Healthcare Financial Services IG Edition 1
0.3.0 - ci-build
Healthcare Financial Services IG Edition 1 - Local Development build (v0.3.0) built by the FHIR (HL7® FHIR® Standard) Build Tools. See the Directory of published versions
Extension: Adjudication Outcome
| Official URL: http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-adjudication-outcome | Version: 0.3.0 | |||
| Draft as of 2025-06-23 | Computable Name: EXAdjudicationOutcome | |||
A code indicating the outcome of the adjudication such as rejected, partially approved/paid or approved/paid as submitted.
Context of Use
This extension may be used on the following element(s):
- Element ID ClaimResponse
- Element ID ClaimResponse.item
- Element ID ClaimResponse.addItem
Usage info
Usage:
- Use this Extension: Nphies Advanced Authorization, Nphies Claim Response and Nphies Authorization Response
- Examples for this Extension: Bundle/c2c63768-a65b-4784-ab91-6c09012c3ab1, Bundle/c2c63768-a65b-4784-ab91-6c09012c3cbc, Bundle/c2c63768-a65b-5784-ab91-6c09012c3cbc, Bundle/dccc9ae9-e640-4fe1-b3fd-5af3c1c12210... Show 6 more
Formal Views of Extension Content
Description of Profiles, Differentials, Snapshots, and how the XML and JSON presentations work.
This structure is derived from Extension
This structure is derived from Extension
| Name | Flags | Card. | Type | Description & Constraints |
|---|---|---|---|---|
  Extension |
0..* | Extension | Adjudication Outcome | |
  extension |
0..0 | |||
| url |
1..1 | uri | "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-adjudication-outcome" | |
  Slices for value[x] |
1..1 | DP_CodeableConcept | Value of extension Slice: Unordered, Open by type:$this | |
   value[x]:valueCodeableConcept |
1..1 | CodeableConcept | Value of extension Binding: Adjudication Outcome (required) | |
| Documentation for this format | ||||
| Name | Flags | Card. | Type | Description & Constraints |
|---|---|---|---|---|
| Extension |
0..* | Extension | Adjudication Outcome | |
 id |
0..1 | string | Unique id for inter-element referencing | |
| extension |
0..0 | |||
| url |
1..1 | uri | "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-adjudication-outcome" | |
| Slices for value[x] |
1..1 | DP_CodeableConcept | Value of extension Slice: Unordered, Closed by type:$this | |
| value[x]:valueCodeableConcept |
1..1 | CodeableConcept | Value of extension Binding: Adjudication Outcome (required) | |
| Documentation for this format | ||||
This structure is derived from Extension
Differential View
This structure is derived from Extension
| Name | Flags | Card. | Type | Description & Constraints |
|---|---|---|---|---|
| Extension |
0..* | Extension | Adjudication Outcome | |
| extension |
0..0 | |||
| url |
1..1 | uri | "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-adjudication-outcome" | |
| Slices for value[x] |
1..1 | DP_CodeableConcept | Value of extension Slice: Unordered, Open by type:$this | |
| value[x]:valueCodeableConcept |
1..1 | CodeableConcept | Value of extension Binding: Adjudication Outcome (required) | |
| Documentation for this format | ||||
Snapshot View
| Name | Flags | Card. | Type | Description & Constraints |
|---|---|---|---|---|
| Extension |
0..* | Extension | Adjudication Outcome | |
| id |
0..1 | string | Unique id for inter-element referencing | |
| extension |
0..0 | |||
| url |
1..1 | uri | "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-adjudication-outcome" | |
| Slices for value[x] |
1..1 | DP_CodeableConcept | Value of extension Slice: Unordered, Closed by type:$this | |
| value[x]:valueCodeableConcept |
1..1 | CodeableConcept | Value of extension Binding: Adjudication Outcome (required) | |
| Documentation for this format | ||||
Other representations of profile: CSV, Excel, Schematron
Terminology Bindings
| Path | Conformance | ValueSet | URI |
| Extension.value[x]:valueCodeableConcept | required | AdjudicationOutcome (a valid code from Adjudication Outcome)http://nphies.sa/terminology/ValueSet/adjudication-outcomefrom this IG |
Constraints
| Id | Grade | Path(s) | Details | Requirements |
| ele-1 | error | **ALL** elements | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ext-1 | error | **ALL** extensions | Must have either extensions or value[x], not both : extension.exists() != value.exists() |