ClaimResponse - FHIR Resource (dstu2)
This ClaimResponse Resource uses the FHIR API standard for access and structure.
Validate an ClaimResponse FHIR Resource (dstu2)
ClaimResponse Attributes
AttributeField is listTypeDescription
Description: Funds reserved status
FHIR Version: dstu2
Attribute Type : Coding
Required: N/A
Countability: Singleton
Flags: N/A
Terminology bindings: N/A
Requirements: N/A
Comments: N/A
Example:
"reserved": Learn more about the (ClaimResponse) reserved FHIR attribute
Description: Insurance or medical plan
FHIR Version: dstu2
Attribute Type : Data Type
Required: N/A
Countability: Array
Flags: N/A
Terminology bindings: N/A
Requirements: N/A
Comments: N/A
Example:
"coverage": Learn more about the (ClaimResponse) coverage FHIR attribute
Description: Id of resource triggering adjudication
FHIR Version: dstu2
Attribute Type : Reference
Required: N/A
Countability: Singleton
Flags: N/A
Terminology bindings: N/A
Requirements: N/A
Comments: N/A
Example:
"request": Learn more about the (ClaimResponse) request FHIR attribute
Description: Party to be paid any benefits payable
FHIR Version: dstu2
Attribute Type : Coding
Required: N/A
Countability: Singleton
Flags: N/A
Terminology bindings: N/A
Requirements: N/A
Comments: N/A
Example:
"payeeType": Learn more about the (ClaimResponse) payeeType FHIR attribute
Description: Total Cost of service from the Claim
FHIR Version: dstu2
Attribute Type : Quantity
Required: N/A
Countability: Singleton
Flags: N/A
Terminology bindings: N/A
Requirements: N/A
Comments: N/A
Example:
"totalCost": Learn more about the (ClaimResponse) totalCost FHIR attribute
Description: Processing errors
FHIR Version: dstu2
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
Description: Payment amount
FHIR Version: dstu2
Attribute Type : Quantity
Required: N/A
Countability: Singleton
Flags: N/A
Terminology bindings: N/A
Requirements: N/A
Comments: N/A
Example:
"paymentAmount": Learn more about the (ClaimResponse) paymentAmount FHIR attribute
Description: Processing notes
FHIR Version: dstu2
Attribute Type : Data Type
Required: N/A
Countability: Array
Flags: N/A
Terminology bindings: N/A
Requirements: N/A
Comments: N/A
Example:
"note": Learn more about the (ClaimResponse) note FHIR attribute
Description: Resource version
FHIR Version: dstu2
Attribute Type : Coding
Required: N/A
Countability: Singleton
Flags: N/A
Terminology bindings: N/A
Requirements: N/A
Comments: N/A
Example:
"ruleset": Learn more about the (ClaimResponse) ruleset FHIR attribute
Description: Expected data of Payment
FHIR Version: dstu2
Attribute Type : date
Required: N/A
Countability: Singleton
Flags: N/A
Terminology bindings: N/A
Requirements: N/A
Comments: N/A
Example:
"paymentDate": Learn more about the (ClaimResponse) paymentDate FHIR attribute
Description: Printed Form Identifier
FHIR Version: dstu2
Attribute Type : Coding
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: Insurer added line items
FHIR Version: dstu2
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: Disposition Message
FHIR Version: dstu2
Attribute Type : string
Required: N/A
Countability: Singleton
Flags: N/A
Terminology bindings: N/A
Requirements: N/A
Comments: N/A
Example:
"disposition": Learn more about the (ClaimResponse) disposition FHIR attribute
Description: Responsible organization
FHIR Version: dstu2
Attribute Type : Reference
Required: N/A
Countability: Singleton
Flags: N/A
Terminology bindings: N/A
Requirements: N/A
Comments: N/A
Example:
"requestOrganization": Learn more about the (ClaimResponse) requestOrganization FHIR attribute
Description: Original version
FHIR Version: dstu2
Attribute Type : Coding
Required: N/A
Countability: Singleton
Flags: N/A
Terminology bindings: N/A
Requirements: N/A
Comments: N/A
Example:
"originalRuleset": Learn more about the (ClaimResponse) originalRuleset FHIR attribute
Description: complete | error
FHIR Version: dstu2
Attribute Type : code
Required: N/A
Countability: Singleton
Flags: N/A
Terminology bindings: N/A
Requirements: N/A
Comments: N/A
Example:
"outcome": Learn more about the (ClaimResponse) outcome FHIR attribute
Description: Creation date
FHIR Version: dstu2
Attribute Type : dateTime
Required: N/A
Countability: Singleton
Flags: N/A
Terminology bindings: N/A
Requirements: N/A
Comments: N/A
Example:
"created": Learn more about the (ClaimResponse) created FHIR attribute
Description: Reason for Payment adjustment
FHIR Version: dstu2
Attribute Type : Coding
Required: N/A
Countability: Singleton
Flags: N/A
Terminology bindings: N/A
Requirements: N/A
Comments: N/A
Example:
"paymentAdjustmentReason": Learn more about the (ClaimResponse) paymentAdjustmentReason FHIR attribute
Description: Payment adjustment for non-Claim issues
FHIR Version: dstu2
Attribute Type : Quantity
Required: N/A
Countability: Singleton
Flags: N/A
Terminology bindings: N/A
Requirements: N/A
Comments: N/A
Example:
"paymentAdjustment": Learn more about the (ClaimResponse) paymentAdjustment FHIR attribute
Description: Total benefit payable for the Claim
FHIR Version: dstu2
Attribute Type : Quantity
Required: N/A
Countability: Singleton
Flags: N/A
Terminology bindings: N/A
Requirements: N/A
Comments: N/A
Example:
"totalBenefit": Learn more about the (ClaimResponse) totalBenefit FHIR attribute
Description: Unallocated deductible
FHIR Version: dstu2
Attribute Type : Quantity
Required: N/A
Countability: Singleton
Flags: N/A
Terminology bindings: N/A
Requirements: N/A
Comments: N/A
Example:
"unallocDeductable": Learn more about the (ClaimResponse) unallocDeductable FHIR attribute
Description: Line items
FHIR Version: dstu2
Attribute Type : Data Type
Required: N/A
Countability: Array
Flags: N/A
Terminology bindings: N/A
Requirements: N/A
Comments: N/A
Example:
"item": Learn more about the (ClaimResponse) item FHIR attribute
Description: Responsible practitioner
FHIR Version: dstu2
Attribute Type : Reference
Required: N/A
Countability: Singleton
Flags: N/A
Terminology bindings: N/A
Requirements: N/A
Comments: N/A
Example:
"requestProvider": Learn more about the (ClaimResponse) requestProvider FHIR attribute
Description: Insurer
FHIR Version: dstu2
Attribute Type : Reference
Required: N/A
Countability: Singleton
Flags: N/A
Terminology bindings: N/A
Requirements: N/A
Comments: N/A
Example:
"organization": Learn more about the (ClaimResponse) organization FHIR attribute
Description: Response number
FHIR Version: dstu2
Attribute Type : Identifier
Required: N/A
Countability: Array
Flags: N/A
Terminology bindings: N/A
Requirements: N/A
Comments: N/A
Example:
"identifier": Learn more about the (ClaimResponse) identifier FHIR attribute
Description: Payment identifier
FHIR Version: dstu2
Attribute Type : Identifier
Required: N/A
Countability: Singleton
Flags: N/A
Terminology bindings: N/A
Requirements: N/A
Comments: N/A
Example:
"paymentRef": Learn more about the (ClaimResponse) paymentRef FHIR attribute
ClaimResponse Structure
{
"resourceType" : "ClaimResponse",
// from Resource: id, meta, implicitRules, and language
// from DomainResource: text, contained, extension, and modifierExtension
"identifier" : [{ Identifier }], // Response number
"request" : { Reference(Claim) }, // Id of resource triggering adjudication
"ruleset" : { Coding }, // Resource version
"originalRuleset" : { Coding }, // Original version
"created" : "<dateTime>", // Creation date
"organization" : { Reference(Organization) }, // Insurer
"requestProvider" : { Reference(Practitioner) }, // Responsible practitioner
"requestOrganization" : { Reference(Organization) }, // Responsible organization
"outcome" : "<code>", // complete | error
"disposition" : "<string>", // Disposition Message
"payeeType" : { Coding }, // Party to be paid any benefits payable
"item" : [{ // Line items
"sequenceLinkId" : "<positiveInt>", // R! Service instance
"noteNumber" : ["<positiveInt>"], // List of note numbers which apply
"adjudication" : [{ // Adjudication details
"code" : { Coding }, // R! Adjudication category such as co-pay, eligible, benefit, etc.
"amount" : { Quantity(Money) }, // Monetary amount
"value" : <decimal> // Non-monetary value
}],
"detail" : [{ // Detail line items
"sequenceLinkId" : "<positiveInt>", // R! Service instance
"adjudication" : [{ // Detail adjudication
"code" : { Coding }, // R! Adjudication category such as co-pay, eligible, benefit, etc.
"amount" : { Quantity(Money) }, // Monetary amount
"value" : <decimal> // Non-monetary value
}],
"subDetail" : [{ // Subdetail line items
"sequenceLinkId" : "<positiveInt>", // R! Service instance
"adjudication" : [{ // Subdetail adjudication
"code" : { Coding }, // R! Adjudication category such as co-pay, eligible, benefit, etc.
"amount" : { Quantity(Money) }, // Monetary amount
"value" : <decimal> // Non-monetary value
}]
}]
}]
}],
"addItem" : [{ // Insurer added line items
"sequenceLinkId" : ["<positiveInt>"], // Service instances
"service" : { Coding }, // R! Group, Service or Product
"fee" : { Quantity(Money) }, // Professional fee or Product charge
"noteNumberLinkId" : ["<positiveInt>"], // List of note numbers which apply
"adjudication" : [{ // Added items adjudication
"code" : { Coding }, // R! Adjudication category such as co-pay, eligible, benefit, etc.
"amount" : { Quantity(Money) }, // Monetary amount
"value" : <decimal> // Non-monetary value
}],
"detail" : [{ // Added items details
"service" : { Coding }, // R! Service or Product
"fee" : { Quantity(Money) }, // Professional fee or Product charge
"adjudication" : [{ // Added items detail adjudication
"code" : { Coding }, // R! Adjudication category such as co-pay, eligible, benefit, etc.
"amount" : { Quantity(Money) }, // Monetary amount
"value" : <decimal> // Non-monetary value
}]
}]
}],
"error" : [{ // Processing errors
"sequenceLinkId" : "<positiveInt>", // Item sequence number
"detailSequenceLinkId" : "<positiveInt>", // Detail sequence number
"subdetailSequenceLinkId" : "<positiveInt>", // Subdetail sequence number
"code" : { Coding } // R! Error code detailing processing issues
}],
"totalCost" : { Quantity(Money) }, // Total Cost of service from the Claim
"unallocDeductable" : { Quantity(Money) }, // Unallocated deductible
"totalBenefit" : { Quantity(Money) }, // Total benefit payable for the Claim
"paymentAdjustment" : { Quantity(Money) }, // Payment adjustment for non-Claim issues
"paymentAdjustmentReason" : { Coding }, // Reason for Payment adjustment
"paymentDate" : "<date>", // Expected data of Payment
"paymentAmount" : { Quantity(Money) }, // Payment amount
"paymentRef" : { Identifier }, // Payment identifier
"reserved" : { Coding }, // Funds reserved status
"form" : { Coding }, // Printed Form Identifier
"note" : [{ // Processing notes
"number" : "<positiveInt>", // Note Number for this note
"type" : { Coding }, // display | print | printoper
"text" : "<string>" // Note explanatory text
}],
"coverage" : [{ // Insurance or medical plan
"sequence" : "<positiveInt>", // R! Service instance identifier
"focal" : <boolean>, // R! Is the focal Coverage
"coverage" : { Reference(Coverage) }, // R! Insurance information
"businessArrangement" : "<string>", // Business agreement
"relationship" : { Coding }, // R! Patient relationship to subscriber
"preAuthRef" : ["<string>"], // Pre-Authorization/Determination Reference
"claimResponse" : { Reference(ClaimResponse) }, // Adjudication results
"originalRuleset" : { Coding } // Original version
}]
}
ClaimResponse Search Parameters
The following search parameters can be used to query ClaimResponse resources. Just submit them like so:
https://api.1up.health/fhir/dstu2/ClaimResponse?query-param=queryvalue| Search Parameter | Field Type | Resource Fields Searched |
|---|---|---|
identifier | text | identifier |
