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ClaimResponseAdjudication

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

type ClaimResponseAdjudication implements Element {
  category: CodeableConcept
  reason: CodeableConcept
  amount: Money
  value: String
  modifierExtension: [Extension]
  extension: [Extension]
  id: String
}

Fields​

ClaimResponseAdjudication.category ● CodeableConcept object​

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

ClaimResponseAdjudication.reason ● CodeableConcept object​

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

ClaimResponseAdjudication.amount ● Money object​

Monetary amount associated with the category.

ClaimResponseAdjudication.value ● String scalar​

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

ClaimResponseAdjudication.modifierExtension ● [Extension] list object​

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

ClaimResponseAdjudication.extension ● [Extension] list object​

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

ClaimResponseAdjudication.id ● String scalar​

Interfaces​

Element interface​

Base definition for all elements in a resource. If the element is present, it must have a value for at least one of the defined elements, an @id referenced from the Narrative, or extensions

Member Of​

ClaimResponse object ● ClaimResponseAddItem object ● ClaimResponseDetail object ● ClaimResponseDetail1 object ● ClaimResponseItem object ● ClaimResponseSubDetail object ● ClaimResponseSubDetail1 object