ClaimResponse
Description
The ClaimResponse resource 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, Predetermination or a Preauthorization.This resource is the only appropriate response to a Claim which a processing system recognizes as a Claim resource. This is the adjudicated response to a Claim, Predetermination or Preauthorization. The strength of the payment aspect of the response is matching to the strength of the original request. For a Claim the adjudication indicates payment which is intended to be made. For Preauthorization no payment will actually be made however funds may be reserved to settle a claim submitted later. For Predetermination no payment will actually be made and no assurance is given that the adjudication of a claim submitted later will match the adjudication provided, for example funds may have been exhausted in the interim. Only an actual claim may be expected to result in actual payment.
Source https://hl7.org/fhir/r4/claimresponse
Tables
| Resource Specific Tables | Common Tables |
|---|---|
| hc_claimresponse | hc_address |
| hc_claimresponse_additem | hc_ancestor |
| hc_claimresponse_adjudication | hc_assigner |
| hc_claimresponse_detail | hc_attachment |
| hc_claimresponse_error | hc_canonical |
| hc_claimresponse_insurance | hc_codeableconcept |
| hc_claimresponse_item | hc_contactpoint |
| hc_claimresponse_payment | hc_extension |
| hc_claimresponse_processnote | hc_humanname |
| hc_claimresponse_subdetail | hc_identifier |
| hc_claimresponse_total | hc_reference |
| hc_uri |
Referenced By
- Claim
- ExplanationOfBenefit
- MedicationRequest
- ServiceRequest