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ElementAliasesCard.Inv.TypeIs ModifierModifier ReasonSummaryBindingExampleDefault ValueMissing MeaningRegexShort NameDefinitionRequirementsComments
ClaimResponseRemittance AdviceDomainResourceResponse to a claim predetermination or preauthorizationThis resource provides the adjudication details from the processing of a Claim resource.
!IdentificationResource identification
ClaimResponse.identifier0..*IdentifierBusiness Identifier for a claim responseA unique identifier assigned to this claim response.Allows claim responses to be distinguished and referenced.
ClaimResponse.status1..1codeYThis element is labeled as a modifier because it is a status element that contains status entered-in-error which means that the resource should not be treated as validYClaimResponseStatusactive | cancelled | draft | entered-in-errorThe status of the resource instance.Need to track the status of the resource as 'draft' resources may undergo further edits while 'active' resources are immutable and may only have their status changed to 'cancelled'.This element is labeled as a modifier because the status contains codes that mark the resource as not currently valid
ClaimResponse.type1..1CodeableConceptClaimTypeCategory or disciplineThe category of claim, e.g. oral, pharmacy, vision, institutional, professional.Claim type determine the general sets of business rules applied for information requirements and adjudication. The majority of jurisdictions use: oral, pharmacy, vision, professional and institutional, or variants on those terms, as the general styles of claims. The valueset is extensible to accommodate other jurisdictional requirements.
ClaimResponse.subType0..1CodeableConceptClaimSubTypeMore granular claim typeA finer grained suite of claim type codes which may convey additional information such as Inpatient vs Outpatient and/or a specialty service.Some jurisdictions need a finer grained claim type for routing and adjudication.This may contain the local bill type codes, for example the US UB-04 bill type code or the CMS bill type.
ClaimResponse.use1..1codeYUseclaim | preauthorization | predeterminationA code to indicate whether the nature of the request is: to request adjudication of products and services previously rendered; or requesting authorization and adjudication for provision in the future; or requesting the non-binding adjudication of the listed products and services which could be provided in the future.This element is required to understand the nature of the request for adjudication.Make 1..1
ClaimResponse.patient1..1Reference(Patient)The recipient of the products and servicesThe party to whom the professional services and/or products have been supplied or are being considered and for whom actual for facast reimburement is sought.The patient must be supplied to the insurer so that confirmation of coverage and service hstory may be considered as part of the authorization and/or adjudiction.Make 1..1
ClaimResponse.created1..1dateTimeResponse creation dateThe date this resource was created.Need to record a timestamp for use by both the recipient and the issuer.
ClaimResponse.insurer1.1Reference(Organization)Party responsible for reimbursementThe party responsible for authorization, adjudication and reimbursement.To be a valid claim, preauthorization or predetermination there must be a party who is responsible for adjudicating the contents against a policy which provides benefits for the patient.Make 1..1
ClaimResponse.requestor0..1Reference(Practitioner|PractitionerRole|Organization)Party responsible for the claimThe provider which is responsible for the claim, predetermination or preauthorization.Typically this field would be 1..1 where this party is responsible for the claim but not necessarily professionally responsible for the provision of the individual products and services listed below.Make 1..1 Was Provider
ClaimResponse.request1..1Reference(Claim)Claim, preauthorization, or predetermination triggering adjudicationReference to the original request resource.Needed to allow the response to be linked to the request.
ClaimResponse.outcome1..1codeRemittanceOutcomequeued | complete | error | partialThe outcome of the claim, predetermination, or preauthorization processing.To advise the requestor of an overall processing outcome.The resource may be used to indicate that: the request has been held (queued) for processing; that it has been processed and errors found (error); that no errors were found and that some of the adjudication has been undertaken (partial) or that all of the adjudication has been undertaken (complete).
ClaimResponse.disposition0..1stringDisposition MessageA human readable description of the status of the adjudication.Provided for user display.
ClaimResponse.preAuthRef0..1stringPreauthorization referenceReference from the Insurer which is used in later communications which refers to this adjudication.On subsequent claims, the insurer may require the provider to quote this value. This value is only present on preauthorization adjudications.
!Payee InformationPayee
ClaimResponse.payeeType0..1CodeableConceptPayeeTypeParty to be paid any benefits payableType of Party to be reimbursed: subscriber, provider, other.Need to know who should receive payment with the most common situations being the Provider (assignment of benefits) or the Subscriber.
!Services Provided1st tier line items
ClaimResponse.item0..*=ItemAdjudication for claim line itemsA 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.The adjudication for items provided on the claim.
ClaimResponse.item.itemSequence1..1positiveIntClaim item instance identifierA number to uniquely reference the claim item entries.Necessary to provide a mechanism to link the adjudication result to the submitted claim item.
ClaimResponse.item.noteNumber0..*positiveIntApplicable note numbersThe numbers associated with notes below which apply to the adjudication of this item.Provides a condensed manner for associating human readable descriptive explanations for adjudications on the line item.
!Response FieldsLine item adjudication
ClaimResponse.item.adjudication1..*=AdjudicationAdjudication detailsIf this item is a group then the values here are a summary of the adjudication of the detail items. If this item is a simple product or service then this is the result of the adjudication of this item.The adjudication results conveys the insurer's assessment of the item provided in the claim under the terms of the patient's insurance coverage.
ClaimResponse.item.adjudication.category1..1CodeableConceptAdjudicationType of adjudication informationA code to indicate the information type of this adjudication record. Information types may include the value submitted, maximum values or percentages allowed or payable under the plan, amounts that the patient is resonsible for in-aggregate or pertaining to this item, amounts paid by other coverages, and the benefit payable for this item.Needed to enable understanding of the context of the other information in the adjudication.For example codes indicating: Co-Pay, deductible, eligible, benefit, tax, etc.
ClaimResponse.item.adjudication.reason0..1CodeableConceptAdjudicationReasonExplanation of adjudication outcomeA code supporting the understanding of the adjudication result and explaining variance from expected amount.To support understanding of variance from adjudication expectations.For example may indicate that the funds for this benefit type have been exhausted.
ClaimResponse.item.adjudication.amount0..1MoneyMonetary amountMonetary amount associated with the category.Most adjuciation categories convey a monetary amount.For example: amount submitted, eligible amount, co-payment, and benefit payable.
ClaimResponse.item.adjudication.value0..1decimalNon-monetary valueA non-monetary value associated with the category. Mutually exclusive to the amount element above.Some adjudication categories convey a percentage or a fixed value.For example: eligible percentage or co-payment percentage.
!Additional Charges (lab, expense, materials, components, tax)2nd tier line items
ClaimResponse.item.detail0..*=ItemDetailAdjudication for claim detailsA claim detail. Either a simple (a product or service) or a 'group' of sub-details which are simple items.The adjudication for details provided on the claim.
ClaimResponse.item.detail.detailSequence1..1positiveIntClaim detail instance identifierA number to uniquely reference the claim detail entry.Necessary to provide a mechanism to link the adjudication result to the submitted claim detail.
ClaimResponse.item.detail.noteNumber0..*positiveIntApplicable note numbersThe numbers associated with notes below which apply to the adjudication of this item.Provides a condensed manner for associating human readable descriptive explanations for adjudications on the line item.
ClaimResponse.item.detail.adjudication1..*@ClaimResponse.item.adjudicationDetail level adjudication detailsThe adjudication results.
!Additional.Additional Charges (lab, expense, materials, components, tax)3rd tier line items
ClaimResponse.item.detail.subDetail0..*=SubDetailAdjudication for claim sub-detailsA sub-detail adjudication of a simple product or service.The adjudication for sub-details provided on the claim.
ClaimResponse.item.detail.subDetail.subDetailSequence1..1positiveIntClaim sub-detail instance identifierA number to uniquely reference the claim sub-detail entry.Necessary to provide a mechanism to link the adjudication result to the submitted claim sub-detail.
ClaimResponse.item.detail.subDetail.noteNumber0..*positiveIntApplicable note numbersThe numbers associated with notes below which apply to the adjudication of this item.Provides a condensed manner for associating human readable descriptive explanations for adjudications on the line item.
ClaimResponse.item.detail.subDetail.adjudication1..*@ClaimResponse.item.adjudicationSubdetail level adjudication detailsThe adjudication results.
!Additional ItemsInsurer added items
ClaimResponse.addItem0..*=AddedItemInsurer added line itemsThe first-tier service adjudications for payor added product or service lines.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.
ClaimResponse.addItem.itemSequence0..*positiveIntItem sequence numberClaim items which this service line is intended to replace.Provides references to the claim items.
ClaimResponse.addItem.detailSequence0..*positiveIntDetail sequence numberThe sequence number of the details within the claim item which this line is intended to replace.Provides references to the claim details within the claim item.
ClaimResponse.addItem.subdetailSequence0..*positiveIntSubdetail sequence numberThe sequence number of the sub-details woithin the details within the claim item which this line is intended to replace.Provides references to the claim sub-details within the claim detail.
ClaimResponse.addItem.provider0..*Reference(Practitioner|PractitionerRole|Organization)Authorized providersThe providers who are authorized for the services rendered to the patient.Insurer may provide authorization specifically to a restricted set of providers rather than an open authorization.
ClaimResponse.addItem.productOrService1..1CodeableConceptServiceProductBilling, service, product, or drug codeWhen 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.Necessary to state what was provided or done.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'.
ClaimResponse.addItem.modifier0..*CodeableConceptModifiersService/Product billing modifiersItem typification or modifiers codes to convey additional context for the product or service.To support inclusion of the item for adjudication or to charge an elevated fee.For example in Oral whether the treatment is cosmetic or associated with TMJ, or for Medical whether the treatment was outside the clinic or out of office hours.
ClaimResponse.addItem.programCode0..*CodeableConceptProgramCodeProgram the product or service is provided underIdentifies the program under which this may be recovered.Commonly used in in the identification of publicly provided program focused on population segments or disease classifications.For example: Neonatal program, child dental program or drug users recovery program
ClaimResponse.addItem.serviced[x]0..1date|PeriodDate or dates of service or product deliveryThe date or dates when the service or product was supplied, performed or completed.Needed to determine whether the service or product was provided during the term of the insurance coverage.
ClaimResponse.addItem.location[x]0..1CodeableConcept|Address|Reference(Location)ServicePlacePlace of service or where product was suppliedWhere the product or service was provided.The location can alter whether the item was acceptable for insurance purposes or impact the determination of the benefit amount.
ClaimResponse.addItem.quantity0..1SimpleQuantityCount of products or servicesThe number of repetitions of a service or product.Required when the product or service code does not convey the quantity provided.
ClaimResponse.addItem.unitPrice0..1MoneyFee, charge or cost per itemIf 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. The amount charged to the patient by the provider for a single unit.
ClaimResponse.addItem.factor0..1decimalPrice scaling factorA 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. When discounts are provided to a patient (example: Senior's discount) then this must be documented for adjudication.To show a 10% Senior's discount, the value entered is: 0.90 (1.00 - 0.10)
ClaimResponse.addItem.net0..1MoneyTotal item costThe quantity times the unit price for an additional service or product or charge. Provides the total amount claimed for the group (if a grouper) or the line item.For example, the formula: quantity * unitPrice * factor = net. Quantity and factor are assumed to be 1 if not supplied.
ClaimResponse.addItem.bodySite0..1CodeableConceptOralSitesAnatomical locationPhysical service site on the patient (limb, tooth, etc.).Allows insurer to validate specific procedures.For example: Providing a tooth code, allows an insurer to identify a provider performing a filling on a tooth that was previously removed.
ClaimResponse.addItem.subSite0..*CodeableConceptSurfaceAnatomical sub-locationA region or surface of the bodySite, e.g. limb region or tooth surface(s).Allows insurer to validate specific procedures.
ClaimResponse.addItem.noteNumber0..*positiveIntApplicable note numbersThe numbers associated with notes below which apply to the adjudication of this item.Provides a condensed manner for associating human readable descriptive explanations for adjudications on the line item.
ClaimResponse.addItem.adjudication1..*@ClaimResponse.item.adjudicationAdded items adjudicationThe adjudication results.
ClaimResponse.addItem.detail0..*=AddedItemDetailInsurer added line detailsThe second-tier service adjudications for payor added services.
ClaimResponse.addItem.detail.productOrService1..1CodeableConceptServiceProductBilling, service, product, or drug codeWhen 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.Necessary to state what was provided or done.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'.
ClaimResponse.addItem.detail.modifier0..*CodeableConceptModifiersService/Product billing modifiersItem typification or modifiers codes to convey additional context for the product or service.To support inclusion of the item for adjudication or to charge an elevated fee.For example in Oral whether the treatment is cosmetic or associated with TMJ, or for Medical whether the treatment was outside the clinic or out of office hours.
ClaimResponse.addItem.detail.quantity0..1SimpleQuantityCount of products or servicesThe number of repetitions of a service or product.Required when the product or service code does not convey the quantity provided.
ClaimResponse.addItem.detail.unitPrice0..1MoneyFee, charge or cost per itemIf 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. The amount charged to the patient by the provider for a single unit.
ClaimResponse.addItem.detail.factor0..1decimalPrice scaling factorA 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. When discounts are provided to a patient (example: Senior's discount) then this must be documented for adjudication.To show a 10% Senior's discount, the value entered is: 0.90 (1.00 - 0.10)
ClaimResponse.addItem.detail.net0..1MoneyTotal item costThe quantity times the unit price for an additional service or product or charge. Provides the total amount claimed for the group (if a grouper) or the line item.For example, the formula: quantity * unitPrice * factor = net. Quantity and factor are assumed to be 1 if not supplied.
ClaimResponse.addItem.detail.noteNumber0..*positiveIntApplicable note numbersThe numbers associated with notes below which apply to the adjudication of this item.Provides a condensed manner for associating human readable descriptive explanations for adjudications on the line item.
ClaimResponse.addItem.detail.adjudication1..*@ClaimResponse.item.adjudicationAdded items detail adjudicationThe adjudication results.
ClaimResponse.addItem.detail.subDetail0..*=AddedItemSubDetailInsurer added line itemsThe third-tier service adjudications for payor added services.
ClaimResponse.addItem.detail.subDetail.productOrService1..1CodeableConceptServiceProductBilling, service, product, or drug codeWhen 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.Necessary to state what was provided or done.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'.
ClaimResponse.addItem.detail.subDetail.modifier0..*CodeableConceptModifiersService/Product billing modifiersItem typification or modifiers codes to convey additional context for the product or service.To support inclusion of the item for adjudication or to charge an elevated fee.For example in Oral whether the treatment is cosmetic or associated with TMJ, or for Medical whether the treatment was outside the clinic or out of office hours.
ClaimResponse.addItem.detail.subDetail.quantity0..1SimpleQuantityCount of products or servicesThe number of repetitions of a service or product.Required when the product or service code does not convey the quantity provided.
ClaimResponse.addItem.detail.subDetail.unitPrice0..1MoneyFee, charge or cost per itemIf 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. The amount charged to the patient by the provider for a single unit.
ClaimResponse.addItem.detail.subDetail.factor0..1decimalPrice scaling factorA 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. When discounts are provided to a patient (example: Senior's discount) then this must be documented for adjudication.To show a 10% Senior's discount, the value entered is: 0.90 (1.00 - 0.10)
ClaimResponse.addItem.detail.subDetail.net0..1MoneyTotal item costThe quantity times the unit price for an additional service or product or charge. Provides the total amount claimed for the group (if a grouper) or the line item.For example, the formula: quantity * unitPrice * factor = net. Quantity and factor are assumed to be 1 if not supplied.
ClaimResponse.addItem.detail.subDetail.noteNumber0..*positiveIntApplicable note numbersThe numbers associated with notes below which apply to the adjudication of this item.Provides a condensed manner for associating human readable descriptive explanations for adjudications on the line item.
ClaimResponse.addItem.detail.subDetail.adjudication1..*@ClaimResponse.item.adjudicationAdded items detail adjudicationThe adjudication results.
!ErrorsProcessing errors
ClaimResponse.error0..*=ErrorProcessing errorsErrors encountered during the processing of the adjudication.Need to communicate processing issues to the requestor.If the request contains errors then an error element should be provided and no adjudication related sections (item, addItem, or payment) should be present.
ClaimResponse.error.itemSequence0..1positiveIntItem sequence numberThe sequence number of the line item submitted which contains the error. This value is omitted when the error occurs outside of the item structure.Provides references to the claim items.
ClaimResponse.error.detailSequence0..1positiveIntDetail sequence numberThe sequence number of the detail within the line item submitted which contains the error. This value is omitted when the error occurs outside of the item structure.Provides references to the claim details within the claim item.
ClaimResponse.error.subDetailSequence0..1positiveIntSubdetail sequence numberThe sequence number of the sub-detail within the detail within the line item submitted which contains the error. This value is omitted when the error occurs outside of the item structure.Provides references to the claim sub-details within the claim detail.
ClaimResponse.error.code1..1CodeableConceptAdjudicationErrorError code detailing processing issuesAn error code, from a specified code system, which details why the claim could not be adjudicated.Required to convey processing errors.
!Response InformationFinancial Information
ClaimResponse.total0..*=TotalAdjudication totalsCategorized monetary totals for the adjudication.To provide the requestor with financial totals by category for the adjudication.Totals for amounts submitted, co-pays, benefits payable etc.
ClaimResponse.total.category1..1CodeableConceptAdjudicationType of adjudication informationA code to indicate the information type of this adjudication record. Information types may include the value submitted, maximum values or percentages allowed or payable under the plan, amounts that the patient is resonsible for in-aggregate or pertaining to this item, amounts paid by other coverages, and the benefit payable for this item.Needed to convey the type of total provided.For example codes indicating: Co-Pay, deductible, eligible, benefit, tax, etc.
ClaimResponse.total.amount1..1MoneyFinancial total for the categoryMonetary total amount associated with the category.Needed to convey the total monetary amount.
ClaimResponse.payment0..1=PaymentPayment DetailsPayment details for the adjudication of the claim.Needed to convey references to the financial instrument that has been used if payment has been made.
ClaimResponse.payment.type1..1CodeableConceptPaymentTypePartial or complete paymentWhether this represents partial or complete payment of the benefits payable.To advise the requestor when the insurer believes all payments to have been completed.
ClaimResponse.payment.adjustment0..1MoneyPayment adjustment for non-claim issuesTotal amount of all adjustments to this payment included in this transaction which are not related to this claim's adjudication.To advise the requestor of adjustments applied to the payment.Insurers will deduct amounts owing from the provider (adjustment), such as a prior overpayment, from the amount owing to the provider (benefits payable) when payment is made to the provider.
ClaimResponse.payment.adjustmentReason0..1CodeableConceptPaymentAdjustmentReasonExplanation for the adjustmentReason for the payment adjustment.Needed to clarify the monetary adjustment.
ClaimResponse.payment.date0..1dateExpected date of paymentEstimated date the payment will be issued or the actual issue date of payment.To advise the payee when payment can be expected.
ClaimResponse.payment.amount1..1MoneyPayable amount after adjustmentBenefits payable less any payment adjustment.Needed to provide the actual payment amount.
ClaimResponse.payment.identifier0..1IdentifierBusiness identifier for the payment Issuer's unique identifier for the payment instrument.Enable the receiver to reconcile when payment received.For example: EFT number or check number.
ClaimResponse.fundsReserve0..1CodingFundsReserveFunds reserved statusA code, used only on a response to a preauthorization, to indicate whether the benefits payable have been reserved and for whom.Needed to advise the submitting provider on whether the rquest for reservation of funds has been honored.Fund would be release by a future claim quoting the preAuthRef of this response. Examples of values include: provider, patient, none
ClaimResponse.form0..1CodeableConceptFormsPrinted form identifierA code for the form to be used for printing the content.Needed to specify the specific form used for producing output for this response.May be needed to identify specific jurisdictional forms.
ClaimResponse.processNote0..*=NoteNote concerning adjudicationA note that describes or explains adjudication results in a human readable form.Provides the insurer specific textual explanations associated with the processing.
ClaimResponse.processNote.number0..1positiveIntNote instance identifierA number to uniquely identify a note entry.Necessary to provide a mechanism to link from adjudications.
ClaimResponse.processNote.type0..1codeNoteTypedisplay | print | printoperThe business purpose of the note text.To convey the expectation for when the text is used.
ClaimResponse.processNote.text1..1stringNote explanatory textThe explanation or description associated with the processing.Required to provide human readable explanation.
ClaimResponse.processNote.language0..1CodeableConceptLanguageNote languageA code to define the language used in the text of the note.Note text may vary from the resource defined language.Only requred if the language is different from the resource language.
ClaimResponse.communicationRequest0..*Reference(CommunicationRequest)Request for additional informationRequest for additional supporting or authorizing information.Need to communicate insurer request for additional information required to support the adjudication.For example: professional reports, documents, images, clinical resources, or accident reports.
!Insurance Information
ClaimResponse.insurance0..*=InsurancePatient insurance informationFinancial instruments for reimbursement for the health care products and services specified on the claim. At least one insurer is required for a claim to be a 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.
ClaimResponse.insurance.sequence1..1positiveIntInsurance instance identifierA number to uniquely identify insurance entries and provide a sequence of coverages to convey coordination of benefit order.To maintain order of the coverages.
ClaimResponse.insurance.focal1..1booleanCoverage to be used for adjudicationA flag to indicate that this Coverage is to be used for adjudication of this claim when set to true.To identify which coverage in the list is being used to adjudicate this claim.A patient may (will) have multiple insurance policies which provide reimburement for healthcare services and products. For example a person may also be covered by their spouse's policy and both appear in the list (and may be from the same insurer). This flag will be set to true for only one of the listed policies and that policy will be used for adjudicating this claim. Other claims woul dbe created to request adjudication against the other listed policies.
ClaimResponse.insurance.coverage1..1Reference(Coverage)Insurance informationReference to the insurance card level information contained in the Coverage resource. The coverage issuing insurer will use these details to locate the patient's actual coverage within the insurer's information system.Required to allow the adjudicator to locate the correct policy and history within their information system.
ClaimResponse.insurance.businessArrangement0..1stringAdditional provider contract number A business agreement number established between the provider and the insurer for special business processing purposes.Providers may have multiple business arrangements with a given insurer and must supply the specific contract number for adjudication.
ClaimResponse.insurance.claimResponse0..1Reference(ClaimResponse)Adjudication resultsThe result of the adjudication of the line items for the Coverage specified in this insurance.An insurer need the adjudication results from prior insurers to determine the outstanding balance remaining by item for the items in the curent claim.Must not be specified when 'focal=true' for this insurance.