An asynchronous response to the $status operation on Claim. Reports various statuses on per item basis.
Identifies the type of the resource
Indicates the purpose of this bundle - how it is intended to be used.
An array of FHIR resources. At a minimum, a the claim status response should include the following entries:
The Resource for the entry. The purpose/meaning of the resource is determined by the Bundle.type.
Identifies the type of the resource
The status of the resource instance.
Type of claim. Example Codes
The recommended system is http://terminology.hl7.org/CodeSystem/claim-type. Typical values include
pharmacy - Pharmacy claims for goods and servicesprofessional - Typically outpatient claims such as Psychological, Chiropractor, rehabilitative, consultinginstitutional - Hospital, clinic and other inpatient claimsA reference to a code defined by a terminology system.
The identification of the code system that defines the meaning of the symbol in the code.
A symbol in syntax defined by the system. The symbol may be a predefined code or an expression in a syntax defined by the coding system (e.g. post-coordination).
A human language representation of the concept as seen/selected/uttered by the user who entered the data and/or which represents the intended meaning of the user.
A code to indicate whether the nature of the request is: to request adjudication of products and services previously rendered; or requesting authorization and adjudication for provision in the future; or requesting the non-binding adjudication of the listed products and services which could be provided in the future.
The party to whom the professional services and/or products have been supplied or are being considered and for whom actual for facast reimbursement is sought.
Must be a resource of type Patient.
A reference to a Patient resource
The date this resource was created.
The party responsible for authorization, adjudication and reimbursement.
Must be a resource of type Organization.
A reference to another resource. This is typically either a relative reference which includes the resource type and ID, or an internal reference which starts with # and refers to a contained resource.
The outcome of the claim, predetermination, or preauthorization processing.
A response detailing the status of each line item.
The provider which is responsible for the claim, predetermination or preauthorization.
Must reference one of the following types of resources:
PractitionerOrganizationA reference to a Practitioner or Organization resource, depending on the setting.
A claim line. Either a simple (a product or service) or a 'group' of details which can also be a simple items or groups of sub-details.
A number to uniquely reference the claim item entries.
If this item is a group then the values here are a summary of the adjudication of the detail items. If this item is a simple product or service then this is the result of the adjudication of this item.
A code to indicate the information type of this adjudication record. Information types may include the value submitted, maximum values or percentages allowed or payable under the plan, amounts that: the patient is responsible for in aggregate or pertaining to this item; amounts paid by other coverages; and, the benefit payable for this item.
A reference to a code defined by a terminology system.
The identification of the code system that defines the meaning of the symbol in the code.
A symbol in syntax defined by the system. The symbol may be a predefined code or an expression in a syntax defined by the coding system (e.g. post-coordination).
A human language representation of the concept as seen/selected/uttered by the user who entered the data and/or which represents the intended meaning of the user.
A code supporting the understanding of the adjudication result and explaining variance from expected amount.
A reference to a code defined by a terminology system.
The identification of the code system that defines the meaning of the symbol in the code.
A symbol in syntax defined by the system. The symbol may be a predefined code or an expression in a syntax defined by the coding system (e.g. post-coordination).
A human language representation of the concept as seen/selected/uttered by the user who entered the data and/or which represents the intended meaning of the user.
The adjudication results which are presented at the header level rather than at the line-item or add-item levels.
A code to indicate the information type of this adjudication record. Information types may include the value submitted, maximum values or percentages allowed or payable under the plan, amounts that: the patient is responsible for in aggregate or pertaining to this item; amounts paid by other coverages; and, the benefit payable for this item.
A reference to a code defined by a terminology system.
The identification of the code system that defines the meaning of the symbol in the code.
A symbol in syntax defined by the system. The symbol may be a predefined code or an expression in a syntax defined by the coding system (e.g. post-coordination).
A human language representation of the concept as seen/selected/uttered by the user who entered the data and/or which represents the intended meaning of the user.
A code supporting the understanding of the adjudication result and explaining variance from expected amount.
A reference to a code defined by a terminology system.
The identification of the code system that defines the meaning of the symbol in the code.
A symbol in syntax defined by the system. The symbol may be a predefined code or an expression in a syntax defined by the coding system (e.g. post-coordination).
A human language representation of the concept as seen/selected/uttered by the user who entered the data and/or which represents the intended meaning of the user.
Financial instruments for reimbursement for the health care products and services specified on the claim.
A number to uniquely identify insurance entries and provide a sequence of coverages to convey coordination of benefit order.
A flag to indicate that this Coverage is to be used for adjudication of this claim when set to true.
Reference to Coverage resource for patient.
Must be a resource of type Coverage.
A reference to another resource. This is typically either a relative reference which includes the resource type and ID, or an internal reference which starts with # and refers to a contained resource.
A business agreement number established between the provider and the insurer for special business processing purposes.
A claim for one patient receiving inpatient services for blood work and an EKG. Attending Provider was Pat Granite, and Referring provider was Joan Fishman.
Identifies the type of the resource
A structured respresentation of the error that occurred
Generally error or fatal
A FHIR category code that describes the general type of issue. See http://hl7.org/fhir/ValueSet/issue-type for details
If the error occurs in the RedoxEngine, this corresponds to an Error record in the organization.
Additional details about the error. This may be a text description of the error or a system code that identifies the error.
A more granular FHIR code for the specific error. Typically from http://hl7.org/fhir/ValueSet/operation-outcome
The identification of the code system that defines the meaning of the symbol in the code.
A symbol in syntax defined by the system. The symbol may be a predefined code or an expression in a syntax defined by the coding system (e.g. post-coordination).
A human-readable interpretation of the issue code
Additional diagnostic information about the issue.