> ## Documentation Index
> Fetch the complete documentation index at: https://docs.metriport.com/llms.txt
> Use this file to discover all available pages before exploring further.

# ClaimResponse

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

## Properties

| Name | Required | Type | Description |
| - | - | - | - |
| identifier | No | [Identifier](/medical-api/fhir/data-types/identifier)\[] | Business Identifier for a claim response |
| status | Yes | code | active / cancelled / draft / entered-in-error |
| type | Yes | [CodeableConcept](/medical-api/fhir/data-types/codeableconcept) | More granular claim type |
| subType | No | [CodeableConcept](/medical-api/fhir/data-types/codeableconcept) | More granular claim type |
| use | Yes | code | claim / preauthorization / predetermination |
| patient | Yes | Reference\<[Patient](/medical-api/fhir/resources/patient)> | The recipient of the products and services |
| created | Yes | dateTime | Response creation date |
| insurer | Yes | Reference\<[Organization](/medical-api/fhir/resources/organization)> | Party responsible for reimbursement |
| requestor | No | Reference\<[Practitioner](/medical-api/fhir/resources/practitioner) / [PractitionerRole](/medical-api/fhir/resources/practitionerrole) / [Organization](/medical-api/fhir/resources/organization)> | Party responsible for the claim |
| request | No | Reference\<[Claim](/medical-api/fhir/resources/claim)> | Id of resource triggering adjudication |
| outcome | Yes | code | queued / complete / error / partial |
| disposition | No | string | Disposition Message |
| preAuthRef | No | string | Preauthorization reference |
| preAuthPeriod | No | [Period](/medical-api/fhir/data-types/period) | Preauthorization reference effective period |
| payeeType | No | [CodeableConcept](/medical-api/fhir/data-types/codeableconcept) | Party to be paid any benefits payable |
| item | No | ClaimResponseItem | Adjudication for claim line items |
| - id | No | string | Unique id for inter-element referencing |
| - extension | No | [Extension](/medical-api/fhir/data-types/extension)\[] | Additional content defined by implementations |
| - modifierExtension | No | [Extension](/medical-api/fhir/data-types/extension)\[] | Extensions that cannot be ignored even if unrecognized |
| - itemSequence | Yes | positiveInt | Claim item instance identifier |
| - noteNumber | No | positiveInt\[] | Applicable note numbers |
| - adjudication | Yes | ClaimResponseItemAdjudication | Adjudication details |
| - id | No | string | Unique id for inter-element referencing |
| - extension | No | [Extension](/medical-api/fhir/data-types/extension)\[] | Additional content defined by implementations |
| - modifierExtension | No | [Extension](/medical-api/fhir/data-types/extension)\[] | Extensions that cannot be ignored even if unrecognized |
| - category | Yes | [CodeableConcept](/medical-api/fhir/data-types/codeableconcept) | Type of adjudication information |
| - reason | No | [CodeableConcept](/medical-api/fhir/data-types/codeableconcept) | Explanation of adjudication outcome |
| - amount | No | [Money](/medical-api/fhir/data-types/money) | Monetary amount |
| - value | No | decimal | Non-monetary value |
| - detail | No | ClaimResponseItemDetail | Adjudication for claim details |
| - id | No | string | Unique id for inter-element referencing |
| - extension | No | [Extension](/medical-api/fhir/data-types/extension)\[] | Additional content defined by implementations |
| - modifierExtension | No | [Extension](/medical-api/fhir/data-types/extension)\[] | Extensions that cannot be ignored even if unrecognized |
| - detailSequence | Yes | positiveInt | Claim detail instance identifier |
| - noteNumber | No | positiveInt\[] | Applicable note numbers |
| - adjudication | Yes | \[] | Detail level adjudication details |
| - subDetail | No | ClaimResponseItemDetailSubDetail | Adjudication for claim sub-details |
| - id | No | string | Unique id for inter-element referencing |
| - extension | No | [Extension](/medical-api/fhir/data-types/extension)\[] | Additional content defined by implementations |
| - modifierExtension | No | [Extension](/medical-api/fhir/data-types/extension)\[] | Extensions that cannot be ignored even if unrecognized |
| - subDetailSequence | Yes | positiveInt | Claim sub-detail instance identifier |
| - noteNumber | No | positiveInt\[] | Applicable note numbers |
| - adjudication | No | \[] | Subdetail level adjudication details |
| addItem | No | ClaimResponseAddItem | Insurer added line items |
| - id | No | string | Unique id for inter-element referencing |
| - extension | No | [Extension](/medical-api/fhir/data-types/extension)\[] | Additional content defined by implementations |
| - modifierExtension | No | [Extension](/medical-api/fhir/data-types/extension)\[] | Extensions that cannot be ignored even if unrecognized |
| - itemSequence | No | positiveInt\[] | Item sequence number |
| - detailSequence | No | positiveInt\[] | Detail sequence number |
| - subdetailSequence | No | positiveInt\[] | Subdetail sequence number |
| - provider | No | Reference\<[Practitioner](/medical-api/fhir/resources/practitioner) / [PractitionerRole](/medical-api/fhir/resources/practitionerrole) / [Organization](/medical-api/fhir/resources/organization)>\[] | Authorized providers |
| - productOrService | Yes | [CodeableConcept](/medical-api/fhir/data-types/codeableconcept) | Billing, service, product, or drug code |
| - modifier | No | [CodeableConcept](/medical-api/fhir/data-types/codeableconcept)\[] | Service/Product billing modifiers |
| - programCode | No | [CodeableConcept](/medical-api/fhir/data-types/codeableconcept)\[] | Program the product or service is provided under |
| - serviced\[x] | No | date, [Period](/medical-api/fhir/data-types/period) | Date or dates of service or product delivery |
| - location\[x] | No | [CodeableConcept](/medical-api/fhir/data-types/codeableconcept), [Address](/medical-api/fhir/data-types/address), Reference\<[Location](/medical-api/fhir/resources/location)> | Place of service or where product was supplied |
| - quantity | No | [Quantity](/medical-api/fhir/data-types/quantity) | Count of products or services |
| - unitPrice | No | [Money](/medical-api/fhir/data-types/money) | Fee, charge or cost per item |
| - factor | No | decimal | Price scaling factor |
| - net | No | [Money](/medical-api/fhir/data-types/money) | Total item cost |
| - bodySite | No | [CodeableConcept](/medical-api/fhir/data-types/codeableconcept) | Anatomical location |
| - subSite | No | [CodeableConcept](/medical-api/fhir/data-types/codeableconcept)\[] | Anatomical sub-location |
| - noteNumber | No | positiveInt\[] | Applicable note numbers |
| - adjudication | Yes | \[] | Added items adjudication |
| - detail | No | ClaimResponseAddItemDetail | Insurer added line details |
| - id | No | string | Unique id for inter-element referencing |
| - extension | No | [Extension](/medical-api/fhir/data-types/extension)\[] | Additional content defined by implementations |
| - modifierExtension | No | [Extension](/medical-api/fhir/data-types/extension)\[] | Extensions that cannot be ignored even if unrecognized |
| - productOrService | Yes | [CodeableConcept](/medical-api/fhir/data-types/codeableconcept) | Billing, service, product, or drug code |
| - modifier | No | [CodeableConcept](/medical-api/fhir/data-types/codeableconcept)\[] | Service/Product billing modifiers |
| - quantity | No | [Quantity](/medical-api/fhir/data-types/quantity) | Count of products or services |
| - unitPrice | No | [Money](/medical-api/fhir/data-types/money) | Fee, charge or cost per item |
| - factor | No | decimal | Price scaling factor |
| - net | No | [Money](/medical-api/fhir/data-types/money) | Total item cost |
| - noteNumber | No | positiveInt\[] | Applicable note numbers |
| - adjudication | Yes | \[] | Added items detail adjudication |
| - subDetail | No | ClaimResponseAddItemDetailSubDetail | Insurer added line items |
| - id | No | string | Unique id for inter-element referencing |
| - extension | No | [Extension](/medical-api/fhir/data-types/extension)\[] | Additional content defined by implementations |
| - modifierExtension | No | [Extension](/medical-api/fhir/data-types/extension)\[] | Extensions that cannot be ignored even if unrecognized |
| - productOrService | Yes | [CodeableConcept](/medical-api/fhir/data-types/codeableconcept) | Billing, service, product, or drug code |
| - modifier | No | [CodeableConcept](/medical-api/fhir/data-types/codeableconcept)\[] | Service/Product billing modifiers |
| - quantity | No | [Quantity](/medical-api/fhir/data-types/quantity) | Count of products or services |
| - unitPrice | No | [Money](/medical-api/fhir/data-types/money) | Fee, charge or cost per item |
| - factor | No | decimal | Price scaling factor |
| - net | No | [Money](/medical-api/fhir/data-types/money) | Total item cost |
| - noteNumber | No | positiveInt\[] | Applicable note numbers |
| - adjudication | Yes | \[] | Added items detail adjudication |
| adjudication | No | \[] | Header-level adjudication |
| total | No | ClaimResponseTotal | Adjudication totals |
| - id | No | string | Unique id for inter-element referencing |
| - extension | No | [Extension](/medical-api/fhir/data-types/extension)\[] | Additional content defined by implementations |
| - modifierExtension | No | [Extension](/medical-api/fhir/data-types/extension)\[] | Extensions that cannot be ignored even if unrecognized |
| - category | Yes | [CodeableConcept](/medical-api/fhir/data-types/codeableconcept) | Type of adjudication information |
| - amount | Yes | [Money](/medical-api/fhir/data-types/money) | Financial total for the category |
| payment | No | ClaimResponsePayment | Payment Details |
| - id | No | string | Unique id for inter-element referencing |
| - extension | No | [Extension](/medical-api/fhir/data-types/extension)\[] | Additional content defined by implementations |
| - modifierExtension | No | [Extension](/medical-api/fhir/data-types/extension)\[] | Extensions that cannot be ignored even if unrecognized |
| - type | Yes | [CodeableConcept](/medical-api/fhir/data-types/codeableconcept) | Partial or complete payment |
| - adjustment | No | [Money](/medical-api/fhir/data-types/money) | Payment adjustment for non-claim issues |
| - adjustmentReason | No | [CodeableConcept](/medical-api/fhir/data-types/codeableconcept) | Explanation for the adjustment |
| - date | No | date | Expected date of payment |
| - amount | Yes | [Money](/medical-api/fhir/data-types/money) | Payable amount after adjustment |
| - identifier | No | [Identifier](/medical-api/fhir/data-types/identifier) | Business identifier for the payment |
| fundsReserve | No | [CodeableConcept](/medical-api/fhir/data-types/codeableconcept) | Funds reserved status |
| formCode | No | [CodeableConcept](/medical-api/fhir/data-types/codeableconcept) | Printed form identifier |
| form | No | [Attachment](/medical-api/fhir/data-types/attachment) | Printed reference or actual form |
| processNote | No | ClaimResponseProcessNote | Note concerning adjudication |
| - id | No | string | Unique id for inter-element referencing |
| - extension | No | [Extension](/medical-api/fhir/data-types/extension)\[] | Additional content defined by implementations |
| - modifierExtension | No | [Extension](/medical-api/fhir/data-types/extension)\[] | Extensions that cannot be ignored even if unrecognized |
| - number | No | positiveInt | Note instance identifier |
| - type | No | code | display / print / printoper |
| - text | Yes | string | Note explanatory text |
| - language | No | [CodeableConcept](/medical-api/fhir/data-types/codeableconcept) | Language of the text |
| communicationRequest | No | Reference\<[CommunicationRequest](/medical-api/fhir/resources/communicationrequest)>\[] | Request for additional information |
| insurance | No | ClaimResponseInsurance | Patient insurance information |
| - id | No | string | Unique id for inter-element referencing |
| - extension | No | [Extension](/medical-api/fhir/data-types/extension)\[] | Additional content defined by implementations |
| - modifierExtension | No | [Extension](/medical-api/fhir/data-types/extension)\[] | Extensions that cannot be ignored even if unrecognized |
| - sequence | Yes | positiveInt | Insurance instance identifier |
| - focal | Yes | boolean | Coverage to be used for adjudication |
| - coverage | Yes | Reference\<[Coverage](/medical-api/fhir/resources/coverage)> | Insurance information |
| - businessArrangement | No | string | Additional provider contract number |
| - claimResponse | No | Reference\<[ClaimResponse](/medical-api/fhir/resources/claimresponse)> | Adjudication results |
| error | No | ClaimResponseError | Processing errors |
| - id | No | string | Unique id for inter-element referencing |
| - extension | No | [Extension](/medical-api/fhir/data-types/extension)\[] | Additional content defined by implementations |
| - modifierExtension | No | [Extension](/medical-api/fhir/data-types/extension)\[] | Extensions that cannot be ignored even if unrecognized |
| - itemSequence | No | positiveInt | Item sequence number |
| - detailSequence | No | positiveInt | Detail sequence number |
| - subDetailSequence | No | positiveInt | Subdetail sequence number |
| - code | Yes | [CodeableConcept](/medical-api/fhir/data-types/codeableconcept) | Error code detailing processing issues |

## Search Parameters

| Name | Type | Description | Expression |
| - | - | - | - |
| created | date | The creation date | ClaimResponse.created |
| disposition | string | The contents of the disposition message | ClaimResponse.disposition |
| identifier | token | The identity of the ClaimResponse | ClaimResponse.identifier |
| insurer | reference | The organization which generated this resource | ClaimResponse.insurer |
| outcome | token | The processing outcome | ClaimResponse.outcome |
| patient | reference | The subject of care | ClaimResponse.patient |
| payment-date | date | The expected payment date | ClaimResponse.payment.date |
| request | reference | The claim reference | ClaimResponse.request |
| requestor | reference | The Provider of the claim | ClaimResponse.requestor |
| status | token | The status of the ClaimResponse | ClaimResponse.status |
| use | token | The type of claim | ClaimResponse.use |

## Inherited Properties

| Name | Required | Type | Description |
| - | - | - | - |
| id | No | string | Logical id of this artifact |
| meta | No | [Meta](/medical-api/fhir/data-types/meta) | Metadata about the resource |
| implicitRules | No | uri | A set of rules under which this content was created |
| language | No | code | Language of the resource content |
| text | No | [Narrative](/medical-api/fhir/data-types/narrative) | Text summary of the resource, for human interpretation |
| contained | No | Resource\[] | Contained, inline Resources |
| extension | No | [Extension](/medical-api/fhir/data-types/extension)\[] | Additional content defined by implementations |
| modifierExtension | No | [Extension](/medical-api/fhir/data-types/extension)\[] | Extensions that cannot be ignored |

To view the FHIR specification for this resource, see [ClaimResponse](https://www.hl7.org/fhir/StructureDefinition/ClaimResponse).


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