SA Approval ClaimResponse - HSAAP Special Authority FHIR Implementation Guide v0.1.1

HSAAP Special Authority FHIR Implementation Guide - Local Development build (v0.1.1) built by the FHIR (HL7® FHIR® Standard) Build Tools. See the Directory of published versions

Resource Profile: SA Approval ClaimResponse

Official URL: https://fhir-ig.digital.health.nz/special-authority/StructureDefinition/sa-approval-claimresponse				Version: 0.1.1
Draft as of 2026-10-16				Computable Name: SAApprovalClaimResponse

A Special Authority Approval, returned by Approval Enquiry (GET [base]/ClaimResponse?...). Constructed fresh from the current Approval Store record on every enquiry; it is not a replay of the ClaimResponse returned at submission.

identifier and preAuthRef carry the Approval Number; preAuthPeriod the effective and expiry dates. A lifetime Approval carries a far-future expiry date - there is no sentinel value.
requestor is the prescribing Practitioner who authored the originating Application (D24). The provider (pharmacy) is carried in the approval-detail extension.
Approval type, status, form number and form version are carried in the approval-detail extension (D16).
Coverage is carried in approval-coverage only for NPPA and panel Approvals (D15).
Approval versions are not FHIR resource versions (D17). meta.versionId is not used and vread/_history are not supported. When approval-version-state=ALL returns several versions, each is a distinct ClaimResponse and recency is carried on meta.lastUpdated (the Approval's createdOn).
status is always active and outcome always complete. Both are mandatory in FHIR R4 and carry no HSAAP meaning; the Approval status is approval-detail.status.

Usages:

Examples for this Profile: ClaimResponse/sa-example-approval-chem and ClaimResponse/sa-example-approval-nppa
CapabilityStatements using this Profile: Special Authority FHIR Server Capability Statement

You can also check for usages in the FHIR IG Statistics

Formal Views of Profile Content

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

Key Elements Table
Differential Table
Snapshot Table
Statistics/References
All

Name	Flags	Card.	Type	Description & Constraints Filter: Bindings Constraints Obligations
ClaimResponse	C	0..*	ClaimResponse	Response to a claim predetermination or preauthorization Constraints: sa-cr-1
ClaimResponse.meta	This element is included in summaries.	1..1	Meta	Metadata about the resource
ClaimResponse.meta.lastUpdated	This element must be supported. This element is included in summaries.	1..1	instant	Approval version createdOn - orders versions by recency (D17)
ClaimResponse.implicitRules	This element is a modifier element. This element is included in summaries.	0..1	uri	A set of rules under which this content was created
ClaimResponse.Slices for extension		1..*	Extension	Extension Slice: Unordered, Open by value:url Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them
ClaimResponse.Slices for extension.extension:approvalDetail	This element must be supported. C	1..1	(Complex)	Approval Detail URL: https://fhir-ig.digital.health.nz/special-authority/StructureDefinition/approval-detail Constraints: sa-detail-1
ClaimResponse.Slices for extension.extension:approvalCoverage	This element must be supported. C	0..1	(Complex)	Approval Coverage URL: https://fhir-ig.digital.health.nz/special-authority/StructureDefinition/approval-coverage Constraints: sa-cov-1, sa-cov-2
ClaimResponse.modifierExtension	This element is a modifier element.	0..*	Extension	Extensions that cannot be ignored
ClaimResponse.identifier	This element must be supported.	1..1	Identifier	Business Identifier for a claim response
ClaimResponse.identifier.use	This element is a modifier element. This element is included in summaries.	0..1	code	usual \| official \| temp \| secondary \| old (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .
ClaimResponse.identifier.system	This element is included in summaries.	1..1	uri	The namespace for the identifier value Fixed Value: https://fhir-ig.digital.health.nz/special-authority/ns/approval-number (no extensions allowed)
ClaimResponse.identifier.value	This element is included in summaries.	1..1	string	The value that is unique Example General: 123456
ClaimResponse.status	This element is a modifier element. This element is included in summaries.	1..1	code	active \| cancelled \| draft \| entered-in-error Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance. Required Pattern: active (extensions allowed)
ClaimResponse.type	This element is included in summaries.	1..1	CodeableConcept	More granular claim type Binding: ClaimTypeCodes (extensible): The type or discipline-style of the claim. Required Pattern: `{ "coding" : [ { "system" : "http://terminology.hl7.org/CodeSystem/claim-type", "code" : "pharmacy" } ] }`
ClaimResponse.use	This element is included in summaries.	1..1	code	claim \| preauthorization \| predetermination Binding: Use (required): Claim, preauthorization, predetermination. Required Pattern: preauthorization (extensions allowed)
ClaimResponse.patient	This element must be supported. This element is included in summaries.	1..1	Reference(SA Patient)	The recipient of the products and services
ClaimResponse.created	This element must be supported. This element is included in summaries.	1..1	dateTime	Response creation date
ClaimResponse.insurer	This element must be supported. This element is included in summaries.	1..1	Reference(Organization)	Party responsible for reimbursement
ClaimResponse.insurer.display	This element is included in summaries.	1..1	string	Text alternative for the resource
ClaimResponse.requestor	This element must be supported.	1..1	Reference(SA Practitioner)	Prescribing Practitioner who authored the originating Application
ClaimResponse.request	This element must be supported. This element is included in summaries.	0..1	Reference(SA Claim)	The originating Application, where still retrievable
ClaimResponse.outcome	This element is included in summaries.	1..1	code	queued \| complete \| error \| partial Binding: ClaimProcessingCodes (required): The result of the claim processing. Required Pattern: complete (extensions allowed)
ClaimResponse.preAuthRef	This element must be supported.	1..1	string	Preauthorization reference
ClaimResponse.preAuthPeriod	This element must be supported.	1..1	Period	Preauthorization reference effective period
ClaimResponse.preAuthPeriod.start	This element must be supported. This element is included in summaries. C	1..1	dateTime	Starting time with inclusive boundary
ClaimResponse.preAuthPeriod.end	This element must be supported. This element is included in summaries. C	1..1	dateTime	End time with inclusive boundary, if not ongoing
Documentation for this format

Terminology Bindings

Path	Status	Usage	ValueSet	Version	Source
ClaimResponse.identifier.use	Base	required	IdentifierUse	📍4.0.1	FHIR Std.
ClaimResponse.status	Base	required	Financial Resource Status Codes	📍4.0.1	FHIR Std.
ClaimResponse.type	Base	extensible	Claim Type Codes	📍4.0.1	FHIR Std.
ClaimResponse.use	Base	required	Use	📍4.0.1	FHIR Std.
ClaimResponse.outcome	Base	required	Claim Processing Codes	📍4.0.1	FHIR Std.
ClaimResponse.item.adjudication.category	Base	example	Adjudication Value Codes	📍4.0.1	FHIR Std.
ClaimResponse.addItem.productOrService	Base	example	USCLS Codes	📍4.0.1	FHIR Std.
ClaimResponse.total.category	Base	example	Adjudication Value Codes	📍4.0.1	FHIR Std.
ClaimResponse.payment.type	Base	example	Example Payment Type Codes	📍4.0.1	FHIR Std.
ClaimResponse.error.code	Base	example	AdjudicationError	📍4.0.1	FHIR Std.

Constraints

Id	Grade	Path(s)	Description	Expression
sa-cr-1	error	ClaimResponse	Where both are present, ClaimResponse.identifier (Approval Number) and ClaimResponse.preAuthRef SHALL carry the same value.	`(identifier.exists() and preAuthRef.exists()) implies identifier.value contains preAuthRef`

This structure is derived from ClaimResponse

Name	Flags	Card.	Type	Description & Constraints Filter: Bindings Constraints Obligations
ClaimResponse	C	0..*	ClaimResponse	Response to a claim predetermination or preauthorization Constraints: sa-cr-1
ClaimResponse.meta		1..1	Meta	Metadata about the resource
ClaimResponse.meta.versionId		0..0		Version specific identifier
ClaimResponse.meta.lastUpdated	This element must be supported.	1..1	instant	Approval version createdOn - orders versions by recency (D17)
ClaimResponse.Slices for extension		1..*	Extension	Extension Slice: Unordered, Open by value:url Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them
ClaimResponse.Slices for extension.extension:approvalDetail	This element must be supported.	1..1	(Complex)	Approval Detail URL: https://fhir-ig.digital.health.nz/special-authority/StructureDefinition/approval-detail
ClaimResponse.Slices for extension.extension:approvalCoverage	This element must be supported.	0..1	(Complex)	Approval Coverage URL: https://fhir-ig.digital.health.nz/special-authority/StructureDefinition/approval-coverage
ClaimResponse.identifier	This element must be supported.	1..1	Identifier	Business Identifier for a claim response
ClaimResponse.identifier.system		1..1	uri	The namespace for the identifier value Fixed Value: https://fhir-ig.digital.health.nz/special-authority/ns/approval-number (no extensions allowed)
ClaimResponse.identifier.value		1..1	string	The value that is unique
ClaimResponse.status		1..1	code	active \| cancelled \| draft \| entered-in-error Required Pattern: active (extensions allowed)
ClaimResponse.type		1..1	CodeableConcept	More granular claim type Required Pattern: `{ "coding" : [ { "system" : "http://terminology.hl7.org/CodeSystem/claim-type", "code" : "pharmacy" } ] }`
ClaimResponse.subType		0..0		More granular claim type
ClaimResponse.use		1..1	code	claim \| preauthorization \| predetermination Required Pattern: preauthorization (extensions allowed)
ClaimResponse.patient	This element must be supported.	1..1	Reference(SA Patient)	The recipient of the products and services
ClaimResponse.created	This element must be supported.	1..1	dateTime	Response creation date
ClaimResponse.insurer	This element must be supported.	1..1	Reference(Organization)	Party responsible for reimbursement
ClaimResponse.insurer.reference		0..0		Literal reference, Relative, internal or absolute URL
ClaimResponse.insurer.display		1..1	string	Text alternative for the resource
ClaimResponse.requestor	This element must be supported.	1..1	Reference(SA Practitioner)	Prescribing Practitioner who authored the originating Application
ClaimResponse.request	This element must be supported.	0..1	Reference(SA Claim)	The originating Application, where still retrievable
ClaimResponse.outcome		1..1	code	queued \| complete \| error \| partial Required Pattern: complete (extensions allowed)
ClaimResponse.preAuthRef	This element must be supported.	1..1	string	Preauthorization reference
ClaimResponse.preAuthPeriod	This element must be supported.	1..1	Period	Preauthorization reference effective period
ClaimResponse.preAuthPeriod.start	This element must be supported.	1..1	dateTime	Starting time with inclusive boundary
ClaimResponse.preAuthPeriod.end	This element must be supported.	1..1	dateTime	End time with inclusive boundary, if not ongoing
ClaimResponse.payeeType		0..0		Party to be paid any benefits payable
ClaimResponse.item		0..0		Adjudication for claim line items
ClaimResponse.addItem		0..0		Insurer added line items
ClaimResponse.adjudication		0..0		Header-level adjudication
ClaimResponse.total		0..0		Adjudication totals
ClaimResponse.payment		0..0		Payment Details
ClaimResponse.fundsReserve		0..0		Funds reserved status
ClaimResponse.formCode		0..0		Printed form identifier
ClaimResponse.form		0..0		Printed reference or actual form
ClaimResponse.insurance		0..0		Patient insurance information
ClaimResponse.error		0..0		Processing errors
Documentation for this format

Constraints

Id	Grade	Path(s)	Description	Expression
sa-cr-1	error	ClaimResponse	Where both are present, ClaimResponse.identifier (Approval Number) and ClaimResponse.preAuthRef SHALL carry the same value.	`(identifier.exists() and preAuthRef.exists()) implies identifier.value contains preAuthRef`

Description & Constraints Filter:

ClaimResponse C 0..* ClaimResponse Response to a claim predetermination or preauthorization
Constraints: sa-cr-1

ClaimResponse.id This element is included in summaries. 0..1 id Logical id of this artifact

ClaimResponse.meta This element is included in summaries. 1..1 Meta Metadata about the resource

ClaimResponse.meta.id 0..1 string Unique id for inter-element referencing

ClaimResponse.meta.extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url

ClaimResponse.meta.lastUpdated This element must be supported. This element is included in summaries. 1..1 instant Approval version createdOn - orders versions by recency (D17)

ClaimResponse.meta.source This element is included in summaries. 0..1 uri Identifies where the resource comes from

ClaimResponse.meta.profile This element is included in summaries. 0..* canonical(StructureDefinition) Profiles this resource claims to conform to

ClaimResponse.meta.security This element is included in summaries. 0..* Coding Security Labels applied to this resource
Binding: All Security Labels (extensible): Security Labels from the Healthcare Privacy and Security Classification System.

ClaimResponse.meta.tag This element is included in summaries. 0..* Coding Tags applied to this resource
Binding: CommonTags (example): Codes that represent various types of tags, commonly workflow-related; e.g. "Needs review by Dr. Jones".

ClaimResponse.implicitRules This element is a modifier element. This element is included in summaries. 0..1 uri A set of rules under which this content was created

language

0..1

code

Language of the resource content
Binding: CommonLanguages (preferred): A human language.

Additional Bindings

Purpose

AllLanguages

Max Binding

ClaimResponse.text 0..1 Narrative Text summary of the resource, for human interpretation
This profile does not constrain the narrative in regard to content, language, or traceability to data elements

ClaimResponse.contained 0..* Resource Contained, inline Resources

ClaimResponse.Slices for extension 1..* Extension Extension
Slice: Unordered, Open by value:url

Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them

ClaimResponse.Slices for extension.extension:approvalDetail This element must be supported. C 1..1 (Complex) Approval Detail
URL: https://fhir-ig.digital.health.nz/special-authority/StructureDefinition/approval-detail
Constraints: sa-detail-1

ClaimResponse.Slices for extension.extension:approvalCoverage This element must be supported. C 0..1 (Complex) Approval Coverage
URL: https://fhir-ig.digital.health.nz/special-authority/StructureDefinition/approval-coverage
Constraints: sa-cov-1, sa-cov-2

ClaimResponse.modifierExtension This element is a modifier element. 0..* Extension Extensions that cannot be ignored

ClaimResponse.identifier This element must be supported. 1..1 Identifier Business Identifier for a claim response

ClaimResponse.identifier.id 0..1 string Unique id for inter-element referencing

ClaimResponse.identifier.extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url

ClaimResponse.identifier.use This element is a modifier element. This element is included in summaries. 0..1 code usual | official | temp | secondary | old (If known)
Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .

ClaimResponse.identifier.type This element is included in summaries. 0..1 CodeableConcept Description of identifier
Binding: Identifier Type Codes (extensible): A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.

ClaimResponse.identifier.system This element is included in summaries. 1..1 uri The namespace for the identifier value
Fixed Value: https://fhir-ig.digital.health.nz/special-authority/ns/approval-number (no extensions allowed)

ClaimResponse.identifier.value This element is included in summaries. 1..1 string The value that is unique
Example General: 123456

ClaimResponse.identifier.period This element is included in summaries. 0..1 Period Time period when id is/was valid for use

ClaimResponse.identifier.assigner This element is included in summaries. 0..1 Reference(Organization) Organization that issued id (may be just text)

ClaimResponse.status This element is a modifier element. This element is included in summaries. 1..1 code active | cancelled | draft | entered-in-error
Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance.
Required Pattern: active (extensions allowed)

type

1..1

CodeableConcept

More granular claim type
Binding: ClaimTypeCodes (extensible): The type or discipline-style of the claim.
Required Pattern:

{
  "coding" : [
    {
      "system" : "http://terminology.hl7.org/CodeSystem/claim-type",
      "code" : "pharmacy"
    }
  ]
}

ClaimResponse.use This element is included in summaries. 1..1 code claim | preauthorization | predetermination
Binding: Use (required): Claim, preauthorization, predetermination.
Required Pattern: preauthorization (extensions allowed)

ClaimResponse.patient This element must be supported. This element is included in summaries. 1..1 Reference(SA Patient) The recipient of the products and services

ClaimResponse.created This element must be supported. This element is included in summaries. 1..1 dateTime Response creation date

ClaimResponse.insurer This element must be supported. This element is included in summaries. 1..1 Reference(Organization) Party responsible for reimbursement

ClaimResponse.insurer.id 0..1 string Unique id for inter-element referencing

ClaimResponse.insurer.extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url

ClaimResponse.insurer.type This element is included in summaries. 0..1 uri Type the reference refers to (e.g. "Patient")
Binding: ResourceType (extensible): Aa resource (or, for logical models, the URI of the logical model).

ClaimResponse.insurer.identifier This element is included in summaries. 0..1 Identifier Logical reference, when literal reference is not known

ClaimResponse.insurer.display This element is included in summaries. 1..1 string Text alternative for the resource

ClaimResponse.requestor This element must be supported. 1..1 Reference(SA Practitioner) Prescribing Practitioner who authored the originating Application

ClaimResponse.request This element must be supported. This element is included in summaries. 0..1 Reference(SA Claim) The originating Application, where still retrievable

ClaimResponse.outcome This element is included in summaries. 1..1 code queued | complete | error | partial
Binding: ClaimProcessingCodes (required): The result of the claim processing.
Required Pattern: complete (extensions allowed)

ClaimResponse.disposition 0..1 string Disposition Message

ClaimResponse.preAuthRef This element must be supported. 1..1 string Preauthorization reference

ClaimResponse.preAuthPeriod This element must be supported. 1..1 Period Preauthorization reference effective period

ClaimResponse.preAuthPeriod.id 0..1 string Unique id for inter-element referencing

ClaimResponse.preAuthPeriod.extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url

ClaimResponse.preAuthPeriod.start This element must be supported. This element is included in summaries. C 1..1 dateTime Starting time with inclusive boundary

ClaimResponse.preAuthPeriod.end This element must be supported. This element is included in summaries. C 1..1 dateTime End time with inclusive boundary, if not ongoing

ClaimResponse.processNote 0..* BackboneElement Note concerning adjudication

ClaimResponse.processNote.id 0..1 string Unique id for inter-element referencing

ClaimResponse.processNote.extension 0..* Extension Additional content defined by implementations

ClaimResponse.processNote.modifierExtension This element is a modifier element. This element is included in summaries. 0..* Extension Extensions that cannot be ignored even if unrecognized

ClaimResponse.processNote.number 0..1 positiveInt Note instance identifier

ClaimResponse.processNote.type 0..1 code display | print | printoper
Binding: NoteType (required): The presentation types of notes.

ClaimResponse.processNote.text 1..1 string Note explanatory text

language

0..1

CodeableConcept

Language of the text
Binding: CommonLanguages (preferred): A human language.

Additional Bindings

Purpose

AllLanguages

Max Binding

ClaimResponse.communicationRequest 0..* Reference(CommunicationRequest) Request for additional information

Documentation for this format

Terminology Bindings

Path	Status	Usage	ValueSet	Version	Source
ClaimResponse.meta.security	Base	extensible	SecurityLabels	📍4.0.1	FHIR Std.
ClaimResponse.meta.tag	Base	example	Common Tags	📍4.0.1	FHIR Std.
ClaimResponse.language	Base	preferred	Common Languages	📍4.0.1	FHIR Std.
ClaimResponse.identifier.use	Base	required	IdentifierUse	📍4.0.1	FHIR Std.
ClaimResponse.identifier.type	Base	extensible	IdentifierType	📍4.0.1	FHIR Std.
ClaimResponse.status	Base	required	Financial Resource Status Codes	📍4.0.1	FHIR Std.
ClaimResponse.type	Base	extensible	Claim Type Codes	📍4.0.1	FHIR Std.
ClaimResponse.use	Base	required	Use	📍4.0.1	FHIR Std.
ClaimResponse.insurer.type	Base	extensible	ResourceType	📍4.0.1	FHIR Std.
ClaimResponse.outcome	Base	required	Claim Processing Codes	📍4.0.1	FHIR Std.
ClaimResponse.item.adjudication.category	Base	example	Adjudication Value Codes	📍4.0.1	FHIR Std.
ClaimResponse.item.adjudication.reason	Base	example	Adjudication Reason Codes	📍4.0.1	FHIR Std.
ClaimResponse.addItem.productOrService	Base	example	USCLS Codes	📍4.0.1	FHIR Std.
ClaimResponse.addItem.modifier	Base	example	Modifier type Codes	📍4.0.1	FHIR Std.
ClaimResponse.addItem.programCode	Base	example	Example Program Reason Codes	📍4.0.1	FHIR Std.
ClaimResponse.addItem.location[x]	Base	example	Example Service Place Codes	📍4.0.1	FHIR Std.
ClaimResponse.addItem.bodySite	Base	example	Oral Site Codes	📍4.0.1	FHIR Std.
ClaimResponse.addItem.subSite	Base	example	Surface Codes	📍4.0.1	FHIR Std.
ClaimResponse.addItem.detail.productOrService	Base	example	USCLS Codes	📍4.0.1	FHIR Std.
ClaimResponse.addItem.detail.modifier	Base	example	Modifier type Codes	📍4.0.1	FHIR Std.
ClaimResponse.addItem.detail.subDetail.productOrService	Base	example	USCLS Codes	📍4.0.1	FHIR Std.
ClaimResponse.addItem.detail.subDetail.modifier	Base	example	Modifier type Codes	📍4.0.1	FHIR Std.
ClaimResponse.total.category	Base	example	Adjudication Value Codes	📍4.0.1	FHIR Std.
ClaimResponse.payment.type	Base	example	Example Payment Type Codes	📍4.0.1	FHIR Std.
ClaimResponse.payment.adjustmentReason	Base	example	Payment Adjustment Reason Codes	📍4.0.1	FHIR Std.
ClaimResponse.processNote.type	Base	required	NoteType	📍4.0.1	FHIR Std.
ClaimResponse.processNote.language	Base	preferred	Common Languages	📍4.0.1	FHIR Std.
ClaimResponse.error.code	Base	example	AdjudicationError	📍4.0.1	FHIR Std.

Constraints

Id	Grade	Path(s)	Description	Expression
sa-cr-1	error	ClaimResponse	Where both are present, ClaimResponse.identifier (Approval Number) and ClaimResponse.preAuthRef SHALL carry the same value.	`(identifier.exists() and preAuthRef.exists()) implies identifier.value contains preAuthRef`

This structure is derived from ClaimResponse

Summary

Mandatory: 13 elements
Must-Support: 13 elements
Fixed: 1 element
Prohibited: 14 elements

Structures

This structure refers to these other structures:

Extensions

This structure refers to these extensions:

Key Elements View

Name	Flags	Card.	Type	Description & Constraints Filter: Bindings Constraints Obligations
ClaimResponse	C	0..*	ClaimResponse	Response to a claim predetermination or preauthorization Constraints: sa-cr-1
ClaimResponse.meta	This element is included in summaries.	1..1	Meta	Metadata about the resource
ClaimResponse.meta.lastUpdated	This element must be supported. This element is included in summaries.	1..1	instant	Approval version createdOn - orders versions by recency (D17)
ClaimResponse.implicitRules	This element is a modifier element. This element is included in summaries.	0..1	uri	A set of rules under which this content was created
ClaimResponse.Slices for extension		1..*	Extension	Extension Slice: Unordered, Open by value:url Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them
ClaimResponse.Slices for extension.extension:approvalDetail	This element must be supported. C	1..1	(Complex)	Approval Detail URL: https://fhir-ig.digital.health.nz/special-authority/StructureDefinition/approval-detail Constraints: sa-detail-1
ClaimResponse.Slices for extension.extension:approvalCoverage	This element must be supported. C	0..1	(Complex)	Approval Coverage URL: https://fhir-ig.digital.health.nz/special-authority/StructureDefinition/approval-coverage Constraints: sa-cov-1, sa-cov-2
ClaimResponse.modifierExtension	This element is a modifier element.	0..*	Extension	Extensions that cannot be ignored
ClaimResponse.identifier	This element must be supported.	1..1	Identifier	Business Identifier for a claim response
ClaimResponse.identifier.use	This element is a modifier element. This element is included in summaries.	0..1	code	usual \| official \| temp \| secondary \| old (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .
ClaimResponse.identifier.system	This element is included in summaries.	1..1	uri	The namespace for the identifier value Fixed Value: https://fhir-ig.digital.health.nz/special-authority/ns/approval-number (no extensions allowed)
ClaimResponse.identifier.value	This element is included in summaries.	1..1	string	The value that is unique Example General: 123456
ClaimResponse.status	This element is a modifier element. This element is included in summaries.	1..1	code	active \| cancelled \| draft \| entered-in-error Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance. Required Pattern: active (extensions allowed)
ClaimResponse.type	This element is included in summaries.	1..1	CodeableConcept	More granular claim type Binding: ClaimTypeCodes (extensible): The type or discipline-style of the claim. Required Pattern: `{ "coding" : [ { "system" : "http://terminology.hl7.org/CodeSystem/claim-type", "code" : "pharmacy" } ] }`
ClaimResponse.use	This element is included in summaries.	1..1	code	claim \| preauthorization \| predetermination Binding: Use (required): Claim, preauthorization, predetermination. Required Pattern: preauthorization (extensions allowed)
ClaimResponse.patient	This element must be supported. This element is included in summaries.	1..1	Reference(SA Patient)	The recipient of the products and services
ClaimResponse.created	This element must be supported. This element is included in summaries.	1..1	dateTime	Response creation date
ClaimResponse.insurer	This element must be supported. This element is included in summaries.	1..1	Reference(Organization)	Party responsible for reimbursement
ClaimResponse.insurer.display	This element is included in summaries.	1..1	string	Text alternative for the resource
ClaimResponse.requestor	This element must be supported.	1..1	Reference(SA Practitioner)	Prescribing Practitioner who authored the originating Application
ClaimResponse.request	This element must be supported. This element is included in summaries.	0..1	Reference(SA Claim)	The originating Application, where still retrievable
ClaimResponse.outcome	This element is included in summaries.	1..1	code	queued \| complete \| error \| partial Binding: ClaimProcessingCodes (required): The result of the claim processing. Required Pattern: complete (extensions allowed)
ClaimResponse.preAuthRef	This element must be supported.	1..1	string	Preauthorization reference
ClaimResponse.preAuthPeriod	This element must be supported.	1..1	Period	Preauthorization reference effective period
ClaimResponse.preAuthPeriod.start	This element must be supported. This element is included in summaries. C	1..1	dateTime	Starting time with inclusive boundary
ClaimResponse.preAuthPeriod.end	This element must be supported. This element is included in summaries. C	1..1	dateTime	End time with inclusive boundary, if not ongoing
Documentation for this format

Terminology Bindings

Path	Status	Usage	ValueSet	Version	Source
ClaimResponse.identifier.use	Base	required	IdentifierUse	📍4.0.1	FHIR Std.
ClaimResponse.status	Base	required	Financial Resource Status Codes	📍4.0.1	FHIR Std.
ClaimResponse.type	Base	extensible	Claim Type Codes	📍4.0.1	FHIR Std.
ClaimResponse.use	Base	required	Use	📍4.0.1	FHIR Std.
ClaimResponse.outcome	Base	required	Claim Processing Codes	📍4.0.1	FHIR Std.
ClaimResponse.item.adjudication.category	Base	example	Adjudication Value Codes	📍4.0.1	FHIR Std.
ClaimResponse.addItem.productOrService	Base	example	USCLS Codes	📍4.0.1	FHIR Std.
ClaimResponse.total.category	Base	example	Adjudication Value Codes	📍4.0.1	FHIR Std.
ClaimResponse.payment.type	Base	example	Example Payment Type Codes	📍4.0.1	FHIR Std.
ClaimResponse.error.code	Base	example	AdjudicationError	📍4.0.1	FHIR Std.

Constraints

Id	Grade	Path(s)	Description	Expression
sa-cr-1	error	ClaimResponse	Where both are present, ClaimResponse.identifier (Approval Number) and ClaimResponse.preAuthRef SHALL carry the same value.	`(identifier.exists() and preAuthRef.exists()) implies identifier.value contains preAuthRef`

Differential View

This structure is derived from ClaimResponse

Name	Flags	Card.	Type	Description & Constraints Filter: Bindings Constraints Obligations
ClaimResponse	C	0..*	ClaimResponse	Response to a claim predetermination or preauthorization Constraints: sa-cr-1
ClaimResponse.meta		1..1	Meta	Metadata about the resource
ClaimResponse.meta.versionId		0..0		Version specific identifier
ClaimResponse.meta.lastUpdated	This element must be supported.	1..1	instant	Approval version createdOn - orders versions by recency (D17)
ClaimResponse.Slices for extension		1..*	Extension	Extension Slice: Unordered, Open by value:url Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them
ClaimResponse.Slices for extension.extension:approvalDetail	This element must be supported.	1..1	(Complex)	Approval Detail URL: https://fhir-ig.digital.health.nz/special-authority/StructureDefinition/approval-detail
ClaimResponse.Slices for extension.extension:approvalCoverage	This element must be supported.	0..1	(Complex)	Approval Coverage URL: https://fhir-ig.digital.health.nz/special-authority/StructureDefinition/approval-coverage
ClaimResponse.identifier	This element must be supported.	1..1	Identifier	Business Identifier for a claim response
ClaimResponse.identifier.system		1..1	uri	The namespace for the identifier value Fixed Value: https://fhir-ig.digital.health.nz/special-authority/ns/approval-number (no extensions allowed)
ClaimResponse.identifier.value		1..1	string	The value that is unique
ClaimResponse.status		1..1	code	active \| cancelled \| draft \| entered-in-error Required Pattern: active (extensions allowed)
ClaimResponse.type		1..1	CodeableConcept	More granular claim type Required Pattern: `{ "coding" : [ { "system" : "http://terminology.hl7.org/CodeSystem/claim-type", "code" : "pharmacy" } ] }`
ClaimResponse.subType		0..0		More granular claim type
ClaimResponse.use		1..1	code	claim \| preauthorization \| predetermination Required Pattern: preauthorization (extensions allowed)
ClaimResponse.patient	This element must be supported.	1..1	Reference(SA Patient)	The recipient of the products and services
ClaimResponse.created	This element must be supported.	1..1	dateTime	Response creation date
ClaimResponse.insurer	This element must be supported.	1..1	Reference(Organization)	Party responsible for reimbursement
ClaimResponse.insurer.reference		0..0		Literal reference, Relative, internal or absolute URL
ClaimResponse.insurer.display		1..1	string	Text alternative for the resource
ClaimResponse.requestor	This element must be supported.	1..1	Reference(SA Practitioner)	Prescribing Practitioner who authored the originating Application
ClaimResponse.request	This element must be supported.	0..1	Reference(SA Claim)	The originating Application, where still retrievable
ClaimResponse.outcome		1..1	code	queued \| complete \| error \| partial Required Pattern: complete (extensions allowed)
ClaimResponse.preAuthRef	This element must be supported.	1..1	string	Preauthorization reference
ClaimResponse.preAuthPeriod	This element must be supported.	1..1	Period	Preauthorization reference effective period
ClaimResponse.preAuthPeriod.start	This element must be supported.	1..1	dateTime	Starting time with inclusive boundary
ClaimResponse.preAuthPeriod.end	This element must be supported.	1..1	dateTime	End time with inclusive boundary, if not ongoing
ClaimResponse.payeeType		0..0		Party to be paid any benefits payable
ClaimResponse.item		0..0		Adjudication for claim line items
ClaimResponse.addItem		0..0		Insurer added line items
ClaimResponse.adjudication		0..0		Header-level adjudication
ClaimResponse.total		0..0		Adjudication totals
ClaimResponse.payment		0..0		Payment Details
ClaimResponse.fundsReserve		0..0		Funds reserved status
ClaimResponse.formCode		0..0		Printed form identifier
ClaimResponse.form		0..0		Printed reference or actual form
ClaimResponse.insurance		0..0		Patient insurance information
ClaimResponse.error		0..0		Processing errors
Documentation for this format

Constraints

Id	Grade	Path(s)	Description	Expression
sa-cr-1	error	ClaimResponse	Where both are present, ClaimResponse.identifier (Approval Number) and ClaimResponse.preAuthRef SHALL carry the same value.	`(identifier.exists() and preAuthRef.exists()) implies identifier.value contains preAuthRef`

Snapshot View