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Type:
Change Request
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Resolution: Unresolved
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Priority:
Medium
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FHIR Core (FHIR)
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R4
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Financial Mgmt
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ClaimResponse
For Prior Authorization responses (specifically the X12 278 response we are modelling on the Davinci Prior Authorization Specification), we generally do not have any adjudication information. Currently ClaimResponse.adjudication is 1..* and the ClaimResponse.adjudication.category is 1..1. I have no information coming back from the payor about adjudication so I have nothing to put here. I believe that ClaimResponse.adjudication should be made 0..*.