identifier | Identifier | 0..* | Business Identifier for a claim response |
traceNumber | Identifier | 0..* | Number for tracking |
status | code | 1..1 | active |
type | CodeableConcept | 1..1 | More granular claim type |
subType | CodeableConcept | 0..1 | More granular claim type |
use | code | 1..1 | claim |
patient | Reference | 1..1 | The recipient of the products and services |
created | dateTime | 1..1 | Response creation date |
insurer | Reference | 0..1 | Party responsible for reimbursement |
requestor | Reference | 0..1 | Party responsible for the claim |
request | Reference | 0..1 | Id of resource triggering adjudication |
outcome | code | 1..1 | queued |
decision | CodeableConcept | 0..1 | Result of the adjudication |
disposition | string | 0..1 | Disposition Message |
preAuthRef | string | 0..1 | Preauthorization reference |
preAuthPeriod | Period | 0..1 | Preauthorization reference effective period |
event | BackboneElement | 0..* | Event information |
payeeType | CodeableConcept | 0..1 | Party to be paid any benefits payable |
encounter | Reference | 0..* | Encounters associated with the listed treatments |
diagnosisRelatedGroup | CodeableConcept | 0..1 | Package billing code |
item | BackboneElement | 0..* | Adjudication for claim line items |
addItem | BackboneElement | 0..* | Insurer added line items |
adjudication | — | 0..* | Header-level adjudication |
total | BackboneElement | 0..* | Adjudication totals |
payment | BackboneElement | 0..1 | Payment Details |
fundsReserve | CodeableConcept | 0..1 | Funds reserved status |
formCode | CodeableConcept | 0..1 | Printed form identifier |
form | Attachment | 0..1 | Printed reference or actual form |
processNote | BackboneElement | 0..* | Note concerning adjudication |
communicationRequest | Reference | 0..* | Request for additional information |
insurance | BackboneElement | 0..* | Patient insurance information |
error | BackboneElement | 0..* | Processing errors |