SA Application 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 Application ClaimResponse

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

The status and outcome of a Special Authority Application. Returned in the SA Response Bundle from Claim/$submit, and from Application Enquiry (GET [base]/ClaimResponse?request.identifier=...).

HSAAP status, outcome, outcome code and outcome reason are carried in the application-status extension. The shape is identical at submission and enquiry (D22).
existing-approval is returned only on the synchronous $submit response, where the Application was declined because a conflicting Approval exists.
The Approval Number, once approved, is carried on identifier and preAuthRef (D23).
error carries the single machine readable outcome code (D9). The same code and reason are also rendered in the OperationOutcome in the response Bundle.
status, type, use, insurer and outcome are mandatory in FHIR R4. outcome is set per the mapping on the Validation and Outcomes page; it does not replace application-status.

Usages:

Use this Profile: SA Response Bundle
Examples for this Profile: ClaimResponse/sa-example-cr-approved, ClaimResponse/sa-example-cr-declined and ClaimResponse/sa-example-cr-pending
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, sa-cr-2, sa-cr-3
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:applicationStatus	This element must be supported. C	1..1	(Complex)	Application Status URL: https://fhir-ig.digital.health.nz/special-authority/StructureDefinition/application-status Constraints: sa-appstatus-1
ClaimResponse.Slices for extension.extension:existingApproval	This element must be supported.	0..1	(Complex)	Existing Approval URL: https://fhir-ig.digital.health.nz/special-authority/StructureDefinition/existing-approval
ClaimResponse.modifierExtension	This element is a modifier element.	0..*	Extension	Extensions that cannot be ignored
ClaimResponse.identifier	This element must be supported.	0..1	Identifier	Approval Number - present only once approved
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.	0..1	Reference(SA Practitioner)	Party responsible for the claim
ClaimResponse.request	This element must be supported. This element is included in summaries.	1..1	Reference(SA Claim)	The Application (Claim). Carries the Application Number in request.identifier
ClaimResponse.request.identifier	This element must be supported. This element is included in summaries.	1..1	Identifier	Logical reference, when literal reference is not known
ClaimResponse.request.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.request.identifier.system	This element is included in summaries.	0..1	uri	The namespace for the identifier value Fixed Value: https://fhir-ig.digital.health.nz/special-authority/ns/application-number (no extensions allowed)
ClaimResponse.request.identifier.value	This element is included in summaries.	1..1	string	The value that is unique Example General: 123456
ClaimResponse.outcome	This element must be supported. This element is included in summaries.	1..1	code	queued \| complete \| error \| partial Binding: ClaimProcessingCodes (required): The result of the claim processing.
ClaimResponse.disposition	This element must be supported.	0..1	string	Human readable outcome reason (mirrors application-status.outcomeReason)
ClaimResponse.preAuthRef	This element must be supported.	0..1	string	Approval Number - same value as identifier
ClaimResponse.preAuthPeriod	This element must be supported.	0..1	Period	Approval effective and expiry dates
ClaimResponse.error	This element must be supported.	0..1	BackboneElement	The single outcome code (fail fast - D9)
ClaimResponse.error.modifierExtension	This element is a modifier element. This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
ClaimResponse.error.code		1..1	CodeableConcept	Error code detailing processing issues Binding: SA Outcome Code (extensible)
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.request.identifier.use	Base	required	IdentifierUse	📍4.0.1	FHIR Std.
ClaimResponse.outcome	Base	required	Claim Processing Codes	📍4.0.1	FHIR Std.
ClaimResponse.item.adjudication.category	Base	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	extensible	SA Outcome Code	📦0.1.1	This IG

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`
sa-cr-2	error	ClaimResponse	An Approval Number is present only where the Application outcome is APPROVED.	`(identifier.exists() or preAuthRef.exists()) implies extension('https://fhir-ig.digital.health.nz/special-authority/StructureDefinition/application-status').extension('outcome').where(value = 'APPROVED').exists()`
sa-cr-3	error	ClaimResponse	existing-approval is present only where the Application outcome is DECLINED.	`extension('https://fhir-ig.digital.health.nz/special-authority/StructureDefinition/existing-approval').exists() implies extension('https://fhir-ig.digital.health.nz/special-authority/StructureDefinition/application-status').extension('outcome').where(value = 'DECLINED').exists()`

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, sa-cr-2, sa-cr-3
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:applicationStatus	This element must be supported.	1..1	(Complex)	Application Status URL: https://fhir-ig.digital.health.nz/special-authority/StructureDefinition/application-status
ClaimResponse.Slices for extension.extension:existingApproval	This element must be supported.	0..1	(Complex)	Existing Approval URL: https://fhir-ig.digital.health.nz/special-authority/StructureDefinition/existing-approval
ClaimResponse.identifier	This element must be supported.	0..1	Identifier	Approval Number - present only once approved
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.	0..1	Reference(SA Practitioner)	Party responsible for the claim
ClaimResponse.request	This element must be supported.	1..1	Reference(SA Claim)	The Application (Claim). Carries the Application Number in request.identifier
ClaimResponse.request.identifier	This element must be supported.	1..1	Identifier	Logical reference, when literal reference is not known
ClaimResponse.request.identifier.system		0..1	uri	The namespace for the identifier value Fixed Value: https://fhir-ig.digital.health.nz/special-authority/ns/application-number (no extensions allowed)
ClaimResponse.request.identifier.value		1..1	string	The value that is unique
ClaimResponse.outcome	This element must be supported.	1..1	code	queued \| complete \| error \| partial
ClaimResponse.disposition	This element must be supported.	0..1	string	Human readable outcome reason (mirrors application-status.outcomeReason)
ClaimResponse.preAuthRef	This element must be supported.	0..1	string	Approval Number - same value as identifier
ClaimResponse.preAuthPeriod	This element must be supported.	0..1	Period	Approval effective and expiry dates
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	This element must be supported.	0..1	BackboneElement	The single outcome code (fail fast - D9)
ClaimResponse.error.itemSequence		0..0		Item sequence number
ClaimResponse.error.detailSequence		0..0		Detail sequence number
ClaimResponse.error.subDetailSequence		0..0		Subdetail sequence number
ClaimResponse.error.code		1..1	CodeableConcept	Error code detailing processing issues Binding: SA Outcome Code (extensible)
Documentation for this format

Terminology Bindings (Differential)

Path	Status	Usage	ValueSet	Version	Source
ClaimResponse.error.code	Base	extensible	SA Outcome Code	📦0.1.1	This IG

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`
sa-cr-2	error	ClaimResponse	An Approval Number is present only where the Application outcome is APPROVED.	`(identifier.exists() or preAuthRef.exists()) implies extension('https://fhir-ig.digital.health.nz/special-authority/StructureDefinition/application-status').extension('outcome').where(value = 'APPROVED').exists()`
sa-cr-3	error	ClaimResponse	existing-approval is present only where the Application outcome is DECLINED.	`extension('https://fhir-ig.digital.health.nz/special-authority/StructureDefinition/existing-approval').exists() implies extension('https://fhir-ig.digital.health.nz/special-authority/StructureDefinition/application-status').extension('outcome').where(value = 'DECLINED').exists()`

Description & Constraints Filter:

ClaimResponse C 0..* ClaimResponse Response to a claim predetermination or preauthorization
Constraints: sa-cr-1, sa-cr-2, sa-cr-3

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

ClaimResponse.meta This element is included in summaries. 0..1 Meta Metadata about the resource

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:applicationStatus This element must be supported. C 1..1 (Complex) Application Status
URL: https://fhir-ig.digital.health.nz/special-authority/StructureDefinition/application-status
Constraints: sa-appstatus-1

ClaimResponse.Slices for extension.extension:existingApproval This element must be supported. 0..1 (Complex) Existing Approval
URL: https://fhir-ig.digital.health.nz/special-authority/StructureDefinition/existing-approval

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

ClaimResponse.identifier This element must be supported. 0..1 Identifier Approval Number - present only once approved

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. 0..1 Reference(SA Practitioner) Party responsible for the claim

ClaimResponse.request This element must be supported. This element is included in summaries. 1..1 Reference(SA Claim) The Application (Claim). Carries the Application Number in request.identifier

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

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

ClaimResponse.request.reference This element is included in summaries. C 0..1 string Literal reference, Relative, internal or absolute URL

ClaimResponse.request.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.request.identifier This element must be supported. This element is included in summaries. 1..1 Identifier Logical reference, when literal reference is not known

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

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

ClaimResponse.request.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.request.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.request.identifier.system This element is included in summaries. 0..1 uri The namespace for the identifier value
Fixed Value: https://fhir-ig.digital.health.nz/special-authority/ns/application-number (no extensions allowed)

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

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

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

ClaimResponse.request.display This element is included in summaries. 0..1 string Text alternative for the resource

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

ClaimResponse.disposition This element must be supported. 0..1 string Human readable outcome reason (mirrors application-status.outcomeReason)

ClaimResponse.preAuthRef This element must be supported. 0..1 string Approval Number - same value as identifier

ClaimResponse.preAuthPeriod This element must be supported. 0..1 Period Approval effective and expiry dates

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

ClaimResponse.error This element must be supported. 0..1 BackboneElement The single outcome code (fail fast - D9)

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

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

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

ClaimResponse.error.code 1..1 CodeableConcept Error code detailing processing issues
Binding: SA Outcome Code (extensible)

Documentation for this format

Terminology Bindings

Path	Status	Usage	ValueSet	Version	Source
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.request.type	Base	extensible	ResourceType	📍4.0.1	FHIR Std.
ClaimResponse.request.identifier.use	Base	required	IdentifierUse	📍4.0.1	FHIR Std.
ClaimResponse.request.identifier.type	Base	extensible	IdentifierType	📍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	extensible	SA Outcome Code	📦0.1.1	This IG

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`
sa-cr-2	error	ClaimResponse	An Approval Number is present only where the Application outcome is APPROVED.	`(identifier.exists() or preAuthRef.exists()) implies extension('https://fhir-ig.digital.health.nz/special-authority/StructureDefinition/application-status').extension('outcome').where(value = 'APPROVED').exists()`
sa-cr-3	error	ClaimResponse	existing-approval is present only where the Application outcome is DECLINED.	`extension('https://fhir-ig.digital.health.nz/special-authority/StructureDefinition/existing-approval').exists() implies extension('https://fhir-ig.digital.health.nz/special-authority/StructureDefinition/application-status').extension('outcome').where(value = 'DECLINED').exists()`

This structure is derived from ClaimResponse

Summary

Mandatory: 6 elements(2 nested mandatory elements)
Must-Support: 14 elements
Fixed: 2 elements
Prohibited: 15 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, sa-cr-2, sa-cr-3
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:applicationStatus	This element must be supported. C	1..1	(Complex)	Application Status URL: https://fhir-ig.digital.health.nz/special-authority/StructureDefinition/application-status Constraints: sa-appstatus-1
ClaimResponse.Slices for extension.extension:existingApproval	This element must be supported.	0..1	(Complex)	Existing Approval URL: https://fhir-ig.digital.health.nz/special-authority/StructureDefinition/existing-approval
ClaimResponse.modifierExtension	This element is a modifier element.	0..*	Extension	Extensions that cannot be ignored
ClaimResponse.identifier	This element must be supported.	0..1	Identifier	Approval Number - present only once approved
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.	0..1	Reference(SA Practitioner)	Party responsible for the claim
ClaimResponse.request	This element must be supported. This element is included in summaries.	1..1	Reference(SA Claim)	The Application (Claim). Carries the Application Number in request.identifier
ClaimResponse.request.identifier	This element must be supported. This element is included in summaries.	1..1	Identifier	Logical reference, when literal reference is not known
ClaimResponse.request.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.request.identifier.system	This element is included in summaries.	0..1	uri	The namespace for the identifier value Fixed Value: https://fhir-ig.digital.health.nz/special-authority/ns/application-number (no extensions allowed)
ClaimResponse.request.identifier.value	This element is included in summaries.	1..1	string	The value that is unique Example General: 123456
ClaimResponse.outcome	This element must be supported. This element is included in summaries.	1..1	code	queued \| complete \| error \| partial Binding: ClaimProcessingCodes (required): The result of the claim processing.
ClaimResponse.disposition	This element must be supported.	0..1	string	Human readable outcome reason (mirrors application-status.outcomeReason)
ClaimResponse.preAuthRef	This element must be supported.	0..1	string	Approval Number - same value as identifier
ClaimResponse.preAuthPeriod	This element must be supported.	0..1	Period	Approval effective and expiry dates
ClaimResponse.error	This element must be supported.	0..1	BackboneElement	The single outcome code (fail fast - D9)
ClaimResponse.error.modifierExtension	This element is a modifier element. This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
ClaimResponse.error.code		1..1	CodeableConcept	Error code detailing processing issues Binding: SA Outcome Code (extensible)
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.request.identifier.use	Base	required	IdentifierUse	📍4.0.1	FHIR Std.
ClaimResponse.outcome	Base	required	Claim Processing Codes	📍4.0.1	FHIR Std.
ClaimResponse.item.adjudication.category	Base	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	extensible	SA Outcome Code	📦0.1.1	This IG

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`
sa-cr-2	error	ClaimResponse	An Approval Number is present only where the Application outcome is APPROVED.	`(identifier.exists() or preAuthRef.exists()) implies extension('https://fhir-ig.digital.health.nz/special-authority/StructureDefinition/application-status').extension('outcome').where(value = 'APPROVED').exists()`
sa-cr-3	error	ClaimResponse	existing-approval is present only where the Application outcome is DECLINED.	`extension('https://fhir-ig.digital.health.nz/special-authority/StructureDefinition/existing-approval').exists() implies extension('https://fhir-ig.digital.health.nz/special-authority/StructureDefinition/application-status').extension('outcome').where(value = 'DECLINED').exists()`

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, sa-cr-2, sa-cr-3
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:applicationStatus	This element must be supported.	1..1	(Complex)	Application Status URL: https://fhir-ig.digital.health.nz/special-authority/StructureDefinition/application-status
ClaimResponse.Slices for extension.extension:existingApproval	This element must be supported.	0..1	(Complex)	Existing Approval URL: https://fhir-ig.digital.health.nz/special-authority/StructureDefinition/existing-approval
ClaimResponse.identifier	This element must be supported.	0..1	Identifier	Approval Number - present only once approved
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.	0..1	Reference(SA Practitioner)	Party responsible for the claim
ClaimResponse.request	This element must be supported.	1..1	Reference(SA Claim)	The Application (Claim). Carries the Application Number in request.identifier
ClaimResponse.request.identifier	This element must be supported.	1..1	Identifier	Logical reference, when literal reference is not known
ClaimResponse.request.identifier.system		0..1	uri	The namespace for the identifier value Fixed Value: https://fhir-ig.digital.health.nz/special-authority/ns/application-number (no extensions allowed)
ClaimResponse.request.identifier.value		1..1	string	The value that is unique
ClaimResponse.outcome	This element must be supported.	1..1	code	queued \| complete \| error \| partial
ClaimResponse.disposition	This element must be supported.	0..1	string	Human readable outcome reason (mirrors application-status.outcomeReason)
ClaimResponse.preAuthRef	This element must be supported.	0..1	string	Approval Number - same value as identifier
ClaimResponse.preAuthPeriod	This element must be supported.	0..1	Period	Approval effective and expiry dates
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	This element must be supported.	0..1	BackboneElement	The single outcome code (fail fast - D9)
ClaimResponse.error.itemSequence		0..0		Item sequence number
ClaimResponse.error.detailSequence		0..0		Detail sequence number
ClaimResponse.error.subDetailSequence		0..0		Subdetail sequence number
ClaimResponse.error.code		1..1	CodeableConcept	Error code detailing processing issues Binding: SA Outcome Code (extensible)
Documentation for this format

Terminology Bindings (Differential)

Path	Status	Usage	ValueSet	Version	Source
ClaimResponse.error.code	Base	extensible	SA Outcome Code	📦0.1.1	This IG

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`
sa-cr-2	error	ClaimResponse	An Approval Number is present only where the Application outcome is APPROVED.	`(identifier.exists() or preAuthRef.exists()) implies extension('https://fhir-ig.digital.health.nz/special-authority/StructureDefinition/application-status').extension('outcome').where(value = 'APPROVED').exists()`
sa-cr-3	error	ClaimResponse	existing-approval is present only where the Application outcome is DECLINED.	`extension('https://fhir-ig.digital.health.nz/special-authority/StructureDefinition/existing-approval').exists() implies extension('https://fhir-ig.digital.health.nz/special-authority/StructureDefinition/application-status').extension('outcome').where(value = 'DECLINED').exists()`

Snapshot View