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 getTraceNumber setTraceNumber addTraceNumber hasTraceNumber getProvider setProvider addProvider hasProvider getRevenue setRevenue hasRevenue getProductOrService setProductOrService hasProductOrService getProductOrServiceEnd setProductOrServiceEnd hasProductOrServiceEnd getRequest setRequest addRequest hasRequest 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 getTax setTax hasTax getNet setNet hasNet getBodySite setBodySite addBodySite hasBodySite getNoteNumberElement setNoteNumberElement addNoteNumberElement hasNoteNumberElement getNoteNumber setNoteNumber addNoteNumber hasNoteNumber getReviewOutcome setReviewOutcome hasReviewOutcome getAdjudication setAdjudication addAdjudication hasAdjudication getDetail setDetail addDetail hasDetail fhirType isEmpty copy toJSON getModifierExtension setModifierExtension hasModifierExtension getModifierExtensionByUrl addModifierExtension removeModifierExtension getId setId hasId getExtension setExtension hasExtension getExtensionByUrl addExtension removeExtension isRequiredFieldsEmpty isResource isDataType isComplexDataType isPrimitive isBooleanPrimitive isStringPrimitive isNumberPrimitive isBigIntPrimitive isDateTimePrimitive copyValues initItemSequence initDetailSequence initSubdetailSequence initTraceNumber initProvider initRequest initModifier initProgramCode initBodySite 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
    traceNumber?: Identifier[]

    ClaimResponse.addItem.traceNumber Element

    FHIR Specification

    • Short: Number for tracking
    • Definition: Trace number for tracking purposes. May be defined at the jurisdiction level or between trading partners.
    • Requirements: Allows partners to uniquely identify components for tracking.
    • FHIR Type: Identifier
    • Cardinality: 0..*
    • isModifier: false
    • isSummary: false
    provider?: Reference[]

    ClaimResponse.addItem.provider Element

    FHIR Specification

    revenue?: CodeableConcept

    ClaimResponse.addItem.revenue Element

    FHIR Specification

    • Short: Revenue or cost center code
    • Definition: The type of revenue or cost center providing the product and/or service.
    • Requirements: Needed in the processing of institutional claims.
    • FHIR Type: CodeableConcept
    • Cardinality: 0..1
    • isModifier: false
    • isSummary: false
    productOrService?: 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 item details, otherwise this contains the product, service, drug or other billing code for the item. This element may be the start of a range of .productOrService codes used in conjunction with .productOrServiceEnd or it may be a solo element where .productOrServiceEnd is not used.
    • 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: 0..1
    • isModifier: false
    • isSummary: false
    productOrServiceEnd?: CodeableConcept

    ClaimResponse.addItem.productOrServiceEnd Element

    FHIR Specification

    • Short: End of a range of codes
    • Definition: This contains the end of a range of product, service, drug or other billing codes for the item. This element is not used when the .productOrService is a group code. This value may only be present when a .productOfService code has been provided to convey the start of the range. Typically this value may be used only with preauthorizations and not with claims.
    • FHIR Type: CodeableConcept
    • Cardinality: 0..1
    • isModifier: false
    • isSummary: false
    request?: Reference[]

    ClaimResponse.addItem.request Element

    FHIR Specification

    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
    tax?: Money

    ClaimResponse.addItem.tax Element

    FHIR Specification

    • Short: Total tax
    • Definition: The total of taxes applicable for this product or service.
    • Requirements: Required when taxes are not embedded in the unit price or provided as a separate service.
    • FHIR Type: Money
    • Cardinality: 0..1
    • isModifier: false
    • isSummary: false
    net?: Money

    FHIR Specification

    • Short: Total item cost
    • Definition: The total amount claimed for the group (if a grouper) or the addItem. Net = unit price * quantity * factor.
    • 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

    ClaimResponse.addItem.bodySite Element

    FHIR Specification

    • Short: Anatomical location
    • Definition: Physical location where the service is performed or applies.
    • FHIR Type: BackboneElement
    • 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.reviewOutcome Element

    FHIR Specification

    • Short: Added items adjudication results
    • Definition: The high-level results of the adjudication if adjudication has been performed.
    • FHIR Type: BackboneElement
    • Cardinality: 0..1
    • isModifier: false
    • isSummary: false

    ClaimResponse.addItem.adjudication Element

    FHIR Specification

    • Short: Added items adjudication
    • Definition: The adjudication results.
    • FHIR Type: BackboneElement
    • Cardinality: 0..*
    • 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

    • Assigns the provided Reference array value to the request property.

      Parameters

      • value: undefined | Reference[]

        the request array value

      Returns this

      this

      @ReferenceTargets('ClaimResponse.addItem.request', ['DeviceRequest','MedicationRequest','NutritionOrder','ServiceRequest','SupplyRequest','VisionPrescription',])

      InvalidTypeError for invalid data type or reference value

    • Add the provided Reference value to the request array property.

      Parameters

      • value: undefined | Reference

        the request value

      Returns this

      this

      @ReferenceTargets('ClaimResponse.addItem.request', ['DeviceRequest','MedicationRequest','NutritionOrder','ServiceRequest','SupplyRequest','VisionPrescription',])

      InvalidTypeError for invalid data type or reference value

    • 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 and only if the data model has required fields (min cardinality > 0) and at least one of those required fields in the instance is empty; false otherwise

    • Returns boolean

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