Health New Zealand Te Whatu Ora Shared Care FHIR API
0.4.7 - release
Health New Zealand Te Whatu Ora Shared Care FHIR API
0.4.7 - release
Health New Zealand Te Whatu Ora Shared Care FHIR API - Local Development build (v0.4.7) built by the FHIR (HL7® FHIR® Standard) Build Tools. See the Directory of published versions
| Official URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/SharedCareClaimResponse | Version: 1.0.7 | |||
| Active as of 2026-10-13 | Computable Name: SharedCareClaimResponse | |||
A FHIR resource profile describing the outcome of NZ generic payment claims.
Note: In 4B item.adjudication, item.detail.adjudication, payment.amount, insurer are compulsory fields, but not utilized in the telehealth implementation. item.adjudication.quantity R5 is item.adjudication.value in R4B.
A FHIR resource profile describing the outcome of NZ generic payment claims
Usages:
You can also check for usages in the FHIR IG Statistics
Description of Profiles, Differentials, Snapshots and how the different presentations work.
| Name | Flags | Card. | Type | Description & Constraints Filter:  |
|---|---|---|---|---|
  ClaimResponse |
C | 0..* | ClaimResponse | Response to a claim predetermination or preauthorization Constraints: unique-item-sequence |
  meta |
1..1 | Meta | Metadata about the resource | |
   source |
C | 1..1 | uri | HPI Facility ID from where the record is sourced Constraints: hpi-location-url-format |
| profile |
1..1 | canonical(StructureDefinition) | Profiles this resource claims to conform to | |
  Slices for tag |
1..* | Coding | Tags applied to this resource Slice: Unordered, Open by value:system Binding: CommonTags (example): Codes that represent various types of tags, commonly workflow-related; e.g. "Needs review by Dr. Jones". Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them | |
   tag:correlationId |
1..1 | Coding | Tags applied to this resource Binding: CommonTags (example): Codes that represent various types of tags, commonly workflow-related; e.g. "Needs review by Dr. Jones". | |
 system |
1..1 | uri | Hub correlation ID system Required Pattern: https://hub.services.digital.health.nz/ns/correlation-id | |
 code |
1..1 | code | Symbol in syntax defined by the system | |
| implicitRules |
0..1 | uri | A set of rules under which this content was created | |
 Slices for extension |
0..* | Extension | Extension Slice: Unordered, Open by value:url Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them | |
 extension:traceNumber |
0..* | Identifier | Shared Care Claim Trace Number URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/shared-care-trace-number | |
 modifierExtension |
0..* | Extension | Extensions that cannot be ignored | |
| identifier |
1..* | Identifier | Business identifier(s) for the claim response | |
| use |
0..1 | code | usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known . | |
| system |
1..1 | uri | The namespace for the identifier value Example General: http://www.acme.com/identifiers/patient | |
 value |
1..1 | string | The value that is unique Example General: 123456 | |
| status |
1..1 | code | Status of the Claim Response: active, cancelled, draft, entered-in-error Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance. | |
| type |
1..1 | CodeableConcept | More granular claim type Binding: NZ Claim Types (extensible) | |
| subType |
1..1 | CodeableConcept | More granular claim type Binding: NZ Claim Subtypes (extensible) | |
| use |
1..1 | code | claim | preauthorization | predetermination Binding: Use (required): Claim, preauthorization, predetermination. | |
 patient |
1..1 | Reference(Patient) | The recipient of the products and services | |
| created |
1..1 | dateTime | Date & time of claim determination | |
| insurer |
1..1 | Reference(Organization) | Party responsible for reimbursement | |
| requestor |
0..1 | Reference(Practitioner | PractitionerRole | Organization) | Party responsible for the Claim | |
| request |
1..1 | Reference(NZ SharedCare Claim) | Reference to the Claim that was determined | |
| outcome |
1..1 | code | queued | complete | error | partial Binding: ClaimProcessingCodes (required): The result of the claim processing. | |
| item |
0..* | BackboneElement | Claim response items | |
| Slices for extension |
1..* | Extension | Extension Slice: Unordered, Open by value:url Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them | |
 extension:traceNumber |
0..* | Identifier | Shared Care Claim Trace Number URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/shared-care-trace-number | |
| extension:productOrService |
1..1 | CodeableConcept | Shared Care Product Or Service URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/shared-care-product-or-service | |
| extension:reviewOutcome |
0..1 | (Complex) | Shared Care Review Outcome URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/shared-care-review-outcome | |
| modifierExtension |
0..* | Extension | Extensions that cannot be ignored even if unrecognized | |
| itemSequence |
1..1 | positiveInt | Value of the corresponding Claim.item.sequence | |
| adjudication |
1..* | BackboneElement | Adjudication (reason, amount, quantity) for each Adjudication Value Code | |
| modifierExtension |
0..* | Extension | Extensions that cannot be ignored even if unrecognized | |
| category |
1..1 | CodeableConcept | Codified representation of adjudication outcome Binding: Adjudication Value Codes (extensible) | |
| reason |
0..1 | CodeableConcept | Codified reason(s) for the adjudication Binding: Adjudication Reason Codes (extensible) | |
| amount |
1..1 | Money | Monetary value of the adjudication | |
| value |
0..1 | decimal | Non-monetary value of the adjudication | |
| detail |
0..* | BackboneElement | Any sub-determinations of this itemSequence | |
| Slices for extension |
0..* | Extension | Extension Slice: Unordered, Open by value:url Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them | |
| extension:traceNumber |
0..* | Identifier | Shared Care Claim Trace Number URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/shared-care-trace-number | |
| extension:reviewOutcome |
0..1 | (Complex) | Shared Care Review Outcome URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/shared-care-review-outcome | |
| modifierExtension |
0..* | Extension | Extensions that cannot be ignored even if unrecognized | |
| detailSequence |
1..1 | positiveInt | Value of the corresponding Claim.item.detail.sequence | |
 adjudication |
1..* | See adjudication (ClaimResponse) | Detail level adjudication details | |
| addItem |
0..* | BackboneElement | Any line items added by Health NZ to the claim determination that were not in the original claim | |
| modifierExtension |
0..* | Extension | Extensions that cannot be ignored even if unrecognized | |
| productOrService |
1..1 | CodeableConcept | Billing, service, product, or drug code Binding: USCLSCodes (example): Allowable service and product codes. | |
| adjudication |
1..* | See adjudication (ClaimResponse) | Added items adjudication | |
| adjudication |
0..* | See adjudication (ClaimResponse) | Claim-level adjudication | |
| total |
0..* | BackboneElement | Financial total of the claim for each Adjudication Value Code | |
| modifierExtension |
0..* | Extension | Extensions that cannot be ignored even if unrecognized | |
| category |
1..1 | CodeableConcept | Type of adjudication information Binding: AdjudicationValueCodes (example): The adjudication codes. | |
| amount |
1..1 | Money | Financial total for the category | |
| payment |
0..1 | BackboneElement | Summary of the payment being made | |
| modifierExtension |
0..* | Extension | Extensions that cannot be ignored even if unrecognized | |
| type |
1..1 | CodeableConcept | Payment Type Code = complete or partial Binding: Payment Type Codes (extensible) | |
| date |
0..1 | date | Expected date of payment (if known) | |
| amount |
1..1 | Money | Payment amount | |
| error |
0..* | BackboneElement | Collection of errors produced during claim determination | |
| modifierExtension |
0..* | Extension | Extensions that cannot be ignored even if unrecognized | |
| itemSequence |
0..1 | positiveInt | Refers to itemSequence to which the error relates | |
| detailSequence |
0..1 | positiveInt | Refers to detailSequence to which the error relates | |
| code |
1..1 | CodeableConcept | Error code Binding: Adjudication Error Codes (example): The adjudication error codes. | |
| Documentation for this format | ||||
| Path | Status | Usage | ValueSet | Version | Source |
| ClaimResponse.meta.tag | Base | example | Common Tags | 📍4.0.1 | FHIR Std. |
| ClaimResponse.meta.tag:correlationId | Base | example | Common Tags | 📍4.0.1 | FHIR Std. |
| ClaimResponse.identifier.use | Base | required | IdentifierUse | 📍4.0.1 | FHIR Std. |
| ClaimResponse.status | Base | required | Financial Resource Status Codes | 📍4.0.1 | FHIR Std. |
| ClaimResponse.type | Base | extensible | NZ Claim Types | 📦0.4.7 | This IG |
| ClaimResponse.subType | Base | extensible | NZ Claim Subtypes | 📦0.4.7 | This IG |
| ClaimResponse.use | Base | required | Use | 📍4.0.1 | FHIR Std. |
| ClaimResponse.outcome | Base | required | Claim Processing Codes | 📍4.0.1 | FHIR Std. |
| ClaimResponse.item.adjudication.category | Base | extensible | Adjudication Value Codes | 📦0.4.7 | This IG |
| ClaimResponse.item.adjudication.reason | Base | extensible | Adjudication Reason Codes | 📦0.4.7 | This IG |
| ClaimResponse.addItem.productOrService | Base | example | USCLS Codes | 📍4.0.1 | FHIR Std. |
| ClaimResponse.total.category | Base | example | Adjudication Value Codes | 📍4.0.1 | FHIR Std. |
| ClaimResponse.payment.type | Base | extensible | Payment Type Codes | 📦0.4.7 | This IG |
| ClaimResponse.error.code | Base | example | AdjudicationError | 📍4.0.1 | FHIR Std. |
| Id | Grade | Path(s) | Description | Expression |
| hpi-location-url-format | error | ClaimResponse.meta.source | Reference must be an HPI facility URL with format https://standards.digital.health.nz/ns/hpi-facility-id/FZZ111-A |
matches('^https://standards.digital.health.nz/ns/hpi-facility-id/F[A-Za-z0-9]{2}[0-9]{3}-[A-Za-z0-9]$')
|
| unique-item-sequence | error | ClaimResponse | Each item.itemSequence must be unique within the ClaimResponse |
item.itemSequence.isDistinct()
|
This structure is derived from ClaimResponse
| Name | Flags | Card. | Type | Description & Constraints Filter: |
|---|---|---|---|---|
| ClaimResponse |
C | 0..* | ClaimResponse | Response to a claim predetermination or preauthorization Constraints: unique-item-sequence |
| meta |
1..1 | Meta | Metadata about the resource | |
| source |
C | 1..1 | uri | HPI Facility ID from where the record is sourced Constraints: hpi-location-url-format |
| profile |
1..1 | canonical(StructureDefinition) | Profiles this resource claims to conform to | |
| Slices for tag |
1..* | Coding | Tags applied to this resource Slice: Unordered, Open by value:system Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them | |
| tag:correlationId |
1..1 | Coding | Tags applied to this resource | |
| system |
1..1 | uri | Hub correlation ID system Required Pattern: https://hub.services.digital.health.nz/ns/correlation-id | |
| code |
1..1 | code | Symbol in syntax defined by the system | |
| contained |
0..0 | Contained, inline Resources | ||
| Slices for extension |
0..* | Extension | Extension Slice: Unordered, Open by value:url Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them | |
| extension:traceNumber |
0..* | Identifier | Shared Care Claim Trace Number URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/shared-care-trace-number | |
| identifier |
1..* | Identifier | Business identifier(s) for the claim response | |
| system |
1..1 | uri | The namespace for the identifier value | |
| value |
1..1 | string | The value that is unique | |
| status |
1..1 | code | Status of the Claim Response: active, cancelled, draft, entered-in-error | |
| type |
1..1 | CodeableConcept | More granular claim type Binding: NZ Claim Types (extensible) | |
| subType |
1..1 | CodeableConcept | More granular claim type Binding: NZ Claim Subtypes (extensible) | |
| patient |
||||
| display |
0..0 | Remove from all examples. Never return in a response. Never save if provided. | ||
| created |
1..1 | dateTime | Date & time of claim determination | |
| requestor |
0..1 | Reference(Practitioner | PractitionerRole | Organization) | Party responsible for the Claim | |
| request |
1..1 | Reference(NZ SharedCare Claim) | Reference to the Claim that was determined | |
| item |
0..* | BackboneElement | Claim response items | |
| Slices for extension |
1..* | Extension | Extension Slice: Unordered, Open by value:url Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them | |
| extension:traceNumber |
0..* | Identifier | Shared Care Claim Trace Number URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/shared-care-trace-number | |
| extension:productOrService |
1..1 | CodeableConcept | Shared Care Product Or Service URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/shared-care-product-or-service | |
| extension:reviewOutcome |
0..1 | (Complex) | Shared Care Review Outcome URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/shared-care-review-outcome | |
| itemSequence |
1..1 | positiveInt | Value of the corresponding Claim.item.sequence | |
| adjudication |
1..* | BackboneElement | Adjudication (reason, amount, quantity) for each Adjudication Value Code | |
| category |
1..1 | CodeableConcept | Codified representation of adjudication outcome Binding: Adjudication Value Codes (extensible) | |
| reason |
0..1 | CodeableConcept | Codified reason(s) for the adjudication Binding: Adjudication Reason Codes (extensible) | |
| amount |
1..1 | Money | Monetary value of the adjudication | |
| value |
0..1 | decimal | Non-monetary value of the adjudication | |
| detail |
0..* | BackboneElement | Any sub-determinations of this itemSequence | |
| Slices for extension |
0..* | Extension | Extension Slice: Unordered, Open by value:url Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them | |
| extension:traceNumber |
0..* | Identifier | Shared Care Claim Trace Number URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/shared-care-trace-number | |
| extension:reviewOutcome |
0..1 | (Complex) | Shared Care Review Outcome URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/shared-care-review-outcome | |
| detailSequence |
1..1 | positiveInt | Value of the corresponding Claim.item.detail.sequence | |
| addItem |
0..* | BackboneElement | Any line items added by Health NZ to the claim determination that were not in the original claim | |
| adjudication |
0..* | Claim-level adjudication | ||
| total |
0..* | BackboneElement | Financial total of the claim for each Adjudication Value Code | |
| payment |
0..1 | BackboneElement | Summary of the payment being made | |
| type |
1..1 | CodeableConcept | Payment Type Code = complete or partial Binding: Payment Type Codes (extensible) | |
| date |
0..1 | date | Expected date of payment (if known) | |
| amount |
1..1 | Money | Payment amount | |
| error |
0..* | BackboneElement | Collection of errors produced during claim determination | |
| itemSequence |
0..1 | positiveInt | Refers to itemSequence to which the error relates | |
| detailSequence |
0..1 | positiveInt | Refers to detailSequence to which the error relates | |
| code |
1..1 | CodeableConcept | Error code | |
| Documentation for this format | ||||
| Path | Status | Usage | ValueSet | Version | Source |
| ClaimResponse.type | Base | extensible | NZ Claim Types | 📦0.4.7 | This IG |
| ClaimResponse.subType | Base | extensible | NZ Claim Subtypes | 📦0.4.7 | This IG |
| ClaimResponse.item.adjudication.category | Base | extensible | Adjudication Value Codes | 📦0.4.7 | This IG |
| ClaimResponse.item.adjudication.reason | Base | extensible | Adjudication Reason Codes | 📦0.4.7 | This IG |
| ClaimResponse.payment.type | Base | extensible | Payment Type Codes | 📦0.4.7 | This IG |
| Id | Grade | Path(s) | Description | Expression |
| hpi-location-url-format | error | ClaimResponse.meta.source | Reference must be an HPI facility URL with format https://standards.digital.health.nz/ns/hpi-facility-id/FZZ111-A |
matches('^https://standards.digital.health.nz/ns/hpi-facility-id/F[A-Za-z0-9]{2}[0-9]{3}-[A-Za-z0-9]$')
|
| unique-item-sequence | error | ClaimResponse | Each item.itemSequence must be unique within the ClaimResponse |
item.itemSequence.isDistinct()
|
| Name | Flags | Card. | Type | Description & Constraints Filter: | ||||
|---|---|---|---|---|---|---|---|---|
| ClaimResponse |
C | 0..* | ClaimResponse | Response to a claim predetermination or preauthorization Constraints: unique-item-sequence | ||||
| id |
0..1 | id | Logical id of this artifact | |||||
| meta |
1..1 | Meta | Metadata about the resource | |||||
| id |
0..1 | string | Unique id for inter-element referencing | |||||
| extension |
0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | |||||
| versionId |
0..1 | id | Version specific identifier | |||||
| lastUpdated |
0..1 | instant | When the resource version last changed | |||||
| source |
C | 1..1 | uri | HPI Facility ID from where the record is sourced Constraints: hpi-location-url-format | ||||
| profile |
1..1 | canonical(StructureDefinition) | Profiles this resource claims to conform to | |||||
| security |
0..* | Coding | Security Labels applied to this resource Binding: All Security Labels (extensible): Security Labels from the Healthcare Privacy and Security Classification System. | |||||
| Slices for tag |
1..* | Coding | Tags applied to this resource Slice: Unordered, Open by value:system Binding: CommonTags (example): Codes that represent various types of tags, commonly workflow-related; e.g. "Needs review by Dr. Jones". Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them | |||||
| tag:correlationId |
1..1 | Coding | Tags applied to this resource Binding: CommonTags (example): Codes that represent various types of tags, commonly workflow-related; e.g. "Needs review by Dr. Jones". | |||||
| id |
0..1 | string | Unique id for inter-element referencing | |||||
| extension |
0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | |||||
| system |
1..1 | uri | Hub correlation ID system Required Pattern: https://hub.services.digital.health.nz/ns/correlation-id | |||||
| version |
0..1 | string | Version of the system - if relevant | |||||
| code |
1..1 | code | Symbol in syntax defined by the system | |||||
| display |
0..1 | string | Representation defined by the system | |||||
| userSelected |
0..1 | boolean | If this coding was chosen directly by the user | |||||
| implicitRules |
0..1 | uri | A set of rules under which this content was created | |||||
| language |
0..1 | code | Language of the resource content Binding: CommonLanguages (preferred): A human language.
| |||||
| text |
0..1 | Narrative | Text summary of the resource, for human interpretation This profile does not constrain the narrative in regard to content, language, or traceability to data elements | |||||
| Slices for extension |
0..* | Extension | Extension Slice: Unordered, Open by value:url Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them | |||||
| extension:traceNumber |
0..* | Identifier | Shared Care Claim Trace Number URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/shared-care-trace-number | |||||
| modifierExtension |
0..* | Extension | Extensions that cannot be ignored | |||||
| identifier |
1..* | Identifier | Business identifier(s) for the claim response | |||||
| id |
0..1 | string | Unique id for inter-element referencing | |||||
| extension |
0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | |||||
| use |
0..1 | code | usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known . | |||||
| type |
0..1 | CodeableConcept | Description of identifier Binding: Identifier Type Codes (extensible): A coded type for an identifier that can be used to determine which identifier to use for a specific purpose. | |||||
| system |
1..1 | uri | The namespace for the identifier value Example General: http://www.acme.com/identifiers/patient | |||||
| value |
1..1 | string | The value that is unique Example General: 123456 | |||||
| period |
0..1 | Period | Time period when id is/was valid for use | |||||
| assigner |
0..1 | Reference(Organization) | Organization that issued id (may be just text) | |||||
| status |
1..1 | code | Status of the Claim Response: active, cancelled, draft, entered-in-error Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance. | |||||
| type |
1..1 | CodeableConcept | More granular claim type Binding: NZ Claim Types (extensible) | |||||
| subType |
1..1 | CodeableConcept | More granular claim type Binding: NZ Claim Subtypes (extensible) | |||||
| use |
1..1 | code | claim | preauthorization | predetermination Binding: Use (required): Claim, preauthorization, predetermination. | |||||
| patient |
1..1 | Reference(Patient) | The recipient of the products and services | |||||
| id |
0..1 | string | Unique id for inter-element referencing | |||||
| extension |
0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | |||||
| reference |
C | 0..1 | string | Literal reference, Relative, internal or absolute URL | ||||
| type |
0..1 | uri | Type the reference refers to (e.g. "Patient") Binding: ResourceType (extensible): Aa resource (or, for logical models, the URI of the logical model). | |||||
| identifier |
0..1 | Identifier | Logical reference, when literal reference is not known | |||||
| created |
1..1 | dateTime | Date & time of claim determination | |||||
| insurer |
1..1 | Reference(Organization) | Party responsible for reimbursement | |||||
| requestor |
0..1 | Reference(Practitioner | PractitionerRole | Organization) | Party responsible for the Claim | |||||
| request |
1..1 | Reference(NZ SharedCare Claim) | Reference to the Claim that was determined | |||||
| outcome |
1..1 | code | queued | complete | error | partial Binding: ClaimProcessingCodes (required): The result of the claim processing. | |||||
| disposition |
0..1 | string | Disposition Message | |||||
| preAuthRef |
0..1 | string | Preauthorization reference | |||||
| preAuthPeriod |
0..1 | Period | Preauthorization reference effective period | |||||
| payeeType |
0..1 | CodeableConcept | Party to be paid any benefits payable Binding: Claim Payee Type Codes (example): A code for the party to be reimbursed. | |||||
| item |
0..* | BackboneElement | Claim response items | |||||
| id |
0..1 | string | Unique id for inter-element referencing | |||||
| Slices for extension |
1..* | Extension | Extension Slice: Unordered, Open by value:url Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them | |||||
| extension:traceNumber |
0..* | Identifier | Shared Care Claim Trace Number URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/shared-care-trace-number | |||||
| extension:productOrService |
1..1 | CodeableConcept | Shared Care Product Or Service URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/shared-care-product-or-service | |||||
| extension:reviewOutcome |
0..1 | (Complex) | Shared Care Review Outcome URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/shared-care-review-outcome | |||||
| modifierExtension |
0..* | Extension | Extensions that cannot be ignored even if unrecognized | |||||
| itemSequence |
1..1 | positiveInt | Value of the corresponding Claim.item.sequence | |||||
| noteNumber |
0..* | positiveInt | Applicable note numbers | |||||
| adjudication |
1..* | BackboneElement | Adjudication (reason, amount, quantity) for each Adjudication Value Code | |||||
| id |
0..1 | string | Unique id for inter-element referencing | |||||
| extension |
0..* | Extension | Additional content defined by implementations | |||||
| modifierExtension |
0..* | Extension | Extensions that cannot be ignored even if unrecognized | |||||
| category |
1..1 | CodeableConcept | Codified representation of adjudication outcome Binding: Adjudication Value Codes (extensible) | |||||
| reason |
0..1 | CodeableConcept | Codified reason(s) for the adjudication Binding: Adjudication Reason Codes (extensible) | |||||
| amount |
1..1 | Money | Monetary value of the adjudication | |||||
| value |
0..1 | decimal | Non-monetary value of the adjudication | |||||
| detail |
0..* | BackboneElement | Any sub-determinations of this itemSequence | |||||
| id |
0..1 | string | Unique id for inter-element referencing | |||||
| Slices for extension |
0..* | Extension | Extension Slice: Unordered, Open by value:url Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them | |||||
| extension:traceNumber |
0..* | Identifier | Shared Care Claim Trace Number URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/shared-care-trace-number | |||||
| extension:reviewOutcome |
0..1 | (Complex) | Shared Care Review Outcome URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/shared-care-review-outcome | |||||
| modifierExtension |
0..* | Extension | Extensions that cannot be ignored even if unrecognized | |||||
| detailSequence |
1..1 | positiveInt | Value of the corresponding Claim.item.detail.sequence | |||||
| noteNumber |
0..* | positiveInt | Applicable note numbers | |||||
| adjudication |
1..* | See adjudication (ClaimResponse) | Detail level adjudication details | |||||
| subDetail |
0..* | BackboneElement | Adjudication for claim sub-details | |||||
| id |
0..1 | string | Unique id for inter-element referencing | |||||
| extension |
0..* | Extension | Additional content defined by implementations | |||||
| modifierExtension |
0..* | Extension | Extensions that cannot be ignored even if unrecognized | |||||
| subDetailSequence |
1..1 | positiveInt | Claim sub-detail instance identifier | |||||
| noteNumber |
0..* | positiveInt | Applicable note numbers | |||||
| adjudication |
0..* | See adjudication (ClaimResponse) | Subdetail level adjudication details | |||||
| addItem |
0..* | BackboneElement | Any line items added by Health NZ to the claim determination that were not in the original claim | |||||
| id |
0..1 | string | Unique id for inter-element referencing | |||||
| extension |
0..* | Extension | Additional content defined by implementations | |||||
| modifierExtension |
0..* | Extension | Extensions that cannot be ignored even if unrecognized | |||||
| itemSequence |
0..* | positiveInt | Item sequence number | |||||
| detailSequence |
0..* | positiveInt | Detail sequence number | |||||
| subdetailSequence |
0..* | positiveInt | Subdetail sequence number | |||||
| provider |
0..* | Reference(Practitioner | PractitionerRole | Organization) | Authorized providers | |||||
| productOrService |
1..1 | CodeableConcept | Billing, service, product, or drug code Binding: USCLSCodes (example): Allowable service and product codes. | |||||
| modifier |
0..* | CodeableConcept | Service/Product billing modifiers Binding: ModifierTypeCodes (example): Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen. | |||||
| programCode |
0..* | CodeableConcept | Program the product or service is provided under Binding: ExampleProgramReasonCodes (example): Program specific reason codes. | |||||
 serviced[x] |
0..1 | Date or dates of service or product delivery | ||||||
| servicedDate |
date | |||||||
| servicedPeriod |
Period | |||||||
| location[x] |
0..1 | Place of service or where product was supplied Binding: ExampleServicePlaceCodes (example): Place of service: pharmacy, school, prison, etc. | ||||||
| locationCodeableConcept |
CodeableConcept | |||||||
| locationAddress |
Address | |||||||
| locationReference |
Reference(Location) | |||||||
| quantity |
C | 0..1 | SimpleQuantity(4.0.1) | Count of products or services Constraints: sqty-1 | ||||
| unitPrice |
0..1 | Money | Fee, charge or cost per item | |||||
| factor |
0..1 | decimal | Price scaling factor | |||||
| net |
0..1 | Money | Total item cost | |||||
| bodySite |
0..1 | CodeableConcept | Anatomical location Binding: OralSiteCodes (example): The code for the teeth, quadrant, sextant and arch. | |||||
| subSite |
0..* | CodeableConcept | Anatomical sub-location Binding: SurfaceCodes (example): The code for the tooth surface and surface combinations. | |||||
| noteNumber |
0..* | positiveInt | Applicable note numbers | |||||
| adjudication |
1..* | See adjudication (ClaimResponse) | Added items adjudication | |||||
| detail |
0..* | BackboneElement | Insurer added line details | |||||
| id |
0..1 | string | Unique id for inter-element referencing | |||||
| extension |
0..* | Extension | Additional content defined by implementations | |||||
| modifierExtension |
0..* | Extension | Extensions that cannot be ignored even if unrecognized | |||||
| productOrService |
1..1 | CodeableConcept | Billing, service, product, or drug code Binding: USCLSCodes (example): Allowable service and product codes. | |||||
| modifier |
0..* | CodeableConcept | Service/Product billing modifiers Binding: ModifierTypeCodes (example): Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen. | |||||
| quantity |
C | 0..1 | SimpleQuantity(4.0.1) | Count of products or services Constraints: sqty-1 | ||||
| unitPrice |
0..1 | Money | Fee, charge or cost per item | |||||
| factor |
0..1 | decimal | Price scaling factor | |||||
| net |
0..1 | Money | Total item cost | |||||
| noteNumber |
0..* | positiveInt | Applicable note numbers | |||||
| adjudication |
1..* | See adjudication (ClaimResponse) | Added items detail adjudication | |||||
| subDetail |
0..* | BackboneElement | Insurer added line items | |||||
| id |
0..1 | string | Unique id for inter-element referencing | |||||
| extension |
0..* | Extension | Additional content defined by implementations | |||||
| modifierExtension |
0..* | Extension | Extensions that cannot be ignored even if unrecognized | |||||
| productOrService |
1..1 | CodeableConcept | Billing, service, product, or drug code Binding: USCLSCodes (example): Allowable service and product codes. | |||||
| modifier |
0..* | CodeableConcept | Service/Product billing modifiers Binding: ModifierTypeCodes (example): Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen. | |||||
| quantity |
C | 0..1 | SimpleQuantity(4.0.1) | Count of products or services Constraints: sqty-1 | ||||
| unitPrice |
0..1 | Money | Fee, charge or cost per item | |||||
| factor |
0..1 | decimal | Price scaling factor | |||||
| net |
0..1 | Money | Total item cost | |||||
| noteNumber |
0..* | positiveInt | Applicable note numbers | |||||
| adjudication |
1..* | See adjudication (ClaimResponse) | Added items detail adjudication | |||||
| adjudication |
0..* | See adjudication (ClaimResponse) | Claim-level adjudication | |||||
| total |
0..* | BackboneElement | Financial total of the claim for each Adjudication Value Code | |||||
| id |
0..1 | string | Unique id for inter-element referencing | |||||
| extension |
0..* | Extension | Additional content defined by implementations | |||||
| modifierExtension |
0..* | Extension | Extensions that cannot be ignored even if unrecognized | |||||
| category |
1..1 | CodeableConcept | Type of adjudication information Binding: AdjudicationValueCodes (example): The adjudication codes. | |||||
| amount |
1..1 | Money | Financial total for the category | |||||
| payment |
0..1 | BackboneElement | Summary of the payment being made | |||||
| id |
0..1 | string | Unique id for inter-element referencing | |||||
| extension |
0..* | Extension | Additional content defined by implementations | |||||
| modifierExtension |
0..* | Extension | Extensions that cannot be ignored even if unrecognized | |||||
| type |
1..1 | CodeableConcept | Payment Type Code = complete or partial Binding: Payment Type Codes (extensible) | |||||
| adjustment |
0..1 | Money | Payment adjustment for non-claim issues | |||||
| adjustmentReason |
0..1 | CodeableConcept | Explanation for the adjustment Binding: PaymentAdjustmentReasonCodes (example): Payment Adjustment reason codes. | |||||
| date |
0..1 | date | Expected date of payment (if known) | |||||
| amount |
1..1 | Money | Payment amount | |||||
| identifier |
0..1 | Identifier | Business identifier for the payment | |||||
| fundsReserve |
0..1 | CodeableConcept | Funds reserved status Binding: Funds Reservation Codes (example): For whom funds are to be reserved: (Patient, Provider, None). | |||||
| formCode |
0..1 | CodeableConcept | Printed form identifier Binding: Form Codes (example): The forms codes. | |||||
| form |
0..1 | Attachment | Printed reference or actual form | |||||
| processNote |
0..* | BackboneElement | Note concerning adjudication | |||||
| id |
0..1 | string | Unique id for inter-element referencing | |||||
| extension |
0..* | Extension | Additional content defined by implementations | |||||
| modifierExtension |
0..* | Extension | Extensions that cannot be ignored even if unrecognized | |||||
| number |
0..1 | positiveInt | Note instance identifier | |||||
| type |
0..1 | code | display | print | printoper Binding: NoteType (required): The presentation types of notes. | |||||
| text |
1..1 | string | Note explanatory text | |||||
| language |
0..1 | CodeableConcept | Language of the text Binding: CommonLanguages (preferred): A human language.
| |||||
| communicationRequest |
0..* | Reference(CommunicationRequest) | Request for additional information | |||||
| insurance |
0..* | BackboneElement | Patient insurance information | |||||
| id |
0..1 | string | Unique id for inter-element referencing | |||||
| extension |
0..* | Extension | Additional content defined by implementations | |||||
| modifierExtension |
0..* | Extension | Extensions that cannot be ignored even if unrecognized | |||||
| sequence |
1..1 | positiveInt | Insurance instance identifier | |||||
| focal |
1..1 | boolean | Coverage to be used for adjudication | |||||
| coverage |
1..1 | Reference(Coverage) | Insurance information | |||||
| businessArrangement |
0..1 | string | Additional provider contract number | |||||
| claimResponse |
0..1 | Reference(ClaimResponse) | Adjudication results | |||||
| error |
0..* | BackboneElement | Collection of errors produced during claim determination | |||||
| id |
0..1 | string | Unique id for inter-element referencing | |||||
| extension |
0..* | Extension | Additional content defined by implementations | |||||
| modifierExtension |
0..* | Extension | Extensions that cannot be ignored even if unrecognized | |||||
| itemSequence |
0..1 | positiveInt | Refers to itemSequence to which the error relates | |||||
| detailSequence |
0..1 | positiveInt | Refers to detailSequence to which the error relates | |||||
| subDetailSequence |
0..1 | positiveInt | Subdetail sequence number | |||||
| code |
1..1 | CodeableConcept | Error code Binding: Adjudication Error Codes (example): The adjudication error codes. | |||||
| Documentation for this format | ||||||||
| Path | Status | Usage | ValueSet | Version | Source |
| ClaimResponse.meta.security | Base | extensible | SecurityLabels | 📍4.0.1 | FHIR Std. |
| ClaimResponse.meta.tag | Base | example | Common Tags | 📍4.0.1 | FHIR Std. |
| ClaimResponse.meta.tag:correlationId | Base | example | Common Tags | 📍4.0.1 | FHIR Std. |
| ClaimResponse.language | Base | preferred | Common Languages | 📍4.0.1 | FHIR Std. |
| ClaimResponse.identifier.use | Base | required | IdentifierUse | 📍4.0.1 | FHIR Std. |
| ClaimResponse.identifier.type | Base | extensible | IdentifierType | 📍4.0.1 | FHIR Std. |
| ClaimResponse.status | Base | required | Financial Resource Status Codes | 📍4.0.1 | FHIR Std. |
| ClaimResponse.type | Base | extensible | NZ Claim Types | 📦0.4.7 | This IG |
| ClaimResponse.subType | Base | extensible | NZ Claim Subtypes | 📦0.4.7 | This IG |
| ClaimResponse.use | Base | required | Use | 📍4.0.1 | FHIR Std. |
| ClaimResponse.patient.type | Base | extensible | ResourceType | 📍4.0.1 | FHIR Std. |
| ClaimResponse.outcome | Base | required | Claim Processing Codes | 📍4.0.1 | FHIR Std. |
| ClaimResponse.payeeType | Base | example | PayeeType | 📍4.0.1 | FHIR Std. |
| ClaimResponse.item.adjudication.category | Base | extensible | Adjudication Value Codes | 📦0.4.7 | This IG |
| ClaimResponse.item.adjudication.reason | Base | extensible | Adjudication Reason Codes | 📦0.4.7 | This IG |
| ClaimResponse.addItem.productOrService | Base | example | USCLS Codes | 📍4.0.1 | FHIR Std. |
| ClaimResponse.addItem.modifier | Base | example | Modifier type Codes | 📍4.0.1 | FHIR Std. |
| ClaimResponse.addItem.programCode | Base | example | Example Program Reason Codes | 📍4.0.1 | FHIR Std. |
| ClaimResponse.addItem.location[x] | Base | example | Example Service Place Codes | 📍4.0.1 | FHIR Std. |
| ClaimResponse.addItem.bodySite | Base | example | Oral Site Codes | 📍4.0.1 | FHIR Std. |
| ClaimResponse.addItem.subSite | Base | example | Surface Codes | 📍4.0.1 | FHIR Std. |
| ClaimResponse.addItem.detail.productOrService | Base | example | USCLS Codes | 📍4.0.1 | FHIR Std. |
| ClaimResponse.addItem.detail.modifier | Base | example | Modifier type Codes | 📍4.0.1 | FHIR Std. |
| ClaimResponse.addItem.detail.subDetail.productOrService | Base | example | USCLS Codes | 📍4.0.1 | FHIR Std. |
| ClaimResponse.addItem.detail.subDetail.modifier | Base | example | Modifier type Codes | 📍4.0.1 | FHIR Std. |
| ClaimResponse.total.category | Base | example | Adjudication Value Codes | 📍4.0.1 | FHIR Std. |
| ClaimResponse.payment.type | Base | extensible | Payment Type Codes | 📦0.4.7 | This IG |
| ClaimResponse.payment.adjustmentReason | Base | example | Payment Adjustment Reason Codes | 📍4.0.1 | FHIR Std. |
| ClaimResponse.fundsReserve | Base | example | FundsReserve | 📍4.0.1 | FHIR Std. |
| ClaimResponse.formCode | Base | example | Forms | 📍4.0.1 | FHIR Std. |
| ClaimResponse.processNote.type | Base | required | NoteType | 📍4.0.1 | FHIR Std. |
| ClaimResponse.processNote.language | Base | preferred | Common Languages | 📍4.0.1 | FHIR Std. |
| ClaimResponse.error.code | Base | example | AdjudicationError | 📍4.0.1 | FHIR Std. |
| Id | Grade | Path(s) | Description | Expression |
| hpi-location-url-format | error | ClaimResponse.meta.source | Reference must be an HPI facility URL with format https://standards.digital.health.nz/ns/hpi-facility-id/FZZ111-A |
matches('^https://standards.digital.health.nz/ns/hpi-facility-id/F[A-Za-z0-9]{2}[0-9]{3}-[A-Za-z0-9]$')
|
| unique-item-sequence | error | ClaimResponse | Each item.itemSequence must be unique within the ClaimResponse |
item.itemSequence.isDistinct()
|
This structure is derived from ClaimResponse
Summary
Mandatory: 12 elements(3 nested mandatory elements)
Prohibited: 2 elements
Structures
This structure refers to these other structures:
Extensions
This structure refers to these extensions:
Slices
This structure defines the following Slices:
Key Elements View
| Name | Flags | Card. | Type | Description & Constraints Filter: |
|---|---|---|---|---|
| ClaimResponse |
C | 0..* | ClaimResponse | Response to a claim predetermination or preauthorization Constraints: unique-item-sequence |
| meta |
1..1 | Meta | Metadata about the resource | |
| source |
C | 1..1 | uri | HPI Facility ID from where the record is sourced Constraints: hpi-location-url-format |
| profile |
1..1 | canonical(StructureDefinition) | Profiles this resource claims to conform to | |
| Slices for tag |
1..* | Coding | Tags applied to this resource Slice: Unordered, Open by value:system Binding: CommonTags (example): Codes that represent various types of tags, commonly workflow-related; e.g. "Needs review by Dr. Jones". Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them | |
| tag:correlationId |
1..1 | Coding | Tags applied to this resource Binding: CommonTags (example): Codes that represent various types of tags, commonly workflow-related; e.g. "Needs review by Dr. Jones". | |
| system |
1..1 | uri | Hub correlation ID system Required Pattern: https://hub.services.digital.health.nz/ns/correlation-id | |
| code |
1..1 | code | Symbol in syntax defined by the system | |
| implicitRules |
0..1 | uri | A set of rules under which this content was created | |
| Slices for extension |
0..* | Extension | Extension Slice: Unordered, Open by value:url Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them | |
| extension:traceNumber |
0..* | Identifier | Shared Care Claim Trace Number URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/shared-care-trace-number | |
| modifierExtension |
0..* | Extension | Extensions that cannot be ignored | |
| identifier |
1..* | Identifier | Business identifier(s) for the claim response | |
| use |
0..1 | code | usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known . | |
| system |
1..1 | uri | The namespace for the identifier value Example General: http://www.acme.com/identifiers/patient | |
| value |
1..1 | string | The value that is unique Example General: 123456 | |
| status |
1..1 | code | Status of the Claim Response: active, cancelled, draft, entered-in-error Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance. | |
| type |
1..1 | CodeableConcept | More granular claim type Binding: NZ Claim Types (extensible) | |
| subType |
1..1 | CodeableConcept | More granular claim type Binding: NZ Claim Subtypes (extensible) | |
| use |
1..1 | code | claim | preauthorization | predetermination Binding: Use (required): Claim, preauthorization, predetermination. | |
| patient |
1..1 | Reference(Patient) | The recipient of the products and services | |
| created |
1..1 | dateTime | Date & time of claim determination | |
| insurer |
1..1 | Reference(Organization) | Party responsible for reimbursement | |
| requestor |
0..1 | Reference(Practitioner | PractitionerRole | Organization) | Party responsible for the Claim | |
| request |
1..1 | Reference(NZ SharedCare Claim) | Reference to the Claim that was determined | |
| outcome |
1..1 | code | queued | complete | error | partial Binding: ClaimProcessingCodes (required): The result of the claim processing. | |
| item |
0..* | BackboneElement | Claim response items | |
| Slices for extension |
1..* | Extension | Extension Slice: Unordered, Open by value:url Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them | |
| extension:traceNumber |
0..* | Identifier | Shared Care Claim Trace Number URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/shared-care-trace-number | |
| extension:productOrService |
1..1 | CodeableConcept | Shared Care Product Or Service URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/shared-care-product-or-service | |
| extension:reviewOutcome |
0..1 | (Complex) | Shared Care Review Outcome URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/shared-care-review-outcome | |
| modifierExtension |
0..* | Extension | Extensions that cannot be ignored even if unrecognized | |
| itemSequence |
1..1 | positiveInt | Value of the corresponding Claim.item.sequence | |
| adjudication |
1..* | BackboneElement | Adjudication (reason, amount, quantity) for each Adjudication Value Code | |
| modifierExtension |
0..* | Extension | Extensions that cannot be ignored even if unrecognized | |
| category |
1..1 | CodeableConcept | Codified representation of adjudication outcome Binding: Adjudication Value Codes (extensible) | |
| reason |
0..1 | CodeableConcept | Codified reason(s) for the adjudication Binding: Adjudication Reason Codes (extensible) | |
| amount |
1..1 | Money | Monetary value of the adjudication | |
| value |
0..1 | decimal | Non-monetary value of the adjudication | |
| detail |
0..* | BackboneElement | Any sub-determinations of this itemSequence | |
| Slices for extension |
0..* | Extension | Extension Slice: Unordered, Open by value:url Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them | |
| extension:traceNumber |
0..* | Identifier | Shared Care Claim Trace Number URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/shared-care-trace-number | |
| extension:reviewOutcome |
0..1 | (Complex) | Shared Care Review Outcome URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/shared-care-review-outcome | |
| modifierExtension |
0..* | Extension | Extensions that cannot be ignored even if unrecognized | |
| detailSequence |
1..1 | positiveInt | Value of the corresponding Claim.item.detail.sequence | |
| adjudication |
1..* | See adjudication (ClaimResponse) | Detail level adjudication details | |
| addItem |
0..* | BackboneElement | Any line items added by Health NZ to the claim determination that were not in the original claim | |
| modifierExtension |
0..* | Extension | Extensions that cannot be ignored even if unrecognized | |
| productOrService |
1..1 | CodeableConcept | Billing, service, product, or drug code Binding: USCLSCodes (example): Allowable service and product codes. | |
| adjudication |
1..* | See adjudication (ClaimResponse) | Added items adjudication | |
| adjudication |
0..* | See adjudication (ClaimResponse) | Claim-level adjudication | |
| total |
0..* | BackboneElement | Financial total of the claim for each Adjudication Value Code | |
| modifierExtension |
0..* | Extension | Extensions that cannot be ignored even if unrecognized | |
| category |
1..1 | CodeableConcept | Type of adjudication information Binding: AdjudicationValueCodes (example): The adjudication codes. | |
| amount |
1..1 | Money | Financial total for the category | |
| payment |
0..1 | BackboneElement | Summary of the payment being made | |
| modifierExtension |
0..* | Extension | Extensions that cannot be ignored even if unrecognized | |
| type |
1..1 | CodeableConcept | Payment Type Code = complete or partial Binding: Payment Type Codes (extensible) | |
| date |
0..1 | date | Expected date of payment (if known) | |
| amount |
1..1 | Money | Payment amount | |
| error |
0..* | BackboneElement | Collection of errors produced during claim determination | |
| modifierExtension |
0..* | Extension | Extensions that cannot be ignored even if unrecognized | |
| itemSequence |
0..1 | positiveInt | Refers to itemSequence to which the error relates | |
| detailSequence |
0..1 | positiveInt | Refers to detailSequence to which the error relates | |
| code |
1..1 | CodeableConcept | Error code Binding: Adjudication Error Codes (example): The adjudication error codes. | |
| Documentation for this format | ||||
| Path | Status | Usage | ValueSet | Version | Source |
| ClaimResponse.meta.tag | Base | example | Common Tags | 📍4.0.1 | FHIR Std. |
| ClaimResponse.meta.tag:correlationId | Base | example | Common Tags | 📍4.0.1 | FHIR Std. |
| ClaimResponse.identifier.use | Base | required | IdentifierUse | 📍4.0.1 | FHIR Std. |
| ClaimResponse.status | Base | required | Financial Resource Status Codes | 📍4.0.1 | FHIR Std. |
| ClaimResponse.type | Base | extensible | NZ Claim Types | 📦0.4.7 | This IG |
| ClaimResponse.subType | Base | extensible | NZ Claim Subtypes | 📦0.4.7 | This IG |
| ClaimResponse.use | Base | required | Use | 📍4.0.1 | FHIR Std. |
| ClaimResponse.outcome | Base | required | Claim Processing Codes | 📍4.0.1 | FHIR Std. |
| ClaimResponse.item.adjudication.category | Base | extensible | Adjudication Value Codes | 📦0.4.7 | This IG |
| ClaimResponse.item.adjudication.reason | Base | extensible | Adjudication Reason Codes | 📦0.4.7 | This IG |
| ClaimResponse.addItem.productOrService | Base | example | USCLS Codes | 📍4.0.1 | FHIR Std. |
| ClaimResponse.total.category | Base | example | Adjudication Value Codes | 📍4.0.1 | FHIR Std. |
| ClaimResponse.payment.type | Base | extensible | Payment Type Codes | 📦0.4.7 | This IG |
| ClaimResponse.error.code | Base | example | AdjudicationError | 📍4.0.1 | FHIR Std. |
| Id | Grade | Path(s) | Description | Expression |
| hpi-location-url-format | error | ClaimResponse.meta.source | Reference must be an HPI facility URL with format https://standards.digital.health.nz/ns/hpi-facility-id/FZZ111-A |
matches('^https://standards.digital.health.nz/ns/hpi-facility-id/F[A-Za-z0-9]{2}[0-9]{3}-[A-Za-z0-9]$')
|
| unique-item-sequence | error | ClaimResponse | Each item.itemSequence must be unique within the ClaimResponse |
item.itemSequence.isDistinct()
|
Differential View
This structure is derived from ClaimResponse
| Name | Flags | Card. | Type | Description & Constraints Filter: |
|---|---|---|---|---|
| ClaimResponse |
C | 0..* | ClaimResponse | Response to a claim predetermination or preauthorization Constraints: unique-item-sequence |
| meta |
1..1 | Meta | Metadata about the resource | |
| source |
C | 1..1 | uri | HPI Facility ID from where the record is sourced Constraints: hpi-location-url-format |
| profile |
1..1 | canonical(StructureDefinition) | Profiles this resource claims to conform to | |
| Slices for tag |
1..* | Coding | Tags applied to this resource Slice: Unordered, Open by value:system Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them | |
| tag:correlationId |
1..1 | Coding | Tags applied to this resource | |
| system |
1..1 | uri | Hub correlation ID system Required Pattern: https://hub.services.digital.health.nz/ns/correlation-id | |
| code |
1..1 | code | Symbol in syntax defined by the system | |
| contained |
0..0 | Contained, inline Resources | ||
| Slices for extension |
0..* | Extension | Extension Slice: Unordered, Open by value:url Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them | |
| extension:traceNumber |
0..* | Identifier | Shared Care Claim Trace Number URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/shared-care-trace-number | |
| identifier |
1..* | Identifier | Business identifier(s) for the claim response | |
| system |
1..1 | uri | The namespace for the identifier value | |
| value |
1..1 | string | The value that is unique | |
| status |
1..1 | code | Status of the Claim Response: active, cancelled, draft, entered-in-error | |
| type |
1..1 | CodeableConcept | More granular claim type Binding: NZ Claim Types (extensible) | |
| subType |
1..1 | CodeableConcept | More granular claim type Binding: NZ Claim Subtypes (extensible) | |
| patient |
||||
| display |
0..0 | Remove from all examples. Never return in a response. Never save if provided. | ||
| created |
1..1 | dateTime | Date & time of claim determination | |
| requestor |
0..1 | Reference(Practitioner | PractitionerRole | Organization) | Party responsible for the Claim | |
| request |
1..1 | Reference(NZ SharedCare Claim) | Reference to the Claim that was determined | |
| item |
0..* | BackboneElement | Claim response items | |
| Slices for extension |
1..* | Extension | Extension Slice: Unordered, Open by value:url Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them | |
| extension:traceNumber |
0..* | Identifier | Shared Care Claim Trace Number URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/shared-care-trace-number | |
| extension:productOrService |
1..1 | CodeableConcept | Shared Care Product Or Service URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/shared-care-product-or-service | |
| extension:reviewOutcome |
0..1 | (Complex) | Shared Care Review Outcome URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/shared-care-review-outcome | |
| itemSequence |
1..1 | positiveInt | Value of the corresponding Claim.item.sequence | |
| adjudication |
1..* | BackboneElement | Adjudication (reason, amount, quantity) for each Adjudication Value Code | |
| category |
1..1 | CodeableConcept | Codified representation of adjudication outcome Binding: Adjudication Value Codes (extensible) | |
| reason |
0..1 | CodeableConcept | Codified reason(s) for the adjudication Binding: Adjudication Reason Codes (extensible) | |
| amount |
1..1 | Money | Monetary value of the adjudication | |
| value |
0..1 | decimal | Non-monetary value of the adjudication | |
| detail |
0..* | BackboneElement | Any sub-determinations of this itemSequence | |
| Slices for extension |
0..* | Extension | Extension Slice: Unordered, Open by value:url Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them | |
| extension:traceNumber |
0..* | Identifier | Shared Care Claim Trace Number URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/shared-care-trace-number | |
| extension:reviewOutcome |
0..1 | (Complex) | Shared Care Review Outcome URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/shared-care-review-outcome | |
| detailSequence |
1..1 | positiveInt | Value of the corresponding Claim.item.detail.sequence | |
| addItem |
0..* | BackboneElement | Any line items added by Health NZ to the claim determination that were not in the original claim | |
| adjudication |
0..* | Claim-level adjudication | ||
| total |
0..* | BackboneElement | Financial total of the claim for each Adjudication Value Code | |
| payment |
0..1 | BackboneElement | Summary of the payment being made | |
| type |
1..1 | CodeableConcept | Payment Type Code = complete or partial Binding: Payment Type Codes (extensible) | |
| date |
0..1 | date | Expected date of payment (if known) | |
| amount |
1..1 | Money | Payment amount | |
| error |
0..* | BackboneElement | Collection of errors produced during claim determination | |
| itemSequence |
0..1 | positiveInt | Refers to itemSequence to which the error relates | |
| detailSequence |
0..1 | positiveInt | Refers to detailSequence to which the error relates | |
| code |
1..1 | CodeableConcept | Error code | |
| Documentation for this format | ||||
| Path | Status | Usage | ValueSet | Version | Source |
| ClaimResponse.type | Base | extensible | NZ Claim Types | 📦0.4.7 | This IG |
| ClaimResponse.subType | Base | extensible | NZ Claim Subtypes | 📦0.4.7 | This IG |
| ClaimResponse.item.adjudication.category | Base | extensible | Adjudication Value Codes | 📦0.4.7 | This IG |
| ClaimResponse.item.adjudication.reason | Base | extensible | Adjudication Reason Codes | 📦0.4.7 | This IG |
| ClaimResponse.payment.type | Base | extensible | Payment Type Codes | 📦0.4.7 | This IG |
| Id | Grade | Path(s) | Description | Expression |
| hpi-location-url-format | error | ClaimResponse.meta.source | Reference must be an HPI facility URL with format https://standards.digital.health.nz/ns/hpi-facility-id/FZZ111-A |
matches('^https://standards.digital.health.nz/ns/hpi-facility-id/F[A-Za-z0-9]{2}[0-9]{3}-[A-Za-z0-9]$')
|
| unique-item-sequence | error | ClaimResponse | Each item.itemSequence must be unique within the ClaimResponse |
item.itemSequence.isDistinct()
|
Snapshot View
| Name | Flags | Card. | Type | Description & Constraints Filter: | ||||
|---|---|---|---|---|---|---|---|---|
| ClaimResponse |
C | 0..* | ClaimResponse | Response to a claim predetermination or preauthorization Constraints: unique-item-sequence | ||||
| id |
0..1 | id | Logical id of this artifact | |||||
| meta |
1..1 | Meta | Metadata about the resource | |||||
| id |
0..1 | string | Unique id for inter-element referencing | |||||
| extension |
0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | |||||
| versionId |
0..1 | id | Version specific identifier | |||||
| lastUpdated |
0..1 | instant | When the resource version last changed | |||||
| source |
C | 1..1 | uri | HPI Facility ID from where the record is sourced Constraints: hpi-location-url-format | ||||
| profile |
1..1 | canonical(StructureDefinition) | Profiles this resource claims to conform to | |||||
| security |
0..* | Coding | Security Labels applied to this resource Binding: All Security Labels (extensible): Security Labels from the Healthcare Privacy and Security Classification System. | |||||
| Slices for tag |
1..* | Coding | Tags applied to this resource Slice: Unordered, Open by value:system Binding: CommonTags (example): Codes that represent various types of tags, commonly workflow-related; e.g. "Needs review by Dr. Jones". Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them | |||||
| tag:correlationId |
1..1 | Coding | Tags applied to this resource Binding: CommonTags (example): Codes that represent various types of tags, commonly workflow-related; e.g. "Needs review by Dr. Jones". | |||||
| id |
0..1 | string | Unique id for inter-element referencing | |||||
| extension |
0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | |||||
| system |
1..1 | uri | Hub correlation ID system Required Pattern: https://hub.services.digital.health.nz/ns/correlation-id | |||||
| version |
0..1 | string | Version of the system - if relevant | |||||
| code |
1..1 | code | Symbol in syntax defined by the system | |||||
| display |
0..1 | string | Representation defined by the system | |||||
| userSelected |
0..1 | boolean | If this coding was chosen directly by the user | |||||
| implicitRules |
0..1 | uri | A set of rules under which this content was created | |||||
| language |
0..1 | code | Language of the resource content Binding: CommonLanguages (preferred): A human language.
| |||||
| text |
0..1 | Narrative | Text summary of the resource, for human interpretation This profile does not constrain the narrative in regard to content, language, or traceability to data elements | |||||
| Slices for extension |
0..* | Extension | Extension Slice: Unordered, Open by value:url Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them | |||||
| extension:traceNumber |
0..* | Identifier | Shared Care Claim Trace Number URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/shared-care-trace-number | |||||
| modifierExtension |
0..* | Extension | Extensions that cannot be ignored | |||||
| identifier |
1..* | Identifier | Business identifier(s) for the claim response | |||||
| id |
0..1 | string | Unique id for inter-element referencing | |||||
| extension |
0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | |||||
| use |
0..1 | code | usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known . | |||||
| type |
0..1 | CodeableConcept | Description of identifier Binding: Identifier Type Codes (extensible): A coded type for an identifier that can be used to determine which identifier to use for a specific purpose. | |||||
| system |
1..1 | uri | The namespace for the identifier value Example General: http://www.acme.com/identifiers/patient | |||||
| value |
1..1 | string | The value that is unique Example General: 123456 | |||||
| period |
0..1 | Period | Time period when id is/was valid for use | |||||
| assigner |
0..1 | Reference(Organization) | Organization that issued id (may be just text) | |||||
| status |
1..1 | code | Status of the Claim Response: active, cancelled, draft, entered-in-error Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance. | |||||
| type |
1..1 | CodeableConcept | More granular claim type Binding: NZ Claim Types (extensible) | |||||
| subType |
1..1 | CodeableConcept | More granular claim type Binding: NZ Claim Subtypes (extensible) | |||||
| use |
1..1 | code | claim | preauthorization | predetermination Binding: Use (required): Claim, preauthorization, predetermination. | |||||
| patient |
1..1 | Reference(Patient) | The recipient of the products and services | |||||
| id |
0..1 | string | Unique id for inter-element referencing | |||||
| extension |
0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | |||||
| reference |
C | 0..1 | string | Literal reference, Relative, internal or absolute URL | ||||
| type |
0..1 | uri | Type the reference refers to (e.g. "Patient") Binding: ResourceType (extensible): Aa resource (or, for logical models, the URI of the logical model). | |||||
| identifier |
0..1 | Identifier | Logical reference, when literal reference is not known | |||||
| created |
1..1 | dateTime | Date & time of claim determination | |||||
| insurer |
1..1 | Reference(Organization) | Party responsible for reimbursement | |||||
| requestor |
0..1 | Reference(Practitioner | PractitionerRole | Organization) | Party responsible for the Claim | |||||
| request |
1..1 | Reference(NZ SharedCare Claim) | Reference to the Claim that was determined | |||||
| outcome |
1..1 | code | queued | complete | error | partial Binding: ClaimProcessingCodes (required): The result of the claim processing. | |||||
| disposition |
0..1 | string | Disposition Message | |||||
| preAuthRef |
0..1 | string | Preauthorization reference | |||||
| preAuthPeriod |
0..1 | Period | Preauthorization reference effective period | |||||
| payeeType |
0..1 | CodeableConcept | Party to be paid any benefits payable Binding: Claim Payee Type Codes (example): A code for the party to be reimbursed. | |||||
| item |
0..* | BackboneElement | Claim response items | |||||
| id |
0..1 | string | Unique id for inter-element referencing | |||||
| Slices for extension |
1..* | Extension | Extension Slice: Unordered, Open by value:url Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them | |||||
| extension:traceNumber |
0..* | Identifier | Shared Care Claim Trace Number URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/shared-care-trace-number | |||||
| extension:productOrService |
1..1 | CodeableConcept | Shared Care Product Or Service URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/shared-care-product-or-service | |||||
| extension:reviewOutcome |
0..1 | (Complex) | Shared Care Review Outcome URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/shared-care-review-outcome | |||||
| modifierExtension |
0..* | Extension | Extensions that cannot be ignored even if unrecognized | |||||
| itemSequence |
1..1 | positiveInt | Value of the corresponding Claim.item.sequence | |||||
| noteNumber |
0..* | positiveInt | Applicable note numbers | |||||
| adjudication |
1..* | BackboneElement | Adjudication (reason, amount, quantity) for each Adjudication Value Code | |||||
| id |
0..1 | string | Unique id for inter-element referencing | |||||
| extension |
0..* | Extension | Additional content defined by implementations | |||||
| modifierExtension |
0..* | Extension | Extensions that cannot be ignored even if unrecognized | |||||
| category |
1..1 | CodeableConcept | Codified representation of adjudication outcome Binding: Adjudication Value Codes (extensible) | |||||
| reason |
0..1 | CodeableConcept | Codified reason(s) for the adjudication Binding: Adjudication Reason Codes (extensible) | |||||
| amount |
1..1 | Money | Monetary value of the adjudication | |||||
| value |
0..1 | decimal | Non-monetary value of the adjudication | |||||
| detail |
0..* | BackboneElement | Any sub-determinations of this itemSequence | |||||
| id |
0..1 | string | Unique id for inter-element referencing | |||||
| Slices for extension |
0..* | Extension | Extension Slice: Unordered, Open by value:url Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them | |||||
| extension:traceNumber |
0..* | Identifier | Shared Care Claim Trace Number URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/shared-care-trace-number | |||||
| extension:reviewOutcome |
0..1 | (Complex) | Shared Care Review Outcome URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/shared-care-review-outcome | |||||
| modifierExtension |
0..* | Extension | Extensions that cannot be ignored even if unrecognized | |||||
| detailSequence |
1..1 | positiveInt | Value of the corresponding Claim.item.detail.sequence | |||||
| noteNumber |
0..* | positiveInt | Applicable note numbers | |||||
| adjudication |
1..* | See adjudication (ClaimResponse) | Detail level adjudication details | |||||
| subDetail |
0..* | BackboneElement | Adjudication for claim sub-details | |||||
| id |
0..1 | string | Unique id for inter-element referencing | |||||
| extension |
0..* | Extension | Additional content defined by implementations | |||||
| modifierExtension |
0..* | Extension | Extensions that cannot be ignored even if unrecognized | |||||
| subDetailSequence |
1..1 | positiveInt | Claim sub-detail instance identifier | |||||
| noteNumber |
0..* | positiveInt | Applicable note numbers | |||||
| adjudication |
0..* | See adjudication (ClaimResponse) | Subdetail level adjudication details | |||||
| addItem |
0..* | BackboneElement | Any line items added by Health NZ to the claim determination that were not in the original claim | |||||
| id |
0..1 | string | Unique id for inter-element referencing | |||||
| extension |
0..* | Extension | Additional content defined by implementations | |||||
| modifierExtension |
0..* | Extension | Extensions that cannot be ignored even if unrecognized | |||||
| itemSequence |
0..* | positiveInt | Item sequence number | |||||
| detailSequence |
0..* | positiveInt | Detail sequence number | |||||
| subdetailSequence |
0..* | positiveInt | Subdetail sequence number | |||||
| provider |
0..* | Reference(Practitioner | PractitionerRole | Organization) | Authorized providers | |||||
| productOrService |
1..1 | CodeableConcept | Billing, service, product, or drug code Binding: USCLSCodes (example): Allowable service and product codes. | |||||
| modifier |
0..* | CodeableConcept | Service/Product billing modifiers Binding: ModifierTypeCodes (example): Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen. | |||||
| programCode |
0..* | CodeableConcept | Program the product or service is provided under Binding: ExampleProgramReasonCodes (example): Program specific reason codes. | |||||
| serviced[x] |
0..1 | Date or dates of service or product delivery | ||||||
| servicedDate |
date | |||||||
| servicedPeriod |
Period | |||||||
| location[x] |
0..1 | Place of service or where product was supplied Binding: ExampleServicePlaceCodes (example): Place of service: pharmacy, school, prison, etc. | ||||||
| locationCodeableConcept |
CodeableConcept | |||||||
| locationAddress |
Address | |||||||
| locationReference |
Reference(Location) | |||||||
| quantity |
C | 0..1 | SimpleQuantity(4.0.1) | Count of products or services Constraints: sqty-1 | ||||
| unitPrice |
0..1 | Money | Fee, charge or cost per item | |||||
| factor |
0..1 | decimal | Price scaling factor | |||||
| net |
0..1 | Money | Total item cost | |||||
| bodySite |
0..1 | CodeableConcept | Anatomical location Binding: OralSiteCodes (example): The code for the teeth, quadrant, sextant and arch. | |||||
| subSite |
0..* | CodeableConcept | Anatomical sub-location Binding: SurfaceCodes (example): The code for the tooth surface and surface combinations. | |||||
| noteNumber |
0..* | positiveInt | Applicable note numbers | |||||
| adjudication |
1..* | See adjudication (ClaimResponse) | Added items adjudication | |||||
| detail |
0..* | BackboneElement | Insurer added line details | |||||
| id |
0..1 | string | Unique id for inter-element referencing | |||||
| extension |
0..* | Extension | Additional content defined by implementations | |||||
| modifierExtension |
0..* | Extension | Extensions that cannot be ignored even if unrecognized | |||||
| productOrService |
1..1 | CodeableConcept | Billing, service, product, or drug code Binding: USCLSCodes (example): Allowable service and product codes. | |||||
| modifier |
0..* | CodeableConcept | Service/Product billing modifiers Binding: ModifierTypeCodes (example): Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen. | |||||
| quantity |
C | 0..1 | SimpleQuantity(4.0.1) | Count of products or services Constraints: sqty-1 | ||||
| unitPrice |
0..1 | Money | Fee, charge or cost per item | |||||
| factor |
0..1 | decimal | Price scaling factor | |||||
| net |
0..1 | Money | Total item cost | |||||
| noteNumber |
0..* | positiveInt | Applicable note numbers | |||||
| adjudication |
1..* | See adjudication (ClaimResponse) | Added items detail adjudication | |||||
| subDetail |
0..* | BackboneElement | Insurer added line items | |||||
| id |
0..1 | string | Unique id for inter-element referencing | |||||
| extension |
0..* | Extension | Additional content defined by implementations | |||||
| modifierExtension |
0..* | Extension | Extensions that cannot be ignored even if unrecognized | |||||
| productOrService |
1..1 | CodeableConcept | Billing, service, product, or drug code Binding: USCLSCodes (example): Allowable service and product codes. | |||||
| modifier |
0..* | CodeableConcept | Service/Product billing modifiers Binding: ModifierTypeCodes (example): Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen. | |||||
| quantity |
C | 0..1 | SimpleQuantity(4.0.1) | Count of products or services Constraints: sqty-1 | ||||
| unitPrice |
0..1 | Money | Fee, charge or cost per item | |||||
| factor |
0..1 | decimal | Price scaling factor | |||||
| net |
0..1 | Money | Total item cost | |||||
| noteNumber |
0..* | positiveInt | Applicable note numbers | |||||
| adjudication |
1..* | See adjudication (ClaimResponse) | Added items detail adjudication | |||||
| adjudication |
0..* | See adjudication (ClaimResponse) | Claim-level adjudication | |||||
| total |
0..* | BackboneElement | Financial total of the claim for each Adjudication Value Code | |||||
| id |
0..1 | string | Unique id for inter-element referencing | |||||
| extension |
0..* | Extension | Additional content defined by implementations | |||||
| modifierExtension |
0..* | Extension | Extensions that cannot be ignored even if unrecognized | |||||
| category |
1..1 | CodeableConcept | Type of adjudication information Binding: AdjudicationValueCodes (example): The adjudication codes. | |||||
| amount |
1..1 | Money | Financial total for the category | |||||
| payment |
0..1 | BackboneElement | Summary of the payment being made | |||||
| id |
0..1 | string | Unique id for inter-element referencing | |||||
| extension |
0..* | Extension | Additional content defined by implementations | |||||
| modifierExtension |
0..* | Extension | Extensions that cannot be ignored even if unrecognized | |||||
| type |
1..1 | CodeableConcept | Payment Type Code = complete or partial Binding: Payment Type Codes (extensible) | |||||
| adjustment |
0..1 | Money | Payment adjustment for non-claim issues | |||||
| adjustmentReason |
0..1 | CodeableConcept | Explanation for the adjustment Binding: PaymentAdjustmentReasonCodes (example): Payment Adjustment reason codes. | |||||
| date |
0..1 | date | Expected date of payment (if known) | |||||
| amount |
1..1 | Money | Payment amount | |||||
| identifier |
0..1 | Identifier | Business identifier for the payment | |||||
| fundsReserve |
0..1 | CodeableConcept | Funds reserved status Binding: Funds Reservation Codes (example): For whom funds are to be reserved: (Patient, Provider, None). | |||||
| formCode |
0..1 | CodeableConcept | Printed form identifier Binding: Form Codes (example): The forms codes. | |||||
| form |
0..1 | Attachment | Printed reference or actual form | |||||
| processNote |
0..* | BackboneElement | Note concerning adjudication | |||||
| id |
0..1 | string | Unique id for inter-element referencing | |||||
| extension |
0..* | Extension | Additional content defined by implementations | |||||
| modifierExtension |
0..* | Extension | Extensions that cannot be ignored even if unrecognized | |||||
| number |
0..1 | positiveInt | Note instance identifier | |||||
| type |
0..1 | code | display | print | printoper Binding: NoteType (required): The presentation types of notes. | |||||
| text |
1..1 | string | Note explanatory text | |||||
| language |
0..1 | CodeableConcept | Language of the text Binding: CommonLanguages (preferred): A human language.
| |||||
| communicationRequest |
0..* | Reference(CommunicationRequest) | Request for additional information | |||||
| insurance |
0..* | BackboneElement | Patient insurance information | |||||
| id |
0..1 | string | Unique id for inter-element referencing | |||||
| extension |
0..* | Extension | Additional content defined by implementations | |||||
| modifierExtension |
0..* | Extension | Extensions that cannot be ignored even if unrecognized | |||||
| sequence |
1..1 | positiveInt | Insurance instance identifier | |||||
| focal |
1..1 | boolean | Coverage to be used for adjudication | |||||
| coverage |
1..1 | Reference(Coverage) | Insurance information | |||||
| businessArrangement |
0..1 | string | Additional provider contract number | |||||
| claimResponse |
0..1 | Reference(ClaimResponse) | Adjudication results | |||||
| error |
0..* | BackboneElement | Collection of errors produced during claim determination | |||||
| id |
0..1 | string | Unique id for inter-element referencing | |||||
| extension |
0..* | Extension | Additional content defined by implementations | |||||
| modifierExtension |
0..* | Extension | Extensions that cannot be ignored even if unrecognized | |||||
| itemSequence |
0..1 | positiveInt | Refers to itemSequence to which the error relates | |||||
| detailSequence |
0..1 | positiveInt | Refers to detailSequence to which the error relates | |||||
| subDetailSequence |
0..1 | positiveInt | Subdetail sequence number | |||||
| code |
1..1 | CodeableConcept | Error code Binding: Adjudication Error Codes (example): The adjudication error codes. | |||||
| Documentation for this format | ||||||||
| Path | Status | Usage | ValueSet | Version | Source |
| ClaimResponse.meta.security | Base | extensible | SecurityLabels | 📍4.0.1 | FHIR Std. |
| ClaimResponse.meta.tag | Base | example | Common Tags | 📍4.0.1 | FHIR Std. |
| ClaimResponse.meta.tag:correlationId | Base | example | Common Tags | 📍4.0.1 | FHIR Std. |
| ClaimResponse.language | Base | preferred | Common Languages | 📍4.0.1 | FHIR Std. |
| ClaimResponse.identifier.use | Base | required | IdentifierUse | 📍4.0.1 | FHIR Std. |
| ClaimResponse.identifier.type | Base | extensible | IdentifierType | 📍4.0.1 | FHIR Std. |
| ClaimResponse.status | Base | required | Financial Resource Status Codes | 📍4.0.1 | FHIR Std. |
| ClaimResponse.type | Base | extensible | NZ Claim Types | 📦0.4.7 | This IG |
| ClaimResponse.subType | Base | extensible | NZ Claim Subtypes | 📦0.4.7 | This IG |
| ClaimResponse.use | Base | required | Use | 📍4.0.1 | FHIR Std. |
| ClaimResponse.patient.type | Base | extensible | ResourceType | 📍4.0.1 | FHIR Std. |
| ClaimResponse.outcome | Base | required | Claim Processing Codes | 📍4.0.1 | FHIR Std. |
| ClaimResponse.payeeType | Base | example | PayeeType | 📍4.0.1 | FHIR Std. |
| ClaimResponse.item.adjudication.category | Base | extensible | Adjudication Value Codes | 📦0.4.7 | This IG |
| ClaimResponse.item.adjudication.reason | Base | extensible | Adjudication Reason Codes | 📦0.4.7 | This IG |
| ClaimResponse.addItem.productOrService | Base | example | USCLS Codes | 📍4.0.1 | FHIR Std. |
| ClaimResponse.addItem.modifier | Base | example | Modifier type Codes | 📍4.0.1 | FHIR Std. |
| ClaimResponse.addItem.programCode | Base | example | Example Program Reason Codes | 📍4.0.1 | FHIR Std. |
| ClaimResponse.addItem.location[x] | Base | example | Example Service Place Codes | 📍4.0.1 | FHIR Std. |
| ClaimResponse.addItem.bodySite | Base | example | Oral Site Codes | 📍4.0.1 | FHIR Std. |
| ClaimResponse.addItem.subSite | Base | example | Surface Codes | 📍4.0.1 | FHIR Std. |
| ClaimResponse.addItem.detail.productOrService | Base | example | USCLS Codes | 📍4.0.1 | FHIR Std. |
| ClaimResponse.addItem.detail.modifier | Base | example | Modifier type Codes | 📍4.0.1 | FHIR Std. |
| ClaimResponse.addItem.detail.subDetail.productOrService | Base | example | USCLS Codes | 📍4.0.1 | FHIR Std. |
| ClaimResponse.addItem.detail.subDetail.modifier | Base | example | Modifier type Codes | 📍4.0.1 | FHIR Std. |
| ClaimResponse.total.category | Base | example | Adjudication Value Codes | 📍4.0.1 | FHIR Std. |
| ClaimResponse.payment.type | Base | extensible | Payment Type Codes | 📦0.4.7 | This IG |
| ClaimResponse.payment.adjustmentReason | Base | example | Payment Adjustment Reason Codes | 📍4.0.1 | FHIR Std. |
| ClaimResponse.fundsReserve | Base | example | FundsReserve | 📍4.0.1 | FHIR Std. |
| ClaimResponse.formCode | Base | example | Forms | 📍4.0.1 | FHIR Std. |
| ClaimResponse.processNote.type | Base | required | NoteType | 📍4.0.1 | FHIR Std. |
| ClaimResponse.processNote.language | Base | preferred | Common Languages | 📍4.0.1 | FHIR Std. |
| ClaimResponse.error.code | Base | example | AdjudicationError | 📍4.0.1 | FHIR Std. |
| Id | Grade | Path(s) | Description | Expression |
| hpi-location-url-format | error | ClaimResponse.meta.source | Reference must be an HPI facility URL with format https://standards.digital.health.nz/ns/hpi-facility-id/FZZ111-A |
matches('^https://standards.digital.health.nz/ns/hpi-facility-id/F[A-Za-z0-9]{2}[0-9]{3}-[A-Za-z0-9]$')
|
| unique-item-sequence | error | ClaimResponse | Each item.itemSequence must be unique within the ClaimResponse |
item.itemSequence.isDistinct()
|
This structure is derived from ClaimResponse
Summary
Mandatory: 12 elements(3 nested mandatory elements)
Prohibited: 2 elements
Structures
This structure refers to these other structures:
Extensions
This structure refers to these extensions:
Slices
This structure defines the following Slices:
Other representations of profile: CSV, Excel, Schematron