ClaimResponse.item
FHIR attribute (r4)
In the ClaimResponse resource for FHIR r4 , the item attribute identifies the Adjudication for claim line items
item (ClaimResponse) description
Resource Type: ClaimResponse
Attribute Name: item
Description: Adjudication for claim line items
FHIR Version: r4
Attribute Type :
Required: N/A
Countability: Array
Flags: N/A
Terminology bindings: N/A
Requirements: N/A
Comments: N/A
ClaimResponse.item Example
"item": [
{
"itemSequence": 1,
"adjudication": [
{
"category": {
"coding": [
{
"code": "eligible"
}
]
},
"amount": {
"value": 135.57,
"currency": "USD"
}
},
{
"category": {
"coding": [
{
"code": "copay"
}
]
},
"amount": {
"value": 10,
"currency": "USD"
}
},
{
"category": {
"coding": [
{
"code": "eligpercent"
}
]
},
"value": 80
},
{
"category": {
"coding": [
{
"code": "benefit"
}
]
},
"reason": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/adjudication-reason",
"code": "ar002",
"display": "Plan Limit Reached"
}
]
},
"amount": {
"value": 90.47,
"currency": "USD"
}
}
]
}
]ClaimResponse attributes
AttributeField is listTypeDescription
Description: Business Identifier for a claim response
FHIR Version: r4
Attribute Type : Identifier
Required: N/A
Countability: Array
Flags: N/A
Terminology bindings: N/A
Requirements: N/A
Comments: N/A
Example:
"identifier": [
{
"system": "http://www.BenefitsInc.com/fhir/remittance",
"value": "R3500"
}
]Learn more about the (ClaimResponse) identifier FHIR attribute
Description: active | cancelled | draft | entered-in-error
FHIR Version: r4
Attribute Type : code
Required: N/A
Countability: Singleton
Flags: N/A
Terminology bindings: N/A
Requirements: N/A
Comments: N/A
Example:
"status": "active"Learn more about the (ClaimResponse) status FHIR attribute
Description: More granular claim type
FHIR Version: r4
Attribute Type : CodeableConcept
Required: N/A
Countability: Singleton
Flags: N/A
Terminology bindings: N/A
Requirements: N/A
Comments: N/A
Example:
"type": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/claim-type",
"code": "oral"
}
]
}Learn more about the (ClaimResponse) type FHIR attribute
Description: More granular claim type
FHIR Version: r4
Attribute Type : CodeableConcept
Required: N/A
Countability: Singleton
Flags: N/A
Terminology bindings: N/A
Requirements: N/A
Comments: N/A
Example:
"subType": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/ex-claimsubtype",
"code": "emergency"
}
]
}Learn more about the (ClaimResponse) subType FHIR attribute
Description: claim | preauthorization | predetermination
FHIR Version: r4
Attribute Type : code
Required: N/A
Countability: Singleton
Flags: N/A
Terminology bindings: N/A
Requirements: N/A
Comments: N/A
Example:
"use": "claim"Learn more about the (ClaimResponse) use FHIR attribute
Description: The recipient of the products and services
FHIR Version: r4
Attribute Type : Reference
Required: N/A
Countability: Singleton
Flags: N/A
Terminology bindings: N/A
Requirements: N/A
Comments: N/A
Example:
"patient": {
"reference": "Patient/1"
}Learn more about the (ClaimResponse) patient FHIR attribute
Description: Response creation date
FHIR Version: r4
Attribute Type : dateTime
Required: N/A
Countability: Singleton
Flags: N/A
Terminology bindings: N/A
Requirements: N/A
Comments: N/A
Example:
"created": "2014-08-16"Learn more about the (ClaimResponse) created FHIR attribute
Description: Party responsible for reimbursement
FHIR Version: r4
Attribute Type : Reference
Required: N/A
Countability: Singleton
Flags: N/A
Terminology bindings: N/A
Requirements: N/A
Comments: N/A
Example:
"insurer": {
"identifier": {
"system": "http://www.jurisdiction.org/insurers",
"value": "555123"
}
}Learn more about the (ClaimResponse) insurer FHIR attribute
Description: Party responsible for the claim
FHIR Version: r4
Attribute Type : Reference
Required: N/A
Countability: Singleton
Flags: N/A
Terminology bindings: N/A
Requirements: N/A
Comments: N/A
Example:
"requestor": {
"reference": "Organization/1"
}Learn more about the (ClaimResponse) requestor FHIR attribute
Description: Id of resource triggering adjudication
FHIR Version: r4
Attribute Type : Reference
Required: N/A
Countability: Singleton
Flags: N/A
Terminology bindings: N/A
Requirements: N/A
Comments: N/A
Example:
"request": {
"reference": "http://www.BenefitsInc.com/fhir/oralhealthclaim/15476332402"
}Learn more about the (ClaimResponse) request FHIR attribute
Description: queued | complete | error | partial
FHIR Version: r4
Attribute Type : code
Required: N/A
Countability: Singleton
Flags: N/A
Terminology bindings: N/A
Requirements: N/A
Comments: N/A
Example:
"outcome": "complete"Learn more about the (ClaimResponse) outcome FHIR attribute
Description: Disposition Message
FHIR Version: r4
Attribute Type : string
Required: N/A
Countability: Singleton
Flags: N/A
Terminology bindings: N/A
Requirements: N/A
Comments: N/A
Example:
"disposition": "Claim settled as per contract."Learn more about the (ClaimResponse) disposition FHIR attribute
Description: Preauthorization reference
FHIR Version: r4
Attribute Type : string
Required: N/A
Countability: Singleton
Flags: N/A
Terminology bindings: N/A
Requirements: N/A
Comments: N/A
Example:
"preAuthRef": Learn more about the (ClaimResponse) preAuthRef FHIR attribute
Description: Preauthorization reference effective period
FHIR Version: r4
Attribute Type : Period
Required: N/A
Countability: Singleton
Flags: N/A
Terminology bindings: N/A
Requirements: N/A
Comments: N/A
Example:
"preAuthPeriod": Learn more about the (ClaimResponse) preAuthPeriod FHIR attribute
Description: Party to be paid any benefits payable
FHIR Version: r4
Attribute Type : CodeableConcept
Required: N/A
Countability: Singleton
Flags: N/A
Terminology bindings: N/A
Requirements: N/A
Comments: N/A
Example:
"payeeType": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/payeetype",
"code": "provider"
}
]
}Learn more about the (ClaimResponse) payeeType FHIR attribute
Description: Adjudication for claim line items
FHIR Version: r4
Attribute Type : Data Type
Required: N/A
Countability: Array
Flags: N/A
Terminology bindings: N/A
Requirements: N/A
Comments: N/A
Example:
"item": [
{
"itemSequence": 1,
"adjudication": [
{
"category": {
"coding": [
{
"code": "eligible"
}
]
},
"amount": {
"value": 135.57,
"currency": "USD"
}
},
{
"category": {
"coding": [
{
"code": "copay"
}
]
},
"amount": {
"value": 10,
"currency": "USD"
}
},
{
"category": {
"coding": [
{
"code": "eligpercent"
}
]
},
"value": 80
},
{
"category": {
"coding": [
{
"code": "benefit"
}
]
},
"reason": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/adjudication-reason",
"code": "ar002",
"display": "Plan Limit Reached"
}
]
},
"amount": {
"value": 90.47,
"currency": "USD"
}
}
]
}
]Learn more about the (ClaimResponse) item FHIR attribute
Description: Insurer added line items
FHIR Version: r4
Attribute Type : Data Type
Required: N/A
Countability: Array
Flags: N/A
Terminology bindings: N/A
Requirements: N/A
Comments: N/A
Example:
"addItem": Learn more about the (ClaimResponse) addItem FHIR attribute
Description: Adjudication details
FHIR Version: r4
Attribute Type : See ClaimResponse.item.adjudication
Required: N/A
Countability: Array
Flags: N/A
Terminology bindings: N/A
Requirements: N/A
Comments: N/A
Example:
"adjudication": Learn more about the (ClaimResponse) adjudication FHIR attribute
Description: Adjudication totals
FHIR Version: r4
Attribute Type : Data Type
Required: N/A
Countability: Array
Flags: N/A
Terminology bindings: N/A
Requirements: N/A
Comments: N/A
Example:
"total": [
{
"category": {
"coding": [
{
"code": "submitted"
}
]
},
"amount": {
"value": 135.57,
"currency": "USD"
}
},
{
"category": {
"coding": [
{
"code": "benefit"
}
]
},
"amount": {
"value": 90.47,
"currency": "USD"
}
}
]Learn more about the (ClaimResponse) total FHIR attribute
Description: Payment Details
FHIR Version: r4
Attribute Type : Data Type
Required: N/A
Countability: Singleton
Flags: N/A
Terminology bindings: N/A
Requirements: N/A
Comments: N/A
Example:
"payment": {
"type": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/ex-paymenttype",
"code": "complete"
}
]
},
"date": "2014-08-31",
"amount": {
"value": 100.47,
"currency": "USD"
},
"identifier": {
"system": "http://www.BenefitsInc.com/fhir/paymentidentifier",
"value": "201408-2-1569478"
}
}Learn more about the (ClaimResponse) payment FHIR attribute
Description: Funds reserved status
FHIR Version: r4
Attribute Type : CodeableConcept
Required: N/A
Countability: Singleton
Flags: N/A
Terminology bindings: N/A
Requirements: N/A
Comments: N/A
Example:
"fundsReserve": Learn more about the (ClaimResponse) fundsReserve FHIR attribute
Description: Printed form identifier
FHIR Version: r4
Attribute Type : CodeableConcept
Required: N/A
Countability: Singleton
Flags: N/A
Terminology bindings: N/A
Requirements: N/A
Comments: N/A
Example:
"formCode": Learn more about the (ClaimResponse) formCode FHIR attribute
Description: Printed reference or actual form
FHIR Version: r4
Attribute Type : Attachment
Required: N/A
Countability: Singleton
Flags: N/A
Terminology bindings: N/A
Requirements: N/A
Comments: N/A
Example:
"form": Learn more about the (ClaimResponse) form FHIR attribute
Description: Note concerning adjudication
FHIR Version: r4
Attribute Type : Data Type
Required: N/A
Countability: Array
Flags: N/A
Terminology bindings: N/A
Requirements: N/A
Comments: N/A
Example:
"processNote": Learn more about the (ClaimResponse) processNote FHIR attribute
Description: Request for additional information
FHIR Version: r4
Attribute Type : Reference
Required: N/A
Countability: Array
Flags: N/A
Terminology bindings: N/A
Requirements: N/A
Comments: N/A
Example:
"communicationRequest": Learn more about the (ClaimResponse) communicationRequest FHIR attribute
Description: Patient insurance information
FHIR Version: r4
Attribute Type : Data Type
Required: N/A
Countability: Array
Flags: N/A
Terminology bindings: N/A
Requirements: N/A
Comments: N/A
Example:
"insurance": Learn more about the (ClaimResponse) insurance FHIR attribute
Description: Processing errors
FHIR Version: r4
Attribute Type : Data Type
Required: N/A
Countability: Array
Flags: N/A
Terminology bindings: N/A
Requirements: N/A
Comments: N/A
Example:
"error": Learn more about the (ClaimResponse) error FHIR attribute
