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FoundationShEx statement for claimresponse
PREFIX fhir: <http://hl7.org/fhir/>
PREFIX fhirvs: <http://hl7.org/fhir/ValueSet/>
PREFIX xsd: <http://www.w3.org/2001/XMLSchema#>
BASE <http://hl7.org/fhir/shape/>
start=@<ClaimResponse> AND {fhir:nodeRole [fhir:treeRoot]}
# Remittance resource
<ClaimResponse> CLOSED {
a [fhir:ClaimResponse];
fhir:nodeRole [fhir:treeRoot]?;
fhir:Resource.id @<id>?; # Logical id of this artifact
fhir:Resource.meta @<Meta>?; # Metadata about the resource
fhir:Resource.implicitRules @<uri>?; # A set of rules under which this
# content was created
fhir:Resource.language @<code>?; # Language of the resource content
fhir:DomainResource.text @<Narrative>?; # Text summary of the resource, for
# human interpretation
fhir:DomainResource.contained @<Resource>*; # Contained, inline Resources
fhir:extension @<Extension>*; # Additional Content defined by
# implementations
fhir:modifierExtension @<Extension>*; # Extensions that cannot be ignored
fhir:ClaimResponse.identifier @<Identifier>*; # Response number
fhir:ClaimResponse.status @<code> AND
{fhir:value @fhirvs:fm-status}?; # active | cancelled | draft |
# entered-in-error
fhir:ClaimResponse.created @<dateTime>?; # Creation date
fhir:ClaimResponse.insurer @<Reference>?; # Insurer
fhir:ClaimResponse.requestProvider @<Reference>?; # Responsible practitioner
fhir:ClaimResponse.requestOrganization @<Reference>?; # Responsible organization
fhir:ClaimResponse.request @<Reference>?; # Id of resource triggering
# adjudication
fhir:ClaimResponse.outcome @<CodeableConcept>?; # complete | error | partial
fhir:ClaimResponse.disposition @<string>?; # Disposition Message
fhir:ClaimResponse.payeeType @<CodeableConcept>?; # Party to be paid any benefits
# payable
fhir:ClaimResponse.item @<ClaimResponse.item>*; # Line items
fhir:ClaimResponse.addItem @<ClaimResponse.addItem>*; # Insurer added line items
fhir:ClaimResponse.error @<ClaimResponse.error>*; # Processing errors
fhir:ClaimResponse.totalCost @<Money>?; # Total Cost of service from the
# Claim
fhir:ClaimResponse.unallocDeductable @<Money>?; # Unallocated deductible
fhir:ClaimResponse.totalBenefit @<Money>?; # Total benefit payable for the Claim
fhir:ClaimResponse.payment @<ClaimResponse.payment>?; # Payment details, if paid
fhir:ClaimResponse.reserved @<Coding>?; # Funds reserved status
fhir:ClaimResponse.form @<CodeableConcept> AND
{fhir:value @fhirvs:forms}?; # Printed Form Identifier
fhir:ClaimResponse.note @<ClaimResponse.note>*; # Processing notes
fhir:ClaimResponse.communicationRequest @<Reference>*; # Request for additional information
fhir:ClaimResponse.insurance @<ClaimResponse.insurance>*; # Insurance or medical plan
fhir:index xsd:integer? # Relative position in a list
}
# Insurance or medical plan
<ClaimResponse.insurance> CLOSED {
fhir:Element.id @<string>?; # xml:id (or equivalent in JSON)
fhir:extension @<Extension>*; # Additional Content defined by
# implementations
fhir:modifierExtension @<Extension>*; # Extensions that cannot be ignored
fhir:ClaimResponse.insurance.sequence @<positiveInt>; # Service instance identifier
fhir:ClaimResponse.insurance.focal @<boolean>; # Is the focal Coverage
fhir:ClaimResponse.insurance.coverage @<Reference>; # Insurance information
fhir:ClaimResponse.insurance.businessArrangement @<string>?; # Business agreement
fhir:ClaimResponse.insurance.preAuthRef @<string>*; # Pre-Authorization/Determination
# Reference
fhir:ClaimResponse.insurance.claimResponse @<Reference>?; # Adjudication results
fhir:index xsd:integer? # Relative position in a list
}
# Insurer added line items
<ClaimResponse.addItem> CLOSED {
fhir:Element.id @<string>?; # xml:id (or equivalent in JSON)
fhir:extension @<Extension>*; # Additional Content defined by
# implementations
fhir:modifierExtension @<Extension>*; # Extensions that cannot be ignored
fhir:ClaimResponse.addItem.sequenceLinkId @<positiveInt>*; # Service instances
fhir:ClaimResponse.addItem.revenue @<CodeableConcept>?; # Revenue or cost center code
fhir:ClaimResponse.addItem.category @<CodeableConcept>?; # Type of service or product
fhir:ClaimResponse.addItem.service @<CodeableConcept>?; # Group, Service or Product
fhir:ClaimResponse.addItem.modifier @<CodeableConcept>*; # Service/Product billing modifiers
fhir:ClaimResponse.addItem.fee @<Money>?; # Professional fee or Product charge
fhir:ClaimResponse.addItem.noteNumber @<positiveInt>*; # List of note numbers which apply
fhir:ClaimResponse.addItem.adjudication @<ClaimResponse.item.adjudication>*; # Added items adjudication
fhir:ClaimResponse.addItem.detail @<ClaimResponse.addItem.detail>*; # Added items details
fhir:index xsd:integer? # Relative position in a list
}
# Processing errors
<ClaimResponse.error> CLOSED {
fhir:Element.id @<string>?; # xml:id (or equivalent in JSON)
fhir:extension @<Extension>*; # Additional Content defined by
# implementations
fhir:modifierExtension @<Extension>*; # Extensions that cannot be ignored
fhir:ClaimResponse.error.sequenceLinkId @<positiveInt>?; # Item sequence number
fhir:ClaimResponse.error.detailSequenceLinkId @<positiveInt>?; # Detail sequence number
fhir:ClaimResponse.error.subdetailSequenceLinkId @<positiveInt>?; # Subdetail sequence number
fhir:ClaimResponse.error.code @<CodeableConcept>; # Error code detailing processing
# issues
fhir:index xsd:integer? # Relative position in a list
}
# Processing notes
<ClaimResponse.note> CLOSED {
fhir:Element.id @<string>?; # xml:id (or equivalent in JSON)
fhir:extension @<Extension>*; # Additional Content defined by
# implementations
fhir:modifierExtension @<Extension>*; # Extensions that cannot be ignored
fhir:ClaimResponse.note.number @<positiveInt>?; # Note Number for this note
fhir:ClaimResponse.note.type @<CodeableConcept> AND
{fhir:value @fhirvs:note-type}?; # display | print | printoper
fhir:ClaimResponse.note.text @<string>?; # Note explanatory text
fhir:ClaimResponse.note.language @<CodeableConcept>?; # Language
fhir:index xsd:integer? # Relative position in a list
}
# Line items
<ClaimResponse.item> CLOSED {
fhir:Element.id @<string>?; # xml:id (or equivalent in JSON)
fhir:extension @<Extension>*; # Additional Content defined by
# implementations
fhir:modifierExtension @<Extension>*; # Extensions that cannot be ignored
fhir:ClaimResponse.item.sequenceLinkId @<positiveInt>; # Service instance
fhir:ClaimResponse.item.noteNumber @<positiveInt>*; # List of note numbers which apply
fhir:ClaimResponse.item.adjudication @<ClaimResponse.item.adjudication>*; # Adjudication details
fhir:ClaimResponse.item.detail @<ClaimResponse.item.detail>*; # Detail line items
fhir:index xsd:integer? # Relative position in a list
}
# Payment details, if paid
<ClaimResponse.payment> CLOSED {
fhir:Element.id @<string>?; # xml:id (or equivalent in JSON)
fhir:extension @<Extension>*; # Additional Content defined by
# implementations
fhir:modifierExtension @<Extension>*; # Extensions that cannot be ignored
fhir:ClaimResponse.payment.type @<CodeableConcept>?; # Partial or Complete
fhir:ClaimResponse.payment.adjustment @<Money>?; # Payment adjustment for non-Claim
# issues
fhir:ClaimResponse.payment.adjustmentReason @<CodeableConcept>?; # Reason for Payment adjustment
fhir:ClaimResponse.payment.date @<date>?; # Expected data of Payment
fhir:ClaimResponse.payment.amount @<Money>?; # Payment amount
fhir:ClaimResponse.payment.identifier @<Identifier>?; # Payment identifier
fhir:index xsd:integer? # Relative position in a list
}
# Adjudication details
<ClaimResponse.item.adjudication> CLOSED {
fhir:Element.id @<string>?; # xml:id (or equivalent in JSON)
fhir:extension @<Extension>*; # Additional Content defined by
# implementations
fhir:modifierExtension @<Extension>*; # Extensions that cannot be ignored
fhir:ClaimResponse.item.adjudication.category @<CodeableConcept>; # Adjudication category such as
# co-pay, eligible, benefit, etc.
fhir:ClaimResponse.item.adjudication.reason @<CodeableConcept>?; # Adjudication reason
fhir:ClaimResponse.item.adjudication.amount @<Money>?; # Monetary amount
fhir:ClaimResponse.item.adjudication.value @<decimal>?; # Non-monetary value
fhir:index xsd:integer? # Relative position in a list
}
# Added items details
<ClaimResponse.addItem.detail> CLOSED {
fhir:Element.id @<string>?; # xml:id (or equivalent in JSON)
fhir:extension @<Extension>*; # Additional Content defined by
# implementations
fhir:modifierExtension @<Extension>*; # Extensions that cannot be ignored
fhir:ClaimResponse.addItem.detail.revenue @<CodeableConcept>?; # Revenue or cost center code
fhir:ClaimResponse.addItem.detail.category @<CodeableConcept>?; # Type of service or product
fhir:ClaimResponse.addItem.detail.service @<CodeableConcept>?; # Service or Product
fhir:ClaimResponse.addItem.detail.modifier @<CodeableConcept>*; # Service/Product billing modifiers
fhir:ClaimResponse.addItem.detail.fee @<Money>?; # Professional fee or Product charge
fhir:ClaimResponse.addItem.detail.noteNumber @<positiveInt>*; # List of note numbers which apply
fhir:ClaimResponse.addItem.detail.adjudication @<ClaimResponse.item.adjudication>*; # Added items detail adjudication
fhir:index xsd:integer? # Relative position in a list
}
# Detail line items
<ClaimResponse.item.detail> CLOSED {
fhir:Element.id @<string>?; # xml:id (or equivalent in JSON)
fhir:extension @<Extension>*; # Additional Content defined by
# implementations
fhir:modifierExtension @<Extension>*; # Extensions that cannot be ignored
fhir:ClaimResponse.item.detail.sequenceLinkId @<positiveInt>; # Service instance
fhir:ClaimResponse.item.detail.noteNumber @<positiveInt>*; # List of note numbers which apply
fhir:ClaimResponse.item.detail.adjudication @<ClaimResponse.item.adjudication>*; # Detail adjudication
fhir:ClaimResponse.item.detail.subDetail @<ClaimResponse.item.detail.subDetail>*; # Subdetail line items
fhir:index xsd:integer? # Relative position in a list
}
# Subdetail line items
<ClaimResponse.item.detail.subDetail> CLOSED {
fhir:Element.id @<string>?; # xml:id (or equivalent in JSON)
fhir:extension @<Extension>*; # Additional Content defined by
# implementations
fhir:modifierExtension @<Extension>*; # Extensions that cannot be ignored
fhir:ClaimResponse.item.detail.subDetail.sequenceLinkId @<positiveInt>; # Service instance
fhir:ClaimResponse.item.detail.subDetail.noteNumber @<positiveInt>*; # List of note numbers which apply
fhir:ClaimResponse.item.detail.subDetail.adjudication @<ClaimResponse.item.adjudication>*; # Subdetail adjudication
fhir:index xsd:integer? # Relative position in a list
}
#---------------------- Data Types -------------------
# Primitive Type dateTime
<dateTime> CLOSED {
fhir:Element.id @<id>?; # xml:id (or equivalent in JSON)
fhir:extension @<Extension>*; # Additional Content defined by
# implementations
fhir:value xsd:gYear OR xsd:gYearMonth OR xsd:date OR xsd:dateTime?; # Primitive value for dateTime
fhir:index xsd:integer? # Relative position in a list
}
# Primitive Type date
<date> CLOSED {
fhir:Element.id @<id>?; # xml:id (or equivalent in JSON)
fhir:extension @<Extension>*; # Additional Content defined by
# implementations
fhir:value xsd:gYear OR xsd:gYearMonth OR xsd:date?; # Primitive value for date
fhir:index xsd:integer? # Relative position in a list
}
# Metadata about a resource
<Meta> CLOSED {
fhir:Element.id @<string>?; # xml:id (or equivalent in JSON)
fhir:extension @<Extension>*; # Additional Content defined by
# implementations
fhir:Meta.versionId @<id>?; # Version specific identifier
fhir:Meta.lastUpdated @<instant>?; # When the resource version last
# changed
fhir:Meta.profile @<uri>*; # Profiles this resource claims to
# conform to
fhir:Meta.security @<Coding>*; # Security Labels applied to this
# resource
fhir:Meta.tag @<Coding>*; # Tags applied to this resource
fhir:index xsd:integer? # Relative position in a list
}
# Primitive Type code
<code> CLOSED {
fhir:extension @<Extension>*; # Additional Content defined by
# implementations
fhir:value xsd:string?; # Primitive value for code
fhir:index xsd:integer? # Relative position in a list
}
# Primitive Type string
<string> CLOSED {
fhir:Element.id @<id>?; # xml:id (or equivalent in JSON)
fhir:extension @<Extension>*; # Additional Content defined by
# implementations
fhir:value xsd:string MAXLENGTH 1048576?; # Primitive value for string
fhir:index xsd:integer? # Relative position in a list
}
# A reference from one resource to another
<Reference> CLOSED {
fhir:link IRI?;
fhir:Element.id @<string>?; # xml:id (or equivalent in JSON)
fhir:extension @<Extension>*; # Additional Content defined by
# implementations
fhir:Reference.reference @<string>?; # Literal reference, Relative,
# internal or absolute URL
fhir:Reference.identifier @<Identifier>?; # Logical reference, when literal
# reference is not known
fhir:Reference.display @<string>?; # Text alternative for the resource
fhir:index xsd:integer? # Relative position in a list
}
# Base Resource
<Resource> {a .+;
fhir:Resource.id @<id>?; # Logical id of this artifact
fhir:Resource.meta @<Meta>?; # Metadata about the resource
fhir:Resource.implicitRules @<uri>?; # A set of rules under which this
# content was created
fhir:Resource.language @<code>?; # Language of the resource content
fhir:index xsd:integer?
}
# Primitive Type uri
<uri> CLOSED {
fhir:Element.id @<id>?; # xml:id (or equivalent in JSON)
fhir:extension @<Extension>*; # Additional Content defined by
# implementations
fhir:value xsd:string?; # Primitive value for uri
fhir:index xsd:integer? # Relative position in a list
}
<Extension> {fhir:extension @<Extension>*;
fhir:index xsd:integer?
}
# An amount of economic utility in some recognised currency
<Money> CLOSED {
fhir:Element.id @<string>?; # xml:id (or equivalent in JSON)
fhir:extension @<Extension>*; # Additional Content defined by
# implementations
fhir:Quantity.value @<decimal>?; # Numerical value (with implicit
# precision)
fhir:Quantity.comparator @<code> AND
{fhir:value @fhirvs:quantity-comparator}?; # < | <= | >= | > - how to
# understand the value
fhir:Quantity.unit @<string>?; # Unit representation
fhir:Quantity.system @<uri>?; # System that defines coded unit form
fhir:Quantity.code @<code>?; # Coded form of the unit
fhir:index xsd:integer? # Relative position in a list
}
# An identifier intended for computation
<Identifier> CLOSED {
fhir:Element.id @<string>?; # xml:id (or equivalent in JSON)
fhir:extension @<Extension>*; # Additional Content defined by
# implementations
fhir:Identifier.use @<code> AND
{fhir:value @fhirvs:identifier-use}?; # usual | official | temp |
# secondary (If known)
fhir:Identifier.type @<CodeableConcept>?; # Description of identifier
fhir:Identifier.system @<uri>?; # The namespace for the identifier
fhir:Identifier.value @<string>?; # The value that is unique
fhir:Identifier.period @<Period>?; # Time period when id is/was valid
# for use
fhir:Identifier.assigner @<Reference>?; # Organization that issued id (may
# be just text)
fhir:index xsd:integer? # Relative position in a list
}
# Primitive Type boolean
<boolean> CLOSED {
fhir:Element.id @<id>?; # xml:id (or equivalent in JSON)
fhir:extension @<Extension>*; # Additional Content defined by
# implementations
fhir:value xsd:boolean?; # Primitive value for boolean
fhir:index xsd:integer? # Relative position in a list
}
# A human-readable formatted text, including images
<Narrative> CLOSED {
fhir:Element.id @<string>?; # xml:id (or equivalent in JSON)
fhir:extension @<Extension>*; # Additional Content defined by
# implementations
fhir:Narrative.status @<code> AND
{fhir:value @fhirvs:narrative-status}; # generated | extensions |
# additional | empty
fhir:Narrative.div xsd:string; # Limited xhtml content
fhir:index xsd:integer? # Relative position in a list
}
# A reference to a code defined by a terminology system
<Coding> CLOSED {
fhir:concept IRI?;
fhir:Element.id @<string>?; # xml:id (or equivalent in JSON)
fhir:extension @<Extension>*; # Additional Content defined by
# implementations
fhir:Coding.system @<uri>?; # Identity of the terminology system
fhir:Coding.version @<string>?; # Version of the system - if relevant
fhir:Coding.code @<code>?; # Symbol in syntax defined by the
# system
fhir:Coding.display @<string>?; # Representation defined by the
# system
fhir:Coding.userSelected @<boolean>?; # If this coding was chosen directly
# by the user
fhir:index xsd:integer? # Relative position in a list
}
# Primitive Type id
<id> CLOSED {
fhir:extension @<Extension>*; # Additional Content defined by
# implementations
fhir:value xsd:string?; # Primitive value for id
fhir:index xsd:integer? # Relative position in a list
}
# Primitive Type positiveInt
<positiveInt> CLOSED {
fhir:extension @<Extension>*; # Additional Content defined by
# implementations
fhir:value xsd:positiveInteger?; # Primitive value for positiveInt
fhir:index xsd:integer? # Relative position in a list
}
# Primitive Type decimal
<decimal> CLOSED {
fhir:Element.id @<id>?; # xml:id (or equivalent in JSON)
fhir:extension @<Extension>*; # Additional Content defined by
# implementations
fhir:value xsd:decimal?; # Primitive value for decimal
fhir:index xsd:integer? # Relative position in a list
}
# Concept - reference to a terminology or just text
<CodeableConcept> CLOSED {
fhir:concept IRI*;
fhir:Element.id @<string>?; # xml:id (or equivalent in JSON)
fhir:extension @<Extension>*; # Additional Content defined by
# implementations
fhir:CodeableConcept.coding @<Coding>*; # Code defined by a terminology
# system
fhir:CodeableConcept.text @<string>?; # Plain text representation of the
# concept
fhir:index xsd:integer? # Relative position in a list
}
# Time range defined by start and end date/time
<Period> CLOSED {
fhir:Element.id @<string>?; # xml:id (or equivalent in JSON)
fhir:extension @<Extension>*; # Additional Content defined by
# implementations
fhir:Period.start @<dateTime>?; # Starting time with inclusive
# boundary
fhir:Period.end @<dateTime>?; # End time with inclusive boundary,
# if not ongoing
fhir:index xsd:integer? # Relative position in a list
}
# Primitive Type instant
<instant> CLOSED {
fhir:Element.id @<id>?; # xml:id (or equivalent in JSON)
fhir:extension @<Extension>*; # Additional Content defined by
# implementations
fhir:value xsd:dateTime?; # Primitive value for instant
fhir:index xsd:integer? # Relative position in a list
}
#---------------------- Reference Types -------------------
#---------------------- Value Sets ------------------------
# This value set includes a sample set of Forms codes.
fhirvs:forms ["1" "2"]
# Identifies the purpose for this identifier, if known .
fhirvs:identifier-use ["usual" "official" "temp" "secondary"]
# This value set includes STatus codes.
fhirvs:fm-status ["active" "cancelled" "draft" "entered-in-error"]
# The status of a resource narrative
fhirvs:narrative-status ["generated" "extensions" "additional" "empty"]
# The presentation types of notes.
fhirvs:note-type ["display" "print" "printoper"]
# How the Quantity should be understood and represented.
fhirvs:quantity-comparator ["<" "<=" ">=" ">"]
Usage note: every effort has been made to ensure that the ShEx files are correct and useful, but they are not a normative part of the specification.
© HL7.org 2011+. FHIR STU3 Candidate (v1.8.0-10605) generated on Mon, Dec 19, 2016 23:20-0500. QA Page
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