HSAAP Special Authority FHIR Implementation Guide
0.1.1 - draft New Zealand flag

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:

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.

NameFlagsCard.TypeDescription & Constraints    Filter: doco
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

doco 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

NameFlagsCard.TypeDescription & Constraints    Filter: doco
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.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

doco 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
NameFlagsCard.TypeDescription & Constraints    Filter: doco
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
ClaimResponse.language 0..1 code Language of the resource content
Binding: CommonLanguages (preferred): A human language.
Additional BindingsPurpose
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)
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.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
ClaimResponse.processNote.language 0..1 CodeableConcept Language of the text
Binding: CommonLanguages (preferred): A human language.
Additional BindingsPurpose
AllLanguages Max Binding
ClaimResponse.communicationRequest 0..* Reference(CommunicationRequest) Request for additional information

doco 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

Key Elements View

NameFlagsCard.TypeDescription & Constraints    Filter: doco
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

doco 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

NameFlagsCard.TypeDescription & Constraints    Filter: doco
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

doco 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

NameFlagsCard.TypeDescription & Constraints    Filter: doco
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
ClaimResponse.language 0..1 code Language of the resource content
Binding: CommonLanguages (preferred): A human language.
Additional BindingsPurpose
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)
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.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
ClaimResponse.processNote.language 0..1 CodeableConcept Language of the text
Binding: CommonLanguages (preferred): A human language.
Additional BindingsPurpose
AllLanguages Max Binding
ClaimResponse.communicationRequest 0..* Reference(CommunicationRequest) Request for additional information

doco 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

 

Other representations of profile: CSV, Excel, Schematron