Health New Zealand Te Whatu Ora Shared Care FHIR API
0.4.1 - release New Zealand flag

Health New Zealand Te Whatu Ora Shared Care FHIR API - Local Development build (v0.4.1) built by the FHIR (HL7® FHIR® Standard) Build Tools. See the Directory of published versions

Resource Profile: SharedCareClaimResponse - Detailed Descriptions

Draft as of 2025-08-31

Definitions for the SharedCareClaimResponse resource profile.

Guidance on how to interpret the contents of this table can be foundhere

0. ClaimResponse
Definition

This resource provides the adjudication details from the processing of a Claim resource.

ShortResponse to a claim predetermination or preauthorization
Control0..*
Is Modifierfalse
Summaryfalse
Alternate NamesRemittance Advice
Invariantsdom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources (contained.contained.empty())
dom-3: If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource (contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty())
dom-4: If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated (contained.meta.versionId.empty() and contained.meta.lastUpdated.empty())
dom-5: If a resource is contained in another resource, it SHALL NOT have a security label (contained.meta.security.empty())
dom-6: A resource should have narrative for robust management (text.`div`.exists())
2. ClaimResponse.implicitRules
Definition

A reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content. Often, this is a reference to an implementation guide that defines the special rules along with other profiles etc.

ShortA set of rules under which this content was created
Comments

Asserting this rule set restricts the content to be only understood by a limited set of trading partners. This inherently limits the usefulness of the data in the long term. However, the existing health eco-system is highly fractured, and not yet ready to define, collect, and exchange data in a generally computable sense. Wherever possible, implementers and/or specification writers should avoid using this element. Often, when used, the URL is a reference to an implementation guide that defines these special rules as part of it's narrative along with other profiles, value sets, etc.

Control0..1
Typeuri
Is Modifiertrue because This element is labeled as a modifier because the implicit rules may provide additional knowledge about the resource that modifies it's meaning or interpretation
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
Summarytrue
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
4. ClaimResponse.extension
Definition

An Extension


May be used to represent additional information that is not part of the basic definition of the resource. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

ShortExtensionAdditional content defined by implementations
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

Control0..*
TypeExtension
Is Modifierfalse
Summaryfalse
Alternate Namesextensions, user content
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
SlicingThis element introduces a set of slices on ClaimResponse.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
  • value @ url
  • 6. ClaimResponse.extension:traceNumber
    Slice NametraceNumber
    Definition

    Internal primary key ID for the claim

    ShortTrace Number
    Control0..*
    This element is affected by the following invariants: ele-1
    TypeExtension(Trace Number) (Extension Type: Identifier)
    Is Modifierfalse
    Summaryfalse
    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
    ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
    8. ClaimResponse.modifierExtension
    Definition

    May be used to represent additional information that is not part of the basic definition of the resource and that modifies the understanding of the element that contains it and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

    Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

    ShortExtensions that cannot be ignored
    Comments

    There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

    Control0..*
    TypeExtension
    Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the resource that contains them
    Summaryfalse
    Requirements

    Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

    Alternate Namesextensions, user content
    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
    10. ClaimResponse.identifier
    Definition

    A unique identifier assigned to this claim response.

    ShortBusiness identifier(s) for the claim responseBusiness Identifier for a claim response
    NoteThis is a business identifier, not a resource identifier (see discussion)
    Control10..*
    TypeIdentifier
    Is Modifierfalse
    Summaryfalse
    Requirements

    Allows claim responses to be distinguished and referenced.

    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    12. ClaimResponse.status
    Definition

    The status of the resource instance.

    ShortStatus of the Claim Response: active, cancelled, draft, entered-in-erroractive | cancelled | draft | entered-in-error
    Comments

    This element is labeled as a modifier because the status contains codes that mark the resource as not currently valid.

    Control1..1
    BindingThe codes SHALL be taken from FinancialResourceStatusCodeshttp://hl7.org/fhir/ValueSet/fm-status|4.0.1
    (required to http://hl7.org/fhir/ValueSet/fm-status|4.0.1)

    A code specifying the state of the resource instance.

    Typecode
    Is Modifiertrue because This element is labeled as a modifier because it is a status element that contains status entered-in-error which means that the resource should not be treated as valid
    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
    Summarytrue
    Requirements

    Need to track the status of the resource as 'draft' resources may undergo further edits while 'active' resources are immutable and may only have their status changed to 'cancelled'.

    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    14. ClaimResponse.type
    Definition

    A finer grained suite of claim type codes which may convey additional information such as Inpatient vs Outpatient and/or a specialty service.

    ShortMore granular claim type
    Comments

    This may contain the local bill type codes, for example the US UB-04 bill type code or the CMS bill type.

    Control1..1
    BindingUnless not suitable, these codes SHALL be taken from NZ Claim Typeshttp://hl7.org/fhir/ValueSet/claim-type
    (extensible to https://fhir-ig.digital.health.nz/shared-care/ValueSet/nz-claim-types)
    TypeCodeableConcept
    Is Modifierfalse
    Summarytrue
    Requirements

    Some jurisdictions need a finer grained claim type for routing and adjudication.

    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    16. ClaimResponse.subType
    Definition

    A finer grained suite of claim type codes which may convey additional information such as Inpatient vs Outpatient and/or a specialty service.

    ShortMore granular claim type
    Comments

    This may contain the local bill type codes, for example the US UB-04 bill type code or the CMS bill type.

    Control0..1
    BindingUnless not suitable, these codes SHALL be taken from For example codes, see NZ Claim Subtypeshttp://hl7.org/fhir/ValueSet/claim-subtype
    (extensible to https://fhir-ig.digital.health.nz/shared-care/ValueSet/nz-claim-subtypes)
    TypeCodeableConcept
    Is Modifierfalse
    Summaryfalse
    Requirements

    Some jurisdictions need a finer grained claim type for routing and adjudication.

    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    18. ClaimResponse.use
    Definition

    A code to indicate whether the nature of the request is: to request adjudication of products and services previously rendered; or requesting authorization and adjudication for provision in the future; or requesting the non-binding adjudication of the listed products and services which could be provided in the future.

    Shortclaim | preauthorization | predetermination
    Control1..1
    BindingThe codes SHALL be taken from Usehttp://hl7.org/fhir/ValueSet/claim-use|4.0.1
    (required to http://hl7.org/fhir/ValueSet/claim-use|4.0.1)

    Claim, preauthorization, predetermination.

    Typecode
    Is Modifierfalse
    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
    Summarytrue
    Requirements

    This element is required to understand the nature of the request for adjudication.

    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    20. ClaimResponse.patient
    Definition

    The party to whom the professional services and/or products have been supplied or are being considered and for whom actual for facast reimbursement is sought.

    ShortThe recipient of the products and services
    Control1..1
    TypeReference(Patient)
    Is Modifierfalse
    Summarytrue
    Requirements

    The patient must be supplied to the insurer so that confirmation of coverage and service hstory may be considered as part of the authorization and/or adjudiction.

    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    22. ClaimResponse.created
    Definition

    The date this resource was created.

    ShortDate & time of claim determinationResponse creation date
    Control1..1
    TypedateTime
    Is Modifierfalse
    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
    Summarytrue
    Requirements

    Need to record a timestamp for use by both the recipient and the issuer.

    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    24. ClaimResponse.insurer
    Definition

    The party responsible for authorization, adjudication and reimbursement.

    ShortParty responsible for reimbursement
    Control1..1
    TypeReference(Organization)
    Is Modifierfalse
    Summarytrue
    Requirements

    To be a valid claim, preauthorization or predetermination there must be a party who is responsible for adjudicating the contents against a policy which provides benefits for the patient.

    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    26. ClaimResponse.requestor
    Definition

    The provider which is responsible for the claim, predetermination or preauthorization.

    ShortParty responsible for the ClaimParty responsible for the claim
    Comments

    Typically this field would be 1..1 where this party is responsible for the claim but not necessarily professionally responsible for the provision of the individual products and services listed below.

    Control0..1
    TypeReference(Practitioner, PractitionerRole, Organization)
    Is Modifierfalse
    Summaryfalse
    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    28. ClaimResponse.request
    Definition

    Original request resource reference.

    ShortReference to the Claim that was determinedId of resource triggering adjudication
    Control10..1
    TypeReference(NZ Telehealth Claim, Claim)
    Is Modifierfalse
    Summarytrue
    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    30. ClaimResponse.outcome
    Definition

    The outcome of the claim, predetermination, or preauthorization processing.

    Shortqueued | complete | error | partial
    Comments

    The resource may be used to indicate that: the request has been held (queued) for processing; that it has been processed and errors found (error); that no errors were found and that some of the adjudication has been undertaken (partial) or that all of the adjudication has been undertaken (complete).

    Control1..1
    BindingThe codes SHALL be taken from ClaimProcessingCodeshttp://hl7.org/fhir/ValueSet/remittance-outcome|4.0.1
    (required to http://hl7.org/fhir/ValueSet/remittance-outcome|4.0.1)

    The result of the claim processing.

    Typecode
    Is Modifierfalse
    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
    Summarytrue
    Requirements

    To advise the requestor of an overall processing outcome.

    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    32. ClaimResponse.item
    Definition

    A claim line. Either a simple (a product or service) or a 'group' of details which can also be a simple items or groups of sub-details.

    ShortClaim response itemsAdjudication for claim line items
    Control10..*
    TypeBackboneElement
    Is Modifierfalse
    Summaryfalse
    Requirements

    The adjudication for items provided on the claim.

    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    34. ClaimResponse.item.extension
    Definition

    An Extension


    May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

    ShortExtensionAdditional content defined by implementations
    Comments

    There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

    Control10..*
    TypeExtension
    Is Modifierfalse
    Summaryfalse
    Alternate Namesextensions, user content
    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
    SlicingThis element introduces a set of slices on ClaimResponse.item.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
    • value @ url
    • 36. ClaimResponse.item.extension:traceNumber
      Slice NametraceNumber
      Definition

      Internal primary key ID for the claim

      ShortTrace Number
      Control0..*
      This element is affected by the following invariants: ele-1
      TypeExtension(Trace Number) (Extension Type: Identifier)
      Is Modifierfalse
      Summaryfalse
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
      ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
      38. ClaimResponse.item.extension:productOrService
      Slice NameproductOrService
      Definition

      To enable validation and, if required, supply or correction of the PU code

      ShortProduct Or Service
      Control1..1
      This element is affected by the following invariants: ele-1
      TypeExtension(Product Or Service) (Extension Type: CodeableConcept)
      Is Modifierfalse
      Summaryfalse
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
      ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
      40. ClaimResponse.item.extension:reviewOutcome
      Slice NamereviewOutcome
      Definition

      Result of adjudication for this item

      ShortReview Outcome
      Control0..1
      This element is affected by the following invariants: ele-1
      TypeExtension(Review Outcome) (Complex Extension)
      Is Modifierfalse
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
      42. ClaimResponse.item.modifierExtension
      Definition

      May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

      Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

      ShortExtensions that cannot be ignored even if unrecognized
      Comments

      There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

      Control0..*
      TypeExtension
      Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
      Summarytrue
      Requirements

      Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

      Alternate Namesextensions, user content, modifiers
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
      44. ClaimResponse.item.itemSequence
      Definition

      A number to uniquely reference the claim item entries.

      ShortValue of the corresponding Claim.item.sequenceClaim item instance identifier
      Control1..1
      TypepositiveInt
      Is Modifierfalse
      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
      Summaryfalse
      Requirements

      Necessary to provide a mechanism to link the adjudication result to the submitted claim item.

      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      46. ClaimResponse.item.adjudication
      Definition

      If this item is a group then the values here are a summary of the adjudication of the detail items. If this item is a simple product or service then this is the result of the adjudication of this item.

      ShortAdjudication (reason, amount, quantity) for each Adjudication Value CodeAdjudication details
      Control1..*
      TypeBackboneElement
      Is Modifierfalse
      Summaryfalse
      Requirements

      The adjudication results conveys the insurer's assessment of the item provided in the claim under the terms of the patient's insurance coverage.

      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      48. ClaimResponse.item.adjudication.modifierExtension
      Definition

      May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

      Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

      ShortExtensions that cannot be ignored even if unrecognized
      Comments

      There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

      Control0..*
      TypeExtension
      Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
      Summarytrue
      Requirements

      Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

      Alternate Namesextensions, user content, modifiers
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
      50. ClaimResponse.item.adjudication.category
      Definition

      A code to indicate the information type of this adjudication record. Information types may include the value submitted, maximum values or percentages allowed or payable under the plan, amounts that: the patient is responsible for in aggregate or pertaining to this item; amounts paid by other coverages; and, the benefit payable for this item.

      ShortCodified representation of adjudication outcomeType of adjudication information
      Comments

      For example codes indicating: Co-Pay, deductible, eligible, benefit, tax, etc.

      Control1..1
      BindingUnless not suitable, these codes SHALL be taken from For example codes, see Adjudication Value Codeshttp://hl7.org/fhir/ValueSet/adjudication
      (extensible to https://fhir-ig.digital.health.nz/shared-care/ValueSet/adjudication-value-codes)
      TypeCodeableConcept
      Is Modifierfalse
      Summaryfalse
      Requirements

      Needed to enable understanding of the context of the other information in the adjudication.

      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      52. ClaimResponse.item.adjudication.reason
      Definition

      A code supporting the understanding of the adjudication result and explaining variance from expected amount.

      ShortCodified reason(s) for the adjudicationExplanation of adjudication outcome
      Comments

      For example may indicate that the funds for this benefit type have been exhausted.

      Control0..1
      BindingUnless not suitable, these codes SHALL be taken from For example codes, see Adjudication Reason Codeshttp://hl7.org/fhir/ValueSet/adjudication-reason
      (extensible to https://fhir-ig.digital.health.nz/shared-care/ValueSet/adjudication-reason-codes)
      TypeCodeableConcept
      Is Modifierfalse
      Summaryfalse
      Requirements

      To support understanding of variance from adjudication expectations.

      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      54. ClaimResponse.item.adjudication.amount
      Definition

      Monetary amount associated with the category.

      ShortMonetary value of the adjudicationMonetary amount
      Comments

      For example: amount submitted, eligible amount, co-payment, and benefit payable.

      Control10..1
      TypeMoney
      Is Modifierfalse
      Summaryfalse
      Requirements

      Most adjuciation categories convey a monetary amount.

      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      56. ClaimResponse.item.adjudication.value
      Definition

      A non-monetary value associated with the category. Mutually exclusive to the amount element above.

      ShortNon-monetary value of the adjudication
      Comments

      For example: eligible percentage or co-payment percentage.

      Control0..1
      Typedecimal
      Is Modifierfalse
      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
      Summaryfalse
      Requirements

      Some adjudication categories convey a percentage or a fixed value.

      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      58. ClaimResponse.item.detail
      Definition

      A claim detail. Either a simple (a product or service) or a 'group' of sub-details which are simple items.

      ShortAny sub-determinations of this itemSequenceAdjudication for claim details
      Control0..*
      TypeBackboneElement
      Is Modifierfalse
      Summaryfalse
      Requirements

      The adjudication for details provided on the claim.

      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      60. ClaimResponse.item.detail.extension
      Definition

      An Extension


      May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

      ShortExtensionAdditional content defined by implementations
      Comments

      There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

      Control0..*
      TypeExtension
      Is Modifierfalse
      Summaryfalse
      Alternate Namesextensions, user content
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
      SlicingThis element introduces a set of slices on ClaimResponse.item.detail.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
      • value @ url
      • 62. ClaimResponse.item.detail.extension:traceNumber
        Slice NametraceNumber
        Definition

        Internal primary key ID for the claim

        ShortTrace Number
        Control0..*
        This element is affected by the following invariants: ele-1
        TypeExtension(Trace Number) (Extension Type: Identifier)
        Is Modifierfalse
        Summaryfalse
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
        ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
        64. ClaimResponse.item.detail.extension:reviewOutcome
        Slice NamereviewOutcome
        Definition

        Result of adjudication for this item

        ShortReview Outcome
        Control0..1
        This element is affected by the following invariants: ele-1
        TypeExtension(Review Outcome) (Complex Extension)
        Is Modifierfalse
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
        66. ClaimResponse.item.detail.modifierExtension
        Definition

        May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

        Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

        ShortExtensions that cannot be ignored even if unrecognized
        Comments

        There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

        Control0..*
        TypeExtension
        Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
        Summarytrue
        Requirements

        Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

        Alternate Namesextensions, user content, modifiers
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
        68. ClaimResponse.item.detail.detailSequence
        Definition

        A number to uniquely reference the claim detail entry.

        ShortValue of the corresponding Claim.item.detail.sequenceClaim detail instance identifier
        Control1..1
        TypepositiveInt
        Is Modifierfalse
        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
        Summaryfalse
        Requirements

        Necessary to provide a mechanism to link the adjudication result to the submitted claim detail.

        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        70. ClaimResponse.item.detail.adjudication
        Definition

        The adjudication results.

        ShortDetail level adjudication details
        Control1..*
        TypeSeettp://hl7.org/fhir/StructureDefinition/ClaimResponse#ClaimResponse.item.adjudication
        Is Modifierfalse
        Summaryfalse
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        72. ClaimResponse.addItem
        Definition

        The first-tier service adjudications for payor added product or service lines.

        ShortAny line items added by Health NZ to the claim determination that were not in the original claimInsurer added line items
        Control0..*
        TypeBackboneElement
        Is Modifierfalse
        Summaryfalse
        Requirements

        Insurers may redefine the provided product or service or may package and/or decompose groups of products and services. The addItems allows the insurer to provide their line item list with linkage to the submitted items/details/sub-details. In a preauthorization the insurer may use the addItem structure to provide additional information on authorized products and services.

        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        74. ClaimResponse.addItem.modifierExtension
        Definition

        May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

        Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

        ShortExtensions that cannot be ignored even if unrecognized
        Comments

        There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

        Control0..*
        TypeExtension
        Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
        Summarytrue
        Requirements

        Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

        Alternate Namesextensions, user content, modifiers
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
        76. ClaimResponse.addItem.productOrService
        Definition

        When the value is a group code then this item collects a set of related claim details, otherwise this contains the product, service, drug or other billing code for the item.

        ShortBilling, service, product, or drug code
        Comments

        If this is an actual service or product line, i.e. not a Group, then use code to indicate the Professional Service or Product supplied (e.g. CTP, HCPCS, USCLS, ICD10, NCPDP, DIN, RxNorm, ACHI, CCI). If a grouping item then use a group code to indicate the type of thing being grouped e.g. 'glasses' or 'compound'.

        Control1..1
        BindingFor example codes, see USCLSCodeshttp://hl7.org/fhir/ValueSet/service-uscls
        (example to http://hl7.org/fhir/ValueSet/service-uscls)

        Allowable service and product codes.

        TypeCodeableConcept
        Is Modifierfalse
        Summaryfalse
        Requirements

        Necessary to state what was provided or done.

        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        78. ClaimResponse.addItem.adjudication
        Definition

        The adjudication results.

        ShortAdded items adjudication
        Control1..*
        TypeSeettp://hl7.org/fhir/StructureDefinition/ClaimResponse#ClaimResponse.item.adjudication
        Is Modifierfalse
        Summaryfalse
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        80. ClaimResponse.adjudication
        Definition

        The adjudication results which are presented at the header level rather than at the line-item or add-item levels.

        ShortClaim-level adjudicationHeader-level adjudication
        Control0..*
        TypeSeettp://hl7.org/fhir/StructureDefinition/ClaimResponse#ClaimResponse.item.adjudication
        Is Modifierfalse
        Summaryfalse
        Requirements

        Some insurers will receive line-items but provide the adjudication only at a summary or header-level.

        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        82. ClaimResponse.total
        Definition

        Categorized monetary totals for the adjudication.

        ShortFinancial total of the claim for each Adjudication Value CodeAdjudication totals
        Comments

        Totals for amounts submitted, co-pays, benefits payable etc.

        Control0..*
        TypeBackboneElement
        Is Modifierfalse
        Summarytrue
        Requirements

        To provide the requestor with financial totals by category for the adjudication.

        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        84. ClaimResponse.total.modifierExtension
        Definition

        May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

        Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

        ShortExtensions that cannot be ignored even if unrecognized
        Comments

        There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

        Control0..*
        TypeExtension
        Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
        Summarytrue
        Requirements

        Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

        Alternate Namesextensions, user content, modifiers
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
        86. ClaimResponse.total.category
        Definition

        A code to indicate the information type of this adjudication record. Information types may include: the value submitted, maximum values or percentages allowed or payable under the plan, amounts that the patient is responsible for in aggregate or pertaining to this item, amounts paid by other coverages, and the benefit payable for this item.

        ShortType of adjudication information
        Comments

        For example codes indicating: Co-Pay, deductible, eligible, benefit, tax, etc.

        Control1..1
        BindingFor example codes, see AdjudicationValueCodeshttp://hl7.org/fhir/ValueSet/adjudication
        (example to http://hl7.org/fhir/ValueSet/adjudication)

        The adjudication codes.

        TypeCodeableConcept
        Is Modifierfalse
        Summarytrue
        Requirements

        Needed to convey the type of total provided.

        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        88. ClaimResponse.total.amount
        Definition

        Monetary total amount associated with the category.

        ShortFinancial total for the category
        Control1..1
        TypeMoney
        Is Modifierfalse
        Summarytrue
        Requirements

        Needed to convey the total monetary amount.

        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        90. ClaimResponse.payment
        Definition

        Payment details for the adjudication of the claim.

        ShortSummary of the payment being madePayment Details
        Control0..1
        TypeBackboneElement
        Is Modifierfalse
        Summaryfalse
        Requirements

        Needed to convey references to the financial instrument that has been used if payment has been made.

        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        92. ClaimResponse.payment.modifierExtension
        Definition

        May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

        Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

        ShortExtensions that cannot be ignored even if unrecognized
        Comments

        There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

        Control0..*
        TypeExtension
        Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
        Summarytrue
        Requirements

        Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

        Alternate Namesextensions, user content, modifiers
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
        94. ClaimResponse.payment.type
        Definition

        Whether this represents partial or complete payment of the benefits payable.

        ShortPayment Type Code = complete or partialPartial or complete payment
        Control1..1
        BindingUnless not suitable, these codes SHALL be taken from For example codes, see Payment Type Codeshttp://hl7.org/fhir/ValueSet/ex-paymenttype
        (extensible to https://fhir-ig.digital.health.nz/shared-care/ValueSet/payment-type-codes)
        TypeCodeableConcept
        Is Modifierfalse
        Summaryfalse
        Requirements

        To advise the requestor when the insurer believes all payments to have been completed.

        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        96. ClaimResponse.payment.date
        Definition

        Estimated date the payment will be issued or the actual issue date of payment.

        ShortExpected date of payment (if known)
        Control0..1
        Typedate
        Is Modifierfalse
        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
        Summaryfalse
        Requirements

        To advise the payee when payment can be expected.

        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        98. ClaimResponse.payment.amount
        Definition

        Benefits payable less any payment adjustment.

        ShortPayment amountPayable amount after adjustment
        Control1..1
        TypeMoney
        Is Modifierfalse
        Summaryfalse
        Requirements

        Needed to provide the actual payment amount.

        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        100. ClaimResponse.error
        Definition

        Errors encountered during the processing of the adjudication.

        ShortCollection of errors produced during claim determinationProcessing errors
        Comments

        If the request contains errors then an error element should be provided and no adjudication related sections (item, addItem, or payment) should be present.

        Control0..*
        TypeBackboneElement
        Is Modifierfalse
        Summaryfalse
        Requirements

        Need to communicate processing issues to the requestor.

        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        102. ClaimResponse.error.modifierExtension
        Definition

        May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

        Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

        ShortExtensions that cannot be ignored even if unrecognized
        Comments

        There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

        Control0..*
        TypeExtension
        Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
        Summarytrue
        Requirements

        Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

        Alternate Namesextensions, user content, modifiers
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
        104. ClaimResponse.error.itemSequence
        Definition

        The sequence number of the line item submitted which contains the error. This value is omitted when the error occurs outside of the item structure.

        ShortRefers to itemSequence to which the error relatesItem sequence number
        Control0..1
        TypepositiveInt
        Is Modifierfalse
        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
        Summaryfalse
        Requirements

        Provides references to the claim items.

        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        106. ClaimResponse.error.detailSequence
        Definition

        The sequence number of the detail within the line item submitted which contains the error. This value is omitted when the error occurs outside of the item structure.

        ShortRefers to detailSequence to which the error relatesDetail sequence number
        Control0..1
        TypepositiveInt
        Is Modifierfalse
        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
        Summaryfalse
        Requirements

        Provides references to the claim details within the claim item.

        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        108. ClaimResponse.error.code
        Definition

        An error code, from a specified code system, which details why the claim could not be adjudicated.

        ShortError codeError code detailing processing issues
        Control1..1
        BindingFor example codes, see Adjudication Error Codeshttp://hl7.org/fhir/ValueSet/adjudication-error
        (example to http://hl7.org/fhir/ValueSet/adjudication-error)

        The adjudication error codes.

        TypeCodeableConcept
        Is Modifierfalse
        Summaryfalse
        Requirements

        Required to convey processing errors.

        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

        Guidance on how to interpret the contents of this table can be foundhere

        0. ClaimResponse
        2. ClaimResponse.extension
        SlicingThis element introduces a set of slices on ClaimResponse.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
        • value @ url
        • 4. ClaimResponse.extension:traceNumber
          Slice NametraceNumber
          Control0..*
          TypeExtension(Trace Number) (Extension Type: Identifier)
          6. ClaimResponse.identifier
          ShortBusiness identifier(s) for the claim response
          NoteThis is a business identifier, not a resource identifier (see discussion)
          Control1..?
          8. ClaimResponse.status
          ShortStatus of the Claim Response: active, cancelled, draft, entered-in-error
          10. ClaimResponse.type
          BindingUnless not suitable, these codes SHALL be taken from NZ Claim Types
          (extensible to https://fhir-ig.digital.health.nz/shared-care/ValueSet/nz-claim-types)
          12. ClaimResponse.subType
          BindingUnless not suitable, these codes SHALL be taken from NZ Claim Subtypes
          (extensible to https://fhir-ig.digital.health.nz/shared-care/ValueSet/nz-claim-subtypes)
          14. ClaimResponse.created
          ShortDate & time of claim determination
          16. ClaimResponse.requestor
          ShortParty responsible for the Claim
          18. ClaimResponse.request
          ShortReference to the Claim that was determined
          Control1..?
          TypeReference(NZ Telehealth Claim)
          20. ClaimResponse.item
          ShortClaim response items
          Control1..?
          22. ClaimResponse.item.extension
          Control1..?
          SlicingThis element introduces a set of slices on ClaimResponse.item.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
          • value @ url
          • 24. ClaimResponse.item.extension:traceNumber
            Slice NametraceNumber
            Control0..*
            TypeExtension(Trace Number) (Extension Type: Identifier)
            26. ClaimResponse.item.extension:productOrService
            Slice NameproductOrService
            Control1..1
            TypeExtension(Product Or Service) (Extension Type: CodeableConcept)
            28. ClaimResponse.item.extension:reviewOutcome
            Slice NamereviewOutcome
            Control0..1
            TypeExtension(Review Outcome) (Complex Extension)
            30. ClaimResponse.item.itemSequence
            ShortValue of the corresponding Claim.item.sequence
            32. ClaimResponse.item.adjudication
            ShortAdjudication (reason, amount, quantity) for each Adjudication Value Code
            34. ClaimResponse.item.adjudication.category
            ShortCodified representation of adjudication outcome
            BindingUnless not suitable, these codes SHALL be taken from Adjudication Value Codes
            (extensible to https://fhir-ig.digital.health.nz/shared-care/ValueSet/adjudication-value-codes)
            36. ClaimResponse.item.adjudication.reason
            ShortCodified reason(s) for the adjudication
            BindingUnless not suitable, these codes SHALL be taken from Adjudication Reason Codes
            (extensible to https://fhir-ig.digital.health.nz/shared-care/ValueSet/adjudication-reason-codes)
            38. ClaimResponse.item.adjudication.amount
            ShortMonetary value of the adjudication
            Control1..?
            40. ClaimResponse.item.adjudication.value
            ShortNon-monetary value of the adjudication
            42. ClaimResponse.item.detail
            ShortAny sub-determinations of this itemSequence
            44. ClaimResponse.item.detail.extension
            SlicingThis element introduces a set of slices on ClaimResponse.item.detail.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
            • value @ url
            • 46. ClaimResponse.item.detail.extension:traceNumber
              Slice NametraceNumber
              Control0..*
              TypeExtension(Trace Number) (Extension Type: Identifier)
              48. ClaimResponse.item.detail.extension:reviewOutcome
              Slice NamereviewOutcome
              Control0..1
              TypeExtension(Review Outcome) (Complex Extension)
              50. ClaimResponse.item.detail.detailSequence
              ShortValue of the corresponding Claim.item.detail.sequence
              52. ClaimResponse.addItem
              ShortAny line items added by Health NZ to the claim determination that were not in the original claim
              54. ClaimResponse.adjudication
              ShortClaim-level adjudication
              56. ClaimResponse.total
              ShortFinancial total of the claim for each Adjudication Value Code
              58. ClaimResponse.payment
              ShortSummary of the payment being made
              60. ClaimResponse.payment.type
              ShortPayment Type Code = complete or partial
              BindingUnless not suitable, these codes SHALL be taken from Payment Type Codes
              (extensible to https://fhir-ig.digital.health.nz/shared-care/ValueSet/payment-type-codes)
              62. ClaimResponse.payment.date
              ShortExpected date of payment (if known)
              64. ClaimResponse.payment.amount
              ShortPayment amount
              66. ClaimResponse.error
              ShortCollection of errors produced during claim determination
              68. ClaimResponse.error.itemSequence
              ShortRefers to itemSequence to which the error relates
              70. ClaimResponse.error.detailSequence
              ShortRefers to detailSequence to which the error relates
              72. ClaimResponse.error.code
              ShortError code

              Guidance on how to interpret the contents of this table can be foundhere

              0. ClaimResponse
              Definition

              This resource provides the adjudication details from the processing of a Claim resource.

              ShortResponse to a claim predetermination or preauthorization
              Control0..*
              Is Modifierfalse
              Summaryfalse
              Alternate NamesRemittance Advice
              Invariantsdom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources (contained.contained.empty())
              dom-3: If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource (contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty())
              dom-4: If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated (contained.meta.versionId.empty() and contained.meta.lastUpdated.empty())
              dom-5: If a resource is contained in another resource, it SHALL NOT have a security label (contained.meta.security.empty())
              dom-6: A resource should have narrative for robust management (text.`div`.exists())
              2. ClaimResponse.id
              Definition

              The logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes.

              ShortLogical id of this artifact
              Comments

              The only time that a resource does not have an id is when it is being submitted to the server using a create operation.

              Control0..1
              Typeid
              Is Modifierfalse
              Summarytrue
              4. ClaimResponse.meta
              Definition

              The metadata about the resource. This is content that is maintained by the infrastructure. Changes to the content might not always be associated with version changes to the resource.

              ShortMetadata about the resource
              Control0..1
              TypeMeta
              Is Modifierfalse
              Summarytrue
              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              6. ClaimResponse.implicitRules
              Definition

              A reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content. Often, this is a reference to an implementation guide that defines the special rules along with other profiles etc.

              ShortA set of rules under which this content was created
              Comments

              Asserting this rule set restricts the content to be only understood by a limited set of trading partners. This inherently limits the usefulness of the data in the long term. However, the existing health eco-system is highly fractured, and not yet ready to define, collect, and exchange data in a generally computable sense. Wherever possible, implementers and/or specification writers should avoid using this element. Often, when used, the URL is a reference to an implementation guide that defines these special rules as part of it's narrative along with other profiles, value sets, etc.

              Control0..1
              Typeuri
              Is Modifiertrue because This element is labeled as a modifier because the implicit rules may provide additional knowledge about the resource that modifies it's meaning or interpretation
              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
              Summarytrue
              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              8. ClaimResponse.language
              Definition

              The base language in which the resource is written.

              ShortLanguage of the resource content
              Comments

              Language is provided to support indexing and accessibility (typically, services such as text to speech use the language tag). The html language tag in the narrative applies to the narrative. The language tag on the resource may be used to specify the language of other presentations generated from the data in the resource. Not all the content has to be in the base language. The Resource.language should not be assumed to apply to the narrative automatically. If a language is specified, it should it also be specified on the div element in the html (see rules in HTML5 for information about the relationship between xml:lang and the html lang attribute).

              Control0..1
              BindingThe codes SHOULD be taken from CommonLanguages
              (preferred to http://hl7.org/fhir/ValueSet/languages)

              A human language.

              Additional BindingsPurpose
              AllLanguagesMax Binding
              Typecode
              Is Modifierfalse
              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
              Summaryfalse
              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              10. ClaimResponse.text
              Definition

              A human-readable narrative that contains a summary of the resource and can be used to represent the content of the resource to a human. The narrative need not encode all the structured data, but is required to contain sufficient detail to make it "clinically safe" for a human to just read the narrative. Resource definitions may define what content should be represented in the narrative to ensure clinical safety.

              ShortText summary of the resource, for human interpretation
              Comments

              Contained resources do not have narrative. Resources that are not contained SHOULD have a narrative. In some cases, a resource may only have text with little or no additional discrete data (as long as all minOccurs=1 elements are satisfied). This may be necessary for data from legacy systems where information is captured as a "text blob" or where text is additionally entered raw or narrated and encoded information is added later.

              Control0..1
              TypeNarrative
              Is Modifierfalse
              Summaryfalse
              Alternate Namesnarrative, html, xhtml, display
              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              12. ClaimResponse.contained
              Definition

              These resources do not have an independent existence apart from the resource that contains them - they cannot be identified independently, and nor can they have their own independent transaction scope.

              ShortContained, inline Resources
              Comments

              This should never be done when the content can be identified properly, as once identification is lost, it is extremely difficult (and context dependent) to restore it again. Contained resources may have profiles and tags In their meta elements, but SHALL NOT have security labels.

              Control0..*
              TypeResource
              Is Modifierfalse
              Summaryfalse
              Alternate Namesinline resources, anonymous resources, contained resources
              14. ClaimResponse.extension
              Definition

              An Extension

              ShortExtension
              Control0..*
              TypeExtension
              Is Modifierfalse
              Summaryfalse
              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
              SlicingThis element introduces a set of slices on ClaimResponse.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
              • value @ url
              • 16. ClaimResponse.extension:traceNumber
                Slice NametraceNumber
                Definition

                Internal primary key ID for the claim

                ShortTrace Number
                Control0..*
                This element is affected by the following invariants: ele-1
                TypeExtension(Trace Number) (Extension Type: Identifier)
                Is Modifierfalse
                Summaryfalse
                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                18. ClaimResponse.modifierExtension
                Definition

                May be used to represent additional information that is not part of the basic definition of the resource and that modifies the understanding of the element that contains it and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

                Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

                ShortExtensions that cannot be ignored
                Comments

                There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                Control0..*
                TypeExtension
                Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the resource that contains them
                Summaryfalse
                Requirements

                Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

                Alternate Namesextensions, user content
                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                20. ClaimResponse.identifier
                Definition

                A unique identifier assigned to this claim response.

                ShortBusiness identifier(s) for the claim response
                NoteThis is a business identifier, not a resource identifier (see discussion)
                Control1..*
                TypeIdentifier
                Is Modifierfalse
                Summaryfalse
                Requirements

                Allows claim responses to be distinguished and referenced.

                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                22. ClaimResponse.status
                Definition

                The status of the resource instance.

                ShortStatus of the Claim Response: active, cancelled, draft, entered-in-error
                Comments

                This element is labeled as a modifier because the status contains codes that mark the resource as not currently valid.

                Control1..1
                BindingThe codes SHALL be taken from FinancialResourceStatusCodes
                (required to http://hl7.org/fhir/ValueSet/fm-status|4.0.1)

                A code specifying the state of the resource instance.

                Typecode
                Is Modifiertrue because This element is labeled as a modifier because it is a status element that contains status entered-in-error which means that the resource should not be treated as valid
                Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                Summarytrue
                Requirements

                Need to track the status of the resource as 'draft' resources may undergo further edits while 'active' resources are immutable and may only have their status changed to 'cancelled'.

                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                24. ClaimResponse.type
                Definition

                A finer grained suite of claim type codes which may convey additional information such as Inpatient vs Outpatient and/or a specialty service.

                ShortMore granular claim type
                Comments

                This may contain the local bill type codes, for example the US UB-04 bill type code or the CMS bill type.

                Control1..1
                BindingUnless not suitable, these codes SHALL be taken from NZ Claim Types
                (extensible to https://fhir-ig.digital.health.nz/shared-care/ValueSet/nz-claim-types)
                TypeCodeableConcept
                Is Modifierfalse
                Summarytrue
                Requirements

                Some jurisdictions need a finer grained claim type for routing and adjudication.

                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                26. ClaimResponse.subType
                Definition

                A finer grained suite of claim type codes which may convey additional information such as Inpatient vs Outpatient and/or a specialty service.

                ShortMore granular claim type
                Comments

                This may contain the local bill type codes, for example the US UB-04 bill type code or the CMS bill type.

                Control0..1
                BindingUnless not suitable, these codes SHALL be taken from NZ Claim Subtypes
                (extensible to https://fhir-ig.digital.health.nz/shared-care/ValueSet/nz-claim-subtypes)
                TypeCodeableConcept
                Is Modifierfalse
                Summaryfalse
                Requirements

                Some jurisdictions need a finer grained claim type for routing and adjudication.

                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                28. ClaimResponse.use
                Definition

                A code to indicate whether the nature of the request is: to request adjudication of products and services previously rendered; or requesting authorization and adjudication for provision in the future; or requesting the non-binding adjudication of the listed products and services which could be provided in the future.

                Shortclaim | preauthorization | predetermination
                Control1..1
                BindingThe codes SHALL be taken from Use
                (required to http://hl7.org/fhir/ValueSet/claim-use|4.0.1)

                Claim, preauthorization, predetermination.

                Typecode
                Is Modifierfalse
                Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                Summarytrue
                Requirements

                This element is required to understand the nature of the request for adjudication.

                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                30. ClaimResponse.patient
                Definition

                The party to whom the professional services and/or products have been supplied or are being considered and for whom actual for facast reimbursement is sought.

                ShortThe recipient of the products and services
                Control1..1
                TypeReference(Patient)
                Is Modifierfalse
                Summarytrue
                Requirements

                The patient must be supplied to the insurer so that confirmation of coverage and service hstory may be considered as part of the authorization and/or adjudiction.

                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                32. ClaimResponse.created
                Definition

                The date this resource was created.

                ShortDate & time of claim determination
                Control1..1
                TypedateTime
                Is Modifierfalse
                Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                Summarytrue
                Requirements

                Need to record a timestamp for use by both the recipient and the issuer.

                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                34. ClaimResponse.insurer
                Definition

                The party responsible for authorization, adjudication and reimbursement.

                ShortParty responsible for reimbursement
                Control1..1
                TypeReference(Organization)
                Is Modifierfalse
                Summarytrue
                Requirements

                To be a valid claim, preauthorization or predetermination there must be a party who is responsible for adjudicating the contents against a policy which provides benefits for the patient.

                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                36. ClaimResponse.requestor
                Definition

                The provider which is responsible for the claim, predetermination or preauthorization.

                ShortParty responsible for the Claim
                Comments

                Typically this field would be 1..1 where this party is responsible for the claim but not necessarily professionally responsible for the provision of the individual products and services listed below.

                Control0..1
                TypeReference(Practitioner, PractitionerRole, Organization)
                Is Modifierfalse
                Summaryfalse
                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                38. ClaimResponse.request
                Definition

                Original request resource reference.

                ShortReference to the Claim that was determined
                Control1..1
                TypeReference(NZ Telehealth Claim)
                Is Modifierfalse
                Summarytrue
                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                40. ClaimResponse.outcome
                Definition

                The outcome of the claim, predetermination, or preauthorization processing.

                Shortqueued | complete | error | partial
                Comments

                The resource may be used to indicate that: the request has been held (queued) for processing; that it has been processed and errors found (error); that no errors were found and that some of the adjudication has been undertaken (partial) or that all of the adjudication has been undertaken (complete).

                Control1..1
                BindingThe codes SHALL be taken from ClaimProcessingCodes
                (required to http://hl7.org/fhir/ValueSet/remittance-outcome|4.0.1)

                The result of the claim processing.

                Typecode
                Is Modifierfalse
                Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                Summarytrue
                Requirements

                To advise the requestor of an overall processing outcome.

                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                42. ClaimResponse.disposition
                Definition

                A human readable description of the status of the adjudication.

                ShortDisposition Message
                Control0..1
                Typestring
                Is Modifierfalse
                Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                Summaryfalse
                Requirements

                Provided for user display.

                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                44. ClaimResponse.preAuthRef
                Definition

                Reference from the Insurer which is used in later communications which refers to this adjudication.

                ShortPreauthorization reference
                Comments

                This value is only present on preauthorization adjudications.

                Control0..1
                Typestring
                Is Modifierfalse
                Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                Summaryfalse
                Requirements

                On subsequent claims, the insurer may require the provider to quote this value.

                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                46. ClaimResponse.preAuthPeriod
                Definition

                The time frame during which this authorization is effective.

                ShortPreauthorization reference effective period
                Control0..1
                TypePeriod
                Is Modifierfalse
                Summaryfalse
                Requirements

                To convey to the provider when the authorized products and services must be supplied for the authorized adjudication to apply.

                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                48. ClaimResponse.payeeType
                Definition

                Type of Party to be reimbursed: subscriber, provider, other.

                ShortParty to be paid any benefits payable
                Control0..1
                BindingFor example codes, see Claim Payee Type Codes
                (example to http://hl7.org/fhir/ValueSet/payeetype)

                A code for the party to be reimbursed.

                TypeCodeableConcept
                Is Modifierfalse
                Summaryfalse
                Requirements

                Need to know who should receive payment with the most common situations being the Provider (assignment of benefits) or the Subscriber.

                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                50. ClaimResponse.item
                Definition

                A claim line. Either a simple (a product or service) or a 'group' of details which can also be a simple items or groups of sub-details.

                ShortClaim response items
                Control1..*
                TypeBackboneElement
                Is Modifierfalse
                Summaryfalse
                Requirements

                The adjudication for items provided on the claim.

                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                52. ClaimResponse.item.id
                Definition

                Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                ShortUnique id for inter-element referencing
                Control0..1
                Typestring
                Is Modifierfalse
                XML FormatIn the XML format, this property is represented as an attribute.
                Summaryfalse
                54. ClaimResponse.item.extension
                Definition

                An Extension

                ShortExtension
                Control1..*
                TypeExtension
                Is Modifierfalse
                Summaryfalse
                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                SlicingThis element introduces a set of slices on ClaimResponse.item.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                • value @ url
                • 56. ClaimResponse.item.extension:traceNumber
                  Slice NametraceNumber
                  Definition

                  Internal primary key ID for the claim

                  ShortTrace Number
                  Control0..*
                  This element is affected by the following invariants: ele-1
                  TypeExtension(Trace Number) (Extension Type: Identifier)
                  Is Modifierfalse
                  Summaryfalse
                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                  58. ClaimResponse.item.extension:productOrService
                  Slice NameproductOrService
                  Definition

                  To enable validation and, if required, supply or correction of the PU code

                  ShortProduct Or Service
                  Control1..1
                  This element is affected by the following invariants: ele-1
                  TypeExtension(Product Or Service) (Extension Type: CodeableConcept)
                  Is Modifierfalse
                  Summaryfalse
                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                  60. ClaimResponse.item.extension:reviewOutcome
                  Slice NamereviewOutcome
                  Definition

                  Result of adjudication for this item

                  ShortReview Outcome
                  Control0..1
                  This element is affected by the following invariants: ele-1
                  TypeExtension(Review Outcome) (Complex Extension)
                  Is Modifierfalse
                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                  62. ClaimResponse.item.modifierExtension
                  Definition

                  May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

                  Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

                  ShortExtensions that cannot be ignored even if unrecognized
                  Comments

                  There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                  Control0..*
                  TypeExtension
                  Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
                  Summarytrue
                  Requirements

                  Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

                  Alternate Namesextensions, user content, modifiers
                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                  64. ClaimResponse.item.itemSequence
                  Definition

                  A number to uniquely reference the claim item entries.

                  ShortValue of the corresponding Claim.item.sequence
                  Control1..1
                  TypepositiveInt
                  Is Modifierfalse
                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                  Summaryfalse
                  Requirements

                  Necessary to provide a mechanism to link the adjudication result to the submitted claim item.

                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  66. ClaimResponse.item.noteNumber
                  Definition

                  The numbers associated with notes below which apply to the adjudication of this item.

                  ShortApplicable note numbers
                  Control0..*
                  TypepositiveInt
                  Is Modifierfalse
                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                  Summaryfalse
                  Requirements

                  Provides a condensed manner for associating human readable descriptive explanations for adjudications on the line item.

                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  68. ClaimResponse.item.adjudication
                  Definition

                  If this item is a group then the values here are a summary of the adjudication of the detail items. If this item is a simple product or service then this is the result of the adjudication of this item.

                  ShortAdjudication (reason, amount, quantity) for each Adjudication Value Code
                  Control1..*
                  TypeBackboneElement
                  Is Modifierfalse
                  Summaryfalse
                  Requirements

                  The adjudication results conveys the insurer's assessment of the item provided in the claim under the terms of the patient's insurance coverage.

                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  70. ClaimResponse.item.adjudication.id
                  Definition

                  Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                  ShortUnique id for inter-element referencing
                  Control0..1
                  Typestring
                  Is Modifierfalse
                  XML FormatIn the XML format, this property is represented as an attribute.
                  Summaryfalse
                  72. ClaimResponse.item.adjudication.extension
                  Definition

                  May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                  ShortAdditional content defined by implementations
                  Comments

                  There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                  Control0..*
                  TypeExtension
                  Is Modifierfalse
                  Summaryfalse
                  Alternate Namesextensions, user content
                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                  74. ClaimResponse.item.adjudication.modifierExtension
                  Definition

                  May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

                  Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

                  ShortExtensions that cannot be ignored even if unrecognized
                  Comments

                  There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                  Control0..*
                  TypeExtension
                  Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
                  Summarytrue
                  Requirements

                  Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

                  Alternate Namesextensions, user content, modifiers
                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                  76. ClaimResponse.item.adjudication.category
                  Definition

                  A code to indicate the information type of this adjudication record. Information types may include the value submitted, maximum values or percentages allowed or payable under the plan, amounts that: the patient is responsible for in aggregate or pertaining to this item; amounts paid by other coverages; and, the benefit payable for this item.

                  ShortCodified representation of adjudication outcome
                  Comments

                  For example codes indicating: Co-Pay, deductible, eligible, benefit, tax, etc.

                  Control1..1
                  BindingUnless not suitable, these codes SHALL be taken from Adjudication Value Codes
                  (extensible to https://fhir-ig.digital.health.nz/shared-care/ValueSet/adjudication-value-codes)
                  TypeCodeableConcept
                  Is Modifierfalse
                  Summaryfalse
                  Requirements

                  Needed to enable understanding of the context of the other information in the adjudication.

                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  78. ClaimResponse.item.adjudication.reason
                  Definition

                  A code supporting the understanding of the adjudication result and explaining variance from expected amount.

                  ShortCodified reason(s) for the adjudication
                  Comments

                  For example may indicate that the funds for this benefit type have been exhausted.

                  Control0..1
                  BindingUnless not suitable, these codes SHALL be taken from Adjudication Reason Codes
                  (extensible to https://fhir-ig.digital.health.nz/shared-care/ValueSet/adjudication-reason-codes)
                  TypeCodeableConcept
                  Is Modifierfalse
                  Summaryfalse
                  Requirements

                  To support understanding of variance from adjudication expectations.

                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  80. ClaimResponse.item.adjudication.amount
                  Definition

                  Monetary amount associated with the category.

                  ShortMonetary value of the adjudication
                  Comments

                  For example: amount submitted, eligible amount, co-payment, and benefit payable.

                  Control1..1
                  TypeMoney
                  Is Modifierfalse
                  Summaryfalse
                  Requirements

                  Most adjuciation categories convey a monetary amount.

                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  82. ClaimResponse.item.adjudication.value
                  Definition

                  A non-monetary value associated with the category. Mutually exclusive to the amount element above.

                  ShortNon-monetary value of the adjudication
                  Comments

                  For example: eligible percentage or co-payment percentage.

                  Control0..1
                  Typedecimal
                  Is Modifierfalse
                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                  Summaryfalse
                  Requirements

                  Some adjudication categories convey a percentage or a fixed value.

                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  84. ClaimResponse.item.detail
                  Definition

                  A claim detail. Either a simple (a product or service) or a 'group' of sub-details which are simple items.

                  ShortAny sub-determinations of this itemSequence
                  Control0..*
                  TypeBackboneElement
                  Is Modifierfalse
                  Summaryfalse
                  Requirements

                  The adjudication for details provided on the claim.

                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  86. ClaimResponse.item.detail.id
                  Definition

                  Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                  ShortUnique id for inter-element referencing
                  Control0..1
                  Typestring
                  Is Modifierfalse
                  XML FormatIn the XML format, this property is represented as an attribute.
                  Summaryfalse
                  88. ClaimResponse.item.detail.extension
                  Definition

                  An Extension

                  ShortExtension
                  Control0..*
                  TypeExtension
                  Is Modifierfalse
                  Summaryfalse
                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                  SlicingThis element introduces a set of slices on ClaimResponse.item.detail.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                  • value @ url
                  • 90. ClaimResponse.item.detail.extension:traceNumber
                    Slice NametraceNumber
                    Definition

                    Internal primary key ID for the claim

                    ShortTrace Number
                    Control0..*
                    This element is affected by the following invariants: ele-1
                    TypeExtension(Trace Number) (Extension Type: Identifier)
                    Is Modifierfalse
                    Summaryfalse
                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                    ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                    92. ClaimResponse.item.detail.extension:reviewOutcome
                    Slice NamereviewOutcome
                    Definition

                    Result of adjudication for this item

                    ShortReview Outcome
                    Control0..1
                    This element is affected by the following invariants: ele-1
                    TypeExtension(Review Outcome) (Complex Extension)
                    Is Modifierfalse
                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                    ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                    94. ClaimResponse.item.detail.modifierExtension
                    Definition

                    May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

                    Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

                    ShortExtensions that cannot be ignored even if unrecognized
                    Comments

                    There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                    Control0..*
                    TypeExtension
                    Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
                    Summarytrue
                    Requirements

                    Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

                    Alternate Namesextensions, user content, modifiers
                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                    ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                    96. ClaimResponse.item.detail.detailSequence
                    Definition

                    A number to uniquely reference the claim detail entry.

                    ShortValue of the corresponding Claim.item.detail.sequence
                    Control1..1
                    TypepositiveInt
                    Is Modifierfalse
                    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                    Summaryfalse
                    Requirements

                    Necessary to provide a mechanism to link the adjudication result to the submitted claim detail.

                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                    98. ClaimResponse.item.detail.noteNumber
                    Definition

                    The numbers associated with notes below which apply to the adjudication of this item.

                    ShortApplicable note numbers
                    Control0..*
                    TypepositiveInt
                    Is Modifierfalse
                    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                    Summaryfalse
                    Requirements

                    Provides a condensed manner for associating human readable descriptive explanations for adjudications on the line item.

                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                    100. ClaimResponse.item.detail.adjudication
                    Definition

                    The adjudication results.

                    ShortDetail level adjudication details
                    Control1..*
                    TypeSeettp://hl7.org/fhir/StructureDefinition/ClaimResponse#ClaimResponse.item.adjudication
                    Is Modifierfalse
                    Summaryfalse
                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                    102. ClaimResponse.item.detail.subDetail
                    Definition

                    A sub-detail adjudication of a simple product or service.

                    ShortAdjudication for claim sub-details
                    Control0..*
                    TypeBackboneElement
                    Is Modifierfalse
                    Summaryfalse
                    Requirements

                    The adjudication for sub-details provided on the claim.

                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                    104. ClaimResponse.item.detail.subDetail.id
                    Definition

                    Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                    ShortUnique id for inter-element referencing
                    Control0..1
                    Typestring
                    Is Modifierfalse
                    XML FormatIn the XML format, this property is represented as an attribute.
                    Summaryfalse
                    106. ClaimResponse.item.detail.subDetail.extension
                    Definition

                    May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                    ShortAdditional content defined by implementations
                    Comments

                    There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                    Control0..*
                    TypeExtension
                    Is Modifierfalse
                    Summaryfalse
                    Alternate Namesextensions, user content
                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                    ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                    108. ClaimResponse.item.detail.subDetail.modifierExtension
                    Definition

                    May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

                    Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

                    ShortExtensions that cannot be ignored even if unrecognized
                    Comments

                    There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                    Control0..*
                    TypeExtension
                    Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
                    Summarytrue
                    Requirements

                    Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

                    Alternate Namesextensions, user content, modifiers
                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                    ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                    110. ClaimResponse.item.detail.subDetail.subDetailSequence
                    Definition

                    A number to uniquely reference the claim sub-detail entry.

                    ShortClaim sub-detail instance identifier
                    Control1..1
                    TypepositiveInt
                    Is Modifierfalse
                    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                    Summaryfalse
                    Requirements

                    Necessary to provide a mechanism to link the adjudication result to the submitted claim sub-detail.

                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                    112. ClaimResponse.item.detail.subDetail.noteNumber
                    Definition

                    The numbers associated with notes below which apply to the adjudication of this item.

                    ShortApplicable note numbers
                    Control0..*
                    TypepositiveInt
                    Is Modifierfalse
                    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                    Summaryfalse
                    Requirements

                    Provides a condensed manner for associating human readable descriptive explanations for adjudications on the line item.

                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                    114. ClaimResponse.item.detail.subDetail.adjudication
                    Definition

                    The adjudication results.

                    ShortSubdetail level adjudication details
                    Control0..*
                    TypeSeettp://hl7.org/fhir/StructureDefinition/ClaimResponse#ClaimResponse.item.adjudication
                    Is Modifierfalse
                    Summaryfalse
                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                    116. ClaimResponse.addItem
                    Definition

                    The first-tier service adjudications for payor added product or service lines.

                    ShortAny line items added by Health NZ to the claim determination that were not in the original claim
                    Control0..*
                    TypeBackboneElement
                    Is Modifierfalse
                    Summaryfalse
                    Requirements

                    Insurers may redefine the provided product or service or may package and/or decompose groups of products and services. The addItems allows the insurer to provide their line item list with linkage to the submitted items/details/sub-details. In a preauthorization the insurer may use the addItem structure to provide additional information on authorized products and services.

                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                    118. ClaimResponse.addItem.id
                    Definition

                    Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                    ShortUnique id for inter-element referencing
                    Control0..1
                    Typestring
                    Is Modifierfalse
                    XML FormatIn the XML format, this property is represented as an attribute.
                    Summaryfalse
                    120. ClaimResponse.addItem.extension
                    Definition

                    May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                    ShortAdditional content defined by implementations
                    Comments

                    There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                    Control0..*
                    TypeExtension
                    Is Modifierfalse
                    Summaryfalse
                    Alternate Namesextensions, user content
                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                    ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                    122. ClaimResponse.addItem.modifierExtension
                    Definition

                    May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

                    Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

                    ShortExtensions that cannot be ignored even if unrecognized
                    Comments

                    There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                    Control0..*
                    TypeExtension
                    Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
                    Summarytrue
                    Requirements

                    Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

                    Alternate Namesextensions, user content, modifiers
                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                    ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                    124. ClaimResponse.addItem.itemSequence
                    Definition

                    Claim items which this service line is intended to replace.

                    ShortItem sequence number
                    Control0..*
                    TypepositiveInt
                    Is Modifierfalse
                    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                    Summaryfalse
                    Requirements

                    Provides references to the claim items.

                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                    126. ClaimResponse.addItem.detailSequence
                    Definition

                    The sequence number of the details within the claim item which this line is intended to replace.

                    ShortDetail sequence number
                    Control0..*
                    TypepositiveInt
                    Is Modifierfalse
                    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                    Summaryfalse
                    Requirements

                    Provides references to the claim details within the claim item.

                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                    128. ClaimResponse.addItem.subdetailSequence
                    Definition

                    The sequence number of the sub-details within the details within the claim item which this line is intended to replace.

                    ShortSubdetail sequence number
                    Control0..*
                    TypepositiveInt
                    Is Modifierfalse
                    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                    Summaryfalse
                    Requirements

                    Provides references to the claim sub-details within the claim detail.

                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                    130. ClaimResponse.addItem.provider
                    Definition

                    The providers who are authorized for the services rendered to the patient.

                    ShortAuthorized providers
                    Control0..*
                    TypeReference(Practitioner, PractitionerRole, Organization)
                    Is Modifierfalse
                    Summaryfalse
                    Requirements

                    Insurer may provide authorization specifically to a restricted set of providers rather than an open authorization.

                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                    132. ClaimResponse.addItem.productOrService
                    Definition

                    When the value is a group code then this item collects a set of related claim details, otherwise this contains the product, service, drug or other billing code for the item.

                    ShortBilling, service, product, or drug code
                    Comments

                    If this is an actual service or product line, i.e. not a Group, then use code to indicate the Professional Service or Product supplied (e.g. CTP, HCPCS, USCLS, ICD10, NCPDP, DIN, RxNorm, ACHI, CCI). If a grouping item then use a group code to indicate the type of thing being grouped e.g. 'glasses' or 'compound'.

                    Control1..1
                    BindingFor example codes, see USCLSCodes
                    (example to http://hl7.org/fhir/ValueSet/service-uscls)

                    Allowable service and product codes.

                    TypeCodeableConcept
                    Is Modifierfalse
                    Summaryfalse
                    Requirements

                    Necessary to state what was provided or done.

                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                    134. ClaimResponse.addItem.modifier
                    Definition

                    Item typification or modifiers codes to convey additional context for the product or service.

                    ShortService/Product billing modifiers
                    Comments

                    For example in Oral whether the treatment is cosmetic or associated with TMJ, or for Medical whether the treatment was outside the clinic or outside of office hours.

                    Control0..*
                    BindingFor example codes, see ModifierTypeCodes
                    (example to http://hl7.org/fhir/ValueSet/claim-modifiers)

                    Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen.

                    TypeCodeableConcept
                    Is Modifierfalse
                    Summaryfalse
                    Requirements

                    To support inclusion of the item for adjudication or to charge an elevated fee.

                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                    136. ClaimResponse.addItem.programCode
                    Definition

                    Identifies the program under which this may be recovered.

                    ShortProgram the product or service is provided under
                    Comments

                    For example: Neonatal program, child dental program or drug users recovery program.

                    Control0..*
                    BindingFor example codes, see ExampleProgramReasonCodes
                    (example to http://hl7.org/fhir/ValueSet/ex-program-code)

                    Program specific reason codes.

                    TypeCodeableConcept
                    Is Modifierfalse
                    Summaryfalse
                    Requirements

                    Commonly used in in the identification of publicly provided program focused on population segments or disease classifications.

                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                    138. ClaimResponse.addItem.serviced[x]
                    Definition

                    The date or dates when the service or product was supplied, performed or completed.

                    ShortDate or dates of service or product delivery
                    Control0..1
                    TypeChoice of: date, Period
                    [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                    Is Modifierfalse
                    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                    Summaryfalse
                    Requirements

                    Needed to determine whether the service or product was provided during the term of the insurance coverage.

                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                    140. ClaimResponse.addItem.location[x]
                    Definition

                    Where the product or service was provided.

                    ShortPlace of service or where product was supplied
                    Control0..1
                    BindingFor example codes, see ExampleServicePlaceCodes
                    (example to http://hl7.org/fhir/ValueSet/service-place)

                    Place of service: pharmacy, school, prison, etc.

                    TypeChoice of: CodeableConcept, Address, Reference(Location)
                    [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                    Is Modifierfalse
                    Summaryfalse
                    Requirements

                    The location can alter whether the item was acceptable for insurance purposes or impact the determination of the benefit amount.

                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                    142. ClaimResponse.addItem.quantity
                    Definition

                    The number of repetitions of a service or product.

                    ShortCount of products or services
                    Control0..1
                    TypeQuantity(SimpleQuantity)
                    Is Modifierfalse
                    Summaryfalse
                    Requirements

                    Required when the product or service code does not convey the quantity provided.

                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                    144. ClaimResponse.addItem.unitPrice
                    Definition

                    If the item is not a group then this is the fee for the product or service, otherwise this is the total of the fees for the details of the group.

                    ShortFee, charge or cost per item
                    Control0..1
                    TypeMoney
                    Is Modifierfalse
                    Summaryfalse
                    Requirements

                    The amount charged to the patient by the provider for a single unit.

                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                    146. ClaimResponse.addItem.factor
                    Definition

                    A real number that represents a multiplier used in determining the overall value of services delivered and/or goods received. The concept of a Factor allows for a discount or surcharge multiplier to be applied to a monetary amount.

                    ShortPrice scaling factor
                    Comments

                    To show a 10% senior's discount, the value entered is: 0.90 (1.00 - 0.10).

                    Control0..1
                    Typedecimal
                    Is Modifierfalse
                    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                    Summaryfalse
                    Requirements

                    When discounts are provided to a patient (example: Senior's discount) then this must be documented for adjudication.

                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                    148. ClaimResponse.addItem.net
                    Definition

                    The quantity times the unit price for an additional service or product or charge.

                    ShortTotal item cost
                    Comments

                    For example, the formula: quantity * unitPrice * factor = net. Quantity and factor are assumed to be 1 if not supplied.

                    Control0..1
                    TypeMoney
                    Is Modifierfalse
                    Summaryfalse
                    Requirements

                    Provides the total amount claimed for the group (if a grouper) or the line item.

                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                    150. ClaimResponse.addItem.bodySite
                    Definition

                    Physical service site on the patient (limb, tooth, etc.).

                    ShortAnatomical location
                    Comments

                    For example: Providing a tooth code allows an insurer to identify a provider performing a filling on a tooth that was previously removed.

                    Control0..1
                    BindingFor example codes, see OralSiteCodes
                    (example to http://hl7.org/fhir/ValueSet/tooth)

                    The code for the teeth, quadrant, sextant and arch.

                    TypeCodeableConcept
                    Is Modifierfalse
                    Summaryfalse
                    Requirements

                    Allows insurer to validate specific procedures.

                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                    152. ClaimResponse.addItem.subSite
                    Definition

                    A region or surface of the bodySite, e.g. limb region or tooth surface(s).

                    ShortAnatomical sub-location
                    Control0..*
                    BindingFor example codes, see SurfaceCodes
                    (example to http://hl7.org/fhir/ValueSet/surface)

                    The code for the tooth surface and surface combinations.

                    TypeCodeableConcept
                    Is Modifierfalse
                    Summaryfalse
                    Requirements

                    Allows insurer to validate specific procedures.

                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                    154. ClaimResponse.addItem.noteNumber
                    Definition

                    The numbers associated with notes below which apply to the adjudication of this item.

                    ShortApplicable note numbers
                    Control0..*
                    TypepositiveInt
                    Is Modifierfalse
                    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                    Summaryfalse
                    Requirements

                    Provides a condensed manner for associating human readable descriptive explanations for adjudications on the line item.

                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                    156. ClaimResponse.addItem.adjudication
                    Definition

                    The adjudication results.

                    ShortAdded items adjudication
                    Control1..*
                    TypeSeettp://hl7.org/fhir/StructureDefinition/ClaimResponse#ClaimResponse.item.adjudication
                    Is Modifierfalse
                    Summaryfalse
                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                    158. ClaimResponse.addItem.detail
                    Definition

                    The second-tier service adjudications for payor added services.

                    ShortInsurer added line details
                    Control0..*
                    TypeBackboneElement
                    Is Modifierfalse
                    Summaryfalse
                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                    160. ClaimResponse.addItem.detail.id
                    Definition

                    Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                    ShortUnique id for inter-element referencing
                    Control0..1
                    Typestring
                    Is Modifierfalse
                    XML FormatIn the XML format, this property is represented as an attribute.
                    Summaryfalse
                    162. ClaimResponse.addItem.detail.extension
                    Definition

                    May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                    ShortAdditional content defined by implementations
                    Comments

                    There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                    Control0..*
                    TypeExtension
                    Is Modifierfalse
                    Summaryfalse
                    Alternate Namesextensions, user content
                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                    ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                    164. ClaimResponse.addItem.detail.modifierExtension
                    Definition

                    May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

                    Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

                    ShortExtensions that cannot be ignored even if unrecognized
                    Comments

                    There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                    Control0..*
                    TypeExtension
                    Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
                    Summarytrue
                    Requirements

                    Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

                    Alternate Namesextensions, user content, modifiers
                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                    ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                    166. ClaimResponse.addItem.detail.productOrService
                    Definition

                    When the value is a group code then this item collects a set of related claim details, otherwise this contains the product, service, drug or other billing code for the item.

                    ShortBilling, service, product, or drug code
                    Comments

                    If this is an actual service or product line, i.e. not a Group, then use code to indicate the Professional Service or Product supplied (e.g. CTP, HCPCS, USCLS, ICD10, NCPDP, DIN, RxNorm, ACHI, CCI). If a grouping item then use a group code to indicate the type of thing being grouped e.g. 'glasses' or 'compound'.

                    Control1..1
                    BindingFor example codes, see USCLSCodes
                    (example to http://hl7.org/fhir/ValueSet/service-uscls)

                    Allowable service and product codes.

                    TypeCodeableConcept
                    Is Modifierfalse
                    Summaryfalse
                    Requirements

                    Necessary to state what was provided or done.

                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                    168. ClaimResponse.addItem.detail.modifier
                    Definition

                    Item typification or modifiers codes to convey additional context for the product or service.

                    ShortService/Product billing modifiers
                    Comments

                    For example in Oral whether the treatment is cosmetic or associated with TMJ, or for Medical whether the treatment was outside the clinic or outside of office hours.

                    Control0..*
                    BindingFor example codes, see ModifierTypeCodes
                    (example to http://hl7.org/fhir/ValueSet/claim-modifiers)

                    Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen.

                    TypeCodeableConcept
                    Is Modifierfalse
                    Summaryfalse
                    Requirements

                    To support inclusion of the item for adjudication or to charge an elevated fee.

                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                    170. ClaimResponse.addItem.detail.quantity
                    Definition

                    The number of repetitions of a service or product.

                    ShortCount of products or services
                    Control0..1
                    TypeQuantity(SimpleQuantity)
                    Is Modifierfalse
                    Summaryfalse
                    Requirements

                    Required when the product or service code does not convey the quantity provided.

                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                    172. ClaimResponse.addItem.detail.unitPrice
                    Definition

                    If the item is not a group then this is the fee for the product or service, otherwise this is the total of the fees for the details of the group.

                    ShortFee, charge or cost per item
                    Control0..1
                    TypeMoney
                    Is Modifierfalse
                    Summaryfalse
                    Requirements

                    The amount charged to the patient by the provider for a single unit.

                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                    174. ClaimResponse.addItem.detail.factor
                    Definition

                    A real number that represents a multiplier used in determining the overall value of services delivered and/or goods received. The concept of a Factor allows for a discount or surcharge multiplier to be applied to a monetary amount.

                    ShortPrice scaling factor
                    Comments

                    To show a 10% senior's discount, the value entered is: 0.90 (1.00 - 0.10).

                    Control0..1
                    Typedecimal
                    Is Modifierfalse
                    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                    Summaryfalse
                    Requirements

                    When discounts are provided to a patient (example: Senior's discount) then this must be documented for adjudication.

                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                    176. ClaimResponse.addItem.detail.net
                    Definition

                    The quantity times the unit price for an additional service or product or charge.

                    ShortTotal item cost
                    Comments

                    For example, the formula: quantity * unitPrice * factor = net. Quantity and factor are assumed to be 1 if not supplied.

                    Control0..1
                    TypeMoney
                    Is Modifierfalse
                    Summaryfalse
                    Requirements

                    Provides the total amount claimed for the group (if a grouper) or the line item.

                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                    178. ClaimResponse.addItem.detail.noteNumber
                    Definition

                    The numbers associated with notes below which apply to the adjudication of this item.

                    ShortApplicable note numbers
                    Control0..*
                    TypepositiveInt
                    Is Modifierfalse
                    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                    Summaryfalse
                    Requirements

                    Provides a condensed manner for associating human readable descriptive explanations for adjudications on the line item.

                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                    180. ClaimResponse.addItem.detail.adjudication
                    Definition

                    The adjudication results.

                    ShortAdded items detail adjudication
                    Control1..*
                    TypeSeettp://hl7.org/fhir/StructureDefinition/ClaimResponse#ClaimResponse.item.adjudication
                    Is Modifierfalse
                    Summaryfalse
                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                    182. ClaimResponse.addItem.detail.subDetail
                    Definition

                    The third-tier service adjudications for payor added services.

                    ShortInsurer added line items
                    Control0..*
                    TypeBackboneElement
                    Is Modifierfalse
                    Summaryfalse
                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                    184. ClaimResponse.addItem.detail.subDetail.id
                    Definition

                    Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                    ShortUnique id for inter-element referencing
                    Control0..1
                    Typestring
                    Is Modifierfalse
                    XML FormatIn the XML format, this property is represented as an attribute.
                    Summaryfalse
                    186. ClaimResponse.addItem.detail.subDetail.extension
                    Definition

                    May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                    ShortAdditional content defined by implementations
                    Comments

                    There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                    Control0..*
                    TypeExtension
                    Is Modifierfalse
                    Summaryfalse
                    Alternate Namesextensions, user content
                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                    ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                    188. ClaimResponse.addItem.detail.subDetail.modifierExtension
                    Definition

                    May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

                    Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

                    ShortExtensions that cannot be ignored even if unrecognized
                    Comments

                    There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                    Control0..*
                    TypeExtension
                    Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
                    Summarytrue
                    Requirements

                    Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

                    Alternate Namesextensions, user content, modifiers
                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                    ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                    190. ClaimResponse.addItem.detail.subDetail.productOrService
                    Definition

                    When the value is a group code then this item collects a set of related claim details, otherwise this contains the product, service, drug or other billing code for the item.

                    ShortBilling, service, product, or drug code
                    Comments

                    If this is an actual service or product line, i.e. not a Group, then use code to indicate the Professional Service or Product supplied (e.g. CTP, HCPCS, USCLS, ICD10, NCPDP, DIN, RxNorm, ACHI, CCI). If a grouping item then use a group code to indicate the type of thing being grouped e.g. 'glasses' or 'compound'.

                    Control1..1
                    BindingFor example codes, see USCLSCodes
                    (example to http://hl7.org/fhir/ValueSet/service-uscls)

                    Allowable service and product codes.

                    TypeCodeableConcept
                    Is Modifierfalse
                    Summaryfalse
                    Requirements

                    Necessary to state what was provided or done.

                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                    192. ClaimResponse.addItem.detail.subDetail.modifier
                    Definition

                    Item typification or modifiers codes to convey additional context for the product or service.

                    ShortService/Product billing modifiers
                    Comments

                    For example in Oral whether the treatment is cosmetic or associated with TMJ, or for Medical whether the treatment was outside the clinic or outside of office hours.

                    Control0..*
                    BindingFor example codes, see ModifierTypeCodes
                    (example to http://hl7.org/fhir/ValueSet/claim-modifiers)

                    Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen.

                    TypeCodeableConcept
                    Is Modifierfalse
                    Summaryfalse
                    Requirements

                    To support inclusion of the item for adjudication or to charge an elevated fee.

                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                    194. ClaimResponse.addItem.detail.subDetail.quantity
                    Definition

                    The number of repetitions of a service or product.

                    ShortCount of products or services
                    Control0..1
                    TypeQuantity(SimpleQuantity)
                    Is Modifierfalse
                    Summaryfalse
                    Requirements

                    Required when the product or service code does not convey the quantity provided.

                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                    196. ClaimResponse.addItem.detail.subDetail.unitPrice
                    Definition

                    If the item is not a group then this is the fee for the product or service, otherwise this is the total of the fees for the details of the group.

                    ShortFee, charge or cost per item
                    Control0..1
                    TypeMoney
                    Is Modifierfalse
                    Summaryfalse
                    Requirements

                    The amount charged to the patient by the provider for a single unit.

                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                    198. ClaimResponse.addItem.detail.subDetail.factor
                    Definition

                    A real number that represents a multiplier used in determining the overall value of services delivered and/or goods received. The concept of a Factor allows for a discount or surcharge multiplier to be applied to a monetary amount.

                    ShortPrice scaling factor
                    Comments

                    To show a 10% senior's discount, the value entered is: 0.90 (1.00 - 0.10).

                    Control0..1
                    Typedecimal
                    Is Modifierfalse
                    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                    Summaryfalse
                    Requirements

                    When discounts are provided to a patient (example: Senior's discount) then this must be documented for adjudication.

                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                    200. ClaimResponse.addItem.detail.subDetail.net
                    Definition

                    The quantity times the unit price for an additional service or product or charge.

                    ShortTotal item cost
                    Comments

                    For example, the formula: quantity * unitPrice * factor = net. Quantity and factor are assumed to be 1 if not supplied.

                    Control0..1
                    TypeMoney
                    Is Modifierfalse
                    Summaryfalse
                    Requirements

                    Provides the total amount claimed for the group (if a grouper) or the line item.

                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                    202. ClaimResponse.addItem.detail.subDetail.noteNumber
                    Definition

                    The numbers associated with notes below which apply to the adjudication of this item.

                    ShortApplicable note numbers
                    Control0..*
                    TypepositiveInt
                    Is Modifierfalse
                    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                    Summaryfalse
                    Requirements

                    Provides a condensed manner for associating human readable descriptive explanations for adjudications on the line item.

                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                    204. ClaimResponse.addItem.detail.subDetail.adjudication
                    Definition

                    The adjudication results.

                    ShortAdded items detail adjudication
                    Control1..*
                    TypeSeettp://hl7.org/fhir/StructureDefinition/ClaimResponse#ClaimResponse.item.adjudication
                    Is Modifierfalse
                    Summaryfalse
                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                    206. ClaimResponse.adjudication
                    Definition

                    The adjudication results which are presented at the header level rather than at the line-item or add-item levels.

                    ShortClaim-level adjudication
                    Control0..*
                    TypeSeettp://hl7.org/fhir/StructureDefinition/ClaimResponse#ClaimResponse.item.adjudication
                    Is Modifierfalse
                    Summaryfalse
                    Requirements

                    Some insurers will receive line-items but provide the adjudication only at a summary or header-level.

                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                    208. ClaimResponse.total
                    Definition

                    Categorized monetary totals for the adjudication.

                    ShortFinancial total of the claim for each Adjudication Value Code
                    Comments

                    Totals for amounts submitted, co-pays, benefits payable etc.

                    Control0..*
                    TypeBackboneElement
                    Is Modifierfalse
                    Summarytrue
                    Requirements

                    To provide the requestor with financial totals by category for the adjudication.

                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                    210. ClaimResponse.total.id
                    Definition

                    Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                    ShortUnique id for inter-element referencing
                    Control0..1
                    Typestring
                    Is Modifierfalse
                    XML FormatIn the XML format, this property is represented as an attribute.
                    Summaryfalse
                    212. ClaimResponse.total.extension
                    Definition

                    May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                    ShortAdditional content defined by implementations
                    Comments

                    There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                    Control0..*
                    TypeExtension
                    Is Modifierfalse
                    Summaryfalse
                    Alternate Namesextensions, user content
                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                    ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                    214. ClaimResponse.total.modifierExtension
                    Definition

                    May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

                    Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

                    ShortExtensions that cannot be ignored even if unrecognized
                    Comments

                    There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                    Control0..*
                    TypeExtension
                    Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
                    Summarytrue
                    Requirements

                    Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

                    Alternate Namesextensions, user content, modifiers
                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                    ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                    216. ClaimResponse.total.category
                    Definition

                    A code to indicate the information type of this adjudication record. Information types may include: the value submitted, maximum values or percentages allowed or payable under the plan, amounts that the patient is responsible for in aggregate or pertaining to this item, amounts paid by other coverages, and the benefit payable for this item.

                    ShortType of adjudication information
                    Comments

                    For example codes indicating: Co-Pay, deductible, eligible, benefit, tax, etc.

                    Control1..1
                    BindingFor example codes, see AdjudicationValueCodes
                    (example to http://hl7.org/fhir/ValueSet/adjudication)

                    The adjudication codes.

                    TypeCodeableConcept
                    Is Modifierfalse
                    Summarytrue
                    Requirements

                    Needed to convey the type of total provided.

                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                    218. ClaimResponse.total.amount
                    Definition

                    Monetary total amount associated with the category.

                    ShortFinancial total for the category
                    Control1..1
                    TypeMoney
                    Is Modifierfalse
                    Summarytrue
                    Requirements

                    Needed to convey the total monetary amount.

                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                    220. ClaimResponse.payment
                    Definition

                    Payment details for the adjudication of the claim.

                    ShortSummary of the payment being made
                    Control0..1
                    TypeBackboneElement
                    Is Modifierfalse
                    Summaryfalse
                    Requirements

                    Needed to convey references to the financial instrument that has been used if payment has been made.

                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                    222. ClaimResponse.payment.id
                    Definition

                    Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                    ShortUnique id for inter-element referencing
                    Control0..1
                    Typestring
                    Is Modifierfalse
                    XML FormatIn the XML format, this property is represented as an attribute.
                    Summaryfalse
                    224. ClaimResponse.payment.extension
                    Definition

                    May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                    ShortAdditional content defined by implementations
                    Comments

                    There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                    Control0..*
                    TypeExtension
                    Is Modifierfalse
                    Summaryfalse
                    Alternate Namesextensions, user content
                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                    ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                    226. ClaimResponse.payment.modifierExtension
                    Definition

                    May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

                    Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

                    ShortExtensions that cannot be ignored even if unrecognized
                    Comments

                    There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                    Control0..*
                    TypeExtension
                    Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
                    Summarytrue
                    Requirements

                    Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

                    Alternate Namesextensions, user content, modifiers
                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                    ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                    228. ClaimResponse.payment.type
                    Definition

                    Whether this represents partial or complete payment of the benefits payable.

                    ShortPayment Type Code = complete or partial
                    Control1..1
                    BindingUnless not suitable, these codes SHALL be taken from Payment Type Codes
                    (extensible to https://fhir-ig.digital.health.nz/shared-care/ValueSet/payment-type-codes)
                    TypeCodeableConcept
                    Is Modifierfalse
                    Summaryfalse
                    Requirements

                    To advise the requestor when the insurer believes all payments to have been completed.

                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                    230. ClaimResponse.payment.adjustment
                    Definition

                    Total amount of all adjustments to this payment included in this transaction which are not related to this claim's adjudication.

                    ShortPayment adjustment for non-claim issues
                    Comments

                    Insurers will deduct amounts owing from the provider (adjustment), such as a prior overpayment, from the amount owing to the provider (benefits payable) when payment is made to the provider.

                    Control0..1
                    TypeMoney
                    Is Modifierfalse
                    Summaryfalse
                    Requirements

                    To advise the requestor of adjustments applied to the payment.

                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                    232. ClaimResponse.payment.adjustmentReason
                    Definition

                    Reason for the payment adjustment.

                    ShortExplanation for the adjustment
                    Control0..1
                    BindingFor example codes, see PaymentAdjustmentReasonCodes
                    (example to http://hl7.org/fhir/ValueSet/payment-adjustment-reason)

                    Payment Adjustment reason codes.

                    TypeCodeableConcept
                    Is Modifierfalse
                    Summaryfalse
                    Requirements

                    Needed to clarify the monetary adjustment.

                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                    234. ClaimResponse.payment.date
                    Definition

                    Estimated date the payment will be issued or the actual issue date of payment.

                    ShortExpected date of payment (if known)
                    Control0..1
                    Typedate
                    Is Modifierfalse
                    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                    Summaryfalse
                    Requirements

                    To advise the payee when payment can be expected.

                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                    236. ClaimResponse.payment.amount
                    Definition

                    Benefits payable less any payment adjustment.

                    ShortPayment amount
                    Control1..1
                    TypeMoney
                    Is Modifierfalse
                    Summaryfalse
                    Requirements

                    Needed to provide the actual payment amount.

                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                    238. ClaimResponse.payment.identifier
                    Definition

                    Issuer's unique identifier for the payment instrument.

                    ShortBusiness identifier for the payment
                    Comments

                    For example: EFT number or check number.

                    NoteThis is a business identifier, not a resource identifier (see discussion)
                    Control0..1
                    TypeIdentifier
                    Is Modifierfalse
                    Summaryfalse
                    Requirements

                    Enable the receiver to reconcile when payment received.

                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                    240. ClaimResponse.fundsReserve
                    Definition

                    A code, used only on a response to a preauthorization, to indicate whether the benefits payable have been reserved and for whom.

                    ShortFunds reserved status
                    Comments

                    Fund would be release by a future claim quoting the preAuthRef of this response. Examples of values include: provider, patient, none.

                    Control0..1
                    BindingFor example codes, see Funds Reservation Codes
                    (example to http://hl7.org/fhir/ValueSet/fundsreserve)

                    For whom funds are to be reserved: (Patient, Provider, None).

                    TypeCodeableConcept
                    Is Modifierfalse
                    Summaryfalse
                    Requirements

                    Needed to advise the submitting provider on whether the rquest for reservation of funds has been honored.

                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                    242. ClaimResponse.formCode
                    Definition

                    A code for the form to be used for printing the content.

                    ShortPrinted form identifier
                    Comments

                    May be needed to identify specific jurisdictional forms.

                    Control0..1
                    BindingFor example codes, see Form Codes
                    (example to http://hl7.org/fhir/ValueSet/forms)

                    The forms codes.

                    TypeCodeableConcept
                    Is Modifierfalse
                    Summaryfalse
                    Requirements

                    Needed to specify the specific form used for producing output for this response.

                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                    244. ClaimResponse.form
                    Definition

                    The actual form, by reference or inclusion, for printing the content or an EOB.

                    ShortPrinted reference or actual form
                    Comments

                    Needed to permit insurers to include the actual form.

                    Control0..1
                    TypeAttachment
                    Is Modifierfalse
                    Summaryfalse
                    Requirements

                    Needed to include the specific form used for producing output for this response.

                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                    246. ClaimResponse.processNote
                    Definition

                    A note that describes or explains adjudication results in a human readable form.

                    ShortNote concerning adjudication
                    Control0..*
                    TypeBackboneElement
                    Is Modifierfalse
                    Summaryfalse
                    Requirements

                    Provides the insurer specific textual explanations associated with the processing.

                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                    248. ClaimResponse.processNote.id
                    Definition

                    Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                    ShortUnique id for inter-element referencing
                    Control0..1
                    Typestring
                    Is Modifierfalse
                    XML FormatIn the XML format, this property is represented as an attribute.
                    Summaryfalse
                    250. ClaimResponse.processNote.extension
                    Definition

                    May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                    ShortAdditional content defined by implementations
                    Comments

                    There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                    Control0..*
                    TypeExtension
                    Is Modifierfalse
                    Summaryfalse
                    Alternate Namesextensions, user content
                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                    ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                    252. ClaimResponse.processNote.modifierExtension
                    Definition

                    May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

                    Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

                    ShortExtensions that cannot be ignored even if unrecognized
                    Comments

                    There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                    Control0..*
                    TypeExtension
                    Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
                    Summarytrue
                    Requirements

                    Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

                    Alternate Namesextensions, user content, modifiers
                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                    ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                    254. ClaimResponse.processNote.number
                    Definition

                    A number to uniquely identify a note entry.

                    ShortNote instance identifier
                    Control0..1
                    TypepositiveInt
                    Is Modifierfalse
                    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                    Summaryfalse
                    Requirements

                    Necessary to provide a mechanism to link from adjudications.

                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                    256. ClaimResponse.processNote.type
                    Definition

                    The business purpose of the note text.

                    Shortdisplay | print | printoper
                    Control0..1
                    BindingThe codes SHALL be taken from NoteType
                    (required to http://hl7.org/fhir/ValueSet/note-type|4.0.1)

                    The presentation types of notes.

                    Typecode
                    Is Modifierfalse
                    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                    Summaryfalse
                    Requirements

                    To convey the expectation for when the text is used.

                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                    258. ClaimResponse.processNote.text
                    Definition

                    The explanation or description associated with the processing.

                    ShortNote explanatory text
                    Control1..1
                    Typestring
                    Is Modifierfalse
                    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                    Summaryfalse
                    Requirements

                    Required to provide human readable explanation.

                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                    260. ClaimResponse.processNote.language
                    Definition

                    A code to define the language used in the text of the note.

                    ShortLanguage of the text
                    Comments

                    Only required if the language is different from the resource language.

                    Control0..1
                    BindingThe codes SHOULD be taken from CommonLanguages
                    (preferred to http://hl7.org/fhir/ValueSet/languages)

                    A human language.

                    Additional BindingsPurpose
                    AllLanguagesMax Binding
                    TypeCodeableConcept
                    Is Modifierfalse
                    Summaryfalse
                    Requirements

                    Note text may vary from the resource defined language.

                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                    262. ClaimResponse.communicationRequest
                    Definition

                    Request for additional supporting or authorizing information.

                    ShortRequest for additional information
                    Comments

                    For example: professional reports, documents, images, clinical resources, or accident reports.

                    Control0..*
                    TypeReference(CommunicationRequest)
                    Is Modifierfalse
                    Summaryfalse
                    Requirements

                    Need to communicate insurer request for additional information required to support the adjudication.

                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                    264. ClaimResponse.insurance
                    Definition

                    Financial instruments for reimbursement for the health care products and services specified on the claim.

                    ShortPatient insurance information
                    Comments

                    All insurance coverages for the patient which may be applicable for reimbursement, of the products and services listed in the claim, are typically provided in the claim to allow insurers to confirm the ordering of the insurance coverages relative to local 'coordination of benefit' rules. One coverage (and only one) with 'focal=true' is to be used in the adjudication of this claim. Coverages appearing before the focal Coverage in the list, and where 'subrogation=false', should provide a reference to the ClaimResponse containing the adjudication results of the prior claim.

                    Control0..*
                    TypeBackboneElement
                    Is Modifierfalse
                    Summaryfalse
                    Requirements

                    At least one insurer is required for a claim to be a claim.

                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                    266. ClaimResponse.insurance.id
                    Definition

                    Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                    ShortUnique id for inter-element referencing
                    Control0..1
                    Typestring
                    Is Modifierfalse
                    XML FormatIn the XML format, this property is represented as an attribute.
                    Summaryfalse
                    268. ClaimResponse.insurance.extension
                    Definition

                    May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                    ShortAdditional content defined by implementations
                    Comments

                    There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                    Control0..*
                    TypeExtension
                    Is Modifierfalse
                    Summaryfalse
                    Alternate Namesextensions, user content
                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                    ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                    270. ClaimResponse.insurance.modifierExtension
                    Definition

                    May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

                    Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

                    ShortExtensions that cannot be ignored even if unrecognized
                    Comments

                    There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                    Control0..*
                    TypeExtension
                    Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
                    Summarytrue
                    Requirements

                    Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

                    Alternate Namesextensions, user content, modifiers
                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                    ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                    272. ClaimResponse.insurance.sequence
                    Definition

                    A number to uniquely identify insurance entries and provide a sequence of coverages to convey coordination of benefit order.

                    ShortInsurance instance identifier
                    Control1..1
                    TypepositiveInt
                    Is Modifierfalse
                    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                    Summaryfalse
                    Requirements

                    To maintain order of the coverages.

                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                    274. ClaimResponse.insurance.focal
                    Definition

                    A flag to indicate that this Coverage is to be used for adjudication of this claim when set to true.

                    ShortCoverage to be used for adjudication
                    Comments

                    A patient may (will) have multiple insurance policies which provide reimbursement for healthcare services and products. For example a person may also be covered by their spouse's policy and both appear in the list (and may be from the same insurer). This flag will be set to true for only one of the listed policies and that policy will be used for adjudicating this claim. Other claims would be created to request adjudication against the other listed policies.

                    Control1..1
                    Typeboolean
                    Is Modifierfalse
                    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                    Summaryfalse
                    Requirements

                    To identify which coverage in the list is being used to adjudicate this claim.

                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                    276. ClaimResponse.insurance.coverage
                    Definition

                    Reference to the insurance card level information contained in the Coverage resource. The coverage issuing insurer will use these details to locate the patient's actual coverage within the insurer's information system.

                    ShortInsurance information
                    Control1..1
                    TypeReference(Coverage)
                    Is Modifierfalse
                    Summaryfalse
                    Requirements

                    Required to allow the adjudicator to locate the correct policy and history within their information system.

                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                    278. ClaimResponse.insurance.businessArrangement
                    Definition

                    A business agreement number established between the provider and the insurer for special business processing purposes.

                    ShortAdditional provider contract number
                    Control0..1
                    Typestring
                    Is Modifierfalse
                    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                    Summaryfalse
                    Requirements

                    Providers may have multiple business arrangements with a given insurer and must supply the specific contract number for adjudication.

                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                    280. ClaimResponse.insurance.claimResponse
                    Definition

                    The result of the adjudication of the line items for the Coverage specified in this insurance.

                    ShortAdjudication results
                    Comments

                    Must not be specified when 'focal=true' for this insurance.

                    Control0..1
                    TypeReference(ClaimResponse)
                    Is Modifierfalse
                    Summaryfalse
                    Requirements

                    An insurer need the adjudication results from prior insurers to determine the outstanding balance remaining by item for the items in the curent claim.

                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                    282. ClaimResponse.error
                    Definition

                    Errors encountered during the processing of the adjudication.

                    ShortCollection of errors produced during claim determination
                    Comments

                    If the request contains errors then an error element should be provided and no adjudication related sections (item, addItem, or payment) should be present.

                    Control0..*
                    TypeBackboneElement
                    Is Modifierfalse
                    Summaryfalse
                    Requirements

                    Need to communicate processing issues to the requestor.

                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                    284. ClaimResponse.error.id
                    Definition

                    Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                    ShortUnique id for inter-element referencing
                    Control0..1
                    Typestring
                    Is Modifierfalse
                    XML FormatIn the XML format, this property is represented as an attribute.
                    Summaryfalse
                    286. ClaimResponse.error.extension
                    Definition

                    May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                    ShortAdditional content defined by implementations
                    Comments

                    There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                    Control0..*
                    TypeExtension
                    Is Modifierfalse
                    Summaryfalse
                    Alternate Namesextensions, user content
                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                    ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                    288. ClaimResponse.error.modifierExtension
                    Definition

                    May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

                    Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

                    ShortExtensions that cannot be ignored even if unrecognized
                    Comments

                    There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                    Control0..*
                    TypeExtension
                    Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
                    Summarytrue
                    Requirements

                    Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

                    Alternate Namesextensions, user content, modifiers
                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                    ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                    290. ClaimResponse.error.itemSequence
                    Definition

                    The sequence number of the line item submitted which contains the error. This value is omitted when the error occurs outside of the item structure.

                    ShortRefers to itemSequence to which the error relates
                    Control0..1
                    TypepositiveInt
                    Is Modifierfalse
                    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                    Summaryfalse
                    Requirements

                    Provides references to the claim items.

                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                    292. ClaimResponse.error.detailSequence
                    Definition

                    The sequence number of the detail within the line item submitted which contains the error. This value is omitted when the error occurs outside of the item structure.

                    ShortRefers to detailSequence to which the error relates
                    Control0..1
                    TypepositiveInt
                    Is Modifierfalse
                    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                    Summaryfalse
                    Requirements

                    Provides references to the claim details within the claim item.

                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                    294. ClaimResponse.error.subDetailSequence
                    Definition

                    The sequence number of the sub-detail within the detail within the line item submitted which contains the error. This value is omitted when the error occurs outside of the item structure.

                    ShortSubdetail sequence number
                    Control0..1
                    TypepositiveInt
                    Is Modifierfalse
                    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                    Summaryfalse
                    Requirements

                    Provides references to the claim sub-details within the claim detail.

                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                    296. ClaimResponse.error.code
                    Definition

                    An error code, from a specified code system, which details why the claim could not be adjudicated.

                    ShortError code
                    Control1..1
                    BindingFor example codes, see Adjudication Error Codes
                    (example to http://hl7.org/fhir/ValueSet/adjudication-error)

                    The adjudication error codes.

                    TypeCodeableConcept
                    Is Modifierfalse
                    Summaryfalse
                    Requirements

                    Required to convey processing errors.

                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))