Data Model Libraries
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    ClaimResponseAddItemComponent Class

    FHIR Specification

    • Short: Insurer added line items
    • Definition: The first-tier service adjudications for payor added product or service lines.
    • Requirements: Insurers may redefine the provided product or service or may package and/or decompose groups of products and services. The addItems allows the insurer to provide their line item list with linkage to the submitted items/details/sub-details. In a preauthorization the insurer may use the addItem structure to provide additional information on authorized products and services.

    Hierarchy (View Summary)

    Implements

    Index

    Constructors

    Properties

    Methods

    parse getItemSequenceElement setItemSequenceElement addItemSequenceElement hasItemSequenceElement getItemSequence setItemSequence addItemSequence hasItemSequence getDetailSequenceElement setDetailSequenceElement addDetailSequenceElement hasDetailSequenceElement getDetailSequence setDetailSequence addDetailSequence hasDetailSequence getSubdetailSequenceElement setSubdetailSequenceElement addSubdetailSequenceElement hasSubdetailSequenceElement getSubdetailSequence setSubdetailSequence addSubdetailSequence hasSubdetailSequence getProvider setProvider addProvider hasProvider getProductOrService setProductOrService hasProductOrService getModifier setModifier addModifier hasModifier getProgramCode setProgramCode addProgramCode hasProgramCode getServiced setServiced hasServiced getServicedDateType hasServicedDateType getServicedPeriod hasServicedPeriod getLocation setLocation hasLocation getLocationCodeableConcept hasLocationCodeableConcept getLocationAddress hasLocationAddress getLocationReference hasLocationReference getQuantity setQuantity hasQuantity getUnitPrice setUnitPrice hasUnitPrice getFactorElement setFactorElement hasFactorElement getFactor setFactor hasFactor getNet setNet hasNet getBodySite setBodySite hasBodySite getSubSite setSubSite addSubSite hasSubSite getNoteNumberElement setNoteNumberElement addNoteNumberElement hasNoteNumberElement getNoteNumber setNoteNumber addNoteNumber hasNoteNumber getAdjudication setAdjudication addAdjudication hasAdjudication getDetail setDetail addDetail hasDetail fhirType isEmpty isRequiredFieldsEmpty copy toJSON getModifierExtension setModifierExtension hasModifierExtension getModifierExtensionByUrl addModifierExtension removeModifierExtension getId setId hasId getExtension setExtension hasExtension getExtensionByUrl addExtension removeExtension isResource isDataType isComplexDataType isPrimitive isBooleanPrimitive isStringPrimitive isNumberPrimitive isBigIntPrimitive isDateTimePrimitive copyValues initItemSequence initDetailSequence initSubdetailSequence initProvider initModifier initProgramCode initSubSite initNoteNumber initAdjudication initDetail

    Constructors

    Properties

    itemSequence?: PositiveIntType[]

    ClaimResponse.addItem.itemSequence Element

    FHIR Specification

    • Short: Item sequence number
    • Definition: Claim items which this service line is intended to replace.
    • Requirements: Provides references to the claim items.
    • FHIR Type: positiveInt
    • Cardinality: 0..*
    • isModifier: false
    • isSummary: false
    detailSequence?: PositiveIntType[]

    ClaimResponse.addItem.detailSequence Element

    FHIR Specification

    • Short: Detail sequence number
    • Definition: The sequence number of the details within the claim item which this line is intended to replace.
    • Requirements: Provides references to the claim details within the claim item.
    • FHIR Type: positiveInt
    • Cardinality: 0..*
    • isModifier: false
    • isSummary: false
    subdetailSequence?: PositiveIntType[]

    ClaimResponse.addItem.subdetailSequence Element

    FHIR Specification

    • Short: Subdetail sequence number
    • Definition: The sequence number of the sub-details within the details within the claim item which this line is intended to replace.
    • Requirements: Provides references to the claim sub-details within the claim detail.
    • FHIR Type: positiveInt
    • Cardinality: 0..*
    • isModifier: false
    • isSummary: false
    provider?: Reference[]

    ClaimResponse.addItem.provider Element

    FHIR Specification

    productOrService: null | CodeableConcept

    ClaimResponse.addItem.productOrService Element

    FHIR Specification

    • Short: Billing, service, product, or drug code
    • Definition: When the value is a group code then this item collects a set of related claim details, otherwise this contains the product, service, drug or other billing code for the item.
    • Comment: If this is an actual service or product line, i.e. not a Group, then use code to indicate the Professional Service or Product supplied (e.g. CTP, HCPCS, USCLS, ICD10, NCPDP, DIN, RxNorm, ACHI, CCI). If a grouping item then use a group code to indicate the type of thing being grouped e.g. 'glasses' or 'compound'.
    • Requirements: Necessary to state what was provided or done.
    • FHIR Type: CodeableConcept
    • Cardinality: 1..1
    • isModifier: false
    • isSummary: false
    modifier?: CodeableConcept[]

    ClaimResponse.addItem.modifier Element

    FHIR Specification

    • Short: Service/Product billing modifiers
    • Definition: Item typification or modifiers codes to convey additional context for the product or service.
    • Comment: For example in Oral whether the treatment is cosmetic or associated with TMJ, or for Medical whether the treatment was outside the clinic or outside of office hours.
    • Requirements: To support inclusion of the item for adjudication or to charge an elevated fee.
    • FHIR Type: CodeableConcept
    • Cardinality: 0..*
    • isModifier: false
    • isSummary: false
    programCode?: CodeableConcept[]

    ClaimResponse.addItem.programCode Element

    FHIR Specification

    • Short: Program the product or service is provided under
    • Definition: Identifies the program under which this may be recovered.
    • Comment: For example: Neonatal program, child dental program or drug users recovery program.
    • Requirements: Commonly used in in the identification of publicly provided program focused on population segments or disease classifications.
    • FHIR Type: CodeableConcept
    • Cardinality: 0..*
    • isModifier: false
    • isSummary: false
    serviced?: IDataType

    ClaimResponse.addItem.serviced[x] Element

    @ChoiceDataTypesMeta('ClaimResponse.addItem.serviced[x]', ['date','Period',]

    FHIR Specification

    • Short: Date or dates of service or product delivery
    • Definition: The date or dates when the service or product was supplied, performed or completed.
    • Requirements: Needed to determine whether the service or product was provided during the term of the insurance coverage.
    • FHIR Types: 'date', 'Period',
    • Cardinality: 0..1
    • isModifier: false
    • isSummary: false
    location?: IDataType

    ClaimResponse.addItem.location[x] Element

    @ChoiceDataTypesMeta('ClaimResponse.addItem.location[x]', ['CodeableConcept','Address','Reference',]

    FHIR Specification

    • Short: Place of service or where product was supplied
    • Definition: Where the product or service was provided.
    • Requirements: The location can alter whether the item was acceptable for insurance purposes or impact the determination of the benefit amount.
    • FHIR Types: 'CodeableConcept', 'Address', 'Reference',
    • Cardinality: 0..1
    • isModifier: false
    • isSummary: false
    quantity?: Quantity

    ClaimResponse.addItem.quantity Element

    FHIR Specification

    • Short: Count of products or services
    • Definition: The number of repetitions of a service or product.
    • Requirements: Required when the product or service code does not convey the quantity provided.
    • FHIR Type: Quantity
    • Cardinality: 0..1
    • isModifier: false
    • isSummary: false
    unitPrice?: Money

    ClaimResponse.addItem.unitPrice Element

    FHIR Specification

    • Short: Fee, charge or cost per item
    • Definition: If the item is not a group then this is the fee for the product or service, otherwise this is the total of the fees for the details of the group.
    • Requirements: The amount charged to the patient by the provider for a single unit.
    • FHIR Type: Money
    • Cardinality: 0..1
    • isModifier: false
    • isSummary: false
    factor?: DecimalType

    ClaimResponse.addItem.factor Element

    FHIR Specification

    • Short: Price scaling factor
    • Definition: A real number that represents a multiplier used in determining the overall value of services delivered and/or goods received. The concept of a Factor allows for a discount or surcharge multiplier to be applied to a monetary amount.
    • Comment: To show a 10% senior's discount, the value entered is: 0.90 (1.00 - 0.10).
    • Requirements: When discounts are provided to a patient (example: Senior's discount) then this must be documented for adjudication.
    • FHIR Type: decimal
    • Cardinality: 0..1
    • isModifier: false
    • isSummary: false
    net?: Money

    FHIR Specification

    • Short: Total item cost
    • Definition: The quantity times the unit price for an additional service or product or charge.
    • Comment: For example, the formula: quantity * unitPrice * factor = net. Quantity and factor are assumed to be 1 if not supplied.
    • Requirements: Provides the total amount claimed for the group (if a grouper) or the line item.
    • FHIR Type: Money
    • Cardinality: 0..1
    • isModifier: false
    • isSummary: false
    bodySite?: CodeableConcept

    ClaimResponse.addItem.bodySite Element

    FHIR Specification

    • Short: Anatomical location
    • Definition: Physical service site on the patient (limb, tooth, etc.).
    • Comment: For example: Providing a tooth code allows an insurer to identify a provider performing a filling on a tooth that was previously removed.
    • Requirements: Allows insurer to validate specific procedures.
    • FHIR Type: CodeableConcept
    • Cardinality: 0..1
    • isModifier: false
    • isSummary: false
    subSite?: CodeableConcept[]

    ClaimResponse.addItem.subSite Element

    FHIR Specification

    • Short: Anatomical sub-location
    • Definition: A region or surface of the bodySite, e.g. limb region or tooth surface(s).
    • Requirements: Allows insurer to validate specific procedures.
    • FHIR Type: CodeableConcept
    • Cardinality: 0..*
    • isModifier: false
    • isSummary: false
    noteNumber?: PositiveIntType[]

    ClaimResponse.addItem.noteNumber Element

    FHIR Specification

    • Short: Applicable note numbers
    • Definition: The numbers associated with notes below which apply to the adjudication of this item.
    • Requirements: Provides a condensed manner for associating human readable descriptive explanations for adjudications on the line item.
    • FHIR Type: positiveInt
    • Cardinality: 0..*
    • isModifier: false
    • isSummary: false

    ClaimResponse.addItem.adjudication Element

    FHIR Specification

    • Short: Added items adjudication
    • Definition: The adjudication results.
    • FHIR Type: BackboneElement
    • Cardinality: 1..*
    • isModifier: false
    • isSummary: false

    ClaimResponse.addItem.detail Element

    FHIR Specification

    • Short: Insurer added line details
    • Definition: The second-tier service adjudications for payor added services.
    • FHIR Type: BackboneElement
    • Cardinality: 0..*
    • isModifier: false
    • isSummary: false

    Methods

    • Parse the provided ClaimResponseAddItemComponent JSON to instantiate the ClaimResponseAddItemComponent data model.

      Parameters

      • sourceJson: Value

        JSON representing FHIR ClaimResponseAddItemComponent

      • OptionaloptSourceField: string

        Optional data source field (e.g. <complexTypeName>.<complexTypeFieldName>); defaults to ClaimResponseAddItemComponent

      Returns undefined | ClaimResponseAddItemComponent

      ClaimResponseAddItemComponent data model or undefined for ClaimResponseAddItemComponent

      JsonError if the provided JSON is not a valid JSON object

    • Determines if the modifierExtension property exists.

      Parameters

      • Optionalurl: string

        the url that identifies a specific Extension

      Returns boolean

      true if an Extension has the provided url; false otherwise

      If the url is provided, determines if an Extension having the provided url exists. If the url is not provided, determines if the modifierExtension property exists and has any values.

      AssertionError for invalid url

    • Returns undefined | string

      the id property value

    • Assigns the provided value to the id property.

      Parameters

      • value: undefined | string

        the id value

      Returns this

      this

      PrimitiveTypeError for invalid value

    • Returns boolean

      true if id exists and has a value; false otherwise

    • Determines if the extension property exists.

      Parameters

      • Optionalurl: string

        the url that identifies a specific Extension

      Returns boolean

      true if an Extension has the provided url; false otherwise

      If the url is provided, determines if an Extension having the provided url exists. If the url is not provided, determines if the extension property exists and has any values.

      AssertionError for invalid url

    • Determines if the extension property exists.

      Parameters

      • url: string

        the url that identifies a specific Extension

      Returns undefined | IExtension

      an Extension having the provided url

      If the url is provided, determines if an Extension having the provided url exists. If the url is not provided, determines if the extension property exists and has any values.

      AssertionError for invalid url

    • Adds the provided Extension to the extension property array.

      Parameters

      • extension: undefined | IExtension

        the Extension value to add to the extension property array

      Returns this

      this

    • Removes the Extension having the provided url from the extension property array.

      Parameters

      • url: string

        the url that identifies a specific Extension to remove

      Returns void

      AssertionError for invalid url

    • Returns boolean

      true if the instance is a FHIR complex or primitive datatype; false otherwise