## Intersection of https://nhicore.nhi.gov.tw/pas/StructureDefinition/ClaimResponse-self-assessment-twpas and https://nhicore.nhi.gov.tw/pas/StructureDefinition/ClaimResponse-self-assessment-twpas

This is the set of resources that conform to both 自主審查-ClaimResponse Self Assessment TWPAS (https://nhicore.nhi.gov.tw/pas/StructureDefinition/ClaimResponse-self-assessment-twpas) and 自主審查-ClaimResponse Self Assessment TWPAS (https://nhicore.nhi.gov.tw/pas/StructureDefinition/ClaimResponse-self-assessment-twpas).

### Structure

Name | Flags | Card. | Type | Description & Constraints Filter: Bindings Constraints Obligations
--- | --- | --- | --- | ---
ClaimResponse |  | 0..* |  | Response to a claim predetermination or preauthorization
meta | Σ | 1..1 | Meta | Metadata about the resource
extension |  | 0..* | Extension | Additional content defined by implementations
versionId | Σ | 0..1 | id | Version specific identifier
lastUpdated | Σ | 0..1 | instant | When the resource version last changed
source | Σ | 0..1 | uri | Identifies where the resource comes from
profile | Σ | 1..1 | canonical(StructureDefinition) | Profiles this resource claims to conform to
security | Σ | 0..* | Coding | Security Labels applied to this resource Binding: ?? (extensible): Security Labels from the Healthcare Privacy and Security Classification System.
tag | Σ | 0..* | Coding | Tags applied to this resource Binding: ?? (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: ?? (preferred): A human language.
Additional Bindings | Purpose
?? | Max Binding
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
extension |  | 1..* | Extension | Extension
modifierExtension | ?! | 0..* | Extension | Extensions that cannot be ignored
identifier |  | 0..* | Identifier | Business Identifier for a claim response
status | ?!Σ | 1..1 | code | active | cancelled | draft | entered-in-error Binding: ?? (required): A code specifying the state of the resource instance.
type | Σ | 1..1 | CodeableConcept | More granular claim type Binding: ?? (extensible): The type or discipline-style of the claim.
subType |  | 0..1 | CodeableConcept | More granular claim type Binding: ?? (example): A more granular claim typecode.
use | Σ | 1..1 | code | claim | preauthorization | predetermination Binding: ?? (required): Claim, preauthorization, predetermination.
patient | Σ | 1..1 | Reference(病人資訊-Patient TWPAS | #sd-Patient-twpas-Patient-twpas) | The recipient of the products and services
created | S Σ | 1..1 | dateTime | 核定日期。若申請案件類別為3時須填寫。YYYY-MM-DD，西元年月日。
insurer | Σ | 1..1 | Reference(TW Core Organization Government) | Party responsible for reimbursement
requestor |  | 0..1 | Reference(Practitioner | PractitionerRole | Organization) | Party responsible for the claim
request | Σ | 0..1 | Reference(Claim) | Id of resource triggering adjudication
outcome | Σ | 1..1 | code | queued | complete | error | partial Binding: ?? (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: ?? (example): A code for the party to be reimbursed.
item |  | 1..* | BackboneElement | Adjudication for claim line items
extension |  | 0..* | Extension | Additional content defined by implementations
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
itemSequence |  | 1..1 | positiveInt | Claim item instance identifier
noteNumber |  | 0..* | positiveInt | Applicable note numbers
adjudication |  | 1..* | BackboneElement | Adjudication details
extension |  | 0..* | Extension | Additional content defined by implementations
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
category |  | 1..1 | CodeableConcept | 【因FHIR設計而需必填】 Binding: ?? (example): The adjudication codes.
extension |  | 0..* | Extension | Additional content defined by implementations
coding | Σ | 0..* | Coding | Code defined by a terminology system
extension |  | 0..* | Extension | Additional content defined by implementations
system | Σ | 0..1 | uri | Identity of the terminology system Example General: http://terminology.hl7.org/CodeSystem/adjudication
version | Σ | 0..1 | string | Version of the system - if relevant
code | Σ | 0..1 | code | Symbol in syntax defined by the system Example General: submitted
display | Σ | 0..1 | string | Representation defined by the system
userSelected | Σ | 0..1 | boolean | If this coding was chosen directly by the user
text | Σ | 0..1 | string | Plain text representation of the concept
reason | S | 1..1 | CodeableConcept | 受理審查案件核定註記。若申請案件類別為3時須填寫。1:同意 | 2:不予同意 | 3:部份同意 | 4:補件 | 5:退件 Binding: ?? (required)
amount |  | 0..1 | Money | Monetary amount
value | S | 1..1 | decimal | 審查結果數量，若申請案件類別為3時須填寫。
detail |  | 0..* | BackboneElement | Adjudication for claim details
extension |  | 0..* | Extension | Additional content defined by implementations
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
detailSequence |  | 1..1 | positiveInt | 請填寫對應的Claim.item.sequence
noteNumber |  | 0..* | positiveInt | Applicable note numbers
adjudication |  | 1..* | BackboneElement | Detail level adjudication details
extension |  | 0..* | Extension | Additional content defined by implementations
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
category |  | 1..1 | CodeableConcept | 【因FHIR設計而需必填】 Binding: ?? (example): The adjudication codes.
extension |  | 0..* | Extension | Additional content defined by implementations
coding | Σ | 0..* | Coding | Code defined by a terminology system
extension |  | 0..* | Extension | Additional content defined by implementations
system | Σ | 0..1 | uri | Identity of the terminology system Example General: http://terminology.hl7.org/CodeSystem/adjudication
version | Σ | 0..1 | string | Version of the system - if relevant
code | Σ | 0..1 | code | Symbol in syntax defined by the system Example General: submitted
display | Σ | 0..1 | string | Representation defined by the system
userSelected | Σ | 0..1 | boolean | If this coding was chosen directly by the user
text | Σ | 0..1 | string | Plain text representation of the concept
reason |  | 1..1 | CodeableConcept | 個別醫令核定註記。0:審核中 | 1:同意 | 2:不予同意 | 3:部份同意 | 4:補件 | 5:退件 | 6:不予同意:對應手術亦不支付 | 7:改核:如審查核定意見 Binding: ?? (required)
amount |  | 0..1 | Money | Monetary amount
value |  | 0..1 | decimal | Non-monetary value
subDetail |  | 0..* | BackboneElement | Adjudication for claim sub-details
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..* |  | Subdetail level adjudication details
extension |  | 0..* | Extension | Additional content defined by implementations
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
category |  | 1..1 | CodeableConcept | 【因FHIR設計而需必填】 Binding: ?? (example): The adjudication codes.
extension |  | 0..* | Extension | Additional content defined by implementations
coding | Σ | 0..* | Coding | Code defined by a terminology system
extension |  | 0..* | Extension | Additional content defined by implementations
system | Σ | 0..1 | uri | Identity of the terminology system Example General: http://terminology.hl7.org/CodeSystem/adjudication
version | Σ | 0..1 | string | Version of the system - if relevant
code | Σ | 0..1 | code | Symbol in syntax defined by the system Example General: submitted
display | Σ | 0..1 | string | Representation defined by the system
userSelected | Σ | 0..1 | boolean | If this coding was chosen directly by the user
text | Σ | 0..1 | string | Plain text representation of the concept
extension |  | 0..* | Extension | Additional content defined by implementations
coding | Σ | 0..* | Coding | Code defined by a terminology system
extension |  | 0..* | Extension | Additional content defined by implementations
system | Σ | 0..1 | uri | Identity of the terminology system Example General: http://terminology.hl7.org/CodeSystem/adjudication
version | Σ | 0..1 | string | Version of the system - if relevant
code | Σ | 0..1 | code | Symbol in syntax defined by the system Example General: submitted
display | Σ | 0..1 | string | Representation defined by the system
userSelected | Σ | 0..1 | boolean | If this coding was chosen directly by the user
extension |  | 0..* | Extension | Additional content defined by implementations
system | Σ | 0..1 | uri | Identity of the terminology system Example General: http://terminology.hl7.org/CodeSystem/adjudication
version | Σ | 0..1 | string | Version of the system - if relevant
code | Σ | 0..1 | code | Symbol in syntax defined by the system Example General: submitted
display | Σ | 0..1 | string | Representation defined by the system
userSelected | Σ | 0..1 | boolean | If this coding was chosen directly by the user
text | Σ | 0..1 | string | Plain text representation of the concept
reason | S | 1..1 | CodeableConcept | 受理審查案件核定註記。若申請案件類別為3時須填寫。1:同意 | 2:不予同意 | 3:部份同意 | 4:補件 | 5:退件 Binding: ?? (required)
amount |  | 0..1 | Money | Monetary amount
value | S | 1..1 | decimal | 審查結果數量，若申請案件類別為3時須填寫。
addItem |  | 0..* | BackboneElement | Insurer added line items
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: ?? (example): Allowable service and product codes.
modifier |  | 0..* | CodeableConcept | Service/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..* | CodeableConcept | Program the product or service is provided under Binding: ?? (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: ?? (example): Place of service: pharmacy, school, prison, etc.
locationCodeableConcept |  |  | CodeableConcept |
locationAddress |  |  | Address |
locationReference |  |  | Reference(Location) |
quantity |  | 0..1 | ??, ?? | 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: ?? (example): The code for the teeth, quadrant, sextant and arch.
subSite |  | 0..* | CodeableConcept | Anatomical sub-location Binding: ?? (example): The code for the tooth surface and surface combinations.
noteNumber |  | 0..* | positiveInt | Applicable note numbers
adjudication |  | 1..* |  | Added items adjudication
extension |  | 0..* | Extension | Additional content defined by implementations
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
category |  | 1..1 | CodeableConcept | 【因FHIR設計而需必填】 Binding: ?? (example): The adjudication codes.
extension |  | 0..* | Extension | Additional content defined by implementations
coding | Σ | 0..* | Coding | Code defined by a terminology system
extension |  | 0..* | Extension | Additional content defined by implementations
system | Σ | 0..1 | uri | Identity of the terminology system Example General: http://terminology.hl7.org/CodeSystem/adjudication
version | Σ | 0..1 | string | Version of the system - if relevant
code | Σ | 0..1 | code | Symbol in syntax defined by the system Example General: submitted
display | Σ | 0..1 | string | Representation defined by the system
userSelected | Σ | 0..1 | boolean | If this coding was chosen directly by the user
text | Σ | 0..1 | string | Plain text representation of the concept
extension |  | 0..* | Extension | Additional content defined by implementations
coding | Σ | 0..* | Coding | Code defined by a terminology system
extension |  | 0..* | Extension | Additional content defined by implementations
system | Σ | 0..1 | uri | Identity of the terminology system Example General: http://terminology.hl7.org/CodeSystem/adjudication
version | Σ | 0..1 | string | Version of the system - if relevant
code | Σ | 0..1 | code | Symbol in syntax defined by the system Example General: submitted
display | Σ | 0..1 | string | Representation defined by the system
userSelected | Σ | 0..1 | boolean | If this coding was chosen directly by the user
extension |  | 0..* | Extension | Additional content defined by implementations
system | Σ | 0..1 | uri | Identity of the terminology system Example General: http://terminology.hl7.org/CodeSystem/adjudication
version | Σ | 0..1 | string | Version of the system - if relevant
code | Σ | 0..1 | code | Symbol in syntax defined by the system Example General: submitted
display | Σ | 0..1 | string | Representation defined by the system
userSelected | Σ | 0..1 | boolean | If this coding was chosen directly by the user
text | Σ | 0..1 | string | Plain text representation of the concept
reason | S | 1..1 | CodeableConcept | 受理審查案件核定註記。若申請案件類別為3時須填寫。1:同意 | 2:不予同意 | 3:部份同意 | 4:補件 | 5:退件 Binding: ?? (required)
amount |  | 0..1 | Money | Monetary amount
value | S | 1..1 | decimal | 審查結果數量，若申請案件類別為3時須填寫。
detail |  | 0..* | BackboneElement | Insurer added line details
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: ?? (example): Allowable service and product codes.
modifier |  | 0..* | CodeableConcept | Service/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..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..* |  | Added items detail adjudication
extension |  | 0..* | Extension | Additional content defined by implementations
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
category |  | 1..1 | CodeableConcept | 【因FHIR設計而需必填】 Binding: ?? (example): The adjudication codes.
extension |  | 0..* | Extension | Additional content defined by implementations
coding | Σ | 0..* | Coding | Code defined by a terminology system
extension |  | 0..* | Extension | Additional content defined by implementations
system | Σ | 0..1 | uri | Identity of the terminology system Example General: http://terminology.hl7.org/CodeSystem/adjudication
version | Σ | 0..1 | string | Version of the system - if relevant
code | Σ | 0..1 | code | Symbol in syntax defined by the system Example General: submitted
display | Σ | 0..1 | string | Representation defined by the system
userSelected | Σ | 0..1 | boolean | If this coding was chosen directly by the user
text | Σ | 0..1 | string | Plain text representation of the concept
extension |  | 0..* | Extension | Additional content defined by implementations
coding | Σ | 0..* | Coding | Code defined by a terminology system
extension |  | 0..* | Extension | Additional content defined by implementations
system | Σ | 0..1 | uri | Identity of the terminology system Example General: http://terminology.hl7.org/CodeSystem/adjudication
version | Σ | 0..1 | string | Version of the system - if relevant
code | Σ | 0..1 | code | Symbol in syntax defined by the system Example General: submitted
display | Σ | 0..1 | string | Representation defined by the system
userSelected | Σ | 0..1 | boolean | If this coding was chosen directly by the user
extension |  | 0..* | Extension | Additional content defined by implementations
system | Σ | 0..1 | uri | Identity of the terminology system Example General: http://terminology.hl7.org/CodeSystem/adjudication
version | Σ | 0..1 | string | Version of the system - if relevant
code | Σ | 0..1 | code | Symbol in syntax defined by the system Example General: submitted
display | Σ | 0..1 | string | Representation defined by the system
userSelected | Σ | 0..1 | boolean | If this coding was chosen directly by the user
text | Σ | 0..1 | string | Plain text representation of the concept
reason | S | 1..1 | CodeableConcept | 受理審查案件核定註記。若申請案件類別為3時須填寫。1:同意 | 2:不予同意 | 3:部份同意 | 4:補件 | 5:退件 Binding: ?? (required)
amount |  | 0..1 | Money | Monetary amount
value | S | 1..1 | decimal | 審查結果數量，若申請案件類別為3時須填寫。
subDetail |  | 0..* | BackboneElement | Insurer added line items
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: ?? (example): Allowable service and product codes.
modifier |  | 0..* | CodeableConcept | Service/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..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..* |  | Added items detail adjudication
extension |  | 0..* | Extension | Additional content defined by implementations
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
category |  | 1..1 | CodeableConcept | 【因FHIR設計而需必填】 Binding: ?? (example): The adjudication codes.
extension |  | 0..* | Extension | Additional content defined by implementations
coding | Σ | 0..* | Coding | Code defined by a terminology system
extension |  | 0..* | Extension | Additional content defined by implementations
system | Σ | 0..1 | uri | Identity of the terminology system Example General: http://terminology.hl7.org/CodeSystem/adjudication
version | Σ | 0..1 | string | Version of the system - if relevant
code | Σ | 0..1 | code | Symbol in syntax defined by the system Example General: submitted
display | Σ | 0..1 | string | Representation defined by the system
userSelected | Σ | 0..1 | boolean | If this coding was chosen directly by the user
text | Σ | 0..1 | string | Plain text representation of the concept
extension |  | 0..* | Extension | Additional content defined by implementations
coding | Σ | 0..* | Coding | Code defined by a terminology system
extension |  | 0..* | Extension | Additional content defined by implementations
system | Σ | 0..1 | uri | Identity of the terminology system Example General: http://terminology.hl7.org/CodeSystem/adjudication
version | Σ | 0..1 | string | Version of the system - if relevant
code | Σ | 0..1 | code | Symbol in syntax defined by the system Example General: submitted
display | Σ | 0..1 | string | Representation defined by the system
userSelected | Σ | 0..1 | boolean | If this coding was chosen directly by the user
extension |  | 0..* | Extension | Additional content defined by implementations
system | Σ | 0..1 | uri | Identity of the terminology system Example General: http://terminology.hl7.org/CodeSystem/adjudication
version | Σ | 0..1 | string | Version of the system - if relevant
code | Σ | 0..1 | code | Symbol in syntax defined by the system Example General: submitted
display | Σ | 0..1 | string | Representation defined by the system
userSelected | Σ | 0..1 | boolean | If this coding was chosen directly by the user
text | Σ | 0..1 | string | Plain text representation of the concept
reason | S | 1..1 | CodeableConcept | 受理審查案件核定註記。若申請案件類別為3時須填寫。1:同意 | 2:不予同意 | 3:部份同意 | 4:補件 | 5:退件 Binding: ?? (required)
amount |  | 0..1 | Money | Monetary amount
value | S | 1..1 | decimal | 審查結果數量，若申請案件類別為3時須填寫。
adjudication |  | 0..* |  | Header-level adjudication
extension |  | 0..* | Extension | Additional content defined by implementations
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
category |  | 1..1 | CodeableConcept | 【因FHIR設計而需必填】 Binding: ?? (example): The adjudication codes.
extension |  | 0..* | Extension | Additional content defined by implementations
coding | Σ | 0..* | Coding | Code defined by a terminology system
extension |  | 0..* | Extension | Additional content defined by implementations
system | Σ | 0..1 | uri | Identity of the terminology system Example General: http://terminology.hl7.org/CodeSystem/adjudication
version | Σ | 0..1 | string | Version of the system - if relevant
code | Σ | 0..1 | code | Symbol in syntax defined by the system Example General: submitted
display | Σ | 0..1 | string | Representation defined by the system
userSelected | Σ | 0..1 | boolean | If this coding was chosen directly by the user
text | Σ | 0..1 | string | Plain text representation of the concept
extension |  | 0..* | Extension | Additional content defined by implementations
coding | Σ | 0..* | Coding | Code defined by a terminology system
extension |  | 0..* | Extension | Additional content defined by implementations
system | Σ | 0..1 | uri | Identity of the terminology system Example General: http://terminology.hl7.org/CodeSystem/adjudication
version | Σ | 0..1 | string | Version of the system - if relevant
code | Σ | 0..1 | code | Symbol in syntax defined by the system Example General: submitted
display | Σ | 0..1 | string | Representation defined by the system
userSelected | Σ | 0..1 | boolean | If this coding was chosen directly by the user
extension |  | 0..* | Extension | Additional content defined by implementations
system | Σ | 0..1 | uri | Identity of the terminology system Example General: http://terminology.hl7.org/CodeSystem/adjudication
version | Σ | 0..1 | string | Version of the system - if relevant
code | Σ | 0..1 | code | Symbol in syntax defined by the system Example General: submitted
display | Σ | 0..1 | string | Representation defined by the system
userSelected | Σ | 0..1 | boolean | If this coding was chosen directly by the user
text | Σ | 0..1 | string | Plain text representation of the concept
reason | S | 1..1 | CodeableConcept | 受理審查案件核定註記。若申請案件類別為3時須填寫。1:同意 | 2:不予同意 | 3:部份同意 | 4:補件 | 5:退件 Binding: ?? (required)
amount |  | 0..1 | Money | Monetary amount
value | S | 1..1 | decimal | 審查結果數量，若申請案件類別為3時須填寫。
total | Σ | 0..* | BackboneElement | Adjudication totals
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: ?? (example): The adjudication codes.
amount | Σ | 1..1 | Money | Financial total for the category
payment |  | 0..1 | BackboneElement | Payment Details
extension |  | 0..* | Extension | Additional content defined by implementations
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
type |  | 1..1 | CodeableConcept | Partial or complete payment Binding: ?? (example): The type (partial, complete) of the payment.
adjustment |  | 0..1 | Money | Payment adjustment for non-claim issues
adjustmentReason |  | 0..1 | CodeableConcept | Explanation for the adjustment Binding: ?? (example): Payment Adjustment reason codes.
date |  | 0..1 | date | Expected date of payment
amount |  | 1..1 | Money | Payable amount after adjustment
identifier |  | 0..1 | Identifier | Business identifier for the payment
fundsReserve |  | 0..1 | CodeableConcept | Funds reserved status Binding: ?? (example): For whom funds are to be reserved: (Patient, Provider, None).
formCode |  | 0..1 | CodeableConcept | Printed form identifier Binding: ?? (example): The forms codes.
form |  | 0..1 | Attachment | Printed reference or actual form
processNote |  | 0..* | BackboneElement | Note concerning adjudication
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: ?? (required): The presentation types of notes.
text |  | 1..1 | string | Note explanatory text
language |  | 0..1 | CodeableConcept | Language of the text Binding: ?? (preferred): A human language.
Additional Bindings | Purpose
?? | Max Binding
communicationRequest |  | 0..* | Reference(CommunicationRequest) | Request for additional information
insurance |  | 0..* | BackboneElement | Patient insurance information
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 | Processing errors
extension |  | 0..* | Extension | Additional content defined by implementations
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
itemSequence |  | 0..1 | positiveInt | Item sequence number
detailSequence |  | 0..1 | positiveInt | Detail sequence number
subDetailSequence |  | 0..1 | positiveInt | Subdetail sequence number
code |  | 1..1 | CodeableConcept | Error code detailing processing issues Binding: ?? (example): The adjudication error codes.
Documentation for this format