Health New Zealand Te Whatu Ora Shared Care FHIR API
0.4.3 - release
Health New Zealand Te Whatu Ora Shared Care FHIR API
0.4.3 - release
Health New Zealand Te Whatu Ora Shared Care FHIR API - Local Development build (v0.4.3) built by the FHIR (HL7® FHIR® Standard) Build Tools. See the Directory of published versions
| Official URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/SharedCareClaimResponse | Version: 0.0.1 | |||
| Draft as of 2025-11-13 | Computable Name: SharedCareClaimResponse | |||
A FHIR resource profile describing the outcome of NZ generic payment claims.
Note: In 4B item.adjudication, item.detail.adjudication, payment.amount, insurer are compulsory fields, but not utilized in the telehealth implementation. item.adjudication.quantity R5 is item.adjudication.value in R4B.
A FHIR resource profile describing the outcome of NZ generic payment claims
Usages:
You can also check for usages in the FHIR IG Statistics
Description of Profiles, Differentials, Snapshots and how the different presentations work.
| Name | Flags | Card. | Type | Description & Constraints Filter:   |
|---|---|---|---|---|
  ClaimResponse |
C | 0..* | ClaimResponse | Response to a claim predetermination or preauthorization Constraints: hpiOrNzbnIdentifierPattern |
  meta |
Σ | 1..1 | Meta | Metadata about the resource |
   source |
Σ | 1..1 | uri | HPI Facility ID from where the record is sourced |
 tag |
Σ | 1..* | Coding | Correlation-id where the record is sourced Binding: CommonTags (example): Codes that represent various types of tags, commonly workflow-related; e.g. "Needs review by Dr. Jones". |
| implicitRules |
?!Σ | 0..1 | uri | A set of rules under which this content was created |
 Slices for extension |
0..* | Extension | Extension Slice: Unordered, Open by value:url | |
  extension:traceNumber |
0..* | Identifier | Shared Care Claim Trace Number URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/shared-care-trace-number | |
 modifierExtension |
?! | 0..* | Extension | Extensions that cannot be ignored |
| identifier |
1..* | Identifier | Business identifier(s) for the claim response | |
| status |
?!Σ | 1..1 | code | Status of the Claim Response: 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 |
0..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 | Date & time of claim determination |
| insurer |
Σ | 1..1 | Reference(Organization) | Party responsible for reimbursement |
| requestor |
0..1 | Reference(Practitioner | PractitionerRole | Organization) | Party responsible for the Claim | |
| request |
Σ | 1..1 | Reference(NZ SharedCare Claim) | Reference to the Claim that was determined |
| outcome |
Σ | 1..1 | code | queued | complete | error | partial Binding: ClaimProcessingCodes (required): The result of the claim processing. |
| item |
1..* | BackboneElement | Claim response items | |
| Slices for extension |
1..* | Extension | Extension Slice: Unordered, Open by value:url | |
 extension:traceNumber |
0..* | Identifier | Shared Care Claim Trace Number URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/shared-care-trace-number | |
| extension:productOrService |
1..1 | CodeableConcept | Shared Care Product Or Service URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/shared-care-product-or-service | |
| extension:reviewOutcome |
0..1 | (Complex) | Shared Care Review Outcome URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/shared-care-review-outcome | |
| modifierExtension |
?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
| itemSequence |
1..1 | positiveInt | Value of the corresponding 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 | Codified representation of adjudication outcome Binding: Adjudication Value Codes (extensible) | |
| reason |
0..1 | CodeableConcept | Codified reason(s) for the adjudication Binding: Adjudication Reason Codes (extensible) | |
| amount |
1..1 | Money | Monetary value of the adjudication | |
| value |
0..1 | decimal | Non-monetary value of the adjudication | |
 detail |
0..* | BackboneElement | Any sub-determinations of this itemSequence | |
 Slices for extension |
0..* | Extension | Extension Slice: Unordered, Open by value:url | |
| extension:traceNumber |
0..* | Identifier | Shared Care Claim Trace Number URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/shared-care-trace-number | |
| extension:reviewOutcome |
0..1 | (Complex) | Shared Care Review Outcome URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/shared-care-review-outcome | |
| modifierExtension |
?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
| detailSequence |
1..1 | positiveInt | Value of the corresponding Claim.item.detail.sequence | |
 adjudication |
1..* | See adjudication (ClaimResponse) | Detail level adjudication details | |
| addItem |
0..* | BackboneElement | Any line items added by Health NZ to the claim determination that were not in the original claim | |
| 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. | |
| adjudication |
1..* | See adjudication (ClaimResponse) | Added items adjudication | |
| adjudication |
0..* | See adjudication (ClaimResponse) | Claim-level adjudication | |
| total |
Σ | 0..* | BackboneElement | Financial total of the claim for each Adjudication Value Code |
| 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 | Summary of the payment being made | |
| modifierExtension |
?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
| type |
1..1 | CodeableConcept | Payment Type Code = complete or partial Binding: Payment Type Codes (extensible) | |
| date |
0..1 | date | Expected date of payment (if known) | |
| amount |
1..1 | Money | Payment amount | |
| error |
0..* | BackboneElement | Collection of errors produced during claim determination | |
| modifierExtension |
?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
| itemSequence |
0..1 | positiveInt | Refers to itemSequence to which the error relates | |
| detailSequence |
0..1 | positiveInt | Refers to detailSequence to which the error relates | |
| code |
1..1 | CodeableConcept | Error code Binding: Adjudication Error Codes (example): The adjudication error codes. | |
| Documentation for this format | ||||
| Path | Conformance | ValueSet | URI |
| ClaimResponse.meta.tag | example | CommonTagshttp://hl7.org/fhir/ValueSet/common-tagsFrom the FHIR Standard | |
| ClaimResponse.status | required | FinancialResourceStatusCodeshttp://hl7.org/fhir/ValueSet/fm-status|4.0.1From the FHIR Standard | |
| ClaimResponse.type | extensible | NzClaimTypeshttps://fhir-ig.digital.health.nz/shared-care/ValueSet/nz-claim-typesFrom 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-subtypesFrom this IG | |
| ClaimResponse.use | required | Usehttp://hl7.org/fhir/ValueSet/claim-use|4.0.1From the FHIR Standard | |
| ClaimResponse.outcome | required | ClaimProcessingCodeshttp://hl7.org/fhir/ValueSet/remittance-outcome|4.0.1From the FHIR Standard | |
| ClaimResponse.item.adjudication.category | extensible | AdjudicationValueCodes(a valid code from Adjudication Value Code System)https://fhir-ig.digital.health.nz/shared-care/ValueSet/adjudication-value-codesFrom 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-codesFrom this IG | |
| ClaimResponse.addItem.productOrService | example | USCLSCodeshttp://hl7.org/fhir/ValueSet/service-usclsFrom the FHIR Standard | |
| ClaimResponse.total.category | example | AdjudicationValueCodeshttp://hl7.org/fhir/ValueSet/adjudicationFrom the FHIR Standard | |
| ClaimResponse.payment.type | extensible | PaymentTypeCodeshttps://fhir-ig.digital.health.nz/shared-care/ValueSet/payment-type-codesFrom this IG | |
| ClaimResponse.error.code | example | Adjudication Error Codeshttp://hl7.org/fhir/ValueSet/adjudication-errorFrom the FHIR Standard |
| Id | Grade | Path(s) | Details | Requirements |
| 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() | |
| hpiOrNzbnIdentifierPattern | error | ClaimResponse | Identifiers with system 'https://standards.digital.health.nz/ns/hpi-organisation-id', 'https://standards.digital.health.nz/ns/hpi-facility-id' or 'https://standards.digital.health.nz/ns/hpi-nzbn' must conform to the NZ HPI/NZBN identifier patterns. : %context.descendants().identifier.all( (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]$')) and (system = 'https://standards.digital.health.nz/ns/hpi-facility-id' implies value.matches('^F[a-zA-Z0-9]{2}[0-9]{3}-[a-zA-Z0-9]$')) and (system = 'https://standards.digital.health.nz/ns/hpi-nzbn' implies value.matches('^[0-9]{13}$')) ).exists() or %context.descendants().identifier.where( system = 'https://standards.digital.health.nz/ns/hpi-organisation-id' or system = 'https://standards.digital.health.nz/ns/hpi-facility-id' or system = 'https://standards.digital.health.nz/ns/hpi-nzbn' ).empty() |
This structure is derived from ClaimResponse
| Name | Flags | Card. | Type | Description & Constraints Filter: |
|---|---|---|---|---|
| ClaimResponse |
C | 0..* | ClaimResponse | Response to a claim predetermination or preauthorization Constraints: hpiOrNzbnIdentifierPattern |
| meta |
1..1 | Meta | Metadata about the resource | |
| source |
1..1 | uri | HPI Facility ID from where the record is sourced | |
| tag |
1..* | Coding | Correlation-id where the record is sourced | |
| Slices for extension |
0..* | Extension | Extension Slice: Unordered, Open by value:url | |
| extension:traceNumber |
0..* | Identifier | Shared Care Claim Trace Number URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/shared-care-trace-number | |
| identifier |
1..* | Identifier | Business identifier(s) for the claim response | |
| status |
1..1 | code | Status of the Claim Response: active, cancelled, draft, entered-in-error | |
| type |
1..1 | CodeableConcept | More granular claim type Binding: NZ Claim Types (extensible) | |
| subType |
0..1 | CodeableConcept | More granular claim type Binding: NZ Claim Subtypes (extensible) | |
| created |
1..1 | dateTime | Date & time of claim determination | |
| requestor |
0..1 | Reference(Practitioner | PractitionerRole | Organization) | Party responsible for the Claim | |
| request |
1..1 | Reference(NZ SharedCare Claim) | Reference to the Claim that was determined | |
| item |
1..* | BackboneElement | Claim response items | |
| Slices for extension |
1..* | Extension | Extension Slice: Unordered, Open by value:url | |
| extension:traceNumber |
0..* | Identifier | Shared Care Claim Trace Number URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/shared-care-trace-number | |
| extension:productOrService |
1..1 | CodeableConcept | Shared Care Product Or Service URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/shared-care-product-or-service | |
| extension:reviewOutcome |
0..1 | (Complex) | Shared Care Review Outcome URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/shared-care-review-outcome | |
| itemSequence |
1..1 | positiveInt | Value of the corresponding Claim.item.sequence | |
| adjudication |
1..* | BackboneElement | Adjudication (reason, amount, quantity) for each Adjudication Value Code | |
| category |
1..1 | CodeableConcept | Codified representation of adjudication outcome Binding: Adjudication Value Codes (extensible) | |
| reason |
0..1 | CodeableConcept | Codified reason(s) for the adjudication Binding: Adjudication Reason Codes (extensible) | |
| amount |
1..1 | Money | Monetary value of the adjudication | |
| value |
0..1 | decimal | Non-monetary value of the adjudication | |
| detail |
0..* | BackboneElement | Any sub-determinations of this itemSequence | |
| Slices for extension |
0..* | Extension | Extension Slice: Unordered, Open by value:url | |
| extension:traceNumber |
0..* | Identifier | Shared Care Claim Trace Number URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/shared-care-trace-number | |
| extension:reviewOutcome |
0..1 | (Complex) | Shared Care Review Outcome URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/shared-care-review-outcome | |
| detailSequence |
1..1 | positiveInt | Value of the corresponding Claim.item.detail.sequence | |
| addItem |
0..* | BackboneElement | Any line items added by Health NZ to the claim determination that were not in the original claim | |
| adjudication |
0..* | Claim-level adjudication | ||
| total |
0..* | BackboneElement | Financial total of the claim for each Adjudication Value Code | |
| payment |
0..1 | BackboneElement | Summary of the payment being made | |
| type |
1..1 | CodeableConcept | Payment Type Code = complete or partial Binding: Payment Type Codes (extensible) | |
| date |
0..1 | date | Expected date of payment (if known) | |
| amount |
1..1 | Money | Payment amount | |
| error |
0..* | BackboneElement | Collection of errors produced during claim determination | |
| itemSequence |
0..1 | positiveInt | Refers to itemSequence to which the error relates | |
| detailSequence |
0..1 | positiveInt | Refers to detailSequence to which the error relates | |
| code |
1..1 | CodeableConcept | Error code | |
| Documentation for this format | ||||
| Path | Conformance | ValueSet | URI |
| ClaimResponse.type | extensible | NzClaimTypeshttps://fhir-ig.digital.health.nz/shared-care/ValueSet/nz-claim-typesFrom 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-subtypesFrom this IG | |
| ClaimResponse.item.adjudication.category | extensible | AdjudicationValueCodes(a valid code from Adjudication Value Code System)https://fhir-ig.digital.health.nz/shared-care/ValueSet/adjudication-value-codesFrom 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-codesFrom this IG | |
| ClaimResponse.payment.type | extensible | PaymentTypeCodeshttps://fhir-ig.digital.health.nz/shared-care/ValueSet/payment-type-codesFrom this IG |
| Id | Grade | Path(s) | Details | Requirements |
| hpiOrNzbnIdentifierPattern | error | ClaimResponse | Identifiers with system 'https://standards.digital.health.nz/ns/hpi-organisation-id', 'https://standards.digital.health.nz/ns/hpi-facility-id' or 'https://standards.digital.health.nz/ns/hpi-nzbn' must conform to the NZ HPI/NZBN identifier patterns. : %context.descendants().identifier.all( (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]$')) and (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]$')) and (system = 'https://standards.digital.health.nz/ns/hpi-nzbn' implies value.matches('^[0-9]{13}$')) ).exists() or %context.descendants().identifier.where( system = 'https://standards.digital.health.nz/ns/hpi-organisation-id' or system = 'https://standards.digital.health.nz/ns/hpi-facility-id' or system = 'https://standards.digital.health.nz/ns/hpi-nzbn' ).empty() |
| Name | Flags | Card. | Type | Description & Constraints Filter: | ||||
|---|---|---|---|---|---|---|---|---|
| ClaimResponse |
C | 0..* | ClaimResponse | Response to a claim predetermination or preauthorization Constraints: hpiOrNzbnIdentifierPattern | ||||
| 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 |
Σ | 1..1 | uri | HPI Facility ID from where the record is sourced | ||||
| profile |
Σ | 0..* | 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. | ||||
| tag |
Σ | 1..* | Coding | Correlation-id where the record is sourced Binding: CommonTags (example): Codes that represent various types of tags, commonly workflow-related; e.g. "Needs review by Dr. Jones". | ||||
| 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.
| |||||
| 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 | |||||
| contained |
0..* | Resource | Contained, inline Resources | |||||
| Slices for extension |
0..* | Extension | Extension Slice: Unordered, Open by value:url | |||||
| extension:traceNumber |
0..* | Identifier | Shared Care Claim Trace Number URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/shared-care-trace-number | |||||
| modifierExtension |
?! | 0..* | Extension | Extensions that cannot be ignored | ||||
| identifier |
1..* | Identifier | Business identifier(s) for the claim response | |||||
| status |
?!Σ | 1..1 | code | Status of the Claim Response: 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 |
0..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 | Date & time of claim determination | ||||
| insurer |
Σ | 1..1 | Reference(Organization) | Party responsible for reimbursement | ||||
| requestor |
0..1 | Reference(Practitioner | PractitionerRole | Organization) | Party responsible for the Claim | |||||
| request |
Σ | 1..1 | Reference(NZ SharedCare Claim) | Reference to the Claim that was determined | ||||
| outcome |
Σ | 1..1 | code | queued | complete | error | partial Binding: ClaimProcessingCodes (required): The result of the claim processing. | ||||
| 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 |
1..* | BackboneElement | Claim response items | |||||
| id |
0..1 | string | Unique id for inter-element referencing | |||||
| Slices for extension |
1..* | Extension | Extension Slice: Unordered, Open by value:url | |||||
| extension:traceNumber |
0..* | Identifier | Shared Care Claim Trace Number URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/shared-care-trace-number | |||||
| extension:productOrService |
1..1 | CodeableConcept | Shared Care Product Or Service URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/shared-care-product-or-service | |||||
| extension:reviewOutcome |
0..1 | (Complex) | Shared Care Review Outcome URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/shared-care-review-outcome | |||||
| modifierExtension |
?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
| itemSequence |
1..1 | positiveInt | Value of the corresponding 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 | Codified representation of adjudication outcome Binding: Adjudication Value Codes (extensible) | |||||
| reason |
0..1 | CodeableConcept | Codified reason(s) for the adjudication Binding: Adjudication Reason Codes (extensible) | |||||
| amount |
1..1 | Money | Monetary value of the adjudication | |||||
| value |
0..1 | decimal | Non-monetary value of the adjudication | |||||
| detail |
0..* | BackboneElement | Any sub-determinations of this itemSequence | |||||
| id |
0..1 | string | Unique id for inter-element referencing | |||||
| Slices for extension |
0..* | Extension | Extension Slice: Unordered, Open by value:url | |||||
| extension:traceNumber |
0..* | Identifier | Shared Care Claim Trace Number URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/shared-care-trace-number | |||||
| extension:reviewOutcome |
0..1 | (Complex) | Shared Care Review Outcome URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/shared-care-review-outcome | |||||
| modifierExtension |
?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
| detailSequence |
1..1 | positiveInt | Value of the corresponding Claim.item.detail.sequence | |||||
| noteNumber |
0..* | positiveInt | Applicable note numbers | |||||
| adjudication |
1..* | See adjudication (ClaimResponse) | Detail level adjudication details | |||||
| 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 | Any line items added by Health NZ to the claim determination that were not in the original claim | |||||
| 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) | Claim-level adjudication | |||||
| total |
Σ | 0..* | BackboneElement | Financial total of the claim 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 |
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 | Summary of the payment being made | |||||
| 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 | Payment Type Code = complete or partial Binding: Payment Type Codes (extensible) | |||||
| 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 | Expected date of payment (if known) | |||||
| 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.
| |||||
| 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 | Collection of errors produced during claim determination | |||||
| 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..1 | positiveInt | Refers to itemSequence to which the error relates | |||||
| detailSequence |
0..1 | positiveInt | Refers to detailSequence to which the error relates | |||||
| subDetailSequence |
0..1 | positiveInt | Subdetail sequence number | |||||
| code |
1..1 | CodeableConcept | Error code Binding: Adjudication Error Codes (example): The adjudication error codes. | |||||
| Documentation for this format | ||||||||
| Path | Conformance | ValueSet | URI | |||
| ClaimResponse.meta.security | extensible | All Security Labelshttp://hl7.org/fhir/ValueSet/security-labelsFrom the FHIR Standard | ||||
| ClaimResponse.meta.tag | example | CommonTagshttp://hl7.org/fhir/ValueSet/common-tagsFrom the FHIR Standard | ||||
| ClaimResponse.language | preferred | CommonLanguageshttp://hl7.org/fhir/ValueSet/languagesFrom the FHIR Standard
| ||||
| ClaimResponse.status | required | FinancialResourceStatusCodeshttp://hl7.org/fhir/ValueSet/fm-status|4.0.1From the FHIR Standard | ||||
| ClaimResponse.type | extensible | NzClaimTypeshttps://fhir-ig.digital.health.nz/shared-care/ValueSet/nz-claim-typesFrom 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-subtypesFrom this IG | ||||
| ClaimResponse.use | required | Usehttp://hl7.org/fhir/ValueSet/claim-use|4.0.1From the FHIR Standard | ||||
| ClaimResponse.outcome | required | ClaimProcessingCodeshttp://hl7.org/fhir/ValueSet/remittance-outcome|4.0.1From the FHIR Standard | ||||
| ClaimResponse.payeeType | example | Claim Payee Type Codeshttp://hl7.org/fhir/ValueSet/payeetypeFrom the FHIR Standard | ||||
| ClaimResponse.item.adjudication.category | extensible | AdjudicationValueCodes(a valid code from Adjudication Value Code System)https://fhir-ig.digital.health.nz/shared-care/ValueSet/adjudication-value-codesFrom 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-codesFrom this IG | ||||
| ClaimResponse.addItem.productOrService | example | USCLSCodeshttp://hl7.org/fhir/ValueSet/service-usclsFrom the FHIR Standard | ||||
| ClaimResponse.addItem.modifier | example | ModifierTypeCodeshttp://hl7.org/fhir/ValueSet/claim-modifiersFrom the FHIR Standard | ||||
| ClaimResponse.addItem.programCode | example | ExampleProgramReasonCodeshttp://hl7.org/fhir/ValueSet/ex-program-codeFrom the FHIR Standard | ||||
| ClaimResponse.addItem.location[x] | example | ExampleServicePlaceCodeshttp://hl7.org/fhir/ValueSet/service-placeFrom the FHIR Standard | ||||
| ClaimResponse.addItem.bodySite | example | OralSiteCodeshttp://hl7.org/fhir/ValueSet/toothFrom the FHIR Standard | ||||
| ClaimResponse.addItem.subSite | example | SurfaceCodeshttp://hl7.org/fhir/ValueSet/surfaceFrom the FHIR Standard | ||||
| ClaimResponse.addItem.detail.productOrService | example | USCLSCodeshttp://hl7.org/fhir/ValueSet/service-usclsFrom the FHIR Standard | ||||
| ClaimResponse.addItem.detail.modifier | example | ModifierTypeCodeshttp://hl7.org/fhir/ValueSet/claim-modifiersFrom the FHIR Standard | ||||
| ClaimResponse.addItem.detail.subDetail.productOrService | example | USCLSCodeshttp://hl7.org/fhir/ValueSet/service-usclsFrom the FHIR Standard | ||||
| ClaimResponse.addItem.detail.subDetail.modifier | example | ModifierTypeCodeshttp://hl7.org/fhir/ValueSet/claim-modifiersFrom the FHIR Standard | ||||
| ClaimResponse.total.category | example | AdjudicationValueCodeshttp://hl7.org/fhir/ValueSet/adjudicationFrom the FHIR Standard | ||||
| ClaimResponse.payment.type | extensible | PaymentTypeCodeshttps://fhir-ig.digital.health.nz/shared-care/ValueSet/payment-type-codesFrom this IG | ||||
| ClaimResponse.payment.adjustmentReason | example | PaymentAdjustmentReasonCodeshttp://hl7.org/fhir/ValueSet/payment-adjustment-reasonFrom the FHIR Standard | ||||
| ClaimResponse.fundsReserve | example | Funds Reservation Codeshttp://hl7.org/fhir/ValueSet/fundsreserveFrom the FHIR Standard | ||||
| ClaimResponse.formCode | example | Form Codeshttp://hl7.org/fhir/ValueSet/formsFrom the FHIR Standard | ||||
| ClaimResponse.processNote.type | required | NoteTypehttp://hl7.org/fhir/ValueSet/note-type|4.0.1From the FHIR Standard | ||||
| ClaimResponse.processNote.language | preferred | CommonLanguageshttp://hl7.org/fhir/ValueSet/languagesFrom the FHIR Standard
| ||||
| ClaimResponse.error.code | example | Adjudication Error Codeshttp://hl7.org/fhir/ValueSet/adjudication-errorFrom the FHIR Standard |
| Id | Grade | Path(s) | Details | Requirements |
| 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() | |
| hpiOrNzbnIdentifierPattern | error | ClaimResponse | Identifiers with system 'https://standards.digital.health.nz/ns/hpi-organisation-id', 'https://standards.digital.health.nz/ns/hpi-facility-id' or 'https://standards.digital.health.nz/ns/hpi-nzbn' must conform to the NZ HPI/NZBN identifier patterns. : %context.descendants().identifier.all( (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]$')) and (system = 'https://standards.digital.health.nz/ns/hpi-facility-id' implies value.matches('^F[a-zA-Z0-9]{2}[0-9]{3}-[a-zA-Z0-9]$')) and (system = 'https://standards.digital.health.nz/ns/hpi-nzbn' implies value.matches('^[0-9]{13}$')) ).exists() or %context.descendants().identifier.where( system = 'https://standards.digital.health.nz/ns/hpi-organisation-id' or system = 'https://standards.digital.health.nz/ns/hpi-facility-id' or system = 'https://standards.digital.health.nz/ns/hpi-nzbn' ).empty() |
This structure is derived from ClaimResponse
Key Elements View
| Name | Flags | Card. | Type | Description & Constraints Filter: |
|---|---|---|---|---|
| ClaimResponse |
C | 0..* | ClaimResponse | Response to a claim predetermination or preauthorization Constraints: hpiOrNzbnIdentifierPattern |
| meta |
Σ | 1..1 | Meta | Metadata about the resource |
| source |
Σ | 1..1 | uri | HPI Facility ID from where the record is sourced |
| tag |
Σ | 1..* | Coding | Correlation-id where the record is sourced Binding: CommonTags (example): Codes that represent various types of tags, commonly workflow-related; e.g. "Needs review by Dr. Jones". |
| implicitRules |
?!Σ | 0..1 | uri | A set of rules under which this content was created |
| Slices for extension |
0..* | Extension | Extension Slice: Unordered, Open by value:url | |
| extension:traceNumber |
0..* | Identifier | Shared Care Claim Trace Number URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/shared-care-trace-number | |
| modifierExtension |
?! | 0..* | Extension | Extensions that cannot be ignored |
| identifier |
1..* | Identifier | Business identifier(s) for the claim response | |
| status |
?!Σ | 1..1 | code | Status of the Claim Response: 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 |
0..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 | Date & time of claim determination |
| insurer |
Σ | 1..1 | Reference(Organization) | Party responsible for reimbursement |
| requestor |
0..1 | Reference(Practitioner | PractitionerRole | Organization) | Party responsible for the Claim | |
| request |
Σ | 1..1 | Reference(NZ SharedCare Claim) | Reference to the Claim that was determined |
| outcome |
Σ | 1..1 | code | queued | complete | error | partial Binding: ClaimProcessingCodes (required): The result of the claim processing. |
| item |
1..* | BackboneElement | Claim response items | |
| Slices for extension |
1..* | Extension | Extension Slice: Unordered, Open by value:url | |
| extension:traceNumber |
0..* | Identifier | Shared Care Claim Trace Number URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/shared-care-trace-number | |
| extension:productOrService |
1..1 | CodeableConcept | Shared Care Product Or Service URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/shared-care-product-or-service | |
| extension:reviewOutcome |
0..1 | (Complex) | Shared Care Review Outcome URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/shared-care-review-outcome | |
| modifierExtension |
?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
| itemSequence |
1..1 | positiveInt | Value of the corresponding 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 | Codified representation of adjudication outcome Binding: Adjudication Value Codes (extensible) | |
| reason |
0..1 | CodeableConcept | Codified reason(s) for the adjudication Binding: Adjudication Reason Codes (extensible) | |
| amount |
1..1 | Money | Monetary value of the adjudication | |
| value |
0..1 | decimal | Non-monetary value of the adjudication | |
| detail |
0..* | BackboneElement | Any sub-determinations of this itemSequence | |
| Slices for extension |
0..* | Extension | Extension Slice: Unordered, Open by value:url | |
| extension:traceNumber |
0..* | Identifier | Shared Care Claim Trace Number URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/shared-care-trace-number | |
| extension:reviewOutcome |
0..1 | (Complex) | Shared Care Review Outcome URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/shared-care-review-outcome | |
| modifierExtension |
?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
| detailSequence |
1..1 | positiveInt | Value of the corresponding Claim.item.detail.sequence | |
| adjudication |
1..* | See adjudication (ClaimResponse) | Detail level adjudication details | |
| addItem |
0..* | BackboneElement | Any line items added by Health NZ to the claim determination that were not in the original claim | |
| 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. | |
| adjudication |
1..* | See adjudication (ClaimResponse) | Added items adjudication | |
| adjudication |
0..* | See adjudication (ClaimResponse) | Claim-level adjudication | |
| total |
Σ | 0..* | BackboneElement | Financial total of the claim for each Adjudication Value Code |
| 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 | Summary of the payment being made | |
| modifierExtension |
?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
| type |
1..1 | CodeableConcept | Payment Type Code = complete or partial Binding: Payment Type Codes (extensible) | |
| date |
0..1 | date | Expected date of payment (if known) | |
| amount |
1..1 | Money | Payment amount | |
| error |
0..* | BackboneElement | Collection of errors produced during claim determination | |
| modifierExtension |
?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
| itemSequence |
0..1 | positiveInt | Refers to itemSequence to which the error relates | |
| detailSequence |
0..1 | positiveInt | Refers to detailSequence to which the error relates | |
| code |
1..1 | CodeableConcept | Error code Binding: Adjudication Error Codes (example): The adjudication error codes. | |
| Documentation for this format | ||||
| Path | Conformance | ValueSet | URI |
| ClaimResponse.meta.tag | example | CommonTagshttp://hl7.org/fhir/ValueSet/common-tagsFrom the FHIR Standard | |
| ClaimResponse.status | required | FinancialResourceStatusCodeshttp://hl7.org/fhir/ValueSet/fm-status|4.0.1From the FHIR Standard | |
| ClaimResponse.type | extensible | NzClaimTypeshttps://fhir-ig.digital.health.nz/shared-care/ValueSet/nz-claim-typesFrom 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-subtypesFrom this IG | |
| ClaimResponse.use | required | Usehttp://hl7.org/fhir/ValueSet/claim-use|4.0.1From the FHIR Standard | |
| ClaimResponse.outcome | required | ClaimProcessingCodeshttp://hl7.org/fhir/ValueSet/remittance-outcome|4.0.1From the FHIR Standard | |
| ClaimResponse.item.adjudication.category | extensible | AdjudicationValueCodes(a valid code from Adjudication Value Code System)https://fhir-ig.digital.health.nz/shared-care/ValueSet/adjudication-value-codesFrom 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-codesFrom this IG | |
| ClaimResponse.addItem.productOrService | example | USCLSCodeshttp://hl7.org/fhir/ValueSet/service-usclsFrom the FHIR Standard | |
| ClaimResponse.total.category | example | AdjudicationValueCodeshttp://hl7.org/fhir/ValueSet/adjudicationFrom the FHIR Standard | |
| ClaimResponse.payment.type | extensible | PaymentTypeCodeshttps://fhir-ig.digital.health.nz/shared-care/ValueSet/payment-type-codesFrom this IG | |
| ClaimResponse.error.code | example | Adjudication Error Codeshttp://hl7.org/fhir/ValueSet/adjudication-errorFrom the FHIR Standard |
| Id | Grade | Path(s) | Details | Requirements |
| 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() | |
| hpiOrNzbnIdentifierPattern | error | ClaimResponse | Identifiers with system 'https://standards.digital.health.nz/ns/hpi-organisation-id', 'https://standards.digital.health.nz/ns/hpi-facility-id' or 'https://standards.digital.health.nz/ns/hpi-nzbn' must conform to the NZ HPI/NZBN identifier patterns. : %context.descendants().identifier.all( (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]$')) and (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]$')) and (system = 'https://standards.digital.health.nz/ns/hpi-nzbn' implies value.matches('^[0-9]{13}$')) ).exists() or %context.descendants().identifier.where( system = 'https://standards.digital.health.nz/ns/hpi-organisation-id' or system = 'https://standards.digital.health.nz/ns/hpi-facility-id' or system = 'https://standards.digital.health.nz/ns/hpi-nzbn' ).empty() |
Differential View
This structure is derived from ClaimResponse
| Name | Flags | Card. | Type | Description & Constraints Filter: |
|---|---|---|---|---|
| ClaimResponse |
C | 0..* | ClaimResponse | Response to a claim predetermination or preauthorization Constraints: hpiOrNzbnIdentifierPattern |
| meta |
1..1 | Meta | Metadata about the resource | |
| source |
1..1 | uri | HPI Facility ID from where the record is sourced | |
| tag |
1..* | Coding | Correlation-id where the record is sourced | |
| Slices for extension |
0..* | Extension | Extension Slice: Unordered, Open by value:url | |
| extension:traceNumber |
0..* | Identifier | Shared Care Claim Trace Number URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/shared-care-trace-number | |
| identifier |
1..* | Identifier | Business identifier(s) for the claim response | |
| status |
1..1 | code | Status of the Claim Response: active, cancelled, draft, entered-in-error | |
| type |
1..1 | CodeableConcept | More granular claim type Binding: NZ Claim Types (extensible) | |
| subType |
0..1 | CodeableConcept | More granular claim type Binding: NZ Claim Subtypes (extensible) | |
| created |
1..1 | dateTime | Date & time of claim determination | |
| requestor |
0..1 | Reference(Practitioner | PractitionerRole | Organization) | Party responsible for the Claim | |
| request |
1..1 | Reference(NZ SharedCare Claim) | Reference to the Claim that was determined | |
| item |
1..* | BackboneElement | Claim response items | |
| Slices for extension |
1..* | Extension | Extension Slice: Unordered, Open by value:url | |
| extension:traceNumber |
0..* | Identifier | Shared Care Claim Trace Number URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/shared-care-trace-number | |
| extension:productOrService |
1..1 | CodeableConcept | Shared Care Product Or Service URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/shared-care-product-or-service | |
| extension:reviewOutcome |
0..1 | (Complex) | Shared Care Review Outcome URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/shared-care-review-outcome | |
| itemSequence |
1..1 | positiveInt | Value of the corresponding Claim.item.sequence | |
| adjudication |
1..* | BackboneElement | Adjudication (reason, amount, quantity) for each Adjudication Value Code | |
| category |
1..1 | CodeableConcept | Codified representation of adjudication outcome Binding: Adjudication Value Codes (extensible) | |
| reason |
0..1 | CodeableConcept | Codified reason(s) for the adjudication Binding: Adjudication Reason Codes (extensible) | |
| amount |
1..1 | Money | Monetary value of the adjudication | |
| value |
0..1 | decimal | Non-monetary value of the adjudication | |
| detail |
0..* | BackboneElement | Any sub-determinations of this itemSequence | |
| Slices for extension |
0..* | Extension | Extension Slice: Unordered, Open by value:url | |
| extension:traceNumber |
0..* | Identifier | Shared Care Claim Trace Number URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/shared-care-trace-number | |
| extension:reviewOutcome |
0..1 | (Complex) | Shared Care Review Outcome URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/shared-care-review-outcome | |
| detailSequence |
1..1 | positiveInt | Value of the corresponding Claim.item.detail.sequence | |
| addItem |
0..* | BackboneElement | Any line items added by Health NZ to the claim determination that were not in the original claim | |
| adjudication |
0..* | Claim-level adjudication | ||
| total |
0..* | BackboneElement | Financial total of the claim for each Adjudication Value Code | |
| payment |
0..1 | BackboneElement | Summary of the payment being made | |
| type |
1..1 | CodeableConcept | Payment Type Code = complete or partial Binding: Payment Type Codes (extensible) | |
| date |
0..1 | date | Expected date of payment (if known) | |
| amount |
1..1 | Money | Payment amount | |
| error |
0..* | BackboneElement | Collection of errors produced during claim determination | |
| itemSequence |
0..1 | positiveInt | Refers to itemSequence to which the error relates | |
| detailSequence |
0..1 | positiveInt | Refers to detailSequence to which the error relates | |
| code |
1..1 | CodeableConcept | Error code | |
| Documentation for this format | ||||
| Path | Conformance | ValueSet | URI |
| ClaimResponse.type | extensible | NzClaimTypeshttps://fhir-ig.digital.health.nz/shared-care/ValueSet/nz-claim-typesFrom 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-subtypesFrom this IG | |
| ClaimResponse.item.adjudication.category | extensible | AdjudicationValueCodes(a valid code from Adjudication Value Code System)https://fhir-ig.digital.health.nz/shared-care/ValueSet/adjudication-value-codesFrom 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-codesFrom this IG | |
| ClaimResponse.payment.type | extensible | PaymentTypeCodeshttps://fhir-ig.digital.health.nz/shared-care/ValueSet/payment-type-codesFrom this IG |
| Id | Grade | Path(s) | Details | Requirements |
| hpiOrNzbnIdentifierPattern | error | ClaimResponse | Identifiers with system 'https://standards.digital.health.nz/ns/hpi-organisation-id', 'https://standards.digital.health.nz/ns/hpi-facility-id' or 'https://standards.digital.health.nz/ns/hpi-nzbn' must conform to the NZ HPI/NZBN identifier patterns. : %context.descendants().identifier.all( (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]$')) and (system = 'https://standards.digital.health.nz/ns/hpi-facility-id' implies value.matches('^F[a-zA-Z0-9]{2}[0-9]{3}-[a-zA-Z0-9]$')) and (system = 'https://standards.digital.health.nz/ns/hpi-nzbn' implies value.matches('^[0-9]{13}$')) ).exists() or %context.descendants().identifier.where( system = 'https://standards.digital.health.nz/ns/hpi-organisation-id' or system = 'https://standards.digital.health.nz/ns/hpi-facility-id' or system = 'https://standards.digital.health.nz/ns/hpi-nzbn' ).empty() |
Snapshot View
| Name | Flags | Card. | Type | Description & Constraints Filter: | ||||
|---|---|---|---|---|---|---|---|---|
| ClaimResponse |
C | 0..* | ClaimResponse | Response to a claim predetermination or preauthorization Constraints: hpiOrNzbnIdentifierPattern | ||||
| 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 |
Σ | 1..1 | uri | HPI Facility ID from where the record is sourced | ||||
| profile |
Σ | 0..* | 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. | ||||
| tag |
Σ | 1..* | Coding | Correlation-id where the record is sourced Binding: CommonTags (example): Codes that represent various types of tags, commonly workflow-related; e.g. "Needs review by Dr. Jones". | ||||
| 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.
| |||||
| 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 | |||||
| contained |
0..* | Resource | Contained, inline Resources | |||||
| Slices for extension |
0..* | Extension | Extension Slice: Unordered, Open by value:url | |||||
| extension:traceNumber |
0..* | Identifier | Shared Care Claim Trace Number URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/shared-care-trace-number | |||||
| modifierExtension |
?! | 0..* | Extension | Extensions that cannot be ignored | ||||
| identifier |
1..* | Identifier | Business identifier(s) for the claim response | |||||
| status |
?!Σ | 1..1 | code | Status of the Claim Response: 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 |
0..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 | Date & time of claim determination | ||||
| insurer |
Σ | 1..1 | Reference(Organization) | Party responsible for reimbursement | ||||
| requestor |
0..1 | Reference(Practitioner | PractitionerRole | Organization) | Party responsible for the Claim | |||||
| request |
Σ | 1..1 | Reference(NZ SharedCare Claim) | Reference to the Claim that was determined | ||||
| outcome |
Σ | 1..1 | code | queued | complete | error | partial Binding: ClaimProcessingCodes (required): The result of the claim processing. | ||||
| 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 |
1..* | BackboneElement | Claim response items | |||||
| id |
0..1 | string | Unique id for inter-element referencing | |||||
| Slices for extension |
1..* | Extension | Extension Slice: Unordered, Open by value:url | |||||
| extension:traceNumber |
0..* | Identifier | Shared Care Claim Trace Number URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/shared-care-trace-number | |||||
| extension:productOrService |
1..1 | CodeableConcept | Shared Care Product Or Service URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/shared-care-product-or-service | |||||
| extension:reviewOutcome |
0..1 | (Complex) | Shared Care Review Outcome URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/shared-care-review-outcome | |||||
| modifierExtension |
?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
| itemSequence |
1..1 | positiveInt | Value of the corresponding 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 | Codified representation of adjudication outcome Binding: Adjudication Value Codes (extensible) | |||||
| reason |
0..1 | CodeableConcept | Codified reason(s) for the adjudication Binding: Adjudication Reason Codes (extensible) | |||||
| amount |
1..1 | Money | Monetary value of the adjudication | |||||
| value |
0..1 | decimal | Non-monetary value of the adjudication | |||||
| detail |
0..* | BackboneElement | Any sub-determinations of this itemSequence | |||||
| id |
0..1 | string | Unique id for inter-element referencing | |||||
| Slices for extension |
0..* | Extension | Extension Slice: Unordered, Open by value:url | |||||
| extension:traceNumber |
0..* | Identifier | Shared Care Claim Trace Number URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/shared-care-trace-number | |||||
| extension:reviewOutcome |
0..1 | (Complex) | Shared Care Review Outcome URL: https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/shared-care-review-outcome | |||||
| modifierExtension |
?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
| detailSequence |
1..1 | positiveInt | Value of the corresponding Claim.item.detail.sequence | |||||
| noteNumber |
0..* | positiveInt | Applicable note numbers | |||||
| adjudication |
1..* | See adjudication (ClaimResponse) | Detail level adjudication details | |||||
| 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 | Any line items added by Health NZ to the claim determination that were not in the original claim | |||||
| 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) | Claim-level adjudication | |||||
| total |
Σ | 0..* | BackboneElement | Financial total of the claim 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 |
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 | Summary of the payment being made | |||||
| 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 | Payment Type Code = complete or partial Binding: Payment Type Codes (extensible) | |||||
| 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 | Expected date of payment (if known) | |||||
| 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.
| |||||
| 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 | Collection of errors produced during claim determination | |||||
| 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..1 | positiveInt | Refers to itemSequence to which the error relates | |||||
| detailSequence |
0..1 | positiveInt | Refers to detailSequence to which the error relates | |||||
| subDetailSequence |
0..1 | positiveInt | Subdetail sequence number | |||||
| code |
1..1 | CodeableConcept | Error code Binding: Adjudication Error Codes (example): The adjudication error codes. | |||||
| Documentation for this format | ||||||||
| Path | Conformance | ValueSet | URI | |||
| ClaimResponse.meta.security | extensible | All Security Labelshttp://hl7.org/fhir/ValueSet/security-labelsFrom the FHIR Standard | ||||
| ClaimResponse.meta.tag | example | CommonTagshttp://hl7.org/fhir/ValueSet/common-tagsFrom the FHIR Standard | ||||
| ClaimResponse.language | preferred | CommonLanguageshttp://hl7.org/fhir/ValueSet/languagesFrom the FHIR Standard
| ||||
| ClaimResponse.status | required | FinancialResourceStatusCodeshttp://hl7.org/fhir/ValueSet/fm-status|4.0.1From the FHIR Standard | ||||
| ClaimResponse.type | extensible | NzClaimTypeshttps://fhir-ig.digital.health.nz/shared-care/ValueSet/nz-claim-typesFrom 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-subtypesFrom this IG | ||||
| ClaimResponse.use | required | Usehttp://hl7.org/fhir/ValueSet/claim-use|4.0.1From the FHIR Standard | ||||
| ClaimResponse.outcome | required | ClaimProcessingCodeshttp://hl7.org/fhir/ValueSet/remittance-outcome|4.0.1From the FHIR Standard | ||||
| ClaimResponse.payeeType | example | Claim Payee Type Codeshttp://hl7.org/fhir/ValueSet/payeetypeFrom the FHIR Standard | ||||
| ClaimResponse.item.adjudication.category | extensible | AdjudicationValueCodes(a valid code from Adjudication Value Code System)https://fhir-ig.digital.health.nz/shared-care/ValueSet/adjudication-value-codesFrom 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-codesFrom this IG | ||||
| ClaimResponse.addItem.productOrService | example | USCLSCodeshttp://hl7.org/fhir/ValueSet/service-usclsFrom the FHIR Standard | ||||
| ClaimResponse.addItem.modifier | example | ModifierTypeCodeshttp://hl7.org/fhir/ValueSet/claim-modifiersFrom the FHIR Standard | ||||
| ClaimResponse.addItem.programCode | example | ExampleProgramReasonCodeshttp://hl7.org/fhir/ValueSet/ex-program-codeFrom the FHIR Standard | ||||
| ClaimResponse.addItem.location[x] | example | ExampleServicePlaceCodeshttp://hl7.org/fhir/ValueSet/service-placeFrom the FHIR Standard | ||||
| ClaimResponse.addItem.bodySite | example | OralSiteCodeshttp://hl7.org/fhir/ValueSet/toothFrom the FHIR Standard | ||||
| ClaimResponse.addItem.subSite | example | SurfaceCodeshttp://hl7.org/fhir/ValueSet/surfaceFrom the FHIR Standard | ||||
| ClaimResponse.addItem.detail.productOrService | example | USCLSCodeshttp://hl7.org/fhir/ValueSet/service-usclsFrom the FHIR Standard | ||||
| ClaimResponse.addItem.detail.modifier | example | ModifierTypeCodeshttp://hl7.org/fhir/ValueSet/claim-modifiersFrom the FHIR Standard | ||||
| ClaimResponse.addItem.detail.subDetail.productOrService | example | USCLSCodeshttp://hl7.org/fhir/ValueSet/service-usclsFrom the FHIR Standard | ||||
| ClaimResponse.addItem.detail.subDetail.modifier | example | ModifierTypeCodeshttp://hl7.org/fhir/ValueSet/claim-modifiersFrom the FHIR Standard | ||||
| ClaimResponse.total.category | example | AdjudicationValueCodeshttp://hl7.org/fhir/ValueSet/adjudicationFrom the FHIR Standard | ||||
| ClaimResponse.payment.type | extensible | PaymentTypeCodeshttps://fhir-ig.digital.health.nz/shared-care/ValueSet/payment-type-codesFrom this IG | ||||
| ClaimResponse.payment.adjustmentReason | example | PaymentAdjustmentReasonCodeshttp://hl7.org/fhir/ValueSet/payment-adjustment-reasonFrom the FHIR Standard | ||||
| ClaimResponse.fundsReserve | example | Funds Reservation Codeshttp://hl7.org/fhir/ValueSet/fundsreserveFrom the FHIR Standard | ||||
| ClaimResponse.formCode | example | Form Codeshttp://hl7.org/fhir/ValueSet/formsFrom the FHIR Standard | ||||
| ClaimResponse.processNote.type | required | NoteTypehttp://hl7.org/fhir/ValueSet/note-type|4.0.1From the FHIR Standard | ||||
| ClaimResponse.processNote.language | preferred | CommonLanguageshttp://hl7.org/fhir/ValueSet/languagesFrom the FHIR Standard
| ||||
| ClaimResponse.error.code | example | Adjudication Error Codeshttp://hl7.org/fhir/ValueSet/adjudication-errorFrom the FHIR Standard |
| Id | Grade | Path(s) | Details | Requirements |
| 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() | |
| hpiOrNzbnIdentifierPattern | error | ClaimResponse | Identifiers with system 'https://standards.digital.health.nz/ns/hpi-organisation-id', 'https://standards.digital.health.nz/ns/hpi-facility-id' or 'https://standards.digital.health.nz/ns/hpi-nzbn' must conform to the NZ HPI/NZBN identifier patterns. : %context.descendants().identifier.all( (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]$')) and (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]$')) and (system = 'https://standards.digital.health.nz/ns/hpi-nzbn' implies value.matches('^[0-9]{13}$')) ).exists() or %context.descendants().identifier.where( system = 'https://standards.digital.health.nz/ns/hpi-organisation-id' or system = 'https://standards.digital.health.nz/ns/hpi-facility-id' or system = 'https://standards.digital.health.nz/ns/hpi-nzbn' ).empty() |
This structure is derived from ClaimResponse
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