HL7.FHIR.IN.CORE\HCX Claim Response Document

FHIR Implementation Guide for HCX
0.0.1 - CI Build

FHIR Implementation Guide for HCX - Local Development build (v0.0.1). See the Directory of published versions

Resource Profile: HCX Claim Response Document

Defining URL:

http://hl7.org/fhir/StructureDefinition/HCXClaimResponseDocument

Version:

0.0.1

Name:

ClaimResponseDocument

Status:

Draft as of 2021-08-14T17:23:00.000+05:30 (Standards Status: Trial Use)

Definition:

This profile sets minimum expectations for the Claim Response document that provides application level adjudication results, or an application level error, which are the result of processing a submitted Claim resource where that Claim may be the functional corollary of a Claim or a Preauthorization. It identifies the mandatory core elements, vocabularies and value sets which SHALL be present in the Composition resource when using this profile.

Publisher:

HL7 International - HCX

Committee:

Structured Documents

Maturity:

2

Source Resource:

XML / JSON / Turtle

The official URL for this profile is:

http://hl7.org/fhir/StructureDefinition/HCXClaimResponseDocument

Formal Views of Profile Content

Description of Profiles, Differentials, Snapshots and how the different presentations work.

This structure is derived from Composition

Summary

Mandatory: 2 elements
Fixed Value: 1 element

Maturity: 2

This structure is derived from Composition

Name	Card.	Type	Description & Constraints
Composition	0..*	Composition	A set of resources composed into a single coherent clinical statement with clinical attestation
type	1..1	CodeableConcept	Kind of composition (LOINC if possible) Binding: FHIRDocumentTypeCodes (required): Type of a composition. TODO - Value set of all HCX objects.
section	1..1	BackboneElement	Composition is broken into sections
code	0..1	CodeableConcept	Classification of section (recommended) Binding: DocumentSectionCodes (required): TODO - value set listing all HCX eObjects including ClaimResponse for this one. Fixed Value: As shown
text	1..1	string	Plain text representation of the concept Fixed Value: ClaimResponse
entry	1..1	Reference(ClaimResponse)	A reference to data that supports this section
Documentation for this format

Name	Flags	Card.	Type	Description & Constraints
Composition		0..*	Composition	A set of resources composed into a single coherent clinical statement with clinical attestation
id	Σ	0..1	string	Logical id of this artifact
meta	Σ	0..1	Meta	Metadata about the resource
implicitRules	?!Σ	0..1	uri	A set of rules under which this content was created
language		0..1	code	Language of the resource content Binding: CommonLanguages (preferred) Max Binding: AllLanguages: A human language.
text		0..1	Narrative	Text summary of the resource, for human interpretation
contained		0..*	Resource	Contained, inline Resources
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored
identifier	Σ	0..1	Identifier	Version-independent identifier for the Composition
status	?!Σ	1..1	code	preliminary \| final \| amended \| entered-in-error Binding: CompositionStatus (required): The workflow/clinical status of the composition.
type	Σ	1..1	CodeableConcept	Kind of composition (LOINC if possible) Binding: FHIRDocumentTypeCodes (required): Type of a composition. TODO - Value set of all HCX objects.
category	Σ	0..*	CodeableConcept	Categorization of Composition Binding: DocumentClassValueSet (example): High-level kind of a clinical document at a macro level.
subject	Σ	0..1	Reference(Resource)	Who and/or what the composition is about
encounter	Σ	0..1	Reference(Encounter)	Context of the Composition
date	Σ	1..1	dateTime	Composition editing time
author	Σ	1..*	Reference(Practitioner \| PractitionerRole \| Device \| Patient \| RelatedPerson \| Organization)	Who and/or what authored the composition
title	Σ	1..1	string	Human Readable name/title
confidentiality	Σ	0..1	code	As defined by affinity domain Binding: v3.ConfidentialityClassification (2014-03-26) (required): Codes specifying the level of confidentiality of the composition.
attester		0..*	BackboneElement	Attests to accuracy of composition
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
mode		1..1	code	personal \| professional \| legal \| official Binding: CompositionAttestationMode (required): The way in which a person authenticated a composition.
time		0..1	dateTime	When the composition was attested
party		0..1	Reference(Patient \| RelatedPerson \| Practitioner \| PractitionerRole \| Organization)	Who attested the composition
custodian	Σ	0..1	Reference(Organization)	Organization which maintains the composition
relatesTo		0..*	BackboneElement	Relationships to other compositions/documents
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
code		1..1	code	replaces \| transforms \| signs \| appends Binding: DocumentRelationshipType (required): The type of relationship between documents.
target[x]		1..1		Target of the relationship
targetIdentifier			Identifier
targetReference			Reference(Composition)
event	Σ	0..*	BackboneElement	The clinical service(s) being documented
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
code	Σ	0..*	CodeableConcept	Code(s) that apply to the event being documented Binding: v3 Code System ActCode (example): This list of codes represents the main clinical acts being documented.
period	Σ	0..1	Period	The period covered by the documentation
detail	Σ	0..*	Reference(Resource)	The event(s) being documented
section	I	1..1	BackboneElement	Composition is broken into sections
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
title		0..1	string	Label for section (e.g. for ToC)
code		0..1	CodeableConcept	Classification of section (recommended) Binding: DocumentSectionCodes (required): TODO - value set listing all HCX eObjects including ClaimResponse for this one. Fixed Value: As shown
id		0..0	string	Unique id for inter-element referencing
extension		0..0	Extension	Additional content defined by implementations
coding		0..0	Coding	Code defined by a terminology system
text		1..1	string	Plain text representation of the concept Fixed Value: ClaimResponse
author		0..*	Reference(Practitioner \| PractitionerRole \| Device \| Patient \| RelatedPerson \| Organization)	Who and/or what authored the section
focus		0..1	Reference(Resource)	Who/what the section is about, when it is not about the subject of composition
text	I	0..1	Narrative	Text summary of the section, for human interpretation
mode		0..1	code	working \| snapshot \| changes Binding: ListMode (required): The processing mode that applies to this section.
orderedBy		0..1	CodeableConcept	Order of section entries Binding: ListOrderCodes (preferred): What order applies to the items in the entry.
entry	I	1..1	Reference(ClaimResponse)	A reference to data that supports this section
emptyReason	I	0..1	CodeableConcept	Why the section is empty Binding: ListEmptyReasons (preferred): If a section is empty, why it is empty.
section	I	0..*	See section (Composition)	Nested Section
Documentation for this format

This structure is derived from Composition

Summary

Mandatory: 2 elements
Fixed Value: 1 element

Maturity: 2

Differential View

This structure is derived from Composition

Name	Card.	Type	Description & Constraints
Composition	0..*	Composition	A set of resources composed into a single coherent clinical statement with clinical attestation
type	1..1	CodeableConcept	Kind of composition (LOINC if possible) Binding: FHIRDocumentTypeCodes (required): Type of a composition. TODO - Value set of all HCX objects.
section	1..1	BackboneElement	Composition is broken into sections
code	0..1	CodeableConcept	Classification of section (recommended) Binding: DocumentSectionCodes (required): TODO - value set listing all HCX eObjects including ClaimResponse for this one. Fixed Value: As shown
text	1..1	string	Plain text representation of the concept Fixed Value: ClaimResponse
entry	1..1	Reference(ClaimResponse)	A reference to data that supports this section
Documentation for this format

Snapshot View

Name	Flags	Card.	Type	Description & Constraints
Composition		0..*	Composition	A set of resources composed into a single coherent clinical statement with clinical attestation
id	Σ	0..1	string	Logical id of this artifact
meta	Σ	0..1	Meta	Metadata about the resource
implicitRules	?!Σ	0..1	uri	A set of rules under which this content was created
language		0..1	code	Language of the resource content Binding: CommonLanguages (preferred) Max Binding: AllLanguages: A human language.
text		0..1	Narrative	Text summary of the resource, for human interpretation
contained		0..*	Resource	Contained, inline Resources
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored
identifier	Σ	0..1	Identifier	Version-independent identifier for the Composition
status	?!Σ	1..1	code	preliminary \| final \| amended \| entered-in-error Binding: CompositionStatus (required): The workflow/clinical status of the composition.
type	Σ	1..1	CodeableConcept	Kind of composition (LOINC if possible) Binding: FHIRDocumentTypeCodes (required): Type of a composition. TODO - Value set of all HCX objects.
category	Σ	0..*	CodeableConcept	Categorization of Composition Binding: DocumentClassValueSet (example): High-level kind of a clinical document at a macro level.
subject	Σ	0..1	Reference(Resource)	Who and/or what the composition is about
encounter	Σ	0..1	Reference(Encounter)	Context of the Composition
date	Σ	1..1	dateTime	Composition editing time
author	Σ	1..*	Reference(Practitioner \| PractitionerRole \| Device \| Patient \| RelatedPerson \| Organization)	Who and/or what authored the composition
title	Σ	1..1	string	Human Readable name/title
confidentiality	Σ	0..1	code	As defined by affinity domain Binding: v3.ConfidentialityClassification (2014-03-26) (required): Codes specifying the level of confidentiality of the composition.
attester		0..*	BackboneElement	Attests to accuracy of composition
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
mode		1..1	code	personal \| professional \| legal \| official Binding: CompositionAttestationMode (required): The way in which a person authenticated a composition.
time		0..1	dateTime	When the composition was attested
party		0..1	Reference(Patient \| RelatedPerson \| Practitioner \| PractitionerRole \| Organization)	Who attested the composition
custodian	Σ	0..1	Reference(Organization)	Organization which maintains the composition
relatesTo		0..*	BackboneElement	Relationships to other compositions/documents
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
code		1..1	code	replaces \| transforms \| signs \| appends Binding: DocumentRelationshipType (required): The type of relationship between documents.
target[x]		1..1		Target of the relationship
targetIdentifier			Identifier
targetReference			Reference(Composition)
event	Σ	0..*	BackboneElement	The clinical service(s) being documented
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
code	Σ	0..*	CodeableConcept	Code(s) that apply to the event being documented Binding: v3 Code System ActCode (example): This list of codes represents the main clinical acts being documented.
period	Σ	0..1	Period	The period covered by the documentation
detail	Σ	0..*	Reference(Resource)	The event(s) being documented
section	I	1..1	BackboneElement	Composition is broken into sections
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
title		0..1	string	Label for section (e.g. for ToC)
code		0..1	CodeableConcept	Classification of section (recommended) Binding: DocumentSectionCodes (required): TODO - value set listing all HCX eObjects including ClaimResponse for this one. Fixed Value: As shown
id		0..0	string	Unique id for inter-element referencing
extension		0..0	Extension	Additional content defined by implementations
coding		0..0	Coding	Code defined by a terminology system
text		1..1	string	Plain text representation of the concept Fixed Value: ClaimResponse
author		0..*	Reference(Practitioner \| PractitionerRole \| Device \| Patient \| RelatedPerson \| Organization)	Who and/or what authored the section
focus		0..1	Reference(Resource)	Who/what the section is about, when it is not about the subject of composition
text	I	0..1	Narrative	Text summary of the section, for human interpretation
mode		0..1	code	working \| snapshot \| changes Binding: ListMode (required): The processing mode that applies to this section.
orderedBy		0..1	CodeableConcept	Order of section entries Binding: ListOrderCodes (preferred): What order applies to the items in the entry.
entry	I	1..1	Reference(ClaimResponse)	A reference to data that supports this section
emptyReason	I	0..1	CodeableConcept	Why the section is empty Binding: ListEmptyReasons (preferred): If a section is empty, why it is empty.
section	I	0..*	See section (Composition)	Nested Section
Documentation for this format

Other representations of profile: CSV, Excel, Schematron

Terminology Bindings

Path	Conformance	ValueSet / Code
Composition.language	preferred	CommonLanguages Max Binding: AllLanguages
Composition.status	required	CompositionStatus
Composition.type	required	FHIRDocumentTypeCodes
Composition.category	example	DocumentClassValueSet
Composition.confidentiality	required	v3.ConfidentialityClassification
Composition.attester.mode	required	CompositionAttestationMode
Composition.relatesTo.code	required	DocumentRelationshipType
Composition.event.code	example	ActCode
Composition.section.code	required	Fixed Value: "ClaimResponse"
Composition.section.mode	required	ListMode
Composition.section.orderedBy	preferred	ListOrderCodes
Composition.section.emptyReason	preferred	ListEmptyReasons

Constraints

Id	Path	Details	Requirements
dom-2	Composition	If the resource is contained in another resource, it SHALL NOT contain nested Resources : contained.contained.empty()
dom-3	Composition	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 : 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()
dom-4	Composition	If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated : contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
dom-5	Composition	If a resource is contained in another resource, it SHALL NOT have a security label : contained.meta.security.empty()
dom-6	Composition	A resource should have narrative for robust management : text.`div`.exists()
ele-1	Composition.meta	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ele-1	Composition.implicitRules	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ele-1	Composition.language	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ele-1	Composition.text	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ele-1	Composition.extension	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ext-1	Composition.extension	Must have either extensions or value[x], not both : extension.exists() != value.exists()
ele-1	Composition.modifierExtension	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ext-1	Composition.modifierExtension	Must have either extensions or value[x], not both : extension.exists() != value.exists()
ele-1	Composition.identifier	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ele-1	Composition.status	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ele-1	Composition.type	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ele-1	Composition.category	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ele-1	Composition.subject	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ele-1	Composition.encounter	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ele-1	Composition.date	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ele-1	Composition.author	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ele-1	Composition.title	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ele-1	Composition.confidentiality	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ele-1	Composition.attester	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ele-1	Composition.attester.extension	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ext-1	Composition.attester.extension	Must have either extensions or value[x], not both : extension.exists() != value.exists()
ele-1	Composition.attester.modifierExtension	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ext-1	Composition.attester.modifierExtension	Must have either extensions or value[x], not both : extension.exists() != value.exists()
ele-1	Composition.attester.mode	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ele-1	Composition.attester.time	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ele-1	Composition.attester.party	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ele-1	Composition.custodian	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ele-1	Composition.relatesTo	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ele-1	Composition.relatesTo.extension	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ext-1	Composition.relatesTo.extension	Must have either extensions or value[x], not both : extension.exists() != value.exists()
ele-1	Composition.relatesTo.modifierExtension	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ext-1	Composition.relatesTo.modifierExtension	Must have either extensions or value[x], not both : extension.exists() != value.exists()
ele-1	Composition.relatesTo.code	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ele-1	Composition.relatesTo.target[x]	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ele-1	Composition.event	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ele-1	Composition.event.extension	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ext-1	Composition.event.extension	Must have either extensions or value[x], not both : extension.exists() != value.exists()
ele-1	Composition.event.modifierExtension	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ext-1	Composition.event.modifierExtension	Must have either extensions or value[x], not both : extension.exists() != value.exists()
ele-1	Composition.event.code	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ele-1	Composition.event.period	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ele-1	Composition.event.detail	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
cmp-1	Composition.section	A section must contain at least one of text, entries, or sub-sections : text.exists() or entry.exists() or section.exists()
cmp-2	Composition.section	A section can only have an emptyReason if it is empty : emptyReason.empty() or entry.empty()
ele-1	Composition.section	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ele-1	Composition.section.extension	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ext-1	Composition.section.extension	Must have either extensions or value[x], not both : extension.exists() != value.exists()
ele-1	Composition.section.modifierExtension	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ext-1	Composition.section.modifierExtension	Must have either extensions or value[x], not both : extension.exists() != value.exists()
ele-1	Composition.section.title	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ele-1	Composition.section.code	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ele-1	Composition.section.author	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ele-1	Composition.section.focus	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ele-1	Composition.section.text	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ele-1	Composition.section.mode	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ele-1	Composition.section.orderedBy	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ele-1	Composition.section.entry	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ele-1	Composition.section.emptyReason	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ele-1	Composition.section.section	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())

IG © 2021+ HL7 International - HCX. Package ig#0.0.1 based on FHIR 4.0.1. Generated 2021-09-22
Links: Table of Contents | QA Report