claim-response
type: StructureDefinition
node role: treeRoot
id:
  v: claim-response
text:
  status:
    v: extensions
  div: Generated Narrative: StructureDefinition claim-response Name Flags Card. Type Description & Constraints ClaimResponse ClaimResponse id 1..1 id Logical id of this artifact Max Length:64 meta 1..1 Meta Metadata about the resource profile 1..* DP_canonical(StructureDefinition) Profiles this resource claims to conform to Slices for extension 0..* Extension Extension Slice: Unordered, Open by value:url extension:diagnosisRelatedGroup S 0..1 DP_CodeableConcept Diagnosis Related Group URL: http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-ksa-diagnosis-related-group Binding: Diagnosis Related Group (required) extension:reissue-reason S 0..1 CodeableConcept Adjudication Reissue Reason URL: http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-adjudication-reissue Binding: Reissue Reason (required) extension:adjudication-outcome S 0..1 CodeableConcept Adjudication Outcome URL: http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-adjudication-outcome Binding: Adjudication Outcome (required) extension:batch-identifier S 0..1 DP_Identifier_A Claim Batch Identifier URL: http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-batch-identifier extension:batch-number S 0..1 DP_positiveInt Claim Batch Number URL: http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-batch-number extension:batch-period S 0..1 DP_Period_2 Claim Batch Period URL: http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-batch-period identifier 1..1 DP_Identifier_A Business Identifier for a claim response status 1..1 DP_code active | cancelled | draft | entered-in-error Required Pattern: active type 1..1 DP_CodeableConcept More granular claim type Binding: Claim Type Codes (required) subType 1..1 DP_CodeableConcept More granular claim type Binding: Claim SubType (required) use 1..1 DP_code claim | preauthorization | predetermination patient 1..1 DP_Reference_1or2a(Nphies Patient) The recipient of the products and services identifier …
url:
  v: http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/claim-response
version:
  v: 0.3.0
name:
  v: NphiesClaimResponse
title:
  v: Nphies Claim Response
status:
  v: draft
date:
  v: 2025-06-23T22:09:21+03:00
publisher:
  v: HL7 Saudi Arabia
contact:
  name:
    v: HL7 Saudi Arabia
  telecom:
    system:
      v: url
    value:
      v: http://test-project.org/test-publisher
description:
  v: Nphies Claim Response Profile
jurisdiction:
  coding:
    system:
      v: urn:iso:std:iso:3166
    code:
      v: SA
    display:
      v: Saudi Arabia
copyright:
  v: Used by permission of HL7 International, all rights reserved Creative Commons License
fhir version:
  v: 4.0.1
mapping:
  identity:
    v: workflow
  uri:
    v: http://hl7.org/fhir/workflow
  name:
    v: Workflow Pattern
mapping:
  identity:
    v: w5
  uri:
    v: http://hl7.org/fhir/fivews
  name:
    v: FiveWs Pattern Mapping
mapping:
  identity:
    v: rim
  uri:
    v: http://hl7.org/v3
  name:
    v: RIM Mapping
kind:
  v: resource
abstract:
  v: false
type:
  v: ClaimResponse
base definition:
  v: http://hl7.org/fhir/StructureDefinition/ClaimResponse
  link: http://hl7.org/fhir/StructureDefinition/ClaimResponse
derivation:
  v: constraint
snapshot:
  extension:
    url:
      v: http://hl7.org/fhir/tools/StructureDefinition/snapshot-base-version
    value: string
      v: 4.0.1
  element:
    id:
      v: ClaimResponse
    path:
      v: ClaimResponse
    short:
      v: Response to a claim predetermination or preauthorization
    definition:
      v: This resource provides the adjudication details from the processing of a Claim resource.
    alias:
      v: Remittance Advice
    min:
      v: 0
    max:
      v: *
    base:
      path:
        v: ClaimResponse
      min:
        v: 0
      max:
        v: *
    constraint:
      key:
        v: dom-2
      severity:
        v: error
      human:
        v: If the resource is contained in another resource, it SHALL NOT contain nested Resources
      expression:
        v: contained.contained.empty()
      xpath:
        v: not(parent::f:contained and f:contained)
      source:
        v: http://hl7.org/fhir/StructureDefinition/DomainResource
        link: http://hl7.org/fhir/StructureDefinition/DomainResource
    constraint:
      key:
        v: dom-3
      severity:
        v: error
      human:
        v: If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource
      expression:
        v: contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
      xpath:
        v: not(exists(for $id in f:contained/*/f:id/@value return $contained[not(parent::*/descendant::f:reference/@value=concat('#', $contained/*/id/@value) or descendant::f:reference[@value='#'])]))
      source:
        v: http://hl7.org/fhir/StructureDefinition/DomainResource
        link: http://hl7.org/fhir/StructureDefinition/DomainResource
    constraint:
      key:
        v: dom-4
      severity:
        v: error
      human:
        v: If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated
      expression:
        v: contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
      xpath:
        v: not(exists(f:contained/*/f:meta/f:versionId)) and not(exists(f:contained/*/f:meta/f:lastUpdated))
      source:
        v: http://hl7.org/fhir/StructureDefinition/DomainResource
        link: http://hl7.org/fhir/StructureDefinition/DomainResource
    constraint:
      key:
        v: dom-5
      severity:
        v: error
      human:
        v: If a resource is contained in another resource, it SHALL NOT have a security label
      expression:
        v: contained.meta.security.empty()
      xpath:
        v: not(exists(f:contained/*/f:meta/f:security))
      source:
        v: http://hl7.org/fhir/StructureDefinition/DomainResource
        link: http://hl7.org/fhir/StructureDefinition/DomainResource
    constraint:
      extension:
        value: boolean
      extension:
        value: markdown
      key:
        v: dom-6
      severity:
        v: warning
      human:
        v: A resource should have narrative for robust management
      expression:
        v: text.`div`.exists()
      xpath:
        v: exists(f:text/h:div)
      source:
        v: http://hl7.org/fhir/StructureDefinition/DomainResource
        link: http://hl7.org/fhir/StructureDefinition/DomainResource
    is modifier:
      v: false
    is summary:
      v: false
    mapping:
      identity:
        v: rim
      map:
        v: Entity. Role, or Act
    mapping:
      identity:
        v: workflow
      map:
        v: Event
  element:
    id:
      v: ClaimResponse.id
    path:
      v: ClaimResponse.id
    short:
      v: Logical id of this artifact
    definition:
      v: The logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes.
    comment:
      v: The only time that a resource does not have an id is when it is being submitted to the server using a create operation.

boolean
v: true

markdown
v: When a resource has no narrative, only systems that fully understand the data can display the resource to a human safely. Including a human readable representation in the resource makes for a much more robust eco-system and cheaper handling of resources by intermediary systems. Some ecosystems restrict distribution of resources to only those systems that do fully understand the resources, and as a consequence implementers may believe that the narrative is superfluous. However experience shows that such eco-systems often open up to new participants over time.

v: 1

v: 1

path:
  v: Resource.id
min:
  v: 0
max:
  v: 1

extension:
  url:
    v: http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type
  value: url
    v: id
code:
  v: http://hl7.org/fhirpath/System.String

v: 64

v: false

v: true

id:
  v: ClaimResponse.meta
path:
  v: ClaimResponse.meta
short:
  v: Metadata about the resource
definition:
  v: The metadata about the resource. This is content that is maintained by the infrastructure. Changes to the content might not always be associated with version changes to the resource.
min:
  v: 1
max:
  v: 1
base:
  path:
    v: Resource.meta
  min:
    v: 0
  max:
    v: 1
type:
  code:
    v: Meta
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    link: http://hl7.org/fhir/StructureDefinition/Element
is modifier:
  v: false
is summary:
  v: true

id:
  v: ClaimResponse.meta.id
path:
  v: ClaimResponse.meta.id
representation:
  v: xmlAttr
short:
  v: Unique id for inter-element referencing
definition:
  v: Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: Element.id
  min:
    v: 0
  max:
    v: 1
type:
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type
    value: url
      v: string
  code:
    v: http://hl7.org/fhirpath/System.String
is modifier:
  v: false
is summary:
  v: false
mapping:
  identity:
    v: rim
  map:
    v: n/a

id:
  v: ClaimResponse.meta.extension
path:
  v: ClaimResponse.meta.extension
slicing:
  discriminator:
    type:
      v: value
    path:
      v: url
  description:
    v: Extensions are always sliced by (at least) url
  rules:
    v: open
short:
  v: Additional content defined by implementations
definition:
  v: May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
comment:
  v: There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
alias:
  v: extensions
alias:
  v: user content
min:
  v: 0
max:
  v: *
base:
  path:
    v: Element.extension
  min:
    v: 0
  max:
    v: *
type:
  code:
    v: Extension
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    link: http://hl7.org/fhir/StructureDefinition/Element
constraint:
  key:
    v: ext-1
  severity:
    v: error
  human:
    v: Must have either extensions or value[x], not both
  expression:
    v: extension.exists() != value.exists()
  xpath:
    v: exists(f:extension)!=exists(f:*[starts-with(local-name(.), "value")])
  source:
    v: http://hl7.org/fhir/StructureDefinition/Extension
    link: http://hl7.org/fhir/StructureDefinition/Extension
is modifier:
  v: false
is summary:
  v: false
mapping:
  identity:
    v: rim
  map:
    v: n/a

id:
  v: ClaimResponse.meta.versionId
path:
  v: ClaimResponse.meta.versionId
short:
  v: Version specific identifier
definition:
  v: The version specific identifier, as it appears in the version portion of the URL. This value changes when the resource is created, updated, or deleted.
comment:
  v: The server assigns this value, and ignores what the client specifies, except in the case that the server is imposing version integrity on updates/deletes.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: Meta.versionId
  min:
    v: 0
  max:
    v: 1
type:
  code:
    v: id
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    link: http://hl7.org/fhir/StructureDefinition/Element
is modifier:
  v: false
is summary:
  v: true

id:
  v: ClaimResponse.meta.lastUpdated
path:
  v: ClaimResponse.meta.lastUpdated
short:
  v: When the resource version last changed
definition:
  v: When the resource last changed - e.g. when the version changed.
comment:
  v: This value is always populated except when the resource is first being created. The server / resource manager sets this value; what a client provides is irrelevant. This is equivalent to the HTTP Last-Modified and SHOULD have the same value on a [read](http://hl7.org/fhir/R4/http.html#read) interaction.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: Meta.lastUpdated
  min:
    v: 0
  max:
    v: 1
type:
  code:
    v: instant
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    link: http://hl7.org/fhir/StructureDefinition/Element
is modifier:
  v: false
is summary:
  v: true

id:
  v: ClaimResponse.meta.source
path:
  v: ClaimResponse.meta.source
short:
  v: Identifies where the resource comes from
definition:
  v: A uri that identifies the source system of the resource. This provides a minimal amount of [Provenance](http://hl7.org/fhir/R4/provenance.html#) information that can be used to track or differentiate the source of information in the resource. The source may identify another FHIR server, document, message, database, etc.
comment:
  v: In the provenance resource, this corresponds to Provenance.entity.what[x]. The exact use of the source (and the implied Provenance.entity.role) is left to implementer discretion. Only one nominated source is allowed; for additional provenance details, a full Provenance resource should be used. This element can be used to indicate where the current master source of a resource that has a canonical URL if the resource is no longer hosted at the canonical URL.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: Meta.source
  min:
    v: 0
  max:
    v: 1
type:
  code:
    v: uri
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    link: http://hl7.org/fhir/StructureDefinition/Element
is modifier:
  v: false
is summary:
  v: true

id:
  v: ClaimResponse.meta.profile
path:
  v: ClaimResponse.meta.profile
short:
  v: Profiles this resource claims to conform to
definition:
  v: A list of profiles (references to [StructureDefinition](http://hl7.org/fhir/R4/structuredefinition.html#) resources) that this resource claims to conform to. The URL is a reference to [StructureDefinition.url](http://hl7.org/fhir/R4/structuredefinition-definitions.html#StructureDefinition.url).
comment:
  v: It is up to the server and/or other infrastructure of policy to determine whether/how these claims are verified and/or updated over time. The list of profile URLs is a set.
min:
  v: 1
max:
  v: *
base:
  path:
    v: Meta.profile
  min:
    v: 0
  max:
    v: *
type:
  code:
    v: canonical
  profile:
    v: http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/DP-canonical
    link: http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/DP-canonical
  target profile:
    v: http://hl7.org/fhir/StructureDefinition/StructureDefinition
    link: http://hl7.org/fhir/StructureDefinition/StructureDefinition
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    link: http://hl7.org/fhir/StructureDefinition/Element
is modifier:
  v: false
is summary:
  v: true

id:
  v: ClaimResponse.meta.security
path:
  v: ClaimResponse.meta.security
short:
  v: Security Labels applied to this resource
definition:
  v: Security labels applied to this resource. These tags connect specific resources to the overall security policy and infrastructure.
comment:
  v: The security labels can be updated without changing the stated version of the resource. The list of security labels is a set. Uniqueness is based the system/code, and version and display are ignored.
min:
  v: 0
max:
  v: *
base:
  path:
    v: Meta.security
  min:
    v: 0
  max:
    v: *
type:
  code:
    v: Coding
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    link: http://hl7.org/fhir/StructureDefinition/Element
is modifier:
  v: false
is summary:
  v: true
binding:
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName
    value: string
      v: SecurityLabels
  strength:
    v: extensible
  description:
    v: Security Labels from the Healthcare Privacy and Security Classification System.
  value set:
    v: http://hl7.org/fhir/ValueSet/security-labels
    link: http://hl7.org/fhir/ValueSet/security-labels

id:
  v: ClaimResponse.meta.tag
path:
  v: ClaimResponse.meta.tag
short:
  v: Tags applied to this resource
definition:
  v: Tags applied to this resource. Tags are intended to be used to identify and relate resources to process and workflow, and applications are not required to consider the tags when interpreting the meaning of a resource.
comment:
  v: The tags can be updated without changing the stated version of the resource. The list of tags is a set. Uniqueness is based the system/code, and version and display are ignored.
min:
  v: 0
max:
  v: *
base:
  path:
    v: Meta.tag
  min:
    v: 0
  max:
    v: *
type:
  code:
    v: Coding
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    link: http://hl7.org/fhir/StructureDefinition/Element
is modifier:
  v: false
is summary:
  v: true
binding:
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName
    value: string
      v: Tags
  strength:
    v: example
  description:
    v: Codes that represent various types of tags, commonly workflow-related; e.g. "Needs review by Dr. Jones".
  value set:
    v: http://hl7.org/fhir/ValueSet/common-tags
    link: http://hl7.org/fhir/ValueSet/common-tags

id:
  v: ClaimResponse.implicitRules
path:
  v: ClaimResponse.implicitRules
short:
  v: A set of rules under which this content was created
definition:
  v: A reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content. Often, this is a reference to an implementation guide that defines the special rules along with other profiles etc.
comment:
  v: Asserting this rule set restricts the content to be only understood by a limited set of trading partners. This inherently limits the usefulness of the data in the long term. However, the existing health eco-system is highly fractured, and not yet ready to define, collect, and exchange data in a generally computable sense. Wherever possible, implementers and/or specification writers should avoid using this element. Often, when used, the URL is a reference to an implementation guide that defines these special rules as part of it's narrative along with other profiles, value sets, etc.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: Resource.implicitRules
  min:
    v: 0
  max:
    v: 1
type:
  code:
    v: uri
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    link: http://hl7.org/fhir/StructureDefinition/Element
is modifier:
  v: true
is modifier reason:
  v: This element is labeled as a modifier because the implicit rules may provide additional knowledge about the resource that modifies it's meaning or interpretation
is summary:
  v: true

id:
  v: ClaimResponse.language
path:
  v: ClaimResponse.language
short:
  v: Language of the resource content
definition:
  v: The base language in which the resource is written.
comment:
  v: Language is provided to support indexing and accessibility (typically, services such as text to speech use the language tag). The html language tag in the narrative applies to the narrative. The language tag on the resource may be used to specify the language of other presentations generated from the data in the resource. Not all the content has to be in the base language. The Resource.language should not be assumed to apply to the narrative automatically. If a language is specified, it should it also be specified on the div element in the html (see rules in HTML5 for information about the relationship between xml:lang and the html lang attribute).
min:
  v: 0
max:
  v: 1
base:
  path:
    v: Resource.language
  min:
    v: 0
  max:
    v: 1
type:
  code:
    v: code
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    link: http://hl7.org/fhir/StructureDefinition/Element
is modifier:
  v: false
is summary:
  v: false
binding:
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/elementdefinition-maxValueSet
    value: canonical
      v: http://hl7.org/fhir/ValueSet/all-languages
      link: http://hl7.org/fhir/ValueSet/all-languages
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName
    value: string
      v: Language
  strength:
    v: preferred
  description:
    v: A human language.
  value set:
    v: http://hl7.org/fhir/ValueSet/languages
    link: http://hl7.org/fhir/ValueSet/languages

id:
  v: ClaimResponse.text
path:
  v: ClaimResponse.text
short:
  v: Text summary of the resource, for human interpretation
definition:
  v: A human-readable narrative that contains a summary of the resource and can be used to represent the content of the resource to a human. The narrative need not encode all the structured data, but is required to contain sufficient detail to make it "clinically safe" for a human to just read the narrative. Resource definitions may define what content should be represented in the narrative to ensure clinical safety.
comment:
  v: Contained resources do not have narrative. Resources that are not contained SHOULD have a narrative. In some cases, a resource may only have text with little or no additional discrete data (as long as all minOccurs=1 elements are satisfied). This may be necessary for data from legacy systems where information is captured as a "text blob" or where text is additionally entered raw or narrated and encoded information is added later.
alias:
  v: narrative
alias:
  v: html
alias:
  v: xhtml
alias:
  v: display
min:
  v: 0
max:
  v: 1
base:
  path:
    v: DomainResource.text
  min:
    v: 0
  max:
    v: 1
type:
  code:
    v: Narrative
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    link: http://hl7.org/fhir/StructureDefinition/Element
is modifier:
  v: false
is summary:
  v: false
mapping:
  identity:
    v: rim
  map:
    v: Act.text?

id:
  v: ClaimResponse.contained
path:
  v: ClaimResponse.contained
short:
  v: Contained, inline Resources
definition:
  v: These resources do not have an independent existence apart from the resource that contains them - they cannot be identified independently, and nor can they have their own independent transaction scope.
comment:
  v: This should never be done when the content can be identified properly, as once identification is lost, it is extremely difficult (and context dependent) to restore it again. Contained resources may have profiles and tags In their meta elements, but SHALL NOT have security labels.
alias:
  v: inline resources
alias:
  v: anonymous resources
alias:
  v: contained resources
min:
  v: 0
max:
  v: *
base:
  path:
    v: DomainResource.contained
  min:
    v: 0
  max:
    v: *
type:
  code:
    v: Resource
is modifier:
  v: false
is summary:
  v: false
mapping:
  identity:
    v: rim
  map:
    v: N/A

id:
  v: ClaimResponse.extension
path:
  v: ClaimResponse.extension
slicing:
  discriminator:
    type:
      v: value
    path:
      v: url
  ordered:
    v: false
  rules:
    v: open
short:
  v: Extension
definition:
  v: An Extension
min:
  v: 0
max:
  v: *
base:
  path:
    v: DomainResource.extension
  min:
    v: 0
  max:
    v: *
type:
  code:
    v: Extension
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    link: http://hl7.org/fhir/StructureDefinition/Element
constraint:
  key:
    v: ext-1
  severity:
    v: error
  human:
    v: Must have either extensions or value[x], not both
  expression:
    v: extension.exists() != value.exists()
  xpath:
    v: exists(f:extension)!=exists(f:*[starts-with(local-name(.), "value")])
  source:
    v: http://hl7.org/fhir/StructureDefinition/Extension
    link: http://hl7.org/fhir/StructureDefinition/Extension
is modifier:
  v: false
is summary:
  v: false

id:
  v: ClaimResponse.extension:diagnosisRelatedGroup
path:
  v: ClaimResponse.extension
slice name:
  v: diagnosisRelatedGroup
short:
  v: Diagnosis Related Group
definition:
  v: The Diagnosis Related Group code assigned to the suite of treatment, proposed or performed, value-based care.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: DomainResource.extension
  min:
    v: 0
  max:
    v: *
type:
  code:
    v: Extension
  profile:
    v: http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-ksa-diagnosis-related-group
    link: http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-ksa-diagnosis-related-group
condition:
  v: ele-1
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    link: http://hl7.org/fhir/StructureDefinition/Element
constraint:
  key:
    v: ext-1
  severity:
    v: error
  human:
    v: Must have either extensions or value[x], not both
  expression:
    v: extension.exists() != value.exists()
  xpath:
    v: exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])
  source:
    v: http://hl7.org/fhir/StructureDefinition/Extension
    link: http://hl7.org/fhir/StructureDefinition/Extension
must support:
  v: true
is modifier:
  v: false
is summary:
  v: false

id:
  v: ClaimResponse.extension:reissue-reason
path:
  v: ClaimResponse.extension
slice name:
  v: reissue-reason
short:
  v: Adjudication Reissue Reason
definition:
  v: The reason the adjudicator has reissued an authroization or claim response.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: DomainResource.extension
  min:
    v: 0
  max:
    v: *
type:
  code:
    v: Extension
  profile:
    v: http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-adjudication-reissue
    link: http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-adjudication-reissue
condition:
  v: ele-1
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    link: http://hl7.org/fhir/StructureDefinition/Element
constraint:
  key:
    v: ext-1
  severity:
    v: error
  human:
    v: Must have either extensions or value[x], not both
  expression:
    v: extension.exists() != value.exists()
  xpath:
    v: exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])
  source:
    v: http://hl7.org/fhir/StructureDefinition/Extension
    link: http://hl7.org/fhir/StructureDefinition/Extension
must support:
  v: true
is modifier:
  v: false
is summary:
  v: false

id:
  v: ClaimResponse.extension:adjudication-outcome
path:
  v: ClaimResponse.extension
slice name:
  v: adjudication-outcome
short:
  v: Adjudication Outcome
definition:
  v: A code indicating the outcome of the adjudication such as rejected, partially approved/paid or approved/paid as submitted.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: DomainResource.extension
  min:
    v: 0
  max:
    v: *
type:
  code:
    v: Extension
  profile:
    v: http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-adjudication-outcome
    link: http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-adjudication-outcome
condition:
  v: ele-1
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    link: http://hl7.org/fhir/StructureDefinition/Element
constraint:
  key:
    v: ext-1
  severity:
    v: error
  human:
    v: Must have either extensions or value[x], not both
  expression:
    v: extension.exists() != value.exists()
  xpath:
    v: exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])
  source:
    v: http://hl7.org/fhir/StructureDefinition/Extension
    link: http://hl7.org/fhir/StructureDefinition/Extension
must support:
  v: true
is modifier:
  v: false
is summary:
  v: false

id:
  v: ClaimResponse.extension:batch-identifier
path:
  v: ClaimResponse.extension
slice name:
  v: batch-identifier
short:
  v: Claim Batch Identifier
definition:
  v: A provider supplied id for the Batch. Each Batch must have a unique Batch Id for the issuing provider.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: DomainResource.extension
  min:
    v: 0
  max:
    v: *
type:
  code:
    v: Extension
  profile:
    v: http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-batch-identifier
    link: http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-batch-identifier
condition:
  v: ele-1
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    link: http://hl7.org/fhir/StructureDefinition/Element
constraint:
  key:
    v: ext-1
  severity:
    v: error
  human:
    v: Must have either extensions or value[x], not both
  expression:
    v: extension.exists() != value.exists()
  xpath:
    v: exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])
  source:
    v: http://hl7.org/fhir/StructureDefinition/Extension
    link: http://hl7.org/fhir/StructureDefinition/Extension
must support:
  v: true
is modifier:
  v: false
is summary:
  v: false

id:
  v: ClaimResponse.extension:batch-number
path:
  v: ClaimResponse.extension
slice name:
  v: batch-number
short:
  v: Claim Batch Number
definition:
  v: A provider supplied unique number for each claim within a batch.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: DomainResource.extension
  min:
    v: 0
  max:
    v: *
type:
  code:
    v: Extension
  profile:
    v: http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-batch-number
    link: http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-batch-number
condition:
  v: ele-1
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    link: http://hl7.org/fhir/StructureDefinition/Element
constraint:
  key:
    v: ext-1
  severity:
    v: error
  human:
    v: Must have either extensions or value[x], not both
  expression:
    v: extension.exists() != value.exists()
  xpath:
    v: exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])
  source:
    v: http://hl7.org/fhir/StructureDefinition/Extension
    link: http://hl7.org/fhir/StructureDefinition/Extension
must support:
  v: true
is modifier:
  v: false
is summary:
  v: false

id:
  v: ClaimResponse.extension:batch-period
path:
  v: ClaimResponse.extension
slice name:
  v: batch-period
short:
  v: Claim Batch Period
definition:
  v: The creation period associated with the claims in the batch.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: DomainResource.extension
  min:
    v: 0
  max:
    v: *
type:
  code:
    v: Extension
  profile:
    v: http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-batch-period
    link: http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-batch-period
condition:
  v: ele-1
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    link: http://hl7.org/fhir/StructureDefinition/Element
constraint:
  key:
    v: ext-1
  severity:
    v: error
  human:
    v: Must have either extensions or value[x], not both
  expression:
    v: extension.exists() != value.exists()
  xpath:
    v: exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])
  source:
    v: http://hl7.org/fhir/StructureDefinition/Extension
    link: http://hl7.org/fhir/StructureDefinition/Extension
must support:
  v: true
is modifier:
  v: false
is summary:
  v: false

id:
  v: ClaimResponse.modifierExtension
path:
  v: ClaimResponse.modifierExtension
short:
  v: Extensions that cannot be ignored
definition:
  v: May be used to represent additional information that is not part of the basic definition of the resource and that modifies the understanding of the element that contains it and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).
comment:
  v: There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
requirements:
  v: Modifier extensions allow for extensions that *cannot* be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the [definition of modifier extensions](http://hl7.org/fhir/R4/extensibility.html#modifierExtension).
alias:
  v: extensions
alias:
  v: user content
min:
  v: 0
max:
  v: *
base:
  path:
    v: DomainResource.modifierExtension
  min:
    v: 0
  max:
    v: *
type:
  code:
    v: Extension
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    link: http://hl7.org/fhir/StructureDefinition/Element
constraint:
  key:
    v: ext-1
  severity:
    v: error
  human:
    v: Must have either extensions or value[x], not both
  expression:
    v: extension.exists() != value.exists()
  xpath:
    v: exists(f:extension)!=exists(f:*[starts-with(local-name(.), "value")])
  source:
    v: http://hl7.org/fhir/StructureDefinition/Extension
    link: http://hl7.org/fhir/StructureDefinition/Extension
is modifier:
  v: true
is modifier reason:
  v: Modifier extensions are expected to modify the meaning or interpretation of the resource that contains them
is summary:
  v: false
mapping:
  identity:
    v: rim
  map:
    v: N/A

id:
  v: ClaimResponse.identifier
path:
  v: ClaimResponse.identifier
short:
  v: Business Identifier for a claim response
definition:
  v: A unique identifier assigned to this claim response.
requirements:
  v: Allows claim responses to be distinguished and referenced.
min:
  v: 1
max:
  v: 1
base:
  path:
    v: ClaimResponse.identifier
  min:
    v: 0
  max:
    v: *
type:
  code:
    v: Identifier
  profile:
    v: http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/DP-Identifier-A
    link: http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/DP-Identifier-A
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    link: http://hl7.org/fhir/StructureDefinition/Element
is modifier:
  v: false
is summary:
  v: false
mapping:
  identity:
    v: workflow
  map:
    v: Event.identifier
mapping:
  identity:
    v: w5
  map:
    v: FiveWs.identifier

id:
  v: ClaimResponse.status
path:
  v: ClaimResponse.status
short:
  v: active | cancelled | draft | entered-in-error
definition:
  v: The status of the resource instance.
comment:
  v: This element is labeled as a modifier because the status contains codes that mark the resource as not currently valid.
requirements:
  v: Need to track the status of the resource as 'draft' resources may undergo further edits while 'active' resources are immutable and may only have their status changed to 'cancelled'.
min:
  v: 1
max:
  v: 1
base:
  path:
    v: ClaimResponse.status
  min:
    v: 1
  max:
    v: 1
type:
  code:
    v: code
  profile:
    v: http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/DP-code
    link: http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/DP-code
pattern: code
  v: active
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    link: http://hl7.org/fhir/StructureDefinition/Element
is modifier:
  v: true
is modifier reason:
  v: This element is labeled as a modifier because it is a status element that contains status entered-in-error which means that the resource should not be treated as valid
is summary:
  v: true
binding:
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName
    value: string
      v: ClaimResponseStatus
  strength:
    v: required
  description:
    v: A code specifying the state of the resource instance.
  value set:
    v: http://hl7.org/fhir/ValueSet/fm-status|4.0.1
    link: 4.0
    link: .1
mapping:
  identity:
    v: workflow
  map:
    v: Event.status
mapping:
  identity:
    v: w5
  map:
    v: FiveWs.status

id:
  v: ClaimResponse.type
path:
  v: ClaimResponse.type
short:
  v: More granular claim type
definition:
  v: A finer grained suite of claim type codes which may convey additional information such as Inpatient vs Outpatient and/or a specialty service.
comment:
  v: This may contain the local bill type codes, for example the US UB-04 bill type code or the CMS bill type.
requirements:
  v: Some jurisdictions need a finer grained claim type for routing and adjudication.
min:
  v: 1
max:
  v: 1
base:
  path:
    v: ClaimResponse.type
  min:
    v: 1
  max:
    v: 1
type:
  code:
    v: CodeableConcept
  profile:
    v: http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/DP-CodeableConcept
    link: http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/DP-CodeableConcept
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    link: http://hl7.org/fhir/StructureDefinition/Element
is modifier:
  v: false
is summary:
  v: true
binding:
  strength:
    v: required
  value set:
    v: http://nphies.sa/terminology/ValueSet/claim-type
    link: http://nphies.sa/terminology/ValueSet/claim-type
mapping:
  identity:
    v: w5
  map:
    v: FiveWs.class

id:
  v: ClaimResponse.subType
path:
  v: ClaimResponse.subType
short:
  v: More granular claim type
definition:
  v: A finer grained suite of claim type codes which may convey additional information such as Inpatient vs Outpatient and/or a specialty service.
comment:
  v: This may contain the local bill type codes, for example the US UB-04 bill type code or the CMS bill type.
requirements:
  v: Some jurisdictions need a finer grained claim type for routing and adjudication.
min:
  v: 1
max:
  v: 1
base:
  path:
    v: ClaimResponse.subType
  min:
    v: 0
  max:
    v: 1
type:
  code:
    v: CodeableConcept
  profile:
    v: http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/DP-CodeableConcept
    link: http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/DP-CodeableConcept
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    link: http://hl7.org/fhir/StructureDefinition/Element
is modifier:
  v: false
is summary:
  v: false
binding:
  strength:
    v: required
  value set:
    v: http://nphies.sa/terminology/ValueSet/claim-subtype
    link: http://nphies.sa/terminology/ValueSet/claim-subtype
mapping:
  identity:
    v: w5
  map:
    v: FiveWs.class

id:
  v: ClaimResponse.use
path:
  v: ClaimResponse.use
short:
  v: claim | preauthorization | predetermination
definition:
  v: 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.
requirements:
  v: This element is required to understand the nature of the request for adjudication.
min:
  v: 1
max:
  v: 1
base:
  path:
    v: ClaimResponse.use
  min:
    v: 1
  max:
    v: 1
type:
  code:
    v: code
  profile:
    v: http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/DP-code
    link: http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/DP-code
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    link: http://hl7.org/fhir/StructureDefinition/Element
is modifier:
  v: false
is summary:
  v: true
binding:
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName
    value: string
      v: Use
  strength:
    v: required
  description:
    v: Claim, preauthorization, predetermination.
  value set:
    v: http://hl7.org/fhir/ValueSet/claim-use|4.0.1
    link: 4.0
    link: .1
mapping:
  identity:
    v: w5
  map:
    v: FiveWs.class

id:
  v: ClaimResponse.patient
path:
  v: ClaimResponse.patient
short:
  v: The recipient of the products and services
definition:
  v: 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.
requirements:
  v: The patient must be supplied to the insurer so that confirmation of coverage and service hstory may be considered as part of the authorization and/or adjudiction.
min:
  v: 1
max:
  v: 1
base:
  path:
    v: ClaimResponse.patient
  min:
    v: 1
  max:
    v: 1
type:
  code:
    v: Reference
  profile:
    v: http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/DP-Reference-1or2a
    link: http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/DP-Reference-1or2a
  target profile:
    v: http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/patient
    link: http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/patient
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    link: http://hl7.org/fhir/StructureDefinition/Element
is modifier:
  v: false
is summary:
  v: true
mapping:
  identity:
    v: w5
  map:
    v: FiveWs.subject[x]
mapping:
  identity:
    v: w5
  map:
    v: FiveWs.subject

id:
  v: ClaimResponse.patient.id
path:
  v: ClaimResponse.patient.id
representation:
  v: xmlAttr
short:
  v: Unique id for inter-element referencing
definition:
  v: Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: Element.id
  min:
    v: 0
  max:
    v: 1
type:
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type
    value: url
      v: string
  code:
    v: http://hl7.org/fhirpath/System.String
is modifier:
  v: false
is summary:
  v: false
mapping:
  identity:
    v: rim
  map:
    v: n/a

id:
  v: ClaimResponse.patient.extension
path:
  v: ClaimResponse.patient.extension
slicing:
  discriminator:
    type:
      v: value
    path:
      v: url
  description:
    v: Extensions are always sliced by (at least) url
  rules:
    v: open
short:
  v: Additional content defined by implementations
definition:
  v: May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
comment:
  v: There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
alias:
  v: extensions
alias:
  v: user content
min:
  v: 0
max:
  v: *
base:
  path:
    v: Element.extension
  min:
    v: 0
  max:
    v: *
type:
  code:
    v: Extension
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    link: http://hl7.org/fhir/StructureDefinition/Element
constraint:
  key:
    v: ext-1
  severity:
    v: error
  human:
    v: Must have either extensions or value[x], not both
  expression:
    v: extension.exists() != value.exists()
  xpath:
    v: exists(f:extension)!=exists(f:*[starts-with(local-name(.), "value")])
  source:
    v: http://hl7.org/fhir/StructureDefinition/Extension
    link: http://hl7.org/fhir/StructureDefinition/Extension
is modifier:
  v: false
is summary:
  v: false
mapping:
  identity:
    v: rim
  map:
    v: n/a

id:
  v: ClaimResponse.patient.reference
path:
  v: ClaimResponse.patient.reference
short:
  v: Literal reference, Relative, internal or absolute URL
definition:
  v: A reference to a location at which the other resource is found. The reference may be a relative reference, in which case it is relative to the service base URL, or an absolute URL that resolves to the location where the resource is found. The reference may be version specific or not. If the reference is not to a FHIR RESTful server, then it should be assumed to be version specific. Internal fragment references (start with '#') refer to contained resources.
comment:
  v: Using absolute URLs provides a stable scalable approach suitable for a cloud/web context, while using relative/logical references provides a flexible approach suitable for use when trading across closed eco-system boundaries. Absolute URLs do not need to point to a FHIR RESTful server, though this is the preferred approach. If the URL conforms to the structure "/[type]/[id]" then it should be assumed that the reference is to a FHIR RESTful server.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: Reference.reference
  min:
    v: 0
  max:
    v: 1
type:
  code:
    v: string
max length:
  v: 250
condition:
  v: ref-1
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    link: http://hl7.org/fhir/StructureDefinition/Element
must support:
  v: true
is modifier:
  v: false
is summary:
  v: true
mapping:
  identity:
    v: rim
  map:
    v: N/A

id:
  v: ClaimResponse.patient.type
path:
  v: ClaimResponse.patient.type
short:
  v: Type the reference refers to (e.g. "Patient")
definition:
  v: The expected type of the target of the reference. If both Reference.type and Reference.reference are populated and Reference.reference is a FHIR URL, both SHALL be consistent. The type is the Canonical URL of Resource Definition that is the type this reference refers to. References are URLs that are relative to http://hl7.org/fhir/StructureDefinition/ e.g. "Patient" is a reference to http://hl7.org/fhir/StructureDefinition/Patient. Absolute URLs are only allowed for logical models (and can only be used in references in logical models, not resources).
comment:
  v: This element is used to indicate the type of the target of the reference. This may be used which ever of the other elements are populated (or not). In some cases, the type of the target may be determined by inspection of the reference (e.g. a RESTful URL) or by resolving the target of the reference; if both the type and a reference is provided, the reference SHALL resolve to a resource of the same type as that specified.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: Reference.type
  min:
    v: 0
  max:
    v: 1
type:
  code:
    v: uri
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    link: http://hl7.org/fhir/StructureDefinition/Element
is modifier:
  v: false
is summary:
  v: true
binding:
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName
    value: string
      v: FHIRResourceTypeExt
  strength:
    v: extensible
  description:
    v: Aa resource (or, for logical models, the URI of the logical model).
  value set:
    v: http://hl7.org/fhir/ValueSet/resource-types
    link: http://hl7.org/fhir/ValueSet/resource-types
mapping:
  identity:
    v: rim
  map:
    v: N/A

id:
  v: ClaimResponse.patient.identifier
path:
  v: ClaimResponse.patient.identifier
short:
  v: Logical reference, when literal reference is not known
definition:
  v: An identifier for the target resource. This is used when there is no way to reference the other resource directly, either because the entity it represents is not available through a FHIR server, or because there is no way for the author of the resource to convert a known identifier to an actual location. There is no requirement that a Reference.identifier point to something that is actually exposed as a FHIR instance, but it SHALL point to a business concept that would be expected to be exposed as a FHIR instance, and that instance would need to be of a FHIR resource type allowed by the reference.
comment:
  v: When an identifier is provided in place of a reference, any system processing the reference will only be able to resolve the identifier to a reference if it understands the business context in which the identifier is used. Sometimes this is global (e.g. a national identifier) but often it is not. For this reason, none of the useful mechanisms described for working with references (e.g. chaining, includes) are possible, nor should servers be expected to be able resolve the reference. Servers may accept an identifier based reference untouched, resolve it, and/or reject it - see CapabilityStatement.rest.resource.referencePolicy. When both an identifier and a literal reference are provided, the literal reference is preferred. Applications processing the resource are allowed - but not required - to check that the identifier matches the literal reference Applications converting a logical reference to a literal reference may choose to leave the logical reference present, or remove it. Reference is intended to point to a structure that can potentially be expressed as a FHIR resource, though there is no need for it to exist as an actual FHIR resource instance - except in as much as an application wishes to actual find the target of the reference. The content referred to be the identifier must meet the logical constraints implied by any limitations on what resource types are permitted for the reference. For example, it would not be legitimate to send the identifier for a drug prescription if the type were Reference(Observation|DiagnosticReport). One of the use-cases for Reference.identifier is the situation where no FHIR representation exists (where the type is Reference (Any).
min:
  v: 0
max:
  v: 1
base:
  path:
    v: Reference.identifier
  min:
    v: 0
  max:
    v: 1
type:
  code:
    v: Identifier
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    link: http://hl7.org/fhir/StructureDefinition/Element
must support:
  v: true
is modifier:
  v: false
is summary:
  v: true
mapping:
  identity:
    v: rim
  map:
    v: .identifier

id:
  v: ClaimResponse.patient.identifier.id
path:
  v: ClaimResponse.patient.identifier.id
representation:
  v: xmlAttr
short:
  v: Unique id for inter-element referencing
definition:
  v: Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: Element.id
  min:
    v: 0
  max:
    v: 1
type:
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type
    value: url
      v: string
  code:
    v: http://hl7.org/fhirpath/System.String
is modifier:
  v: false
is summary:
  v: false
mapping:
  identity:
    v: rim
  map:
    v: n/a

id:
  v: ClaimResponse.patient.identifier.extension
path:
  v: ClaimResponse.patient.identifier.extension
slicing:
  discriminator:
    type:
      v: value
    path:
      v: url
  description:
    v: Extensions are always sliced by (at least) url
  rules:
    v: open
short:
  v: Additional content defined by implementations
definition:
  v: May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
comment:
  v: There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
alias:
  v: extensions
alias:
  v: user content
min:
  v: 0
max:
  v: *
base:
  path:
    v: Element.extension
  min:
    v: 0
  max:
    v: *
type:
  code:
    v: Extension
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    link: http://hl7.org/fhir/StructureDefinition/Element
constraint:
  key:
    v: ext-1
  severity:
    v: error
  human:
    v: Must have either extensions or value[x], not both
  expression:
    v: extension.exists() != value.exists()
  xpath:
    v: exists(f:extension)!=exists(f:*[starts-with(local-name(.), "value")])
  source:
    v: http://hl7.org/fhir/StructureDefinition/Extension
    link: http://hl7.org/fhir/StructureDefinition/Extension
is modifier:
  v: false
is summary:
  v: false
mapping:
  identity:
    v: rim
  map:
    v: n/a

id:
  v: ClaimResponse.patient.identifier.use
path:
  v: ClaimResponse.patient.identifier.use
short:
  v: usual | official | temp | secondary | old (If known)
definition:
  v: The purpose of this identifier.
comment:
  v: Applications can assume that an identifier is permanent unless it explicitly says that it is temporary.
requirements:
  v: Allows the appropriate identifier for a particular context of use to be selected from among a set of identifiers.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: Identifier.use
  min:
    v: 0
  max:
    v: 1
type:
  code:
    v: code
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    link: http://hl7.org/fhir/StructureDefinition/Element
is modifier:
  v: true
is modifier reason:
  v: This is labeled as "Is Modifier" because applications should not mistake a temporary id for a permanent one.
is summary:
  v: true
binding:
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName
    value: string
      v: IdentifierUse
  strength:
    v: required
  description:
    v: Identifies the purpose for this identifier, if known .
  value set:
    v: http://hl7.org/fhir/ValueSet/identifier-use|4.0.1
    link: 4.0
    link: .1
mapping:
  identity:
    v: v2
  map:
    v: N/A
mapping:
  identity:
    v: rim
  map:
    v: Role.code or implied by context

id:
  v: ClaimResponse.patient.identifier.type
path:
  v: ClaimResponse.patient.identifier.type
short:
  v: Description of identifier
definition:
  v: A coded type for the identifier that can be used to determine which identifier to use for a specific purpose.
comment:
  v: This element deals only with general categories of identifiers. It SHOULD not be used for codes that correspond 1..1 with the Identifier.system. Some identifiers may fall into multiple categories due to common usage. Where the system is known, a type is unnecessary because the type is always part of the system definition. However systems often need to handle identifiers where the system is not known. There is not a 1:1 relationship between type and system, since many different systems have the same type.
requirements:
  v: Allows users to make use of identifiers when the identifier system is not known.
min:
  v: 1
max:
  v: 1
base:
  path:
    v: Identifier.type
  min:
    v: 0
  max:
    v: 1
type:
  code:
    v: CodeableConcept
  profile:
    v: http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/DP-CodeableConcept
    link: http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/DP-CodeableConcept
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    link: http://hl7.org/fhir/StructureDefinition/Element
is modifier:
  v: false
is summary:
  v: true
binding:
  strength:
    v: required
  value set:
    v: http://nphies.sa/terminology/ValueSet/patient-identifier-type
    link: http://nphies.sa/terminology/ValueSet/patient-identifier-type
mapping:
  identity:
    v: v2
  map:
    v: CX.5
mapping:
  identity:
    v: rim
  map:
    v: Role.code or implied by context

id:
  v: ClaimResponse.patient.identifier.system
path:
  v: ClaimResponse.patient.identifier.system
short:
  v: The namespace for the identifier value
definition:
  v: Establishes the namespace for the value - that is, a URL that describes a set values that are unique.
comment:
  v: Identifier.system is always case sensitive.
requirements:
  v: There are many sets of identifiers. To perform matching of two identifiers, we need to know what set we're dealing with. The system identifies a particular set of unique identifiers.
min:
  v: 1
max:
  v: 1
base:
  path:
    v: Identifier.system
  min:
    v: 0
  max:
    v: 1
type:
  code:
    v: uri
  profile:
    v: http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/DP-uri
    link: http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/DP-uri
example:
  label:
    v: General
  value: uri
    v: http://www.acme.com/identifiers/patient
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    link: http://hl7.org/fhir/StructureDefinition/Element
is modifier:
  v: false
is summary:
  v: true
mapping:
  identity:
    v: v2
  map:
    v: CX.4 / EI-2-4
mapping:
  identity:
    v: rim
  map:
    v: II.root or Role.id.root
mapping:
  identity:
    v: servd
  map:
    v: ./IdentifierType

id:
  v: ClaimResponse.patient.identifier.value
path:
  v: ClaimResponse.patient.identifier.value
short:
  v: The value that is unique
definition:
  v: The portion of the identifier typically relevant to the user and which is unique within the context of the system.
comment:
  v: If the value is a full URI, then the system SHALL be urn:ietf:rfc:3986. The value's primary purpose is computational mapping. As a result, it may be normalized for comparison purposes (e.g. removing non-significant whitespace, dashes, etc.) A value formatted for human display can be conveyed using the [Rendered Value extension](http://hl7.org/fhir/R4/extension-rendered-value.html). Identifier.value is to be treated as case sensitive unless knowledge of the Identifier.system allows the processer to be confident that non-case-sensitive processing is safe.
min:
  v: 1
max:
  v: 1
base:
  path:
    v: Identifier.value
  min:
    v: 0
  max:
    v: 1
type:
  code:
    v: string
example:
  label:
    v: General
  value: string
    v: 123456
max length:
  v: 50
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    link: http://hl7.org/fhir/StructureDefinition/Element
is modifier:
  v: false
is summary:
  v: true
mapping:
  identity:
    v: v2
  map:
    v: CX.1 / EI.1
mapping:
  identity:
    v: rim
  map:
    v: II.extension or II.root if system indicates OID or GUID (Or Role.id.extension or root)
mapping:
  identity:
    v: servd
  map:
    v: ./Value

id:
  v: ClaimResponse.patient.identifier.period
path:
  v: ClaimResponse.patient.identifier.period
short:
  v: Time period when id is/was valid for use
definition:
  v: Time period during which identifier is/was valid for use.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: Identifier.period
  min:
    v: 0
  max:
    v: 1
type:
  code:
    v: Period
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    link: http://hl7.org/fhir/StructureDefinition/Element
is modifier:
  v: false
is summary:
  v: true
mapping:
  identity:
    v: v2
  map:
    v: CX.7 + CX.8
mapping:
  identity:
    v: rim
  map:
    v: Role.effectiveTime or implied by context
mapping:
  identity:
    v: servd
  map:
    v: ./StartDate and ./EndDate

id:
  v: ClaimResponse.patient.identifier.assigner
path:
  v: ClaimResponse.patient.identifier.assigner
short:
  v: Organization that issued id (may be just text)
definition:
  v: Organization that issued/manages the identifier.
comment:
  v: The Identifier.assigner may omit the .reference element and only contain a .display element reflecting the name or other textual information about the assigning organization.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: Identifier.assigner
  min:
    v: 0
  max:
    v: 1
type:
  code:
    v: Reference
  target profile:
    v: http://hl7.org/fhir/StructureDefinition/Organization
    link: http://hl7.org/fhir/StructureDefinition/Organization
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    link: http://hl7.org/fhir/StructureDefinition/Element
is modifier:
  v: false
is summary:
  v: true
mapping:
  identity:
    v: v2
  map:
    v: CX.4 / (CX.4,CX.9,CX.10)
mapping:
  identity:
    v: rim
  map:
    v: II.assigningAuthorityName but note that this is an improper use by the definition of the field. Also Role.scoper
mapping:
  identity:
    v: servd
  map:
    v: ./IdentifierIssuingAuthority

id:
  v: ClaimResponse.patient.display
extension:
  url:
    v: http://hl7.org/fhir/StructureDefinition/elementdefinition-translatable
  value: boolean
    v: true
path:
  v: ClaimResponse.patient.display
short:
  v: Text alternative for the resource
definition:
  v: Plain text narrative that identifies the resource in addition to the resource reference.
comment:
  v: This is generally not the same as the Resource.text of the referenced resource. The purpose is to identify what's being referenced, not to fully describe it.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: Reference.display
  min:
    v: 0
  max:
    v: 1
type:
  code:
    v: string
max length:
  v: 200
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    link: http://hl7.org/fhir/StructureDefinition/Element
is modifier:
  v: false
is summary:
  v: true
mapping:
  identity:
    v: rim
  map:
    v: N/A

id:
  v: ClaimResponse.created
path:
  v: ClaimResponse.created
short:
  v: Response creation date
definition:
  v: The date this resource was created.
requirements:
  v: Need to record a timestamp for use by both the recipient and the issuer.
min:
  v: 1
max:
  v: 1
base:
  path:
    v: ClaimResponse.created
  min:
    v: 1
  max:
    v: 1
type:
  code:
    v: dateTime
  profile:
    v: http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/DP-dateTime
    link: http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/DP-dateTime
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    link: http://hl7.org/fhir/StructureDefinition/Element
is modifier:
  v: false
is summary:
  v: true
mapping:
  identity:
    v: workflow
  map:
    v: Event.occurrence[x]
mapping:
  identity:
    v: w5
  map:
    v: FiveWs.recorded

id:
  v: ClaimResponse.insurer
path:
  v: ClaimResponse.insurer
short:
  v: Party responsible for reimbursement
definition:
  v: The party responsible for authorization, adjudication and reimbursement.
requirements:
  v: To be a valid claim, preauthorization or predetermination there must be a party who is responsible for adjudicating the contents against a policy which provides benefits for the patient.
min:
  v: 1
max:
  v: 1
base:
  path:
    v: ClaimResponse.insurer
  min:
    v: 1
  max:
    v: 1
type:
  code:
    v: Reference
  profile:
    v: http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/DP-Reference-1or2a
    link: http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/DP-Reference-1or2a
  target profile:
    v: http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/insurer-organization
    link: http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/insurer-organization
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    link: http://hl7.org/fhir/StructureDefinition/Element
is modifier:
  v: false
is summary:
  v: true
mapping:
  identity:
    v: workflow
  map:
    v: Event.performer

id:
  v: ClaimResponse.requestor
path:
  v: ClaimResponse.requestor
short:
  v: Party responsible for the claim
definition:
  v: The provider which is responsible for the claim, predetermination or preauthorization.
comment:
  v: Typically this field would be 1..1 where this party is responsible for the claim but not necessarily professionally responsible for the provision of the individual products and services listed below.
min:
  v: 1
max:
  v: 1
base:
  path:
    v: ClaimResponse.requestor
  min:
    v: 0
  max:
    v: 1
type:
  code:
    v: Reference
  profile:
    v: http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/DP-Reference-1or2a
    link: http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/DP-Reference-1or2a
  target profile:
    v: http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/provider-organization
    link: http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/provider-organization
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    link: http://hl7.org/fhir/StructureDefinition/Element
is modifier:
  v: false
is summary:
  v: false
mapping:
  identity:
    v: w5
  map:
    v: FiveWs.source

id:
  v: ClaimResponse.request
path:
  v: ClaimResponse.request
short:
  v: Id of resource triggering adjudication
definition:
  v: Original request resource reference.
min:
  v: 1
max:
  v: 1
base:
  path:
    v: ClaimResponse.request
  min:
    v: 0
  max:
    v: 1
type:
  code:
    v: Reference
  profile:
    v: http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/DP-Reference-1or3a
    link: http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/DP-Reference-1or3a
  target profile:
    v: http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/claim-base
    link: http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/claim-base
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    link: http://hl7.org/fhir/StructureDefinition/Element
is modifier:
  v: false
is summary:
  v: true
mapping:
  identity:
    v: workflow
  map:
    v: Event.basedOn
mapping:
  identity:
    v: w5
  map:
    v: FiveWs.why[x]

id:
  v: ClaimResponse.outcome
path:
  v: ClaimResponse.outcome
short:
  v: queued | complete | error | partial
definition:
  v: The outcome of the claim, predetermination, or preauthorization processing.
comment:
  v: The resource may be used to indicate that: the request has been held (queued) for processing; that it has been processed and errors found (error); that no errors were found and that some of the adjudication has been undertaken (partial) or that all of the adjudication has been undertaken (complete).
requirements:
  v: To advise the requestor of an overall processing outcome.
min:
  v: 1
max:
  v: 1
base:
  path:
    v: ClaimResponse.outcome
  min:
    v: 1
  max:
    v: 1
type:
  code:
    v: code
  profile:
    v: http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/DP-code
    link: http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/DP-code
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    link: http://hl7.org/fhir/StructureDefinition/Element
is modifier:
  v: false
is summary:
  v: true
binding:
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName
    value: string
      v: RemittanceOutcome
  strength:
    v: required
  description:
    v: The result of the claim processing.
  value set:
    v: http://hl7.org/fhir/ValueSet/remittance-outcome|4.0.1
    link: 4.0
    link: .1

id:
  v: ClaimResponse.disposition
path:
  v: ClaimResponse.disposition
short:
  v: Disposition Message
definition:
  v: A human readable description of the status of the adjudication.
requirements:
  v: Provided for user display.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: ClaimResponse.disposition
  min:
    v: 0
  max:
    v: 1
type:
  code:
    v: string
  profile:
    v: http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/DP-string
    link: http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/DP-string
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    link: http://hl7.org/fhir/StructureDefinition/Element
must support:
  v: true
is modifier:
  v: false
is summary:
  v: false
mapping:
  identity:
    v: workflow
  map:
    v: Event.note

id:
  v: ClaimResponse.preAuthRef
path:
  v: ClaimResponse.preAuthRef
short:
  v: Preauthorization reference
definition:
  v: Reference from the Insurer which is used in later communications which refers to this adjudication.
comment:
  v: This value is only present on preauthorization adjudications.
requirements:
  v: On subsequent claims, the insurer may require the provider to quote this value.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: ClaimResponse.preAuthRef
  min:
    v: 0
  max:
    v: 1
type:
  code:
    v: string
  profile:
    v: http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/DP-string
    link: http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/DP-string
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    link: http://hl7.org/fhir/StructureDefinition/Element
must support:
  v: true
is modifier:
  v: false
is summary:
  v: false

id:
  v: ClaimResponse.preAuthPeriod
path:
  v: ClaimResponse.preAuthPeriod
short:
  v: Preauthorization reference effective period
definition:
  v: The time frame during which this authorization is effective.
requirements:
  v: To convey to the provider when the authorized products and services must be supplied for the authorized adjudication to apply.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: ClaimResponse.preAuthPeriod
  min:
    v: 0
  max:
    v: 1
type:
  code:
    v: Period
  profile:
    v: http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/DP-Period-2
    link: http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/DP-Period-2
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    link: http://hl7.org/fhir/StructureDefinition/Element
must support:
  v: true
is modifier:
  v: false
is summary:
  v: false

id:
  v: ClaimResponse.payeeType
path:
  v: ClaimResponse.payeeType
short:
  v: Party to be paid any benefits payable
definition:
  v: Type of Party to be reimbursed: subscriber, provider, other.
requirements:
  v: Need to know who should receive payment with the most common situations being the Provider (assignment of benefits) or the Subscriber.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: ClaimResponse.payeeType
  min:
    v: 0
  max:
    v: 1
type:
  code:
    v: CodeableConcept
  profile:
    v: http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/DP-CodeableConcept
    link: http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/DP-CodeableConcept
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    link: http://hl7.org/fhir/StructureDefinition/Element
must support:
  v: true
is modifier:
  v: false
is summary:
  v: false
binding:
  strength:
    v: required
  value set:
    v: http://hl7.org/fhir/ValueSet/payeetype
    link: http://hl7.org/fhir/ValueSet/payeetype

id:
  v: ClaimResponse.item
path:
  v: ClaimResponse.item
short:
  v: Adjudication for claim line items
definition:
  v: 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.
requirements:
  v: The adjudication for items provided on the claim.
min:
  v: 0
max:
  v: *
base:
  path:
    v: ClaimResponse.item
  min:
    v: 0
  max:
    v: *
type:
  code:
    v: BackboneElement
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    link: http://hl7.org/fhir/StructureDefinition/Element
must support:
  v: true
is modifier:
  v: false
is summary:
  v: false

id:
  v: ClaimResponse.item.id
path:
  v: ClaimResponse.item.id
representation:
  v: xmlAttr
short:
  v: Unique id for inter-element referencing
definition:
  v: Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: Element.id
  min:
    v: 0
  max:
    v: 1
type:
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type
    value: url
      v: string
  code:
    v: http://hl7.org/fhirpath/System.String
is modifier:
  v: false
is summary:
  v: false
mapping:
  identity:
    v: rim
  map:
    v: n/a

id:
  v: ClaimResponse.item.extension
path:
  v: ClaimResponse.item.extension
slicing:
  discriminator:
    type:
      v: value
    path:
      v: url
  ordered:
    v: false
  rules:
    v: open
short:
  v: Extension
definition:
  v: An Extension
min:
  v: 0
max:
  v: *
base:
  path:
    v: Element.extension
  min:
    v: 0
  max:
    v: *
type:
  code:
    v: Extension
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    link: http://hl7.org/fhir/StructureDefinition/Element
constraint:
  key:
    v: ext-1
  severity:
    v: error
  human:
    v: Must have either extensions or value[x], not both
  expression:
    v: extension.exists() != value.exists()
  xpath:
    v: exists(f:extension)!=exists(f:*[starts-with(local-name(.), "value")])
  source:
    v: http://hl7.org/fhir/StructureDefinition/Extension
    link: http://hl7.org/fhir/StructureDefinition/Extension
is modifier:
  v: false
is summary:
  v: false

id:
  v: ClaimResponse.item.extension:adjudication-outcome
path:
  v: ClaimResponse.item.extension
slice name:
  v: adjudication-outcome
short:
  v: Adjudication Outcome
definition:
  v: A code indicating the outcome of the adjudication such as rejected, partially approved/paid or approved/paid as submitted.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: Element.extension
  min:
    v: 0
  max:
    v: *
type:
  code:
    v: Extension
  profile:
    v: http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-adjudication-outcome
    link: http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-adjudication-outcome
condition:
  v: ele-1
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    link: http://hl7.org/fhir/StructureDefinition/Element
constraint:
  key:
    v: ext-1
  severity:
    v: error
  human:
    v: Must have either extensions or value[x], not both
  expression:
    v: extension.exists() != value.exists()
  xpath:
    v: exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])
  source:
    v: http://hl7.org/fhir/StructureDefinition/Extension
    link: http://hl7.org/fhir/StructureDefinition/Extension
must support:
  v: true
is modifier:
  v: false
is summary:
  v: false

id:
  v: ClaimResponse.item.extension:patientInvoice
path:
  v: ClaimResponse.item.extension
slice name:
  v: patientInvoice
short:
  v: Patient Invoice
definition:
  v: The number of the patient invoice on which the service was billed.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: Element.extension
  min:
    v: 0
  max:
    v: *
type:
  code:
    v: Extension
  profile:
    v: http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-patientInvoice
    link: http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-patientInvoice
condition:
  v: ele-1
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    link: http://hl7.org/fhir/StructureDefinition/Element
constraint:
  key:
    v: ext-1
  severity:
    v: error
  human:
    v: Must have either extensions or value[x], not both
  expression:
    v: extension.exists() != value.exists()
  xpath:
    v: exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])
  source:
    v: http://hl7.org/fhir/StructureDefinition/Extension
    link: http://hl7.org/fhir/StructureDefinition/Extension
must support:
  v: true
is modifier:
  v: false
is summary:
  v: false

id:
  v: ClaimResponse.item.modifierExtension
path:
  v: ClaimResponse.item.modifierExtension
short:
  v: Extensions that cannot be ignored even if unrecognized
definition:
  v: May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).
comment:
  v: There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
requirements:
  v: Modifier extensions allow for extensions that *cannot* be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the [definition of modifier extensions](http://hl7.org/fhir/R4/extensibility.html#modifierExtension).
alias:
  v: extensions
alias:
  v: user content
alias:
  v: modifiers
min:
  v: 0
max:
  v: *
base:
  path:
    v: BackboneElement.modifierExtension
  min:
    v: 0
  max:
    v: *
type:
  code:
    v: Extension
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    link: http://hl7.org/fhir/StructureDefinition/Element
constraint:
  key:
    v: ext-1
  severity:
    v: error
  human:
    v: Must have either extensions or value[x], not both
  expression:
    v: extension.exists() != value.exists()
  xpath:
    v: exists(f:extension)!=exists(f:*[starts-with(local-name(.), "value")])
  source:
    v: http://hl7.org/fhir/StructureDefinition/Extension
    link: http://hl7.org/fhir/StructureDefinition/Extension
is modifier:
  v: true
is modifier reason:
  v: Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
is summary:
  v: true
mapping:
  identity:
    v: rim
  map:
    v: N/A

id:
  v: ClaimResponse.item.itemSequence
path:
  v: ClaimResponse.item.itemSequence
short:
  v: Claim item instance identifier
definition:
  v: A number to uniquely reference the claim item entries.
requirements:
  v: Necessary to provide a mechanism to link the adjudication result to the submitted claim item.
min:
  v: 1
max:
  v: 1
base:
  path:
    v: ClaimResponse.item.itemSequence
  min:
    v: 1
  max:
    v: 1
type:
  code:
    v: positiveInt
  profile:
    v: http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/DP-positiveInt
    link: http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/DP-positiveInt
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    link: http://hl7.org/fhir/StructureDefinition/Element
is modifier:
  v: false
is summary:
  v: false

id:
  v: ClaimResponse.item.noteNumber
path:
  v: ClaimResponse.item.noteNumber
short:
  v: Applicable note numbers
definition:
  v: The numbers associated with notes below which apply to the adjudication of this item.
requirements:
  v: Provides a condensed manner for associating human readable descriptive explanations for adjudications on the line item.
min:
  v: 0
max:
  v: *
base:
  path:
    v: ClaimResponse.item.noteNumber
  min:
    v: 0
  max:
    v: *
type:
  code:
    v: positiveInt
  profile:
    v: http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/DP-positiveInt
    link: http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/DP-positiveInt
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    link: http://hl7.org/fhir/StructureDefinition/Element
must support:
  v: true
is modifier:
  v: false
is summary:
  v: false

id:
  v: ClaimResponse.item.adjudication
path:
  v: ClaimResponse.item.adjudication
short:
  v: Adjudication details
definition:
  v: 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.
requirements:
  v: The adjudication results conveys the insurer's assessment of the item provided in the claim under the terms of the patient's insurance coverage.
min:
  v: 1
max:
  v: *
base:
  path:
    v: ClaimResponse.item.adjudication
  min:
    v: 1
  max:
    v: *
type:
  code:
    v: BackboneElement
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    link: http://hl7.org/fhir/StructureDefinition/Element
is modifier:
  v: false
is summary:
  v: false

id:
  v: ClaimResponse.item.adjudication.id
path:
  v: ClaimResponse.item.adjudication.id
representation:
  v: xmlAttr
short:
  v: Unique id for inter-element referencing
definition:
  v: Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: Element.id
  min:
    v: 0
  max:
    v: 1
type:
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type
    value: url
      v: string
  code:
    v: http://hl7.org/fhirpath/System.String
is modifier:
  v: false
is summary:
  v: false
mapping:
  identity:
    v: rim
  map:
    v: n/a

id:
  v: ClaimResponse.item.adjudication.extension
path:
  v: ClaimResponse.item.adjudication.extension
short:
  v: Additional content defined by implementations
definition:
  v: May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
comment:
  v: There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
alias:
  v: extensions
alias:
  v: user content
min:
  v: 0
max:
  v: *
base:
  path:
    v: Element.extension
  min:
    v: 0
  max:
    v: *
type:
  code:
    v: Extension
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    link: http://hl7.org/fhir/StructureDefinition/Element
constraint:
  key:
    v: ext-1
  severity:
    v: error
  human:
    v: Must have either extensions or value[x], not both
  expression:
    v: extension.exists() != value.exists()
  xpath:
    v: exists(f:extension)!=exists(f:*[starts-with(local-name(.), "value")])
  source:
    v: http://hl7.org/fhir/StructureDefinition/Extension
    link: http://hl7.org/fhir/StructureDefinition/Extension
is modifier:
  v: false
is summary:
  v: false
mapping:
  identity:
    v: rim
  map:
    v: n/a

id:
  v: ClaimResponse.item.adjudication.modifierExtension
path:
  v: ClaimResponse.item.adjudication.modifierExtension
short:
  v: Extensions that cannot be ignored even if unrecognized
definition:
  v: May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).
comment:
  v: There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
requirements:
  v: Modifier extensions allow for extensions that *cannot* be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the [definition of modifier extensions](http://hl7.org/fhir/R4/extensibility.html#modifierExtension).
alias:
  v: extensions
alias:
  v: user content
alias:
  v: modifiers
min:
  v: 0
max:
  v: *
base:
  path:
    v: BackboneElement.modifierExtension
  min:
    v: 0
  max:
    v: *
type:
  code:
    v: Extension
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    link: http://hl7.org/fhir/StructureDefinition/Element
constraint:
  key:
    v: ext-1
  severity:
    v: error
  human:
    v: Must have either extensions or value[x], not both
  expression:
    v: extension.exists() != value.exists()
  xpath:
    v: exists(f:extension)!=exists(f:*[starts-with(local-name(.), "value")])
  source:
    v: http://hl7.org/fhir/StructureDefinition/Extension
    link: http://hl7.org/fhir/StructureDefinition/Extension
is modifier:
  v: true
is modifier reason:
  v: Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
is summary:
  v: true
mapping:
  identity:
    v: rim
  map:
    v: N/A

id:
  v: ClaimResponse.item.adjudication.category
path:
  v: ClaimResponse.item.adjudication.category
short:
  v: Type of adjudication information
definition:
  v: 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.
comment:
  v: For example codes indicating: Co-Pay, deductible, eligible, benefit, tax, etc.
requirements:
  v: Needed to enable understanding of the context of the other information in the adjudication.
min:
  v: 1
max:
  v: 1
base:
  path:
    v: ClaimResponse.item.adjudication.category
  min:
    v: 1
  max:
    v: 1
type:
  code:
    v: CodeableConcept
  profile:
    v: http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/DP-CodeableConcept
    link: http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/DP-CodeableConcept
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    link: http://hl7.org/fhir/StructureDefinition/Element
is modifier:
  v: false
is summary:
  v: false
binding:
  strength:
    v: required
  value set:
    v: http://nphies.sa/terminology/ValueSet/adjudication
    link: http://nphies.sa/terminology/ValueSet/adjudication

id:
  v: ClaimResponse.item.adjudication.reason
path:
  v: ClaimResponse.item.adjudication.reason
short:
  v: Explanation of adjudication outcome
definition:
  v: A code supporting the understanding of the adjudication result and explaining variance from expected amount.
comment:
  v: For example may indicate that the funds for this benefit type have been exhausted.
requirements:
  v: To support understanding of variance from adjudication expectations.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: ClaimResponse.item.adjudication.reason
  min:
    v: 0
  max:
    v: 1
type:
  code:
    v: CodeableConcept
  profile:
    v: http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/DP-CodeableConcept
    link: http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/DP-CodeableConcept
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    link: http://hl7.org/fhir/StructureDefinition/Element
must support:
  v: true
is modifier:
  v: false
is summary:
  v: false
binding:
  strength:
    v: required
  value set:
    v: http://nphies.sa/terminology/ValueSet/adjudication-reason
    link: http://nphies.sa/terminology/ValueSet/adjudication-reason

id:
  v: ClaimResponse.item.adjudication.amount
path:
  v: ClaimResponse.item.adjudication.amount
short:
  v: Monetary amount
definition:
  v: Monetary amount associated with the category.
comment:
  v: For example: amount submitted, eligible amount, co-payment, and benefit payable.
requirements:
  v: Most adjuciation categories convey a monetary amount.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: ClaimResponse.item.adjudication.amount
  min:
    v: 0
  max:
    v: 1
type:
  code:
    v: Money
  profile:
    v: http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/DP-Money-SAR
    link: http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/DP-Money-SAR
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    link: http://hl7.org/fhir/StructureDefinition/Element
must support:
  v: true
is modifier:
  v: false
is summary:
  v: false

id:
  v: ClaimResponse.item.adjudication.value
path:
  v: ClaimResponse.item.adjudication.value
short:
  v: Non-monetary value
definition:
  v: A non-monetary value associated with the category. Mutually exclusive to the amount element above.
comment:
  v: For example: eligible percentage or co-payment percentage.
requirements:
  v: Some adjudication categories convey a percentage or a fixed value.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: ClaimResponse.item.adjudication.value
  min:
    v: 0
  max:
    v: 1
type:
  code:
    v: decimal
  profile:
    v: http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/DP-decimal
    link: http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/DP-decimal
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    link: http://hl7.org/fhir/StructureDefinition/Element
must support:
  v: true
is modifier:
  v: false
is summary:
  v: false

id:
  v: ClaimResponse.item.detail
path:
  v: ClaimResponse.item.detail
short:
  v: Adjudication for claim details
definition:
  v: A claim detail. Either a simple (a product or service) or a 'group' of sub-details which are simple items.
requirements:
  v: The adjudication for details provided on the claim.
min:
  v: 0
max:
  v: *
base:
  path:
    v: ClaimResponse.item.detail
  min:
    v: 0
  max:
    v: *
type:
  code:
    v: BackboneElement
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    link: http://hl7.org/fhir/StructureDefinition/Element
must support:
  v: true
is modifier:
  v: false
is summary:
  v: false

id:
  v: ClaimResponse.item.detail.id
path:
  v: ClaimResponse.item.detail.id
representation:
  v: xmlAttr
short:
  v: Unique id for inter-element referencing
definition:
  v: Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: Element.id
  min:
    v: 0
  max:
    v: 1
type:
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type
    value: url
      v: string
  code:
    v: http://hl7.org/fhirpath/System.String
is modifier:
  v: false
is summary:
  v: false
mapping:
  identity:
    v: rim
  map:
    v: n/a

id:
  v: ClaimResponse.item.detail.extension
path:
  v: ClaimResponse.item.detail.extension
short:
  v: Additional content defined by implementations
definition:
  v: May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
comment:
  v: There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
alias:
  v: extensions
alias:
  v: user content
min:
  v: 0
max:
  v: *
base:
  path:
    v: Element.extension
  min:
    v: 0
  max:
    v: *
type:
  code:
    v: Extension
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    link: http://hl7.org/fhir/StructureDefinition/Element
constraint:
  key:
    v: ext-1
  severity:
    v: error
  human:
    v: Must have either extensions or value[x], not both
  expression:
    v: extension.exists() != value.exists()
  xpath:
    v: exists(f:extension)!=exists(f:*[starts-with(local-name(.), "value")])
  source:
    v: http://hl7.org/fhir/StructureDefinition/Extension
    link: http://hl7.org/fhir/StructureDefinition/Extension
is modifier:
  v: false
is summary:
  v: false
mapping:
  identity:
    v: rim
  map:
    v: n/a

id:
  v: ClaimResponse.item.detail.modifierExtension
path:
  v: ClaimResponse.item.detail.modifierExtension
short:
  v: Extensions that cannot be ignored even if unrecognized
definition:
  v: May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).
comment:
  v: There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
requirements:
  v: Modifier extensions allow for extensions that *cannot* be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the [definition of modifier extensions](http://hl7.org/fhir/R4/extensibility.html#modifierExtension).
alias:
  v: extensions
alias:
  v: user content
alias:
  v: modifiers
min:
  v: 0
max:
  v: *
base:
  path:
    v: BackboneElement.modifierExtension
  min:
    v: 0
  max:
    v: *
type:
  code:
    v: Extension
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    link: http://hl7.org/fhir/StructureDefinition/Element
constraint:
  key:
    v: ext-1
  severity:
    v: error
  human:
    v: Must have either extensions or value[x], not both
  expression:
    v: extension.exists() != value.exists()
  xpath:
    v: exists(f:extension)!=exists(f:*[starts-with(local-name(.), "value")])
  source:
    v: http://hl7.org/fhir/StructureDefinition/Extension
    link: http://hl7.org/fhir/StructureDefinition/Extension
is modifier:
  v: true
is modifier reason:
  v: Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
is summary:
  v: true
mapping:
  identity:
    v: rim
  map:
    v: N/A

id:
  v: ClaimResponse.item.detail.detailSequence
path:
  v: ClaimResponse.item.detail.detailSequence
short:
  v: Claim detail instance identifier
definition:
  v: A number to uniquely reference the claim detail entry.
requirements:
  v: Necessary to provide a mechanism to link the adjudication result to the submitted claim detail.
min:
  v: 1
max:
  v: 1
base:
  path:
    v: ClaimResponse.item.detail.detailSequence
  min:
    v: 1
  max:
    v: 1
type:
  code:
    v: positiveInt
  profile:
    v: http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/DP-positiveInt
    link: http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/DP-positiveInt
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    link: http://hl7.org/fhir/StructureDefinition/Element
is modifier:
  v: false
is summary:
  v: false

id:
  v: ClaimResponse.item.detail.noteNumber
path:
  v: ClaimResponse.item.detail.noteNumber
short:
  v: Applicable note numbers
definition:
  v: The numbers associated with notes below which apply to the adjudication of this item.
requirements:
  v: Provides a condensed manner for associating human readable descriptive explanations for adjudications on the line item.
min:
  v: 0
max:
  v: *
base:
  path:
    v: ClaimResponse.item.detail.noteNumber
  min:
    v: 0
  max:
    v: *
type:
  code:
    v: positiveInt
  profile:
    v: http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/DP-positiveInt
    link: http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/DP-positiveInt
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    link: http://hl7.org/fhir/StructureDefinition/Element
must support:
  v: true
is modifier:
  v: false
is summary:
  v: false

id:
  v: ClaimResponse.item.detail.adjudication
path:
  v: ClaimResponse.item.detail.adjudication
short:
  v: Detail level adjudication details
definition:
  v: The adjudication results.
min:
  v: 1
max:
  v: *
base:
  path:
    v: ClaimResponse.item.detail.adjudication
  min:
    v: 1
  max:
    v: *
type:
  code:
    v: BackboneElement
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    link: http://hl7.org/fhir/StructureDefinition/Element
is modifier:
  v: false
is summary:
  v: false

id:
  v: ClaimResponse.item.detail.adjudication.id
path:
  v: ClaimResponse.item.detail.adjudication.id
representation:
  v: xmlAttr
short:
  v: Unique id for inter-element referencing
definition:
  v: Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: Element.id
  min:
    v: 0
  max:
    v: 1
type:
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type
    value: url
      v: string
  code:
    v: http://hl7.org/fhirpath/System.String
is modifier:
  v: false
is summary:
  v: false
mapping:
  identity:
    v: rim
  map:
    v: n/a

id:
  v: ClaimResponse.item.detail.adjudication.extension
path:
  v: ClaimResponse.item.detail.adjudication.extension
short:
  v: Additional content defined by implementations
definition:
  v: May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
comment:
  v: There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
alias:
  v: extensions
alias:
  v: user content
min:
  v: 0
max:
  v: *
base:
  path:
    v: Element.extension
  min:
    v: 0
  max:
    v: *
type:
  code:
    v: Extension
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    link: http://hl7.org/fhir/StructureDefinition/Element
constraint:
  key:
    v: ext-1
  severity:
    v: error
  human:
    v: Must have either extensions or value[x], not both
  expression:
    v: extension.exists() != value.exists()
  xpath:
    v: exists(f:extension)!=exists(f:*[starts-with(local-name(.), "value")])
  source:
    v: http://hl7.org/fhir/StructureDefinition/Extension
    link: http://hl7.org/fhir/StructureDefinition/Extension
is modifier:
  v: false
is summary:
  v: false
mapping:
  identity:
    v: rim
  map:
    v: n/a

id:
  v: ClaimResponse.item.detail.adjudication.modifierExtension
path:
  v: ClaimResponse.item.detail.adjudication.modifierExtension
short:
  v: Extensions that cannot be ignored even if unrecognized
definition:
  v: May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).
comment:
  v: There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
requirements:
  v: Modifier extensions allow for extensions that *cannot* be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the [definition of modifier extensions](http://hl7.org/fhir/R4/extensibility.html#modifierExtension).
alias:
  v: extensions
alias:
  v: user content
alias:
  v: modifiers
min:
  v: 0
max:
  v: *
base:
  path:
    v: BackboneElement.modifierExtension
  min:
    v: 0
  max:
    v: *
type:
  code:
    v: Extension
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    link: http://hl7.org/fhir/StructureDefinition/Element
constraint:
  key:
    v: ext-1
  severity:
    v: error
  human:
    v: Must have either extensions or value[x], not both
  expression:
    v: extension.exists() != value.exists()
  xpath:
    v: exists(f:extension)!=exists(f:*[starts-with(local-name(.), "value")])
  source:
    v: http://hl7.org/fhir/StructureDefinition/Extension
    link: http://hl7.org/fhir/StructureDefinition/Extension
is modifier:
  v: true
is modifier reason:
  v: Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
is summary:
  v: true
mapping:
  identity:
    v: rim
  map:
    v: N/A

id:
  v: ClaimResponse.item.detail.adjudication.category
path:
  v: ClaimResponse.item.detail.adjudication.category
short:
  v: Type of adjudication information
definition:
  v: 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.
comment:
  v: For example codes indicating: Co-Pay, deductible, eligible, benefit, tax, etc.
requirements:
  v: Needed to enable understanding of the context of the other information in the adjudication.
min:
  v: 1
max:
  v: 1
base:
  path:
    v: ClaimResponse.item.adjudication.category
  min:
    v: 1
  max:
    v: 1
type:
  code:
    v: CodeableConcept
  profile:
    v: http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/DP-CodeableConcept
    link: http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/DP-CodeableConcept
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    link: http://hl7.org/fhir/StructureDefinition/Element
is modifier:
  v: false
is summary:
  v: false
binding:
  strength:
    v: required
  value set:
    v: http://nphies.sa/terminology/ValueSet/adjudication
    link: http://nphies.sa/terminology/ValueSet/adjudication

id:
  v: ClaimResponse.item.detail.adjudication.reason
path:
  v: ClaimResponse.item.detail.adjudication.reason
short:
  v: Explanation of adjudication outcome
definition:
  v: A code supporting the understanding of the adjudication result and explaining variance from expected amount.
comment:
  v: For example may indicate that the funds for this benefit type have been exhausted.
requirements:
  v: To support understanding of variance from adjudication expectations.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: ClaimResponse.item.adjudication.reason
  min:
    v: 0
  max:
    v: 1
type:
  code:
    v: CodeableConcept
  profile:
    v: http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/DP-CodeableConcept
    link: http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/DP-CodeableConcept
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    link: http://hl7.org/fhir/StructureDefinition/Element
must support:
  v: true
is modifier:
  v: false
is summary:
  v: false
binding:
  strength:
    v: required
  value set:
    v: http://nphies.sa/terminology/ValueSet/adjudication-reason
    link: http://nphies.sa/terminology/ValueSet/adjudication-reason

id:
  v: ClaimResponse.item.detail.adjudication.amount
path:
  v: ClaimResponse.item.detail.adjudication.amount
short:
  v: Monetary amount
definition:
  v: Monetary amount associated with the category.
comment:
  v: For example: amount submitted, eligible amount, co-payment, and benefit payable.
requirements:
  v: Most adjuciation categories convey a monetary amount.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: ClaimResponse.item.adjudication.amount
  min:
    v: 0
  max:
    v: 1
type:
  code:
    v: Money
  profile:
    v: http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/DP-Money-SAR
    link: http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/DP-Money-SAR
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    link: http://hl7.org/fhir/StructureDefinition/Element
must support:
  v: true
is modifier:
  v: false
is summary:
  v: false

id:
  v: ClaimResponse.item.detail.adjudication.value
path:
  v: ClaimResponse.item.detail.adjudication.value
short:
  v: Non-monetary value
definition:
  v: A non-monetary value associated with the category. Mutually exclusive to the amount element above.
comment:
  v: For example: eligible percentage or co-payment percentage.
requirements:
  v: Some adjudication categories convey a percentage or a fixed value.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: ClaimResponse.item.adjudication.value
  min:
    v: 0
  max:
    v: 1
type:
  code:
    v: decimal
  profile:
    v: http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/DP-decimal
    link: http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/DP-decimal
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    link: http://hl7.org/fhir/StructureDefinition/Element
must support:
  v: true
is modifier:
  v: false
is summary:
  v: false

id:
  v: ClaimResponse.item.detail.subDetail
path:
  v: ClaimResponse.item.detail.subDetail
short:
  v: Adjudication for claim sub-details
definition:
  v: A sub-detail adjudication of a simple product or service.
requirements:
  v: The adjudication for sub-details provided on the claim.
min:
  v: 0
max:
  v: *
base:
  path:
    v: ClaimResponse.item.detail.subDetail
  min:
    v: 0
  max:
    v: *
type:
  code:
    v: BackboneElement
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    link: http://hl7.org/fhir/StructureDefinition/Element
must support:
  v: true
is modifier:
  v: false
is summary:
  v: false

id:
  v: ClaimResponse.item.detail.subDetail.id
path:
  v: ClaimResponse.item.detail.subDetail.id
representation:
  v: xmlAttr
short:
  v: Unique id for inter-element referencing
definition:
  v: Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: Element.id
  min:
    v: 0
  max:
    v: 1
type:
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type
    value: url
      v: string
  code:
    v: http://hl7.org/fhirpath/System.String
is modifier:
  v: false
is summary:
  v: false
mapping:
  identity:
    v: rim
  map:
    v: n/a

id:
  v: ClaimResponse.item.detail.subDetail.extension
path:
  v: ClaimResponse.item.detail.subDetail.extension
short:
  v: Additional content defined by implementations
definition:
  v: May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
comment:
  v: There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
alias:
  v: extensions
alias:
  v: user content
min:
  v: 0
max:
  v: *
base:
  path:
    v: Element.extension
  min:
    v: 0
  max:
    v: *
type:
  code:
    v: Extension
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    link: http://hl7.org/fhir/StructureDefinition/Element
constraint:
  key:
    v: ext-1
  severity:
    v: error
  human:
    v: Must have either extensions or value[x], not both
  expression:
    v: extension.exists() != value.exists()
  xpath:
    v: exists(f:extension)!=exists(f:*[starts-with(local-name(.), "value")])
  source:
    v: http://hl7.org/fhir/StructureDefinition/Extension
    link: http://hl7.org/fhir/StructureDefinition/Extension
is modifier:
  v: false
is summary:
  v: false
mapping:
  identity:
    v: rim
  map:
    v: n/a

id:
  v: ClaimResponse.item.detail.subDetail.modifierExtension
path:
  v: ClaimResponse.item.detail.subDetail.modifierExtension
short:
  v: Extensions that cannot be ignored even if unrecognized
definition:
  v: May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).
comment:
  v: There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
requirements:
  v: Modifier extensions allow for extensions that *cannot* be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the [definition of modifier extensions](http://hl7.org/fhir/R4/extensibility.html#modifierExtension).
alias:
  v: extensions
alias:
  v: user content
alias:
  v: modifiers
min:
  v: 0
max:
  v: *
base:
  path:
    v: BackboneElement.modifierExtension
  min:
    v: 0
  max:
    v: *
type:
  code:
    v: Extension
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    link: http://hl7.org/fhir/StructureDefinition/Element
constraint:
  key:
    v: ext-1
  severity:
    v: error
  human:
    v: Must have either extensions or value[x], not both
  expression:
    v: extension.exists() != value.exists()
  xpath:
    v: exists(f:extension)!=exists(f:*[starts-with(local-name(.), "value")])
  source:
    v: http://hl7.org/fhir/StructureDefinition/Extension
    link: http://hl7.org/fhir/StructureDefinition/Extension
is modifier:
  v: true
is modifier reason:
  v: Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
is summary:
  v: true
mapping:
  identity:
    v: rim
  map:
    v: N/A

id:
  v: ClaimResponse.item.detail.subDetail.subDetailSequence
path:
  v: ClaimResponse.item.detail.subDetail.subDetailSequence
short:
  v: Claim sub-detail instance identifier
definition:
  v: A number to uniquely reference the claim sub-detail entry.
requirements:
  v: Necessary to provide a mechanism to link the adjudication result to the submitted claim sub-detail.
min:
  v: 1
max:
  v: 1
base:
  path:
    v: ClaimResponse.item.detail.subDetail.subDetailSequence
  min:
    v: 1
  max:
    v: 1
type:
  code:
    v: positiveInt
  profile:
    v: http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/DP-positiveInt
    link: http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/DP-positiveInt
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    link: http://hl7.org/fhir/StructureDefinition/Element
is modifier:
  v: false
is summary:
  v: false

id:
  v: ClaimResponse.item.detail.subDetail.noteNumber
path:
  v: ClaimResponse.item.detail.subDetail.noteNumber
short:
  v: Applicable note numbers
definition:
  v: The numbers associated with notes below which apply to the adjudication of this item.
requirements:
  v: Provides a condensed manner for associating human readable descriptive explanations for adjudications on the line item.
min:
  v: 0
max:
  v: *
base:
  path:
    v: ClaimResponse.item.detail.subDetail.noteNumber
  min:
    v: 0
  max:
    v: *
type:
  code:
    v: positiveInt
  profile:
    v: http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/DP-positiveInt
    link: http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/DP-positiveInt
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    link: http://hl7.org/fhir/StructureDefinition/Element
must support:
  v: true
is modifier:
  v: false
is summary:
  v: false

id:
  v: ClaimResponse.item.detail.subDetail.adjudication
path:
  v: ClaimResponse.item.detail.subDetail.adjudication
short:
  v: Subdetail level adjudication details
definition:
  v: The adjudication results.
min:
  v: 1
max:
  v: *
base:
  path:
    v: ClaimResponse.item.detail.subDetail.adjudication
  min:
    v: 0
  max:
    v: *
type:
  code:
    v: BackboneElement
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    link: http://hl7.org/fhir/StructureDefinition/Element
is modifier:
  v: false
is summary:
  v: false

id:
  v: ClaimResponse.item.detail.subDetail.adjudication.id
path:
  v: ClaimResponse.item.detail.subDetail.adjudication.id
representation:
  v: xmlAttr
short:
  v: Unique id for inter-element referencing
definition:
  v: Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: Element.id
  min:
    v: 0
  max:
    v: 1
type:
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type
    value: url
      v: string
  code:
    v: http://hl7.org/fhirpath/System.String
is modifier:
  v: false
is summary:
  v: false
mapping:
  identity:
    v: rim
  map:
    v: n/a

id:
  v: ClaimResponse.item.detail.subDetail.adjudication.extension
path:
  v: ClaimResponse.item.detail.subDetail.adjudication.extension
short:
  v: Additional content defined by implementations
definition:
  v: May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
comment:
  v: There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
alias:
  v: extensions
alias:
  v: user content
min:
  v: 0
max:
  v: *
base:
  path:
    v: Element.extension
  min:
    v: 0
  max:
    v: *
type:
  code:
    v: Extension
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    link: http://hl7.org/fhir/StructureDefinition/Element
constraint:
  key:
    v: ext-1
  severity:
    v: error
  human:
    v: Must have either extensions or value[x], not both
  expression:
    v: extension.exists() != value.exists()
  xpath:
    v: exists(f:extension)!=exists(f:*[starts-with(local-name(.), "value")])
  source:
    v: http://hl7.org/fhir/StructureDefinition/Extension
    link: http://hl7.org/fhir/StructureDefinition/Extension
is modifier:
  v: false
is summary:
  v: false
mapping:
  identity:
    v: rim
  map:
    v: n/a

id:
  v: ClaimResponse.item.detail.subDetail.adjudication.modifierExtension
path:
  v: ClaimResponse.item.detail.subDetail.adjudication.modifierExtension
short:
  v: Extensions that cannot be ignored even if unrecognized
definition:
  v: May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).
comment:
  v: There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
requirements:
  v: Modifier extensions allow for extensions that *cannot* be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the [definition of modifier extensions](http://hl7.org/fhir/R4/extensibility.html#modifierExtension).
alias:
  v: extensions
alias:
  v: user content
alias:
  v: modifiers
min:
  v: 0
max:
  v: *
base:
  path:
    v: BackboneElement.modifierExtension
  min:
    v: 0
  max:
    v: *
type:
  code:
    v: Extension
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    link: http://hl7.org/fhir/StructureDefinition/Element
constraint:
  key:
    v: ext-1
  severity:
    v: error
  human:
    v: Must have either extensions or value[x], not both
  expression:
    v: extension.exists() != value.exists()
  xpath:
    v: exists(f:extension)!=exists(f:*[starts-with(local-name(.), "value")])
  source:
    v: http://hl7.org/fhir/StructureDefinition/Extension
    link: http://hl7.org/fhir/StructureDefinition/Extension
is modifier:
  v: true
is modifier reason:
  v: Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
is summary:
  v: true
mapping:
  identity:
    v: rim
  map:
    v: N/A

id:
  v: ClaimResponse.item.detail.subDetail.adjudication.category
path:
  v: ClaimResponse.item.detail.subDetail.adjudication.category
short:
  v: Type of adjudication information
definition:
  v: 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.
comment:
  v: For example codes indicating: Co-Pay, deductible, eligible, benefit, tax, etc.
requirements:
  v: Needed to enable understanding of the context of the other information in the adjudication.
min:
  v: 1
max:
  v: 1
base:
  path:
    v: ClaimResponse.item.adjudication.category
  min:
    v: 1
  max:
    v: 1
type:
  code:
    v: CodeableConcept
  profile:
    v: http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/DP-CodeableConcept
    link: http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/DP-CodeableConcept
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    link: http://hl7.org/fhir/StructureDefinition/Element
is modifier:
  v: false
is summary:
  v: false
binding:
  strength:
    v: required
  value set:
    v: http://nphies.sa/terminology/ValueSet/adjudication
    link: http://nphies.sa/terminology/ValueSet/adjudication

id:
  v: ClaimResponse.item.detail.subDetail.adjudication.reason
path:
  v: ClaimResponse.item.detail.subDetail.adjudication.reason
short:
  v: Explanation of adjudication outcome
definition:
  v: A code supporting the understanding of the adjudication result and explaining variance from expected amount.
comment:
  v: For example may indicate that the funds for this benefit type have been exhausted.
requirements:
  v: To support understanding of variance from adjudication expectations.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: ClaimResponse.item.adjudication.reason
  min:
    v: 0
  max:
    v: 1
type:
  code:
    v: CodeableConcept
  profile:
    v: http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/DP-CodeableConcept
    link: http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/DP-CodeableConcept
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    link: http://hl7.org/fhir/StructureDefinition/Element
must support:
  v: true
is modifier:
  v: false
is summary:
  v: false
binding:
  strength:
    v: required
  value set:
    v: http://nphies.sa/terminology/ValueSet/adjudication-reason
    link: http://nphies.sa/terminology/ValueSet/adjudication-reason

id:
  v: ClaimResponse.item.detail.subDetail.adjudication.amount
path:
  v: ClaimResponse.item.detail.subDetail.adjudication.amount
short:
  v: Monetary amount
definition:
  v: Monetary amount associated with the category.
comment:
  v: For example: amount submitted, eligible amount, co-payment, and benefit payable.
requirements:
  v: Most adjuciation categories convey a monetary amount.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: ClaimResponse.item.adjudication.amount
  min:
    v: 0
  max:
    v: 1
type:
  code:
    v: Money
  profile:
    v: http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/DP-Money-SAR
    link: http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/DP-Money-SAR
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    link: http://hl7.org/fhir/StructureDefinition/Element
must support:
  v: true
is modifier:
  v: false
is summary:
  v: false

id:
  v: ClaimResponse.item.detail.subDetail.adjudication.value
path:
  v: ClaimResponse.item.detail.subDetail.adjudication.value
short:
  v: Non-monetary value
definition:
  v: A non-monetary value associated with the category. Mutually exclusive to the amount element above.
comment:
  v: For example: eligible percentage or co-payment percentage.
requirements:
  v: Some adjudication categories convey a percentage or a fixed value.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: ClaimResponse.item.adjudication.value
  min:
    v: 0
  max:
    v: 1
type:
  code:
    v: decimal
  profile:
    v: http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/DP-decimal
    link: http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/DP-decimal
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    link: http://hl7.org/fhir/StructureDefinition/Element
must support:
  v: true
is modifier:
  v: false
is summary:
  v: false

id:
  v: ClaimResponse.addItem
path:
  v: ClaimResponse.addItem
short:
  v: Insurer added line items
definition:
  v: The first-tier service adjudications for payor added product or service lines.
requirements:
  v: Insurers may redefine the provided product or service or may package and/or decompose groups of products and services. The addItems allows the insurer to provide their line item list with linkage to the submitted items/details/sub-details. In a preauthorization the insurer may use the addItem structure to provide additional information on authorized products and services.
min:
  v: 0
max:
  v: *
base:
  path:
    v: ClaimResponse.addItem
  min:
    v: 0
  max:
    v: *
type:
  code:
    v: BackboneElement
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    link: http://hl7.org/fhir/StructureDefinition/Element
is modifier:
  v: false
is summary:
  v: false

id:
  v: ClaimResponse.addItem.id
path:
  v: ClaimResponse.addItem.id
representation:
  v: xmlAttr
short:
  v: Unique id for inter-element referencing
definition:
  v: Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: Element.id
  min:
    v: 0
  max:
    v: 1
type:
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type
    value: url
      v: string
  code:
    v: http://hl7.org/fhirpath/System.String
is modifier:
  v: false
is summary:
  v: false
mapping:
  identity:
    v: rim
  map:
    v: n/a

id:
  v: ClaimResponse.addItem.extension
path:
  v: ClaimResponse.addItem.extension
short:
  v: Additional content defined by implementations
definition:
  v: May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
comment:
  v: There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
alias:
  v: extensions
alias:
  v: user content
min:
  v: 0
max:
  v: *
base:
  path:
    v: Element.extension
  min:
    v: 0
  max:
    v: *
type:
  code:
    v: Extension
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    link: http://hl7.org/fhir/StructureDefinition/Element
constraint:
  key:
    v: ext-1
  severity:
    v: error
  human:
    v: Must have either extensions or value[x], not both
  expression:
    v: extension.exists() != value.exists()
  xpath:
    v: exists(f:extension)!=exists(f:*[starts-with(local-name(.), "value")])
  source:
    v: http://hl7.org/fhir/StructureDefinition/Extension
    link: http://hl7.org/fhir/StructureDefinition/Extension
is modifier:
  v: false
is summary:
  v: false
mapping:
  identity:
    v: rim
  map:
    v: n/a

id:
  v: ClaimResponse.addItem.modifierExtension
path:
  v: ClaimResponse.addItem.modifierExtension
short:
  v: Extensions that cannot be ignored even if unrecognized
definition:
  v: May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).
comment:
  v: There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
requirements:
  v: Modifier extensions allow for extensions that *cannot* be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the [definition of modifier extensions](http://hl7.org/fhir/R4/extensibility.html#modifierExtension).
alias:
  v: extensions
alias:
  v: user content
alias:
  v: modifiers
min:
  v: 0
max:
  v: *
base:
  path:
    v: BackboneElement.modifierExtension
  min:
    v: 0
  max:
    v: *
type:
  code:
    v: Extension
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    link: http://hl7.org/fhir/StructureDefinition/Element
constraint:
  key:
    v: ext-1
  severity:
    v: error
  human:
    v: Must have either extensions or value[x], not both
  expression:
    v: extension.exists() != value.exists()
  xpath:
    v: exists(f:extension)!=exists(f:*[starts-with(local-name(.), "value")])
  source:
    v: http://hl7.org/fhir/StructureDefinition/Extension
    link: http://hl7.org/fhir/StructureDefinition/Extension
is modifier:
  v: true
is modifier reason:
  v: Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
is summary:
  v: true
mapping:
  identity:
    v: rim
  map:
    v: N/A

id:
  v: ClaimResponse.addItem.itemSequence
path:
  v: ClaimResponse.addItem.itemSequence
short:
  v: Item sequence number
definition:
  v: Claim items which this service line is intended to replace.
requirements:
  v: Provides references to the claim items.
min:
  v: 0
max:
  v: *
base:
  path:
    v: ClaimResponse.addItem.itemSequence
  min:
    v: 0
  max:
    v: *
type:
  code:
    v: positiveInt
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    link: http://hl7.org/fhir/StructureDefinition/Element
is modifier:
  v: false
is summary:
  v: false

id:
  v: ClaimResponse.addItem.detailSequence
path:
  v: ClaimResponse.addItem.detailSequence
short:
  v: Detail sequence number
definition:
  v: The sequence number of the details within the claim item which this line is intended to replace.
requirements:
  v: Provides references to the claim details within the claim item.
min:
  v: 0
max:
  v: *
base:
  path:
    v: ClaimResponse.addItem.detailSequence
  min:
    v: 0
  max:
    v: *
type:
  code:
    v: positiveInt
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    link: http://hl7.org/fhir/StructureDefinition/Element
is modifier:
  v: false
is summary:
  v: false

id:
  v: ClaimResponse.addItem.subdetailSequence
path:
  v: ClaimResponse.addItem.subdetailSequence
short:
  v: Subdetail sequence number
definition:
  v: The sequence number of the sub-details within the details within the claim item which this line is intended to replace.
requirements:
  v: Provides references to the claim sub-details within the claim detail.
min:
  v: 0
max:
  v: *
base:
  path:
    v: ClaimResponse.addItem.subdetailSequence
  min:
    v: 0
  max:
    v: *
type:
  code:
    v: positiveInt
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    link: http://hl7.org/fhir/StructureDefinition/Element
is modifier:
  v: false
is summary:
  v: false

id:
  v: ClaimResponse.addItem.provider
path:
  v: ClaimResponse.addItem.provider
short:
  v: Authorized providers
definition:
  v: The providers who are authorized for the services rendered to the patient.
requirements:
  v: Insurer may provide authorization specifically to a restricted set of providers rather than an open authorization.
min:
  v: 0
max:
  v: *
base:
  path:
    v: ClaimResponse.addItem.provider
  min:
    v: 0
  max:
    v: *
type:
  code:
    v: Reference
  target profile:
    v: http://hl7.org/fhir/StructureDefinition/Practitioner
    link: http://hl7.org/fhir/StructureDefinition/Practitioner
  target profile:
    v: http://hl7.org/fhir/StructureDefinition/PractitionerRole
    link: http://hl7.org/fhir/StructureDefinition/PractitionerRole
  target profile:
    v: http://hl7.org/fhir/StructureDefinition/Organization
    link: http://hl7.org/fhir/StructureDefinition/Organization
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    link: http://hl7.org/fhir/StructureDefinition/Element
is modifier:
  v: false
is summary:
  v: false
mapping:
  identity:
    v: w5
  map:
    v: FiveWs.source

id:
  v: ClaimResponse.addItem.productOrService
path:
  v: ClaimResponse.addItem.productOrService
short:
  v: Billing, service, product, or drug code
definition:
  v: When the value is a group code then this item collects a set of related claim details, otherwise this contains the product, service, drug or other billing code for the item.
comment:
  v: If this is an actual service or product line, i.e. not a Group, then use code to indicate the Professional Service or Product supplied (e.g. CTP, HCPCS, USCLS, ICD10, NCPDP, DIN, RxNorm, ACHI, CCI). If a grouping item then use a group code to indicate the type of thing being grouped e.g. 'glasses' or 'compound'.
requirements:
  v: Necessary to state what was provided or done.
min:
  v: 1
max:
  v: 1
base:
  path:
    v: ClaimResponse.addItem.productOrService
  min:
    v: 1
  max:
    v: 1
type:
  code:
    v: CodeableConcept
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    link: http://hl7.org/fhir/StructureDefinition/Element
is modifier:
  v: false
is summary:
  v: false
binding:
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName
    value: string
      v: ServiceProduct
  strength:
    v: example
  description:
    v: Allowable service and product codes.
  value set:
    v: http://hl7.org/fhir/ValueSet/service-uscls
    link: http://hl7.org/fhir/ValueSet/service-uscls

id:
  v: ClaimResponse.addItem.modifier
path:
  v: ClaimResponse.addItem.modifier
short:
  v: Service/Product billing modifiers
definition:
  v: Item typification or modifiers codes to convey additional context for the product or service.
comment:
  v: For example in Oral whether the treatment is cosmetic or associated with TMJ, or for Medical whether the treatment was outside the clinic or outside of office hours.
requirements:
  v: To support inclusion of the item for adjudication or to charge an elevated fee.
min:
  v: 0
max:
  v: *
base:
  path:
    v: ClaimResponse.addItem.modifier
  min:
    v: 0
  max:
    v: *
type:
  code:
    v: CodeableConcept
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    link: http://hl7.org/fhir/StructureDefinition/Element
is modifier:
  v: false
is summary:
  v: false
binding:
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName
    value: string
      v: Modifiers
  strength:
    v: example
  description:
    v: Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen.
  value set:
    v: http://hl7.org/fhir/ValueSet/claim-modifiers
    link: http://hl7.org/fhir/ValueSet/claim-modifiers
mapping:
  identity:
    v: rim
  map:
    v: 24.C, 24.D mods

id:
  v: ClaimResponse.addItem.programCode
path:
  v: ClaimResponse.addItem.programCode
short:
  v: Program the product or service is provided under
definition:
  v: Identifies the program under which this may be recovered.
comment:
  v: For example: Neonatal program, child dental program or drug users recovery program.
requirements:
  v: Commonly used in in the identification of publicly provided program focused on population segments or disease classifications.
min:
  v: 0
max:
  v: *
base:
  path:
    v: ClaimResponse.addItem.programCode
  min:
    v: 0
  max:
    v: *
type:
  code:
    v: CodeableConcept
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    link: http://hl7.org/fhir/StructureDefinition/Element
is modifier:
  v: false
is summary:
  v: false
binding:
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName
    value: string
      v: ProgramCode
  strength:
    v: example
  description:
    v: Program specific reason codes.
  value set:
    v: http://hl7.org/fhir/ValueSet/ex-program-code
    link: http://hl7.org/fhir/ValueSet/ex-program-code
mapping:
  identity:
    v: rim
  map:
    v: 24.H

id:
  v: ClaimResponse.addItem.serviced[x]
path:
  v: ClaimResponse.addItem.serviced[x]
short:
  v: Date or dates of service or product delivery
definition:
  v: The date or dates when the service or product was supplied, performed or completed.
requirements:
  v: Needed to determine whether the service or product was provided during the term of the insurance coverage.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: ClaimResponse.addItem.serviced[x]
  min:
    v: 0
  max:
    v: 1
type:
  code:
    v: date
type:
  code:
    v: Period
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    link: http://hl7.org/fhir/StructureDefinition/Element
is modifier:
  v: false
is summary:
  v: false
mapping:
  identity:
    v: w5
  map:
    v: FiveWs.done[x]
mapping:
  identity:
    v: rim
  map:
    v: 24.A

id:
  v: ClaimResponse.addItem.location[x]
path:
  v: ClaimResponse.addItem.location[x]
short:
  v: Place of service or where product was supplied
definition:
  v: Where the product or service was provided.
requirements:
  v: The location can alter whether the item was acceptable for insurance purposes or impact the determination of the benefit amount.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: ClaimResponse.addItem.location[x]
  min:
    v: 0
  max:
    v: 1
type:
  code:
    v: CodeableConcept
type:
  code:
    v: Address
type:
  code:
    v: Reference
  target profile:
    v: http://hl7.org/fhir/StructureDefinition/Location
    link: http://hl7.org/fhir/StructureDefinition/Location
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    link: http://hl7.org/fhir/StructureDefinition/Element
is modifier:
  v: false
is summary:
  v: false
binding:
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName
    value: string
      v: ServicePlace
  strength:
    v: example
  description:
    v: Place of service: pharmacy, school, prison, etc.
  value set:
    v: http://hl7.org/fhir/ValueSet/service-place
    link: http://hl7.org/fhir/ValueSet/service-place
mapping:
  identity:
    v: w5
  map:
    v: FiveWs.where[x]
mapping:
  identity:
    v: rim
  map:
    v: 24.B

id:
  v: ClaimResponse.addItem.quantity
path:
  v: ClaimResponse.addItem.quantity
short:
  v: Count of products or services
definition:
  v: The number of repetitions of a service or product.
requirements:
  v: Required when the product or service code does not convey the quantity provided.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: ClaimResponse.addItem.quantity
  min:
    v: 0
  max:
    v: 1
type:
  code:
    v: Quantity
  profile:
    v: http://hl7.org/fhir/StructureDefinition/SimpleQuantity
    link: http://hl7.org/fhir/StructureDefinition/SimpleQuantity
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    link: http://hl7.org/fhir/StructureDefinition/Element
is modifier:
  v: false
is summary:
  v: false
mapping:
  identity:
    v: rim
  map:
    v: 24.G

id:
  v: ClaimResponse.addItem.unitPrice
path:
  v: ClaimResponse.addItem.unitPrice
short:
  v: Fee, charge or cost per item
definition:
  v: If the item is not a group then this is the fee for the product or service, otherwise this is the total of the fees for the details of the group.
requirements:
  v: The amount charged to the patient by the provider for a single unit.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: ClaimResponse.addItem.unitPrice
  min:
    v: 0
  max:
    v: 1
type:
  code:
    v: Money
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    link: http://hl7.org/fhir/StructureDefinition/Element
is modifier:
  v: false
is summary:
  v: false

id:
  v: ClaimResponse.addItem.factor
path:
  v: ClaimResponse.addItem.factor
short:
  v: Price scaling factor
definition:
  v: A real number that represents a multiplier used in determining the overall value of services delivered and/or goods received. The concept of a Factor allows for a discount or surcharge multiplier to be applied to a monetary amount.
comment:
  v: To show a 10% senior's discount, the value entered is: 0.90 (1.00 - 0.10).
requirements:
  v: When discounts are provided to a patient (example: Senior's discount) then this must be documented for adjudication.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: ClaimResponse.addItem.factor
  min:
    v: 0
  max:
    v: 1
type:
  code:
    v: decimal
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    link: http://hl7.org/fhir/StructureDefinition/Element
is modifier:
  v: false
is summary:
  v: false

id:
  v: ClaimResponse.addItem.net
path:
  v: ClaimResponse.addItem.net
short:
  v: Total item cost
definition:
  v: The quantity times the unit price for an additional service or product or charge.
comment:
  v: For example, the formula: quantity * unitPrice * factor = net. Quantity and factor are assumed to be 1 if not supplied.
requirements:
  v: Provides the total amount claimed for the group (if a grouper) or the line item.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: ClaimResponse.addItem.net
  min:
    v: 0
  max:
    v: 1
type:
  code:
    v: Money
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    link: http://hl7.org/fhir/StructureDefinition/Element
is modifier:
  v: false
is summary:
  v: false
mapping:
  identity:
    v: rim
  map:
    v: 24.F

id:
  v: ClaimResponse.addItem.bodySite
path:
  v: ClaimResponse.addItem.bodySite
short:
  v: Anatomical location
definition:
  v: Physical service site on the patient (limb, tooth, etc.).
comment:
  v: For example: Providing a tooth code allows an insurer to identify a provider performing a filling on a tooth that was previously removed.
requirements:
  v: Allows insurer to validate specific procedures.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: ClaimResponse.addItem.bodySite
  min:
    v: 0
  max:
    v: 1
type:
  code:
    v: CodeableConcept
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    link: http://hl7.org/fhir/StructureDefinition/Element
is modifier:
  v: false
is summary:
  v: false
binding:
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName
    value: string
      v: OralSites
  strength:
    v: example
  description:
    v: The code for the teeth, quadrant, sextant and arch.
  value set:
    v: http://hl7.org/fhir/ValueSet/tooth
    link: http://hl7.org/fhir/ValueSet/tooth

id:
  v: ClaimResponse.addItem.subSite
path:
  v: ClaimResponse.addItem.subSite
short:
  v: Anatomical sub-location
definition:
  v: A region or surface of the bodySite, e.g. limb region or tooth surface(s).
requirements:
  v: Allows insurer to validate specific procedures.
min:
  v: 0
max:
  v: *
base:
  path:
    v: ClaimResponse.addItem.subSite
  min:
    v: 0
  max:
    v: *
type:
  code:
    v: CodeableConcept
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    link: http://hl7.org/fhir/StructureDefinition/Element
is modifier:
  v: false
is summary:
  v: false
binding:
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName
    value: string
      v: Surface
  strength:
    v: example
  description:
    v: The code for the tooth surface and surface combinations.
  value set:
    v: http://hl7.org/fhir/ValueSet/surface
    link: http://hl7.org/fhir/ValueSet/surface

id:
  v: ClaimResponse.addItem.noteNumber
path:
  v: ClaimResponse.addItem.noteNumber
short:
  v: Applicable note numbers
definition:
  v: The numbers associated with notes below which apply to the adjudication of this item.
requirements:
  v: Provides a condensed manner for associating human readable descriptive explanations for adjudications on the line item.
min:
  v: 0
max:
  v: *
base:
  path:
    v: ClaimResponse.addItem.noteNumber
  min:
    v: 0
  max:
    v: *
type:
  code:
    v: positiveInt
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    link: http://hl7.org/fhir/StructureDefinition/Element
is modifier:
  v: false
is summary:
  v: false

id:
  v: ClaimResponse.addItem.adjudication
path:
  v: ClaimResponse.addItem.adjudication
short:
  v: Added items adjudication
definition:
  v: The adjudication results.
min:
  v: 1
max:
  v: *
base:
  path:
    v: ClaimResponse.addItem.adjudication
  min:
    v: 1
  max:
    v: *
content reference:
  v: http://hl7.org/fhir/StructureDefinition/ClaimResponse#ClaimResponse.item.adjudication
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    link: http://hl7.org/fhir/StructureDefinition/Element
is modifier:
  v: false
is summary:
  v: false

id:
  v: ClaimResponse.addItem.detail
path:
  v: ClaimResponse.addItem.detail
short:
  v: Insurer added line details
definition:
  v: The second-tier service adjudications for payor added services.
min:
  v: 0
max:
  v: *
base:
  path:
    v: ClaimResponse.addItem.detail
  min:
    v: 0
  max:
    v: *
type:
  code:
    v: BackboneElement
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    link: http://hl7.org/fhir/StructureDefinition/Element
is modifier:
  v: false
is summary:
  v: false

id:
  v: ClaimResponse.addItem.detail.id
path:
  v: ClaimResponse.addItem.detail.id
representation:
  v: xmlAttr
short:
  v: Unique id for inter-element referencing
definition:
  v: Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: Element.id
  min:
    v: 0
  max:
    v: 1
type:
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type
    value: url
      v: string
  code:
    v: http://hl7.org/fhirpath/System.String
is modifier:
  v: false
is summary:
  v: false
mapping:
  identity:
    v: rim
  map:
    v: n/a

id:
  v: ClaimResponse.addItem.detail.extension
path:
  v: ClaimResponse.addItem.detail.extension
short:
  v: Additional content defined by implementations
definition:
  v: May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
comment:
  v: There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
alias:
  v: extensions
alias:
  v: user content
min:
  v: 0
max:
  v: *
base:
  path:
    v: Element.extension
  min:
    v: 0
  max:
    v: *
type:
  code:
    v: Extension
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    link: http://hl7.org/fhir/StructureDefinition/Element
constraint:
  key:
    v: ext-1
  severity:
    v: error
  human:
    v: Must have either extensions or value[x], not both
  expression:
    v: extension.exists() != value.exists()
  xpath:
    v: exists(f:extension)!=exists(f:*[starts-with(local-name(.), "value")])
  source:
    v: http://hl7.org/fhir/StructureDefinition/Extension
    link: http://hl7.org/fhir/StructureDefinition/Extension
is modifier:
  v: false
is summary:
  v: false
mapping:
  identity:
    v: rim
  map:
    v: n/a

id:
  v: ClaimResponse.addItem.detail.modifierExtension
path:
  v: ClaimResponse.addItem.detail.modifierExtension
short:
  v: Extensions that cannot be ignored even if unrecognized
definition:
  v: May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).
comment:
  v: There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
requirements:
  v: Modifier extensions allow for extensions that *cannot* be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the [definition of modifier extensions](http://hl7.org/fhir/R4/extensibility.html#modifierExtension).
alias:
  v: extensions
alias:
  v: user content
alias:
  v: modifiers
min:
  v: 0
max:
  v: *
base:
  path:
    v: BackboneElement.modifierExtension
  min:
    v: 0
  max:
    v: *
type:
  code:
    v: Extension
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    link: http://hl7.org/fhir/StructureDefinition/Element
constraint:
  key:
    v: ext-1
  severity:
    v: error
  human:
    v: Must have either extensions or value[x], not both
  expression:
    v: extension.exists() != value.exists()
  xpath:
    v: exists(f:extension)!=exists(f:*[starts-with(local-name(.), "value")])
  source:
    v: http://hl7.org/fhir/StructureDefinition/Extension
    link: http://hl7.org/fhir/StructureDefinition/Extension
is modifier:
  v: true
is modifier reason:
  v: Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
is summary:
  v: true
mapping:
  identity:
    v: rim
  map:
    v: N/A

id:
  v: ClaimResponse.addItem.detail.productOrService
path:
  v: ClaimResponse.addItem.detail.productOrService
short:
  v: Billing, service, product, or drug code
definition:
  v: When the value is a group code then this item collects a set of related claim details, otherwise this contains the product, service, drug or other billing code for the item.
comment:
  v: If this is an actual service or product line, i.e. not a Group, then use code to indicate the Professional Service or Product supplied (e.g. CTP, HCPCS, USCLS, ICD10, NCPDP, DIN, RxNorm, ACHI, CCI). If a grouping item then use a group code to indicate the type of thing being grouped e.g. 'glasses' or 'compound'.
requirements:
  v: Necessary to state what was provided or done.
min:
  v: 1
max:
  v: 1
base:
  path:
    v: ClaimResponse.addItem.detail.productOrService
  min:
    v: 1
  max:
    v: 1
type:
  code:
    v: CodeableConcept
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    link: http://hl7.org/fhir/StructureDefinition/Element
is modifier:
  v: false
is summary:
  v: false
binding:
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName
    value: string
      v: ServiceProduct
  strength:
    v: example
  description:
    v: Allowable service and product codes.
  value set:
    v: http://hl7.org/fhir/ValueSet/service-uscls
    link: http://hl7.org/fhir/ValueSet/service-uscls

id:
  v: ClaimResponse.addItem.detail.modifier
path:
  v: ClaimResponse.addItem.detail.modifier
short:
  v: Service/Product billing modifiers
definition:
  v: Item typification or modifiers codes to convey additional context for the product or service.
comment:
  v: For example in Oral whether the treatment is cosmetic or associated with TMJ, or for Medical whether the treatment was outside the clinic or outside of office hours.
requirements:
  v: To support inclusion of the item for adjudication or to charge an elevated fee.
min:
  v: 0
max:
  v: *
base:
  path:
    v: ClaimResponse.addItem.detail.modifier
  min:
    v: 0
  max:
    v: *
type:
  code:
    v: CodeableConcept
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    link: http://hl7.org/fhir/StructureDefinition/Element
is modifier:
  v: false
is summary:
  v: false
binding:
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName
    value: string
      v: Modifiers
  strength:
    v: example
  description:
    v: Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen.
  value set:
    v: http://hl7.org/fhir/ValueSet/claim-modifiers
    link: http://hl7.org/fhir/ValueSet/claim-modifiers
mapping:
  identity:
    v: rim
  map:
    v: 24.C, 24.D mods

id:
  v: ClaimResponse.addItem.detail.quantity
path:
  v: ClaimResponse.addItem.detail.quantity
short:
  v: Count of products or services
definition:
  v: The number of repetitions of a service or product.
requirements:
  v: Required when the product or service code does not convey the quantity provided.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: ClaimResponse.addItem.detail.quantity
  min:
    v: 0
  max:
    v: 1
type:
  code:
    v: Quantity
  profile:
    v: http://hl7.org/fhir/StructureDefinition/SimpleQuantity
    link: http://hl7.org/fhir/StructureDefinition/SimpleQuantity
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    link: http://hl7.org/fhir/StructureDefinition/Element
is modifier:
  v: false
is summary:
  v: false
mapping:
  identity:
    v: rim
  map:
    v: 24.G

id:
  v: ClaimResponse.addItem.detail.unitPrice
path:
  v: ClaimResponse.addItem.detail.unitPrice
short:
  v: Fee, charge or cost per item
definition:
  v: If the item is not a group then this is the fee for the product or service, otherwise this is the total of the fees for the details of the group.
requirements:
  v: The amount charged to the patient by the provider for a single unit.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: ClaimResponse.addItem.detail.unitPrice
  min:
    v: 0
  max:
    v: 1
type:
  code:
    v: Money
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    link: http://hl7.org/fhir/StructureDefinition/Element
is modifier:
  v: false
is summary:
  v: false

id:
  v: ClaimResponse.addItem.detail.factor
path:
  v: ClaimResponse.addItem.detail.factor
short:
  v: Price scaling factor
definition:
  v: A real number that represents a multiplier used in determining the overall value of services delivered and/or goods received. The concept of a Factor allows for a discount or surcharge multiplier to be applied to a monetary amount.
comment:
  v: To show a 10% senior's discount, the value entered is: 0.90 (1.00 - 0.10).
requirements:
  v: When discounts are provided to a patient (example: Senior's discount) then this must be documented for adjudication.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: ClaimResponse.addItem.detail.factor
  min:
    v: 0
  max:
    v: 1
type:
  code:
    v: decimal
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    link: http://hl7.org/fhir/StructureDefinition/Element
is modifier:
  v: false
is summary:
  v: false

id:
  v: ClaimResponse.addItem.detail.net
path:
  v: ClaimResponse.addItem.detail.net
short:
  v: Total item cost
definition:
  v: The quantity times the unit price for an additional service or product or charge.
comment:
  v: For example, the formula: quantity * unitPrice * factor = net. Quantity and factor are assumed to be 1 if not supplied.
requirements:
  v: Provides the total amount claimed for the group (if a grouper) or the line item.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: ClaimResponse.addItem.detail.net
  min:
    v: 0
  max:
    v: 1
type:
  code:
    v: Money
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    link: http://hl7.org/fhir/StructureDefinition/Element
is modifier:
  v: false
is summary:
  v: false
mapping:
  identity:
    v: rim
  map:
    v: 24.F

id:
  v: ClaimResponse.addItem.detail.noteNumber
path:
  v: ClaimResponse.addItem.detail.noteNumber
short:
  v: Applicable note numbers
definition:
  v: The numbers associated with notes below which apply to the adjudication of this item.
requirements:
  v: Provides a condensed manner for associating human readable descriptive explanations for adjudications on the line item.
min:
  v: 0
max:
  v: *
base:
  path:
    v: ClaimResponse.addItem.detail.noteNumber
  min:
    v: 0
  max:
    v: *
type:
  code:
    v: positiveInt
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    link: http://hl7.org/fhir/StructureDefinition/Element
is modifier:
  v: false
is summary:
  v: false

id:
  v: ClaimResponse.addItem.detail.adjudication
path:
  v: ClaimResponse.addItem.detail.adjudication
short:
  v: Added items detail adjudication
definition:
  v: The adjudication results.
min:
  v: 1
max:
  v: *
base:
  path:
    v: ClaimResponse.addItem.detail.adjudication
  min:
    v: 1
  max:
    v: *
content reference:
  v: http://hl7.org/fhir/StructureDefinition/ClaimResponse#ClaimResponse.item.adjudication
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    link: http://hl7.org/fhir/StructureDefinition/Element
is modifier:
  v: false
is summary:
  v: false

id:
  v: ClaimResponse.addItem.detail.subDetail
path:
  v: ClaimResponse.addItem.detail.subDetail
short:
  v: Insurer added line items
definition:
  v: The third-tier service adjudications for payor added services.
min:
  v: 0
max:
  v: *
base:
  path:
    v: ClaimResponse.addItem.detail.subDetail
  min:
    v: 0
  max:
    v: *
type:
  code:
    v: BackboneElement
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    link: http://hl7.org/fhir/StructureDefinition/Element
is modifier:
  v: false
is summary:
  v: false

id:
  v: ClaimResponse.addItem.detail.subDetail.id
path:
  v: ClaimResponse.addItem.detail.subDetail.id
representation:
  v: xmlAttr
short:
  v: Unique id for inter-element referencing
definition:
  v: Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: Element.id
  min:
    v: 0
  max:
    v: 1
type:
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type
    value: url
      v: string
  code:
    v: http://hl7.org/fhirpath/System.String
is modifier:
  v: false
is summary:
  v: false
mapping:
  identity:
    v: rim
  map:
    v: n/a

id:
  v: ClaimResponse.addItem.detail.subDetail.extension
path:
  v: ClaimResponse.addItem.detail.subDetail.extension
short:
  v: Additional content defined by implementations
definition:
  v: May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
comment:
  v: There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
alias:
  v: extensions
alias:
  v: user content
min:
  v: 0
max:
  v: *
base:
  path:
    v: Element.extension
  min:
    v: 0
  max:
    v: *
type:
  code:
    v: Extension
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    link: http://hl7.org/fhir/StructureDefinition/Element
constraint:
  key:
    v: ext-1
  severity:
    v: error
  human:
    v: Must have either extensions or value[x], not both
  expression:
    v: extension.exists() != value.exists()
  xpath:
    v: exists(f:extension)!=exists(f:*[starts-with(local-name(.), "value")])
  source:
    v: http://hl7.org/fhir/StructureDefinition/Extension
    link: http://hl7.org/fhir/StructureDefinition/Extension
is modifier:
  v: false
is summary:
  v: false
mapping:
  identity:
    v: rim
  map:
    v: n/a

id:
  v: ClaimResponse.addItem.detail.subDetail.modifierExtension
path:
  v: ClaimResponse.addItem.detail.subDetail.modifierExtension
short:
  v: Extensions that cannot be ignored even if unrecognized
definition:
  v: May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).
comment:
  v: There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
requirements:
  v: Modifier extensions allow for extensions that *cannot* be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the [definition of modifier extensions](http://hl7.org/fhir/R4/extensibility.html#modifierExtension).
alias:
  v: extensions
alias:
  v: user content
alias:
  v: modifiers
min:
  v: 0
max:
  v: *
base:
  path:
    v: BackboneElement.modifierExtension
  min:
    v: 0
  max:
    v: *
type:
  code:
    v: Extension
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    link: http://hl7.org/fhir/StructureDefinition/Element
constraint:
  key:
    v: ext-1
  severity:
    v: error
  human:
    v: Must have either extensions or value[x], not both
  expression:
    v: extension.exists() != value.exists()
  xpath:
    v: exists(f:extension)!=exists(f:*[starts-with(local-name(.), "value")])
  source:
    v: http://hl7.org/fhir/StructureDefinition/Extension
    link: http://hl7.org/fhir/StructureDefinition/Extension
is modifier:
  v: true
is modifier reason:
  v: Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
is summary:
  v: true
mapping:
  identity:
    v: rim
  map:
    v: N/A

id:
  v: ClaimResponse.addItem.detail.subDetail.productOrService
path:
  v: ClaimResponse.addItem.detail.subDetail.productOrService
short:
  v: Billing, service, product, or drug code
definition:
  v: When the value is a group code then this item collects a set of related claim details, otherwise this contains the product, service, drug or other billing code for the item.
comment:
  v: If this is an actual service or product line, i.e. not a Group, then use code to indicate the Professional Service or Product supplied (e.g. CTP, HCPCS, USCLS, ICD10, NCPDP, DIN, RxNorm, ACHI, CCI). If a grouping item then use a group code to indicate the type of thing being grouped e.g. 'glasses' or 'compound'.
requirements:
  v: Necessary to state what was provided or done.
min:
  v: 1
max:
  v: 1
base:
  path:
    v: ClaimResponse.addItem.detail.subDetail.productOrService
  min:
    v: 1
  max:
    v: 1
type:
  code:
    v: CodeableConcept
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    link: http://hl7.org/fhir/StructureDefinition/Element
is modifier:
  v: false
is summary:
  v: false
binding:
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName
    value: string
      v: ServiceProduct
  strength:
    v: example
  description:
    v: Allowable service and product codes.
  value set:
    v: http://hl7.org/fhir/ValueSet/service-uscls
    link: http://hl7.org/fhir/ValueSet/service-uscls

id:
  v: ClaimResponse.addItem.detail.subDetail.modifier
path:
  v: ClaimResponse.addItem.detail.subDetail.modifier
short:
  v: Service/Product billing modifiers
definition:
  v: Item typification or modifiers codes to convey additional context for the product or service.
comment:
  v: For example in Oral whether the treatment is cosmetic or associated with TMJ, or for Medical whether the treatment was outside the clinic or outside of office hours.
requirements:
  v: To support inclusion of the item for adjudication or to charge an elevated fee.
min:
  v: 0
max:
  v: *
base:
  path:
    v: ClaimResponse.addItem.detail.subDetail.modifier
  min:
    v: 0
  max:
    v: *
type:
  code:
    v: CodeableConcept
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    link: http://hl7.org/fhir/StructureDefinition/Element
is modifier:
  v: false
is summary:
  v: false
binding:
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName
    value: string
      v: Modifiers
  strength:
    v: example
  description:
    v: Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen.
  value set:
    v: http://hl7.org/fhir/ValueSet/claim-modifiers
    link: http://hl7.org/fhir/ValueSet/claim-modifiers
mapping:
  identity:
    v: rim
  map:
    v: 24.C, 24.D mods

id:
  v: ClaimResponse.addItem.detail.subDetail.quantity
path:
  v: ClaimResponse.addItem.detail.subDetail.quantity
short:
  v: Count of products or services
definition:
  v: The number of repetitions of a service or product.
requirements:
  v: Required when the product or service code does not convey the quantity provided.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: ClaimResponse.addItem.detail.subDetail.quantity
  min:
    v: 0
  max:
    v: 1
type:
  code:
    v: Quantity
  profile:
    v: http://hl7.org/fhir/StructureDefinition/SimpleQuantity
    link: http://hl7.org/fhir/StructureDefinition/SimpleQuantity
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    link: http://hl7.org/fhir/StructureDefinition/Element
is modifier:
  v: false
is summary:
  v: false
mapping:
  identity:
    v: rim
  map:
    v: 24.G

id:
  v: ClaimResponse.addItem.detail.subDetail.unitPrice
path:
  v: ClaimResponse.addItem.detail.subDetail.unitPrice
short:
  v: Fee, charge or cost per item
definition:
  v: If the item is not a group then this is the fee for the product or service, otherwise this is the total of the fees for the details of the group.
requirements:
  v: The amount charged to the patient by the provider for a single unit.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: ClaimResponse.addItem.detail.subDetail.unitPrice
  min:
    v: 0
  max:
    v: 1
type:
  code:
    v: Money
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    link: http://hl7.org/fhir/StructureDefinition/Element
is modifier:
  v: false
is summary:
  v: false

id:
  v: ClaimResponse.addItem.detail.subDetail.factor
path:
  v: ClaimResponse.addItem.detail.subDetail.factor
short:
  v: Price scaling factor
definition:
  v: A real number that represents a multiplier used in determining the overall value of services delivered and/or goods received. The concept of a Factor allows for a discount or surcharge multiplier to be applied to a monetary amount.
comment:
  v: To show a 10% senior's discount, the value entered is: 0.90 (1.00 - 0.10).
requirements:
  v: When discounts are provided to a patient (example: Senior's discount) then this must be documented for adjudication.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: ClaimResponse.addItem.detail.subDetail.factor
  min:
    v: 0
  max:
    v: 1
type:
  code:
    v: decimal
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    link: http://hl7.org/fhir/StructureDefinition/Element
is modifier:
  v: false
is summary:
  v: false

id:
  v: ClaimResponse.addItem.detail.subDetail.net
path:
  v: ClaimResponse.addItem.detail.subDetail.net
short:
  v: Total item cost
definition:
  v: The quantity times the unit price for an additional service or product or charge.
comment:
  v: For example, the formula: quantity * unitPrice * factor = net. Quantity and factor are assumed to be 1 if not supplied.
requirements:
  v: Provides the total amount claimed for the group (if a grouper) or the line item.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: ClaimResponse.addItem.detail.subDetail.net
  min:
    v: 0
  max:
    v: 1
type:
  code:
    v: Money
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    link: http://hl7.org/fhir/StructureDefinition/Element
is modifier:
  v: false
is summary:
  v: false
mapping:
  identity:
    v: rim
  map:
    v: 24.F

id:
  v: ClaimResponse.addItem.detail.subDetail.noteNumber
path:
  v: ClaimResponse.addItem.detail.subDetail.noteNumber
short:
  v: Applicable note numbers
definition:
  v: The numbers associated with notes below which apply to the adjudication of this item.
requirements:
  v: Provides a condensed manner for associating human readable descriptive explanations for adjudications on the line item.
min:
  v: 0
max:
  v: *
base:
  path:
    v: ClaimResponse.addItem.detail.subDetail.noteNumber
  min:
    v: 0
  max:
    v: *
type:
  code:
    v: positiveInt
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    link: http://hl7.org/fhir/StructureDefinition/Element
is modifier:
  v: false
is summary:
  v: false

id:
  v: ClaimResponse.addItem.detail.subDetail.adjudication
path:
  v: ClaimResponse.addItem.detail.subDetail.adjudication
short:
  v: Added items detail adjudication
definition:
  v: The adjudication results.
min:
  v: 1
max:
  v: *
base:
  path:
    v: ClaimResponse.addItem.detail.subDetail.adjudication
  min:
    v: 1
  max:
    v: *
content reference:
  v: http://hl7.org/fhir/StructureDefinition/ClaimResponse#ClaimResponse.item.adjudication
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    link: http://hl7.org/fhir/StructureDefinition/Element
is modifier:
  v: false
is summary:
  v: false

id:
  v: ClaimResponse.adjudication
path:
  v: ClaimResponse.adjudication
short:
  v: Header-level adjudication
definition:
  v: The adjudication results which are presented at the header level rather than at the line-item or add-item levels.
requirements:
  v: Some insurers will receive line-items but provide the adjudication only at a summary or header-level.
min:
  v: 0
max:
  v: *
base:
  path:
    v: ClaimResponse.adjudication
  min:
    v: 0
  max:
    v: *
content reference:
  v: http://hl7.org/fhir/StructureDefinition/ClaimResponse#ClaimResponse.item.adjudication
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    link: http://hl7.org/fhir/StructureDefinition/Element
is modifier:
  v: false
is summary:
  v: false

id:
  v: ClaimResponse.total
path:
  v: ClaimResponse.total
short:
  v: Adjudication totals
definition:
  v: Categorized monetary totals for the adjudication.
comment:
  v: Totals for amounts submitted, co-pays, benefits payable etc.
requirements:
  v: To provide the requestor with financial totals by category for the adjudication.
min:
  v: 0
max:
  v: *
base:
  path:
    v: ClaimResponse.total
  min:
    v: 0
  max:
    v: *
type:
  code:
    v: BackboneElement
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    link: http://hl7.org/fhir/StructureDefinition/Element
must support:
  v: true
is modifier:
  v: false
is summary:
  v: true

id:
  v: ClaimResponse.total.id
path:
  v: ClaimResponse.total.id
representation:
  v: xmlAttr
short:
  v: Unique id for inter-element referencing
definition:
  v: Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: Element.id
  min:
    v: 0
  max:
    v: 1
type:
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type
    value: url
      v: string
  code:
    v: http://hl7.org/fhirpath/System.String
is modifier:
  v: false
is summary:
  v: false
mapping:
  identity:
    v: rim
  map:
    v: n/a

id:
  v: ClaimResponse.total.extension
path:
  v: ClaimResponse.total.extension
short:
  v: Additional content defined by implementations
definition:
  v: May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
comment:
  v: There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
alias:
  v: extensions
alias:
  v: user content
min:
  v: 0
max:
  v: *
base:
  path:
    v: Element.extension
  min:
    v: 0
  max:
    v: *
type:
  code:
    v: Extension
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    link: http://hl7.org/fhir/StructureDefinition/Element
constraint:
  key:
    v: ext-1
  severity:
    v: error
  human:
    v: Must have either extensions or value[x], not both
  expression:
    v: extension.exists() != value.exists()
  xpath:
    v: exists(f:extension)!=exists(f:*[starts-with(local-name(.), "value")])
  source:
    v: http://hl7.org/fhir/StructureDefinition/Extension
    link: http://hl7.org/fhir/StructureDefinition/Extension
is modifier:
  v: false
is summary:
  v: false
mapping:
  identity:
    v: rim
  map:
    v: n/a

id:
  v: ClaimResponse.total.modifierExtension
path:
  v: ClaimResponse.total.modifierExtension
short:
  v: Extensions that cannot be ignored even if unrecognized
definition:
  v: May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).
comment:
  v: There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
requirements:
  v: Modifier extensions allow for extensions that *cannot* be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the [definition of modifier extensions](http://hl7.org/fhir/R4/extensibility.html#modifierExtension).
alias:
  v: extensions
alias:
  v: user content
alias:
  v: modifiers
min:
  v: 0
max:
  v: *
base:
  path:
    v: BackboneElement.modifierExtension
  min:
    v: 0
  max:
    v: *
type:
  code:
    v: Extension
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    link: http://hl7.org/fhir/StructureDefinition/Element
constraint:
  key:
    v: ext-1
  severity:
    v: error
  human:
    v: Must have either extensions or value[x], not both
  expression:
    v: extension.exists() != value.exists()
  xpath:
    v: exists(f:extension)!=exists(f:*[starts-with(local-name(.), "value")])
  source:
    v: http://hl7.org/fhir/StructureDefinition/Extension
    link: http://hl7.org/fhir/StructureDefinition/Extension
is modifier:
  v: true
is modifier reason:
  v: Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
is summary:
  v: true
mapping:
  identity:
    v: rim
  map:
    v: N/A

id:
  v: ClaimResponse.total.category
path:
  v: ClaimResponse.total.category
short:
  v: Type of adjudication information
definition:
  v: 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.
comment:
  v: For example codes indicating: Co-Pay, deductible, eligible, benefit, tax, etc.
requirements:
  v: Needed to convey the type of total provided.
min:
  v: 1
max:
  v: 1
base:
  path:
    v: ClaimResponse.total.category
  min:
    v: 1
  max:
    v: 1
type:
  code:
    v: CodeableConcept
  profile:
    v: http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/DP-CodeableConcept
    link: http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/DP-CodeableConcept
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    link: http://hl7.org/fhir/StructureDefinition/Element
is modifier:
  v: false
is summary:
  v: true
binding:
  strength:
    v: required
  value set:
    v: http://nphies.sa/terminology/ValueSet/adjudication
    link: http://nphies.sa/terminology/ValueSet/adjudication

id:
  v: ClaimResponse.total.amount
path:
  v: ClaimResponse.total.amount
short:
  v: Financial total for the category
definition:
  v: Monetary total amount associated with the category.
requirements:
  v: Needed to convey the total monetary amount.
min:
  v: 1
max:
  v: 1
base:
  path:
    v: ClaimResponse.total.amount
  min:
    v: 1
  max:
    v: 1
type:
  code:
    v: Money
  profile:
    v: http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/DP-Money-SAR
    link: http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/DP-Money-SAR
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    link: http://hl7.org/fhir/StructureDefinition/Element
is modifier:
  v: false
is summary:
  v: true

id:
  v: ClaimResponse.payment
path:
  v: ClaimResponse.payment
short:
  v: Payment Details
definition:
  v: Payment details for the adjudication of the claim.
requirements:
  v: Needed to convey references to the financial instrument that has been used if payment has been made.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: ClaimResponse.payment
  min:
    v: 0
  max:
    v: 1
type:
  code:
    v: BackboneElement
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    link: http://hl7.org/fhir/StructureDefinition/Element
is modifier:
  v: false
is summary:
  v: false

id:
  v: ClaimResponse.payment.id
path:
  v: ClaimResponse.payment.id
representation:
  v: xmlAttr
short:
  v: Unique id for inter-element referencing
definition:
  v: Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: Element.id
  min:
    v: 0
  max:
    v: 1
type:
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type
    value: url
      v: string
  code:
    v: http://hl7.org/fhirpath/System.String
is modifier:
  v: false
is summary:
  v: false
mapping:
  identity:
    v: rim
  map:
    v: n/a

id:
  v: ClaimResponse.payment.extension
path:
  v: ClaimResponse.payment.extension
short:
  v: Additional content defined by implementations
definition:
  v: May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
comment:
  v: There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
alias:
  v: extensions
alias:
  v: user content
min:
  v: 0
max:
  v: *
base:
  path:
    v: Element.extension
  min:
    v: 0
  max:
    v: *
type:
  code:
    v: Extension
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    link: http://hl7.org/fhir/StructureDefinition/Element
constraint:
  key:
    v: ext-1
  severity:
    v: error
  human:
    v: Must have either extensions or value[x], not both
  expression:
    v: extension.exists() != value.exists()
  xpath:
    v: exists(f:extension)!=exists(f:*[starts-with(local-name(.), "value")])
  source:
    v: http://hl7.org/fhir/StructureDefinition/Extension
    link: http://hl7.org/fhir/StructureDefinition/Extension
is modifier:
  v: false
is summary:
  v: false
mapping:
  identity:
    v: rim
  map:
    v: n/a

id:
  v: ClaimResponse.payment.modifierExtension
path:
  v: ClaimResponse.payment.modifierExtension
short:
  v: Extensions that cannot be ignored even if unrecognized
definition:
  v: May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).
comment:
  v: There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
requirements:
  v: Modifier extensions allow for extensions that *cannot* be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the [definition of modifier extensions](http://hl7.org/fhir/R4/extensibility.html#modifierExtension).
alias:
  v: extensions
alias:
  v: user content
alias:
  v: modifiers
min:
  v: 0
max:
  v: *
base:
  path:
    v: BackboneElement.modifierExtension
  min:
    v: 0
  max:
    v: *
type:
  code:
    v: Extension
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    link: http://hl7.org/fhir/StructureDefinition/Element
constraint:
  key:
    v: ext-1
  severity:
    v: error
  human:
    v: Must have either extensions or value[x], not both
  expression:
    v: extension.exists() != value.exists()
  xpath:
    v: exists(f:extension)!=exists(f:*[starts-with(local-name(.), "value")])
  source:
    v: http://hl7.org/fhir/StructureDefinition/Extension
    link: http://hl7.org/fhir/StructureDefinition/Extension
is modifier:
  v: true
is modifier reason:
  v: Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
is summary:
  v: true
mapping:
  identity:
    v: rim
  map:
    v: N/A

id:
  v: ClaimResponse.payment.type
path:
  v: ClaimResponse.payment.type
short:
  v: Partial or complete payment
definition:
  v: Whether this represents partial or complete payment of the benefits payable.
requirements:
  v: To advise the requestor when the insurer believes all payments to have been completed.
min:
  v: 1
max:
  v: 1
base:
  path:
    v: ClaimResponse.payment.type
  min:
    v: 1
  max:
    v: 1
type:
  code:
    v: CodeableConcept
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    link: http://hl7.org/fhir/StructureDefinition/Element
is modifier:
  v: false
is summary:
  v: false
binding:
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName
    value: string
      v: PaymentType
  strength:
    v: example
  description:
    v: The type (partial, complete) of the payment.
  value set:
    v: http://hl7.org/fhir/ValueSet/ex-paymenttype
    link: http://hl7.org/fhir/ValueSet/ex-paymenttype

id:
  v: ClaimResponse.payment.adjustment
path:
  v: ClaimResponse.payment.adjustment
short:
  v: Payment adjustment for non-claim issues
definition:
  v: Total amount of all adjustments to this payment included in this transaction which are not related to this claim's adjudication.
comment:
  v: Insurers will deduct amounts owing from the provider (adjustment), such as a prior overpayment, from the amount owing to the provider (benefits payable) when payment is made to the provider.
requirements:
  v: To advise the requestor of adjustments applied to the payment.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: ClaimResponse.payment.adjustment
  min:
    v: 0
  max:
    v: 1
type:
  code:
    v: Money
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    link: http://hl7.org/fhir/StructureDefinition/Element
is modifier:
  v: false
is summary:
  v: false

id:
  v: ClaimResponse.payment.adjustmentReason
path:
  v: ClaimResponse.payment.adjustmentReason
short:
  v: Explanation for the adjustment
definition:
  v: Reason for the payment adjustment.
requirements:
  v: Needed to clarify the monetary adjustment.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: ClaimResponse.payment.adjustmentReason
  min:
    v: 0
  max:
    v: 1
type:
  code:
    v: CodeableConcept
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    link: http://hl7.org/fhir/StructureDefinition/Element
is modifier:
  v: false
is summary:
  v: false
binding:
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName
    value: string
      v: PaymentAdjustmentReason
  strength:
    v: example
  description:
    v: Payment Adjustment reason codes.
  value set:
    v: http://hl7.org/fhir/ValueSet/payment-adjustment-reason
    link: http://hl7.org/fhir/ValueSet/payment-adjustment-reason

id:
  v: ClaimResponse.payment.date
path:
  v: ClaimResponse.payment.date
short:
  v: Expected date of payment
definition:
  v: Estimated date the payment will be issued or the actual issue date of payment.
requirements:
  v: To advise the payee when payment can be expected.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: ClaimResponse.payment.date
  min:
    v: 0
  max:
    v: 1
type:
  code:
    v: date
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    link: http://hl7.org/fhir/StructureDefinition/Element
is modifier:
  v: false
is summary:
  v: false

id:
  v: ClaimResponse.payment.amount
path:
  v: ClaimResponse.payment.amount
short:
  v: Payable amount after adjustment
definition:
  v: Benefits payable less any payment adjustment.
requirements:
  v: Needed to provide the actual payment amount.
min:
  v: 1
max:
  v: 1
base:
  path:
    v: ClaimResponse.payment.amount
  min:
    v: 1
  max:
    v: 1
type:
  code:
    v: Money
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    link: http://hl7.org/fhir/StructureDefinition/Element
is modifier:
  v: false
is summary:
  v: false

id:
  v: ClaimResponse.payment.identifier
path:
  v: ClaimResponse.payment.identifier
short:
  v: Business identifier for the payment
definition:
  v: Issuer's unique identifier for the payment instrument.
comment:
  v: For example: EFT number or check number.
requirements:
  v: Enable the receiver to reconcile when payment received.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: ClaimResponse.payment.identifier
  min:
    v: 0
  max:
    v: 1
type:
  code:
    v: Identifier
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    link: http://hl7.org/fhir/StructureDefinition/Element
is modifier:
  v: false
is summary:
  v: false

id:
  v: ClaimResponse.fundsReserve
path:
  v: ClaimResponse.fundsReserve
short:
  v: Funds reserved status
definition:
  v: A code, used only on a response to a preauthorization, to indicate whether the benefits payable have been reserved and for whom.
comment:
  v: Fund would be release by a future claim quoting the preAuthRef of this response. Examples of values include: provider, patient, none.
requirements:
  v: Needed to advise the submitting provider on whether the rquest for reservation of funds has been honored.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: ClaimResponse.fundsReserve
  min:
    v: 0
  max:
    v: 1
type:
  code:
    v: CodeableConcept
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    link: http://hl7.org/fhir/StructureDefinition/Element
must support:
  v: true
is modifier:
  v: false
is summary:
  v: false
binding:
  strength:
    v: required
  value set:
    v: http://hl7.org/fhir/ValueSet/fundsreserve
    link: http://hl7.org/fhir/ValueSet/fundsreserve

id:
  v: ClaimResponse.formCode
path:
  v: ClaimResponse.formCode
short:
  v: Printed form identifier
definition:
  v: A code for the form to be used for printing the content.
comment:
  v: May be needed to identify specific jurisdictional forms.
requirements:
  v: Needed to specify the specific form used for producing output for this response.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: ClaimResponse.formCode
  min:
    v: 0
  max:
    v: 1
type:
  code:
    v: CodeableConcept
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    link: http://hl7.org/fhir/StructureDefinition/Element
is modifier:
  v: false
is summary:
  v: false
binding:
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName
    value: string
      v: Forms
  strength:
    v: example
  description:
    v: The forms codes.
  value set:
    v: http://hl7.org/fhir/ValueSet/forms
    link: http://hl7.org/fhir/ValueSet/forms

id:
  v: ClaimResponse.form
path:
  v: ClaimResponse.form
short:
  v: Printed reference or actual form
definition:
  v: The actual form, by reference or inclusion, for printing the content or an EOB.
comment:
  v: Needed to permit insurers to include the actual form.
requirements:
  v: Needed to include the specific form used for producing output for this response.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: ClaimResponse.form
  min:
    v: 0
  max:
    v: 1
type:
  code:
    v: Attachment
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    link: http://hl7.org/fhir/StructureDefinition/Element
is modifier:
  v: false
is summary:
  v: false

id:
  v: ClaimResponse.processNote
path:
  v: ClaimResponse.processNote
short:
  v: Note concerning adjudication
definition:
  v: A note that describes or explains adjudication results in a human readable form.
requirements:
  v: Provides the insurer specific textual explanations associated with the processing.
min:
  v: 0
max:
  v: *
base:
  path:
    v: ClaimResponse.processNote
  min:
    v: 0
  max:
    v: *
type:
  code:
    v: BackboneElement
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    link: http://hl7.org/fhir/StructureDefinition/Element
must support:
  v: true
is modifier:
  v: false
is summary:
  v: false

id:
  v: ClaimResponse.processNote.id
path:
  v: ClaimResponse.processNote.id
representation:
  v: xmlAttr
short:
  v: Unique id for inter-element referencing
definition:
  v: Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: Element.id
  min:
    v: 0
  max:
    v: 1
type:
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type
    value: url
      v: string
  code:
    v: http://hl7.org/fhirpath/System.String
is modifier:
  v: false
is summary:
  v: false
mapping:
  identity:
    v: rim
  map:
    v: n/a

id:
  v: ClaimResponse.processNote.extension
path:
  v: ClaimResponse.processNote.extension
short:
  v: Additional content defined by implementations
definition:
  v: May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
comment:
  v: There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
alias:
  v: extensions
alias:
  v: user content
min:
  v: 0
max:
  v: *
base:
  path:
    v: Element.extension
  min:
    v: 0
  max:
    v: *
type:
  code:
    v: Extension
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    link: http://hl7.org/fhir/StructureDefinition/Element
constraint:
  key:
    v: ext-1
  severity:
    v: error
  human:
    v: Must have either extensions or value[x], not both
  expression:
    v: extension.exists() != value.exists()
  xpath:
    v: exists(f:extension)!=exists(f:*[starts-with(local-name(.), "value")])
  source:
    v: http://hl7.org/fhir/StructureDefinition/Extension
    link: http://hl7.org/fhir/StructureDefinition/Extension
is modifier:
  v: false
is summary:
  v: false
mapping:
  identity:
    v: rim
  map:
    v: n/a

id:
  v: ClaimResponse.processNote.modifierExtension
path:
  v: ClaimResponse.processNote.modifierExtension
short:
  v: Extensions that cannot be ignored even if unrecognized
definition:
  v: May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).
comment:
  v: There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
requirements:
  v: Modifier extensions allow for extensions that *cannot* be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the [definition of modifier extensions](http://hl7.org/fhir/R4/extensibility.html#modifierExtension).
alias:
  v: extensions
alias:
  v: user content
alias:
  v: modifiers
min:
  v: 0
max:
  v: *
base:
  path:
    v: BackboneElement.modifierExtension
  min:
    v: 0
  max:
    v: *
type:
  code:
    v: Extension
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    link: http://hl7.org/fhir/StructureDefinition/Element
constraint:
  key:
    v: ext-1
  severity:
    v: error
  human:
    v: Must have either extensions or value[x], not both
  expression:
    v: extension.exists() != value.exists()
  xpath:
    v: exists(f:extension)!=exists(f:*[starts-with(local-name(.), "value")])
  source:
    v: http://hl7.org/fhir/StructureDefinition/Extension
    link: http://hl7.org/fhir/StructureDefinition/Extension
is modifier:
  v: true
is modifier reason:
  v: Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
is summary:
  v: true
mapping:
  identity:
    v: rim
  map:
    v: N/A

id:
  v: ClaimResponse.processNote.number
path:
  v: ClaimResponse.processNote.number
short:
  v: Note instance identifier
definition:
  v: A number to uniquely identify a note entry.
requirements:
  v: Necessary to provide a mechanism to link from adjudications.
min:
  v: 1
max:
  v: 1
base:
  path:
    v: ClaimResponse.processNote.number
  min:
    v: 0
  max:
    v: 1
type:
  code:
    v: positiveInt
  profile:
    v: http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/DP-positiveInt
    link: http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/DP-positiveInt
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    link: http://hl7.org/fhir/StructureDefinition/Element
is modifier:
  v: false
is summary:
  v: false

id:
  v: ClaimResponse.processNote.type
path:
  v: ClaimResponse.processNote.type
short:
  v: display | print | printoper
definition:
  v: The business purpose of the note text.
requirements:
  v: To convey the expectation for when the text is used.
min:
  v: 1
max:
  v: 1
base:
  path:
    v: ClaimResponse.processNote.type
  min:
    v: 0
  max:
    v: 1
type:
  code:
    v: code
  profile:
    v: http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/DP-code
    link: http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/DP-code
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    link: http://hl7.org/fhir/StructureDefinition/Element
is modifier:
  v: false
is summary:
  v: false
binding:
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName
    value: string
      v: NoteType
  strength:
    v: required
  description:
    v: The presentation types of notes.
  value set:
    v: http://hl7.org/fhir/ValueSet/note-type|4.0.1
    link: 4.0
    link: .1

id:
  v: ClaimResponse.processNote.text
path:
  v: ClaimResponse.processNote.text
short:
  v: Note explanatory text
definition:
  v: The explanation or description associated with the processing.
requirements:
  v: Required to provide human readable explanation.
min:
  v: 1
max:
  v: 1
base:
  path:
    v: ClaimResponse.processNote.text
  min:
    v: 1
  max:
    v: 1
type:
  code:
    v: string
  profile:
    v: http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/DP-string
    link: http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/DP-string
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    link: http://hl7.org/fhir/StructureDefinition/Element
is modifier:
  v: false
is summary:
  v: false

id:
  v: ClaimResponse.processNote.language
path:
  v: ClaimResponse.processNote.language
short:
  v: Language of the text
definition:
  v: A code to define the language used in the text of the note.
comment:
  v: Only required if the language is different from the resource language.
requirements:
  v: Note text may vary from the resource defined language.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: ClaimResponse.processNote.language
  min:
    v: 0
  max:
    v: 1
type:
  code:
    v: CodeableConcept
  profile:
    v: http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/DP-CodeableConcept
    link: http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/DP-CodeableConcept
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    link: http://hl7.org/fhir/StructureDefinition/Element
must support:
  v: true
is modifier:
  v: false
is summary:
  v: false
binding:
  strength:
    v: required
  value set:
    v: http://nphies.sa/terminology/ValueSet/ksa-languages
    link: http://nphies.sa/terminology/ValueSet/ksa-languages

id:
  v: ClaimResponse.communicationRequest
path:
  v: ClaimResponse.communicationRequest
short:
  v: Request for additional information
definition:
  v: Request for additional supporting or authorizing information.
comment:
  v: For example: professional reports, documents, images, clinical resources, or accident reports.
requirements:
  v: Need to communicate insurer request for additional information required to support the adjudication.
min:
  v: 0
max:
  v: *
base:
  path:
    v: ClaimResponse.communicationRequest
  min:
    v: 0
  max:
    v: *
type:
  code:
    v: Reference
  target profile:
    v: http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/communication-request
    link: http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/communication-request
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    link: http://hl7.org/fhir/StructureDefinition/Element
must support:
  v: true
is modifier:
  v: false
is summary:
  v: false

id:
  v: ClaimResponse.insurance
path:
  v: ClaimResponse.insurance
short:
  v: Patient insurance information
definition:
  v: Financial instruments for reimbursement for the health care products and services specified on the claim.
comment:
  v: All insurance coverages for the patient which may be applicable for reimbursement, of the products and services listed in the claim, are typically provided in the claim to allow insurers to confirm the ordering of the insurance coverages relative to local 'coordination of benefit' rules. One coverage (and only one) with 'focal=true' is to be used in the adjudication of this claim. Coverages appearing before the focal Coverage in the list, and where 'subrogation=false', should provide a reference to the ClaimResponse containing the adjudication results of the prior claim.
requirements:
  v: At least one insurer is required for a claim to be a claim.
min:
  v: 0
max:
  v: *
base:
  path:
    v: ClaimResponse.insurance
  min:
    v: 0
  max:
    v: *
type:
  code:
    v: BackboneElement
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    link: http://hl7.org/fhir/StructureDefinition/Element
must support:
  v: true
is modifier:
  v: false
is summary:
  v: false
mapping:
  identity:
    v: rim
  map:
    v: Coverage

id:
  v: ClaimResponse.insurance.id
path:
  v: ClaimResponse.insurance.id
representation:
  v: xmlAttr
short:
  v: Unique id for inter-element referencing
definition:
  v: Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: Element.id
  min:
    v: 0
  max:
    v: 1
type:
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type
    value: url
      v: string
  code:
    v: http://hl7.org/fhirpath/System.String
is modifier:
  v: false
is summary:
  v: false
mapping:
  identity:
    v: rim
  map:
    v: n/a

id:
  v: ClaimResponse.insurance.extension