Intersection of https://www.ehealth.fgov.be/standards/fhir/mycarenet/StructureDefinition/be-eagreementclaimresponse and https://www.ehealth.fgov.be/standards/fhir/mycarenet/StructureDefinition/be-eagreementclaimresponse

This is the set of resources that conform to both MyCareNet eAgreement Claim Response BE profile (https://www.ehealth.fgov.be/standards/fhir/mycarenet/StructureDefinition/be-eagreementclaimresponse) and MyCareNet eAgreement Claim Response BE profile (https://www.ehealth.fgov.be/standards/fhir/mycarenet/StructureDefinition/be-eagreementclaimresponse).

Structure

NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
.. ClaimResponse C0..*Response to a claim predetermination or preauthorization
Constraints: be-rule-eagreementclaimresponse-1, be-rule-eagreementclaimresponse-2
... meta SΣ1..1MetaMetadata about the resource
.... extension 0..*ExtensionAdditional content defined by implementations
Constraints: ext-1
.... versionId Σ0..1idVersion specific identifier
.... lastUpdated Σ0..1instantWhen the resource version last changed
.... source Σ0..1uriIdentifies where the resource comes from
.... profile Σ1..1canonical(StructureDefinition)Profiles this resource claims to conform to
.... security Σ0..*CodingSecurity Labels applied to this resource
Binding: ?? (extensible): Security Labels from the Healthcare Privacy and Security Classification System.
.... tag Σ0..*CodingTags applied to this resource
Binding: ?? (example): Codes that represent various types of tags, commonly workflow-related; e.g. "Needs review by Dr. Jones".
... implicitRules ?!Σ0..1uriA set of rules under which this content was created
... language 0..1codeLanguage of the resource content
Binding: ?? (preferred): A human language.
Additional BindingsPurpose
??Max Binding
... text 0..1NarrativeText 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..*ResourceContained, inline Resources
... extension 0..*ExtensionAdditional content defined by implementations
Constraints: ext-1
... modifierExtension ?!0..*ExtensionExtensions that cannot be ignored
Constraints: ext-1
... identifier 0..*IdentifierBusiness Identifier for a claim response
... status ?!SΣ1..1codeactive | cancelled | draft | entered-in-error
Binding: ?? (required): A code specifying the state of the resource instance.
... type SΣ1..1CodeableConceptMore granular claim type
Binding: ?? (extensible): The type or discipline-style of the claim.
.... extension 0..*ExtensionAdditional content defined by implementations
Constraints: ext-1
.... coding Σ1..1CodingCode defined by a terminology system
..... extension 0..*ExtensionAdditional content defined by implementations
Constraints: ext-1
..... system Σ1..1uriIdentity of the terminology system
..... version Σ0..1stringVersion of the system - if relevant
..... code Σ1..1codeSymbol in syntax defined by the system
..... display Σ0..1stringRepresentation defined by the system
..... userSelected Σ0..1booleanIf this coding was chosen directly by the user
.... text Σ0..1stringPlain text representation of the concept
... subType S1..1CodeableConceptMore granular claim type
Binding: ?? (example): A more granular claim typecode.
.... extension 0..*ExtensionAdditional content defined by implementations
Constraints: ext-1
.... coding Σ1..1CodingCode defined by a terminology system
..... extension 0..*ExtensionAdditional content defined by implementations
Constraints: ext-1
..... system Σ1..1uriIdentity of the terminology system
..... version Σ0..1stringVersion of the system - if relevant
..... code Σ1..1codeSymbol in syntax defined by the system
..... display Σ0..1stringRepresentation defined by the system
..... userSelected Σ0..1booleanIf this coding was chosen directly by the user
.... text Σ0..1stringPlain text representation of the concept
... use SΣ1..1codeclaim | preauthorization | predetermination
Binding: ?? (required): Claim, preauthorization, predetermination.
... patient SΣ1..1Reference(BePatient(2.1.2))The recipient of the products and services
... created SΣ1..1dateTimeResponse creation date
... insurer SΣ1..1Reference(BeOrganization(2.1.2))Party responsible for reimbursement
... requestor S1..1Reference(BeOrganization(2.1.2) | BePractitioner(2.1.2) | BePractitionerRole(2.1.2))Party responsible for the claim
.... extension 0..*ExtensionAdditional content defined by implementations
Constraints: ext-1
.... reference Σ1..1stringLiteral reference, Relative, internal or absolute URL
.... type Σ0..1uriType the reference refers to (e.g. "Patient")
Binding: ?? (extensible): Aa resource (or, for logical models, the URI of the logical model).
.... identifier Σ0..1IdentifierLogical reference, when literal reference is not known
.... display Σ0..1stringText alternative for the resource
... request Σ0..1Reference(Claim)Id of resource triggering adjudication
... outcome SΣ1..1codequeued | complete | error | partial
Binding: ?? (required): The result of the claim processing.
... disposition 0..1stringDisposition Message
... preAuthRef S1..1stringPreauthorization reference
... preAuthPeriod S0..1PeriodPreauthorization reference effective period
.... extension 0..*ExtensionAdditional content defined by implementations
Constraints: ext-1
.... start Σ1..1dateTimeStarting time with inclusive boundary
.... end Σ0..1dateTimeEnd time with inclusive boundary, if not ongoing
... payeeType 0..1CodeableConceptParty to be paid any benefits payable
Binding: ?? (example): A code for the party to be reimbursed.
... item 0..*BackboneElementAdjudication for claim line items
.... extension 0..*ExtensionAdditional content defined by implementations
Constraints: ext-1
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
Constraints: ext-1
.... itemSequence 1..1positiveIntClaim item instance identifier
.... noteNumber 0..*positiveIntApplicable note numbers
.... adjudication S1..1BackboneElementAdjudication details
..... extension 0..*ExtensionAdditional content defined by implementations
Constraints: ext-1
..... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
Constraints: ext-1
..... category 1..1CodeableConceptType of adjudication information
Binding: ?? (example): The adjudication codes.
...... extension 0..*ExtensionAdditional content defined by implementations
Constraints: ext-1
...... coding Σ1..1CodingCode defined by a terminology system
....... extension 0..*ExtensionAdditional content defined by implementations
Constraints: ext-1
....... system Σ1..1uriIdentity of the terminology system
....... version Σ0..1stringVersion of the system - if relevant
....... code Σ1..1codeSymbol in syntax defined by the system
....... display Σ0..1stringRepresentation defined by the system
....... userSelected Σ0..1booleanIf this coding was chosen directly by the user
...... text Σ0..1stringPlain text representation of the concept
..... reason 0..1CodeableConceptExplanation of adjudication outcome
Binding: ?? (example): The adjudication reason codes.
...... extension 0..*ExtensionAdditional content defined by implementations
Constraints: ext-1
...... coding Σ1..1CodingCode defined by a terminology system
Binding: ?? (extensible)
....... extension 0..*ExtensionAdditional content defined by implementations
Constraints: ext-1
....... system Σ1..1uriIdentity of the terminology system
....... version Σ0..1stringVersion of the system - if relevant
....... code Σ1..1codeSymbol in syntax defined by the system
....... display Σ0..1stringRepresentation defined by the system
....... userSelected Σ0..1booleanIf this coding was chosen directly by the user
...... text Σ0..1stringPlain text representation of the concept
..... amount 0..1MoneyMonetary amount
..... value 0..1decimalNon-monetary value
.... detail 0..*BackboneElementAdjudication for claim details
..... extension 0..*ExtensionAdditional content defined by implementations
Constraints: ext-1
..... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
Constraints: ext-1
..... detailSequence 1..1positiveIntClaim detail instance identifier
..... noteNumber 0..*positiveIntApplicable note numbers
..... adjudication 1..*Detail level adjudication details
..... subDetail 0..*BackboneElementAdjudication for claim sub-details
...... extension 0..*ExtensionAdditional content defined by implementations
Constraints: ext-1
...... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
Constraints: ext-1
...... subDetailSequence 1..1positiveIntClaim sub-detail instance identifier
...... noteNumber 0..*positiveIntApplicable note numbers
...... adjudication 0..*Subdetail level adjudication details
... addItem S0..*BackboneElementInsurer added line items
.... extension 0..*ExtensionAdditional content defined by implementations
Constraints: ext-1
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
Constraints: ext-1
.... itemSequence S1..1positiveIntItem sequence number
.... detailSequence 0..*positiveIntDetail sequence number
.... subdetailSequence 0..*positiveIntSubdetail sequence number
.... provider 0..*Reference(Practitioner | PractitionerRole | Organization)Authorized providers
.... productOrService 1..1CodeableConceptBilling, service, product, or drug code
Binding: ?? (extensible)
..... extension 0..*ExtensionAdditional content defined by implementations
Constraints: ext-1
..... coding Σ1..1CodingCode defined by a terminology system
...... extension 0..*ExtensionAdditional content defined by implementations
Constraints: ext-1
...... system Σ1..1uriIdentity of the terminology system
...... version Σ0..1stringVersion of the system - if relevant
...... code Σ1..1codeSymbol in syntax defined by the system
...... display Σ0..1stringRepresentation defined by the system
...... userSelected Σ0..1booleanIf this coding was chosen directly by the user
..... text Σ0..1stringPlain text representation of the concept
.... modifier 0..*CodeableConceptService/Product billing modifiers
Binding: ?? (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..*CodeableConceptProgram the product or service is provided under
Binding: ?? (example): Program specific reason codes.
.... serviced[x] 0..1Date or dates of service or product delivery
..... servicedDatedate
..... servicedPeriodPeriod
.... location[x] 0..1Place of service or where product was supplied
Binding: ?? (example): Place of service: pharmacy, school, prison, etc.
..... locationCodeableConceptCodeableConcept
..... locationAddressAddress
..... locationReferenceReference(Location)
.... quantity 0..1??, ??Count of products or services
.... unitPrice 0..1MoneyFee, charge or cost per item
.... factor 0..1decimalPrice scaling factor
.... net 0..1MoneyTotal item cost
.... bodySite 0..1CodeableConceptAnatomical location
Binding: ?? (example): The code for the teeth, quadrant, sextant and arch.
.... subSite 0..*CodeableConceptAnatomical sub-location
Binding: ?? (example): The code for the tooth surface and surface combinations.
.... noteNumber 0..*positiveIntApplicable note numbers
.... adjudication S1..*Added items adjudication
.... detail 0..*BackboneElementInsurer added line details
..... extension 0..*ExtensionAdditional content defined by implementations
Constraints: ext-1
..... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
Constraints: ext-1
..... productOrService 1..1CodeableConceptBilling, service, product, or drug code
Binding: ?? (example): Allowable service and product codes.
..... modifier 0..*CodeableConceptService/Product billing modifiers
Binding: ?? (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??, ??Count of products or services
..... unitPrice 0..1MoneyFee, charge or cost per item
..... factor 0..1decimalPrice scaling factor
..... net 0..1MoneyTotal item cost
..... noteNumber 0..*positiveIntApplicable note numbers
..... adjudication 1..*Added items detail adjudication
..... subDetail 0..*BackboneElementInsurer added line items
...... extension 0..*ExtensionAdditional content defined by implementations
Constraints: ext-1
...... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
Constraints: ext-1
...... productOrService 1..1CodeableConceptBilling, service, product, or drug code
Binding: ?? (example): Allowable service and product codes.
...... modifier 0..*CodeableConceptService/Product billing modifiers
Binding: ?? (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??, ??Count of products or services
...... unitPrice 0..1MoneyFee, charge or cost per item
...... factor 0..1decimalPrice scaling factor
...... net 0..1MoneyTotal item cost
...... noteNumber 0..*positiveIntApplicable note numbers
...... adjudication 1..*Added items detail adjudication
... adjudication 0..*Header-level adjudication
... total Σ0..*BackboneElementAdjudication totals
.... extension 0..*ExtensionAdditional content defined by implementations
Constraints: ext-1
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
Constraints: ext-1
.... category Σ1..1CodeableConceptType of adjudication information
Binding: ?? (example): The adjudication codes.
.... amount Σ1..1MoneyFinancial total for the category
... payment 0..1BackboneElementPayment Details
.... extension 0..*ExtensionAdditional content defined by implementations
Constraints: ext-1
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
Constraints: ext-1
.... type 1..1CodeableConceptPartial or complete payment
Binding: ?? (example): The type (partial, complete) of the payment.
.... adjustment 0..1MoneyPayment adjustment for non-claim issues
.... adjustmentReason 0..1CodeableConceptExplanation for the adjustment
Binding: ?? (example): Payment Adjustment reason codes.
.... date 0..1dateExpected date of payment
.... amount 1..1MoneyPayable amount after adjustment
.... identifier 0..1IdentifierBusiness identifier for the payment
... fundsReserve 0..1CodeableConceptFunds reserved status
Binding: ?? (example): For whom funds are to be reserved: (Patient, Provider, None).
... formCode 0..1CodeableConceptPrinted form identifier
Binding: ?? (example): The forms codes.
... form 0..1AttachmentPrinted reference or actual form
... processNote 0..*BackboneElementNote concerning adjudication
.... extension 0..*ExtensionAdditional content defined by implementations
Constraints: ext-1
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
Constraints: ext-1
.... number 0..1positiveIntNote instance identifier
.... type 0..1codedisplay | print | printoper
Binding: ?? (required): The presentation types of notes.
.... text 1..1stringNote explanatory text
.... language 0..1CodeableConceptLanguage of the text
Binding: ?? (preferred): A human language.
Additional BindingsPurpose
??Max Binding
... communicationRequest 0..*Reference(CommunicationRequest)Request for additional information
... insurance 0..*BackboneElementPatient insurance information
.... extension 0..*ExtensionAdditional content defined by implementations
Constraints: ext-1
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
Constraints: ext-1
.... sequence 1..1positiveIntInsurance instance identifier
.... focal 1..1booleanCoverage to be used for adjudication
.... coverage 1..1Reference(Coverage)Insurance information
.... businessArrangement 0..1stringAdditional provider contract number
.... claimResponse 0..1Reference(ClaimResponse)Adjudication results
... error 0..*BackboneElementProcessing errors
.... extension 0..*ExtensionAdditional content defined by implementations
Constraints: ext-1
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
Constraints: ext-1
.... itemSequence 0..1positiveIntItem sequence number
.... detailSequence 0..1positiveIntDetail sequence number
.... subDetailSequence 0..1positiveIntSubdetail sequence number
.... code 1..1CodeableConceptError code detailing processing issues
Binding: ?? (example): The adjudication error codes.

doco Documentation for this format