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ClaimResponse

This resource provides the adjudication details from the processing of a Claim resource. If the element is present, it must have either a @value, an @id, or extensions

type ClaimResponse implements Resource {
  identifier: [Identifier]
  status: String
  type: CodeableConcept
  subType: CodeableConcept
  use: String
  patient: Reference
  created: Date
  insurer: Reference
  requestor: Reference
  request: Reference
  outcome: String
  disposition: String
  preAuthRef: String
  preAuthPeriod: Period
  payeeType: CodeableConcept
  item: [ClaimResponseItem]
  addItem: [ClaimResponseAddItem]
  adjudication: [ClaimResponseAdjudication]
  total: [ClaimResponseTotal]
  payment: ClaimResponsePayment
  fundsReserve: CodeableConcept
  formCode: CodeableConcept
  form: Attachment
  processNote: [ClaimResponseProcessNote]
  communicationRequest: [Reference]
  insurance: [ClaimResponseInsurance]
  error: [ClaimResponseError]
  text: Narrative
  contained: [Resource]
  extension: [Extension]
  modifierExtension: [Extension]
  id: String
  meta: Meta
  implicitRules: Uri
  language: String
}

Fields​

ClaimResponse.identifier ● [Identifier] list object​

A unique identifier assigned to this claim response.

ClaimResponse.status ● String scalar​

The status of the resource instance.

ClaimResponse.type ● CodeableConcept object​

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

ClaimResponse.subType ● CodeableConcept object​

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

ClaimResponse.use ● String scalar​

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

ClaimResponse.patient ● Reference object​

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

ClaimResponse.created ● Date scalar​

The date this resource was created.

ClaimResponse.insurer ● Reference object​

The party responsible for authorization, adjudication and reimbursement.

ClaimResponse.requestor ● Reference object​

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

ClaimResponse.request ● Reference object​

Original request resource reference.

ClaimResponse.outcome ● String scalar​

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

ClaimResponse.disposition ● String scalar​

A human readable description of the status of the adjudication.

ClaimResponse.preAuthRef ● String scalar​

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

ClaimResponse.preAuthPeriod ● Period object​

The time frame during which this authorization is effective.

ClaimResponse.payeeType ● CodeableConcept object​

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

ClaimResponse.item ● [ClaimResponseItem] list object​

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

ClaimResponse.addItem ● [ClaimResponseAddItem] list object​

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

ClaimResponse.adjudication ● [ClaimResponseAdjudication] list object​

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

ClaimResponse.total ● [ClaimResponseTotal] list object​

Categorized monetary totals for the adjudication.

ClaimResponse.payment ● ClaimResponsePayment object​

Payment details for the adjudication of the claim.

ClaimResponse.fundsReserve ● CodeableConcept object​

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

ClaimResponse.formCode ● CodeableConcept object​

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

ClaimResponse.form ● Attachment object​

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

ClaimResponse.processNote ● [ClaimResponseProcessNote] list object​

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

ClaimResponse.communicationRequest ● [Reference] list object​

Request for additional supporting or authorizing information.

ClaimResponse.insurance ● [ClaimResponseInsurance] list object​

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

ClaimResponse.error ● [ClaimResponseError] list object​

Errors encountered during the processing of the adjudication.

ClaimResponse.text ● Narrative object​

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

ClaimResponse.contained ● [Resource] list interface​

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

ClaimResponse.extension ● [Extension] list object​

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

ClaimResponse.modifierExtension ● [Extension] list object​

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

ClaimResponse.id ● String scalar​

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

ClaimResponse.meta ● Meta object​

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

ClaimResponse.implicitRules ● Uri scalar​

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

ClaimResponse.language ● String scalar​

The base language in which the resource is written.

Interfaces​

Resource interface​

This is the base resource type for everything.

Returned By​

ClaimResponse query ● ClaimResponseCreate mutation ● ClaimResponseList query ● ClaimResponseUpdate mutation