Besa Fhir Help File

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Class TClaimResponse

Description
Hierarchy
Fields
Methods
Properties

Unit

bsFhir_r5

Declaration

type TClaimResponse = class(TDomainResource)

Description

This resource provides the adjudication details from the processing of a Claim resource. If the element is present, it must have either a @value, an @id, or extensions

Hierarchy

Overview

Methods

Public constructor Create; override;

Properties

Public property identifier : TIdentifierArray read GetidentifierArray;
Public property traceNumber : TIdentifierArray read GettraceNumberArray;
Public property status : string read Getstatus write Setstatus;
Public property statusElement : TFinancialResourceStatusCodes read GetstatusElement write SetstatusElement;
Public property type_ : TCodeableConcept read Gettype_ write Settype_;
Public property subType : TCodeableConcept read GetsubType write SetsubType;
Public property use : string read Getuse write Setuse;
Public property useElement : TUse read GetuseElement write SetuseElement;
Public property patient : TReference read Getpatient write Setpatient;
Public property created : string read Getcreated write Setcreated;
Public property createdElement : TdateTime_ read GetcreatedElement write SetcreatedElement;
Public property insurer : TReference read Getinsurer write Setinsurer;
Public property requestor : TReference read Getrequestor write Setrequestor;
Public property request : TReference read Getrequest write Setrequest;
Public property outcome : string read Getoutcome write Setoutcome;
Public property outcomeElement : TClaimProcessingCodes read GetoutcomeElement write SetoutcomeElement;
Public property decision : TCodeableConcept read Getdecision write Setdecision;
Public property disposition : string read Getdisposition write Setdisposition;
Public property dispositionElement : Tstring read GetdispositionElement write SetdispositionElement;
Public property preAuthRef : string read GetpreAuthRef write SetpreAuthRef;
Public property preAuthRefElement : Tstring read GetpreAuthRefElement write SetpreAuthRefElement;
Public property preAuthPeriod : TPeriod read GetpreAuthPeriod write SetpreAuthPeriod;
Public property event : TClaimResponseEventArray read GeteventArray;
Public property payeeType : TCodeableConcept read GetpayeeType write SetpayeeType;
Public property encounter : TReferenceArray read GetencounterArray;
Public property diagnosisRelatedGroup : TCodeableConcept read GetdiagnosisRelatedGroup write SetdiagnosisRelatedGroup;
Public property item : TClaimResponseItemArray read GetitemArray;
Public property addItem : TClaimResponseAddItemArray read GetaddItemArray;
Public property adjudication : TClaimResponseAdjudicationArray read GetadjudicationArray;
Public property total : TClaimResponseTotalArray read GettotalArray;
Public property payment : TClaimResponsePayment read Getpayment write Setpayment;
Public property fundsReserve : TCodeableConcept read GetfundsReserve write SetfundsReserve;
Public property formCode : TCodeableConcept read GetformCode write SetformCode;
Public property form : TAttachment read Getform write Setform;
Public property processNote : TClaimResponseProcessNoteArray read GetprocessNoteArray;
Public property communicationRequest : TReferenceArray read GetcommunicationRequestArray;
Public property insurance : TClaimResponseInsuranceArray read GetinsuranceArray;
Public property error : TClaimResponseErrorArray read GeterrorArray;

Description

Methods

Public constructor Create; override;
 

Properties

Public property identifier : TIdentifierArray read GetidentifierArray;

A unique identifier assigned to this claim response.

Public property traceNumber : TIdentifierArray read GettraceNumberArray;

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

Public property status : string read Getstatus write Setstatus;

The status of the resource instance.

Public property statusElement : TFinancialResourceStatusCodes read GetstatusElement write SetstatusElement;
 
Public property type_ : TCodeableConcept read Gettype_ write Settype_;

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

Public property subType : TCodeableConcept read GetsubType write SetsubType;

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

Public property use : string read Getuse write Setuse;

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.

Public property useElement : TUse read GetuseElement write SetuseElement;
 
Public property patient : TReference read Getpatient write Setpatient;

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.

Public property created : string read Getcreated write Setcreated;

The date this resource was created.

Public property createdElement : TdateTime_ read GetcreatedElement write SetcreatedElement;
 
Public property insurer : TReference read Getinsurer write Setinsurer;

The party responsible for authorization, adjudication and reimbursement.

Public property requestor : TReference read Getrequestor write Setrequestor;

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

Public property request : TReference read Getrequest write Setrequest;

Original request resource reference.

Public property outcome : string read Getoutcome write Setoutcome;

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

Public property outcomeElement : TClaimProcessingCodes read GetoutcomeElement write SetoutcomeElement;
 
Public property decision : TCodeableConcept read Getdecision write Setdecision;

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

Public property disposition : string read Getdisposition write Setdisposition;

A human readable description of the status of the adjudication.

Public property dispositionElement : Tstring read GetdispositionElement write SetdispositionElement;
 
Public property preAuthRef : string read GetpreAuthRef write SetpreAuthRef;

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

Public property preAuthRefElement : Tstring read GetpreAuthRefElement write SetpreAuthRefElement;
 
Public property preAuthPeriod : TPeriod read GetpreAuthPeriod write SetpreAuthPeriod;

The time frame during which this authorization is effective.

Public property event : TClaimResponseEventArray read GeteventArray;

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

Public property payeeType : TCodeableConcept read GetpayeeType write SetpayeeType;

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

Public property encounter : TReferenceArray read GetencounterArray;

Healthcare encounters related to this claim.

Public property diagnosisRelatedGroup : TCodeableConcept read GetdiagnosisRelatedGroup write SetdiagnosisRelatedGroup;

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.

Public property item : TClaimResponseItemArray read GetitemArray;

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.

Public property addItem : TClaimResponseAddItemArray read GetaddItemArray;

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

Public property adjudication : TClaimResponseAdjudicationArray read GetadjudicationArray;

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

Public property total : TClaimResponseTotalArray read GettotalArray;

Categorized monetary totals for the adjudication.

Public property payment : TClaimResponsePayment read Getpayment write Setpayment;

Payment details for the adjudication of the claim.

Public property fundsReserve : TCodeableConcept read GetfundsReserve write SetfundsReserve;

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

Public property formCode : TCodeableConcept read GetformCode write SetformCode;

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

Public property form : TAttachment read Getform write Setform;

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

Public property processNote : TClaimResponseProcessNoteArray read GetprocessNoteArray;

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

Public property communicationRequest : TReferenceArray read GetcommunicationRequestArray;

Request for additional supporting or authorizing information.

Public property insurance : TClaimResponseInsuranceArray read GetinsuranceArray;

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

Public property error : TClaimResponseErrorArray read GeterrorArray;

Errors encountered during the processing of the adjudication.

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