Struct ClaimResponseInner 

pub struct ClaimResponseInner {

    pub id: Option<String>,
    pub meta: Option<Meta>,
    pub implicit_rules: Option<String>,
    pub language: Option<String>,
    pub text: Option<Narrative>,
    pub contained: Vec<Resource>,
    pub extension: Vec<Extension>,
    pub modifier_extension: Vec<Extension>,
    pub identifier: Vec<Option<Identifier>>,
    pub identifier_ext: Vec<Option<FieldExtension>>,
    pub trace_number: Vec<Option<Identifier>>,
    pub trace_number_ext: Vec<Option<FieldExtension>>,
    pub status: String,
    pub status_ext: Option<FieldExtension>,
    pub type: CodeableConcept,
    pub type_ext: Option<FieldExtension>,
    pub sub_type: Option<CodeableConcept>,
    pub sub_type_ext: Option<FieldExtension>,
    pub use: Use,
    pub use_ext: Option<FieldExtension>,
    pub patient: Reference,
    pub patient_ext: Option<FieldExtension>,
    pub created: DateTime,
    pub created_ext: Option<FieldExtension>,
    pub insurer: Option<Reference>,
    pub insurer_ext: Option<FieldExtension>,
    pub requestor: Option<Reference>,
    pub requestor_ext: Option<FieldExtension>,
    pub request: Option<Reference>,
    pub request_ext: Option<FieldExtension>,
    pub outcome: RemittanceOutcome,
    pub outcome_ext: Option<FieldExtension>,
    pub decision: Option<CodeableConcept>,
    pub decision_ext: Option<FieldExtension>,
    pub disposition: Option<String>,
    pub disposition_ext: Option<FieldExtension>,
    pub pre_auth_ref: Option<String>,
    pub pre_auth_ref_ext: Option<FieldExtension>,
    pub pre_auth_period: Option<Period>,
    pub pre_auth_period_ext: Option<FieldExtension>,
    pub event: Vec<Option<ClaimResponseEvent>>,
    pub event_ext: Vec<Option<FieldExtension>>,
    pub payee_type: Option<CodeableConcept>,
    pub payee_type_ext: Option<FieldExtension>,
    pub encounter: Vec<Option<Reference>>,
    pub encounter_ext: Vec<Option<FieldExtension>>,
    pub diagnosis_related_group: Option<CodeableConcept>,
    pub diagnosis_related_group_ext: Option<FieldExtension>,
    pub item: Vec<Option<ClaimResponseItem>>,
    pub item_ext: Vec<Option<FieldExtension>>,
    pub add_item: Vec<Option<ClaimResponseAddItem>>,
    pub add_item_ext: Vec<Option<FieldExtension>>,
    pub adjudication: Vec<Option<ClaimResponseItemAdjudication>>,
    pub adjudication_ext: Vec<Option<FieldExtension>>,
    pub total: Vec<Option<ClaimResponseTotal>>,
    pub total_ext: Vec<Option<FieldExtension>>,
    pub payment: Option<ClaimResponsePayment>,
    pub payment_ext: Option<FieldExtension>,
    pub funds_reserve: Option<CodeableConcept>,
    pub funds_reserve_ext: Option<FieldExtension>,
    pub form_code: Option<CodeableConcept>,
    pub form_code_ext: Option<FieldExtension>,
    pub form: Option<Attachment>,
    pub form_ext: Option<FieldExtension>,
    pub process_note: Vec<Option<ClaimResponseProcessNote>>,
    pub process_note_ext: Vec<Option<FieldExtension>>,
    pub communication_request: Vec<Option<Reference>>,
    pub communication_request_ext: Vec<Option<FieldExtension>>,
    pub insurance: Vec<Option<ClaimResponseInsurance>>,
    pub insurance_ext: Vec<Option<FieldExtension>>,
    pub error: Vec<Option<ClaimResponseError>>,
    pub error_ext: Vec<Option<FieldExtension>>,
    /* private fields */
}

This resource provides the adjudication details from the processing of a Claim resource.

ClaimResponse v5.0.0

Response to a claim predetermination or preauthorization

This resource provides the adjudication details from the processing of a Claim resource.

Fields

id: Option<String>

Logical id of this artifact

The logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes.

Within the context of the FHIR RESTful interactions, the resource has an id except for cases like the create and conditional update. Otherwise, the use of the resouce id depends on the given use case.

meta: Option<Meta>

Metadata about the resource

The metadata about the resource. This is content that is maintained by the infrastructure. Changes to the content might not always be associated with version changes to the resource.

implicit_rules: Option<String>

A set of rules under which this content was created

A reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content. Often, this is a reference to an implementation guide that defines the special rules along with other profiles etc.

Asserting this rule set restricts the content to be only understood by a limited set of trading partners. This inherently limits the usefulness of the data in the long term. However, the existing health eco-system is highly fractured, and not yet ready to define, collect, and exchange data in a generally computable sense. Wherever possible, implementers and/or specification writers should avoid using this element. Often, when used, the URL is a reference to an implementation guide that defines these special rules as part of its narrative along with other profiles, value sets, etc.

language: Option<String>

Language; Language of the resource content

The base language in which the resource is written.

Language is provided to support indexing and accessibility (typically, services such as text to speech use the language tag). The html language tag in the narrative applies to the narrative. The language tag on the resource may be used to specify the language of other presentations generated from the data in the resource. Not all the content has to be in the base language. The Resource.language should not be assumed to apply to the narrative automatically. If a language is specified, it should it also be specified on the div element in the html (see rules in HTML5 for information about the relationship between xml:lang and the html lang attribute).

text: Option<Narrative>

Text summary of the resource, for human interpretation

A human-readable narrative that contains a summary of the resource and can be used to represent the content of the resource to a human. The narrative need not encode all the structured data, but is required to contain sufficient detail to make it “clinically safe” for a human to just read the narrative. Resource definitions may define what content should be represented in the narrative to ensure clinical safety.

Contained resources do not have a narrative. Resources that are not contained SHOULD have a narrative. In some cases, a resource may only have text with little or no additional discrete data (as long as all minOccurs=1 elements are satisfied). This may be necessary for data from legacy systems where information is captured as a “text blob” or where text is additionally entered raw or narrated and encoded information is added later.

contained: Vec<Resource>

Contained, inline Resources

These resources do not have an independent existence apart from the resource that contains them - they cannot be identified independently, nor can they have their own independent transaction scope. This is allowed to be a Parameters resource if and only if it is referenced by a resource that provides context/meaning.

This should never be done when the content can be identified properly, as once identification is lost, it is extremely difficult (and context dependent) to restore it again. Contained resources may have profiles and tags in their meta elements, but SHALL NOT have security labels.

extension: Vec<Extension>

Additional content defined by implementations

May be used to represent additional information that is not part of the basic definition of the resource. To make the use of extensions safe and managable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

modifier_extension: Vec<Extension>

Extensions that cannot be ignored

May be used to represent additional information that is not part of the basic definition of the resource and that modifies the understanding of the element that contains it and/or the understanding of the containing element’s descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and managable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

identifier: Vec<Option<Identifier>>

Business Identifier for a claim response

A unique identifier assigned to this claim response.

identifier_ext: Vec<Option<FieldExtension>>

Extension field.

trace_number: Vec<Option<Identifier>>

Number for tracking

Trace number for tracking purposes. May be defined at the jurisdiction level or between trading partners.

trace_number_ext: Vec<Option<FieldExtension>>

Extension field.

status: String

ClaimResponseStatus; active | cancelled | draft | entered-in-error

The status of the resource instance.

This element is labeled as a modifier because the status contains codes that mark the resource as not currently valid.

status_ext: Option<FieldExtension>

Extension field.

type: CodeableConcept

ClaimType; More granular claim type

A finer grained suite of claim type codes which may convey additional information such as Inpatient vs Outpatient and/or a specialty service.

This may contain the local bill type codes, for example the US UB-04 bill type code or the CMS bill type.

type_ext: Option<FieldExtension>

Extension field.

sub_type: Option<CodeableConcept>

ClaimSubType; More granular claim type

A finer grained suite of claim type codes which may convey additional information such as Inpatient vs Outpatient and/or a specialty service.

This may contain the local bill type codes, for example the US UB-04 bill type code or the CMS bill type.

sub_type_ext: Option<FieldExtension>

Extension field.

use: Use

Use; claim | preauthorization | predetermination

A code to indicate whether the nature of the request is: Claim - A request to an Insurer to adjudicate the supplied charges for health care goods and services under the identified policy and to pay the determined Benefit amount, if any; Preauthorization - A request to an Insurer to adjudicate the supplied proposed future charges for health care goods and services under the identified policy and to approve the services and provide the expected benefit amounts and potentially to reserve funds to pay the benefits when Claims for the indicated services are later submitted; or, Pre-determination - A request to an Insurer to adjudicate the supplied ‘what if’ charges for health care goods and services under the identified policy and report back what the Benefit payable would be had the services actually been provided.

use_ext: Option<FieldExtension>

Extension field.

patient: Reference

The recipient of the products and services

The party to whom the professional services and/or products have been supplied or are being considered and for whom actual for facast reimbursement is sought.

patient_ext: Option<FieldExtension>

Extension field.

created: DateTime

Response creation date

The date this resource was created.

created_ext: Option<FieldExtension>

Extension field.

insurer: Option<Reference>

Party responsible for reimbursement

The party responsible for authorization, adjudication and reimbursement.

insurer_ext: Option<FieldExtension>

Extension field.

requestor: Option<Reference>

Party responsible for the claim

The provider which is responsible for the claim, predetermination or preauthorization.

Typically this field would be 1..1 where this party is accountable for the data content within the claim but is not necessarily the facility, provider group or practitioner who provided the products and services listed within this claim resource. This field is the Billing Provider, for example, a facility, provider group, lab or practitioner..

requestor_ext: Option<FieldExtension>

Extension field.

request: Option<Reference>

Id of resource triggering adjudication

Original request resource reference.

request_ext: Option<FieldExtension>

Extension field.

outcome: RemittanceOutcome

RemittanceOutcome; queued | complete | error | partial

The outcome of the claim, predetermination, or preauthorization processing.

The resource may be used to indicate that the Claim/Preauthorization/Pre-determination has been received but processing has not begun (queued); that it has been processed and one or more errors have been detected (error); no errors were detected and some of the adjudication processing has been performed (partial); or all of the adjudication processing has completed without errors (complete).

outcome_ext: Option<FieldExtension>

Extension field.

decision: Option<CodeableConcept>

AdjudicationDecision; Result of the adjudication

The result of the claim, predetermination, or preauthorization adjudication.

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).

decision_ext: Option<FieldExtension>

Extension field.

disposition: Option<String>

Disposition Message

A human readable description of the status of the adjudication.

disposition_ext: Option<FieldExtension>

Extension field.

pre_auth_ref: Option<String>

Preauthorization reference

Reference from the Insurer which is used in later communications which refers to this adjudication.

This value is only present on preauthorization adjudications.

pre_auth_ref_ext: Option<FieldExtension>

Extension field.

pre_auth_period: Option<Period>

Preauthorization reference effective period

The time frame during which this authorization is effective.

pre_auth_period_ext: Option<FieldExtension>

Extension field.

event: Vec<Option<ClaimResponseEvent>>

Event information

Information code for an event with a corresponding date or period.

event_ext: Vec<Option<FieldExtension>>

Extension field.

payee_type: Option<CodeableConcept>

PayeeType; Party to be paid any benefits payable

Type of Party to be reimbursed: subscriber, provider, other.

payee_type_ext: Option<FieldExtension>

Extension field.

encounter: Vec<Option<Reference>>

Encounters associated with the listed treatments

Healthcare encounters related to this claim.

This will typically be the encounter the event occurred within, but some activities may be initiated prior to or after the official completion of an encounter but still be tied to the context of the encounter.

encounter_ext: Vec<Option<FieldExtension>>

Extension field.

diagnosis_related_group: Option<CodeableConcept>

DiagnosisRelatedGroup; Package billing code

A package billing code or bundle code used to group products and services to a particular health condition (such as heart attack) which is based on a predetermined grouping code system.

For example DRG (Diagnosis Related Group) or a bundled billing code. A patient may have a diagnosis of a Myocardial Infarction and a DRG for HeartAttack would be assigned. The Claim item (and possible subsequent claims) would refer to the DRG for those line items that were for services related to the heart attack event.

diagnosis_related_group_ext: Option<FieldExtension>

Extension field.

item: Vec<Option<ClaimResponseItem>>

Adjudication for claim line items

A claim line. Either a simple (a product or service) or a ‘group’ of details which can also be a simple items or groups of sub-details.

item_ext: Vec<Option<FieldExtension>>

Extension field.

add_item: Vec<Option<ClaimResponseAddItem>>

Insurer added line items

The first-tier service adjudications for payor added product or service lines.

add_item_ext: Vec<Option<FieldExtension>>

Extension field.

adjudication: Vec<Option<ClaimResponseItemAdjudication>>

Header-level adjudication

The adjudication results which are presented at the header level rather than at the line-item or add-item levels.

adjudication_ext: Vec<Option<FieldExtension>>

Extension field.

total: Vec<Option<ClaimResponseTotal>>

Adjudication totals

Categorized monetary totals for the adjudication.

Totals for amounts submitted, co-pays, benefits payable etc.

total_ext: Vec<Option<FieldExtension>>

Extension field.

payment: Option<ClaimResponsePayment>

Payment Details

Payment details for the adjudication of the claim.

payment_ext: Option<FieldExtension>

Extension field.

funds_reserve: Option<CodeableConcept>

FundsReserve; Funds reserved status

A code, used only on a response to a preauthorization, to indicate whether the benefits payable have been reserved and for whom.

Fund would be release by a future claim quoting the preAuthRef of this response. Examples of values include: provider, patient, none.

funds_reserve_ext: Option<FieldExtension>

Extension field.

form_code: Option<CodeableConcept>

Forms; Printed form identifier

A code for the form to be used for printing the content.

May be needed to identify specific jurisdictional forms.

form_code_ext: Option<FieldExtension>

Extension field.

form: Option<Attachment>

Printed reference or actual form

The actual form, by reference or inclusion, for printing the content or an EOB.

Needed to permit insurers to include the actual form.

form_ext: Option<FieldExtension>

Extension field.

process_note: Vec<Option<ClaimResponseProcessNote>>

Note concerning adjudication

A note that describes or explains adjudication results in a human readable form.

process_note_ext: Vec<Option<FieldExtension>>

Extension field.

communication_request: Vec<Option<Reference>>

Request for additional information

Request for additional supporting or authorizing information.

For example: professional reports, documents, images, clinical resources, or accident reports.

communication_request_ext: Vec<Option<FieldExtension>>

Extension field.

insurance: Vec<Option<ClaimResponseInsurance>>

Patient insurance information

Financial instruments for reimbursement for the health care products and services specified on the claim.

All insurance coverages for the patient which may be applicable for reimbursement, of the products and services listed in the claim, are typically provided in the claim to allow insurers to confirm the ordering of the insurance coverages relative to local ‘coordination of benefit’ rules. One coverage (and only one) with ‘focal=true’ is to be used in the adjudication of this claim. Coverages appearing before the focal Coverage in the list, and where ‘subrogation=false’, should provide a reference to the ClaimResponse containing the adjudication results of the prior claim.

insurance_ext: Vec<Option<FieldExtension>>

Extension field.

error: Vec<Option<ClaimResponseError>>

Processing errors

Errors encountered during the processing of the adjudication.

If the request contains errors then an error element should be provided and no adjudication related sections (item, addItem, or payment) should be present.

error_ext: Vec<Option<FieldExtension>>

Extension field.

Trait Implementations

impl Clone for ClaimResponseInner

fn clone(&self) -> ClaimResponseInner

Returns a duplicate of the value.

fn clone_from(&mut self, source: &Self)

Performs copy-assignment from source.

impl Debug for ClaimResponseInner

fn fmt(&self, f: &mut Formatter<'_>) -> Result<(), Error>

Formats the value using the given formatter.

impl<'de> Deserialize<'de> for ClaimResponseInner

fn deserialize<__D>( __deserializer: __D, ) -> Result<ClaimResponseInner, <__D as Deserializer<'de>>::Error>

where __D: Deserializer<'de>,

Deserialize this value from the given Serde deserializer.

impl From<ClaimResponseInner> for ClaimResponse

fn from(inner: ClaimResponseInner) -> ClaimResponse

Converts to this type from the input type.

impl PartialEq for ClaimResponseInner

fn eq(&self, other: &ClaimResponseInner) -> bool

Tests for self and other values to be equal, and is used by ==.

fn ne(&self, other: &Rhs) -> bool

Tests for !=. The default implementation is almost always sufficient, and should not be overridden without very good reason.

impl Serialize for ClaimResponseInner

fn serialize<__S>( &self, __serializer: __S, ) -> Result<<__S as Serializer>::Ok, <__S as Serializer>::Error>

where __S: Serializer,

Serialize this value into the given Serde serializer.

impl StructuralPartialEq for ClaimResponseInner