fhirtypes/dist/r4/resources/IClaimResponse.d.ts

FHIR Types

import { IClaimResponseAddItem, IClaimResponseAdjudication, IClaimResponseError, IClaimResponseInsurance, IClaimResponseItem, IClaimResponsePayment, IClaimResponseProcessNote, IClaimResponseTotal } from '../backbones';
import { IDomainResource, IElement } from '../base';
import { IAttachment, ICodeableConcept, IIdentifier, IPeriod, IReference } from '../datatypes';
import { ClaimUseType, FmStatusType, RemittanceOutcomeType } from '../types';
/**
 * @name IClaimResponse
 * @description This resource provides the adjudication details from the processing of a Claim resource.
 * @see <a href="https://hl7.org/fhir/R4/claimresponse.html">ClaimResponse</a>
 * @version R4
 * @extends {IDomainResource}
 * @author Claudia Alarcón Lazo
 */
export interface IClaimResponse extends IDomainResource {
    /**
     * @description A unique identifier assigned to this claim response.
     */
    identifier?: IIdentifier[];
    /**
     * @description The status of the resource instance.
     * @description active | cancelled | draft | entered-in-error
     * @see <a href="https://hl7.org/fhir/R4/valueset-fm-status.html">FmStatus</a>
     */
    status: FmStatusType;
    /**
     * @description Extensions for status
     */
    _status?: IElement;
    /**
     * @description A finer grained suite of claim type codes which may convey additional information such as Inpatient vs Outpatient and/or a specialty service.
     */
    type: ICodeableConcept;
    /**
     * @description A finer grained suite of claim type codes which may convey additional information such as Inpatient vs Outpatient and/or a specialty service.
     */
    subType?: ICodeableConcept;
    /**
     * @description 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.
     * @description claim | preauthorization | predetermination
     * @see <a href="https://hl7.org/fhir/R4/valueset-claim-use.html">ClaimUse</a>
     */
    use: ClaimUseType;
    /**
     * @description Extensions for use
     */
    _use?: IElement;
    /**
     * @description 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.
     */
    patient: IReference;
    /**
     * @description The date this resource was created.
     */
    created: string;
    /**
     * @description Extensions for created
     */
    _created?: IElement;
    /**
     * @description The party responsible for authorization, adjudication and reimbursement.
     */
    insurer: IReference;
    /**
     * @description The provider which is responsible for the claim, predetermination or preauthorization.
     */
    requestor?: IReference;
    /**
     * @description Original request resource reference.
     */
    request?: IReference;
    /**
     * @description The outcome of the claim, predetermination, or preauthorization processing.
     * @description queued | complete | error | partial
     * @see <a href="https://hl7.org/fhir/R4/valueset-remittance-outcome.html">RemittanceOutcome</a>
     */
    outcome: RemittanceOutcomeType;
    /**
     * @description Extensions for outcome
     */
    _outcome?: IElement;
    /**
     * @description A human readable description of the status of the adjudication.
     */
    disposition?: string;
    /**
     * @description Extensions for disposition
     */
    _disposition?: IElement;
    /**
     * @description Reference from the Insurer which is used in later communications which refers to this adjudication.
     */
    preAuthRef?: string;
    /**
     * @description Extensions for preAuthRef
     */
    _preAuthRef?: IElement;
    /**
     * @description The time frame during which this authorization is effective.
     */
    preAuthPeriod?: IPeriod;
    /**
     * @description Type of Party to be reimbursed: subscriber, provider, other.
     */
    payeeType?: ICodeableConcept;
    /**
     * @description A claim line. Either a simple (a product or service) or a \u0027group\u0027 of details which can also be a simple items or groups of sub-details.
     */
    item?: IClaimResponseItem[];
    /**
     * @description The first-tier service adjudications for payor added product or service lines.
     */
    addItem?: IClaimResponseAddItem[];
    /**
     * @description The adjudication results which are presented at the header level rather than at the line-item or add-item levels.
     */
    adjudication?: IClaimResponseAdjudication[];
    /**
     * @description Categorized monetary totals for the adjudication.
     */
    total?: IClaimResponseTotal[];
    /**
     * @description Payment details for the adjudication of the claim.
     */
    payment?: IClaimResponsePayment;
    /**
     * @description A code, used only on a response to a preauthorization, to indicate whether the benefits payable have been reserved and for whom.
     */
    fundsReserve?: ICodeableConcept;
    /**
     * @description A code for the form to be used for printing the content.
     */
    formCode?: ICodeableConcept;
    /**
     * @description The actual form, by reference or inclusion, for printing the content or an EOB.
     */
    form?: IAttachment;
    /**
     * @description A note that describes or explains adjudication results in a human readable form.
     */
    processNote?: IClaimResponseProcessNote[];
    /**
     * @description Request for additional supporting or authorizing information.
     */
    communicationRequest?: IReference[];
    /**
     * @description Financial instruments for reimbursement for the health care products and services specified on the claim.
     */
    insurance?: IClaimResponseInsurance[];
    /**
     * @description Errors encountered during the processing of the adjudication.
     */
    error?: IClaimResponseError[];
}