ClaimResponse

outcome

tblClaim.ClaimStatus

mapped

payment.adjustmentReason

tblClaim.Adjustment

mapped

totalBenefit

tblClaim.Approved

mapped

payment.date

tblClaimed.DateProcessed

mapped

communicationRequest

tblClaim.feedbackId

mapped

error

tblClaim.rejectionReason

mapped

item.adjudication.reason

tblClaimItems.ClaimItemStatus / tblClaimItems.RejectionReason / tblClaimServices.RejectionReason

adjudication.reason contains the rejection code
(with adjudication.category = "rejected_reason")

mapped

item.adjudication.value

tblClaimItems.QtyApproved

mapped

item.adjudication.amount

tblClaimItems.PriceAdjusted / tblClaimItems.PriceApproved / tblClaimitems.PriceValuated / tblClaimItems.LimitationValue / tblClaimItems.RemuneratedAmount / tblClaimItems.DeductableAmount / tblClaimItems.ExceedCeilingAmount / tblClaimServices.PriceAdjusted / tblClaimServices.PriceApproved / tblClaimServices.PriceValuated / tblClaimServices.LimitationValue / tblClaimServices.RemunratedAmount / tblClaimServices.DeductableAmount / tblClaimServices.ExceededCeilingAmount

Monetary amount / value is taken from limitation value by default

only tblClaimItems.LimitationValue and tblClaimServices.LimitationValue mapped

processNote

tblClaimItems.Justification / tblClaimItems.PriceOrigin / tblClaimServices.Justification / tblClaimServices.Limitation / tblClaimServices.PriceOrigin

claimResponse.item.noteNumber can be used to join information about the mapped field and claim item

mapped

{

"resourceType": "ClaimResponse",

"communicationRequest": [

{

"reference": "CommunicationRequest/1"

}

],

"error": [

{

"code": {

"coding": [

{

"code": "1"

}

]

}

}

],

"id": "code",

"identifier": [

{

"type": {

"coding": [

{

"code": "ACSN",

"system": "https://hl7.org/fhir/valueset-identifier-type.html"

}

]

},

"use": "usual",

"value": 1

},

{

"type": {

"coding": [

{

"code": "MR",

"system": "https://hl7.org/fhir/valueset-identifier-type.html"

}

]

},

"use": "usual",

"value": "code"

}

],

"item": [

{

"adjudication": [

{

"amount": {

"value": 2

},

"category": {

"text": "general"

},

"reason": {

"coding": [

{

"code": "1",

"system": "passed"

}

]

},

"value": 4

},

{

"category": {

"text": "rejected_reason"

},

"reason": {

"coding": [

{

"code": "1"

}

]

}

}

],

"noteNumber": [

1

],

"sequenceLinkId": 1

},

{

"adjudication": [

{

"amount": {

"value": 4

},

"category": {

"text": "general"

},

"reason": {

"coding": [

{

"code": "2",

"system": "rejected"

}

]

},

"value": 3

},

{

"category": {

"text": "rejected_reason"

},

"reason": {

"coding": [

{

"code": "3"

}

]

}

}

],

"noteNumber": [

2

],

"sequenceLinkId": 2

}

],

"outcome": {

"coding": [

{

"code": "1"

}

],

"text": "rejected"

},

"payment": {

"adjustmentReason": {

"text": "adjustment"

},

"date": "2010-11-16T00:00:00"

},

"processNote": [

{

"number": 1,

"text": "item justification"

},

{

"number": 2,

"text": "service justification"

}

],

"totalBenefit": {

"value": 214.25

}

}