Abstract parent profile that includes constraints that are common to the four specific ExplanationOfBenefit (EOB) profiles defined in this Implementation Guide. All EOB instances should be from one of the four concrete EOB profiles defined in this Implementation Guide: Inpatient, Outpatient, Pharmacy, and Professional/NonClinician

---

ExplanationOfBenefit

Definition	This resource provides: the claim details; adjudication details from the processing of a Claim; and optionally account balance information, for informing the subscriber of the benefits provided.
Control	0..*
Summary	False
Alternate Names	EOB

ExplanationOfBenefit.id

Definition	The logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes.
Control	0..1
Summary	True
Type	http://hl7.org/fhirpath/System.String

ExplanationOfBenefit.meta

Definition	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.
Control	1..1
Summary	True
Type	Meta

ExplanationOfBenefit.meta.id

Definition	Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Control	0..1
Summary	False
Type	http://hl7.org/fhirpath/System.String

ExplanationOfBenefit.meta.extension

Definition	May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, 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.
Control	0..*
Summary	False
Alternate Names	extensions, user content
Type	Extension

ExplanationOfBenefit.meta.versionId

Definition	The version specific identifier, as it appears in the version portion of the URL. This value changes when the resource is created, updated, or deleted.
Control	0..1
Summary	True
Type	id

ExplanationOfBenefit.meta.lastUpdated

Definition	When the resource last changed - e.g. when the version changed.
Control	1..1
Summary	True
Type	instant

ExplanationOfBenefit.meta.source

Definition	A uri that identifies the source system of the resource. This provides a minimal amount of [Provenance](http://hl7.org/fhir/R4/provenance.html#) information that can be used to track or differentiate the source of information in the resource. The source may identify another FHIR server, document, message, database, etc.
Control	0..1
Summary	True
Type	uri

ExplanationOfBenefit.meta.profile

Definition	A list of profiles (references to [StructureDefinition](http://hl7.org/fhir/R4/structuredefinition.html#) resources) that this resource claims to conform to. The URL is a reference to [StructureDefinition.url](http://hl7.org/fhir/R4/structuredefinition-definitions.html#StructureDefinition.url).
Control	1..*
Summary	True
Type	canonical

ExplanationOfBenefit.meta.security

Definition	Security labels applied to this resource. These tags connect specific resources to the overall security policy and infrastructure.
Control	0..*
Summary	True
Type	Coding

ExplanationOfBenefit.meta.tag

Definition	Tags applied to this resource. Tags are intended to be used to identify and relate resources to process and workflow, and applications are not required to consider the tags when interpreting the meaning of a resource.
Control	0..*
Summary	True
Type	Coding

ExplanationOfBenefit.implicitRules

Definition	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.
Control	0..1
Summary	True
Type	uri

ExplanationOfBenefit.language

Definition	The base language in which the resource is written.
Control	0..1
Summary	False
Type	code

ExplanationOfBenefit.text

Definition	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.
Control	0..1
Summary	False
Alternate Names	narrative, html, xhtml, display
Type	Narrative

ExplanationOfBenefit.contained

Definition	These resources do not have an independent existence apart from the resource that contains them - they cannot be identified independently, and nor can they have their own independent transaction scope.
Control	0..*
Summary	False
Alternate Names	inline resources, anonymous resources, contained resources
Type	Resource

ExplanationOfBenefit.extension

Definition	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 manageable, 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.
Control	0..*
Summary	False
Alternate Names	extensions, user content
Type	Extension

ExplanationOfBenefit.modifierExtension

Definition	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 manageable, 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).
Control	0..*
Summary	False
Alternate Names	extensions, user content
Type	Extension

ExplanationOfBenefit.identifier

Definition	A unique identifier assigned to this explanation of benefit.
Control	1..*
Summary	False
Type	Identifier

ExplanationOfBenefit.identifier.id

Definition	Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Control	0..1
Summary	False
Type	http://hl7.org/fhirpath/System.String

ExplanationOfBenefit.identifier.extension

Definition	May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, 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.
Control	0..*
Summary	False
Alternate Names	extensions, user content
Type	Extension

ExplanationOfBenefit.identifier.use

Definition	The purpose of this identifier.
Control	0..1
Summary	True
Type	code

ExplanationOfBenefit.identifier.type

Definition	A coded type for the identifier that can be used to determine which identifier to use for a specific purpose.
Control	0..1
Summary	True
Type	CodeableConcept

ExplanationOfBenefit.identifier.system

Definition	Establishes the namespace for the value - that is, a URL that describes a set values that are unique.
Control	0..1
Summary	True
Type	uri

ExplanationOfBenefit.identifier.value

Definition	The portion of the identifier typically relevant to the user and which is unique within the context of the system.
Control	0..1
Summary	True
Type	string

ExplanationOfBenefit.identifier.period

Definition	Time period during which identifier is/was valid for use.
Control	0..1
Summary	True
Type	Period

ExplanationOfBenefit.identifier.assigner

Definition	Organization that issued/manages the identifier.
Control	0..1
Summary	True
Type	Reference

ExplanationOfBenefit.identifier:uniqueclaimid

Definition	A unique identifier assigned to this explanation of benefit.
Control	1..1
Summary	False
Type	Identifier

ExplanationOfBenefit.identifier:uniqueclaimid.id

Definition	Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Control	0..1
Summary	False
Type	http://hl7.org/fhirpath/System.String

ExplanationOfBenefit.identifier:uniqueclaimid.extension

Definition	May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, 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.
Control	0..*
Summary	False
Alternate Names	extensions, user content
Type	Extension

ExplanationOfBenefit.identifier:uniqueclaimid.use

Definition	The purpose of this identifier.
Control	0..1
Summary	True
Type	code

ExplanationOfBenefit.identifier:uniqueclaimid.type

Definition	A coded type for the identifier that can be used to determine which identifier to use for a specific purpose.
Control	1..1
Summary	True
Type	CodeableConcept

ExplanationOfBenefit.identifier:uniqueclaimid.system

Definition	Establishes the namespace for the value - that is, a URL that describes a set values that are unique.
Control	0..1
Summary	True
Type	uri

ExplanationOfBenefit.identifier:uniqueclaimid.value

Definition	The portion of the identifier typically relevant to the user and which is unique within the context of the system.
Control	1..1
Summary	True
Type	string

ExplanationOfBenefit.identifier:uniqueclaimid.period

Definition	Time period during which identifier is/was valid for use.
Control	0..1
Summary	True
Type	Period

ExplanationOfBenefit.identifier:uniqueclaimid.assigner

Definition	Organization that issued/manages the identifier.
Control	0..1
Summary	True
Type	Reference

ExplanationOfBenefit.status

Definition	The status of the resource instance.
Control	1..1
Summary	True
Type	code

ExplanationOfBenefit.type

Definition	The category of claim, e.g. oral, pharmacy, vision, institutional, professional.
Control	1..1
Summary	True
Type	CodeableConcept

ExplanationOfBenefit.subType

Definition	A finer grained suite of claim type codes which may convey additional information such as Inpatient vs Outpatient and/or a specialty service.
Control	0..1
Summary	False
Type	CodeableConcept

ExplanationOfBenefit.use

Definition	A 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.
Control	1..1
Summary	True
Type	code

ExplanationOfBenefit.patient

Definition	The party to whom the professional services and/or products have been supplied or are being considered and for whom actual for forecast reimbursement is sought.
Control	1..1
Summary	True
Type	Reference

ExplanationOfBenefit.billablePeriod

Definition	The period for which charges are being submitted.
Control	1..1
Summary	True
Type	Period

ExplanationOfBenefit.billablePeriod.id

Definition	Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Control	0..1
Summary	False
Type	http://hl7.org/fhirpath/System.String

ExplanationOfBenefit.billablePeriod.extension

Definition	May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, 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.
Control	0..*
Summary	False
Alternate Names	extensions, user content
Type	Extension

ExplanationOfBenefit.billablePeriod.start

Definition	The start of the period. The boundary is inclusive.
Control	1..1
Summary	True
Type	dateTime

ExplanationOfBenefit.billablePeriod.end

Definition	The end of the period. If the end of the period is missing, it means no end was known or planned at the time the instance was created. The start may be in the past, and the end date in the future, which means that period is expected/planned to end at that time.
Control	0..1
Summary	True
Type	dateTime

ExplanationOfBenefit.created

Definition	The date this resource was created.
Control	1..1
Summary	True
Type	dateTime

ExplanationOfBenefit.enterer

Definition	Individual who created the claim, predetermination or preauthorization.
Control	0..1
Summary	False
Type	Reference

ExplanationOfBenefit.insurer

Definition	The party responsible for authorization, adjudication and reimbursement.
Control	1..1
Summary	True
Type	Reference

ExplanationOfBenefit.provider

Definition	The provider which is responsible for the claim, predetermination or preauthorization.
Control	1..1
Summary	True
Type	Reference

ExplanationOfBenefit.priority

Definition	The provider-required urgency of processing the request. Typical values include: stat, routine deferred.
Control	0..1
Summary	False
Type	CodeableConcept

ExplanationOfBenefit.fundsReserveRequested

Definition	A code to indicate whether and for whom funds are to be reserved for future claims.
Control	0..1
Summary	False
Alternate Names	Fund pre-allocation
Type	CodeableConcept

ExplanationOfBenefit.fundsReserve

Definition	A code, used only on a response to a preauthorization, to indicate whether the benefits payable have been reserved and for whom.
Control	0..1
Summary	False
Type	CodeableConcept

ExplanationOfBenefit.related

Definition	Other claims which are related to this claim such as prior submissions or claims for related services or for the same event.
Control	0..*
Summary	False
Type	BackboneElement

ExplanationOfBenefit.related.id

Definition	Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Control	0..1
Summary	False
Type	http://hl7.org/fhirpath/System.String

ExplanationOfBenefit.related.extension

Definition	May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, 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.
Control	0..*
Summary	False
Alternate Names	extensions, user content
Type	Extension

ExplanationOfBenefit.related.modifierExtension

Definition	May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained 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 manageable, 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. 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).
Control	0..*
Summary	True
Alternate Names	extensions, user content, modifiers
Type	Extension

ExplanationOfBenefit.related.claim

Definition	Reference to a related claim.
Control	0..1
Summary	False
Type	Reference

ExplanationOfBenefit.related.relationship

Definition	A code to convey how the claims are related.
Control	1..1
Summary	False
Type	CodeableConcept

ExplanationOfBenefit.related.reference

Definition	An alternate organizational reference to the case or file to which this particular claim pertains.
Control	1..1
Summary	False
Type	Identifier

ExplanationOfBenefit.prescription

Definition	Prescription to support the dispensing of pharmacy, device or vision products.
Control	0..1
Summary	False
Type	Reference

ExplanationOfBenefit.originalPrescription

Definition	Original prescription which has been superseded by this prescription to support the dispensing of pharmacy services, medications or products.
Control	0..1
Summary	False
Type	Reference

ExplanationOfBenefit.payee

Definition	The party to be reimbursed for cost of the products and services according to the terms of the policy.
Control	0..1
Summary	False
Type	BackboneElement

ExplanationOfBenefit.payee.id

Definition	Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Control	0..1
Summary	False
Type	http://hl7.org/fhirpath/System.String

ExplanationOfBenefit.payee.extension

Definition	May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, 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.
Control	0..*
Summary	False
Alternate Names	extensions, user content
Type	Extension

ExplanationOfBenefit.payee.modifierExtension

Definition	May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained 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 manageable, 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. 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).
Control	0..*
Summary	True
Alternate Names	extensions, user content, modifiers
Type	Extension

ExplanationOfBenefit.payee.type

Definition	Type of Party to be reimbursed: Subscriber, provider, other.
Control	1..1
Summary	False
Type	CodeableConcept

ExplanationOfBenefit.payee.party

Definition	Reference to the individual or organization to whom any payment will be made.
Control	0..1
Summary	False
Type	Reference

ExplanationOfBenefit.referral

Definition	A reference to a referral resource.
Control	0..1
Summary	False
Type	Reference

ExplanationOfBenefit.facility

Definition	Facility where the services were provided.
Control	0..1
Summary	False
Type	Reference

ExplanationOfBenefit.claim

Definition	The business identifier for the instance of the adjudication request: claim predetermination or preauthorization.
Control	0..1
Summary	False
Type	Reference

ExplanationOfBenefit.claimResponse

Definition	The business identifier for the instance of the adjudication response: claim, predetermination or preauthorization response.
Control	0..1
Summary	False
Type	Reference

ExplanationOfBenefit.outcome

Definition	The outcome of the claim, predetermination, or preauthorization processing.
Control	1..1
Summary	True
Type	code

ExplanationOfBenefit.disposition

Definition	A human readable description of the status of the adjudication.
Control	0..1
Summary	False
Type	string

ExplanationOfBenefit.preAuthRef

Definition	Reference from the Insurer which is used in later communications which refers to this adjudication.
Control	0..*
Summary	False
Type	string

ExplanationOfBenefit.preAuthRefPeriod

Definition	The timeframe during which the supplied preauthorization reference may be quoted on claims to obtain the adjudication as provided.
Control	0..*
Summary	False
Type	Period

ExplanationOfBenefit.careTeam

Definition	The members of the team who provided the products and services.
Control	0..*
Summary	False
Type	BackboneElement

ExplanationOfBenefit.careTeam.id

Definition	Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Control	0..1
Summary	False
Type	http://hl7.org/fhirpath/System.String

ExplanationOfBenefit.careTeam.extension

Definition	May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, 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.
Control	0..*
Summary	False
Alternate Names	extensions, user content
Type	Extension

ExplanationOfBenefit.careTeam.modifierExtension

Definition	May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained 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 manageable, 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. 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).
Control	0..*
Summary	True
Alternate Names	extensions, user content, modifiers
Type	Extension

ExplanationOfBenefit.careTeam.sequence

Definition	A number to uniquely identify care team entries.
Control	1..1
Summary	False
Type	positiveInt

ExplanationOfBenefit.careTeam.provider

Definition	Member of the team who provided the product or service.
Control	1..1
Summary	False
Type	Reference

ExplanationOfBenefit.careTeam.responsible

Definition	The party who is billing and/or responsible for the claimed products or services.
Control	0..1
Summary	False
Type	boolean

ExplanationOfBenefit.careTeam.role

Definition	The lead, assisting or supervising practitioner and their discipline if a multidisciplinary team.
Control	0..1
Summary	False
Type	CodeableConcept

ExplanationOfBenefit.careTeam.qualification

Definition	The qualification of the practitioner which is applicable for this service.
Control	0..1
Summary	False
Type	CodeableConcept

ExplanationOfBenefit.supportingInfo

Definition	Additional information codes regarding exceptions, special considerations, the condition, situation, prior or concurrent issues.
Control	0..*
Summary	False
Type	BackboneElement

ExplanationOfBenefit.supportingInfo.id

Definition	Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Control	0..1
Summary	False
Type	http://hl7.org/fhirpath/System.String

ExplanationOfBenefit.supportingInfo.extension

Definition	May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, 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.
Control	0..*
Summary	False
Alternate Names	extensions, user content
Type	Extension

ExplanationOfBenefit.supportingInfo.modifierExtension

Definition	May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained 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 manageable, 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. 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).
Control	0..*
Summary	True
Alternate Names	extensions, user content, modifiers
Type	Extension

ExplanationOfBenefit.supportingInfo.sequence

Definition	A number to uniquely identify supporting information entries.
Control	1..1
Summary	False
Type	positiveInt

ExplanationOfBenefit.supportingInfo.category

Definition	The general class of the information supplied: information; exception; accident, employment; onset, etc.
Control	1..1
Summary	False
Type	CodeableConcept

ExplanationOfBenefit.supportingInfo.code

Definition	System and code pertaining to the specific information regarding special conditions relating to the setting, treatment or patient for which care is sought.
Control	0..1
Summary	False
Type	CodeableConcept

ExplanationOfBenefit.supportingInfo.timing[x]

Definition	The date when or period to which this information refers.
Control	0..1
Summary	False
Type	date

ExplanationOfBenefit.supportingInfo.value[x]

Definition	Additional data or information such as resources, documents, images etc. including references to the data or the actual inclusion of the data.
Control	0..1
Summary	False
Type	boolean

ExplanationOfBenefit.supportingInfo.reason

Definition	Provides the reason in the situation where a reason code is required in addition to the content.
Control	0..1
Summary	False
Type	Coding

ExplanationOfBenefit.diagnosis

Definition	Information about diagnoses relevant to the claim items.
Control	0..*
Summary	False
Type	BackboneElement

ExplanationOfBenefit.diagnosis.id

Definition	Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Control	0..1
Summary	False
Type	http://hl7.org/fhirpath/System.String

ExplanationOfBenefit.diagnosis.extension

Definition	May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, 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.
Control	0..*
Summary	False
Alternate Names	extensions, user content
Type	Extension

ExplanationOfBenefit.diagnosis.modifierExtension

Definition	May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained 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 manageable, 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. 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).
Control	0..*
Summary	True
Alternate Names	extensions, user content, modifiers
Type	Extension

ExplanationOfBenefit.diagnosis.sequence

Definition	A number to uniquely identify diagnosis entries.
Control	1..1
Summary	False
Type	positiveInt

ExplanationOfBenefit.diagnosis.diagnosis[x]

Definition	The nature of illness or problem in a coded form or as a reference to an external defined Condition.
Control	1..1
Summary	False
Type	CodeableConcept

ExplanationOfBenefit.diagnosis.type

Definition	When the condition was observed or the relative ranking.
Control	0..*
Summary	False
Type	CodeableConcept

ExplanationOfBenefit.diagnosis.onAdmission

Definition	Indication of whether the diagnosis was present on admission to a facility.
Control	0..1
Summary	False
Type	CodeableConcept

ExplanationOfBenefit.diagnosis.packageCode

Definition	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.
Control	0..1
Summary	False
Type	CodeableConcept

ExplanationOfBenefit.procedure

Definition	Procedures performed on the patient relevant to the billing items with the claim.
Control	0..*
Summary	False
Type	BackboneElement

ExplanationOfBenefit.procedure.id

Definition	Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Control	0..1
Summary	False
Type	http://hl7.org/fhirpath/System.String

ExplanationOfBenefit.procedure.extension

Definition	May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, 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.
Control	0..*
Summary	False
Alternate Names	extensions, user content
Type	Extension

ExplanationOfBenefit.procedure.modifierExtension

Definition	May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained 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 manageable, 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. 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).
Control	0..*
Summary	True
Alternate Names	extensions, user content, modifiers
Type	Extension

ExplanationOfBenefit.procedure.sequence

Definition	A number to uniquely identify procedure entries.
Control	1..1
Summary	False
Type	positiveInt

ExplanationOfBenefit.procedure.type

Definition	When the condition was observed or the relative ranking.
Control	0..*
Summary	False
Type	CodeableConcept

ExplanationOfBenefit.procedure.date

Definition	Date and optionally time the procedure was performed.
Control	0..1
Summary	False
Type	dateTime

ExplanationOfBenefit.procedure.procedure[x]

Definition	The code or reference to a Procedure resource which identifies the clinical intervention performed.
Control	1..1
Summary	False
Type	CodeableConcept

ExplanationOfBenefit.procedure.udi

Definition	Unique Device Identifiers associated with this line item.
Control	0..*
Summary	False
Type	Reference

ExplanationOfBenefit.precedence

Definition	This indicates the relative order of a series of EOBs related to different coverages for the same suite of services.
Control	0..1
Summary	False
Type	positiveInt

ExplanationOfBenefit.insurance

Definition	Financial instruments for reimbursement for the health care products and services specified on the claim.
Control	1..*
Summary	True
Type	BackboneElement

ExplanationOfBenefit.insurance.id

Definition	Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Control	0..1
Summary	False
Type	http://hl7.org/fhirpath/System.String

ExplanationOfBenefit.insurance.extension

Definition	May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, 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.
Control	0..*
Summary	False
Alternate Names	extensions, user content
Type	Extension

ExplanationOfBenefit.insurance.modifierExtension

Definition	May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained 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 manageable, 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. 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).
Control	0..*
Summary	True
Alternate Names	extensions, user content, modifiers
Type	Extension

ExplanationOfBenefit.insurance.focal

Definition	A flag to indicate that this Coverage is to be used for adjudication of this claim when set to true.
Control	1..1
Summary	True
Type	boolean

ExplanationOfBenefit.insurance.coverage

Definition	Reference 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.
Control	1..1
Summary	True
Type	Reference

ExplanationOfBenefit.insurance.preAuthRef

Definition	Reference numbers previously provided by the insurer to the provider to be quoted on subsequent claims containing services or products related to the prior authorization.
Control	0..*
Summary	False
Type	string

ExplanationOfBenefit.accident

Definition	Details of a accident which resulted in injuries which required the products and services listed in the claim.
Control	0..1
Summary	False
Type	BackboneElement

ExplanationOfBenefit.accident.id

Definition	Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Control	0..1
Summary	False
Type	http://hl7.org/fhirpath/System.String

ExplanationOfBenefit.accident.extension

Definition	May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, 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.
Control	0..*
Summary	False
Alternate Names	extensions, user content
Type	Extension

ExplanationOfBenefit.accident.modifierExtension

Definition	May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained 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 manageable, 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. 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).
Control	0..*
Summary	True
Alternate Names	extensions, user content, modifiers
Type	Extension

ExplanationOfBenefit.accident.date

Definition	Date of an accident event related to the products and services contained in the claim.
Control	0..1
Summary	False
Type	date

ExplanationOfBenefit.accident.type

Definition	The type or context of the accident event for the purposes of selection of potential insurance coverages and determination of coordination between insurers.
Control	0..1
Summary	False
Type	CodeableConcept

ExplanationOfBenefit.accident.location[x]

Definition	The physical location of the accident event.
Control	0..1
Summary	False
Type	Address

ExplanationOfBenefit.item

Definition	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.
Control	1..*
Summary	False
Type	BackboneElement

ExplanationOfBenefit.item.id

Definition	Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Control	0..1
Summary	False
Type	http://hl7.org/fhirpath/System.String

ExplanationOfBenefit.item.extension

Definition	May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, 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.
Control	0..*
Summary	False
Alternate Names	extensions, user content
Type	Extension

ExplanationOfBenefit.item.modifierExtension

Definition	May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained 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 manageable, 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. 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).
Control	0..*
Summary	True
Alternate Names	extensions, user content, modifiers
Type	Extension

ExplanationOfBenefit.item.sequence

Definition	A number to uniquely identify item entries.
Control	1..1
Summary	False
Type	positiveInt

ExplanationOfBenefit.item.careTeamSequence

Definition	Care team members related to this service or product.
Control	0..*
Summary	False
Type	positiveInt

ExplanationOfBenefit.item.diagnosisSequence

Definition	Diagnoses applicable for this service or product.
Control	0..*
Summary	False
Type	positiveInt

ExplanationOfBenefit.item.procedureSequence

Definition	Procedures applicable for this service or product.
Control	0..*
Summary	False
Type	positiveInt

ExplanationOfBenefit.item.informationSequence

Definition	Exceptions, special conditions and supporting information applicable for this service or product.
Control	0..*
Summary	False
Type	positiveInt

ExplanationOfBenefit.item.revenue

Definition	The type of revenue or cost center providing the product and/or service.
Control	0..1
Summary	False
Type	CodeableConcept

ExplanationOfBenefit.item.category

Definition	Code to identify the general type of benefits under which products and services are provided.
Control	0..1
Summary	False
Type	CodeableConcept

ExplanationOfBenefit.item.productOrService

Definition	When 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.
Control	1..1
Summary	False
Alternate Names	Drug Code, Bill Code, Service Code
Type	CodeableConcept

ExplanationOfBenefit.item.modifier

Definition	Item typification or modifiers codes to convey additional context for the product or service.
Control	0..*
Summary	False
Type	CodeableConcept

ExplanationOfBenefit.item.programCode

Definition	Identifies the program under which this may be recovered.
Control	0..*
Summary	False
Type	CodeableConcept

ExplanationOfBenefit.item.serviced[x]

Definition	The date or dates when the service or product was supplied, performed or completed.
Control	0..1
Summary	False
Type	date

ExplanationOfBenefit.item.location[x]

Definition	Where the product or service was provided.
Control	0..1
Summary	False
Type	CodeableConcept

ExplanationOfBenefit.item.quantity

Definition	The number of repetitions of a service or product.
Control	0..1
Summary	False
Type	Quantity

ExplanationOfBenefit.item.unitPrice

Definition	If 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.
Control	0..1
Summary	False
Type	Money

ExplanationOfBenefit.item.factor

Definition	A 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.
Control	0..1
Summary	False
Type	decimal

ExplanationOfBenefit.item.net

Definition	The quantity times the unit price for an additional service or product or charge.
Control	0..1
Summary	False
Type	Money

ExplanationOfBenefit.item.udi

Definition	Unique Device Identifiers associated with this line item.
Control	0..*
Summary	False
Type	Reference

ExplanationOfBenefit.item.bodySite

Definition	Physical service site on the patient (limb, tooth, etc.).
Control	0..1
Summary	False
Type	CodeableConcept

ExplanationOfBenefit.item.subSite

Definition	A region or surface of the bodySite, e.g. limb region or tooth surface(s).
Control	0..*
Summary	False
Type	CodeableConcept

ExplanationOfBenefit.item.encounter

Definition	A billed item may include goods or services provided in multiple encounters.
Control	0..*
Summary	False
Type	Reference

ExplanationOfBenefit.item.noteNumber

Definition	The numbers associated with notes below which apply to the adjudication of this item.
Control	0..*
Summary	False
Type	positiveInt

ExplanationOfBenefit.item.adjudication

Definition	If 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.
Control	0..*
Summary	False
Type	BackboneElement

ExplanationOfBenefit.item.adjudication.id

Definition	Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Control	0..1
Summary	False
Type	http://hl7.org/fhirpath/System.String

ExplanationOfBenefit.item.adjudication.extension

Definition	May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, 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.
Control	0..*
Summary	False
Alternate Names	extensions, user content
Type	Extension

ExplanationOfBenefit.item.adjudication.modifierExtension

Definition	May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained 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 manageable, 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. 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).
Control	0..*
Summary	True
Alternate Names	extensions, user content, modifiers
Type	Extension

ExplanationOfBenefit.item.adjudication.category

Definition	A 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 responsible for in-aggregate or pertaining to this item, amounts paid by other coverages, and the benefit payable for this item.
Control	1..1
Summary	False
Type	CodeableConcept

ExplanationOfBenefit.item.adjudication.reason

Definition	A code supporting the understanding of the adjudication result and explaining variance from expected amount.
Control	0..1
Summary	False
Type	CodeableConcept

ExplanationOfBenefit.item.adjudication.amount

Definition	Monetary amount associated with the category.
Control	0..1
Summary	False
Type	Money

ExplanationOfBenefit.item.adjudication.value

Definition	A non-monetary value associated with the category. Mutually exclusive to the amount element above.
Control	0..1
Summary	False
Type	decimal

ExplanationOfBenefit.item.detail

Definition	Second-tier of goods and services.
Control	0..*
Summary	False
Type	BackboneElement

ExplanationOfBenefit.item.detail.id

Definition	Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Control	0..1
Summary	False
Type	http://hl7.org/fhirpath/System.String

ExplanationOfBenefit.item.detail.extension

Definition	May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, 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.
Control	0..*
Summary	False
Alternate Names	extensions, user content
Type	Extension

ExplanationOfBenefit.item.detail.modifierExtension

Definition	May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained 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 manageable, 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. 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).
Control	0..*
Summary	True
Alternate Names	extensions, user content, modifiers
Type	Extension

ExplanationOfBenefit.item.detail.sequence

Definition	A claim detail line. Either a simple (a product or service) or a 'group' of sub-details which are simple items.
Control	1..1
Summary	False
Type	positiveInt

ExplanationOfBenefit.item.detail.revenue

Definition	The type of revenue or cost center providing the product and/or service.
Control	0..1
Summary	False
Type	CodeableConcept

ExplanationOfBenefit.item.detail.category

Definition	Code to identify the general type of benefits under which products and services are provided.
Control	0..1
Summary	False
Type	CodeableConcept

ExplanationOfBenefit.item.detail.productOrService

Definition	When 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.
Control	1..1
Summary	False
Alternate Names	Drug Code, Bill Code, Service Code
Type	CodeableConcept

ExplanationOfBenefit.item.detail.modifier

Definition	Item typification or modifiers codes to convey additional context for the product or service.
Control	0..*
Summary	False
Type	CodeableConcept

ExplanationOfBenefit.item.detail.programCode

Definition	Identifies the program under which this may be recovered.
Control	0..*
Summary	False
Type	CodeableConcept

ExplanationOfBenefit.item.detail.quantity

Definition	The number of repetitions of a service or product.
Control	0..1
Summary	False
Type	Quantity

ExplanationOfBenefit.item.detail.unitPrice

Definition	If 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.
Control	0..1
Summary	False
Type	Money

ExplanationOfBenefit.item.detail.factor

Definition	A 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.
Control	0..1
Summary	False
Type	decimal

ExplanationOfBenefit.item.detail.net

Definition	The quantity times the unit price for an additional service or product or charge.
Control	0..1
Summary	False
Type	Money

ExplanationOfBenefit.item.detail.udi

Definition	Unique Device Identifiers associated with this line item.
Control	0..*
Summary	False
Type	Reference

ExplanationOfBenefit.item.detail.noteNumber

Definition	The numbers associated with notes below which apply to the adjudication of this item.
Control	0..*
Summary	False
Type	positiveInt

ExplanationOfBenefit.item.detail.adjudication

Definition	The adjudication results.
Control	0..*
Summary	False

ExplanationOfBenefit.item.detail.subDetail

Definition	Third-tier of goods and services.
Control	0..*
Summary	False
Type	BackboneElement

ExplanationOfBenefit.item.detail.subDetail.id

Definition	Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Control	0..1
Summary	False
Type	http://hl7.org/fhirpath/System.String

ExplanationOfBenefit.item.detail.subDetail.extension

Definition	May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, 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.
Control	0..*
Summary	False
Alternate Names	extensions, user content
Type	Extension

ExplanationOfBenefit.item.detail.subDetail.modifierExtension

Definition	May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained 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 manageable, 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. 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).
Control	0..*
Summary	True
Alternate Names	extensions, user content, modifiers
Type	Extension

ExplanationOfBenefit.item.detail.subDetail.sequence

Definition	A claim detail line. Either a simple (a product or service) or a 'group' of sub-details which are simple items.
Control	1..1
Summary	False
Type	positiveInt

ExplanationOfBenefit.item.detail.subDetail.revenue

Definition	The type of revenue or cost center providing the product and/or service.
Control	0..1
Summary	False
Type	CodeableConcept

ExplanationOfBenefit.item.detail.subDetail.category

Definition	Code to identify the general type of benefits under which products and services are provided.
Control	0..1
Summary	False
Type	CodeableConcept

ExplanationOfBenefit.item.detail.subDetail.productOrService

Definition	When 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.
Control	1..1
Summary	False
Alternate Names	Drug Code, Bill Code, Service Code
Type	CodeableConcept

ExplanationOfBenefit.item.detail.subDetail.modifier

Definition	Item typification or modifiers codes to convey additional context for the product or service.
Control	0..*
Summary	False
Type	CodeableConcept

ExplanationOfBenefit.item.detail.subDetail.programCode

Definition	Identifies the program under which this may be recovered.
Control	0..*
Summary	False
Type	CodeableConcept

ExplanationOfBenefit.item.detail.subDetail.quantity

Definition	The number of repetitions of a service or product.
Control	0..1
Summary	False
Type	Quantity

ExplanationOfBenefit.item.detail.subDetail.unitPrice

Definition	If 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.
Control	0..1
Summary	False
Type	Money

ExplanationOfBenefit.item.detail.subDetail.factor

Definition	A 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.
Control	0..1
Summary	False
Type	decimal

ExplanationOfBenefit.item.detail.subDetail.net

Definition	The quantity times the unit price for an additional service or product or charge.
Control	0..1
Summary	False
Type	Money

ExplanationOfBenefit.item.detail.subDetail.udi

Definition	Unique Device Identifiers associated with this line item.
Control	0..*
Summary	False
Type	Reference

ExplanationOfBenefit.item.detail.subDetail.noteNumber

Definition	The numbers associated with notes below which apply to the adjudication of this item.
Control	0..*
Summary	False
Type	positiveInt

ExplanationOfBenefit.item.detail.subDetail.adjudication

Definition	The adjudication results.
Control	0..*
Summary	False

ExplanationOfBenefit.addItem

Definition	The first-tier service adjudications for payor added product or service lines.
Control	0..*
Summary	False
Type	BackboneElement

ExplanationOfBenefit.addItem.id

Definition	Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Control	0..1
Summary	False
Type	http://hl7.org/fhirpath/System.String

ExplanationOfBenefit.addItem.extension

Definition	May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, 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.
Control	0..*
Summary	False
Alternate Names	extensions, user content
Type	Extension

ExplanationOfBenefit.addItem.modifierExtension

Definition	May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained 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 manageable, 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. 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).
Control	0..*
Summary	True
Alternate Names	extensions, user content, modifiers
Type	Extension

ExplanationOfBenefit.addItem.itemSequence

Definition	Claim items which this service line is intended to replace.
Control	0..*
Summary	False
Type	positiveInt

ExplanationOfBenefit.addItem.detailSequence

Definition	The sequence number of the details within the claim item which this line is intended to replace.
Control	0..*
Summary	False
Type	positiveInt

ExplanationOfBenefit.addItem.subDetailSequence

Definition	The sequence number of the sub-details woithin the details within the claim item which this line is intended to replace.
Control	0..*
Summary	False
Type	positiveInt

ExplanationOfBenefit.addItem.provider

Definition	The providers who are authorized for the services rendered to the patient.
Control	0..*
Summary	False
Type	Reference

ExplanationOfBenefit.addItem.productOrService

Definition	When 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.
Control	1..1
Summary	False
Alternate Names	Drug Code, Bill Code, Service Code
Type	CodeableConcept

ExplanationOfBenefit.addItem.modifier

Definition	Item typification or modifiers codes to convey additional context for the product or service.
Control	0..*
Summary	False
Type	CodeableConcept

ExplanationOfBenefit.addItem.programCode

Definition	Identifies the program under which this may be recovered.
Control	0..*
Summary	False
Type	CodeableConcept

ExplanationOfBenefit.addItem.serviced[x]

Definition	The date or dates when the service or product was supplied, performed or completed.
Control	0..1
Summary	False
Type	date

ExplanationOfBenefit.addItem.location[x]

Definition	Where the product or service was provided.
Control	0..1
Summary	False
Type	CodeableConcept

ExplanationOfBenefit.addItem.quantity

Definition	The number of repetitions of a service or product.
Control	0..1
Summary	False
Type	Quantity

ExplanationOfBenefit.addItem.unitPrice

Definition	If 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.
Control	0..1
Summary	False
Type	Money

ExplanationOfBenefit.addItem.factor

Definition	A 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.
Control	0..1
Summary	False
Type	decimal

ExplanationOfBenefit.addItem.net

Definition	The quantity times the unit price for an additional service or product or charge.
Control	0..1
Summary	False
Type	Money

ExplanationOfBenefit.addItem.bodySite

Definition	Physical service site on the patient (limb, tooth, etc.).
Control	0..1
Summary	False
Type	CodeableConcept

ExplanationOfBenefit.addItem.subSite

Definition	A region or surface of the bodySite, e.g. limb region or tooth surface(s).
Control	0..*
Summary	False
Type	CodeableConcept

ExplanationOfBenefit.addItem.noteNumber

Definition	The numbers associated with notes below which apply to the adjudication of this item.
Control	0..*
Summary	False
Type	positiveInt

ExplanationOfBenefit.addItem.adjudication

Definition	The adjudication results.
Control	0..*
Summary	False

ExplanationOfBenefit.addItem.detail

Definition	The second-tier service adjudications for payor added services.
Control	0..*
Summary	False
Type	BackboneElement

ExplanationOfBenefit.addItem.detail.id

Definition	Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Control	0..1
Summary	False
Type	http://hl7.org/fhirpath/System.String

ExplanationOfBenefit.addItem.detail.extension

Definition	May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, 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.
Control	0..*
Summary	False
Alternate Names	extensions, user content
Type	Extension

ExplanationOfBenefit.addItem.detail.modifierExtension

Definition	May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained 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 manageable, 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. 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).
Control	0..*
Summary	True
Alternate Names	extensions, user content, modifiers
Type	Extension

ExplanationOfBenefit.addItem.detail.productOrService

Definition	When 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.
Control	1..1
Summary	False
Alternate Names	Drug Code, Bill Code, Service Code
Type	CodeableConcept

ExplanationOfBenefit.addItem.detail.modifier

Definition	Item typification or modifiers codes to convey additional context for the product or service.
Control	0..*
Summary	False
Type	CodeableConcept

ExplanationOfBenefit.addItem.detail.quantity

Definition	The number of repetitions of a service or product.
Control	0..1
Summary	False
Type	Quantity

ExplanationOfBenefit.addItem.detail.unitPrice

Definition	If 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.
Control	0..1
Summary	False
Type	Money

ExplanationOfBenefit.addItem.detail.factor

Definition	A 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.
Control	0..1
Summary	False
Type	decimal

ExplanationOfBenefit.addItem.detail.net

Definition	The quantity times the unit price for an additional service or product or charge.
Control	0..1
Summary	False
Type	Money

ExplanationOfBenefit.addItem.detail.noteNumber

Definition	The numbers associated with notes below which apply to the adjudication of this item.
Control	0..*
Summary	False
Type	positiveInt

ExplanationOfBenefit.addItem.detail.adjudication

Definition	The adjudication results.
Control	0..*
Summary	False

ExplanationOfBenefit.addItem.detail.subDetail

Definition	The third-tier service adjudications for payor added services.
Control	0..*
Summary	False
Type	BackboneElement

ExplanationOfBenefit.addItem.detail.subDetail.id

Definition	Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Control	0..1
Summary	False
Type	http://hl7.org/fhirpath/System.String

ExplanationOfBenefit.addItem.detail.subDetail.extension

Definition	May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, 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.
Control	0..*
Summary	False
Alternate Names	extensions, user content
Type	Extension

ExplanationOfBenefit.addItem.detail.subDetail.modifierExtension

Definition	May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained 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 manageable, 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. 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).
Control	0..*
Summary	True
Alternate Names	extensions, user content, modifiers
Type	Extension

ExplanationOfBenefit.addItem.detail.subDetail.productOrService

Definition	When 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.
Control	1..1
Summary	False
Alternate Names	Drug Code, Bill Code, Service Code
Type	CodeableConcept

ExplanationOfBenefit.addItem.detail.subDetail.modifier

Definition	Item typification or modifiers codes to convey additional context for the product or service.
Control	0..*
Summary	False
Type	CodeableConcept

ExplanationOfBenefit.addItem.detail.subDetail.quantity

Definition	The number of repetitions of a service or product.
Control	0..1
Summary	False
Type	Quantity

ExplanationOfBenefit.addItem.detail.subDetail.unitPrice

Definition	If 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.
Control	0..1
Summary	False
Type	Money

ExplanationOfBenefit.addItem.detail.subDetail.factor

Definition	A 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.
Control	0..1
Summary	False
Type	decimal

ExplanationOfBenefit.addItem.detail.subDetail.net

Definition	The quantity times the unit price for an additional service or product or charge.
Control	0..1
Summary	False
Type	Money

ExplanationOfBenefit.addItem.detail.subDetail.noteNumber

Definition	The numbers associated with notes below which apply to the adjudication of this item.
Control	0..*
Summary	False
Type	positiveInt

ExplanationOfBenefit.addItem.detail.subDetail.adjudication

Definition	The adjudication results.
Control	0..*
Summary	False

ExplanationOfBenefit.adjudication

Definition	The adjudication results which are presented at the header level rather than at the line-item or add-item levels.
Control	0..*
Summary	False

ExplanationOfBenefit.total

Definition	Categorized monetary totals for the adjudication.
Control	1..*
Summary	True
Type	BackboneElement

ExplanationOfBenefit.total.id

Definition	Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Control	0..1
Summary	False
Type	http://hl7.org/fhirpath/System.String

ExplanationOfBenefit.total.extension

Definition	May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, 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.
Control	0..*
Summary	False
Alternate Names	extensions, user content
Type	Extension

ExplanationOfBenefit.total.modifierExtension

Definition	May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained 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 manageable, 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. 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).
Control	0..*
Summary	True
Alternate Names	extensions, user content, modifiers
Type	Extension

ExplanationOfBenefit.total.category

Definition	A 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 responsible for in aggregate or pertaining to this item, amounts paid by other coverages, and the benefit payable for this item.
Control	1..1
Summary	True
Type	CodeableConcept

ExplanationOfBenefit.total.amount

Definition	Monetary total amount associated with the category.
Control	1..1
Summary	True
Type	Money

ExplanationOfBenefit.payment

Definition	Payment details for the adjudication of the claim.
Control	0..1
Summary	False
Type	BackboneElement

ExplanationOfBenefit.payment.id

Definition	Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Control	0..1
Summary	False
Type	http://hl7.org/fhirpath/System.String

ExplanationOfBenefit.payment.extension

Definition	May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, 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.
Control	0..*
Summary	False
Alternate Names	extensions, user content
Type	Extension

ExplanationOfBenefit.payment.modifierExtension

Definition	May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained 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 manageable, 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. 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).
Control	0..*
Summary	True
Alternate Names	extensions, user content, modifiers
Type	Extension

ExplanationOfBenefit.payment.type

Definition	Whether this represents partial or complete payment of the benefits payable.
Control	0..1
Summary	False
Type	CodeableConcept

ExplanationOfBenefit.payment.adjustment

Definition	Total amount of all adjustments to this payment included in this transaction which are not related to this claim's adjudication.
Control	0..1
Summary	False
Type	Money

ExplanationOfBenefit.payment.adjustmentReason

Definition	Reason for the payment adjustment.
Control	0..1
Summary	False
Type	CodeableConcept

ExplanationOfBenefit.payment.date

Definition	Estimated date the payment will be issued or the actual issue date of payment.
Control	0..1
Summary	False
Type	date

ExplanationOfBenefit.payment.amount

Definition	Benefits payable less any payment adjustment.
Control	0..1
Summary	False
Type	Money

ExplanationOfBenefit.payment.identifier

Definition	Issuer's unique identifier for the payment instrument.
Control	0..1
Summary	False
Type	Identifier

ExplanationOfBenefit.formCode

Definition	A code for the form to be used for printing the content.
Control	0..1
Summary	False
Type	CodeableConcept

ExplanationOfBenefit.form

Definition	The actual form, by reference or inclusion, for printing the content or an EOB.
Control	0..1
Summary	False
Type	Attachment

ExplanationOfBenefit.processNote

Definition	A note that describes or explains adjudication results in a human readable form.
Control	0..*
Summary	False
Type	BackboneElement

ExplanationOfBenefit.processNote.id

Definition	Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Control	0..1
Summary	False
Type	http://hl7.org/fhirpath/System.String

ExplanationOfBenefit.processNote.extension

Definition	May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, 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.
Control	0..*
Summary	False
Alternate Names	extensions, user content
Type	Extension

ExplanationOfBenefit.processNote.modifierExtension

Definition	May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained 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 manageable, 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. 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).
Control	0..*
Summary	True
Alternate Names	extensions, user content, modifiers
Type	Extension

ExplanationOfBenefit.processNote.number

Definition	A number to uniquely identify a note entry.
Control	0..1
Summary	False
Type	positiveInt

ExplanationOfBenefit.processNote.type

Definition	The business purpose of the note text.
Control	0..1
Summary	False
Type	code

ExplanationOfBenefit.processNote.text

Definition	The explanation or description associated with the processing.
Control	0..1
Summary	False
Type	string

ExplanationOfBenefit.processNote.language

Definition	A code to define the language used in the text of the note.
Control	0..1
Summary	False
Type	CodeableConcept

ExplanationOfBenefit.benefitPeriod

Definition	The term of the benefits documented in this response.
Control	0..1
Summary	False
Type	Period

ExplanationOfBenefit.benefitBalance

Definition	Balance by Benefit Category.
Control	0..*
Summary	False
Type	BackboneElement

ExplanationOfBenefit.benefitBalance.id

Definition	Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Control	0..1
Summary	False
Type	http://hl7.org/fhirpath/System.String

ExplanationOfBenefit.benefitBalance.extension

Definition	May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, 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.
Control	0..*
Summary	False
Alternate Names	extensions, user content
Type	Extension

ExplanationOfBenefit.benefitBalance.modifierExtension

Definition	May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained 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 manageable, 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. 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).
Control	0..*
Summary	True
Alternate Names	extensions, user content, modifiers
Type	Extension

ExplanationOfBenefit.benefitBalance.category

Definition	Code to identify the general type of benefits under which products and services are provided.
Control	1..1
Summary	False
Type	CodeableConcept

ExplanationOfBenefit.benefitBalance.excluded

Definition	True if the indicated class of service is excluded from the plan, missing or False indicates the product or service is included in the coverage.
Control	0..1
Summary	False
Type	boolean

ExplanationOfBenefit.benefitBalance.name

Definition	A short name or tag for the benefit.
Control	0..1
Summary	False
Type	string

ExplanationOfBenefit.benefitBalance.description

Definition	A richer description of the benefit or services covered.
Control	0..1
Summary	False
Type	string

ExplanationOfBenefit.benefitBalance.network

Definition	Is a flag to indicate whether the benefits refer to in-network providers or out-of-network providers.
Control	0..1
Summary	False
Type	CodeableConcept

ExplanationOfBenefit.benefitBalance.unit

Definition	Indicates if the benefits apply to an individual or to the family.
Control	0..1
Summary	False
Type	CodeableConcept

ExplanationOfBenefit.benefitBalance.term

Definition	The term or period of the values such as 'maximum lifetime benefit' or 'maximum annual visits'.
Control	0..1
Summary	False
Type	CodeableConcept

ExplanationOfBenefit.benefitBalance.financial

Definition	Benefits Used to date.
Control	0..*
Summary	False
Type	BackboneElement

ExplanationOfBenefit.benefitBalance.financial.id

Definition	Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Control	0..1
Summary	False
Type	http://hl7.org/fhirpath/System.String

ExplanationOfBenefit.benefitBalance.financial.extension

Definition	May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, 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.
Control	0..*
Summary	False
Alternate Names	extensions, user content
Type	Extension

ExplanationOfBenefit.benefitBalance.financial.modifierExtension

Definition	May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained 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 manageable, 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. 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).
Control	0..*
Summary	True
Alternate Names	extensions, user content, modifiers
Type	Extension

ExplanationOfBenefit.benefitBalance.financial.type

Definition	Classification of benefit being provided.
Control	1..1
Summary	False
Type	CodeableConcept

ExplanationOfBenefit.benefitBalance.financial.allowed[x]

Definition	The quantity of the benefit which is permitted under the coverage.
Control	0..1
Summary	False
Type	unsignedInt

ExplanationOfBenefit.benefitBalance.financial.used[x]

Definition	The quantity of the benefit which have been consumed to date.
Control	0..1
Summary	False
Type	unsignedInt