Data Model Libraries
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    Class ClaimResponseItemReviewOutcomeComponent

    ClaimResponseItemReviewOutcomeComponent Class

    FHIR Specification

    • Short: Adjudication results
    • Definition: The high-level results of the adjudication if adjudication has been performed.

    Hierarchy (View Summary)

    Implements

    Index

    Constructors

    Properties

    decision?: CodeableConcept

    ClaimResponse.item.reviewOutcome.decision Element

    FHIR Specification

    • Short: Result of the adjudication
    • Definition: The result of the claim, predetermination, or preauthorization adjudication.
    • Comment: The element is used to indicate the current state of the adjudication overall for the claim resource, for example: the request has been held (pended) for adjudication processing, for manual review or other reasons; that it has been processed and will be paid, or the outstanding paid, as submitted (approved); that no amount will be paid (denied); or that some amount between zero and the submitted amount will be paid (partial).
    • Requirements: To advise the requestor of the result of the adjudication process.
    • FHIR Type: CodeableConcept
    • Cardinality: 0..1
    • isModifier: false
    • isSummary: false
    reason?: CodeableConcept[]

    ClaimResponse.item.reviewOutcome.reason Element

    FHIR Specification

    • Short: Reason for result of the adjudication
    • Definition: The reasons for the result of the claim, predetermination, or preauthorization adjudication.
    • Requirements: To advise the requestor of the contributors to the result of the adjudication process.
    • FHIR Type: CodeableConcept
    • Cardinality: 0..*
    • isModifier: false
    • isSummary: false
    preAuthRef?: StringType

    ClaimResponse.item.reviewOutcome.preAuthRef Element

    FHIR Specification

    • Short: Preauthorization reference
    • Definition: Reference from the Insurer which is used in later communications which refers to this adjudication.
    • Comment: This value is only present on preauthorization adjudications.
    • Requirements: On subsequent claims, the insurer may require the provider to quote this value.
    • FHIR Type: string
    • Cardinality: 0..1
    • isModifier: false
    • isSummary: false
    preAuthPeriod?: Period

    ClaimResponse.item.reviewOutcome.preAuthPeriod Element

    FHIR Specification

    • Short: Preauthorization reference effective period
    • Definition: The time frame during which this authorization is effective.
    • Requirements: To convey to the provider when the authorized products and services must be supplied for the authorized adjudication to apply.
    • FHIR Type: Period
    • Cardinality: 0..1
    • isModifier: false
    • isSummary: false

    Methods

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

      Parameters

      • sourceJson: Value

        JSON representing FHIR ClaimResponseItemReviewOutcomeComponent

      • OptionaloptSourceField: string

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

      Returns undefined | ClaimResponseItemReviewOutcomeComponent

      ClaimResponseItemReviewOutcomeComponent data model or undefined for ClaimResponseItemReviewOutcomeComponent

      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 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