ClaimResponse FHIR Resource Proposal

ClaimResponse

Owning committee name

Financial Management

Contributing or Reviewing Work Groups

• Claims with Attachments
• Patient Administration

FHIR Resource Development Project Insight ID

994

Scope of coverage

The Remittance resource provides simple acknowledgement, application level error or application level adjudication results which are the result of processing a submitted Claim resource. The nature of the processing may depend on whether the Claim is used to convey a Claim, Pre-Determination or Pre-Authorization of identified goods and services in the context of an identified insurance coverage.

RIM scope

PaymentIntent (classCode=XACT,moodCode=INT)

Resource appropriateness

This is the adjudicated response to a Claim, Pre-determination or Pre-Authorization. The strength of the payment aspect of the response is matchiung to the strength of the original request. For a Claim the adjudication indicates payment which is intended to be made, or Pre-Authorization and Pre-Determination no payment will actually be made until and actual claim is submitted by the payment information in the adjudication indicate the level of coverage which might be provided.

Expected implementations

This is a key resource expected by most Healthcare billing implementations where Health care products and services are provided.

Content sources

Existing normative V3 and V2 specifications, Canadian Specifications, X12, NCPDP

Resource Relationships

Refers to a Claim resource, and uses Organization, Practitiioner. Is referred to by Claim resources, Reconciliation and StatusRequest.

Timelines

Ready for DSTU 2

gForge Users

paulknapp