臺灣健保事前審查實作指引
1.2.6 - STU1.2.6

This page is part of the 臺灣健保癌症用藥事前審查實作指引(TWPAS IG) (v1.2.6: STU1.2.6) based on FHIR (HL7® FHIR® Standard) R4. The current version which supersedes this version is 1.2.7. For a full list of available versions, see the Directory of published versions

Resource Profile: ClaimResponseTWPAS - Mappings

Active as of 2026-08-27

Mappings for the ClaimResponse-twpas resource profile.

Mappings to Structures in this Implementation Guide

NameMapping to TWPAS ClaimResponsedoco
.. ClaimResponse
    ... id
      ... meta
        .... id
          .... extension
            .... versionId
              .... lastUpdated
                .... source
                  .... profile
                    .... security
                      .... tag
                        ... implicitRules
                          ... language
                            ... text
                              ... contained
                                ... extension
                                  ... modifierExtension
                                    ... identifier
                                      .... id
                                        .... extension
                                          .... use
                                            .... type
                                              .... system
                                                .... value
                                                  .... period
                                                    .... assigner
                                                      ... status
                                                        ... type
                                                          ... subType
                                                            ... use
                                                              ... patient
                                                                ... created
                                                                ... insurer
                                                                  ... requestor
                                                                    ... request
                                                                      ... outcome
                                                                        ... disposition
                                                                        ... preAuthRef
                                                                          ... preAuthPeriod
                                                                            ... payeeType
                                                                              ... item
                                                                                .... id
                                                                                  .... extension
                                                                                    .... modifierExtension
                                                                                      .... itemSequence
                                                                                        .... noteNumber
                                                                                          .... adjudication
                                                                                            ..... id
                                                                                              ..... extension
                                                                                                ..... modifierExtension
                                                                                                  ..... category
                                                                                                    ...... id
                                                                                                      ...... extension
                                                                                                        ...... coding
                                                                                                          ....... id
                                                                                                            ....... extension
                                                                                                              ....... system
                                                                                                                ....... version
                                                                                                                  ....... code
                                                                                                                    ....... display
                                                                                                                      ....... userSelected
                                                                                                                        ...... text
                                                                                                                          ..... reason
                                                                                                                            ...... id
                                                                                                                              ...... extension
                                                                                                                                ...... coding
                                                                                                                                  ...... text
                                                                                                                                  ..... amount
                                                                                                                                    ..... value
                                                                                                                                      .... detail
                                                                                                                                        ..... id
                                                                                                                                          ..... extension
                                                                                                                                            ..... modifierExtension
                                                                                                                                              ..... detailSequence
                                                                                                                                                ..... noteNumber
                                                                                                                                                  ..... adjudication
                                                                                                                                                    ...... id
                                                                                                                                                      ...... extension
                                                                                                                                                        ...... modifierExtension
                                                                                                                                                          ...... category
                                                                                                                                                            ....... id
                                                                                                                                                              ....... extension
                                                                                                                                                                ....... coding
                                                                                                                                                                  ........ id
                                                                                                                                                                    ........ extension
                                                                                                                                                                      ........ system
                                                                                                                                                                        ........ version
                                                                                                                                                                          ........ code
                                                                                                                                                                            ........ display
                                                                                                                                                                              ........ userSelected
                                                                                                                                                                                ....... text
                                                                                                                                                                                  ...... reason
                                                                                                                                                                                  ...... amount
                                                                                                                                                                                    ...... value
                                                                                                                                                                                    ..... subDetail
                                                                                                                                                                                      ...... id
                                                                                                                                                                                        ...... extension
                                                                                                                                                                                          ...... modifierExtension
                                                                                                                                                                                            ...... subDetailSequence
                                                                                                                                                                                              ...... noteNumber
                                                                                                                                                                                                ...... adjudication
                                                                                                                                                                                                  ... addItem
                                                                                                                                                                                                    .... id
                                                                                                                                                                                                      .... extension
                                                                                                                                                                                                        .... modifierExtension
                                                                                                                                                                                                          .... itemSequence
                                                                                                                                                                                                            .... detailSequence
                                                                                                                                                                                                              .... subdetailSequence
                                                                                                                                                                                                                .... provider
                                                                                                                                                                                                                  .... productOrService
                                                                                                                                                                                                                    .... modifier
                                                                                                                                                                                                                      .... programCode
                                                                                                                                                                                                                        .... serviced[x]
                                                                                                                                                                                                                          .... location[x]
                                                                                                                                                                                                                            .... quantity
                                                                                                                                                                                                                              .... unitPrice
                                                                                                                                                                                                                                .... factor
                                                                                                                                                                                                                                  .... net
                                                                                                                                                                                                                                    .... bodySite
                                                                                                                                                                                                                                      .... subSite
                                                                                                                                                                                                                                        .... noteNumber
                                                                                                                                                                                                                                          .... adjudication
                                                                                                                                                                                                                                            .... detail
                                                                                                                                                                                                                                              ..... id
                                                                                                                                                                                                                                                ..... extension
                                                                                                                                                                                                                                                  ..... modifierExtension
                                                                                                                                                                                                                                                    ..... productOrService
                                                                                                                                                                                                                                                      ..... modifier
                                                                                                                                                                                                                                                        ..... quantity
                                                                                                                                                                                                                                                          ..... unitPrice
                                                                                                                                                                                                                                                            ..... factor
                                                                                                                                                                                                                                                              ..... net
                                                                                                                                                                                                                                                                ..... noteNumber
                                                                                                                                                                                                                                                                  ..... adjudication
                                                                                                                                                                                                                                                                    ..... subDetail
                                                                                                                                                                                                                                                                      ...... id
                                                                                                                                                                                                                                                                        ...... extension
                                                                                                                                                                                                                                                                          ...... modifierExtension
                                                                                                                                                                                                                                                                            ...... productOrService
                                                                                                                                                                                                                                                                              ...... modifier
                                                                                                                                                                                                                                                                                ...... quantity
                                                                                                                                                                                                                                                                                  ...... unitPrice
                                                                                                                                                                                                                                                                                    ...... factor
                                                                                                                                                                                                                                                                                      ...... net
                                                                                                                                                                                                                                                                                        ...... noteNumber
                                                                                                                                                                                                                                                                                          ...... adjudication
                                                                                                                                                                                                                                                                                            ... adjudication
                                                                                                                                                                                                                                                                                              ... total
                                                                                                                                                                                                                                                                                                .... id
                                                                                                                                                                                                                                                                                                  .... extension
                                                                                                                                                                                                                                                                                                    .... modifierExtension
                                                                                                                                                                                                                                                                                                      .... category
                                                                                                                                                                                                                                                                                                        .... amount
                                                                                                                                                                                                                                                                                                          ... payment
                                                                                                                                                                                                                                                                                                            .... id
                                                                                                                                                                                                                                                                                                              .... extension
                                                                                                                                                                                                                                                                                                                .... modifierExtension
                                                                                                                                                                                                                                                                                                                  .... type
                                                                                                                                                                                                                                                                                                                    .... adjustment
                                                                                                                                                                                                                                                                                                                      .... adjustmentReason
                                                                                                                                                                                                                                                                                                                        .... date
                                                                                                                                                                                                                                                                                                                          .... amount
                                                                                                                                                                                                                                                                                                                            .... identifier
                                                                                                                                                                                                                                                                                                                              ... fundsReserve
                                                                                                                                                                                                                                                                                                                                ... formCode
                                                                                                                                                                                                                                                                                                                                  ... form
                                                                                                                                                                                                                                                                                                                                    ... processNote
                                                                                                                                                                                                                                                                                                                                      .... id
                                                                                                                                                                                                                                                                                                                                        .... extension
                                                                                                                                                                                                                                                                                                                                          .... modifierExtension
                                                                                                                                                                                                                                                                                                                                            .... number
                                                                                                                                                                                                                                                                                                                                              .... type
                                                                                                                                                                                                                                                                                                                                                .... text
                                                                                                                                                                                                                                                                                                                                                  .... language
                                                                                                                                                                                                                                                                                                                                                    ... communicationRequest
                                                                                                                                                                                                                                                                                                                                                      ... insurance
                                                                                                                                                                                                                                                                                                                                                        .... id
                                                                                                                                                                                                                                                                                                                                                          .... extension
                                                                                                                                                                                                                                                                                                                                                            .... modifierExtension
                                                                                                                                                                                                                                                                                                                                                              .... sequence
                                                                                                                                                                                                                                                                                                                                                                .... focal
                                                                                                                                                                                                                                                                                                                                                                  .... coverage
                                                                                                                                                                                                                                                                                                                                                                    .... businessArrangement
                                                                                                                                                                                                                                                                                                                                                                      .... claimResponse
                                                                                                                                                                                                                                                                                                                                                                        ... error
                                                                                                                                                                                                                                                                                                                                                                          .... id
                                                                                                                                                                                                                                                                                                                                                                            .... extension
                                                                                                                                                                                                                                                                                                                                                                              .... modifierExtension
                                                                                                                                                                                                                                                                                                                                                                                .... itemSequence
                                                                                                                                                                                                                                                                                                                                                                                  .... detailSequence
                                                                                                                                                                                                                                                                                                                                                                                    .... subDetailSequence
                                                                                                                                                                                                                                                                                                                                                                                      .... code

                                                                                                                                                                                                                                                                                                                                                                                        doco Documentation for this format

                                                                                                                                                                                                                                                                                                                                                                                        Mappings to other Structures

                                                                                                                                                                                                                                                                                                                                                                                        No Mappings Found

                                                                                                                                                                                                                                                                                                                                                                                        Other Mappings

                                                                                                                                                                                                                                                                                                                                                                                        NameWorkflow PatternFiveWs Pattern MappingRIM Mappingdoco
                                                                                                                                                                                                                                                                                                                                                                                        .. ClaimResponse
                                                                                                                                                                                                                                                                                                                                                                                        Event
                                                                                                                                                                                                                                                                                                                                                                                        • Entity. Role
                                                                                                                                                                                                                                                                                                                                                                                        • or Act
                                                                                                                                                                                                                                                                                                                                                                                        ... id
                                                                                                                                                                                                                                                                                                                                                                                        ... meta
                                                                                                                                                                                                                                                                                                                                                                                        .... id
                                                                                                                                                                                                                                                                                                                                                                                        n/a
                                                                                                                                                                                                                                                                                                                                                                                        .... extension
                                                                                                                                                                                                                                                                                                                                                                                        n/a
                                                                                                                                                                                                                                                                                                                                                                                        .... versionId
                                                                                                                                                                                                                                                                                                                                                                                        .... lastUpdated
                                                                                                                                                                                                                                                                                                                                                                                        .... source
                                                                                                                                                                                                                                                                                                                                                                                        .... profile
                                                                                                                                                                                                                                                                                                                                                                                        .... security
                                                                                                                                                                                                                                                                                                                                                                                        .... tag
                                                                                                                                                                                                                                                                                                                                                                                        ... implicitRules
                                                                                                                                                                                                                                                                                                                                                                                        ... language
                                                                                                                                                                                                                                                                                                                                                                                        ... text
                                                                                                                                                                                                                                                                                                                                                                                        Act.text?
                                                                                                                                                                                                                                                                                                                                                                                        ... contained
                                                                                                                                                                                                                                                                                                                                                                                        N/A
                                                                                                                                                                                                                                                                                                                                                                                        ... extension
                                                                                                                                                                                                                                                                                                                                                                                        N/A
                                                                                                                                                                                                                                                                                                                                                                                        ... modifierExtension
                                                                                                                                                                                                                                                                                                                                                                                        N/A
                                                                                                                                                                                                                                                                                                                                                                                        ... identifier
                                                                                                                                                                                                                                                                                                                                                                                        Event.identifier
                                                                                                                                                                                                                                                                                                                                                                                        FiveWs.identifier
                                                                                                                                                                                                                                                                                                                                                                                        .... id
                                                                                                                                                                                                                                                                                                                                                                                        n/a
                                                                                                                                                                                                                                                                                                                                                                                        .... extension
                                                                                                                                                                                                                                                                                                                                                                                        n/a
                                                                                                                                                                                                                                                                                                                                                                                        .... use
                                                                                                                                                                                                                                                                                                                                                                                        Role.code or implied by context
                                                                                                                                                                                                                                                                                                                                                                                        .... type
                                                                                                                                                                                                                                                                                                                                                                                        Role.code or implied by context
                                                                                                                                                                                                                                                                                                                                                                                        .... system
                                                                                                                                                                                                                                                                                                                                                                                        II.root or Role.id.root
                                                                                                                                                                                                                                                                                                                                                                                        .... value
                                                                                                                                                                                                                                                                                                                                                                                        II.extension or II.root if system indicates OID or GUID (Or Role.id.extension or root)
                                                                                                                                                                                                                                                                                                                                                                                        .... period
                                                                                                                                                                                                                                                                                                                                                                                        Role.effectiveTime or implied by context
                                                                                                                                                                                                                                                                                                                                                                                        .... assigner
                                                                                                                                                                                                                                                                                                                                                                                        II.assigningAuthorityName but note that this is an improper use by the definition of the field. Also Role.scoper
                                                                                                                                                                                                                                                                                                                                                                                        ... status
                                                                                                                                                                                                                                                                                                                                                                                        Event.status
                                                                                                                                                                                                                                                                                                                                                                                        FiveWs.status
                                                                                                                                                                                                                                                                                                                                                                                        ... type
                                                                                                                                                                                                                                                                                                                                                                                        FiveWs.class
                                                                                                                                                                                                                                                                                                                                                                                        ... subType
                                                                                                                                                                                                                                                                                                                                                                                        FiveWs.class
                                                                                                                                                                                                                                                                                                                                                                                        ... use
                                                                                                                                                                                                                                                                                                                                                                                        FiveWs.class
                                                                                                                                                                                                                                                                                                                                                                                        ... patient
                                                                                                                                                                                                                                                                                                                                                                                        FiveWs.subject
                                                                                                                                                                                                                                                                                                                                                                                        ... created
                                                                                                                                                                                                                                                                                                                                                                                        Event.occurrence[x]
                                                                                                                                                                                                                                                                                                                                                                                        FiveWs.recorded
                                                                                                                                                                                                                                                                                                                                                                                        ... insurer
                                                                                                                                                                                                                                                                                                                                                                                        Event.performer
                                                                                                                                                                                                                                                                                                                                                                                        ... requestor
                                                                                                                                                                                                                                                                                                                                                                                        FiveWs.source
                                                                                                                                                                                                                                                                                                                                                                                        ... request
                                                                                                                                                                                                                                                                                                                                                                                        Event.basedOn
                                                                                                                                                                                                                                                                                                                                                                                        FiveWs.why[x]
                                                                                                                                                                                                                                                                                                                                                                                        ... outcome
                                                                                                                                                                                                                                                                                                                                                                                        ... disposition
                                                                                                                                                                                                                                                                                                                                                                                        Event.note
                                                                                                                                                                                                                                                                                                                                                                                        ... preAuthRef
                                                                                                                                                                                                                                                                                                                                                                                        ... preAuthPeriod
                                                                                                                                                                                                                                                                                                                                                                                        ... payeeType
                                                                                                                                                                                                                                                                                                                                                                                        ... item
                                                                                                                                                                                                                                                                                                                                                                                        .... id
                                                                                                                                                                                                                                                                                                                                                                                        n/a
                                                                                                                                                                                                                                                                                                                                                                                        .... extension
                                                                                                                                                                                                                                                                                                                                                                                        n/a
                                                                                                                                                                                                                                                                                                                                                                                        .... modifierExtension
                                                                                                                                                                                                                                                                                                                                                                                        N/A
                                                                                                                                                                                                                                                                                                                                                                                        .... itemSequence
                                                                                                                                                                                                                                                                                                                                                                                        .... noteNumber
                                                                                                                                                                                                                                                                                                                                                                                        .... adjudication
                                                                                                                                                                                                                                                                                                                                                                                        ..... id
                                                                                                                                                                                                                                                                                                                                                                                        n/a
                                                                                                                                                                                                                                                                                                                                                                                        ..... extension
                                                                                                                                                                                                                                                                                                                                                                                        n/a
                                                                                                                                                                                                                                                                                                                                                                                        ..... modifierExtension
                                                                                                                                                                                                                                                                                                                                                                                        N/A
                                                                                                                                                                                                                                                                                                                                                                                        ..... category
                                                                                                                                                                                                                                                                                                                                                                                        ...... id
                                                                                                                                                                                                                                                                                                                                                                                        n/a
                                                                                                                                                                                                                                                                                                                                                                                        ...... extension
                                                                                                                                                                                                                                                                                                                                                                                        n/a
                                                                                                                                                                                                                                                                                                                                                                                        ...... coding
                                                                                                                                                                                                                                                                                                                                                                                        • union(.
                                                                                                                                                                                                                                                                                                                                                                                        • ./translation)
                                                                                                                                                                                                                                                                                                                                                                                        ....... id
                                                                                                                                                                                                                                                                                                                                                                                        n/a
                                                                                                                                                                                                                                                                                                                                                                                        ....... extension
                                                                                                                                                                                                                                                                                                                                                                                        n/a
                                                                                                                                                                                                                                                                                                                                                                                        ....... system
                                                                                                                                                                                                                                                                                                                                                                                        ./codeSystem
                                                                                                                                                                                                                                                                                                                                                                                        ....... version
                                                                                                                                                                                                                                                                                                                                                                                        ./codeSystemVersion
                                                                                                                                                                                                                                                                                                                                                                                        ....... code
                                                                                                                                                                                                                                                                                                                                                                                        ./code
                                                                                                                                                                                                                                                                                                                                                                                        ....... display
                                                                                                                                                                                                                                                                                                                                                                                        CV.displayName
                                                                                                                                                                                                                                                                                                                                                                                        ....... userSelected
                                                                                                                                                                                                                                                                                                                                                                                        CD.codingRationale
                                                                                                                                                                                                                                                                                                                                                                                        ...... text
                                                                                                                                                                                                                                                                                                                                                                                        ./originalText[mediaType/code="text/plain"]/data
                                                                                                                                                                                                                                                                                                                                                                                        ..... reason
                                                                                                                                                                                                                                                                                                                                                                                        ...... id
                                                                                                                                                                                                                                                                                                                                                                                        n/a
                                                                                                                                                                                                                                                                                                                                                                                        ...... extension
                                                                                                                                                                                                                                                                                                                                                                                        n/a
                                                                                                                                                                                                                                                                                                                                                                                        ...... coding
                                                                                                                                                                                                                                                                                                                                                                                        • union(.
                                                                                                                                                                                                                                                                                                                                                                                        • ./translation)
                                                                                                                                                                                                                                                                                                                                                                                        ...... text
                                                                                                                                                                                                                                                                                                                                                                                        ./originalText[mediaType/code="text/plain"]/data
                                                                                                                                                                                                                                                                                                                                                                                        ..... amount
                                                                                                                                                                                                                                                                                                                                                                                        ..... value
                                                                                                                                                                                                                                                                                                                                                                                        .... detail
                                                                                                                                                                                                                                                                                                                                                                                        ..... id
                                                                                                                                                                                                                                                                                                                                                                                        n/a
                                                                                                                                                                                                                                                                                                                                                                                        ..... extension
                                                                                                                                                                                                                                                                                                                                                                                        n/a
                                                                                                                                                                                                                                                                                                                                                                                        ..... modifierExtension
                                                                                                                                                                                                                                                                                                                                                                                        N/A
                                                                                                                                                                                                                                                                                                                                                                                        ..... detailSequence
                                                                                                                                                                                                                                                                                                                                                                                        ..... noteNumber
                                                                                                                                                                                                                                                                                                                                                                                        ..... adjudication
                                                                                                                                                                                                                                                                                                                                                                                        ...... id
                                                                                                                                                                                                                                                                                                                                                                                        n/a
                                                                                                                                                                                                                                                                                                                                                                                        ...... extension
                                                                                                                                                                                                                                                                                                                                                                                        n/a
                                                                                                                                                                                                                                                                                                                                                                                        ...... modifierExtension
                                                                                                                                                                                                                                                                                                                                                                                        N/A
                                                                                                                                                                                                                                                                                                                                                                                        ...... category
                                                                                                                                                                                                                                                                                                                                                                                        ....... id
                                                                                                                                                                                                                                                                                                                                                                                        n/a
                                                                                                                                                                                                                                                                                                                                                                                        ....... extension
                                                                                                                                                                                                                                                                                                                                                                                        n/a
                                                                                                                                                                                                                                                                                                                                                                                        ....... coding
                                                                                                                                                                                                                                                                                                                                                                                        • union(.
                                                                                                                                                                                                                                                                                                                                                                                        • ./translation)
                                                                                                                                                                                                                                                                                                                                                                                        ........ id
                                                                                                                                                                                                                                                                                                                                                                                        n/a
                                                                                                                                                                                                                                                                                                                                                                                        ........ extension
                                                                                                                                                                                                                                                                                                                                                                                        n/a
                                                                                                                                                                                                                                                                                                                                                                                        ........ system
                                                                                                                                                                                                                                                                                                                                                                                        ./codeSystem
                                                                                                                                                                                                                                                                                                                                                                                        ........ version
                                                                                                                                                                                                                                                                                                                                                                                        ./codeSystemVersion
                                                                                                                                                                                                                                                                                                                                                                                        ........ code
                                                                                                                                                                                                                                                                                                                                                                                        ./code
                                                                                                                                                                                                                                                                                                                                                                                        ........ display
                                                                                                                                                                                                                                                                                                                                                                                        CV.displayName
                                                                                                                                                                                                                                                                                                                                                                                        ........ userSelected
                                                                                                                                                                                                                                                                                                                                                                                        CD.codingRationale
                                                                                                                                                                                                                                                                                                                                                                                        ....... text
                                                                                                                                                                                                                                                                                                                                                                                        ./originalText[mediaType/code="text/plain"]/data
                                                                                                                                                                                                                                                                                                                                                                                        ...... reason
                                                                                                                                                                                                                                                                                                                                                                                        ...... amount
                                                                                                                                                                                                                                                                                                                                                                                        ...... value
                                                                                                                                                                                                                                                                                                                                                                                        ..... subDetail
                                                                                                                                                                                                                                                                                                                                                                                        ...... id
                                                                                                                                                                                                                                                                                                                                                                                        n/a
                                                                                                                                                                                                                                                                                                                                                                                        ...... extension
                                                                                                                                                                                                                                                                                                                                                                                        n/a
                                                                                                                                                                                                                                                                                                                                                                                        ...... modifierExtension
                                                                                                                                                                                                                                                                                                                                                                                        N/A
                                                                                                                                                                                                                                                                                                                                                                                        ...... subDetailSequence
                                                                                                                                                                                                                                                                                                                                                                                        ...... noteNumber
                                                                                                                                                                                                                                                                                                                                                                                        ...... adjudication
                                                                                                                                                                                                                                                                                                                                                                                        ... addItem
                                                                                                                                                                                                                                                                                                                                                                                        .... id
                                                                                                                                                                                                                                                                                                                                                                                        n/a
                                                                                                                                                                                                                                                                                                                                                                                        .... extension
                                                                                                                                                                                                                                                                                                                                                                                        n/a
                                                                                                                                                                                                                                                                                                                                                                                        .... modifierExtension
                                                                                                                                                                                                                                                                                                                                                                                        N/A
                                                                                                                                                                                                                                                                                                                                                                                        .... itemSequence
                                                                                                                                                                                                                                                                                                                                                                                        .... detailSequence
                                                                                                                                                                                                                                                                                                                                                                                        .... subdetailSequence
                                                                                                                                                                                                                                                                                                                                                                                        .... provider
                                                                                                                                                                                                                                                                                                                                                                                        FiveWs.source
                                                                                                                                                                                                                                                                                                                                                                                        .... productOrService
                                                                                                                                                                                                                                                                                                                                                                                        .... modifier
                                                                                                                                                                                                                                                                                                                                                                                        • 24.C
                                                                                                                                                                                                                                                                                                                                                                                        • 24.D mods
                                                                                                                                                                                                                                                                                                                                                                                        .... programCode
                                                                                                                                                                                                                                                                                                                                                                                        24.H
                                                                                                                                                                                                                                                                                                                                                                                        .... serviced[x]
                                                                                                                                                                                                                                                                                                                                                                                        FiveWs.done[x]
                                                                                                                                                                                                                                                                                                                                                                                        24.A
                                                                                                                                                                                                                                                                                                                                                                                        .... location[x]
                                                                                                                                                                                                                                                                                                                                                                                        FiveWs.where[x]
                                                                                                                                                                                                                                                                                                                                                                                        24.B
                                                                                                                                                                                                                                                                                                                                                                                        .... quantity
                                                                                                                                                                                                                                                                                                                                                                                        24.G
                                                                                                                                                                                                                                                                                                                                                                                        .... unitPrice
                                                                                                                                                                                                                                                                                                                                                                                        .... factor
                                                                                                                                                                                                                                                                                                                                                                                        .... net
                                                                                                                                                                                                                                                                                                                                                                                        24.F
                                                                                                                                                                                                                                                                                                                                                                                        .... bodySite
                                                                                                                                                                                                                                                                                                                                                                                        .... subSite
                                                                                                                                                                                                                                                                                                                                                                                        .... noteNumber
                                                                                                                                                                                                                                                                                                                                                                                        .... adjudication
                                                                                                                                                                                                                                                                                                                                                                                        .... detail
                                                                                                                                                                                                                                                                                                                                                                                        ..... id
                                                                                                                                                                                                                                                                                                                                                                                        n/a
                                                                                                                                                                                                                                                                                                                                                                                        ..... extension
                                                                                                                                                                                                                                                                                                                                                                                        n/a
                                                                                                                                                                                                                                                                                                                                                                                        ..... modifierExtension
                                                                                                                                                                                                                                                                                                                                                                                        N/A
                                                                                                                                                                                                                                                                                                                                                                                        ..... productOrService
                                                                                                                                                                                                                                                                                                                                                                                        ..... modifier
                                                                                                                                                                                                                                                                                                                                                                                        • 24.C
                                                                                                                                                                                                                                                                                                                                                                                        • 24.D mods
                                                                                                                                                                                                                                                                                                                                                                                        ..... quantity
                                                                                                                                                                                                                                                                                                                                                                                        24.G
                                                                                                                                                                                                                                                                                                                                                                                        ..... unitPrice
                                                                                                                                                                                                                                                                                                                                                                                        ..... factor
                                                                                                                                                                                                                                                                                                                                                                                        ..... net
                                                                                                                                                                                                                                                                                                                                                                                        24.F
                                                                                                                                                                                                                                                                                                                                                                                        ..... noteNumber
                                                                                                                                                                                                                                                                                                                                                                                        ..... adjudication
                                                                                                                                                                                                                                                                                                                                                                                        ..... subDetail
                                                                                                                                                                                                                                                                                                                                                                                        ...... id
                                                                                                                                                                                                                                                                                                                                                                                        n/a
                                                                                                                                                                                                                                                                                                                                                                                        ...... extension
                                                                                                                                                                                                                                                                                                                                                                                        n/a
                                                                                                                                                                                                                                                                                                                                                                                        ...... modifierExtension
                                                                                                                                                                                                                                                                                                                                                                                        N/A
                                                                                                                                                                                                                                                                                                                                                                                        ...... productOrService
                                                                                                                                                                                                                                                                                                                                                                                        ...... modifier
                                                                                                                                                                                                                                                                                                                                                                                        • 24.C
                                                                                                                                                                                                                                                                                                                                                                                        • 24.D mods
                                                                                                                                                                                                                                                                                                                                                                                        ...... quantity
                                                                                                                                                                                                                                                                                                                                                                                        24.G
                                                                                                                                                                                                                                                                                                                                                                                        ...... unitPrice
                                                                                                                                                                                                                                                                                                                                                                                        ...... factor
                                                                                                                                                                                                                                                                                                                                                                                        ...... net
                                                                                                                                                                                                                                                                                                                                                                                        24.F
                                                                                                                                                                                                                                                                                                                                                                                        ...... noteNumber
                                                                                                                                                                                                                                                                                                                                                                                        ...... adjudication
                                                                                                                                                                                                                                                                                                                                                                                        ... adjudication
                                                                                                                                                                                                                                                                                                                                                                                        ... total
                                                                                                                                                                                                                                                                                                                                                                                        .... id
                                                                                                                                                                                                                                                                                                                                                                                        n/a
                                                                                                                                                                                                                                                                                                                                                                                        .... extension
                                                                                                                                                                                                                                                                                                                                                                                        n/a
                                                                                                                                                                                                                                                                                                                                                                                        .... modifierExtension
                                                                                                                                                                                                                                                                                                                                                                                        N/A
                                                                                                                                                                                                                                                                                                                                                                                        .... category
                                                                                                                                                                                                                                                                                                                                                                                        .... amount
                                                                                                                                                                                                                                                                                                                                                                                        ... payment
                                                                                                                                                                                                                                                                                                                                                                                        .... id
                                                                                                                                                                                                                                                                                                                                                                                        n/a
                                                                                                                                                                                                                                                                                                                                                                                        .... extension
                                                                                                                                                                                                                                                                                                                                                                                        n/a
                                                                                                                                                                                                                                                                                                                                                                                        .... modifierExtension
                                                                                                                                                                                                                                                                                                                                                                                        N/A
                                                                                                                                                                                                                                                                                                                                                                                        .... type
                                                                                                                                                                                                                                                                                                                                                                                        .... adjustment
                                                                                                                                                                                                                                                                                                                                                                                        .... adjustmentReason
                                                                                                                                                                                                                                                                                                                                                                                        .... date
                                                                                                                                                                                                                                                                                                                                                                                        .... amount
                                                                                                                                                                                                                                                                                                                                                                                        .... identifier
                                                                                                                                                                                                                                                                                                                                                                                        ... fundsReserve
                                                                                                                                                                                                                                                                                                                                                                                        ... formCode
                                                                                                                                                                                                                                                                                                                                                                                        ... form
                                                                                                                                                                                                                                                                                                                                                                                        ... processNote
                                                                                                                                                                                                                                                                                                                                                                                        .... id
                                                                                                                                                                                                                                                                                                                                                                                        n/a
                                                                                                                                                                                                                                                                                                                                                                                        .... extension
                                                                                                                                                                                                                                                                                                                                                                                        n/a
                                                                                                                                                                                                                                                                                                                                                                                        .... modifierExtension
                                                                                                                                                                                                                                                                                                                                                                                        N/A
                                                                                                                                                                                                                                                                                                                                                                                        .... number
                                                                                                                                                                                                                                                                                                                                                                                        .... type
                                                                                                                                                                                                                                                                                                                                                                                        .... text
                                                                                                                                                                                                                                                                                                                                                                                        .... language
                                                                                                                                                                                                                                                                                                                                                                                        ... communicationRequest
                                                                                                                                                                                                                                                                                                                                                                                        ... insurance
                                                                                                                                                                                                                                                                                                                                                                                        Coverage
                                                                                                                                                                                                                                                                                                                                                                                        .... id
                                                                                                                                                                                                                                                                                                                                                                                        n/a
                                                                                                                                                                                                                                                                                                                                                                                        .... extension
                                                                                                                                                                                                                                                                                                                                                                                        n/a
                                                                                                                                                                                                                                                                                                                                                                                        .... modifierExtension
                                                                                                                                                                                                                                                                                                                                                                                        N/A
                                                                                                                                                                                                                                                                                                                                                                                        .... sequence
                                                                                                                                                                                                                                                                                                                                                                                        .... focal
                                                                                                                                                                                                                                                                                                                                                                                        .... coverage
                                                                                                                                                                                                                                                                                                                                                                                        .... businessArrangement
                                                                                                                                                                                                                                                                                                                                                                                        .... claimResponse
                                                                                                                                                                                                                                                                                                                                                                                        ... error
                                                                                                                                                                                                                                                                                                                                                                                        .... id
                                                                                                                                                                                                                                                                                                                                                                                        n/a
                                                                                                                                                                                                                                                                                                                                                                                        .... extension
                                                                                                                                                                                                                                                                                                                                                                                        n/a
                                                                                                                                                                                                                                                                                                                                                                                        .... modifierExtension
                                                                                                                                                                                                                                                                                                                                                                                        N/A
                                                                                                                                                                                                                                                                                                                                                                                        .... itemSequence
                                                                                                                                                                                                                                                                                                                                                                                        .... detailSequence
                                                                                                                                                                                                                                                                                                                                                                                        .... subDetailSequence
                                                                                                                                                                                                                                                                                                                                                                                        .... code

                                                                                                                                                                                                                                                                                                                                                                                        doco Documentation for this format