer",
"required" : false,
"repeats" : false
}]
},
{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs",
"valueInteger" : 1
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType",
"valueString" : "CodeableConcept"
}],
"linkId" : "ClaimResponse.processNote.type",
"text" : "Note purpose",
"type" : "group",
"required" : false,
"repeats" : true,
"item" : [{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept" : {
"coding" : [{
"system" : "http://hl7.org/fhir/questionnaire-item-control",
"code" : "flyover",
"display" : "Fly-over"
}]
}
}],
"linkId" : "ClaimResponse.processNote.type-flyover",
"text" : "The business purpose of the note text.",
"type" : "display"
},
{
"linkId" : "ClaimResponse.processNote.type.coding",
"text" : "code:",
"type" : "coding",
"required" : false,
"repeats" : false,
"answerConstraint" : "optionsOnly"
},
{
"linkId" : "ClaimResponse.processNote.type.text",
"text" : "text:",
"type" : "string",
"required" : false,
"repeats" : false
}]
},
{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-minOccurs",
"valueInteger" : 1
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs",
"valueInteger" : 1
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType",
"valueString" : "string"
}],
"linkId" : "ClaimResponse.processNote.text",
"type" : "group",
"required" : true,
"repeats" : true,
"item" : [{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept" : {
"coding" : [{
"system" : "http://hl7.org/fhir/questionnaire-item-control",
"code" : "flyover",
"display" : "Fly-over"
}]
}
}],
"linkId" : "ClaimResponse.processNote.text-flyover",
"text" : "The explanation or description associated with the processing.",
"type" : "display"
},
{
"linkId" : "ClaimResponse.processNote.text.value",
"text" : "Note explanatory text",
"type" : "string",
"required" : false,
"repeats" : false
}]
},
{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs",
"valueInteger" : 1
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType",
"valueString" : "CodeableConcept"
}],
"linkId" : "ClaimResponse.processNote.language",
"text" : "Language of the text",
"type" : "group",
"required" : false,
"repeats" : true,
"item" : [{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept" : {
"coding" : [{
"system" : "http://hl7.org/fhir/questionnaire-item-control",
"code" : "flyover",
"display" : "Fly-over"
}]
}
}],
"linkId" : "ClaimResponse.processNote.language-flyover",
"text" : "A code to define the language used in the text of the note. Only required if the language is different from the resource language.",
"type" : "display"
},
{
"linkId" : "ClaimResponse.processNote.language.coding",
"text" : "code:",
"type" : "coding",
"required" : false,
"repeats" : false,
"answerConstraint" : "optionsOrType"
},
{
"linkId" : "ClaimResponse.processNote.language.text",
"text" : "text:",
"type" : "string",
"required" : false,
"repeats" : false
}]
}]
},
{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType",
"valueString" : "Reference"
}],
"linkId" : "ClaimResponse.communicationRequest",
"type" : "group",
"required" : false,
"repeats" : true,
"item" : [{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept" : {
"coding" : [{
"system" : "http://hl7.org/fhir/questionnaire-item-control",
"code" : "flyover",
"display" : "Fly-over"
}]
}
}],
"linkId" : "ClaimResponse.communicationRequest-flyover",
"text" : "Request for additional supporting or authorizing information. For example: professional reports, documents, images, clinical resources, or accident reports.",
"type" : "display"
},
{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-referenceResource",
"valueCode" : "CommunicationRequest"
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-referenceFilter",
"valueString" : "subject=$subj&patient=$subj&encounter=$encounter"
}],
"linkId" : "ClaimResponse.communicationRequest.value",
"text" : "Request for additional information",
"type" : "reference",
"required" : false,
"repeats" : false
}]
},
{
"linkId" : "ClaimResponse.insurance",
"text" : "Patient insurance information",
"type" : "group",
"required" : false,
"repeats" : true,
"item" : [{
"linkId" : "ClaimResponse.insurance-display",
"text" : "All insurance coverages for the patient which may be applicable for reimbursement, of the products and services listed in the claim, are typically provided in the claim to allow insurers to confirm the ordering of the insurance coverages relative to local 'coordination of benefit' rules. One coverage (and only one) with 'focal=true' is to be used in the adjudication of this claim. Coverages appearing before the focal Coverage in the list, and where 'subrogation=false', should provide a reference to the ClaimResponse containing the adjudication results of the prior claim.",
"type" : "display"
},
{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept" : {
"coding" : [{
"system" : "http://hl7.org/fhir/questionnaire-item-control",
"code" : "flyover",
"display" : "Fly-over"
}]
}
}],
"linkId" : "ClaimResponse.insurance-flyover",
"text" : "Financial instruments for reimbursement for the health care products and services specified on the claim.",
"type" : "display"
},
{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs",
"valueInteger" : 1
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType",
"valueString" : "string"
}],
"linkId" : "ClaimResponse.insurance.id",
"type" : "group",
"required" : false,
"repeats" : true,
"item" : [{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept" : {
"coding" : [{
"system" : "http://hl7.org/fhir/questionnaire-item-control",
"code" : "flyover",
"display" : "Fly-over"
}]
}
}],
"linkId" : "ClaimResponse.insurance.id-flyover",
"text" : "Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.",
"type" : "display"
},
{
"linkId" : "ClaimResponse.insurance.id.value",
"text" : "Unique id for inter-element referencing",
"type" : "string",
"required" : false,
"repeats" : false
}]
},
{
"linkId" : "ClaimResponse.insurance.extension",
"text" : "Additional content defined by implementations",
"type" : "group",
"required" : false,
"repeats" : true,
"item" : [{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept" : {
"coding" : [{
"system" : "http://hl7.org/fhir/questionnaire-item-control",
"code" : "flyover",
"display" : "Fly-over"
}]
}
}],
"linkId" : "ClaimResponse.insurance.extension-flyover",
"text" : "May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and managable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.",
"type" : "display"
}]
},
{
"linkId" : "ClaimResponse.insurance.modifierExtension",
"text" : "Extensions that cannot be ignored even if unrecognized",
"type" : "group",
"required" : false,
"repeats" : true,
"item" : [{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept" : {
"coding" : [{
"system" : "http://hl7.org/fhir/questionnaire-item-control",
"code" : "flyover",
"display" : "Fly-over"
}]
}
}],
"linkId" : "ClaimResponse.insurance.modifierExtension-flyover",
"text" : "May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and managable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can 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.\n\nModifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.",
"type" : "display"
}]
},
{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-minOccurs",
"valueInteger" : 1
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs",
"valueInteger" : 1
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType",
"valueString" : "integer"
}],
"linkId" : "ClaimResponse.insurance.sequence",
"type" : "group",
"required" : true,
"repeats" : true,
"item" : [{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept" : {
"coding" : [{
"system" : "http://hl7.org/fhir/questionnaire-item-control",
"code" : "flyover",
"display" : "Fly-over"
}]
}
}],
"linkId" : "ClaimResponse.insurance.sequence-flyover",
"text" : "A number to uniquely identify insurance entries and provide a sequence of coverages to convey coordination of benefit order.",
"type" : "display"
},
{
"linkId" : "ClaimResponse.insurance.sequence.value",
"text" : "Insurance instance identifier",
"type" : "integer",
"required" : false,
"repeats" : false
}]
},
{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-minOccurs",
"valueInteger" : 1
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs",
"valueInteger" : 1
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType",
"valueString" : "boolean"
}],
"linkId" : "ClaimResponse.insurance.focal",
"type" : "group",
"required" : true,
"repeats" : true,
"item" : [{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept" : {
"coding" : [{
"system" : "http://hl7.org/fhir/questionnaire-item-control",
"code" : "flyover",
"display" : "Fly-over"
}]
}
}],
"linkId" : "ClaimResponse.insurance.focal-flyover",
"text" : "A flag to indicate that this Coverage is to be used for adjudication of this claim when set to true. A patient may (will) have multiple insurance policies which provide reimbursement for healthcare services and products. For example a person may also be covered by their spouse's policy and both appear in the list (and may be from the same insurer). This flag will be set to true for only one of the listed policies and that policy will be used for adjudicating this claim. Other claims would be created to request adjudication against the other listed policies.",
"type" : "display"
},
{
"linkId" : "ClaimResponse.insurance.focal.value",
"text" : "Coverage to be used for adjudication",
"type" : "boolean",
"required" : false,
"repeats" : false
}]
},
{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-minOccurs",
"valueInteger" : 1
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs",
"valueInteger" : 1
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType",
"valueString" : "Reference"
}],
"linkId" : "ClaimResponse.insurance.coverage",
"type" : "group",
"required" : true,
"repeats" : true,
"item" : [{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept" : {
"coding" : [{
"system" : "http://hl7.org/fhir/questionnaire-item-control",
"code" : "flyover",
"display" : "Fly-over"
}]
}
}],
"linkId" : "ClaimResponse.insurance.coverage-flyover",
"text" : "Reference to the insurance card level information contained in the Coverage resource. The coverage issuing insurer will use these details to locate the patient's actual coverage within the insurer's information system.",
"type" : "display"
},
{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-referenceResource",
"valueCode" : "Coverage"
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-referenceFilter",
"valueString" : "subject=$subj&patient=$subj&encounter=$encounter"
}],
"linkId" : "ClaimResponse.insurance.coverage.value",
"text" : "Insurance information",
"type" : "reference",
"required" : false,
"repeats" : false
}]
},
{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs",
"valueInteger" : 1
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType",
"valueString" : "string"
}],
"linkId" : "ClaimResponse.insurance.businessArrangement",
"type" : "group",
"required" : false,
"repeats" : true,
"item" : [{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept" : {
"coding" : [{
"system" : "http://hl7.org/fhir/questionnaire-item-control",
"code" : "flyover",
"display" : "Fly-over"
}]
}
}],
"linkId" : "ClaimResponse.insurance.businessArrangement-flyover",
"text" : "A business agreement number established between the provider and the insurer for special business processing purposes.",
"type" : "display"
},
{
"linkId" : "ClaimResponse.insurance.businessArrangement.value",
"text" : "Additional provider contract number",
"type" : "string",
"required" : false,
"repeats" : false
}]
},
{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs",
"valueInteger" : 1
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType",
"valueString" : "Reference"
}],
"linkId" : "ClaimResponse.insurance.claimResponse",
"type" : "group",
"required" : false,
"repeats" : true,
"item" : [{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept" : {
"coding" : [{
"system" : "http://hl7.org/fhir/questionnaire-item-control",
"code" : "flyover",
"display" : "Fly-over"
}]
}
}],
"linkId" : "ClaimResponse.insurance.claimResponse-flyover",
"text" : "The result of the adjudication of the line items for the Coverage specified in this insurance. Must not be specified when 'focal=true' for this insurance.",
"type" : "display"
},
{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-referenceResource",
"valueCode" : "ClaimResponse"
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-referenceFilter",
"valueString" : "subject=$subj&patient=$subj&encounter=$encounter"
}],
"linkId" : "ClaimResponse.insurance.claimResponse.value",
"text" : "Adjudication results",
"type" : "reference",
"required" : false,
"repeats" : false
}]
}]
},
{
"linkId" : "ClaimResponse.error",
"text" : "Processing errors",
"type" : "group",
"required" : false,
"repeats" : true,
"item" : [{
"linkId" : "ClaimResponse.error-display",
"text" : "If the request contains errors then an error element should be provided and no adjudication related sections (item, addItem, or payment) should be present.",
"type" : "display"
},
{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept" : {
"coding" : [{
"system" : "http://hl7.org/fhir/questionnaire-item-control",
"code" : "flyover",
"display" : "Fly-over"
}]
}
}],
"linkId" : "ClaimResponse.error-flyover",
"text" : "Errors encountered during the processing of the adjudication.",
"type" : "display"
},
{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs",
"valueInteger" : 1
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType",
"valueString" : "string"
}],
"linkId" : "ClaimResponse.error.id",
"type" : "group",
"required" : false,
"repeats" : true,
"item" : [{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept" : {
"coding" : [{
"system" : "http://hl7.org/fhir/questionnaire-item-control",
"code" : "flyover",
"display" : "Fly-over"
}]
}
}],
"linkId" : "ClaimResponse.error.id-flyover",
"text" : "Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.",
"type" : "display"
},
{
"linkId" : "ClaimResponse.error.id.value",
"text" : "Unique id for inter-element referencing",
"type" : "string",
"required" : false,
"repeats" : false
}]
},
{
"linkId" : "ClaimResponse.error.extension",
"text" : "Additional content defined by implementations",
"type" : "group",
"required" : false,
"repeats" : true,
"item" : [{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept" : {
"coding" : [{
"system" : "http://hl7.org/fhir/questionnaire-item-control",
"code" : "flyover",
"display" : "Fly-over"
}]
}
}],
"linkId" : "ClaimResponse.error.extension-flyover",
"text" : "May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and managable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.",
"type" : "display"
}]
},
{
"linkId" : "ClaimResponse.error.modifierExtension",
"text" : "Extensions that cannot be ignored even if unrecognized",
"type" : "group",
"required" : false,
"repeats" : true,
"item" : [{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept" : {
"coding" : [{
"system" : "http://hl7.org/fhir/questionnaire-item-control",
"code" : "flyover",
"display" : "Fly-over"
}]
}
}],
"linkId" : "ClaimResponse.error.modifierExtension-flyover",
"text" : "May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and managable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can 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.\n\nModifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.",
"type" : "display"
}]
},
{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs",
"valueInteger" : 1
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType",
"valueString" : "integer"
}],
"linkId" : "ClaimResponse.error.itemSequence",
"type" : "group",
"required" : false,
"repeats" : true,
"item" : [{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept" : {
"coding" : [{
"system" : "http://hl7.org/fhir/questionnaire-item-control",
"code" : "flyover",
"display" : "Fly-over"
}]
}
}],
"linkId" : "ClaimResponse.error.itemSequence-flyover",
"text" : "The sequence number of the line item submitted which contains the error. This value is omitted when the error occurs outside of the item structure.",
"type" : "display"
},
{
"linkId" : "ClaimResponse.error.itemSequence.value",
"text" : "Item sequence number",
"type" : "integer",
"required" : false,
"repeats" : false
}]
},
{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs",
"valueInteger" : 1
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType",
"valueString" : "integer"
}],
"linkId" : "ClaimResponse.error.detailSequence",
"type" : "group",
"required" : false,
"repeats" : true,
"item" : [{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept" : {
"coding" : [{
"system" : "http://hl7.org/fhir/questionnaire-item-control",
"code" : "flyover",
"display" : "Fly-over"
}]
}
}],
"linkId" : "ClaimResponse.error.detailSequence-flyover",
"text" : "The sequence number of the detail within the line item submitted which contains the error. This value is omitted when the error occurs outside of the item structure.",
"type" : "display"
},
{
"linkId" : "ClaimResponse.error.detailSequence.value",
"text" : "Detail sequence number",
"type" : "integer",
"required" : false,
"repeats" : false
}]
},
{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs",
"valueInteger" : 1
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType",
"valueString" : "integer"
}],
"linkId" : "ClaimResponse.error.subDetailSequence",
"type" : "group",
"required" : false,
"repeats" : true,
"item" : [{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept" : {
"coding" : [{
"system" : "http://hl7.org/fhir/questionnaire-item-control",
"code" : "flyover",
"display" : "Fly-over"
}]
}
}],
"linkId" : "ClaimResponse.error.subDetailSequence-flyover",
"text" : "The sequence number of the sub-detail within the detail within the line item submitted which contains the error. This value is omitted when the error occurs outside of the item structure.",
"type" : "display"
},
{
"linkId" : "ClaimResponse.error.subDetailSequence.value",
"text" : "Subdetail sequence number",
"type" : "integer",
"required" : false,
"repeats" : false
}]
},
{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-minOccurs",
"valueInteger" : 1
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs",
"valueInteger" : 1
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType",
"valueString" : "CodeableConcept"
}],
"linkId" : "ClaimResponse.error.code",
"text" : "Error code detailing processing issues",
"type" : "group",
"required" : true,
"repeats" : true,
"item" : [{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept" : {
"coding" : [{
"system" : "http://hl7.org/fhir/questionnaire-item-control",
"code" : "flyover",
"display" : "Fly-over"
}]
}
}],
"linkId" : "ClaimResponse.error.code-flyover",
"text" : "An error code, from a specified code system, which details why the claim could not be adjudicated.",
"type" : "display"
},
{
"linkId" : "ClaimResponse.error.code.coding",
"text" : "code:",
"type" : "coding",
"required" : false,
"repeats" : false,
"answerConstraint" : "optionsOnly"
},
{
"linkId" : "ClaimResponse.error.code.text",
"text" : "text:",
"type" : "string",
"required" : false,
"repeats" : false
}]
},
{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType",
"valueString" : "string"
}],
"linkId" : "ClaimResponse.error.expression",
"type" : "group",
"required" : false,
"repeats" : true,
"item" : [{
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept" : {
"coding" : [{
"system" : "http://hl7.org/fhir/questionnaire-item-control",
"code" : "flyover",
"display" : "Fly-over"
}]
}
}],
"linkId" : "ClaimResponse.error.expression-flyover",
"text" : "A [simple subset of FHIRPath](fhirpath.html#simple) limited to element names, repetition indicators and the default child accessor that identifies one of the elements in the resource that caused this issue to be raised. The root of the FHIRPath is the resource or bundle that generated OperationOutcome. Each FHIRPath SHALL resolve to a single node.",
"type" : "display"
},
{
"linkId" : "ClaimResponse.error.expression.value",
"text" : "FHIRPath of element(s) related to issue",
"type" : "string",
"required" : false,
"repeats" : false
}]
}]
}]
}]
}
Usage note: every effort has been made to ensure that the examples are correct and useful, but they are not a normative part of the specification.
FHIR ®© HL7.org 2011+. FHIR R5 hl7.fhir.core#5.0.0 generated on Sun, Mar 26, 2023 15:24+1100.
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