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

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Resource Profile: New Zealand Pharmacy Claim Response

FHIR profile for New Zealand pharmacy claim responses

Usages:

• Examples for this Profile: ClaimResponse/NzPharmacyClaimResponseExample
• CapabilityStatements using this Profile: Shared Care FHIR Server Capability Statement

You can also check for usages in the FHIR IG Statistics

Formal Views of Profile Content

Description of Profiles, Differentials, Snapshots and how the different presentations work.

• Key Elements Table
• Differential Table
• Snapshot Table
• Statistics/References
• All

Name	Flags	Card.	Type	Description & Constraints    Filter: Bindings Constraints Obligations
ClaimResponse		0..*	ClaimResponse	Response to a claim predetermination or preauthorization
ClaimResponse.meta	Σ This element is included in summaries.	1..1	Meta	Metadata about the resource
ClaimResponse.meta.source	Σ This element is included in summaries. C	1..1	uri	HPI Facility ID from where the record is sourced Constraints: hpi-location-url-format
ClaimResponse.meta.profile	Σ This element is included in summaries.	1..1	canonical(StructureDefinition)	Profiles this resource claims to conform to
ClaimResponse.meta.Slices for tag	Σ This element is included in summaries.	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
ClaimResponse.meta.Slices for tag.tag:correlationId	Σ This element is included in summaries.	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".
ClaimResponse.meta.Slices for tag.tag:correlationId.system	Σ This element is included in summaries.	1..1	uri	Hub correlation ID system Required Pattern: https://hub.services.digital.health.nz/ns/correlation-id
ClaimResponse.meta.Slices for tag.tag:correlationId.code	Σ This element is included in summaries.	1..1	code	Symbol in syntax defined by the system
ClaimResponse.implicitRules	?! This element is a modifier element. Σ This element is included in summaries.	0..1	uri	A set of rules under which this content was created
ClaimResponse.modifierExtension	?! This element is a modifier element.	0..*	Extension	Extensions that cannot be ignored
ClaimResponse.identifier		1..1	Identifier	ClaimResponse identifier
ClaimResponse.identifier.use	?! This element is a modifier element. Σ This element is included in summaries.	0..1	code	usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .
ClaimResponse.identifier.system	Σ This element is included in summaries.	1..1	uri	The namespace for the identifier value Fixed Value: https://standards.digital.health.nz/ns/claim-response-identifier
ClaimResponse.identifier.value	Σ This element is included in summaries.	1..1	string	The value that is unique Example General: 123456
ClaimResponse.status	?! This element is a modifier element. Σ This element is included in summaries.	1..1	code	active | cancelled | draft | entered-in-error Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance.
ClaimResponse.type	Σ This element is included in summaries.	1..1	CodeableConcept	More granular claim type Binding: NZ Claim Types (extensible)
ClaimResponse.subType		1..1	CodeableConcept	More granular claim type Binding: NZ Claim Subtypes (extensible)
ClaimResponse.use	Σ This element is included in summaries.	1..1	code	claim | preauthorization | predetermination Binding: Use (required): Claim, preauthorization, predetermination.
ClaimResponse.patient	Σ This element is included in summaries.	1..1	Reference(Patient)	The recipient of the products and services
ClaimResponse.created	Σ This element is included in summaries.	1..1	dateTime	DateValidated
ClaimResponse.insurer	Σ This element is included in summaries.	1..1	Reference(Organization)	Party responsible for reimbursement
ClaimResponse.insurer.identifier	Σ This element is included in summaries. C	1..1	Identifier	A local identifier MUST be added to this section. Constraints: hpiOrganizationIdPattern, hpiFacilityIdPattern, nzbnPattern, hpiCpnPattern
ClaimResponse.insurer.identifier.use	?! This element is a modifier element. Σ This element is included in summaries.	0..1	code	The local identifier use SHOULD be set to official. Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .
ClaimResponse.insurer.identifier.system	Σ This element is included in summaries. C	1..1	uri	The system identifier for the organization, facility or nzbn Constraints: allowedLocalIdentifierSystems Example General: http://www.acme.com/identifiers/patient Example HPI Organisation ID: https://standards.digital.health.nz/ns/hpi-organisation-id
ClaimResponse.insurer.identifier.value	Σ This element is included in summaries.	1..1	string	The actual local identifier value, e.g. GZZ999-Z Example General: 123456 Example Example HPI Org ID: GZZ999-Z
ClaimResponse.requestor		1..1	Reference(Organization)	Party submitting the claim
ClaimResponse.requestor.identifier	Σ This element is included in summaries. C	1..1	Identifier	A local identifier MUST be added to this section. Constraints: hpiOrganizationIdPattern, hpiFacilityIdPattern, nzbnPattern, hpiCpnPattern
ClaimResponse.requestor.identifier.use	?! This element is a modifier element. Σ This element is included in summaries.	0..1	code	The local identifier use SHOULD be set to official. Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .
ClaimResponse.requestor.identifier.system	Σ This element is included in summaries. C	1..1	uri	The system identifier for the organization, facility or nzbn Constraints: allowedLocalIdentifierSystems Example General: http://www.acme.com/identifiers/patient Example HPI Organisation ID: https://standards.digital.health.nz/ns/hpi-organisation-id
ClaimResponse.requestor.identifier.value	Σ This element is included in summaries.	1..1	string	The actual local identifier value, e.g. GZZ999-Z Example General: 123456 Example Example HPI Org ID: GZZ999-Z
ClaimResponse.request	Σ This element is included in summaries.	1..1	Reference(Claim)	Reference to the original Claim
ClaimResponse.outcome	Σ This element is included in summaries.	1..1	code	Claim processing outcome Binding: ClaimProcessingCodes (required)
ClaimResponse.item		0..*	BackboneElement	Adjudication for claim line items
ClaimResponse.item.Slices for extension		2..*	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
ClaimResponse.item.Slices for extension.extension:productOrService		1..1	CodeableConcept	Product or Service code URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/shared-care-product-or-service
ClaimResponse.item.Slices for extension.extension:reviewOutcome		1..1	(Complex)	Item-level review outcome summary URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/shared-care-review-outcome
ClaimResponse.item.Slices for extension.extension:traceNumber		0..*	Identifier	Internal trace identifier URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/shared-care-trace-number
ClaimResponse.item.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
ClaimResponse.item.itemSequence		1..1	positiveInt	To match Claim.item.sequence
ClaimResponse.item.adjudication		1..*	BackboneElement	Adjudication (reason, amount, quantity) for each Adjudication Value Code
ClaimResponse.item.adjudication.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
ClaimResponse.item.adjudication.category		1..1	CodeableConcept	Type of adjudication information Binding: Pharmacy Adjudication Category (extensible)
ClaimResponse.item.adjudication.reason		0..1	CodeableConcept	Codified reason(s) for the adjudication Binding: Adjudication Reason Codes (extensible)
ClaimResponse.item.adjudication.amount		1..1	Money	Monetary amount
ClaimResponse.item.detail		1..*	BackboneElement	Adjudication for claim detail items
ClaimResponse.item.detail.Slices for extension		2..*	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
ClaimResponse.item.detail.Slices for extension.extension:traceNumber		0..1	Identifier	Internal trace identifier URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/shared-care-trace-number
ClaimResponse.item.detail.Slices for extension.extension:productOrService		1..1	CodeableConcept	Dispensed pharmaceutical component URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/pharmacy-item-detail-product-or-service
ClaimResponse.item.detail.Slices for extension.extension:reviewOutcome		1..1	(Complex)	Pharmacy Claim Item Detail Review Outcome URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/pharmacy-item-detail-review-outcome
ClaimResponse.item.detail.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
ClaimResponse.item.detail.detailSequence		1..1	positiveInt	To match Claim.item.detail.sequence
ClaimResponse.item.detail.adjudication		1..*	BackboneElement	Adjudication details breakdown
ClaimResponse.item.detail.adjudication.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
ClaimResponse.item.detail.adjudication.category		1..1	CodeableConcept	Type of adjudication information Binding: Pharmacy Adjudication Category (extensible)
ClaimResponse.item.detail.adjudication.reason		0..1	CodeableConcept	Explanation of adjudication outcome Binding: Adjudication Reason Codes (extensible)
ClaimResponse.payment		0..1	BackboneElement	Payment details
ClaimResponse.payment.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
ClaimResponse.payment.type		1..1	CodeableConcept	Partial or complete payment Binding: ExamplePaymentTypeCodes (example): The type (partial, complete) of the payment.
ClaimResponse.payment.date		0..1	date	Payment date
ClaimResponse.payment.amount		1..1	Money	Payment amount
Documentation for this format

Terminology Bindings

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.insurer.​identifier.use	Base	required	IdentifierUse	📍4.0.1	FHIR Std.
ClaimResponse.requestor.​identifier.use	Base	required	IdentifierUse	📍4.0.1	FHIR Std.
ClaimResponse.outcome	Base	required	Claim Processing Codes	📦4.0.1	FHIR Std.
ClaimResponse.item.adjudication.​category	Base	extensible	Pharmacy Adjudication Category	📦0.4.7	This IG
ClaimResponse.item.adjudication.​reason	Base	extensible	Adjudication Reason Codes	📦0.4.7	This IG
ClaimResponse.item.detail.​adjudication.category	Base	extensible	Pharmacy Adjudication Category	📦0.4.7	This IG
ClaimResponse.item.detail.​adjudication.reason	Base	extensible	Adjudication Reason Codes	📦0.4.7	This IG
ClaimResponse.payment.​type	Base	example	Example Payment Type Codes	📍4.0.1	FHIR Std.

Constraints

Id	Grade	Path(s)	Description	Expression
allowedLocalIdentifierSystems	error	ClaimResponse.insurer.identifier.system, ClaimResponse.requestor.identifier.system	Identifier system must be HPI facility, HPI Organisation, HPI CPN or NZBN	$this = 'https://standards.digital.health.nz/ns/hpi-organisation-id' or $this = 'https://standards.digital.health.nz/ns/hpi-nzbn' or $this = 'https://standards.digital.health.nz/ns/hpi-facility-id' or $this = 'https://standards.digital.health.nz/ns/hpi-person-id'
hpi-location-url-format	error	ClaimResponse.meta.source	Reference must be an HPI facility URL with format https://standards.digital.health.nz/ns/hpi-facility-id/FZZ111-A	matches('^https://standards.digital.health.nz/ns/hpi-facility-id/F[A-Za-z0-9]{2}[0-9]{3}-[A-Za-z0-9]$')
hpiCpnPattern	error	ClaimResponse.insurer.identifier, ClaimResponse.requestor.identifier	HPI CPN must conform to format (NNXXXX where N is numeric and X is alphabetic).	system = 'https://standards.digital.health.nz/ns/hpi-person-id' implies value.matches('^[0-9]{2}[A-Za-z]{4}$')
hpiFacilityIdPattern	error	ClaimResponse.insurer.identifier, ClaimResponse.requestor.identifier	HPI Facility ID must conform to format (FXXnnn-C).	system = 'https://standards.digital.health.nz/ns/hpi-facility-id' implies value.matches('^F[A-Za-z0-9]{2}[0-9]{3}-[A-Za-z0-9]$')
hpiOrganizationIdPattern	error	ClaimResponse.insurer.identifier, ClaimResponse.requestor.identifier	HPI Organisation ID must conform to format (GXXnnn-C).	system = 'https://standards.digital.health.nz/ns/hpi-organisation-id' implies value.matches('^G[a-zA-Z0-9]{2}[0-9]{3}-[a-zA-Z0-9]$')
nzbnPattern	error	ClaimResponse.insurer.identifier, ClaimResponse.requestor.identifier	NZBN must conform to format (13 digits).	system = 'https://standards.digital.health.nz/ns/hpi-nzbn' implies value.matches('^[0-9]{13}$')

This structure is derived from ClaimResponse

Name	Flags	Card.	Type	Description & Constraints    Filter: Bindings Constraints Obligations
ClaimResponse		0..*	ClaimResponse	Response to a claim predetermination or preauthorization
ClaimResponse.meta		1..1	Meta	Metadata about the resource
ClaimResponse.meta.source	C	1..1	uri	HPI Facility ID from where the record is sourced Constraints: hpi-location-url-format
ClaimResponse.meta.profile		1..1	canonical(StructureDefinition)	Profiles this resource claims to conform to
ClaimResponse.meta.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
ClaimResponse.meta.Slices for tag.tag:correlationId		1..1	Coding	Tags applied to this resource
ClaimResponse.meta.Slices for tag.tag:correlationId.system		1..1	uri	Hub correlation ID system Required Pattern: https://hub.services.digital.health.nz/ns/correlation-id
ClaimResponse.meta.Slices for tag.tag:correlationId.code		1..1	code	Symbol in syntax defined by the system
ClaimResponse.contained		0..0		Contained, inline Resources
ClaimResponse.identifier		1..1	Identifier	ClaimResponse identifier
ClaimResponse.identifier.system		1..1	uri	The namespace for the identifier value Fixed Value: https://standards.digital.health.nz/ns/claim-response-identifier
ClaimResponse.identifier.value		1..1	string	The value that is unique
ClaimResponse.type		1..1	CodeableConcept	More granular claim type Binding: NZ Claim Types (extensible)
ClaimResponse.subType		1..1	CodeableConcept	More granular claim type Binding: NZ Claim Subtypes (extensible)
ClaimResponse.created		1..1	dateTime	DateValidated
ClaimResponse.insurer
ClaimResponse.insurer.identifier	C	1..1	Identifier	A local identifier MUST be added to this section. Constraints: hpiOrganizationIdPattern, hpiFacilityIdPattern, nzbnPattern, hpiCpnPattern
ClaimResponse.insurer.identifier.use		0..1	code	The local identifier use SHOULD be set to official.
ClaimResponse.insurer.identifier.system	C	1..1	uri	The system identifier for the organization, facility or nzbn Constraints: allowedLocalIdentifierSystems Example HPI Organisation ID: https://standards.digital.health.nz/ns/hpi-organisation-id
ClaimResponse.insurer.identifier.value		1..1	string	The actual local identifier value, e.g. GZZ999-Z Example Example HPI Org ID: GZZ999-Z
ClaimResponse.requestor		1..1	Reference(Organization)	Party submitting the claim
ClaimResponse.requestor.identifier	C	1..1	Identifier	A local identifier MUST be added to this section. Constraints: hpiOrganizationIdPattern, hpiFacilityIdPattern, nzbnPattern, hpiCpnPattern
ClaimResponse.requestor.identifier.use		0..1	code	The local identifier use SHOULD be set to official.
ClaimResponse.requestor.identifier.system	C	1..1	uri	The system identifier for the organization, facility or nzbn Constraints: allowedLocalIdentifierSystems Example HPI Organisation ID: https://standards.digital.health.nz/ns/hpi-organisation-id
ClaimResponse.requestor.identifier.value		1..1	string	The actual local identifier value, e.g. GZZ999-Z Example Example HPI Org ID: GZZ999-Z
ClaimResponse.request		1..1	Reference(Claim)	Reference to the original Claim
ClaimResponse.outcome		1..1	code	Claim processing outcome Binding: ClaimProcessingCodes (required)
ClaimResponse.item		0..*	BackboneElement	Adjudication for claim line items
ClaimResponse.item.Slices for extension		2..*	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
ClaimResponse.item.Slices for extension.extension:productOrService		1..1	CodeableConcept	Product or Service code URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/shared-care-product-or-service
ClaimResponse.item.Slices for extension.extension:reviewOutcome		1..1	(Complex)	Item-level review outcome summary URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/shared-care-review-outcome
ClaimResponse.item.Slices for extension.extension:traceNumber		0..*	Identifier	Internal trace identifier URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/shared-care-trace-number
ClaimResponse.item.itemSequence		1..1	positiveInt	To match Claim.item.sequence
ClaimResponse.item.adjudication		1..*	BackboneElement	Adjudication (reason, amount, quantity) for each Adjudication Value Code
ClaimResponse.item.adjudication.category		1..1	CodeableConcept	Type of adjudication information Binding: Pharmacy Adjudication Category (extensible)
ClaimResponse.item.adjudication.reason		0..1	CodeableConcept	Codified reason(s) for the adjudication Binding: Adjudication Reason Codes (extensible)
ClaimResponse.item.adjudication.amount		1..1	Money	Monetary amount
ClaimResponse.item.detail		1..*	BackboneElement	Adjudication for claim detail items
ClaimResponse.item.detail.Slices for extension		2..*	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
ClaimResponse.item.detail.Slices for extension.extension:traceNumber		0..1	Identifier	Internal trace identifier URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/shared-care-trace-number
ClaimResponse.item.detail.Slices for extension.extension:productOrService		1..1	CodeableConcept	Dispensed pharmaceutical component URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/pharmacy-item-detail-product-or-service
ClaimResponse.item.detail.Slices for extension.extension:reviewOutcome		1..1	(Complex)	Pharmacy Claim Item Detail Review Outcome URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/pharmacy-item-detail-review-outcome
ClaimResponse.item.detail.detailSequence		1..1	positiveInt	To match Claim.item.detail.sequence
ClaimResponse.item.detail.adjudication		1..*	BackboneElement	Adjudication details breakdown
ClaimResponse.item.detail.adjudication.category		1..1	CodeableConcept	Type of adjudication information Binding: Pharmacy Adjudication Category (extensible)
ClaimResponse.item.detail.adjudication.reason		0..1	CodeableConcept	Explanation of adjudication outcome Binding: Adjudication Reason Codes (extensible)
ClaimResponse.payment		0..1	BackboneElement	Payment details
ClaimResponse.payment.date		0..1	date	Payment date
ClaimResponse.payment.amount		1..1	Money	Payment amount
ClaimResponse.error
ClaimResponse.error.itemSequence		1..1	positiveInt	Item sequence number
ClaimResponse.error.detailSequence		1..1	positiveInt	Detail sequence number
ClaimResponse.error.code		1..1	CodeableConcept	Error code Binding: Claim Decision Reason Codes (required)
Documentation for this format

Terminology Bindings (Differential)

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.outcome	Base	required	Claim Processing Codes	📦4.0.1	FHIR Std.
ClaimResponse.item.adjudication.​category	Base	extensible	Pharmacy Adjudication Category	📦0.4.7	This IG
ClaimResponse.item.adjudication.​reason	Base	extensible	Adjudication Reason Codes	📦0.4.7	This IG
ClaimResponse.item.detail.​adjudication.category	Base	extensible	Pharmacy Adjudication Category	📦0.4.7	This IG
ClaimResponse.item.detail.​adjudication.reason	Base	extensible	Adjudication Reason Codes	📦0.4.7	This IG
ClaimResponse.error.​code	Base	required	Claim Decision Reason Codes	📦0.4.7	This IG

Constraints

Id	Grade	Path(s)	Description	Expression
allowedLocalIdentifierSystems	error	ClaimResponse.insurer.identifier.system, ClaimResponse.requestor.identifier.system	Identifier system must be HPI facility, HPI Organisation, HPI CPN or NZBN	$this = 'https://standards.digital.health.nz/ns/hpi-organisation-id' or $this = 'https://standards.digital.health.nz/ns/hpi-nzbn' or $this = 'https://standards.digital.health.nz/ns/hpi-facility-id' or $this = 'https://standards.digital.health.nz/ns/hpi-person-id'
hpi-location-url-format	error	ClaimResponse.meta.source	Reference must be an HPI facility URL with format https://standards.digital.health.nz/ns/hpi-facility-id/FZZ111-A	matches('^https://standards.digital.health.nz/ns/hpi-facility-id/F[A-Za-z0-9]{2}[0-9]{3}-[A-Za-z0-9]$')
hpiCpnPattern	error	ClaimResponse.insurer.identifier, ClaimResponse.requestor.identifier	HPI CPN must conform to format (NNXXXX where N is numeric and X is alphabetic).	system = 'https://standards.digital.health.nz/ns/hpi-person-id' implies value.matches('^[0-9]{2}[A-Za-z]{4}$')
hpiFacilityIdPattern	error	ClaimResponse.insurer.identifier, ClaimResponse.requestor.identifier	HPI Facility ID must conform to format (FXXnnn-C).	system = 'https://standards.digital.health.nz/ns/hpi-facility-id' implies value.matches('^F[A-Za-z0-9]{2}[0-9]{3}-[A-Za-z0-9]$')
hpiOrganizationIdPattern	error	ClaimResponse.insurer.identifier, ClaimResponse.requestor.identifier	HPI Organisation ID must conform to format (GXXnnn-C).	system = 'https://standards.digital.health.nz/ns/hpi-organisation-id' implies value.matches('^G[a-zA-Z0-9]{2}[0-9]{3}-[a-zA-Z0-9]$')
nzbnPattern	error	ClaimResponse.insurer.identifier, ClaimResponse.requestor.identifier	NZBN must conform to format (13 digits).	system = 'https://standards.digital.health.nz/ns/hpi-nzbn' implies value.matches('^[0-9]{13}$')

Name	Flags	Card.	Type	Description & Constraints    Filter: Bindings Constraints Obligations
ClaimResponse		0..*	ClaimResponse	Response to a claim predetermination or preauthorization
ClaimResponse.id	Σ This element is included in summaries.	0..1	id	Logical id of this artifact
ClaimResponse.meta	Σ This element is included in summaries.	1..1	Meta	Metadata about the resource
ClaimResponse.meta.id		0..1	string	Unique id for inter-element referencing
ClaimResponse.meta.extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
ClaimResponse.meta.versionId	Σ This element is included in summaries.	0..1	id	Version specific identifier
ClaimResponse.meta.lastUpdated	Σ This element is included in summaries.	0..1	instant	When the resource version last changed
ClaimResponse.meta.source	Σ This element is included in summaries. C	1..1	uri	HPI Facility ID from where the record is sourced Constraints: hpi-location-url-format
ClaimResponse.meta.profile	Σ This element is included in summaries.	1..1	canonical(StructureDefinition)	Profiles this resource claims to conform to
ClaimResponse.meta.security	Σ This element is included in summaries.	0..*	Coding	Security Labels applied to this resource Binding: All Security Labels (extensible): Security Labels from the Healthcare Privacy and Security Classification System.
ClaimResponse.meta.Slices for tag	Σ This element is included in summaries.	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
ClaimResponse.meta.Slices for tag.tag:correlationId	Σ This element is included in summaries.	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".
ClaimResponse.meta.Slices for tag.tag:correlationId.id		0..1	string	Unique id for inter-element referencing
ClaimResponse.meta.Slices for tag.tag:correlationId.extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
ClaimResponse.meta.Slices for tag.tag:correlationId.system	Σ This element is included in summaries.	1..1	uri	Hub correlation ID system Required Pattern: https://hub.services.digital.health.nz/ns/correlation-id
ClaimResponse.meta.Slices for tag.tag:correlationId.version	Σ This element is included in summaries.	0..1	string	Version of the system - if relevant
ClaimResponse.meta.Slices for tag.tag:correlationId.code	Σ This element is included in summaries.	1..1	code	Symbol in syntax defined by the system
ClaimResponse.meta.Slices for tag.tag:correlationId.display	Σ This element is included in summaries.	0..1	string	Representation defined by the system
ClaimResponse.meta.Slices for tag.tag:correlationId.userSelected	Σ This element is included in summaries.	0..1	boolean	If this coding was chosen directly by the user
ClaimResponse.implicitRules	?! This element is a modifier element. Σ This element is included in summaries.	0..1	uri	A set of rules under which this content was created
ClaimResponse.language		0..1	code	Language of the resource content Binding: CommonLanguages (preferred): A human language. Additional Bindings Purpose AllLanguages Max Binding
ClaimResponse.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
ClaimResponse.extension		0..*	Extension	Additional content defined by implementations
ClaimResponse.modifierExtension	?! This element is a modifier element.	0..*	Extension	Extensions that cannot be ignored
ClaimResponse.identifier		1..1	Identifier	ClaimResponse identifier
ClaimResponse.identifier.id		0..1	string	Unique id for inter-element referencing
ClaimResponse.identifier.extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
ClaimResponse.identifier.use	?! This element is a modifier element. Σ This element is included in summaries.	0..1	code	usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .
ClaimResponse.identifier.type	Σ This element is included in summaries.	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.
ClaimResponse.identifier.system	Σ This element is included in summaries.	1..1	uri	The namespace for the identifier value Fixed Value: https://standards.digital.health.nz/ns/claim-response-identifier
ClaimResponse.identifier.value	Σ This element is included in summaries.	1..1	string	The value that is unique Example General: 123456
ClaimResponse.identifier.period	Σ This element is included in summaries.	0..1	Period	Time period when id is/was valid for use
ClaimResponse.identifier.assigner	Σ This element is included in summaries.	0..1	Reference(Organization)	Organization that issued id (may be just text)
ClaimResponse.status	?! This element is a modifier element. Σ This element is included in summaries.	1..1	code	active | cancelled | draft | entered-in-error Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance.
ClaimResponse.type	Σ This element is included in summaries.	1..1	CodeableConcept	More granular claim type Binding: NZ Claim Types (extensible)
ClaimResponse.subType		1..1	CodeableConcept	More granular claim type Binding: NZ Claim Subtypes (extensible)
ClaimResponse.use	Σ This element is included in summaries.	1..1	code	claim | preauthorization | predetermination Binding: Use (required): Claim, preauthorization, predetermination.
ClaimResponse.patient	Σ This element is included in summaries.	1..1	Reference(Patient)	The recipient of the products and services
ClaimResponse.created	Σ This element is included in summaries.	1..1	dateTime	DateValidated
ClaimResponse.insurer	Σ This element is included in summaries.	1..1	Reference(Organization)	Party responsible for reimbursement
ClaimResponse.insurer.id		0..1	string	Unique id for inter-element referencing
ClaimResponse.insurer.extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
ClaimResponse.insurer.reference	Σ This element is included in summaries. C	0..1	string	Literal reference, Relative, internal or absolute URL
ClaimResponse.insurer.type	Σ This element is included in summaries.	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).
ClaimResponse.insurer.identifier	Σ This element is included in summaries. C	1..1	Identifier	A local identifier MUST be added to this section. Constraints: hpiOrganizationIdPattern, hpiFacilityIdPattern, nzbnPattern, hpiCpnPattern
ClaimResponse.insurer.identifier.id		0..1	string	Unique id for inter-element referencing
ClaimResponse.insurer.identifier.extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
ClaimResponse.insurer.identifier.use	?! This element is a modifier element. Σ This element is included in summaries.	0..1	code	The local identifier use SHOULD be set to official. Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .
ClaimResponse.insurer.identifier.type	Σ This element is included in summaries.	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.
ClaimResponse.insurer.identifier.system	Σ This element is included in summaries. C	1..1	uri	The system identifier for the organization, facility or nzbn Constraints: allowedLocalIdentifierSystems Example General: http://www.acme.com/identifiers/patient Example HPI Organisation ID: https://standards.digital.health.nz/ns/hpi-organisation-id
ClaimResponse.insurer.identifier.value	Σ This element is included in summaries.	1..1	string	The actual local identifier value, e.g. GZZ999-Z Example General: 123456 Example Example HPI Org ID: GZZ999-Z
ClaimResponse.insurer.identifier.period	Σ This element is included in summaries.	0..1	Period	Time period when id is/was valid for use
ClaimResponse.insurer.identifier.assigner	Σ This element is included in summaries.	0..1	Reference(Organization)	Organization that issued id (may be just text)
ClaimResponse.insurer.display	Σ This element is included in summaries.	0..1	string	Text alternative for the resource
ClaimResponse.requestor		1..1	Reference(Organization)	Party submitting the claim
ClaimResponse.requestor.id		0..1	string	Unique id for inter-element referencing
ClaimResponse.requestor.extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
ClaimResponse.requestor.reference	Σ This element is included in summaries. C	0..1	string	Literal reference, Relative, internal or absolute URL
ClaimResponse.requestor.type	Σ This element is included in summaries.	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).
ClaimResponse.requestor.identifier	Σ This element is included in summaries. C	1..1	Identifier	A local identifier MUST be added to this section. Constraints: hpiOrganizationIdPattern, hpiFacilityIdPattern, nzbnPattern, hpiCpnPattern
ClaimResponse.requestor.identifier.id		0..1	string	Unique id for inter-element referencing
ClaimResponse.requestor.identifier.extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
ClaimResponse.requestor.identifier.use	?! This element is a modifier element. Σ This element is included in summaries.	0..1	code	The local identifier use SHOULD be set to official. Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .
ClaimResponse.requestor.identifier.type	Σ This element is included in summaries.	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.
ClaimResponse.requestor.identifier.system	Σ This element is included in summaries. C	1..1	uri	The system identifier for the organization, facility or nzbn Constraints: allowedLocalIdentifierSystems Example General: http://www.acme.com/identifiers/patient Example HPI Organisation ID: https://standards.digital.health.nz/ns/hpi-organisation-id
ClaimResponse.requestor.identifier.value	Σ This element is included in summaries.	1..1	string	The actual local identifier value, e.g. GZZ999-Z Example General: 123456 Example Example HPI Org ID: GZZ999-Z
ClaimResponse.requestor.identifier.period	Σ This element is included in summaries.	0..1	Period	Time period when id is/was valid for use
ClaimResponse.requestor.identifier.assigner	Σ This element is included in summaries.	0..1	Reference(Organization)	Organization that issued id (may be just text)
ClaimResponse.requestor.display	Σ This element is included in summaries.	0..1	string	Text alternative for the resource
ClaimResponse.request	Σ This element is included in summaries.	1..1	Reference(Claim)	Reference to the original Claim
ClaimResponse.outcome	Σ This element is included in summaries.	1..1	code	Claim processing outcome Binding: ClaimProcessingCodes (required)
ClaimResponse.disposition		0..1	string	Disposition Message
ClaimResponse.preAuthRef		0..1	string	Preauthorization reference
ClaimResponse.preAuthPeriod		0..1	Period	Preauthorization reference effective period
ClaimResponse.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.
ClaimResponse.item		0..*	BackboneElement	Adjudication for claim line items
ClaimResponse.item.id		0..1	string	Unique id for inter-element referencing
ClaimResponse.item.Slices for extension		2..*	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
ClaimResponse.item.Slices for extension.extension:productOrService		1..1	CodeableConcept	Product or Service code URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/shared-care-product-or-service
ClaimResponse.item.Slices for extension.extension:reviewOutcome		1..1	(Complex)	Item-level review outcome summary URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/shared-care-review-outcome
ClaimResponse.item.Slices for extension.extension:traceNumber		0..*	Identifier	Internal trace identifier URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/shared-care-trace-number
ClaimResponse.item.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
ClaimResponse.item.itemSequence		1..1	positiveInt	To match Claim.item.sequence
ClaimResponse.item.noteNumber		0..*	positiveInt	Applicable note numbers
ClaimResponse.item.adjudication		1..*	BackboneElement	Adjudication (reason, amount, quantity) for each Adjudication Value Code
ClaimResponse.item.adjudication.id		0..1	string	Unique id for inter-element referencing
ClaimResponse.item.adjudication.extension		0..*	Extension	Additional content defined by implementations
ClaimResponse.item.adjudication.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
ClaimResponse.item.adjudication.category		1..1	CodeableConcept	Type of adjudication information Binding: Pharmacy Adjudication Category (extensible)
ClaimResponse.item.adjudication.reason		0..1	CodeableConcept	Codified reason(s) for the adjudication Binding: Adjudication Reason Codes (extensible)
ClaimResponse.item.adjudication.amount		1..1	Money	Monetary amount
ClaimResponse.item.adjudication.value		0..1	decimal	Non-monetary value
ClaimResponse.item.detail		1..*	BackboneElement	Adjudication for claim detail items
ClaimResponse.item.detail.id		0..1	string	Unique id for inter-element referencing
ClaimResponse.item.detail.Slices for extension		2..*	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
ClaimResponse.item.detail.Slices for extension.extension:traceNumber		0..1	Identifier	Internal trace identifier URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/shared-care-trace-number
ClaimResponse.item.detail.Slices for extension.extension:productOrService		1..1	CodeableConcept	Dispensed pharmaceutical component URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/pharmacy-item-detail-product-or-service
ClaimResponse.item.detail.Slices for extension.extension:reviewOutcome		1..1	(Complex)	Pharmacy Claim Item Detail Review Outcome URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/pharmacy-item-detail-review-outcome
ClaimResponse.item.detail.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
ClaimResponse.item.detail.detailSequence		1..1	positiveInt	To match Claim.item.detail.sequence
ClaimResponse.item.detail.noteNumber		0..*	positiveInt	Applicable note numbers
ClaimResponse.item.detail.adjudication		1..*	BackboneElement	Adjudication details breakdown
ClaimResponse.item.detail.adjudication.id		0..1	string	Unique id for inter-element referencing
ClaimResponse.item.detail.adjudication.extension		0..*	Extension	Additional content defined by implementations
ClaimResponse.item.detail.adjudication.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
ClaimResponse.item.detail.adjudication.category		1..1	CodeableConcept	Type of adjudication information Binding: Pharmacy Adjudication Category (extensible)
ClaimResponse.item.detail.adjudication.reason		0..1	CodeableConcept	Explanation of adjudication outcome Binding: Adjudication Reason Codes (extensible)
ClaimResponse.item.detail.adjudication.amount		0..1	Money	Monetary amount
ClaimResponse.item.detail.adjudication.value		0..1	decimal	Non-monetary value
ClaimResponse.item.detail.subDetail		0..*	BackboneElement	Adjudication for claim sub-details
ClaimResponse.item.detail.subDetail.id		0..1	string	Unique id for inter-element referencing
ClaimResponse.item.detail.subDetail.extension		0..*	Extension	Additional content defined by implementations
ClaimResponse.item.detail.subDetail.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
ClaimResponse.item.detail.subDetail.subDetailSequence		1..1	positiveInt	Claim sub-detail instance identifier
ClaimResponse.item.detail.subDetail.noteNumber		0..*	positiveInt	Applicable note numbers
ClaimResponse.item.detail.subDetail.adjudication		0..*	See adjudication (ClaimResponse)	Subdetail level adjudication details
ClaimResponse.addItem		0..*	BackboneElement	Insurer added line items
ClaimResponse.addItem.id		0..1	string	Unique id for inter-element referencing
ClaimResponse.addItem.extension		0..*	Extension	Additional content defined by implementations
ClaimResponse.addItem.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
ClaimResponse.addItem.itemSequence		0..*	positiveInt	Item sequence number
ClaimResponse.addItem.detailSequence		0..*	positiveInt	Detail sequence number
ClaimResponse.addItem.subdetailSequence		0..*	positiveInt	Subdetail sequence number
ClaimResponse.addItem.provider		0..*	Reference(Practitioner | PractitionerRole | Organization)	Authorized providers
ClaimResponse.addItem.productOrService		1..1	CodeableConcept	Billing, service, product, or drug code Binding: USCLSCodes (example): Allowable service and product codes.
ClaimResponse.addItem.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.
ClaimResponse.addItem.programCode		0..*	CodeableConcept	Program the product or service is provided under Binding: ExampleProgramReasonCodes (example): Program specific reason codes.
ClaimResponse.addItem.serviced[x]		0..1		Date or dates of service or product delivery
ClaimResponse.addItem.serviced[x].servicedDate			date
ClaimResponse.addItem.serviced[x].servicedPeriod			Period
ClaimResponse.addItem.location[x]		0..1		Place of service or where product was supplied Binding: ExampleServicePlaceCodes (example): Place of service: pharmacy, school, prison, etc.
ClaimResponse.addItem.location[x].locationCodeableConcept			CodeableConcept
ClaimResponse.addItem.location[x].locationAddress			Address
ClaimResponse.addItem.location[x].locationReference			Reference(Location)
ClaimResponse.addItem.quantity	C	0..1	SimpleQuantity(4.0.1)	Count of products or services Constraints: sqty-1
ClaimResponse.addItem.unitPrice		0..1	Money	Fee, charge or cost per item
ClaimResponse.addItem.factor		0..1	decimal	Price scaling factor
ClaimResponse.addItem.net		0..1	Money	Total item cost
ClaimResponse.addItem.bodySite		0..1	CodeableConcept	Anatomical location Binding: OralSiteCodes (example): The code for the teeth, quadrant, sextant and arch.
ClaimResponse.addItem.subSite		0..*	CodeableConcept	Anatomical sub-location Binding: SurfaceCodes (example): The code for the tooth surface and surface combinations.
ClaimResponse.addItem.noteNumber		0..*	positiveInt	Applicable note numbers
ClaimResponse.addItem.adjudication		1..*	See adjudication (ClaimResponse)	Added items adjudication
ClaimResponse.addItem.detail		0..*	BackboneElement	Insurer added line details
ClaimResponse.addItem.detail.id		0..1	string	Unique id for inter-element referencing
ClaimResponse.addItem.detail.extension		0..*	Extension	Additional content defined by implementations
ClaimResponse.addItem.detail.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
ClaimResponse.addItem.detail.productOrService		1..1	CodeableConcept	Billing, service, product, or drug code Binding: USCLSCodes (example): Allowable service and product codes.
ClaimResponse.addItem.detail.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.
ClaimResponse.addItem.detail.quantity	C	0..1	SimpleQuantity(4.0.1)	Count of products or services Constraints: sqty-1
ClaimResponse.addItem.detail.unitPrice		0..1	Money	Fee, charge or cost per item
ClaimResponse.addItem.detail.factor		0..1	decimal	Price scaling factor
ClaimResponse.addItem.detail.net		0..1	Money	Total item cost
ClaimResponse.addItem.detail.noteNumber		0..*	positiveInt	Applicable note numbers
ClaimResponse.addItem.detail.adjudication		1..*	See adjudication (ClaimResponse)	Added items detail adjudication
ClaimResponse.addItem.detail.subDetail		0..*	BackboneElement	Insurer added line items
ClaimResponse.addItem.detail.subDetail.id		0..1	string	Unique id for inter-element referencing
ClaimResponse.addItem.detail.subDetail.extension		0..*	Extension	Additional content defined by implementations
ClaimResponse.addItem.detail.subDetail.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
ClaimResponse.addItem.detail.subDetail.productOrService		1..1	CodeableConcept	Billing, service, product, or drug code Binding: USCLSCodes (example): Allowable service and product codes.
ClaimResponse.addItem.detail.subDetail.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.
ClaimResponse.addItem.detail.subDetail.quantity	C	0..1	SimpleQuantity(4.0.1)	Count of products or services Constraints: sqty-1
ClaimResponse.addItem.detail.subDetail.unitPrice		0..1	Money	Fee, charge or cost per item
ClaimResponse.addItem.detail.subDetail.factor		0..1	decimal	Price scaling factor
ClaimResponse.addItem.detail.subDetail.net		0..1	Money	Total item cost
ClaimResponse.addItem.detail.subDetail.noteNumber		0..*	positiveInt	Applicable note numbers
ClaimResponse.addItem.detail.subDetail.adjudication		1..*	See adjudication (ClaimResponse)	Added items detail adjudication
ClaimResponse.adjudication		0..*	See adjudication (ClaimResponse)	Header-level adjudication
ClaimResponse.total	Σ This element is included in summaries.	0..*	BackboneElement	Adjudication totals
ClaimResponse.total.id		0..1	string	Unique id for inter-element referencing
ClaimResponse.total.extension		0..*	Extension	Additional content defined by implementations
ClaimResponse.total.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
ClaimResponse.total.category	Σ This element is included in summaries.	1..1	CodeableConcept	Type of adjudication information Binding: AdjudicationValueCodes (example): The adjudication codes.
ClaimResponse.total.amount	Σ This element is included in summaries.	1..1	Money	Financial total for the category
ClaimResponse.payment		0..1	BackboneElement	Payment details
ClaimResponse.payment.id		0..1	string	Unique id for inter-element referencing
ClaimResponse.payment.extension		0..*	Extension	Additional content defined by implementations
ClaimResponse.payment.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
ClaimResponse.payment.type		1..1	CodeableConcept	Partial or complete payment Binding: ExamplePaymentTypeCodes (example): The type (partial, complete) of the payment.
ClaimResponse.payment.adjustment		0..1	Money	Payment adjustment for non-claim issues
ClaimResponse.payment.adjustmentReason		0..1	CodeableConcept	Explanation for the adjustment Binding: PaymentAdjustmentReasonCodes (example): Payment Adjustment reason codes.
ClaimResponse.payment.date		0..1	date	Payment date
ClaimResponse.payment.amount		1..1	Money	Payment amount
ClaimResponse.payment.identifier		0..1	Identifier	Business identifier for the payment
ClaimResponse.fundsReserve		0..1	CodeableConcept	Funds reserved status Binding: Funds Reservation Codes (example): For whom funds are to be reserved: (Patient, Provider, None).
ClaimResponse.formCode		0..1	CodeableConcept	Printed form identifier Binding: Form Codes (example): The forms codes.
ClaimResponse.form		0..1	Attachment	Printed reference or actual form
ClaimResponse.processNote		0..*	BackboneElement	Note concerning adjudication
ClaimResponse.processNote.id		0..1	string	Unique id for inter-element referencing
ClaimResponse.processNote.extension		0..*	Extension	Additional content defined by implementations
ClaimResponse.processNote.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
ClaimResponse.processNote.number		0..1	positiveInt	Note instance identifier
ClaimResponse.processNote.type		0..1	code	display | print | printoper Binding: NoteType (required): The presentation types of notes.
ClaimResponse.processNote.text		1..1	string	Note explanatory text
ClaimResponse.processNote.language		0..1	CodeableConcept	Language of the text Binding: CommonLanguages (preferred): A human language. Additional Bindings Purpose AllLanguages Max Binding
ClaimResponse.communicationRequest		0..*	Reference(CommunicationRequest)	Request for additional information
ClaimResponse.insurance		0..*	BackboneElement	Patient insurance information
ClaimResponse.insurance.id		0..1	string	Unique id for inter-element referencing
ClaimResponse.insurance.extension		0..*	Extension	Additional content defined by implementations
ClaimResponse.insurance.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
ClaimResponse.insurance.sequence		1..1	positiveInt	Insurance instance identifier
ClaimResponse.insurance.focal		1..1	boolean	Coverage to be used for adjudication
ClaimResponse.insurance.coverage		1..1	Reference(Coverage)	Insurance information
ClaimResponse.insurance.businessArrangement		0..1	string	Additional provider contract number
ClaimResponse.insurance.claimResponse		0..1	Reference(ClaimResponse)	Adjudication results
ClaimResponse.error		0..*	BackboneElement	Processing errors
ClaimResponse.error.id		0..1	string	Unique id for inter-element referencing
ClaimResponse.error.extension		0..*	Extension	Additional content defined by implementations
ClaimResponse.error.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
ClaimResponse.error.itemSequence		1..1	positiveInt	Item sequence number
ClaimResponse.error.detailSequence		1..1	positiveInt	Detail sequence number
ClaimResponse.error.subDetailSequence		0..1	positiveInt	Subdetail sequence number
ClaimResponse.error.code		1..1	CodeableConcept	Error code Binding: Claim Decision Reason Codes (required)
Documentation for this format

Terminology Bindings

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.insurer.​type	Base	extensible	ResourceType	📍4.0.1	FHIR Std.
ClaimResponse.insurer.​identifier.use	Base	required	IdentifierUse	📍4.0.1	FHIR Std.
ClaimResponse.insurer.​identifier.type	Base	extensible	IdentifierType	📍4.0.1	FHIR Std.
ClaimResponse.requestor.​type	Base	extensible	ResourceType	📍4.0.1	FHIR Std.
ClaimResponse.requestor.​identifier.use	Base	required	IdentifierUse	📍4.0.1	FHIR Std.
ClaimResponse.requestor.​identifier.type	Base	extensible	IdentifierType	📍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	Pharmacy Adjudication Category	📦0.4.7	This IG
ClaimResponse.item.adjudication.​reason	Base	extensible	Adjudication Reason Codes	📦0.4.7	This IG
ClaimResponse.item.detail.​adjudication.category	Base	extensible	Pharmacy Adjudication Category	📦0.4.7	This IG
ClaimResponse.item.detail.​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	example	Example Payment Type Codes	📍4.0.1	FHIR Std.
ClaimResponse.payment.​adjustmentReason	Base	example	Payment Adjustment Reason Codes	📍4.0.1	FHIR Std.
ClaimResponse.fundsReserve	Base	example	FundsReserve	📍4.0.1	FHIR Std.
ClaimResponse.formCode	Base	example	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	required	Claim Decision Reason Codes	📦0.4.7	This IG

Constraints

Id	Grade	Path(s)	Description	Expression
allowedLocalIdentifierSystems	error	ClaimResponse.insurer.identifier.system, ClaimResponse.requestor.identifier.system	Identifier system must be HPI facility, HPI Organisation, HPI CPN or NZBN	$this = 'https://standards.digital.health.nz/ns/hpi-organisation-id' or $this = 'https://standards.digital.health.nz/ns/hpi-nzbn' or $this = 'https://standards.digital.health.nz/ns/hpi-facility-id' or $this = 'https://standards.digital.health.nz/ns/hpi-person-id'
hpi-location-url-format	error	ClaimResponse.meta.source	Reference must be an HPI facility URL with format https://standards.digital.health.nz/ns/hpi-facility-id/FZZ111-A	matches('^https://standards.digital.health.nz/ns/hpi-facility-id/F[A-Za-z0-9]{2}[0-9]{3}-[A-Za-z0-9]$')
hpiCpnPattern	error	ClaimResponse.insurer.identifier, ClaimResponse.requestor.identifier	HPI CPN must conform to format (NNXXXX where N is numeric and X is alphabetic).	system = 'https://standards.digital.health.nz/ns/hpi-person-id' implies value.matches('^[0-9]{2}[A-Za-z]{4}$')
hpiFacilityIdPattern	error	ClaimResponse.insurer.identifier, ClaimResponse.requestor.identifier	HPI Facility ID must conform to format (FXXnnn-C).	system = 'https://standards.digital.health.nz/ns/hpi-facility-id' implies value.matches('^F[A-Za-z0-9]{2}[0-9]{3}-[A-Za-z0-9]$')
hpiOrganizationIdPattern	error	ClaimResponse.insurer.identifier, ClaimResponse.requestor.identifier	HPI Organisation ID must conform to format (GXXnnn-C).	system = 'https://standards.digital.health.nz/ns/hpi-organisation-id' implies value.matches('^G[a-zA-Z0-9]{2}[0-9]{3}-[a-zA-Z0-9]$')
nzbnPattern	error	ClaimResponse.insurer.identifier, ClaimResponse.requestor.identifier	NZBN must conform to format (13 digits).	system = 'https://standards.digital.health.nz/ns/hpi-nzbn' implies value.matches('^[0-9]{13}$')

This structure is derived from ClaimResponse

Summary

Mandatory: 19 elements(8 nested mandatory elements)
Fixed: 1 element
Prohibited: 1 element

Extensions

This structure refers to these extensions:

• https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/shared-care-product-or-service
• https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/shared-care-review-outcome
• https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/shared-care-trace-number
• https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/pharmacy-item-detail-product-or-service
• https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/pharmacy-item-detail-review-outcome

Slices

This structure defines the following Slices:

• The element 1 is sliced based on the value of ClaimResponse.meta.tag

Key Elements View

Name	Flags	Card.	Type	Description & Constraints    Filter: Bindings Constraints Obligations
ClaimResponse		0..*	ClaimResponse	Response to a claim predetermination or preauthorization
ClaimResponse.meta	Σ This element is included in summaries.	1..1	Meta	Metadata about the resource
ClaimResponse.meta.source	Σ This element is included in summaries. C	1..1	uri	HPI Facility ID from where the record is sourced Constraints: hpi-location-url-format
ClaimResponse.meta.profile	Σ This element is included in summaries.	1..1	canonical(StructureDefinition)	Profiles this resource claims to conform to
ClaimResponse.meta.Slices for tag	Σ This element is included in summaries.	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
ClaimResponse.meta.Slices for tag.tag:correlationId	Σ This element is included in summaries.	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".
ClaimResponse.meta.Slices for tag.tag:correlationId.system	Σ This element is included in summaries.	1..1	uri	Hub correlation ID system Required Pattern: https://hub.services.digital.health.nz/ns/correlation-id
ClaimResponse.meta.Slices for tag.tag:correlationId.code	Σ This element is included in summaries.	1..1	code	Symbol in syntax defined by the system
ClaimResponse.implicitRules	?! This element is a modifier element. Σ This element is included in summaries.	0..1	uri	A set of rules under which this content was created
ClaimResponse.modifierExtension	?! This element is a modifier element.	0..*	Extension	Extensions that cannot be ignored
ClaimResponse.identifier		1..1	Identifier	ClaimResponse identifier
ClaimResponse.identifier.use	?! This element is a modifier element. Σ This element is included in summaries.	0..1	code	usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .
ClaimResponse.identifier.system	Σ This element is included in summaries.	1..1	uri	The namespace for the identifier value Fixed Value: https://standards.digital.health.nz/ns/claim-response-identifier
ClaimResponse.identifier.value	Σ This element is included in summaries.	1..1	string	The value that is unique Example General: 123456
ClaimResponse.status	?! This element is a modifier element. Σ This element is included in summaries.	1..1	code	active | cancelled | draft | entered-in-error Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance.
ClaimResponse.type	Σ This element is included in summaries.	1..1	CodeableConcept	More granular claim type Binding: NZ Claim Types (extensible)
ClaimResponse.subType		1..1	CodeableConcept	More granular claim type Binding: NZ Claim Subtypes (extensible)
ClaimResponse.use	Σ This element is included in summaries.	1..1	code	claim | preauthorization | predetermination Binding: Use (required): Claim, preauthorization, predetermination.
ClaimResponse.patient	Σ This element is included in summaries.	1..1	Reference(Patient)	The recipient of the products and services
ClaimResponse.created	Σ This element is included in summaries.	1..1	dateTime	DateValidated
ClaimResponse.insurer	Σ This element is included in summaries.	1..1	Reference(Organization)	Party responsible for reimbursement
ClaimResponse.insurer.identifier	Σ This element is included in summaries. C	1..1	Identifier	A local identifier MUST be added to this section. Constraints: hpiOrganizationIdPattern, hpiFacilityIdPattern, nzbnPattern, hpiCpnPattern
ClaimResponse.insurer.identifier.use	?! This element is a modifier element. Σ This element is included in summaries.	0..1	code	The local identifier use SHOULD be set to official. Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .
ClaimResponse.insurer.identifier.system	Σ This element is included in summaries. C	1..1	uri	The system identifier for the organization, facility or nzbn Constraints: allowedLocalIdentifierSystems Example General: http://www.acme.com/identifiers/patient Example HPI Organisation ID: https://standards.digital.health.nz/ns/hpi-organisation-id
ClaimResponse.insurer.identifier.value	Σ This element is included in summaries.	1..1	string	The actual local identifier value, e.g. GZZ999-Z Example General: 123456 Example Example HPI Org ID: GZZ999-Z
ClaimResponse.requestor		1..1	Reference(Organization)	Party submitting the claim
ClaimResponse.requestor.identifier	Σ This element is included in summaries. C	1..1	Identifier	A local identifier MUST be added to this section. Constraints: hpiOrganizationIdPattern, hpiFacilityIdPattern, nzbnPattern, hpiCpnPattern
ClaimResponse.requestor.identifier.use	?! This element is a modifier element. Σ This element is included in summaries.	0..1	code	The local identifier use SHOULD be set to official. Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .
ClaimResponse.requestor.identifier.system	Σ This element is included in summaries. C	1..1	uri	The system identifier for the organization, facility or nzbn Constraints: allowedLocalIdentifierSystems Example General: http://www.acme.com/identifiers/patient Example HPI Organisation ID: https://standards.digital.health.nz/ns/hpi-organisation-id
ClaimResponse.requestor.identifier.value	Σ This element is included in summaries.	1..1	string	The actual local identifier value, e.g. GZZ999-Z Example General: 123456 Example Example HPI Org ID: GZZ999-Z
ClaimResponse.request	Σ This element is included in summaries.	1..1	Reference(Claim)	Reference to the original Claim
ClaimResponse.outcome	Σ This element is included in summaries.	1..1	code	Claim processing outcome Binding: ClaimProcessingCodes (required)
ClaimResponse.item		0..*	BackboneElement	Adjudication for claim line items
ClaimResponse.item.Slices for extension		2..*	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
ClaimResponse.item.Slices for extension.extension:productOrService		1..1	CodeableConcept	Product or Service code URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/shared-care-product-or-service
ClaimResponse.item.Slices for extension.extension:reviewOutcome		1..1	(Complex)	Item-level review outcome summary URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/shared-care-review-outcome
ClaimResponse.item.Slices for extension.extension:traceNumber		0..*	Identifier	Internal trace identifier URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/shared-care-trace-number
ClaimResponse.item.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
ClaimResponse.item.itemSequence		1..1	positiveInt	To match Claim.item.sequence
ClaimResponse.item.adjudication		1..*	BackboneElement	Adjudication (reason, amount, quantity) for each Adjudication Value Code
ClaimResponse.item.adjudication.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
ClaimResponse.item.adjudication.category		1..1	CodeableConcept	Type of adjudication information Binding: Pharmacy Adjudication Category (extensible)
ClaimResponse.item.adjudication.reason		0..1	CodeableConcept	Codified reason(s) for the adjudication Binding: Adjudication Reason Codes (extensible)
ClaimResponse.item.adjudication.amount		1..1	Money	Monetary amount
ClaimResponse.item.detail		1..*	BackboneElement	Adjudication for claim detail items
ClaimResponse.item.detail.Slices for extension		2..*	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
ClaimResponse.item.detail.Slices for extension.extension:traceNumber		0..1	Identifier	Internal trace identifier URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/shared-care-trace-number
ClaimResponse.item.detail.Slices for extension.extension:productOrService		1..1	CodeableConcept	Dispensed pharmaceutical component URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/pharmacy-item-detail-product-or-service
ClaimResponse.item.detail.Slices for extension.extension:reviewOutcome		1..1	(Complex)	Pharmacy Claim Item Detail Review Outcome URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/pharmacy-item-detail-review-outcome
ClaimResponse.item.detail.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
ClaimResponse.item.detail.detailSequence		1..1	positiveInt	To match Claim.item.detail.sequence
ClaimResponse.item.detail.adjudication		1..*	BackboneElement	Adjudication details breakdown
ClaimResponse.item.detail.adjudication.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
ClaimResponse.item.detail.adjudication.category		1..1	CodeableConcept	Type of adjudication information Binding: Pharmacy Adjudication Category (extensible)
ClaimResponse.item.detail.adjudication.reason		0..1	CodeableConcept	Explanation of adjudication outcome Binding: Adjudication Reason Codes (extensible)
ClaimResponse.payment		0..1	BackboneElement	Payment details
ClaimResponse.payment.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
ClaimResponse.payment.type		1..1	CodeableConcept	Partial or complete payment Binding: ExamplePaymentTypeCodes (example): The type (partial, complete) of the payment.
ClaimResponse.payment.date		0..1	date	Payment date
ClaimResponse.payment.amount		1..1	Money	Payment amount
Documentation for this format

Terminology Bindings

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.insurer.​identifier.use	Base	required	IdentifierUse	📍4.0.1	FHIR Std.
ClaimResponse.requestor.​identifier.use	Base	required	IdentifierUse	📍4.0.1	FHIR Std.
ClaimResponse.outcome	Base	required	Claim Processing Codes	📦4.0.1	FHIR Std.
ClaimResponse.item.adjudication.​category	Base	extensible	Pharmacy Adjudication Category	📦0.4.7	This IG
ClaimResponse.item.adjudication.​reason	Base	extensible	Adjudication Reason Codes	📦0.4.7	This IG
ClaimResponse.item.detail.​adjudication.category	Base	extensible	Pharmacy Adjudication Category	📦0.4.7	This IG
ClaimResponse.item.detail.​adjudication.reason	Base	extensible	Adjudication Reason Codes	📦0.4.7	This IG
ClaimResponse.payment.​type	Base	example	Example Payment Type Codes	📍4.0.1	FHIR Std.

Constraints

Id	Grade	Path(s)	Description	Expression
allowedLocalIdentifierSystems	error	ClaimResponse.insurer.identifier.system, ClaimResponse.requestor.identifier.system	Identifier system must be HPI facility, HPI Organisation, HPI CPN or NZBN	$this = 'https://standards.digital.health.nz/ns/hpi-organisation-id' or $this = 'https://standards.digital.health.nz/ns/hpi-nzbn' or $this = 'https://standards.digital.health.nz/ns/hpi-facility-id' or $this = 'https://standards.digital.health.nz/ns/hpi-person-id'
hpi-location-url-format	error	ClaimResponse.meta.source	Reference must be an HPI facility URL with format https://standards.digital.health.nz/ns/hpi-facility-id/FZZ111-A	matches('^https://standards.digital.health.nz/ns/hpi-facility-id/F[A-Za-z0-9]{2}[0-9]{3}-[A-Za-z0-9]$')
hpiCpnPattern	error	ClaimResponse.insurer.identifier, ClaimResponse.requestor.identifier	HPI CPN must conform to format (NNXXXX where N is numeric and X is alphabetic).	system = 'https://standards.digital.health.nz/ns/hpi-person-id' implies value.matches('^[0-9]{2}[A-Za-z]{4}$')
hpiFacilityIdPattern	error	ClaimResponse.insurer.identifier, ClaimResponse.requestor.identifier	HPI Facility ID must conform to format (FXXnnn-C).	system = 'https://standards.digital.health.nz/ns/hpi-facility-id' implies value.matches('^F[A-Za-z0-9]{2}[0-9]{3}-[A-Za-z0-9]$')
hpiOrganizationIdPattern	error	ClaimResponse.insurer.identifier, ClaimResponse.requestor.identifier	HPI Organisation ID must conform to format (GXXnnn-C).	system = 'https://standards.digital.health.nz/ns/hpi-organisation-id' implies value.matches('^G[a-zA-Z0-9]{2}[0-9]{3}-[a-zA-Z0-9]$')
nzbnPattern	error	ClaimResponse.insurer.identifier, ClaimResponse.requestor.identifier	NZBN must conform to format (13 digits).	system = 'https://standards.digital.health.nz/ns/hpi-nzbn' implies value.matches('^[0-9]{13}$')

Differential View

This structure is derived from ClaimResponse

Name	Flags	Card.	Type	Description & Constraints    Filter: Bindings Constraints Obligations
ClaimResponse		0..*	ClaimResponse	Response to a claim predetermination or preauthorization
ClaimResponse.meta		1..1	Meta	Metadata about the resource
ClaimResponse.meta.source	C	1..1	uri	HPI Facility ID from where the record is sourced Constraints: hpi-location-url-format
ClaimResponse.meta.profile		1..1	canonical(StructureDefinition)	Profiles this resource claims to conform to
ClaimResponse.meta.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
ClaimResponse.meta.Slices for tag.tag:correlationId		1..1	Coding	Tags applied to this resource
ClaimResponse.meta.Slices for tag.tag:correlationId.system		1..1	uri	Hub correlation ID system Required Pattern: https://hub.services.digital.health.nz/ns/correlation-id
ClaimResponse.meta.Slices for tag.tag:correlationId.code		1..1	code	Symbol in syntax defined by the system
ClaimResponse.contained		0..0		Contained, inline Resources
ClaimResponse.identifier		1..1	Identifier	ClaimResponse identifier
ClaimResponse.identifier.system		1..1	uri	The namespace for the identifier value Fixed Value: https://standards.digital.health.nz/ns/claim-response-identifier
ClaimResponse.identifier.value		1..1	string	The value that is unique
ClaimResponse.type		1..1	CodeableConcept	More granular claim type Binding: NZ Claim Types (extensible)
ClaimResponse.subType		1..1	CodeableConcept	More granular claim type Binding: NZ Claim Subtypes (extensible)
ClaimResponse.created		1..1	dateTime	DateValidated
ClaimResponse.insurer
ClaimResponse.insurer.identifier	C	1..1	Identifier	A local identifier MUST be added to this section. Constraints: hpiOrganizationIdPattern, hpiFacilityIdPattern, nzbnPattern, hpiCpnPattern
ClaimResponse.insurer.identifier.use		0..1	code	The local identifier use SHOULD be set to official.
ClaimResponse.insurer.identifier.system	C	1..1	uri	The system identifier for the organization, facility or nzbn Constraints: allowedLocalIdentifierSystems Example HPI Organisation ID: https://standards.digital.health.nz/ns/hpi-organisation-id
ClaimResponse.insurer.identifier.value		1..1	string	The actual local identifier value, e.g. GZZ999-Z Example Example HPI Org ID: GZZ999-Z
ClaimResponse.requestor		1..1	Reference(Organization)	Party submitting the claim
ClaimResponse.requestor.identifier	C	1..1	Identifier	A local identifier MUST be added to this section. Constraints: hpiOrganizationIdPattern, hpiFacilityIdPattern, nzbnPattern, hpiCpnPattern
ClaimResponse.requestor.identifier.use		0..1	code	The local identifier use SHOULD be set to official.
ClaimResponse.requestor.identifier.system	C	1..1	uri	The system identifier for the organization, facility or nzbn Constraints: allowedLocalIdentifierSystems Example HPI Organisation ID: https://standards.digital.health.nz/ns/hpi-organisation-id
ClaimResponse.requestor.identifier.value		1..1	string	The actual local identifier value, e.g. GZZ999-Z Example Example HPI Org ID: GZZ999-Z
ClaimResponse.request		1..1	Reference(Claim)	Reference to the original Claim
ClaimResponse.outcome		1..1	code	Claim processing outcome Binding: ClaimProcessingCodes (required)
ClaimResponse.item		0..*	BackboneElement	Adjudication for claim line items
ClaimResponse.item.Slices for extension		2..*	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
ClaimResponse.item.Slices for extension.extension:productOrService		1..1	CodeableConcept	Product or Service code URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/shared-care-product-or-service
ClaimResponse.item.Slices for extension.extension:reviewOutcome		1..1	(Complex)	Item-level review outcome summary URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/shared-care-review-outcome
ClaimResponse.item.Slices for extension.extension:traceNumber		0..*	Identifier	Internal trace identifier URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/shared-care-trace-number
ClaimResponse.item.itemSequence		1..1	positiveInt	To match Claim.item.sequence
ClaimResponse.item.adjudication		1..*	BackboneElement	Adjudication (reason, amount, quantity) for each Adjudication Value Code
ClaimResponse.item.adjudication.category		1..1	CodeableConcept	Type of adjudication information Binding: Pharmacy Adjudication Category (extensible)
ClaimResponse.item.adjudication.reason		0..1	CodeableConcept	Codified reason(s) for the adjudication Binding: Adjudication Reason Codes (extensible)
ClaimResponse.item.adjudication.amount		1..1	Money	Monetary amount
ClaimResponse.item.detail		1..*	BackboneElement	Adjudication for claim detail items
ClaimResponse.item.detail.Slices for extension		2..*	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
ClaimResponse.item.detail.Slices for extension.extension:traceNumber		0..1	Identifier	Internal trace identifier URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/shared-care-trace-number
ClaimResponse.item.detail.Slices for extension.extension:productOrService		1..1	CodeableConcept	Dispensed pharmaceutical component URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/pharmacy-item-detail-product-or-service
ClaimResponse.item.detail.Slices for extension.extension:reviewOutcome		1..1	(Complex)	Pharmacy Claim Item Detail Review Outcome URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/pharmacy-item-detail-review-outcome
ClaimResponse.item.detail.detailSequence		1..1	positiveInt	To match Claim.item.detail.sequence
ClaimResponse.item.detail.adjudication		1..*	BackboneElement	Adjudication details breakdown
ClaimResponse.item.detail.adjudication.category		1..1	CodeableConcept	Type of adjudication information Binding: Pharmacy Adjudication Category (extensible)
ClaimResponse.item.detail.adjudication.reason		0..1	CodeableConcept	Explanation of adjudication outcome Binding: Adjudication Reason Codes (extensible)
ClaimResponse.payment		0..1	BackboneElement	Payment details
ClaimResponse.payment.date		0..1	date	Payment date
ClaimResponse.payment.amount		1..1	Money	Payment amount
ClaimResponse.error
ClaimResponse.error.itemSequence		1..1	positiveInt	Item sequence number
ClaimResponse.error.detailSequence		1..1	positiveInt	Detail sequence number
ClaimResponse.error.code		1..1	CodeableConcept	Error code Binding: Claim Decision Reason Codes (required)
Documentation for this format

Terminology Bindings (Differential)

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.outcome	Base	required	Claim Processing Codes	📦4.0.1	FHIR Std.
ClaimResponse.item.adjudication.​category	Base	extensible	Pharmacy Adjudication Category	📦0.4.7	This IG
ClaimResponse.item.adjudication.​reason	Base	extensible	Adjudication Reason Codes	📦0.4.7	This IG
ClaimResponse.item.detail.​adjudication.category	Base	extensible	Pharmacy Adjudication Category	📦0.4.7	This IG
ClaimResponse.item.detail.​adjudication.reason	Base	extensible	Adjudication Reason Codes	📦0.4.7	This IG
ClaimResponse.error.​code	Base	required	Claim Decision Reason Codes	📦0.4.7	This IG

Constraints

Id	Grade	Path(s)	Description	Expression
allowedLocalIdentifierSystems	error	ClaimResponse.insurer.identifier.system, ClaimResponse.requestor.identifier.system	Identifier system must be HPI facility, HPI Organisation, HPI CPN or NZBN	$this = 'https://standards.digital.health.nz/ns/hpi-organisation-id' or $this = 'https://standards.digital.health.nz/ns/hpi-nzbn' or $this = 'https://standards.digital.health.nz/ns/hpi-facility-id' or $this = 'https://standards.digital.health.nz/ns/hpi-person-id'
hpi-location-url-format	error	ClaimResponse.meta.source	Reference must be an HPI facility URL with format https://standards.digital.health.nz/ns/hpi-facility-id/FZZ111-A	matches('^https://standards.digital.health.nz/ns/hpi-facility-id/F[A-Za-z0-9]{2}[0-9]{3}-[A-Za-z0-9]$')
hpiCpnPattern	error	ClaimResponse.insurer.identifier, ClaimResponse.requestor.identifier	HPI CPN must conform to format (NNXXXX where N is numeric and X is alphabetic).	system = 'https://standards.digital.health.nz/ns/hpi-person-id' implies value.matches('^[0-9]{2}[A-Za-z]{4}$')
hpiFacilityIdPattern	error	ClaimResponse.insurer.identifier, ClaimResponse.requestor.identifier	HPI Facility ID must conform to format (FXXnnn-C).	system = 'https://standards.digital.health.nz/ns/hpi-facility-id' implies value.matches('^F[A-Za-z0-9]{2}[0-9]{3}-[A-Za-z0-9]$')
hpiOrganizationIdPattern	error	ClaimResponse.insurer.identifier, ClaimResponse.requestor.identifier	HPI Organisation ID must conform to format (GXXnnn-C).	system = 'https://standards.digital.health.nz/ns/hpi-organisation-id' implies value.matches('^G[a-zA-Z0-9]{2}[0-9]{3}-[a-zA-Z0-9]$')
nzbnPattern	error	ClaimResponse.insurer.identifier, ClaimResponse.requestor.identifier	NZBN must conform to format (13 digits).	system = 'https://standards.digital.health.nz/ns/hpi-nzbn' implies value.matches('^[0-9]{13}$')

Snapshot View

Name	Flags	Card.	Type	Description & Constraints    Filter: Bindings Constraints Obligations
ClaimResponse		0..*	ClaimResponse	Response to a claim predetermination or preauthorization
ClaimResponse.id	Σ This element is included in summaries.	0..1	id	Logical id of this artifact
ClaimResponse.meta	Σ This element is included in summaries.	1..1	Meta	Metadata about the resource
ClaimResponse.meta.id		0..1	string	Unique id for inter-element referencing
ClaimResponse.meta.extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
ClaimResponse.meta.versionId	Σ This element is included in summaries.	0..1	id	Version specific identifier
ClaimResponse.meta.lastUpdated	Σ This element is included in summaries.	0..1	instant	When the resource version last changed
ClaimResponse.meta.source	Σ This element is included in summaries. C	1..1	uri	HPI Facility ID from where the record is sourced Constraints: hpi-location-url-format
ClaimResponse.meta.profile	Σ This element is included in summaries.	1..1	canonical(StructureDefinition)	Profiles this resource claims to conform to
ClaimResponse.meta.security	Σ This element is included in summaries.	0..*	Coding	Security Labels applied to this resource Binding: All Security Labels (extensible): Security Labels from the Healthcare Privacy and Security Classification System.
ClaimResponse.meta.Slices for tag	Σ This element is included in summaries.	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
ClaimResponse.meta.Slices for tag.tag:correlationId	Σ This element is included in summaries.	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".
ClaimResponse.meta.Slices for tag.tag:correlationId.id		0..1	string	Unique id for inter-element referencing
ClaimResponse.meta.Slices for tag.tag:correlationId.extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
ClaimResponse.meta.Slices for tag.tag:correlationId.system	Σ This element is included in summaries.	1..1	uri	Hub correlation ID system Required Pattern: https://hub.services.digital.health.nz/ns/correlation-id
ClaimResponse.meta.Slices for tag.tag:correlationId.version	Σ This element is included in summaries.	0..1	string	Version of the system - if relevant
ClaimResponse.meta.Slices for tag.tag:correlationId.code	Σ This element is included in summaries.	1..1	code	Symbol in syntax defined by the system
ClaimResponse.meta.Slices for tag.tag:correlationId.display	Σ This element is included in summaries.	0..1	string	Representation defined by the system
ClaimResponse.meta.Slices for tag.tag:correlationId.userSelected	Σ This element is included in summaries.	0..1	boolean	If this coding was chosen directly by the user
ClaimResponse.implicitRules	?! This element is a modifier element. Σ This element is included in summaries.	0..1	uri	A set of rules under which this content was created
ClaimResponse.language		0..1	code	Language of the resource content Binding: CommonLanguages (preferred): A human language. Additional Bindings Purpose AllLanguages Max Binding
ClaimResponse.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
ClaimResponse.extension		0..*	Extension	Additional content defined by implementations
ClaimResponse.modifierExtension	?! This element is a modifier element.	0..*	Extension	Extensions that cannot be ignored
ClaimResponse.identifier		1..1	Identifier	ClaimResponse identifier
ClaimResponse.identifier.id		0..1	string	Unique id for inter-element referencing
ClaimResponse.identifier.extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
ClaimResponse.identifier.use	?! This element is a modifier element. Σ This element is included in summaries.	0..1	code	usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .
ClaimResponse.identifier.type	Σ This element is included in summaries.	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.
ClaimResponse.identifier.system	Σ This element is included in summaries.	1..1	uri	The namespace for the identifier value Fixed Value: https://standards.digital.health.nz/ns/claim-response-identifier
ClaimResponse.identifier.value	Σ This element is included in summaries.	1..1	string	The value that is unique Example General: 123456
ClaimResponse.identifier.period	Σ This element is included in summaries.	0..1	Period	Time period when id is/was valid for use
ClaimResponse.identifier.assigner	Σ This element is included in summaries.	0..1	Reference(Organization)	Organization that issued id (may be just text)
ClaimResponse.status	?! This element is a modifier element. Σ This element is included in summaries.	1..1	code	active | cancelled | draft | entered-in-error Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance.
ClaimResponse.type	Σ This element is included in summaries.	1..1	CodeableConcept	More granular claim type Binding: NZ Claim Types (extensible)
ClaimResponse.subType		1..1	CodeableConcept	More granular claim type Binding: NZ Claim Subtypes (extensible)
ClaimResponse.use	Σ This element is included in summaries.	1..1	code	claim | preauthorization | predetermination Binding: Use (required): Claim, preauthorization, predetermination.
ClaimResponse.patient	Σ This element is included in summaries.	1..1	Reference(Patient)	The recipient of the products and services
ClaimResponse.created	Σ This element is included in summaries.	1..1	dateTime	DateValidated
ClaimResponse.insurer	Σ This element is included in summaries.	1..1	Reference(Organization)	Party responsible for reimbursement
ClaimResponse.insurer.id		0..1	string	Unique id for inter-element referencing
ClaimResponse.insurer.extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
ClaimResponse.insurer.reference	Σ This element is included in summaries. C	0..1	string	Literal reference, Relative, internal or absolute URL
ClaimResponse.insurer.type	Σ This element is included in summaries.	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).
ClaimResponse.insurer.identifier	Σ This element is included in summaries. C	1..1	Identifier	A local identifier MUST be added to this section. Constraints: hpiOrganizationIdPattern, hpiFacilityIdPattern, nzbnPattern, hpiCpnPattern
ClaimResponse.insurer.identifier.id		0..1	string	Unique id for inter-element referencing
ClaimResponse.insurer.identifier.extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
ClaimResponse.insurer.identifier.use	?! This element is a modifier element. Σ This element is included in summaries.	0..1	code	The local identifier use SHOULD be set to official. Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .
ClaimResponse.insurer.identifier.type	Σ This element is included in summaries.	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.
ClaimResponse.insurer.identifier.system	Σ This element is included in summaries. C	1..1	uri	The system identifier for the organization, facility or nzbn Constraints: allowedLocalIdentifierSystems Example General: http://www.acme.com/identifiers/patient Example HPI Organisation ID: https://standards.digital.health.nz/ns/hpi-organisation-id
ClaimResponse.insurer.identifier.value	Σ This element is included in summaries.	1..1	string	The actual local identifier value, e.g. GZZ999-Z Example General: 123456 Example Example HPI Org ID: GZZ999-Z
ClaimResponse.insurer.identifier.period	Σ This element is included in summaries.	0..1	Period	Time period when id is/was valid for use
ClaimResponse.insurer.identifier.assigner	Σ This element is included in summaries.	0..1	Reference(Organization)	Organization that issued id (may be just text)
ClaimResponse.insurer.display	Σ This element is included in summaries.	0..1	string	Text alternative for the resource
ClaimResponse.requestor		1..1	Reference(Organization)	Party submitting the claim
ClaimResponse.requestor.id		0..1	string	Unique id for inter-element referencing
ClaimResponse.requestor.extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
ClaimResponse.requestor.reference	Σ This element is included in summaries. C	0..1	string	Literal reference, Relative, internal or absolute URL
ClaimResponse.requestor.type	Σ This element is included in summaries.	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).
ClaimResponse.requestor.identifier	Σ This element is included in summaries. C	1..1	Identifier	A local identifier MUST be added to this section. Constraints: hpiOrganizationIdPattern, hpiFacilityIdPattern, nzbnPattern, hpiCpnPattern
ClaimResponse.requestor.identifier.id		0..1	string	Unique id for inter-element referencing
ClaimResponse.requestor.identifier.extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
ClaimResponse.requestor.identifier.use	?! This element is a modifier element. Σ This element is included in summaries.	0..1	code	The local identifier use SHOULD be set to official. Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .
ClaimResponse.requestor.identifier.type	Σ This element is included in summaries.	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.
ClaimResponse.requestor.identifier.system	Σ This element is included in summaries. C	1..1	uri	The system identifier for the organization, facility or nzbn Constraints: allowedLocalIdentifierSystems Example General: http://www.acme.com/identifiers/patient Example HPI Organisation ID: https://standards.digital.health.nz/ns/hpi-organisation-id
ClaimResponse.requestor.identifier.value	Σ This element is included in summaries.	1..1	string	The actual local identifier value, e.g. GZZ999-Z Example General: 123456 Example Example HPI Org ID: GZZ999-Z
ClaimResponse.requestor.identifier.period	Σ This element is included in summaries.	0..1	Period	Time period when id is/was valid for use
ClaimResponse.requestor.identifier.assigner	Σ This element is included in summaries.	0..1	Reference(Organization)	Organization that issued id (may be just text)
ClaimResponse.requestor.display	Σ This element is included in summaries.	0..1	string	Text alternative for the resource
ClaimResponse.request	Σ This element is included in summaries.	1..1	Reference(Claim)	Reference to the original Claim
ClaimResponse.outcome	Σ This element is included in summaries.	1..1	code	Claim processing outcome Binding: ClaimProcessingCodes (required)
ClaimResponse.disposition		0..1	string	Disposition Message
ClaimResponse.preAuthRef		0..1	string	Preauthorization reference
ClaimResponse.preAuthPeriod		0..1	Period	Preauthorization reference effective period
ClaimResponse.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.
ClaimResponse.item		0..*	BackboneElement	Adjudication for claim line items
ClaimResponse.item.id		0..1	string	Unique id for inter-element referencing
ClaimResponse.item.Slices for extension		2..*	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
ClaimResponse.item.Slices for extension.extension:productOrService		1..1	CodeableConcept	Product or Service code URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/shared-care-product-or-service
ClaimResponse.item.Slices for extension.extension:reviewOutcome		1..1	(Complex)	Item-level review outcome summary URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/shared-care-review-outcome
ClaimResponse.item.Slices for extension.extension:traceNumber		0..*	Identifier	Internal trace identifier URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/shared-care-trace-number
ClaimResponse.item.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
ClaimResponse.item.itemSequence		1..1	positiveInt	To match Claim.item.sequence
ClaimResponse.item.noteNumber		0..*	positiveInt	Applicable note numbers
ClaimResponse.item.adjudication		1..*	BackboneElement	Adjudication (reason, amount, quantity) for each Adjudication Value Code
ClaimResponse.item.adjudication.id		0..1	string	Unique id for inter-element referencing
ClaimResponse.item.adjudication.extension		0..*	Extension	Additional content defined by implementations
ClaimResponse.item.adjudication.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
ClaimResponse.item.adjudication.category		1..1	CodeableConcept	Type of adjudication information Binding: Pharmacy Adjudication Category (extensible)
ClaimResponse.item.adjudication.reason		0..1	CodeableConcept	Codified reason(s) for the adjudication Binding: Adjudication Reason Codes (extensible)
ClaimResponse.item.adjudication.amount		1..1	Money	Monetary amount
ClaimResponse.item.adjudication.value		0..1	decimal	Non-monetary value
ClaimResponse.item.detail		1..*	BackboneElement	Adjudication for claim detail items
ClaimResponse.item.detail.id		0..1	string	Unique id for inter-element referencing
ClaimResponse.item.detail.Slices for extension		2..*	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
ClaimResponse.item.detail.Slices for extension.extension:traceNumber		0..1	Identifier	Internal trace identifier URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/shared-care-trace-number
ClaimResponse.item.detail.Slices for extension.extension:productOrService		1..1	CodeableConcept	Dispensed pharmaceutical component URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/pharmacy-item-detail-product-or-service
ClaimResponse.item.detail.Slices for extension.extension:reviewOutcome		1..1	(Complex)	Pharmacy Claim Item Detail Review Outcome URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/pharmacy-item-detail-review-outcome
ClaimResponse.item.detail.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
ClaimResponse.item.detail.detailSequence		1..1	positiveInt	To match Claim.item.detail.sequence
ClaimResponse.item.detail.noteNumber		0..*	positiveInt	Applicable note numbers
ClaimResponse.item.detail.adjudication		1..*	BackboneElement	Adjudication details breakdown
ClaimResponse.item.detail.adjudication.id		0..1	string	Unique id for inter-element referencing
ClaimResponse.item.detail.adjudication.extension		0..*	Extension	Additional content defined by implementations
ClaimResponse.item.detail.adjudication.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
ClaimResponse.item.detail.adjudication.category		1..1	CodeableConcept	Type of adjudication information Binding: Pharmacy Adjudication Category (extensible)
ClaimResponse.item.detail.adjudication.reason		0..1	CodeableConcept	Explanation of adjudication outcome Binding: Adjudication Reason Codes (extensible)
ClaimResponse.item.detail.adjudication.amount		0..1	Money	Monetary amount
ClaimResponse.item.detail.adjudication.value		0..1	decimal	Non-monetary value
ClaimResponse.item.detail.subDetail		0..*	BackboneElement	Adjudication for claim sub-details
ClaimResponse.item.detail.subDetail.id		0..1	string	Unique id for inter-element referencing
ClaimResponse.item.detail.subDetail.extension		0..*	Extension	Additional content defined by implementations
ClaimResponse.item.detail.subDetail.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
ClaimResponse.item.detail.subDetail.subDetailSequence		1..1	positiveInt	Claim sub-detail instance identifier
ClaimResponse.item.detail.subDetail.noteNumber		0..*	positiveInt	Applicable note numbers
ClaimResponse.item.detail.subDetail.adjudication		0..*	See adjudication (ClaimResponse)	Subdetail level adjudication details
ClaimResponse.addItem		0..*	BackboneElement	Insurer added line items
ClaimResponse.addItem.id		0..1	string	Unique id for inter-element referencing
ClaimResponse.addItem.extension		0..*	Extension	Additional content defined by implementations
ClaimResponse.addItem.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
ClaimResponse.addItem.itemSequence		0..*	positiveInt	Item sequence number
ClaimResponse.addItem.detailSequence		0..*	positiveInt	Detail sequence number
ClaimResponse.addItem.subdetailSequence		0..*	positiveInt	Subdetail sequence number
ClaimResponse.addItem.provider		0..*	Reference(Practitioner | PractitionerRole | Organization)	Authorized providers
ClaimResponse.addItem.productOrService		1..1	CodeableConcept	Billing, service, product, or drug code Binding: USCLSCodes (example): Allowable service and product codes.
ClaimResponse.addItem.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.
ClaimResponse.addItem.programCode		0..*	CodeableConcept	Program the product or service is provided under Binding: ExampleProgramReasonCodes (example): Program specific reason codes.
ClaimResponse.addItem.serviced[x]		0..1		Date or dates of service or product delivery
ClaimResponse.addItem.serviced[x].servicedDate			date
ClaimResponse.addItem.serviced[x].servicedPeriod			Period
ClaimResponse.addItem.location[x]		0..1		Place of service or where product was supplied Binding: ExampleServicePlaceCodes (example): Place of service: pharmacy, school, prison, etc.
ClaimResponse.addItem.location[x].locationCodeableConcept			CodeableConcept
ClaimResponse.addItem.location[x].locationAddress			Address
ClaimResponse.addItem.location[x].locationReference			Reference(Location)
ClaimResponse.addItem.quantity	C	0..1	SimpleQuantity(4.0.1)	Count of products or services Constraints: sqty-1
ClaimResponse.addItem.unitPrice		0..1	Money	Fee, charge or cost per item
ClaimResponse.addItem.factor		0..1	decimal	Price scaling factor
ClaimResponse.addItem.net		0..1	Money	Total item cost
ClaimResponse.addItem.bodySite		0..1	CodeableConcept	Anatomical location Binding: OralSiteCodes (example): The code for the teeth, quadrant, sextant and arch.
ClaimResponse.addItem.subSite		0..*	CodeableConcept	Anatomical sub-location Binding: SurfaceCodes (example): The code for the tooth surface and surface combinations.
ClaimResponse.addItem.noteNumber		0..*	positiveInt	Applicable note numbers
ClaimResponse.addItem.adjudication		1..*	See adjudication (ClaimResponse)	Added items adjudication
ClaimResponse.addItem.detail		0..*	BackboneElement	Insurer added line details
ClaimResponse.addItem.detail.id		0..1	string	Unique id for inter-element referencing
ClaimResponse.addItem.detail.extension		0..*	Extension	Additional content defined by implementations
ClaimResponse.addItem.detail.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
ClaimResponse.addItem.detail.productOrService		1..1	CodeableConcept	Billing, service, product, or drug code Binding: USCLSCodes (example): Allowable service and product codes.
ClaimResponse.addItem.detail.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.
ClaimResponse.addItem.detail.quantity	C	0..1	SimpleQuantity(4.0.1)	Count of products or services Constraints: sqty-1
ClaimResponse.addItem.detail.unitPrice		0..1	Money	Fee, charge or cost per item
ClaimResponse.addItem.detail.factor		0..1	decimal	Price scaling factor
ClaimResponse.addItem.detail.net		0..1	Money	Total item cost
ClaimResponse.addItem.detail.noteNumber		0..*	positiveInt	Applicable note numbers
ClaimResponse.addItem.detail.adjudication		1..*	See adjudication (ClaimResponse)	Added items detail adjudication
ClaimResponse.addItem.detail.subDetail		0..*	BackboneElement	Insurer added line items
ClaimResponse.addItem.detail.subDetail.id		0..1	string	Unique id for inter-element referencing
ClaimResponse.addItem.detail.subDetail.extension		0..*	Extension	Additional content defined by implementations
ClaimResponse.addItem.detail.subDetail.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
ClaimResponse.addItem.detail.subDetail.productOrService		1..1	CodeableConcept	Billing, service, product, or drug code Binding: USCLSCodes (example): Allowable service and product codes.
ClaimResponse.addItem.detail.subDetail.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.
ClaimResponse.addItem.detail.subDetail.quantity	C	0..1	SimpleQuantity(4.0.1)	Count of products or services Constraints: sqty-1
ClaimResponse.addItem.detail.subDetail.unitPrice		0..1	Money	Fee, charge or cost per item
ClaimResponse.addItem.detail.subDetail.factor		0..1	decimal	Price scaling factor
ClaimResponse.addItem.detail.subDetail.net		0..1	Money	Total item cost
ClaimResponse.addItem.detail.subDetail.noteNumber		0..*	positiveInt	Applicable note numbers
ClaimResponse.addItem.detail.subDetail.adjudication		1..*	See adjudication (ClaimResponse)	Added items detail adjudication
ClaimResponse.adjudication		0..*	See adjudication (ClaimResponse)	Header-level adjudication
ClaimResponse.total	Σ This element is included in summaries.	0..*	BackboneElement	Adjudication totals
ClaimResponse.total.id		0..1	string	Unique id for inter-element referencing
ClaimResponse.total.extension		0..*	Extension	Additional content defined by implementations
ClaimResponse.total.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
ClaimResponse.total.category	Σ This element is included in summaries.	1..1	CodeableConcept	Type of adjudication information Binding: AdjudicationValueCodes (example): The adjudication codes.
ClaimResponse.total.amount	Σ This element is included in summaries.	1..1	Money	Financial total for the category
ClaimResponse.payment		0..1	BackboneElement	Payment details
ClaimResponse.payment.id		0..1	string	Unique id for inter-element referencing
ClaimResponse.payment.extension		0..*	Extension	Additional content defined by implementations
ClaimResponse.payment.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
ClaimResponse.payment.type		1..1	CodeableConcept	Partial or complete payment Binding: ExamplePaymentTypeCodes (example): The type (partial, complete) of the payment.
ClaimResponse.payment.adjustment		0..1	Money	Payment adjustment for non-claim issues
ClaimResponse.payment.adjustmentReason		0..1	CodeableConcept	Explanation for the adjustment Binding: PaymentAdjustmentReasonCodes (example): Payment Adjustment reason codes.
ClaimResponse.payment.date		0..1	date	Payment date
ClaimResponse.payment.amount		1..1	Money	Payment amount
ClaimResponse.payment.identifier		0..1	Identifier	Business identifier for the payment
ClaimResponse.fundsReserve		0..1	CodeableConcept	Funds reserved status Binding: Funds Reservation Codes (example): For whom funds are to be reserved: (Patient, Provider, None).
ClaimResponse.formCode		0..1	CodeableConcept	Printed form identifier Binding: Form Codes (example): The forms codes.
ClaimResponse.form		0..1	Attachment	Printed reference or actual form
ClaimResponse.processNote		0..*	BackboneElement	Note concerning adjudication
ClaimResponse.processNote.id		0..1	string	Unique id for inter-element referencing
ClaimResponse.processNote.extension		0..*	Extension	Additional content defined by implementations
ClaimResponse.processNote.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
ClaimResponse.processNote.number		0..1	positiveInt	Note instance identifier
ClaimResponse.processNote.type		0..1	code	display | print | printoper Binding: NoteType (required): The presentation types of notes.
ClaimResponse.processNote.text		1..1	string	Note explanatory text
ClaimResponse.processNote.language		0..1	CodeableConcept	Language of the text Binding: CommonLanguages (preferred): A human language. Additional Bindings Purpose AllLanguages Max Binding
ClaimResponse.communicationRequest		0..*	Reference(CommunicationRequest)	Request for additional information
ClaimResponse.insurance		0..*	BackboneElement	Patient insurance information
ClaimResponse.insurance.id		0..1	string	Unique id for inter-element referencing
ClaimResponse.insurance.extension		0..*	Extension	Additional content defined by implementations
ClaimResponse.insurance.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
ClaimResponse.insurance.sequence		1..1	positiveInt	Insurance instance identifier
ClaimResponse.insurance.focal		1..1	boolean	Coverage to be used for adjudication
ClaimResponse.insurance.coverage		1..1	Reference(Coverage)	Insurance information
ClaimResponse.insurance.businessArrangement		0..1	string	Additional provider contract number
ClaimResponse.insurance.claimResponse		0..1	Reference(ClaimResponse)	Adjudication results
ClaimResponse.error		0..*	BackboneElement	Processing errors
ClaimResponse.error.id		0..1	string	Unique id for inter-element referencing
ClaimResponse.error.extension		0..*	Extension	Additional content defined by implementations
ClaimResponse.error.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
ClaimResponse.error.itemSequence		1..1	positiveInt	Item sequence number
ClaimResponse.error.detailSequence		1..1	positiveInt	Detail sequence number
ClaimResponse.error.subDetailSequence		0..1	positiveInt	Subdetail sequence number
ClaimResponse.error.code		1..1	CodeableConcept	Error code Binding: Claim Decision Reason Codes (required)
Documentation for this format

Terminology Bindings

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.insurer.​type	Base	extensible	ResourceType	📍4.0.1	FHIR Std.
ClaimResponse.insurer.​identifier.use	Base	required	IdentifierUse	📍4.0.1	FHIR Std.
ClaimResponse.insurer.​identifier.type	Base	extensible	IdentifierType	📍4.0.1	FHIR Std.
ClaimResponse.requestor.​type	Base	extensible	ResourceType	📍4.0.1	FHIR Std.
ClaimResponse.requestor.​identifier.use	Base	required	IdentifierUse	📍4.0.1	FHIR Std.
ClaimResponse.requestor.​identifier.type	Base	extensible	IdentifierType	📍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	Pharmacy Adjudication Category	📦0.4.7	This IG
ClaimResponse.item.adjudication.​reason	Base	extensible	Adjudication Reason Codes	📦0.4.7	This IG
ClaimResponse.item.detail.​adjudication.category	Base	extensible	Pharmacy Adjudication Category	📦0.4.7	This IG
ClaimResponse.item.detail.​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	example	Example Payment Type Codes	📍4.0.1	FHIR Std.
ClaimResponse.payment.​adjustmentReason	Base	example	Payment Adjustment Reason Codes	📍4.0.1	FHIR Std.
ClaimResponse.fundsReserve	Base	example	FundsReserve	📍4.0.1	FHIR Std.
ClaimResponse.formCode	Base	example	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	required	Claim Decision Reason Codes	📦0.4.7	This IG

Constraints

Id	Grade	Path(s)	Description	Expression
allowedLocalIdentifierSystems	error	ClaimResponse.insurer.identifier.system, ClaimResponse.requestor.identifier.system	Identifier system must be HPI facility, HPI Organisation, HPI CPN or NZBN	$this = 'https://standards.digital.health.nz/ns/hpi-organisation-id' or $this = 'https://standards.digital.health.nz/ns/hpi-nzbn' or $this = 'https://standards.digital.health.nz/ns/hpi-facility-id' or $this = 'https://standards.digital.health.nz/ns/hpi-person-id'
hpi-location-url-format	error	ClaimResponse.meta.source	Reference must be an HPI facility URL with format https://standards.digital.health.nz/ns/hpi-facility-id/FZZ111-A	matches('^https://standards.digital.health.nz/ns/hpi-facility-id/F[A-Za-z0-9]{2}[0-9]{3}-[A-Za-z0-9]$')
hpiCpnPattern	error	ClaimResponse.insurer.identifier, ClaimResponse.requestor.identifier	HPI CPN must conform to format (NNXXXX where N is numeric and X is alphabetic).	system = 'https://standards.digital.health.nz/ns/hpi-person-id' implies value.matches('^[0-9]{2}[A-Za-z]{4}$')
hpiFacilityIdPattern	error	ClaimResponse.insurer.identifier, ClaimResponse.requestor.identifier	HPI Facility ID must conform to format (FXXnnn-C).	system = 'https://standards.digital.health.nz/ns/hpi-facility-id' implies value.matches('^F[A-Za-z0-9]{2}[0-9]{3}-[A-Za-z0-9]$')
hpiOrganizationIdPattern	error	ClaimResponse.insurer.identifier, ClaimResponse.requestor.identifier	HPI Organisation ID must conform to format (GXXnnn-C).	system = 'https://standards.digital.health.nz/ns/hpi-organisation-id' implies value.matches('^G[a-zA-Z0-9]{2}[0-9]{3}-[a-zA-Z0-9]$')
nzbnPattern	error	ClaimResponse.insurer.identifier, ClaimResponse.requestor.identifier	NZBN must conform to format (13 digits).	system = 'https://standards.digital.health.nz/ns/hpi-nzbn' implies value.matches('^[0-9]{13}$')

This structure is derived from ClaimResponse

Summary

Mandatory: 19 elements(8 nested mandatory elements)
Fixed: 1 element
Prohibited: 1 element

Extensions

This structure refers to these extensions:

• https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/shared-care-product-or-service
• https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/shared-care-review-outcome
• https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/shared-care-trace-number
• https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/pharmacy-item-detail-product-or-service
• https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/pharmacy-item-detail-review-outcome

Slices

This structure defines the following Slices:

• The element 1 is sliced based on the value of ClaimResponse.meta.tag