Health New Zealand Te Whatu Ora Shared Care FHIR API - Local Development build (v0.4.5) built by the FHIR (HL7® FHIR® Standard) Build Tools. See the Directory of published versions

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Resource Profile: New Zealand Pharmacy Claim Response

FHIR profile for New Zealand pharmacy claim responses

Usages:

• Examples for this Profile: ClaimResponse/NzPharmacyClaimResponseExample
• CapabilityStatements using this Profile: Shared Care 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		0..*	ClaimResponse	Response to a claim predetermination or preauthorization
meta	Σ	1..1	Meta	Metadata about the resource
source	ΣC	1..1	uri	HPI Facility ID from where the record is sourced Constraints: hpi-location-url-format
profile	Σ	1..1	canonical(StructureDefinition)	Profiles this resource claims to conform to
Slices for tag	Σ	1..*	Coding	Tags applied to this resource Slice: Unordered, Open by value:system Binding: CommonTags (example): Codes that represent various types of tags, commonly workflow-related; e.g. "Needs review by Dr. Jones".
tag:correlationId	Σ	1..1	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".
system	Σ	1..1	uri	Hub correlation ID system Required Pattern: https://hub.services.digital.health.nz/ns/correlation-id
code	Σ	1..1	code	Symbol in syntax defined by the system
implicitRules	?!Σ	0..1	uri	A set of rules under which this content was created
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored
identifier		1..1	Identifier	ClaimResponse identifier
use	?!Σ	0..1	code	usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .
system	Σ	1..1	uri	The namespace for the identifier value Fixed Value: https://standards.digital.health.nz/ns/claim-response-identifier
value	Σ	1..1	string	The value that is unique Example General: 123456
status	?!Σ	1..1	code	active | cancelled | draft | entered-in-error Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance.
type	Σ	1..1	CodeableConcept	More granular claim type Binding: NZ Claim Types (extensible)
subType		1..1	CodeableConcept	More granular claim type Binding: NZ Claim Subtypes (extensible)
use	Σ	1..1	code	claim | preauthorization | predetermination Binding: Use (required): Claim, preauthorization, predetermination.
patient	Σ	1..1	Reference(Patient)	The recipient of the products and services
created	Σ	1..1	dateTime	DateValidated
insurer	Σ	1..1	Reference(Organization)	Party responsible for reimbursement
identifier	ΣC	1..1	Identifier	A local identifier MUST be added to this section. Constraints: hpiOrganizationIdPattern, hpiFacilityIdPattern, nzbnPattern, hpiCpnPattern
use	?!Σ	0..1	code	The local identifier use SHOULD be set to official. Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .
system	ΣC	1..1	uri	The system identifier for the organization, facility or nzbn Constraints: allowedLocalIdentifierSystems Example General: http://www.acme.com/identifiers/patient Example HPI Organisation ID: https://standards.digital.health.nz/ns/hpi-organisation-id
value	Σ	1..1	string	The actual local identifier value, e.g. GZZ999-Z Example General: 123456 Example Example HPI Org ID: GZZ999-Z
requestor		1..1	Reference(Organization)	Party submitting the claim
identifier	ΣC	1..1	Identifier	A local identifier MUST be added to this section. Constraints: hpiOrganizationIdPattern, hpiFacilityIdPattern, nzbnPattern, hpiCpnPattern
use	?!Σ	0..1	code	The local identifier use SHOULD be set to official. Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .
system	ΣC	1..1	uri	The system identifier for the organization, facility or nzbn Constraints: allowedLocalIdentifierSystems Example General: http://www.acme.com/identifiers/patient Example HPI Organisation ID: https://standards.digital.health.nz/ns/hpi-organisation-id
value	Σ	1..1	string	The actual local identifier value, e.g. GZZ999-Z Example General: 123456 Example Example HPI Org ID: GZZ999-Z
request	Σ	1..1	Reference(Claim)	Reference to the original Claim
outcome	Σ	1..1	code	Claim processing outcome Binding: ClaimProcessingCodes (required)
item		0..*	BackboneElement	Adjudication for claim line items
Slices for extension		2..*	Extension	Extension Slice: Unordered, Open by value:url
extension:productOrService		1..1	CodeableConcept	Product or Service code URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/shared-care-product-or-service
extension:reviewOutcome		1..1	(Complex)	Item-level review outcome summary URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/shared-care-review-outcome
extension:traceNumber		0..*	Identifier	Internal trace identifier URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/shared-care-trace-number
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
itemSequence		1..1	positiveInt	To match Claim.item.sequence
adjudication		1..*	BackboneElement	Adjudication (reason, amount, quantity) for each Adjudication Value Code
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
category		1..1	CodeableConcept	Type of adjudication information Binding: Pharmacy Adjudication Category (extensible)
reason		0..1	CodeableConcept	Codified reason(s) for the adjudication Binding: Adjudication Reason Codes (extensible)
amount		1..1	Money	Monetary amount
detail		1..*	BackboneElement	Adjudication for claim detail items
Slices for extension		2..*	Extension	Extension Slice: Unordered, Open by value:url
extension:traceNumber		0..1	Identifier	Internal trace identifier URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/shared-care-trace-number
extension:productOrService		1..1	CodeableConcept	Dispensed pharmaceutical component URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/pharmacy-item-detail-product-or-service
extension:reviewOutcome		1..1	(Complex)	Pharmacy Claim Item Detail Review Outcome URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/pharmacy-item-detail-review-outcome
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
detailSequence		1..1	positiveInt	To match Claim.item.detail.sequence
adjudication		1..*	BackboneElement	Adjudication details breakdown
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
category		1..1	CodeableConcept	Type of adjudication information Binding: Pharmacy Adjudication Category (extensible)
reason		0..1	CodeableConcept	Explanation of adjudication outcome Binding: Adjudication Reason Codes (extensible)
payment		0..1	BackboneElement	Payment details
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
type		1..1	CodeableConcept	Partial or complete payment Binding: ExamplePaymentTypeCodes (example): The type (partial, complete) of the payment.
date		0..1	date	Payment date
amount		1..1	Money	Payment amount
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet	URI
ClaimResponse.meta.tag	example	CommonTags http://hl7.org/fhir/ValueSet/common-tags From the FHIR Standard
ClaimResponse.meta.tag:correlationId	example	CommonTags http://hl7.org/fhir/ValueSet/common-tags From the FHIR Standard
ClaimResponse.identifier.use	required	IdentifierUse http://hl7.org/fhir/ValueSet/identifier-use|4.0.1 From the FHIR Standard
ClaimResponse.status	required	FinancialResourceStatusCodes http://hl7.org/fhir/ValueSet/fm-status|4.0.1 From the FHIR Standard
ClaimResponse.type	extensible	NzClaimTypes https://fhir-ig.digital.health.nz/shared-care/ValueSet/nz-claim-types From this IG
ClaimResponse.subType	extensible	NzClaimSubtypes(a valid code from NZ Claim Subtype Code System) https://fhir-ig.digital.health.nz/shared-care/ValueSet/nz-claim-subtypes From this IG
ClaimResponse.use	required	Use http://hl7.org/fhir/ValueSet/claim-use|4.0.1 From the FHIR Standard
ClaimResponse.insurer.identifier.use	required	IdentifierUse http://hl7.org/fhir/ValueSet/identifier-use|4.0.1 From the FHIR Standard
ClaimResponse.requestor.identifier.use	required	IdentifierUse http://hl7.org/fhir/ValueSet/identifier-use|4.0.1 From the FHIR Standard
ClaimResponse.outcome	required	ClaimProcessingCodes http://hl7.org/fhir/ValueSet/remittance-outcome From the FHIR Standard
ClaimResponse.item.adjudication.category	extensible	PharmacyAdjudicationCategoryValueSet(a valid code from Pharmacy Adjudication Category Code System) https://fhir-ig.digital.health.nz/shared-care/ValueSet/pharmacy-adjudication-category From this IG
ClaimResponse.item.adjudication.reason	extensible	AdjudicationReasonCodes(a valid code from Adjudication Reason Code System) https://fhir-ig.digital.health.nz/shared-care/ValueSet/adjudication-reason-codes From this IG
ClaimResponse.item.detail.adjudication.category	extensible	PharmacyAdjudicationCategoryValueSet(a valid code from Pharmacy Adjudication Category Code System) https://fhir-ig.digital.health.nz/shared-care/ValueSet/pharmacy-adjudication-category From this IG
ClaimResponse.item.detail.adjudication.reason	extensible	AdjudicationReasonCodes(a valid code from Adjudication Reason Code System) https://fhir-ig.digital.health.nz/shared-care/ValueSet/adjudication-reason-codes From this IG
ClaimResponse.payment.type	example	ExamplePaymentTypeCodes http://hl7.org/fhir/ValueSet/ex-paymenttype From the FHIR Standard

Constraints

Id	Grade	Path(s)	Details	Requirements
allowedLocalIdentifierSystems	error	ClaimResponse.insurer.identifier.system, ClaimResponse.requestor.identifier.system	Identifier system must be HPI facility, HPI Organisation, HPI CPN or NZBN : $this = 'https://standards.digital.health.nz/ns/hpi-organisation-id' or $this = 'https://standards.digital.health.nz/ns/hpi-nzbn' or $this = 'https://standards.digital.health.nz/ns/hpi-facility-id' or $this = 'https://standards.digital.health.nz/ns/hpi-person-id'
dom-2	error	ClaimResponse	If the resource is contained in another resource, it SHALL NOT contain nested Resources : contained.contained.empty()
dom-3	error	ClaimResponse	If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource : contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
dom-4	error	ClaimResponse	If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated : contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
dom-5	error	ClaimResponse	If a resource is contained in another resource, it SHALL NOT have a security label : contained.meta.security.empty()
dom-6	best practice	ClaimResponse	A resource should have narrative for robust management : text.`div`.exists()
ele-1	error	**ALL** elements	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ext-1	error	**ALL** extensions	Must have either extensions or value[x], not both : extension.exists() != value.exists()
hpi-location-url-format	error	ClaimResponse.meta.source	Reference must be an HPI facility URL with format https://standards.digital.health.nz/ns/hpi-facility-id/FZZ111-A : matches('^https://standards.digital.health.nz/ns/hpi-facility-id/F[A-Za-z0-9]{2}[0-9]{3}-[A-Za-z0-9]$')
hpiCpnPattern	error	ClaimResponse.insurer.identifier, ClaimResponse.requestor.identifier	HPI CPN must conform to format (NNXXXX where N is numeric and X is alphabetic). : system = 'https://standards.digital.health.nz/ns/hpi-person-id' implies value.matches('^[0-9]{2}[A-Za-z]{4}$')
hpiFacilityIdPattern	error	ClaimResponse.insurer.identifier, ClaimResponse.requestor.identifier	HPI Facility ID must conform to format (FXXnnn-C). : system = 'https://standards.digital.health.nz/ns/hpi-facility-id' implies value.matches('^F[A-Za-z0-9]{2}[0-9]{3}-[A-Za-z0-9]$')
hpiOrganizationIdPattern	error	ClaimResponse.insurer.identifier, ClaimResponse.requestor.identifier	HPI Organisation ID must conform to format (GXXnnn-C). : system = 'https://standards.digital.health.nz/ns/hpi-organisation-id' implies value.matches('^G[a-zA-Z0-9]{2}[0-9]{3}-[a-zA-Z0-9]$')
nzbnPattern	error	ClaimResponse.insurer.identifier, ClaimResponse.requestor.identifier	NZBN must conform to format (13 digits). : system = 'https://standards.digital.health.nz/ns/hpi-nzbn' implies value.matches('^[0-9]{13}$')

This structure is derived from ClaimResponse

Name	Flags	Card.	Type	Description & Constraints    Filter: Bindings Constraints Obligations
ClaimResponse		0..*	ClaimResponse	Response to a claim predetermination or preauthorization
meta		1..1	Meta	Metadata about the resource
source	C	1..1	uri	HPI Facility ID from where the record is sourced Constraints: hpi-location-url-format
profile		1..1	canonical(StructureDefinition)	Profiles this resource claims to conform to
Slices for tag		1..*	Coding	Tags applied to this resource Slice: Unordered, Open by value:system
tag:correlationId		1..1	Coding	Tags applied to this resource
system		1..1	uri	Hub correlation ID system Required Pattern: https://hub.services.digital.health.nz/ns/correlation-id
code		1..1	code	Symbol in syntax defined by the system
contained		0..0
identifier		1..1	Identifier	ClaimResponse identifier
system		1..1	uri	The namespace for the identifier value Fixed Value: https://standards.digital.health.nz/ns/claim-response-identifier
value		1..1	string	The value that is unique
type		1..1	CodeableConcept	More granular claim type Binding: NZ Claim Types (extensible)
subType		1..1	CodeableConcept	More granular claim type Binding: NZ Claim Subtypes (extensible)
created		1..1	dateTime	DateValidated
insurer
identifier	C	1..1	Identifier	A local identifier MUST be added to this section. Constraints: hpiOrganizationIdPattern, hpiFacilityIdPattern, nzbnPattern, hpiCpnPattern
use		0..1	code	The local identifier use SHOULD be set to official.
system	C	1..1	uri	The system identifier for the organization, facility or nzbn Constraints: allowedLocalIdentifierSystems Example HPI Organisation ID: https://standards.digital.health.nz/ns/hpi-organisation-id
value		1..1	string	The actual local identifier value, e.g. GZZ999-Z Example Example HPI Org ID: GZZ999-Z
requestor		1..1	Reference(Organization)	Party submitting the claim
identifier	C	1..1	Identifier	A local identifier MUST be added to this section. Constraints: hpiOrganizationIdPattern, hpiFacilityIdPattern, nzbnPattern, hpiCpnPattern
use		0..1	code	The local identifier use SHOULD be set to official.
system	C	1..1	uri	The system identifier for the organization, facility or nzbn Constraints: allowedLocalIdentifierSystems Example HPI Organisation ID: https://standards.digital.health.nz/ns/hpi-organisation-id
value		1..1	string	The actual local identifier value, e.g. GZZ999-Z Example Example HPI Org ID: GZZ999-Z
request		1..1	Reference(Claim)	Reference to the original Claim
outcome		1..1	code	Claim processing outcome Binding: ClaimProcessingCodes (required)
item		0..*	BackboneElement	Adjudication for claim line items
Slices for extension		2..*	Extension	Extension Slice: Unordered, Open by value:url
extension:productOrService		1..1	CodeableConcept	Product or Service code URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/shared-care-product-or-service
extension:reviewOutcome		1..1	(Complex)	Item-level review outcome summary URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/shared-care-review-outcome
extension:traceNumber		0..*	Identifier	Internal trace identifier URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/shared-care-trace-number
itemSequence		1..1	positiveInt	To match Claim.item.sequence
adjudication		1..*	BackboneElement	Adjudication (reason, amount, quantity) for each Adjudication Value Code
category		1..1	CodeableConcept	Type of adjudication information Binding: Pharmacy Adjudication Category (extensible)
reason		0..1	CodeableConcept	Codified reason(s) for the adjudication Binding: Adjudication Reason Codes (extensible)
amount		1..1	Money	Monetary amount
detail		1..*	BackboneElement	Adjudication for claim detail items
Slices for extension		2..*	Extension	Extension Slice: Unordered, Open by value:url
extension:traceNumber		0..1	Identifier	Internal trace identifier URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/shared-care-trace-number
extension:productOrService		1..1	CodeableConcept	Dispensed pharmaceutical component URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/pharmacy-item-detail-product-or-service
extension:reviewOutcome		1..1	(Complex)	Pharmacy Claim Item Detail Review Outcome URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/pharmacy-item-detail-review-outcome
detailSequence		1..1	positiveInt	To match Claim.item.detail.sequence
adjudication		1..*	BackboneElement	Adjudication details breakdown
category		1..1	CodeableConcept	Type of adjudication information Binding: Pharmacy Adjudication Category (extensible)
reason		0..1	CodeableConcept	Explanation of adjudication outcome Binding: Adjudication Reason Codes (extensible)
payment		0..1	BackboneElement	Payment details
date		0..1	date	Payment date
amount		1..1	Money	Payment amount
error
itemSequence		1..1	positiveInt	Item sequence number
detailSequence		1..1	positiveInt	Detail sequence number
code		1..1	CodeableConcept	Error code Binding: Claim Decision Reason Codes (required)
Documentation for this format

Terminology Bindings (Differential)

Path	Conformance	ValueSet	URI
ClaimResponse.type	extensible	NzClaimTypes https://fhir-ig.digital.health.nz/shared-care/ValueSet/nz-claim-types From this IG
ClaimResponse.subType	extensible	NzClaimSubtypes(a valid code from NZ Claim Subtype Code System) https://fhir-ig.digital.health.nz/shared-care/ValueSet/nz-claim-subtypes From this IG
ClaimResponse.outcome	required	ClaimProcessingCodes http://hl7.org/fhir/ValueSet/remittance-outcome From the FHIR Standard
ClaimResponse.item.adjudication.category	extensible	PharmacyAdjudicationCategoryValueSet(a valid code from Pharmacy Adjudication Category Code System) https://fhir-ig.digital.health.nz/shared-care/ValueSet/pharmacy-adjudication-category From this IG
ClaimResponse.item.adjudication.reason	extensible	AdjudicationReasonCodes(a valid code from Adjudication Reason Code System) https://fhir-ig.digital.health.nz/shared-care/ValueSet/adjudication-reason-codes From this IG
ClaimResponse.item.detail.adjudication.category	extensible	PharmacyAdjudicationCategoryValueSet(a valid code from Pharmacy Adjudication Category Code System) https://fhir-ig.digital.health.nz/shared-care/ValueSet/pharmacy-adjudication-category From this IG
ClaimResponse.item.detail.adjudication.reason	extensible	AdjudicationReasonCodes(a valid code from Adjudication Reason Code System) https://fhir-ig.digital.health.nz/shared-care/ValueSet/adjudication-reason-codes From this IG
ClaimResponse.error.code	required	ClaimDecisionReasonCodes(a valid code from Claim Decision Reason Code System) https://fhir-ig.digital.health.nz/shared-care/ValueSet/claim-decision-reason-codes From this IG

Constraints

Id	Grade	Path(s)	Details	Requirements
allowedLocalIdentifierSystems	error	ClaimResponse.insurer.identifier.system, ClaimResponse.requestor.identifier.system	Identifier system must be HPI facility, HPI Organisation, HPI CPN or NZBN : $this = 'https://standards.digital.health.nz/ns/hpi-organisation-id' or $this = 'https://standards.digital.health.nz/ns/hpi-nzbn' or $this = 'https://standards.digital.health.nz/ns/hpi-facility-id' or $this = 'https://standards.digital.health.nz/ns/hpi-person-id'
hpi-location-url-format	error	ClaimResponse.meta.source	Reference must be an HPI facility URL with format https://standards.digital.health.nz/ns/hpi-facility-id/FZZ111-A : matches('^https://standards.digital.health.nz/ns/hpi-facility-id/F[A-Za-z0-9]{2}[0-9]{3}-[A-Za-z0-9]$')
hpiCpnPattern	error	ClaimResponse.insurer.identifier, ClaimResponse.requestor.identifier	HPI CPN must conform to format (NNXXXX where N is numeric and X is alphabetic). : system = 'https://standards.digital.health.nz/ns/hpi-person-id' implies value.matches('^[0-9]{2}[A-Za-z]{4}$')
hpiFacilityIdPattern	error	ClaimResponse.insurer.identifier, ClaimResponse.requestor.identifier	HPI Facility ID must conform to format (FXXnnn-C). : system = 'https://standards.digital.health.nz/ns/hpi-facility-id' implies value.matches('^F[A-Za-z0-9]{2}[0-9]{3}-[A-Za-z0-9]$')
hpiOrganizationIdPattern	error	ClaimResponse.insurer.identifier, ClaimResponse.requestor.identifier	HPI Organisation ID must conform to format (GXXnnn-C). : system = 'https://standards.digital.health.nz/ns/hpi-organisation-id' implies value.matches('^G[a-zA-Z0-9]{2}[0-9]{3}-[a-zA-Z0-9]$')
nzbnPattern	error	ClaimResponse.insurer.identifier, ClaimResponse.requestor.identifier	NZBN must conform to format (13 digits). : system = 'https://standards.digital.health.nz/ns/hpi-nzbn' implies value.matches('^[0-9]{13}$')

Name	Flags	Card.	Type	Description & Constraints    Filter: Bindings Constraints Obligations
ClaimResponse		0..*	ClaimResponse	Response to a claim predetermination or preauthorization
id	Σ	0..1	id	Logical id of this artifact
meta	Σ	1..1	Meta	Metadata about the resource
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
versionId	Σ	0..1	id	Version specific identifier
lastUpdated	Σ	0..1	instant	When the resource version last changed
source	ΣC	1..1	uri	HPI Facility ID from where the record is sourced Constraints: hpi-location-url-format
profile	Σ	1..1	canonical(StructureDefinition)	Profiles this resource claims to conform to
security	Σ	0..*	Coding	Security Labels applied to this resource Binding: All Security Labels (extensible): Security Labels from the Healthcare Privacy and Security Classification System.
Slices for tag	Σ	1..*	Coding	Tags applied to this resource Slice: Unordered, Open by value:system Binding: CommonTags (example): Codes that represent various types of tags, commonly workflow-related; e.g. "Needs review by Dr. Jones".
tag:correlationId	Σ	1..1	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".
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
system	Σ	1..1	uri	Hub correlation ID system Required Pattern: https://hub.services.digital.health.nz/ns/correlation-id
version	Σ	0..1	string	Version of the system - if relevant
code	Σ	1..1	code	Symbol in syntax defined by the system
display	Σ	0..1	string	Representation defined by the system
userSelected	Σ	0..1	boolean	If this coding was chosen directly by the user
implicitRules	?!Σ	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
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
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored
identifier		1..1	Identifier	ClaimResponse identifier
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
use	?!Σ	0..1	code	usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .
type	Σ	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.
system	Σ	1..1	uri	The namespace for the identifier value Fixed Value: https://standards.digital.health.nz/ns/claim-response-identifier
value	Σ	1..1	string	The value that is unique Example General: 123456
period	Σ	0..1	Period	Time period when id is/was valid for use
assigner	Σ	0..1	Reference(Organization)	Organization that issued id (may be just text)
status	?!Σ	1..1	code	active | cancelled | draft | entered-in-error Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance.
type	Σ	1..1	CodeableConcept	More granular claim type Binding: NZ Claim Types (extensible)
subType		1..1	CodeableConcept	More granular claim type Binding: NZ Claim Subtypes (extensible)
use	Σ	1..1	code	claim | preauthorization | predetermination Binding: Use (required): Claim, preauthorization, predetermination.
patient	Σ	1..1	Reference(Patient)	The recipient of the products and services
created	Σ	1..1	dateTime	DateValidated
insurer	Σ	1..1	Reference(Organization)	Party responsible for reimbursement
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
reference	ΣC	0..1	string	Literal reference, Relative, internal or absolute URL
type	Σ	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).
identifier	ΣC	1..1	Identifier	A local identifier MUST be added to this section. Constraints: hpiOrganizationIdPattern, hpiFacilityIdPattern, nzbnPattern, hpiCpnPattern
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
use	?!Σ	0..1	code	The local identifier use SHOULD be set to official. Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .
type	Σ	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.
system	ΣC	1..1	uri	The system identifier for the organization, facility or nzbn Constraints: allowedLocalIdentifierSystems Example General: http://www.acme.com/identifiers/patient Example HPI Organisation ID: https://standards.digital.health.nz/ns/hpi-organisation-id
value	Σ	1..1	string	The actual local identifier value, e.g. GZZ999-Z Example General: 123456 Example Example HPI Org ID: GZZ999-Z
period	Σ	0..1	Period	Time period when id is/was valid for use
assigner	Σ	0..1	Reference(Organization)	Organization that issued id (may be just text)
display	Σ	0..1	string	Text alternative for the resource
requestor		1..1	Reference(Organization)	Party submitting the claim
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
reference	ΣC	0..1	string	Literal reference, Relative, internal or absolute URL
type	Σ	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).
identifier	ΣC	1..1	Identifier	A local identifier MUST be added to this section. Constraints: hpiOrganizationIdPattern, hpiFacilityIdPattern, nzbnPattern, hpiCpnPattern
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
use	?!Σ	0..1	code	The local identifier use SHOULD be set to official. Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .
type	Σ	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.
system	ΣC	1..1	uri	The system identifier for the organization, facility or nzbn Constraints: allowedLocalIdentifierSystems Example General: http://www.acme.com/identifiers/patient Example HPI Organisation ID: https://standards.digital.health.nz/ns/hpi-organisation-id
value	Σ	1..1	string	The actual local identifier value, e.g. GZZ999-Z Example General: 123456 Example Example HPI Org ID: GZZ999-Z
period	Σ	0..1	Period	Time period when id is/was valid for use
assigner	Σ	0..1	Reference(Organization)	Organization that issued id (may be just text)
display	Σ	0..1	string	Text alternative for the resource
request	Σ	1..1	Reference(Claim)	Reference to the original Claim
outcome	Σ	1..1	code	Claim processing outcome Binding: ClaimProcessingCodes (required)
disposition		0..1	string	Disposition Message
preAuthRef		0..1	string	Preauthorization reference
preAuthPeriod		0..1	Period	Preauthorization reference effective period
payeeType		0..1	CodeableConcept	Party to be paid any benefits payable Binding: Claim Payee Type Codes (example): A code for the party to be reimbursed.
item		0..*	BackboneElement	Adjudication for claim line items
id		0..1	string	Unique id for inter-element referencing
Slices for extension		2..*	Extension	Extension Slice: Unordered, Open by value:url
extension:productOrService		1..1	CodeableConcept	Product or Service code URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/shared-care-product-or-service
extension:reviewOutcome		1..1	(Complex)	Item-level review outcome summary URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/shared-care-review-outcome
extension:traceNumber		0..*	Identifier	Internal trace identifier URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/shared-care-trace-number
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
itemSequence		1..1	positiveInt	To match Claim.item.sequence
noteNumber		0..*	positiveInt	Applicable note numbers
adjudication		1..*	BackboneElement	Adjudication (reason, amount, quantity) for each Adjudication Value Code
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
category		1..1	CodeableConcept	Type of adjudication information Binding: Pharmacy Adjudication Category (extensible)
reason		0..1	CodeableConcept	Codified reason(s) for the adjudication Binding: Adjudication Reason Codes (extensible)
amount		1..1	Money	Monetary amount
value		0..1	decimal	Non-monetary value
detail		1..*	BackboneElement	Adjudication for claim detail items
id		0..1	string	Unique id for inter-element referencing
Slices for extension		2..*	Extension	Extension Slice: Unordered, Open by value:url
extension:traceNumber		0..1	Identifier	Internal trace identifier URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/shared-care-trace-number
extension:productOrService		1..1	CodeableConcept	Dispensed pharmaceutical component URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/pharmacy-item-detail-product-or-service
extension:reviewOutcome		1..1	(Complex)	Pharmacy Claim Item Detail Review Outcome URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/pharmacy-item-detail-review-outcome
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
detailSequence		1..1	positiveInt	To match Claim.item.detail.sequence
noteNumber		0..*	positiveInt	Applicable note numbers
adjudication		1..*	BackboneElement	Adjudication details breakdown
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
category		1..1	CodeableConcept	Type of adjudication information Binding: Pharmacy Adjudication Category (extensible)
reason		0..1	CodeableConcept	Explanation of adjudication outcome Binding: Adjudication Reason Codes (extensible)
amount		0..1	Money	Monetary amount
value		0..1	decimal	Non-monetary value
subDetail		0..*	BackboneElement	Adjudication for claim sub-details
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
subDetailSequence		1..1	positiveInt	Claim sub-detail instance identifier
noteNumber		0..*	positiveInt	Applicable note numbers
adjudication		0..*	See adjudication (ClaimResponse)	Subdetail level adjudication details
addItem		0..*	BackboneElement	Insurer added line items
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
itemSequence		0..*	positiveInt	Item sequence number
detailSequence		0..*	positiveInt	Detail sequence number
subdetailSequence		0..*	positiveInt	Subdetail sequence number
provider		0..*	Reference(Practitioner | PractitionerRole | Organization)	Authorized providers
productOrService		1..1	CodeableConcept	Billing, service, product, or drug code Binding: USCLSCodes (example): Allowable service and product codes.
modifier		0..*	CodeableConcept	Service/Product billing modifiers Binding: ModifierTypeCodes (example): Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen.
programCode		0..*	CodeableConcept	Program the product or service is provided under Binding: ExampleProgramReasonCodes (example): Program specific reason codes.
serviced[x]		0..1		Date or dates of service or product delivery
servicedDate			date
servicedPeriod			Period
location[x]		0..1		Place of service or where product was supplied Binding: ExampleServicePlaceCodes (example): Place of service: pharmacy, school, prison, etc.
locationCodeableConcept			CodeableConcept
locationAddress			Address
locationReference			Reference(Location)
quantity		0..1	SimpleQuantity	Count of products or services
unitPrice		0..1	Money	Fee, charge or cost per item
factor		0..1	decimal	Price scaling factor
net		0..1	Money	Total item cost
bodySite		0..1	CodeableConcept	Anatomical location Binding: OralSiteCodes (example): The code for the teeth, quadrant, sextant and arch.
subSite		0..*	CodeableConcept	Anatomical sub-location Binding: SurfaceCodes (example): The code for the tooth surface and surface combinations.
noteNumber		0..*	positiveInt	Applicable note numbers
adjudication		1..*	See adjudication (ClaimResponse)	Added items adjudication
detail		0..*	BackboneElement	Insurer added line details
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
productOrService		1..1	CodeableConcept	Billing, service, product, or drug code Binding: USCLSCodes (example): Allowable service and product codes.
modifier		0..*	CodeableConcept	Service/Product billing modifiers Binding: ModifierTypeCodes (example): Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen.
quantity		0..1	SimpleQuantity	Count of products or services
unitPrice		0..1	Money	Fee, charge or cost per item
factor		0..1	decimal	Price scaling factor
net		0..1	Money	Total item cost
noteNumber		0..*	positiveInt	Applicable note numbers
adjudication		1..*	See adjudication (ClaimResponse)	Added items detail adjudication
subDetail		0..*	BackboneElement	Insurer added line items
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
productOrService		1..1	CodeableConcept	Billing, service, product, or drug code Binding: USCLSCodes (example): Allowable service and product codes.
modifier		0..*	CodeableConcept	Service/Product billing modifiers Binding: ModifierTypeCodes (example): Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen.
quantity		0..1	SimpleQuantity	Count of products or services
unitPrice		0..1	Money	Fee, charge or cost per item
factor		0..1	decimal	Price scaling factor
net		0..1	Money	Total item cost
noteNumber		0..*	positiveInt	Applicable note numbers
adjudication		1..*	See adjudication (ClaimResponse)	Added items detail adjudication
adjudication		0..*	See adjudication (ClaimResponse)	Header-level adjudication
total	Σ	0..*	BackboneElement	Adjudication totals
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
category	Σ	1..1	CodeableConcept	Type of adjudication information Binding: AdjudicationValueCodes (example): The adjudication codes.
amount	Σ	1..1	Money	Financial total for the category
payment		0..1	BackboneElement	Payment details
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
type		1..1	CodeableConcept	Partial or complete payment Binding: ExamplePaymentTypeCodes (example): The type (partial, complete) of the payment.
adjustment		0..1	Money	Payment adjustment for non-claim issues
adjustmentReason		0..1	CodeableConcept	Explanation for the adjustment Binding: PaymentAdjustmentReasonCodes (example): Payment Adjustment reason codes.
date		0..1	date	Payment date
amount		1..1	Money	Payment amount
identifier		0..1	Identifier	Business identifier for the payment
fundsReserve		0..1	CodeableConcept	Funds reserved status Binding: Funds Reservation Codes (example): For whom funds are to be reserved: (Patient, Provider, None).
formCode		0..1	CodeableConcept	Printed form identifier Binding: Form Codes (example): The forms codes.
form		0..1	Attachment	Printed reference or actual form
processNote		0..*	BackboneElement	Note concerning adjudication
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
number		0..1	positiveInt	Note instance identifier
type		0..1	code	display | print | printoper Binding: NoteType (required): The presentation types of notes.
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
communicationRequest		0..*	Reference(CommunicationRequest)	Request for additional information
insurance		0..*	BackboneElement	Patient insurance information
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
sequence		1..1	positiveInt	Insurance instance identifier
focal		1..1	boolean	Coverage to be used for adjudication
coverage		1..1	Reference(Coverage)	Insurance information
businessArrangement		0..1	string	Additional provider contract number
claimResponse		0..1	Reference(ClaimResponse)	Adjudication results
error		0..*	BackboneElement	Processing errors
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
itemSequence		1..1	positiveInt	Item sequence number
detailSequence		1..1	positiveInt	Detail sequence number
subDetailSequence		0..1	positiveInt	Subdetail sequence number
code		1..1	CodeableConcept	Error code Binding: Claim Decision Reason Codes (required)
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet	URI
ClaimResponse.meta.security	extensible	All Security Labels http://hl7.org/fhir/ValueSet/security-labels From the FHIR Standard
ClaimResponse.meta.tag	example	CommonTags http://hl7.org/fhir/ValueSet/common-tags From the FHIR Standard
ClaimResponse.meta.tag:correlationId	example	CommonTags http://hl7.org/fhir/ValueSet/common-tags From the FHIR Standard
ClaimResponse.language	preferred	CommonLanguages http://hl7.org/fhir/ValueSet/languages From the FHIR Standard Additional Bindings Purpose AllLanguages Max Binding
ClaimResponse.identifier.use	required	IdentifierUse http://hl7.org/fhir/ValueSet/identifier-use|4.0.1 From the FHIR Standard
ClaimResponse.identifier.type	extensible	Identifier Type Codes http://hl7.org/fhir/ValueSet/identifier-type From the FHIR Standard
ClaimResponse.status	required	FinancialResourceStatusCodes http://hl7.org/fhir/ValueSet/fm-status|4.0.1 From the FHIR Standard
ClaimResponse.type	extensible	NzClaimTypes https://fhir-ig.digital.health.nz/shared-care/ValueSet/nz-claim-types From this IG
ClaimResponse.subType	extensible	NzClaimSubtypes(a valid code from NZ Claim Subtype Code System) https://fhir-ig.digital.health.nz/shared-care/ValueSet/nz-claim-subtypes From this IG
ClaimResponse.use	required	Use http://hl7.org/fhir/ValueSet/claim-use|4.0.1 From the FHIR Standard
ClaimResponse.insurer.type	extensible	ResourceType http://hl7.org/fhir/ValueSet/resource-types From the FHIR Standard
ClaimResponse.insurer.identifier.use	required	IdentifierUse http://hl7.org/fhir/ValueSet/identifier-use|4.0.1 From the FHIR Standard
ClaimResponse.insurer.identifier.type	extensible	Identifier Type Codes http://hl7.org/fhir/ValueSet/identifier-type From the FHIR Standard
ClaimResponse.requestor.type	extensible	ResourceType http://hl7.org/fhir/ValueSet/resource-types From the FHIR Standard
ClaimResponse.requestor.identifier.use	required	IdentifierUse http://hl7.org/fhir/ValueSet/identifier-use|4.0.1 From the FHIR Standard
ClaimResponse.requestor.identifier.type	extensible	Identifier Type Codes http://hl7.org/fhir/ValueSet/identifier-type From the FHIR Standard
ClaimResponse.outcome	required	ClaimProcessingCodes http://hl7.org/fhir/ValueSet/remittance-outcome From the FHIR Standard
ClaimResponse.payeeType	example	Claim Payee Type Codes http://hl7.org/fhir/ValueSet/payeetype From the FHIR Standard
ClaimResponse.item.adjudication.category	extensible	PharmacyAdjudicationCategoryValueSet(a valid code from Pharmacy Adjudication Category Code System) https://fhir-ig.digital.health.nz/shared-care/ValueSet/pharmacy-adjudication-category From this IG
ClaimResponse.item.adjudication.reason	extensible	AdjudicationReasonCodes(a valid code from Adjudication Reason Code System) https://fhir-ig.digital.health.nz/shared-care/ValueSet/adjudication-reason-codes From this IG
ClaimResponse.item.detail.adjudication.category	extensible	PharmacyAdjudicationCategoryValueSet(a valid code from Pharmacy Adjudication Category Code System) https://fhir-ig.digital.health.nz/shared-care/ValueSet/pharmacy-adjudication-category From this IG
ClaimResponse.item.detail.adjudication.reason	extensible	AdjudicationReasonCodes(a valid code from Adjudication Reason Code System) https://fhir-ig.digital.health.nz/shared-care/ValueSet/adjudication-reason-codes From this IG
ClaimResponse.addItem.productOrService	example	USCLSCodes http://hl7.org/fhir/ValueSet/service-uscls From the FHIR Standard
ClaimResponse.addItem.modifier	example	ModifierTypeCodes http://hl7.org/fhir/ValueSet/claim-modifiers From the FHIR Standard
ClaimResponse.addItem.programCode	example	ExampleProgramReasonCodes http://hl7.org/fhir/ValueSet/ex-program-code From the FHIR Standard
ClaimResponse.addItem.location[x]	example	ExampleServicePlaceCodes http://hl7.org/fhir/ValueSet/service-place From the FHIR Standard
ClaimResponse.addItem.bodySite	example	OralSiteCodes http://hl7.org/fhir/ValueSet/tooth From the FHIR Standard
ClaimResponse.addItem.subSite	example	SurfaceCodes http://hl7.org/fhir/ValueSet/surface From the FHIR Standard
ClaimResponse.addItem.detail.productOrService	example	USCLSCodes http://hl7.org/fhir/ValueSet/service-uscls From the FHIR Standard
ClaimResponse.addItem.detail.modifier	example	ModifierTypeCodes http://hl7.org/fhir/ValueSet/claim-modifiers From the FHIR Standard
ClaimResponse.addItem.detail.subDetail.productOrService	example	USCLSCodes http://hl7.org/fhir/ValueSet/service-uscls From the FHIR Standard
ClaimResponse.addItem.detail.subDetail.modifier	example	ModifierTypeCodes http://hl7.org/fhir/ValueSet/claim-modifiers From the FHIR Standard
ClaimResponse.total.category	example	AdjudicationValueCodes http://hl7.org/fhir/ValueSet/adjudication From the FHIR Standard
ClaimResponse.payment.type	example	ExamplePaymentTypeCodes http://hl7.org/fhir/ValueSet/ex-paymenttype From the FHIR Standard
ClaimResponse.payment.adjustmentReason	example	PaymentAdjustmentReasonCodes http://hl7.org/fhir/ValueSet/payment-adjustment-reason From the FHIR Standard
ClaimResponse.fundsReserve	example	Funds Reservation Codes http://hl7.org/fhir/ValueSet/fundsreserve From the FHIR Standard
ClaimResponse.formCode	example	Form Codes http://hl7.org/fhir/ValueSet/forms From the FHIR Standard
ClaimResponse.processNote.type	required	NoteType http://hl7.org/fhir/ValueSet/note-type|4.0.1 From the FHIR Standard
ClaimResponse.processNote.language	preferred	CommonLanguages http://hl7.org/fhir/ValueSet/languages From the FHIR Standard Additional Bindings Purpose AllLanguages Max Binding
ClaimResponse.error.code	required	ClaimDecisionReasonCodes(a valid code from Claim Decision Reason Code System) https://fhir-ig.digital.health.nz/shared-care/ValueSet/claim-decision-reason-codes From this IG

Constraints

Id	Grade	Path(s)	Details	Requirements
allowedLocalIdentifierSystems	error	ClaimResponse.insurer.identifier.system, ClaimResponse.requestor.identifier.system	Identifier system must be HPI facility, HPI Organisation, HPI CPN or NZBN : $this = 'https://standards.digital.health.nz/ns/hpi-organisation-id' or $this = 'https://standards.digital.health.nz/ns/hpi-nzbn' or $this = 'https://standards.digital.health.nz/ns/hpi-facility-id' or $this = 'https://standards.digital.health.nz/ns/hpi-person-id'
dom-2	error	ClaimResponse	If the resource is contained in another resource, it SHALL NOT contain nested Resources : contained.contained.empty()
dom-3	error	ClaimResponse	If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource : contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
dom-4	error	ClaimResponse	If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated : contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
dom-5	error	ClaimResponse	If a resource is contained in another resource, it SHALL NOT have a security label : contained.meta.security.empty()
dom-6	best practice	ClaimResponse	A resource should have narrative for robust management : text.`div`.exists()
ele-1	error	**ALL** elements	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ext-1	error	**ALL** extensions	Must have either extensions or value[x], not both : extension.exists() != value.exists()
hpi-location-url-format	error	ClaimResponse.meta.source	Reference must be an HPI facility URL with format https://standards.digital.health.nz/ns/hpi-facility-id/FZZ111-A : matches('^https://standards.digital.health.nz/ns/hpi-facility-id/F[A-Za-z0-9]{2}[0-9]{3}-[A-Za-z0-9]$')
hpiCpnPattern	error	ClaimResponse.insurer.identifier, ClaimResponse.requestor.identifier	HPI CPN must conform to format (NNXXXX where N is numeric and X is alphabetic). : system = 'https://standards.digital.health.nz/ns/hpi-person-id' implies value.matches('^[0-9]{2}[A-Za-z]{4}$')
hpiFacilityIdPattern	error	ClaimResponse.insurer.identifier, ClaimResponse.requestor.identifier	HPI Facility ID must conform to format (FXXnnn-C). : system = 'https://standards.digital.health.nz/ns/hpi-facility-id' implies value.matches('^F[A-Za-z0-9]{2}[0-9]{3}-[A-Za-z0-9]$')
hpiOrganizationIdPattern	error	ClaimResponse.insurer.identifier, ClaimResponse.requestor.identifier	HPI Organisation ID must conform to format (GXXnnn-C). : system = 'https://standards.digital.health.nz/ns/hpi-organisation-id' implies value.matches('^G[a-zA-Z0-9]{2}[0-9]{3}-[a-zA-Z0-9]$')
nzbnPattern	error	ClaimResponse.insurer.identifier, ClaimResponse.requestor.identifier	NZBN must conform to format (13 digits). : system = 'https://standards.digital.health.nz/ns/hpi-nzbn' implies value.matches('^[0-9]{13}$')

This structure is derived from ClaimResponse

Summary

Mandatory: 19 elements(8 nested mandatory elements)
Fixed: 1 element
Prohibited: 1 element

Extensions

This structure refers to these extensions:

• https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/shared-care-product-or-service
• https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/shared-care-review-outcome
• https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/shared-care-trace-number
• https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/pharmacy-item-detail-product-or-service
• https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/pharmacy-item-detail-review-outcome

Slices

This structure defines the following Slices:

• The element 1 is sliced based on the value of ClaimResponse.meta.tag

Key Elements View

Name	Flags	Card.	Type	Description & Constraints    Filter: Bindings Constraints Obligations
ClaimResponse		0..*	ClaimResponse	Response to a claim predetermination or preauthorization
meta	Σ	1..1	Meta	Metadata about the resource
source	ΣC	1..1	uri	HPI Facility ID from where the record is sourced Constraints: hpi-location-url-format
profile	Σ	1..1	canonical(StructureDefinition)	Profiles this resource claims to conform to
Slices for tag	Σ	1..*	Coding	Tags applied to this resource Slice: Unordered, Open by value:system Binding: CommonTags (example): Codes that represent various types of tags, commonly workflow-related; e.g. "Needs review by Dr. Jones".
tag:correlationId	Σ	1..1	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".
system	Σ	1..1	uri	Hub correlation ID system Required Pattern: https://hub.services.digital.health.nz/ns/correlation-id
code	Σ	1..1	code	Symbol in syntax defined by the system
implicitRules	?!Σ	0..1	uri	A set of rules under which this content was created
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored
identifier		1..1	Identifier	ClaimResponse identifier
use	?!Σ	0..1	code	usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .
system	Σ	1..1	uri	The namespace for the identifier value Fixed Value: https://standards.digital.health.nz/ns/claim-response-identifier
value	Σ	1..1	string	The value that is unique Example General: 123456
status	?!Σ	1..1	code	active | cancelled | draft | entered-in-error Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance.
type	Σ	1..1	CodeableConcept	More granular claim type Binding: NZ Claim Types (extensible)
subType		1..1	CodeableConcept	More granular claim type Binding: NZ Claim Subtypes (extensible)
use	Σ	1..1	code	claim | preauthorization | predetermination Binding: Use (required): Claim, preauthorization, predetermination.
patient	Σ	1..1	Reference(Patient)	The recipient of the products and services
created	Σ	1..1	dateTime	DateValidated
insurer	Σ	1..1	Reference(Organization)	Party responsible for reimbursement
identifier	ΣC	1..1	Identifier	A local identifier MUST be added to this section. Constraints: hpiOrganizationIdPattern, hpiFacilityIdPattern, nzbnPattern, hpiCpnPattern
use	?!Σ	0..1	code	The local identifier use SHOULD be set to official. Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .
system	ΣC	1..1	uri	The system identifier for the organization, facility or nzbn Constraints: allowedLocalIdentifierSystems Example General: http://www.acme.com/identifiers/patient Example HPI Organisation ID: https://standards.digital.health.nz/ns/hpi-organisation-id
value	Σ	1..1	string	The actual local identifier value, e.g. GZZ999-Z Example General: 123456 Example Example HPI Org ID: GZZ999-Z
requestor		1..1	Reference(Organization)	Party submitting the claim
identifier	ΣC	1..1	Identifier	A local identifier MUST be added to this section. Constraints: hpiOrganizationIdPattern, hpiFacilityIdPattern, nzbnPattern, hpiCpnPattern
use	?!Σ	0..1	code	The local identifier use SHOULD be set to official. Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .
system	ΣC	1..1	uri	The system identifier for the organization, facility or nzbn Constraints: allowedLocalIdentifierSystems Example General: http://www.acme.com/identifiers/patient Example HPI Organisation ID: https://standards.digital.health.nz/ns/hpi-organisation-id
value	Σ	1..1	string	The actual local identifier value, e.g. GZZ999-Z Example General: 123456 Example Example HPI Org ID: GZZ999-Z
request	Σ	1..1	Reference(Claim)	Reference to the original Claim
outcome	Σ	1..1	code	Claim processing outcome Binding: ClaimProcessingCodes (required)
item		0..*	BackboneElement	Adjudication for claim line items
Slices for extension		2..*	Extension	Extension Slice: Unordered, Open by value:url
extension:productOrService		1..1	CodeableConcept	Product or Service code URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/shared-care-product-or-service
extension:reviewOutcome		1..1	(Complex)	Item-level review outcome summary URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/shared-care-review-outcome
extension:traceNumber		0..*	Identifier	Internal trace identifier URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/shared-care-trace-number
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
itemSequence		1..1	positiveInt	To match Claim.item.sequence
adjudication		1..*	BackboneElement	Adjudication (reason, amount, quantity) for each Adjudication Value Code
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
category		1..1	CodeableConcept	Type of adjudication information Binding: Pharmacy Adjudication Category (extensible)
reason		0..1	CodeableConcept	Codified reason(s) for the adjudication Binding: Adjudication Reason Codes (extensible)
amount		1..1	Money	Monetary amount
detail		1..*	BackboneElement	Adjudication for claim detail items
Slices for extension		2..*	Extension	Extension Slice: Unordered, Open by value:url
extension:traceNumber		0..1	Identifier	Internal trace identifier URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/shared-care-trace-number
extension:productOrService		1..1	CodeableConcept	Dispensed pharmaceutical component URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/pharmacy-item-detail-product-or-service
extension:reviewOutcome		1..1	(Complex)	Pharmacy Claim Item Detail Review Outcome URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/pharmacy-item-detail-review-outcome
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
detailSequence		1..1	positiveInt	To match Claim.item.detail.sequence
adjudication		1..*	BackboneElement	Adjudication details breakdown
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
category		1..1	CodeableConcept	Type of adjudication information Binding: Pharmacy Adjudication Category (extensible)
reason		0..1	CodeableConcept	Explanation of adjudication outcome Binding: Adjudication Reason Codes (extensible)
payment		0..1	BackboneElement	Payment details
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
type		1..1	CodeableConcept	Partial or complete payment Binding: ExamplePaymentTypeCodes (example): The type (partial, complete) of the payment.
date		0..1	date	Payment date
amount		1..1	Money	Payment amount
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet	URI
ClaimResponse.meta.tag	example	CommonTags http://hl7.org/fhir/ValueSet/common-tags From the FHIR Standard
ClaimResponse.meta.tag:correlationId	example	CommonTags http://hl7.org/fhir/ValueSet/common-tags From the FHIR Standard
ClaimResponse.identifier.use	required	IdentifierUse http://hl7.org/fhir/ValueSet/identifier-use|4.0.1 From the FHIR Standard
ClaimResponse.status	required	FinancialResourceStatusCodes http://hl7.org/fhir/ValueSet/fm-status|4.0.1 From the FHIR Standard
ClaimResponse.type	extensible	NzClaimTypes https://fhir-ig.digital.health.nz/shared-care/ValueSet/nz-claim-types From this IG
ClaimResponse.subType	extensible	NzClaimSubtypes(a valid code from NZ Claim Subtype Code System) https://fhir-ig.digital.health.nz/shared-care/ValueSet/nz-claim-subtypes From this IG
ClaimResponse.use	required	Use http://hl7.org/fhir/ValueSet/claim-use|4.0.1 From the FHIR Standard
ClaimResponse.insurer.identifier.use	required	IdentifierUse http://hl7.org/fhir/ValueSet/identifier-use|4.0.1 From the FHIR Standard
ClaimResponse.requestor.identifier.use	required	IdentifierUse http://hl7.org/fhir/ValueSet/identifier-use|4.0.1 From the FHIR Standard
ClaimResponse.outcome	required	ClaimProcessingCodes http://hl7.org/fhir/ValueSet/remittance-outcome From the FHIR Standard
ClaimResponse.item.adjudication.category	extensible	PharmacyAdjudicationCategoryValueSet(a valid code from Pharmacy Adjudication Category Code System) https://fhir-ig.digital.health.nz/shared-care/ValueSet/pharmacy-adjudication-category From this IG
ClaimResponse.item.adjudication.reason	extensible	AdjudicationReasonCodes(a valid code from Adjudication Reason Code System) https://fhir-ig.digital.health.nz/shared-care/ValueSet/adjudication-reason-codes From this IG
ClaimResponse.item.detail.adjudication.category	extensible	PharmacyAdjudicationCategoryValueSet(a valid code from Pharmacy Adjudication Category Code System) https://fhir-ig.digital.health.nz/shared-care/ValueSet/pharmacy-adjudication-category From this IG
ClaimResponse.item.detail.adjudication.reason	extensible	AdjudicationReasonCodes(a valid code from Adjudication Reason Code System) https://fhir-ig.digital.health.nz/shared-care/ValueSet/adjudication-reason-codes From this IG
ClaimResponse.payment.type	example	ExamplePaymentTypeCodes http://hl7.org/fhir/ValueSet/ex-paymenttype From the FHIR Standard

Constraints

Id	Grade	Path(s)	Details	Requirements
allowedLocalIdentifierSystems	error	ClaimResponse.insurer.identifier.system, ClaimResponse.requestor.identifier.system	Identifier system must be HPI facility, HPI Organisation, HPI CPN or NZBN : $this = 'https://standards.digital.health.nz/ns/hpi-organisation-id' or $this = 'https://standards.digital.health.nz/ns/hpi-nzbn' or $this = 'https://standards.digital.health.nz/ns/hpi-facility-id' or $this = 'https://standards.digital.health.nz/ns/hpi-person-id'
dom-2	error	ClaimResponse	If the resource is contained in another resource, it SHALL NOT contain nested Resources : contained.contained.empty()
dom-3	error	ClaimResponse	If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource : contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
dom-4	error	ClaimResponse	If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated : contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
dom-5	error	ClaimResponse	If a resource is contained in another resource, it SHALL NOT have a security label : contained.meta.security.empty()
dom-6	best practice	ClaimResponse	A resource should have narrative for robust management : text.`div`.exists()
ele-1	error	**ALL** elements	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ext-1	error	**ALL** extensions	Must have either extensions or value[x], not both : extension.exists() != value.exists()
hpi-location-url-format	error	ClaimResponse.meta.source	Reference must be an HPI facility URL with format https://standards.digital.health.nz/ns/hpi-facility-id/FZZ111-A : matches('^https://standards.digital.health.nz/ns/hpi-facility-id/F[A-Za-z0-9]{2}[0-9]{3}-[A-Za-z0-9]$')
hpiCpnPattern	error	ClaimResponse.insurer.identifier, ClaimResponse.requestor.identifier	HPI CPN must conform to format (NNXXXX where N is numeric and X is alphabetic). : system = 'https://standards.digital.health.nz/ns/hpi-person-id' implies value.matches('^[0-9]{2}[A-Za-z]{4}$')
hpiFacilityIdPattern	error	ClaimResponse.insurer.identifier, ClaimResponse.requestor.identifier	HPI Facility ID must conform to format (FXXnnn-C). : system = 'https://standards.digital.health.nz/ns/hpi-facility-id' implies value.matches('^F[A-Za-z0-9]{2}[0-9]{3}-[A-Za-z0-9]$')
hpiOrganizationIdPattern	error	ClaimResponse.insurer.identifier, ClaimResponse.requestor.identifier	HPI Organisation ID must conform to format (GXXnnn-C). : system = 'https://standards.digital.health.nz/ns/hpi-organisation-id' implies value.matches('^G[a-zA-Z0-9]{2}[0-9]{3}-[a-zA-Z0-9]$')
nzbnPattern	error	ClaimResponse.insurer.identifier, ClaimResponse.requestor.identifier	NZBN must conform to format (13 digits). : system = 'https://standards.digital.health.nz/ns/hpi-nzbn' implies value.matches('^[0-9]{13}$')

Differential View

This structure is derived from ClaimResponse

Name	Flags	Card.	Type	Description & Constraints    Filter: Bindings Constraints Obligations
ClaimResponse		0..*	ClaimResponse	Response to a claim predetermination or preauthorization
meta		1..1	Meta	Metadata about the resource
source	C	1..1	uri	HPI Facility ID from where the record is sourced Constraints: hpi-location-url-format
profile		1..1	canonical(StructureDefinition)	Profiles this resource claims to conform to
Slices for tag		1..*	Coding	Tags applied to this resource Slice: Unordered, Open by value:system
tag:correlationId		1..1	Coding	Tags applied to this resource
system		1..1	uri	Hub correlation ID system Required Pattern: https://hub.services.digital.health.nz/ns/correlation-id
code		1..1	code	Symbol in syntax defined by the system
contained		0..0
identifier		1..1	Identifier	ClaimResponse identifier
system		1..1	uri	The namespace for the identifier value Fixed Value: https://standards.digital.health.nz/ns/claim-response-identifier
value		1..1	string	The value that is unique
type		1..1	CodeableConcept	More granular claim type Binding: NZ Claim Types (extensible)
subType		1..1	CodeableConcept	More granular claim type Binding: NZ Claim Subtypes (extensible)
created		1..1	dateTime	DateValidated
insurer
identifier	C	1..1	Identifier	A local identifier MUST be added to this section. Constraints: hpiOrganizationIdPattern, hpiFacilityIdPattern, nzbnPattern, hpiCpnPattern
use		0..1	code	The local identifier use SHOULD be set to official.
system	C	1..1	uri	The system identifier for the organization, facility or nzbn Constraints: allowedLocalIdentifierSystems Example HPI Organisation ID: https://standards.digital.health.nz/ns/hpi-organisation-id
value		1..1	string	The actual local identifier value, e.g. GZZ999-Z Example Example HPI Org ID: GZZ999-Z
requestor		1..1	Reference(Organization)	Party submitting the claim
identifier	C	1..1	Identifier	A local identifier MUST be added to this section. Constraints: hpiOrganizationIdPattern, hpiFacilityIdPattern, nzbnPattern, hpiCpnPattern
use		0..1	code	The local identifier use SHOULD be set to official.
system	C	1..1	uri	The system identifier for the organization, facility or nzbn Constraints: allowedLocalIdentifierSystems Example HPI Organisation ID: https://standards.digital.health.nz/ns/hpi-organisation-id
value		1..1	string	The actual local identifier value, e.g. GZZ999-Z Example Example HPI Org ID: GZZ999-Z
request		1..1	Reference(Claim)	Reference to the original Claim
outcome		1..1	code	Claim processing outcome Binding: ClaimProcessingCodes (required)
item		0..*	BackboneElement	Adjudication for claim line items
Slices for extension		2..*	Extension	Extension Slice: Unordered, Open by value:url
extension:productOrService		1..1	CodeableConcept	Product or Service code URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/shared-care-product-or-service
extension:reviewOutcome		1..1	(Complex)	Item-level review outcome summary URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/shared-care-review-outcome
extension:traceNumber		0..*	Identifier	Internal trace identifier URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/shared-care-trace-number
itemSequence		1..1	positiveInt	To match Claim.item.sequence
adjudication		1..*	BackboneElement	Adjudication (reason, amount, quantity) for each Adjudication Value Code
category		1..1	CodeableConcept	Type of adjudication information Binding: Pharmacy Adjudication Category (extensible)
reason		0..1	CodeableConcept	Codified reason(s) for the adjudication Binding: Adjudication Reason Codes (extensible)
amount		1..1	Money	Monetary amount
detail		1..*	BackboneElement	Adjudication for claim detail items
Slices for extension		2..*	Extension	Extension Slice: Unordered, Open by value:url
extension:traceNumber		0..1	Identifier	Internal trace identifier URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/shared-care-trace-number
extension:productOrService		1..1	CodeableConcept	Dispensed pharmaceutical component URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/pharmacy-item-detail-product-or-service
extension:reviewOutcome		1..1	(Complex)	Pharmacy Claim Item Detail Review Outcome URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/pharmacy-item-detail-review-outcome
detailSequence		1..1	positiveInt	To match Claim.item.detail.sequence
adjudication		1..*	BackboneElement	Adjudication details breakdown
category		1..1	CodeableConcept	Type of adjudication information Binding: Pharmacy Adjudication Category (extensible)
reason		0..1	CodeableConcept	Explanation of adjudication outcome Binding: Adjudication Reason Codes (extensible)
payment		0..1	BackboneElement	Payment details
date		0..1	date	Payment date
amount		1..1	Money	Payment amount
error
itemSequence		1..1	positiveInt	Item sequence number
detailSequence		1..1	positiveInt	Detail sequence number
code		1..1	CodeableConcept	Error code Binding: Claim Decision Reason Codes (required)
Documentation for this format

Terminology Bindings (Differential)

Path	Conformance	ValueSet	URI
ClaimResponse.type	extensible	NzClaimTypes https://fhir-ig.digital.health.nz/shared-care/ValueSet/nz-claim-types From this IG
ClaimResponse.subType	extensible	NzClaimSubtypes(a valid code from NZ Claim Subtype Code System) https://fhir-ig.digital.health.nz/shared-care/ValueSet/nz-claim-subtypes From this IG
ClaimResponse.outcome	required	ClaimProcessingCodes http://hl7.org/fhir/ValueSet/remittance-outcome From the FHIR Standard
ClaimResponse.item.adjudication.category	extensible	PharmacyAdjudicationCategoryValueSet(a valid code from Pharmacy Adjudication Category Code System) https://fhir-ig.digital.health.nz/shared-care/ValueSet/pharmacy-adjudication-category From this IG
ClaimResponse.item.adjudication.reason	extensible	AdjudicationReasonCodes(a valid code from Adjudication Reason Code System) https://fhir-ig.digital.health.nz/shared-care/ValueSet/adjudication-reason-codes From this IG
ClaimResponse.item.detail.adjudication.category	extensible	PharmacyAdjudicationCategoryValueSet(a valid code from Pharmacy Adjudication Category Code System) https://fhir-ig.digital.health.nz/shared-care/ValueSet/pharmacy-adjudication-category From this IG
ClaimResponse.item.detail.adjudication.reason	extensible	AdjudicationReasonCodes(a valid code from Adjudication Reason Code System) https://fhir-ig.digital.health.nz/shared-care/ValueSet/adjudication-reason-codes From this IG
ClaimResponse.error.code	required	ClaimDecisionReasonCodes(a valid code from Claim Decision Reason Code System) https://fhir-ig.digital.health.nz/shared-care/ValueSet/claim-decision-reason-codes From this IG

Constraints

Id	Grade	Path(s)	Details	Requirements
allowedLocalIdentifierSystems	error	ClaimResponse.insurer.identifier.system, ClaimResponse.requestor.identifier.system	Identifier system must be HPI facility, HPI Organisation, HPI CPN or NZBN : $this = 'https://standards.digital.health.nz/ns/hpi-organisation-id' or $this = 'https://standards.digital.health.nz/ns/hpi-nzbn' or $this = 'https://standards.digital.health.nz/ns/hpi-facility-id' or $this = 'https://standards.digital.health.nz/ns/hpi-person-id'
hpi-location-url-format	error	ClaimResponse.meta.source	Reference must be an HPI facility URL with format https://standards.digital.health.nz/ns/hpi-facility-id/FZZ111-A : matches('^https://standards.digital.health.nz/ns/hpi-facility-id/F[A-Za-z0-9]{2}[0-9]{3}-[A-Za-z0-9]$')
hpiCpnPattern	error	ClaimResponse.insurer.identifier, ClaimResponse.requestor.identifier	HPI CPN must conform to format (NNXXXX where N is numeric and X is alphabetic). : system = 'https://standards.digital.health.nz/ns/hpi-person-id' implies value.matches('^[0-9]{2}[A-Za-z]{4}$')
hpiFacilityIdPattern	error	ClaimResponse.insurer.identifier, ClaimResponse.requestor.identifier	HPI Facility ID must conform to format (FXXnnn-C). : system = 'https://standards.digital.health.nz/ns/hpi-facility-id' implies value.matches('^F[A-Za-z0-9]{2}[0-9]{3}-[A-Za-z0-9]$')
hpiOrganizationIdPattern	error	ClaimResponse.insurer.identifier, ClaimResponse.requestor.identifier	HPI Organisation ID must conform to format (GXXnnn-C). : system = 'https://standards.digital.health.nz/ns/hpi-organisation-id' implies value.matches('^G[a-zA-Z0-9]{2}[0-9]{3}-[a-zA-Z0-9]$')
nzbnPattern	error	ClaimResponse.insurer.identifier, ClaimResponse.requestor.identifier	NZBN must conform to format (13 digits). : system = 'https://standards.digital.health.nz/ns/hpi-nzbn' implies value.matches('^[0-9]{13}$')

Snapshot View

Name	Flags	Card.	Type	Description & Constraints    Filter: Bindings Constraints Obligations
ClaimResponse		0..*	ClaimResponse	Response to a claim predetermination or preauthorization
id	Σ	0..1	id	Logical id of this artifact
meta	Σ	1..1	Meta	Metadata about the resource
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
versionId	Σ	0..1	id	Version specific identifier
lastUpdated	Σ	0..1	instant	When the resource version last changed
source	ΣC	1..1	uri	HPI Facility ID from where the record is sourced Constraints: hpi-location-url-format
profile	Σ	1..1	canonical(StructureDefinition)	Profiles this resource claims to conform to
security	Σ	0..*	Coding	Security Labels applied to this resource Binding: All Security Labels (extensible): Security Labels from the Healthcare Privacy and Security Classification System.
Slices for tag	Σ	1..*	Coding	Tags applied to this resource Slice: Unordered, Open by value:system Binding: CommonTags (example): Codes that represent various types of tags, commonly workflow-related; e.g. "Needs review by Dr. Jones".
tag:correlationId	Σ	1..1	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".
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
system	Σ	1..1	uri	Hub correlation ID system Required Pattern: https://hub.services.digital.health.nz/ns/correlation-id
version	Σ	0..1	string	Version of the system - if relevant
code	Σ	1..1	code	Symbol in syntax defined by the system
display	Σ	0..1	string	Representation defined by the system
userSelected	Σ	0..1	boolean	If this coding was chosen directly by the user
implicitRules	?!Σ	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
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
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored
identifier		1..1	Identifier	ClaimResponse identifier
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
use	?!Σ	0..1	code	usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .
type	Σ	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.
system	Σ	1..1	uri	The namespace for the identifier value Fixed Value: https://standards.digital.health.nz/ns/claim-response-identifier
value	Σ	1..1	string	The value that is unique Example General: 123456
period	Σ	0..1	Period	Time period when id is/was valid for use
assigner	Σ	0..1	Reference(Organization)	Organization that issued id (may be just text)
status	?!Σ	1..1	code	active | cancelled | draft | entered-in-error Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance.
type	Σ	1..1	CodeableConcept	More granular claim type Binding: NZ Claim Types (extensible)
subType		1..1	CodeableConcept	More granular claim type Binding: NZ Claim Subtypes (extensible)
use	Σ	1..1	code	claim | preauthorization | predetermination Binding: Use (required): Claim, preauthorization, predetermination.
patient	Σ	1..1	Reference(Patient)	The recipient of the products and services
created	Σ	1..1	dateTime	DateValidated
insurer	Σ	1..1	Reference(Organization)	Party responsible for reimbursement
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
reference	ΣC	0..1	string	Literal reference, Relative, internal or absolute URL
type	Σ	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).
identifier	ΣC	1..1	Identifier	A local identifier MUST be added to this section. Constraints: hpiOrganizationIdPattern, hpiFacilityIdPattern, nzbnPattern, hpiCpnPattern
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
use	?!Σ	0..1	code	The local identifier use SHOULD be set to official. Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .
type	Σ	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.
system	ΣC	1..1	uri	The system identifier for the organization, facility or nzbn Constraints: allowedLocalIdentifierSystems Example General: http://www.acme.com/identifiers/patient Example HPI Organisation ID: https://standards.digital.health.nz/ns/hpi-organisation-id
value	Σ	1..1	string	The actual local identifier value, e.g. GZZ999-Z Example General: 123456 Example Example HPI Org ID: GZZ999-Z
period	Σ	0..1	Period	Time period when id is/was valid for use
assigner	Σ	0..1	Reference(Organization)	Organization that issued id (may be just text)
display	Σ	0..1	string	Text alternative for the resource
requestor		1..1	Reference(Organization)	Party submitting the claim
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
reference	ΣC	0..1	string	Literal reference, Relative, internal or absolute URL
type	Σ	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).
identifier	ΣC	1..1	Identifier	A local identifier MUST be added to this section. Constraints: hpiOrganizationIdPattern, hpiFacilityIdPattern, nzbnPattern, hpiCpnPattern
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
use	?!Σ	0..1	code	The local identifier use SHOULD be set to official. Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .
type	Σ	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.
system	ΣC	1..1	uri	The system identifier for the organization, facility or nzbn Constraints: allowedLocalIdentifierSystems Example General: http://www.acme.com/identifiers/patient Example HPI Organisation ID: https://standards.digital.health.nz/ns/hpi-organisation-id
value	Σ	1..1	string	The actual local identifier value, e.g. GZZ999-Z Example General: 123456 Example Example HPI Org ID: GZZ999-Z
period	Σ	0..1	Period	Time period when id is/was valid for use
assigner	Σ	0..1	Reference(Organization)	Organization that issued id (may be just text)
display	Σ	0..1	string	Text alternative for the resource
request	Σ	1..1	Reference(Claim)	Reference to the original Claim
outcome	Σ	1..1	code	Claim processing outcome Binding: ClaimProcessingCodes (required)
disposition		0..1	string	Disposition Message
preAuthRef		0..1	string	Preauthorization reference
preAuthPeriod		0..1	Period	Preauthorization reference effective period
payeeType		0..1	CodeableConcept	Party to be paid any benefits payable Binding: Claim Payee Type Codes (example): A code for the party to be reimbursed.
item		0..*	BackboneElement	Adjudication for claim line items
id		0..1	string	Unique id for inter-element referencing
Slices for extension		2..*	Extension	Extension Slice: Unordered, Open by value:url
extension:productOrService		1..1	CodeableConcept	Product or Service code URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/shared-care-product-or-service
extension:reviewOutcome		1..1	(Complex)	Item-level review outcome summary URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/shared-care-review-outcome
extension:traceNumber		0..*	Identifier	Internal trace identifier URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/shared-care-trace-number
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
itemSequence		1..1	positiveInt	To match Claim.item.sequence
noteNumber		0..*	positiveInt	Applicable note numbers
adjudication		1..*	BackboneElement	Adjudication (reason, amount, quantity) for each Adjudication Value Code
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
category		1..1	CodeableConcept	Type of adjudication information Binding: Pharmacy Adjudication Category (extensible)
reason		0..1	CodeableConcept	Codified reason(s) for the adjudication Binding: Adjudication Reason Codes (extensible)
amount		1..1	Money	Monetary amount
value		0..1	decimal	Non-monetary value
detail		1..*	BackboneElement	Adjudication for claim detail items
id		0..1	string	Unique id for inter-element referencing
Slices for extension		2..*	Extension	Extension Slice: Unordered, Open by value:url
extension:traceNumber		0..1	Identifier	Internal trace identifier URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/shared-care-trace-number
extension:productOrService		1..1	CodeableConcept	Dispensed pharmaceutical component URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/pharmacy-item-detail-product-or-service
extension:reviewOutcome		1..1	(Complex)	Pharmacy Claim Item Detail Review Outcome URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/pharmacy-item-detail-review-outcome
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
detailSequence		1..1	positiveInt	To match Claim.item.detail.sequence
noteNumber		0..*	positiveInt	Applicable note numbers
adjudication		1..*	BackboneElement	Adjudication details breakdown
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
category		1..1	CodeableConcept	Type of adjudication information Binding: Pharmacy Adjudication Category (extensible)
reason		0..1	CodeableConcept	Explanation of adjudication outcome Binding: Adjudication Reason Codes (extensible)
amount		0..1	Money	Monetary amount
value		0..1	decimal	Non-monetary value
subDetail		0..*	BackboneElement	Adjudication for claim sub-details
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
subDetailSequence		1..1	positiveInt	Claim sub-detail instance identifier
noteNumber		0..*	positiveInt	Applicable note numbers
adjudication		0..*	See adjudication (ClaimResponse)	Subdetail level adjudication details
addItem		0..*	BackboneElement	Insurer added line items
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
itemSequence		0..*	positiveInt	Item sequence number
detailSequence		0..*	positiveInt	Detail sequence number
subdetailSequence		0..*	positiveInt	Subdetail sequence number
provider		0..*	Reference(Practitioner | PractitionerRole | Organization)	Authorized providers
productOrService		1..1	CodeableConcept	Billing, service, product, or drug code Binding: USCLSCodes (example): Allowable service and product codes.
modifier		0..*	CodeableConcept	Service/Product billing modifiers Binding: ModifierTypeCodes (example): Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen.
programCode		0..*	CodeableConcept	Program the product or service is provided under Binding: ExampleProgramReasonCodes (example): Program specific reason codes.
serviced[x]		0..1		Date or dates of service or product delivery
servicedDate			date
servicedPeriod			Period
location[x]		0..1		Place of service or where product was supplied Binding: ExampleServicePlaceCodes (example): Place of service: pharmacy, school, prison, etc.
locationCodeableConcept			CodeableConcept
locationAddress			Address
locationReference			Reference(Location)
quantity		0..1	SimpleQuantity	Count of products or services
unitPrice		0..1	Money	Fee, charge or cost per item
factor		0..1	decimal	Price scaling factor
net		0..1	Money	Total item cost
bodySite		0..1	CodeableConcept	Anatomical location Binding: OralSiteCodes (example): The code for the teeth, quadrant, sextant and arch.
subSite		0..*	CodeableConcept	Anatomical sub-location Binding: SurfaceCodes (example): The code for the tooth surface and surface combinations.
noteNumber		0..*	positiveInt	Applicable note numbers
adjudication		1..*	See adjudication (ClaimResponse)	Added items adjudication
detail		0..*	BackboneElement	Insurer added line details
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
productOrService		1..1	CodeableConcept	Billing, service, product, or drug code Binding: USCLSCodes (example): Allowable service and product codes.
modifier		0..*	CodeableConcept	Service/Product billing modifiers Binding: ModifierTypeCodes (example): Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen.
quantity		0..1	SimpleQuantity	Count of products or services
unitPrice		0..1	Money	Fee, charge or cost per item
factor		0..1	decimal	Price scaling factor
net		0..1	Money	Total item cost
noteNumber		0..*	positiveInt	Applicable note numbers
adjudication		1..*	See adjudication (ClaimResponse)	Added items detail adjudication
subDetail		0..*	BackboneElement	Insurer added line items
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
productOrService		1..1	CodeableConcept	Billing, service, product, or drug code Binding: USCLSCodes (example): Allowable service and product codes.
modifier		0..*	CodeableConcept	Service/Product billing modifiers Binding: ModifierTypeCodes (example): Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen.
quantity		0..1	SimpleQuantity	Count of products or services
unitPrice		0..1	Money	Fee, charge or cost per item
factor		0..1	decimal	Price scaling factor
net		0..1	Money	Total item cost
noteNumber		0..*	positiveInt	Applicable note numbers
adjudication		1..*	See adjudication (ClaimResponse)	Added items detail adjudication
adjudication		0..*	See adjudication (ClaimResponse)	Header-level adjudication
total	Σ	0..*	BackboneElement	Adjudication totals
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
category	Σ	1..1	CodeableConcept	Type of adjudication information Binding: AdjudicationValueCodes (example): The adjudication codes.
amount	Σ	1..1	Money	Financial total for the category
payment		0..1	BackboneElement	Payment details
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
type		1..1	CodeableConcept	Partial or complete payment Binding: ExamplePaymentTypeCodes (example): The type (partial, complete) of the payment.
adjustment		0..1	Money	Payment adjustment for non-claim issues
adjustmentReason		0..1	CodeableConcept	Explanation for the adjustment Binding: PaymentAdjustmentReasonCodes (example): Payment Adjustment reason codes.
date		0..1	date	Payment date
amount		1..1	Money	Payment amount
identifier		0..1	Identifier	Business identifier for the payment
fundsReserve		0..1	CodeableConcept	Funds reserved status Binding: Funds Reservation Codes (example): For whom funds are to be reserved: (Patient, Provider, None).
formCode		0..1	CodeableConcept	Printed form identifier Binding: Form Codes (example): The forms codes.
form		0..1	Attachment	Printed reference or actual form
processNote		0..*	BackboneElement	Note concerning adjudication
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
number		0..1	positiveInt	Note instance identifier
type		0..1	code	display | print | printoper Binding: NoteType (required): The presentation types of notes.
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
communicationRequest		0..*	Reference(CommunicationRequest)	Request for additional information
insurance		0..*	BackboneElement	Patient insurance information
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
sequence		1..1	positiveInt	Insurance instance identifier
focal		1..1	boolean	Coverage to be used for adjudication
coverage		1..1	Reference(Coverage)	Insurance information
businessArrangement		0..1	string	Additional provider contract number
claimResponse		0..1	Reference(ClaimResponse)	Adjudication results
error		0..*	BackboneElement	Processing errors
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
itemSequence		1..1	positiveInt	Item sequence number
detailSequence		1..1	positiveInt	Detail sequence number
subDetailSequence		0..1	positiveInt	Subdetail sequence number
code		1..1	CodeableConcept	Error code Binding: Claim Decision Reason Codes (required)
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet	URI
ClaimResponse.meta.security	extensible	All Security Labels http://hl7.org/fhir/ValueSet/security-labels From the FHIR Standard
ClaimResponse.meta.tag	example	CommonTags http://hl7.org/fhir/ValueSet/common-tags From the FHIR Standard
ClaimResponse.meta.tag:correlationId	example	CommonTags http://hl7.org/fhir/ValueSet/common-tags From the FHIR Standard
ClaimResponse.language	preferred	CommonLanguages http://hl7.org/fhir/ValueSet/languages From the FHIR Standard Additional Bindings Purpose AllLanguages Max Binding
ClaimResponse.identifier.use	required	IdentifierUse http://hl7.org/fhir/ValueSet/identifier-use|4.0.1 From the FHIR Standard
ClaimResponse.identifier.type	extensible	Identifier Type Codes http://hl7.org/fhir/ValueSet/identifier-type From the FHIR Standard
ClaimResponse.status	required	FinancialResourceStatusCodes http://hl7.org/fhir/ValueSet/fm-status|4.0.1 From the FHIR Standard
ClaimResponse.type	extensible	NzClaimTypes https://fhir-ig.digital.health.nz/shared-care/ValueSet/nz-claim-types From this IG
ClaimResponse.subType	extensible	NzClaimSubtypes(a valid code from NZ Claim Subtype Code System) https://fhir-ig.digital.health.nz/shared-care/ValueSet/nz-claim-subtypes From this IG
ClaimResponse.use	required	Use http://hl7.org/fhir/ValueSet/claim-use|4.0.1 From the FHIR Standard
ClaimResponse.insurer.type	extensible	ResourceType http://hl7.org/fhir/ValueSet/resource-types From the FHIR Standard
ClaimResponse.insurer.identifier.use	required	IdentifierUse http://hl7.org/fhir/ValueSet/identifier-use|4.0.1 From the FHIR Standard
ClaimResponse.insurer.identifier.type	extensible	Identifier Type Codes http://hl7.org/fhir/ValueSet/identifier-type From the FHIR Standard
ClaimResponse.requestor.type	extensible	ResourceType http://hl7.org/fhir/ValueSet/resource-types From the FHIR Standard
ClaimResponse.requestor.identifier.use	required	IdentifierUse http://hl7.org/fhir/ValueSet/identifier-use|4.0.1 From the FHIR Standard
ClaimResponse.requestor.identifier.type	extensible	Identifier Type Codes http://hl7.org/fhir/ValueSet/identifier-type From the FHIR Standard
ClaimResponse.outcome	required	ClaimProcessingCodes http://hl7.org/fhir/ValueSet/remittance-outcome From the FHIR Standard
ClaimResponse.payeeType	example	Claim Payee Type Codes http://hl7.org/fhir/ValueSet/payeetype From the FHIR Standard
ClaimResponse.item.adjudication.category	extensible	PharmacyAdjudicationCategoryValueSet(a valid code from Pharmacy Adjudication Category Code System) https://fhir-ig.digital.health.nz/shared-care/ValueSet/pharmacy-adjudication-category From this IG
ClaimResponse.item.adjudication.reason	extensible	AdjudicationReasonCodes(a valid code from Adjudication Reason Code System) https://fhir-ig.digital.health.nz/shared-care/ValueSet/adjudication-reason-codes From this IG
ClaimResponse.item.detail.adjudication.category	extensible	PharmacyAdjudicationCategoryValueSet(a valid code from Pharmacy Adjudication Category Code System) https://fhir-ig.digital.health.nz/shared-care/ValueSet/pharmacy-adjudication-category From this IG
ClaimResponse.item.detail.adjudication.reason	extensible	AdjudicationReasonCodes(a valid code from Adjudication Reason Code System) https://fhir-ig.digital.health.nz/shared-care/ValueSet/adjudication-reason-codes From this IG
ClaimResponse.addItem.productOrService	example	USCLSCodes http://hl7.org/fhir/ValueSet/service-uscls From the FHIR Standard
ClaimResponse.addItem.modifier	example	ModifierTypeCodes http://hl7.org/fhir/ValueSet/claim-modifiers From the FHIR Standard
ClaimResponse.addItem.programCode	example	ExampleProgramReasonCodes http://hl7.org/fhir/ValueSet/ex-program-code From the FHIR Standard
ClaimResponse.addItem.location[x]	example	ExampleServicePlaceCodes http://hl7.org/fhir/ValueSet/service-place From the FHIR Standard
ClaimResponse.addItem.bodySite	example	OralSiteCodes http://hl7.org/fhir/ValueSet/tooth From the FHIR Standard
ClaimResponse.addItem.subSite	example	SurfaceCodes http://hl7.org/fhir/ValueSet/surface From the FHIR Standard
ClaimResponse.addItem.detail.productOrService	example	USCLSCodes http://hl7.org/fhir/ValueSet/service-uscls From the FHIR Standard
ClaimResponse.addItem.detail.modifier	example	ModifierTypeCodes http://hl7.org/fhir/ValueSet/claim-modifiers From the FHIR Standard
ClaimResponse.addItem.detail.subDetail.productOrService	example	USCLSCodes http://hl7.org/fhir/ValueSet/service-uscls From the FHIR Standard
ClaimResponse.addItem.detail.subDetail.modifier	example	ModifierTypeCodes http://hl7.org/fhir/ValueSet/claim-modifiers From the FHIR Standard
ClaimResponse.total.category	example	AdjudicationValueCodes http://hl7.org/fhir/ValueSet/adjudication From the FHIR Standard
ClaimResponse.payment.type	example	ExamplePaymentTypeCodes http://hl7.org/fhir/ValueSet/ex-paymenttype From the FHIR Standard
ClaimResponse.payment.adjustmentReason	example	PaymentAdjustmentReasonCodes http://hl7.org/fhir/ValueSet/payment-adjustment-reason From the FHIR Standard
ClaimResponse.fundsReserve	example	Funds Reservation Codes http://hl7.org/fhir/ValueSet/fundsreserve From the FHIR Standard
ClaimResponse.formCode	example	Form Codes http://hl7.org/fhir/ValueSet/forms From the FHIR Standard
ClaimResponse.processNote.type	required	NoteType http://hl7.org/fhir/ValueSet/note-type|4.0.1 From the FHIR Standard
ClaimResponse.processNote.language	preferred	CommonLanguages http://hl7.org/fhir/ValueSet/languages From the FHIR Standard Additional Bindings Purpose AllLanguages Max Binding
ClaimResponse.error.code	required	ClaimDecisionReasonCodes(a valid code from Claim Decision Reason Code System) https://fhir-ig.digital.health.nz/shared-care/ValueSet/claim-decision-reason-codes From this IG

Constraints

Id	Grade	Path(s)	Details	Requirements
allowedLocalIdentifierSystems	error	ClaimResponse.insurer.identifier.system, ClaimResponse.requestor.identifier.system	Identifier system must be HPI facility, HPI Organisation, HPI CPN or NZBN : $this = 'https://standards.digital.health.nz/ns/hpi-organisation-id' or $this = 'https://standards.digital.health.nz/ns/hpi-nzbn' or $this = 'https://standards.digital.health.nz/ns/hpi-facility-id' or $this = 'https://standards.digital.health.nz/ns/hpi-person-id'
dom-2	error	ClaimResponse	If the resource is contained in another resource, it SHALL NOT contain nested Resources : contained.contained.empty()
dom-3	error	ClaimResponse	If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource : contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
dom-4	error	ClaimResponse	If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated : contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
dom-5	error	ClaimResponse	If a resource is contained in another resource, it SHALL NOT have a security label : contained.meta.security.empty()
dom-6	best practice	ClaimResponse	A resource should have narrative for robust management : text.`div`.exists()
ele-1	error	**ALL** elements	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ext-1	error	**ALL** extensions	Must have either extensions or value[x], not both : extension.exists() != value.exists()
hpi-location-url-format	error	ClaimResponse.meta.source	Reference must be an HPI facility URL with format https://standards.digital.health.nz/ns/hpi-facility-id/FZZ111-A : matches('^https://standards.digital.health.nz/ns/hpi-facility-id/F[A-Za-z0-9]{2}[0-9]{3}-[A-Za-z0-9]$')
hpiCpnPattern	error	ClaimResponse.insurer.identifier, ClaimResponse.requestor.identifier	HPI CPN must conform to format (NNXXXX where N is numeric and X is alphabetic). : system = 'https://standards.digital.health.nz/ns/hpi-person-id' implies value.matches('^[0-9]{2}[A-Za-z]{4}$')
hpiFacilityIdPattern	error	ClaimResponse.insurer.identifier, ClaimResponse.requestor.identifier	HPI Facility ID must conform to format (FXXnnn-C). : system = 'https://standards.digital.health.nz/ns/hpi-facility-id' implies value.matches('^F[A-Za-z0-9]{2}[0-9]{3}-[A-Za-z0-9]$')
hpiOrganizationIdPattern	error	ClaimResponse.insurer.identifier, ClaimResponse.requestor.identifier	HPI Organisation ID must conform to format (GXXnnn-C). : system = 'https://standards.digital.health.nz/ns/hpi-organisation-id' implies value.matches('^G[a-zA-Z0-9]{2}[0-9]{3}-[a-zA-Z0-9]$')
nzbnPattern	error	ClaimResponse.insurer.identifier, ClaimResponse.requestor.identifier	NZBN must conform to format (13 digits). : system = 'https://standards.digital.health.nz/ns/hpi-nzbn' implies value.matches('^[0-9]{13}$')

This structure is derived from ClaimResponse

Summary

Mandatory: 19 elements(8 nested mandatory elements)
Fixed: 1 element
Prohibited: 1 element

Extensions

This structure refers to these extensions:

• https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/shared-care-product-or-service
• https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/shared-care-review-outcome
• https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/shared-care-trace-number
• https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/pharmacy-item-detail-product-or-service
• https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/pharmacy-item-detail-review-outcome

Slices

This structure defines the following Slices:

• The element 1 is sliced based on the value of ClaimResponse.meta.tag